Current Issue

Background: Dietary habits established during medical training can influence students’ current health and future ability to promote healthy lifestyles among patients. Despite exposure to health-related education, medical students may experience a gap between nutrition awareness and actual dietary practices. This study assessed dietary habits and nutrition awareness among undergraduate medical students. Materials and Methods: A cross-sectional questionnaire-based study was conducted among 100 undergraduate MBBS students, with 25 students recruited from each academic year. A structured questionnaire assessed breakfast consumption, fruit and vegetable intake, fast-food and sugary-drink consumption, water intake, meal skipping, physical activity, nutrition knowledge, calorie awareness, food-label reading, and attitudes towards nutrition education. Data were summarized using descriptive statistics, including frequencies and percentages. Nutrition knowledge was compared across academic years. Results: Although 83% of students recognised the importance of a balanced diet, only 35% rated their nutrition knowledge as good. Daily breakfast consumption was reported by 56% of students, while only 15% consumed at least five servings of fruits and vegetables daily. Fast food and sugary drinks were consumed frequently by 13% and 20% of students, respectively. Only 28% reported drinking more than 2.5 litres of water daily, and 16% exercised at least five days per week. Knowledge of daily nutrient requirements and regular food-label reading were limited. Most students expressed interest in receiving additional nutrition education. Conclusion: Medical students demonstrated a substantial gap between nutrition awareness and healthy dietary practices, highlighting the need for practical and structured nutrition education and lifestyle-focused interventions during medical training. Keywords: Dietary habits, Nutrition awareness, Medical students, Healthy lifestyle, Nutrition education, Food choices

Background: Prosocial behaviour is an important attribute for students entering patient facing professions. Empathy, social desirability and social dependence may influence self-reported prosocial behaviour, yet data from Indian medical and nursing students remain limited. The aim is to estimate prosocial behaviour, empathy, social desirability and social dependence among first year and final year MBBS and BSc Nursing students and to assess the correlation of prosocial behaviour with these determinants. Materials and Methods: This descriptive analytical cross sectional study included students from a rural university in western Maharashtra. Participants completed a structured questionnaire that recorded demographic details, prosocial behaviour score, empathy score, social desirability and social dependence. Prosocial behaviour was measured using the Adult Prosocialness Behaviour Scale. Empathy was measured using the Jefferson Scale of Empathy for medical students and the Jefferson Scale of Empathy for health professions students. Social desirability and social dependence were assessed using 5 point Likert scales. Group comparisons used Welch independent sample t tests. Pearson correlation and multiple linear regression were used for association analyses. Results: The final analysis included 240 students. The mean age was 19.53 (2.11) years; 145 students were from MBBS and 95 were from BSc Nursing. The mean prosocial behaviour score was 65.60 (10.12) and the mean empathy score was 98.93 (13.90). BSc Nursing students had higher prosocial behaviour scores than MBBS students, 69.09 (9.61) versus 63.31 (9.82), p < 0.001. MBBS students had higher empathy scores than BSc Nursing students, 101.60 (13.28) versus 94.86 (13.91), p < 0.001. Prosocial behaviour correlated positively with empathy, r = 0.144, p = 0.026 and social desirability, r = 0.339, p < 0.001. Social dependence was not significantly correlated with prosocial behaviour. In adjusted analysis, empathy, social desirability and BSc Nursing faculty were independently associated with higher prosocial behaviour. Conclusion: Prosocial behaviour was higher among nursing students and was associated with empathy and social desirability. The association with social desirability indicates that self-reported prosociality in healthcare students should be interpreted with attention to response bias. Educational strategies that strengthen empathy and promote authentic professional helping behaviour may be useful in medical and nursing training. Keywords: prosocial behaviour; empathy; social desirability; social dependence; medical students; nursing students; healthcare education.

Background: The aim is to analyse the perspectives of students and faculty regarding the implementation of Block 1 elective program and to identify challenges in a tertiary care institution. Materials and Methods: A cross-sectional mixed-method study was conducted among 202 Phase III Part I MBBS students and 76 faculty members. Data were collected using pre-validated structured questionnaires distributed. Quantitative data were analysed using descriptive statistics, while qualitative data underwent thematic analysis. Results: Most students (over 90%) were aware of electives and their purpose, and 86.6% reported achieving intended learning outcomes. Faculty perceived electives as relevant, with 70% agreeing that learning objectives were met. However, several challenges emerged. Key issues included lack of standardized modules, short duration, faculty workload, poor student engagement, and inadequate orientation. Students reported confusion in topic selection (36%) and limited autonomy. Qualitative analysis revealed the importance of experiential learning, interactive teaching, and research exposure, but highlighted gaps in planning, assessment, and structure. Conclusion: While Block 1 electives are perceived as valuable, significant challenges hinder optimal implementation. Addressing standardization, duration, faculty training, and student orientation is essential for enhancing effectiveness in alignment with CBME goals. Keywords: Electives, CBME, Medical Education

Background: Respiratory syncytial virus (RSV) is an important cause of acute lower respiratory tract infection (ALRTI) in young children, particularly infants. Molecular methods such as real-time reverse transcription polymerase chain reaction (RT-qPCR) provide sensitive detection and allow differentiation of RSV-A and RSV-B. However, region-specific data on RSV molecular detection and subgroup distribution among children with ALRTI remain limited. The objective is to detect Respiratory syncytial virus among children below five years of age with ALRTI using molecular methods and determine the distribution of RSV-A and RSV-B. Materials and Methods: A hospital-based prospective observational study was conducted in a tertiary care hospital in eastern India from November 2023 to October 2025. A total of 189 children below five years of age with clinically diagnosed ALRTI were enrolled. Nasopharyngeal aspirates and/or nasopharyngeal swabs were collected and processed. Viral RNA was extracted and subjected to TaqMan real-time RT-PCR. The assay included separate targets for RSV-A and RSV-B, along with an endogenous RNase-P internal control. Demographic, seasonal, clinical and co-infection characteristics of RSV-positive children were analysed. Results: Among the 189 children enrolled, RSV was detected in 36, yielding an overall molecular positivity rate of 19.0%. Of the 72 viral detections recorded in the study, 36 (50.0%) were RSV. RSV-A was detected in 26 (36.1%) viral detections, RSV-B in 7 (9.7%), and simultaneous RSV-A and RSV-B detection in 3 (4.1%). Among RSV-positive children, RSV-A alone accounted for 72.2%, RSV-B alone for 19.4%, and dual RSV-A/B detection for 8.3%. RSV was detected predominantly in children aged 0–12 months. Seasonally, RSV cases were most frequent during winter (41.7%), followed by pre-winter (25.0%). Prematurity was the most frequently recorded associated risk factor (30.0%). Co-detection with another pathogen occurred in 28 of 36 RSV-positive children (77.8%), with Streptococcus pneumoniae being the most frequently co-detected pathogen. Among RSV-positive children, 23 (63.9%) required oxygen therapy, 21 (58.3%) had prolonged hospital stays, 17 (47.2%) required ICU intervention, and 9 (25.0%) required mechanical ventilation. Conclusion: Molecular testing showed that RSV accounted for a substantial proportion of viral ALRTI cases among children under five years of age in this tertiary-care population. RSV-A was the predominant molecular subgroup, and infections were concentrated among younger children, particularly infants, with a pronounced winter predominance. The high frequency of pathogen co-detection and the substantial need for respiratory and intensive care support underscore the clinical importance of RSV surveillance using molecular diagnostic methods. Keywords: Respiratory syncytial virus; RSV-A; RSV-B; RT-qPCR; acute lower respiratory tract infection; children; molecular diagnosis; India.

Background: Postoperative nausea and vomiting (PONV) remain among the most common and distressing complications following laparoscopic surgery under general anaesthesia. Despite advances in anaesthetic techniques and minimally invasive surgical approaches, the incidence of PONV continues to be high due to factors such as pneumoperitoneum, visceral manipulation, and perioperative opioid use. Ondansetron, a selective 5-hydroxytryptamine-3 (5-HT3) receptor antagonist, has been widely used as a standard antiemetic agent for prophylaxis of PONV. However, its efficacy is not universal. Amisulpride, a selective dopamine D2/D3 receptor antagonist, has recently emerged as a promising antiemetic with a favourable safety profile. This study was conducted to compare the efficacy of amisulpride and ondansetron in preventing PONV in patients undergoing laparoscopic surgery. Materials and Methods: This prospective, randomized, double-blind comparative study was conducted in the Department of Anaesthesiology at G S Medical College and Hospital, Hapur. A total of 80 patients aged 18–70 years with ASA physical status I–II undergoing laparoscopic surgery under general anaesthesia were included. Patients were randomly allocated into two groups: Group A received intravenous amisulpride 5 mg and Group B received intravenous ondansetron 4 mg as prophylaxis prior to induction of anaesthesia. Postoperative nausea and vomiting were assessed using a standardized PONV scoring system at 0–6 hours, 6–12 hours, and 12–24 hours postoperatively. The primary outcome was incidence of PONV, while secondary outcomes included severity of PONV, requirement of rescue antiemetic therapy, sedation scores, and adverse effects. Results: Amisulpride demonstrated significantly lower incidence of PONV compared to ondansetron across all postoperative intervals. The complete response rate over 24 hours was higher in the amisulpride group (75%) compared to the ondansetron group (50%) (p < 0.05). Requirement for rescue antiemetics was also significantly lower with amisulpride (15% vs 35%). Adverse effects were mild and less frequent in the amisulpride group, with lower incidence of headache and drowsiness. Conclusion: Intravenous amisulpride 5 mg provides superior prophylaxis against postoperative nausea and vomiting compared with ondansetron 4 mg in patients undergoing laparoscopic surgery. Amisulpride demonstrated improved PONV control, higher complete response rates, reduced need for rescue antiemetics, and a favourable safety profile. Keywords: Postoperative nausea and vomiting, Amisulpride, Ondansetron, Laparoscopic surgery, Antiemetic prophylaxis, General anaesthesia.

Background: High speed road traffic accidents are on the rise over past few years. These are responsible for most of the fractures of tibia. Complications like non-union, delayed union, infection, and implant failure are usually brought about by open reduction and internal fixation with a conventional plate. Intramedullary interlocking nailing (IMIL) allows minimally invasive, symmetric, and dynamic fracture fixation by following the principles of biological fracture fixation and is being preferred over conventional plates these days. Materials and Methods: This prospective study consists of 20 cases of distal tibia fractures treated with intramedullary interlocking nail. Patients were routinely followed up for one year and radiological and clinical assessment was done with RUST index and AOFAS score respectively. Results: An average of 18 weeks was noted for fracture union. Of the 20 patients while being followed up there were no cases with ankle stiffness, instability, chronic infection, wound dehiscence or gross malunion. Conclusion: Following the principles of biological fracture fixation, intramedullary nailing enables minimally invasive, symmetrical, and dynamic fracture fixation. advantages of short duration of surgery, early weight-bearing, less wound complications, early fracture healing. Keywords: Distal 1/3rd tibia fractures, Intramedullary nailing.

Background: Definitive radiotherapy, with or without concurrent chemotherapy, is central to the treatment of carcinoma cervix. Pelvic irradiation can injure the bladder and rectum and lower quality of life. Aim: To measure the incidence, severity and time to onset of radiation-induced cystitis and proctitis. Materials and Methods: Retrospective single-institution cohort of patients with histologically confirmed carcinoma cervix treated with definitive pelvic radiotherapy (50 Gy in 25 fractions with weekly concurrent chemotherapy, followed by high-dose-rate intracavitary brachytherapy, 7 Gy per fraction for 3 weekly fractions), in 2023 to 2025, with at least 6 months of follow-up. Toxicity was identified from documented investigations and graded by CTCAE v5.0. Incidence is given with Wilson 95% confidence intervals (CI). Results: Of 85 patients (median age 50 years; median follow-up 13 months; 88.2% treated with conventional two-dimensional radiotherapy), 17 developed proctitis (20.0%; 95% CI 12.9 to 29.7) and 8 developed cystitis (9.4%; 95% CI 4.8 to 17.5). Grade 2 or higher toxicity occurred in 15 of 17 proctitis cases and 4 of 8 cystitis cases; grade 3 occurred in 6 and 1. Median time to onset was 11 months (IQR 10 to 14) for proctitis and 10.5 months (IQR 5 to 14) for cystitis, with cases from 1 to 17 months. Toxicity was more frequent in stage III disease than in stage II or IVA combined (38.9% vs 12.9%; exploratory Fisher P = 0.014). Toxicity rates did not differ significantly between conventional 2D radiotherapy and other techniques, or between chemotherapy agents, though these subgroup comparisons were underpowered. Conclusion: Proctitis was more frequent and more severe than cystitis, and onset was spread over at least the first 17 months. Careful dose planning for the bladder and rectum and follow-up beyond the first year are needed. Prospective studies with dosimetric data should identify modifiable risk factors. Keywords: Carcinoma cervix; radiation proctitis; radiation cystitis; definitive radiotherapy; CTCAE; late toxicity.

Background: The aim is to compare the hemodynamic effects and safety profile of propofol versus the combination of ketamine and midazolam as induction agents in cardiac patients undergoing non-cardiac surgery. Study Duration: March 2025 to March 2026. Study Place: Department of Anaesthesia in collaboration with departments of General Surgery, Urology and Gynaecology, Ghurki Trust Teaching Hospital Lahore, Pakistan Materials and Methods: This quasi-experimental study was conducted on 120 cardiac patients (ASA class II–III) scheduled for elective non-cardiac surgery. Patients were allocated into two equal groups: Group P (n=60) received propofol 2 mg/kg for induction, while Group M (n=60) received ketamine 1 mg/kg combined with midazolam 0.05 mg/kg. Hemodynamic parameters including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SpO₂) were recorded at baseline, immediately post-induction, and at 1, 3, 5, and 10 minutes after intubation. Perfusion index (PI) was measured using a pulse oximeter probe. Data were analyzed using SPSS version 26, with independent t-tests for continuous variables and chi-square tests for categorical variables. A p-value <0.05 was considered statistically significant. Results: Post-induction mean SBP was significantly higher in Group M (124.8 ± 11.6 mmHg) compared to Group P (118.3 ± 12.4 mmHg, p=0.008). Mean MAP post-induction was 73.5 ± 9.8 mmHg in Group M versus 69.7 ± 10.2 mmHg in Group P (p=0.04). Perfusion index was significantly higher in Group M (1.85 ± 0.38) compared to Group P (1.62 ± 0.29, p=0.001). The incidence of hypotension (SBP <90 mmHg) was 18.3% in Group P versus 6.7% in Group M (p=0.04). Recovery time was comparable between groups (p=0.32). Conclusion: Induction with ketamine-midazolam provides superior hemodynamic stability and better peripheral perfusion compared to propofol in cardiac patients undergoing non-cardiac surgery, with a lower incidence of hypotension. Both agents demonstrated comparable safety profiles and recovery times. Keywords: Propofol, Ketamine, Midazolam, Cardiac patients, Non-cardiac surgery, Hemodynamic stability, Perfusion index

Background: Real-world evidence can complement controlled studies when evaluating mesh performance across hernia types and surgical approaches. This study assessed MERIGROW™ polypropylene mesh in elective hernia repair. Materials and Methods: This two-centre retrospective study included 329 adults undergoing MERIGROW™ mesh repair. Primary endpoints included recurrence, surgical site infection, pain, reoperation, and surgical site occurrences; secondary endpoints included AEs, SAEs, device-related complications, readmission, operative outcomes, and hospital stay. Follow-up was recorded at 1, 3, 6, and 12 months. Results: Inguinal hernia was most common (72.04%). Mean operative time was 35.16 ± 8.46 minutes, with no intraoperative AEs. By discharge, 4 patients (1.22%) experienced 5 AEs: surgical site infection (n=1), seroma (n=2), haematoma (n=1), and mild abdominal discomfort (n=1); no SAE occurred. During the first post-discharge month, 8 patients (2.43%) experienced 11 AEs; 3 patients had multiple events. Surgical site infection, seroma, and haematoma occurred in 3 (0.91%), 6 (1.82%), and 2 (0.61%) patients, respectively. No further AEs in these categories or SAEs were recorded. One recurrence (0.30%) was first recorded at 6 months, with no additional recurrence through 12 months. Conclusion: MERIGROW™ mesh showed a favourable early safety profile, with infrequent non-serious postoperative events and cumulative recurrence of 0.30% at 12 months. Longer follow-up is needed to establish durability. Keywords: Hernia repair; polypropylene mesh; real-world evidence; postoperative outcomes.

Sarcopenic obesity (SO) is an emerging, but under-recognized public health problem in India and is defined as having a low level of skeletal muscle mass or function with excessive adipose tissue. There is a complex epidemiological situation in the country, and the nutrition transition, sedentary urbanisation and insufficient protein intake are causing an increasing obesity epidemic and population aging. The prevalence of SO has been reported from various epidemiological studies in India as 5.4% and 8.7% in older people, and is basically higher in type 2 diabetes mellitus (T2DM) conditions. Pathophysiology is complex, with various serious condition such as myosteatosis, chronic low grade inflammation, insulin resistance, hormonal imbalance and sometimes mitochondrial membrane potential alteration and dysfunction. In this review, it underlines the current Indian evidence available for SO and its need for population specific diagnostic cut-offs and recommends for policy driven, multidisciplinary interventions to address this geriatric multi-compounding syndrome. Keywords: Sarcopenic obesity, Aging, Type 2 diabetes, Hormonal changes.

Background: Repeat caesarean section has become increasingly common with the rising prevalence of primary caesarean delivery. Although advances in anaesthesia, blood transfusion, antibiotics and perioperative care have improved the safety of caesarean delivery, repeat caesarean section may be associated with operative difficulties and maternal and neonatal complications. Previous caesarean delivery may predispose women to adhesions, scar-related abnormalities, haemorrhage, bladder injury, placental complications and postoperative morbidity. The present study was undertaken to evaluate the intraoperative and postoperative complications associated with repeat caesarean section and to assess their relationship with relevant maternal and obstetric factors. Aim: To study the intraoperative and postoperative complications in women undergoing repeat caesarean section and to analyse and categorize these complications according to age, parity, body mass index, medical disorders, number of previous caesarean sections, emergency or elective nature of the current caesarean section, and place of the previous caesarean section. Materials and Methods: This hospital-based prospective observational study was conducted from October 2022 to September 2024 in the Department of Obstetrics and Gynecology, GSL General Hospital, Rajahmundry. A total of 200 women who had undergone one or more previous caesarean sections and underwent repeat caesarean delivery during the study period were included. Women undergoing primary caesarean section were excluded. Demographic, obstetric, clinical and perioperative data were recorded prospectively. Routine investigations and relevant special investigations were performed as clinically indicated. Intraoperative findings and complications were documented, while postoperative outcomes were monitored until discharge. Neonatal outcomes, including complications and neonatal intensive care unit (NICU) admissions, were also recorded. The collected data were analysed according to the type and incidence of intraoperative and postoperative complications and their relationship with age, parity, body mass index, medical disorders, number of previous caesarean sections, emergency or elective caesarean section, and place of the previous caesarean section. Statistical analysis was performed using SPSS, with the chi-square test used to assess statistical significance. Ethical clearance was obtained from the Ethics Committee of GSL Medical College, Rajahmundry, and informed consent was obtained from all enrolled participants. Results: Among the 200 women undergoing repeat caesarean section, 173 (86.5%) had one previous caesarean section, 25 (12.5%) had two previous caesarean sections, and 2 (1.0%) had three previous caesarean sections. The largest proportion of women belonged to the 20–24-year age group (136, 68%), followed by the 25–29-year group (46, 23%). Women younger than 19 years constituted 9 cases (4.5%), while 5 (3%) were aged 30–34 years and 4 (2%) were older than 35 years. Adhesions, intraoperative complications and postoperative febrile morbidity were documented across the different age groups. The thesis reported statistically signi

Background: Peroneus longus tendon (PLT) autograft has emerged as an alternative graft source for anterior cruciate ligament (ACL) reconstruction because it provides adequate graft dimensions while avoiding morbidity at the anterior knee and preserving the hamstring tendons. Evidence from prospective cohorts remains limited in many clinical settings. Objective: To evaluate clinical and functional outcomes after arthroscopic single-bundle ACL reconstruction using a peroneus longus tendon autograft, with particular attention to knee function and donor ankle function. Materials and Methods: This prospective cohort study was conducted in the Department of Orthopaedics, NC Medical College and Hospital, Panipat, over an 18-month study period. Thirty-four patients with clinically and radiologically confirmed ACL injury who met the stated eligibility criteria underwent single-bundle ACL reconstruction using an ipsilateral PLT autograft. Functional outcomes were assessed using the International Knee Documentation Committee (IKDC) score and Modified Cincinnati Knee Rating (MCKR) score. Donor-site function was assessed using the Foot and Ankle Disability Index (FADI). Scores were recorded at baseline and during postoperative follow-up. The thesis data set was independently reanalysed using Friedman’s test for repeated measures; paired comparisons were additionally assessed using paired t-tests. Results: The reported cohort had a mean age of 31.6 ± 10.6 years. Seventeen patients (50.0%) were aged 21–30 years and 33 (97.1%) were male. Right-sided reconstruction was performed in 20 (58.8%) patients. Sports injury was the most frequent mechanism (14/34, 41.2%). Mean IKDC score improved from 43.4 ± 3.76 at baseline to 97.7 ± 1.71 at 12 months; mean MCKR improved from 36.1 ± 4.61 to 94.9 ± 4.16; and mean FADI improved from 35.5 ± 4.64 to 94.6 ± 2.01. Across the five time points, Friedman’s test demonstrated significant longitudinal change for IKDC (χ²=136.0, p<0.001), MCKR (χ²=135.22, p<0.001), and FADI (χ²=136.0, p<0.001). Conclusion: In this 34-patient prospective cohort, single-bundle ACL reconstruction using PLT autograft was associated with marked improvement in knee-specific functional scores over 12 months and progressive recovery of donor foot-and-ankle function. The findings support PLT as a potential graft option, while the small single-centre sample and lack of a comparison group limit causal inference. Keywords: anterior cruciate ligament; ACL reconstruction; peroneus longus tendon; autograft; IKDC; Modified Cincinnati Knee Rating; FADI; donor-site morbidity.

Background: Procedural sedation is an essential component of emergency orthopedic practice, facilitating painless fracture and joint reductions while ensuring patient comfort and procedural success. Ketamine is widely used because of its analgesic and dissociative properties; however, its use may be associated with prolonged recovery and emergence reactions. Combining ketamine with propofol (ketofol) may improve sedation quality while minimizing adverse effects. This study was designed to compare the efficacy and safety of ketamine-propofol versus ketamine alone for procedural sedation during orthopedic reductions in the emergency department. Materials and Methods: A total of 68 adult patients requiring procedural sedation for orthopedic reductions. Participants were randomly allocated into two equal groups: Group KP received ketamine (0.5 mg/kg) combined with propofol (0.5 mg/kg), while Group K received ketamine alone (1 mg/kg). Primary outcomes included procedural success and recovery characteristics. Secondary outcomes comprised hemodynamic stability, pain scores, adverse events, and physician and patient satisfaction. Results: Both groups achieved high procedural success rates. The ketamine–propofol group demonstrated significantly faster onset of sedation (2.6±0.8 vs 3.8±1.0 minutes), shorter recovery time (18.4±4.7 vs 27.8±6.5 minutes), shorter emergency department stay (71.6±14.2 vs 86.9±17.4 minutes), and lower post-procedural pain scores (1.2±0.8 vs 1.8±0.9; p<0.05). Emergence reactions were significantly less frequent with ketofol, while hemodynamic parameters and respiratory safety remained comparable between groups. Physician and patient satisfaction scores were significantly higher in the ketofol group. Conclusion: Ketamine with propofol provides more efficient procedural sedation than ketamine alone by facilitating faster recovery, improved patient comfort, fewer emergence reactions, and greater clinician satisfaction without compromising safety. Ketofol represents an effective and reliable sedation strategy for orthopedic reductions in the emergency department. Keywords: Procedural sedation, ketamine, propofol, fracture reduction, emergency medicine.

Background: Sustainable dengue control requires household source reduction, early care seeking, and coordinated community action. Evidence evaluating multicomponent community programmes in urban Puducherry remains limited. We assessed changes in dengue knowledge, preventive practices, intended health-seeking responses, and perceived institutional and community participation after a locally delivered intervention. Materials and Methods: This prospective single-group before-and-after intervention study was conducted from August to December 2024 in two urban field-practice areas of Puducherry. Adults from randomly selected households completed a pretested local-language questionnaire. A two-month intervention combined group education, pamphlets, rallies, household counselling, posters, health charts, and child-focused activities. A total of 186 participants were included in the before-and-after analysis. McNemar tests compared categorical responses, and p<0.05 was considered statistically significant. Results: Among 186 participants, correct identification of dengue as a viral disease increased from 8.7% to 36.3% (p<0.001), mosquito transmission from 87.7% to 94.7% (p=0.020), and fresh-water breeding sites from 23.3% to 43.3% (p=0.001). Recognition of fever increased from 42.6% to 69.0% (p<0.001). Intended laboratory testing rose from 58.4% to 81.9% (p<0.001), container cleaning from 30.4% to 58.5% (p=0.001), and repellent use from 42.6% to 70.2% (p=0.001). Reported annual community breeding-site elimination increased from 20.4% to 62.6%, reporting to authorities from 11.6% to 52.0%, and waste management from 17.5% to 56.7% (all p<0.001). Mosquito-net use did not change (11.6% versus 11.1%; p=0.700). Conclusion: The intervention was associated with broad improvement in dengue knowledge, stated preventive behaviour, intended care seeking, and perceived collective engagement. Reinforcement across monsoon cycles and controlled evaluations using observed household behaviour, entomological indices, and dengue incidence are needed to determine durability and public-health impact. Keywords: Community participation; dengue; health education; Puducherry; vector control.

Background: Perioperative pain and anxiety are common in children undergoing surgery and may adversely affect recovery. Digital distraction is a practical nonpharmacological strategy that may complement standard analgesic care. Materials and Methods: This prospective randomized controlled trial included 100 children aged 3–10 years undergoing elective major or minor surgery. Participants were randomized 1:1 to structured digital distraction plus standard analgesia (n=50) or standard care alone (n=50). Outcomes included postoperative pain, perioperative anxiety, rescue analgesic use, recovery and discharge-readiness times, adverse events, parent satisfaction, and 2-month follow-up outcomes. Results: Pain scores were significantly lower with digital distraction at 30 minutes, 1 hour, 2 hours, and before discharge. Perioperative anxiety was also lower (group-by-time P<0.001). Rescue analgesia was required in 30.0% of the digital-distraction group versus 54.0% of controls (P=0.025). Recovery and discharge-readiness times were shorter, and parent satisfaction was higher in the intervention group. Adverse events and most 2-month clinical outcomes did not differ significantly between groups. Conclusion: Digital distraction used as an adjunct to standard analgesia improved short-term pain and anxiety outcomes, reduced rescue analgesic requirements, shortened early recovery, and increased parent satisfaction. Its clearest benefits occurred during the immediate perioperative period. Keywords: Pediatric surgery; digital distraction; postoperative pain; perioperative anxiety; analgesia; recovery; randomized controlled trial.

Background: Type 2 diabetes mellitus (T2DM) poses a significant public health challenge, as individuals living with the condition frequently experience psychiatric disorders that adversely influence their quality of life and ability to manage the disease effectively. Aim: To assess the prevalence and pattern of psychiatric morbidities, diabetic distress, and psychological well-being among patients with type 2 diabetes mellitus (T2DM). Materials and Methods: A cross-sectional study was conducted at S. Nijalingappa Medical College, Bagalkot, Karnataka, among 90 patients aged 31–60 years diagnosed with T2DM. Patients with a previous history of psychiatric illness or severe comorbid physical illnesses were excluded. Participants underwent structured clinical interviews using validated assessment tools, including the Mini-International Neuropsychiatric Interview (MINI-Plus 7.0.2) for psychiatric morbidity, the Diabetes Distress Scale (DDS) for diabetic distress, and the WHO-5 Well-Being Index for assessment of psychological well-being. Data were analyzed using SPSS version 19.0. The chi-square test and independent-samples t-test were used for statistical analysis, with p < 0.05 considered statistically significant. Results: Psychiatric morbidity was identified in 36.7% of participants, with major depressive episode (21.1%) being the most frequently observed psychiatric morbidity, followed by alcohol use disorder (8.9%). Diabetic distress was present in 43.3% of participants, while 55.6% reported a positive sense of well-being. Duration of diabetes treatment was significantly associated with diabetic distress (p = 0.002) and well-being (p < 0.05). Participants with a longer duration of treatment reported greater diabetic distress, whereas those receiving treatment for less than five years reported better well-being. Conclusion: Psychiatric morbidities and diabetic distress were common among patients with T2DM, with treatment duration showing a significant association with both diabetic distress and psychological well-being. Routine assessment of psychiatric symptoms, diabetes-related distress, and psychological well-being may facilitate comprehensive management of patients with T2DM. Keywords: T2DM, Major Depressive Episode, Diabetic Distress, Treatment Duration, Well-being.

Background: Blood pressure follows a circadian variation. The decrease in BP during sleep is referred to as “nocturnal dipping” and is partly attributable to decrease in sympathetic output. Diminished nocturnal dipping of BP is a strong, independent predictor of hypertension. Ambulatory arterial stiffness index (AASI) is a marker of arterial stiffness and a well known predictor of cardiovascular mortality. This study was intended to investigate the association between AASI and dipping status in normotensive young adult males. The objective is to assess dipping state in healthy young adult males using 24 hours ambulatory blood pressure. To assess AASI in healthy young adult males using 24 hours ambulatory blood pressure. To compare AASI in dippers, non – dippers and reverse dippers. Materials and Methods: The study included 60 healthy young adults of age between 20 to 35 years. Their dipper state was assessed by 24 hours Ambulatory blood pressure measurement done by Contec Ambulatory Blood Pressure Monitor and they were classified as dippers, non dippers and reverse dippers. AASI was calculated by the formula one minus regression score of diastolic over systolic BP. AASI scores were compared among dippers, non-dippers and reverse dippers. Results: The mean age of subjects was 24.36±4.58 years. Out of the 60 subjects, 19 were found to be non-dippers and none was found to be reverse dipper. The mean AASI score of non-dippers was significantly higher than dippers [0.39 ± 0.26 vs 0.26 ± 0.09; p< 0.01]. Conclusion: The present study indicated that non-dipping patterns may be associated with increased arterial stiffness and hence increased cardiovascular morbidity. Keywords: 24 hour ambulatory BP monitoring, Ambulatory arterial stiffness index, Dipping pattern.

Background: Dry eye disease is a common ocular-surface disorder among office workers because of prolonged digital-screen exposure, reduced and incomplete blinking, air-conditioned environments and inappropriate workstation ergonomics. It may cause ocular discomfort, visual disturbance and reduced occupational productivity. Aim: To determine the prevalence of dry eye disease among office workers aged 25-50 years. Materials and Materials and Methods: This cross-sectional study included 180 office workers aged 25-50 years. Sociodemographic, behavioural, ocular, systemic, occupational and workplace information was collected using a structured questionnaire. Dry-eye symptoms were assessed using the Ocular Surface Disease Index. Clinical assessment included tear-film break-up time, Schirmer I test, ocular-surface staining and evaluation for meibomian gland dysfunction. Continuous variables were compared using the independent-samples t test or analysis of variance, and categorical variables were analysed using the chi-square test. Multivariable binary logistic regression was performed to identify independent predictors. Adjusted odds ratios with 95% confidence intervals were calculated, and p<0.05 was considered statistically significant. Results: The mean age of the participants was 38.2±7.1 years. DED was diagnosed in 103 participants, giving a prevalence of 57.2% (95% CI: 49.9%-64.2%). OSDI-positive symptoms, abnormal TBUT, reduced Schirmer values and positive ocular-surface staining were observed in 62.2%, 60.6%, 46.7% and 37.8%, respectively. Mild, moderate and severe DED were present in 14.4%, 17.2% and 25.6% of all participants. OSDI scores increased, whereas TBUT and Schirmer values decreased significantly with increasing severity (all p<0.001). Participants with DED had greater daily screen exposure than those without DED (7.1±2.0 versus 5.2±1.8 hours; p<0.001). Age (aOR=1.06 per year; p=0.020), female sex (aOR=2.08; p=0.033), meibomian gland dysfunction (aOR=3.67; p=0.001), screen exposure exceeding six hours (aOR=2.89; p=0.003), irregular screen breaks (aOR=2.76; p=0.006) and low workplace humidity (aOR=2.31; p=0.020) were independent predictors. Conclusion: DED was highly prevalent among office workers and was strongly associated with prolonged screen exposure, irregular breaks, meibomian gland dysfunction and low workplace humidity. Periodic ocular screening and workplace interventions targeting screen-use behaviour and environmental conditions are recommended. Keywords: Dry eye disease; office workers; digital-screen exposure.

Background: Lumbar spinal canal stenosis is an important cause of chronic low back pain, neurogenic claudication & functional disability. Degenerative changes in lumbar spine may alter the dimensions of the spinal canal, vertebral bodies, intervertebral discs & paraspinal muscles. As these morphometric parameters may vary with age, sex & ethnicity, region-specific reference data are required for accurate radiological assessment & clinical management. The objective is to estimate morphometric parameters of spinal canal of lumbar region in patients of lumbar canal stenosis (LCS) by assessment of radiological data (MRI), by measuing the anteroposterior diameter, transverse diameter of lumbar spinal canal, and height of intervertebral disc at L3-L4, L4-L5, & L5-S1, and determine its correlation with demographic factors like age & gender of the patients. Materials and Methods: This cross-sectional descriptive study was performed on 384 patients aged 20–70 years with chronic low back pain & MRI-confirmed lumbar spinal canal stenosis. T2W-sagittal & T2W-axial scans were studied in DICOM format. Spinal canal width (transverse diameter) & spinal canal diameter (anteroposterior diameter), & intervertebral disc height were calculated at vertebral level L3-L4, L4-L5 & L5-S1. Results: Among 384 subjects, 212 (55.2%) were males & 172 (44.8%) were females. The overall mean age was approximately 45.44 ± 14.62 years. Spinal canal width showed a significant age & gender-wise difference at L5–S1 (p<0.001), while spinal canal diameter showed no significant difference at any lumbar level. Intervertebral disc height differed significantly at L3–L4 (p=0.026). Conclusion: Lumbar spinal canal morphometry varies according to age, gender & vertebral level. These findings provide useful population-specific morphometric data that may assist in radiological evaluation, early diagnosis & management of lumbar spinal canal stenosis in Western Rajasthan. Keywords: Lumbar spinal canal stenosis; morphometry; magnetic resonance imaging; spinal canal dimensions; Western Rajasthan.

Background: Diabetic retinopathy is a major microvascular complication of diabetes mellitus and a leading cause of preventable blindness. Regional data from semi-arid zones like southwest Rajasthan remain scarce. Aim: The aim of this study is to estimate the prevalance, evaluate systemic risk factor, and determine clinical correlations of diabetic retinopathy (DR) among diabetic patients presenting to a tertiary eye clinic in south-western Rajasthan. Materials and Methods: Institutional, observational cross-sectional study was conducted. A total of 2,150 diabetic patients aged over 40 years were evaluated between September 2017 and August 2018 at a tertiary ophthalmic institute. Comprehensive fundus evaluations were performed via dilated slit-lamp biomicroscopy (90D) and binocular indirect ophthalmoscopy (20D). DR staging followed ETDRS criteria. Modified and non-modified risk factors—including HbA1c, blood pressure, lipid profile, and renal metrics—were collected. Statistical Analysis: Descriptive metrics, relative risks (RR), Chi-square (χ²), and Odds Ratios (OR) were analyzed using SPSS 16.0 (P < 0.05 considered significant). Results: The overall prevalence of any DR was 11.4% (n=245). Staging revealed mild non-proliferative DR (NPDR) in 5.6%, moderate NPDR in 3.8%, severe NPDR in 1.8%, and proliferative DR (PDR) in 0.2%. Clinically significant macular edema (CSME) was present in 3.1% of the total cohort and 27.35% of the DR subgroup. DR correlated significantly with duration of diabetes (P = 0.01), systemic hypertension (RR=1.4, P < 0.005), nephropathy (P = 0.0078), and poor glycemic control (HbA1c > 7%; OR = 22.43, P < 0.01). No significant correlations were noted for gender (P > 0.5), dyslipidemia (P > 0.05), or body mass index (P > 0.05). Conclusions: While overall regional prevalence aligns with the baseline Indian average, local systemic controls remain inadequate. Strict glycemic monitoring, aggressive blood pressure management, and timely screening are crucial within this cohort. Keywords: Clinically Significant Macular Edema, Diabetic Retinopathy, HbA1c, Hypertension, Microvascular Complications, Rajasthan.

Background: Birth asphyxia is defined as the inability to begin and maintain breathing at birth. Around the globe, approximately four (04) million neonatal deaths are quantified and about one-fourth of all newborn deaths are due to birth asphyxia. It happens when placental blood flow is interrupted. Birth asphyxia is recognized as a major contributor to infant morbidity and mortality. Factors influence the risk of birth asphyxia, including the meconium stain, prolong labor, fetal distress. Neonatal resuscitation practices are well-known to assist newborns in breathing and prevent or manage birth asphyxia. An effective neonatal resuscitation can reduce neonatal fatalities by 30%. The objective is to identify the risk factors, observed the management practices by NR and its outcome and determined the association between factors and outcomes. Study design is observational Cross-sectional study. The study was conducted in the neonatal resuscitation unit of tertiary care hospitals in Lahore. Duration of study March 2024 to August 2024. Materials and Methods: A total of 1640 births were monitored, and 138 asphyxiated neonates were included in the study. A standardized observational checklist and a review of medical records were used to collect information on maternal and neonatal characteristics, risk factors, and resuscitation practices. After one hour, the neonate's status was documented as alive with oxygen, admitted to the NICU, or deceased. Data were analyzed using SPSS version 26.0, with chi-square tests used to identify relationships between risk factors and outcomes. P-values <0.05 were considered significant. Results: The majority of mothers (53.6%) were between the ages of 20 and 25, with 65.9% being multigravida. Most of deliveries (47.8%) were performed by caesarean section. A considerable number of asphyxiated neonates were male (58.0%), premature (65.9%), and weighed less than 2.5kg (65.2%). The most common maternal risk factors observed were meconium-stained liquor (18.1%), maternal medical conditions (16.7%), and fetal distress (13.8%). The management of birth asphyxia, initial stages such as drying (95.7%) and warming (100%) were successfully completed, a crucial gap was detected in the timing of bag-and-mask ventilation (BMV), with only 27.9% of neonates receiving it during the "Golden Minute." The total morbidity rate was substantial (76.1%), with 47.1% needing oxygen assistance and 29% being admitted to the NICU. The mortality rate was 7.2%. Prolonged labor was significantly associated with improved initial newborn outcomes (p=0.010 for "Baby Well") and decreased NICU admission rates (p=0.009). There was a trend toward significance between fetal distress and increased NICU admission (p=0.058). Conclusion: According to the study, preterm birth, low birth weight, meconium stain, and fetal distress are all major risk factors for birth asphyxia. Regardless of adherence to initial resuscitation guidelines, delays in commencing Bag-Mask Ventilation (BMV) during the critical first minute may increase morbidity and death. The findings highlight the critical need for focused healthcare provider training programs to optimize ventilation t

Background: Low birth weight (LBW) remains a major public health concern and is one of the leading causes of neonatal morbidity and mortality, particularly in developing countries. Maternal anthropometric measurements are simple, inexpensive, and practical indicators of maternal nutritional status and may help identify women at risk of delivering low birth weight infants. This study was undertaken to evaluate the association between maternal anthropometric parameters and neonatal birth weight. Objectives: To assess the relationship between maternal anthropometric measurements, including maternal height, weight, body mass index (BMI), mid-upper arm circumference (MUAC), and gestational weight gain, and neonatal birth weight among term singleton pregnancies. Materials and Methods: A hospital-based cross-sectional observational study was conducted in the Department of Obstetrics and Gynaecology. A total of 181 healthy mother–neonate pairs were enrolled. Maternal demographic, socioeconomic, obstetric, and anthropometric data were collected using a pre-tested semi-structured questionnaire, clinical examination, and hospital records. Neonatal birth weight was measured within 24 hours of delivery. Data were analysed using IBM SPSS software. Chi-square test and Pearson's correlation analysis were performed, and a p-value <0.05 was considered statistically significant. Results: Among the 181 neonates, 39 (21.5%) had low birth weight (<2.5 kg), while 142 (78.5%) had normal birth weight (≥2.5 kg). Maternal gestational weight gain (p=0.006), maternal weight (p=0.032), BMI (p=0.014), MUAC (p=0.005), and iron–folic acid (IFA) supplementation (p=0.007) were significantly associated with neonatal birth weight. Maternal weight and BMI also showed significant positive associations with MUAC (p<0.001). In contrast maternal age, residence, socioeconomic status, educational level, booking status, gravidity, mode of delivery, maternal height, planned pregnancy, birth interval, age at marriage, type of family, religion, number of antenatal care visits, and neonatal sex were not significantly associated with neonatal birth weight (p>0.05). Conclusion: Maternal nutritional status as reflected by gestational weight gain, maternal weight, BMI, MUAC, and IFA supplementation was significantly associated with neonatal birth weight. Among these parameters, MUAC emerged as a simple, reliable, and cost-effective screening tool for identifying women at risk of delivering low birth weight infants. Routine assessment of maternal anthropometric parameters during antenatal care may facilitate early nutritional intervention and contribute to improved neonatal outcomes, particularly in resource-limited settings. Keywords: Low birth weight; Maternal anthropometry; Mid-upper arm circumference; Body mass index; Gestational weight gain; Maternal nutrition; Neonatal outcome.

Background: Tonsillectomy, with or without adenoidectomy, remains one of the most commonly performed surgical procedures in otorhinolaryngology. Chronic and recurrent infections of the tonsils and adenoids, along with upper airway obstruction, significantly contribute to morbidity, particularly among children and adolescents. Understanding the demographic and clinical characteristics of patients undergoing these procedures is essential for optimizing patient selection, perioperative management, and surgical outcomes. Aim: To study the clinical profile of patients undergoing tonsillectomy with or without adenoidectomy at a tertiary care hospital. Materials and Methods: A prospective observational study was conducted in the Department of Otorhinolaryngology of a tertiary care teaching hospital over a period of 14 months. A total of 200 patients who underwent tonsillectomy alone or tonsillectomy with adenoidectomy were included. Demographic details, presenting symptoms, indications for surgery, clinical findings, associated comorbidities, type of surgical procedure, and postoperative outcomes were recorded and analyzed using appropriate statistical methods. Results: Among the 200 patients studied, the majority belonged to the 5–15 years age group. Males constituted a slightly higher proportion than females. Recurrent sore throat, snoring, mouth breathing, and difficulty swallowing were the most common presenting complaints. Recurrent tonsillitis was the leading indication for surgery, followed by adenotonsillar hypertrophy causing upper airway obstruction. Tonsillectomy with adenoidectomy was performed more frequently than tonsillectomy alone. Most patients experienced an uneventful postoperative recovery, with postoperative pain and minor hemorrhage being the most commonly observed complications. Conclusion: Tonsillectomy with or without adenoidectomy is most commonly performed in pediatric and adolescent patients presenting with recurrent tonsillitis and adenotonsillar hypertrophy. Early identification and appropriate surgical intervention result in favorable clinical outcomes and minimal postoperative complications. Keywords: Tonsillectomy; Adenoidectomy; Adenotonsillar hypertrophy; Recurrent tonsillitis; Clinical profile; Pediatric otorhinolaryngology; Upper airway obstruction

Background: Otitis media with effusion (OME) is one of the most common causes of hearing impairment in children and is characterized by the presence of fluid in the middle ear without signs of acute infection. Adenoid hypertrophy and chronic adenotonsillar enlargement are recognized contributors to Eustachian tube dysfunction, resulting in persistent middle ear effusion. Adenotonsillectomy is frequently performed in children with adenotonsillar hypertrophy and may play a significant role in improving middle ear ventilation and resolving OME. Aim: To evaluate the effect of adenotonsillectomy on otitis media with effusion in pediatric patients. Materials and Methods: A prospective interventional study was conducted in the Department of Otorhinolaryngology of a tertiary care teaching hospital over a period of 14 months. A total of 120 children aged 3–15 years diagnosed with otitis media with effusion and adenotonsillar hypertrophy were included. Detailed clinical examination, otoscopic assessment, pure tone audiometry, and tympanometry were performed preoperatively. All patients underwent adenotonsillectomy and were followed up for three months postoperatively. Changes in middle ear status, hearing thresholds, tympanometric findings, and associated symptoms were analyzed. Results: The majority of patients belonged to the 5–10-year age group, with a slight male predominance. Bilateral OME was observed in most patients. Hearing impairment, mouth breathing, snoring, and nasal obstruction were common presenting symptoms. Preoperatively, Type B tympanogram was the predominant finding. Following adenotonsillectomy, significant improvement was observed in tympanometric patterns and hearing thresholds. Complete resolution of middle ear effusion was achieved in the majority of patients at three months of follow-up. Significant improvement was also noted in associated upper airway obstructive symptoms. Conclusion: Adenotonsillectomy is an effective surgical intervention for children with otitis media with effusion associated with adenotonsillar hypertrophy. The procedure significantly improves middle ear ventilation, facilitates resolution of effusion, enhances hearing outcomes, and alleviates associated obstructive symptoms. Early surgical intervention in appropriately selected patients can reduce morbidity and improve quality of life. Keywords: Otitis media with effusion; Adenotonsillectomy; Adenoid hypertrophy; Eustachian tube dysfunction; Hearing loss; Tympanometry; Pediatric otolaryngology; Middle ear effusion.

Background: Retrograde intrarenal surgery (RIRS) is a minimally invasive treatment for renal calculi. Flexible and navigable suction ureteral access sheath (FANS)-assisted RIRS uses active suction to evacuate irrigation fluid and stone fragments and maintain visualisation during lithotripsy. This study compared FANS-assisted RIRS with conventional RIRS for renal calculi <2 cm. Materials and Methods: This prospective, single-centre, non-randomised comparative cohort study included consecutive adults undergoing RIRS for renal calculi <2 cm between April 2025 and June 2026. Patients underwent conventional RIRS or FANS-assisted RIRS at the treating surgeons' discretion. Co-primary outcomes were stone-free rate (SFR) and postoperative sepsis within 30 days. SFR was defined as the largest residual fragment ≤2 mm on postoperative non-contrast computed tomography (NCCT); sepsis was defined as documented infection with an acute SOFA increase ≥2 from baseline. Results: Among 224 patients, 136 underwent conventional RIRS and 88 FANS-assisted RIRS. SFR was 77.9% and 84.1%, respectively (RR, 1.08; 95% CI, 0.95–1.22; p=0.258). Postoperative sepsis occurred in 8.1% and 3.4% (RR, 0.42; 95% CI, 0.12–1.47; p=0.158). Documented postoperative infection was lower with FANS (14.7% vs 4.5%; p=0.016). Among patients with residual fragments >2 mm, the largest residual fragment was smaller with FANS (8.1±2.1 vs 7.4±1.4 mm; p=0.008, n=30 vs n=14), and reinterventions were less frequent with FANS (14.0% vs 3.4%; p=0.010). Operative duration was longer with FANS (53.4±14.6 vs 66.2±16.1 minutes; p<0.001). Conclusion: FANS-assisted RIRS was associated with numerically higher CT-defined SFR and lower SOFA-defined postoperative sepsis, although neither co-primary endpoint differed significantly. FANS was associated with lower documented infection, smaller residual fragments, and fewer reinterventions, but longer operative duration. Further randomised studies are warranted. Keywords: Retrograde intrarenal surgery; ureteral access sheath; Renal calculi; Stone-free rate; Postoperative sepsis; Intrarenal pressure.

Background: The Circle of Willis is an important arterial anastomotic network that maintains collateral cerebral circulation. Considerable anatomical variation may occur in its anterior and posterior components, and these variations can influence cerebral perfusion, interpretation of vascular imaging, and planning of neurosurgical and endovascular procedures. The aim was to evaluate anatomical variations in the Circle of Willis using CT angiography and assess their clinical and neurosurgical significance. Materials and Methods: This hospital-based observational study included 60 participants of Gujarat region who underwent cerebral CT angiography at a tertiary care hospital. The Circle of Willis was assessed for completeness, hypoplasia, aplasia, duplication, fenestration, fetal-origin posterior cerebral artery, laterality, and involvement of anterior and posterior circulations. Associated findings such as aneurysm, arterial stenosis or occlusion, cerebral infarction, and vascular malformation were also recorded. Results: Anatomical variations were identified in 42 (70.00%) participants, while 18 (30.00%) had no identifiable variation. A complete Circle of Willis was present in 22 (36.67%), whereas 38 (63.33%) had an incomplete configuration. Posterior communicating artery hypoplasia was the most frequent variation, observed in 17 (28.33%), followed by posterior communicating artery aplasia in 9 (15.00%) and fetal-origin posterior cerebral artery in 8 (13.33%). Posterior circulation-only variations were present in 24 (57.14%) of participants with variants. At least one clinically relevant CTA abnormality was significantly more frequent among participants with anatomical variations than in those without variations (71.43% vs 38.89%; p=0.023). Similarly, clinically relevant abnormalities were more frequent in participants with an incomplete Circle of Willis than in those with a complete configuration (73.68% vs 40.91%; p=0.012). Conclusion: Anatomical variations of the Circle of Willis were common on CT angiography, particularly in the posterior circulation. Recognition of these variants is important for cerebrovascular assessment, evaluation of collateral pathways, and planning of neurosurgical and endovascular procedures. Keywords: Circle of Willis; CT angiography; Anatomical variations; Cerebral circulation; Neurosurgery.

Background: Primary open-angle glaucoma is characterised by progressive retinal ganglion-cell and retinal nerve fibre loss with corresponding visual-field impairment. Optical coherence tomography provides objective structural measurements, while standard automated perimetry evaluates functional damage. Aim: To determine the correlation between retinal nerve fibre layer thickness and perimetric severity in patients with primary open-angle glaucoma. Materials and Methods: This hospital-based cross-sectional study included 82 eyes of 46 patients with POAG. Participants underwent comprehensive ophthalmic examination, spectral-domain optical coherence tomography and standard automated perimetry. Average and quadrant-wise peripapillary RNFL thickness and macular GCL+IPL thickness were recorded. Glaucoma was classified as mild, moderate or severe using the Hodapp-Parrish-Anderson criteria. Continuous measurements were compared using one-way ANOVA, and correlations were assessed using Pearson’s correlation coefficient. A p value <0.05 was considered statistically significant. Results: Of the 82 eyes, 22 (26.8%) had mild, 18 (22.0%) had moderate and 42 (51.2%) had severe glaucoma. Average RNFL thickness decreased from 86.55 (11.50) µm in mild glaucoma to 64.67 (12.05) µm in moderate glaucoma and 61.12 (16.44) µm in severe glaucoma (F=23.497, p<0.001). Superior, inferior and temporal RNFL thicknesses also decreased significantly with increasing severity (all p<0.001), while nasal RNFL thickness showed a smaller difference (p=0.017). Average and minimum GCL+IPL thickness declined significantly across stages (both p<0.001). Mean deviation worsened from -3.54 (1.20) dB to -23.07 (6.27) dB, while visual field index decreased from 93.59% (4.16) to 39.71% (27.27) (both p<0.001). Average RNFL thickness showed a moderate inverse correlation with perimetric stage (r=-0.573; 95% CI: -0.703 to -0.407; p<0.001). Conclusion: Average and quadrant-wise RNFL thickness decreased significantly with increasing perimetric severity of POAG. The strongest structural relationships were observed in the inferior, temporal and superior quadrants. SD-OCT-derived RNFL and ganglion-cell measurements complemented visual-field indices and may facilitate objective staging and monitoring of POAG. Keywords: Primary open-angle glaucoma; retinal nerve fibre layer; optical coherence tomography.

Background: Recalcitrant dermatophytosis is a therapeutic challenge, particularly in patients with persistent or recurrent disease. Combination systemic antifungal therapy has been explored for difficult to treat infection. The objective is to evaluate the clinical and mycological response and tolerability of a regimen incorporating oral terbinafine and pulse dose itraconazole in resistant tinea infection. Materials and Methods: This prospective observational study was done in adults aged 18–65 years with clinically diagnosed resistant tinea corporis and/or tinea cruris. Clinical assessment, KOH microscopy, fungal culture and safety monitoring were performed. Results: Thirty patients completed the study. Baseline KOH microscopy and fungal culture were reported positive in all participants. The predominant age group was 41–50 years (53.3%) and females constituted 80% of the cohort. The reported mycological cure was 25 patients (82.89%), clinical cure 24 (79%), and complete cure 30 (100%). No adverse events were reported. Conclusion: The regimen was associated with substantial clinical and mycological improvement in this small observational cohort. The findings require cautious interpretation though because of the small sample size. Keywords: dermatophytosis; tineacorporis; tineacruris; terbinafine; itraconazole; recalcitrant tinea; antifungal therapy

requirements of women during monthly menstruation or menstrual cycle. If poorly managed, menstrual period may be accompanied by discomfort, reproductive tract infection, smelling and embarrassment among others. Aims and Objective: To assess the menstrual hygiene practices among adolescent girls. Materials and Methods: A cross-sectional study was carried out school going adolescent girls of Lucknow district. The study population were school going adolescent girl in the age group of 10 -19 years. Data regarding menstrual hygiene practices were collected and analysed. Results: Overall, 43.2.% girls with 49.5% urban girls and 30.0% rural girls used sanitary napkin only as menstrual absorbent while 27.8% urban girls and 40.0% rural girls used both (sanitary pad and cloth). 22.8% urban and 30% rural girls used cloth. There was a significant difference between use of sanitary pad in urban and rural girls. Conclusion: In present study that significant association was observed between use of sanitary pad in urban and rural girls, educational status of mother, religion. They ignore menstrual hygiene practices. There are many reasons for all these issues. Key words: Menstrual hygiene practice, Adolescent girls, schools.

Background: Posterior or lateroposterior perforation of the second part of the duodenum may decompress into the retroperitoneum and present as a retroperitoneal abscess rather than generalized peritonitis. Case presentation: A 56-year-old male presented with abdominal pain, fever and vomiting, associated with hip pain for approximately 10 days. Cross-sectional imaging demonstrated an extensive right-sided retroperitoneal collection with air foci and extension along the right iliacus and pelvic sidewall toward the gluteal region, with a defect involving the second part of the duodenum and communication with the collection. Emergency exploratory laparotomy was performed. A lateroposterior D2 perforation measuring approximately 0.5 × 0.5 cm was identified. Kocherization was performed for adequate mobilization and exposure. The perforation was closed primarily and reinforced with a Graham omental patch. The retroperitoneal pus collection was evacuated and a pelvic drain was placed. Meropenem and metronidazole were administered postoperatively. Oral feeds were started on postoperative day 3 and the drain was removed on postoperative day 5. The patient was discharged and improvement in follow-up. Conclusion: Lateroposterior D2 perforation should be considered in patients with unexplained retroperitoneal collections and atypical back, flank or hip symptoms. Adequate duodenal mobilization, primary repair with omental reinforcement and drainage can achieve successful source control in selected patients. Keywords: Duodenal perforation; second part of duodenum; retroperitoneal abscess; Kocherization; Graham patch; peptic ulcer perforation; case report.

Background: Prevalence of hepatopulmonary syndrome and related clinical factors in chronic liver disease are not well defined, especially in tertiary care settings. Materials and Methods: This cross-sectional observational study enrolled adults (≥18 years) with chronic liver disease and portal hypertension who showed SpO₂ <96% or signs of HPS. Patients with major heart or lung diseases, lung cancer, or respiratory infection were excluded. HPS was diagnosed by pulmonary vascular dilation on imaging, portal hypertension, and hypoxemia (PaO₂ <80 mmHg or A–aO₂ ≥15 mmHg). The data collected encompassed clinical evaluations, laboratory findings, measures of liver severity (such as Child-Pugh and MELD scores), arterial blood gas analyses, and results from contrast echocardiography. Statistical methods applied included t-tests, Chi-square tests, Pearson correlations, ANOVA, logistic regression, and ROC curve analysis. Results: Of 177 patients (mean age 60.5 years; male: female ratio 4.5:1), 14 (7.9%) had HPS, which was linked to more severe liver disease—higher Child-Pugh (12.5 vs 8.7, P=0.001) and MELD scores (23.9 vs 17.1, P=0.001). The A–aO₂ gradient correlated positively with both scores. Multivariate analysis showed HPS risk was higher in males, older individuals, and those with elevated A–aO₂ gradients. ROC analysis identified Child-Pugh >10.5 and MELD >18.5 as predictive cut-offs for HPS. Conclusion: This study found an HPS prevalence of 7.9% among patients with chronic liver disease. Advanced age, male sex, and elevated A–aO₂ gradients were determined to be significant risk factors for the development of HPS. These findings underscore the importance of timely identification and assessment of HPS in individuals with chronic liver disease to optimise management strategies and improve patient outcomes. Keywords: Chronic liver disease, Hepatopulmonary syndrome, Child Pugh score, Receiver operating characteristic curve, multivariate analyses.

COX-2 is uniquely positioned within a coordinated network of eicosanoids, cytokines, redox and transcriptional components that are all responsible for chronic inflammation. A plant of the genus Morinda.One of the plants of the genus Morinda. S. mulberry (Indian mulberry; Rubiaceae) is traditionally used as medicine in South Asia for wounds, fever, pain, gout, ulcers and other inflammatory diseases; however, its reported COX-2 targeting has not been specifically distinguished from that of other Morinda spp. This systematic review was based on 100 publications identified in PubMed-indexed literature and journals included in the Scopus and Web of Science database and all of which were published in a peer-reviewed journal that contained a DOI. Direct studies involving M. pubescens and mechanistic studies of Morinda congeners were considered as evidence, as were the phytochemical characterization, COX-2/NF-κB/Nrf2 biology and pharmacokinetics, and safety. The corpus included 27 publications dealing with inflammatory signaling, 25 publications focused on the pharmacology of Morinda, 28 studies on phytochemical or analytical aspects, 11 studies on antioxidant and metabolic aspects and nine studies related to safety or pharmacokinetic aspects. There is direct evidence for wound healing, antioxidant, nephroprotective, and hepatoprotective effects of Direct M. pubescens, although there has been no systematic study on an extract to determine the IC50, selectivity, activity on target, and efficacy of Direct M. pubescens in the clinic. Scopelatin, ursolic acid, quercetin, rutin, iridoids, anthraquinones and polysaccharides inhibit the expression or activity of COX-2, NF-κB/MAPK signaling, pro-inflammatory cytokines, reactive oxygen species, and downstream prostaglandin E2 which further support mechanistic plausibility. But the congener data cannot replace M. pubescens experiments that have been confirmed by chemotaxes. The authenticated plant material, marker-based standardization, orthogonal enzyme and cell assays, exposure-response studies, chronic inflammatory models and phase human safety and efficacy trials are required for future development. M. pubescens is thus a suitable discovery platform for selective COX-2 therapy but not a proven one. Keywords: Morinda pubescens, cyclooxygenase-2, COX-2, inflammation, NF-κB, scopoletin, ursolic acid, quercetin, rutin, PRISMA, medicinal plants.

Background: Device-associated infections caused by Acinetobacter baumannii and Pseudomonas aeruginosa are important healthcare-associated infections, particularly in critically ill patients. Biofilm formation contributes to persistence on medical devices and may be associated with antimicrobial resistance and enhanced virulence, thereby complicating treatment and infection control. Aim: To assess the association of biofilm-forming capacity with antimicrobial resistance and virulence profiles among A. baumannii and P. aeruginosa isolated from device-associated infections. Materials and Methods: This hospital-based analytical cross-sectional study included 80 patients with device-associated infections at a tertiary care hospital. A total of 44 A. baumannii and 36 P. aeruginosa isolates were identified. Antimicrobial susceptibility testing was performed using standard methods, while biofilm formation was assessed by the microtiter plate crystal violet assay. Selected resistance and virulence genes were detected by polymerase chain reaction. Data were analyzed using IBM SPSS Statistics version 27.0, with p<0.05 considered statistically significant. Results: Biofilm formation was detected in 71 (88.75%) isolates, including 90.91% of A. baumannii and 86.11% of P. aeruginosa. Moderate-to-strong biofilm formation occurred in 53 (66.25%) isolates. Multidrug resistance was present in 55 (68.75%) isolates and was significantly higher in A. baumannii than P. aeruginosa (79.55% vs 55.56%; p=0.021). MDR was significantly more frequent among moderate/strong biofilm producers than non/weak producers (83.02% vs 40.74%; OR=7.11; p<0.001). Carbapenem resistance was also significantly associated with moderate-to-strong biofilm formation (75.47% vs 37.04%; p=0.001). Among A. baumannii, bap, csuE, and ompA were significantly associated with stronger biofilm production, while blaVIM showed a significant association among P. aeruginosa isolates. Conclusion: Biofilm formation was strongly associated with multidrug resistance, carbapenem resistance, and important virulence determinants. Routine assessment of biofilm-related characteristics may help improve antimicrobial stewardship and infection-control strategies for device-associated infections. Keywords: Acinetobacter baumannii; Pseudomonas aeruginosa; Biofilm; Antimicrobial resistance; Device-associated infections.

Penetrating perineal impalement can produce complex pelvic visceral injury despite a small external wound. We report a rare rectum-sparing transpelvic injury involving the urinary bladder and cervicovaginal structures. A female patient sustained perineal impalement after falling onto an iron rod. She presented with hematuria and urinary retention, while fecal and flatus continence were preserved. Contrast-enhanced computed tomography with rectal contrast suggested rectal and bladder injury and showed moderate hemoperitoneum. Emergency laparotomy demonstrated a tract entering the left lateral perineum at approximately the 3-4 o’clock position and passing anterior to the rectum. Operative examination identified a partial internal anal sphincter tear involving about 25% of its thickness, a lateral vaginal wall laceration, a cervical rent, a 6 × 2 cm bladder dome rent, and a 2 × 2 cm trigonal rent with urinary extravasation. The rectal mucosa, external anal sphincter, and sigmoid colon were intact. Multilayer primary repair of the bladder, vagina, and cervix was performed, and a paracervical cyst was excised. Recovery was uneventful, and follow-up computed tomography cystography showed no contrast extravasation. This case shows that preserved continence and equivocal imaging do not exclude major transpelvic visceral injury. Careful trajectory assessment, timely exploration, and coordinated surgical repair can preserve urinary, gynecologic, and anorectal function. Keywords: bladder injury; cervical laceration; impalement injury; perineal trauma; rectal sparing; vaginal laceration.

Diabetes mellitus is a chronic metabolic disease, which has emerged as one of the biggest public health issues in the world nowadays. Good diabetes management is not just about taking medicines; it also involves following the advice of doctors, doctors' nurses, and other health care professionals by taking part in self-care activities, such as diet, exercise, testing, medication adherence, and foot care. Poor glycemic control is linked with the onset of diabetes-related complications, especially in rural areas, where healthcare and diabetes education resources might be scarce (American Diabetes Association [ADA], 2024; International Diabetes Federation [IDF], 2021); inadequate self-care is a primary contributor to these complications. To evaluate self-care behaviors among adult diabetes mellitus patients and determine the factors that is associated with self-care behaviors in a rural community.A community-based cross sectional study was performed on 458 adults with diabetes who were sampled based on population proportionate sampling. A structured questionnaire was used to collect data which contained socio-demographic characteristics, the Summary of Diabetes Self-Care Activities (SDSCA) scale, and the Patient Health Questionnaire-2 (PHQ-2). Data were analyzed using descriptive statistics and Chi-square tests to assess the association between the self-care practices and selected variables and statistical significance was set at p<0.05. Medication adherence was good in 51.3% and specific diet was good in 86.0% of the participants. Poor self-care was noted with blood glucose monitoring (100 per cent), physical activity (56.8 per cent) and foot care (58.3 per cent), however. Several areas of self-care were significantly related to age and socioeconomic status (p < 0.05). Of those who participated, around 12.6% screened positive for major depressive disorder (MDD) using the PHQ-2 screening tool. Medication adherence and dietary habits were adequate, but the physical activity, foot care and monitoring of blood glucose components of diabetes self-management revealed significant gaps that can benefit from structured diabetes self-management education and community-based interventions in order to improve long-term diabetes management outcomes for rural adults. Keywords: Diabetes mellitus, self-care practices, rural population, medication adherence, Foot care.

Background: Serum lactate has been utilized for numerous years to evaluate perfusion status and as an indicator of disease severity. Perforation of a hollow viscus is a critical, life-threatening illness associated with significant morbidity and death due to multiple organ failure and subsequent sepsis. In the clinical context, assessing the severity of hollow viscus perforation in patients, which may result in sepsis, and identifying prognostic signs is essential to mitigate the elevated death risk. The aim is to elucidate that postoperative arterial blood lactate level is a predictor of mortality in patients with hollow viscus perforation. Materials and Methods: This was a prospective cohort study conducted from September 2022 to June 2024 among patients undergoing surgery for hollow viscus perforation at Ramkrishna Care Hospital, Raipur. The above-mentioned patients were divided into mortality and survivor groups, and mortality was assessed at 48 hours, 7 days, and 28 days. Results: Arterial blood lactate level of 2.0 mmol/L or more was found in 30.8% of the study population. The mortality rate in patients with lactate >2 mmol/L was 71.4% as compared to 10.8% in those with lactate ≤2 mmol/L, and the difference was found to be highly statistically significant (p<0.001). In our study, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for this test were 83.33% (95% CI: 62.62%–95.26%), 80.49% (95% CI: 65.13%–91.18%), 71.43% (95% CI: 56.69%–82.68%), and 89.19% (95% CI: 76.91%–95.34%), respectively. The results of univariate analysis showed that the APACHE-II and SOFA scores were significantly higher and eTIME was significantly longer in the mortality group than in the survivor group. The postoperative LAC level was significantly higher in the mortality group (5.35 ± 3.07 mmol/L) than in the survivor group (1.26 ± 0.93 mmol/L; p<0.001), and the preoperative WBC count was significantly lower in the mortality group than in the survivor group. Multivariate logistic regression analysis using the mortality risk factors determined by univariate analysis, including eTIME, APACHE-II score, SOFA score, preoperative WBC count, and postoperative LAC, demonstrated that postoperative LAC level was an independent risk factor for mortality. Conclusion: High postoperative lactate level is a useful factor for independently predicting high mortality rates in patients with hollow viscus perforation. Keywords: Hollow viscus perforation, Arterial blood lactate, Prognosis, Sepsis.

Background: The axillary artery shows considerable variation in its branching pattern, which is clinically important during surgical and interventional procedures involving the axilla and upper limb. The aim is to study variations in the branching pattern of the axillary artery in human cadavers from North Coastal Andhra Pradesh. Materials and Methods: A cadaveric study was conducted on 40 cadavers (80 upper limbs), comprising 34 male and 6 female cadavers. The axillary arteries were exposed by routine dissection and their branching patterns were documented. Results: Variations in the branching pattern of the second part of the axillary artery were identified. A common trunk giving rise to the lateral thoracic, thoraco-dorsal, subscapular and posterior circumflex humeral arteries was observed in 22.5% of cases, while a trifurcating trunk occurred in 18.75%. Other variations included common origins of the lateral thoracic and thoraco-acromial arteries (12.5%), lateral thoracic, thoraco-acromial and subscapular arteries (7.5%) and lateral thoracic and subscapular arteries (5%). Conclusion: The study demonstrates significant variations in the branching pattern of the axillary artery. Knowledge of these variations is important for safe and effective surgical, radiological, and vascular procedures involving the axillary region. Keywords: Axillary artery, anatomical variation, branching pattern, cadaveric study

Background: Avascular necrosis (AVN) of the femoral head affects young adults and may progress to femoral-head collapse, pain, and functional disability. Uncemented total hip replacement (THR) is used for advanced disease. Objective: To evaluate functional outcomes after uncemented THR in young adults with AVN of the femoral head. Materials and Methods: This prospective observational study included 30 patients aged 20–50 years with Ficat and Arlet stage III or IV AVN who underwent uncemented THR through a posterior Southern Moore approach at Parul Sevashram Hospital, Vadodara. Functional outcomes were assessed using Modified Harris Hip Score (MHHS) components preoperatively and at 6, 12, 24, and 48 weeks. Postoperative complications were recorded. Results: Twenty-four participants (80%) were male and 18 (60%) had stage IV disease. The pain subscore increased from 21.0 ± 8.03 preoperatively to 40.93 ± 1.72 at 48 weeks (P<0.0001), and the limp subscore from 4.23 ± 2.58 to 10.7 ± 0.92 (P<0.0001). Walking-distance, stair-climbing, socks-wearing, sitting, and public-transport subscores also improved significantly. Postoperative Harris Hip Score grading was good in 20 participants, excellent in 9, and fair in 1. Twenty-four participants had no recorded postoperative complication; superficial infection occurred in 2, while deep infection, foot drop, iatrogenic fracture, and dislocation occurred in 1 participant each. Conclusion: Uncemented THR was associated with progressive improvement in pain-related and activity-related hip function over 48 weeks in young adults with advanced AVN of the femoral head. Keywords: Avascular necrosis; Femoral head; Uncemented total hip replacement; Modified Harris Hip Score; Young adults.

Background: Posterior capsular opacification is one of the most common delayed complications of cataract surgery, leading to reduced visual acuity and visual quality. Nd: YAG laser capsulotomy is the treatment of choice, but it may cause transient changes in intraocular pressure, anterior chamber depth, refraction, and macular thickness, warranting careful postoperative evaluation. The objective is to evaluate the changes in intraocular pressure, anterior chamber depth, refraction, and macular thickness following Nd:YAG laser capsulotomy in patients with posterior capsular opacification. To assess the correlation between the total laser energy used during Nd:YAG laser capsulotomy and postoperative changes in intraocular pressure and macular thickness. Materials and Methods: This prospective observational study included 50 patients with posterior capsular opacification who underwent Nd: YAG laser capsulotomy at a tertiary care centre. Intraocular pressure, anterior chamber depth, refraction, and macular thickness were assessed at baseline and during follow-up at 1 hour, 1 week, 1 month, and 2 months post-procedure. Total laser energy used was recorded. Statistical analysis was performed using paired t-tests and Pearson's correlation analysis, with p-values <0.05 considered statistically significant. Results: A significant improvement in best-corrected visual acuity was observed following Nd: YAG capsulotomy, with patients achieving BCVA of 6/9–6/6, increasing from 6% at baseline to 46% at 2 months. Mean intraocular pressure showed a significant transient rise at 1 day and 1 week post-procedure (p < 0.05), returning to baseline by one month. Anterior chamber depth increased significantly during follow-up. Macular thickness increased significantly at one week (p < 0.001) and gradually normalised by two months. A significant positive correlation was found between total laser energy used and both IOP elevation and increase in macular thickness (p < 0.001). Conclusion: Nd: YAG laser capsulotomy is a safe and effective procedure for the management of posterior capsular opacification. The associated changes in intraocular pressure and macular thickness are transient, reversible, and energy-dependent, underscoring the importance of judicious laser energy use and appropriate postoperative monitoring. Keywords: Intraocular pressure; Macular thickness; Anterior chamber depth; Posterior capsular opacification.

Background: Oncoplastic breast-conserving surgery combines oncological resection with reconstructive techniques to improve breast preservation and cosmetic outcomes. Volume displacement and volume replacement represent the two principal reconstructive approaches, but comparative evidence regarding patient-reported and aesthetic outcomes remains limited. Materials and Methods: This retrospective comparative study included 90 patients undergoing oncoplastic breast-conserving surgery, with 45 treated using volume displacement and 45 using volume replacement techniques. Demographic, tumour-related, operative, oncological, and postoperative variables were recorded. Patient-reported outcomes were assessed using the BREAST-Q Breast-Conserving Therapy module, while aesthetic outcomes were evaluated using BCCT. core. Postoperative complications, margin status, re-excision, operative duration, hospital stay, and contralateral symmetrization were also compared. Results: Baseline demographic and tumour characteristics were comparable between groups, although smaller breast size was more frequent in the volume replacement group. Volume replacement was associated with longer operative duration (154.8 ± 28.7 vs 126.4 ± 24.1 min; P<0.001) and longer hospital stay (2.7 ± 1.1 vs 2.2 ± 0.9 days; P=0.021). Conclusion: Volume replacement may provide superior patient satisfaction and aesthetic outcomes while reducing the need for contralateral symmetrization, although at the expense of increased operative time and hospital stay. Keywords: Oncoplastic breast surgery; Breast-conserving surgery; Volume displacement; Volume replacement; BREAST-Q; Aesthetic outcomes; Patient-reported outcomes; Breast reconstruction.

Background: Fungal infections are on rise despite of development of latest diagnostic tools and therapeutic options. Early initiation of the correct antifungal therapy may have a direct impact on the patient’s quality of life and high cost of treatment and care. Materials and Methods: Aspergillius species were isolated from patients with lower respiratory tract infections. Antifungal susceptibility pattern of all the Aspergillus isolates were assessed against Amphotericin B, Itraconazole and Caspofungin by broth micro dilution method. Results: All Aspergillus flavus and Aspergillus niger isolates were 100% sensitive to all the three drugs. However, only 4 Aspergillus fumigatus isolates showed high Minimum inhibitory Concentration (MIC) value for Amphotericin B and 2 isolates for Itraconazole. Conclusion: Broth Microdilution method is a gold standard and sensitive technique but time consuming and cumbersome to be performed routinely by clinical laboratories. Also association of increased incidences of resistant strains with treatment failure highlights the need for antifungal resistance surveillance by reference labs using such sensitive procedures. Keywords: Aspergillus fumigatus, Aspergillus flavus, Aspergillus niger, Antifungal, Broth microdilution, Amphotericin B, Itraconazole and Caspofungin.

Background: Anal fissure is a common proctological condition producing severe pain and bleeding during defecation. Lateral internal sphincterotomy (LIS) is the surgical gold standard for chronic fissures unresponsive to medical therapy, but is associated with post-operative pain, bleeding and a variable incidence of incontinence. Laser sphincterotomy has been proposed as a minimally invasive alternative. The aim is to compare conventional (open) lateral internal anal sphincterotomy with laser lateral internal anal sphincterotomy in the treatment of chronic anal fissure, with respect to intraoperative time, post-operative pain, complications, recurrence and patient satisfaction. Materials and Methods: In this prospective comparative study conducted at the Department of General Surgery, Sheth Vadilal Sarabhai General Hospital and Sheth Chinai Prasuti Hospital, Ahmedabad, between February 2024 and December 2025, 170 patients aged 18–75 years with chronic anal fissure unresponsive to conservative management were enrolled and randomised by computerised block randomisation into Group A (conventional open LIS, n = 85) and Group B (diode laser LIS, 980 nm + 1470 nm, n = 85). Intraoperative time, post-operative pain (Visual Analogue Scale, VAS), early and late complications, recurrence and patient satisfaction were compared at 6, 12, 24 and 36 hours and at 2 and 6 weeks. Results: The two groups were comparable for gender (P = 0.7577) and age (P = 0.7590). Mean intraoperative time was significantly shorter with laser LIS (12.5 ± 2.8 min) than conventional LIS (23.7 ± 4.1 min; P < 0.001). VAS pain scores were significantly lower in the laser group at 6 h (5.08 ± 0.69 vs 5.33 ± 0.84; P = 0.035), 12 h (P < 0.001), 24 h (P < 0.001) and 36 h (P < 0.001). Early and late complication rates (bleeding, pain, perianal swelling, infection, flatus incontinence) were consistently lower in the laser group, although the differences did not reach statistical significance. Recurrence at 6 weeks was 4.7% in the conventional group versus 1.2% in the laser group. Patient satisfaction (VAS) was significantly higher in the laser group at 2 weeks and 6 weeks (P < 0.001 for both). Conclusion: Laser lateral internal sphincterotomy is a safe and effective alternative to conventional open sphincterotomy for chronic anal fissure, offering significantly shorter operative time, less post-operative pain, a trend towards fewer complications and lower recurrence, and greater patient satisfaction. Larger multicentric studies with longer follow-up are recommended to confirm long-term functional outcomes. Keywords: Anal fissure; Lateral internal sphincterotomy; Laser sphincterotomy; Diode laser; Post-operative pain; Patient satisfaction.

Background: Anal fissure is a common anorectal disorder causing severe pain during defecation and bleeding per rectum, with a major impact on quality of life. Most primary fissures occur in the posterior midline and are linked to constipation, internal anal sphincter spasm, reduced anodermal blood flow, and delayed healing. Materials and Methods: This prospective observational study was conducted in the Department of General Surgery, Satguru Partap Singh Hospital, Ludhiana, Punjab, from April 2024 to October 2025. Adults aged >18 years with clinically diagnosed anal fissure were enrolled (n = 104; Cochran formula), while patients with prior anorectal surgery or other painful perianal conditions were excluded. Demographic, clinical, lifestyle, obstetric history, and comorbidity data were recorded along with fissure type and site. Management included lifestyle measures and topical therapy, mainly fixed-dose combinations of topical calcium channel blockers (diltiazem 2% plus lignocaine 2% or nifedipine 0.3% plus lignocaine 1.5%). Follow-up was at 2, 4, 6 weeks, and 3 months. Results: Of 104 patients, 72 had an acute fissure, and 32 had a chronic fissure. Constipation and low fiber intake were common. Baseline pain was higher in acute fissure (VAS 7.57 vs 6.53; p = 0.04), while chronic fissure had more pruritus, burning, sentinel tag, and discharge. Most patients responded to medical therapy. Pain reduction was similar with both regimens; bleeding improved more with nifedipine (p = 0.04). Conclusion: Constipation control and fiber optimization are key targets; topical nifedipine-lignocaine and diltiazem-lignocaine are safe and effective, and LAS should be reserved for refractory cases. Keywords: Anal fissure, constipation, low fiber intake, topical calcium channel blockers, lateral internal sphincterotomy.

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a leading cause of hospitalization and death. The DECAF score (Dyspnoea, Eosinopenia, Consolidation, Acidaemia, atrial Fibrillation) is a simple bedside predictor of in-hospital mortality, but data from India remain limited. The objective is to evaluate the admission DECAF score for predicting in-hospital mortality and secondary outcomes (need for non-invasive ventilation [NIV], invasive mechanical ventilation [IMV], intensive care unit [ICU] admission, and length of stay) in patients hospitalized with AECOPD. Materials and Methods: This prospective observational study enrolled 70 consecutive patients aged ≥40 years admitted with AECOPD to a tertiary-care hospital in eastern India between May 2023 and May 2025. The DECAF score was calculated at admission, and patients were classified as low (0–1), moderate (2), or high (3–6) risk and followed until discharge or death. Discrimination was assessed by receiver operating characteristic (ROC) analysis. Results: The mean age was 62.33 ± 9.98 years, and 64.3% were men. Acidaemia and atrial fibrillation were each present in 54.3% of patients, eosinopenia in 48.6%, consolidation in 47.1%, and severe dyspnoea (eMRCD 5b) in 40.0%. In total, 18.6%, 32.9% and 48.6% were low, moderate, and high risk. NIV was required in 81.4%, ICU admission in 48.6% and IMV in 17.1%; in-hospital mortality was 15.7%. All deaths, all IMV and all ICU admissions occurred in the high-risk group (p < 0.001). The area under the ROC curve for mortality was 0.845 (95% CI 0.745–0.928). A cut-off of ≥3 gave 100% sensitivity, 61.0% specificity and 100% negative predictive value. Length of stay did not differ across risk groups (p = 0.984). Conclusion: The DECAF score showed good discrimination for in-hospital mortality and closely tracked the need for ventilatory and critical care support. A score below 3 reliably identified low-risk patients, supporting its use for early triage in resource-limited settings. Keywords: COPD; acute exacerbation; DECAF score; in-hospital mortality; risk stratification; non-invasive ventilation; India

Background: Noncommunicable diseases, especially metabolic disorders like Type 2 Diabetes Mellitus, have become a challenge in the present. This is usually associated with progressive qualitative and quantitative decline in muscle mass. The earliest indicator of muscle degeneration in Type 2 Diabetes Mellitus is myosteatosis. Materials and Methods: The present study helps to provide diagnostic insights, potentially aiding in early intervention and disease monitoring, thereby preventing or delaying long-term musculoskeletal complications. The present study is a prospective observational height and weight-matched case-control study designed to investigate MRI-derived quantitative measures of myosteatosis in young adults with Type 2 Diabetes Mellitus (T2DM) and healthy controls. Results: A total of 40 cases and 27 controls were recruited into the study. Demographic, biochemical, and MRI-based muscle composition analysis parameters were recorded and analyzed using appropriate statistical tests based on the nature of the data. Diabetics(10.8 ± 2.3) had statistically significantly higher proton density fat fraction as compared to healthy age-matched and gender-matched controls (7.2 ± 1.8) with a p value of <0.001. Conclusion: The present study shows a statistically significantly higher proton density fat fraction as compared to healthy height and weight-matched controls and shedding more light on these new diagnostic utilization areas as to the utilization of MRI in Type 2 Diabetes Mellitus. Keywords: Proton density fat fraction (mri-pdff), Biochemical profile, Mri imaging, Sarcopenia, Diabetes mellitus type 2.

Background: Laryngoscopy and endotracheal intubation provoke a sympathoadrenal stress response that can precipitate myocardial ischaemia or cerebrovascular events in vulnerable patients. Nebulized dexmedetomidine has been proposed as a non-invasive premedication that may attenuate this response with fewer haemodynamic side effects than the intravenous route. We evaluated the efficacy and safety of preoperative nebulized dexmedetomidine for attenuating the haemodynamic response to laryngoscopy and endotracheal intubation. Materials and Methods: In this prospective, randomized, double-blind, placebo-controlled trial, 110 adult patients of ASA physical status I-II undergoing elective surgery under general anaesthesia were randomized to Group D (nebulized dexmedetomidine 1 µg/kg, n=55) or Group S (nebulized 0.9% saline, n=55), administered 20 minutes before induction. Heart rate (HR), systolic (SBP), diastolic (DBP) and mean arterial (MAP) blood pressures were recorded at baseline, after nebulization, and at 1, 2, 4, 6, 8 and 10 minutes after laryngoscopy. Perioperative adverse events were recorded. Results: Baseline characteristics and haemodynamics were comparable between groups (all p>0.05). Following laryngoscopy, Group S showed marked increases in all four parameters, whereas Group D showed a substantially attenuated response. HR peaked at 96.96±7.11 bpm in Group S versus 90.64±10.97 bpm in Group D; SBP, DBP and MAP remained near or below baseline in Group D throughout. Between-group differences were significant from 1 minute after laryngoscopy onward (p<0.001 from 2 minutes for all parameters). Hypotension occurred in 12.7% of Group D versus 1.8% of Group S (p=0.07, all transient); no bradycardia occurred in either group. PONV and postoperative sore throat rates were not significantly different between groups. Conclusion: Preoperative nebulized dexmedetomidine (1 µg/kg) effectively and safely attenuates the haemodynamic stress response to laryngoscopy and endotracheal intubation, without bradycardia, supporting its use as a non-invasive premedication strategy. Keywords: Nebulized dexmedetomidine; laryngoscopy; endotracheal intubation; haemodynamic response; general anaesthesia

Background: Objective: Female histopathology represents malignant, premalignant and benign lesions encountered routinely. Global and national evidence identifies breast and cervix as leading cancer sites, while studies from Bihar highlights gallbladder cancer as important regional malignancy. This study tries to appraise site specific classification, frequency, proportion and burden of benign, premalignant and malignant lesions among female patients. Materials and Methods: A descriptive retrospective observational study was conducted using archived histopathology reports of female patients from 2020-2025 in Department of Pathology, NSMCH, Patna, Bihar. Female patients of any age with final histopathological diagnosis were included while duplicate entries and records lacking final diagnosis were excluded. Data were summarised using frequencies and percentages. Results: Total of 3,029 female pathology records were analysed, comprising 82.1% benign, 1.3% premalignant and 16.6% malignant lesions. Overall commonest organ involved was breast with 21.5% cases, followed by cervix 14.3% and corpus uteri 13.8%. Of these commonest malignant sites include breast with 23.6% cases, followed by 13.5% cervix and 11.1% gallbladder cases and in benign lesions commonest site was breast with 21.2% cases, followed by 15.7% corpus uteri and 14.3% cervix. The largest malignant burden was observed in women aged 40–64 years (286/504; 56.7%). Conclusion: Benign lesions being major routine diagnostic burden, while the malignant profile was led by breast, cervix, and gallbladder. These findings emphasise need for strengthening screening for early detection, and better coordination between health services. Keywords: Female pathology; Retrospective observational study; Malignant lesions; Breast cancer; Cervical cancer; Gallbladder cancer; Bihar.

Background: Peripheral arterial disease (PAD) is an important manifestation of systemic atherosclerosis, while the ankle-brachial index (ABI) is a simple, non-invasive and inexpensive method used for screening and risk stratification. The aim is to assess knowledge, attitude, practice and perceived barriers regarding the use of ABI for screening of PAD among healthcare workers in selected tertiary care hospitals of Kolkata. Materials and Methods: An institution-based cross-sectional questionnaire survey was conducted among 120 healthcare workers. A branching question regarding prior knowledge of ABI was used; 41 (34.2%) reported that they knew about ABI and completed the KAP and barrier sections. Results: Among these 41 participants, mean knowledge score was 7.98±1.93/10; 28 (68.3%) had good, 10 (24.4%) moderate and 3 (7.3%) poor knowledge. Mean attitude score was 38.27±13.79/50, with 30 (73.2%) favourable. Mean practice score was 30.56±11.78/50, with 12 (29.3%) demonstrating good practice. All 41 participants reported at least one barrier; the mean barrier count was 7.22±1.93. The most frequent barriers were lack of awareness of ABI recommendations and indications (40, 97.6%), limited emphasis on PAD screening in routine practice (38, 92.7%), lack of institutional protocols (35, 85.4%), preference for Doppler ultrasonography over ABI (35, 85.4%), and lack of trained supporting staff (31, 75.6%). Conclusion: Participants who knew about ABI demonstrated good knowledge and generally favourable attitudes, but reported practice was comparatively low and substantial barriers were present. Because of the branching structure, KAP findings apply to 41 respondents and should not be generalized to all 120 respondents. Keywords: Ankle-brachial index; Peripheral artery disease; Healthcare professionals.

Background: Folic acid is an essential micronutrient involved in one-carbon metabolism and the remethylation of homocysteine to methionine. Altered homocysteine metabolism has been associated with oxidative stress, insulin resistance and metabolic abnormalities. However, the effects of folic acid supplementation on glycemic control and insulin sensitivity remain inconclusive. This study aimed to evaluate the effect of folic acid supplementation on glycemic parameters, insulin resistance and plasma homocysteine levels among adults attending a tertiary care hospital. Materials and Methods: A hospital-based interventional study was conducted in the Department of General Medicine, Government Dindigul Medical College Hospital, Dindigul, Tamil Nadu, India. Seventy consecutive adults aged ≥18 years were enrolled and received folic acid supplementation according to the study protocol for three months. Baseline and post-intervention assessments included fasting blood glucose (FBG), glycated hemoglobin (HbA1c), fasting serum insulin and plasma total homocysteine. Insulin resistance was estimated using the homeostatic model assessment of insulin resistance (HOMA-IR). Continuous variables were expressed as mean ± standard deviation or median with interquartile range, as appropriate. Baseline and follow-up parameters were compared using paired statistical tests, with p<0.05 considered statistically significant. Results: Among the 70 participants, the mean age was 48.6 ± 10.2 years, with 39 (55.7%) males and 31 (44.3%) females. In the illustrative dataset, mean FBG decreased from 132.5 ± 18.6 mg/dL at baseline to 124.8 ± 16.9 mg/dL after three months. Mean HbA1c decreased from 7.2 ± 0.8% to 7.0 ± 0.7%. Fasting insulin decreased from 15.8 ± 4.2 to 13.9 ± 3.8 µIU/mL, while HOMA-IR decreased from 5.2 ± 1.6 to 4.3 ± 1.4. Plasma total homocysteine decreased from 15.6 ± 3.4 to 12.8 ± 2.9 µmol/L. However, these values are illustrative and require verification using the actual study dataset and statistical analysis before being reported as study findings. Conclusion: Folic acid supplementation may potentially improve fasting glycemic parameters, insulin resistance and plasma homocysteine levels in adults. However, the effect on HbA1c and long-term glycemic control remains uncertain. Well-designed randomized controlled studies with adequate sample sizes, longer follow-up and appropriate control groups are required to establish the clinical significance and therapeutic role of folic acid supplementation in glucose metabolism. Keywords: Folic acid, glycemic control, type 2 diabetes mellitus, fasting blood glucose, HbA1c, insulin resistance, HOMA-IR, homocysteine.

Background: to compare changes in macular edema secondary to Retinitis Pigmentosa, after oral Acetazolamide 250mg BD given for a duration of three months. Materials and Methods: The prospective observational study was carried out at the Regional Institute of Ophthalmology (M.D. Eye Hospital, Dr. Katju Road, Nakhas Kohna, Prayagraj) which is a tertiary care centre and one of the largest eye hospital in Prayagraj, after taking permission from ethical committee of M.L.N Medical College, Prayagraj. Results: The Mean age of patients was 33.56+±07.61 years. Male and female patients had mean age of 34.60±08.12 years and 31.50±06.38 years respectively. Mean visual acuity of all 30 patients at base line was 0.12±0.06 (decimal equivalent). Mean visual acuity (with pinhole) of all 30 patients at base line was 0.10±0.04 (decimal equivalent). The mean central macular thickness (micrometre) at baseline and at follow up. The mean central macular thickness(micrometre) at baseline and at follow up. there is no statistical significance in the difference between the mean visual acuity among the study subjects when the baseline visual acuity and the visual acuity at the end of 12 weeks are compared, thereby concluding that the change in visual acuity is variable. There is a statistically significant difference between the visual acuity (decimal equivalent) at baseline and at the end of 12 weeks (3rd month). Conclusion: In our study, even though there is no statistical difference between number of male and female patients, but the number of male patients is definitely more than female patients. The severity of the disease increases with age. There is marked optic disc pallor, arterial attenuation in later stages as well with increasing age. Macular edema is one of the treatable causes of central vision loss in Retinitis Pigmentosa. Optical Coherence Tomography is one of the best investigative modality for assessing the retinal thickness. Keywords: Retinitis Pigmentosa, Macular edema, Optical Coherence Tomography.

Background: Ralstonia species are aerobic, non-fermenting, Gram-negative bacilli widely distributed in environmental sources, including water, soil and plants. Although traditionally regarded as organisms of low pathogenicity, Ralstonia pickettii, Ralstonia mannitolilytica and Ralstonia insidiosa are increasingly recognized as opportunistic pathogens associated with healthcare-associated infections, particularly among immunocompromised patients and those with indwelling medical devices. Their phenotypic similarity to other non-fermenting Gram-negative bacilli presents diagnostic challenges, while their antimicrobial susceptibility patterns remain incompletely characterized. Aim: To identify and characterize clinical Ralstonia species using conventional phenotypic methods and determine their antimicrobial susceptibility profiles in a tertiary care hospital. Materials and Methods: A prospective observational study was conducted in the Department of Microbiology, Coimbatore Medical College and Hospital, Tamil Nadu, India, from March 2023 to February 2024. A total of 100 non-lactose-fermenting, oxidase-positive clinical isolates were included. The isolates were subjected to conventional culture, Gram staining, motility testing, catalase and oxidase testing, and a series of biochemical tests for identification and speciation. Antimicrobial susceptibility testing was performed using the modified Kirby–Bauer disk diffusion method on Mueller–Hinton agar. The results were interpreted using the criteria described in the dissertation, with the limitations of applying non-species-specific breakpoints to Ralstonia taken into consideration. Results: Among the 100 isolates, Pseudomonas species accounted for 93 (93%), R. mannitolilytica for 4 (4%) and R. pickettii for 3 (3%). No R. insidiosa was identified. All seven Ralstonia isolates were obtained from male patients, and six were associated with the nephrology department. Blood was the predominant specimen type among the Ralstonia isolates, accounting for six of the seven isolates, while one R. mannitolilytica isolate was recovered from urine. All Ralstonia isolates demonstrated resistance to colistin and polymyxin B. They were reported as susceptible to gentamicin, amikacin, ciprofloxacin, ofloxacin, levofloxacin and aztreonam. Resistance to ceftazidime and cefepime was observed in all seven isolates. Variable resistance was observed to cefoperazone–sulbactam, piperacillin–tazobactam, imipenem and meropenem. Among Pseudomonas isolates, resistance was highest to cotrimoxazole (100%), followed by ceftazidime (68.8%) and ciprofloxacin (65.6%). Conclusion: Ralstonia species constituted a small but clinically relevant proportion of the non-lactose-fermenting, oxidase-positive isolates investigated. Their recovery predominantly from blood specimens and their concentration in the nephrology department highlight the importance of accurate identification and careful clinical correlation. The observed antimicrobial susceptibility patterns support continued laboratory surveillance, while the small number of Ralstonia isolates and the limitations of phenotypic identification and susceptibility interpretation warrant

Background: Pancytopenia has diverse causes, and identifying the etiology is essential for management. This study assessed the profile, hematological parameters, peripheral smear, bone marrow findings, and etiological spectrum of pancytopenia. Materials and Methods: This observational cross-sectional study was conducted in the Department of General Medicine, Coimbatore Medical College Hospital, Tamil Nadu, from July 2017 to June 2018. One hundred patients aged 18–65 years fulfilling criteria for pancytopenia were included. History and examination were followed by complete blood count, peripheral smear, biochemical investigations, vitamin B12, HIV testing and special investigations. Bone marrow aspiration and trephine biopsy were performed when indicated. Data were analyzed using SPSS and summarized using frequencies, percentages, mean and standard deviation. Results: The mean age was 43.75 ± 17.15 years, and 61% were males. Fatigue was the commonest symptom (89%), followed by bleeding manifestations (72%), dyspnoea (70%) and anorexia (67%). Pallor was the commonest physical finding (99%). Hemoglobin <5 g/dL was present in 33%. Mean corpuscular volume was elevated in 61%, while vitamin B12 was low in 59%. Peripheral smear most frequently showed dimorphic anemia with macrocytic and microcytic components (32%). Bone marrow examination showed megaloblastic anemia in 33%, reactive hypercellular marrow in 15%, myelodysplastic syndrome in 10% and aplastic anemia in 18%. Megaloblastic anemia was the commonest etiological diagnosis (36%), followed by aplastic anemia (18%), myelodysplastic syndrome (10%) and chronic liver disease (10%). Conclusion: Pancytopenia showed a clinico-hematological spectrum, with megaloblastic anemia as the predominant etiology. Assessment combined with peripheral smear and bone marrow examination facilitates etiological diagnosis and management. Keywords: Pancytopenia; aplastic anaemia; megaloblastic anaemia; bone marrow; peripheral smear; hematological parameters.

Background: Handwashing significantly reduces the major causes of mortality among young children i.e. acute respiratory and intestinal infections. Handwashing with soap may be more effective than any single vaccine or hygiene behaviour in view of its role in disease prevention. It has profound effect on public health. Better handwashing practice by school children decreases school absenteeism and can have community ripple effect. The objectives of the study were to determine the socio demographic profile of government high school students and to assess their knowledge, attitude and practice of handwashing and to assess the relationship between socio demographic factors and handwashing. Materials and Methods: An institutional based cross sectional study was conducted among High school students of Government High School located in urban field practice area of Gandhi Medical College. All high school students willing to participate were included in the study. A total of 110 students participated. A pre designed semi structured questionnaire was used. The data was analyzed using MS excel and and epi info 3.01. Results: The mean age of the study population was 13.88+1.02 years. Majority of the subjects were females and had literate parents. Female gender was significantly associated with knowledge of disease transmission. Higher age groups and literate mother were significantly associated with positive attitude of the student. Conclusion: Majority of the students had adequate knowledge and positive attitude but lacked adequate practice. Handwashing before eating and following handwashing steps were significantly associated with reduced past history of respiratory and or diarrhoeal diseases. Keywords: Knowledge, Attitude, Practice, Handwashing, High School Students.

Background: Potent P2Y12 inhibitors such as prasugrel is superior to clopidogrel in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). There is a significant evidence gap in the risk benefit profile of potent P2Y12 inhibitors in chronic coronary syndromes (CCS) post PCI. Aim: To compare prasugrel versus clopidogrel in patients who had undergone PCI for CCS, and the incidence of major adverse cardiovascular events (MACE) and bleeding complications within 6 months post-PCI. Materials and Methods: Consecutive patients who had undergone PCI for CCS in a tertiary care centre between January 2024 to June 2025 and were discharged on prasugrel were compared with those discharged on clopidogrel. The primary outcome was to compare the incidence of death or myocardial infarction (MI), with secondary outcome to determine the rates of bleeding, stroke, stent thrombosis, target vessel revascularization at 6 months of follow up. Results: Total 400 patients, 200 in each group, were included in study. Death and MI, each occurred at a rate of 1.0% in the Prasugrel group compared with 1.5% in the Clopidogrel group. Prasugrel showed a lower numerical rate of outcome (2.5% vs. 3.0%, HR 0.83). A notable numerical difference was seen in Stent Thrombosis with 1% in the Prasugrel group vs. 5% in the Clopidogrel group. Target Lesion Revascularization (TLR) was less frequent in the Prasugrel group (2.0% vs. 6.0%) than the clopidogrel group. For the composite endpoint of death or MI, the event rate was numerically lower in the prasugrel group than the clopidogrel group. (2.0% [4/200] vs 3.0% [6/200]; HR 0.67). However, with a sample size of 200 per group, this difference was not statistically significant (p > 0.05). Regarding bleeding events, 12 events (6.0%) occurred in Prasugrel Group (n=200) compared with 3 events (1.5%) Clopidogrel Group (n=200). Conclusion: In real-world clinical practice, prasugrel was preferentially prescribed to younger patients with complex coronary anatomy. Ischemic event rates were low in both groups, but prasugrel was associated with a higher observed rate of bleeding, highlighting the need for careful risk stratification when selecting P2Y12 inhibitors in CCS. Keywords: prasugrel, clopidogrel, chronic coronary syndromes, percutaneous coronary intervention, bleeding.

Background: In 1988, a single electrophysiological observation, that a potassium current in carotid body glomus cells was directly inhibited by low oxygen tension, opened an entire field of research into how cells sense oxygen on a moment-to-moment basis. Thirty-five years on, the core observation has been reproduced many times over, yet the identity of the specific potassium channel responsible, and the biochemical mechanism linking hypoxia to channel closure, remain genuinely unresolved. Objective: This review synthesises the physiology, molecular biology, and ongoing controversies surrounding oxygen-sensitive potassium channels, with particular focus on carotid body chemoreceptor cells and pulmonary artery smooth muscle cells, the two tissues in which this mechanism has been studied most intensively. Materials and Methods: A structured narrative synthesis was built from the foundational electrophysiological literature, the two principal mechanistic frameworks (the membrane model and the mitochondrial hypothesis), and the still-active redox controversy, using primary sources located through PubMed and cross-referenced against a 2024 anniversary review of the field. Results: Voltage-gated (KV), calcium-activated (BKCa), and background TASK potassium channels have each been implicated as oxygen sensors, with substantial species and tissue variability complicating a unified account. Two competing mitochondrial models, the redox theory and the mitochondrial ROS theory, offer opposite predictions about whether hypoxia raises or lowers reactive oxygen species, and this disagreement has still not been definitively resolved despite two decades of investigation. Parallel signalling through AMP-activated protein kinase, carbon monoxide and hydrogen sulphide, and lactate-driven acidosis further complicate a single unifying mechanism. Conclusion: Oxygen sensing by potassium channels is one of the best-documented yet least-settled stories in cellular physiology; resolving it further will matter directly for understanding pulmonary hypertension, high-altitude adaptation, and chemoreceptor pathology. Keywords: AMPK; BKCa channel; Carotid body; Hydrogen sulphide; Hypoxia; Hypoxic pulmonary vasoconstriction; KV channel; Mitochondria; Oxygen sensing; Reactive oxygen species; TASK channel.

Background: Metabolic syndrome now affects an estimated 1.54 billion adults worldwide, and diabetes-associated cardiovascular disease remains the leading cause of death in this population. Conventional biomarkers — fasting glucose, HbA1c, lipid panels, and high-sensitivity C-reactive protein — capture only part of the underlying pathophysiology and often detect cardiovascular risk only after subclinical damage has occurred. Extracellular vesicles (EVs), particularly exosomes, have emerged as nanoscale carriers of tissue-specific molecular cargo that may close this gap. The objective is to systematically review evidence for EVs/exosomes as biomarkers of metabolic syndrome and diabetic cardiovascular risk, appraise their merits and demerits relative to conventional biomarkers, and outline a translational research agenda suited to a medical physiology–biotechnology collaboration. Materials and Methods: A PRISMA-informed search of PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library, supplemented by ISEV/MISEV methodological archives and ClinicalTrials.gov, was conducted for records to July 2026. Human biomarker/cohort studies, mechanistic studies with human validation, EV isolation/characterisation papers, and therapeutic EV studies were included; 87 sources met eligibility and were synthesised narratively across four domains. Results: Adipose, hepatic, skeletal-muscle, and endothelial cell-derived EVs act as genuine endocrine mediators, transferring miRNA and protein cargo that modulates insulin signalling, inflammation, and vascular tone in recipient tissues. Circulating EV numbers and cargo correlate with HOMA-IR and respond to interventions such as insulin infusion. In diabetic cardiovascular disease, exosomal miRNA panels — including miR-155-5p (AUC 0.901) and a four-miRNA panel (AUC 0.833, validated at 0.816) — showed strong diagnostic performance for subclinical carotid atherosclerosis, consistently outperforming unfractionated plasma markers. Conclusion: EV-based biomarkers offer mechanistically grounded advantages over conventional markers, particularly earlier detection and tissue-of-origin specificity, but face standardisation, cost, and validation barriers. Pairing physiological cohort access with biotechnological EV analysis capability represents an under-exploited research opportunity. Keywords: extracellular vesicles; exosomes; metabolic syndrome; insulin resistance; type 2 diabetes; cardiovascular risk; biomarkers; microRNA; MISEV; systematic review.

Background: The rapid integration of Artificial Intelligence (AI) is transforming academic research and scientific writing. While offering substantial efficiency in Literature synthesis and drafting, these tools introduce critical challenges regarding transparency, original authorship and research integrity. Objectives: To assess the awareness, utilization patterns and perceptions of AI tools in scientific research writing among postgraduate (PG) medical students and to evaluate self-reported disclosure practices and institutional training needs. Materials and Methods: An institutional Mix Method study was conducted among 104 PG medical residents At a tertiary care teaching hospital in Dahod Gujarat, between August 2025 to February 2026.Data were collected using A validated, pre-tested, self-administered questionnaire covering socio-demographics, domain-specific awareness/experience. A 14-item Likert-scale instrument on AI integration (Cronbach’s α = 0.857, Scale-Content Validity Index S-CVI = 0.975) and qualitative responses on barriers and disclosure practices. Statistical analysis included descriptive metrics and inferential cross-tabulations using Chi-square (χ²) test. Results: Out of 140 eligible postgraduate residents, 104 (74.29%) participated in the survey. The mean age was 26.8 ± 2.1 years, with 65.38% males and 33.65% females. Overall, 94.23% (n=98) were aware of AI tools and 88.46% (n=92) were comfortable using AI for scientific writing. However, only 41.35% (n=43) were aware of established ethical guidelines for AI use in academic publishing. AI was mainly used for language/grammar refinement, literature search, paraphrasing and citation formatting. A major disclosure gap was observed with 59.62% (n=62) never disclosing AI assistance in research submissions. Ethical awareness was significantly higher among second-year residents (54.55%) than first-year residents (31.67%), ChatGPT was the most commonly used AI tool (97.11%), followed by Gemini (58.65%). Social media/blogs (72.10%) and peer discussions (64.40%) were the major sources of AI-related learning. Most residents (89.42%, n=93) requested formal AI-ethics workshops. Overall, the findings indicate positive AI adoption but important gaps in ethical awareness and disclosure practices among postgraduate medical residents. Conclusion: AI adoption is pervasive among PG medical trainees, yet ethical literacy and transparent disclosure lag substantially behind utility. Medical education programs must implement structured curricula, institutional standard operating procedures (SOPs) and mandatory disclosure frameworks. Keywords: Artificial Intelligence, Medical Writing, Ethics, Research, Education, Medical, Graduate.

Background: In India, oral cancer had become an increasing public health concern, mainly due to habits like chewing tobacco and areca nut. Detecting it early made a big difference in treatment and outcomes. One of the easiest and most affordable ways to identify the early signs was through a simple Visual Oral Examination (OVE). Objectives: This study aimed to identify risk factors linked to oral cancer and to screen adults over 30 years of age in the Kolar district. It also aimed to guide people with suspicious findings to the proper medical care. Materials and Methods: A total of 423 individuals aged above 30 years from both urban and rural areas of Kolar were selected through a random sampling method between July 2023 and December 2024. Data was collected using a semi-structured questionnaire, followed by a basic oral Visual Examination. The data was analysed with SPSS, considering p-values below 0.05 as statistically significant. Results: Nearly 26% of the participants showed early signs of oral changes that required further evaluation. The prevalence was higher among individuals with habits like smoking, using smokeless tobacco, or placing quid in the mouth. These signs were also more common among people from rural or economically weaker sections. Conclusion: This study highlights the importance of early screening and awareness campaigns to combat oral cancer. Strengthening public health interventions, especially in rural and low-income communities, can help reduce the burden of this preventable disease. Keywords: Oral cancer, Risk factors, Screening, Oral visual examination.

Background: Injuries over the Malar region following Road Traffic accident are a common presentation to the Emergency department. Thin integument, proximity to vital structures like eyes, nose, mouth etc, complexity of the wounds makes the reconstruction in this area challenging. Thorough debridement followed by careful assessment of the wounds and choosing appropriate reconstructive procedure yields good functional and aesthetic outcome. Aim: To study the various reconstructive options for the coverage of injuries over the Malar region. Materials and Methods: This is a Retrospective study, we considered a total of 15 such patients in the age group ranging from 17 to 64 years over a period of 1 year at our institute, taking into account the gender (13 male and 2 female), site, size, associated injuries, type of surgical procedure and outcome. Results: Among these 15 patients, Advancement flap cover was performed in ten cases (Mustarde’ flap (5) and V-Y flap (5)), followed by Anatomical Closure (2), Reading-Man’s flap (1), McGregor flap (1) and Fricke [Transposition] flap (1). The most common associated injury was eyebrow injury, noted in 6 cases, followed by forehead injury and Eyelid injury (3 cases each); Minimal incidences of complication noted). Complications were minimal, such as suture line dehiscence, seen in 2 cases and lid lag in one. Conclusion: Facial injuries due to RTA or any other aetiology involving Malar defects and associated periorbital area injuries need to be meticulously debrided and assessed to plan and choose from a multitude of available procedures from the reconstructive armament of a plastic surgeon to provide reliable, stable soft tissue coverage and to address functional deficit along with adjacent soft tissue distortion to provide appropriate function and cosmesis. Keywords: Malar injuries, Facial injuries, Aesthetics.

Background: Adjuvant drugs are commonly added to local anaesthetics in brachial plexus block to prolong block duration and reduce postoperative analgesic requirement, but comparative postoperative data on buprenorphine and clonidine specifically in the supraclavicular approach remain limited. Objectives: To compare the postoperative analgesic efficacy and safety of buprenorphine and clonidine, each added to bupivacaine, for supraclavicular brachial plexus block. Materials and Methods: In this prospective, randomised, observer-blind, comparative study, 60 ASA I/II patients aged 20–60 years undergoing unilateral upper-limb surgery below the elbow were randomly allocated to three groups of 20 each: Group B (bupivacaine 0.5%, 20 mL, plus normal saline), Group BB (bupivacaine 0.5%, 20 mL, plus buprenorphine 100 mcg), and Group BC (bupivacaine 0.5%, 20 mL, plus clonidine 50 mcg), each to a total volume of 30 mL, for peripheral-nerve-stimulator-guided supraclavicular block. Primary outcomes were duration of postoperative analgesia, time to first rescue analgesic, and 24-hour rescue analgesic consumption. Secondary outcomes were postoperative visual analogue scale (VAS) trajectory, quality of anaesthesia, haemodynamic parameters, and adverse effects. Continuous variables were compared using one-way ANOVA and categorical variables using the chi-square test; p<0.05 was considered significant. Results: Mean duration of analgesia was significantly longer with buprenorphine (815.20 ± 266.06 min) than with clonidine (432.35 ± 96.40 min) or bupivacaine alone (367.75 ± 36.26 min) (p<0.05). Time to first rescue analgesic was similarly delayed with buprenorphine (17.10 ± 6.64 h) and clonidine (16.35 ± 5.90 h) compared with bupivacaine alone (8.15 ± 2.56 h; p<0.05), with no difference between the two adjuvants (p>0.05). Twenty-four-hour rescue analgesic consumption fell from 2.50 ± 0.76 doses with bupivacaine alone to 1.45 ± 0.60 (buprenorphine) and 1.45 ± 0.89 (clonidine) doses (p<0.05). VAS scores were significantly higher with bupivacaine alone at 6, 8, and 10 hours (p<0.05). Sedation, nausea, vomiting, and pruritus were numerically more frequent with buprenorphine, but the overall between-group difference in adverse effects was not statistically significant (p>0.05); haemodynamic parameters and SpO₂ remained comparable throughout. Conclusion: Both buprenorphine and clonidine, added to bupivacaine for supraclavicular brachial plexus block, provided significantly prolonged and comparably delayed postoperative analgesia with reduced rescue analgesic consumption relative to bupivacaine alone, without a statistically significant increase in adverse effects; buprenorphine produced the longest overall duration of analgesia. Keywords: Brachial Plexus Block; Buprenorphine; Clonidine; Pain, Postoperative; Bupivacaine.

Background: Early Clinical Exposure (ECE), a key component of Competency-Based Medical Education (CBME), aims to integrate basic sciences with clinical practice, but its value depends on implementation quality. This study assessed ECE implementation, student perceptions, benefits, challenges and suggestions in a government medical college in Gujarat. Materials and Methods: This mixed-methods study combined a cross-sectional survey and Key Informant Interviews (KIIs) among 193 purposively selected MBBS students who had undergone ECE under CBME. Data were collected using a pre-tested, CBME-based semi-structured Google Forms questionnaire; satisfaction was rated on a five-point Likert scale. Five KIIs with batch representatives were conducted until thematic saturation. Descriptive statistics (Jamovi 2.3.28) and manual thematic analysis were used. Results: Participants were 64.2% male; 54.9%, 28.0% and 17.1% were in second, third and final year, respectively. Familiarity with ECE guidelines was 49% (familiar) and 15% (very familiar). ECE was useful for 71.5% and interesting for 33.7%. Common modalities were case scenario discussions (81.9%), lectures (76.2%) and hospital visits (61.1%). Clinical correlation with basic sciences was the most perceived benefit (63.7%); 52.3% applied ECE learning during clinical rotations. Overall, 65.8% were satisfied and 15.5% very satisfied. Qualitative themes revealed student-, faculty- and system-related challenges: conceptual gaps, passive learning, mentorship gaps, limited clinical exposure, documentation burden and time pressure. Conclusion: ECE was perceived positively, particularly for linking basic sciences with clinical practice, but variable clinical exposure, passive teaching, mentorship gaps and system constraints may limit its potential. Strengthening interactive teaching, faculty development, clinical integration and institutional support may improve implementation. Keywords: Early Clinical Exposure; Competency-Based Medical Education; Medical Students; Undergraduate Medical Education; Clinical Correlation.

Background: Labour pain is one of the most intense forms of pain experienced by women and is associated with significant physiological and psychological stress. Effective pain relief during labour improves maternal comfort, reduces stress responses, and enhances the overall childbirth experience. Epidural analgesia is widely considered the gold standard for labour pain relief because it provides superior analgesia while allowing the mother to remain conscious and actively participate in the birthing process. The addition of opioid adjuvants such as fentanyl or tramadol to local anaesthetics like bupivacaine enhances analgesic efficacy while reducing the dose requirement of local anaesthetics. Aim: To compare the efficacy and safety of epidural administration of bupivacaine with fentanyl versus bupivacaine with tramadol for labour analgesia. Materials and Methods: This prospective, randomized, patient and observer-blinded study was conducted in the Department of Anaesthesiology in association with the Department of Obstetrics and Gynaecology at GS Medical College and Hospital, Hapur, for the period of 18 months. Ninety ASA II parturients aged 18–35 years with uncomplicated singleton pregnancies in active labour were included. Patients were randomly divided into two groups of 45 each. Group F received epidural bupivacaine 10 ml of 0.125% with fentanyl 20 µg, while Group T received epidural bupivacaine 10 ml of 0.125% with tramadol 20 mg. Results: The onset of analgesia was significantly faster in the fentanyl group (5.76 ± 2.57 minutes) compared with the tramadol group (8.00 ± 3.04 minutes) (p < 0.001). The duration of analgesia was significantly longer in the fentanyl group (183.67 ± 43.34 minutes) compared with the tramadol group (145.98 ± 52.15 minutes) (p < 0.001). Both groups showed comparable VAS scores throughout labour. Maternal hemodynamic parameters remained stable in both groups. The duration of labour stages, mode of delivery, and neonatal APGAR scores were similar between the groups. However, maternal adverse effects such as pruritus, nausea, vomiting, hypotension, and urinary retention were significantly more frequent in the fentanyl group. The tramadol group required more repeat analgesic doses due to shorter duration of analgesia. Conclusion: Epidural bupivacaine with fentanyl provides faster onset and longer duration of labour analgesia compared with bupivacaine with tramadol. However, fentanyl is associated with a higher incidence of maternal adverse effects. Tramadol provides effective analgesia with fewer side effects but requires more frequent dosing. Both regimens are safe with respect to maternal hemodynamic stability, labour progression, and neonatal outcomes. Keywords: Labour analgesia, Epidural analgesia, Bupivacaine, Fentanyl, Tramadol, Visual Analogue Scale, Obstetric anaesthesia.

Background: Jigsaw is one of the cooperative teaching learning methods with emphasis on active participation of students. Traditional didactic lectures remain largely the predominant teaching method in undergraduate medical education, but they are teacher-centred and encourage passive learning. Jigsaw method engages students actively and reported to improve conceptual understanding, critical thinking and communication skills. However, evidence on the use of jigsaw in pathology teaching is limited. This study was therefore undertaken to introduce jigsaw as a teaching-learning method for Phase II MBBS students in the Department of Pathology, to compare its effectiveness with didactic lecture in terms of academic performance, and to assess the perceptions of students and faculty regarding this method. Materials and Methods: A quasi-experimental study was conducted among second-phase MBBS students in the Department of Pathology after IEC approval. Four topics of comparable difficulty were selected. Pre-validated MCQ questionnaires were used for pre-/post-tests and feedback. Total 72 students participated in the study. They were allocated to study (Jigsaw) and control (didactic lecture) groups based on roll numbers, with crossover in subsequent sessions. Quantitative data (pre- and post-test scores) was analysed to assess the effectiveness of Jigsaw method. Qualitative data about students and faculty perception was collected by using prevalidated questionnaire (5-point Likert scale and open-ended responses). Long term retention was tested after one month. Results: Pretest scores revealed comparable baseline knowledge for both the groups. Post-test scores were significantly higher (p < 0.05) in the Jigsaw group than in the didactic lecture group. Long-term retention was also significantly better with the Jigsaw method. Student feedback indicated high acceptance of the method. Conclusion: This study demonstrates that the Jigsaw method is more effective than didactic lectures in enhancing immediate learning outcomes and long-term knowledge retention. Positive student perceptions re-enforce the method’s ability to promote active participation, deeper understanding, communication skills and critical thinking. Keywords: Jigsaw, didactic lecture, Active learning, student-centric methods.

Background: Pediatric trauma is a major cause of emergency department attendance and may vary according to demographic characteristics, injury mechanism, severity, anatomical location etc.As there is limited data in hospitals of North-East India regarding this issue, the present study was undertaken to assess the patterns of trauma among pediatric patients attending the emergency department of a tertiary care hospital in Assam. Materials and Methods: This was a prospective observational study conducted over a period of one year, from July 2024 to June 2025, at a tertiary care institute in Assam. The pediatric trauma patients up to the age of 18 years brought to the Emergency Department of the institute were included in the study. Demographic variables, Injury related characteristics, and Treatment related factors were recorded. Data were analyzed using descriptive and inferential statistical methods using Jamovi. Results: 185 pediatric trauma patients were initially assessed for eligibility and finally 149 patients were included in the analyses. The mean age of the cohort was 7.71 ± 3.89 years. There were 107 males (71.8%) and 42 females (28.2%). Falls from height and road traffic accidents together accounted for more than half of all pediatric trauma cases (29.5% and 27.5% respectively). A statistically significant association was observed between sex and mechanism of injury by Pearson’s Chi-square test (p = 0.018). Mechanism of injury also differed significantly across age groups. Mild injuries constituted the majority of cases (69.8%). A Chi-Square test of independence demonstrated that injury severity was significantly associated with patient outcome (p<0.001). Hospital admission varied significantly according to the injured body system and patients with multisystem involvement or polytrauma had the highest admission rate. After adjustment for age, sex and severity, severe injury was associated with higher odds of hospital admission compared with mild injury (adjusted OR 2.304) in multivariate binary logistic regression. Kruskal-Wallis H test utilized to evaluate differences in length of stay across clinical severity categories revealed a statistically significant difference in hospital duration based on injury severity (p = 0.001). Conclusion: The mean age of 7.71 ± 3.89 years reflects the fact that children are increasingly prone to injury as they grow due to increased exposure to outdoor activities, greater mobility and decreased parenteral monitoring. The pediatric trauma population was predominantly male, with fall from height and road traffic accidents being the major causes of trauma. Our findings highlights that organised and timely triage can create a pathway for the disposition of pediatric trauma patients without requiring hospital admission as was evident by the high percentage (47.7%) of patients discharged directly from the emergency department and only two-fifths (37.6%) of patients requiring hospital admission. The study findings also highlight the importance of understanding local pediatric trauma patterns for emergency care planning and resource allocation. Keywords: Pediatric Trauma, wounds, injury, accidental falls

Background: Bilateral knee osteoarthritis can produce substantial pain, restricted mobility, and functional disability. In some patients, the two knees can be replaced at the same time, in a single anesthetic and single hospital stay, called single-stage bilateral total knee replacement. This could reduce the total rehabilitation time, but the potential for perioperative blood loss, transfusion needs and post-operative complications are still a concern. The objective is to evaluate the clinical, functional, and perioperative outcomes of patients undergoing single-stage bilateral total knee replacement. Materials and Methods: This descriptive prospective study was conducted in the Department of Orthopaedics, Khyber Teaching Hospital, Peshawar, from January 2024 to June 2026. There were 40 patients undergoing single-stage bilateral total knee replacement included. Demographic data, history of morbidity, duration of surgery, estimated blood loss, hemoglobin, need for transfusion, hospital stay and complications were noted. Functional outcome measures were the Visual Analogue Scale (VAS) for pain, knee range of motion and Knee Society Score (KSS). Preoperative and postoperative results were compared and a p-value of less than 0.05 was deemed statistically significant. Results: The mean age of the patients was 63.7 ± 7.4 years, and 26 (65.0%) were female. The mean operative duration was 168.4 ± 21.6 minutes, while mean estimated blood loss was 615.3 ± 142.8 mL. Blood transfusion was required in 13 (32.5%) patients. Mean VAS pain score decreased significantly from 8.1 ± 1.0 preoperatively to 2.4 ± 1.1 postoperatively (p<0.001). Mean knee range of motion improved from 87.6 ± 12.5° to 112.9 ± 10.8° (p<0.001), while mean KSS increased from 42.8 ± 9.6 to 83.5 ± 8.7 (p<0.001). Superficial surgical-site infection occurred in 3 (7.5%) patients and deep-vein thrombosis in 2 (5.0%). No pulmonary embolism, myocardial infarction, prosthetic joint infection, revision surgery, or mortality was observed. Conclusion: Single-stage bilateral total knee replacement produced substantial improvement in pain, knee mobility, and functional status in appropriately selected patients. Although perioperative blood loss and transfusion requirements were notable, major complications were uncommon. Careful patient selection, perioperative optimization, thromboprophylaxis, and early rehabilitation remain important for achieving favorable outcomes. Keywords: Bilateral knee osteoarthritis; bilateral total knee replacement; total knee arthroplasty; functional outcome; Knee Society Score; postoperative complications.

Background: Objective: To determine whether the neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV) and platelet distribution width (PDW) independently predict angiographic no-reflow in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), and to compare their discriminative performance alone and in combination. Materials and Methods: In this single-centre, cross-sectional observational study at a tertiary-care cardiology department in Jaipur, India, 240 consecutive adults with STEMI undergoing primary PCI were enrolled. Venous blood was drawn before any antiplatelet loading dose. No-reflow was defined as post-stenting Thrombolysis in Myocardial Infarction (TIMI) flow grade <3 without mechanical obstruction. Independent predictors were identified by multivariable logistic regression, and discrimination was assessed by receiver-operating-characteristic (ROC) analysis. Results: No-reflow occurred in 70 patients (29.2%). Admission NLR (6.8 ± 2.9 vs 3.2 ± 1.4), MPV (10.9 ± 1.2 vs 9.1 ± 1.0 fL) and PDW (16.8 ± 2.4 vs 13.9 ± 2.0%) were higher in the no-reflow group (all p < 0.001). NLR (adjusted odds ratio [aOR] 1.48 per unit; 95% CI 1.24–1.77), MPV (aOR 1.42 per fL; 1.11–1.82), PDW (aOR 1.28 per %; 1.05–1.56), diabetes mellitus, pain-to-balloon time >6 h and high thrombus grade were independent predictors. NLR had the highest area under the curve (AUC 0.82; cut-off >4.9, sensitivity 78.6%, specificity 74.7%); a combined haematological model improved the AUC to 0.87. No-reflow rose from 8.8% to 52.5% across ascending NLR tertiles (p for trend < 0.001). Conclusions: Admission NLR, MPV and PDW—available from a routine complete blood count—independently predict no-reflow after primary PCI for STEMI, and their combination improves risk discrimination. Keywords: Mean platelet volume; Neutrophil-to-lymphocyte ratio; No-reflow phenomenon; Primary percutaneous coronary intervention; ST-segment elevation myocardial infarction.

Background: Antibiotics are often supplied without a prescription through community pharmacies in Pakistan, although prescription-only dispensing is required. Little is known about how pharmacy staff make these decisions at the counter. The objective is to explore how community pharmacists and pharmacy technicians experience antibiotic dispensing rules in routine practice, and what shapes their decisions when a patient has no prescription. Materials and Methods: A qualitative descriptive study was conducted in community pharmacies in Sargodha, Pakistan. Nine pharmacists took part in in-depth interviews, and 10 pharmacy technicians took part in two focus group discussions of five participants each. Participants were selected purposively. Data were analysed thematically using a combined inductive-deductive approach, and data collection and analysis were conducted concurrently. Results: Four connected themes were identified. First, prescription-only dispensing was accepted in principle but applied conditionally, as staff used informal rules based on symptoms, duration of illness, affordability and patient insistence. Second, the counter worked as a marketplace, where refusal risked losing the customer to a nearby pharmacy. Third, staff worked without a supporting system, with little current guidance and few links to prescribers or the regulator. Fourth, participants explained non-prescription dispensing mainly through patient, prescriber, regulatory and workforce pressures. Technicians described non-prescription supply more openly than pharmacists. Conclusion: The gap between rule and practice was not mainly a gap in knowledge. Stewardship in community pharmacy should address the informal decision rules that staff already use, apply prescription rules consistently across all outlets, link pharmacies with prescribers, and include pharmacy technicians. Keywords: Antimicrobial Resistance; Anti-Bacterial Agents; Antimicrobial Stewardship; Pharmacies; Pharmacists; Qualitative Research; Pakistan.

Background: Maximal oxygen uptake (VO₂ max) is a recognized gold-standard indicator of cardiorespiratory fitness and is widely used for exercise prescription, patient monitoring, and evaluation of wellness interventions. Automated treadmill-generated VO₂ max estimations are commonly used in wellness settings; however, their validity under varying exercise conditions remains uncertain. Inaccurate VO₂ max estimation may negatively affect clinical decision-making, documentation reliability, and patient-centered care outcomes. The objective is to evaluate the accuracy of treadmill-generated VO₂ max values compared with a policy-approved formula-derived reference method. Materials and Methods: A prospective quality improvement and validation study was conducted between February and May 2026 at a Primary Health Care Corporation wellness center in Qatar. Treadmill-generated VO₂ max values were compared with reference values calculated using the Cooper 12-minute test equation from PHCC approved policy. Validation was performed under three testing conditions: controlled fixed-speed and variable subject weight testing, controlled variable-speed with constant subject weight testing, and no control real-world testing. Patient expectations regarding documentation accuracy were additionally evaluated using a structured Patient-Centered Care survey Results: Under controlled fixed-speed and varied body weight conditions, treadmill-generated VO₂ max values demonstrated a consistent systematic underestimation of −11.99% across all observations, independent of body weight variation. When treadmill speed was varied with constant subject weight conditions, substantial overestimation was observed, with percentage errors ranging from +82.95% to +120.19%. In real-world no control practice, error variability ranged from +7.92% to +100.41%, with a persistent trend toward overestimation. Controlled fixed-speed testing demonstrated negligible variability (SD 0.00), whereas both controlled variable-speed testing and no control real-world testing demonstrated high variability (SD 18.70 and SD 24.11, respectively). Conclusion: Treadmill-generated VO₂ max estimations demonstrated substantial systematic inaccuracies and clinically significant variability, particularly under conditions involving treadmill speed fluctuations. The errors ranged leading that the treadmill speed fluctuation may the primary determinant of measurement error. Keywords: VO₂ max assessment; cardiorespiratory fitness; documentation accuracy

Background: Early childhood caries (ECC) is one of the most common chronic diseases affecting children and can result in extensive destruction of primary teeth when left untreated. Primary teeth contribute to mastication, speech, maintenance of dental arch integrity, preservation of space, and guidance of permanent tooth eruption. Consequently, severe caries and premature loss of primary teeth may influence the development of occlusion. This study aimed to evaluate the association between ECC severity, premature loss of primary teeth, dental arch characteristics, and malocclusion among preschool children. Materials and Methods: An analytical cross-sectional study was designed among 300 children aged 3–6 years. Dental caries experience was assessed using the decayed, missing, and filled teeth (dmft) index. ECC severity was categorized according to established clinical criteria. Premature loss of primary teeth was recorded clinically, while malocclusion was assessed according to sagittal, vertical, and transverse occlusal characteristics. Dental arch measurements, including arch length and intercanine and intermolar widths, were also recorded. Descriptive statistics, chi-square tests, independent-samples t-tests, and multivariable logistic regression were used for analysis. Results: In the study, 188 (62.7%) children had ECC, including 91 (30.3%) with severe ECC. Premature loss of at least one primary tooth was observed in 72 (24.0%) children, while malocclusion was identified in 126 (42.0%). Malocclusion was more frequent among children with severe ECC than among caries-free children (57.1% versus 27.7%, p<0.001). Premature tooth loss was also more common among children with severe ECC (40.7%) than among caries-free children (9.8%, p<0.001). Conclusion: The findings demonstrate a possible association between severe ECC, premature primary-tooth loss, altered dental arch characteristics, and malocclusion. The relationship is more appropriately interpreted through a dentoalveolar pathway rather than as direct evidence that ECC causes skeletal craniofacial growth abnormalities. Longitudinal studies are required to establish temporal and causal relationships. Keywords: Craniofacial growth, dmft, early childhood caries, premature tooth loss.

Background: Liver cirrhosis is often associated with altered thyroid function, which may reflect the severity of liver dysfunction. Understanding this relationship can help in predicting disease progression and prognosis in cirrhotic patients. The aim of this study was to study of thyroid dysfunction in decompensated cirrhosis of liver and correlation with etiology of cirrhosis and severity of underlying liver disease. Materials and Methods: The present Institution based descriptive observational cross sectional study was carried in the Department of General Medicine of Calcutta National Medical College and Hospital, Kolkata. 113 Known case of Thyroid disorder or Family history of Thyroid disorder fulfilling the inclusion criteria were included in the study. The research was carried out between January2020toJune2021. The statistical data were analyzed using SPSS V.25.0 and Microsoft Excel. Results: Mean age of the patients was 56.23±11.21 years. Cirrhosis of liver was more prevalent among males (79%) compared to females (21%). During study, gross ascites (73.5%) was found most common presentation. There was a significant difference regarding the etiology of liver cirrhosis and thyroid profile. Patient with low T3 levels were highest in Child-Pugh class C (82.1%) followed by Child-Pugh class B (61.9 %) and Child-Pugh class A (50%) and this difference was found to be statistically significant (p=0.037). Patients with low FT4 level having MELD score of more than 20 were significantly higher as compared to the patients with MELD score less than 20. Conclusions: Thyroid abnormalities are not uncommon in patients with cirrhosis. Hypothyroidism is the most common abnormality that was detected. Thyroid function test should be carried out in all cirrhotic patients to assess the severity and prognostication of such patients. Keywords: Liver cirrhosis, Thyroid dysfunction, T3, FT3, TSH, Hypothyroidism, Liver dysfunction.

Background: Intraocular pressure (IOP) is a key determinant in glaucoma pathogenesis and may be influenced by systemic factors such as body mass index (BMI) and hormonal status. Menopause-related hormonal changes, particularly reduced estrogen levels, are known to affect ocular physiology, necessitating evaluation of their combined impact on IOP. Objectives: To determine the influence of BMI on IOP in premenopausal and postmenopausal women, compare mean IOP between groups, and assess the correlation between BMI categories and IOP. Materials and Methods: A hospital-based prospective observational study was conducted on 140 women aged 45–55 years, divided into premenopausal (n=35) and postmenopausal (n=105) groups. BMI was categorized, and IOP was measured and analyzed using SYSTAT, with p<0.05 considered significant. Results: Mean IOP was significantly higher in postmenopausal women (16.92 ± 0.83 mmHg) than premenopausal women (14.84 ± 0.81 mmHg; p<0.001). IOP increased progressively with BMI in both groups (p<0.001). Two-way ANOVA showed significant independent effects of BMI and menopausal status on IOP without interaction. Conclusion: Both BMI and menopausal status independently influence IOP, with higher values observed in obese and postmenopausal women, indicating increased risk for ocular hypertension. Keywords: Body Mass Index, Intraocular Pressure, Menopause, Premenopausal, Postmenopausal, Glaucoma Risk.

Background: Distal humerus fractures are commonly managed by open reduction and internal fixation through a posterior approach. The olecranon osteotomy offers the widest view of the articular surface but adds a second bony injury, while the paratricipital approach preserves the extensor mechanism at the cost of a smaller view. Hence we compared both approaches to find out which is better. The aim and objective is to compare a modified paratricipital (MPT) approach with the chevron olecranon osteotomy (COO) approach for distal humerus fractures. Materials and Methods: In this prospective comparative cohort study, thirty patients were operated through the MPT approach and 30 through the COO approach. Operative time, blood loss, incision length, intraoperative fluoroscopy use, range of motion (ROM) at 12 weeks, Mayo Elbow Performance Score (MEPS) at 6 months, time to union and complications were compared. Results: The groups were similar in age, sex and mechanism of injury. The modified paratricipital approach gave shorter surgery duration, less blood loss, a smaller incision and better elbow motion at 12 weeks than the chevron olecranon osteotomy, and mean functional scores at 6 months were comparable. Chevron olecranon osteotomy had higher overall risk of complications like infection and implant complications. Conclusion: The modified paratricipital approach is a reasonable alternative to osteotomy for distal humerus fractures if used along with intraoperative fluoroscopy. Keywords: Distal humerus fracture, Paratricipital approach, Olecranon osteotomy, Chevron osteotomy, Mayo Elbow Performance Score.

Background: Women may experience postpartum depression after childbirth which negatively impact the health of both mother and child. Materials and Methods: An observational cross-sectional study was conducted among 200 women attending immunization camp at Anganwadi centers in the Dahod district, Gujarat, India. EPDS scale was used to assess postpartum depression in eligible women. The data were recorded in notes and analyzed further. Results: This study has 200 participants out which 92(46%) were screened positive for postpartum depression according to EPDS scale. In bivariate analysis, younger age, lower educational status, low household income, joint family structure, high parity and having female children were significantly associated with postpartum depression. After adjustment for potential confounders, younger maternal age (AOR 2.75, 95% CI: 1.79–4.20) and having two or more female children (AOR 2.56, 95% CI: 1.64–4.00) remained significant independent predictors of postpartum depression. Lack of education was significantly associated with non-exclusivity of breastfeeding, rather than postpartum depression. Conclusion: This study shows a high prevalence of postpartum depression in this region. Factors such as young maternal age and having two or more female children are independent predictors of postpartum depression. There is a need for education and awareness in the community regarding maternal mental health. Keywords: Breastfeeding, child health, maternal health, mental health, mood disorders, postpartum depression, Tribal health.

Background: Serum prolactin may serve as a potential biomarker for assessing the severity of liver cirrhosis. This study evaluated its correlation with the Child–Pugh score. Materials and Methods: A hospital-based observational study was conducted on 79 patients with liver cirrhosis over 12 months. Serum prolactin levels were measured and correlated with Child–Pugh classification. Results: Serum prolactin showed a significant positive correlation with Child–Pugh score (r = 0.544, p < 0.001). ROC analysis demonstrated an AUC of 0.818, with 92.6% sensitivity and 61.5% specificity at a cut-off of ≥1029 mIU/mL for identifying Child–Pugh Class C cirrhosis. Conclusion: Serum prolactin is significantly associated with cirrhosis severity and may serve as an adjunctive biomarker for identifying advanced liver disease. Keywords: Serum prolactin, Liver cirrhosis, Child–Pugh score, Biomarker.

Background: Diabetic kidney disease (DKD) is a major microvascular complication of diabetes and a leading cause of chronic kidney disease and end-stage kidney disease. Early detection is crucial, as renal injury may develop before abnormalities in conventional markers such as estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR). Emerging biomarkers, including kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, N-acetyl-β-D-glucosaminidase (NAG), liver-type fatty acid-binding protein (L-FABP), inflammatory and tubular injury markers, and proteomic/metabolomic signatures, may improve early detection and prediction of DKD progression. However, evidence regarding their diagnostic and predictive value remains heterogeneous. Objectives: The study aims to identify and evaluate emerging biomarkers for early detection and progression of DKD, assess their diagnostic performance, compare them with conventional markers such as UACR and eGFR, and determine the most promising biomarkers while identifying gaps for future research. Materials and Methods: This systematic review was conducted in accordance with the PRISMA guidelines. A comprehensive literature search was performed using PubMed/MEDLINE, Scopus, Web of Science, Embase, Cochrane Library, and Google Scholar. Relevant keywords such as Diabetic kidney disease, Emerging biomarkers, Diagnostic biomarkers, Kidney injury molecule-1, Neutrophil gelatinase-associated lipocalin, Cystatin C, Tubular injury biomarkers, Proteomics, Metabolomics were used. Original research studies, including cohort, case-control, cross-sectional, randomized controlled trials, case report studies evaluating emerging biomarkers for early detection and progression of DKD in adults with diabetes were included. Articles published from the year 2012 were included in results. Study selection involved title and abstract screening followed by full-text assessment, with the process documented using a PRISMA flow diagram. Findings were synthesized narratively. Results: The identified biomarkers included urinary proteomic and metabolomic signatures, podocyte-associated markers, tubular injury markers, inflammatory mediators, and circulating proteins. Urinary proteomic signatures, particularly the Chronic Kidney Disease 273 (CKD273) classifier, demonstrated strong potential for predicting progression from normoalbuminuria to microalbuminuria or macroalbuminuria, with reported area under the curve (AUC) values of approximately 0.93. Several biomarkers, including podocalyxin, kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, and angiopoietin-like protein-4, were significantly associated with albuminuria, reduced estimated glomerular filtration rate (eGFR), or early tubular and podocyte injury. Circulating tumor necrosis factor receptors 1 and 2 (TNFR-1 and TNFR-2) were consistently associated with subsequent eGFR decline and progression to end-stage renal disease. Emerging multi-biomarker and omics-based panels demonstrated improved diagnostic and prognostic performance, with reported AUC values ranging from 0.81

Background: High-flow nasal cannula (HFNC) therapy may be better tolerated than non-invasive ventilation (NIV) during acute exacerbations of chronic obstructive pulmonary disease (COPD), but their comparative performance in hypercapnic respiratory failure remains uncertain. Materials and Methods: This study included 102 adults with COPD and acute hypercapnic respiratory failure: 51 initially treated with HFNC and 51 with NIV. The planned comparisons include arterial blood gases, respiratory rate, treatment failure, clinical outcomes and treatment-related complications. Treatment failure comprises intubation or a switch from the initial support modality. Results: Baseline characteristics were similar between groups. At 24 hours, among patients still assessed on initial support, NIV was associated with lower PaCO₂ (54.8 versus 59.4 mmHg; p=0.033), higher pH (7.36 versus 7.33; p=0.012) and lower respiratory rate (23.6 versus 25.4 breaths/min; p=0.038). Treatment failure occurred in 10/51 NIV patients (19.6%) and 17/51 HFNC patients (33.3%; p=0.178). HFNC had a higher comfort score (7.5 versus 6.3; p<0.001) and fewer pressure-related skin injuries (2.0% versus 17.6%; p=0.016). In-hospital mortality did not differ significantly. Conclusion: The study findings suggest better 24-hour ventilatory measures with NIV and greater comfort with HFNC. The non-significant treatment-failure comparison does not establish equivalence. Keywords: Chronic obstructive pulmonary disease; acute hypercapnic respiratory failure; high-flow nasal cannula; non-invasive ventilation; treatment failure.

Background: Intrapartum fetal surveillance is essential for early identification of fetal compromise during labour. Cardiotocography (CTG) is a widely used non-invasive method for assessing fetal wellbeing, although its relationship with fetal and neonatal outcomes remains variable. Objectives: To evaluate the association between CTG patterns in the first stage of labour and fetal distress, mode of delivery and neonatal outcomes. Materials and Methods: This study included 300 term antenatal women in the first stage of labour admitted to the Department of Obstetrics and Gynaecology. All women underwent CTG recording and the tracings were classified as normal, suspicious or pathological. Maternal and intrapartum outcomes, including meconium-stained liquor, fetal distress and mode of delivery, were recorded. Neonatal outcomes were assessed using Apgar scores, neonatal complications and NICU-related outcomes. The diagnostic performance of CTG was assessed using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: Of the 300 women, 228 (76.0%) had normal CTG, 38 (12.67%) had suspicious CTG and 34 (11.33%) had pathological CTG. Fetal distress occurred in 17.10% of the normal group, 34.21% of the suspicious group and 73.53% of the pathological group (p < 0.0001). Meconium-stained liquor was observed in 9.21%, 31.58% and 47.06% of the respective groups. LSCS was performed in 10.09% of women with normal CTG, 84.21% with suspicious CTG and 91.18% with pathological CTG. Among neonates in the pathological CTG group, 55.89% had Apgar <7 at 1 minute and 20.59% had Apgar <7 at 5 minutes. Meconium aspiration syndrome, neonatal seizures and hypoxic-ischaemic encephalopathy occurred in 14.70%, 17.65% and 8.82%, respectively. CTG demonstrated a sensitivity of 49.35%, specificity of 84.75%, PPV of 52.78% and NPV of 82.89%. Conclusion: CTG is a useful, simple and non-invasive method of intrapartum fetal surveillance and is significantly associated with fetal distress, operative delivery and adverse neonatal outcomes. Its relatively high specificity and negative predictive value support its usefulness in identifying fetuses unlikely to have significant compromise. However, its lower sensitivity and positive predictive value indicate that CTG findings should be interpreted in conjunction with maternal risk factors, labour progress and other clinical findings rather than being used as an isolated diagnostic test for fetal hypoxia. Keywords: Cardiotocography; fetal distress; intrapartum fetal monitoring; labour; Apgar score; neonatal outcome; caesarean section.

Background: Dental development provides an important biological indicator of maturation and has applications in orthodontics, forensic odontology, and clinical dentistry. The objective is to determine the correlation between dental age and chronological age among orthodontic patients aged 10–14 years using third-molar development assessed according to the Köhler method. Materials and Methods: A cross-sectional study was conducted among 100 orthodontic patients aged 10–14 years. Panoramic radiographs were evaluated for third-molar developmental stage using the ten-stage Gleiser–Hunt classification modified by Köhler. Chronological age was calculated from the date of birth and date of radiographic examination. Dental age was estimated according to the age corresponding to the recorded Köhler developmental stage. Descriptive statistics were calculated, and Spearman’s rank correlation coefficient was used to assess the association between Köhler developmental stage and chronological age. Results: The participants had a mean chronological age of 12.16±1.39 years. The mean estimated dental age was 12.04±1.42 years, with a mean chronological–dental age difference of 0.12±0.74 years. A strong positive correlation was observed between chronological age and Köhler developmental stage (Spearman’s ρ=0.82, p<0.001). Similar significant positive relationships were observed among males (ρ=0.84, p<0.001) and females (ρ=0.79, p<0.001). Conclusion: Third-molar development assessed using the Köhler method showed a strong positive correlation with chronological age among orthodontic patients aged 10–14 years. The findings support the use of standardized third-molar developmental assessment as a useful component of dental-age estimation in this age group. Keywords: Dental age; chronological age; Köhler method; third molar; orthodontic patients; dental development.

Background: Coronary artery disease usually remains asymptomatic in type 2 diabetes mellitus (T2DM) due to diabetic cardiac autonomic neuropathy. This study evaluates whether the ankle-brachial index (ABI) can serve as a non-invasive predictor of silent myocardial ischemia (SMI) in asymptomatic T2DM patients. Materials and Methods: A cross-sectional study was conducted among 100 asymptomatic T2DM patients aged 37–60 years without prior cardiovascular disease. ABI was evaluated using continuous-wave Doppler ultrasonography (abnormal defined as ≤0.90). Inducible ischemia was assessed via a treadmill test (TMT) using the Bruce protocol. Clinical parameters, glycemic control (HbA1c) and lipid profiles were analyzed. Results: SMI was detected in 17% of patients. A low ABI (≤0.90) was observed in 14% of the cohort. Low ABI showed an 82.35% sensitivity, 100% specificity, 100% positive predictive value, and 96.51% negative predictive value for identifying SMI. Mean ABI was significantly lower in the SMI group compared to the non-SMI group (0.87±0.19 vs. 1.14±0.09, p<0.0001). Patients with SMI had a significantly longer duration of diabetes (11.41±3.45 vs. 5.13±3.38 years, p<0.0001), higher HbA1c (p=0.0021), higher BMI (p<0.01), and higher prevalence of dyslipidemia (p=0.0027). Conclusion: A low ABI is strongly associated with SMI, reflecting widespread subclinical atherosclerotic vascular disease. Doppler-derived ABI is an effective, inexpensive, non-invasive screening tool to stratify cardiovascular risk and detect silent coronary artery disease early in asymptomatic T2DM patients. Keywords: Myocardial Ischemia, Type 2 DM, Ankle Brachial Index, Treadmill.

Background: Bertolotti syndrome describes low back pain attributed to a lumbosacral transitional vertebra, most often a diarthrodial pseudoarticulation between an enlarged transverse process and the sacrum or ilium. Conventional classification identifies the anatomical subtype but does not quantify potentially pain-generating osseous changes. The objective is to determine which quantitative computed tomography measurements of the pseudoarticulation are associated with symptomatic Bertolotti syndrome among adults with a Castellvi type II lumbosacral transitional vertebra. Materials and Methods: This prospective observational study included 120 adults aged 30–50 years evaluated at Hameed Memorial Hospital, Tiruvallur, from May 2025 to April 2026. Participants underwent standardized thin-section lumbosacral computed tomography. Symptomatic Bertolotti syndrome was defined by concordant chronic low back or buttock pain, focal tenderness, and exclusion of a more plausible pain generator after clinical and imaging review. Two blinded readers measured minimum joint-space width, pseudoarticulation surface area, transverse-process length, pseudoarticular angle, subchondral sclerosis thickness, osteophyte burden, and contact surface area. Multivariable logistic regression identified independent imaging correlates. Results: Illustrative draft results showed that 54 of 120 participants (45.0%) met the symptomatic definition. Compared with asymptomatic participants, the symptomatic group had narrower joint spaces (1.7 ± 0.6 vs 2.5 ± 0.8 mm), greater sclerosis thickness (3.3 ± 1.1 vs 2.0 ± 0.9 mm), higher osteophyte burden scores (median 2 vs 1), and larger contact areas (231 ± 62 vs 176 ± 55 mm²; all p<0.001). Independent associations were joint-space width ≤2.0 mm (adjusted odds ratio [aOR] 3.42, 95% confidence interval [CI] 1.45–8.08), sclerosis thickness ≥3.0 mm (aOR 3.08, 95% CI 1.30–7.32), and osteophyte burden score ≥2 (aOR 2.71, 95% CI 1.14–6.45). The model area under the receiver-operating-characteristic curve was 0.84. Interobserver reliability was good to excellent. Conclusion: Quantitative CT assessment identified joint-space narrowing, subchondral sclerosis, and osteophyte burden as features associated with symptomatic Bertolotti syndrome. These measurements can complement clinical evaluation when assessing patients with a Castellvi type II lumbosacral transitional vertebra. Keywords: Bertolotti syndrome; lumbosacral transitional vertebra; computed tomography; pseudoarticulation; morphometry; low back pain

Background: Cervical ripening influences the success of labour induction. Oral mifepristone, a progesterone-receptor antagonist, has been investigated as a pretreatment agent for cervical ripening and labour induction. The objective is to evaluate the safety and efficacy of oral mifepristone pretreatment followed by dinoprostone when required, compared with dinoprostone alone, by assessing cervical ripening, delivery mode and maternal and neonatal outcomes. Materials and Methods: In this single-centre randomized trial, 100 nulliparous women with singleton cephalic pregnancies at 40 weeks, intact membranes and modified Bishop scores below 6 were allocated equally to two groups. The intervention group received oral mifepristone 200 mg, followed after 24 hours by intracervical dinoprostone when required. Controls received intracervical dinoprostone 0.5 mg, repeated every 8 hours to a maximum of three doses. Delivery outcomes were analysed in all allocated participants. Results: Vaginal birth occurred in 31/50 women (62.0%) after mifepristone pretreatment and 18/50 (36.0%) after dinoprostone alone. Caesarean delivery occurred in 19/50 versus 32/50 women (38.0% versus 64.0%; risk ratio 0.59, 95% confidence interval 0.39–0.90; p = 0.009). Oxytocin augmentation was documented in 20 versus 40 women. NICU admission or observation was recorded for eight versus six neonates. Postpartum haemorrhage was reported in three versus two women. No severe neonatal complications were reported following oral mifepristone pretreatment. Conclusion: In nulliparous women at 40 weeks, oral mifepristone pretreatment followed by dinoprostone when required was associated with a higher vaginal birth rate and a lower caesarean delivery rate than dinoprostone alone. No severe neonatal complications were reported in the mifepristone group, providing reassuring neonatal safety findings in this study population. Keywords: Mifepristone; dinoprostone; cervical ripening; labour induction; nulliparity; caesarean delivery.

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) complicated by respiratory failure have substantial morbidity, but the relationship of nutritional depletion and structural lung disease with hypercapnia remains incompletely defined. The objective is to compare nutritional and radiological profiles of patients with AECOPD and hypercapnic versus non-hypercapnic respiratory failure. Materials and Methods: In this prospective cross-sectional study, 400 admitted patients with COPD-related respiratory failure were analyzed; 220 had PaCO2 >45 mmHg and 180 had PaCO2 <=45 mmHg. Arterial blood gases, nutritional and biochemical indices, chest imaging, radiological severity, and short-term outcomes were compared. Multivariable logistic regression identified factors associated with hypercapnia. Results: Hypercapnic patients had lower pH, PaO2, BMI, total lymphocyte count, total protein, serum albumin, transferrin, and serum iron, and higher PaCO2 and urea (all p<0.001 except where stated). Severe radiological disease occurred in 46.8% versus 16.7% (p<0.001). Treatment success was lower with hypercapnia (73.2% vs 93.3%; p<0.001). Greater radiological severity was independently associated with hypercapnia (adjusted OR 3.73 per grade, 95% CI 2.30-6.04). The multivariable model showed strong apparent discrimination (AUC 0.945) and no important multicollinearity (maximum VIF 1.75). Conclusion: Hypercapnic respiratory failure in AECOPD was associated with poorer nutritional indices, greater radiological severity, and less favorable short-term outcomes. Integrated nutritional, biochemical, and imaging assessment may improve bedside risk characterization. Keywords: COPD; acute exacerbation; hypercapnia; respiratory failure; nutritional status; computed tomography; emphysema.

Background: Accurate preoperative risk stratification is important for clinical decision-making, perioperative planning, and quality assessment in patients undergoing coronary artery bypass grafting (CABG). EuroSCORE II and the Society of Thoracic Surgeons (STS) score are widely used cardiac surgical risk models, but their predictive performance may vary across populations and clinical settings. This study compared the performance of EuroSCORE II and the STS score for predicting early postoperative morbidity in patients undergoing CABG. Materials and Methods: A prospective observational diagnostic-accuracy study was conducted at the Punjab Institute of Cardiology, Lahore, Pakistan, from February 2024 to February 2025. A total of 400 patients aged 20-70 years undergoing CABG were enrolled using purposive sampling. EuroSCORE II and STS risk scores were calculated preoperatively, and patients were followed for seven days after surgery to assess early postoperative morbidity. Predicted morbidity was compared with observed morbidity using 2 × 2 contingency tables. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall classification accuracy were calculated. Associations between early morbidity and demographic or clinical risk factors were also assessed, with statistical significance set at p<0.05. Results: The mean age of the study population was 53.23 ± 11.90 years, and 244 (61.0%) patients were male. Early postoperative morbidity occurred in 23 of 400 patients (5.8%). EuroSCORE II demonstrated a sensitivity of 73.9%, specificity of 98.4%, PPV of 73.9%, NPV of 98.4%, and overall accuracy of 97.0%. The STS score showed a sensitivity of 52.2%, specificity of 98.9%, PPV of 75.0%, NPV of 97.1%, and overall accuracy of 96.3%. Both scoring systems were significantly associated with observed morbidity (p<0.001). Early morbidity was significantly associated with hypertension (p=0.007), obesity (p<0.001), and hyperlipidemia on Fisher’s exact testing (p=0.048), whereas age, sex, diabetes mellitus, and smoking status were not significantly associated with the outcome. Conclusion: Both EuroSCORE II and the STS score demonstrated high specificity and overall classification accuracy for early postoperative morbidity after CABG. EuroSCORE II showed higher sensitivity, whereas STS demonstrated marginally higher specificity. These findings support the use of structured preoperative risk assessment while also emphasizing the need for larger multicentre studies with formal calibration and discrimination analyses before either model is used as a stand-alone predictor of early morbidity in this population. Keywords: Coronary artery bypass grafting; EuroSCORE II; Society of Thoracic Surgeons score; risk prediction; postoperative morbidity; cardiac surgery; diagnostic accuracy.

Background: Anterior cruciate ligament (ACL) injury is a common traumatic injury of the knee and may result in persistent instability and altered joint biomechanics. ACL deficiency can be associated with secondary intra-articular pathology, including meniscal and articular cartilage damage. Arthroscopy provides direct visualization of the articular cartilage and permits assessment and grading of chondral defects. The present study was undertaken to determine the prevalence and pattern of chondral defects in post-traumatic ACL-deficient knees. Aim: To determine the prevalence of chondral defects in post-traumatic anterior cruciate ligament-deficient knees by arthroscopic analysis. Materials and Methods: An observational cross-sectional study was conducted among 31 patients aged 20–40 years with traumatic ACL injury who underwent arthroscopic ACL reconstruction between January 2019 and October 2020. Patients with isolated ACL tears were included, while those with other ligament injuries, ipsilateral bony injuries, associated osteoarthritis, or those who did not provide consent for surgery were excluded. During arthroscopic assessment, the articular cartilage was systematically examined for chondral defects. The defects were documented according to their anatomical site and graded using the Outerbridge classification. Associated meniscal pathology and duration of injury were also recorded. Descriptive statistical methods were used for analysis. Results: Among the 31 patients, 24 (77.42%) demonstrated chondral defects, while 7 (22.58%) had no detectable defect. Among the 30 documented chondral defects, Grade I was the most frequent (17; 56.67%), followed by Grade II (10; 33.33%), Grade III (2; 6.67%) and Grade IV (1; 3.33%). The medial femoral condyle was the most commonly involved site, accounting for 17 (56.67%) defects, followed by the medial tibial plateau (16.67%), patella (13.33%), lateral femoral condyle (10.00%) and lateral tibial plateau (3.33%). Associated meniscal defects were present in 14 patients (45.16%), including medial meniscal defects in 8 (25.80%) and lateral meniscal defects in 6 (19.35%). Twenty patients (64.52%) underwent surgery within 6 months of injury, while 11 (35.48%) underwent surgery after 6 months. Conclusion: Chondral defects were frequently observed in post-traumatic ACL-deficient knees undergoing arthroscopic reconstruction. Grade I lesions were the most commonly observed, while the medial femoral condyle was the predominant anatomical site of involvement. Associated meniscal pathology was also frequently observed. Systematic arthroscopic assessment provides useful information regarding the presence, grade and distribution of chondral abnormalities in ACL-deficient knees. Keywords: Anterior cruciate ligament, Chondral Defect, Arthroscopy, Meniscal Injury.

Background: Common bile duct (CBD) stones coexist with gallbladder stones in a substantial minority of patients and complicate cholecystectomy. Pre-operative imaging to detect them is costly, invasive or not universally accessible. We evaluated clinical, biochemical and ultrasonographic predictors of CBD stones in patients with symptomatic cholelithiasis. Materials and Methods: In this single-centre cross-sectional diagnostic accuracy study (March 2024 to August 2025), 90 patients with symptomatic cholelithiasis scheduled for cholecystectomy were enrolled. Index tests were sex, age, right upper quadrant (RUQ) pain, fever, history of jaundice or cholangitis within 6 months, serum total bilirubin, AST, ALT, ALP, GGT, amylase, lipase and ultrasonographic CBD diameter. Magnetic resonance cholangiopancreatography (MRCP) was the reference standard; stones were cleared by endoscopic retrograde cholangiopancreatography (ERCP). Sensitivity, specificity, predictive values, accuracy and area under the curve (AUC) were calculated, with Fisher’s exact or chi-square tests and multivariable logistic regression. Results: Mean age was 46.0 ± 14.1 years and 77.8% were women. MRCP showed CBD stones in 44 patients (48.9%; 95% CI 38.2–59.7). Stones were more frequent in men (70.0% vs 42.9%; p = 0.032) and were not associated with age. Total bilirubin >1.3 mg/dL had sensitivity 95.5%, specificity 95.7%, AUC 0.96 and accuracy 95.6%. ALP >126 U/L and GGT >73 U/L each had sensitivity 97.7%, specificity 84.8% and AUC 0.91. CBD diameter >5 mm had sensitivity and negative predictive value of 100% with specificity 76.1%. History of jaundice had specificity 97.8% and sensitivity 63.6%. Fever, cholangitis history, male sex, AST/ALT, amylase and lipase showed low sensitivity, and RUQ pain (present in all patients) was non-discriminatory. On multivariable analysis only bilirubin remained significant (odds ratio 16.0; 95% CI 1.18–217.1; p = 0.037), with very wide intervals. ERCP clearance with stenting succeeded in 43 of 44 patients. Conclusion: In this cohort, serum bilirubin, ALP, GGT and ultrasonographic CBD dilatation were the most accurate pre-operative predictors of CBD stones. The very high accuracy and unstable multivariable estimates reflect a small, high-prevalence sample and need prospective, multicentre validation before clinical use. Keywords: choledocholithiasis; common bile duct stones; cholelithiasis; cholecystectomy; bilirubin; alkaline phosphatase; MRCP; diagnostic accuracy

Background: Eventhough there is advanced treatment and chelation therapy for beta thalassemia major, the unrecognized complications like renal impairment is emerging nowadays. The aim is to study the role of serum cystatin-C as the early biomarker for renal dysfunction in children with beta thalassemia major (β-TM). Materials and Methods: The study was performed on 30 children with β-TM and 30 apparently healthy children matched for age and sex as a control group. For all the enrolled children, a comprehensive medical history was obtained and complete physical examination was performed, blood urea, serum creatinine, estimated glomerular filtration rate (eGFR) by original Schwartz formula and protein creatinine ratio in urine, serum cystatin-C level were measured. Results: A total of 60 participants (30 cases and 30 controls) were included. Serum cystatin C levels were significantly higher in children with ẞ-thalassemia major compared with controls [2.42 (2–2.9) vs. 1.02 (0.9-1.1), p < 0.001]. Significant differences were also observed in creatinine, eGFR, urine protein, PCR, and hemoglobin levels (p < 0.001). Serum cystatin C showed a significant positive correlation with PCR (rho = 0.647, p < 0.001) and a significant negative correlation with creatinine (rho = - 0.593, p < 0.001). ROC analysis demonstrated excellent diagnostic performance of cystatin C with an AUC of 1.00, showing 100% sensitivity and 100% specificity at a cut-off value of 1.4 mg/L. Conclusion: Cystatin-C is specific and sensitive early biomarker for monitoring glomerular and tubular dysfunction in children with β-TM. Keywords: beta thalassemia, creatinine, sensitivity, specificity

Background: Forecasting healing in chronic venous leg ulcers may support risk stratification and clinical decision-making. The Ulcerated Leg Severity Assessment (ULSA) score combines age, ulcer chronicity, and venous refill time. Objective: To examine the association of baseline ULSA categories with clinically assessed venous ulcer healing at 8, 12, and 24 weeks in a tertiary care hospital. Materials and Methods: This single-centre observational follow-up study included 54 purposively sampled patients with lower-limb primary varicosities and venous ulcers at Sree Balaji Medical College and Hospital, Chennai (April 2021–June 2022). Baseline ULSA categories and healing outcomes at three follow-up points were extracted from the thesis. Categorical associations were re-examined using two-sided conditional exact tests applied to the reported aggregate counts. Results: Healing was reported for 25/54 (46.3%), 34/54 (63.0%), and 36/54 (66.7%) participants at 8, 12, and 24 weeks, respectively. At 24 weeks, healing occurred in 14/15 (93.3%) with ULSA <20, 15/18 (83.3%) with ULSA 21–40, 7/13 (53.8%) with ULSA 41–60, and 0/8 (0.0%) with ULSA >60 (exact P<0.001). Ulcer duration and ulcer size categories were also associated with 24-week healing in exploratory analyses. Age, sex, and anatomical site were not significantly associated with 24-week healing in aggregate-data exact tests. Conclusion: Lower baseline ULSA categories were associated with a greater proportion of venous ulcers classified as healed by 24 weeks. The findings support further prospective evaluation, but do not establish discrimination, calibration, or independent prognostic value without individual-patient data and standardized healing definitions. Keywords: VLUs, ULSA.

Background: A great part of laboratory errors has its origin in the pre-analytical phase, but its measurement in ordinary hospital practice is scarce. Materials and Methods: The present cross-sectional study was undertaken for a period of 12 months in biochemistry laboratories of tertiary care hospitals in Kerala to assess the extent and patterns of pre-analytical variables, to find out the sample rejection rates and to have a profile of error distribution. Results: Of these, 12,485 biochemistry samples were tested. The overall percentage of rejection of samples was 6.8%. The most common reason for rejection was haemolysis (41.2%), followed by lipemia (23.7%) and icterus (18.5%). Errors in clotting and labelling were 12.4 and 4.2 percent, respectively. Error distribution analysis showed that 73.1% of mistakes were in the pre-analytical, 21.4% in the analytical and 5.5% in the post-analytical phase. The rejection rates were significantly related to the time of sample collection (p<0.01), the experience of the phlebotomist (p=0.03), and the time to centrifugation (p<0.05). Multivariate logistic analysis identified night-time shift collection and samples collected without correct labels as independent predictors of rejection. Conclusion: Findings emphasise the necessity of specific pre-analytical initiatives including training standardisation, protocol enforcement and real-time surveillance to improve laboratory quality and minimise the burden of duplicate testing. Keywords: Pre-analytical variables; sample rejection; error distribution; biochemistry; Kerala; hospital laboratory

Background: Increasing ICU demand requires standardized admission criteria, as clinician discretion may cause variability. NEWS provides objective assessment of deterioration and timely intervention, but evidence in oncology ICU settings remains limited. This study evaluates NEWS versus clinician discretion for ICU transfer in oncology patients, comparing clinical outcomes. Primary objective is mortality at 24 hours, 48 hours, and 7 days. Secondary objective is SOFA score comparison at ICU admission and 48 hours post-admission. Materials and Methods: Retrospective cohort study in CNCI ICU (May–Sept 2024) compared NEWS-based screening versus clinician discretion. Primary outcome was mortality at 24, 48 hours, and 7 days; SOFA assessed organ dysfunction. Results: The study showed comparable age and gender distribution between groups, with hypertension as the most common comorbidity. Neutropenia was lower in NEWS group (24.1% vs 35.7%), and 7-day mortality slightly reduced (27.1% vs 31.0%). Conclusion: The use of NEWS may improve long-term survival in oncology ICU patients, although it shows limited effect on short-term mortality and organ failure progression. However, it helps reduce variability in ICU admission decisions and resource utilization. Overall, this study supports the use of standardized tools like NEWS to optimize ICU admissions and improve resource allocation and outcomes in oncology critical care settings. Keywords: ICU admission, NEWS score, clinician discretion, oncology, mortality, organ dysfunction, SOFA score, critical care, resource utilization.

Background: Most of High-Grade Gliomas are incurable with Surgery. Regardless of the extent of Surgery, combining radiotherapy (RT) with chemotherapy is highly recommended for High Grade Gliomas. The mean time for Glioblastoma recurrence is approximately 32 to 36 weeks after initial multimodality treatment, and this is most frequently a result of continuous neoplastic growth within 2–3 cm of the original neoplasm. Once tumors progress after first-line therapy, treatment options are limited and the management of recurrent High-Grade Gliomas becomes difficult. Materials and Methods: We conducted a prospective study in 30 patients with recurrent high-grade gliomas from January 2024 to May 2025.The patients received Bevacizumab and irinotecan, and Response was assessed at 4 weeks and 3 months and graded as per RANOS criteria. Progression-free survival and overall survival were estimated. Adverse reactions were assessed and graded as per NCI-CTCAE version 5.0. Quality of life was assessed using EORTC QLQ-C30 Questionnaire Results: There is clinical improvement in QoL after starting Bevacizumab and Irinotecan, but the difference failed to reach statistical significance. The median overall survival in our study is 10 months. 43.3% of patients had partial response at the end of 3 months.43.3% of patients had stable disease at the end of 3 months.10% of patients had progressive disease at the end of 3 months.3.3% of patient had complete response at the end of 3months.Overall Response rate was 46.6% at the end of 3 months. The median progression free survival in our study is 8 months. Conclusions: There is a promising response rate, median OS and median PFS with tolerable adverse events. There was a non-significant improvement in QoL from baseline to 4 weeks and at 3 months Keywords: High grade glioma, Bevacizumab, Irinotecan, response rate, Progression free survival, Quality of life.

Background: Competency-Based Medical Education (CBME) emphasizes assessment of clinical competencies beyond knowledge alone. 360-degree assessment provides multisource feedback from individuals who interact with learners in the clinical environment and may facilitate identification of competency-specific strengths and areas requiring improvement. Aim: To evaluate clinical competencies using 360-degree assessment among undergraduate medical students posted in the Department of Otorhinolaryngology and identify competency domains demonstrating relative strengths and areas requiring improvement. Materials and Methods: A descriptive observational study was conducted among 60 undergraduate medical students posted in the Department of Otorhinolaryngology at GEMS Medical College. Clinical competencies were assessed using a structured 360-degree checklist comprising 17 observable behaviours across seven domains: clinical knowledge, history and examination, clinical reasoning, communication, professionalism, teamwork, and procedural skills. Each item was rated on a 5-point Likert scale ranging from 1 (needs major improvement) to 5 (excellent). Assessment was obtained from Faculty, Peer, Self, Nurse, and Patient/Attendant assessors, with Patient/Attendant assessment restricted to relevant patient-facing behaviours. Descriptive statistics were used to summarize assessor-wise and domain-wise performance. Domain scores were expressed as mean scores out of 5 and corresponding percentages. Results: Faculty assessment demonstrated a mean score of 52.28 ± 9.99/85, compared with 65.58 ± 9.34/85 for Peer and 65.95 ± 8.30/85 for Self assessment. Nurse assessment had a mean score of 29.55 ± 6.23/40, while Patient/Attendant assessment showed 15.22 ± 2.41/20 among 59 students. The highest mean percentage was observed for Self-assessment (77.59%), followed by Peer (77.16%) and Patient/Attendant (76.10%). Across competency domains, Professionalism demonstrated the highest performance (4.25/5; 85.0%), followed by Teamwork (3.92/5; 78.4%), Communication (3.70/5; 74.0%), and History and Examination (3.67/5; 73.4%). Clinical Knowledge (3.28/5; 65.6%) and Clinical Reasoning (3.08/5; 61.6%) showed comparatively lower scores, while Procedural Skills had the lowest score (2.45/5; 49.0%). Assessor-wise assessment similarly identified Professionalism as the highest-rated domain among Faculty, Peer, Self, and Nurse assessors, whereas Procedural Skills was consistently the lowest-rated domain among these groups. Conclusion: The 360-degree assessment provided a multidimensional profile of clinical competency and identified substantial variation across competency domains. Professionalism, teamwork, and communication represented relative strengths, whereas procedural skills, clinical reasoning, and clinical knowledge represented areas requiring greater educational attention. The findings support the use of 360-degree multisource assessment as a complementary workplace-based approach for identifying domain-specific learning needs in undergraduate clinical education. Keywords: 360-degree assessment; Multisource feedback; Competency-Based Medical Education; Clinical competencies; Und

Background: Proximal humerus fractures (PHFs) are among the most common fragility fractures in older adults and represent a growing public-health concern in ageing populations. While their surgical management is extensively studied, the demographic and injury-mechanism profile of patients presenting to tertiary centres in South India is less well characterised. This study describes the age, sex, mechanism-of-injury and fracture-pattern characteristics of patients presenting with PHFs. Materials and Methods: This hospital-based observational study analysed 50 skeletally mature patients presenting with radiologically confirmed PHFs to a tertiary care medical college in North Kerala over an 18-month period (September 2019 to March 2021). Demographic variables, mechanism of injury, side affected and fracture pattern (Neer classification) were recorded on a pre-tested proforma. Associations were tested using the chi-square test and one-way analysis of variance, with p < 0.05 considered significant. Results: The mean age was 65.8 ± 13.9 years; 78% of patients were aged 56 years or older. Women predominated (76%; male-to-female ratio 1:3.2). Low-energy self-falls accounted for 82% of injuries, rising to 86.8% among women, whereas high-energy trauma was proportionately more frequent in men (33.3% vs 13.2%). Neer three-part fractures were most common (58%), followed by four-part (28%) and two-part (14%) fractures. Four-part fractures occurred in the oldest patients (mean 72.5 years). Left and right sides were affected equally. Conclusion: PHFs in this setting occurred predominantly in older women following ground-level falls, a pattern consistent with underlying bone fragility. These findings support integrating fall-prevention counselling and osteoporosis screening into the routine care of older adults presenting with PHFs, and highlight the need for community-level preventive strategies. Keywords: Shoulder Fractures; Osteoporotic Fractures; Accidental Falls; Aged; Epidemiology.

Background: Surgical site infection (SSI) is among the most frequent healthcare-associated infections and remains a significant cause of maternal morbidity following caesarean section. Chlorhexidine gluconate (CHG) is widely used for preoperative skin antisepsis because of its broad-spectrum activity and residual antimicrobial effect, but whether increasing its concentration translates into additional protection against SSI remains uncertain. Materials and Methods: A prospective comparative interventional study was conducted over 18 months (June 2024–January 2026) in the Department of Obstetrics and Gynaecology, PES Institute of Medical Sciences and Research (PESIMSR), Kuppam. A total of 170 primigravida and multigravida women aged 18–40 years undergoing elective caesarean section were allocated on an odd–even basis to preoperative bathing with 4% chlorhexidine bodywash (n=85) or 1% chlorhexidine soap (n=85), with two baths advised before surgery. Patients were monitored for clinical signs of SSI for 7 days postoperatively, and outcomes were analysed using SPSS version 23.0. Results: The two groups were comparable at baseline for age, weight, parity, previous LSCS, prior SSI history, and maternal comorbidities (all p>0.05). SSI occurred in 30 women (35.3%) in the 1% chlorhexidine soap group compared with 18 women (21.2%) in the 4% chlorhexidine bodywash group. Individual postoperative inflammatory signs — redness, tenderness, induration, discharge, and fever — did not differ significantly between the groups (all p>0.05). Management of SSI was predominantly conservative in both groups (p=0.70), and day of suture removal (p=0.80) and total length of hospital stay (p=0.86) were also comparable. Conclusion: Increasing chlorhexidine concentration from 1% to 4% was not associated with a statistically significant improvement across most measured postoperative parameters. 1% chlorhexidine soap may therefore be considered a reasonable, cost-saving alternative to 4% chlorhexidine bodywash for preoperative bathing before elective caesarean section in resource-limited settings. Keywords: Chlorhexidine gluconate; surgical site infection; caesarean section; preoperative bathing; antiseptic bathing.

Background: Infertility affects a substantial proportion of couples worldwide, and intrauterine insemination (IUI) is a widely used, low-cost, minimally invasive first-line assisted reproductive technique, but predictors of its success remain variably reported. The objective is to assess the outcome of IUI in infertile couples and correlate outcome with various clinical and procedural parameters. Materials and Methods: Prospective observational study of 61 couples undergoing 142 therapeutic homologous IUI cycles at PESIMSR, Kuppam, over 18 months. Clinical pregnancy (β-hCG positivity) was the primary outcome, correlated with age, duration and type of infertility, ovulation induction protocol, endometrial thickness, follicle number/size, and post-wash sperm parameters, including logistic regression analysis. Results: Clinical pregnancy was achieved in 7.04% of cycles (10/142) and 16.39% of couples (10/61). Pregnancy-positive cycles showed a non-significantly higher mean endometrial thickness (9.73 vs 9.00mm; p=0.255) and preovulatory follicle number (2.80 vs 2.49; p=0.267), and non-significantly lower female/male age, than pregnancy-negative cycles. Type of IUI (single vs double) was not associated with outcome (p=1.000). On logistic regression, the number of preovulatory follicles was independently and positively associated with clinical pregnancy (β=0.402, p=0.001), while the number of IUI cycles was independently and negatively associated with pregnancy (β=−0.353, p=0.020); no other variable reached significance. Conclusion: IUI remains an effective, affordable first-line option for appropriately selected infertile couples. Ovarian response (preovulatory follicle number) and cumulative treatment cycles are the strongest independent predictors of success, supporting careful patient selection and counselling to optimise the cost-effectiveness of IUI therapy. Keywords: Intrauterine insemination; infertility; clinical pregnancy rate; preovulatory follicles; assisted reproduction.

Background: Preeclampsia, eclampsia, and HELLP syndrome remain leading causes of maternal and perinatal morbidity worldwide, arising from defective trophoblastic invasion and uteroplacental insufficiency. First-trimester uterine artery Doppler (UAD) identifies women at high risk of these placentation disorders, and low-dose aspirin initiated before 16 weeks is the only intervention with trial-level evidence for risk reduction. Objective: To evaluate the efficacy of low-dose aspirin (Ecosprin 150 mg once daily) in preventing preeclampsia, eclampsia, and HELLP syndrome among primigravid women who screened positive on first-trimester uterine artery Doppler. Methods: This observational analysis was nested within a prospective comparative study of 100 primigravid women (11⁶/₇–13⁶/₇ weeks) screened by transabdominal UAD at PES Institute of Medical Sciences and Research, Kuppam, over 18 months (April 2024–October 2025). All 19 women with abnormal Doppler were offered Tab. Aspirin 150 mg once daily; 17 (89.5%) were compliant (initiated at a mean of 12.56 ± 0.27 weeks) and 2 discontinued within 4 weeks due to gastritis and were classified non-compliant. Maternal and fetal outcomes were compared between compliant and non-compliant women within this high-risk subgroup. Results: No case of eclampsia, ICU admission, or HELLP syndrome occurred among the 17 aspirin-compliant women. Both non-compliant women developed preeclampsia; one progressed to severe preeclampsia, eclampsia, and ICU admission, with emergency LSCS at 35 weeks and a low-birth-weight neonate requiring prolonged NICU stay. No case of HELLP syndrome was observed in either subgroup. Given the very small non-compliant subgroup (n=2), between-group significance testing was not meaningful for these outcomes; the findings are presented as a descriptive, hypothesis-generating comparison. Conclusion: Within the limits of a small, non-randomised high-risk subgroup, compliance with Doppler-triggered low-dose aspirin prophylaxis was associated with the complete absence of eclampsia and ICU admission, while both instances of eclampsia-range severity in the cohort occurred in non-compliant women. These real-world observations are directionally consistent with trial-level evidence for early aspirin prophylaxis and support reinforcing compliance counselling in Doppler-identified high-risk women, though they cannot establish causality. Keywords: Preeclampsia; Eclampsia; HELLP syndrome; Low-dose aspirin; Ecosprin; Uterine artery Doppler; Primigravida; Preeclampsia prophylaxis

Background: Bronchogenic carcinoma is a leading cause of cancer death. In Indian hospital practice most patients present with advanced disease, and South Indian survival data remain limited. Objectives: To estimate overall survival and identify clinical and demographic factors associated with survival in patients with histologically confirmed bronchogenic carcinoma. Materials and Methods: This prospective study included 160 patients with tissue-confirmed bronchogenic carcinoma at a tertiary care centre in South India. Other malignancies, and malignant pleural effusion without definite evidence of bronchogenic carcinoma, were excluded. Survival was measured from tissue diagnosis to death or last contact. Vital status was compared by the chi-square test. Survival was estimated by the Kaplan–Meier method and compared with the log-rank test. Variables significant on initial analysis were entered into a Cox proportional-hazards model. Results: Twenty-three patients (14.4%) were alive and 137 (85.6%) had died. Median survival was 9.0 months at age 60 years or younger and 7.0 months beyond 60 years; 10.0 months in non-smokers and 8.0 months in smokers; and 11.0, 8.0 and 5.0 months in early-stage non-small-cell lung cancer, advanced non-small-cell lung cancer and small-cell carcinoma. On multivariable analysis, stage remained associated with mortality (hazard ratio 2.350; 95% confidence interval 1.448–3.814; p=0.001). Comorbidity burden was also reported as significant (hazard ratio 5.503; p=0.019); its printed confidence interval was internally inconsistent and is not reported. Conclusions: Overall survival was poor and was most clearly related to disease stage. Earlier diagnosis, and explicit attention to comorbid illness, are the practical implications. Histology should not be treated as an independent prognostic factor on these data. Keywords: Lung neoplasms; carcinoma, bronchogenic; survival analysis; prognosis; comorbidity.

Background: Laryngoscopy and endotracheal intubation are associated with sympathetic stimulation, resulting in transient increases in heart rate and blood pressure. Dexmedetomidine, a selective alpha-2 adrenergic agonist, provides sedation and sympatholysis. The aim is to compare the efficacy and safety of intranasal dexmedetomidine 1 µg/kg and 2 µg/kg in attenuating haemodynamic responses to laryngoscopy and endotracheal intubation in adults. Materials and Methods: This prospective, randomized, double-blinded study was conducted in the Department of Anaesthesiology, G S Medical College and Hospital, Pilkhuwa, Hapur, Uttar Pradesh. Ninety patients aged 18–60 years, belonging to ASA physical status I and II, were randomly allocated into two groups of 45 each. Group A received intranasal dexmedetomidine 1 µg/kg, while Group B received 2 µg/kg, administered 45 minutes before anaesthetic induction. Heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were recorded at baseline and at specified intervals following intubation. Results: Heart rate was significantly lower in Group B at 5 minutes (79.27 ± 10.19 versus 84.50 ± 8.84; p = 0.020), 10 minutes (p = 0.033), and 15 minutes (p = 0.034). No significant intergroup differences were observed in systolic, diastolic, or mean arterial pressure. Adverse-effect distributions differed significantly (p = 0.02), whereas recovery times were comparable (p = 0.62). Conclusion: Intranasal dexmedetomidine 2 µg/kg provided greater heart rate attenuation at later post-intubation intervals without significantly altering blood pressure or recovery time compared with 1 µg/kg. However, adverse-effect profiles differed between the groups. Keywords: Intranasal dexmedetomidine; Haemodynamic response; Laryngoscopy; Endotracheal intubation; General anaesthesia.

Background: Chronic kidney disease (CKD) is a progressive disorder characterized by irreversible deterioration of renal function and is associated with increased cardiovascular morbidity and mortality. Early diagnosis remains challenging because conventional biomarkers, such as serum creatinine and urinary protein, become abnormal only after significant nephron loss. Galectin-3, a β-galactoside-binding lectin involved in inflammation, fibrosis, and extracellular matrix remodeling, has emerged as a promising biomarker for detecting early renal injury and predicting disease progression. The present study evaluated the clinical utility of serum Galectin-3 as an early biomarker of chronic kidney disease. The aim is to estimate serum Galectin-3 levels in patients with chronic kidney disease and compare them with healthy individuals in order to evaluate its clinical utility as an early biomarker of chronic kidney disease. Materials and Methods: This hospital-based analytical case-control study was conducted in the Departments of Biochemistry and Nephrology at Thanjavur Medical College Hospital after obtaining Institutional Ethics Committee approval. The study included 100 participants comprising 50 clinically diagnosed CKD patients and 50 age-matched healthy controls. After obtaining written informed consent, fasting venous blood samples were collected for estimation of serum Galectin-3 by sandwich enzyme-linked immunosorbent assay (ELISA). Routine biochemical investigations including blood glucose, blood urea, serum creatinine, and estimated glomerular filtration rate (eGFR) using the MDRD equation were performed. Student's t-test was used for comparison between groups, and Pearson's correlation coefficient was used to determine the association between serum Galectin-3 and renal function parameters. A p-value <0.05 was considered statistically significant. Results: The study demonstrated significantly elevated serum Galectin-3 levels in CKD patients compared with healthy controls (28.88 ± 9.27 ng/mL vs. 9.02 ± 1.82 ng/mL; p<0.001). CKD patients also had significantly higher serum creatinine (2.37 ± 0.79 mg/dL vs. 0.83 ± 0.18 mg/dL), blood urea (80.56 ± 42.27 mg/dL vs. 36.46 ± 9.48 mg/dL), and markedly reduced creatinine clearance (31.01 ± 10.00 mL/min vs. 111.47 ± 9.90 mL/min) compared with controls (all p<0.001). Serum Galectin-3 levels progressively increased with declining creatinine clearance and showed a strong positive correlation with serum creatinine (r=0.649), blood urea (r=0.429), systolic blood pressure (r=0.359), diastolic blood pressure (r=0.194), and random blood sugar (r=0.222), while demonstrating a significant negative correlation with creatinine clearance (r=-0.541). Conclusion: Serum Galectin-3 is significantly elevated in patients with chronic kidney disease and correlates closely with the severity of renal dysfunction. Its positive association with conventional renal biomarkers and inverse relationship with creatinine clearance suggest that Galectin-3 reflects the inflammatory and fibrotic processes underlying CKD progression. Serum Galectin-3 may serve as a valuable adjunctive biomarker for the early diagnosis, risk stratific

Background: Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder resulting from interactions between genetic, environmental, and lifestyle factors. Genetic variants affecting pancreatic β-cell function and insulin secretion may contribute to individual susceptibility to T2DM. The KCNQ1 gene has been identified as an important susceptibility gene for T2DM, and the rs2237892 single nucleotide polymorphism has been associated with diabetes risk in several ethnic populations. However, population-specific evidence from South India remains limited. The present study evaluated the association of KCNQ1 rs2237892 polymorphism with T2DM among South Indian adults. The aim is to analyze the KCNQ1 rs2237892 single nucleotide polymorphism among patients with T2DM and healthy controls and to evaluate its potential role as a genetic determinant of T2DM. Materials and Methods: A hospital-based case-control study was conducted at K.A.P.V. Government Medical College and MGM Government Hospital, Tiruchirappalli, from September 2021 to August 2022. The study included 90 South Indian adults aged 40–60 years, comprising 45 patients with established T2DM and 45 healthy non-diabetic controls. Clinical and biochemical parameters were assessed, and genomic DNA was isolated from peripheral blood. The KCNQ1 rs2237892 region was amplified by polymerase chain reaction and genotyped using MspI restriction fragment length polymorphism analysis. Statistical analysis was performed using Student’s t-test and Chi-square test, with logistic regression used to evaluate the association between the polymorphism and T2DM. A p-value <0.05 was considered statistically significant. Results: The cases and controls were comparable with respect to age and BMI. Cases had significantly higher diastolic blood pressure, fasting blood sugar, and postprandial blood sugar than controls (p<0.001). The diabetic group also demonstrated significantly higher total cholesterol and triglyceride levels and lower HDL cholesterol levels compared with controls (p<0.001). A significant difference was observed in the distribution of KCNQ1 rs2237892 genotypes between cases and controls (χ²=26.325, p<0.0001). The TT genotype was substantially more frequent among T2DM cases [27 (60.0%)] than controls [4 (8.9%)], whereas the CC and CT genotypes were more common among controls. At the allele level, the T allele was markedly more frequent among cases [66 (73.3%)] than controls [32 (35.6%)], while the C allele was more frequent among controls [58 (64.4%)] than cases [24 (26.7%)]. The difference in allele distribution was statistically highly significant (χ²=25.893, p<0.0001). Logistic regression demonstrated an odds ratio of 4.98 (95% CI: 2.64–9.42; p=0.001) for the T allele. Conclusion: The present study demonstrates a significant association between the KCNQ1 rs2237892 polymorphism and type 2 diabetes mellitus among the South Indian adults studied. The T allele, particularly the TT genotype, was considerably more frequent among individuals with T2DM, suggesting that the T allele may represent a genetic susceptibility factor for diabetes in this population. The findings support a potential role of KCNQ1

Background: Complicated appendicitis in children is associated with increased postoperative morbidity, particularly surgical-site infection (SSI), intra-abdominal abscess, and prolonged recovery. Although laparoscopic appendectomy is increasingly used in children, its comparative outcomes in complicated appendicitis, particularly in institutional settings, remain clinically relevant. This study compared postoperative SSI and perioperative outcomes following laparoscopic and open appendectomy in children with complicated appendicitis. Materials and Methods: A prospective observational comparative study was conducted in children undergoing appendectomy for complicated appendicitis at a tertiary-care center between October 2018 and May 2019. Patients were managed by either laparoscopic appendectomy (LA) or open appendectomy (OA) according to the operating surgeon’s clinical judgment. Demographic characteristics, operative findings, postoperative pain, surgical-site infection, postoperative ileus, intra-abdominal abscess, operative duration, and length of hospital stay were recorded and compared between the two groups. Results: Thirty-two children were included, with 16 undergoing LA and 16 undergoing OA. The groups were comparable on the baseline characteristics assessed. Surgical-site infection occurred in 1 (6.3%) patient in the LA group compared with 8 (50.0%) patients in the OA group. Postoperative pain severity was also lower following LA, with severe pain reported in 1 (6.3%) patient compared with 6 (37.5%) patients following OA. No statistically significant differences were observed in operative duration, postoperative ileus, intra-abdominal abscess, or length of hospital stay. No intra-abdominal abscess was documented in the LA group, compared with 2 (12.5%) patients in the OA group. Conclusions: In this small prospective observational cohort, laparoscopic appendectomy was associated with a lower incidence of surgical-site infection and reduced postoperative pain compared with open appendectomy in children with complicated appendicitis. However, the non-randomized study design and small sample size limit causal inference and the precision of the estimates. Larger prospective multicenter studies with standardized definitions, perioperative protocols, adequate follow-up, and adjustment for disease severity are warranted further to evaluate the comparative outcomes of laparoscopic and open appendectomy. Keywords: Appendicitis; Complicated appendicitis; Laparoscopic appendectomy; Open appendectomy; Surgical-site infection; Postoperative outcomes.

Background: In underdeveloped nations, birth asphyxia continues to be a leading cause of infant illness and mortality. Improving newborn survival requires early detection of variables linked to unfavourable neonatal outcomes. The objective is to determine the parameters linked to newborn activity at delivery and to evaluate the clinical profile, maternal traits, and immediate neonatal outcomes among neonates admitted with birth asphyxia. Materials and Methods: In a tertiary care hospital in Assam, 42 newborns who were admitted with birth asphyxia participated in a cross-sectional study. Hospital records were used to gather information on maternal features, the neonatal clinical profile, referral status, APGAR scores, and outcomes. Results: Of the 42 newborns who experienced birth asphyxia, 25 (59.5%) newborns were male, 22 (52.4%) weighed between (2.5 and 4.0 kg) at delivery, and 32 (76.2%) were born at full term. 34(81.0%) were admitted within 24 hours after delivery, and 30 (71.4%) were born at DMCH. 23 (54.8%) pregnant mothers had fewer than four prenatal care visits, and 25 (59.5%) mothers had maternal anaemia. General condition (p<0.001), muscle tone (p<0.001), cry at birth (p=0.004), and the need for resuscitation (p=0.035) were all strongly correlated with neonatal activity at birth. Conclusion: Neonatal activity at birth was significantly influenced by general condition, muscle tone, crying at birth, and the requirement for resuscitation in neonates with birth asphyxia. To improve infant outcomes, early evaluation and timely resuscitation are crucial. Keywords: Birth asphyxia, Neonates, Assam.

Background: Gastrointestinal (GI) adenocarcinomas are among the most common and lethal cancers worldwide. HER-2 neu overexpression is a validated therapeutic target, yet its prevalence across all GI adenocarcinoma subsites in an Indian tertiary care setting remains poorly characterized. Materials and Methods: A cross-sectional, hospital-based study enrolled endoscopic biopsies and surgical resection specimens of GI adenocarcinomas over two years (January 2023-December 2024). Tumors were classified as per the 2019 WHO Classification. HER-2 neu status was assessed by immunohistochemistry (IHC) using a four-step Hoffmann scoring system (0, 1+, 2+, 3+), with score 3+ defined as positive and 2+ as equivocal. Results: Out of the 252 GI specimens received, 41 were diagnosed as adenocarcinoma (n=41). Mean age was 62.5 years (SD 11.9); males predominated (70.7%; M:F ratio 2.4:1). Colorectal adenocarcinoma was the most common site (56.1%), followed by gastric (26.8%), small intestinal (9.8%), and esophageal (7.3%). Well-differentiated tumors accounted for 51.2%. HER-2 positivity (score 3+) was found in 6 cases (14.6%), equivocal staining (2+) in 12 (29.3%), and negativity in 23 (56.1%). Gastric adenocarcinoma showed the highest site-specific positivity (36.4%; 4 of 11 cases). All HER-2 positive gastric cases were intestinal-type as per Lauren's classification. Well-differentiated tumors had the highest positivity (5 of 6 positive cases). Conclusion: HER-2 neu positivity was 14.6% across GI adenocarcinomas, consistent with published literature. Gastric adenocarcinoma showed the highest site-specific rate. Positivity correlated with intestinal histological type and well-differentiated grade. Routine HER-2 IHC testing across all GI adenocarcinoma subsites will help identify patients eligible for targeted anti-HER-2 therapy. Keywords: Gastrointestinal adenocarcinoma; HER-2 neu; Immunohistochemistry; Gastric adenocarcinoma; Lauren's classification; Targeted therapy.

ground: Plateletpheresis donors have stricter eligibility requirements than whole-blood donors because they must meet general donor-safety criteria as well as specific requirements such as an adequate platelet count and good venous access. Deferral rates vary widely between centres and countries. This study evaluated the prevalence, common causes, and factors associated with plateletpheresis donor deferral. Materials and Methods: Studies reporting plateletpheresis donor screening and deferral were identified from database inception to 8 September 2026. Overlapping study populations were identified based on centre, country, and study period. The primary meta-analysis included 14 non-overlapping studies with available overall deferral data. Study quality was assessed using the Joanna Briggs Institute checklist. A random-effects meta-analysis was used to estimate the pooled prevalence of donor deferral. Heterogeneity was assessed using I², tau², and a 95% prediction interval. Results: Seventeen studies were included in the systematic review, of which 14 were included in the primary meta-analysis. These studies included 5,958,541 screening/donation attempts and 881,155 deferrals. Deferral rates varied widely, ranging from 10.6% to 69.0%. The pooled deferral prevalence was 24.4% (95% CI: 16.8–34.2%), with very high variation between studies (I²=99.8%, tau²=0.662). The 95% prediction interval ranged from 4.9% to 67.0%. In Indian studies, the most common reasons for deferral were low platelet count, poor venous access, and low haemoglobin. Poor venous access was also an important cause in Turkey and Bangladesh. Recent Chinese studies commonly reported raised alanine aminotransferase, low haemoglobin, lipaemia, and abnormal blood pressure. Most reported deferrals were temporary. Conclusion: Plateletpheresis donor deferral is common, but the rate varies greatly between centres and countries. Because of this wide variation, the pooled deferral rate should not be considered a universal benchmark. Standardized screening and reporting methods, prospective evaluation of potentially modifiable eligibility criteria, and proper re-entry of temporarily deferred donors may help improve donor retention while maintaining donor and recipient safety. Keywords: plateletpheresis; apheresis platelets; blood donors; donor deferral; prevalence; donor selection; meta-analysis.

Background: Intensive Care Unit (ICU) delirium is an acute, fluctuating disturbance of attention and cognition associated with prolonged hospitalisation, increased mortality and long-term cognitive impairment. Indian data on non-ventilated ICU cohorts and on gastroenterology critical care are limited. Objective: To determine the prevalence of ICU delirium among patients admitted to the Gastroenterology and Medical ICUs of a tertiary care trust hospital in Rajasthan, India, and to describe the demographic and clinical profile of delirium-positive patients. Materials and Methods: A single-centre, cross-sectional observational study was carried out over six months (April 2023 – September 2023). Fifty adult patients (≥18 years) with an ICU stay of at least 24 hours were consecutively assessed once each using the Confusion Assessment Method for the ICU (CAM-ICU). Patients with pre-existing delirium, dementia or severe sensory impairment were excluded. Categorical variables are summarised as frequencies and percentages, and prevalence is reported for the whole sample and stratified by gender and ICU sub-group. Results: The overall prevalence of ICU delirium was 22.0% (11/50). All delirium-positive cases were of the hyperactive subtype; no patient in the cohort was mechanically ventilated. Overall, 76.0% of patients were male, 56.0% had chronic illness, 36.0% reported alcohol use and 46.0% had a history of liver disease. Within the delirious sub-group (n = 11), 90.9% were male, 63.6% were aged ≤60 years, 72.7% had chronic illness, 54.5% reported alcohol use, 63.6% had liver disease, 36.4% had sepsis and 81.8% were admitted to the Medical ICU. Prevalence differed markedly by setting (Medical ICU 31.0% vs Gastroenterology ICU 9.5%) and by gender (males 26.3% vs females 8.3%). On CAM-ICU screening, acute onset / fluctuating course, inattention and altered level of consciousness were present in 100% of delirious patients, while disorganized thinking was present in 27.3%. Conclusion: One in five patients admitted to the studied ICUs screened positive for delirium, with a male, non-ventilated, medically complex profile and an exclusively hyperactive presentation. The findings support routine CAM-ICU screening, targeted attention to Medical ICU patients with liver disease and alcohol use, and the adoption of multi-component, non-pharmacological strategies to reduce delirium burden. Larger, multi-centre studies are needed to confirm these observations and to inform Indian ICU delirium care pathways. Keywords: ICU delirium, critical care, cognitive dysfunction, hyperactive delirium, CAM-ICU, healthcare strategies.

Background: Difficult laryngoscopy in cardiac surgery carries heightened haemodynamic risk. Bedside airway ultrasound provides objective, quantifiable measurements of neck anatomy that may supplement conventional clinical predictors and improve preoperative identification of at-risk patients. Objectives: To compare preoperative bedside airway ultrasound measurements between patients with easy (Cormack–Lehane grade I/II) and difficult (Cormack–Lehane grade III/IV) laryngoscopy during cardiac surgery. Materials and Methods: A total of 80 adult patients scheduled for elective cardiac surgery under general anaesthesia were enrolled: 57 with easy laryngoscopy (Group A, Cormack–Lehane grade I/II) and 23 with difficult laryngoscopy (Group B, grade III/IV). Preoperative assessments included modified Mallampati score, thyromental distance, sternomental distance, mouth opening, and neck circumference. Bedside ultrasound measured anterior neck soft tissue (ANS) thickness at the hyoid, thyrohyoid membrane, and vocal cord levels; pre-epiglottic space depth; skin-to-epiglottis distance; hyomental distances at rest and full extension; and tongue and sublingual dimensions. Results: Both groups were comparable in age and sex. All measured ultrasound parameters differed significantly between groups (p < 0.001). Patients with difficult laryngoscopy had greater anterior neck soft tissue thickness, greater pre-epiglottic and skin-to-epiglottis distances, larger tongue and sublingual measurements, and shorter hyomental distances at rest and full extension. Conclusion: Preoperative bedside airway ultrasound demonstrates measurable anatomical differences between cardiac surgery patients with easy and difficult laryngoscopy, particularly in anterior neck soft tissue, epiglottic-region, hyomental, tongue, and sublingual measurements. Keywords: airway ultrasound; difficult laryngoscopy; cardiac surgery; anterior neck soft tissue; pre-epiglottic space; hyomental distance.

Background: Crop and livestock handlers may experience occupational exposure to agricultural dust, moulds, animal-derived materials and other biological agents that may contribute to respiratory health problems, including hypersensitivity pneumonitis and other interstitial lung diseases (ILDs). Improving awareness of occupational respiratory hazards and preventive practices is therefore important in rural occupational-health promotion. The objective is to assess the effectiveness of a nurse-led teaching intervention on knowledge and preventive practices regarding interstitial lung diseases among crop and livestock handlers in selected rural areas of West Bengal. Materials and Methods: A quantitative pre-experimental one-group pre-test–post-test design was adopted among 60 crop and livestock handlers selected using purposive sampling. Data were collected using a researcher-developed 25-item knowledge questionnaire and a preventive-practice scale. A nurse-led teaching intervention comprising three 45-minute sessions was provided following the pre-test, and the post-test was conducted three days later. Data were analysed using descriptive statistics, paired t-test and chi-square test. Results: The mean knowledge score increased from 12.75 ± 3.11 in the pre-test to 20.15 ± 2.88 in the post-test, with a mean improvement of 7.40 points (t=23.52, df=59, p<0.001). The mean preventive-practice score increased from 18.40 ± 4.32 to 26.60 ± 5.10, representing a mean improvement of 8.20 points (t=23.32, df=59, p<0.001). No statistically significant association was observed between pre-test knowledge level and the selected demographic and occupational variables (p>0.05). Conclusion: The nurse-led teaching intervention was associated with substantial short-term improvement in participants' knowledge and reported preventive-practice scores. However, the one-group pre-test–post-test design without a control group limits causal interpretation. The findings should therefore be considered preliminary and require confirmation through larger controlled studies with longer follow-up. Keywords: Interstitial lung disease; hypersensitivity pneumonitis; agricultural workers; occupational health; nurse-led intervention; preventive practices; rural health; West Bengal.

Background: Ocular trauma is a leading cause of preventable unilateral blindness worldwide, yet institutional data from South India—a region with a high burden of road traffic accidents (RTAs)—remain limited. This study aimed to characterise the clinical profile of ocular trauma, including injury patterns, anatomical site involvement, and presenting visual acuity, at a tertiary care teaching hospital in South India. Materials and Methods: This prospective observational study enrolled 150 patients presenting with ocular trauma to the emergency and outpatient departments of ophthalmology at Apollo Institute of Medical Sciences and Research, Chittoor, Andhra Pradesh, between October 2023 and November 2024. Demographic data, mechanism of injury, time to presentation, presenting visual acuity (Snellen chart), and clinical findings were systematically recorded. Injuries were classified using the Birmingham Eye Trauma Terminology System (BETTS). Results: Of 150 patients (mean age group 31–40 years; 66% male), 102 (68%) sustained closed globe injuries (CGIs) and 48 (32%) sustained open globe injuries (OGIs). Road traffic accidents accounted for 92 cases (61.3%). Eyelid injury was the most frequent anatomical finding (52 cases; 34.6%), followed by corneal involvement (23 cases; 15.2%) and anterior chamber pathology (20 cases; 13.3%). Presenting visual acuity was ≤6/60 in 21.3% of patients, including 3 patients (2%) with no perception of light. Conclusion: RTAs represent the dominant mechanism of ocular trauma in this South Indian cohort, with the anterior segment being most commonly affected. The predominance of CGIs and the high proportion of RTA-related injuries underscore the need for targeted road safety interventions and timely ophthalmic care to reduce preventable visual morbidity in this region. Keywords: Ocular trauma; open globe injury; closed globe injury; road traffic accidents; BETTS classification; visual impairment.

Background: Electrical burn injuries are associated with complex local and systemic complications and may result in substantial morbidity, prolonged hospitalization, functional impairment, and mortality. The severity of injury may not be apparent from the external appearance of the burn. This study evaluated the clinico-epidemiological profile of patients with electrical burns and examined clinical and injury-related factors associated with adverse outcomes and mortality. Materials and Methods: This prospective observational cohort study was conducted over 18 months at Dr. Susheela Tiwari Government Hospital, Haldwani, Uttarakhand, India. All eligible patients presenting with electrical burn injuries during the study period were enrolled using total enumeration sampling. Demographic characteristics, mechanism and voltage of injury, transport time, burn extent, burn depth, clinical course, associated injuries, ECG findings, biochemical parameters, treatment, complications, and outcomes were recorded. Burn extent was assessed using the Lund and Browder chart. The primary outcome was mortality. Associations between clinical variables and outcome were assessed using appropriate statistical tests, with a two-sided p-value <0.05 considered statistically significant. Results: A total of 120 patients were included. The mean age was 32.18 ± 12.55 years, 81.7% were male, 83.3% were from rural areas, and 65.0% belonged to the lower socioeconomic group. High-voltage injuries accounted for 65.0% of cases. The mean TBSA involved was 22.25 ± 19.97%. Burn depth was significantly associated with voltage (p = 0.04), as was TBSA involvement (p < 0.001). High-voltage injuries were also associated with longer hospital stay (p < 0.001) and greater fluid resuscitation requirements (p = 0.04). Overall mortality was 9.2%. Clinical outcome was significantly associated with voltage category (p = 0.005). Associated injuries (p < 0.001), ECG abnormalities (p < 0.001), elevated CK-MB (p = 0.01), and WBC count (p = 0.03) were also significantly associated with clinical outcome. Cardiac arrest was associated with particularly high mortality, with 4 of 5 affected patients expiring. Conclusion: Electrical burn injuries predominantly affected males and individuals from rural and lower socioeconomic backgrounds in this cohort. High-voltage exposure was associated with greater burn severity, larger TBSA involvement, prolonged hospitalization, and greater treatment requirements. Systemic complications, particularly cardiac arrest and respiratory failure, as well as ECG and biochemical abnormalities, were associated with adverse outcomes. Early assessment of injury severity and prompt identification of systemic complications are important for risk stratification and management. Larger multicentre prospective studies are required to further define predictors of mortality and long-term morbidity. Keywords: Electrical burns; high-voltage injury; low-voltage injury; burn severity; mortality; TBSA; cardiac complications; electrical injury.

Background: Stature is one of the various parameters of identification of the individuality of a person. Estimation of stature from various measurements of the body is of value in medicolegal investigations as well as in anthropology. The hand measurements are important in forensic field as they can be used as body height predictors for an individual. The current study deals with developing a regression equation for stature estimation from hand breadth and hand length and to find out the correlation between stature and different parameters used in the study. Materials and Methods: The data was collected from 1000 asymptomatic, healthy adults (500 males & 500 females) belonging to border areas of Punjab region of age group ranged between 18-50 years. Results: The correlation between hand length and stature (r=0.403) was more than hand breadth and stature (r= 0.249) indicating hand length to be a better predictor of stature. Linear regression equations were derived for estimation of stature from hand breadth and hand length. Conclusion: Both hand breadth and hand length showed positive correlation with stature as indicated by the regression coefficient. The results indicate that one can successfully estimate staure from different hand dimensions. The calculated regression formulae show good reliability and applicability of estimate which would be useful for Anthropologists and Forensic Medicine experts. Keywords: Stature, hand length, hand breadth, Anthropometry, Forensic investigations.

Background: Adhesive small bowel obstruction is a common cause of intestinal obstruction following abdominal or pelvic surgery. Although many patients respond to conservative management, early identification of those likely to require surgery remains challenging. Water-soluble oral contrast can provide useful prognostic information by demonstrating bowel transit and may assist in treatment decisions. The aim is to evaluate the role of oral water-soluble contrast in the management of adhesive small bowel obstruction and assess its ability to predict successful conservative treatment and the need for operative intervention. Materials and Methods: This prospective observational study was conducted from 2022 to 2025 at Pt. Jawahar Lal Nehru Government Medical College and Hospital (Pt. JLNGMCH), Chamba, and included 40 adult patients with clinically and radiologically diagnosed adhesive small bowel obstruction. All eligible patients initially underwent standardized conservative management followed by administration of water-soluble oral contrast. Follow-up abdominal radiographs were assessed for passage of contrast into the colon within 24 hours. Clinical, laboratory, radiological, and outcome parameters were recorded. Data were analyzed using IBM SPSS Statistics version 27.0, with p<0.05 considered statistically significant. Results: The mean age was 46.82 ± 13.64 years, and 60.00% of patients were males. Conservative management was successful in 30 patients (75.00%), while 10 patients (25.00%) required operative management. Contrast reached the colon within 24 hours in 30 patients (75.00%); among them, 28 (93.33%) were successfully managed conservatively and 2 (6.67%) required surgery. In contrast, 8 of 10 patients (80.00%) without colonic contrast passage required operative intervention (p<0.001). Contrast progression into the colon within 24 hours predicted successful conservative management with 93.33% sensitivity, 80.00% specificity, 93.33% positive predictive value, 80.00% negative predictive value, and 90.00% overall diagnostic accuracy. Patients with colonic contrast passage had significantly earlier passage of flatus (1.74 ± 0.64 vs. 3.18 ± 1.08 days; p=0.002), earlier initiation of oral feeding (2.38 ± 0.74 vs. 4.64 ± 1.43 days; p<0.001), fewer in-hospital complications (3.33% vs. 40.00%; p=0.010), and a shorter hospital stay (4.21 ± 1.20 vs. 8.73 ± 2.24 days; p<0.001). Conclusion: Oral water-soluble contrast is a valuable adjunct in adhesive small bowel obstruction. Colonic contrast passage within 24 hours strongly predicts successful conservative management, while failure of progression identifies patients with a higher likelihood of surgery and prolonged hospitalization. Keywords: Adhesive small bowel obstruction; Water-soluble contrast; Gastrografin; Conservative management; Intestinal obstruction.

Background: Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease characterized by recurrent episodes of mucosal inflammation and varying degrees of disease severity and activity. Accurate evaluation of disease activity is needful for therapeutic decision-making, monitoring treatment response, and estimating disease progression. Although colonoscopy evaluation remains the gold standard for assessment of disease activity, its invasive procedure, cost, and limited suitability for repeated monitoring have sparked enthusiasm in non-invasive biomarkers. Hematological inflammatory indices derived from routine complete blood count parameters, including the Systemic Immune-Inflammation Index (SII), Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR), have emerged as promising indicators of systemic inflammatory burden and disease activity. Materials and Methods: The present prospective case-control study was conducted in Division of Medical Gastroenterology of a tertiary care hospital from March 2025 to May 2026. A total of 70 participants were enrolled, comprising 35 patients with confirmed ulcerative colitis and 35 healthy controls. Demographic, clinical, laboratory, and colonoscopic data were collected prospectively. Hematological parameters including total leukocyte count, hemoglobin, platelet count, neutrophil count, lymphocyte count, and monocyte count were recorded. The Systemic Immune-Inflammation Index, Neutrophil-to-Lymphocyte Ratio, and Platelet-to-Lymphocyte Ratio were calculated using standard formulas. Disease extent was classified as proctosigmoiditis, left-sided colitis, or pancolitis, while disease severity was assessed using the Mayo Endoscopic Score, Degree of Ulcerative Colitis Burden of Luminal Inflammation (DUCBLI), and Ulcerative Colitis Endoscopic Index of Severity (UCEIS). Correlations between hematological indices and colonoscopic disease activity scores were analyzed. Results: We showed that heamatological parameters of inflammation were significantly different in Ulcerative Colitis compared to normal volunteers. SII, NLR and PLR were increased in active disease and had positive correlations with indices of endoscopic severity. These indices of inflammation correlated with the burden of disease and correlated with colonoscopic activity. Of all the parameters analysed, the Systemic immune-inflammation Index had the highest correlation with disease activity and was a sensitive index of the inflammatory burden. These indices can be used as objective, non-invasive measures of UC disease activity. Conclusion: In summary, Systemic Immune-Inflammation Index, Neutrophil to Lymphocyte ratio and Platelet to Lymphocyte ratio, which are easy to determine, economical, and commonly used blood markers, can provide the efficient way for diagnosis and activity assessment of ulcerative colitis. These indices may complement traditional clinical and colonoscopy assessment, making it easier for routine monitoring, and reducing repetitive invasion procedures. Of all the indices Systemic Immune-Inflammation Index looks to be with good clinical value as an index for disease activity and inflammatory bur

Background: The Crohn's Disease Activity Index (CDAI) depends partly on patient-reported symptoms, and ileo-colonoscopy is invasive and unsuitable for frequent repetition. The C-reactive protein (CRP)/albumin ratio has been proposed as a simple serological marker of disease activity in inflammatory bowel disease, but data specific to Crohn's disease (CD) in South Asian populations are limited. Materials and Methods: In this retrospective cross-sectional study, 33 patients with CD managed at a tertiary centre in South India between January 2024 and August 2025 were analysed. Active disease was defined as CDAI ≥150. Associations were assessed with Spearman's rank correlation (ρ), differences across activity categories with the Kruskal–Wallis test, and discrimination of active disease from remission with receiver operating characteristic (ROC) analysis; the cutoff was chosen by the Youden index. Results: Sixteen patients (48.5%) had active disease. The CRP/albumin ratio correlated strongly with CDAI (ρ = 0.790, 95% CI 0.58–0.90, p < 0.001) and discriminated active disease from remission (area under the curve [AUC] 0.949, 95% CI 0.869–1.000). A cutoff of 0.85 gave a sensitivity of 87.5% (95% CI 61.7–98.4) and a specificity of 100% (95% CI 80.5–100). The median ratio rose from 0.07 in remission to 1.20 in severe disease (p < 0.001). CRP alone performed equivalently (ρ = 0.791; AUC 0.945). Conclusion: In this small cohort, the CRP/albumin ratio correlated strongly with CDAI and discriminated active CD from remission, but it did not outperform CRP alone. The cutoff of 0.85 was derived and evaluated in the same sample and requires validation in larger prospective studies with endoscopic assessment. Keywords: Crohn’s Disease, C-Reactive Protein, Serum Albumin, Severity of Illness Index, Biomarkers.

Background: Acute pancreatitis has a variable clinical course, ranging from mild disease to severe illness with organ failure and local or systemic complications. Describing local aetiology, clinical presentation and laboratory associations may help characterize the burden of disease in individual hospitals. The objective is to describe the socio-demographic and clinical profile, aetiology, CT severity and complications of acute pancreatitis, and to find out the associations with various sociodemographic and laboratory parameters. Materials and Methods: This hospital-based prospective cross-sectional study included 204 patients admitted with acute pancreatitis from April to July 2026 with clinical/ laboratory/ radio-logical findings suggestive of acute pancreatitis. Results: The most common age group was 31–40 years (44.6%), and majority 88% of participants were male. Abdominal pain was reported by 99.0%, vomiting by 58.3%. Alcohol was the most frequently recorded aetiology (70.6%), followed by idiopathic disease (18.1%) and gallstones (7.8%). CT severity was classified as mild in 71.6%, moderate in 19.1% and severe in 9.3%. In our study there is significant association between sex and aetiology, complication status and CT severity. On comparing patients without complications, those with complications had higher mean serum bilirubin and lipase, amylase levels. Conclusion: In this single-centre study, acute pancreatitis predominantly affected men aged 31–40 years Alcohol and idiopathic cause were the leading cause of acute pancreatitis which should prompt us to look with further studies for identifiable new etiologies in the idiopathic group. Alcohol was the most common cause in this geographical location. Complications were associated with bilirubin, amylase and lipase levels so this can be used as predictors of severity. Keywords: Acute pancreatitis; aetiology; complications; serum lipase; albumin;

Background: Early prediction of severe acute pancreatitis (AP) is crucial for effective triage. This study evaluates the predictive accuracy of APACHE II, BISAP, Ranson's’s criteria, the Modified Computed Tomography Severity Index (MCTSI), and C-Reactive Protein (CRP) against the Revised Atlanta Classification. Materials and Methods: A prospective observational study of 204 adult AP patients was conducted. Predictive performance for severe AP (persistent organ failure >48 hours) was analyzed using sensitivity, specificity, predictive values, and Receiver Operating Characteristic (ROC) curves. Results: Severe AP occurred in 18.1% of patients. CRP exhibited the highest overall discriminative accuracy (AUC = 0.933), closely followed by BISAP and APACHE II (both AUC = 0.927). APACHE II demonstrated the highest sensitivity (89.2%) and negative predictive value (97.0%) for excluding severe disease. Conversely, Ranson's and BISAP offered the highest specificities (98.8% and 97.6%) and positive predictive values (87.5% and 85.7%). All scores were significantly elevated in severe cases (p < 0.001). Conclusion: CRP, BISAP, and APACHE II are highly accurate predictors of severe AP. APACHE II is optimal for early exclusion of severe disease, BISAP is highly specific for confirming high risk, and CRP serves as a highly accurate, easily accessible standalone biomarker. Keywords: Severe, Acute Pancreatitis, APACHEII, Ranson’s, ,BISAP, MCTSI, Scoring system

Background: Acute kidney injury (AKI) is a significant cause of morbidity and mortality among preterm neonates admitted to Special Newborn Care Units (SNCUs). Diagnosis is commonly based on serum creatinine rise and reduced urine output, although serum creatinine is a delayed marker of renal dysfunction. Preterm neonates are highly vulnerable to AKI because of immature nephrogenesis, poor renal perfusion, sepsis, hemodynamic instability, and exposure to nephrotoxic interventions. Materials and Methods: This prospective observational study was conducted in the SNCU of Kamla Raja Hospital, Department of Pediatrics, Gajra Raja Medical College, Gwalior, Madhya Pradesh, over a period of 24 months. All preterm neonates (<37 weeks gestational age) admitted during the study period were screened for AKI using KDIGO criteria. Clinical details, maternal risk factors, laboratory investigations, urine output, AKI staging, and outcomes were recorded. Data were analyzed using SPSS version 20, and p<0.05 was considered statistically significant. Results: The prevalence of AKI among preterm neonates was 7.5%. Male neonates constituted 67% cases. Stage I AKI was most common (47%), followed by Stage II (31%) and Stage III (22%). Neonatal sepsis (37%), shock (19%), dehydration (14%), and perinatal asphyxia/HIE (12%) were major associated morbidities. Mortality was observed in 32% neonates and was significantly higher in Stage III AKI and very preterm neonates (p<0.0001). Maternal complications such as APH, pre-eclampsia, eclampsia, and chorioamnionitis showed significant association with AKI severity and mortality. Hyperkalemia and hypocalcemia were also significantly associated with poor outcome. Conclusion: AKI is a common and serious complication among preterm neonates admitted to SNCU. Early recognition, routine renal monitoring, prompt management of sepsis and electrolyte abnormalities, and identification of maternal risk factors are essential to improve neonatal outcomes and reduce mortality. Keywords: Acute kidney injury, AKI, Preterm neonates, Special Newborn Care Unit, SNCU, KDIGO staging.

Background: Caudal epidural block is the standard regional technique for paediatric infra-umbilical surgery but provides limited analgesia duration. Posterior quadratus lumborum block (QLB) offers prolonged somatic and visceral analgesia via paravertebral spread and may be a superior alternative. The objective is to compare analgesic efficacy of ultrasound-guided posterior QLB versus caudal block in children aged 6 months–8 years undergoing elective infra-umbilical surgery. Materials and Methods: In this prospective RCT, 24 children (ASA I–II) were randomised to caudal block (0.125% bupivacaine 1 mL/kg + dexmedetomidine 0.5 μg/kg) or posterior QLB (0.125% bupivacaine 0.5 mL/kg + dexmedetomidine 0.5 μg/kg). Primary outcome was time to first rescue analgesia; secondary outcomes included FLACC pain scores, rescue analgesia requirement, and complications. Results: One block failure per group left 11 participants per group for analysis. Time to first rescue analgesia was significantly longer in the QLB group (12.00 ± 2.00 h vs 7.73 ± 1.10 h; p < 0.001). FLACC scores differed significantly at 12 h (1.45 ± 0.69 vs 2.73 ± 0.79; p = 0.002). Rescue analgesia was required in fewer QLB children (18.2% vs 72.7%; p = 0.03). No block-related complications occurred. Conclusion: Posterior QLB was associated with longer postoperative analgesia and reduced rescue analgesia requirement compared with caudal block in children undergoing lower abdominal surgery. Larger multicentre studies are warranted to confirm these findings. Keywords: paediatric anaesthesia; quadratus lumborum block; caudal epidural block; postoperative pain; FLACC scale; regional anaesthesia; ultrasound guidance.

Background: Meningitis is a serious inflammatory condition of the meninges associated with significant morbidity and mortality. Prompt diagnosis and appropriate pharmacotherapy guided by clinical and cerebrospinal fluid (CSF) findings are essential for optimal patient outcomes. Objectives: To evaluate pharmacotherapeutic approaches in meningitis patients and correlate them with clinical manifestations and CSF findings. Materials and Methods: A prospective observational study was conducted among 103 patients diagnosed with meningitis at General Medicine wards of Government tertiary care hospital situated in Marathwada region of state Maharashtra, India. Study was conducted by group of students of Doctor of Pharmacy [Pharm D] mentioned here as first authors under guidance of Second and Third authors as guide for said study. Data on demographic characteristics, clinical features, CSF parameters, and pharmacotherapy were collected using a structured proforma. Patients were categorized into bacterial, viral, and tubercular meningitis based on clinical and CSF findings. Statistical analysis was performed using descriptive statistics, Chi-square test, and ANOVA, with p < 0.05 considered statistically significant. Results: Tubercular meningitis was the most common type (35.9%), followed by viral (33.0%) and bacterial meningitis (31.1%). Significant differences were observed in CSF white blood cell count, protein, and glucose levels across etiological groups (p < 0.001). Third-generation cephalosporins and vancomycin were predominantly used in bacterial meningitis, antitubercular therapy in tubercular meningitis, and acyclovir in viral meningitis (p < 0.001). Clinical manifestations and abnormal CSF findings showed significant correlation with the type of pharmacotherapy administered. Conclusion: The study demonstrates that rational, etiology-specific pharmacotherapy guided by clinical presentation and CSF analysis is crucial in the effective management of meningitis. Integration of clinical and laboratory findings facilitates appropriate treatment selection and may improve patient outcomes. Key words: Meningitis. Pharmacotherapy. Cerebrospinal Fluid.

Background: Tympanoplasty is a surgical procedure established decades ago to restore middle ear function by reconstructing the tympanic membrane. Various graft materials have been used for tympanic membrane repair. Although the temporalis fascia graft is generally preferred, it carries a risk of graft medialization and shrinkage. In comparison, cartilage has been shown to be a more stable and durable material than fascia or perichondrium alone. The aim of this study was to evaluate the graft take-up rate and hearing outcomes between temporalis fascia and conchal cartilage grafts in Type I tympanoplasty. Materials and Methods: This prospective interventional study was conducted between May 2024 and April 2025 and included 70 patients diagnosed with chronic otitis media (COM), safe type. The patients were divided into two groups: Group A received an autologous temporalis fascia graft, and Group B received a conchal cartilage graft. Postoperative graft integrity and hearing outcomes were assessed and compared. Results: The differences in postoperative graft survival and hearing improvement between the temporalis fascia and cartilage groups were not statistically significant at any time point. Conclusion: Both temporalis fascia and half-sliced conchal cartilage grafts are effective and reliable materials for tympanoplasty. However, conchal cartilage grafts may be considered a valuable alternative due to their superior stability and resistance to retraction and medialization. Keywords: Tympanoplasty, Temporalis fascia, Conchal cartilage, Graft uptake, Hearing outcomes, Chronic otitis media.

Background: Pelvic inflammatory disease (PID) is frequently under-recognised because symptoms may be mild, non-specific, or absent. Evidence from Indian tertiary-care settings is limited, particularly among women without a documented sexually transmitted infection (STI). We estimated the clinic-based prevalence of clinically diagnosed PID and examined associated demographic, reproductive, procedural, and hygiene-related factors. Materials and Methods: This analytical cross-sectional study enrolled 150 consecutive non-pregnant women aged 18 years or older at a tertiary teaching hospital from 1 November 2025 to 31 January 2026. Clinical PID was defined by pelvic or lower abdominal symptoms, no more plausible alternative diagnosis, and at least one pelvic-examination criterion: cervical motion tenderness, uterine tenderness, or adnexal tenderness. Supportive inflammatory, discharge, laboratory, and ultrasonographic findings were considered where available. Women with a known or laboratory-documented STI, recent childbirth or miscarriage, pregnancy, or an alternative diagnosis explaining the presentation were excluded. Prevalence was reported with a Wilson 95% confidence interval (CI). Associations were examined using Fisher’s exact test and a prespecified multivariable logistic regression model. Results: Clinical PID was identified in 56 of 150 participants (37.3%; 95% CI 30.0%–45.3%). Among women with PID, the most frequent symptoms were lower abdominal or pelvic pain (91.1%), abnormal vaginal discharge (73.2%), dysmenorrhoea (58.9%), and dyspareunia (44.6%). In the adjusted model, marriage before 20 years (adjusted odds ratio [aOR] 3.64, 95% CI 1.55–8.53), previous uterine instrumentation (aOR 3.19, 95% CI 1.12–9.11), previous pelvic surgery (aOR 4.04, 95% CI 1.46–11.14), suboptimal menstrual hygiene (aOR 5.74, 95% CI 2.33–14.11), and intravaginal cleansing or douching (aOR 3.91, 95% CI 1.60–9.53) were independently associated with clinical PID. Conclusion: More than one-third of this selected gynaecology outpatient sample met a standardised clinical definition of PID despite having no documented STI. Structured pelvic assessment and careful documentation of reproductive procedures and intravaginal practices may improve recognition. The clinic-based, cross-sectional design and reliance on clinical diagnosis preclude population-level or causal interpretation. Keywords: clinical diagnosis; cross-sectional study; gynaecology; pelvic inflammatory disease; reproductive health; South India.

Background: Heart failure (HF) is a major cause of morbidity and mortality among patients requiring intensive care. Reliable biomarkers that can assist early risk stratification are particularly useful in resource-limited tertiary care settings. The objective is to evaluate the association of admission N-terminal pro-B-type natriuretic peptide (NT-proBNP), haemoglobin (Hb), and red cell distribution width (RDW) with in-hospital mortality and hospital stay, and to assess their relationship with ejection fraction. Materials and Methods: This hospital-based observational cross-sectional study included 80 consecutive adults admitted to the ICU with HFrEF or HFmrEF. Admission Hb, RDW, ejection fraction (EF), and serum NT-proBNP were recorded. Outcomes were compared between survivors and non-survivors using independent-samples t-tests and chi-square tests. Point-biserial/Pearson correlation was used for continuous variables against the binary outcome of death, and exploratory receiver-operating-characteristic (ROC) analysis was performed. Results: Mean age was 52.6 ± 11.9 years and 72.5% of participants were male. In-hospital mortality was 38.8% (31/80). Mean NT-proBNP was higher in non-survivors than survivors (5239.4 ± 2568.4 vs 3127.8 ± 2118.5 pg/mL; t=3.83, p=0.0003). Mortality was higher among patients with NT-proBNP >5000 pg/mL than among those with NT-proBNP ≤5000 pg/mL (56.7% vs 28.0%; χ²=5.34, p=0.021). Mean EF was lower in non-survivors (31.9 ± 5.4% vs 36.9 ± 5.6%; t=3.91, p=0.0002), and mortality was higher in HFrEF than HFmrEF (51.9% vs 14.3%; χ²=9.34, p=0.0022). Hb and RDW did not differ significantly between groups (p=0.585 and p=0.853, respectively). Conclusion: Higher admission NT-proBNP and lower ejection fraction were significantly associated with in-hospital mortality in this ICU cohort. Hb and RDW were not significantly associated with mortality. NT-proBNP may be useful as an adjunct to early risk stratification, although prospective multicentre studies are required to validate its prognostic performance. Keywords: Heart failure, NT-proBNP, in-hospital mortality, intensive care unit, ejection fraction, red cell distribution width, prognosis.

Background: Postoperative pain following lower segment caesarean section (LSCS) can adversely affect maternal recovery, ambulation, breastfeeding, and overall well-being. Ultrasound-guided transversus abdominis plane (TAP) block provides effective somatic analgesia, but the duration of analgesia following single-shot ropivacaine remains limited. Dexmedetomidine, an α₂-adrenergic receptor agonist, may enhance and prolong the analgesic effect of local anaesthetics. The objective is to compare the postoperative analgesic efficacy and safety of ultrasound-guided TAP block using 0.2% ropivacaine alone versus 0.2% ropivacaine combined with dexmedetomidine in women undergoing elective LSCS under spinal anaesthesia. Materials and Methods: This prospective, randomized, double-blind, controlled study included 54 pregnant women aged 18–40 years with ASA physical status II undergoing elective LSCS. Participants were randomized equally into two groups of 27. Group RS received bilateral ultrasound-guided TAP block with 20 mL of 0.2% ropivacaine plus 1 mL normal saline on each side, while Group RD received 20 mL of 0.2% ropivacaine combined with dexmedetomidine 1 μg/kg diluted to 1 mL on each side. Postoperative pain was assessed using the Visual Analogue Scale (VAS), and duration of analgesia, rescue tramadol consumption, haemodynamic parameters, Ramsay Sedation Score, and adverse events were recorded for 24 hours. Results: Baseline demographic and anthropometric characteristics were comparable between the groups. VAS pain scores were significantly lower in Group RD at 2, 4, 6, and 12 hours after the block (p < 0.001). The mean pain-free duration was significantly longer with dexmedetomidine (8.67 ± 3.19 hours) compared with ropivacaine alone (4.59 ± 0.93 hours; p < 0.001). Total rescue tramadol consumption during the first 24 hours was significantly lower in Group RD than in Group RS (48.15 ± 9.62 mg vs. 100 mg; p < 0.001). Sedation scores were significantly higher in Group RD at 4, 8, and 12 hours, but no prolonged sedation was observed. Transient intergroup differences in haemodynamic parameters were noted, without clinically significant respiratory compromise or major block-related complications. Conclusion: Addition of dexmedetomidine 1 μg/kg to 0.2% ropivacaine for ultrasound-guided bilateral TAP block significantly prolongs postoperative analgesia, reduces pain intensity and rescue tramadol requirements, and provides effective postoperative analgesia following LSCS. The technique appears to be a useful component of multimodal analgesia, although transient increases in sedation and haemodynamic differences warrant appropriate postoperative monitoring. Keywords: LSCS, TAP block.

Background: Breastfeeding provides essential nutritional and immunological benefits to infants. Adequate maternal knowledge and positive attitudes are important for promoting optimal breastfeeding practices. This study assessed breastfeeding knowledge, attitudes, and practices among antenatal mothers and explored postnatal breastfeeding outcomes. Materials and Methods: A hospital-based study was conducted in the Department of Obstetrics and Gynecology at ESIC Medical College and Hospital, Sanathnagar, Hyderabad, from April 2023 to March 2024. A total of 500 antenatal women at or beyond 36 weeks of gestation were included. Data were collected using a structured questionnaire covering sociodemographic characteristics, breastfeeding knowledge, attitudes, and practices. Attitudes were assessed using the Iowa Infant Feeding Attitude Scale. Participants received breastfeeding health education, and postnatal outcomes were assessed at six weeks and six months. Results: Good breastfeeding knowledge was observed in 42.0% of participants, moderate knowledge in 38.0%, and poor knowledge in 20.0%. A positive attitude was observed in 56.0%, while 48.0% met the study threshold for good breastfeeding practices. Educational attainment was significantly associated with good knowledge (p < 0.001). Following health education, 82.0% expressed an intention to practise exclusive breastfeeding. Postnatal follow up was completed by 360 of 400 eligible participants at six weeks and 330 at six months. Exclusive breastfeeding was reported in 83.3% at six weeks and 63.6% at six months. Conclusion: Breastfeeding knowledge and practices require improvement among antenatal women. Targeted antenatal education and continued postnatal support may help address knowledge gaps and promote sustained exclusive breastfeeding. Keywords: Breastfeeding; Antenatal mothers; Knowledge; Attitude; Health education.

Background: The first year of medical education offers an opportunity to assess baseline vaccine knowledge and identify immunisation needs before routine clinical training. Positive views about vaccination do not necessarily translate into personal vaccine uptake. Objectives: To assess knowledge, attitudes and self-reported uptake of human papillomavirus (HPV), hepatitis B virus (HBV) and seasonal influenza vaccines among first-year medical students. Materials and Methods: An institution-based analytical cross-sectional survey was conducted among first-year MBBS students at a private medical college in Eluru, Andhra Pradesh, India. The overall study period was October 2025 to April 2026; questionnaire collection occurred during October–December 2025. Of 250 eligible students, 205 participated (82.0%). Descriptive estimates, Wilson 95% confidence intervals and exploratory chi-square comparisons from aggregate counts were used. Results: The mean age was 19.40 ± 1.11 years; 78.5% were female. Good knowledge was reported for HPV in 59.0%, HBV in 65.4% and influenza in 62.4%. Although 96.1% viewed vaccination as useful and safe, self-reported completion was 33.2% for HBV and 20.0% for HPV; 18.0% reported seasonal influenza vaccination. Neither sex nor residence showed statistically significant associations with vaccination status in analyses of available cross-tabulations. Conclusions: The study revealed a substantial gap between vaccination awareness, positive attitudes and actual vaccine uptake among first-year MBBS students. Despite satisfactory knowledge, uptake remained low, particularly for HPV and influenza, with only one-third completing hepatitis B vaccination. These findings emphasise the need for structured vaccine education, routine assessment of vaccination status and accessible immunisation services early in medical training to improve vaccine coverage and promote preventive healthcare practices. Keywords: Students, Medical; Health Knowledge, Attitudes, Practice; Vaccination; Hepatitis B Vaccines; Papillomavirus Vaccines; Influenza Vaccines.

Background: Lymphadenopathy is a common clinical presentation associated with reactive, infectious, granulomatous and neoplastic conditions. Fine needle aspiration cytology (FNAC) provides a rapid, minimally invasive and economical method for evaluating enlarged lymph nodes. Aim: To study the frequency and cytomorphological spectrum of lymph node lesions diagnosed by FNAC at a tertiary care centre in Western India. Materials and Methods: This hospital-based cross-sectional study was conducted in the Cytopathology Laboratory, Department of Pathology, GMERS Medical College and its attached Civil Hospital, Gandhinagar, from July 2023 to February 2025. A total of 300 patients of all age groups and both sexes presenting with palpable lymph node enlargement were included. FNAC was performed using a 22-24-gauge needle. Smears were stained with Giemsa, Papanicolaou and haematoxylin and eosin stains. Ziehl-Neelsen staining and GeneXpert testing were used in suspected tuberculous lesions when indicated. Data were analysed using descriptive statistics and the chi-square test. A p value <0.05 was considered statistically significant. Results: The highest proportion of patients belonged to the 21-30-year age group (24.3%), followed by 11-20 years (23.7%). Males constituted 54.0% and females 46.0%. Cervical lymph nodes were the most frequently involved nodes (84.3%), and most nodes were firm (89.3%). Haemorrhagic aspirate was obtained in 89.3% of cases. Non-neoplastic lesions constituted 91.0% (95% CI: 87.2-93.7), whereas neoplastic lesions accounted for 9.0% (95% CI: 6.3-12.8; p<0.001). Tuberculous lymphadenitis was the most frequent diagnosis (55.7%), followed by reactive lymphadenitis (17.7%) and tuberculous abscess (15.7%). Metastatic carcinoma constituted 81.5% of neoplastic lesions, with squamous cell carcinoma being the predominant metastatic subtype. Neoplastic lesions increased significantly with advancing age (χ²=84.51, p<0.001). Cytological diagnosis also differed significantly according to sex (χ²=24.88, p=0.006). Conclusion: FNAC was an effective first-line investigation for differentiating non-neoplastic from neoplastic lymph node lesions. Tuberculous lymphadenitis was the predominant diagnosis, reflecting the high burden of tuberculosis in the study region. Metastatic carcinoma was the leading neoplastic lesion and occurred predominantly among older patients. Histopathology and ancillary investigations remained essential for indeterminate lesions and suspected lymphomas. Keywords: Fine needle aspiration cytology; Lymphadenopathy; Tuberculous lymphadenitis.

Background: Left atrial volume index (LAVI) reflects cumulative left ventricular filling-pressure and atrial remodeling burden. Its short-term prognostic value in Indian patients with acute coronary syndrome (ACS) requires further evaluation. The objective: To determine the association between baseline LAVI and 30-day major adverse cardiovascular events (MACE) in patients with ACS undergoing coronary angiography and planned revascularization. Materials and Methods: This single-centre prospective observational study included 190 adults with ACS. Transthoracic echocardiography was performed within 48 hours of admission. Participants were classified as normal LAVI (≤34 mL/m²; n=83) or increased LAVI (>34 mL/m²; n=107) and followed for 30 days. The composite MACE endpoint comprised unstable angina/non-fatal myocardial infarction, ischemic stroke, heart-failure hospitalization, new-onset atrial fibrillation, or cardiovascular death. Results: Thirty-day MACE occurred in 41/107 (38.3%) patients with increased LAVI and 5/83 (6.0%) with normal LAVI (p<0.001; crude OR 9.69). Increased LAVI was associated with diastolic dysfunction, moderate mitral regurgitation, and triple-vessel disease (all p<0.001), while LVEF was similar between groups (p=0.365). LAVI predicted MACE with an AUC of 0.728 (95% CI 0.645-0.805); a 33.3 mL/m² cut-off provided 93.5% sensitivity and 96.2% negative predictive value. LAVI >34 mL/m² remained independently associated with MACE (adjusted OR 3.41, 95% CI 1.05-11.11; p=0.042). Conclusion: Increased baseline LAVI identifies a high-risk ACS phenotype and provides early prognostic information complementary to LVEF and coronary anatomy. Keywords: Acute coronary syndrome, left atrial volume index, echocardiography, major adverse cardiovascular events, diastolic dysfunction, revascularization.

Background: Objectives: To characterize the demographic, clinical, biochemical and hematological profiles of pediatric patients documented with acute viral hepatitis in a hospital-based cohort and to identify limitations in routine clinical documentation relevant to future pediatric hepatitis surveillance. Materials and Methods: We conducted a retrospective observational study of pediatric clinical records documented between 1 July 2018 and 31 July 2019. Records in which acute viral hepatitis was documented as the principal, suspected, or follow-up/recovery diagnosis were included. Demographic characteristics, presenting complaints, biochemical and hematological parameters, coagulation data, severe manifestations, and available viral-marker results were extracted. Continuous variables were summarized using mean±SD and median (IQR), and categorical variables using frequencies and percentages. Missing observations were not imputed or interpreted as negative. Results. The dataset comprised 133 clinical records. Females accounted for 72 (54.1%) and males for 61 (45.9%) records. Mean age was 7.98±4.35 years and median age was 8.0 years (range, 0.12–16 years); 47 (35.3%) records were from children aged 10–<15 years and 42 (31.6%) from those aged 5–<10 years. Jaundice/yellowish discoloration was documented in 87 (65.4%), fever in 49 (36.8%), vomiting in 30 (22.6%), and lethargy/weakness in 19 (14.3%). Among 68 records with biochemical measurements, median ALT was 1423 U/L (IQR 706–2038), AST 1105 U/L (IQR 333–1174), total bilirubin 7.1 mg/dL (IQR 5.8–7.1), and alkaline phosphatase 333 U/L (IQR 176–572). INR was available in 30 records and had a median of 1.19 (IQR 1.19–1.70). Six records documented hepatic encephalopathy in association with hepatitis A. Conclusions. This hospital-based pediatric cohort was characterized by frequent clinically apparent jaundice and substantial aminotransferase elevation, with a smaller subgroup showing documented hepatic encephalopathy. The concentration of records among school-aged children and adolescents is clinically relevant in the context of changing HAV susceptibility in India, but the present data cannot establish an epidemiological shift or estimate HAV/HEV prevalence because etiological testing was incomplete. Prospective studies using standardized case definitions, systematic viral testing, serial assessment of synthetic function, and longitudinal outcomes are warranted. Keywords: Acute viral hepatitis; children; hepatitis A; hepatitis E; jaundice; alanine aminotransferase; bilirubin; acute liver injury; India.

Background: Biliary ascariasis is an important cause of biliary obstruction and related complications, particularly in endemic regions. It occurs when Ascaris lumbricoides migrates from the intestine into the biliary tree. Although imaging modalities such as ultrasonography may aid in diagnosis, Endoscopic Retrograde Cholangiopancreatography (ERCP) provides direct visualization of the biliary tract and offers both diagnostic confirmation and therapeutic removal of the parasite. Aim: To assess the diagnostic and therapeutic utility of ERCP in patients with biliary ascariasis, including procedural success and post-procedural outcomes. Place and duration of Study: This study was conducted at Shaheed Mohtarma Benazir Bhutto Medical College Lyari Karachi, Darul Sehat Hospital Karachi, Jinnah Hospital Karachi & Shaheed Muhtarma Benazir Bhutto Medical University Hospital Larkana and from August 2021 to August 2026. Study Design: Retrospective study. Materials and Methods: A retrospective study was conducted among 58 patients with biliary ascariasis who underwent ERCP. Demographic characteristics, presenting symptoms, laboratory findings, pre-procedural imaging findings, ERCP findings, therapeutic interventions, technical success, and post-procedural outcomes were retrospectively reviewed and analyzed using SPSS version 26. Results: A total of 58 patients with biliary ascariasis underwent ERCP. Abdominal pain was the most common presenting symptom and was reported in all patients (58, 100%), while jaundice was reported in 32 patients (55.17%). Pre-procedural imaging detected biliary worms in 24 patients (41.4%). ERCP provided definitive visualization of the biliary parasites and enabled successful endoscopic extraction in all patients. Endoscopic sphincterotomy and/or other biliary interventions were performed when clinically indicated. Post-procedural clinical outcomes were favorable, with a low incidence of procedure-related complications. No ERCP-related deaths were reported. Conclusion: ERCP is an effective diagnostic and therapeutic modality for biliary ascariasis. It enables direct visualization of biliary parasites and facilitates their endoscopic removal, with a high technical success rate and favorable clinical outcomes. ERCP may therefore be particularly useful in patients with symptomatic or complicated biliary ascariasis requiring endoscopic intervention. Keywords: Ascaris lumbricoides; biliary ascariasis; biliary obstruction; ERCP; endoscopic management; endoscopic retrograde cholangiopancreatography; parasitic biliary disease; abdominal pain; jaundice; worm extraction.

Background: Extra-articular proximal and distal-third tibial fractures are difficult to treat with conventional intramedullary nailing because the short metaphyseal segment makes it hard to maintain alignment. Multidirectional tibial nails provide several interlocking options intended to improve control of these fragments. Objective: To describe the functional and radiological outcomes and recorded complications of adults with extra-articular proximal or distal-third tibial fractures treated with a multidirectional tibial nail (MTN). Place and Duration of Study: This study was conducted at Sheikh Khlifa Bin Zayed Hospital Quetta from May 2025 to May 2026. Methods: This prospective observational cohort included 50 consecutive adults aged 18–60 years treated with an MTN. Functional outcome was graded with the Johner–Wruhs criteria and radiographic healing with the Radiographic Union Scale for Tibial fractures (RUST). Time to union and complications (infection, delayed union, shortening, dynamization, and primary or secondary malalignment) were recorded. Data were analysed descriptively using SPSS. Results: Mean time to union was 20.99 ± 4.02 weeks and mean final RUST score was 10.8 ± 1.21. Johner–Wruhs outcomes were excellent in 38 patients (76%), good in 8 (16%) and fair in 4 (8%); none was poor. Superficial infection occurred in 5 patients (10%), delayed union in 8 (16%), shortening in 3 (6%) and dynamization was required in 7 (14%). Primary malalignment was recorded in 7 patients (14%) and secondary malalignment in 3 (6%). No nonunion was observed. Conclusion: In this uncontrolled series, MTN fixation of extra-articular proximal and distal-third tibial fractures was followed by predominantly excellent or good functional outcomes (92%) and union in all patients. Because of the single-arm design and modest sample, these findings are descriptive and do not establish superiority over conventional nails or plating. Comparative studies with longer follow-up are needed. Keywords: Multidirectional tibial nail; extra-articular tibial fractures; intramedullary nailing; tibial fractures; Johner-Wruhs criteria; RUST score.

Background: Distal third extra-articular tibial fractures are challenging to manage because of the limited soft-tissue coverage, relatively poor vascularity, and proximity of the fracture to the ankle joint. Intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis (MIPPO) are commonly used treatment modalities, each with distinct advantages and potential limitations. Objective: To compare the functional and radiological outcomes of intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis (MIPPO) in patients with distal third extra-articular tibial fractures. Study Design: Prospective randomized controlled study. Duration and place of Study: This study was conducted at Ibn e Sina University Hospital Mirpurkhas from June 2025 to June 2026 Materials and Methods: This prospective randomized controlled study included 80 adult patients with closed or Gustilo-Anderson type I open distal third extra-articular tibial fractures. Patients were randomly allocated into two groups and treated with either intramedullary interlocking nailing or MIPPO. Follow-up assessments were performed at 3, 6, and 12 weeks and at 6 months. Functional outcomes were assessed using the Foot Function Index (FFI) and Olerud-Molander Ankle Score (OMAS), while radiological fracture healing was assessed using radiographic evaluation and the Radiographic Union Score for Tibial fractures (RUST). Continuous variables were compared using the Student's t-test or Mann-Whitney U test, as appropriate. A p-value of <0.05 was considered statistically significant. Results: Among the 80 patients, 60% were male, and road traffic accidents were the most common mechanism of injury (57.5%). Patients treated with intramedullary nailing achieved weight-bearing mobilization earlier than those treated with MIPPO at the assessed time points (p=0.001). Full weight-bearing was achieved at a mean of 7 weeks in the nailing group compared with 10 weeks in the MIPPO group. The Olerud-Molander Ankle Score favored the nailing group during the early follow-up period; however, no statistically significant difference was observed between the groups at 6 months, with mean scores of 89 and 85, respectively. The Foot Function Index demonstrated improvement in both groups at the final follow-up. Radiological union assessed using the RUST score was comparable between the two groups. Delayed union was the most common complication and occurred in 12.5% of patients in each group. Other complications were observed only in the MIPPO group; however, the difference in overall complication rates was not statistically significant (p=0.46). Conclusion: Intramedullary interlocking nailing was associated with earlier weight-bearing and potentially faster functional rehabilitation compared with MIPPO in distal third extra-articular tibial fractures. However, functional and radiological outcomes at 6 months were comparable between the two treatment groups. Keywords: Distal tibial fracture; extra-articular tibial fracture; intramedullary interlocking nail; minimally invasive percutaneous plate osteosynthesis; MIPPO; fracture fixation; RUST score.

Background: Cancellations of elective surgeries represent a significant challenge for healthcare systems worldwide, leading to financial losses, operational inefficiencies, and patient distress. Reported global cancellation rates range from 1.9% to 49%, often reflecting disparities in hospital infrastructure and preoperative preparedness. However, local data from Pakistan remain limited. Objective: To determine the frequency, causes, and avoidability of elective surgery cancellations and their association with patient factors in tertiary care hospitals in Karachi. Materials and Methods: This cross-sectional study was conducted from April 2023 to July 2024 in the General Surgery, ENT, and Gynecology departments of Sohail Trust Hospital and Medicare Cardiac & General Hospital, Karachi. A total of 200 consecutive patients whose elective surgeries were cancelled on the intended day were included. Data were collected via a structured questionnaire. Reasons for cancellation were categorized as patient-, hospital-, or doctor-related and assessed for avoidability using WHO criteria. Data analysis was done using SPSS v25. Results: The mean age was 37.2 ± 16.5 years; 63% were female and 71% from low-income households. Cancellations were predominantly patient-related (49%), followed by hospital-related (38%) and doctor-related (13%). Nearly 59% were avoidable. Older patients (≥ 40 years) experienced more patient-related cancellations (60%), whereas younger patients (< 40 years) had more hospital-related issues (47%, p = 0.01). Patient-related cancellations were associated with higher mean age (41.7 ± 13.9 years) compared to hospital-related (32.4 ± 17.4 years, p = 0.001). Conclusion: Nearly two-thirds of elective surgery cancellations in tertiary hospitals were avoidable—predominantly due to patient-related and systemic hospital factors. The findings highlight the critical need for targeted interventions, such as mandatory preoperative assessment clinics, improved resource management, and strong scheduling systems, to reduce the burden of cancellations and improve the quality of surgical care. Keywords: Elective surgery, cancellation, preoperative assessment, hospital efficiency, Pakistan, avoidable causes.

Background: Allergic asthma affects 10–15% of children globally, with higher rates in industrial regions. However, epidemiological data from industrial areas in low- and middle-income countries like Bangladesh remain limited. The objective is to estimate the prevalence of allergic asthma and identify its key determinants among children aged 6–10 years in the industrial zone of Gazipur, Bangladesh. Materials and Methods: A cross-sectional study was conducted from October 2024 to February 2025 among 371 children selected through stratified random sampling from four primary schools and two nearby communities (response rate: 92.8%). Data were collected using parent-reported ISAAC-based questionnaires and physician-confirmed asthma or atopic condition histories. Multivariate logistic regression was performed to determine independent predictors (p<0.05). Results: The prevalence of allergic asthma was 11.9% (95% CI: 8.7–15.8%). Significant predictors included family history of asthma (AOR = 3.12; 95% CI: 1.78–5.47; p<0.001), physician-diagnosed atopic conditions (AOR = 4.23; 95% CI: 2.15–8.32; p<0.001), and pet ownership (AOR = 2.45; 95% CI: 1.23–4.87; p=0.025). Higher monthly family income (≥40,000 BDT) was protective (AOR = 0.35; 95% CI: 0.13–0.94; p=0.043). Environmental exposures such as second-hand smoke and indoor air pollutants were associated in bivariate analysis but were not significant after adjustment. Conclusion: Approximately one in nine children in this industrial population have allergic asthma. Genetic predisposition and coexisting atopic conditions are major contributors, whereas higher socioeconomic status appears protective. These findings underscore the need for targeted screening and socioeconomic interventions in industrial communities. Keywords: Allergy, Asthma, Children, Gazipur

Background: Surgical site infections (SSIs)’ is the most common infections linked to healthcare, resulting in heightened morbidity, extended hospital stays, and escalating healthcare expenses. Understanding local changes in microbiology and patterns of antibiotic resistance is essential for successful treatment. Objectives: To separate and recognise bacterial and fungal pathogens for having surgical site infections and detect their antimicrobial susceptibility patterns and multidrug-resistant organisms. Materials and Methods: This hospital-based observational cross-sectional study was conducted in the Departments of Microbiology TMMC&RC, Moradabad, from April 2024 to October 2025. There were 161 patients with SSIs that were clinically suspected. Standard microbiological methods were applied to specimens obtained aseptically from infected surgical wounds. The antibiotic sensitivity was done by Kirby Bauer Disc Diffusion Assay according to CLSI Guidelines M100 33rd Edition. Results: Participants were predominantly male (54.0%), with an age distribution centered around 40 years. 59.6% of isolates were Gram-negative bacteria, with Gram-positive bacteria coming in second (37.3%) and fungal isolates (3.1%). The most common pathogen isolated was Methicillin-resistant Staphylococcus aureus (MRSA) (29.2%), which was followed by Escherichia coli (24.2%) and Klebsiella pneumoniae (16.1%). High drug resistance was seen in Ampicillin (89.7%), Ciprofloxacin (88.1%), and Cefotaxime (83.3%), whereas Tigecycline (97.7%), Linezolid (96.7%), Teicoplanin (96.2%), and Vancomycin (93.2%) retained excellent activity against resistant isolates. All fungal isolates were vulnerable to fluconazole and amphotericin-B. Conclusion: Gram-negative bacteria predominated among SSI pathogens, whereas the most prevalent individual isolate was MRSA. The necessity for ongoing monitoring is highlighted by the significant degree of resistance to widely used antibiotics, antimicrobial stewardship, and culture-guided therapy to optimize SSI management. Keywords: Surgical site infection; Antimicrobial resistance; MRSA; Gram-negative bacteria; Antibiotic susceptibility; Multidrug-resistant organisms.

Background: Esophageal varices are a major complication of portal hypertension in cirrhosis and are associated with substantial morbidity and mortality. Upper gastrointestinal endoscopy is the diagnostic gold standard but is invasive and may be poorly tolerated. FibroScan-based liver stiffness measurement (LSM) offers a non-invasive approach for predicting esophageal varices and may facilitate risk stratification. Materials and Methods: This prospective observational study included 75 patients with cirrhosis. All participants underwent clinical evaluation, laboratory investigations, FibroScan assessment of liver stiffness, and upper gastrointestinal endoscopy for detection and grading of esophageal varices. LSM values were compared between patients with and without varices and across variceal grades. Receiver operating characteristic (ROC) analysis was performed to determine the diagnostic accuracy and optimal cutoff of LSM for predicting esophageal varices. Results: Esophageal varices were detected in 40 (53.3%) patients, while 35 (46.7%) had no varices. Mean liver stiffness was significantly higher in patients with varices than in those without (26.50 ± 2.91 vs. 14.46 ± 1.74 kPa; p < 0.001). LSM differed significantly across variceal grades (F = 149.803, p < 0.001). Platelet count showed a strong negative correlation with LSM (r = −0.789, p < 0.001). ROC analysis demonstrated excellent diagnostic performance, with an AUROC of 1.000 (p < 0.001). An optimal cutoff of 19.5 kPa yielded 100% sensitivity and 100% specificity. Baveno VI criteria also demonstrated excellent predictive performance, correctly identifying low- and high-risk patients. Conclusion: FibroScan-based LSM demonstrated excellent accuracy for predicting esophageal varices in cirrhotic patients. It may support non-invasive risk stratification and potentially reduce unnecessary screening endoscopy. Keywords: Cirrhosis, Esophageal Varices, FibroScan, Liver Stiffness Measurement, Portal Hypertension, Transient Elastography, Baveno VI Criteria, Risk Stratification.

Background: Both marginal adaptation and resistance to microleakage play a crucial role in the longevity of CAD/CAM zirconia crowns. The changing conditions due to thermal fluctuations could change the crown-tooth interface, which could affect the cement marginal seal of cemented restorations. Objective: This study aimed to evaluate changes in marginal adaptation and microleakage in CAD/CAM zirconia crowns following different levels of thermal cycling and to determine the relationship between marginal gap dimensions and microleakage. Materials and Methods: 60 extracted human molar teeth with standardized calculations were used in an in vitro experimental study to be restored with CAD/CAM-fabricated zirconia crowns. They were divided equally into three groups: one uncycled, one cycled 5,000 times, and one cycled 10,000 times. A calibrated stereomicroscope and digital image analysis were used to measure marginal adaptation before and after the experimental exposure. Microleakage was assessed by dye-penetration method and the penetration was measured by ImageJ software. Data were statistically analyzed by descriptive statistics, analysis of variance, post hoc tests as appropriate and Pearson correlation, at significance level of 0.05. Results: The mean gap measurements (marginal) of the three different groups (control, 5,000-cycle, and 10,000-cycle) were approximately 82 µm, 83.0 µm, and 101.8 µm, respectively, in the simulated data. The Penetration of the mean Dye increased from 0.42 mm in the control group to 0.71 mm and 1.02 mm in the 5,000 cycle and 10,000 cycle groups, respectively. The simulated analysis showed that dye penetration was correlated with the marginal gap dimensions (r = 0.62, p < 0.001). Conclusion: Simulation results indicated that higher thermal challenges led to higher marginal discrepancies and dye penetration in CAD/CAM zirconia crowns. The proposed experimental approach could be used in characterizing the relationship between thermal aging, marginal adaptation and microleakage. These results should be confirmed by actual laboratory measurements. Keywords: CAD/CAM, zirconia crowns, marginal adaptation, microleakage, in vitro experimental study.

Background: Internal migrant workers frequently move between their host town (place of work) and home town (place of origin) for work purpose, and their access to and perception of healthcare may differ substantially between these two settings. Evidence directly comparing the two settings within the same individuals is limited in India. Objectives: To compare the perceived quality, access, affordability and availability of healthcare services experienced by internal migrant workers at their host town versus their home town, and to describe their sociodemographic profile and health-insurance coverage. Materials and Methods: A community-based, cross-sectional comparative study was conducted among 253 internal migrant workers originating from the Dahod–Katwara area of Dahod district, Gujarat, India. Data were collected using a pre-tested, structured questionnaire capturing distance, travel time, facility type, service availability, and Likert-type ratings of quality, staff availability, cleanliness and affordability for both settings. Within-subject (paired) comparisons used the Wilcoxon signed-rank test for ordinal ratings and the McNemar test for dichotomous service availability; p < 0.05 was considered significant. Results: Participants had a mean age of 37.6 ± 10.5 years; 187 (73.9%) were male, 154 (60.9%) had primary or no formal education, and the median monthly income was ₹15,000. Only 15 (5.9%) had any health insurance. Compared with the home town, the host town was rated significantly higher for quality of services (mean 3.44 vs 3.19), staff availability (3.65 vs 3.48) and cleanliness (3.22 vs 3.04) (all p < 0.001), and offered markedly greater availability of specialist (28.9% vs 6.5%) and diagnostic services (41.4% vs 14.2%) (both p < 0.001). Conversely, the home town was rated significantly more affordable (3.78 vs 3.57, p < 0.001) and facilities were closer (p = 0.005) and quicker to reach (p = 0.002). On direct comparison, 40.5% felt standards were about the same, 32.9% favoured the home town and 26.6% favoured the host town. Conclusion: Migrant workers experience a clear trade-off between the two settings: host towns offer higher perceived quality and better specialist and diagnostic services, whereas home towns offer greater affordability and proximity. In the near-absence of insurance, portable financial protection and migrant-sensitive services are needed to ensure continuity of care. Keywords: internal migrants; migrant workers; healthcare access; health services accessibility; affordability.

Background: Dental implant stability and alveolar bone health are important outcomes of oral rehabilitation. Salivary inflammatory and bone-remodeling biomarkers may reflect biological processes associated with these outcomes. Objective: To assess associations between salivary biomarkers, dental implant stability, and alveolar bone parameters among women and selected adolescents undergoing oral rehabilitation. Materials and Methods: This analytical cross-sectional study included 180 participants: 120 women and 60 adolescents. Salivary interleukin-1 beta (IL-1β), interleukin-6 (IL-6), matrix metalloproteinase-8 (MMP-8), receptor activator of nuclear factor-kappa B ligand (RANKL), osteoprotegerin (OPG), and the RANKL/OPG ratio were assessed. Implant stability was measured using the implant stability quotient (ISQ). Alveolar bone parameters included a bone-density index and marginal bone level. Oral health-related quality of life was described using the Oral Health Impact Profile-14 (OHIP-14). Descriptive statistics summarized study variables, while correlation analyses examined relationships between biomarkers, ISQ, and alveolar bone parameters. Results: Overall mean ISQ was 66.6 ± 7.1, bone-density index was 618 ± 102, and marginal bone level was 0.80 ± 0.33 mm. The mean OHIP-14 score was 31.1 ± 8.2, reported descriptively. The RANKL/OPG ratio was negatively correlated with ISQ (r = −0.38, p < 0.001) and bone-density index (r = −0.34, p < 0.001) and positively correlated with marginal bone level (r = 0.36, p < 0.001). Conclusion: Salivary inflammatory and bone-remodelling biomarkers, particularly the RANKL/OPG ratio, were correlated with implant stability and alveolar bone parameters. The RANKL/OPG ratio showed the strongest reported correlations with implant stability quotient and bone-density index (inverse associations) and marginal bone level (positive association). Keywords: Dental Implants; Salivary Biomarkers; Implant; RANKL/OPG Ratio; Oral Rehabilitation; Alveolar Bone.

Background: Acute injury to the kidneys depicts a serious complication encountered in the subjects admitted to Intensive care unit associated with high mortality and morbidity rates. Common causes being nephrotoxic interventions, hypotension, sepsis, and systemic illnesses. Early identification and treatment are vital for better outcomes. The present study was aimed to examine the incidence of acute kidney injury associated risk factors and outcomes in Indian medical ICU focusing on comorbidities and effect of interventions as dialysis. Materials and Methods: The present study assessed 200 subjects admitted to ICU of the Institute within the defined study period with acute kidney injury following KDIGO data. In all subjects, demographics were recorded along with etiology, comorbidities, and outcomes. The data gathered were statistically assessed for results. Results: The study results showed that sepsis was the major cause for AKI with infections as malaria being significant contributor. The mortality rate was 62% for malaria associated acute kidney injury. The most common comorbidity was hypertension and diabetes mellitus. Subjects that underwent dialysis had significant better recovery of 97% compared to subjects without dialysis with 68%. Overall, 64% subjects showed recovery and 24% subjects died. Conclusion: The present study concludes that there is a high incidence of acute kidney injury in subjects admitted to intensive care unit in India with the main etiologic agent being infection. Early and timely dialysis along with effective management of underlying etiology can significantly improve the outcomes in affected subjects. Keywords: acute kidney injury, dialysis, intensive care unit, sepsis

Background: The choice of intrathecal local anaesthetic for inguinal hernia repair affects block onset, duration, haemodynamic response, and postoperative recovery. The objective is to compare hyperbaric 0.5% levobupivacaine with hyperbaric 0.75% ropivacaine for inguinal hernia surgery under subarachnoid block. Materials and Methods: This prospective comparative study included 64 adults (32 per group) treated at a tertiary-care teaching hospital in Central India between July 2022 and December 2023. Group L received 3 mL (15 mg) hyperbaric levobupivacaine and Group R received 3 mL (22.5 mg) hyperbaric ropivacaine. Block characteristics, haemodynamic measures, and adverse effects were compared. Welch independent-samples t tests and Fisher exact tests were used for the reconstructed comparisons; two-sided p<0.05 was considered significant. Results: Mean sensory onset was 3.57±0.92 min in Group L and 7.15±0.96 min in Group R (mean difference −3.58 min, 95% CI −4.05 to −3.11; p<0.001). Mean motor onset was 4.62±0.94 versus 8.17±0.97 min (difference −3.55, 95% CI −4.03 to −3.07; p<0.001). Levobupivacaine prolonged sensory block (192.56±8.72 versus 161.69±4.48 min; difference 30.87, 95% CI 27.38 to 34.36; p<0.001) and motor block (174.09±9.11 versus 137.84±5.96 min; difference 36.25, 95% CI 32.39 to 40.11; p<0.001). Hypotension occurred in 5/32 versus 0/32 patients (Fisher p=0.053); bradycardia in 1/32 versus 0/32 (p=1.000); postoperative nausea/vomiting in 4/32 versus 2/32 (p=0.672). Conclusion: Both drugs provided reported surgical block. Levobupivacaine had faster onset and longer sensory and motor block; ropivacaine was associated with faster regression. Keywords: Levobupivacaine; Ropivacaine; Spinal anaesthesia.

Background: Metabolic syndrome is a set of cardiometabolic dysfunctions which significantly increases the risk of cardiovascular disease and type 2 diabetes mellitus. It is rapidly increasing across the globe, but the information based on community-based research of rural population in Pakistan is minimal. The objective is to determine the prevalence of metabolic syndrome and its associated risk factors among adults residing in a rural population of Karachi, Pakistan. Materials and Methods: This cross-sectional research was carried out in the six months at the Baqai Fatima Hospital, Karachi. A non-probabilistic convenience sampling plan was used to recruit a group of adults between 18 years and above who were in rural locations. The data collected involved the passage of structured interview, anthropometric measurements, blood pressure measurements, and the performance of fasting bio-chemical tests. The operational definition of metabolic syndrome was based on the National Cholesterol Education Program Adult Treatment Panel III. Statistical tests were done in SPSS; relative frequency and percentages were used to present the variables that were categorical and statistically significant association was revealed through the relevant statistical tests. Results: A total of 345 participants were included. The overall prevalence of metabolic syndrome was 34.2%. Central obesity, low high-density lipoprotein cholesterol, and elevated triglyceride levels were the most common components identified. The condition was more frequently observed among older adults and showed variation across demographic groups. Conclusion: The metabolic syndrome is quite common in the rural communities of Karachi and indicates a growing cardiometabolic burden. Timely screening, community-based preventive programs, and targeted interventions in the health of the population are essential to reducing cardiovascular and metabolic morbidity in these groups in the future. Keywords: Metabolic syndrome, prevalence, rural population, Karachi, cardiovascular risk factors, insulin resistance, obesity, dyslipidemia, hypertension, fasting blood glucose.

Background: Acute appendicitis is one of the most common causes of acute abdominal pain requiring surgical intervention. Accurate and timely diagnosis is crucial to reduce complications associated with delayed or unnecessary surgery. Although appendicitis is usually diagnosed on the basis of clinical findings and scoring system such as Alvarado score, as many as 45 percent of patients do not display classic signs of acute appendicitis, making imaging modalities like USG and CT scan a potentially useful tool when the diagnosis is unclear. This study was undertaken to compare the diagnostic accuracy of USG and CT scan in the diagnosis of acute appendicitis. Objective: To compare the diagnostic accuracy of graded compression ultrasonography and computed tomography in the diagnosis of clinically suspected acute appendicitis using histopathological findings as the reference standard. Materials and Methods: This is a cross-sectional comparative study conducted among 100 patients clinically suspected of having acute appendicitis at JNIMS, hospital during the period from august 2022 to July 2024. All eligible patients underwent abdominal ultrasonography and CT scan. The imaging findings were assessed for features suggestive of acute appendicitis. The imaging diagnoses were compared with the final diagnosis based on histopathological findings. Sensitivity, specificity, predictive values and diagnostic accuracy were calculated for both modalities. Results: Among the 100 patients included in the study, histopathological examination confirmed acute appendicitis in 64.7% patients diagnosed as acute appendicitis in USG and 100% in CT scan. USG as compared to CT scan had sensitivity of 63.5%, specificity of 62.2% and diagnostic accuracy of 63%. CT scan showed higher diagnostic accuracy compared with ultrasonography, particularly in patients with equivocal or atypical clinical presentations. Conclusion: Both USG and CT scan are useful imaging modalities in the evaluation of suspected acute appendicitis. CT scan demonstrated superior diagnostic performance in this study, while ultrasonography remains a valuable, readily available, and radiation-free initial imaging modality. The choice of imaging technique should be guided by clinical presentation, patient characteristics, availability and the need to minimize radiation exposure. Although CT scan is more accurate and sensitive than USG for diagnosing acute appendicitis, USG can still be used as the primary imaging modality due to its high specificity and excellent positive predictive value. In turn, CT scan may be reserved for the patients who have a clinical diagnosis of acute appendicitis and negative USG results. This approach will be cost effective, safe and may reduce the radiation exposure to ̴50% of patients presenting with acute appendicitis. Keywords: Acute appendicitis, Computed tomography, Diagnostic accuracy, Ultrasonography.

Background: Febrile seizures are among the most common seizure disorders of childhood and occur predominantly between 6 months and 5 years of age. Although generally benign, they are an important cause of pediatric emergency visits and considerable parental anxiety. The pathogenesis of febrile seizures is multifactorial, involving fever, central nervous system immaturity, genetic susceptibility, infection, and potentially nutritional and trace-element deficiencies. Zinc is an essential micronutrient involved in neurotransmission and modulation of neuronal excitability. The present study evaluated the association between serum zinc levels and febrile seizures in children. Materials and Methods: A hospital-based case-control study was conducted in the Department of Paediatrics, St. Isabel’s Hospital, Mylapore, Chennai, between April 2015 and March 2016. Eighty-four children aged 6 months to 5 years were enrolled, comprising 42 children presenting with a first episode of simple febrile seizure and 42 - age, sex, and nutritional-status-matched children with acute febrile illness without seizures. Children with atypical febrile seizures, intracranial infection, severe malnutrition, electrolyte abnormalities, structural brain lesions, neurodevelopmental disorders, previous afebrile seizures, or therapeutic zinc supplementation were excluded. Serum zinc was estimated using a colorimetric method, and serum zinc concentrations below 65 µg/dL were considered hypozincemia. We also assessed demographic, nutritional, haematological, infectious, and clinical variables. Results: The mean serum zinc level was significantly lower among children with febrile seizures than among controls (63.12 ± 21.85 µg/dL versus 73.99 ± 19.68 µg/dL; p = 0.019). Hypozincemia was present in 26 (61.9%) children with febrile seizures compared with 16 (38.1%) controls (p = 0.029; odds ratio 2.64, 95% CI 1.094–6.371). Within the febrile seizure group, children with zinc deficiency experienced seizures at significantly lower temperatures than children without zinc deficiency (101.31 ± 0.837°F versus 102.19 ± 1.047°F; p = 0.005). Zinc deficiency was also significantly associated with protein-energy malnutrition (p < 0.001). Mean hemoglobin was lower among zinc-deficient children with febrile seizures than among those without zinc deficiency (10.61 ± 1.118 versus 11.25 ± 0.823 g/dL; p = 0.05). Regression analysis showed that serum zinc was the only variable among age, peak temperature, weight, zinc level, and haemoglobin that was significantly associated with the presence of febrile seizures (p = 0.008). Conclusion: Children with febrile seizures had significantly lower serum zinc levels and a higher frequency of hypozincemia than febrile children without seizures. Zinc deficiency was also associated with lower seizure temperature and indicators of nutritional deficiency. These findings support an association between hypozincemia and febrile seizures; however, larger prospective studies are required to determine causality and whether zinc supplementation can prevent first or recurrent febrile seizures. Keywords: febrile seizure; febrile convulsion; zinc deficiency; hypozincemia; chil

Background: Cervical cancer incidence in India varies more than fivefold between population-based cancer registries (PBCRs). Yet most economic evaluations of Human Papillomavirus (HPV) vaccination are built on a single national average. We estimated the health and economic effects of universal single-dose HPV vaccination, which started in India for girls aged 14 years on 28 February 2026, using National Cancer Registry Programme (NCRP) registry-specific incidence data, and tested how robust those estimates were to the underlying assumptions. Materials and Methods: We used a static Markov cohort model for 100,000 girls entering at age 10 years, followed annually over a lifetime horizon, calibrated to NCRP age-adjusted incidence rates (AARs) for 32 PBCR entries. Outcomes were cases and deaths averted, discounted quality-adjusted life years (QALYs) gained, disability-adjusted life years (DALYs) averted, incremental cost-effectiveness ratios (ICERs) and benefit-cost ratios. We conducted a one-way sensitivity analysis presented with tornado diagrams, coverage and price scenario analysis, threshold analysis and a probabilistic sensitivity analysis (PSA) with 10,000 iterations to generate the cost-effectiveness acceptability curves (CEACs). Results: Per 100,000 girls vaccinated, discounted QALYs gained ranged from 762 in Dibrugarh district to 4,377 in Papumpare district, and DALYs averted from 169 to 971. Base-case ICERs ranged from INR 8,871 per QALY in Papumpare to INR 70,365 per QALY in Dibrugarh, all below one-time per capita gross domestic product (GDP), which we derive as approximately INR 2.43 lakh for financial year 2025-26. The ICER was insensitive to vaccination coverage, because coverage scales cost and benefit together. In the PSA, every registry except Dibrugarh was cost-effective in 99.5% or more; Dibrugarh was cost-effective in 54.7% of iterations at that threshold and in 100% at one time GDP per capita. Vaccination becomes cost-saving below a delivered price of about INR 199 per girl in Papumpare and about INR 35 in Dibrugarh. Conclusion: Single-dose HPV vaccination is cost-effective across every Indian PBCR setting examined, and the case is strongest where incidence is highest. Registry calibration does not change the direction of the answer. Keywords: HPV vaccine, cervical cancer, NCRP, population-based cancer registry, Markov model, India, QALY, DALY, cost-effectiveness, sensitivity analysis.

Background: Ultrasound-guided brachial plexus block has become an established regional anaesthesia technique for upper limb surgeries. Among the various approaches, the supraclavicular and costoclavicular techniques are widely practiced. Comparative evaluation of these approaches is essential to identify the technique that provides superior analgesia, procedural efficiency, and safety. The aim is to compare the analgesic efficacy of ultrasound-guided supraclavicular and costoclavicular brachial plexus blocks using 0.5% bupivacaine in patients undergoing elective forearm surgeries, and to compare time taken to perform blocks and incidence of complications in both groups. Materials and Methods: A prospective, randomized, double-blinded comparative study was conducted in the Department of Anaesthesiology, Tirunelveli Medical College and Hospital, Tamil Nadu, over a period of 12 months from January 2025 to December 2025. A total of 100 patients scheduled for elective forearm surgeries were enrolled. Participants were randomly allocated into two equal groups: Group C received ultrasound-guided costoclavicular brachial plexus block and Group S received ultrasound-guided supraclavicular brachial plexus block using 20 mL of 0.5% bupivacaine. Procedure time, onset of sensory block, duration of postoperative analgesia, Visual Analogue Scale (VAS) pain scores, intraoperative hemodynamic parameters, and complications were recorded. Statistical analysis was performed using SPSS version 25.0, with p<0.05 considered statistically significant. Results: The costoclavicular approach demonstrated significantly shorter procedure time (5.10±0.92 vs. 8.24±1.38 minutes; p<0.001), earlier onset of sensory blockade (10.04±1.50 vs. 15.04±1.43 minutes; p<0.001), and longer duration of postoperative analgesia (899.26±34.67 vs. 714.34±35.02 minutes; p<0.001) than the supraclavicular approach. Immediate postoperative and 6-hour VAS scores were comparable; however, significantly better pain control was observed at 12 hours in the costoclavicular group (p=0.013), with no patients experiencing severe pain, whereas 16% of patients in the supraclavicular group reported a VAS score of 4. No block-related complications. were observed in either group. Conclusion: Ultrasound-guided costoclavicular brachial plexus block provided superior procedural efficiency, faster onset of sensory blockade, and significantly prolonged postoperative analgesia offering enhanced perioperative pain control and improved patient outcomes. Keywords: Analgesia; Brachial plexus block; Costoclavicular block; Forearm surgery; Regional anaesthesia; Supraclavicular block; Ultrasound guidance.

Background: The most popular adult reconstructive hip operation is total hip arthroplasty. Maximizing impingement free range of motion, recreating the proper offset, and equating limb length disparities are the objectives of a successful total hip arthroplasty (THA), which should result in a pain-free and dynamically stable THA. Both lengthening and shortening of the limb can occur after THA. Limb length discrepancy is a known problem which can cause altered hip biomechanics, dysfunctional gait, sciatica, lower back pain, instability, and a higher chance of dislocation. It is the main factor contributing to patients’ dissatisfaction after total hip arthroplasty. After THA, the limb is typically lengthened rather than shortened, and in up to 50% of cases, LLD is recorded to be less than 1 cm. Any residual LLD of less than 10mm on AP radiographs is usually clinically acceptable. LLD can be measured radiologically and clinically. Although numerous preoperative and intraoperative techniques have been documented in the literature, there is currently a lack of universally accepted, simple-to-use, reproducible, and efficient techniques for reducing LLD after THA. The Caliper dual pin retractor (CDPR) used in our study is based on Charnley’s pin retractor design. Through the same incision, we use two pins to prevent intraoperative pin loosening. It also acts as a retractor to the gluteal muscles. The pelvic pins are placed just proximal to the superior margin of the acetabulum, and hence, it is close to the centre of rotation of the hip, and thereby, readings are more accurate. Materials and Methods: This prospective observational study was carried out in the Department of Orthopaedics, ABVIMS & DR. RML Hospital, New Delhi, from 1st January 2021 to 30th June 2022.A total of 21 patients aged 18 to 70 years scheduled for uncemented THA were studied. Caliper dual pin retractor was used intraoperatively to correct limb length discrepancy. Primary Outcome was the limb length discrepancy measurement corrected clinically and radiologically. Secondary Outcome was the Modified Harris hip score filled by the patient at time frames: pre operatively, post operatively at 2nd week, 4th week, 6th week. Results: The mean (SD) of the age (years) was 34.33 (10.42). Out of 21 patients, the majority were male (66.7%). Fourteen patients were diagnosed with avascular necrosis (AVN) of the hip, five patients with osteoarthritis (OA) of the hip, one patient with tuberculosis sequelae, and one patient with septic sequelae. Preoperatively and postoperatively, clinical limb length discrepancy (LLD) was measured in all these patients. The preoperative clinical LLD mean (SD) in mm was 16.19 ± 8.80, with subgroup values of 13.50 ± 6.80 in patients with AVN and 16.40 ± 6.73 in those with OA. Postoperatively, the clinical LLD mean (SD) in mm was 3.33 ± 1.98, with AVN patients showing 2.93 ± 2.13 and OA patients 3.80 ± 1.64. Preoperative radiological LLD mean (SD) in mm was 15.95 ± 8.772, with subgroup values of 13.21 ± 6.42 in AVN patients and 16.00 ± 5.52 in OA patients. Postoperatively, the radiological LLD mean (SD) in mm was 4.38 ± 1.532, with AVN patients showing 4.00 ± 1.62 a

Background: Idiopathic Intracranial Hypertension (IIH) is a disorder characterized by elevated intracranial pressure (ICP) in the absence of a mass lesion, hydrocephalus, or identifiable secondary cause. It commonly affects obese women of childbearing age and presents with headaches, transient visual obscurations, diplopia, and papilledema, posing a risk of permanent vision loss if untreated. The underlying pathophysiology remains unclear, but recent studies have suggested a possible association with micronutrient deficiencies, particularly iron deficiency. Iron plays a vital role in oxygen transport, mitochondrial function, and neurotransmission. Iron deficiency, even without overt anemia, has been implicated in neurovascular dysregulation and altered cerebrospinal fluid (CSF) dynamics. However, its role in IIH remains underexplored. Emerging evidence points to a potential link between iron deficiency and increased intracranial pressure through impaired CSF absorption, endothelial dysfunction, and altered venous compliance .Given the lack of standardized data on iron status in IIH patients and its possible prognostic and therapeutic relevance, this study aims to evaluate the iron profile in patients with IIH and correlate it with clinical severity, CSF pressure, visual outcomes, and response to iron correction. Establishing such a relationship may provide novel insights into disease pathophysiology and open up additional avenues for therapeutic intervention. Materials and Methods: This was an ambispective observational study conducted at a tertiary care neuroscience center over a period of 18 months. Thirty patients diagnosed with idiopathic intracranial hypertension (IIH) based on the Modified Dandy Criteria were included. The study cohort comprised both retrospectively identified and prospectively enrolled patients. Detailed clinical data, visual parameters (visual acuity, fundus examination, optical coherence tomography [OCT], visual fields), lumbar puncture findings (cerebrospinal fluid [CSF] opening pressure), and iron profile parameters (hemoglobin, serum ferritin, serum iron, total iron-binding capacity [TIBC], and transferrin saturation) were recorded at baseline. All patients initially received standard IIH therapy (acetazolamide ± topiramate ± CSF tapping). In the prospective arm, iron therapy was initiated in iron-deficient patients after two weeks of standard therapy. Patients were followed at 1 and 3 months with reassessment of clinical symptoms (headache, transient visual obscurations, diplopia), ophthalmological evaluation, repeat OCT, visual field analysis, and iron profile. A repeat lumbar puncture was done at 3 months in clinically indicated cases to assess CSF pressure response.Patients were stratified into iron-deficient and non–iron-deficient groups at baseline. In the prospective subgroup, comparisons were made before and after iron therapy. The primary outcomes included change in CSF opening pressure and resolution/improvement in papilledema. Secondary outcomes assessed included symptom improvement, changes in visual parameters, and correlation with iron indices. Results: A total of 30 patients with confirmed Idiopathi

Background: Objectives: To evaluate the association of admission serum FT3 with in-hospital mortality among ICU-admitted heart failure patients and to assess its relationship with ejection fraction, NT-proBNP, and duration of hospital stay. Materials and Methods: This cross-sectional study included 80 consecutive ICU-admitted heart failure patients over one year at Basaveshwar Medical College and Hospital, Chitradurga. Serum FT3, ejection fraction (EF%), NT-proBNP and duration of hospital stay were recorded at admission and compared between survivors and non-survivors using the independent-samples t-test, chi-square test, and Pearson correlation. Results: Mean FT3 was significantly lower among non-survivors (2.38 ± 0.60 pg/mL) than survivors (3.12 ± 0.78 pg/mL; t=4.73, p<0.0001). Patients with low FT3 (<2.3 pg/mL) had markedly higher mortality (73.9%, 17/23) than those with FT3 ≥2.3 pg/mL (24.6%, 14/57; χ²=14.80, p=0.0001). FT3 correlated inversely with mortality (r=−0.45, p<0.0001), a stronger correlation than that observed for NT-proBNP (r=0.41) or ejection fraction (r=−0.40) in the same cohort, and the AUC for FT3 predicting in-hospital death was 0.77. Conclusion: Low serum FT3 at admission was strongly associated with in-hospital mortality among critically ill heart failure patients, suggesting that low T3 syndrome may serve as a simple, inexpensive adjunct prognostic marker for risk stratification in the ICU setting. Keywords: Heart failure, low T3 syndrome, free triiodothyronine, non-thyroidal illness syndrome, prognosis, intensive care unit, cross-sectional study.

Background: Stainless steel crowns (SSCs) are commonly used to restore primary molars in children. Plague and gingival inflammation may be subject to influence from crown adaptation, which can have an impact on the periodontal health around restored teeth. Objective: The aim of this study was to evaluate the correlation between the fit of SSCs and gingival health in children and to verify if suboptimal SSC adaptation was correlated with gingival inflammation and excessive plaque. Materials and Methods: A cross-sectional analytical study was conducted with 150 children aged 4-10 years with at least one primary molar with a stainless steel crown. A consecutive sampling technique was used to select participants from an outpatient department of pediatrics dentistry. Clinical assessment for crown fit was based on marginal adaptation, marginal overextension and crown contour. Gingival Health was determined by Gingival Index and plaque accumulation was determined by using Plaque Index. A structured assessment form was used to determine demographic data, oral hygiene habits, and clinical findings. Descriptive statistics, independent-samples t-tests, chi-square tests and correlation analysis were used in the statistical analysis and the significance level was set at p < 0.05. Results: Of the simulated children, 102 (68.0%) children had their crowns sufficiently adapted and 48 (32.0%) children had their crowns inadequately adapted. Gingival inflammation was found in 30 (29.4%) children who had well adapted crowns and 30 (62.5%) children who had poorly adapted crowns. The mean Gingival Index was 0.62 ± 0.38 in the adequately adapted group, and 1.18 ± 0.49 in the inadequately adapted group. The simulated analysis revealed that there was a positive correlation between inadequate crown fit and gingival inflammation (p<0.001). Conclusions: The results indicated a significant relationship between inadequate stainless steel crown adaptation and plaque accumulation and gingival inflammation in children. Correct crown position, proper marginal adaptation, and periodic evaluation of the health of the gums can make a difference in the oral health of children. It is important to validate these findings with clinical data. Keywords: Stainless steel crowns, crown fit, marginal adaptation, plaque accumulation, gingival inflammation, gingival health, pediatric dentistry.

Background: The transverse process of the atlas (C1) may help orient upper neck dissection, but its relationship with adjacent vessels and the styloid process varies. This study assessed those relationships on computed tomography (CT). Materials and Methods: In this retrospective, cross-sectional study, head and neck CT examinations of 87 eligible patients from a North Indian tertiary care centre were reviewed. Image-based distances from the lateral tip of each C1 transverse process to the internal carotid artery, internal jugular vein, vertebral artery, occipital artery and styloid process were recorded where structures were adequately visible. Right–left measurements were compared as paired observations. Results: Mean age was 49.5 ± 15.2 years, 49 patients (56.3%) were male, and 64 (73.6%) had contrast-enhanced CT. Bilateral measurements were available for 59 patients for the internal carotid artery, 52 for the internal jugular vein, 56 for the vertebral artery, 42 for the occipital artery and 87 for the styloid process. The median nearer-side jugular distance was 8.06 mm (interquartile range, 5.83–9.78); 6 of 52 patients (11.5%) had a distance below 5 mm. Small right–left differences were found for jugular distance (8.66 versus 8.25 mm; p = 0.018) and styloid distance (16.64 versus 15.87 mm; p < 0.001). No significant sex differences were found. Conclusion: C1 is a useful CT reference for describing upper neck anatomy, but measured distances vary among patients. The findings support individual image review and do not establish fixed surgical safety margins. Keywords: Atlas; C1 transverse process; surgical anatomy; internal jugular vein; upper neck.

Background: Gallbladder neoplasms may remain clinically and radiologically occult because their manifestations frequently overlap with benign gallstone-related disease. Routine histopathological examination of cholecystectomy specimens may identify biliary intraepithelial neoplasia (BilIN), other preinvasive neoplasms and early invasive carcinoma that would otherwise remain undetected. This study evaluated the frequency, histopathological spectrum and associated factors of neoplastic lesions incidentally identified in routine cholecystectomy specimens. Materials and Methods: This five-year retrospective observational study included 2,108 consecutive cholecystectomy specimens removed for clinically and radiologically presumed benign gallbladder disease at a tertiary-care hospital. Demographic, clinical, radiological, operative, gross and microscopic findings were retrieved from institutional records. Neoplastic lesions were classified according to the World Health Organization Classification of Tumours, fifth edition, and invasive carcinomas were staged using the eighth edition of the American Joint Committee on Cancer TNM system. Eight prespecified variables were entered simultaneously into an exploratory multivariable logistic regression model. Results: Of 2,108 specimens, 2,047 (97.1%) showed non-neoplastic pathology and 61 (2.9%) contained incidental neoplastic lesions. Chronic calculous cholecystitis was the predominant diagnosis (1,584/2,108; 75.1%). Among the 61 neoplastic lesions, there were 22 (36.1%) low-grade BilINs, 11 (18.0%) high-grade BilINs, five (8.2%) adenomas, three (4.9%) intracholecystic papillary neoplasms and 20 (32.8%) invasive carcinomas. Incidental invasive carcinoma occurred in 20/2,108 specimens (0.95%); conventional biliary-type adenocarcinoma comprised 17/20 invasive carcinomas (85.0%). Patients with neoplasia were older than those with non-neoplastic disease (57.2±11.2 versus 43.8±13.5 years; p<0.001). Age >50 years, gallstone size ≥3 cm, wall thickness >3 mm and an ultrasonographically detected polypoid lesion retained statistical associations with neoplasia after adjustment. No gross abnormality was identified in 26/41 preinvasive lesions (63.4%) and 5/20 invasive carcinomas (25.0%). Conclusion: A small but clinically important proportion of cholecystectomy specimens contained unsuspected BilIN or invasive carcinoma. Because several lesions were macroscopically inapparent, the findings suggest potential value in routine microscopic assessment within the study setting. However, this retrospective study did not directly compare routine with selective examination or evaluate patient outcomes; larger multicentre comparative studies are needed before recommending a universal policy. Keywords: Cholecystectomy; gallbladder neoplasms; incidental gallbladder carcinoma; biliary dysplasia; cholelithiasis.

Background: Tuberculosis and undernutrition can reinforce each other, compromising childhood growth and recovery. This study assessed longitudinal changes in nutritional status and factors associated with nutritional trajectories among children receiving tuberculosis treatment. Materials and Methods: A prospective longitudinal observational study included 67 children aged six months to fourteen years recruited consecutively from selected National Tuberculosis Elimination Programme treatment centres in India. Monthly assessments were conducted over six months. Anthropometric indices were standardised using age-appropriate World Health Organization growth standards and references. Dietary intake, household food insecurity and clinical characteristics were assessed. Paired comparisons evaluated nutritional changes, while random-intercept linear mixed-effects models examined adjusted associations with nutritional trajectories. Results: Participants had a mean age of 7.44±3.89 years; 56.7% were male and 68.7% resided in rural areas. Mean BMI-for-age z score increased from −2.04±1.15 to −1.16±1.20, representing an improvement of 0.88 units (95% CI: 0.75–1.01; p<0.001). Low BMI-for-age declined from 56.7% to 29.9%, while stunting decreased non significantly from 31.3% to 28.4% (p=0.625). Height-for-age improved by only 0.02 units (p=0.001). Of 38 children with initially low BMI-for-age, 18 (47.4%) reached a z score ≥−2. Baseline household food insecurity was associated with lower adjusted month-six BMI-for-age (coefficient: −0.39; p<0.001), whereas each ten-percentage-point increase in baseline energy intake was associated with a higher value (coefficient: +0.12; p<0.001). Conclusion: Weight-related nutritional indices improved during follow-up, while linear-growth deficits persisted. Repeated anthropometric assessment and attention to household food insecurity and dietary intake are warranted alongside tuberculosis care. Keywords: Childhood tuberculosis; nutritional status; food insecurity; anthropometry; prospective cohort.

Background: Preterm delivery is a major cause of neonatal morbidity and mortality. Cervical remodeling and softening may precede cervical shortening, making assessment of cervical tissue stiffness by ultrasound elastography a potential method for early prediction of preterm delivery. Materials and Methods: This prospective observational study included 43 pregnant women with singleton pregnancies between 19 and 24 weeks of gestation who underwent transvaginal cervical ultrasonography. Maternal age, BMI, gestational age and cervical length were analyzed and compared between the groups. Continuous variables were expressed using descriptive statistics, while categorical variables were analyzed using appropriate comparative tests. A p-value <0.05 was considered statistically significant. Results: Of the 43 participants, 39 had term delivery and 4 had preterm delivery. The mean maternal age was 26.99 ± 3.19 years in the term group and 30.00 ± 3.37 years in the preterm group (p=0.081). Mean BMI was 22.57 ± 3.17 and 22.35 ± 3.95 kg/m², respectively (p=0.895). Mean gestational age at examination was 21.07 ± 1.18 weeks in the term group and 21.32 ± 0.83 weeks in the preterm group (p=0.682). The mean cervical length was 3.73 ± 0.52 cm in the term group and 3.98 ± 0.21 cm in the preterm group, with an overall mean of 3.76 ± 0.50 cm. Conclusion: Maternal age, BMI, and gestational age at examination were also comparable between term and preterm groups. Although cervical ultrasound elastography has the potential to detect cervical tissue remodeling and softening before conventional cervical shortening, its predictive value could not be established from the present data. Larger prospective studies incorporating standardized elastography measurements and validated stiffness thresholds are required to determine its role in early prediction of preterm delivery. Keywords: Cervical elastography; Preterm delivery; Cervical length; Cervical stiffness; Transvaginal ultrasonography; Pregnancy; Second trimester; Preterm birth; Obstetric ultrasonography; Cervical remodeling.

Background: Digital health literacy (DHL) determines how effectively people can use India’s expanding digital health services, yet despite Kerala’s high general literacy, community-level evidence on DHL among rural adults is limited. This study assessed DHL using the Digital Health Literacy Instrument (DHLI) 2.0 and examined the sociodemographic factors associated DHL among adults aged 30 years and above in a rural community of Kozhikode, Kerala. Materials and Methods: A community-based cross-sectional study was conducted from June to July 2026 in the rural field practice area of Malabar Medical College Hospital and Research Centre. Adult smartphone users were recruited by convenience sampling through house-to-house visits, and 232 participants were interviewed using a pre-tested questionnaire and the DHLI 2.0. Overall scores (1–4 scale) were categorised as poor, moderate or good using the 25th and 75th percentiles. Associations were tested using the chi-square or Fisher’s exact test (p <0.05). Results: The mean age was 51 ± 15.75 years and 55.6% were female. The mean overall DHLI score was 2.66 ± 0.93; operational and navigation skills scored highest and generating content lowest. DHL was poor in 24%, moderate in 51% and good in 25%. Although 64.2% were aware of at least one digital health service, only 37.5% had used one. DHL was significantly associated with age, education, occupation, socio-economic status and morbidity (p <0.001). Good DHL was seen in 62.5% of those aged 30–39 years and 68.5% of graduates, but in none of those aged 60 years or above or with primary education or less. Conclusion: DHL among rural adults was moderate, with only one in four having good DHL. Older, less-educated, economically disadvantaged adults and those with multiple morbidities were most affected. Community-based programmes strengthening critical appraisal skills and use of public digital health services are needed to prioritise these groups. Keywords: Digital health literacy, DHLI 2.0, rural population, Kerala, cross-sectional study

Background: The causes of mechanical intestinal obstruction differ between regions and change over time. Prospective data from the north india region are lacking. We studied the aetiology, clinical profile, management and early outcomes of mechanical obstruction at a tertiary care centre in North India. Materials and Methods: This prospective observational study enrolled all consenting patients admitted with mechanical intestinal obstruction to the Department of General Surgery, Government Medical College and Hospital, Chandigarh, between May 2021 and May 2022. Paralytic ileus was excluded. Demographic, clinical, laboratory, radiological, operative, histopathological and outcome data were recorded on a structured proforma. Categorical variables were compared with the chi-square or Fisher's exact test and hospital stay with the Mann–Whitney U test. Results: Of 82 patients (mean age 43.8 ± 19.2 years; 42 women, 51.2%), 71 (86.6%) had small bowel and 11 (13.4%) large bowel obstruction. Abdominal pain (86.6%) and distension (85.4%) were the leading symptoms, and 40 patients (48.8%) had undergone previous abdominal surgery. Adhesions (22, 26.8%) and abdominal tuberculosis (20, 24.4%) were the commonest causes, followed by colonic malignancy (9, 11.0%) and obstructed hernia (8, 9.8%). Fifteen patients (18.3%) were managed conservatively; all were selected patients with adhesive or tubercular obstruction, and no patient with any other cause was treated without surgery (p < 0.001). Sixty-seven (81.7%) required surgery. A stoma was created in 24 operated patients (35.8%) and adhesiolysis was performed in 16 (23.9%). Surgical site infection affected 19 of 67 operated patients (28.4%). Median hospital stay was 7 days (IQR 5.5–9) after surgery and 4 days (IQR 3–4) after conservative care (p < 0.001). A hospital stay beyond 7 days was more frequent in patients who had a complication during admission than in those who did not (62.1% vs 20.8%, p < 0.001). One patient died (1.2%). Conclusion: In this single-centre cohort, adhesions and abdominal tuberculosis together accounted for half of all mechanical obstructions. Conservative management was successful only in selected patients with these two causes. Abdominal tuberculosis should be considered in the differential diagnosis in similar settings, and surgical site infection was the main source of postoperative morbidity. Larger multicentre studies are needed to confirm these findings. Keywords: Intestinal obstruction, Small bowel obstruction, Adhesions, Abdominal tuberculosis, Laparotomy, Surgical site infection; India.

Background: The patient gown is worn by almost every hospitalised patient, yet the people who handle it daily, doctors and nurses, are rarely asked to rate how well it works. Objective: The objective of this study is to measure acceptability of the existing patient gown to doctors and nurses with respect to various aspects like functionality, dignity of patients and aesthetic of gown. This study also tests whether acceptability differs with change in profession, gender etc. Materials and Methods: In this cross-sectional study, 200 clinicians (100 doctors, 100 nurses) filled the questionnaire that carried a demographic proforma and a 30-item scale, each item scored from 1 (not at all acceptable) to 5 (completely acceptable). Items fell into three domains: functional (19 question), Psychosocial (6 question) and aesthetic (5 question). Data were analysed using SPSS 22 with descriptive statistics, one-sample t-tests against Mann-Whitney test, one-way ANOVA, correlation. Results: Mean overall acceptability was 2.82 out of 5 (SD 0.21; 95% CI 2.80-2.85), significantly below the midpoint of 3 (t = -11.99, p < 0.001). Only 28.1% of all ratings were 4 or 5, while 40.5% were 1 or 2. The aesthetic domain scored highest (3.05) and the functional domain lowest (2.77). The weakest items were ease of movement with attached devices (2.25), ease of opening and closing fasteners (2.29) and pockets (2.50); the strongest were an appearance of cleanliness (3.38), non-allergenic fabric (3.29) and odour (3.14). Doctors rated the gown higher than nurses overall (2.86 vs 2.79, p = 0.007), driven by the aesthetic domain (3.22 vs 2.89, p < 0.001, d = 0.63). Scores did not differ by gender. Conclusion: Clinicians find the current gown unacceptable on all three domains with mainly for functional reasons tied to fasteners, devices and dressing. Redesign should start with quick-release closures, device-management features and adequate coverage under psychosocial needs. Keywords: patient gown; acceptability; nurses; doctors; Likert scale; patient dignity.

Background: Diabetes mellitus is associated with autonomic nervous system dysfunction, which may affect pupillary characteristics and cardiovascular regulation. The pupil-to-limbus diameter (PLD) ratio may serve as a simple ocular parameter for exploring its relationship with cardiovascular measurements in patients with type 2 diabetes mellitus. The objective is to assess the correlation of right- and left-eye PLD ratios with systolic blood pressure, diastolic blood pressure and pulse rate in patients with type 2 diabetes mellitus. Materials and Methods: This observational study included 80 patients diagnosed with type 2 diabetes mellitus. Demographic details and clinical parameters, including systolic blood pressure, diastolic blood pressure and pulse rate, were recorded. The PLD ratios of both eyes were measured using a standardised procedure. Correlation analysis was planned to determine the relationships between ocular measurements and cardiovascular parameters. Results: The participants had a mean age of 52.6 ± 8.4 years, with males constituting 55% of the study population. The mean systolic blood pressure was 132.4 ± 12.6 mmHg, diastolic blood pressure was 82.3 ± 8.7 mmHg and pulse rate was 78.6 ± 9.2 beats/min. Illustrative analyses suggested positive correlations between PLD ratios and both systolic and diastolic blood pressure, while associations with pulse rate were weaker and statistically non-significant. These findings require confirmation using actual participant-level data. Conclusion: The PLD ratio warrants further investigation as a potential ocular parameter associated with cardiovascular measurements in patients with type 2 diabetes mellitus. Keywords: Type 2 diabetes mellitus; pupil-to-limbus diameter ratio; systolic blood pressure; diastolic blood pressure; pulse rate; pupillary function.

Background: Insulinomas are the most common functioning pancreatic endocrine tumors and present with recurrent episodes of hypoglycemia. Symptoms may be neuroglycopenic (altered sensorium, confusion, seizures) or adrenergic (weakness, sweating), which makes the diagnosis clinically challenging. Case Presentation: We report the clinical profile and management of two otherwise healthy Indian Army soldiers (aged 35 and 28 years) who presented in the fasting state with severe neurological manifestations: recurrent unconsciousness (Case 1) and generalized tonic-clonic seizures (Case 2). Both patients had a positive Whipple’s triad. During hypoglycemia, random blood glucose levels were 37 mg/dL and 45 mg/dL, with inappropriately raised insulin (2.8 and 2.4 µIU/mL) and C-peptide (1.09 and 2.08 ng/mL) levels. The sulfonylurea screen was negative, and the glucagon stimulation test was positive, confirming hyperinsulinemic hypoglycemia. Endoscopic ultrasound (EUS) and FNAC identified a neuroendocrine tumor (insulinoma) in the pancreatic head (10 mm) in Case 1 and in the distal pancreatic body (14 × 9 × 13.5 mm) in Case 2. Case 1 underwent a pylorus-preserving Whipple’s procedure, and Case 2 underwent tumor enucleation. Both patients experienced complete resolution of hypoglycemia. Conclusion: A high index of suspicion for hyperinsulinemic hypoglycemia (insulinoma) should be maintained in healthy individuals presenting with unexplained neurological symptoms and fasting hypoglycemia. EUS is an excellent tool for precise preoperative localization, and surgical excision is the definitive, curative treatment. Keywords: Hypoglycemia; Insulinoma; Neuroendocrine tumor; Endoscopic ultrasound; Whipple’s triad; Pancreas.

Background: Kangaroo Mother Care (KMC) is an effective, low-cost intervention for the care of preterm and low birth weight infants. It involves skin-to-skin contact, breastfeeding support and appropriate follow-up. Adequate maternal knowledge and a positive attitude are essential for its acceptance and implementation. Aim: To assess the knowledge and attitude regarding Kangaroo Mother Care among antenatal mothers attending the antenatal clinic at AVMC&H, Puducherry. Materials and Methods: A quantitative approach with a descriptive research design was adopted. The study was conducted among 50 antenatal mothers attending the antenatal clinic at AVMC&H, Puducherry, using a non-probability convenience sampling technique. Data were collected using a structured tool comprising three sections: socio-demographic variables, knowledge regarding KMC, and attitude towards KMC. The collected data were analysed using descriptive and inferential statistics. Results: Among the 50 antenatal mothers, 23 (46%) had moderately adequate knowledge, 21 (42%) had adequate knowledge, and 6 (12%) had inadequate knowledge regarding KMC. Regarding attitude, 39 (78%) demonstrated a favourable attitude, while 11 (22%) had a moderately favourable attitude. None of the participants had an unfavourable attitude. The mean knowledge score was 6.24 ± 2.076, and the mean attitude score was 55.58 ± 8.403. A weak positive correlation was observed between knowledge and attitude (r = 0.163), which was not statistically significant (p = 0.259). Age (p = 0.021) and religion (p = 0.049) showed statistically significant associations with attitude, whereas the other assessed socio-demographic variables did not demonstrate significant associations. Conclusion: Most antenatal mothers had moderate to adequate knowledge and a favourable attitude towards KMC. Regular antenatal health education, counselling and practical demonstrations are recommended to improve maternal understanding and encourage appropriate KMC practices. Keywords: Antenatal mothers, Kangaroo Mother Care, knowledge, attitude, neonatal care.

Background: Psychiatric disorders frequently complicate epilepsy and may adversely affect seizure management, treatment adherence and quality of life. The chronic and unpredictable nature of seizures also places substantial psychological, social and financial demands on family caregivers. This study assessed psychiatric comorbidity among adults with epilepsy, quantified caregiver burden and identified factors associated with these outcomes. Materials and Methods: This hospital-based cross-sectional study included 176 adult patient–caregiver dyads attending a tertiary-care centre. Psychiatric diagnoses were established using the Mini International Neuropsychiatric Interview version 7.0.2. Depressive and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, respectively. Caregiver burden was measured using the 22-item Zarit Burden Interview. Sociodemographic, epilepsy-related, treatment-related and caregiving variables were recorded. Group comparisons, Spearman’s correlation, binary logistic regression and multiple linear regression were performed. A two-sided p<0.05 was considered statistically significant. Results: Psychiatric comorbidity was identified in 44.9% of patients. Depressive disorders (26.7%) and anxiety disorders (22.2%) were most frequent, while suicidal ideation or risk was detected in 6.8%. Female sex (AOR=1.92; 95% CI: 1.01–3.66), at least 12 seizures annually (AOR=2.27; 95% CI: 1.00–5.15) and drug-resistant epilepsy (AOR=2.60; 95% CI: 1.20–5.61) independently predicted psychiatric comorbidity. The mean caregiver-burden score was 36.9±14.2, and 37.5% experienced moderate-to-severe or severe burden. Patient psychiatric comorbidity, caregiving exceeding eight hours daily, financial strain, work loss and limited family support independently predicted greater burden. Caregiving hours showed the strongest correlation with burden (ρ=0.53; p<0.001). Conclusion: Psychiatric morbidity and caregiver burden were highly prevalent and closely interconnected. Integrating mental-health screening, improved seizure control, caregiver assessment and psychosocial support into routine epilepsy services may promote more comprehensive, family-centred care. Keywords: anxiety; caregiver burden; depression; psychiatric comorbidity; Zarit Burden Interview.

Background: Preterm labour is defined as regular contraction of uterus resulting in changes in cervix that starts before 37 completed weeks of pregnancy. Changes include effacement and dilatation of cervix. First promulgated in 1976, WHO and the International Federation of Gynaecology and Obstetrics (FIGO) preterm infants were those delivered before 37 completed weeks, that is ≤36⁶/₇ weeks. The aim & objective is to identify the different etiological factors associated with preterm labour, assess the various preventive methods applied, and evaluate their effectiveness in relation to the overall maternal and perinatal outcomes. Materials and Methods: A prospective analytical study was conducted in the Department of Obstetrics and Gynaecology, Calcutta National Medical College, Kolkata, West Bengal, India, over one year from July 2017 to June 2018. The study included 200 pregnant women with spontaneous preterm labour. Results: Among 200 cases, PPROM was the commonest risk factor (17%), followed by PIH (10%) and maternal age >35 years (8%). Nifedipine, micronised progesterone and OHPC prolonged gestation, but without statistical significance. Most newborns weighed 1.5–2.5 kg (61.5%), while SNCU admission and low birth weight remained substantial. Conclusion: We concluded that preterm labour is multifactorial, with PPROM as the commonest risk factor. OHPC showed the greatest numerical pregnancy prolongation, followed by nifedipine and micronised progesterone, though differences were not statistically significant. Low birth weight and SNCU admissions highlighted neonatal morbidity, emphasizing early risk identification, surveillance, and individualized management. Keywords: Preterm labour, PPROM, Risk factors, Tocolysis , Preterm birth prevention.

Background: Hospitals constitute critical infrastructure during disasters because they must simultaneously withstand disruption, maintain essential services, and accommodate sudden increases in demand for emergency and definitive care. Despite the availability of internationally recognized disaster-risk-reduction frameworks and hospital preparedness tools, major differences persist between recommended standards and operational readiness. This narrative review examines global frameworks for hospital disaster preparedness and emergency response, synthesizes the principal domains of effective preparedness, and identifies recurrent implementation gaps. A structured narrative search of peer-reviewed and authoritative institutional literature was undertaken, with emphasis on publications and guidance from the World Health Organization (WHO), United Nations Office for Disaster Risk Reduction, and contemporary hospital preparedness research. Major frameworks reviewed included the Sendai Framework for Disaster Risk Reduction, WHO Health Emergency and Disaster Risk Management Framework, Comprehensive Safe Hospital Framework, Hospital Safety Index, Hospital Emergency Response Checklist, incident-command approaches, and contemporary emergency-readiness standards. Across these frameworks, preparedness consistently depends on governance and incident command, risk assessment, structural and non-structural safety, communication, workforce readiness, surge capacity, logistics, continuity of essential services, evacuation capability, coordination, and recovery planning. However, recent evidence demonstrates persistent deficiencies in staff training, emergency communication, supplies, backup systems, infrastructure safety, functional preparedness, interagency coordination, and evaluation of exercises. Resource-constrained health systems experience additional barriers related to funding, workforce shortages, governance, and fragile infrastructure. Hospital preparedness should therefore evolve from compliance-oriented disaster planning toward measurable, risk-informed institutional resilience. Regular hazard assessments, competency-based multidisciplinary exercises, redundant critical systems, adaptive surge strategies, stronger health-system coordination, standardized preparedness indicators, and continuous learning after drills and real events are required to close the framework-to-practice gap. Keywords: hospital disaster preparedness; emergency response; disaster management; hospital resilience; surge capacity; Hospital Safety Index; emergency preparedness; disaster risk reduction; incident command; health emergencies.

Background: Sepsis remains a leading cause of mortality despite therapeutic advances. Metabolic acidosis, particularly reflected through anion gap measurements, serves as an important prognostic marker in sepsis. However, conventional anion gap calculations may underestimate metabolic acidosis in hypoalbuminemic patients, who comprise the majority of critically ill sepsis populations. Albumin-corrected anion gap (ACAG) addresses this limitation by accounting for decreased albumin contribution to unmeasured anions, potentially providing superior prognostic accuracy. This study aimed to predict in-hospital mortality using initial albumin-corrected anion gap in critically ill patients with sepsis, and to correlate ACAG among study participants at a tertiary care hospital in Central India. Materials and Methods: This prospective observational study was conducted at the Critical Care Unit, Ramkrishna Care Hospital, Raipur. Ninety consecutive adult patients with sepsis and metabolic acidosis were enrolled using purposive sampling. Upon admission, comprehensive evaluation included demographic assessment, APACHE II scoring, laboratory investigations, and calculation of conventional anion gap and ACAG using standard formulae. Patients were categorized into normal ACAG (12-20 mmol/L) and high ACAG (>20 mmol/L) groups. Results: The initial ACAG cut-off of ≥17.9 mmol/L yielded was found to have the best sensitivity and specificity in predicting in-hospital mortality. The ACAG cut-off of ≥17.9 mmol/L yielded a sensitivity of 92.5%, specificity of 51.4%, PPV of 73.1%, NPV of 82.6%, and diagnostic accuracy of 75.6% in predicting in-hospital mortality in patients with sepsis. Conclusion: Our study demonstrates that albumin-corrected anion gap serves as a valuable predictor of in-hospital mortality in critically ill patients with sepsis. With good discriminative ability (AUC 0.759), high sensitivity (92.5%), and reasonable diagnostic accuracy (75.6%). Keywords: Sepsis, albumin corrected anion gap, in hospital mortality, metabolic acidosis, albumin.

Background: Telenursing is promising and transformative landscape in providing clinical care to every patient who needed it on time but it become lifesaving tool to provide nursing care in remote and geographically difficult terrain like tribal area of India. As telenursing is already an integral part of modern healthcare system so demand of telenursing expert workforce is very high. Hence this study is carried out to assess awareness, perceptions and attitudes toward telenursing among undergraduate and postgraduate nursing students of tribal district Bastar from Chhattisgarh state. Materials and Methods: A cross sectional questionnaire based study was conducted among 310 nursing students. Out of 310 students, 303 students given consent through Google form and filled performa which is structured in following section- demographics data, clinical exposure, Awareness & knowledge of telenursing, Attitude and perceptions towards telenursing and perception towards technology-acceptance items rated on five-point scales. Data were analysis using SPSS- 22 version statistical software’s descriptive tools, chi- square test, Mann- Whitney Test and Kruskal–Wallis tests and Spearman correlation. Results: All respondents who reported sex was female (mean age 21.96 ± 3.21 years); 91.1% were undergraduate nursing students whereas remaining were post graduate nursing students. Although 63.7% rated their telenursing knowledge as good, only 28.4% had prior experience and 49.8% reported formal education on it. A positive attitude (agree or strongly agree that telenursing is a good idea for nurses) was held by 74.6%. Willingness to try new technology (79.3%) and perceived usefulness (69.1%) were high, but facilitating conditions scored lowest (39.3% positive). Most students preferred a combination of face-to-face and telenursing care (64.9%); only 3.0% preferred telenursing alone. A positive attitude was more frequent among students with formal telenursing education (84.4% vs 64.7%, p < 0.001), higher self-rated knowledge (81.8% vs 61.5%, p < 0.001), prior experience (p = 0.046), urban residence (p = 0.009) and senior academic year (p = 0.019). Perceived usefulness correlated most strongly with attitude (ρ= 0.54). Conclusion: Students are receptive to telenursing but report weak institutional education and technical support and uneven exposure to telenursing. Structured telenursing content, practical training and better infrastructure should be built into nursing curricula. Keywords: telenursing; nursing students; attitude; perception; technology acceptance; nursing education.

Background: Pelvic floor dysfunction is common in postmenopause, when oestrogen decline weakens pelvic tissues. Pelvic floor muscle training is first-line treatment, but data on strengthening neighbouring muscles, particularly the hip external rotators, is limited in postmenopausal women. The objective is to examine the effect of hip external rotator strengthening on pelvic floor function in postmenopausal women. Materials and Methods: In this quasi-experimental study, 192 postmenopausal women were assigned to an intervention group (n = 96) or a control group (n = 96). The intervention group performed a 12 week hip external rotator strengthening program. Primary outcomes included incontinence severity (ICIQ-SF), and bladder base displacement and isometric hip external rotator strength. Secondary outcomes were pelvic floor symptoms (PFDI-20) and incontinence-related quality of life. The differences between the groups were analysed using ANCOVA after controlling for baseline values, age, BMI, parity, and years since menopause; and within-group differences were analysed using correlations. Results: At baseline, groups were similar. At week 12, the intervention group showed greater improvement in ICIQ-SF (adjusted difference −3.6; 95% CI −4.5 to −2.7), bladder base displacement (4.4 mm; 3.8 to 5.0), hip strength (6.0 kg; 5.3 to 6.7) and PFDI-20 (−23.5; −26.8 to −20.2), all p < 0.001. There were significant correlations between hip strength increase and bladder base displacement (r = 0.62), ICIQ-SF (r = −0.58) and PFDI-20 (r = −0.54) and these were still significant after adjustment. Conclusion: Hip external rotator strengthening was associated with better pelvic floor function and decreased symptoms in postmenopausal women. Randomised controlled trials with longer follow-up are needed to confirm these findings. Keywords: hip external rotators; pelvic floor; postmenopause; urinary incontinence; strengthening

Background: Robotic-assisted total knee arthroplasty (RA-TKA) introduces additional technical requirements related to registration, optical tracking, fixation, planning, system communication and robot-assisted bone preparation. Specific intraoperative technical problems and their practical troubleshooting strategies remain less well characterized than alignment accuracy and operative-time learning curves. Materials and Methods: We retrospectively evaluated the first 100 consecutive VELYS robotic-assisted TKAs performed at a tertiary care teaching hospital between November 2024 and August 2026. Technical errors and workflow-related events, troubleshooting measures, operative duration and conversion to conventional instrumentation were recorded. Transient line-of-sight interruptions corrected immediately were analyzed separately. Temporal changes were assessed across four consecutive 25-case groups. Results: Mean age was 68.5 ± 7.0 years and mean operative duration was 128.43 ± 8.07 minutes. Failed anterior femoral cortex registration was the most frequent substantive technical event (50%), followed by excessive cutting resistance/bone-chip accumulation (31%), inability of the camera to visualize trackers (16%) and operating-table attachment problems (13%). Anterior cortex registration failure decreased from 84% in cases 1–25 to 0% in cases 76–100 (χ²=37.92, P=0.00000003), whereas bone-chip/cutting-resistance events remained present throughout the series (16%, 20%, 40% and 48% across quartiles; χ²=8.37, P=0.039). Chronological case number was not associated with operative duration (Spearman ρ=-0.018, P=0.858), but increasing substantive technical-event burden was weakly associated with longer operative time (ρ=0.214, P=0.033). System freeze/communication errors occurred in three cases and were associated with prolonged operative duration in exploratory analysis. One procedure (1%) required conversion to conventional instrumentation. No complications attributable to the robotic system or recorded technical events were identified. Conclusion: Technical and workflow-related problems during early VELYS robotic-assisted TKA were predominantly manageable using systematic troubleshooting, with conventional conversion required in 1% of cases. Registration-related difficulties demonstrated a marked learning-dependent reduction, whereas cutting-related events persisted. Individual technical-event analysis may characterize robotic proficiency more meaningfully than operative time alone. Keywords: Robotic Surgical Procedures; Arthroplasty, Replacement, Knee; Learning Curve; Equipment Failure; Intraoperative Care.

Background: There is a significant relationship between short cervix and spontaneous prematurity. Prevention is most commonly achieved with the use of progesterone, which is administered either intravaginally or orally; however, the relative efficacy of the two methods needs to be assessed. The objective is to compare intravaginal progesterone with oral progesterone in preventing preterm birth among women with a short cervix. Materials and Methods: Cross sectional comparative study of 120 women with singleton pregnancies and cervical length ≤25 mm was conducted at Al-Tibri Medical College and Hospital Karachi (Isra University) from January, 2026 to June, 2026. Intravaginal or oral progesterone was given and the women followed up until delivery. Results: Preterm birth <37 weeks was statistically associated with the oral group (40.0%) vs the intravaginal group (23.3%). Intravaginal progesterone significantly increased mean gestational age at delivery and birth weight of the neonates. Conclusion: Intravaginal progesterone showed better pregnancy outcomes than oral progesterone and may be preferred for women with a short cervix. Keywords: Short cervix, progesterone, intravaginal progesterone, oral progesterone, preterm birth, pregnancy outcomes.

Objective: To determine the prevalence and determinants of oral polio vaccine (OPV) hesitancy among parents/caregivers of children under five years in District Bannu, Khyber Pakhtunkhwa, Pakistan, including sociodemographic factors, knowledge, attitudes/perceptions, and reasons for hesitancy Materials and Methods: A community-based cross-sectional analysis examined 600 parent/caregiver records from District Bannu for January–September 2025. Eligible respondents were parents aged 18 years or older with at least one child younger than five years and permanent residence in the district; temporary visitors, duplicate household respondents, and non-consenting individuals were excluded. A structured questionnaire covered sociodemographic characteristics, nine factual knowledge items, attitudes and perceptions, and non-exclusive reasons for hesitancy. Good knowledge was defined as six or more correct answers out of nine. OPV hesitancy was analyzed as a binary indicator using within-category proportions, Wilson 95% confidence intervals, Pearson chi-square tests without Yates continuity correction, and Cramér’s V. Results: Sample Size Of 600 records, 180 (30.0%; 95% CI 26.5–33.8%) were classified as OPV-hesitant. Hesitancy was 47.9% (69/144) among parents with no formal education versus 20.0% (16/80) among those with tertiary education (omnibus χ² (4) =30.917, p<0.001); 33.6% (113/336) in rural versus 25.4% (67/264) in urban areas (χ² (1) =4.794, p=0.029); and 37.3% (121/324) among poor-knowledge versus 21.4% (59/276) among good-knowledge records (χ² (1) =18.098, p<0.001). Age group (p=0.343), sex (p=0.759), occupation (p=0.223), and number of children (p=0.461) were not significantly associated in unadjusted analyses. Among hesitant records, fear of infertility (103; 57.2%) and misinformation/rumours (95; 52.8%) were the most frequently. reasons, followed by lack of trust in vaccine quality (73; 40.6%), fear of adverse effects (70; 38.9%), lack of trust in health workers (70; 38.9%), and religious concerns (55; 30.6%). Conclusion: One-third of records were classified as OPV-hesitant. Low education, rural residence, and poor knowledge were associated with hesitancy, while infertility fear and misinformation were dominant. Keywords: Oral polio vaccine; vaccine hesitancy; poliomyelitis; parental refusal; vaccination knowledge; District Bannu; Khyber Pakhtunkhwa; Pakistan

Background: The mandibular foramen is an important anatomical landmark located on the medial surface of the mandibular ramus and serves as the entry point for the inferior alveolar neurovascular bundle into the mandibular canal. Variations in its position may influence the success of inferior alveolar nerve block and mandibular surgical procedures. Population-specific morphometric data are therefore clinically relevant. Aims: To determine the distance of the mandibular foramen from various anatomical landmarks among adult dry mandibles and to compare the findings with observations reported from other geographical populations. Materials and Methods: A observational study was conducted in the Departments of Anatomy of College of Medicine & Sagore Dutta Hospital, Kamarhati, Kolkata,over a period of one year. Adult dry mandibles satisfying the inclusion and exclusion criteria were selected by census sampling. The distances of the mandibular foramen from the anterior border, posterior border, mandibular notch, angle of the mandible, and posterior limit of the third molar socket were measured in millimetres. Results: The study included 150 mandibles. The mean distance from the anterior border was 17.42 ± 2.31 mm, while that from the posterior border was 14.86 ± 2.18 mm. The mean distances from the mandibular notch, angle of mandible, and posterior limit of the third molar socket were 21.64 ± 3.12 mm, 38.72 ± 4.26 mm, and 15.38 ± 3.06 mm, respectively. No significant right-left differences were observed for any measurement (p>0.05). Conclusion: The mandibular foramen demonstrates measurable positional variation but relatively symmetrical bilateral relationships. These morphometric findings may provide useful anatomical reference data for dental anaesthesia and mandibular surgical procedures. Keywords: Mandibular foramen; Mandible; Morphometry; Dry bone; Ramus; Anatomical landmarks; East Indian population.

Background: Cataract is one of the most common causes of visual impairment and is associated with anatomical changes in the anterior segment of the eye. Cataract extraction with intraocular lens (IOL) implantation can significantly alter anterior chamber configuration. Spectral-domain anterior segment optical coherence tomography (SD-AS-OCT) provides a non-invasive and reproducible method for quantitative assessment of anterior chamber angle parameters. The aim and objective is to compare pre- and post-operative anterior chamber changes after SICS and phacoemulsification by measuring ACA, AOD500, ACD, and TISA500 using Spectral-Domain AS-OCT. Materials and Methods: A hospital-based longitudinal observational study was conducted among 48 patients aged 40–65 years with age-related cataract undergoing SICS or phacoemulsification with IOL implantation at the Department of Ophthalmology, College of Medicine and Sagore Dutta Hospital, Kolkata, over 18 months. Results: Among 48 participants, IOP decreased from 19.54 mmHg pre-operatively to 15.96 mmHg at 1 month. ACA, AOD500, TISA500 and ACD progressively increased after surgery, demonstrating widening of the anterior chamber angle, expansion of the trabecular-iris space, and deepening of the anterior chamber. Conclusion: Cataract extraction with IOL implantation significantly modifies anterior chamber anatomy, resulting in deepening of the anterior chamber and widening of the anterior chamber angle. SD-AS-OCT is a useful, non-invasive imaging modality for objectively evaluating these anatomical changes and may provide valuable information regarding postoperative anterior segment configuration and angle-related risk. Keywords: Cataract, Anterior Chamber Angle, Spectral-Domain AS-OCT, Intraocular Lens, Anterior Chamber Depth.

Background: Childhood hypertension has emerged as an important public health concern because elevated blood pressure during childhood frequently tracks into adulthood and increases the risk of cardiovascular disease. Increasing body mass index (BMI) has been recognized as an important determinant of childhood blood pressure. This study evaluated the blood pressure profile of school children and its association with BMI. Materials and Methods: A school-based cross-sectional study was conducted among 1,000 apparently healthy children aged 9–15 years from four randomly selected schools near Academy of Medical Sciences, Pariyaram, Kerala, India. Anthropometric measurements, including height, weight, waist circumference, hip circumference, and BMI, were recorded using standardized techniques. Blood pressure was measured using a mercury sphygmomanometer according to the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Associations between blood pressure, BMI, age, and sex were analyzed using independent t-test, one-way ANOVA, Pearson's correlation, and multiple linear regression. A p-value <0.05 was considered statistically significant. Results: Among the participants, 545 (54.5%) were boys and 455 (45.5%) were girls. Mean systolic blood pressure increased from 87 mmHg at 9 years to 109 mmHg at 15 years, while mean diastolic blood pressure increased from 53 mmHg to 70 mmHg. Both systolic and diastolic blood pressure showed significant age-related variation (ANOVA, p<0.001). Obesity prevalence was higher among boys (10%) than girls (5%). BMI demonstrated a significant positive association with blood pressure, with higher BMI categories showing increased prevalence of elevated blood pressure (p<0.001). Conclusion: Blood pressure increases progressively with age and is significantly associated with increasing BMI among school children. Simultaneous assessment of BMI and blood pressure during school health screening provides an effective strategy for early identification of children at increased cardiovascular risk. Lifestyle interventions focusing on healthy diet and regular physical activity should be initiated early to prevent future hypertension. Keywords: Blood pressure, body mass index, childhood hypertension, obesity, school children, cardiovascular risk.

Background: Insulin resistance plays an important role in the development of metabolic disorders, including type 2 diabetes mellitus, obesity, dyslipidaemia, and cardiovascular disease. The triglyceride–glucose (TyG) index is a simple and cost-effective surrogate marker that can be calculated using fasting plasma glucose and serum triglyceride levels. Aim: To evaluate the association between the TyG index and metabolic risk factors among adults attending a hospital. Materials and Methods: A hospital-based cross-sectional observational study is conducted among 140 adults with one or more metabolic risk factors at Malla Reddy Medical College for Women, Hyderabad. Demographic, clinical, anthropometric, and biochemical parameters were assessed. The TyG index is calculated using fasting plasma glucose and serum triglyceride levels. The association between the TyG index and selected metabolic parameters is evaluated using correlation and regression analyses. Results: The mean age of the study participants is 48.6 ± 12.1 years, and 55.7% were male. The mean body mass index is 28.1 ± 4.3 kg/m², and the mean TyG index is 8.78 ± 0.61. The mean TyG index increased progressively across glycaemic categories, from 8.31 ± 0.39 in participants with normal fasting glucose to 9.20 ± 0.55 in those with diabetes mellitus. Positive correlations were observed between the TyG index and BMI (r = 0.34), waist circumference (r = 0.39), fasting plasma glucose (r = 0.61), and triglyceride levels (r = 0.74). HDL cholesterol showed a negative correlation (r = −0.28). In the multivariable regression analysis, BMI is positively associated with the TyG index (β = 0.025, p = 0.001). Conclusion: Our study demonstrated that the TyG index is associated with several anthropometric and biochemical markers of metabolic risk. Its simplicity and reliance on routinely available laboratory investigations suggest that it may be a useful adjunct for metabolic risk assessment. Keywords: Triglyceride–glucose index; insulin resistance; metabolic risk; fasting glucose; triglycerides; cross-sectional study.

Background: Emergency laparotomy is associated with significant postoperative morbidity, mortality, and prolonged hospitalization. Identifying factors associated with prolonged hospital stay may help in early risk stratification, perioperative optimization, and effective utilization of hospital resources. The aim is to identify the preoperative, intraoperative, and postoperative factors predicting prolonged hospital stay following emergency laparotomy. Materials and Methods: A prospective observational study was conducted among 356 adult patients undergoing emergency laparotomy at a tertiary-care hospital. Demographic, clinical, laboratory, intraoperative, and postoperative variables were recorded prospectively. Prolonged hospital stay was defined as a postoperative stay of more than 14 days. Patients were divided into prolonged-stay and non-prolonged-stay groups. Appropriate statistical tests were used for comparison, followed by multivariable logistic regression to identify independent predictors of prolonged hospitalization. A p-value <0.05 was considered statistically significant. Results: Of the 356 patients, 102 (28.7%) had a prolonged hospital stay. Prolonged hospitalization was significantly associated with age ≥60 years, higher ASA grade, preoperative sepsis, hypoalbuminemia, peritoneal contamination, bowel resection, operative duration >2 hours, blood transfusion, and postoperative complications. On multivariable logistic regression, ASA III/IV, preoperative sepsis, hypoalbuminemia, operative duration >2 hours, and postoperative complications were identified as independent predictors of prolonged hospital stay. Postoperative complications showed the strongest association with prolonged hospitalization. Conclusion: Prolonged hospital stay is common following emergency laparotomy and is influenced by multiple perioperative factors. Early recognition of high-risk patients, timely management of sepsis and physiological abnormalities, nutritional optimization, appropriate operative planning, and prevention and early treatment of postoperative complications may help reduce hospitalization and improve outcomes. Keywords: Emergency laparotomy; prolonged hospital stay; predictors; postoperative complications; sepsis; hypoalbuminemia; ASA grade.

Background: Diabetic retinopathy and diabetic kidney disease are important microvascular complications of type 2 diabetes mellitus (T2DM). Optical coherence tomography angiography (OCTA) allows non-invasive assessment of retinal microvascular changes which may be associated with renal involvement. Objective: To systematically review the association between retinal microvascular parameters assessed using OCTA and albuminuria in patients with T2DM. Materials and Methods: A systematic literature search was conducted in PubMed and Scopus for studies published between October 2023 and June 2026. Observational studies reporting direct associations between quantitative retinal OCTA parameters and urinary albumin measurements were considered. The findings were compared according to OCTA parameters, retinal regions and reported statistical associations. Results: The search identified 112 unique records. Five studies were assessed using available full texts, while one additional study contributed abstract-only evidence. Increased albuminuria was generally associated with reduced superficial and deep capillary plexus vessel density, greater retinal non-perfusion and changes in foveal avascular zone parameters. Liu et al. reported negative correlations of urinary albumin-to-creatinine ratio (UACR) with superficial (r = −0.56) and deep capillary plexus vessel density (r = −0.54). Significant associations were also reported for macular perfusion and peripapillary capillary density. The strength of association varied according to retinal region, severity of diabetic retinopathy and statistical adjustment. Conclusion: Retinal microvascular changes assessed using OCTA showed an association with albuminuria in patients with T2DM. OCTA may provide additional information regarding diabetic microvascular involvement. Further prospective studies with standardised measurements are required to establish its clinical utility. Keywords: Type 2 diabetes mellitus; Optical coherence tomography angiography; Albuminuria; Diabetic kidney disease; Retinal microvasculature; Urinary albumin-to-creatinine ratio.

Background: The outcome of tympanoplasty in patients with chronic otitis media (COM) is influenced by several patient- and disease-related factors. The Middle Ear Risk Index (MERI) is a validated prognostic scoring system that incorporates multiple clinical variables to predict surgical outcomes. However, evidence regarding its predictive value in the Indian population remains limited. To evaluate the role of the Middle Ear Risk Index in predicting anatomical and functional outcomes following tympanoplasty in patients with chronic otitis media. Materials and Methods: This prospective observational study included 100 consecutive patients with chronic otitis media who underwent tympanoplasty with or without cortical mastoidectomy at a tertiary care teaching hospital between June 2025 and May 2026. Preoperative MERI scores were calculated for all patients and categorized as mild (1–3), moderate (4–6), or severe (≥7). Anatomical success was defined as an intact tympanic membrane at three months postoperatively. Functional outcome was assessed using postoperative pure-tone average (PTA) and air–bone gap (ABG). Results: The mean MERI score was 2.76 ± 1.58. Mild, moderate, and severe MERI scores were observed in 72%, 27%, and 1% of patients, respectively. Overall graft uptake at three months was 78%. Anatomical success was achieved in 84.7% of patients with mild MERI scores compared with 63.0% of those with moderate MERI scores, while the patient with a severe MERI score experienced graft failure. More than 10 dB hearing improvement was observed in 61.1% of patients with mild MERI scores compared with 40.7% of patients with moderate MERI scores. Smokers demonstrated lower graft uptake than non-smokers (33.3% vs. 82.4%). Conclusion: Lower MERI scores were associated with better graft uptake and greater postoperative hearing improvement following tympanoplasty. The MERI is a practical and reliable preoperative prognostic tool that can facilitate patient counselling, surgical planning, and outcome prediction in chronic otitis media. Keywords: Chronic Otitis Media; Tympanoplasty; Hearing Loss; Prognosis; Risk Assessment; Treatment Outcome.

Background: Emergency abdominal surgery is associated with substantial postoperative morbidity and mortality. Patients frequently present with sepsis, haemodynamic instability, advanced intra-abdominal pathology, and organ dysfunction. Early identification of patients at increased risk may facilitate timely resuscitation, appropriate surgical management, and postoperative critical care. This study evaluated early clinical, laboratory, and perioperative predictors of morbidity and mortality following emergency abdominal surgery. Materials and Methods: A prospective observational cohort study was conducted in the Department of General Surgery, Dr Ulhas Patil Medical college, Jalgaon, Maharashtra, India, over a period of 2 years. A total of 30 consecutive adult patients undergoing emergency abdominal surgery were included. Demographic characteristics, duration of symptoms, comorbidities, haemodynamic parameters, preoperative sepsis and shock, and laboratory investigations were recorded. Intraoperative variables including operative diagnosis, peritoneal contamination, bowel resection, operative duration, and intraoperative hypotension were documented. Patients were followed until hospital discharge or death for postoperative complications, ICU admission, mechanical ventilation, reoperation, length of hospital stay, and in-hospital mortality. Associations between potential predictors and postoperative outcomes were assessed using appropriate statistical tests, with p<0.05 considered statistically significant. Results: Of the 30 patients, 20 (66.7%) were male and 10 (33.3%) were female. Postoperative morbidity occurred in 14 (46.7%) patients, while 5 (16.7%) patients died during hospitalisation. Tachycardia, hypotension, preoperative sepsis, total leukocyte count >15,000/mm³, serum creatinine >1.5 mg/dL, and serum lactate >2 mmol/L were significantly associated with postoperative morbidity. Generalised peritonitis, bowel resection, operative duration >2 hours, and intraoperative hypotension were also significantly associated with morbidity. Preoperative shock was strongly associated with mortality (p<0.001). Preoperative sepsis (p=0.045), tachycardia (p=0.041), elevated serum lactate (p=0.048), and intraoperative hypotension (p=0.030) were significantly associated with mortality. ICU admission was required in 12 (40.0%) patients and mechanical ventilation in 6 (20.0%). Conclusion: Emergency abdominal surgery carries a substantial risk of postoperative morbidity and mortality. Early markers of physiological deterioration, particularly shock, sepsis, tachycardia, hypotension, renal dysfunction, and elevated serum lactate, may help identify high-risk patients. Prompt resuscitation, timely source control, and appropriate postoperative critical-care monitoring may improve risk stratification and perioperative management. Larger prospective multicentric studies are required to validate these predictors. Keywords: Emergency abdominal surgery; postoperative morbidity; mortality; predictors; sepsis; shock; serum lactate; emergency laparotomy.

Background: Acute ischemic stroke is a time-critical neurological emergency in which rapid differentiation of irreversibly infarcted tissue from potentially salvageable ischemic penumbra is essential for treatment selection. Conventional non-contrast computed tomography (NCCT) and CT angiography (CTA) provide important structural and vascular information, while CT perfusion (CTP) enables quantitative assessment of cerebral hemodynamics and tissue viability. The present study evaluated the diagnostic utility of CTP in differentiating reversible and irreversible cerebral ischemia in acute ischemic stroke. Materials and Methods: A prospective observational study was conducted in the Department of Radiology, Khaja Banda Nawaz Institute of Medical Sciences, Kalaburagi, Karnataka. Fifty adult patients with clinically suspected or radiologically confirmed acute ischemic stroke who underwent NCCT, CTA and CTP were included. CTP maps for cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and time to maximum of the residue function (Tmax) were assessed. Ischemic-core volume, hypoperfused tissue volume, penumbral volume, mismatch volume and mismatch ratio were recorded. Baseline neurological severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and functional outcome was assessed using the modified Rankin Scale (mRS) at 30 days. Diagnostic performance was evaluated using sensitivity, specificity and area under the receiver operating characteristic curve (AUC). Results: The mean age of patients was 61.8 ± 11.4 years, with males comprising 64.0% of the study population. Hypertension was the most common vascular risk factor (62.0%). Large-vessel occlusion was identified on CTA in 56.0% of patients. The mean ischemic-core volume was 32.6 ± 27.8 mL, while the mean hypoperfused tissue and penumbral volumes were 86.4 ± 52.1 mL and 53.8 ± 38.7 mL, respectively. A significant core–penumbra mismatch was observed in 54.0% of patients. Ischemic-core volume showed a significant positive correlation with baseline NIHSS (r=0.62, p<0.001) and 30-day mRS (r=0.59, p<0.001). Relative CBF <30% demonstrated 88.9% sensitivity, 90.2% specificity and an AUC of 0.91 for identifying irreversible ischemic core. Combined CTP assessment demonstrated an AUC of 0.94. Conclusion: CT perfusion demonstrated good diagnostic utility in differentiating potentially reversible ischemic penumbra from irreversible ischemic core in acute ischemic stroke. Integration of CTP with NCCT and CTA may provide valuable tissue-based information for rapid assessment, prognostication and treatment selection. Keywords: Acute ischemic stroke; CT perfusion; ischemic core; ischemic penumbra; cerebral blood flow; Tmax; CT angiography.

Background: LASER (Light Amplification by Stimulated Emission of Radiation) has been widely used in medicine for decades. The CO₂ LASER provides precise tissue excision with excellent haemostasis through absorption of tissue water, making it useful for excision of benign, premalignant, and malignant oral lesions. The aim & objective is to assess the clinical outcomes of CO₂ LASER excision in various oral lesions and evaluate the spectrum of oral lesions presenting to a tertiary care centre in Assam. Materials and Methods: A prospective observational study conducted over 1 year among 54 patients aged ≥12 years undergoing CO₂ LASER excision for oral lesions. Detailed history, clinical examination, intraoperative findings, postoperative assessment, and follow-up at 1, 3, 12 months were recorded and analysed. Results: The study showed male preponderance with a mean age of 42.48±18.86 years. Leukoplakia, verrucous carcinoma, papilloma, pyogenic granuloma were the most common lesions. Most procedures (62.96%) were completed within 10 minutes. Intraoperative bleeding was absent in 78% of cases, and only 12.96% required suturing. Mean postoperative pain score was low (VAS 2.4). Postoperatively, 96.3% had no bleeding or oedema & none had scarring or pigmentation. 92.59% patients were discharged on the same day and 91% resumed a routine diet within 1 week. One surgical site infection & two verrucous carcinoma and one leukoplakia recurrence were noted. Conclusion: CO₂ LASER excision is a safe and effective modality for oral lesions, offering minimal bleeding, less postoperative morbidity, and faster recovery. Keywords: Oral lesions, CO2 LASER.

Background: Historically, infections have been acknowledged as a significant contributor to mortality in diabetes and continue to be a crucial factor in morbidity and mortality. This is especially accurate in underdeveloped nations and regions, where infections frequently serve as the initial indication of previously undiagnosed diabetes. The study aimed to assess the pattern and clinical profile of infections occurring among patients with diabetes mellitus, determine the correlation between glycaemic control and the occurrence of infections, and evaluate the outcomes of various infections in the diabetic population. Materials and Methods: This hospital-based observational cross-sectional study was conducted in the Department of Medicine, North Bengal Medical College, Darjeeling, from May 2018 to April 2019, among a total of 200 patients with diabetes mellitus. Results: Among 200 participants, most were aged 50–60 years, male, urban residents, and had type 2 diabetes mellitus. Fever was the predominant clinical feature, while LRTI and SSTI were common infections. Sepsis showed the highest mean TLC, with a statistically significant difference across infection types (p<0.001). Most radiological findings were normal, while consolidation was the commonest chest X-ray abnormality. Conclusion: We concluded that infections in patients with diabetes mellitus showed a diverse clinical spectrum, predominantly involving fever, respiratory and skin infections. Type 2 diabetes and diabetic complications were common. TLC varied significantly across infection syndromes, with highest values in sepsis. Early diagnosis, appropriate investigation, and timely management are essential for improving outcomes. Keywords: Diabetes mellitus, Infections, Glycemic control, Diabetic complications.

Background: Heel bone fractures make up around 2% of all fractures seen in orthopaedic practice. Among these, the displaced intra-articular type is the most serious. It damages the joint surface inside the calcaneum. This can lead to lasting pain, difficulty walking, and problems with footwear. Whether surgery gives better results than non-operative care is still a debated topic. Most published data come from high-income countries, and local evidence from Pakistan is limited. The objective is to compare radiological and functional outcomes in patients treated operatively versus non-operatively for displaced intra-articular calcaneal fractures. Study Design Prospective comparative study. Duration and Place of Study This study was conducted at Ghulam Muhammad Mahar Medical College Hospital Sukkur from August 2025 to August 2026 Materials and Methods: We enrolled 78 patients who had a total of 80 displaced intra-articular calcaneal fractures. Two patients had bilateral fractures. Patients were divided into an operative group (Group A, 40 fractures) and a non-operative group (Group B, 40 fractures). We obtained ethical approval before starting the study. Fractures were graded using the Sanders classification system, which is based on CT scan findings. We used four main outcome measures. These were the AOFAS ankle-hindfoot score, Böhler’s angle, Gissane angle, and time to radiographic union. For comparing groups, we used independent samples t-tests and chi-square tests. A p-value below 0.05 was taken as significant. Results: In Group A, Böhler’s angle was better restored after surgery (mean 21.06° versus 17.5°; p=0.0012). The mean AOFAS score was also higher in Group A (84.2 versus 79.4; p=0.016). Time to bone union was similar in both groups (10.1 versus 10.6 weeks; p=0.33). Excellent or good AOFAS outcomes were seen in 77.5% of operated patients compared with 42.5% in the conservative group. Conclusion: Surgery gave better radiological and functional outcomes in this study. However, the results must be read carefully. There was an imbalance in fracture severity between the two groups. Follow-up was also relatively short. The choice to operate should be made on a case-by-case basis. Keywords: Calcaneus fractures; intra-articular fracture; open reduction and internal fixation; non-operative treatment; AOFAS score; functional outcome; Sanders classification.

Background: Ageing is a universal process. The Common medical problems elderly people suffer from include cardiovascular, musculoskeletal, visual, and gastrointestinal diseases etc. The objectives of the present study were to estimate the prevalence of most common medical health problems and their patterns among the study subjects and to assess the relationship between socio-demographic factors and the medical health problems. Materials and Methods: A Community based Cross sectional study was conducted in rural field practice of study area. A sample of 614 persons aged 60 years and above residing in the study area was taken. Simple Random Sampling was done to select the sub centre and population. Results: Majority 449(73.1%) were in the age group of 60 – 69 years. The most common morbidities reported were Musculoskeletal, Visual, Cardiovascular and Dental problems. Age was found to be significantly associated with musculoskeletal, visual, cardiovascular, genitourinary problems and Diabetes mellitus. Gender was found to have significant association with musculoskeletal problems. Conclusion: Musculoskeletal, visual, cardiovascular, genitourinary problems and Diabetes mellitus were common among the elderly population. This can be reduced by regular screening for non - communicable diseases and consuming nutritious, low calorie and fiber rich diet. Inculcating healthy life style practices life walking, yoga and meditation will be helpful. Keywords: Ageing, Geriatrics, Health problems, Rural area

Background: Abdominal tuberculosis remains a significant diagnostic and therapeutic challenge in developing countries due to its varied clinical presentations and nonspecific symptoms. It can involve the peritoneum, gastrointestinal tract, lymph nodes, and solid abdominal organs. Early diagnosis is essential to prevent morbidity and mortality. Case Presentation: We present a case series of four patients diagnosed with abdominal tuberculosis with different presentations. Two patients presented with ascites and chronic abdominal pain and were diagnosed with peritoneal tuberculosis through diagnostic laparoscopy and biopsy, followed by successful management with anti-tubercular therapy (ATT). One patient presented with features of intestinal obstruction due to ileocecal tuberculosis and underwent right hemicolectomy with histopathological confirmation. Another patient presented with ileal perforation and peritonitis, diagnosed intraoperatively during diagnostic laparoscopy and managed surgically. Conclusion: Abdominal tuberculosis can mimic several surgical and medical conditions. A high index of suspicion, combined with appropriate imaging, diagnostic laparoscopy, histopathology, and timely intervention, is critical for optimal outcomes. Keywords: Abdominal tuberculosis, Peritoneal tuberculosis, Ileocecal tuberculosis, Ileal perforation, Diagnostic laparoscopy, Anti-tubercular therapy.

Background: Aim: The purpose of the study was to estimate serum magnesium concentration and lipid profile in patients with type II diabetes mellitus without complications, diabetic nephropathy, and healthy controls, and to correlate serum magnesium with lipid profile in cases and controls. Materials and Methods: The study was done on 50 clinically diagnosed diabetic nephropathy; 50 Type II diabetics without complications; and 50 age & sex matched healthy controls. Serum Magnesium, Fasting Blood sugar (FBS), lipid profile and spot urine microalbumin were estimated. Data obtained was analyzed for Mean, standard deviation, ‘p’ value and ‘r’ value. Results: We observed highly significant decrease in magnesium (p <0.001) and dyslipidemia in diabetic nephropathy compared to diabetics without complications and controls. Conclusion: Hypomagnesaemia occurs in diabetics due to osmotic diuresis. Decreased Mg progresses the dyslipidemia in Diabetic nephropathy leading to further complications like CRF & coronary artery diseases. Keywords: Diabetic nephropathy, Dyslipidemia, Magnesium, Type II diabetes mellitus, Fasting blood sugar.

Background: Extubation fails in a clinically important minority of intensive care patients and is associated with longer stay and higher morbidity. Once conventional readiness criteria, including a rapid shallow breathing index (RSBI) below 105 breaths/min/L, have already been met, that index has less room to discriminate. Diaphragm ultrasound measures muscle function directly. We estimated the accuracy of diaphragm thickening fraction (DTF), diaphragm excursion (DE), RSBI, and a twelve-zone lung aeration score for extubation failure. Materials and Methods: This prospective observational diagnostic accuracy study was conducted in the intensive critical care unit of a teaching hospital and is reported to STARD 2015. Between August 2025 and February 2026, 50 adults who had been ventilated for more than 48 hours, and who met prespecified readiness criteria, underwent a 30- to 60-minute spontaneous breathing trial. At 30 minutes, RSBI, right-sided DE, DTF, and the lung aeration score were recorded. The team deciding on extubation was blinded to the ultrasound measurements. The reference standard was reintubation, or death, within 48 hours. Optimal cut-offs maximised the Youden index. Results: Extubation succeeded in 44 patients (88.0%) and failed in 6 (12.0%). Failure was associated with longer ventilation before extubation (7.8 ± 3.2 vs 4.4 ± 1.6 days), higher RSBI (81.2 ± 9.4 vs 52.4 ± 8.6 breaths/min/L), a higher lung aeration score (14.8 ± 2.5 vs 8.5 ± 3.6), lower DE (1.18 ± 0.21 vs 1.65 ± 0.24 cm), and lower DTF (25.4 ± 4.5% vs 42.8 ± 6.4%) (all p ≤ 0.002). For prediction of failure, DTF ≤ 32% gave sensitivity 83.3%, specificity 90.9%, positive predictive value 55.6%, negative predictive value 97.6%, and area under the curve 0.898 (95% CI 0.772–1.000). The areas under the curve were 0.875 for DE, 0.864 for RSBI, and 0.848 for the lung aeration score. Confidence intervals overlapped. Conclusion: Among patients who already met readiness-to-wean criteria, a DTF of 32% or less during the spontaneous breathing trial was the strongest point-estimate marker of extubation failure. A DTF above 32% argued against reintubation within 48 hours, but positive predictive values were modest and the failure group was small. The measurement should inform, not replace, the extubation decision. Keywords: Diaphragm Ultrasound, Diaphragm Thickening Fraction, Diaphragm Excursion, Lung Ultrasound, Extubation Failure, Mechanical Ventilation, Spontaneous Breathing Trial.

Background: Razor shaving of the operative site is still routine in many Indian surgical units, although international guidelines advise against it. Evidence specific to laparoscopic surgery, where incisions are small and port sites are few, is limited. We compared surgical site infection (SSI) after razor shaving 12 hours before surgery with no hair removal in clean laparoscopic procedures. Materials and Methods: This prospective randomised comparative study was conducted over 12 months at a tertiary teaching hospital in North India. Adults undergoing elective clean laparoscopic surgery were allocated by a computer-generated sequence to razor shaving the evening before surgery (Group A, n = 88) or no hair removal (Group B, n = 88). All patients received a prophylactic antibiotic 1 hour before and after surgery (two doses) and povidone-iodine skin preparation. A single investigator assessed wounds on postoperative days 7, 14 and 30 using the Southampton wound scoring system. The primary outcome was study-defined SSI, meaning any wound abnormality of Southampton grade I or higher within 30 days. Swabs from affected wounds were cultured. Results: Of 176 patients, 145 (82.4%) were women and 168 (95.5%) underwent laparoscopic cholecystectomy. Study-defined SSI occurred in 3 patients (1.7%; 95% CI 0.6–4.9%): 2 of 88 (2.3%) in the shaved group and 1 of 88 (1.1%) in the unshaved group (risk difference 1.1 percentage points, 95% CI −4.2 to 6.9; p = 1.00). All three events were Southampton grade I, detected on day 7, culture-negative and resolved by day 14. None had purulent discharge. No new SSI was recorded on day 14 or day 30. In an exploratory, unadjusted analysis, SSI was more frequent in patients with diabetes (2/10, 20.0%) than without (1/166, 0.6%; p = 0.008). Operating time did not differ between patients with and without SSI (p = 0.295). Conclusion: In clean laparoscopic surgery, no statistically significant difference in SSI was found between razor shaving and no hair removal. All events were minor. Because only three events occurred and the study was underpowered, the estimate is imprecise and does not exclude clinically meaningful differences. The findings are consistent with guideline advice against routine razor shaving and should be confirmed in a larger trial. Keywords: Surgical wound infection, Hair removal, Preoperative care, Laparoscopy, Cholecystectomy, Diabetes mellitus.

Background: Abnormal uterine bleeding (AUB) is one of the most common gynecological complaints encountered in women of all age groups and significantly impacts quality of life. Histopathological examination of the endometrium remains the gold standard for evaluating its underlying causes and directing management. The objective is to study the histopathological spectrum of endometrial lesions in patients presenting with abnormal uterine bleeding and study their age distribution. Materials and Methods: This is a retrospective study conducted in the Department of Pathology, MIMSR Medical College, Latur, over a period of 3 years from Sept 2022 to Sept 2025.The study included hysterectomy along with endometrial biopsy and curettage specimens obtained from patients presenting with AUB. Samples were fixed in 10% formalin, processed routinely, and stained with hematoxylin and eosin. The histopathological findings were analyzed and classified according to age groups. Results: A total of 136 cases were studied. The majority of cases were seen in the perimenopausal age group (41–50 years, 51.4%). Mean age was 45.2 years. Normal Cyclical endometrium was the most predominant histopathological pattern constituting 65 (47.7%) cases with proliferative being 48(35.2%) and secretory 17(12.5%). Next most common pathology was Endometrial hyperplasia with and without atypia with 26 (19.1%) cases. Other pathologies found were disordered proliferative endometrium (13.9%), Endometrial polyp (5.8%), Atrophic endometrium (5.1%), Endometrium with exogenous hormonal effects (2.9%) and chronic endometritis (2.2%). Endometrial carcinoma was identified in 4(2.2%) cases, predominantly in women> 50 years of age. It has been observed that, there was highly significant association between age group and histopathological diagnosis (p<0.01). Conclusion: The histopathological spectrum of AUB varies with age, with benign proliferative and hyperplastic changes being common in women < 50 years of age, and malignancy more prevalent in women > 50 years of age. Histopathological examination remains an indispensable diagnostic tool for identifying underlying pathology in AUB. Keywords: AUB, Pathology.

Background: Early prediction of severe acute pancreatitis (SAP) is essential to reduce morbidity and mortality through timely intervention. Several laboratory biomarkers and clinical scoring systems have been proposed, but their comparative performance remains an area of ongoing research. The aim is to compare the diagnostic performance of the Neutrophil-to-Lymphocyte Ratio (NLR), C-reactive Protein (CRP), and Bedside Index for Severity in Acute Pancreatitis (BISAP) score for early prediction of severe acute pancreatitis using the Computed Tomography Severity Index (CTSI) as the reference standard. Materials and Methods: This prospective observational study was conducted over a period of two years at Government Medical College, Jammu. A total of 110 adult patients diagnosed with acute pancreatitis were enrolled. NLR and CRP were measured within 24 hours of admission, and BISAP score was calculated using standard criteria. Contrast-enhanced computed tomography was performed after 72 hours to determine the CT Severity Index. Diagnostic performance was assessed using sensitivity, specificity, predictive values, diagnostic accuracy, and receiver operating characteristic (ROC) curve analysis. Results: Of the 110 patients, 32 (29.1%) had severe acute pancreatitis according to CTSI. Patients with severe disease demonstrated significantly higher NLR (12.9 ± 3.8 vs. 5.7 ± 2.1), CRP (182.4 ± 58.6 vs. 78.3 ± 34.2 mg/L), and BISAP score (3.5 ± 0.9 vs. 1.4 ± 0.8) compared with non-severe cases (p<0.001). BISAP score showed the highest diagnostic accuracy (89.1%) and area under the ROC curve (AUC=0.931), followed by NLR (84.5%, AUC=0.914) and CRP (80.0%, AUC=0.872). Elevated values of all three parameters were significantly associated with pancreatic necrosis, organ failure, intensive care unit admission, and mortality. Conclusion: NLR, CRP, and BISAP score are effective early predictors of severe acute pancreatitis. Among these, the BISAP score demonstrated the best overall predictive performance, while NLR provided comparable accuracy as a simple and inexpensive laboratory marker. Their combined use may facilitate early risk stratification and improve clinical management of patients with acute pancreatitis. Keywords: Acute pancreatitis, Severe acute pancreatitis, Neutrophil-to-lymphocyte ratio, C-reactive protein, BISAP score, CT Severity Index, Prognosis.

Background: Galeazzi fracture dislocation is an unstable fracture dislocation of forearm in which fracture occurs at middle to distal 1/3rd of radius with DRUJ subluxation or dislocation. Materials and Methods: The present prospective study was conducted on adults with Galeazzi fracture from May 2022 to January 2024. They were clinically and radiographically assessed for functional outcome as well as union, distal radioulnar joint stability. 25 patients were treated with open reduction with internal fixation by plating and followed up for 9-12 months. Results: Out of 25 patients, 16 patients (64%) had fracture of radius within 7.5 cm of the articular surface. Average injury to surgery time is 3.5 days. Average post operative hospital stay period is 4 days. No case had DRUJ laxity. Average Time for bony union is 17.4 weeks. There is no malunion, delayed union, non-union case in our study. Functional Status is regained by 14 weeks. 60% Patient had Good outcome & 40% have Fair outcome as per DASH score. Conclusion: Rigid Anatomical fixation of radius with stability of DRUJ & immobilisation for 6 weeks followed by physiotherapy is key to success in Galeazzi fracture. Proper education and counselling for surgical management plays an important role in treating tribal population. Postoperative Immobilisation should be followed specifically for Tribal population to prevent early weight lifting. Keywords: Galeazzi fracture Dislocation, Distal radioulnar joint

Background: Diabetes self-management and medication adherence are central to long-term glycemic care, but may be difficult to sustain in communities facing socioeconomic and health-service constraints. Objective: To assess diabetes knowledge, self-management practices and medication adherence and examine their relationship with glycemic control among adults with type 2 diabetes mellitus in an urban slum. Materials and Methods: A descriptive cross-sectional study was conducted among 200 adults with type 2 diabetes mellitus attending an Urban Health Training Centre in Maharashtra. Diabetes knowledge was assessed using the ICMR-INDIAB knowledge questionnaire, self-management using the Diabetes Self-Management Questionnaire (DSMQ), and medication adherence using an eight-item questionnaire. Glycaemic status was assessed using recorded HbA1c. Associations were examined using Pearson chi-square statistics with conditional Monte Carlo testing for sparse tables, and Kruskal–Wallis comparisons. Estimates were presented with 95% confidence intervals. Results: Moderate glycaemic control was present in 149/200 participants (74.5%; 95% CI 68.0–80.0), good control in 21 (10.5%), and poor control in 30 (15.0%). The mean DSMQ sum score was 5.75 (SD 1.32; 95% CI 5.57–5.93). Low medication adherence was reported by 99 participants (49.5%; 95% CI 42.6–56.4), medium adherence by 86 (43.0%), and high adherence by 15 (7.5%). Knowledge category was associated with HbA1c category (χ²=25.40; Monte Carlo p=0.0022). Healthcare-use scores differed across glycaemic groups (p=0.042); other DSMQ domains and the sum score did not. Medication adherence was associated with HbA1c category (χ²=140.31; Monte Carlo p<0.001). Conclusion: Low medication adherence and gaps in diabetes knowledge were common. Knowledge and adherence categories were associated with glycaemic control, whereas most self-management domains were not. Community diabetes services should integrate education and self-management support with assessment of medication barriers and continuity of medicine supply. Keywords: Type 2 diabetes mellitus; diabetes self-management; medication adherence; diabetes knowledge.

Background: Maternal health, encompassing the health of women during pregnancy, childbirth, and the postpartum period, is significantly impacted by factors such as education, economic status, and out-of-pocket expenditure (OOPE). OOPE, defined as direct payments made by individuals when receiving healthcare, can create a substantial financial burden, especially for poor households.[1] Aim & objectives: To assess the out-of-pocket expenditure in antenatal care & its determinants in recently delivered women in rural Maharashtra. Materials and Methods: A community-based cross-sectional study was conducted over a period of 6 months in six randomly selected villages under PHC Bhavthana, Ambajogai, Maharashtra. Using multistage stratified random sampling, we selected 425 mothers who had delivered within the previous six months from ASHA/ANM records or identified through house-to-house surveys. We calculated the sample size assuming a 50% prevalence of out-of-pocket expenditure, a 95% confidence level, 5% absolute precision, and a 10% non-response rate. Results and Conclusion: In the present study, the median total out-of-pocket expenditure (OOPE) for antenatal care was ₹5,800 (IQR: ₹3,750–₹7,400), ranging from ₹1,200 to ₹11,900. Among direct expenses, ultrasound scans accounted for the highest median expenditure (₹2,500), followed by medicines and supplements (₹1,800), laboratory tests (₹600), and consultation fees (₹400). Transportation was the main indirect expense, with a median of ₹500, while informal payments were negligible (median ₹0). High OOPE was significantly associated with maternal education, husband's education, husband's occupation, and BPL card status (p=0.05). Keywords: Out-of-Pocket expenditure, Antenatal care, Maternal health.

Background: Aims: To study and analyse the post operative complications in the patients who have undergone Endovenous laser therapy for the treatment of varicose veins. To study the duration of the procedure and the length of stay in the hospital. To analyse early post operative complications. Materials and Methods: After institutional ethics committee approval and informed consent from participants, a prospective study was conducted in General surgery department of Rajarajeswari Medical College and Hospital over a period of 18 months on 30 patients s who have undergone Endovenous Laser Ablation for varicose veins. Results were analysed and compared. Results: The majority of patients were in the 31–40 years age group, accounting for 46.7% of the study population. Around 60% of the study population were males. Smoking was the most common riskfactor. The great saphenous vein was most commonly involved, seen in 83.3% patients. Most patients belonged to CEAP class 6 followed by CEAP class 5. The most common complication was pain, bruising, and tightness, reported by 26.7% patients. Follow-up findings in our study showed progressive ulcer healing. Conclusion: The present study highlights the demographic, clinical, and postoperative outcomes of patients undergoing treatment for chronic venous insufficiency, primarily through endovenous interventions. The majority of the affected population was middle-aged, with a male predominance. Diabetes mellitus and cardiovascular disease were the most frequent comorbidities, with smoking as major risk factor suggesting a link between systemic health conditions and venous pathology. Surgical intervention was associated with a relatively short operative duration and hospital stay, reflecting procedural efficiency and early recovery. Postoperative complications, though present, were generally mild and self-limiting. Keywords: Varicose veins, Endovenous laser ablation, Venous ulcer, Radiofrequency ablation, CEAP Classification, Telangiectasia, Lipodermatosclerosis.

Background: Medical students face unique psychological challenges in demanding clinical training environments. This study investigates how Big Five personality traits modulate their susceptibility to distress. Methodology: This cross-sectional study was conducted among undergraduate medical students at a Geetanjali Institute of Medical Sciences, Jaipur, Rajasthan (India) utilizing validated psychometric instruments to assess the prevalence of psychological morbidity using the Depression, Anxiety, and Stress Scale and the Big Five Inventory. Results: High rates of anxiety and depression were found. Neuroticism strongly predicted distress, whereas extraversion, agreeableness, and conscientiousness served as protective buffers. Conclusion: Findings highlight the need for early psychological screening and tailored support frameworks to protect student well-being. Keywords: Mental Health, Personality Traits.

Background: Open inguinal hernia surgery commonly uses spinal anaesthesia. Ropivacaine provides effective sensory and motor block, but block duration may be limited. Dexmedetomidine may improve block quality and analgesia. This study compared intrathecal ropivacaine alone with ropivacaine plus dexmedetomidine in patients. Materials and Methods: This prospective randomised comparative study included 100 patients at Velammal Medical College Hospital and Research Institute from December 2022 to November 2023. Group R received 3 ml of 0.75% hyperbaric ropivacaine with 0.1 ml normal saline, while Group RD received 3 ml ropivacaine with 10 mcg dexmedetomidine. Spinal anaesthesia was given at L3–L4 using a 25-gauge Quincke needle. Sensory and motor block, heart rate, blood pressure, mean arterial pressure, rescue analgesia, and adverse effects were recorded. Results: Age and weight were comparable with mean age 45.32 ± 4.43 versus 44.46 ± 4.23 years (P>0.05), and weight 53.52 ± 5.38 versus 53.42 ± 5.32 kg (P>0.05). Sensory onset was 4.12 ± 0.15 versus 3.30 ± 0.10 (P<0.005), and motor onset 5.10 ± 0.32 versus 4.20 ± 0.45 (P<0.001). Motor and sensory durations were 180.40 ± 24.3 versus 253.45 ± 24.2 and 196.40 ± 30.6 versus 275.34 ± 45.2 (P>0.05). Rescue analgesia was 205.35 ± 12.4 versus 295.35 ± 32.1 (P<0.001). MAP and heart rate showed P>0.05 through 120 minutes, P<0.001 at 150 minutes, and P<0.05 at 180 minutes. Side effects were P>0.05. Conclusion: Dexmedetomidine improved block onset and duration and delayed rescue analgesia, while haemodynamics remained generally stable without significant differences in adverse effects. Keywords: Ropivacaine; Dexmedetomidine; Spinal anaesthesia; Inguinal hernia; Sensory block; Motor block.

Background: Mentorship is one of the key factors of dental education that can potentially be a support to academic achievement, competency, professional development, and psychological well-being. Objective: To assess the relationship between mentorship with academic performance, clinical competency, professional confidence and psychological status of undergraduate dental students in Pakistan. Materials and Methods: A multi-centre study of analytical cross-sectional design was carried out with 550 undergraduate dental students using non-probability sampling technique of consecutive sampling. The participants were divided into two groups: mentored (305 participants) and non-mentored (245 participants). The measures of academic performance, clinical competency, professional confidence, and psychological distress were measured by GPA, clinical assessment scores, self-reported confidence rating, and DASS-21, respectively. Data were analysed by SPSS version 26, using the p value of < 0.05 as the level for statistical significance. Conclusions: Student outcomes in terms of academics and clinical practice were significantly better for students who were mentored compared to those who were not. Results: The percentages of GPA ≥3.5 was 48% versus 26% and ≥90 was 38% versus 15%, respectively (p < 0.001). Mentored students reported high or very high professional confidence at 78% while 31% of non-mentored students reported high or very high level of professional confidence. No more than 8% of mentored students experienced severe psychological distress compared to 24% of non-mentored students. A longer mentorship duration was seen to be correlated with increasingly higher scores in GPA, clinical competency and confidence. Conclusion: They found that mentorship participation was strongly correlated with positive academic, clinical, and psychosocial results, indicating the need to continue to investigate structured mentorship programs in undergraduate dental education. Keywords: dental education, mentorship, academic performance, professional development, students, curriculum.

Background: This study sought to investigate the connection between uncontrolled diabetes and periodontal disease in persons living in the Mardan region, KPK, Pakistan. Study design A cross-sectional study. Duration and palace of study. From May 2023 to October 2023 Department of Dentistry MMC Mardan, KPK, Pakistan. Materials and Methods: This study was conducted at the dentistry department of MMC Mardan, Pakistan. Using a random weighted sample, the May-Oct 2023 data safeguarded 1875 senior people who were at least 28 years old. Using a full-month oral examination at six locations according to tooth for periodontal probing depth and scientific attachment loss, we employed the Centres for Disease Control and Prevention/American Academy of Periodontology's popular to degree "PERIODONTAL DISEASES " status. We evaluated the player's diabetes popularity (no diabetes, diabetes with HbA1c < nine percent, and diabetes with HbA1c > 09%) using self-reported answers to the diabetes questionnaire and laboratory data of HbA1c. A study of multiple logistic regression was performed to examine the association between diabetes status and "PERIODONTAL DISEASES." Results: Among the 1875 victims after controlling for covariates, multiple logistic regression confirmed that "PERIODONTAL DISEASE" became significantly associated with both managed diabetes (adjusted odds ratio (OR) = 01.30, 09% confidence interval (CI): 01.01 - 01.70, p <0.05) and out-of-control diabetes (OR = "02.42, 90% CI: 01.50 - four.04, p <zero.001"). The preventive variables against "PERIODONTAL DISEASE" were college education, gender, and yearly dental visits for girls. The risk variables for "PERIODONTAL DISEASE" include included older age, racial minority, wages below 200 percent of the federal poverty level, and smoking reputation. Conclusion: Uncontrolled diabetes was extensively related to a better hazard of periodontal disorder amongst adults. Physicians must paintings with dentists to strongly endorse sufferers with diabetes to check their glycemic degree and feature an annual dental go to. Keywords: Adults’, periodontal disease, uncontrolled diabetes.

Background: Alopecia areata (AA) is an autoimmune condition characterized by hair loss, which frequently has adverse psychosocial effects. Janus kinase (JAK) inhibitors have proven to be promising therapies for patients with moderate to severe disease. Aim: To evaluate the pooled efficacy, relapse rate after discontinuation, and safety of JAK inhibitors in the treatment of AA. Materials and Methods: A PRISMA-compliant systematic review with meta-analysis was performed to assess the efficacy, relapse rate after discontinuation, and safety of JAK inhibitors in the treatment of AA. The literature search was conducted in PubMed/MEDLINE, Embase, Scopus, and CENTRAL in 2026 to identify relevant studies published between 2016 and 2026. The eligibility criteria were met by ten studies investigating the effect of oral and topical JAK inhibitors, including baricitinib, ritlecitinib, tofacitinib, and deuruxolitinib, which were examined in randomized and prospective clinical trials. Study-specific SALT50, SALT75, and SALT90 response rates, relapse after discontinuation, and adverse event (AE) incidence were extracted as primary outcome measures. Results: Oral JAK inhibitors demonstrated significant efficacy in achieving higher SALT response rates compared to placebo. The pooled analysis revealed that the most effective dosages were baricitinib 4 mg and deuruxolitinib 12 mg twice a day, while the discontinuation relapse rate was still notable at 54%. The majority of AEs reported in the studies were acne, increased CPK levels, and mild infections. Conclusion: The review and meta-analysis suggest that JAK inhibitors are highly effective in treating severe alopecia areata, with oral formulations showing better efficacy. However, the overall response sustainability after discontinuation remains a concern, and further research is needed to optimize treatment duration. The most frequent AEs were mild, which supports the tolerability of the medication in most patients. Keywords: Alopecia areata, JAK inhibitors, baricitinib, deuruxolitinib, ritlecitinib, SALT, meta-analysis.

Cardiovascular Diseases are the major cause of human morbidity and mortality worldwide including india.it is reported that coroneryartey ischaemia/reperfusion injury is known to occur during restoration of coronary blood flow after a period of myocardial ischaemia and triggers myocardial cell injury and necrosis. In addition apoptosis, inflammation, oxidative damage play important role in I/R injury progression, therefore the modulation of apoptosis, inflammation and oxidative damage and of related cascade responses must be consideredas a therapeutic strategy for treating cardiovascular disease. Keywords: Naringenin, ischaemia, rat heart, apoptosis

Background: Agricultural workers are exposed to organic and inorganic dusts, endotoxins, pesticides and fertilisers that can impair respiratory health. Field-based spirometric data from Indian farm workers remain limited. Objective: To compare forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, forced expiratory flow between 25% and 75% of FVC (FEF25–75) and peak expiratory flow (PEF) between agricultural workers and healthy controls with sedentary occupations. Materials and Methods: In this cross-sectional study, 250 male agricultural workers and 250 healthy male controls were enrolled at chittor district between 8am to 12pm. Anthropometric and cardiovascular parameters were recorded and spirometry was performed using a computerised spirometer (RMS Medspiror). Groups were compared using Welch’s t-test; p < 0.05 was considered significant. Results: Farm workers were older than controls (57.9 ± 8.3 vs 29.8 ± 7.6 years) and had higher body mass index and blood pressure (all p < 0.001). All spirometric indices were significantly lower in farm workers: FVC 1.55 ± 0.39 vs 4.22 ± 0.55 L, FEV1 1.07 ± 0.38 vs 4.27 ± 0.52 L, FEF25–75 0.92 ± 0.62 vs 6.82 ± 1.03 L/s and PEF 3.00 ± 1.10 vs 8.33 ± 1.17 L/s (all p < 0.001). The mean FEV1/FVC ratio in farm workers was 0.685 ± 0.127. Conclusion: Agricultural workers had markedly lower lung function than controls, with a pattern suggestive of airflow obstruction. Because the groups differed substantially in age, the findings should be confirmed using age-, height- and smoking-adjusted reference values. Periodic spirometric screening of farm workers is recommended. Keywords: Agricultural workers’ diseases; Occupational exposure; Organic dust; Respiratory function tests; Spirometry; India

Background: Gastro-oesophageal reflux disease (GERD) impairs quality of life, and a subset of patients remains refractory to optimal medical therapy. Laparoscopic fundoplication is an established operation, but outcome and satisfaction vary between centres. This study assessed clinical outcomes, complications, and patient satisfaction after laparoscopic fundoplication in a tertiary care centre. Materials and Methods: A retrospective observational study included 40 consecutive patients aged 15–65 years who underwent laparoscopic fundoplication for GERD between March 2023 and March 2026. Every patient had preoperative oesophageal manometry. A complete 360° Nissen fundoplication was used in the majority. Patients older than 60 years underwent a posterior 270° Toupet fundoplication with cruroplasty. Satisfaction was assessed with a standardized questionnaire. Results are reported as counts, percentages, and Wilson 95% confidence intervals. Results: The male-to-female ratio was approximately 60:40. Regurgitation and retrosternal burning were the predominant symptoms. Three patients (7.5%) presented mainly with cough and breathlessness. Satisfaction was achieved in 34 patients (85.0%; 95% CI 70.9–92.9). Persistent GERD symptoms occurred in 3 (7.5%; 95% CI 2.6–19.9) and intermittent bloating in 4 (10.0%; 95% CI 4.0–23.1). No patient developed postoperative dysphagia. One patient (2.5%) had early wrap migration and underwent re-laparoscopy with revision crural repair. One patient developed a paraoesophageal hernia at 6 months and underwent mesh repair. Two patients (5.0%; 95% CI 1.4–16.5) required reoperation. Conclusion: Laparoscopic fundoplication was safe and effective in this consecutive series, with high satisfaction and no recorded postoperative dysphagia. Routine manometry and a tailored wrap are a coherent explanation for that swallowing result. A small number of patients had persistent symptoms or required revision of the hiatus, which supports careful selection and structured follow-up. Keywords: Gastro-oesophageal reflux disease; Laparoscopic fundoplication; Nissen fundoplication; Toupet fundoplication; Surgical outcomes; Patient satisfaction; Complications.

Background: Early and objective assessment of disease severity and organ dysfunction is essential for prognostication and timely intervention in intensive care units. While several pediatric mortality prediction scores exist, many are admission-based and do not reflect the dynamic progression of organ dysfunction. The Pediatric Sequential Organ Failure Assessment (pSOFA) score is an age-adapted modification of the adult SOFA score and allows serial evaluation of organ dysfunction. This study was undertaken to assess the usefulness of the pSOFA score as an outcome predictor in children admitted to the PICU of a tertiary care hospital. Objectives: Primary Objectives: To evaluate the effectiveness of pediatric SOFA score in predicting the clinical outcome of critically ill children. Secondary objective: 1. To compare initial SOFA score and SOFA score at 48 hours in predicting the outcome 2. To compare delta SOFA score with the outcome. Materials and Methods: The pSOFA scoring system was applied at two time points: upon admission and after 48 hours, utilizing both clinical assessments and laboratory investigations. The change in pSOFA scores (delta pSOFA) was determined by calculating the difference between these two measurements. Patient outcomes were categorized as either survival to discharge or mortality. The discriminative capacity of the scoring system was evaluated through the construction of Receiver Operating Characteristic curves. Statistical associations were examined using Chi-square test, Fisher's exact test, and Mann–Whitney U test, with statistical significance defined as p < 0.05. Results: The study enrolled 150 pediatric patients, recording an overall mortality rate of 17% in the PICU setting. Non-survivors exhibited significantly elevated mean pSOFA scores upon admission when compared to survivors, with this disparity becoming more substantial at the 48-hour assessment point. A significant positive correlation was observed between the mean change in pSOFA scores and mortality outcomes. The pSOFA score at 48 hours displayed excellent predictive discriminative capacity for mortality risk, achieving an area under the ROC curve value of 0.99 with a cut off >8. Among the SOFA score components, Serum creatinine is considered the best predictor. Conclusion: The pediatric SOFA score is a reliable and effective tool for predicting outcomes in critically ill children admitted to the PICU. Higher pSOFA scores at admission and a high delta pSOFA are strongly associated with mortality. Serial assessment using pSOFA provides valuable prognostic information and may aid clinicians in early risk stratification, monitoring disease progression, and optimizing management strategies in pediatric intensive care settings. Keywords: pSOFA score, Organ dysfunction, Mortality prediction.

Background: Topical minoxidil is first-line therapy for female pattern hair loss (FPHL), but irritation, cosmetic inconvenience, and poor adherence limit long-term use. Low-dose oral minoxidil (LDOM) is increasingly used off label. The objective is to evaluate the efficacy and safety of LDOM in adult women with FPHL. Materials and Methods: PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane CENTRAL, ClinicalTrials.gov, and WHO ICTRP were searched for English-language studies published from January 2015 through December 2025. Randomized and nonrandomized studies evaluating oral minoxidil at doses <=5 mg/day were eligible. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Because of clinical and methodological heterogeneity, findings were synthesized narratively. Results: Nine studies were included: five contributed FPHL-specific efficacy evidence, and four mixed-population studies contributed indirect safety evidence only. Doses used in FPHL studies ranged from 0.25 to 2 mg/day, with follow-up generally lasting 24 weeks to 12 months. FPHL-specific studies reported improvements in hair density, hair-shaft diameter, hair shedding, and clinical appearance; comparative evidence did not establish superiority over topical minoxidil. Hypertrichosis was the most frequent adverse effect. Edema, dizziness, tachycardia, and postural symptoms were uncommon and usually mild. Evidence certainty was limited by small samples, heterogeneous regimens and outcomes, short follow-up, and reliance on observational data. Conclusion: Low-certainty evidence suggests that LDOM may improve hair outcomes and is generally tolerated in selected women with FPHL, particularly when topical minoxidil is ineffective, poorly tolerated, or impractical. Larger, longer, standardized randomized trials are required before routine first-line use can be recommended. Keywords: Female Pattern Hair Loss, Low-Dose Oral Minoxidil, Oral Minoxidil, Efficacy, Safety, Hypertrichosis, Systematic Review.

Background: Rabies is an almost invariably fatal but entirely preventable zoonotic disease, and appropriate wound management and post-exposure prophylaxis (PEP) delivered by knowledgeable healthcare providers are central to its prevention. Medical students are the physicians of the future, yet knowledge gaps regarding rabies epidemiology, prophylaxis and national guidelines have been reported among undergraduate medical (MBBS) students in India. This study assessed the effect of a structured educational intervention on rabies-related knowledge among third- and final-year MBBS students. Materials and Methods: A non-randomised, quasi-experimental study with a pre-test/post-test design and no control group was conducted among third- and final-year MBBS students at Dr. KNS Memorial Institute of Medical Sciences, Barabanki, Uttar Pradesh, from February to March 2025. A minimum sample size of 246 was calculated (Z = 1.96, p = 80%, e = 5%); 300 students were enrolled to allow for non-response and absence. A predesigned, pretested structured questionnaire administered via Google Forms assessed knowledge across nine domains before and after a one-hour structured educational intervention (a 40-minute interactive lecture and a 20-minute audiovisual demonstration/discussion). The same questionnaire was re-administered four weeks later. Pre- and post-intervention overall knowledge scores were compared using the Wilcoxon signed-rank test (paired analysis, n = 295), with effect size expressed as r = |Z|/√N; p < 0.05 was considered significant. Results: Of 300 students assessed at baseline, five final-year students were absent from the intervention and post-test, leaving 295 students (98.3%) in the paired analysis. Correct responses increased across all nine knowledge domains, with the largest gains in vaccination regimens (+48.1 percentage points), post-exposure prophylaxis (+47.8 percentage points) and animal-bite wound management (+46.8 percentage points). The proportion of students with good overall knowledge increased from 94 (31.9%) before the intervention to 235 (79.7%) afterward, while poor knowledge decreased from 88 (29.8%) to 13 (4.4%). The mean overall knowledge score rose from 15.2 ± 3.8 to 23.1 ± 3.4 (Wilcoxon signed-rank test, Z = −14.04, p < 0.001), corresponding to a large effect size (r ≈ 0.82). Conclusion: A brief, structured one-hour educational intervention was associated with a substantial improvement in rabies-related knowledge among third- and final-year MBBS students across all nine assessed domains. These findings support the incorporation of focused, structured teaching sessions on rabies prevention and management into undergraduate medical curricula, although the single-group pre-test/post-test design without a control group limits causal inference and durability of the effect could not be assessed. Keywords: Rabies; Knowledge; Educational intervention; Medical students; MBBS; Post-exposure prophylaxis; Pre-test post-test study.

Background: Diabetic kidney disease is a major microvascular complication of type 2 diabetes mellitus (T2DM), associated with increased morbidity and progressive renal dysfunction. The triglyceride-glucose–body mass index (TyG-BMI) is an emerging surrogate marker of insulin resistance that may help identify metabolic abnormalities associated with albuminuria and impaired renal function. The aim is to evaluate the association of TyG-BMI with albuminuria and estimated glomerular filtration rate (eGFR) among patients with type 2 diabetes mellitus. Materials and Methods: The present hospital-based observational cross-sectional study was designed to include 95 patients with T2DM attending a tertiary care hospital. Demographic characteristics, anthropometric measurements, glycemic parameters, lipid profile, serum creatinine, urinary albumin-to-creatinine ratio (UACR), and eGFR were assessed. TyG-BMI was calculated using the triglyceride-glucose index and BMI. Statistical analysis was performed using SPSS version 28.0, with p<0.05 considered statistically significant. Results: In the illustrative dataset, the mean age was 54.31 ± 10.71 years, and the mean TyG-BMI was 259.11 ± 34.89. Albuminuria was present in 62.11% of patients, while 23.16% had reduced eGFR. Albuminuria increased from 31.25% in the lowest TyG-BMI tertile to 81.25% in the highest tertile (p<0.001). TyG-BMI showed a positive correlation with UACR (r=0.575) and a negative correlation with eGFR (r=−0.699), both statistically significant (p<0.001). The areas under the ROC curve were 0.752 for albuminuria and 0.846 for reduced eGFR. Conclusion: Higher TyG-BMI was associated with increased albuminuria and reduced renal function in the illustrative analysis. TyG-BMI may serve as an inexpensive supplementary marker for renal risk assessment in patients with T2DM, subject to validation using actual clinical data. Keywords: Type 2 diabetes mellitus; Triglyceride-glucose–body mass index; Albuminuria; Estimated glomerular filtration rate; Diabetic kidney disease.

Background: Surgical site infection (SSI) remains a concern after abdominal surgery, including procedures performed laparoscopically. Obesity has been associated with postoperative infection, but evidence specific to laparoscopic abdominal surgery in Indian tertiary-care settings is limited. The objective is to assess the association between obesity and SSI after laparoscopic abdominal surgery. Materials and Methods: In this prospective observational study, 40 patients undergoing laparoscopic abdominal surgery at Velammal Medical College and Hospital, Madurai, between 1 December 2025 and 1 August 2026 were enrolled. Participants were classified as obese (BMI ≥ 25 kg/m²) or non-obese and monitored for 30 days. SSI was defined according to CDC/NHSN criteria. Between-group comparisons used Fisher's exact test and the independent t-test. Results: Of the 40 participants, 22 (55.0%) were obese. SSI developed in 7 participants (17.5%): 6 of 22 obese patients (27.3%) and 1 of 18 non-obese patients (5.6%). The estimated odds of SSI were higher in the obese group (OR 6.38, 95% CI 0.69–58.96), but the difference was not statistically significant (p = 0.105). Mean operative time was longer among obese than non-obese patients (78.4 ± 18.6 vs 64.2 ± 15.3 min, p = 0.013). Conclusion: SSI was observed more frequently in obese patients, but the difference did not reach statistical significance. The limited sample size and wide confidence interval warrant cautious interpretation. Keywords: Obesity, Surgical site infection, Laparoscopy, Body mass index, Postoperative complications.

Background: Sepsis is a life-threatening condition associated with systemic inflammation, multiple organ dysfunction, and increased mortality. Serial monitoring of C-reactive protein (CRP) and procalcitonin (PCT) may provide valuable information regarding disease progression, treatment response, and clinical prognosis. The aim is to evaluate the prognostic significance of serial CRP and PCT trends in predicting clinical outcomes and 28-day mortality among patients with sepsis. Materials and Methods: The study was designed as a prospective observational study involving 105 patients with sepsis at a tertiary care hospital. CRP and PCT concentrations were assessed on Days 1, 3, 5, and 7. Disease severity was evaluated using the Sequential Organ Failure Assessment (SOFA) score. Clinical outcomes included septic shock, organ dysfunction, mechanical ventilation, and 28-day mortality. Statistical analysis was planned using IBM SPSS Statistics version 27.0. Results: Of 105 patients, 76 (72.38%) survived and 29 (27.62%) died. Nonsurvivors had significantly higher baseline SOFA scores (8.00 vs. 6.00; p<0.001) and serum lactate concentrations (3.69 vs. 2.36 mmol/L; p<0.001). Baseline PCT concentrations were significantly higher among nonsurvivors (9.32 vs. 5.65 ng/mL; p=0.006). By Day 7, CRP concentrations were 116.31 mg/L among nonsurvivors compared with 45.54 mg/L among survivors (p<0.001). Day 7 PCT clearance was significantly greater among survivors (82.61% vs. 41.73%; p<0.001). Day 7 PCT clearance demonstrated excellent mortality discrimination (AUC=0.959), with sensitivity of 93.10% and specificity of 86.84%. Increasing age, higher SOFA scores, and reduced early PCT clearance were associated with mortality. Conclusion: Serial CRP and PCT monitoring, particularly PCT clearance, demonstrated potential prognostic utility in sepsis. These illustrative findings require validation using actual clinical data. Keywords: Sepsis; C-reactive protein; Procalcitonin; Biomarker clearance; Mortality prediction.

Background: Essential hypertension is a major cardiovascular risk factor requiring effective blood pressure control and preservation of renal function. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are widely prescribed antihypertensive agents, although differences in renal effects, electrolyte disturbances, and tolerability may influence treatment selection. Aim: To compare renal function, electrolyte abnormalities, blood pressure control, and adverse drug effects among patients receiving ACE inhibitors versus ARBs for essential hypertension. Materials and Methods: This hospital-based observational comparative study included 104 patients with essential hypertension at a tertiary care hospital. Patients were divided into two groups: Group A received ACE inhibitors (n=52), while Group B received ARBs (n=52). Demographic characteristics, blood pressure parameters, serum creatinine, estimated glomerular filtration rate (eGFR), electrolyte levels, and adverse drug effects were assessed. Statistical analysis was performed using IBM SPSS Statistics version 28.0, with p<0.05 considered statistically significant. Results: Mean systolic blood pressure was significantly lower in the ARB group (132.10 ± 12.10 mmHg) than in the ACE inhibitor group (137.80 ± 12.90 mmHg; p=0.022). Adequate blood pressure control was achieved in 76.92% of ARB users compared with 55.77% of ACE inhibitor users (p=0.037). Mean eGFR was 81.80 ± 17.40 and 76.50 ± 18.60 mL/min/1.73 m², respectively (p=0.137). Serum potassium was significantly higher among ACE inhibitor users (4.62 ± 0.48 versus 4.42 ± 0.44 mmol/L; p=0.029). Dry cough occurred in 23.08% and 3.85% of patients, respectively (p=0.008). Conclusion: ARBs were associated with better observed blood pressure control and fewer cough-related adverse effects than ACE inhibitors. Renal function differences were statistically insignificant. Individualized treatment and regular renal and electrolyte monitoring remain essential. Keywords: Essential Hypertension; ACE Inhibitors; Angiotensin Receptor Blockers; Renal Function; Electrolyte Abnormalities.

Background: Effective glycaemic management in hospitalized patients with type 2 diabetes mellitus is essential to minimize hyperglycaemia, glycaemic fluctuations, and hypoglycaemic complications. Basal-bolus and basal-plus insulin regimens are commonly employed approaches with different treatment intensities and safety profiles. Aim: To compare glycaemic variability, hypoglycaemic episodes, glycaemic control, and hospitalization outcomes among patients receiving basal-bolus versus basal-plus insulin regimens. Materials and Methods: The present prospective comparative observational study included 98 hospitalized patients with type 2 diabetes mellitus at a tertiary care hospital. Patients were divided into two groups: basal-bolus (n=49) and basal-plus (n=49). Demographic characteristics, glycaemic parameters, glucose variability, hypoglycaemic episodes, insulin requirements, and hospitalization outcomes were assessed. Statistical analysis was specified using SPSS version 28.0, with p<0.05 considered statistically significant. Results: In the illustrative dataset, mean blood glucose was significantly lower in the basal-bolus group compared with the basal-plus group (154.60 ± 20.80 versus 174.80 ± 23.60 mg/dL; p<0.001). The percentage of glucose readings within the target range was higher (68.50% versus 59.90%; p=0.001). However, the coefficient of variation was significantly greater in the basal-bolus group (26.50% versus 20.00%; p<0.001). Hypoglycaemic episodes occurred in 28.57% and 10.20% of patients, respectively (p=0.039). Hyperglycaemia above 180 mg/dL was observed in 63.27% and 81.63% of patients (p=0.042). Daily insulin requirements were significantly higher with basal-bolus therapy (p<0.001). Hospital stay did not differ significantly (p=0.264). Conclusion: Basal-bolus insulin provided better overall glycaemic control but was associated with greater glycaemic variability and increased hypoglycaemic episodes. Basal-plus insulin offered a simpler approach with reduced hypoglycaemic risk, emphasizing the importance of individualized inpatient insulin management. Keywords: Type 2 diabetes mellitus; Basal-bolus insulin; Basal-plus insulin; Glycaemic variability; Hypoglycaemia.

Background: Systemic inflammatory progression is central to the pathogenesis of chronic obstructive pulmonary disease (COPD) and accelerates significantly during acute flares. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been proposed as accessible, cost-effective biomarkers to screen for acute inflammation. However, widespread inconsistencies in mathematical unit scaling and multi-collinearity in diagnostic regression models limit their use in clinical screening. This study evaluated the comparative prognostic utility of admission NLR and PLR for predicting disease severity and in-hospital outcomes in patients presenting with an acute exacerbation of COPD (AECOPD). Materials and Methods: We conducted a prospective observational cross-sectional study among 153 consecutive adults aged ≥ 40 years admitted for AECOPD at Al-Falah School of Medical Sciences and Research Centre, Faridabad, India, between May 2024 and March 2026. Admission blood samples were processed via an automated 5-part hematologyanalyzer to calculate absolute leukocyte subsets and platelet counts. Exacerbation severity was categorized using the modified Medical Research Council (mMRC) dyspnea scale and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) definitions.Row-level master charts were re-analyzed to resolve unit scaling errors that distorted prior aggregate indices. Results: The study population (N = 153) had a mean age of 63.87 ± 10.01 years, with a high concentration of current or former smokers (69.3%) and a clear male predominance (75.8%). Severe AECOPD was identified in 73.9% of patients. The corrected mean admission NLR was 6.12 ± 3.08, and the corrected mean PLR was 188.42 ± 95.16. Using a fixed baseline NLR cut-off (≥ 5.6), 43.1% of patients were classified as having high NLR. On univariate analysis, categorical high NLR showed no significant association with exacerbation severity (P = 0.782), oxygen flow requirements (P = 0.328), intensive care unit (ICU) admission (P = 0.234), hospital length of stay (P = 0.665), or in-hospital mortality (P = 0.540). Similarly, receiver operating characteristic (ROC) analysis showed limited diagnostic accuracy for binary thresholds (NLR Area Under the Curve [AUC] = 0.435; Platelet Count AUC = 0.569). However, when adjusting for age, sex, and cardiovascular comorbidities in a stabilized multivariable logistic regression model that resolved cellular multi-collinearity, continuous baseline NLR emerged as a significant independent marker of severe AECOPD presentation (Wald χ² = 8.434, Odds Ratio [OR] = 1.34; 95% Confidence Interval [CI], 1.10–1.69; P = 0.004), alongside active smoking exposure (OR = 1.67, P = 0.017). Conclusion: Admission NLR is a low-cost, widely accessible inflammatory marker that provides valuable prognostic information on AECOPD disease severity when tracked along a continuous numeric index.Conversely, the clinical utility of PLR remains limited by population-specific shifts.These ratios should be used alongside objective clinical metrics rather than as standalone diagnostic tests. Key words: Chronic Obstructive Pulmonary Disease; Acute Exacerbation of

Background: Alcohol dependence affects millions of people, particularly men in India, and is associated with health-related, psychological, and social difficulties. Psychosocial factors, including expressed emotion and social support, may influence treatment outcomes: criticism may exacerbate these difficulties, whereas support may facilitate recovery. In India, the relationship between these factors and dependence severity, from patients' perspectives, remains insufficiently examined. Objectives: To assess the severity of alcohol dependence, perceived expressed emotion, and social support among patients with alcohol dependence syndrome, and to examine associations between expressed emotion and social support and dependence severity. Materials and Methods: We conducted a cross-sectional study of 100 patients with alcohol dependence at Government General Hospital, Vijayawada, using convenience sampling. We collected data using the ICD-11, SADQ, MSPSS, and FEICS. We used Spearman’s correlation and Kruskal–Wallis tests to assess associations and differences in expressed emotion and social support across levels of dependence severity. We set statistical significance at p < 0.05. Results: Among 100 male patients with alcohol dependence, 67% had severe or very severe dependence. Perceived criticism was weakly correlated with dependence severity (ρ = 0.220, p = 0.028), whereas emotional involvement was not significantly associated with severity. Overall perceived social support was not significantly associated with dependence severity (ρ = 0.087, p = 0.389). Family support showed a weak positive correlation (ρ = 0.198, p = 0.049); however, this finding should be interpreted cautiously given multiple comparisons. Conclusion: The study identified a weak positive association between dependence severity and perceived criticism. It found no significant associations with emotional involvement or overall social support. Family support showed a weak positive association, whereas support from friends did not. The cross-sectional design and multiple comparisons limit causal inference. These findings underscore the importance of assessing family emotional climate and social support in psychosocial evaluations. Key words: Perceived Expressed Emotion, Perceived Social Support, Severity of Alcohol Dependence.

Background: Intellectual disability (ID) is a neurodevelopmental disorder characterised by limitations in intellectual functioning and adaptive behaviour. It is often accompanied by comorbidities that exacerbate impairment and increase the caregiver burden. Parental consanguinity may increase the risk of autosomal recessive disorders that cause ID; however, its association with ID severity, comorbidities, and behavioural issues remains unclear. Objectives: To characterise parental consanguinity, intellectual disability severity, medical and psychiatric comorbidities, and behavioural problems; compare these outcomes by consanguinity history; and assess their associations with consanguinity. Materials and Methods: This cross-sectional study, conducted at Government General Hospital, Vijayawada, included 100 individuals aged 5 years and older with ID and their caregivers, selected by convenience sampling. We used the VSMS and the Aberrant Behaviour Checklist for assessment. We analysed the data using chi-square, Fisher–Freeman–Halton, and Mann–Whitney U tests. We reported effect sizes as Cramer's V and rank-biserial correlation. We set statistical significance at p < 0.05. Results: Of the 100 participants, 48% had parental consanguinity, 60% were male, 40% were aged 10 years or younger, and 58% belonged to a lower-middle socioeconomic group. Third-degree consanguinity was the most common (58.3%). Mild and moderate ID affected 51% and 43% of participants, respectively. ID severity was higher among participants with consanguinity (U=1508.5, p=0.043), although the categorical analysis was not statistically significant (χ²=5.046, p=0.080). We observed no significant associations between consanguinity and comorbidities. Conclusion: Participants with parental consanguinity tended to have greater ID severity, although the categorical analysis did not reach statistical significance. Consanguinity was not significantly associated with medical, psychiatric, or behavioural issues, suggesting that it may inform clinical assessment but does not determine severity or related features. Keywords: Intellectual Disability, Parental Consanguinity, Comorbidities, Behavioural Problems.

Background: India carries one of the world's largest diabetes burdens, and Kerala reports the highest state-level prevalence in the country. Foot complications are a major, often underestimated source of morbidity, disability and death in this population, yet prevalence data from Kerala outside specialised podiatry settings remain scarce. The objective is to determine the prevalence and clinical spectrum of diabetic foot complications and the associated mortality among adult diabetic patients at a tertiary care hospital in Kerala. Materials and Methods: We conducted a hospital record-based retrospective descriptive study in the Departments of General Medicine and General Surgery of Amala Institute of Medical Sciences, Thrissur, Central Kerala, over one year (January 2024 to January 2025). Records of 135 adult patients with type 1 or type 2 diabetes were reviewed using a predesigned proforma capturing demographics, anthropometry, glycaemic indices, comorbidities, foot findings, complications, amputation and mortality. Data were analysed in IBM SPSS v27.0; categorical variables were expressed as frequencies and percentages, and continuous variables as mean ± standard deviation. Results: Patients had a mean age of 60.9 ± 10.5 years, and 68.9% were male. Glycaemic control was poor (mean HbA1c 9.4 ± 2.7%), with a mean diabetes duration of 14.0 ± 9.4 years. Comorbidity was present in 80.7%, led by hypertension (58.5%), coronary artery disease (33.3%) and chronic kidney disease (29.6%). Foot ulcers were the commonest lesion (48.9%), followed by cellulitis (38.5%), gangrene (22.2%; predominantly wet), abscess (17.0%), osteomyelitis (2.2%) and necrotising fasciitis (1.5%). Amputation had been performed in 20.7% of patients, mostly at toe level. Mortality was 2.2%. Conclusion: Adult diabetic patients at this tertiary centre carried a heavy burden of foot complications and a substantial amputation rate, concentrated in older individuals with poor glycaemic control, long disease duration and multiple comorbidities. Mortality was low in this cross-section, but the underlying cardiovascular and renal risk profile was pronounced. The findings support routine foot screening, tighter metabolic control and structured patient education. Keywords: Diabetic foot; foot ulcer; amputation; diabetes mellitus; peripheral neuropathy; Kerala; tertiary care.

Background: Patient safety is a global priority and a key indicator of healthcare quality. Increasingly, patient participation is recognized as an essential component in enhancing patient safety and Quality of care provided. Rationale of the study: The purpose of this study is to determine the perceived patient safety related to health care during hospitalization. To understand the extent to which hospitalized patient’s participation in their care, and assess the association of patient’s participation with quality of care and patient safety. • The findings in this study will have several implications for quality improvement in the study areas in the hospital. Also, continuous assessment of patient safety culture in the study area could encourage the staff to report errors without being punished. • Such assessments are the foundation for quality improvement. These results will encourage research into a more explicit understanding of the issues and identification of strategies to address patient safety in health care. Objectives 1. To determine hospitalized patients’ perceptions of patient safety. 2. To assess the extent of patient participation in their care. 3. To evaluate the association between patient participation, quality of care, and patient safety. Materials and Methods: Ethics Committee approval is taken. A cross-sectional descriptive study was conducted among 345 inpatients at a tertiary care teaching hospital. A structured 27-item questionnaire (Items 1–5: Socio-demographic details, Items 6–20: Patient safety perception, Items 21–27: Patient participation) was administered to assess patient safety perception, and patient participation in care provided. Data was analysed using descriptive statistics. Results: Among 345 patients, 98.8% reported participation in at least one safety-related activity. High participation was significantly associated with favourable ratings of quality of care. About 27.8% strongly agreed that all safety measures were adequately met, while 0.5% strongly disagreed with certain safety aspects. Key perceived safety factors included time spent with senior doctors, proper signages, prompt handling of medical errors, and clear communication regarding treatment and adverse effects. • Participation: 98.8% (341 patients) reported participation in at least one safety-related activity. • High Participation: Strongly associated with better quality of care ratings. • Safety Perception: o 27.8% strongly agreed all safety measures were met o 0.5% strongly disagreed with selected safety parameters Conclusion: Patient participation plays a crucial role in enhancing perceived quality of care and patient safety. Strengthening communication, transparency, and patient engagement strategies can significantly improve safety culture in healthcare settings. Keywords: Patient safety, patient participation, quality of care, safety culture, hospitalized patients

Background: Eclampsia may be associated with neurological complications that require prompt evaluation. Computed tomography (CT) and magnetic resonance imaging (MRI) are commonly used to identify intracranial abnormalities in affected patients. This study aimed to assess CT and MRI findings in patients with eclampsia and examine their relationship with clinical presentation. Materials and Methods: This hospital-based study included 36 female patients with clinically confirmed eclampsia presenting during the antepartum, intrapartum, or postpartum period. All patients underwent both CT and MRI of the brain. Clinical symptoms and imaging findings were recorded and compared. The findings were summarized using frequencies and percentages. Results: Headache was the most common symptom, reported in 26 patients (72.2%), followed by recurrent seizures in 23 (63.9%) and visual complaints in 19 (52.8%). Both CT and MRI demonstrated positive findings in 26 patients, whereas both examinations were negative in 8 patients. In 2 patients (5.6%), CT findings were negative while MRI demonstrated abnormalities. No patient had positive CT findings with negative MRI findings. The overall agreement between the two modalities was 94.4%. Conclusion: Both CT and MRI contributed to the evaluation of patients with eclampsia. MRI demonstrated abnormalities in two patients whose CT examinations were negative, suggesting that it may provide additional information in selected cases. Further studies using an appropriate reference standard are required to establish the comparative diagnostic performance of the two modalities. Keywords: Eclampsia, computed tomography, magnetic resonance imaging, neurological manifestations, neuroimaging.

Background: Effective postoperative pain management is crucial for patients undergoing knee surgeries, facilitating early mobilization and recovery. Adductor canal block (ACB) provides sensory blockade with preservation of quadriceps strength. Ropivacaine, a long-acting local anesthetic, is commonly used in ACB. Adjuvants like dexamethasone and fentanyl citrate are added to prolong analgesia and improve block quality. Aims and Objectives: To compare the efficacy and duration of analgesia between Ropivacaine Hydrochloride with Dexamethasone versus Ropivacaine Hydrochloride with Fentanyl Citrate in adductor canal block for postoperative pain management in patients undergoing knee surgeries. Materials and Methods: This observational prospective comparative study was conducted on 60 patients undergoing knee surgeries under spinal anesthesia. Patients were divided into two groups: Group A (n=30) received 20ml of 0.2% Ropivacaine with 2ml Dexamethasone (total 22ml), and Group B (n=30) received 20ml of 0.2% Ropivacaine with Fentanyl Citrate 1mcg/kg diluted to 2ml (total 22ml). Postoperative pain was assessed using Visual Analogue Scale (VAS) at 0, 1, 2, 3, 4, 5, 6, 9, 12, 15, 18, 21, and 24 hours. Time to first rescue analgesia, total analgesic requirements, complications, and patient satisfaction were recorded. Results: Duration of analgesia was significantly longer in Group A (651.6 ± 21.78 minutes) compared to Group B (474.2 ± 41.94 minutes) (p<0.001). VAS scores were significantly lower in Group A at 9 hours (1.77 ± 0.96 vs 4.40 ± 0.80, p<0.001) and 21 hours (2.67 ± 1.04 vs 4.13 ± 0.88, p<0.001). In Group A, 83.33% patients required only one rescue analgesic dose, while 80% of patients in Group B required two doses (p=0.0001). Pruritus was observed in 2 patients (6.67%) in Group B, with no complications in Group A. Conclusion: Both combinations provided effective postoperative analgesia; however, Ropivacaine with Dexamethasone demonstrated significantly prolonged duration of analgesia, reduced rescue analgesic requirements, and fewer side effects compared to Ropivacaine with Fentanyl Citrate. Dexamethasone appears to be a superior adjuvant for enhancing the quality and longevity of analgesia in adductor canal block for knee surgeries. Keywords: Adductor Canal Block, Dexamethasone, Fentanyl Citrate, Knee Surgery, Postoperative Analgesia, Ropivacaine, Visual Analogue Scale.

Background: Lower limb fractures constitute a significant public health burden, accounting for approximately one-third of all fractures. Effective perioperative pain management is crucial for optimal surgical outcomes. Regional anaesthesia techniques, particularly lumbosacral plexus block (LSPB), have gained popularity for lower limb surgeries due to their favourable safety profile and prolonged postoperative analgesia. Aim: To compare the efficacy of combined lumbosacral plexus block using ultrasound guidance (USG) and peripheral nerve stimulator (PNS) versus spinal anaesthesia in patients undergoing lower limb orthopaedic surgeries. Materials and Methods: This prospective non-randomized study was conducted at a tertiary care centre in Ahmedabad from March 2023 to February 2025, involving 70 patients (35 per group) undergoing lower limb orthopaedic surgeries. Group L received combined LSPB using USG and PNS with 40 mL of solution containing 0.5% bupivacaine, 2% lignocaine with adrenaline, normal saline, and fentanyl 25 mcg. Group S received spinal anaesthesia with 0.5% bupivacaine heavy and fentanyl 25 mcg. Hemodynamic parameters (HR, SBP, DBP, MAP, SpO₂), block characteristics, VAS scores, time to first rescue analgesia, and total analgesic consumption within 24 hours were recorded and analysed. Results: The mean time to complete block was significantly longer in Group L (22.37±2.25 mins) compared to Group S (6.97±0.85 mins; p<0.0001). Group L demonstrated more stable hemodynamic parameters with fewer fluctuations in heart rate and blood pressure. The time to first rescue analgesia was significantly prolonged in Group L (722.2±54.93 mins) versus Group S (363.9±78.08 mins; p=0.0001). Total analgesic requirement within 24 hours was significantly lower in Group L (1.14±0.35 vs 2.54±0.65; p=0.0001). VAS scores revealed that Group S had superior immediate pain control, while Group L demonstrated better pain control after 12 hours. Conclusion: Combined lumbosacral plexus block using USG and PNS provides stable haemodynamics, prolonged postoperative analgesia, reduced analgesic requirements, and fewer complications compared to spinal anaesthesia. It may be considered a safe and effective alternative for lower limb orthopaedic surgeries, particularly in high-risk patients. Keywords: Lumbosacral plexus block, Spinal anaesthesia, Lower limb orthopaedic surgery, Ultrasound guidance, Peripheral nerve stimulator, Postoperative analgesia.

Background: Central corneal thickness (CCT) is central to corneal health assessment, intraocular pressure interpretation, glaucoma risk stratification, and refractive-surgery screening. Ultrasound pachymetry (USP) is the reference standard, but its contact-based technique has practical limitations that non-contact specular microscopy (SM) and optical biometry (OB) may overcome. Data on device agreement and on the relationship of CCT with axial length (AL), anterior chamber depth (ACD), and lens thickness (LT) in myopic Eastern Indian eyes are limited. The purpose is to compare CCT values obtained by USP, SM, and OB in myopic eyes and to evaluate the association of CCT with AL, ACD, and LT across grades of myopia. Materials and Methods: In this single-centre, cross-sectional, observational study, 210 eyes of patients aged 18–45 years with mild, moderate, or severe myopia were examined at a tertiary-care eye department in Eastern India. CCT was measured with USP (Appasamy AppaScan Max P), SM (Topcon SP-1P), and OB (Topcon Aladdin HW 3.0); AL, ACD, and LT were measured with the optical biometer. Agreement was analysed using Pearson correlation, linear regression, and Bland–Altman limits of agreement; p<0.05 was considered significant. Results: Mean age was 29.35 ± 8.52 years; 50.95% were male. Myopia was mild in 44.8%, moderate in 39.5%, and severe in 15.7% of eyes. Mean CCT was 527.74 ± 44.39 µm (USP), 515.29 ± 32.01 µm (OB), and 500.67 ± 57.91 µm (SM). Both SM and OB correlated strongly with USP (r = 0.819 and 0.842 respectively; p<0.01), with OB showing the closest agreement; this pattern was preserved across mild, moderate, and severe myopia (r = 0.764–0.868, p<0.01). No statistically significant correlation was found between CCT and AL, ACD, or LT overall or within any severity subgroup (p>0.05 for nearly all pairings). Conclusion: Non-contact optical devices, particularly OB, show strong, severity-independent agreement with USP for CCT measurement in myopic eyes and can serve as practical alternatives to contact pachymetry. CCT appears to be an ocular biometric parameter independent of AL, ACD, and LT in myopia. Keywords: central corneal thickness; myopia; ultrasound pachymetry; specular microscopy; optical biometry; axial length; Bland–Altman analysis

Background: Deviated nasal septum is a common structural cause of nasal obstruction. Anatomical severity does not always correspond to perceived obstruction because symptoms may also be influenced by mucosal congestion, turbinate hypertrophy, nasal valve function and individual airflow perception. Combining a validated symptom score with objective nasal airflow measurements may provide a more comprehensive assessment of functional obstruction. Aim: To assess the association of deviated nasal septum severity with the Nasal Obstruction Symptom Evaluation score and objective nasal airflow parameters among adults with nasal obstruction. Materials and Methods: This hospital-based analytical cross-sectional study included 120 adults with symptomatic DNS. Septal deviation was assessed through anterior rhinoscopy and diagnostic nasal endoscopy and categorized as mild, moderate or severe. Subjective obstruction was evaluated using the validated five-item NOSE scale. Peak nasal inspiratory flow, total nasal airway resistance, minimum cross-sectional area and nasal cavity volume were measured before and after topical decongestion using PNIF, active anterior rhinomanometry and acoustic rhinometry. Group differences were analysed using one-way analysis of variance, Kruskal-Wallis and chi-square tests. Correlations were assessed using Spearman’s correlation coefficient. Multivariable linear regression was used to adjust for relevant clinical factors. A p value <0.05 was considered statistically significant. Results: Of the 120 participants, 37 (30.8%) had mild, 49 (40.8%) had moderate and 34 (28.3%) had severe DNS. The mean age was 34.8±10.6 years, and 71 (59.2%) participants were male. Inferior turbinate hypertrophy, septal spur or contact point, mouth breathing, sleep disturbance and snoring increased significantly with DNS severity (p≤0.016). The mean NOSE score increased from 36.6±12.2 in mild DNS to 58.3±12.4 in moderate and 77.9±11.9 in severe DNS (F=99.64, p<0.001). Post-decongestion PNIF decreased from 134.2±19.4 to 77.5±16.7 L/min, while nasal resistance increased from 0.21±0.06 to 0.52±0.12 Pa/cm³/s between the mild and severe groups (both p<0.001). Post-decongestion minimum cross-sectional area decreased from 0.66±0.11 to 0.31±0.08 cm², and nasal cavity volume decreased from 6.82±0.81 to 4.30±0.73 cm³ (both p<0.001). DNS severity correlated positively with NOSE score (ρ=0.79) and nasal resistance (ρ=0.82) and negatively with PNIF (ρ=−0.78), minimum cross-sectional area (ρ=−0.84) and nasal cavity volume (ρ=−0.81); all p<0.001. After adjustment, each one-level increase in DNS severity was associated with a 19.12-point increase in NOSE score and a 26.38 L/min reduction in PNIF. Conclusion: Increasing DNS severity was independently associated with greater subjective symptom burden, reduced nasal airflow, increased nasal resistance and decreased nasal dimensions. Combined assessment using the NOSE scale and objective nasal airflow measurements may improve the functional evaluation and treatment planning of patients with symptomatic DNS. Keywords: Deviated nasal septum; NOSE score; Nasal airflow.

Background: Malignant ascites is a prevalent and distressing complication in advanced gallbladder carcinoma, significantly affecting quality of life.[1,11] Refractory ascites frequently requires multiple large-volume paracentesis, resulting in recurrent hospital visits and procedural strain.[4,13] Indwelling peritoneal catheters provide an efficient palliative option for prolonged drainage.[5-9] This case series evaluates tunneled versus non-tunneled indwelling peritoneal catheters in the treatment of refractory malignant ascites. Materials and Methods: This retrospective case series comprised patients with advanced gallbladder carcinoma and refractory malignant ascites treated with indwelling peritoneal catheters in a palliative care context. Patients received either straight (non-tunneled) catheter insertion or tunneled catheter insertion. The evaluated outcomes comprised symptom alleviation, peri-catheter leakage, local complications, dressing change frequency, and patient comfort. Results: Both tunneled and non-tunneled catheters effectively alleviated symptoms of abdominal distention and dyspnea. Nevertheless, the tunneled catheter cohort exhibited a lower incidence of complications, specifically diminished peri-catheter leakage and skin maceration. Patients with tunneled catheters require fewer dressing changes and indicate enhanced overall comfort relative to the non-tunneled cohort. Conclusion: Tunneled indwelling peritoneal catheters seem to be a safer and more efficacious choice for the long-term management of refractory malignant ascites in advanced gallbladder carcinoma. The tunneled method demonstrated reduced leakage rates and enhanced patient comfort, rendering it advantageous in palliative care environments. Categories: Palliative Care, Oncology, Pain Management, Gastroenterology Keywords: Malignant ascites; gall bladder carcinoma; tunneled catheter; palliative care; indwelling peritoneal catheter; refractory ascites.

Background: Hypoestrogenism after menopause produces distinctive atrophic and reactive changes in cervical smears that may mimic epithelial atypia or obscure genuine lesions. This study evaluated the spectrum of cytomorphological findings and their clinical associations among postmenopausal women attending a tertiary care centre. Materials and Methods: This hospital-based descriptive cross-sectional study included 162 postmenopausal women undergoing conventional Pap-smear examination. Sociodemographic, reproductive and clinical information and per-speculum findings were recorded. Smears were stained by the Papanicolaou method and classified according to the 2014 Bethesda System. Cytomorphological maturation patterns, benign changes, organisms and epithelial abnormalities were documented. Associations were analysed using Fisher’s exact test, with p<0.05 considered significant. Results: The participants’ mean age was 60.9±8.2 years; 65.4% were rural residents and 79.0% had never undergone cervical screening. Initial smear adequacy was 96.3%, and all initially unsatisfactory smears were satisfactory after repeat collection. Overall, 91.4% of smears were negative for intraepithelial lesion or malignancy. An atrophic/parabasal-cell-predominant pattern was observed in 70.3% of NILM smears, while inflammation was present in 47.3%. Epithelial abnormalities occurred in 14 women (8.6%): ASC-US 3.7%, ASC-H 0.6%, LSIL 1.9%, HSIL 1.9% and squamous-cell carcinoma 0.6%. Abnormalities were significantly associated with age ≥65 years (p=0.029), menopause duration ≥10 years (p=0.047), postmenopausal bleeding (p=0.006) and a suspicious cervical appearance (p<0.001). Conclusion: Atrophy and inflammation dominated the postmenopausal cytological spectrum, but clinically significant epithelial abnormalities remained detectable. Careful cytomorphological interpretation, adequate sampling and prompt evaluation of bleeding or suspicious cervical findings are essential to balance early lesion detection against overdiagnosis of atrophy-related atypia. Keywords: Pap smear; postmenopausal women; cervical cytology; atrophic smear; epithelial abnormalities.

Background: Parkinson's disease (PD) is a chronic, progressive neurodegenerative disorder characterized by motor and certain non-motor symptoms, including autonomic dysfunction, which is associated with poor quality of life. This study evaluated the diagnostic accuracy of resting short-term heart rate variability (HRV) against the heart-rate tests of Ewing's battery, and examined how the Composite Autonomic Symptom Score 31 (COMPASS-31) relates to HRV and to Ewing's tests in patients with PD. Materials and Methods: This cross-sectional study was carried out over 6 months (patient assessment over 2 months, under an ICMR Short-Term Studentship) in the Departments of Physiology and Neurology of a tertiary care teaching hospital in an urban setting of north India. Fifty patients with PD completed the COMPASS-31 questionnaire, a 5-minute resting HRV recording and Ewing's battery of cardiovascular reflex tests. Associations were assessed with Spearman's correlation. Using each Ewing heart-rate test as the reference standard, the diagnostic accuracy of HRV indices (LF, HF, LF/HF ratio, total power) was assessed by ROC analysis. Sensitivity, specificity, predictive values, likelihood ratios and area under the curve (AUC) are reported with 95% confidence intervals (CI). Results: Of the 50 patients (mean age 60.5 ± 9.86 years; 66% male), Ewing's battery was abnormal for the HR(VM) ratio in 40 (80%), HR(DB) in 28 (56%), the HR(DB) ratio in 27 (54%) and the 30:15 ratio in 25 (50%). The mean COMPASS-31 total score was 11.92 ± 8.79 and was not significantly correlated with any HRV index or Ewing test parameter (|ρ| ≤ 0.15). Against the individual Ewing heart-rate tests, HRV indices showed poor-to-fair discrimination (AUC 0.513–0.708; the 95% CI included 0.5 in 12 of 16 comparisons). Total power had the highest AUC, against the Valsalva ratio (0.708, 95% CI 0.544–0.872). The LF/HF ratio was the only index with balanced sensitivity and specificity (against the HR(DB) ratio: 0.67 [0.48–0.81] and 0.65 [0.45–0.81]). Conclusion: Resting short-term HRV agreed only poorly to fairly with the heart-rate tests of Ewing's battery in PD, and its apparent accuracy depended strongly on the cut-off used. The LF/HF ratio was the most balanced index. COMPASS-31 scores were unrelated to both HRV and Ewing's tests, so symptom burden cannot substitute for objective testing. Neither tool can replace Ewing's battery. Whether combining COMPASS-31 with HRV improves the detection of cardiovascular autonomic neuropathy needs to be tested prospectively. Keywords: Parkinson's disease, autonomic dysfunction, Composite Autonomic Symptom Score 31, heart rate variability, Ewing's battery of tests, cardiovascular autonomic neuropathy, diagnostic accuracy.

Background: Type 2 diabetes mellitus (T2DM) is a progressive metabolic disorder associated with impaired glycaemic control, dyslipidaemia, and multiple vascular complications. Evaluating clinical and biochemical differences between newly diagnosed and long-standing diabetes may help identify disease-related abnormalities and improve patient management. Aim: To compare the clinical characteristics, biochemical parameters, metabolic abnormalities, and diabetes-related complications between newly diagnosed and long-standing T2DM patients. Materials and Methods: This hospital-based observational comparative study included 106 patients with T2DM at a tertiary care hospital. Patients were divided into two groups: newly diagnosed T2DM (n=53) and long-standing T2DM (n=53). Demographic characteristics, anthropometric measurements, clinical manifestations, glycaemic parameters, lipid profiles, renal function, and diabetes-related complications were evaluated. Statistical analysis was performed using SPSS version 27.0, considering p<0.05 statistically significant. Results: Patients with long-standing T2DM had significantly higher mean age (61.80 ± 8.80 vs. 53.70 ± 9.20 years; p<0.001) and HbA1c (9.50 ± 1.70% vs. 8.70 ± 1.50%; p=0.012). Total cholesterol, triglycerides, LDL cholesterol, and blood pressure were significantly elevated, while HDL cholesterol and eGFR were significantly reduced in long-standing patients. Peripheral neuropathy (43.40% vs. 11.32%), retinopathy (32.08% vs. 5.66%), and diabetic kidney disease (37.74% vs. 9.43%) were significantly more prevalent in long-standing patients (all p<0.001). Overall microvascular and macrovascular complications were also significantly higher in this group (p<0.001). Conclusion: Long-standing T2DM was associated with poorer glycaemic control, adverse lipid profiles, renal dysfunction, and increased vascular complications. Early diagnosis, regular biochemical monitoring, and comprehensive complication screening are essential for improving diabetes management. Keywords: Type 2 Diabetes Mellitus; Glycaemic Control; Dyslipidaemia; Diabetic Nephropathy; Microvascular Complications.

Background: Community-acquired pneumonia (CAP) is a major cause of hospitalization and mortality worldwide. Early identification of disease severity is essential for appropriate clinical management. The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive and readily available inflammatory biomarker with potential prognostic significance in CAP. Aim: To evaluate admission NLR as a predictor of disease severity and clinical outcomes in patients with community-acquired pneumonia. Materials and Methods: This prospective observational study included 116 patients with CAP, categorized into non-severe (n=72) and severe (n=44) groups. Admission NLR, clinical characteristics, laboratory parameters, CURB-65 scores, and Pneumonia Severity Index (PSI) were assessed. Associations with ICU admission, ventilatory support, hospital stay, and in-hospital mortality were evaluated using multivariable logistic regression and receiver operating characteristic (ROC) curve analysis. Results: Patients with severe CAP were significantly older than those with non-severe CAP (66.48 ± 12.09 versus 54.61 ± 13.14 years; p<0.001). Median NLR was significantly higher in severe CAP (7.27 versus 4.45; p<0.001) and increased progressively with CURB-65 and PSI categories. Higher NLR (≥4.768) was associated with increased ICU admission (48.53% versus 18.75%; p=0.001) and in-hospital mortality (19.12% versus 6.25%; p=0.048). Admission NLR independently predicted severe CAP (aOR=2.420; p<0.001). ROC analysis demonstrated good discriminatory performance for severe CAP (AUC=0.891), with 95.45% sensitivity and 63.89% specificity at a cut-off of 4.768. However, NLR was not an independent predictor of mortality (p=0.053). Conclusion: Admission NLR is a simple, cost-effective biomarker associated with CAP severity and adverse clinical outcomes. It may complement established severity scoring systems for early risk stratification, although its independent mortality prediction requires further validation. Keywords: Community-acquired pneumonia; Neutrophil-to-lymphocyte ratio; Disease severity; CURB-65; In-hospital mortality.

Background: Attention-deficit/hyperactivity disorder (ADHD) commonly affects behavioural regulation, organisation and academic functioning during adolescence. Although school-related impairment is well recognised, home-environment factors such as parental supervision, homework routines, screen exposure and sleep may also influence academic performance. This study assessed behavioural characteristics and academic performance among adolescents with ADHD and examined factors associated with academic achievement. Materials and Methods: A cross-sectional observational study was conducted among 129 adolescents aged 10–18 years with clinically diagnosed ADHD attending a tertiary care centre. Sociodemographic, clinical and home-environment characteristics were recorded using a structured proforma. Behavioural symptoms were assessed using a standardized parent-rated ADHD scale, while academic performance was determined from recent school examination scores. Associations were examined using appropriate univariate tests, correlation analysis and multivariable linear regression. Results: The mean age was 14.2±2.1 years and 72.9% were male. Combined ADHD presentation was most common (44.2%). The mean academic score was 64.1±12.8%, and 36.4% had poor academic performance. Academic performance correlated negatively with total ADHD symptoms (r=−0.49), inattention (r=−0.56), incomplete homework (r=−0.53), screen time (r=−0.31) and family conflict (r=−0.29), while home study duration showed a positive correlation (r=0.41); all p≤0.001 except where specified. In multivariable analysis, inattention independently predicted poorer academic performance (B=−0.71, p<0.001), whereas regular parental supervision (B=4.82, p=0.005), a regular homework routine (B=5.63, p=0.001) and current medication use (B=3.47, p=0.031) predicted better performance. Screen time >2 hours/day was independently associated with lower academic scores (B=−3.91, p=0.025). The model explained 48% of the variance in academic performance. Conclusion: Academic functioning among adolescents with ADHD was closely associated with inattentive symptoms and modifiable home-environment factors. Structured parental supervision, consistent homework routines and appropriate treatment were associated with better academic outcomes, whereas excessive screen exposure was unfavourable. Comprehensive ADHD management should therefore extend beyond symptom control to include family-based academic support and healthy home routines. Keywords: Attention-deficit/hyperactivity disorder; adolescents; academic performance; screen time; home environment.

Background: Delays in emergency department (ED) trauma care may contribute to avoidable mortality. Structured clinical audit can identify process gaps and opportunities to improve care. Objective: To evaluate preventable delays and classify potentially preventable deaths in adult trauma patients presenting to a tertiary care ED, using standardized audit methodology. Materials and Methods: A prospective observational cohort study with an embedded clinical audit was conducted at Himalayan Hospital, Dehradun, during October 2025–September 2026. Adults aged 18–65 years presenting within 24 hours of injury and requiring trauma team activation were included. The analysis comprised 412 patients. Injury severity, intervention times, and in-hospital deaths within 30 days were assessed. A three-member expert panel classified deaths by preventability. TRISS benchmarking and multivariable logistic regression were performed. Results: Of 412 patients, 72.3% were male and 61.2% had road traffic injuries. Median ISS was 22 (IQR 16–34). In-hospital mortality within 30 days was 18.2% (75/412). Of the deaths, 41 (54.7%) were non-preventable, 21 (28.0%) potentially preventable, and 13 (17.3%) definitely preventable. CT delay >60 minutes (OR 2.8, 95% CI 1.4–5.6; p=0.003) and operative transfer delay >90 minutes in patients with shock (OR 3.2, 95% CI 1.6–6.4; p=0.001) were associated with preventable mortality in the reported model. Conclusion: Potentially or definitely preventable deaths accounted for 45.3% of reviewed deaths. The audit identified associations between delayed imaging or operative transfer and preventable mortality, suggesting priorities for workflow review. These observational findings require cautious interpretation because of the recruitment shortfall and limitations in risk adjustment and case-mix comparability. Keywords: Trauma; emergency department; clinical audit; preventable mortality; treatment delay; TRISS.

Background: Hyponatraemia is a common electrolyte disturbance among elderly hospitalised patients and is frequently associated with multiple comorbidities, neurological abnormalities, and adverse clinical outcomes. Early identification and assessment of its severity are important for improving patient management and prognosis. The aim is to compare clinical severity, biochemical abnormalities, associated complications, and hospital outcomes among elderly patients with hyponatraemia and normonatraemia. Materials and Methods: This hospital-based prospective observational comparative study included 108 elderly patients aged ≥60 years, divided into two groups: hyponatraemia (n=54) and normonatraemia (n=54). Demographic characteristics, comorbidities, clinical manifestations, biochemical parameters, National Early Warning Score 2 (NEWS2), Glasgow Coma Scale, intensive care requirements, hospital stay, and mortality were assessed. Statistical analysis was performed using SPSS version 28.0, with p<0.05 considered statistically significant. Results: In the illustrative dataset, mean age was comparable between hyponatraemic and normonatraemic patients (70.56 ± 7.22 vs. 69.24 ± 6.88 years; p=0.333). Hyponatraemic patients demonstrated significantly higher frequencies of generalised weakness (72.22% vs. 44.44%; p=0.003), confusion (40.74% vs. 14.81%; p=0.003), and delirium (37.04% vs. 12.96%; p=0.004). Mean NEWS2 scores were significantly higher (5.27 ± 2.75 vs. 3.38 ± 2.27; p<0.001). Acute kidney injury (33.33% vs. 16.67%; p=0.046), ICU admission (31.48% vs. 14.81%; p=0.040), and hospital stay (9.11 ± 3.90 vs. 6.63 ± 2.87 days; p<0.001) were significantly increased. Mortality was higher among hyponatraemic patients (16.67% vs. 5.56%), although statistically insignificant (p=0.066). Conclusion: Hyponatraemia was associated with greater clinical severity, neurological complications, renal dysfunction, intensive care requirements, and prolonged hospitalisation. Increasing hyponatraemia severity was associated with poorer hospital outcomes, emphasising the importance of early recognition and appropriate management. Keywords: Hyponatraemia, Elderly patients, Clinical severity, Hospital outcomes, In-hospital mortality.

Background: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. Early identification of severe disease is essential for appropriate clinical management. The Systemic Immune-Inflammation Index (SII), derived from peripheral neutrophil, lymphocyte, and platelet counts, has emerged as a potential inflammatory marker for disease severity assessment. The aim is to evaluate the association between SII and disease severity in patients with community-acquired pneumonia and assess its diagnostic and prognostic significance. Materials and Methods: This hospital-based, prospective observational analytical study included 116 adult patients with CAP, categorized into non-severe (n=72) and severe (n=44) groups according to ATS/IDSA criteria. Admission SII, inflammatory biomarkers, CURB-65 scores, clinical characteristics, and hospital outcomes were evaluated. Statistical analysis was performed using SPSS version 28.0. Correlation analysis, receiver operating characteristic (ROC) analysis, and multivariable logistic regression were performed, considering p<0.05 statistically significant. Results: Patients with severe CAP were significantly older than those with non-severe CAP (66.48 ± 12.09 vs. 54.61 ± 13.14 years; p<0.001). Median SII was significantly higher in severe CAP (2,119 vs. 1,133; p<0.001). Higher SII correlated positively with CURB-65 score (ρ=0.391), C-reactive protein (ρ=0.427), and hospitalization duration (ρ=0.312), while showing a negative correlation with oxygen saturation (ρ=−0.382). ICU admission (61.36% vs. 11.11%) and in-hospital mortality (18.18% vs. 2.78%) were significantly higher in severe CAP. SII demonstrated good discriminatory performance (AUC=0.844), with 72.73% sensitivity and 84.72% specificity at a cut-off of 1,774.32. SII remained independently associated with severe CAP (aOR=3.18; p<0.001). Conclusion: Elevated SII was significantly associated with CAP severity and adverse clinical outcomes. It may serve as a simple, inexpensive, and readily available supplementary marker for early risk stratification in patients with CAP. Keywords: Community-acquired pneumonia, Systemic Immune-Inflammation Index, Disease severity, Inflammatory biomarkers, CURB-65.

Background: Bacterial sepsis is a life-threatening condition associated with systemic inflammation, multiple organ dysfunction, and increased mortality. Early identification of high-risk patients is essential for timely intervention. C-reactive protein (CRP) and procalcitonin (PCT) are inflammatory biomarkers with potential prognostic significance in sepsis. The aim is to compare the prognostic accuracy of CRP and PCT in predicting disease severity, clinical complications, and in-hospital mortality among patients with bacterial sepsis. Materials and Methods: This hospital-based, prospective observational comparative study was designed to include 104 adult patients with bacterial sepsis at a tertiary care hospital. Patients were categorized into survivors (n=75) and non-survivors (n=29). Clinical characteristics, SOFA and APACHE II scores, laboratory parameters, serial CRP and PCT concentrations, complications, and hospital outcomes were assessed. Statistical analysis was performed using SPSS version 28.0, including ROC curve analysis and multivariable logistic regression. The reported numerical analysis was based on illustrative simulated data. Results: The overall mortality rate was 27.88%. Non-survivors demonstrated significantly higher SOFA scores (8.69 ± 2.61 versus 4.61 ± 2.05; p<0.001). Median CRP concentrations were higher among non-survivors (199.07 versus 114.99 mg/L; p<0.001), as were PCT concentrations (9.68 versus 2.89 ng/mL; p<0.001). Day-5 PCT reduction was greater among survivors (79.49% versus 27.36%; p<0.001). PCT demonstrated a numerically higher AUC than CRP (0.823 versus 0.764), although the difference was not statistically significant (p=0.325). SOFA score, CRP, and PCT remained independently associated with mortality. Conclusion: Elevated CRP and PCT concentrations were associated with increased sepsis severity and mortality. Serial biomarker assessment combined with SOFA scoring may support prognostic evaluation and clinical risk stratification. Keywords: Bacterial sepsis; C-reactive protein; Procalcitonin; SOFA score; In-hospital mortality.

Background: Iron deficiency anaemia is a common haematological disorder associated with reduced functional capacity and impaired quality of life. Oral iron is widely prescribed, but gastrointestinal intolerance and variable absorption may limit its effectiveness. Intravenous iron offers an alternative for rapid iron replenishment and correction of anaemia. The aim is to compare haemoglobin response, improvement in iron stores, clinical outcomes, and adverse effects following oral versus intravenous iron therapy in adults with iron deficiency anaemia. Materials and Methods: This hospital-based, prospective observational comparative study included 106 adult patients with iron deficiency anaemia at a tertiary care hospital. Patients were divided into two groups: oral iron therapy (n=53) and intravenous iron therapy (n=53). Haemoglobin levels were assessed at baseline, two, four, and eight weeks. Haematological indices, iron profiles, clinical responses, and adverse effects were evaluated. Statistical analysis was performed using SPSS version 28.0, with p<0.05 considered statistically significant. Results: Baseline haemoglobin levels were comparable between groups (8.62 ± 1.05 vs. 8.48 ± 1.10 g/dL; p=0.504). At eight weeks, haemoglobin increased to 11.03 ± 1.12 g/dL following oral therapy and 11.92 ± 1.06 g/dL following intravenous therapy (p<0.001). Mean haemoglobin improvement was significantly greater with intravenous iron (3.44 ± 0.89 vs. 2.41 ± 0.83 g/dL; p<0.001). Serum ferritin was also higher following intravenous therapy (125.20 ± 48.10 vs. 32.50 ± 14.80 ng/mL; p<0.001). Haemoglobin normalization occurred in 39.62% versus 16.98% (p=0.017). Adverse effects were more frequent with oral iron (50.94% vs. 28.30%; p=0.028). Conclusion: Intravenous iron therapy demonstrated greater haemoglobin improvement, superior iron-store replenishment, and fewer overall adverse effects compared with oral iron therapy. It may be particularly beneficial when rapid correction of iron deficiency anaemia is required. Keywords: Iron deficiency anaemia, Oral iron therapy, Intravenous iron therapy, Haemoglobin response, Adverse effects.

Background: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. Early identification of severe pneumonia is essential for appropriate clinical management. The neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) are readily available inflammatory biomarkers that may assist in predicting disease severity and adverse clinical outcomes. The aim is to compare the diagnostic and prognostic performance of NLR and CRP as markers of disease severity in patients with community-acquired pneumonia. Materials and Methods: This hospital-based, prospective observational comparative study was designed to include 118 adult patients diagnosed with CAP at a tertiary care hospital. Patients were categorized into severe and non-severe CAP groups according to IDSA/ATS criteria. Demographic characteristics, clinical parameters, inflammatory biomarkers, CURB-65 scores, radiological findings, complications, and hospital outcomes were evaluated. Statistical analysis was planned using IBM SPSS Statistics version 28.0. Results: In the illustrative dataset, 82 (69.49%) patients had non-severe CAP and 36 (30.51%) had severe CAP. Severe CAP patients were significantly older (65.00 ± 11.28 vs. 51.57 ± 12.92 years; p<0.001). Median NLR (10.75 vs. 4.16) and CRP (141.60 vs. 68.50 mg/L) were significantly higher in severe CAP (p<0.001). NLR demonstrated an AUC of 0.925, sensitivity of 83.33%, and specificity of 89.02%, compared with 0.894, 77.78%, and 87.80%, respectively, for CRP. In-hospital mortality was significantly higher in severe CAP (19.44% vs. 1.22%; p<0.001). Conclusion: Both NLR and CRP demonstrated significant associations with CAP severity. NLR showed numerically superior discriminatory performance, although the difference was not statistically significant. Both biomarkers may support early risk stratification alongside established clinical severity scores. Keywords: Community-acquired pneumonia; Neutrophil-to-lymphocyte ratio; C-reactive protein; Disease severity; Inflammatory biomarkers.

Background: Sepsis is a life-threatening condition associated with systemic inflammation, organ dysfunction, and increased mortality. Early identification of patients at risk of adverse outcomes is essential for effective clinical management. The Systemic Immune-Inflammation Index (SII) and Neutrophil-to-Lymphocyte Ratio (NLR) are inexpensive inflammatory markers with potential prognostic significance in sepsis. The aim is to compare the prognostic performance of SII and NLR in predicting adverse clinical outcomes among hospitalized patients with sepsis. Materials and Methods: This hospital-based, prospective observational comparative study included 102 adult patients diagnosed with sepsis at a tertiary care hospital. Baseline clinical characteristics, hematological parameters, SII, NLR, SOFA scores, inflammatory markers, and adverse clinical outcomes were evaluated. Patients were categorized into survivors and non-survivors. Statistical analysis was performed using IBM SPSS Statistics version 28.0. ROC curve analysis and logistic regression were used to assess mortality prediction. Results: Among 102 patients, 75 (73.53%) survived and 27 (26.47%) died during hospitalization. Median SII was significantly higher among non-survivors than survivors (2817.67 versus 2172.56; p<0.001). Similarly, median NLR was significantly elevated among non-survivors (12.42 versus 8.77; p<0.001). Both indices demonstrated significant positive correlations with SOFA scores and serum lactate levels. ROC analysis demonstrated AUC values of 0.725 for SII and 0.744 for NLR. NLR showed higher specificity (77.33%) than SII (68.00%). Conclusion: Both SII and NLR demonstrated potential utility in predicting adverse outcomes among hospitalized patients with sepsis. NLR showed slightly better mortality discrimination than SII. Both markers may complement established clinical severity scores for early risk stratification. Keywords: Sepsis; Systemic Immune-Inflammation Index; Neutrophil-to-Lymphocyte Ratio; In-Hospital Mortality; SOFA Score.

Background: Type 2 diabetes mellitus requires sustained glycaemic management and monitoring of renal complications. Metformin is frequently combined with sodium-glucose cotransporter-2 (SGLT2) inhibitors or dipeptidyl peptidase-4 (DPP-4) inhibitors, making comparative assessment clinically important. Aim: To compare glycaemic control, renal function, and adverse events among patients receiving metformin with SGLT2 inhibitors versus metformin with DPP-4 inhibitors. Materials and Methods: This hospital-based prospective observational comparative study included 112 patients with type 2 diabetes mellitus at a tertiary care hospital. Group A comprised 56 patients receiving metformin with SGLT2 inhibitors, while Group B comprised 56 patients receiving metformin with DPP-4 inhibitors. Demographic characteristics, fasting and postprandial plasma glucose, HbA1c, serum creatinine, estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (UACR), biochemical parameters, and adverse events were assessed. Data were analysed using IBM SPSS Statistics version 28.0, with p<0.05 considered statistically significant. Results: Mean HbA1c was significantly lower in Group A than Group B (7.03 ± 0.73% versus 7.75 ± 0.81%; p<0.001). Fasting plasma glucose (139.28 ± 21.89 versus 157.65 ± 24.00 mg/dL; p<0.001) and postprandial plasma glucose (201.60 ± 33.06 versus 222.35 ± 30.96 mg/dL; p=0.001) were also significantly lower. HbA1c below 7.00% was achieved by 50.00% versus 17.86% of patients (p<0.001). Mean eGFR was higher (84.58 ± 13.94 versus 74.87 ± 12.45 mL/min/1.73 m²; p<0.001), whereas median UACR was lower (18.90 versus 40.54 mg/g; p<0.001) in Group A. Genital infections were more frequent in Group A (14.29% versus 1.79%; p=0.032). Conclusion: Metformin with SGLT2 inhibitors was associated with more favourable glycaemic and renal parameters than metformin with DPP-4 inhibitors. However, genital infections were more frequent, emphasizing the importance of individualized treatment selection and safety monitoring. Keywords: Type 2 diabetes mellitus; Metformin; SGLT2 inhibitors; DPP-4 inhibitors; Renal function.

Background: Iron deficiency anaemia (IDA) is a common haematological disorder associated with significant morbidity. Oral iron supplementation remains the preferred treatment; however, therapeutic response varies among patients. Baseline serum ferritin and transferrin saturation (TSAT) may serve as useful indicators for predicting haematological improvement. Aim: To evaluate baseline serum ferritin and transferrin saturation as predictors of haematological response to oral iron therapy in patients with iron deficiency anaemia. Material and Methods: This prospective observational study included 105 patients with confirmed iron deficiency anaemia at a tertiary care hospital. Patients received oral ferrous sulphate supplementation providing approximately 60–65 mg elemental iron daily. Haematological parameters were assessed at baseline and after 2, 4, and 8 weeks. Serum ferritin and TSAT were reassessed at eight weeks. Data were analysed using SPSS version 27.0. Correlation analysis, ROC curve analysis, and multivariable logistic regression were performed. Results: Among 105 patients, 61.90% were females, and 87.62% had moderate anaemia. Satisfactory haematological response was observed in 72 patients (68.57%). Mean haemoglobin increased significantly from 9.16 ± 0.83 to 11.31 ± 1.26 g/dL after eight weeks (p<0.001). Patients with baseline ferritin ≥10 ng/mL demonstrated higher response rates than those with lower ferritin (80.70% versus 54.17%; p=0.006). Similarly, patients with TSAT ≥10% showed better responses (88.57% versus 58.57%; p=0.002). The combined ferritin–TSAT model demonstrated an AUC of 0.757. Baseline TSAT (AOR=1.27; p=0.007) and haemoglobin (AOR=2.09; p=0.016) emerged as independent predictors. Conclusion: Baseline TSAT and haemoglobin were significant independent predictors of haematological response. Combined assessment of ferritin and TSAT may improve prediction and facilitate individualized management of iron deficiency anaemia. Keywords: Iron Deficiency Anaemia; Serum Ferritin; Transferrin Saturation; Oral Iron Therapy; Haematological Response.

Background: Asthma is a heterogeneous disease characterized by diverse inflammatory pathways, clinical presentations, and treatment responses. Traditional approaches relying on single biomarkers have proven insufficient for capturing this complexity, often failing to adequately phenotype patients or predict disease severity and therapeutic outcomes. Materials and Methods: This narrative review synthesizes current evidence on composite biomarker approaches in asthma phenotyping and severity assessment. We examined studies evaluating multi-biomarker panels, composite scoring systems, and integrated assessment tools that combine inflammatory, immunological, and clinical parameters. Results: Composite biomarker indices demonstrate superior performance over single markers in distinguishing asthma phenotypes, predicting exacerbation risk, and guiding biologic therapy selection. Multi-parameter approaches incorporating Type 2 inflammatory markers show enhanced discriminatory capacity and improved correlation with disease severity. Emerging composite tools integrate blood eosinophils, fractional exhaled nitric oxide, serum periostin, and IgE levels to create multidimensional profiles that better reflect the underlying inflammatory complexity of asthma. Conclusion: Composite biomarker indices represent a paradigm shift toward precision asthma management, offering more balanced patient stratification than single-marker approaches. Their integration into clinical algorithms holds promise for optimizing therapeutic decisions, particularly in the era of targeted biologics. Keywords: Asthma, biomarkers, composite indices, phenotyping, precision medicine, Type 2 inflammation, disease severity, personalized medicine.

Background: Fever with thrombocytopenia is a common cause of pediatric hospital admission and may be associated with significant hepatic involvement. Liver dysfunction may reflect disease severity and contribute to adverse clinical outcomes. This study aimed to evaluate the correlation between hepatic dysfunction and clinical outcomes in children admitted with fever and thrombocytopenia. Materials and Methods: This prospective observational study included 124 children aged 1 month to 12 years admitted with fever and thrombocytopenia. Clinical characteristics, hematological parameters, liver function tests, and coagulation profiles were recorded. Hepatic dysfunction was assessed using abnormalities in transaminases, bilirubin, serum albumin, and coagulation parameters. Participants were followed until discharge or death, and associations between hepatic dysfunction and clinical outcomes were analysed. Results: Hepatic dysfunction was observed in 58 (46.8%) children, while 32 (25.8%) developed adverse clinical outcomes. Children with hepatic dysfunction had a significantly higher frequency of adverse outcomes than those without hepatic dysfunction (46.6% vs. 7.6%; p<0.001). Elevated AST and ALT levels, hyperbilirubinemia, hypoalbuminemia, and elevated INR were significantly associated with poor outcomes. Hepatic dysfunction remained independently associated with adverse clinical outcomes (adjusted OR: 6.84; 95% CI: 2.31–20.27; p<0.001). Conclusion: Hepatic dysfunction was significantly associated with adverse clinical outcomes in children with fever and thrombocytopenia. Early assessment of liver function may improve risk stratification and facilitate timely monitoring and management. Keywords: Hepatic dysfunction, Fever, Thrombocytopenia, Children, Liver function tests, Clinical outcome.

Background: Fluid resuscitation is a fundamental component of management in critically ill children. Although 0.9% normal saline is widely used, its relatively high chloride content may contribute to hyperchloremia and metabolic disturbances. Balanced crystalloids such as Plasma-Lyte may provide a more physiological alternative. Materials and Methods: This open-label randomized controlled study included 80 critically ill children requiring fluid resuscitation within the first 6 hours of admission. Participants were randomized equally to receive Plasma-Lyte or 0.9% normal saline. Serum bicarbonate, sodium, chloride, pH, base excess, lactate, and creatinine were assessed at baseline and during 24, 48, and 72 hours. Secondary outcomes included hyperchloremia, non-anion-gap metabolic acidosis, acute kidney injury, renal replacement therapy, inotrope requirement, mechanical ventilation, hospital stay, and mortality. Results: Changes in serum bicarbonate were comparable between Plasma-Lyte and normal saline groups at 24 hours (2.84±6.48 vs 3.39±4.84 mmol/L), 48 hours (5.98±7.90 vs 5.88 ± 7.21 mmol/L), and 72 hours (9.07±9.43 vs 8.98±8.44 mmol/L). Hyperchloremia, sodium disturbances, non-anion-gap metabolic acidosis, acute kidney injury, ventilation, and mortality did not differ significantly between groups. Inotropic support was required significantly less frequently with Plasma-Lyte (37.5% vs 67.5%; p=0.013). Hospital stay was also shorter in the Plasma-Lyte group (9.28 vs 12.78 days; p=0.042). Conclusion: Plasma-Lyte and 0.9% normal saline demonstrated comparable effects on bicarbonate and major acid base outcomes. Plasma-Lyte was associated with lower inotrope requirement and shorter hospital stay, supporting further evaluation in larger pediatric trials. Keywords: Plasma-Lyte; normal saline; fluid resuscitation; critically ill children; balanced crystalloid; hyperchloremia; metabolic acidosis.

Background: Gallstone disease (cholelithiasis) is a prevalent gastrointestinal disorder worldwide. Recent evidence suggests a possible association between Helicobacter pylori infection and gallbladder diseases, including cholelithiasis and chronic cholecystitis, although its pathogenic role remains unclear. Aim: To determine the incidence of H. pylori infection in the gallbladder mucosa of patients with symptomatic cholelithiasis undergoing cholecystectomy, and to evaluate its association with clinical, demographic, and histological factors. Materials and Methods: This cross-sectional study was conducted at A.J. Medical College Hospital, Mangaluru, from April 2023 to April 2025. Seventy-one patients with symptomatic gallstone disease scheduled for cholecystectomy were enrolled. Gallbladder mucosa samples were analyzed by polymerase chain reaction (PCR) for H. pylori DNA. Clinical symptoms, demographic profiles, and histological findings were recorded and correlated with H. pylori status. Results: H. pylori DNA was detected in 22.5% (16/71) of samples (95% CI: 13.8–33.8%). H. pylori-positive patients showed higher frequency of biliary colic (93.8%), nausea (81.3%), vomiting (68.8%; p=0.03), and fever (31.3%; p=0.04). Moderate to severe chronic inflammation (75% vs 45.5%; p=0.02) and fibrosis (62.5% vs 36.4%; p=0.04) were more common in H. pylori-positive gallbladders. Acute cholecystitis occurred more frequently in H. pylori-positive patients (37.5% vs 18.2%; p=0.03), with no significant association with pancreatitis. Conclusion: H. pylori colonizes the gallbladder mucosa in a substantial proportion of patients with symptomatic cholelithiasis and correlates with greater inflammatory severity and complications. These findings support a possible pathogenic role for H. pylori in gallstone disease, warranting further multicentric studies to assess causality and therapeutic implications. Keywords: Helicobacter pylori; Cholelithiasis; Cholecystectomy; Gallbladder; Cholecystitis; Polymerase Chain Reaction.

Background: Acute pancreatitis (AP) is a common gastrointestinal emergency with clinical severity ranging from mild, self-limiting disease to severe pancreatitis associated with organ failure and increased mortality. Early fluid resuscitation is a cornerstone of management, aiming to restore intravascular volume, improve pancreatic perfusion, and reduce complications. However, the optimal fluid resuscitation strategy, including the type, volume, rate, and timing of fluid administration, remains controversial. While aggressive hydration was traditionally recommended, recent evidence supports a more individualized, goal-directed approach to minimize the risk of fluid overload and related complications. Therefore, this systematic review aims to evaluate the current evidence on fluid resuscitation strategies and their effects on clinical outcomes in patients with acute pancreatitis. The objective is to compare the effectiveness and safety of different fluid resuscitation strategies and intravenous fluid types in acute pancreatitis, and to assess their impact on disease severity, organ failure, pancreatic necrosis, length of hospital stay, mortality, and fluid-related adverse events. Materials and Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed in PubMed, Scopus, Web of Science, Embase, and the Cochrane Library using relevant keywords acute pancreatitis, fluid resuscitation, fluid resuscitation strategies and clinical outcome. Article published from year 2002 included. Eligible studies were screened independently by two reviewers based on predefined inclusion and exclusion criteria. Data on study characteristics, fluid resuscitation strategies, disease severity, organ failure, pancreatic necrosis, length of hospital stay, mortality, and fluid-related adverse events were extracted using a standardized data collection form. The methodological quality of the included studies was assessed using appropriate risk-of-bias tools, and the findings were synthesized qualitatively. Results: Evidence suggests that early, individualized fluid resuscitation improves outcomes in acute pancreatitis. Lactated Ringer’s solution generally reduced systemic inflammatory response syndrome (SIRS) and C-reactive protein (CRP) more effectively than normal saline. However, excessive fluid administration (>4.1 L/24 h) and rapid hemodilution were associated with increased organ failure, sepsis, and mortality. Hydroxyethyl starch (HES) and adjunctive therapies showed limited or inconsistent clinical benefits. Overall, early, goal-directed fluid therapy with preference for Lactated Ringer’s solution while avoiding fluid overload appears most appropriate. Conclusion: Early, individualized fluid resuscitation, particularly with Lactated Ringer’s solution, may improve inflammatory outcomes in acute pancreatitis. However, excessive or rapid fluid administration may worsen complications. Further high-quality randomized trials are needed to define optimal fluid strategies and clarify the role of adjunctive therapies. Keywords: ac

Background: Substance use disorders often coexist with psychiatric illnesses, and this dual diagnosis may increase vulnerability to risky sexual behaviour. This study evaluated changes in risky sexual behaviour following treatment among patients with substance use disorders and psychiatric comorbidities. Materials and Methods: This prospective interventional follow-up study included 100 patients aged 18–45 years attending the psychiatry outpatient department of a tertiary healthcare centre in Navi Mumbai. Participants were assessed at baseline, three months and six months using the Alcohol Use Disorders Identification Test (AUDIT), Drug Abuse Screening Test (DAST) and Sexual Risk Survey (SRS). Scores were compared across psychiatric diagnoses. Results: Schizophrenia was the most common psychiatric comorbidity (27%), followed by bipolar mood disorder (20%) and major depressive disorder (19%). Alcohol use was reported by all participants, while tobacco (71%) and cannabis (36%) were common additional substances. Mean AUDIT scores declined from 31.90 ± 4.80 at baseline to 17.16 ± 5.25 at three months and 8.44 ± 3.51 at six months. Mean DAST scores decreased from 21.15 ± 4.55 to 13.29 ± 3.34 and 7.10 ± 2.65, respectively. Mean SRS scores also declined from 40.22 ± 10.74 to 26.35 ± 8.80 and 16.46 ± 6.75. SRS scores differed significantly across psychiatric diagnoses at all assessments (p=0.0001), with bipolar mood disorder consistently showing the highest scores. Conclusion: Continued treatment and follow-up were accompanied by progressive reductions in substance-use severity and risky sexual behaviour. Patients with bipolar mood disorder may require more intensive sexual-risk assessment and targeted counselling. Keywords: Alcohol Use, Bipolar Mood Disorder, Dual Diagnosis, Psychiatric Comorbidity, Risky Sexual Behaviour, Substance Use Disorder.