Current Issue

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Background: Body fluid analysis plays a pivotal role in the diagnosis and management of infectious, inflammatory, and malignant conditions, although manual hemocytometric evaluation remains the conventional gold standard, it is labor intensive and subject to inter-observer variability. Automated hematology analyzers with dedicated body fluid (BF) modes offer potential advantages in precision and turnaround time. The aim is to compare the Body Fluid mode of Mindray automated hematology analyzer with the manual counting method for cytological evaluation of body fluids. Settings and Design: Hospital Based Observational Study. Materials and Methods: This hospital-based observational study was conducted over 18 months in the Department of Pathology, of a tertiary teaching hospital. A total of 2530 body fluid samples were analyzed. Total nucleated cell counts and differential cell counts were performed manually using an Improved Neubauer chamber and cytological staining and compared with automated analysis using the Mindray BC-760 in Body Fluid ―BF mode. Statistical analysis used: Chi Square test, Spearman rho correlation, Passing Bablok Regression. Results: Pleural fluid constituted the majority of samples (n= 1300; 51.38%), followed by ascitic fluid (n=950; 37.55%). Mean age was 44.8 ± 19.2 years, with near-equal gender distribution. Automated and manual methods showed comparable median (IQR) TNCC and differential leucocyte counts across most fluid types, with statistically significant correlations. Conclusion: Automated body fluid analysis demonstrates strong agreement with manual counting for quantitative parameters and enhances laboratory efficiency. Yet, a combined approach ensures optimal diagnostic accuracy in body fluid cytology. Keywords: Automated, Body Fluid, Hematology, Manual Microscopy, TNCC.

Background: Gestational diabetes mellitus (GDM) and fetal growth restriction (FGR) are major causes of maternal and perinatal morbidity. Early identification of pregnancies at risk remains challenging. Fetal pancreatic biometry has emerged as a potential ultrasonographic marker reflecting fetal metabolic status and growth, with possible utility in predicting both GDM and FGR. The aim is to evaluate the role of fetal pancreatic biometry in predicting gestational diabetes mellitus and fetal growth restriction during pregnancy. Materials and Methods: This prospective observational study included 80 pregnant women with singleton pregnancies attending a tertiary care teaching hospital. Fetal pancreatic dimensions, including transverse diameter, thickness, and circumference, were measured using obstetric ultrasonography between 22–24 weeks and 28–30 weeks of gestation. Participants underwent routine screening for GDM using oral glucose tolerance testing and were followed until delivery. Pregnancy outcomes, fetal growth parameters, birth weight, and neonatal outcomes were recorded. Statistical analysis was performed using appropriate parametric and non-parametric tests, and a p-value <0.05 was considered statistically significant Results: The mean maternal age was 27.3 ± 4.6 years, and GDM was diagnosed in 23.8% of participants, while FGR occurred in 13.8%. Fetal pancreatic dimensions increased significantly with gestational age (p<0.001). Pregnancies complicated by GDM demonstrated significantly larger pancreatic transverse diameter (20.3 ± 2.4 mm vs. 17.1 ± 2.1 mm), thickness (8.7 ± 1.2 mm vs. 7.0 ± 1.1 mm), and circumference (56.4 ± 6.1 mm vs. 47.7 ± 5.8 mm) compared with non-GDM pregnancies (p<0.001). Conversely, pregnancies with FGR or adverse fetal outcomes showed significantly smaller pancreatic dimensions, including circumference (42.6 ± 5.3 mm vs. 51.9 ± 6.2 mm; p<0.001). Reduced pancreatic biometry was significantly associated with low birth weight and NICU admission Conclusion: Fetal pancreatic biometry is significantly associated with both gestational diabetes mellitus and fetal growth restriction. Increased pancreatic dimensions correlate with GDM, whereas reduced pancreatic measurements are associated with FGR and adverse neonatal outcomes. Fetal pancreatic biometry may serve as a valuable adjunctive sonographic marker for identifying pregnancies at risk for metabolic and growth-related complications. Keywords: Fetal Pancreatic Biometry. Gestational Diabetes Mellitus. Fetal Growth Restriction (FGR).

Background: Hepatitis C virus (HCV) infection remains a major global health concern and a leading cause of chronic liver disease. Hospital-based studies are important for identifying high-risk populations and guiding screening strategies. The objective is to determine the seroprevalence and demographic distribution of HCV infection among hospitalized patients in a tertiary care hospital in Western Uttar Pradesh. Materials and Methods: A retrospective observational study was conducted over three months in the Department of Microbiology. A total of 629 hospitalized patients tested for anti-HCV antibodies were included. Serum samples were analyzed using a third-generation enzyme-linked immunosorbent assay (ELISA). Data were evaluated for age, sex, and department-wise distribution. Statistical analysis was performed using the chi-square test, with p < 0.05 considered statistically significant. Results: Out of 629 patients, 80 were seropositive, yielding an overall prevalence of 12.7%. Positivity was higher among males (14.4%) compared to females (11.9%). The highest prevalence was observed in the 41–60 years age group (16.7%). Department-wise analysis showed higher seropositivity in General Surgery (14.9%) and General Medicine (13.8%). Conclusion: The study demonstrates a relatively high seroprevalence of HCV infection among hospitalized patients. The findings highlight the need for routine screening and strengthening of infection control practices in hospital settings to reduce transmission and disease burden. Keywords: Hepatitis C virus, Seroprevalence, Hospitalized patients, ELISA, Tertiary care.

Background: Acute Chest Syndrome (ACS) is one of the most severe and life-threatening complications of Sickle Cell Disease (SCD), contributing significantly to morbidity, prolonged hospitalization, and mortality. Early identification of clinical features, laboratory abnormalities, and prognostic factors is essential for timely management and improved patient outcomes. The objective is to determine the clinical profile, risk factors, laboratory and radiological characteristics, management strategies, and outcomes of patients with Acute Chest Syndrome admitted with Sickle Cell Disease at a tertiary care centre. Materials and Methods: A prospective longitudinal observational study was conducted among 60 patients with Sickle Cell Disease diagnosed with Acute Chest Syndrome admitted to the Department of Medicine, New Civil Hospital, Surat, over a 16-month period (May 2018–September 2019). Patients aged ≥12 years fulfilling the diagnostic criteria for ACS were included. Clinical history, physical examination, laboratory investigations, radiological findings, treatment modalities, and outcomes were recorded using a predesigned proforma. Data were analyzed using SPSS version 16.0. Descriptive statistics were expressed as mean ± standard deviation and percentages. Results: Among the 60 patients, 40 (66.7%) were females and 20 (33.3%) were males. The majority (71.7%) belonged to the 19–30-year age group. Tachypnoea (91.7%), increased work of breathing (86.7%), chest pain (78.3%), and hypoxaemia (68.3%) were the predominant presenting features. The mean hemoglobin level was 7.03 ± 1.92 g/dL, and the mean white blood cell count was 21,935 ± 14,166/mm³. Bilateral lower-zone consolidation was the most common chest radiographic finding, whileultrasonography frequently demonstrated lung consolidation (85.0%) and splenomegaly (71.7%). Simple blood transfusion was administered to 91.7% of patients, exchange transfusion to 20.0%, and incentive spirometry to 76.7%. Overall, 52 (86.7%) patients were discharged, whereas 8 (13.3%) died. Higher leukocyte counts, elevated HbS levels, lower HbF levels, and the requirement for mechanical ventilation were associated with poorer outcomes. Conclusion: Acute Chest Syndrome remains a major cause of morbidity and mortality among patients with Sickle Cell Disease. Early recognition, prompt supportive care, timely blood transfusion, and multidisciplinary management are essential to improve survival. Leukocytosis, high HbS levels, low HbF levels, and severe respiratory involvement may serve as important prognostic indicators for adverse outcomes. Keywords: Acute Chest Syndrome; Sickle Cell Disease; Hemoglobin S; Hemoglobin F; Blood Transfusion; Leukocytosis; Mechanical Ventilation; Pulmonary Complications; Outcome; Tertiary Care Centre.

Background: Lower respiratory tract infections are a major cause of hospitalization and mortality worldwide. CURB-65 is a widely used bedside severity score, while mean platelet volume (MPV), a routine haemogram parameter reflecting platelet activation, has been proposed as an inexpensive adjunct prognostic marker. The Objective is to assess severity and prognosis using MPV and CURB-65 individually, and to study their correlation in predicting outcome. Materials and Methods: This prospective observational study enrolled 142 adults hospitalized with community-acquired pneumonia or acute exacerbation of COPD over 18 months. CURB-65 was calculated at admission, and MPV was measured serially on Days 1, 3, 5, 7 and 9. Patients were followed until discharge for ICU admission, mechanical ventilation, pleural effusion, hospital stay, and in-hospital mortality. Chi-square, t-test, and one-way ANOVA were used, with p<0.05 considered significant. Results: The cohort was predominantly elderly (61% aged 51–69 years) with a male predominance (54.93%); 66.90% had CAP. ICU admission, mechanical ventilation, and mortality occurred in 26.06%, 21.83%, and 7.04% of patients respectively. High CURB-65 risk was significantly associated with mechanical ventilation (61.54% vs 14.74%, p<0.001), prolonged stay (p=0.006), and mortality (p=0.047). Mean MPV fell significantly from 9.07±0.85 fL (Day 1) to 8.83±0.84 fL (Day 3, p<0.001), and was significantly higher among patients requiring ventilation and prolonged stay. MPV rose significantly across CURB-65 risk strata on both Day 1 and Day 3 (p<0.001 for both). Conclusion: Both CURB-65 and serial MPV correlated significantly with adverse outcomes in LRTI, and MPV tracked closely with CURB-65 severity. Combining this inexpensive, routinely available marker with CURB-65 may improve early risk stratification, particularly in resource-limited settings. Keywords: Mean platelet volume, CURB-65, lower respiratory tract infection, community-acquired pneumonia, prognosis, mechanical ventilation.

Background: The ET Tube cuff ensures a tight seal within the subglottic tracheal structures and promotes effective mechanical ventilation. Maintenance of an adequate intracuff pressure is important to facilitate effective mechanical ventilation and to prevent complications of under inflation or over inflation of the cuff. Objective: to measure the ET tube cuff pressure and its variation in comparison with conventional method of cuff inflation and using a pressure manometer with regard to incidence of variation in cuff pressure, under inflation and over inflation. Materials and Methods: This study was conducted in 80 adult patients aged above 18 years who were admitted to ICU on mechanical ventilation. Patients were randomized into 2 groups of 40 each: • Group C - cuff inflated by conventional method. • Group PM - cuff inflated by pressure manometer. The cuff pressures were monitored over a period of 48 hours with 8th hourly interval. Under inflation of ET tube cuff is defined as cuff pressure less than 20 cm H2O and over inflation of ET cuff is defined as cuff pressure more than 30 cm H2O. Results: The study groups were categorized into low (<20cms H2O), safe (20-30cms H2O) and high cuff pressure (>30cms H2O) at all the time intervals. Our study found that the cuff pressure measured at different time intervals were statistically significant. The cuff pressure observed was in the safe range in the Group PM, at each interval. On the contrary, the cuff pressure of the patients in the Group C, was at a high pressure range. Conclusion: Routine use of cuff pressure manometer at regular intervals helps maintain cuff pressure at a safe range and prevents abnormal variations in mechanically ventilated patients. Keywords: Cuff Pressure; Endotracheal Tube; Measurement; ICU; Conventional Method; Cuff Pressure Manometer.

Background: Bipolar disorder is associated with substantial cardiometabolic morbidity. Mood stabilizers may influence weight, glucose regulation, lipids, and blood pressure, but direct comparisons between lithium and sodium valproate remain limited. The objective was to compare the prevalence of metabolic syndrome and its individual components in euthymic adults receiving maintenance lithium or sodium valproate. Materials and Methods: This hospital-based cross-sectional study included 100 adults aged 18-50 years with DSM-5 bipolar disorder who had been euthymic for at least 2 months and treated for at least 6 months with lithium (n=51) or sodium valproate (n=49). Euthymia was defined as a Young Mania Rating Scale score ≤7 and a Hamilton Depression Rating Scale score ≤8. Metabolic syndrome was identified using the study's modified NCEP ATP III criteria. Waist circumference, blood pressure, fasting glucose, triglycerides, and high-density lipoprotein cholesterol were assessed. Effect estimates included risk difference, risk ratio, odds ratio, 95% confidence intervals, Welch t tests, and Hedges' g. Results: Metabolic syndrome was present in 20 of 51 lithium-treated participants (39.2%) and 23 of 49 valproate-treated participants (46.9%). The absolute risk difference was 7.72 percentage points (95% CI -11.64 to 27.08), risk ratio 1.20 (95% CI 0.76-1.88), and odds ratio 1.37 (95% CI 0.62-3.03); χ²(1)=0.61, p=0.435. Systolic and diastolic blood pressure, fasting glucose, waist circumference, triglycerides, and HDL cholesterol did not differ significantly; standardized mean differences were small. Conclusion: Metabolic syndrome was common in both treatment groups, but the study did not demonstrate a statistically significant difference between lithium and sodium valproate. Wide confidence intervals preclude a conclusion of equivalence. Routine cardiometabolic surveillance is warranted regardless of the prescribed mood stabilizer. Keywords: Bipolar disorder, metabolic syndrome, lithium, sodium valproate, cardiometabolic risk, NCEP ATP III.

Background: Radiation-induced alopecia (RIA) is a frequent adverse effect of radiotherapy involving hair-bearing regions, particularly in patients undergoing cranial, scalp, and head and neck irradiation. While hair loss is often temporary, higher radiation doses, larger treatment volumes, and concurrent systemic therapies may result in permanent alopecia, leading to considerable cosmetic concerns, psychological distress, and reduced quality of life. Despite advances in radiotherapy techniques such as intensity-modulated radiotherapy (IMRT), volumetric-modulated arc therapy (VMAT), stereotactic radiosurgery (SRS), and proton therapy, RIA remains an important survivorship issue. The objective is to systematically review the current evidence on the incidence, risk factors, preventive strategies, and management of radiation-induced alopecia in patients receiving therapeutic radiotherapy. Methods: A systematic review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Electronic databases including PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library will be searched from inception to the final search date. Eligible studies will include randomized controlled trials, prospective and retrospective cohort studies, case-control studies, and observational studies reporting radiation-induced alopecia. Two independent reviewers will perform study selection, data extraction, and risk-of-bias assessment using validated appraisal tools. Data will be synthesized narratively, and where sufficient homogeneity exists, a random-effects meta-analysis will be performed. Results: The review will summarize the reported incidence and severity of radiation-induced alopecia, identify patient- and treatment-related risk factors, evaluate radiation dose thresholds associated with temporary and permanent hair loss, and assess the effectiveness of preventive measures and available therapeutic interventions. Where appropriate, pooled estimates of incidence and treatment outcomes will be calculated. Conclusion: This systematic review will provide a comprehensive synthesis of current evidence on radiation-induced alopecia, identify knowledge gaps, and support evidence-based clinical practice. The findings are expected to improve patient counseling, optimize radiotherapy planning, and guide future research on preventive and therapeutic strategies. Keywords: Radiation-induced alopecia; radiotherapy; hair loss; permanent alopecia; risk factors; prevention; management; systematic review.

Background: Objective: To predict the illness severity and outcome of children less than or equal to 12 years with kerosene ingestion admitted at Tirunelveli Medical College on admission using the Scoring System for Hydrocarbon poisoning. Materials and Methods: This hospital based observational study was conducted among All children less than or equal to 12 years with history of kerosene oil ingestion admitted in Tirunelveli Medical college are evaluated with the scoring System for Hydrocarbon poisoning at the time of admission and serially every 2 hours upto 8 hours. Results: Among the 40 total subjects 13 cases admitted in the hospital within 2 hours after kerosene ingestion. 20 subjects admitted in 2 to 3 hours and 7 subjects admitted after three hours of ingestion. Among the total 40 subjects 22 subjects developed no complications, 17 subjects developed Chemical pneumonitis and 1 subject needed ventilator support and subsequently died. Out of 40 subjects 39 subjects had absence of cyanosis (score 0) and one subject had cyanosis (Score 3). 19 subjects had SpO2 >95% (Score 0), 20 subjects had SpO2 81% to 95% (score 1) and 1 subject had SpO2 <60% (score 3). There was no subject with SpO2 61% to 80% (score 2). auscultatory findings 14 subjects had wheeze (score 1) and 26 subjects had crepitation and or diminished air entry (score 2). Conclusion: The Scoring system for hydrocarbon poisoning can be applied bedside and is useful in assessing the clinical severity and outcome of children with kerosene poisoning. Keywords: Illness Severity, Kerosene Ingestion, The Scoring System, Hydrocarbon Poisoning.

Background: Male reproductive health is influenced by several environmental and lifestyle factors beyond substance use. Increasing age, obesity, sedentary behavior, prolonged mobile phone exposure, and occupational heat or radiation may adversely affect spermatogenesis through hormonal imbalance, oxidative stress, and thermal injury. This study evaluated the association of these non-addictive lifestyle and occupational factors with semen quality among men attending an infertility clinic. Materials and Methods: A descriptive cross-sectional study was conducted among 215 men presenting for infertility evaluation. Clinical information regarding age, body mass index, sedentary lifestyle, occupational exposure, prolonged sitting, and mobile phone usage was collected using a structured questionnaire. Semen analysis was performed according to WHO 2010 guidelines. Associations between lifestyle variables and semen abnormalities were evaluated using Pearson's Chi-square test. Results: Increasing age was associated with reduced semen volume and impaired motility. Obesity demonstrated significant associations with reduced sperm concentration and impaired progressive motility. Sedentary lifestyle showed significant relationships with oligospermia, asthenozoospermia, necrozoospermia, and abnormal progressive motility. Occupational heat exposure was associated with impaired sperm concentration, vitality, and motility, while radiation exposure adversely affected multiple semen parameters including morphology. Prolonged sitting was associated with reduced sperm concentration and motility. Mobile phone exposure demonstrated an association with abnormal sperm morphology. Conclusion: Non-addictive lifestyle and occupational factors exert significant adverse effects on semen quality. Weight optimization, increased physical activity, minimizing occupational heat exposure, and reducing prolonged sedentary behavior should be incorporated into fertility counselling for men undergoing infertility evaluation. Keywords: Male infertility, Obesity, Sedentary lifestyle, Occupational exposure, Mobile phone, Semen quality.

Background: Polycythemia, encompassing both primary and secondary forms, is characterized by an increase in red blood cell mass resulting in elevated hemoglobin and hematocrit levels. Hyperviscosity, endothelial dysfunction, and thrombotic complications associated with polycythemia may adversely affect renal microcirculation, predisposing patients to chronic kidney disease and proteinuria. However, evidence regarding the burden of renal involvement among patients with polycythemia remains limited, particularly from developing countries. Early identification of renal impairment may facilitate timely intervention and improve long-term renal outcomes. The objective is to determine the prevalence of renal dysfunction and proteinuria among patients with polycythemia and to evaluate the relationship between hemoglobin concentration and renal function. Materials and Methods: A hospital-based cross-sectional observational study was conducted among 93 adult patients diagnosed with polycythemia attending the Departments of General Medicine and Hematology of a tertiary care teaching hospital. Clinical characteristics, laboratory investigations, serum creatinine, estimated glomerular filtration rate (eGFR), urine protein-creatinine ratio (UPCR), hemoglobin, hematocrit, and other hematological parameters were recorded. Renal dysfunction was defined as eGFR <60 mL/min/1.73 m². Pearson correlation analysis was performed to evaluate the relationship between hemoglobin level and renal parameters. Statistical significance was considered at p<0.05. Results: Among the 93 participants, the mean age was 54.3±12.7 years. Renal dysfunction was identified in 38.7% of patients, while clinically significant proteinuria was observed in 23.7%. Mean hemoglobin concentration was 18.8±1.9 g/dL and mean eGFR was 68.7±23.7 mL/min/1.73 m². Hemoglobin level demonstrated a statistically significant negative correlation with eGFR (r=-0.222, p=0.032), suggesting declining renal function with increasing hemoglobin concentration. No statistically significant correlation was observed between hemoglobin concentration and proteinuria (r=0.167, p=0.110). Conclusion: Renal dysfunction and proteinuria are relatively common among patients with polycythemia. Increasing hemoglobin concentration appears to be associated with declining renal function. Routine renal evaluation including eGFR estimation and proteinuria assessment should be considered during the clinical follow-up of patients with polycythemia for early detection of kidney involvement. Keywords: Polycythemia, Chronic kidney disease, Proteinuria, Estimated glomerular filtration rate, Hemoglobin, Renal dysfunction.

Background: Enhanced Recovery After Surgery (ERAS) is an evidence-based, multidisciplinary perioperative care pathway that aims to minimize the physiological stress of surgery, accelerate recovery, and improve patient outcomes. Objective: To review the current evidence on the principles, implementation, clinical outcomes, and future perspectives of ERAS across different surgical specialties. Materials and Methods: A comprehensive literature search was conducted using PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and the Cochrane Library. Randomized controlled trials, systematic reviews, meta-analyses, and international guidelines published between 2015 and 2025, along with landmark studies, were reviewed. Data on ERAS interventions, postoperative outcomes, complications, hospital length of stay, readmission, mortality, and patient satisfaction were synthesized narratively. Results: The reviewed evidence consistently demonstrated that ERAS improves perioperative outcomes across multiple surgical specialties. Meta-analyses have shown reductions in postoperative complications, shorter hospital stays, decreased opioid use, earlier mobilization, faster return of bowel function, and lower healthcare costs without increasing readmission or mortality. The greatest benefits were observed in colorectal surgery, with increasing evidence supporting ERAS in gynecological, orthopedic, urological, hepatobiliary, thoracic, and cardiac procedures. Conclusion: ERAS is a safe, effective, and cost-efficient perioperative care model that enhances recovery and improves surgical outcomes. Successful implementation requires multidisciplinary collaboration, adherence to standardized protocols, and continuous quality improvement. Wider adoption of ERAS is expected to further improve patient care and healthcare efficiency. Keywords: Enhanced Recovery After Surgery (ERAS); perioperative care; fast-track surgery; multimodal rehabilitation; postoperative recovery; evidence-based practice; patient outcomes; enhanced recovery pathway.

Background: Heart failure (HF) is a major cause of morbidity and mortality worldwide. Neurohormonal activation in HF contributes to electrolyte disturbances, among which magnesium imbalance is associated with arrhythmias and adverse cardiovascular outcomes. This study aimed to evaluate serum magnesium levels in patients with heart failure and their association with ejection fraction and disease severity. Materials and Methods: A hospital-based cross-sectional observational study was conducted in the Departments of Cardiology and General Medicine at Pushpagiri Institute of Medical Sciences and Research Centre, Kerala, over 1.5 years. Fifty adults (>18 years) fulfilling Framingham criteria with elevated BNP/NT-proBNP levels were included. Patients receiving magnesium supplements and those with stage 5 chronic kidney disease were excluded. Serum magnesium levels were measured using a Beckman analyzer. Echocardiography was performed using the VIVID E system, and heart failure severity was assessed using the New York Heart Association (NYHA) classification. Data were analyzed using SPSS version 24. Results: Among the 50 patients, 54% were males and most belonged to the 51–75-year age group. Twenty-six patients had heart failure with reduced ejection fraction (HFrEF) and 24 had preserved ejection fraction (HFpEF). Mean serum magnesium level was 1.62 mmol/L. Normal magnesium levels were observed in 48% of patients, while 22% had mild hypomagnesemia and 30% had significantly low levels. Serum magnesium levels were lower in HFrEF patients and in those with NYHA class III–IV compared with HFpEF and NYHA class II patients. Conclusion: Lower serum magnesium levels are associated with reduced ejection fraction and increased severity of heart failure, highlighting the importance of routine magnesium assessment in HF patients. Keywords: Heart failure, magnesium, ejection fraction, echocardiography, NYHA class, electrolytes.

Background: Water is a vital nutrient that keeps the body balanced and functioning properly. Even a slight dehydration, such as losing 1% to 2% of body's water content, can impair ability to function both intellectually and physically. Hydration levels and body composition can be checked with Bioelectrical Impedance Analysis (BIA). Cognition is defined as a process of knowing an individual’s awareness. Cognitive function is assessed by cognitive evoked potential and reaction time. Materials and Methods: Cross sectional observational study was done among 70 adult healthcare staff from age 26 years to 44 years. Hydration status and body composition parameters were assessed by Bioelectrical Impedance Analysis method and Cognitive Performance was assessed by measuring Reaction time both auditory and visual and Cognitive evoked potential. Multivariate regression analysis was performed to assess the effects of body composition parameters on cognitive performance. Results: The regression analysis highlights gender and BMI as the determinants of body composition. Male gender was associated with higher hydration, lean mass, muscle mass, fat-free mass whereas BMI was the strongest predictor of fat-related parameters and influenced fat-free mass. Reaction time and P300 latencies are neurophysiological measures that are minimally influenced by body composition differences. Conclusion: The findings demonstrate that body composition parameters did not independently predict either visual or auditory P300 latency or reaction time. This implies that P300 latency and reaction time are relatively stable neurophysiological markers in a healthy adult population that are largely insensitive to changes in body composition and hydration. Keywords: Body Composition, Hydration, Cognitive Performance, Bioimpedance Analysis, Reaction time.

Background: Quality control (QC) is a fundamental component of clinical biochemistry laboratories, ensuring the accuracy, precision, and reliability of laboratory test results that support clinical decision-making and patient care. Advances in laboratory automation, statistical quality control, and international accreditation standards have enhanced analytical performance; however, laboratory errors continue to occur throughout the pre-analytical, analytical, and post-analytical phases. This review aims to evaluate current quality control practices in clinical biochemistry laboratories, highlighting internal quality control (IQC), external quality assessment (EQA), statistical quality control methods, accreditation standards, emerging technologies, and future perspectives for improving laboratory quality. Materials and Methods: A narrative review of the literature was conducted using PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, and Google Scholar. Peer-reviewed articles, systematic reviews, international guidelines, and consensus documents published primarily between 2015 and 2026 were critically analyzed. Evidence relating to IQC, EQA, Six Sigma methodology, ISO 15189 accreditation, laboratory automation, and quality indicators was synthesized. Results: The reviewed literature indicates that comprehensive quality management systems significantly improve analytical accuracy, precision, and consistency. Routine implementation of IQC using Levey–Jennings charts and Westgard multirule procedures, combined with participation in EQA programs, enhances laboratory performance and minimizes analytical errors. Adoption of ISO 15189 standards, Six Sigma metrics, standardized quality indicators, and automation further strengthens quality assurance by improving workflow efficiency and supporting continuous quality improvement. Nevertheless, pre-analytical errors, workforce limitations, and resource constraints remain major challenges, particularly in resource-limited settings. Conclusion: Integrating robust quality control practices with accreditation standards, risk-based quality management, and technological innovations is essential for ensuring reliable laboratory services. Continuous monitoring, staff competency development, and harmonization of quality management practices will further enhance patient safety and diagnostic excellence in clinical biochemistry laboratories. Keywords: Clinical biochemistry; quality control; internal quality control; external quality assessment; ISO 15189; Six Sigma; laboratory accreditation; quality assurance.

Background: Lichtenstein tension-free mesh repair remains the standard surgical procedure for inguinal hernia repair because of its simplicity and low recurrence rates. However, chronic postoperative pain, sensory disturbances, and recurrence remain important concerns. Open transinguinal preperitoneal (TIPP) mesh repair has emerged as an alternative technique that places the mesh in the preperitoneal space, potentially reducing postoperative pain and nerve-related complications. This study compared the surgical outcomes of TIPP and Lichtenstein hernia repair. The objective is to compare the effectiveness and safety of Open Transinguinal Preperitoneal (TIPP) mesh repair with Lichtenstein tension-free mesh repair in patients undergoing elective inguinal hernia surgery. Materials and Methods: A prospective comparative study was conducted in the Department of General Surgery, Coimbatore Medical College Hospital, Tamil Nadu, India, betweenNovember 2023 and November 2024. Fifty patients aged 20–80 years with uncomplicated inguinal hernia were randomly allocated into two equal groups. Group A (n=25) underwent Lichtenstein hernioplasty, while Group B (n=25) underwent TIPP repair using polypropylene mesh. Patients with complicated hernias, pregnancy, significant comorbidities, or unwillingness to participate were excluded. Operative duration, intraoperative complications, early postoperative complications, and late postoperative outcomes were compared. Statistical analysis was performed using the Chi-square test, with p<0.05 considered statistically significant. Results: Among the 50 patients, 49 (98%) were males and one (2%) was female. The majority (56%) were between 41 and 60 years of age. Indirect inguinal hernia was more common (58%) than direct hernia (42%). Operative time was significantly shorter in the Lichtenstein group, with 80% of procedures completed within 45 minutes compared with 40% in the TIPP group (χ²=8.33, p=0.003). Intraoperative complications were comparable between groups without statistical significance. Early postoperative complications, including severe pain, cord edema, seroma, scrotal collection, and surgical site infection, occurred more frequently following Lichtenstein repair. Late postoperative complications such as chronic pain (8%) and loss of sensation (12%) were observed only in the Lichtenstein group, whereas none were reported following TIPP repair. Conclusion: Both Lichtenstein and TIPP repairs are safe and effective techniques for elective inguinal hernia repair. Lichtenstein repair offers the advantage of shorter operative duration, whereas TIPP repair demonstrates fewer postoperative complications, particularly chronic pain and sensory disturbances. TIPP represents a promising alternative technique, although additional studies with larger sample sizes and longer follow-up are necessary to evaluate recurrence rates and long-term outcomes. Keywords: Inguinal hernia, Lichtenstein hernioplasty, Transinguinal preperitoneal repair, TIPP, Mesh hernioplasty, Chronic postoperative pain, Hernia surgery.

Background: Tuberculosis is a major infectious disease associated with significant changes in haematological and coagulation parameters due to persistent inflammation. These abnormalities may indicate disease severity and treatment response. The present study was undertaken to evaluate haematological and blood coagulation parameters in tuberculosis patients before and after the intensive phase of anti-tubercular treatment. Objectives: The present study aimed to evaluate alterations in haematological and blood coagulation parameters among patients with tuberculosis and to determine the changes occurring after completion of the intensive phase of anti-tubercular treatment. Materials and Methods: A prospective case-control study was conducted among 50 newly diagnosed tuberculosis patients and 50 healthy controls. Haematological and coagulation parameters were measured at diagnosis and after the intensive phase of anti-tubercular treatment. The findings were statistically analysed to determine disease-related changes and treatment-associated improvements. Results: TB patients and healthy controls had comparable age, gender, smoking status, and comorbidity profiles, minimizing potential confounding effects. Pulmonary tuberculosis was the predominant form of disease. Before treatment, TB patients exhibited anemia, elevated WBC and neutrophil counts, thrombocytosis, and increased CRP and fibrinogen levels, indicating active inflammation and a hypercoagulable state. After two months of intensive anti-tubercular therapy, significant improvements were observed, including increased hemoglobin levels and reductions in inflammatory and coagulation markers, demonstrating effective disease control and clinical recovery. Conclusion: This study showed that active tuberculosis is associated with anemia, inflammation, and coagulation abnormalities. After two months of intensive anti-tubercular therapy, significant improvements were observed in hemoglobin, WBC count, neutrophil count, platelet count, CRP, and fibrinogen levels. These findings indicate that effective treatment reduces systemic inflammation and coagulation disturbances and may help monitor disease progression and therapeutic response. Keywords: Tuberculosis, Anti-tubercular therapy, Hematological parameters, C-reactive protein, Coagulation profile.

Background: Vitamin D plays an important role in musculoskeletal health, muscle strength, and athletic performance. Athletes are considered vulnerable to vitamin D insufficiency despite regular physical activity. Data regarding vitamin D status among athletes from northeastern India are limited. The objective is to assess serum 25-hydroxy vitamin D [25(OH)D] levels among regularly trained athletes in Manipur. Materials and Methods: This study was conducted in the Department of Physiology, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, on regularly trained healthy young athletes. 25(OH)D levels were estimated using ELISA. Statistical analysis was performed using SPSS version 21. Results: The mean serum vitamin D level among the athletes was 33.48 ± 8.01 ng/ml. Male athletes had a higher mean vitamin D level(34.69± 9.89 ng/ml) than female athletes (31.91±4.29 ng/ml; p=0.204). Out of 55 athletes, 36 (65%) had sufficient vitamin D levels and 19 (35%) had vitamin D insufficiency. None of the athletes had vitamin D deficiency. Cyclists demonstrated relatively higher vitamin D levels compared to sepak takraw players. Conclusion: Most athletes in the present study had sufficient vitamin D levels, although a considerable proportion demonstrated vitamin D insufficiency. Regular monitoring and preventive strategies may help maintain optimal vitamin D status among athletes. Keywords: Vitamin D; Athletes; 25-hydroxy vitamin D; Sports physiology; Manipur.

Background: Diabetic retinopathy (DR) remains a leading cause of preventable blindness, with severity classically attributed to glycemic exposure, disease duration, and systemic hypertension. The relative and combined contribution of these three determinants remains insufficiently quantified in Indian tertiary care populations. The objective is to evaluate the severity of DR and its correlation with glycated hemoglobin (HbA1c), duration of diabetes, and systemic hypertension among patients attending a tertiary ophthalmology centre. Materials and Methods: This cross-sectional study enrolled 370 consecutive patients with type 2 diabetes mellitus at the Department of Ophthalmology, Surabhi Institute of Medical Sciences, Siddipet, over an eleven-month period (October 2024–August 2025). DR severity was graded using the ETDRS classification. Associations between DR severity and HbA1c category, diabetes duration, and hypertension status were assessed using Kruskal–Wallis and Spearman correlation tests, with independent predictors identified through ordinal logistic regression. Results: Mild non-proliferative DR was the most common finding (34.9%), followed by no DR (30.0%), moderate (20.0%), severe non-proliferative (8.1%), and proliferative DR (7.0%). Proliferative disease was entirely absent among well-controlled patients (HbA1c <7.0%) but present in 22.7% of poorly controlled patients (HbA1c ≥9.0%), and rose from 0% in patients with diabetes duration under five years to 19.0% beyond a decade. HbA1c category, diabetes duration, and hypertension each independently predicted higher DR severity on multivariable analysis (all p<0.001). Conclusion: DR severity was driven cumulatively and independently by glycemic control, disease duration, and hypertension, supporting integrated, duration-aware screening strategies that extend beyond glycemic monitoring alone in similar tertiary care settings. Keywords: Diabetic retinopathy, diabetic eye disease, glycemic control, comorbidities, hypertension.

Background: Tibial shaft fractures are the most common long-bone fractures, and surgical fixation aims to restore anatomical alignment to optimize biomechanical loading and facilitate union. Iatrogenic malalignment remains a significant complication, particularly in fractures involving the metaphyseal flare (proximal or distal thirds). This review synthesizes current evidence on the mechanisms, risk factors, modern assessment techniques, and preventive strategies for malalignment following tibial shaft fracture fixation. Materials and Methods: A narrative systematic review of the literature was conducted utilizing electronic databases (PubMed, EMBASE, Cochrane) with PRISMA guidelines .Priority was given to recent studies published between 2020 and 2025, supported by seminal foundational papers. Studies evaluating intramedullary nailing (IMN), plate osteosynthesis, and external fixation were included. Results: Malalignment acts as a critical independent predictor of nonunion and long-term joint degeneration. Commonly accepted thresholds for unacceptable malalignment include >5° in the coronal plane, >5-10° in the sagittal plane, >10-15° of rotation, and >1-2 cm of shortening. Recent cohorts report distal fracture coronal/sagittal malalignment rates around 13%. Furthermore, computed tomography (CT)-based studies reveal that rotational malalignment affects approximately 30% of patients, frequently unrecognized on standard radiographs. Preventative strategies, such as multiplanar distal interlocking and the use of poller (blocking) screws, demonstrate robust efficacy in minimizing deformity. While the suprapatellar approach improves intraoperative positioning and sagittal reduction, recent data suggests it does not significantly reduce the incidence of CT-defined rotational malalignment compared to infrapatellar approaches. Conclusion: Precise surgical planning, utilization of adjunctive reduction tools (e.g., blocking screws), and advanced assessment modalities (e.g., postoperative CT for rotational profiling) are essential to mitigate the risk of malalignment. Clinicians must address specific plane-dependent deforming forces to minimize mechanical complications and improve patient outcomes. Keywords: Tibial shaft fracture; Intramedullary nailing; Malalignment; Malunion; Poller screws; Rotational deformity.

Background: Hepatitis A virus (HAV) remains one of the leading causes of acute viral hepatitis (AVH), particularly in developing countries where fecal–oral transmission is facilitated by inadequate sanitation and poor hygiene. India has traditionally been considered highly endemic for HAV; however, recent improvements in socioeconomic conditions have led to an epidemiological shift, with increasing susceptibility among older children and adolescents. Data on the epidemiology of HAV infection from Uttarakhand is limited. This study aimed to determine the seroprevalence of acute HAV infection among clinically suspected AVH cases and to describe its demographic and seasonal distribution in a tertiary care hospital in Uttarakhand. Materials and Methods: A prospective cross-sectional study was conducted between January and December 2023 at the Department of Microbiology, Government Doon Medical College and Hospital, Dehradun. Consecutive patients presenting with clinically suspected AVH were enrolled. Serum samples were tested for anti-HAV immunoglobulin M (IgM) antibodies using the ARCHITECT® HAVAb-IgM chemiluminescent microparticle immunoassay. Demographic, clinical, laboratory, and seasonal data were analyzed descriptively. Results: A total of 161 patients were included, comprising 104 (64.6%) males and 57 (35.4%) females. Anti-HAV IgM antibodies were detected in 83 (51.6%) patients, indicating acute HAV infection. Among seropositive cases, males accounted for 59.0% and females for 41.0%. The highest seropositivity was observed among children aged 11–15 years (90.0%), followed by those aged 6–10 years (84.2%) and 0–5 years (83.3%). No seropositive cases were identified among individuals older than 30 years. A seasonal increase in HAV cases was observed during the monsoon months, with the highest number of cases reported in July. Conclusion: More than half of the patients with suspected AVH had evidence of acute HAV infection, with the greatest burden occurring among older children and adolescents. These findings support the evolving epidemiology of HAV in Uttarakhand and underscore the need for continued surveillance, improved sanitation, and consideration of targeted hepatitis A vaccination strategy for susceptible populations. Keywords: Acute viral hepatitis, Anti-HAV IgM, Epidemiological transition, Hepatitis A virus, Seroprevalence.

Background: Stromal CD10 expression was correlated with clinicopathological and molecular parameters to determine its association with established prognostic factors and to evaluate its potential utility as a prognostic biomarker in breast carcinoma. The aim and objective is to evaluate the histomorphological characteristics of various types of breast carcinoma and analyse the immunohistochemical expression patterns of ER, PR, HER2/neu, and CD10, with special emphasis on the association of stromal CD10 expression with tumour grade and prognostic factors including age, tumour size, histological type, lymphovascular invasion, lymph node status, and hormonal receptor and HER2/neu status. Materials and Methods: This prospective study was conducted from July 2018 to July 2020 in the Department of Pathology, Guntur Medical College and Government General Hospital, Guntur. A total of 102 histologically confirmed cases of breast carcinoma were included. Formalin-fixed, paraffin-embedded tissue sections were processed routinely and stained with hematoxylin and eosin for histopathological evaluation. Immunohistochemistry for estrogen receptor (ER), progesterone receptor (PR), HER2/neu, and stromal CD10 was performed using the streptavidin–biotin–peroxidase method. Stromal CD10 expression was evaluated and correlated with clinicopathological and molecular prognostic parameters using appropriate statistical analysis. Results: Among 302 breast specimens, 102 (33.77%) were diagnosed as breast carcinoma. Grade II tumors and invasive carcinoma NST were the predominant findings. Strong stromal CD10 expression was significantly associated with higher histological grade, ER negativity, PR negativity, and HER2 positivity (p < 0.05). These findings suggest that stromal CD10 is a useful marker of aggressive tumor behavior and poor prognosis. Conclusion: Stromal CD10 expression was significantly associated with higher histological grade, ER negativity, PR negativity, and HER2/neu positivity, indicating its association with aggressive breast carcinoma and poor prognosis. Stromal CD10 may serve as a simple, cost-effective prognostic biomarker and could be incorporated into routine histopathological evaluation for improved prognostic assessment. Keywords: Histomorphological study of breast carcinoma, CD10 stromal marker, Carcinoma, Breast cancer.

Background: Fatal falls from height constitute an important cause of unnatural death and represent a unique form of blunt force trauma characterized by complex injury patterns involving multiple body regions and vital organs. Detailed evaluation of injury distribution and organ involvement is essential for forensic reconstruction and determination of the cause of death. Materials and Methods: A prospective autopsy-based descriptive study was conducted in the Department of Forensic Medicine of a tertiary care teaching hospital in South India over a period of three years from June 2012 to May 2015. Thirty-five medico-legal autopsy cases of deaths due to falls from height were included. Data regarding height of fall, external injuries, skeletal injuries, internal soft tissue injuries, organ involvement, survival interval, and cause of death were collected from autopsy records and analyzed using descriptive statistics. Results: Among the 35 cases studied, the majority of victims had fallen from heights of 30–39 feet (25.71%). External injuries were most commonly observed in the limbs (77.14%), followed by the head and neck region (71.42%). Thoracic skeletal injuries were the most frequent fractures (74.28%), while internal soft tissue injuries predominantly involved the head and neck region (80.00%). The brain was the most commonly injured organ (82.86%), followed by the lungs (77.14%) and liver (57.14%). Most victims died at the scene or within 30 minutes of injury (65.71%). Shock and hemorrhage accounted for the majority of deaths (65.71%), followed by severe head injury (31.43%). Conclusion: Fatal falls from height are associated with extensive multisystem trauma, predominantly affecting the brain, lungs, and liver. Thoracic skeletal injuries and cranio-cerebral trauma were the most characteristic injury patterns observed. The high proportion of immediate deaths highlights the severity of injuries sustained. Comprehensive autopsy evaluation of injury patterns and organ involvement plays a crucial role in determining the cause of death and reconstructing the circumstances surrounding fatal falls. Keywords: Fall from height; Autopsy; Injury pattern; Organ involvement; Blunt force trauma.

Background: The ilioinguinal nerve is commonly encountered during surgery and may be a source of postoperative neuralgia due to entrapment, stretching, or injury. Whether routine preservation or elective division of the ilioinguinal nerve provides better postoperative outcomes remains controversial. The objective is to compare the outcomes of ilioinguinal nerve preservation versus elective ilioinguinal neurectomy during Lichtenstein mesh hernioplasty, with special emphasis on chronic groin pain and sensory disturbances. Materials and Methods: A prospective comparative study was conducted in the Department of General Surgery, Government Medical College and Hospital, Ongole. One hundred male patients aged 18–70 years with primary unilateral uncomplicated inguinal hernia were included. Patients undergoing elective Lichtenstein mesh hernioplasty were divided into two groups: ilioinguinal nerve preservation and elective ilioinguinal neurectomy. Postoperative follow-up included assessment of chronic groin pain, sensory changes, postoperative complications, and patient satisfaction using standardized clinical evaluation methods. Results: Patients who underwent elective ilioinguinal neurectomy demonstrated a lower incidence and severity of chronic postoperative groin pain compared with those in whom the nerve was preserved. Although sensory disturbances such as numbness were more common in the neurectomy group, these symptoms were generally mild and well tolerated. No significant differences were observed in other postoperative complications. Conclusion: Elective ilioinguinal neurectomy during Lichtenstein mesh hernioplasty may reduce chronic postoperative groin pain with acceptable sensory morbidity, making it a useful strategy for improving long-term patient outcomes. Keywords: Inguinal hernia, Lichtenstein repair, ilioinguinal nerve, neurectomy, chronic groin pain, mesh hernioplasty.

Background: Urinary tract infection (UTI) is one of the most common bacterial infections encountered in clinical practice and is associated with significant morbidity if not diagnosed and treated promptly. Urine culture remains the gold standard for diagnosis; however, it is time-consuming and may not be readily available in all healthcare settings. Urine dipstick testing, which detects leukocyte esterase and nitrite, offers a rapid, inexpensive, and easily accessible method for preliminary screening of UTI. The aim of the study is to assess the role and utility of urine dipstick in screening for Urinary tract infections in children. The objective of the study is to determine the performance characteristics of urine nitrite and leukocyte esterase dipstick test. To compare the efficacy of dipstick test with the gold standard test gi.e.urine culture. Materials and Methods: This hospital based cross sectional study included 300 patients presenting with symptoms suggestive of UTI. At Outpatient department of paediatrics and wards, Sri Venkateswara Ramnarayan Ruia Government General Hospital (SVRRGGH), Tirupathi. A period of 1 year from date of approval by Institutional Scientific committee and Ethics committee. Midstream urine samples were collected under aseptic precautions and subjected to dipstick analysis for leukocyte esterase and nitrite. Urine culture was performed for all samples and considered the reference standard. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy of urine dipstick testing were calculated. Results: This study involved 300 paediatric patients to evaluate the clinical profile, diagnostic efficacy of urine dipstick tests, and microbiological and imaging results in children with suspected urinary tract infections (UTIs). Dysuria and urgency were the predominant symptoms reported (89.33% each), followed by increased micturition frequency (85%), stomach discomfort (58.67%), and continuous vomiting (65%). In frequent symptoms were fever, haematuria, pyuria, and constipation. Upon general examination, the majority of children exhibited systemic stability, with little indications of pallor, oedema, or pedal swelling. Significantly, 22.45% of male children exhibited phimosis.93.33% percent of children exhibited no related comorbidities, although a minor proportion presented with diseases including nephrotic syndrome, neurogenic bladder, posterior urethral valves, and vesicoureteral reflux. Positive cultures were identified in 40.33% of the patients, whereas 59.67% exhibited negative cultures. The urine dipstick results had significant diagnostic value. Leucocyte esterase had a sensitivity of 83% and a specificity of 94%, whereas nitrite demonstrated a sensitivity of 89% and a specificity of 88%. The diagnostic performance was strong, exhibiting good predictive values when combined. Pyuria had considerable sensitivity (76%) and specificity (79%). Haematuria had poor sensitivity (43%) with excellent specificity (91%). The predominant uropathogen identified was Escherichia coli (23%), succeeded by Klebsiella (9%) and Proteus species (6%).Imaging indica

Background: Mental health literacy, help-seeking behaviour, and resilience are important determinants of psychological well-being among healthcare students. Adequate mental health literacy promotes early recognition of mental health problems and appropriate help-seeking, while resilience enables students to cope effectively with academic and emotional challenges. Aim: To assess mental health literacy, attitudes toward professional help-seeking behaviour, and resilience among healthcare students and to evaluate their interrelationship. Materials and Methods: This institution-based cross-sectional observational study was conducted among 716 undergraduate healthcare students at Akash Group of Institutions, Bengaluru, Karnataka, from December 2025 to May 2026. Data were collected using validated questionnaires assessing Mental Health Literacy (MHLQ), attitudes toward seeking professional psychological help, and resilience using the Brief Resilience Scale (BRS). Statistical analysis was performed using SPSS version 27.0 and GraphPad Prism version 5. Associations were analyzed using the Chi-square test or Fisher's exact test, while Spearman's rank correlation coefficient was used to assess correlations. A p-value <0.05 was considered statistically significant. Results: Of the 716 participants, 66.9% were females and 33.1% were males. Overall, 99.4% demonstrated above-average mental health literacy, 62.6% had positive attitudes toward seeking professional psychological help, and 70.1% exhibited normal resilience as assessed by the Brief Resilience Scale (BRS). Significant associations were observed between gender and selected MHLQ domains, help-seeking attitudes, and resilience. Professional course was significantly associated with selected MHLQ domains and help-seeking attitudes. Resilience was also significantly associated with gender, professional course, overall mental health literacy, and selected MHLQ domains (p<0.05). Conclusion: Healthcare students demonstrated high mental health literacy, generally positive attitudes toward seeking professional psychological help, and predominantly normal resilience. Resilience showed significant associations with gender, professional course, and mental health literacy, highlighting its important role in students' psychological well-being. Integrating structured mental health literacy programs and resilience-building interventions into healthcare education may strengthen adaptive coping, promote timely help-seeking, and enhance the psychological preparedness of future healthcare professionals. Keywords: Mental health literacy; Healthcare students; Help-seeking behaviour; Resilience; Mental Health Literacy Questionnaire (MHLQ); Brief Resilience Scale (BRS); Psychological well-being; Cross-sectional study.

Background: Emergency laparotomy in obstetrics and gynaecology is a life-saving surgical intervention performed for acute conditions such as ruptured ectopic pregnancy, ovarian torsion, ruptured uterus, pelvic abscess, obstetric haemorrhage, placenta accreta spectrum-related complications, and postoperative complications. Timely diagnosis, prompt resuscitation, blood product availability, and early surgical intervention are essential to reduce morbidity and mortality. Aim: To study the clinical profile, indications, intraoperative findings, perioperative morbidity, and outcomes of patients who underwent emergency laparotomy in the Department of Obstetrics and Gynaecology, Government General Hospital, Guntur, during the one-year period from January to December 2024. Materials and Methods: This was a retrospective observational study conducted in the Department of Obstetrics and Gynaecology, Government General Hospital, Guntur. All patients who underwent emergency laparotomy for obstetric and gynaecological indications from January 2024 to December 2024 were included. A total of 75 cases were analysed. Data were collected from case sheets, emergency admission records, operation theatre registers, operative notes, anaesthesia records, blood transfusion records, ICU records, postoperative ward records, and discharge summaries. The variables analysed included age, parity, risk factors, indication for laparotomy, ectopic pregnancy subtype, intraoperative findings, blood transfusion requirement, ICU care, ventilatory support, duration of hospital stay, postoperative morbidity, and maternal outcome. Data were expressed as frequency and percentage. Association between categorical variables was assessed using Chi-square test or Fisher’s exact test, as appropriate. Results: A total of 75 emergency laparotomies were performed during the study period. Ectopic pregnancy was the most common indication, accounting for 53 cases (70.7%). Among ectopic pregnancies, ruptured tubal ectopic pregnancy was the predominant subtype, observed in 48 cases (90.6% of ectopic cases). Ovarian torsion was the second most common indication, seen in 11 cases (14.7%). Other indications included peripartum hysterectomy in 3 cases (4.0%), ruptured uterus in 2 cases (2.7%), pelvic abscess in 2 cases (2.7%), placenta increta/accreta-related emergency surgery in 2 cases (2.7%), post-LSCS complication in 1 case (1.3%), and post-tubectomy complication in 1 case (1.3%). Blood transfusion was required in 52 cases (69.3%), ICU care in 11 cases (14.7%), and ventilatory support in 4 cases (5.3%). Most patients had a hospital stay of 4–7 days. No maternal mortality was observed. Conclusion: Ectopic pregnancy, particularly ruptured tubal ectopic pregnancy, was the leading indication for emergency laparotomy in the present study. Ovarian torsion was the next most common indication, while obstetric haemorrhage-related conditions contributed fewer but clinically high-risk cases. Blood transfusion requirement, ICU care, ventilatory support, and prolonged hospital stay were the major morbidity indicators. Early diagnosis, timely referral, rapid resuscitation, availability of blood products, promp

Background: Salivary gland neoplasms represent a heterogeneous group of neoplasms with diverse histopathological featureswith multiple uncommon variants that can make diagnosis difficult. Case Presentation: This case series presents six uncommon salivary gland neoplasms: two Basal Cell Adenomas (BCA), one Canalicular Adenoma (CA), two Epithelial-Myoepithelial Carcinomas (EMC), and one Salivary Duct Carcinoma (SDC). BCA and CA are benign monomorphic adenomas that typically arise in specific anatomical locations—the parotid gland and the minor salivary glands, respectively. In contrast, EMC and SDC are malignant salivary gland neoplasms. EMC is a low-grade carcinoma characterized by biphasic epithelial and myoepithelial differentiation and generally exhibits indolent biological behavior. Conversely, SDC is a rare, high-grade, and highly aggressive malignancy with a marked propensity for local recurrence, regional lymph node metastasis and distant dissemination. Conclusion: By correlating the clinical presentation with gross, histopathological and immunohistochemical finding along with review of relevant literature, this case series highlights the key histological and immunohistochemical characteristics essential for precise diagnosis and appropriate treatment of this rare neoplasm in the salivary glands. By correlating the clinical presentation with gross, histopathological, and immunohistochemical finding along with review of relevant literature, this case series highlights the key histological and immunohistochemical characteristics essential for precise diagnosis and appropriate treatment of this rare neoplasm in the salivary glands. Keywords: Basal cell adenoma, Canalicular adenoma are rare benign neoplasms.

Background: Labour pain is severe and requires effective analgesia to improve maternal comfort and outcomes. Epidural techniques are limited in resource settings, making systemic agents important. Paracetamol and tramadol are commonly used alternatives, but comparative evidence regarding their efficacy and safety remains essential. The objective is to compare the efficacy and safety of intravenous paracetamol and intramuscular tramadol for labour analgesia in term pregnant women by evaluating pain relief, labour progression, maternal adverse effects, maternal satisfaction, and neonatal outcomes, and to identify the more effective and safer analgesic option in a tertiary care setting. Materials and Methods: This prospective randomized controlled study was conducted at Government Raja Mirasudhar Hospital, Thanjavur, from January to December 2020. A total of 500 primigravida women in active labour were randomized into two groups: intravenous paracetamol (n=250) and intramuscular tramadol (n=250). VAS scores, labour outcomes, maternal adverse effects, and neonatal APGAR scores were assessed and statistically analysed using SPSS. Results: Participants in both groups had comparable age, gestational age, and baseline pain distribution. After treatment, both paracetamol and tramadol significantly reduced labour pain, with most women reporting mild pain. Normal vaginal delivery was predominant. Neonatal APGAR scores at 1 and 5 minutes were comparable and showed favourable outcomes in both groups. Conclusion: Both paracetamol and tramadol provide effective labour analgesia with significant reduction in pain scores. Maternal outcomes were comparable with predominance of normal vaginal delivery and no increase in operative interventions. Neonatal APGAR scores were reassuring in both groups. Hence, both drugs are safe and effective options for labour analgesia, and can be used based on clinical setting and requirement. Keywords: Labour analgesia, Paracetamol, Tramadol, VAS score, APGAR score.

Background: Cockayne syndrome (CS) is a rare autosomal recessive neurodegenerative disorder caused by defects in transcription-coupled nucleotide excision repair. Pathogenic variants in the ERCC8 gene are responsible for Cockayne syndrome type A. The disorder is characterized by growth failure, developmental delay, progressive neurological deterioration, and multisystem involvement. Early diagnosis is often challenging because of marked clinical heterogeneity and overlap with several neurodevelopmental disorders. Case Presentation: We report a two-year-old male child born to non-consanguineous parents who presented with fever, progressive generalized weakness, gait instability, recurrent falls, and inability to walk independently. Developmental assessment revealed global developmental delay with an overall developmental quotient of approximately 54% and evidence of neuroregression. Clinical examination demonstrated moderate acute malnutrition and dysmorphic facial features, dental abnormalities, and bilateral otorrhea. On Neurological examination truncal ataxia and reflexes diminished in bilateral lower limbs. magnetic resonance imaging of the brain revealed vermian hypoplasia, however whole exome sequencing was performed and identified a homozygous likely pathogenic ERCC8 frameshift variant, c.952del (p.Val318PhefsTer10), thereby confirming the diagnosis of Cockayne syndrome type A. The child received supportive care, nutritional rehabilitation, physiotherapy, developmental intervention, and treatment for bilateral ear discharge. Although acute infective symptoms improved, neurological deficits persisted. Conclusion: This case highlights the importance of considering Cockayne syndrome in children presenting with developmental delay, neuroregression, progressive gait abnormalities, and characteristic dysmorphic features. It also underscores the pivotal role of whole exome sequencing in establishing a definitive diagnosis in children with clinically unresolved neurodevelopmental disorders. Keywords: Cockayne syndrome; ERCC8; neuroregression; developmental delay; whole exome sequencing; global developmental delay; gait instability.

Background: Severe mental illness (SMI), including schizophrenia spectrum disorders, bipolar disorder, major depressive disorder, anxiety disorders, and attention deficit hyperactivity disorder (ADHD), is frequently complicated by co-occurring substance use disorders (SUDs). The coexistence of psychiatric illness and substance misuse, commonly referred to as dual diagnosis, is associated with greater disease severity, poor medication adherence, increased relapse, repeated hospitalization, impaired psychosocial functioning, and higher mortality. Although integrated psychiatric and addiction treatment has shown promising outcomes, data regarding the patterns of substance use and their influence on treatment outcomes among patients with severe mental illness remain limited, particularly in developing countries. This study was undertaken to evaluate the patterns of co-occurring substance use disorders and determine their impact on treatment outcomes in patients with severe mental illness. Materials and Methods: A prospective observational study was conducted over a period of 12 months in the Department of Psychiatry of a tertiary care teaching hospital. Ninety-four consecutive adult patients diagnosed with severe mental illness and co-occurring substance use disorder according to DSM-5-TR criteria were enrolled. The study included 71 (75.5%) males and 23 (24.5%) females. Demographic characteristics, body mass index, educational status, socioeconomic status, residential background, psychiatric diagnosis, pattern of substance use, pharmacological treatment, medication adherence, psychiatric symptom severity, quality of life, functional recovery, and treatment outcomes were recorded. Psychiatric disorders included major psychosis, major depressive disorder, anxiety disorders, bipolar affective disorder, and ADHD. Substance use included alcohol, marijuana, cocaine, and lysergic acid diethylamide (LSD). Standardized assessment instruments, including PHQ-9, GAD-7, PANSS, YMRS, ASRS-v1.1, AUDIT, and structured DSM-5 substance use assessment, were utilized. Patients received individualized pharmacotherapy, psychological counselling, cognitive behavioural therapy, motivational interviewing, relapse prevention therapy, psychoeducation, de-addiction interventions, and regular psychiatric follow-up. Statistical analysis was performed using IBM SPSS version 26.0, with a p-value <0.05 considered statistically significant. Results: The majority of participants were males aged between 31 and 45 years and were predominantly from urban areas. Major psychosis (30.9%) was the most frequent psychiatric diagnosis, followed by major depressive disorder (25.5%), anxiety disorders (20.2%), bipolar disorder (14.9%), and ADHD (8.5%). Alcohol was the most commonly abused substance (45.7%), followed by marijuana (25.5%), cocaine (17.0%), and LSD (11.8%). Selective serotonin reuptake inhibitors and atypical antipsychotics constituted the most frequently prescribed medications. Following integrated psychiatric and de-addiction treatment, improvement was observed in psychiatric symptoms (77.7%), medication adherence (73.4%), reduction in substance use (70.2%), quality of life (

Background: Postmenopausal bleeding is defined as blood loss occurring at least 12 months after menopause[1]. Women with PMB have 10-15% chance of having endometrial cancer.[2] the aim and objective is to evaluate PMB and determine its causes via TVS and hysteroscopy. . To detect cases of endometrial ca amongst PMB. To determine risk factors associated with endometrial Ca. Materials and Methods: The study was conducted at Department of Obstetrics and Gynecology, Government Medical College and Rajindra Hospital, Patiala.Sixty postmenopausal women with complaint of bleeding per vaginum were included after exclusion criteria.Clinical and sonographic evaluation, followed by diagnostic and/or therapeutic hysteroscopy and guided biopsy. Hysteroscopic images were analyzed and compared with histopathologic results. Results: On hysteroscopy, endometrium was classified as suggestive of atrophic, endometrial hyperplasia or endometrial carcinoma. Histopathologic diagnosis was taken as a gold standard to determine the efficacy of hysteroscopy in diagnosing endometrial pathologies. The sensitivity and specificity of hysteroscopy in diagnosing endometrial pathologies was assessed. Conclusion: The goal of evaluation of Postmenopausal bleeding is to make the accurate diagnosis with the least risk and expense for the patient. Hystsroscopic evaluation and TVS can provide accurate diagnosis of cause of PMB and so can be used to detect endometrial Carcinoma. Risk factors associated with this malignancy if assesed can be used for prevention. Keywords: Hysteroscopy, hysteroscopy-guided biopsy, postmenopausal bleeding, endometrial carcinoma.

Background: The aim is to assess the validity of P-POSSUM scoring system in predicting anticipated morbidity & mortality rate. Materials and Methods: This prospective study was done on 80 cases of acute abdomen which underwent emergency GI surgery in MGM Hospital, Warangal from April 2024 to March 2025. Results: In the present study, majority of the cases were those of acute appendicitis. Physiological variables having significant association with mortality were pulse rate, systolic blood pressure, blood urea level, serum sodium level, serum potassium level and TLC. Septicaemia was found to be the commonest cause of mortality while wound infection was found to be the commonest cause of morbidity. O:E ratio for mortality was found to be 0.71 while for mortality it was 0.60. Sensitivity of P-POSSUM score in predicting mortality was found to be 100% with a positive predictive value of 71.43%. Specificity of P-POSSUM score in predicting mortality was found to be 97.3% with a negative predictive value of 100%. P-POSSUM score for mortality was found to over predict mortality in low risk groups while it could accurately predict in high risk groups. P-POSSUM score for morbidity was found to over predict morbidity in low risk groups while it could accurately predict in high risk groups. No significant difference was found between observed and expected mortality and morbidity using P-POSSUM score with Yates’ P= 0.23 and Yates’ P=0.09 respectively. Conclusion: To conclude, P-POSSUM is a good tool for assessing the outcome of surgery and in turn to assess the quality of surgical care provided in variable settings. It can be used for surgical audit in assessing the outcome in cases undergoing emergency GI surgeries. Keywords: P-POSSUM, Mortality, Appendicitis, Morbidity, Serum Potassium

Background: Co-infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) is common among people living with HIV (PLHIV) and may influence antiretroviral therapy (ART) outcomes. The World Health Organization (WHO) recommends the use of HBV-active ART regimens and routine screening for viral hepatitis co-infections, while UNAIDS emphasizes achieving the 95-95-95 targets for HIV control. Materials and Methods: A retrospective cross-sectional record review was conducted among patients attending a tertiary HIV care clinic between 2019 and 2024. A total of 56 patient records were screened, of which 55 HIV-positive individuals with documented HBV and/or HCV co-infection were included in the analysis. Data on demographic characteristics, CD4 cell counts, ART regimens, HBV/HCV serostatus, and HIV viral load (VL) were extracted. Viral load was measured using the Abbott m2000sp/m2000rt platform. Viral suppression was defined as either “target not detected” or VL <150 copies/mL. CD4 count data were available for 52 patients and viral load data for 51 patients. Results: The mean age of participants was 44.7 years (SD: 14.1), and 72.7% were male. HBV co-infection was observed in 81.8% of patients, HCV in 16.4%, and dual HBV/HCV co-infection in 1.8%. Mean CD4 counts were similar between HBV-only (341.5 cells/µL) and HCV-only (342.7 cells/µL) groups, while the single dual-infected patient had a CD4 count of 145 cells/µL. Overall, viral suppression was achieved in 85.5% of patients. The majority (89.1%) were receiving first-line ART regimens. Conclusion: In this cohort of HIV patients with HBV and/or HCV co-infection, high rates of viral suppression were observed despite a substantial burden of hepatitis co-infection. These findings highlight the effectiveness of HBV-active first-line ART regimens and support the integration of HIV and viral hepatitis services to optimize treatment outcomes. Keywords: HBV, HIV, PLHIV, HCV.

Background: Sepsis remains a major cause of morbidity and mortality, particularly among critically ill patients. Early identification of causative organisms is essential for timely initiation of appropriate antimicrobial therapy. Conventional blood culture, though considered the gold standard, is limited by prolonged turnaround time and reduced sensitivity. Molecular sepsis panels have emerged as rapid diagnostic tools enabling early pathogen detection and improved clinical decision-making. The aim and objective is to compare the positivity rate and etiological spectrum of pathogens detected by molecular sepsis panel and conventional blood culture in clinically suspected sepsis cases, and to evaluate their distribution across different clinical care units in a tertiary care hospital. Materials and Methods: This descriptive observational study included clinically suspected sepsis cases. A total of 246 samples were tested using a molecular sepsis panel. Out of these, 116 samples were simultaneously subjected to conventional blood culture. Pathogens identified by both methods were analyzed and compared, along with their distribution across different clinical care units. Results: Among the 116 paired samples, the sepsis panel detected 27 (23.3%) positive cases, whereas blood culture detected 13 (11.2%) positive cases, demonstrating a higher detection yield with the molecular method. Overall positivity of the sepsis panel was 27/246 (11.0%). Blood culture positivity was 13/116 (11.2%). Klebsiella pneumoniae was the most frequently isolated organism in both methods, accounting for 62.96% of sepsis panel detections and 53.84% of blood culture isolates. The Neonatal Intensive Care Unit (NICU) contributed the highest number of positive cases. Conclusion: Klebsiella pneumoniae was the predominant pathogen associated with sepsis, with the NICU showing the highest burden. Molecular sepsis panels demonstrated a higher diagnostic yield and faster detection compared to conventional blood culture, supporting their role as a valuable adjunct in critical care settings. Keywords: Conventional Blood Culture, PCR.

Background: Tuberculosis (TB) and diabetes mellitus (DM) are major public health problems, particularly in developing countries like India. Diabetes is an established risk factor for active tuberculosis and has been associated with altered clinical presentation, atypical radiological findings, delayed diagnosis, and poor treatment outcomes. The present study was undertaken to evaluate the clinical profile and radiological patterns of pulmonary tuberculosis in patients with diabetes mellitus. Materials and Methods: A hospital based cross-sectional observational study was conducted at a tertiary care hospital in Maharashtra, India, from June 2015 to November 2018. Fifty adult patients with confirmed pulmonary tuberculosis and diabetes mellitus were enrolled. Demographic characteristics, clinical features, laboratory investigations, glycemic status, sputum examination, and chest radiographic findings were recorded using a predesigned proforma. Glycemic control was assessed using glycated hemoglobin (HbA1c). Statistical analysis was performed using SPSS software, and a p-value of <0.05 was considered statistically significant. Results: A total of 50 patients were included in the study, with a mean age of 47.12 ± 12.17 years. The majority of patients belonged to the 46–60-year age group (42%) and were male (74%). The most common presenting symptoms were cough (90%), fever (74%), dyspnea (66%), anorexia (54%), and weight loss (52%). Diabetes was diagnosed before tuberculosis in 86% of patients. Poor glycemic control (HbA1c ≥7%) was observed in 74% of participants. Chest radiography revealed lower lung field involvement in 60% of patients and cavitary lesions in 36%, the latter being the most common radiological abnormality. Pulmonary tuberculosis was confirmed by sputum smear positivity in 30% of patients, while the remaining patients were diagnosed based on clinical and radiological findings. Conclusion: Pulmonary tuberculosis in patients with diabetes mellitus predominantly affected middle aged men and was frequently associated with poor glycemic control, cavitary lesions, and lower lung field involvement. These findings emphasize the importance of routine bidirectional screening for tuberculosis and diabetes, early recognition of atypical radiological patterns, and optimal glycemic control to improve diagnosis and clinical outcomes. Larger multicenter prospective studies are required to further clarify the impact of diabetes on the clinical presentation and prognosis of pulmonary tuberculosis. Keywords: Pulmonary tuberculosis, Diabetes mellitus, Clinical profile, Radiological patterns, Glycemic control, Chest radiography, Pulmonary cavitation.

Background: The introduction of Competency-Based Medical Education (CBME) in India has shifted the focus of undergraduate medical education from teacher-centered approaches to learner-centered competency-oriented teaching-learning methods. Understanding students' preferences and perceptions regarding different teaching-learning methods is essential for effective curriculum implementation and educational planning. Furthermore, the COVID-19 pandemic led to increased use of online learning modalities, making it important to evaluate student perceptions regarding various educational approaches during this period. The objective is to assess the preferences regarding teaching-learning methods, evaluate their perceived effectiveness and identify the learning barriers. Materials and Methods: A cross-sectional study was conducted among 200 undergraduate medical students in a medical college in Telangana from January to February 2021. Fifty students were selected from each MBBS year through simple random sampling. Data was collected using a pretested and pilot-tested structured questionnaire after obtaining Informed Consent. Information regarding preferences for theory and clinical teaching-learning methods, perceived effectiveness of different methods and learning barriers was collected. Data was analyzed using MS Excel and Open Epi Info version 3.0. Results: Among the 200 participants, 133 (66.5%) were females and 67 (33.5%) were males. Small-group discussion was the most preferred theory teaching-learning method (37%), while bedside clinics were the most preferred clinical teaching learning method (66.5%). More than half of the students preferred small-group teaching approaches overall. Small-group discussion was perceived to be most effective for engagement and understanding, whereas problem-based learning was perceived to improve retention of knowledge. Bedside clinics were perceived as most effective for improving clinical skills and confidence in patient handling. Non-interactive teaching was identified as the most common learning barrier (60.5%). Conclusion: Medical students demonstrated a strong preference for active, learner-centered, and clinically oriented teaching-learning methods. The findings support the principles of CBME and highlight the importance of small-group learning, integrated teaching, and bedside clinical training in undergraduate medical education. Keywords: Competency-Based Medical Education; Teaching-learning methods; Undergraduate medical students; Small-group discussion; Integrated teaching; Bedside clinics; Learning barriers.

Background: Postpartum Depression is a significant public health problem. It is a major depressive disorder with peripartum onset. It has adverse effects on the women, child, spouse and the entire family. Yet, it is under-taught, underdiagnosed and undertreated health problem. The objectives of the study were to determine the proportion and risk factors associated with postnatal depression. Materials and Methods: An institutional based cross sectional study was conducted in a Government Tertiary Health Centre, Telangana from August to October 2021. The sample size of 200 was taken based on prevalence from literature and study subjects were selected by systematic random sampling. A pre designed semi structured questionnaire & Edinburgh Postnatal Depression Scale was used. The data was analyzed using MS excel and SPSS 25. Results: Mean age of the study population was 26.33+4.05 years. About 16.8% of the subjects were found to be depressed. Conclusion: Lower-socioeconomic status, lack of social support, unhealthy newborn and unplanned pregnancy were found to be significantly associated with postpartum depression. Keywords: Postpartum depression, Edinburgh Postnatal Depression Scale, Tertiary health center.

Background: Epilepsy is a chronic neurological disorder frequently associated with psychiatric comorbidities, particularly depression, which significantly impairs quality of life, treatment adherence, and overall prognosis. Despite its clinical importance, depression in people with epilepsy often remains underdiagnosed and undertreated. Understanding its prevalence and associated factors is essential to comprehensive patient care. The objective is to study the sociodemographic profile of patients with epilepsy attending the Neurology Department for antiepileptic drug therapy. To examine the association between antiepileptic drug (AED) therapy and depression among people with epilepsy, compare the prevalence and severity of depression between AED monotherapy and polytherapy, and evaluate the association of individual AEDs with depression. Materials and Methods: A cross-sectional observational study was conducted among people with epilepsy attending a tertiary care hospital. Eligible participants were screened for depression using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), and the Hamilton Depression Rating Scale (HAM-D) was used to assess the severity of depression. Demographic and clinical data were collected, and statistical analysis was performed to identify correlations between depression and relevant clinical parameters. Results: This cross-sectional observational study involving 157 epilepsy patients attending a tertiary care hospital identified a high prevalence of depression, with 59.9% screening positive on the NDDI-E. The majority of participants were undergoing polytherapy (59.2%), which was significantly correlated with depression compared with monotherapy (p = 0.006). The HAM-D assessment indicated that very severe depression was the predominant category among patients with depression. Although severe depression was more prevalent among individuals on polytherapy, the association with depression severity did not attain statistical significance (p = 0.114). These findings underscore the importance of routine depression screening and multidisciplinary management in patients with epilepsy, particularly those receiving multiple antiepileptic agents. Conclusion: This study identified a high prevalence of depression among patients with epilepsy, with polytherapy notably associated with depressive symptoms compared with monotherapy. These findings underscore the importance of implementing routine depression screening using validated instruments such as NDDI-E and HAM-D, particularly in patients receiving multiple antiepileptic medications. Early psychiatric intervention, coupled with a multidisciplinary approach, may enhance treatment adherence, seizure management, quality of life, and overall prognosis. Further longitudinal, multicentric research is essential to clarify the relationship between antiepileptic therapy and depression. Keywords: Epilepsy, Antiepileptic drugs, Depression, NDDI-E, HAM-D, Cross-sectional study.

Background: Type 1 Diabetes Mellitus (T 1 DM) is a chronic autoimmune disorder requiring lifelong insulin therapy and continuous self- management. Adolescents with T 1 DM are particularly vulnerable to psychological distress due to the challenges of maintaining glycaemic control amid developmental, social, and emotional changes. Research shows that depression and anxiety are more prevalent among adolescents with T 1 DM than among healthy peers, and these conditions are linked to poorer adherence to treatment, suboptimal glycaemic control, and reduced quality of life. In India, limited mental health resources, social stigma, and barriers to specialised care may exacerbate these issues. Therefore, assessing depression and anxiety in this population is essential for developing comprehensive care strategies that improve both psychological well- being and diabetes management. The objective is to study the prevalence and severity of depression and anxiety among adolescents with T 1 DM and their relationship with HbA1c levels. Materials and Methods: This 12-month cross-sectional study in the Department of Endocrinology at King George Hospital, Visakhapatnam, included 60 adolescents aged 10–19 years with Type 1 Diabetes Mellitus who had been diagnosed at least 6 months earlier. Participants were recruited via convenience sampling after obtaining written consent from parents or guardians. Data on sociodemographic, HbA1c, and illness duration were collected. Anxiety and depression were assessed using the HAM- A and HAM- D scales. Data were analysed in SPSS 28.0. 0 using descriptive statistics, Chi- square, and Spearman's correlation; p< 0. 05 was considered significant. Results: The study found poor glycaemic control, with most participants exhibiting elevated HbA1c levels. Anxiety symptoms were highly prevalent, whereas depressive symptoms were less common and generally mild. Although no significant association was found between HbA1c levels and anxiety or depression, anxiety and depression showed a strong positive correlation. These findings emphasise the importance of regular psychological screening and holistic care for adolescents with T1DM to support both metabolic and emotional well-being. Conclusion: The study found high anxiety and lower depression among adolescents with T 1 DM, along with poor glycaemic control. While anxiety and depression were strongly linked, neither was significantly associated with HbA1c levels. These findings emphasise the need for routine psychological screening and psychosocial support to enhance emotional well- being and health outcomes. Keywords: Type 1 Diabetes Mellitus, Adolescents, Depression, Anxiety.

Background: The objective is to find out the prevalence and analyze the Clinico-microbiological profile, identify predictors of complications, intensive care unit (ICU) admission, and in hospital mortality in patients with SBP at a tertiary care center in Kerala. Materials and Methods: This descriptive cross-sectional study involved 90 patients diagnosed with SBP after applying diagnostic criteria among a total of 250 patients with cirrhosis with ascites. Clinical features, microbiological results, and laboratory parameters were systematically collected. Statistical analysis was conducted using descriptive methods, Chi-square tests, and Mann-Whitney U tests. Results: The prevalence of SBP among studied patients was found to be 36%. The mean patient age was 55.97 years; 92.2% were male, and 98.9% had a history of alcohol consumption. Predominant symptoms were abdominal distension (91.1%), abdominal pain (72.2%), and fever (67.8%). Altered mental status (25.6%) significantly predicted complications (p < 0.001) and ICU admission (p = 0.027). Elevated ascitic fluid total cell count significantly correlated with mortality (p < 0.001) and ICU admission (p = 0.004). Increased INR levels (p = 0.010) and elevated bilirubin (p = 0.036) were associated with adverse outcomes. Child-Pugh classification significantly predicted mortality (p = 0.037). Culture positivity was low (13.3%), emphasizing reliance on empirical antibiotic therapy. Conclusion: The prevalence of SBP among chronic liver disease patients with ascites was 36%. Altered mental status, ascitic fluid total count, INR, bilirubin, and Child-Pugh scores are key predictors of poor outcomes in SBP patients. As seen in previous studies ,no significant association between presence of multiple comorbidities or low ascitic fluid albumin with outcome in SBP patients. These findings underscore the importance of timely diagnosis, close monitoring, and proactive management strategies to improve patient survival and outcomes. Keywords: Spontaneous bacterial peritonitis, hepatic encephalopathy, bacterascites, cirrhosis, Child-Pugh score.

Background: Adductor canal block (ACB) is an effective technique for postoperative analgesia in knee surgeries; however, the duration of analgesia with single-shot block remains limited. The addition of adjuvant dexmedetomidine may enhance and prolong analgesic efficacy. The aim is to compare the postoperative analgesic efficacy of adductor canal block using dexmedetomidine with conventional analgesia in patients undergoing knee procedures. Materials and Methods: This prospective, randomized, double-blind study was conducted on 58 ASA I–II patients aged 18–65 years undergoing elective knee surgery. Patients were allocated into two groups (n = 29 each). Group A received ultrasound-guided adductor canal block with 20 mL of 0.2% ropivacaine with dexmedetomidine 0.5 µg/kg. Group B received conventional postoperative analgesia. Postoperative pain was assessed using the Numerical Rating Scale (NRS) at 2, 4, 6, 12, 18, and 24 hours. Primary outcomes included NRS scores, effective analgesic duration, and total 24-hour analgesic consumption. Hemodynamic parameters and complications were also recorded. Results: Group A showed significantly lower NRS scores at early postoperative intervals (2, 4, and 10 hours; p < 0.05). Effective analgesic duration was significantly longer in Group A (13.86 ± 6.44 hours vs 4.21 ± 1.63 hours; p < 0.001). Total 24-hour analgesic requirement was significantly lower in Group A compared to Group B (1.48 ± 0.91 vs 3.07 ± 0.46; p < 0.001). Hemodynamic parameters were more stable in Group A. The incidence of complications was comparable between groups (p > 0.05). Conclusion: The dexmedetomidine as adjuvants to adductor canal block provides superior postoperative analgesia, reduces analgesic consumption, and maintains a favourable safety profile compared to conventional analgesia in knee surgeries. Keywords: Adductor canal block; dexmedetomidine; postoperative analgesia; knee surgery; ropivacaine.

Background: Supracondylar fractures of the humerus are the most common elbow fractures in children, with Gartland Type III fractures requiring operative stabilization because of their inherent instability and risk of neurovascular complications. Closed reduction with percutaneous Kirschner wire fixation is the standard treatment; however, the optimal pin configuration remains controversial. While crossed pinning provides greater mechanical stability, lateral pinning is preferred by many surgeons because it minimizes the risk of iatrogenic ulnar nerve injury. The aim is to compare the functional and radiological outcomes of crossed pinning and lateral pinning in the management of Gartland Type III supracondylar fractures of the humerus in the pediatric age group. Materials and Methods: This prospective comparative study included 30 children with closed Gartland Type III supracondylar fractures treated between January 2020 and January 2021. Fourteen patients underwent lateral pinning (Group A) and sixteen underwent crossed pinning (Group B). Patients were followed clinically and radiologically until fracture union and subsequently assessed using Flynn's criteria. Postoperative Baumann's angle, carrying angle, range of motion, fracture union, and complications were evaluated. Results: The mean age was 7.2 ± 2.2 years in Group A and 6.28 ± 2.0 years in Group B. The mean postoperative Baumann's angle was 69.4° in Group A and 71.2° in Group B, while the mean carrying angle was 11.5° and 9.2°, respectively. Fracture union was achieved in all patients at a mean of five weeks. Mean elbow flexion was 130.5° in the lateral pinning group and 142° in the crossed pinning group, with extension loss of 5° and 2°, respectively. According to Flynn's criteria, excellent outcomes were observed in 78.6% of Group A and 81.25% of Group B. Two cases of transient ulnar nerve palsy occurred in the crossed pinning group, whereas one case of pin loosening was observed in the lateral pinning group. Superficial pin tract infection occurred in one patient in each group. Conclusion: Both crossed pinning and lateral pinning are effective treatment methods for Gartland Type III supracondylar fractures in children, providing excellent fracture union and satisfactory functional outcomes. Crossed pinning demonstrated slightly better radiological alignment and elbow range of motion but was associated with a higher incidence of transient ulnar nerve injury. Lateral pinning achieved comparable clinical outcomes while avoiding ulnar nerve complications. Appropriate pin configuration should be selected based on fracture stability and surgeon experience. Keywords: Supracondylar fracture humerus, Pediatric elbow fracture, Gartland Type III, Cross pinning, Lateral pinning, Kirschner wire fixation, Flynn criteria.

Background: Distal end radius fractures are among the most common fractures encountered in orthopedic practice. While stable fractures can be managed conservatively, unstable and intra-articular fractures often require surgical fixation to restore wrist anatomy and function. External fixation and volar locking plate fixation are widely used treatment modalities, each with distinct advantages and limitations. The present study was undertaken to compare the clinical and radiological outcomes of these two techniques. The aim is to compare the functional and radiological outcomes of unstable distal end radius fractures treated with external fixation and volar locking plate fixation. Materials and Methods: This prospective comparative study included 46 patients with unstable distal end radius fractures treated surgically between 1st October 2024 till 30th March 2026. Twenty-one patients underwent external fixation (Group A) and twenty-five patients underwent volar locking plate fixation (Group B). Patients were evaluated clinically and radiologically at regular follow-up visits. Functional assessment included wrist range of motion, while radiological evaluation comprised measurement of ulnar variance, articular step-off, palmar tilt, and radial inclination. Postoperative complications were also recorded. Results: The majority of patients were males (71.7%), and the most commonly affected age group was 31–50 years (47.8%). Road traffic accidents were the predominant mode of injury (60.9%). Type III fractures according to the Frykman classification were the most frequent (30.4%). At the final follow-up, patients treated with volar locking plates demonstrated better wrist mobility, with mean palmar flexion of 75°, dorsiflexion of 70°, radial deviation of 20°, supination of 80°, and pronation of 76°, compared with 70°, 64°, 16°, 76°, and 72°, respectively, in the external fixation group. Radiological assessment also favored the plating group, showing better restoration of ulnar variance (0.58 mm vs 1.07 mm), palmar tilt (9.3° vs 7.03°), and radial inclination (19.66° vs 15.5°). Superficial infection occurred in two patients following volar plating, whereas postoperative wrist stiffness was observed in two patients treated with external fixation. Loss of reduction occurred in one patient in each group. Conclusion: Both external fixation and volar locking plate fixation provide satisfactory outcomes in the management of unstable distal end radius fractures. However, volar locking plate fixation offers superior restoration of wrist anatomy and improved functional recovery, allowing earlier mobilization of the wrist. External fixation remains an effective alternative in selected cases, particularly where soft-tissue conditions favor a less invasive approach. Treatment should be individualized based on fracture characteristics, patient factors, and surgeon expertise. Keywords: Distal end radius fracture, Volar locking plate, External fixator, Frykman classification, Functional outcome, Radiological outcome, Wrist fractures.

Background: Neonatal resuscitation is one of the life-saving methods in the delivery room. Moreover, about 10% of the neonates were found to need some form of assistance at the time of birth for the smooth transition from intrauterine to extrauterine life. Moreover, positive pressure ventilation (PPV) is an effective method in resuscitation for those who fail to establish spontaneous breathing. Moreover, most of the time, the PPV was delivered via the self-inflating bag (SIB). However, this was found to be associated with many disadvantages. Moreover, the newly designed T-piece resuscitator had been used in the delivery of the PPV to the newborns. The aim is to find the efficacy of the T-piece resuscitator versus the self-inflating bag in neonatal positive pressure ventilation. Materials and Methods: This prospective comparative study was conducted in the department of paediatrics in a tertiary care centre in Puducherry. Moreover, all neonates who required resuscitation were included in the study. After the initial assessment, all participants were randomised into two groups. All the neonates in one group had received self-inflating bag resuscitation, and in another group, all the patients received T-piece resuscitation. Moreover, the patient's outcomes, including PPV duration, resuscitation in the room, intubation in the delivery room, and neonatal outcomes, were evaluated. Moreover, all the data had been entered into Excel and analysed using SPSS version 25. Results: A total of 90 neonates were included in the study. Moreover, they were randomly and equally divided into two groups. The mean gestational age of the patients in the SIB and TPR groups was 36.2 ± 1.3 weeks and 37.4 ± 1.2 weeks, respectively. The mean duration of the positive pressure ventilation among the SIB and TPR group was found to be 55.4 + 6.6 and 25.6 + 5.9 (p <0.001), and about 80% of the patients with TPR were found to have resuscitation in room air when compared to only 31.1% in the SIB group (p < 0.001). The intubation rate in the delivery room was higher in the SIB group (44.4%). The TPR group showed an overall favourable outcome in neonatal parameters, including NICU admission (p=0.001), APGAR score (p <0.001), and duration of mechanical ventilation (p=0.016). Conclusion: The study concluded that resuscitation with TPR decreased PPV and reduced the need for intubation during delivery room resuscitation. Moreover, the study noted that the TPR also reduces the need for invasive ventilation. Keywords: neonatal resuscitation; outcome; t-piece- self inflating bag.

Background: Vitamin B12 is an important vitamin for the body and plays vital roles in DNA synthesis, blood cell formation, neurological development, and myelin formation. Its deficiency leads to failure to thrive, lethargy, hypotonia, and delays in cognitive and motor development. And the recent studies had shown that a significant number of patients who had exclusive breastfeeding during the early part of their lives were found ot be affected with the vitamin B12 deficiency. The aim is to compare the effect of exclusive breastfeeding versus mixed feeding on the development of Vitamin B12 deficiency among the infants aged 3 to 6 months. Materials and Methods: This prospective comparative study was conducted among infants aged 3 to 5 months at a tertiary care centre in Puducherry, India. After the initial assessment, all infants were divided into two groups: Group I was exclusively breastfed, whereas Group 2 received mixed feeding, including breast milk along with formula or animal milk. And all the infants had been subjected to the general physical examination and systemic examination, followed by the serum vitamin B12 estimation. All the data were entered into Microsoft Excel and analysed using SPSS version 25. Results: A total of 120 infants participated in the study; 60 were assigned to group 1 and 60 to group 2. 43.3% of infants in group 1 and 41.6% in group 2 were 5 to 6 months old. In both groups, male infants outnumbered female infants. The prevalence of vitamin B12 deficiency was 15% in exclusively breastfed infants and 3.3% in mixed-fed infants. Mothers with associated comorbidities and vegetarian consumers were found ot eb associated with very low vitamin B12 levels. Conclusion: The study recommends that maternal supplementation during pregnancy and lactation helps reduce vitamin B12 deficiency, and that early screening of infants also helps prevent later complications. Keywords: breastfeeding; mixed-fed; infants; vitamin B12 deficiency.

Background: Pipkin type III femoral head fractures are rare and severe injuries characterized by the coexistence of femoral head and ipsilateral femoral neck fractures. These injuries are associated with a high risk of avascular necrosis (AVN), fixation failure, and poor functional outcomes. Optimal management remains controversial, particularly regarding the choice between joint-preserving fixation and primary arthroplasty. Materials and Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Electronic databases were searched to identify studies involving adult patients (≥18 years) with Pipkin type III fractures reporting outcomes with a minimum follow-up of 24 months. Surgical strategies including open reduction and internal fixation (ORIF), hemiarthroplasty, and total hip arthroplasty (THA) were evaluated. Data were synthesized descriptively due to heterogeneity. Results: A total of 10 studies comprising 104 patients were included. ORIF was the most commonly performed procedure in younger patients but was associated with high complication rates, including AVN (24%–33%), fixation failure (10%–17%), and conversion to THA (up to 25%). Arthroplasty procedures demonstrated more consistent functional outcomes with lower complication rates. Mean Harris Hip Scores ranged from 75 to 86 across studies. Conclusion: Pipkin type III fractures carry a guarded prognosis. An evidence-based treatment algorithm is proposed to guide clinical decision-making, favouring arthroplasty in older patients and complex fracture patterns, while reserving ORIF for carefully selected younger patients with reconstructible fractures. Keywords: Femoral Head, Hip Fractures, Femoral Neck Fractures, Arthroplasty, Osteonecrosis; Internal Fixation.

Background: Maternal obesity is an increasing public health concern associated with adverse maternal and neonatal outcomes. This study aimed to evaluate the impact of maternal obesity on pregnancy and neonatal outcomes among women delivering at a tertiary care teaching hospital. Materials and Methods: A prospective observational cohort study was conducted in the Department of Obstetrics and Gynaecology, Sri Venkateshwara Medical College and Research Institute, from July 2025 to June 2026 (12months). A total of 200 pregnant women aged 18–40 years with singleton pregnancies of ≥28 weeks' gestation were enrolled. Participants were divided into two groups: 100 obese women (BMI ≥30 kg/m²) and 100 women with normal BMI (18.5–24.9 kg/m²). Maternal and neonatal outcomes were compared using the independent Student's t-test and Chi-square/Fisher's exact test, with a p-value <0.05 considered statistically significant. Results: Obese women had significantly higher incidences of gestational diabetes mellitus (24% vs. 8%; p=0.002), gestational hypertension (18% vs. 6%; p=0.009), preeclampsia (14% vs. 5%; p=0.030), induction of labour (36% vs. 20%; p=0.012), cesarean section (46% vs. 24%; p=0.001), postpartum haemorrhage (12% vs. 4%; p=0.037), and wound infection (8% vs. 2%; p=0.050). Neonates born to obese mothers had significantly higher birth weight, increased macrosomia (18% vs. 5%; p=0.004), NICU admission (22% vs. 10%; p=0.021), and respiratory distress syndrome (14% vs. 6%; p=0.049). Conclusion: Maternal obesity is significantly associated with increased maternal and neonatal morbidity. Early identification, preconception counseling, nutritional intervention, and close antenatal surveillance may improve pregnancy outcomes and reduce obesity-related complications. Keywords: Maternal obesity; Body mass index; Pregnancy outcomes; Gestational diabetes mellitus; Cesarean section; Neonatal outcomes; Macrosomia; NICU admission.

Background: The postnatal period is a critical phase for the survival and well-being of both mother and newborn. Despite improvements in maternal healthcare services, postnatal care practices remain suboptimal among vulnerable populations, particularly those residing in urban slums. Objectives: To assess postnatal care practices among mothers residing in urban slums and evaluate their impact on maternal and neonatal health outcomes. Materials and Methods: A community-based descriptive longitudinal study was conducted among 270 postpartum mothers residing in the notified urban slums of Kurnool, Andhra Pradesh, India, between 2011 and 2012. Eligible mothers within 24 hours to six weeks after delivery were identified through Anganwadi and health workers. Data were collected using a pre-tested structured interview schedule and clinical examination during two postnatal visits. Maternal and neonatal health outcomes were assessed, and data were analyzed using Microsoft Excel and Epi Info. Associations were tested using the Chi-square test, with p<0.05 considered statistically significant. Results: The majority of mothers (60.4%) were aged 21–25 years, and 67.8% were literate. Most mothers (93.3%) had more than three antenatal visits, 95.9% received complete tetanus toxoid immunization, and 87.8% consumed ≥100 iron-folic acid tablets. Institutional deliveries accounted for 93.3%, while only 47.8% received postnatal home visits. Maternal anaemia (35.2%) was the most common postpartum morbidity. Acute respiratory infection (11.9%) and low birth weight (10.0%) were the leading neonatal morbidities. Breast problems were significantly associated with maternal occupation and parity, whereas low birth weight was significantly associated with socioeconomic status and parity (p<0.05). Conclusion: Although antenatal care utilization, institutional delivery, and neonatal immunization were satisfactory, gaps persisted in postnatal follow-up and maternal awareness. Strengthening community-based postnatal care, health education, and regular home visits is essential to improve maternal and neonatal health outcomes in urban slum populations. Keywords: Postnatal care, maternal health, neonatal health, urban slums, postpartum mothers, newborn care, maternal morbidity, India.

Background: Coronary artery disease (CAD) remains a leading cause of morbidity and mortality, and evidence increasingly points to its origins in fetal and neonatal life. Cord blood lipid profile at birth may serve as an early marker of future cardiovascular risk, with variations expected across gestational maturity and birth-weight categories. The objective is to estimate and compare cord blood lipid profile (total cholesterol [TC], triglycerides [TG], LDL-cholesterol, HDL-cholesterol) in term versus preterm neonates, and in small-for-gestational-age (SGA) versus appropriate-for-gestational-age (AGA) neonates within each gestational group. Materials and Methods: This analytical, comparative study enrolled 70 neonates (35 term, 35 preterm) delivered at Father Muller Medical College Hospital, Mangaluru, over 18 months. Each gestational group was sub-classified as AGA or SGA using the Fenton growth chart. Umbilical cord blood was collected at delivery and analysed for TC, TG, HDL-C and LDL-C using standard enzymatic/oxidase-peroxidase methods. Gestational age was assessed by last menstrual period, ultrasound, and modified Ballard scoring. Data were analysed using mean ± SD, frequency, percentage, Student's t-test and Chi-square test. Results: Preterm neonates had significantly higher TC (68.0 ± 14.16 vs 53.17 ± 8.52 mg/dL, p<0.001), LDL-C (33.4 ± 5.52 vs 30.7 ± 1.9 mg/dL, p<0.001) and HDL-C (23.1 ± 7.3 vs 19.05 ± 5.9 mg/dL, p=0.018) than term neonates, with no significant difference in triglycerides. SGA neonates had significantly higher TC (67.66 ± 19.32 vs 58.63 ± 10.93 mg/dL, p=0.044) and HDL-C (24.50 ± 9.43 vs 19.90 ± 5.51 mg/dL, p=0.047) than AGA neonates. Among term neonates, SGA babies had significantly higher TC and LDL-C than term AGA babies. Among preterm neonates, SGA babies had significantly higher TC, TG and HDL-C than preterm AGA babies. No significant differences were found between male and female neonates, or by maternal age (≤30 vs >30 years). Conclusion: Gestational age and birth weight significantly influence neonatal cord blood lipid profile. Preterm and SGA neonates demonstrate a more atherogenic lipid pattern at birth, suggesting they may be at higher long-term risk for hypercholesterolemia and cardiovascular disease. Early identification and monitoring of lipid profile in these high-risk neonates, along with appropriate lifestyle guidance, may help in primordial prevention of coronary artery disease later in life. Keywords: Cord blood, lipid profile, cholesterol, small for gestational age, low birth weight, atherosclerosis, preterm.

Background: Insulin resistance commonly develops years before glucose elevation becomes clinically detectable. This metabolically silent phenotype represents an overlooked intervention window in nutrition clinic populations. Objective: To quantify insulin resistance prevalence among normoglycemic nutrition clinic attendees and identify independent metabolic predictors using rigorous statistical methodology. Materials and Methods: We conducted a prospective observational study at a tertiary nutrition clinic (August 2025–July 2026). Adults aged ≥18 years with fasting plasma glucose below 100 mg/dL underwent comprehensive metabolic assessment. Insulin resistance was operationalized as HOMA-IR exceeding 2.0. We measured anthropometrics, fasting glucose, insulin, lipid profiles, micronutrients (vitamins D and B12), and inflammatory markers. Multivariable logistic regression with backward selection identified independent predictors, with model diagnostics including Hosmer-Lemeshow goodness-of-fit testing and ROC curve analysis. Results: Among 50 normoglycemic adults (mean age 45.9 ± 13.8 years; 62% female), 18 participants (36%; 95% CI: 23.5–51.5%) demonstrated insulin resistance. Mean HOMA-IR measured 3.41 ± 2.84. Insulin-resistant individuals exhibited significantly elevated waist circumference (p=0.031), triglycerides (median 154 vs 104 mg/dL; p=0.001), TG/HDL ratio (3.28 vs 1.82; p<0.001), and C-reactive protein (median 4.1 vs 2.1 mg/L; p=0.018). HDL cholesterol was notably reduced (47 vs 56 mg/dL; p=0.043). After multivariable adjustment, two independent predictors emerged: triglyceride concentration (OR=1.009 per mg/dL; 95% CI: 1.002–1.016; p=0.013) and vitamin D insufficiency (OR=0.949 per ng/mL; 95% CI: 0.906–0.996; p=0.034). The model demonstrated excellent discrimination (AUC=0.842). Conclusion: More than one-third of normoglycemic nutrition clinic patients harbor undetected insulin resistance despite normal fasting glucose. Routine HOMA-IR assessment coupled with lipid profiling and vitamin D screening enables early identification of this high-risk phenotype, creating actionable intervention opportunities aligned with precision nutrition principles. Keywords: Insulin resistance; HOMA-IR; Normoglycemia; Metabolic phenotyping; Cross-sectional study.

Background: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Myocardial injury is frequently observed in sepsis and may occur even without acute coronary syndrome. Cardiac Troponin-I is a sensitive marker of myocardial injury and may reflect disease severity. This study evaluated Troponin-I levels in sepsis and correlated them with SOFA score and inflammatory markers. The aim is to study the correlation between cardiac Troponin-I levels with SOFA score and inflammatory markers, hs-CRP and TNF-α, in patients with sepsis. Materials and Methods: This observational cross-sectional study was conducted in the Department of General Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, over 18 months. A total of 38 adult patients diagnosed with sepsis according to Sepsis-3 guidelines were included. Patients with acute coronary syndrome, severe renal/hepatic dysfunction, pulmonary embolism, and malignancy were excluded. Troponin-I, hs-CRP, TNF-α, complete blood count, liver and renal function tests, arterial blood gas analysis, ECG, and SOFA score were assessed within 24 hours of admission. Statistical analysis was performed using SPSS version 17.0. Spearman correlation was used for non-normally distributed variables, and p<0.05 was considered statistically significant. Results: The mean age was 45.08 ± 14.26 years, and 71.1% were males. The mean SOFA score was 7.76 ± 4.85, hs-CRP was 10.26 ± 3.78 mg/L, TNF-α was 343.58 ± 175.58 pg/mL, and Troponin-I was 0.56 ± 0.52 ng/mL. Troponin-I showed a significant positive correlation with SOFA score (rho=0.55, p<0.001) and hs-CRP (rho=0.51, p<0.001). Troponin-I was significantly higher among patients requiring inotropes compared with those not requiring inotropes (0.97 ± 0.54 vs 0.43 ± 0.45 ng/mL; p=0.006). Significant negative correlations were observed between Troponin-I and MAP (rho=-0.48, p=0.002), PaO₂/FiO₂ ratio (rho=-0.48, p=0.002), and GCS (rho=-0.38, p=0.017). TNF-α showed a weak positive but statistically non-significant correlation with Troponin-I (rho=0.19, p=0.257). Conclusion: Cardiac Troponin-I levels were significantly correlated with SOFA score and hs-CRP levels in sepsis, suggesting that Troponin-I may serve as a useful biomarker of myocardial injury and disease severity. Its association with hypotension, respiratory dysfunction, altered sensorium, and inotropic requirement highlights its potential role in early risk stratification of septic patients. Keywords: Sepsis, Troponin-I, SOFA score, hs-CRP, TNF-α, myocardial injury.

The global incidence of skin cancer is rising, and ultraviolet (UV) radiation is the most critical modifiable risk factor. As future healthcare workers, medical students represent a core force for sun safety education, yet their own sun protection behaviors fall far short of guideline requirements. This study aimed to assess the knowledge, attitude, and practice (KAP) levels related to sunscreen use among medical students at Muzaffarnagar Medical College. A cross-sectional study design was adopted, and a validated structured questionnaire was used to survey 30 medical students from January to June 2026. Four categories of data were collected: demographic characteristics, sun protection knowledge, attitudes toward sunscreen, and actual sunscreen use behaviors. The study results showed that 83.3% of respondents had sufficient knowledge of the benefits of sunscreen, while only 36.7% used sunscreen on a regular basis. Female students had significantly better sun protection behaviors (p=0.001). The most common reasons for non-regular use were forgetting to apply sunscreen (30%) and concerns about the cost of products (20%). A total of 76.7% of participants held positive attitudes toward sunscreen, but a notable gap existed between their knowledge and actual practice. While their knowledge and attitudes met basic standards, sunscreen use remained far from ideal. Targeted educational interventions should be integrated into medical curricula to close this gap, and support future physicians to develop consistent, evidence-based sun protection habits. Keywords: Sunscreen, Medical Students, Skin Cancer Prevention, UV Protection.

The proliferation of digital media is reshaping the childhood experiences of children across the globe, and has also triggered widespread academic concerns over children’s emotional development. The World Health Organization (WHO) explicitly puts forward that children aged 6 to 12 years old should spend no more than 2 hours per day on recreational screen time. However, in India’s local context, the connection between this screen time threshold and childhood emotional dysregulation has not been fully explored. From April 1 to 25, 2026, this study carried out a cross-sectional study at GS Medical College, Pilkhua, enrolling 24 children aged 6 to 12 years. Screen time was assessed through a structured parent questionnaire, and emotional dysregulation was measured using the emotional symptoms and conduct problem subscales of the Strengths and Difficulties Questionnaire (SDQ). Analyses were conducted with descriptive statistics, the chi-square test, and ANOVA. The results show that the average daily screen time of participating children was 3.2 hours (SD=1.8). Children with screen time exceeding 2 hours had significantly higher emotional dysregulation scores than children who met the recommended threshold (p=0.02). Children who engaged in interactive screen activities such as online chatting had lower irritability scores than children who engaged in passive viewing (p=0.03), which confirms that content type has a moderating effect on the association between the two variables. This study supports WHO’s threshold, and calls for the development of locally contextualized guidelines that take both screen time duration and content type into account. Keywords: Screen Time, Emotional Dysregulation, Children, WHO Guidelines, Digital Media, Child Mental Health.

Background: The objective is to assess the prevalence, clinical features, and microbiological profile of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in children with subcutaneous abscesses. Study design is prospective cross-sectional study. This research was undertaken at Department of Peadiatrcs Pir Abdul Qadir Shah Jillaani Intitute of Medical Sciences Gambat khairpur from September 2024 to Sepember 2025. Materials and Methods: A total of 168 children aged 7 days to 14 years were included who required incision and drainage of clinically diagnosed subcutaneous abscesses. Pus samples were aseptically collected and cultured for culture and sensitivity testing. Standard microbiological methods were used to identify Staphylococcus aureus, with confirmation of methicillin resistance by cefoxitin disc diffusion. Demographic and clinical information was collected, and statistical analysis was conducted using SPSS version 25. Data were analyzed with the chi-square test (p<0.05). Results: In 78 cases (46.4%), CA-MRSA was found, and in 90 cases (53.6%), non-MRSA growth was observed. The highest proportion of CA-MRSA was seen in neonates (<1 month; 100%), followed by 1–12 months (58.8%), 1–5 years (41.2%), and 5–10 years (33.3%), showing a decreasing trend with age (p < 0.001). The highest CA-MRSA positivity was seen in lower limb abscesses (53.6%), and the lowest was seen in abdominal wall (33.3%) (p = 0.041). An elevated leukocyte count was significantly associated with CA-MRSA infection (76.9% versus 48.9%, p < 0.001). Conclusion: CA-MRSA is frequently associated with subacute pediatric subcutaneous abscesses, occurs more often in younger age groups, and is significantly correlated with leukocytosis and limb involvement. Early empirical coverage is crucial for better results. Keywords: CA-MRSA, Subcutaneous abscess, pediatric, S. aureus.

Background: Alcohol Use Disorder is quite prevalent in general population. Sexual dysfunction in alcoholics is unrecognized and not reported by patients. Moreover, sexual dysfunction can lead to stress which can further increase the consumption of alcohol and it can lead to poor quality of life. Objectives: To study the prevalence of sexual dysfunction and quality of life among male patients of Alcohol Use Disorder. Materials and Methods: This was an observational, cross sectional, single-centered, interview based study of total 100 consecutive male patients aged 20-50 years admitted in psychiatry ward & coming to psychiatry OPD of Sir. T. Hospital, Bhavnagar. Interview was taken for diagnosis of Alcohol Use Disorder using DSM- 5(Diagnostic and Statistical Manual of Mental Disorders-5) Criteria. Every patient was assessed by proforma containing demographic details, questionnaires of SAD-Q (Severity of Alcohol Dependance), CSFQ-M-C (Changes in Sexual Functioning Questionnaire – Male Clinical Version) & WHOQOL BREF (World Health Organization Quality of Life). Statistical analysis was done with graph pad in stat version 3.06(San Diego, California US). Proportion of participant was compared by using chi-square test, while scores of CSFQ-M-C, SAD-Q, WHOQOL BREF were compared by using Mann Whitney test. A p value of <0.05 was considered statistically significant. Results: Frequency of sexual dysfunction among male patients of alcohol use disorder was 70%. Among the domains of sexual dysfunction; the highest frequency was seen for dysfunction in desire/frequency (84%), followed by premature ejaculation (82%), problems in pleasure (80%), difficulty in erection (68%) & least was decrease in libido (64%). Sexual dysfunction was not dependent on the amount (p value=0.1916), duration (p value=0.7038) & severity of alcohol dependence (p value=0.128). The quality of life was poor among patients with alcohol use disorder & it was dependent on severity of alcohol dependence (p value= 0.0009, 0.0014, 0.0014, 0.0007). Conclusion: Sexual Dysfunction had no correlation with the amount, duration of alcohol intake & severity of alcohol dependence. Patients with alcohol dependence had poor quality of life & it was related with severity of alcohol dependence. Keywords: Alcohol Use Disorder, Sexual Dysfunction, Quality of Life.

Background: Relapse remains a major challenge in the long-term management of alcohol dependence, with up to 90% of treated individuals relapsing within four years. The combined contribution of sociodemographic, personality, and psychosocial factors to relapse is poorly studied in resource-limited Indian settings. This study aimed to compare these factors between alcohol-dependent individuals with and without relapse and identify factors independently associated with relapse. Materials and Methods: This case–control study was conducted in the Department of Psychiatry, Government Mohan Kumaramangalam Medical College Hospital, Salem, between Nov 2018 and Dec 2019. Sixty male outpatients aged 18–45 years with ICD-10 alcohol dependence were enrolled: 30 relapsed cases and 30 controls abstinent for at least 12 months. Sociodemographic data were collected using a semi-structured proforma, psychosocial stress with the Presumptive Stressful Life Events Scale, and personality with the International Personality Disorder Examination. Categorical and continuous variables were compared using chi-square and independent-samples t-tests. Variables significant on univariate analysis were entered into a binary logistic regression model to identify independent predictors of relapse; Firth’s penalized logistic regression was used because of quasi-complete separation on the unemployment variable. Results: Cases and controls differed significantly in education, occupation, marital status, family history of alcoholism, duration of dependence, and presence of a significant psychosocial stressor (all p<0.005). Impulsive and anxious personality traits were more frequent among cases (p<0.05 each). On adjusted analysis, low educational attainment independently predicted relapse (adjusted odds ratio [AOR] 10.90, 95% CI 1.15–103.61, p=0.038), with a borderline independent association for longer duration of dependence (AOR 1.23 per year, 95% CI 1.00–1.51, p=0.053); the model correctly classified 96.7% of participants (Hosmer–Lemeshow p=0.720). Unemployment and financial loss were the leading precipitants of relapse. Conclusion: Low education, unemployment, family history of alcoholism, longer duration of dependence, impulsive or anxious personality traits, and unresolved psychosocial stress characterized relapsed patients, with low education and duration of dependence remaining independent predictors after adjustment. Relapse-prevention strategies should adopt a multidimensional approach addressing sociodemographic, personality, and stress-related domains together rather than in isolation. Keywords: Alcohol dependence; Relapse; Case-control studies; Personality; Psychological stress; Logistic regression; Risk factors.

Background: Objective: To compare the efficacy and safety of oral ofloxacin versus intravenous cefotaxime in patients with uncomplicated spontaneous bacterial peritonitis (SBP) in a real-world clinical setting. Materials and Methods: It was a comparative cohort study done at a Teaching Hospital which included sixty cirrhotic patients complaining uncomplicated SBP. Diagnosis was based on ascitic fluid PMN count >250/mm³. Patients were assigned to two treatment groups based on clinical discretion and patient financial circumstances. One group (n=30 patients) received par-oral Ofloxacin 400 mg BD for 7 days, while other group (n=30 patients) received IV Cefotaxime 2 g BD for 7 Days. The primary outcome was resolution of infection (acitic fluid PMN count <250/mm³) and Secondary outcomes included fever resolution, abdominal pain relief, and six-month mortality. Results: Initial features were same among both groups. After seven days, PMN count normalized in 28 of 30 cefotaxime patients (93%) and 26 of 30 ofloxacin patients (87%) (p=0.38). Fever resolved in 93% of both groups. Abdominal pain resolved in all 22 cefotaxime patients who had pain at baseline (100%) and in 24 of 26 ofloxacin patients with baseline pain (92%, p=0.49). mortality rate after six-months was 7% (n=2) and 10% (n=3) in cefotaxime and ofloxacin group (p=0.64) respectively. No patient discontinued treatment due to adverse effects. The most common bacterial isolate was Escherichia coli (54% of positive cultures), followed by Staphylococcus aureus (25%). Conclusion: Both oral ofloxacin and intravenous cefotaxime are effective for uncomplicated SBP, with no statistically significant difference in outcomes. Oral ofloxacin is a reasonable and cost-effective alternative where hospital admission or intravenous access poses challenges. Keywords: Spontaneous bacterial peritonitis, ofloxacin, cefotaxime, cirrhosis, comparative cohort study, Pakistan.

Background: The aim is to study the clinical profile, laboratory abnormalities, and outcomes of patients with systemic envenomation following hump-nosed pit viper (Hypnale hypnale) bites presenting to a tertiary care centre in North Kerala. Materials and Methods: This Prospective observational study-cross sectional was conducted in Department of General Medicine ( OP and IP patients), Government Medical College, Kozhikode for the duration of 1.5year from ethical committee clearance of the study(december 2024-july 2026). A total of 46 patients aged >13 years with confirmed hump-nosed pit viper bites were included. Clinical features, laboratory parameters, and outcomes were recorded. Statistical analysis was performed using SPSS, with associations assessed using Chi-square and Fisher’s exact tests, and multivariable logistic regression used to identify predictors of AKI. Results: The mean age was 42.98 ± 15.86 years, with a male predominance (73.9%). Most bites occurred during the monsoon season (67.4%) and involved the lower limb (67.4%). AKI developed in 33% of patients, with 9% requiring dialysis. Bleeding manifestations were observed in 30% of cases. Laboratory abnormalities included prolonged clotting parameters (mean INR 2.17 ± 1.20), elevated LDH and CPK, and thrombocytopenia. Albuminuria (46.7% vs 3.2%, p<0.01), elevated CPK (>600 IU/L), elevated LDH (>480 IU/L), microangiopathic hemolytic anemia, hypotension at presentation, and delayed hospital presentation (>6 hours) were significantly associated with AKI. Multivariable analysis identified albuminuria and elevated CPK as independent predictors. The 20-minute whole blood clotting test showed moderate sensitivity (72.9%) but poor specificity (11.1%) for detecting coagulopathy. Mortality was 4%. Conclusion: Hump-nosed pit viper envenomation is associated with significant morbidity, particularly due to AKI. Early identification of high-risk patients using markers such as albuminuria and elevated muscle enzymes, along with prompt supportive care, is crucial in improving outcomes. Reliance solely on bedside clotting tests may be inadequate, and laboratory monitoring remains essential. Keywords: Hump-nosed pit viper, Hypnale hypnale, snakebite, acute kidney injury, coagulopathy, envenomation, Kerala.

Background: Acute dyspnea is a common emergency presentation with diverse cardiac and non-cardiac causes. NT-proBNP, a stable marker of ventricular wall stress, has been proposed as a rapid tool to differentiate cardiac from non-cardiac dyspnea and to predict outcome. The objective is to evaluate the role of NT-proBNP in differentiating cardiac from non-cardiac causes of acute dyspnea and to assess its association with mortality in cardiac causes. Materials and Methods: This prospective observational study enrolled 99 adults aged 20-80 years presenting with acute dyspnea to the Emergency Medicine department over 18 months. NT-proBNP was measured by the ELFA method at presentation. Patients were categorized as cardiac or non-cardiac dyspnea, and followed for CCU admission and in-hospital outcome. Student's t-test and chi-square test were used for analysis, with p<0.05 considered significant. Results: Of 99 patients, 52 (52.5%) had cardiac and 47 (47.5%) had non-cardiac dyspnea. Mean NT-proBNP was markedly higher in cardiac dyspnea (3088.77 pg/mL) than non-cardiac dyspnea (258.66 pg/mL, p<0.001). A cutoff of >600 pg/mL identified cardiac dyspnea with 92.3% sensitivity and 93.6% specificity (p<0.001). CCU admission was required in 33 patients, predominantly with cardiac dyspnea (p<0.001). Mortality was higher in cardiac dyspnea (7/52 vs 1/47, p=0.03), and mean NT-proBNP was significantly higher among non-survivors than survivors (5066 vs 1632 pg/mL, p<0.001). NT-proBNP also correlated significantly with echocardiographic abnormalities (p<0.001), though not with specific cardiac pathology subtype (p=0.324). Conclusion: NT-proBNP is a reliable, rapid, and non-invasive biomarker for differentiating cardiac from non-cardiac causes of acute dyspnea, and independently correlates with CCU requirement, echocardiographic dysfunction, and mortality, supporting its routine use in emergency risk stratification. Keywords: NT-proBNP; acute dyspnea; heart failure; biomarker; emergency medicine; mortality.

Background: Sepsis remains a leading cause of morbidity and mortality in intensive care units. Serum albumin, absolute eosinophil count (AEC), and the qSOFA score are simple, low-cost parameters proposed for risk stratification, but their comparative and serial prognostic value remains incompletely defined. The objective in to assess serum albumin, AEC, and qSOFA score in patients with sepsis, and to correlate these parameters with morbidity and mortality. Materials and Methods: This prospective observational study enrolled 105 adults with sepsis (qSOFA ≥2) admitted to the medical intensive care unit over 18 months. Serum albumin, AEC, and qSOFA score were measured serially on Days 0, 3, 5, and 7. Patients were followed for mechanical ventilation, inotropic support, hospital stay, and in-hospital mortality. Chi-square test and Student's independent t-test were used, with p<0.05 considered significant. Results: Of 105 patients, 53 (50.5%) required mechanical ventilation, 77 (73.3%) required inotropic support, and 44 (41.9%) died in hospital. Serum albumin declined progressively from 2.95 g/dL (Day 0) to 2.51 g/dL (Day 7), and was significantly lower among patients requiring mechanical ventilation and non-survivors by Day 5-7 (p<0.05). qSOFA score showed consistent, significant divergence from Day 3 onward between patients requiring mechanical ventilation or inotropic support and those who did not, and between survivors and non-survivors (p<0.001 by Day 5-7). Absolute eosinophil count did not differ significantly by any outcome at any time point (p>0.05). Conclusion: Serial serum albumin and qSOFA score, rather than single admission values, correlate significantly with morbidity and mortality in sepsis, while absolute eosinophil count does not reliably predict outcome in this cohort. Serial qSOFA monitoring combined with serum albumin trend offers a practical, low-cost prognostic strategy in resource-limited critical care settings. Keywords: Sepsis; serum albumin; absolute eosinophil count; qSOFA; mortality; intensive care.

Background: The triglyceride-glucose (TyG) index is a simple, low-cost surrogate marker of insulin resistance proposed as a predictor of diabetic microvascular complications, but its association with diabetic retinopathy and nephropathy remains incompletely defined in Indian populations. Objective: To evaluate the utility of the TyG index as a marker of diabetic retinopathy and nephropathy, and to correlate it with these complications in type 2 diabetes mellitus (T2DM). Materials and Methods: This hospital-based cross-sectional study enrolled 90 adults with T2DM. Fasting triglycerides and glucose were used to calculate the TyG index, and participants were categorized into tertiles. Retinopathy was graded by ETDRS classification and nephropathy assessed by urinary albumin excretion and eGFR. Chi-square test, independent t-test, ANOVA, and Pearson correlation were used, with p<0.05 considered significant. Results: Retinopathy was present in 31 (34.44%) and nephropathy in 61 (67.78%) of 90 participants; 28 (31.11%) had both. Retinopathy and nephropathy prevalence rose across TyG tertiles, from 38.71% and 64.52% in the lowest tertile to 56.67% and 73.33% in the highest. Mean TyG index was numerically higher with retinopathy (5.29 vs 5.19) and nephropathy (5.27 vs 5.16), though not statistically significant (p=0.247, p=0.212). Fasting and post-prandial glucose were significantly higher with retinopathy (p=0.028, p=0.024), while HbA1c was significantly associated with nephropathy (p=0.009). TyG index correlated significantly with fasting glucose (r=0.622), post-prandial glucose (r=0.570), triglycerides (r=0.755), and HbA1c (r=0.538), all p<0.001. Conclusion: The TyG index shows a graded association with diabetic retinopathy and nephropathy across tertiles and correlates strongly with glycemic and lipid parameters, supporting its potential as an inexpensive adjunct for risk stratification, although larger studies are needed to establish significant thresholds for individual complications. Keywords: Triglyceride-glucose index; diabetic retinopathy; diabetic nephropathy; type 2 diabetes mellitus; insulin resistance.

Background: Spinal anaesthesia is widely used for lower abdominal surgeries because of its rapid onset, reliable sensory and motor blockade, and favorable safety profile. Hyperbaric bupivacaine remains the standard intrathecal local anaesthetic; however, it is associated with prolonged motor blockade and greater hemodynamic fluctuations. Hyperbaric ropivacaine, a newer amide local anaesthetic, offers a potentially safer alternative with less cardiotoxicity, earlier motor recovery, and improved postoperative mobilization. This study compares the efficacy and safety of 0.5% heavy bupivacaine and 0.75% heavy ropivacaine for spinal anaesthesia in lower abdominal surgeries. The aim of the study is to compare the efficacy of 0.5% heavy Bupivacaine and 0.75% heavy Ropivacaine for spinal anaesthesia in patients undergoing lower abdominal surgeries in 18 to 50yrs. The objective is to Time of onset of action, Highest level of sensory and motor blockade, Time of onset of bromage 3, Intraoperative heart rate, blood pressure, spo2, Regression to bromage 0 & Side effects. Materials and Methods: It was a randomized controlled study includes Patients of either sex aged between 18 to 50 years of ASA- 1 & 2, undergoing surgeriesunder spinal anaesthesia. The study was conducted during the period from August 2023 to January 2025 at Siddhartha medical college, Government General Hospital, Vijayawada. Patients were randomly allocated into two groups. All spinal blocks were performed by a single anesthesiologist who also recorded the observations. GROUP B – 45 patients given 3 ml of 0.5% Hyperbaric Bupivacaine (15mg) GROUP R – 45 patients given 3ml of 0.75% Hyperbaric Ropivacaine (22.5mg) Results: The present study compared the efficacy and safety of 0.75% heavy ropivacaine and 0.5% heavy bupivacaine for spinal anaesthesia in a cohort of 90 patients. The study aimed to evaluate several key outcomes, including the onset time of sensory and motor blocks, duration of block, hemodynamic effects, pain relief, and complications. The results revealed significant differences in the onset time of sensory and motor blocks, with bupivacaine providing a faster onset of both sensory and motor block compared to ropivacaine. Bupivacaine also reached the T10 sensory level and the highest level of sensory block more quickly than ropivacaine, demonstrating its faster spreading ability in the spinal cord. However, ropivacaine demonstrated a shorter duration of motor block, suggesting a quicker recovery of motor function, which could be beneficial in outpatient surgeries.In terms of hemodynamic effects, bupivacaine caused more pronounced and sustained hypotension compared to ropivacaine. This finding highlights the importance of careful monitoring of blood pressure in patients receiving bupivacaine, especially those with pre-existing cardiovascular conditions. Although both agents had similar VAS scores at later time points, bupivacaine provided better early pain relief, suggesting it is more effective at providing rapid analgesia in the early stages of anaesthesia. The study also reported no significant differences in complications between the two groups, with both drugs demonstratin

Background: Chest radiography (CXR) is the initial imaging modality for evaluating patients with chest trauma because of its widespread availability and rapid acquisition. However, compared with chest computed tomography (CT), the reference standard, its diagnostic accuracy for detecting rib fractures and associated thoracic injuries is limited. This study compared the diagnostic efficacy of chest radiography and chest CT for detecting rib fractures in patients presenting with chest trauma and to evaluate their performance in identifying hemothorax, pneumothorax, pulmonary contusions, clavicle fractures, sternal fractures, and scapular fractures. Materials and Methods: This prospective observational study included 100 hemodynamically stable adult patients with blunt or penetrating chest trauma at a tertiary care hospital between 2023 and 2024. All patients underwent chest radiography and chest CT, with CT serving as the reference standard. The diagnostic performance of chest radiography was assessed by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each injury. Results: The majority of patients were aged 18–40 years (47%), and 61% were male. Chest wall tenderness was the most common clinical finding (85%). For rib fractures, chest radiography demonstrated a sensitivity of 34%, specificity of 94%, PPV of 85%, and NPV of 59%. Sensitivities for hemothorax, pneumothorax, pulmonary contusions, and scapular fractures were 44%, 48%, 34%, and 40%, respectively, with specificity ranging from 92% to 98%. Sensitivities were higher for clavicle fractures (84%) and sternal fractures (70%), with 98% specificity for both injuries. Conclusion: Chest radiography demonstrated high specificity but limited sensitivity for detecting rib fractures and several associated thoracic injuries compared with chest CT. These findings show that chest radiography may miss clinically important injuries, while chest CT remains the preferred imaging modality for comprehensive evaluation of chest trauma, particularly when clinical suspicion persists despite negative chest radiographic findings. Keywords: Chest trauma, Chest radiography, Computed tomography, Rib fractures, Diagnostic accuracy.

Background: Multidrug-resistant tuberculosis (MDR-TB) remains a major public health challenge because of prolonged treatment duration, higher treatment costs, drug-related adverse effects, and comparatively poor treatment outcomes. Continuous evaluation of treatment outcomes under the Programmatic Management of Drug-Resistant Tuberculosis (PMDT) is essential for strengthening tuberculosis control programmes and improving patient care. Aim: To assess the treatment outcomes of multidrug-resistant tuberculosis patients managed under the Programmatic Management of Drug-Resistant Tuberculosis (PMDT) in Raichur district. Materials and Methods: A community-based cross-sectional study was conducted among 60 MDR-TB patients registered under PMDT in Raichur district, Karnataka. Patients were identified through District Tuberculosis Centre records and interviewed using a pre-designed, pre-tested questionnaire. Treatment outcome analysis was performed for 55 patients with documented treatment status. Socio-demographic characteristics, behavioural risk factors, clinical profile, and treatment outcomes were collected from programme records and patient interviews. Data were analysed using SPSS version 26.0. Categorical variables were expressed as frequencies and percentages, while associations were assessed using Chi-square or Fisher's exact test. A p-value <0.05 was considered statistically significant. Results: The majority of patients belonged to the 30–40-year age group (32.7%), were males (69.1%), rural residents (76.4%), Hindus (83.6%), and belonged to socioeconomic Class IV (56.4%). Histories of smoking, alcohol consumption, tobacco chewing, and comorbidities were reported in 27.3%, 32.7%, 9.1%, and 9.1% of patients, respectively. Treatment success (cured or treatment completed) was observed in 11 (20.0%) patients, while 29 (52.7%) were still receiving treatment and 15 (27.3%) experienced unfavourable outcomes, including treatment interruption, death, or progression to XDR-TB. Individually, 6 (10.9%) patients were cured, 5 (9.1%) completed treatment, 10 (18.2%) had treatment interruption or loss to follow-up, 4 (7.3%) died, and 1 (1.8%) progressed to XDR-TB. No statistically significant association was observed between cured status and age, sex, residence, religion, or socioeconomic status (p>0.05). Conclusion: MDR-TB in Raichur district predominantly affected economically productive, rural, and socioeconomically disadvantaged individuals. Although one-fifth of patients had achieved treatment success, more than half remained on treatment at the time of assessment, highlighting the need for continued follow-up before final programme outcomes can be determined. Strengthening adherence support, early management of adverse drug reactions, patient counselling, nutritional assistance, and decentralized PMDT services may improve treatment outcomes and contribute to tuberculosis elimination efforts. Keywords: Multidrug-resistant tuberculosis. Programmatic Management of Drug-Resistant Tuberculosis (PMDT). Treatment outcomes.

Background: Thrombocytopenia defined as blood platelet count below 150,000L is the second leading cause of blood disorders in pregnancy after anemia. Gestational Thrombocytopenia explains 70-80% of all cases of thrombocytopenia in pregnancy. The aim of this study is to review the risks factors for development of thrombocytopenia during pregnancy and their obstetrical implications and management available in tertiary care centre. Aim and Objectives: To study the risk factors, management, maternal and perinatal outcome in Thrombocytopenia complicating pregnancy. Material and Methods: Analysis of 30 pregnant women with Thrombocytopenia who received care at Institute of Obstetrics and Gynaecology, Egmore. Period of study: March 2024 to August 2024 (6 months). The details were collected from medical records, including patient parity, cause of Thrombocytopenia, serial platelet count, management, obstetrical complications and neonatal outcome. Results: Among 30 cases,18 were Gestational Thrombocytopenia,3 were ITP ,7 were Pre eclampsia, 1- Chronic liver disease ,1- Dengue + ve case. Risk factors, management, maternal and perinatal outcome were analysed. All cases had a positive maternal outcome except for one neonatal death due to IVH. Conclusion: Gestational thrombocytopenia is the most common cause of thrombocytopenia in pregnancy. Though the complications observed in Gestational thrombocytopenia are relatively less, serial platelet monitoring, proper AN care, prompt referral, institutional delivery with 24hrs blood bank facility, ICU Care, NICU care will result in better maternal and fetal outcome. Gestational hypertension patients should be closely monitored for preeclampsia and HELLP syndrome, and are advised strict BP control. Known and newly diagnosed ITP are advised to have proper hematological follow up to avoid complications Keywords: Gestatioal Thrombocytopenia, Preclampsia, Idiopathic Thrombocytopeinic Purpura, Dengue.

Background: Dietary patterns directly impact nutrient intake and long-term health outcomes. With increasing worldwide interest in plant-based diets, understanding their nutritional adequacy and health outcome is essential. Objective: To systematically review and quantitatively analyse nutrient intake and health outcomes across vegetarian, vegan and non-vegetarian dietary patterns. Materials and Methods: A comprehensive search was conducted in PubMed, Google Scholar and other databases for studies comparing macronutrient/micronutrient intake and health outcomes like hypertension, diabetes, cardiovascular disease and stroke among three diets. Eleven eligible observational studies and randomised controlled trials (RCTs) were analysed using a random-effects model. Risk of bias was assessed using Newcastle-Ottawa Scale (NOS), Joanna Briggs Institute (JBI) Checklist and Cochrane Risk of Bias Tool 2.0 (RoB 2.0). Results: Non-vegetarians had highest intake of energy, protein, fats, vitamin B12, calcium and vitamin D. Vegans consumed the most fibre, vitamin C and iron; vegetarians had higher vitamin A. Critically low vitamin B12 intake was noted among vegans (mean: 0.33 µg/day) and vegetarians had suboptimal calcium intake (mean: 501 mg/day). Plant-based diets have been related to improved glycemic management and reduced blood pressure. Despite reduced cardiovascular risk (HR: 0.78), stroke risk was increased among vegetarians (HR: 1.12). High heterogeneity (I² > 90%) was observed. Conclusions: Vegetarian and vegan diets offer adequate fibre and antioxidant intake but lack vitamin B12, calcium and vitamin D. Non-vegetarian diets offer broader nutrient coverage but lack fibre. Customized dietary planning and supplementation are recommended for all groups. Keywords: Dietary Patterns, Nutritional Status & Health Outcome, Systematic Review & Meta-Analysis.

Background: Digital devices are integral to undergraduate education, but prolonged screen exposure is associated with ocular discomfort and reduced functional performance. Evidence linking screen time, visual fatigue, and visual reaction time among Indian undergraduate students remains limited. The objective is to determine daily screen-use patterns and evaluate their correlation with visual fatigue and visual reaction time among undergraduate students. Materials and Methods: This cross-sectional observational study included 100 undergraduate students aged 18–24 years at Government Medical College, Wanaparthy, Telangana, India, from September 2025 to February 2026. Screen-use characteristics and sleep duration were recorded using a structured schedule. Visual fatigue was assessed with a symptom-based validated questionnaire, and visual reaction time was measured using a computer-based simple reaction-time task. Group differences were analysed using one-way analysis of variance, the independent-samples t-test, and the chi-square test. Pearson correlation assessed relationships among continuous variables. Results: The mean age was 20.3 ± 1.5 years, and the mean daily screen time was 6.7 ± 2.3 hours. Visual fatigue was present in 65.0% of participants. Mean visual fatigue scores increased from 6.8 ± 3.1 among students with less than four hours of screen time to 18.6 ± 4.8 among those exceeding eight hours. Corresponding reaction times increased from 248.6 ± 28.4 to 318.9 ± 42.1 milliseconds. Screen time correlated positively with visual fatigue score and reaction time. Students with visual fatigue had slower reactions than those without fatigue. Conclusion: Longer daily screen exposure was associated with greater visual fatigue and prolonged visual reaction time. Structured visual breaks, improved screen-use behaviour, and adequate sleep should be promoted within undergraduate learning environments. Keywords: Digital eye strain; Screen time; Undergraduate students; Visual fatigue; Visual reaction time; Computer vision syndrome.

Background: Anaemia during adolescence can impair physical growth, learning capacity, immunity, and future reproductive health. Adolescent girls are particularly vulnerable because rapid growth, inadequate dietary intake, and menstrual blood loss increase their iron requirements. Objectives: To estimate the prevalence and severity of anaemia and assess its association with sociodemographic, nutritional, and menstrual factors among adolescent girls in an urban population. Materials and Methods: A community-based cross-sectional observational study was conducted among 100 adolescent girls aged 10-19 years in the urban field practice area of the Department of Community Medicine, Government Medical College, Wanaparthy, Telangana, India, from August 2025 to January 2026. Sociodemographic, dietary, anthropometric, menstrual, and haemoglobin data were collected. Anaemia was classified using age-appropriate haemoglobin thresholds. Associations were examined using the Pearson χ² test, with p<0.05 considered statistically significant. Results: The mean age was 15.3 ± 2.4 years, and the mean haemoglobin concentration was 11.55 ± 1.43 g/dL. Anaemia was present in 46.0% of participants; 26.0% had mild, 17.0% moderate, and 3.0% severe anaemia. Anaemia was significantly associated with low intake of iron-rich foods, frequent meal skipping, underweight status, lower socioeconomic category, a history suggestive of worm infestation, and heavy menstrual bleeding. Vegetarian dietary pattern, age group, and menstrual duration exceeding five days were not significantly associated with anaemia. Conclusion: Anaemia affected nearly half of the adolescent girls studied and was linked to modifiable nutritional, socioeconomic, parasitic, and menstrual factors. Community-level screening should be integrated with nutrition counselling, regular iron-folic acid supplementation, deworming, and evaluation of heavy menstrual bleeding. Keywords: adolescent girls; anaemia; haemoglobin; nutrition; heavy menstrual bleeding; urban health.

Background: Electrocardiogram (ECG) abnormalities are common in acute ischaemic stroke and may be a manifestation of neurogenic cardiac involvement, autonomic deregulation or underlying cardiovascular disease. In many situations, their prognostic relevance is still unknown. Objective: To determine the frequency and pattern of ECG changes in patients with acute ischaemic stroke and their association with early clinical outcome as measured by the modified National Institutes of Health Stroke Scale (mNIHSS). Materials and Methods: An observational study was conducted in a tertiary care hospital in Kerala for 18 months. Inclusion criteria: Adults > 18 years of age with acute ischaemic stroke confirmed by neuroimaging. All participants had a 12-lead ECG and stroke severity/outcome was assessed using the mNIHSS on day 1, day 5, day 7 or at discharge. Chi-square or Fisher's exact test was used to analyse associations between ECG findings and outcome. Results: We studied 51 patients in total. ECG changes were found in 52.9% of patients. The most frequent abnormality was T wave inversion (59%), followed by sinus tachycardia (17%), atrial fibrillation (14%), and ST-T changes (10%). Based on mNIHSS change, 33.3% were improved, 51.0% unchanged and 15.7% worse. There was no statistically significant association between ECG abnormalities and clinical outcome: T-wave inversion (p=0.671), ST-T changes (p=0.148), atrial fibrillation (p=0.661), and tachycardia (p=0.336). Conclusion: ECG abnormalities are common in acute ischaemic stroke and the commonest abnormality is T-wave inversion. However, in the present study, ECG changes were not significantly associated with early neurologic outcome. Further multicenter studies are warranted to better define the prognostic impact of ECG changes in acute ischaemic stroke. Keywords: Acute ischemic stroke, Electrocardiographic changes, T-wave inversion, Atrial fibrillation, mNIHSS, Prognosis.

Background: Chronic Achilles tendon rupture is a challenging orthopaedic condition characterized by delayed presentation, tendon retraction, scar tissue formation, muscle atrophy, and poor tendon quality, making direct end-to-end repair difficult. Flexor Hallucis Longus (FHL) tendon transfer has emerged as a reliable reconstructive technique owing to its favourable biomechanical properties, anatomical proximity, and low donor-site morbidity. However, evidence regarding the functional outcomes of the modified FHL tendon transfer in the Indian population remains limited. The aim is to evaluate the functional outcome of Modified Flexor Hallucis Longus tendon transfer in the surgical management of chronic Achilles tendon rupture. Materials and Methods: This prospective observational study was conducted in the Department of Orthopaedics, Government Medical College and Government General Hospital, Ongole, Andhra Pradesh, from May 2023 to April 2026. Thirty patients aged ≥18 years with chronic Achilles tendon rupture (>6 weeks), recurrent rupture, or tendon defects unsuitable for primary repair underwent Modified FHL tendon transfer. Functional outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score. Secondary outcome measures included ankle range of motion, six-minute walk distance, calf circumference, heel-rise ability, return to occupation and recreational activities, patient satisfaction, and postoperative complications. Statistical analysis was performed using the Wilcoxon signed-rank test, with p<0.05 considered statistically significant. Results: The study included 30 patients with a mean age of 50.6 ± 12.4 years, of whom 73.3% were males. The mean duration from injury to surgery was 14.5 ± 4.1 weeks, with a mean tendon gap of 6.4 ± 0.9 cm. The mean AOFAS score improved significantly from 49.2 ± 8.4 preoperatively to 90.1 ± 6.7 postoperatively (p<0.001). Significant improvements were also observed in plantar flexion (24.6° to 38.8°), dorsiflexion (6.8° to 13.6°), calf circumference (33.1 cm to 34.5 cm), and six-minute walk distance (392.4 m to 641.2 m) (all p<0.001, except calf circumference p=0.002). At final follow-up, 90.0% of patients could perform a single heel rise, 93.3% returned to their pre-injury occupation, 80.0% resumed recreational activities, and 96.7% reported satisfactory outcomes. Minor complications included superficial wound infection (3.3%), delayed wound healing (3.3%), skin adhesion (3.3%), and mild great toe weakness (6.7%), while no reruptures or sural nerve injuries were observed. Conclusion: Modified Flexor Hallucis Longus tendon transfer is a safe, reliable, and effective surgical technique for the management of chronic Achilles tendon rupture. It provides excellent functional recovery, significant improvement in AOFAS scores and ankle function, high patient satisfaction, and a low complication rate. The procedure represents a valuable reconstructive option for chronic Achilles tendon defects, particularly when primary tendon repair is not feasible. Keywords: Chronic Achilles tendon rupture, Flexor Hallucis Longus tendon transfer, Modified FHL transfer, Achilles tendon

Background: Polycystic Ovarian Syndrome (PCOS) is a proposed diagnostic construct extending beyond classical PCOS to encompass multi-glandular endocrine dysfunction—including concurrent thyroid, adrenal, and pancreatic beta-cell pathology—alongside ovarian hyperandrogenism and anovulation. Comparative therapeutic evidence under this broader framework, particularly from South Asian tertiary care settings, remains limited. The objective is to comparatively evaluate the polycystic and endocrine impacts of COCPs versus insulin-sensitising therapy (IST: metformin plus myo-inositol) in women fulfilling PCOS diagnostic criteria over 12 months. Materials and Methods: A prospective, randomised, open-label, parallel-group controlled trial at JISMSR, Howrah (January 2022–December 2025). One hundred and twenty women aged 18–40 years were randomised to Group A (COCPs: ethinyl estradiol 30 µg + desogestrel 150 µg) or Group B (metformin 1,000 mg twice daily + myo-inositol 4 g/day). Primary outcome was 12-month HOMA-IR; secondary outcomes included lipid profile, androgens, TSH, and menstrual regularity. Results: IST demonstrated significantly greater reduction in HOMA-IR (2.46 ± 0.98 vs. 4.18 ± 1.50; p < 0.001; Cohen's d = 1.18), fasting insulin, LDL-C, and triglycerides, with HDL-C rise. COCPs achieved superior free androgen index suppression (5.2 ± 1.8 vs. 7.6 ± 2.4; p < 0.001) and menstrual regularity (91.7% vs. 76.7%; p < 0.001). TSH was more favourably modulated by IST (p = 0.014). Conclusion: IST confers broader cardiologic, polycystic and polyendocrine benefits in PCOS, while COCPs retain superiority for androgenic suppression and cycle control. A phenotype-guided individualised therapeutic approach is recommended. Keywords: Polysystic Ovarian Syndrome, PCOS; COCPs, Insulin Sensitizers, Metformin, Myo-Inositol, HOMA-IR, Hyperandrogenism, TSH, Randomised Controlled Trial, South Asia.

This study is a retrospective analysis of 93 cases of lymph node biopsy, over a span of one year carried out in Department of Pathology, Ballari Medical College and Research Centre (BMCRC), Ballari, Karnataka. 73.1% cases were non-neoplastic and 26.8% cases were neoplastic lesions. Reactive hyperplasia was the most common cause of lymphadenopathy, occurring in all age groups involving the cervical group of lymph nodes followed by granulomatous lymphadenitis. Neoplastic lesions are most commonly seen in older age group. Persistent lymphadenopathy in all age group should undergo lymph node biopsy, to rule out malignancy and lymphoma which helps in early diagnosis. Keywords: Lymphadenopathy, Reactive hyperplasia, Lymphoma, Metastasis.

Background: Hypotension after neuraxial anaesthesia remains a common and clinically important perioperative event, particularly in older, obstetric and cardiovascularly vulnerable patients. Conventional clinical assessment and left ventricular ejection fraction (LVEF) may not fully capture preload status, diastolic reserve or subclinical myocardial dysfunction. Global longitudinal strain (GLS) is theoretically attractive because it can detect early myocardial impairment, but its direct role in predicting post-neuraxial hypotension is uncertain. Objective: To synthesize available evidence on preoperative echocardiographic and ultrasound-derived predictors of hypotension after spinal or epidural anaesthesia, with emphasis on LVEF, GLS, diastolic indices and inferior vena cava (IVC) parameters. Materials and Methods: A PRISMA 2020-oriented systematic literature review was conducted across PubMed/MEDLINE, Scopus, Google Scholar, EMBASE and Web of Science from inception to June 2026 [1]. Adult studies evaluating preoperative echocardiographic or vascular ultrasound parameters in relation to hypotension after neuraxial anaesthesia were considered. Case reports, narrative reviews, non-peer-reviewed publications and studies without hypotension as an outcome were excluded. Because of heterogeneity in populations, anaesthetic techniques, outcome definitions and reported indices, a narrative synthesis rather than meta-analysis was performed. Results: Twelve studies were retained for qualitative synthesis according to the study-selection flow diagram. The strongest and most consistent evidence related to IVC-derived variables, particularly IVCCI, IVC/aorta-related indices and dIVCmax-to-IVCCI ratio. Point-of-care transthoracic echocardiography studies in elderly patients suggested that combined IVC and cardiac indices may help identify vulnerability to post-spinal hypotension. LVEF alone showed limited discriminatory value, especially when preserved. Diastolic indices, particularly mitral inflow E velocity in older patients with mild left ventricular diastolic dysfunction, showed promising predictive value in one retrospective study. Evidence directly supporting GLS as an independent predictor of hypotension after neuraxial anaesthesia was sparse; in the available studies, GLS was not established as superior to IVC or diastolic indices. Conclusion: Preoperative ultrasound assessment can contribute to risk stratification before neuraxial anaesthesia, but the evidence is not strong enough to recommend routine GLS assessment for this indication. Current evidence is strongest for IVC-based assessment and selected diastolic parameters in elderly and high-risk patients. Future prospective studies should directly compare GLS, LVEF, diastolic indices and IVC-derived parameters using standardized definitions of hypotension and clinically meaningful outcomes. Keywords: spinal anaesthesia; neuraxial anaesthesia; hypotension; echocardiography; ejection fraction; global longitudinal strain; inferior vena cava; point-of-care ultrasound; diastolic dysfunction.

Background: Cardiovascular disease is the leading cause of mortality among patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Elevated cardiac troponin-T (cTnT) is a sensitive biomarker of myocardial injury and may identify subclinical cardiac involvement in these patients. This study aimed to estimate serum cardiac troponin-T levels in patients with CKD stages 3–5 and evaluate their association with disease stage. Materials and Methods: A hospital-based cross-sectional study was conducted over 12 months in the Department of General Medicine of a tertiary care teaching hospital. Sixty-four adult patients with CKD stages 3–5 undergoing maintenance hemodialysis or conservative management were enrolled using consecutive sampling. Patients with recent acute coronary syndrome, myocardial infarction, acute kidney injury, sepsis, or other conditions affecting troponin levels were excluded. Clinical details, laboratory investigations, electrocardiography, echocardiography, and high-sensitivity cardiac troponin-T assays were performed. Data were analyzed using descriptive and inferential statistics. Results: The mean age of participants was 57.25 ± 5.54 years, with 70.3% being males. Stage V CKD constituted 50% of cases, followed by Stage IV (26.6%) and Stage III (23.4%). Diabetes mellitus and hypertension coexisted in 64.1% of patients. All participants were anaemic, 92.2% had elevated ESR, and 64.1% demonstrated left ventricular hypertrophy on echocardiography. Elevated serum cardiac troponin-T levels were detected in 36 (56.25%) patients. Troponin positivity increased with advancing CKD stage, although the association was not statistically significant (P = 0.590). Conclusion: Elevated cardiac troponin-T is common in patients with advanced CKD and ESRD and increases with disease severity. High-sensitivity cardiac troponin-T may serve as a valuable biomarker for detecting subclinical myocardial injury and identifying CKD patients at increased cardiovascular risk. Keywords: Chronic Kidney Disease (CKD), End-Stage Renal Disease (ESRD), Cardiac Troponin-T, Myocardial Injury, Cardiovascular Risk.

Background: Diabetes mellitus is a major global health concern associated with several ocular complications, including structural and functional changes in the cornea. Chronic hyperglycemia can alter corneal endothelial function, increase central corneal thickness (CCT), and influence intraocular pressure (IOP) measurements, potentially affecting glaucoma assessment and the planning of anterior segment surgeries. The present study aimed to compare CCT among healthy individuals, controlled Type 2 diabetes mellitus (T2DM) patients, and uncontrolled T2DM patients, and to evaluate its association with glycemic control. Materials and Methods: This cross-sectional observational study was conducted in the Department of Ophthalmology at Sri Guru Ram Das Institute of Medical Sciences & Research, Amritsar, from July 2024 to December 2025. A total of 300 participants were enrolled and divided into three groups: healthy controls (n = 150), controlled T2DM (HbA1c ≤7%; n = 75), and uncontrolled T2DM (HbA1c >7%; n = 75). Statistical analysis was carried out using SPSS, with p <0.05 considered statistically significant. Results: Mean central corneal thickness increased progressively from 525.8 ± 18.7 μm in healthy controls to 548.6 ± 21.4 μm in controlled diabetics and 566.9 ± 24.5 μm in uncontrolled diabetics (p <0.001). Similarly, mean intraocular pressure was significantly higher in diabetic patients (14.2 ± 2.1, 16.0 ± 2.4, and 17.8 ± 2.8 mmHg, respectively; p <0.001). HbA1c showed a significant positive correlation with CCT (r = 0.58, p <0.001) and IOP (r = 0.46, p <0.001). Multiple regression analysis identified HbA1c as the strongest independent predictor of CCT, while age and gender were not significant predictors. Conclusion: Patients with Type 2 diabetes mellitus, particularly those with poor glycemic control, exhibit significantly increased central corneal thickness and intraocular pressure compared with healthy individuals. Keywords: Type 2 diabetes mellitus; central corneal thickness; intraocular pressure; HbA1c; corneal endothelium; glycemic control.

Background: Cataract remains the leading cause of reversible blindness worldwide, particularly in low- and middle-income countries where access to advanced surgical technologies may be limited. Manual small incision cataract surgery (MSICS) is a cost-effective and widely practiced technique that provides excellent visual outcomes comparable to phacoemulsification. Materials and Methods: A prospective interventional clinical study was conducted on 50 eyes of 50 patients with age-related senile cataract who underwent temporal clear corneal MSICS at the Department of Ophthalmology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, between July 2024 and December 2025. Preoperative assessment included measurement of uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, keratometry, intraocular pressure, and fundus examination. Results: The mean age of the study population was 64.8 ± 7.5 years, with females comprising 56% of participants. Mean UCVA improved significantly from 1.18 ± 0.26 logMAR preoperatively to 0.10 ± 0.08 logMAR at three months (p < 0.001). Mean BCVA improved from 0.94 ± 0.22 logMAR preoperatively to 0.04 ± 0.05 logMAR at the final follow-up (p < 0.001). At three months, 90% of patients achieved a BCVA of 6/9 or better, including 54% attaining 6/6 vision. Conclusion: Temporal clear corneal manual small incision cataract surgery is a safe, effective, and economical technique that provides excellent visual rehabilitation with minimal surgically induced astigmatism and a low rate of postoperative complications. Keywords: Cataract; Manual small incision cataract surgery; Temporal clear corneal incision; Visual outcome; Surgically induced astigmatism; Best-corrected visual acuity; Refractive outcome.

Background: Comprehensive morphometric knowledge of the sub-axial cervical spine is essential for safe surgery and implant selection, as vertebral dimensions vary with sex, race, and geographic origin. Objective: To evaluate magnetic resonance imaging (MRI)-based morphometric parameters of sub-axial cervical vertebrae (C3-C7) in a South Indian population and assess sex-wise and level-wise variations. Materials and Methods: This retrospective observational study was conducted at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, from January 2023 to May 2026, using MRI scans of 100 individuals (49 males, 51 females; aged 16-83 years). Superior and inferior end plate breadth, length, and surface area (elliptical approximation), vertebral body height and diameter, disc height, spinal canal diameter, and Torg-Pavlov ratio were measured at C3-C7. Data were analysed using descriptive statistics, independent t-tests, Spearman’s correlation, and one-way ANOVA. Results: Males showed significantly larger superior and inferior end plate widths, lengths, surface areas, and vertebral body heights and diameters than females. End plate widths and surface areas rose gradually from C3 to C7, but end plate lengths and spinal canal diameter showed no significant upward trend. Vertebral body height followed a non-monotonic U-shaped pattern. Disc height differed significantly between sexes at upper cervical levels, but spinal canal diameter showed no sexual dimorphism. Torg-Pavlov ratios were significantly higher in females than males at all levels. Conclusion: This study revealed considerable sexual dimorphism and level-wise variation in sub-axial cervical spine morphometry. These MRI-derived reference data may assist preoperative planning and design of population-specific cervical spine implants. Keywords: Cervical vertebrae; Magnetic resonance imaging; Morphometry; Sexual dimorphism; Torg-Pavlov ratio.

Background: Cesarean section (CS) is one of the most frequently performed surgical procedures globally. Optimizing skin closure techniques is critical to minimizing postoperative wound complications and enhancing cosmetic outcomes. Subcuticular skin closure is widely preferred; however, a definitive consensus regarding the optimal suture material between synthetic non-absorbable monofilaments like Prolene and synthetic absorbable braided materials like Vicryl remains limited. This study compared the clinical and cosmetic outcomes of Prolene versus Vicryl for subcuticular skin closure in patients undergoing lower segment cesarean section (LSCS). Materials and Methods: A randomized prospective comparative trial was conducted over a one-year period in Department of obstetrics and Gynaecology, Gayatri Vidya parishad institute of health care and medical Technology, Visakhapatnam, Andhra Pradesh. A total of 140 pregnant women undergoing LSCS via a Pfannenstiel incision were recruited and randomized into two equal cohorts (n = 70 per group): Group A received subcuticular skin closure using Prolene 1-0, and Group B received Vicryl 1-0. Assessments included operative duration, postoperative pain via a Visual Analog Scale (VAS), early wound complications (induration, discharge, dehiscence, and infection) up to 2 weeks, scar cosmetic outcomes at 6 weeks, and a comprehensive cost analysis. Results: The demographic and baseline clinical profiles were comparable between both groups (p > 0.05). The mean operative duration (30.0 ± 4.8 vs. 32.5 ± 5.0 minutes; p = 0.03) and skin closure times were significantly shorter in the Prolene group. While postoperative pain scores were statistically similar across all follow-up intervals (p > 0.05), early wound complications within 1 week were significantly lower in the Prolene group compared to the Vicryl group, specifically wound site induration (11.4% vs. 45.7%; p < 0.001) and wound discharge (11.4% vs. 24.3%; p = 0.04). No cases of wound dehiscence occurred in either cohort. Surgical site infections occurred in 7.1% of the Prolene group compared to 21.4% in the Vicryl group (p < 0.05). At the 6-week follow-up, patients in the Prolene group demonstrated significantly higher satisfaction with scar appearance, with 71.4% rating it as "Excellent" compared to 57.1% in the Vicryl group (p = 0.04), and a higher percentage presenting with no visible scar (80.0% vs. 64.3%; p = 0.03). Cost-analysis indicated that the material cost of Prolene was less than half that of Vicryl (INR 350 vs. INR 780 per unit). Conclusion: Subcuticular skin closure with Prolene for lower segment cesarean section offers significant clinical and economic advantages over Vicryl. It reduces operative time, significantly lowers the rate of early wound complications and surgical site infections, enhances cosmetic scar outcomes, and yields superior cost-effectiveness and patient satisfaction. Prolene may therefore be considered the preferred suture material for skin closure in LSCS, particularly in high-volume and resource-limited healthcare setups. Keywords: Lower segment cesarean section (LSCS), Subcuticular skin closure, Prolene, Vicryl, Surgical sit

Background: Artificial intelligence (AI) tools, particularly large language model (LLM)-based applications such as ChatGPT, Google Gemini, and Microsoft Copilot, have rapidly permeated medical education globally. Their adoption among medical students and faculty in low- and middle-income countries (LMICs), including India, remains incompletely characterised with respect to patterns of use, perceptions of utility, ethical concerns, and measurable academic impact. The objective is to assess the prevalence and patterns of AI tool usage, determine perceptions of utility and limitations, evaluate ethical concerns including academic integrity, and examine the self-reported academic impact of AI tools among MBBS students and faculty in a tertiary care teaching institution in Andhra Pradesh, India. Materials and Methods: A cross-sectional analytical study was conducted at Viswabharathi Medical College and General Hospital, Kurnool, from [Month] to [Month] 2026. A total of 345 participants (270 MBBS students [Phase I–III] and 75 faculty members across clinical and paraclinical departments) were recruited through stratified random sampling. A validated, pretested, self-administered structured questionnaire comprising five domains (i) sociodemographic profile, (ii) AI tool usage patterns, (iii) perceptions of utility, (iv) ethical concerns, and (v) academic impact — was the primary data collection instrument. Data were analysed using SPSS version 25.0; descriptive statistics, chi-square tests, and binary logistic regression were applied. Statistical significance was set at p < 0.05. Results: The overall prevalence of AI tool usage was 78.5% (n = 255 of 325). ChatGPT was the most frequently used tool (68.4%), followed by Google Gemini (47.2%) and Microsoft Copilot (29.6%). The primary academic use was assignment writing and clinical case preparation. A significant majority of students (71.3%) reported that AI tools enhanced understanding of complex biomedical concepts. However, 63.7% expressed concern regarding over-reliance, and 58.9% acknowledged submitting AI-generated content without adequate disclosure. Faculty perception of AI as a pedagogical threat was significantly higher than among students (p = 0.003). Binary logistic regression identified year of MBBS study (Phase III; OR: 2.84, 95% CI: 1.67–4.83) and smartphone ownership (OR: 3.12, 95% CI: 1.92–5.07) as significant independent predictors of AI tool use. Institutional AI policy awareness was markedly low (18.6%). Conclusion: AI tools are extensively used by medical students and faculty in this tertiary care setting, with notable benefits in academic productivity, yet significant ethical vulnerabilities and policy gaps persist. An urgent need exists for institutionally integrated AI literacy frameworks, transparent usage policies, and faculty development programmes tailored to the Indian medical education context. Keywords: Artificial intelligence; ChatGPT; Medical education; Academic integrity; MBBS students; Digital health; Large language models; India

Background: The diaphragm is the principal muscle of respiration, and alterations in its movement and thickness reflect underlying pleuro-pulmonary and mediastinal diseases. Early identification of diaphragmatic dysfunction can aid in prompt diagnosis and management of respiratory disorders. This study aimed to evaluate the utility of diaphragmatic movements and ultrasonographic assessment of diaphragmatic thickness as a screening tool for pleuropulmonary-mediastinal diseases in patients attending the Respiratory Medicine Outpatient Department (OPD) of Rama Medical College, Kanpur. Materials and Methods: This prospective, observational study was conducted among 100 adult patients presenting with respiratory symptoms. All participants underwent clinical evaluation, chest radiography, spirometry (where feasible), and diaphragmatic ultrasonography. Diaphragmatic excursion was measured using M-mode ultrasonography, while diaphragm thickness and thickening fraction were assessed using B-mode ultrasonography at the zone of apposition. Ultrasonographic findings were compared with established normative reference values. Results: The most common final diagnosis established was Chronic Obstructive Pulmonary Disease (COPD-40%), followed by Pleural Effusion (25%), Interstitial Lung Disease (ILD, 15%), and Mediastinal Masses (10%). Reduced diaphragmatic excursion, thinning of the diaphragm, and decreased thickening fraction were commonly observed, particularly in patients with chronic obstructive pulmonary disease and pleural effusion. The mean diaphragm thickness was below the lower limit of normal reference values, indicating prevalent diaphragmatic dysfunction. Diaphragmatic parameters showed a statistically significant positive correlation with spirometric indices, especially forced vital capacity and forced expiratory volume in one second. Conclusion: Diaphragmatic ultrasonography is a reliable, non-invasive, and cost-effective screening tool for detecting pleuro-pulmonary-mediastinal diseases in the outpatient setting. Its routine use may facilitate early diagnosis, guide further evaluation, and improve respiratory disease management, particularly in resource-limited healthcare environments. Keywords: Diaphragm, Ultrasonography, Diaphragmatic Excursion, Diaphragm Thickness, Respiratory Muscles, Pulmonary Function Tests, Chronic Obstructive Pulmonary Disease.

Peripheral ulcerative keratitis (PUK) is a crescentic, juxtalimbal corneal disease marked by epithelial breakdown, subepithelial infiltration, and progressive stromal melting. Roughly half of all cases trace back to an underlying collagen vascular disorder, which makes the condition as much a systemic warning sign as an ophthalmic emergency. This prospective case series examined 22 eyes of 12 patients presenting with PUK at a tertiary eye care centre in Telangana, recording demographic patterns, clinical presentation, etiology, treatment, and three-month outcomes. Two-thirds of patients were male, and the mean age was 70 years — nearly two decades older than the North Indian cohort most frequently cited for comparison. Bilateral involvement dominated (83%), a reversal of the pattern typically reported. Watering (91%), diminution of vision (86%), and pain (82%) were the leading complaints, and the inferonasal quadrant was affected most often, consistent with tear pooling in that region. Mooren's ulcer accounted for 42% of cases, the single largest etiological category, followed by rheumatoid arthritis-associated disease. Management ranged from topical steroids and lubrication in milder cases to conjunctival resection, tissue adhesive with bandage contact lens, and corneal patch grafting in eyes with impending or actual perforation. At three months, 45% of eyes retained vision of 6/36 or better, while 8% had failed to heal and 13% had recurred. The findings reinforce that PUK, particularly in elderly, rural population with delayed presentation, demands a coordinated ocular and systemic work-up, and that outcomes hinge on how promptly the underlying cause is identified and treated. Keywords: Peripheral ulcerative keratitis, Mooren's ulcer, collagen vascular disease, corneal melt, conjunctival resection, rheumatoid arthritis.

Background: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder that can substantially impair quality of life. Community-based evidence on IBS prevalence, subtype pattern, and symptom burden remains limited in rural Indian populations. Objective: To estimate the prevalence and subtype distribution of IBS and to examine the association between symptom severity and quality of life among adults in the rural field practice area of UPUMS, Saifai. Materials and Methods: A community-based cross-sectional study was conducted among 260 adults aged 18 years and above. Participants were selected through multistage random sampling. IBS was diagnosed using Rome IV criteria, symptom severity was assessed using the IBS Severity Scoring System (IBS-SSS), and quality of life was measured using the IBS Quality of Life (IBS-QOL) questionnaire. Data were analyzed using descriptive statistics, chi-square test, Fisher’s exact test, and Spearman’s rank correlation coefficient. Results: Of the 260 participants, 30 met the Rome IV diagnostic criteria for IBS, yielding a prevalence of 11.5% (95% CI: 7.8–15.4). Diarrhoea-predominant IBS was the commonest subtype (43.3%), followed by constipation-predominant IBS (26.7%), mixed IBS (20.0%), and unclassified IBS (10.0%). Among participants with IBS, 33.3% had mild, 40.0% moderate, and 26.7% severe disease. The mean IBS-SSS score was 228.4 ± 78.6, and the mean IBS-QOL score was 64.9 ± 17.8. No significant association was observed between IBS and age, sex, education, or socioeconomic status. However, IBS severity was significantly associated with quality of life, and IBS-SSS score showed a strong negative correlation with IBS-QOL score (Spearman’s r=-0.72, p=0.001). Conclusion: IBS affected more than one in ten adults in this rural population, with diarrhoea-predominant IBS as the leading subtype. Greater symptom severity was associated with poorer quality of life, underscoring the need for early recognition and comprehensive management of IBS in primary care and community settings. Keywords: Irritable bowel syndrome; Rome IV; prevalence; quality of life; IBS-SSS; IBS-QOL; rural population; cross-sectional study.

Background: Acute ischemic stroke is a common neurological emergency with substantial morbidity, and inflammatory-lipid markers such as the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) have been proposed as simple indicators of disease severity. Objectives: To estimate the ratio of monocytes to HDL cholesterol in acute ischemic stroke patients and to correlate the monocyte-to-HDL cholesterol ratio with the National Institutes of Health Stroke Scale (NIHSS) score for assessing stroke severity. Materials and Methods: A hospital-based prospective observational study was conducted over 18 months in the Department of General Medicine at a tertiary care centre in Kuppam, Andhra Pradesh. Consecutive patients diagnosed with acute ischemic stroke within 24 hours of symptom onset were enrolled by purposive sampling after written informed consent (n=100). Clinical assessment included Glasgow Coma Scale and NIHSS scoring at admission and before discharge, with diagnosis confirmed by CT or MRI brain imaging. Peripheral venous blood was collected at admission; complete blood count and fasting lipid profile were performed and MHR was calculated. Data were analysed in SPSS v23.0; Pearson correlation assessed associations between monocyte measures, HDL, MHR, and NIHSS, with p<0.05 considered significant. Results: Among 100 participants, the majority were aged 60–69 years (38.0%) or ≥70 years (31.0%), with a nearly equal gender distribution (male 51.0%, female 49.0%). Diabetes mellitus and hypertension were present in 35.0% and 34.0% respectively, while smoking and alcohol consumption were reported in 30.0% and 27.0%. Mean systolic and diastolic blood pressures were 147.32±22.89 mmHg and 83.72±11.71 mmHg. Mean monocyte percentage was 6.33±1.81, mean HDL cholesterol was 35.48±11.71 mg/dL, mean MHR was 0.20±0.09, and mean NIHSS score was 7.42±2.86. Monocyte percentage showed a significant positive correlation with NIHSS score (r=0.339, p=0.0006), whereas HDL cholesterol showed a weak negative non-significant correlation (r=−0.074, p=0.4636). MHR also demonstrated a significant positive correlation with NIHSS score (r=0.227, p=0.0229). Conclusion: Monocyte-to-HDL ratio and monocyte percentage were significantly associated with stroke severity in acute ischemic stroke patients. These findings suggest that MHR may serve as a simple, inexpensive, and readily available biomarker for early assessment of stroke severity and prognostication in acute ischemic stroke. Keywords: Acute ischemic stroke; monocyte-to-HDL ratio; NIHSS; inflammation; dyslipidemia; stroke severity; prognosis.

Background: Male infertility contributes to nearly half of infertility cases worldwide, with lifestyle-related risk factors increasingly recognized as modifiable determinants of semen quality. Among these, alcohol consumption and cigarette smoking have been implicated in oxidative stress, hormonal dysregulation, DNA damage, and impaired spermatogenesis. However, evidence from Indian populations remains limited and inconsistent. The present study evaluated the association of alcohol consumption and cigarette smoking with semen parameters among men undergoing infertility evaluation. Materials and Methods: A descriptive cross-sectional study was conducted among 215 men attending the Fertility Clinic of the Department of Obstetrics and Gynaecology, Government Medical College, Kottayam. After obtaining informed consent, demographic details and detailed history regarding alcohol consumption and smoking habits were recorded. Semen samples were analyzed according to WHO 2010 guidelines. Associations between alcohol use, duration of alcohol consumption, smoking status, smoking chronicity, and semen parameters were analyzed using Pearson's Chi-square test with statistical significance set at p<0.05. Results: Among the study participants, approximately half reported alcohol consumption, while nearly one-fourth were smokers. Alcohol consumption demonstrated significant associations with reduced sperm concentration, impaired motility, abnormal progressive motility, reduced vitality, and abnormal morphology. Longer duration of alcohol use showed a stronger adverse influence on semen quality. Cigarette smoking was significantly associated with oligospermia and abnormal sperm morphology, with greater impairment observed among men with higher cumulative smoking exposure. Conclusion: Alcohol consumption and cigarette smoking were significantly associated with deterioration of multiple semen parameters, supporting the importance of behavioral modification during infertility management. Early counselling regarding cessation of alcohol and tobacco use may improve reproductive outcomes in infertile men. Keywords: Male infertility; Alcohol; Cigarette smoking; Semen analysis; Lifestyle factors.

Background: Obsessive-compulsive symptoms (OCS) are clinically important yet frequently under-recognized in schizophrenia and may complicate illness course and management. The Aim is to determine the burden of OCS and describe the sociodemographic and clinical profile of patients with schizophrenia. Materials and Methods: This hospital-based cross-sectional observational study included 130 adults with DSM-5 schizophrenia attending the Psychiatry outpatient department of SMS Medical College and Attached Group of Hospitals, Jaipur, from September 2024 to August 2025. The MINI OCD module was used to screen for OCS and Y-BOCS was applied to positive cases. Appropriate descriptive statistics and chi-square testing were used. Results: OCS were present in 25 of 130 patients (19.2%). Mixed obsessions and compulsions were most frequent (52.0%). Severity was mild in 44.0%, moderate in 36.0%, severe in 16.0%, and extreme in 4.0%. Illness duration greater than five years showed significant association with OCS (p=0.046). Conclusion: Nearly one-fifth of patients with schizophrenia had OCS. Routine structured screening, especially in patients with longer illness duration, may improve recognition and individualized management. Keywords: Schizophrenia, obsessive-compulsive symptoms, MINI, Y-BOCS, comorbidity.

Background: Enhanced Recovery After Surgery (ERAS) is a multidisciplinary, evidence-based perioperative care pathway designed to minimize surgical stress, reduce postoperative complications, accelerate functional recovery, and improve patient satisfaction. Although ERAS protocols have demonstrated favourable outcomes in several surgical specialties, evidence regarding their effectiveness in instrumented thoracolumbar spine surgery remains limited, particularly in prospective observational studies from developing healthcare settings. Evaluation of ERAS requires assessment of multiple outcome measures, including postoperative pain, functional recovery, opioid consumption, length of hospital stay, postoperative complications, and patient satisfaction using validated clinical assessment tools. Aim: To evaluate the effectiveness of an Enhanced Recovery After Surgery (ERAS) protocol in patients undergoing instrumented thoracolumbar spine procedures by assessing clinical outcomes, opioid consumption, length of hospital stay, postoperative complications, and patient satisfaction. Materials and Methods: A prospective observational study was conducted among 54 patients undergoing elective instrumented thoracolumbar spine surgery at a tertiary care teaching hospital. Of the 54 patients, 42 (77.8%) were males and 12 (22.2%) were females. Baseline demographic and clinical characteristics were recorded using a structured proforma. All patients were managed according to a standardized multidisciplinary ERAS protocol comprising preoperative counselling, nutritional optimization, multimodal analgesia, standardized anaesthesia, early mobilization, early oral feeding, physiotherapy, and coordinated postoperative rehabilitation. Clinical outcomes were assessed using the Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI) for functional disability, Morphine Milligram Equivalents (MME) for opioid consumption, length of hospital stay (LOS), Patient Satisfaction Questionnaire (PSQ-18), and the Clavien–Dindo Classification for postoperative complications. Statistical analysis was performed using IBM SPSS Statistics version 29.0, and a p value of <0.05 was considered statistically significant. Results: The majority of patients belonged to the 41–60-year age group and underwent Posterior Lumbar Interbody Fusion (PLIF) or Transforaminal Lumbar Interbody Fusion (TLIF). Following ERAS implementation, significant improvements were observed in all evaluated outcome measures. The mean VAS score decreased from 8.2 ± 1.1 to 2.6 ± 0.9 (p < 0.001), while the mean ODI improved from 64.4 ± 8.5% to 24.1 ± 6.8% (p < 0.001). Mean postoperative opioid consumption decreased from 78.6 ± 14.3 MME to 32.8 ± 10.5 MME (p < 0.001), and the mean hospital stay was reduced from 8.1 ± 1.4 days to 4.6 ± 0.8 days (p < 0.001). Patient satisfaction scores improved significantly from 2.8 ± 0.6 to 4.5 ± 0.4 (p < 0.001), while postoperative complication severity, assessed using the Clavien–Dindo classification, decreased significantly (p = 0.002). Overall, 88.9% of patients achieved good-to-excellent postoperative recovery with early mobilization, fewer complications, and reduced opio

Background: Stillbirth remains a major global public health problem, particularly in low- and middle-income countries. Accurate classification of stillbirths is essential for identifying the underlying causes and associated risk factors. The Relevant Condition at Death (ReCoDe) classification system is a standardized method used to classify stillbirths. The present study was conducted to determine the proportion of stillbirths and associated risk factors using the ReCoDe classification system in a tertiary care hospital in Ballari. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynecology at a tertiary care hospital in Ballari. Pregnant mothers with intrauterine fetal death at 28 weeks or more gestational age and birth weight of 1000 grams or more were included. Data were collected using a predesigned proforma and stillbirths were classified using the ReCoDe classification system. Data were analyzed using SPSS version 23 and expressed as frequencies and percentages. Results: A total of 209 stillbirths were included in the study. Majority of the mothers (54.5%) belonged to the age group of 24–29 years and 42.6% were primigravida. Most of the deliveries (74.6%) were vaginal deliveries. Macerated stillbirths accounted for 86.1% of cases. According to the ReCoDe classification, fetal growth restriction (17.2%), abruptio placentae (12.4%), oligohydramnios (7.2%), and hypertensive disorders of pregnancy (66%) were the major associated conditions. Intrapartum asphyxia accounted for 13.4% of stillbirths, while 19.1% of cases remained unclassified. Conclusion: The ReCoDe classification system was effective in identifying the relevant conditions associated with stillbirths. Hypertensive disorders of pregnancy, fetal growth restriction, and placental abnormalities were the major contributors to stillbirths. Early identification of high-risk pregnancies, regular antenatal care, and timely obstetric intervention may help reduce stillbirths and improve perinatal outcomes. Keywords: Stillbirth, ReCoDe classification, fetal growth restriction, hypertensive disorders, intrauterine fetal death, placental abnormalities.

Background: Diabetes mellitus is a chronic metabolic disorder that significantly affects patients' physical, psychological, and social well-being. Health-related quality of life (HRQoL, QOLID) has emerged as an important outcome measure in diabetes management. Understanding the influence of sociodemographic factors on HRQoL among diabetic patients can help design targeted interventions to improve treatment outcomes and overall quality of life. Aims: The aim of this study is to assess the health-related quality of life (QOLID) among patients with diabetes attending a diabetic clinic in Kolkata, West Bengal, and to evaluate its association with sociodemographic characteristics, including age, gender, education, occupation, income, marital status, and place of residence. Materials and Methods: A cross-sectional study was conducted among 450 diabetes mellitus patients attending the diabetic clinic of selected hospitals in Kolkata, West Bengal. The study was carried out during the specified study period. Sociodemographic characteristics and health-related quality of life were assessed using validated questionnaires. Data were collected, analyzed, and statistically evaluated to determine associated factors. Result: Among 450 diabetic patients, QOLID was not significantly associated with age, sex, residence, religion, marital status, education, family size, lifestyle factors, diabetes type, treatment modality, family history, or diabetes information. Significant associations were observed with family income (p=0.045) and comorbid illnesses (p=0.044). Most participants were middle-aged, with slight male predominance. Conclusion: Diabetes mellitus significantly affects patients’ health-related quality of life (QOLID), with sociodemographic factors influencing overall well-being. Identifying these correlates can help healthcare providers develop targeted interventions, improve diabetes management strategies, and enhance the quality of life among diabetic patients. Keywords: Diabetes mellitus; Quality of life; Sociodemographic factors; Diabetic clinic; Kolkata; Health assessment; Patient outcomes; Well-being; Cross-sectional study.

Background: Maternal and neonatal tetanus remains a significant public health challenge in resource-limited settings, despite being entirely preventable through immunization. In rural Uttar Pradesh, socio-cultural barriers and systemic healthcare gaps often hinder the optimal delivery of the Tetanus-diphtheria (Td) vaccine, leaving both mother and newborn vulnerable to life-threatening infections. This study aimed to assess the levels of knowledge regarding the Td vaccine and evaluate the actual uptake of the vaccination among pregnant women residing in rural areas of Uttar Pradesh. Materials and Methods: A community-based cross-sectional study was conducted involving 100 pregnant women selected via multistage cluster sampling. Data were collected using a pre-tested, structured interview schedule. Knowledge was quantified based on awareness of timing, dosage, and benefits, while uptake was verified through maternal immunization cards or self-reports. Statistical analysis was performed using Chi-square tests to identify correlations between demographic factors and vaccine adherence. Results: The findings revealed that while 72% of participants had heard of the "tetanus injection," only 38% possessed comprehensive knowledge regarding the recommended two-dose schedule. The uptake rate for at least one dose of the Td vaccine was 82%, but the completion rate for the full course dropped to 56%. Major barriers to uptake included a lack of awareness about the second dose, distance to health centers, and misconceptions regarding vaccine safety during pregnancy. Significant associations were found between higher education levels and improved vaccine compliance. Conclusion: There is a notable "knowledge-practice gap" among pregnant women in rural Uttar Pradesh. While initial contact with healthcare providers ensures high first-dose coverage, retention for the second dose is poor. Strengthening frontline health worker counseling and localized awareness campaigns is essential to ensure "two lives" are fully protected. Keywords: Td Vaccine, Maternal Health, Uttar Pradesh, Antenatal Care, Immunization Uptake, Tetanus.

Introduction: Scrub typhus is a common cause of acute undifferentiated fever and poses a significant public health concern in Asian countries. Due to overlapping symptoms, diagnosing the disease is often difficult. So many of the patients were found to end up with complications, which further increases the morbidity and the mortality of the patient. Serum ferritin is one of the common markers used to determine the body's iron stores. Recent studies have shown its use in diagnosing pathologies, such as inflammation, infection, and malignancy. The aim is to assess the efficacy of the serum ferritin level in evaluating the outcome of the patient with scrub typhus. Materials and Methods: This prospective observational study was conducted at the Department of Paediatrics, Sri Laksmi Narayana Institute of Medical Sciences, Puducherry, India. All patients aged 2 months to 12 years with a laboratory-confirmed diagnosis of scrub typhus were included in the study. After the initial assessment, all patients underwent a complete biochemical evaluation, including serum ferritin levels. The patient's outcomes had been assessed and compared with the serum ferritin level. Results: A total of 144 patients participated in the study; the majority (40.3%) were aged 6-10 years. And the fever had been noted in all the patients. 10.5% of patients had severe elevation of serum ferritin, and 21.5% had normal levels. The non-survivors were found to be significantly higher in patients with an age between 2 months and one year (p <0.001), low socio-economic status patients (p <0.001), TLC (p <0.001), platelet count (p = 0.023) and the serum ferritin level (p<0.001). Conclusion: The study recommends that clinicians measure serum ferritin levels in addition to other biochemical investigations at the time of admission to predict disease severity earlier and prevent the development of complications. Keywords: ferritin; survivors; scrub typhus; fever.

Background: Cervical cancer continues to impose a heavy disease burden on Indian women, particularly those in the reproductive age group who lack access to routine screening services. Government hospitals serving mixed urban and peri-urban populations — such as SAVBGMC, Faridabad — receive a large volume of antenatal cases, many of whom visit a gynecologist for the first time during pregnancy. This offered us a practical opportunity to evaluate the cytological status of the cervix as part of existing antenatal care. The present study was designed to assess the frequency and spectrum of cervical abnormalities detected on conventional Pap smear among second-trimester antenatal women registered at our institution. Materials and Methods: Over a 12-month period from May 2025 to May 2026, we enrolled 220 consenting antenatal women aged 18–40 years, all presenting in the second trimester (13–28 weeks), through the antenatal outpatient services of SAVBGMC, Faridabad. Smears were collected by the Obstetrics team and processed and interpreted in the Department of Pathology using conventional Papanicolaou staining. All slides were reported according to the Bethesda 2014 system. Cytological findings were then correlated with demographic and obstetric parameters including age, parity, and socioeconomic class. Results: Participants had a mean age of 25.4 ± 4.6 years. Of 220 smears, 168 (76.4%) were reported as NILM and 26 (11.8%) showed inflammatory changes. A total of 26 women (11.8%) had epithelial cell abnormalities: ASC-US was identified in 10 cases (4.5%), ASC-H in 3 (1.4%), LSIL in 7 (3.2%), HSIL in 4 (1.8%), AGC in 1 (0.5%), and SCC in 1 (0.5%). On statistical analysis, age above 30 years, multiparity, and belonging to a lower socioeconomic class were each significantly associated with higher-grade cytological findings (p>0.05). Conclusion: Routine Pap smear testing during second-trimester antenatal visits is feasible, acceptable, and capable of identifying significant cervical pathology in a population that would otherwise remain unscreened. Our experience at SAVBGMC demonstrates that embedding cervical cytology within existing antenatal care frameworks at government tertiary hospitals can serve as a practical and cost-effective strategy to reduce the burden of cervical cancer in Haryana. Keywords: Pap smear; cervical cancer screening; antenatal care; Bethesda system; LSIL; HSIL; tertiary care; Faridabad; Haryana.

Background: Endometrial carcinoma is a leading gynecological malignancy where precise risk stratification is critical for determining therapeutic strategies. Pretreatment inflammatory markers offer non-invasive, accessible prognostic insights. This study evaluates the predictive value of the pretreatment monocyte-to-lymphocyte ratio (MLR) and red cell distribution width (RDW) regarding tumor grade and FIGO stage in patients with endometrial carcinoma. Materials and Methods: A hospital-based cross-sectional study was conducted evaluating 100 women presenting with abnormal uterine bleeding, comprising 47 benign cases, 12 hyperplasia cases, and 41 histopathologically confirmed endometrial carcinoma cases. Pretreatment complete blood count parameters were analyzed to compute MLR and evaluate RDW across different histopathological types, tumor grades, and FIGO stages. Results: Pretreatment MLR and RDW demonstrated significant progressive increases from benign lesions to carcinoma (0.22 ± 0.08 vs. 0.31 ± 0.14, p = 0.018 for MLR; 14.9% ± 2.0% vs. 16.1% ± 2.5%, p = 0.027 for RDW). Among carcinoma cases, high-grade tumors demonstrated significantly elevated MLR compared to low-grade tumors (0.33 ± 0.16 vs. 0.25 ± 0.11, p = 0.028). Advanced FIGO stage was strongly associated with higher MLR (0.39 ± 0.14 vs. 0.24 ± 0.09, p = 0.004) and elevated RDW (17.06% ± 2.66% vs. 15.31% ± 2.18%, p = 0.017). Logistic regression confirmed MLR as a powerful independent predictor of malignancy (OR = 2.84, p = 0.011). Conclusion: Pretreatment MLR and RDW are valuable, cost-effective inflammatory biomarkers that reliably predict higher tumor grade and advanced FIGO stage in endometrial carcinoma, facilitating enhanced preoperative risk stratification. Keywords: MLR, RDW, FIGO.

Background: India is the most populous country and one of the developing countries and many people in various states are migrating towards urban areas for improvement of life style and economic status. Epidemic transition of the diseases occurred from communicable diseases to Non-communicable diseases. Non- Communicable Diseases have similar risk factors which include insufficient physical activity and fad diet which leads to obesity. These behavioural and biological risk factors, with a predisposition to the development of NCDs, are use of tobacco and alcohol, physical inactivity, overweight and obesity, increased fat and sodium intake, low fruit and vegetable intake, raised blood-pressure (BP), blood glucose and cholesterol levels. Materials and Methods: A Cross-Sectional Descriptive Study was conducted among 500 people. WHO STEPS questionnaire was used. Statistical tests like chi-square were done to know the significance of results wherever they are appropriate. Results: The mean SBP in males 129.2 ± 2.6 where as in females 129.1± 17.7. In the present study mean DBP is 80.82 ± 9.2 in males where as in females 80.8 ± 10.6. In the present study hypertensives are higher among 46-50 years age group compared to other age groups. This shows with increasing age, BP increasing and this shows statistical significance. Conclusion: Prevalence of risk factors for NCDs such as smoking and alcohol were higher among males compared to females. Prevalence of high BMI and abnormal WHR were higher among females compared to males in the present study. Keywords: Non-communicable diseases, risk factors, obesity, BMI etc.

Background: Aim: To predict stone clearance rates in patients who underwent Percutaneous Nephrolithotomy by using “S.T.O.N.E. Nephrolithometry Score”. Materials and Methods: This is a retrospective observational study. The study was conducted in the department of Urology at Guntur Medical College. The study was carried out with the data of people who underwent PCNL within a period of 2 years from April 2024 to March 2026. All patients who underwent percutaneous nephrolithotomy and fulfilled the below mentioned inclusion and exclusion criteria were studied. All consecutive adult patients of renal calculi who were scheduled for PCNL at Government general hospital Guntur, Urology department were included in the study. Results: A total of 100 patients of renal stones treated by PCNL in the department of Urology at Government general hospital Guntur were selected for this study. We had patients age ranging from 18-70 years with mean age of 46.38 years with SD of 12.385 years. Also, the difference in mean age was not statistically different in between stone free and residual stone group patients. In the present study, equal number of patients involving both sides with no significant difference in their distribution between stone free and residual stone group. We had almost equal number of patients involving both sides with no significant difference in their distribution between stone free and residual stone group. Flank pain was the most common complaint at presentation in our patients. While some had fever, a few patients had hematuria when they presented. All patients were put on prophylactic antibiotic and then taken up for surgery. All patients were evaluated for S.T.O.N.E. score on CT KUB plain. Each criterion is described and correlated with SFR. In our study, tract length ranged from 70 to 140 mm with a mean of 105.44 and S.D. of 19.3mm. Our study had a mean length of 106.5 mm with a SD of 20.4 mm in stone free patients and a mean length of 102.4 mm with a SD of 15.8 mm in residual stone pts. The difference was not statistically significant. Based on the S.T.O.N.E Nephrolithometry score patients were categorised into Low,[5-7] Moderate,[8-10] and High,[11-13] complexity scores. In this study, S.T.O.N.E. score ranged from 5 to 12 with a mean score of 7.6 and S.D. of 1.8. The difference in score was statistically significant for SFR. In our study, minimum hospital stay was 3 days and maximum was 8 days, with an average of 4.9 days. SD was 1.1 days. Conclusion: The present study concluded that high S.T.O.N.E nephrolithometry score is associated with low stone free rate. Hence S.T.O.N.E nephrolithometry can be used as an assessment tool for predicting the stone free rate. Keywords: S.T.O.N.E, Percutaneous, nephrolithometry, SFR, Hematuria.

Background: Chronic hepatitis B virus (HBV) infection remains a major global public health concern and is a leading cause of liver cirrhosis and hepatocellular carcinoma (HCC). Assessment of viral replication is essential for determining disease activity, prognosis, and therapeutic response. Hepatitis B e antigen (HBeAg), antibody to hepatitis B e antigen (anti-HBe), alanine aminotransferase (ALT), and quantitative HBV DNA are important markers used in the evaluation of chronic hepatitis B (CHB). The aim is to assess active viral replication in chronic hepatitis B patients by evaluating the relationship between HBeAg, anti-HBe, ALT levels, and quantitative HBV DNA levels in a tertiary care center in South India. Materials and Methods: This analytical cross-sectional study was conducted at Government Ariyalur Medical College Hospital, Tamil Nadu, India, from February 2025 to April 2025. Among 484 adults clinically suspected of chronic hepatitis B infection, 60 HBsAg-positive patients were enrolled. Serum samples were tested for HBeAg and anti-HBe using enzyme-linked immunosorbent assay (ELISA). ALT levels were measured using a fully automated biochemical analyzer, and quantitative HBV DNA estimation was performed by real-time polymerase chain reaction (RT-PCR). Statistical analysis was performed using SPSS software. Associations between categorical variables were analyzed using Chi-square and Fisher’s exact tests. A p-value <0.05 was considered statistically significant. Results: Of the 60 HBsAg-positive patients, 44 (73.3%) were males and 16 (26.7%) were females. HBeAg positivity was observed in 28 (46.7%) patients, while anti-HBe positivity was detected in 30 (50.0%) patients. HBV DNA was detectable in 96% of HBeAg-positive patients and 90% of anti-HBe-positive patients. High viral load (>20,000 IU/mL) was significantly associated with HBeAg positivity (p<0.001). Elevated ALT levels were more frequently observed among HBeAg-positive patients than among HBeAg-negative patients. Notably, a substantial proportion of anti-HBe-positive patients also demonstrated detectable HBV DNA and elevated viral loads, indicating ongoing viral replication despite seroconversion. Conclusion: HBeAg positivity showed a strong association with elevated HBV DNA levels and active viral replication. However, detectable HBV DNA in a considerable number of anti-HBe-positive patients highlights the limitations of relying solely on serological markers. Quantitative HBV DNA remains the most reliable indicator of viral replication, while HBeAg and ALT may serve as useful surrogate markers in resource-limited settings. Keywords: Chronic hepatitis B, HBeAg, Anti-HBe, HBV DNA, Alanine aminotransferase, Viral replication, South India

Background: Postgraduate medical students experience demanding academic and clinical responsibilities that increase their risk of psychological distress, burnout, and poor sleep quality. The objective is to assess psychological distress, burnout, and sleep quality among postgraduate medical students in a private medical college in Karnataka and to evaluate the relationship between these variables. Materials and Methods: This cross-sectional, questionnaire-based observational study included 138 postgraduate medical students. Data were collected using a structured questionnaire comprising a sociodemographic proforma, Depression Anxiety Stress Scale-21 (DASS-21), Oldenburg Burnout Inventory (OLBI), and Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using SPSS version 26.0. Chi-square test, Pearson's correlation, and multiple logistic regression analyses were performed, with p<0.05 considered statistically significant. Results: Depressive symptoms were observed in 50.0% of participants, anxiety in 58.0%, and stress in 54.3%. Poor sleep quality was present in 55.8%, while high overall burnout was identified in 18.1%. Burnout demonstrated significant positive correlations with depression (r=0.612), anxiety (r=0.544), and stress (r=0.683) (all p<0.001). Poor sleep quality was significantly associated with high exhaustion, disengagement, and overall burnout (p<0.001). High burnout (AOR=3.48), moderate-to-severe depression (AOR=2.96), hostel residence (AOR=2.14), third-year residency (AOR=2.06), and working more than 80 hours per week (AOR=2.42) were independent predictors of poor sleep quality. Conclusion: Psychological distress, burnout, and poor sleep quality are common and closely interrelated among postgraduate medical students. Early identification, institutional mental health support, workload regulation, and wellness interventions are essential to improve residents' well-being and professional performance. Keywords: Psychological distress; Burnout; Sleep quality; Postgraduate medical students; DASS-21.

Background: Young adults in professional academic settings often experience high stress levels and fluctuating self-efficacy. Physical activity has been shown to influence psychological well-being, but evidence from Indian medical student populations remains limited. The objective is to examine the association between physical activities levels, self-efficacy, and perceived stress among medical students at SRM Trichy Medical College. Materials and Methods: A cross-sectional study was conducted with 200 students (aged 18–25 years). Physical activity was measured using the International Physical Activity Questionnaire (IPAQ). General Self-Efficacy Scale (GSES) and Perceived Stress Scale (PSS-10) were administered. Data were analysed using descriptive statistics, Pearson’s correlation, and multiple regression. Results: Of 200 participants (mean age 20.9 ± 1.8 years; 54% female), 62% reported moderate to high physical activity. Higher physical activity was significantly correlated with greater self-efficacy (r = 0.42, p < 0.01) and lower perceived stress scores (r = -0.38, p < 0.01). In regression analyses controlling for age, gender, and academic year, physical activity significantly predicted self-efficacy (β = 0.39, p < 0.001) and inversely predicted perceived stress (β = -0.34, p < 0.001). Conclusion: Among medical students, higher physical activity levels are associated with enhanced self-efficacy and reduced stress. Promoting active lifestyles may benefit psychological well-being in medical education contexts. Keywords: Physical activity, self-efficacy, stress, young adults, medical students.

Background: Single-use plastics (SUP) account for nearly half of the 300 million tonnes of plastic produced worldwide each year and persist in the environment for decades despite being used only briefly. Andhra Pradesh alone generates an estimated 46,222 tonnes of plastic waste annually, and the Plastic Waste Management (Amendment) Rules, 2021 now ban identified SUP items of low utility and high littering potential. Data on public knowledge, attitude, practice (KAP) and perception of this legislation in rural India remain limited. The Objective is to assess the knowledge, attitude and practice of SUP, and the perception about legislation banning SUP, among residents of a rural area of Visakhapatnam district. Materials and Methods: This descriptive cross-sectional study was conducted in the field practice area of the Rural Health Training Centre of a private medical college over two months using multistage random sampling, 362 permanent residents aged ≥18 years were interviewed with a pre-tested, semi-structured questionnaire. Data were analysed in SPSS version 22 using descriptive statistics, Pearson's chi-square test and other appropriate tests, with p<0.05 considered significant. Results: The mean age of participants was 37±11.9 years, with females (55.2%) outnumbering males. Mean knowledge, attitude and practice scores were 18.0±4.0, 19.4±3.2 and 6.5±4.1 respectively. Good knowledge was seen in 90.6% and a good attitude in 97.0% of participants, but only 28.7% demonstrated good practice. Occupation was significantly associated with poor practice (p<0.01). Plastic bags/covers (60.2%) and mineral water bottles (59.9%) were the items most used regularly, mainly because they were easily available, lightweight, cheap and convenient. A majority (86.7%) supported legislative banning of SUP and were willing to adopt eco-friendly alternatives. Conclusion: Rural residents demonstrated sound knowledge and a favourable attitude toward SUP, but actual practice remained poor, reflecting a marked knowledge–practice gap. Sustained behaviour-change interventions, occupation-targeted strategies and strict enforcement of existing legislation are needed to translate awareness into safer practice. Keywords: Single-use plastics, Knowledge, Attitude and Practice, Rural population ion, Plastic ban legislation, Environmental pollution, Cross-sectional study.

Background: Keloids are benign fibroproliferative scars that develop because of abnormal wound healing and excessive collagen deposition beyond the original wound margins. They frequently cause pain, pruritus, cosmetic disfigurement, and psychological distress. Although several treatment modalities have been proposed, surgical excision alone is associated with high recurrence rates. Postoperative radiotherapy has emerged as an effective adjunctive treatment by inhibiting fibroblast proliferation and reducing collagen synthesis, thereby improving local disease control. However, differences in radiation modalities, dose schedules, and treatment timing have resulted in variations in reported outcomes. The objective is to systematically evaluate the effectiveness, safety, and clinical outcomes of postoperative radiotherapy in the management of keloids. Materials and Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. PubMed, Scopus, Embase, Web of Science, and the Cochrane Library were searched for studies published between January 2000 and December 2025. Randomized controlled trials, prospective studies, retrospective cohort studies, and comparative observational studies evaluating postoperative radiotherapy following keloid excision were included. Data regarding patient characteristics, radiation modality, dose fractionation, recurrence rates, cosmetic outcomes, complications, and follow-up were extracted and qualitatively synthesized. Results: A total of 30 studies involving 2,486 patients were included in the qualitative synthesis. Electron beam radiotherapy was the most frequently investigated modality (43.3%), followed by high-dose-rate brachytherapy (23.3%), superficial X-ray radiotherapy (20.0%), and IMRT/other conformal techniques (13.4%). The pooled recurrence rate was approximately 10.5%, with improved local control observed when radiotherapy was initiated within 24 hours after surgical excision. Hyperpigmentation (8.2%) and erythema (6.4%) were the most frequently reported adverse events, while severe late toxicity was rare. Conclusion: Postoperative radiotherapy is a safe and effective adjunct in keloid management, substantially lowering recurrence while maintaining favorable cosmetic outcomes. Standardized treatment protocols and high-quality multicenter randomized trials are required to establish optimal radiation techniques and dose schedules for routine clinical practice. Keywords: Systematic Reviews, Radiotherapy, Keloid.

Background: Hyponatremia is the most common electrolyte abnormality in patients with advanced cirrhosis and portends a poor prognosis. It is associated with disturbances in regulation of water balance leading to abnormalities in serum sodium. Various studies have established a correlation between serum sodium levels and survival in these patients. Dilutional Hyponatremia due to impaired free water clearance is the most common dysnatremia which has been reported in studies. The aim of this study was to study the serum sodium levels in patients with Cirrhosis of liver and to establish its prognostic value. Materials and Methods: This observational study was conducted in department of General Medicine of Civil Hospital, Aizawl, Mizoram, India from September 2019 to December 2020, on patients with cirrhosis of liver. Informed consent will be obtained from all patients to be enrolled for the study. In all the patient’s relevant information will be collected in a predesigned proforma. The patients are selected based on clinical examinations, biochemical tests, and ultrasound abdomen. Data were collected from 50 patients admitted in medical wards. Patients were divided into group based on serum sodium levels and the relevant parameters analyzed among the groups. Results: Among 50 patients, 25 (50%) had serum sodium levels ≥136 mEq/L, while 14(28%) had serum sodium levels between 131 and 135 mEq/L. 11(22%) patients had serum sodium level ≤130 mEq/L. No patients had serum sodium levels greater than 145 mEq/L. Serum sodium levels was associated strongly with the severity of liver disease as assessed by Child Pugh and MELD-Na score. Serum sodium ≤130 mEq/L indicated the existence of Portal Hypertension (p value- 0.036), Hepatic Encephalopathy (p value<0.0001), GI Bleeding (p value- 0.0314, hepatorenal syndrome (p value- 0.0401), SBP (p value <0.0001). Patients with serum sodium less than 130 mEq/L had increased frequency of complications than those with ≥136 mEq/L. Patient with serum sodium levels ≤130 mEq/L had increased mortality (27.27%; p value- 0.01581)) Conclusion: Hyponatremia is more common in DCLD, and low serum sodium levels are associated with increased frequency of complications such as hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, and GI bleeding. Lower serum sodium levels were associated with increased MELD CPS score and mortality indicating the inverse relationship between serum sodium levels and severity of the disease. Keywords: Hyponatremia, Hypernatremia, Decompensated Chronic Liver Disease.

Background: Benign prostatic hyperplasia is one of the most common causes of lower urinary tract symptoms in ageing men and may lead to bladder outlet obstruction, urinary retention, recurrent urinary tract infection, hematuria, bladder stone formation and renal impairment. Monopolar transurethral resection of the prostate remains an established surgical treatment for benign prostatic hyperplasia, especially in centres where cost, availability and surgical familiarity are important considerations. Although the procedure is effective, it may be associated with intraoperative and postoperative complications. Standardized grading of these complications is essential for objective reporting, comparison between studies and surgical audit. The present study was conducted to assess the complications of monopolar transurethral resection of the prostate using the Clavien–Dindo complication grading system. Materials and Methods: This hospital-based retrospective observational study included data of patients diagnosed with benign prostatic hyperplasia who underwent monopolar transurethral resection of the prostate at Government general hospital, Guntur. Preoperative demographic details, clinical presentation, comorbidities, indications for surgery, prostate volume, laboratory investigations, operative characteristics, catheterization duration, hospital stay and follow-up outcomes were recorded. Postoperative complications were assessed during follow-up and classified according to the Clavien–Dindo grading system. Grade I complications included deviations from the normal postoperative course not requiring pharmacological, surgical, endoscopic or radiological intervention. Grade II complications included those requiring pharmacological treatment, antibiotics or blood transfusion. Grade III complications included those requiring surgical, endoscopic or radiological intervention. Grade IV complications included life-threatening events requiring intensive care, while Grade V represented death. Data were analyzed using appropriate statistical methods and expressed as frequencies, percentages, mean, standard deviation and range. Results: The study included 180 patients who underwent monopolar transurethral resection of the prostate at Government general hospital, Guntur. The mean age was 64 years, and nearly half of the patients had associated comorbidities, with hypertension and diabetes mellitus being the most common. Bothersome lower urinary tract symptoms were the most common indication for surgery, followed by recurrent acute urinary retention and failed medical treatment. The mean prostate volume was 52.3 cc, mean operative duration was 62.5 minutes, and mean postoperative hospital stay was 2.2 days. Intraoperative complications occurred in 9.4% of patients, with capsular perforation being the most common event. The overall complication rate was 31.1%. According to the Clavien–Dindo classification, Grade I complications accounted for 11.1%, Grade II for 8.3%, Grade III for 10.6%, Grade IV for 0.6% and Grade V for 0.6%. Postoperative recovery was favorable in most patients, with improvement in voiding lower urinary tract symptoms in 95.0% during the first

Background: Tuberculosis is the most common infectious disease worldwide. Tuberculosis is sometimes accompanied by psychological disturbance, of which depression is the most common. This study is designed to determine frequency of depression in smear positive tuberculous patients and to bring awareness to tuberculous patients to deal depression as a separate entity like TB. The objective is to establish the frequency of depressive illness in patients with pulmonary tuberculosis having positive smear results in a tertiary care hospital of Karachi by using CES-D scale. Study duration and place of study: This study was conducted at department of Medicine, Liaquat National Hospital, Karachi from March 2025 to March 2026 Materials and Methods: A total of 215 patients with pulmonary tuberculosis having positive smear results were included in the study. Depression was evaluated using prescribed questionnaire based on Centre for Epidemiologic Studies Depression Scale (CES-D). Patients with CES-D score >15 were considered having depression. Results: The average age of the patients was 37.67±9.50 years. Frequency of depression in smear positive patients of pulmonary tuberculosis was observed in 46.05% (99/215). Conclusion: We found that patients with pulmonary tuberculosis having positive smear results had high incidence of depression. Keywords: Tuberculosis, Depression, Smear positive, CES-D scale, Anxiety.

Background: Cerebral palsy (CP) is a group of permanent neurodevelopmental disorders caused by non-progressive brain injury occurring during early brain development. It is the most common cause of physical disability in children, with a global prevalence of approximately 1.8 to 2.3 per 1,000 live births. Children with CP often experience impaired gross motor function, which increases the physical, emotional, and psychosocial burden on their parents and caregivers. Objective: To examine the association between the severity of gross motor dysfunction in children with cerebral palsy and the level of depression among their parents. Study Design: Cross-sectional study. Duration and Place of Study: This study was conducted at Liaquat University of Medical and Health Sciences Jamshoro, Hyderabad from April 2025 to April 2026. Materials and Methods: This cross-sectional study included 120 children with cerebral palsy aged 1 to 18 years and one parent of each child. Gross motor function was assessed using the Gross Motor Function Measure-88 (GMFM-88), while parental depression was evaluated using the Depression subscale of the Depression, Anxiety and Stress Scale (DASS-42). Data were analyzed using SPSS version 22. Descriptive statistics were calculated, and because the data were not normally distributed, Spearman's correlation and regression analyses were performed. Results: A total of 120 children and their parents participated in the study. The mean age of the children was 6.81 ± 3.91 years, while the mean age of the parents was 32.90 ± 7.10 years. The mean GMFM-88 score was 38.70 ± 24.90, and the mean depression score was 16.49 ± 9.30. Spearman's correlation analysis demonstrated a statistically significant negative correlation between parental depression and GMFM-88 scores (r = -0.250, p = 0.005). Regression analysis showed that each one-unit increase in parental depression score was associated with a 0.63-unit decrease in GMFM-88 score. Male parents reported lower depression scores, while their children demonstrated higher GMFM-88 scores. Conclusion: A significant inverse association was found between gross motor function in children with cerebral palsy and parental depression. Greater impairment in gross motor function was associated with higher levels of depression among parents, highlighting the importance of integrating psychological support for caregivers into the comprehensive management of children with cerebral palsy. Keywords: Cerebral palsy; Gross motor function; Gross Motor Function Measure (GMFM-88); Parental depression; Caregivers.

Background: Spinal anesthesia is the preferred anesthetic technique for elective caesarean section owing to its rapid onset, excellent sensory and motor blockade, minimal neonatal drug exposure, and reduced maternal morbidity compared with general anesthesia. Hyperbaric bupivacaine remains the most commonly used intrathecal local anesthetic; however, prolonged motor blockade, delayed ambulation, urinary retention, and delayed discharge have prompted interest in shorter-acting spinal anesthetics. Preservative-free 1% 2-chloroprocaine has re-emerged as a safe, rapidly acting local anesthetic with favorable pharmacokinetic characteristics due to rapid hydrolysis by plasma cholinesterase, resulting in predictable recovery and minimal systemic toxicity. Although chloroprocaine provides excellent surgical anesthesia for short-duration procedures, its relatively limited postoperative analgesic duration remains a concern. Intrathecal fentanyl, a highly lipophilic opioid, has been shown to enhance spinal analgesia, improve intraoperative comfort, prolong postoperative pain relief, and reduce rescue analgesic requirements without substantially prolonging motor recovery when used in low doses. However, evidence regarding the effectiveness of adding fentanyl to intrathecal 1% chloroprocaine for elective caesarean section remains limited. This study was undertaken to compare the analgesic efficacy, block characteristics, maternal hemodynamic profile, postoperative recovery, and adverse effects of intrathecal 1% 2-chloroprocaine administered alone or in combination with fentanyl during elective caesarean section. Materials and Methods: A prospective, double-blind, randomized controlled study was conducted in the Department of Anaesthesiology of a tertiary care teaching hospital over a period of 18 months. A total of 120 ASA physical status II parturients aged 18–35 years with singleton term pregnancies scheduled for elective lower segment caesarean section under spinal anesthesia were randomly allocated into two equal groups. Group C (n = 60) received intrathecal 1% 2-chloroprocaine alone, while Group CF (n = 60) received intrathecal 1% 2-chloroprocaine combined with preservative-free fentanyl. Primary outcome measures included duration of postoperative analgesia and time to first rescue analgesic. Secondary outcomes included onset and duration of sensory and motor block, intraoperative hemodynamic parameters, visual analogue scale (VAS) pain scores, neonatal outcome assessed by Apgar score, maternal satisfaction, incidence of adverse effects, and time to ambulation and voiding. Statistical analysis was performed using Student's t-test, Chi-square test, repeated measures ANOVA, and Fisher's exact test, with P <0.05 considered statistically significant. Results: Baseline demographic and obstetric characteristics were comparable between the two groups. The addition of intrathecal fentanyl significantly prolonged the duration of postoperative analgesia (284.6 ± 34.2 vs. 176.8 ± 28.5 minutes, P <0.001) and increased the time to first rescue analgesic requirement. Group CF demonstrated significantly lower postoperative VAS pain scores during the first six posto

Background: Functional voice preservation is central to the management of early stage glottic squamous cell carcinoma (SCC). Although definitive radiotherapy (RT) provides excellent oncologic control, post-treatment voice quality varies and the utility of Videolaryngostroboscopic parameters as outcome measures remain uncertain. Materials and Methods: In this prospective, observational study, patients with early-stage glottic SCC (Tis–T2, N0M0) treated with definitive RT underwent pre-treatment and 3 months post-treatment voice assessment using videolaryngostroboscopy (glottic closure; mucosal wave) and perceptual auditory evaluation using the GRBAS scale (Grade, Roughness, Breathiness, Asthenia, Strain). Results: Thirty patients completed RT and follow-up. Pre-RT, mucosal wave was absent in all patients; glottic closure was complete in 14/30 (46.7%). At 3 months post-RT, mucosal wave was present in 22/30 (73.3%) and glottic closure was complete in 28/30 (93.3%). GRBAS ratings improved significantly across parameters (overall Grade, Roughness, Breathiness, Asthenia, Strain; all p<0.01). Concordance between overall improvement defined by stroboscopy and GRBAS was not statistically significant (p=0.145). Conclusion: Definitive RT for early glottic SCC was associated with significant improvement in stroboscopic vibratory features and perceptual voice quality at 3 months. Videolaryngostroboscopy and GRBAS scoring provide complementary information and are feasible for routine functional outcome assessment. Keywords: Early glottic carcinoma; radiotherapy; voice outcome; Videolaryngostroboscopy; GRBAS.

Background: Subclavian vein cannulation is a widely performed procedure for obtaining central venous access in critically ill and perioperative patients. Both supraclavicular and infraclavicular approaches are commonly used; however, the optimal technique remains controversial. The present study compared the efficacy and safety of these two landmark-guided approaches. Materials and Methods: This prospective randomized controlled trial was conducted in a tertiary care center and included 50 adult patients requiring subclavian vein catheterization. Patients were randomly allocated into two groups: Group S (supraclavicular approach, n = 25) and Group I (infraclavicular approach, n = 25). The primary outcome was the time from skin puncture to successful guidewire insertion. Secondary outcomes included overall success rate, first-attempt success, number of attempts, and procedure-related complications. Results: Baseline demographic characteristics and indications for catheterization were comparable between the groups (p > 0.05). Successful cannulation was achieved in all patients (100%) in both groups. The mean procedural time was significantly shorter in Group S than in Group I (20 ± 18 seconds vs. 133 ± 35 seconds; p < 0.001). First-attempt success was achieved in 23 (92%) patients in Group S and 20 (80%) patients in Group I (p = 0.21). Transient arrhythmias occurred in two patients (8%) in Group S and three patients (12%) in Group I. Two patients (8%) in Group I experienced arterial puncture, and one patient (4%) had catheter malposition into the internal jugular vein. No pneumothorax was observed in either group. Conclusion: The supraclavicular approach was associated with significantly shorter procedural time and a higher first-attempt success rate while maintaining an equivalent overall success rate. It also demonstrated fewer mechanical complications, suggesting that it is a safe and effective alternative to the infraclavicular approach for landmark-guided subclavian vein cannulation. Keywords: Central line, subclavian vein, cannulation, critical care.

Background: Hepatitis B virus (HBV) infection remains a major global public health challenge despite the availability of a safe and effective vaccine. Chronic HBV infection is a leading cause of chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. Although India is considered a country of intermediate HBV endemicity, considerable geographical variation exists and published epidemiological data from Uttarakhand remain limited. highlighting the need for region-specific hospital-based surveillance to guide prevention and control strategies. This study aimed to determine the hospital-based seroprevalence of hepatitis B surface antigen (HBsAg) among patients attending a tertiary care teaching hospital in Uttarakhand, North India. Materials and Methods: A prospective observational study was conducted in the Department of Microbiology, Government Doon Medical College, Dehradun, Uttarakhand, from December 2023 to May 2024. A total of 17,131 patients of all age groups and both sexes who underwent HBsAg testing as part of routine clinical evaluation were included. Serum samples were tested for HBsAg using chemiluminescent microparticle immunoassay (CMIA). Initially reactive samples were retested in duplicate before being reported as positive. Data were analyzed using descriptive statistics, and HBsAg seroprevalence was expressed as frequencies and percentages. Results: Among the 17,131 patients screened, 127 tested positive for HBsAg, yielding an overall seroprevalence of 0.74%. Of the seropositive patients, 70 (55.1%) were males and 57 (44.9%) were females. The highest proportion of HBsAg-positive cases was observed in the 21–30 year age group in both sexes. Conclusion: The present study demonstrated a relatively low hospital-based seroprevalence of HBsAg among patients attending a tertiary care teaching hospital in Uttarakhand. Nevertheless, HBV infection continues to represent an important public health concern, particularly among young adults. These findings provide valuable baseline epidemiological data from Uttarakhand and support continued strengthening of hepatitis B vaccination, targeted screening of at-risk populations, infection prevention measures, and regional epidemiological surveillance to support progress towards the World Health Organization goal of eliminating viral hepatitis as a public health threat by 2030. Keywords: Chemiluminescent immunoassay; CLIA; HBsAg; Hepatitis B virus; Seroprevalence; Uttarakhand.

Background: Epidural anesthesia provides effective surgical anesthesia and can meet the extended duration of surgical needs and provides prolonged post operative analgesia. Bupivacaine is a long acting amide local anesthetic which is commonly used, produces better intensity of motor blockade and longer duration of action compared to other local anesthetics. Dexmedetomidine is a highly selective α 2 adrenergic agonist with an affinity of eight times greater than clonidine and it prolongs the duration of analgesia, motor blockade and post operative analgesia making it a very useful adjuvant. Aim: Hence we compared 0.5% bupivacaine with dexmedetomidine and 0.5% bupivacaine alone. The aim of this study is to evaluate and compare the clinical effects of Dexmedetomidine as an adjuvant to epidural bupivacaine 0.5% for patients undergoing total abdominal hysterectomy. Materials and Methods: Sixty patients, scheduled for total abdominal hysterectomy belonging to ASA class I and II were included in the study. They were randomly divided into two groups with 30 patients in each group. 1. Group C - 20ml of 0.5% bupivacaine , 2.Group D - 20ml of 0.5% bupivacaine with1μg/kg of dexmedetomidine. (not exceeding 50 μg) Epidural anaesthesia was given at L3-L4 level in right lateral decubitus position using 18G tuohy’s needle and catheter inserted 4 cms. The onset time and the maximum level of sensory and motor block, haemodynamic parameters, sedation, sensory and motor regression and post operative analgesia were recorded. Results: Dexmedetomidine group had rapid onset of sensory block (p<0.05), prolonged duration of sensory and motor block (p<0.05), better sedation score and postoperative analgesia (p<0.05), better haemodynamic stability and lesser occurrence of side effects (shivering, nausea and vomiting). Conclusion: There is clear synergism between dexmedetomidine and bupivacaine compared with plain bupivacaine in epidural anesthesia in terms of sensory and motor blockade, post operative analgesia, with hemodynamic stability with lesser side effects. Keywords: Bupivacaine, Dexmedetomidine, Epidural.

Background: Endometriosis is a common gynecological disorder that frequently presents with chronic pelvic pain, dysmenorrhea, infertility, and adnexal masses. Its clinical manifestations often overlap with other pelvic pathologies, making accurate preoperative diagnosis essential for appropriate management. Objectives: This study evaluated the role of magnetic resonance imaging (MRI) in the assessment of women with suspected endometriosis and other pelvic pathologies. Materials and Methods: A hospital-based cross-sectional observational study was conducted at Surabhi Institute of Medical Sciences, Mittapally, Telangana, from January to December 2025. A total of 43 women with clinical suspicion of endometriosis underwent gynecological evaluation, ultrasonography, and pelvic MRI. MRI findings were correlated with operative findings, histopathology, and clinical follow-up where applicable. Data were analyzed using descriptive statistics. Results: On ultrasonography, hypoechoic lesions with low-level ground glass echoes were the most common finding, observed in 13 (30.2%) patients, followed by hypoechoic lesions with internal reticular echoes in 10 (23.3%). On T2-weighted MRI, fluid–fluid level was the predominant feature, identified in 15 (34.9%) patients, while T2 shading was observed in 13 (30.2%). The most frequent final diagnosis was hemorrhagic cyst (13, 30.2%), followed by endometriosis (7, 16.3%) and teratoma (7, 16.3%). Tubo-ovarian abscess and focal adenomyosis accounted for 9.3% each, whereas hematosalpinx and endometrioid carcinoma were diagnosed in 7.0% each. Malignant transformation of endometriosis was identified in 4.7% of patients. Conclusions: MRI is a valuable adjunct to ultrasonography in the evaluation of women with suspected endometriosis. Its superior soft tissue characterization facilitates differentiation of endometriosis from other pelvic pathologies, supports appropriate treatment planning, and contributes to improved gynecological management. Keywords: Endometriosis; Magnetic resonance imaging; Pelvic pain; Adnexal masses; Differential diagnosis.

Background: FNAC is the common method adopted for the diagnosis of breast lesions. The IAC Yokohama System was introduced to standardize reporting of breast cytology and provide category-specific risk of malignancy (ROM) for clinical management. Purpose: To assess the utility of the IAC Yokohama System of reporting breast cytopathology, calculate the ROM for each category and to evaluate the diagnostic accuracy of FNAC with histopathology as the gold standard. Materials and Methods: The present hospital-based observational study was conducted on 89 patients presenting with palpable breast lesions and undergoing FNAC. Cytological smears were categorized as per the IAC Yokohama System. Histopathological correlation was available in 37 cases. For each category, ROM was computed and diagnostic performance parameters were calculated. Results: The most affected age group was the 41–50-year (25.8%). Major cytological category was Category II (Benign) which accounted for 52.8% of cases followed by Category V (Malignant) which accounted for 30.3% of cases. The most common benign and malignant lesion was fibroadenoma and ductal carcinoma, respectively. Histopathological correlation showed invasive ductal carcinoma (NST) as the most common diagnosis (59.4%). ROM was 75% in category I, 11.1% in category II, 0% in category III, and 100% in categories IV and V. The sensitivity of the IAC Yokohama System was 100%, specificity 100%, positive predictive value 100%, negative predictive value 90.9% and diagnostic accuracy 92.5%. Conclusion: IAC Yokohama System found to be an appropriate system for breast cytopathology that can help in the accurate stratification of ROM. This will help in the accurate diagnosis of patients with breast cancer. Keywords: Breast lesions; FNAC; IAC Yokohama System; Risk of malignancy; Breast cytopathology.

Background: Metabolic syndrome (MetS) is associated with systemic metabolic and vascular abnormalities that may adversely affect respiratory function. However, evidence regarding pulmonary function abnormalities across different levels of MetS severity remains limited, particularly among Indian adults. This study evaluated pulmonary function abnormalities in adults with MetS and examined their association with metabolic syndrome severity. Materials and Methods: This cross-sectional study included 380 adults aged 30–65 years with MetS diagnosed according to the modified National Cholesterol Education Program Adult Treatment Panel III criteria. Clinical, anthropometric, and biochemical parameters were assessed. Pulmonary function was evaluated by computerized spirometry, including forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), FEV₁/FVC ratio, peak expiratory flow rate (PEFR), and forced expiratory flow between 25% and 75% of FVC (FEF25–75%). Participants were categorized according to the presence of three, four, or five MetS components. Appropriate correlation and group comparison tests were applied. Results: The mean predicted FVC and FEV₁ were 79.33 ± 13.16% and 81.74 ± 15.36%, respectively, with a preserved FEV₁/FVC ratio. A spirometric restrictive pattern was observed in 39.2% of participants and was the most frequent pulmonary abnormality. Waist circumference showed significant inverse correlations with FVC and FEV₁, while systolic and diastolic blood pressure were inversely correlated with FVC and PEFR. HDL-C showed significant positive correlations with FVC, FEV₁, PEFR, and FEF25–75%. With an increasing number of MetS components, all assessed pulmonary function parameters showed a downward trend; however, statistically significant differences were observed only for PEFR (p=0.036) and FEF25–75% (p=0.031). Conclusion: Pulmonary function impairment in adults with MetS was predominantly characterized by a spirometric restrictive pattern. Central obesity showed the strongest association with reduced lung function, while greater clustering of MetS components was associated with significant deterioration in selected expiratory flow parameters. Keywords: Metabolic syndrome, pulmonary function, spirometry, restrictive pattern, central obesity, metabolic syndrome severity.