Background: Wormian bones or sutural bones, are small, irregularly shaped bones most commonly found in the lambdoid suture of skull, but they may also appear in other cranial sutures. These bones develop due to multiple ossification centers within the sutures of skull during development. The knowledge of Wormian bones plays a major role for the neurosurgeons, neuro-anatomists, radiologists, forensic experts and anthropologists. Presence of few wormian bones is normal. But multiple Wormian bones need attention as it may have underlying skeletal or central nervous system pathology. Objective: To determine morphologic and morphometric characteristics of wormian bones in Southern Odisha population. Materials and Methods: The study was conducted on 53 dry human skulls of unknown gender and age in the Department of Anatomy, MKCG MCH, Berhampur, Odisha. The deformed skulls and skulls of paediatric age group were excluded. The location, shape, number and side of wormian bones were determined. Results: In the present study; wormian bones were observed in 38 (71.7%) skulls out of 53 skulls, and the total number of the observed wormian bones were 129. More than five wormian bones were found in 8 skulls (28%), four in two skulls (5.2%), three in 9 skulls (23.6%), two in 10 skulls (26.3%) and one in nine skulls (23.6%). The wormian bones were seen uniformly distributed both on right and left sides, at a rate of 44.2 %. Maximum number of bones were seen at lambdoid suture (n=78, 60.4 %); followed by lambda 11.6%, pterion 10.8 %, asterion 8.5%, parieto-mastoid suture 6.2 %, squamous suture 2.3% and occipito-mastoid suture 2.3%. The mean values of wormian bones were15.27 ± 5.99 mm vertical diameter and 18.13 ± 7.9 mm horizontal diameter. The mean cranial breadth and cranial length were found as 134.53 ± 6.38 mm and 164.81 ± 7.12 mm respectively. In terms of cephalic index values, 11.3 % were dolicocephalic, 28.3 % mesocephalic, 39.6% brachycephalic and 20.7 % were hyperbrachycephalic skulls. The most common types of skulls in the wormian bone presence group were brachycephalic. Conclusion: Greater cephalic index, higher incidence of wormian bones, large size wormian bones in our study may indicate the influence of genetic and environmental factors over development of skull bones in Southern Odisha population. Keywords: wormian bone, suture, interparietal bone, pterion, asterion, lamba

Background: Being short of health care provisions and preventive measures is a major reason for outbreaks of communicable diseases and delay in controlling its spread. An outbreak of jaundice along with diarrhoea and fever in a cluster mostly among children was investigated. The objective is to identify children suffering from jaundice and to investigate for hepatitis A outbreak. To assess control measures and to analyse epidemic curve for forecasting. Materials and Methods: An epidemic case sheet was used to collect data from the community and health centre laboratory to do basic investigations. Discharge summary of those admitted was used to collect details of confirmation of hepatitis A illness. The Local Primary Health Centre was called in for control activities. Non- Government Organization and their trained work force engaged in health education and surveillance activities. Results: A slum in Bengaluru had an outbreak of Hepatitis A, where 92% of the households had no drainage. 88% was practicing indiscriminate waste disposal and 12% had no toilet facility, 32% practiced open air defaecation. 48 % followed handwashing practice. Total of 25 cases reported from 3 to 16 years. Conclusion: The study revealed sanitation and hygiene deficits. Control measures implemented with community involvement and forecasting tools can significantly improve outbreak response when combined with intersectoral coordination. Keywords: Hepatitis A, Outbreak, Migrants, Slum Area, Forecast.

Background: Cervical cancer remains a leading cause of morbidity and mortality among women in low- and middle-income countries, primarily due to persistent infection with high-risk human papillomavirus (HPV) and limited access to organized screening. This study evaluated cytological abnormalities, HPV prevalence, and associated risk factors in women attending a tertiary care hospital in North India. Materials and Methods: A prospective cross-sectional study was conducted over 18 months at Government Doon Medical College and Hospital, Dehradun. The study received approval from the Institutional Ethics Committee prior to commencement. A total of 250 women aged 25–65 years underwent Pap smear examination, and 125 samples were tested for HPV DNA using PCR. Demographic, clinical, and viral co-infection data (HIV, HBV, HCV, syphilis) were collected and statistically analyzed. Results: Of the 250 Pap smears, 54% were negative for intraepithelial lesion, while 7.6% showed ASC-US, 4.4% ASC-H, and 6.4% HSIL. Among 125 women tested, 30.4% were HPV-positive, with HPV-16 as the predominant genotype. ASC-US smears showed the highest HPV positivity (42.1%). HPV infection was significantly associated with younger age (25–40 years; p=0.04), early sexual debut (p=0.003), and co-infections with HIV, HBV, HCV, and syphilis (all p<0.01). Conclusion: The study demonstrates a substantial HPV prevalence in this population, with HPV-16 as the dominant oncogenic strain. Cytology alone failed to detect several HPV infections, highlighting the need for integrated HPV DNA testing in screening programs. Comprehensive strategies combining cytology, HPV testing, vaccination, and sexual health services are essential to reduce the cervical cancer burden in India. Keywords: Cervical cancer, Human papillomavirus (HPV), Pap smear.

Background: Situation analysis of existing health care infrastructure and diagnostic facilities in any geographical area forms an important determinant of the quality of overall health status of that particular area. It helps in identifying the gaps in the health system which need redressal. At the same time it forms an important input for the policy makers for planning and designing healthcare services. Objective: To conduct the situation analysis of the health care and diagnostic facilities within selected rural and urban underprivileged populations of Kashmir valley. Materials and Methods: It was a cross-sectional study conducted in rural and urban underprivileged population. A situational analysis of the existing health care infrastructure and diagnostic facilities available in the study areas was done by a team of researchers gathering information using a predesigned questionnaire as well as making on-site observations. Results: Out of total 24 health care facilities (HCF) within a radius of 3kms of the study sites, 21 were available in the urban sites and only 3 were available in the rural study sites. 17 Health care facilities belonged to govt. sector, 5 to private and 2 to NGO’s. In rural sites all the facilities were of primary level whereas in urban sites 21.4% were of secondary level and 78.0% of primary level. Out of the total 190 doctors at the study sites 183 were available at the urban health care facilities and only 7 in rural health care facilities. A total of 38 lab facilities were available with 36 in urban and only 2 in rural sites. Almost all the tests like Hb and blood sugar, lipid profile, LFT, KFT, routine urine examination, HBSAg, Widal test, ESR and HIV testing was being done in all the labs. Except for a few, majority of tests in government facilities were paid. There was cent percent acceptance of the proposed home health guide (HHG) intervention in government and NGO’s and 60.0 % in private facilities. There was 82.0% and 35 .0% acceptance respectively for proposed interventions of Mobile lab and health dairies in government HCFs while as the same was cent percent for NGO’s. Health ID creation was supported by 60.0% of the private facilities and 23.5 % of government facilities. Conclusion: There is a gross disparity in availability of health and diagnostic facilities in the study area with a wide rural urban gap in availability of services. One way of addressing this financial and physical inaccessibility is the introduction of Labikes, which aims to revolutionize health care access in the underprivileged areas. Keywords: Healthcare, underprivileged, diagnostic facility, Health care facility.

Background: Hepatitis B virus (HBV) infection remains a global health concern, with significant variability in clinical course depending on viral replication and host immune response. Among these, precore mutant strains represent an important subgroup due to their potential association with more severe outcomes, including hepatocellular carcinoma (HCC). Objectives: To prospectively interpret the viral markers (serological markers) in patients with hepatitis B surface antigen (HBsAg) positivity and to identify cases suggestive of precore mutant HBV strains. Materials and Methods: A prospective observational study was conducted including both acute and chronic HBsAg-positive patients. Viral markers including HBeAg, anti-HBe, and additional HBV DNA polymerase chain reaction (PCR) testing were analyzed. Special attention was given to cases with negative HBeAg and anti-HBe, which were further subjected to PCR for HBV DNA. Results: Out of 100 total HBsAg-positive patients, 70 were classified as chronic carriers. Among these, the majority were either HBeAg-positive or anti-HBe-positive. However, 1–2 patients were identified as negative for both HBeAg and anti-HBe, yet HBV DNA was detectable on PCR. These findings suggest the presence of precore mutant strains. Conclusion: Precore mutant HBV strains, though uncommon, were identified in our cohort. Such patients may remain undetected by conventional serological markers but demonstrate ongoing viral replication. This subgroup is at higher risk of progressive liver disease and hepatocellular carcinoma, underlining the importance of molecular testing in addition to routine serology in HBV patients. Keywords: Hepatitis B, HBsAg, precore mutant, HBeAg, anti-HBe, HBV DNA, hepatocellular carcinoma.

Background: Aim: To evaluate the retinal changes in patients with diabetic macular edema and correlating with visual acuity. Materials and Methods: This is a hospital based cross-sectional observational case study conducted between February 2024 - August 2025 in Department of Ophthalmology, Father Colombo Institute of Medical Sciences, Medicare General Hospital, Warangal. During the above mentioned period a sample of 50 type 2 diabetic patients detected to have clinically significant macular edema were included in the study. The Eyes with clinically significant macular edema were evaluated by OCT examination. Morphological Pattern and macular thickness of DME were documented and evaluated. The data recorded was tabulated and evaluated using SPSS software and statistical techniques. Results: Ratio between patients with NPDR and PDR was 3.47:1. Among the NPDR patients, moderate and severe types were common (38.2% and 36.8% respectively). PDR was relatively less common with PDR without HRC in 1.3% and PDR with HRC in 17.1%. Four different patterns of DME were found on evaluation of the OCT scans. Cystoid Macular Edema was the most common morphology (40.8%), followed by DRT (38.2%), and SRD (17.1%). Least common morphological type was VMIA (3.9%). The mean central macular thickness in all the 76 eyes is 364.34 microns. Mean thickness varied among various groups, being highest in Serous Retinal Detachment 421.77 microns and least among diffuse retinal thickening 283.86 microns. On statistical analysis of variance of mean thickness among various groups a statistically significant difference was observed (p<0.0001). The mean Visual acuity among 76 eyes was observed to be 0.48 log MAR units. Worse visual acuity was found in SRD pattern (0.61 log MAR). Visual acuity was better in DRT pattern (0.36 log MAR) compared to other patterns.CME pattern was also associated with worse visual acuity. There was a significant linear relation between Central Macular Thickness and Visual Acuity with r=0.841 and p Value <0.0001. Conclusion: The present study concluded that OCT can perform micrometre- resolution, cross sectional imaging of retina that closely approximates its histological layers. It is a very comfortable, non invasive procedure with very short measurement time. It facilitates quantification of macular oedema, assessment of vitreomacular interface and detection of VMT that is not clinically identified. It helps to understand the anatomy of DME and the intraretinal damage and is the technique of choice for early detection of DME. Keywords: Diabetic macular edema, OCT, CME, DRT, NPDR.

Background: Post-extubation stridor (PES) is a common complication in paediatric patients after mechanical ventilation, often caused by laryngeal oedema. Timely intervention is essential to prevent respiratory distress and to avoid reintubation. This study compared the effectiveness of nebulised adrenaline and budesonide in reducing stridor symptoms. Materials and Methods: A total of 92 children with stridor were randomly assigned to receive nebulised adrenaline (Group A) or budesonide (Group B) in a paediatric ICU setting. Stridor scores and physiologic parameters were monitored at baseline and at 20, 40, and 60 min, and 2, 4, 8, and 12-hours post-treatment. Results: Baseline mean stridor scores were 6.80 ± 1.49 in Group A and 7.05 ± 1.27 in Group B (p = 0.391). Both groups showed consistent improvements over time. At 20 minutes, scores were 5.61 ± 2.24 in Group A and 5.49 ± 2.39 in Group B (p = 0.798); by 40 minutes, 5.92 ± 2.23 and 6.35 ± 2.35 (p = 0.369); and at 60 minutes, 5.82 ± 2.19 and 5.07 ± 2.38 (p = 0.121), respectively. At 2 h, Group A scored 5.00 ± 1.70 and Group B 4.60 ± 1.55 (p = 0.167). At 12 h, the scores were reduced to 2.08 ± 1.45 and 2.02 ± 1.37 (p = 0.892), with no significant differences observed between the groups in stridor scores. Physiologic parameters remained stable and comparable between the groups throughout the study period. Conclusion: Epinephrine and budesonide showed similar effectiveness in treating post-extubation stridor in paediatric patients, with no significant outcome differences. Both therapies were well tolerated, and the baseline parameters remained comparable. Broader studies with extended follow-up and reintubation analyses are needed for stronger validation. Keywords: Postextubation stridor, Adrenaline, Budesonide, Paediatric ICU, Nebulisation, Stridor.

Background: Rational prescribing is essential to ensure patient safety, minimize adverse drug reactions, and reduce healthcare costs. This study aimed to assess the prescription patterns in the Department of Obstetrics and Gynaecology, focusing on prescribing trends, drug utilization, and adherence to World Health Organization (WHO) guidelines. Materials and Methods: This is an observational cross-sectional study conducted in the Department of Obstetrics and Gynaecology of Tomo Riba Institute of Health and Medical Sciences, Naharlagun, Arunachal Pradesh, India. A total of 198 prescriptions comprising 1014 drugs were retrospectively analyzed. Data on patient demographics, disease categories, polypharmacy, and prescribing indicators were collected and compared with WHO recommended standards. Results: Among the study population, 73.74% were aged 20–39 years. Obstetric complications accounted for 40.91% of cases and Gynecological benign conditions constituted 39.39. Polypharmacy was noted in 61.11% of prescriptions. Antibiotics were the most prescribed drug class (29.49%), followed by proton pump inhibitors (20.41%). The average number of drugs per prescription was 5.12. 36.29% of drugs were prescribed by generic name, 57.58% of encounters included injections and 90.91% included antibiotics. Furthermore, 79.88% of drugs were from the National List of Essential Medicines and fixed-dose combinations accounted for 21.01% of prescriptions. Conclusion: The study highlights considerable gaps in prescribing practices within the obstetrics and gynecology department, including polypharmacy, irrational antibiotic use, low generic prescribing, and excessive injection utilization. Keywords: Prescription pattern, Obstetrics and gynecology, Polypharmacy, Rational drug use, WHO prescribing indicators.

Background: Video-laryngoscopy has revolutionized airway management by improving glottic visualization and intubation success rates. Blade designs vary between channeled and non-channeled types, with limited data comparing their effectiveness with the BPL video-laryngoscope. Aim: To compare the effectiveness of channeled versus non-channeled blades of the BPL video-laryngoscope on glottic visualization and successful oro-tracheal intubation. Materials and Methods: In this prospective randomized controlled study, 134 adult patients (Group CH = 67; Group NC = 67) undergoing elective surgeries under general anesthesia with endotracheal intubation were enrolled. Primary outcomes included time to optimal glottic view and time to successful intubation. Secondary outcomes were first attempt success rate, modified Cormack-Lehane grade, and complication rates. Results: Mean laryngeal exposure time was significantly longer in the channeled blade group (6.03 ± 0.76 s) compared to non-channeled group (3.85 ± 0.68 s; p < 0.001). Time to successful intubation was comparable between groups (16.04 ± 1.09 s vs 15.85 ± 1.05 s; p = 0.296). Both groups had 100% first attempt success with no airway trauma observed. Conclusion: Both channeled and non-channeled blades of BPL video-laryngoscope are effective and safe for oro-tracheal intubation. Non-channeled blades enable faster glottic visualization whereas overall intubation times are similar. Keywords: Video-laryngoscope. Channeled blade. Oro-tracheal intubation.

Congenital Hypertrophic Pyloric Stenosis (CHPS) is a common cause of gastric outlet obstruction in infants, classically presenting with projectile, non-bilious vomiting. Timely diagnosis and surgical management are essential for favorable outcomes. We present a case series of six male infants with CHPS managed at a tertiary care hospital in Arunachal Pradesh. Clinical presentation, laboratory findings, imaging results, surgical management, and outcomes were analyzed. All infants presented with projectile, non-bilious vomiting. Three had severe dehydration and electrolyte imbalance, while others had mild or no biochemical disturbances. A palpable pyloric mass was identified in most cases, though absent in one, where an upper GI contrast study confirmed the diagnosis after inconclusive ultrasonography. USG findings in other cases demonstrated pyloric muscle thickness between 5.6–7 mm and length 1.8–2.5 cm. All infants underwent open Ramstedt’s pyloromyotomy, with uneventful postoperative recovery and favorable follow-up outcomes. CHPS should be suspected in infants with persistent non-bilious vomiting. Early diagnosis using USG or contrast studies, correction of fluid-electrolyte imbalance, and timely pyloromyotomy result in excellent outcomes. Our case series reinforces the clinical spectrum of CHPS and the importance of prompt surgical management. Keywords: Congenital hypertrophic pyloric stenosis, projectile vomiting, infant surgery, Ramstedt’s pyloromyotomy, case series.

Background: Osteoarthritis of the knee is a prevalent degenerative joint disorder causing significant pain and disability. While corticosteroids injections provide short-term relief, platelet-rich plasma (PRP) has emerged as a promising alternative offering longer-lasting benefits. The aim is to compare the analgesic and functional outcomes of USG-guided intra-articular injections of PRP and triamcinolone in patients with grades I–II knee osteoarthritis Materials and Methods: This prospective randomized controlled study enrolled 68 patients who were allocated to receive either PRP or triamcinolone injection under ultrasound guidance. Pain relief was assessed using the Visual Analogue Scale (VAS), and functional outcomes were measured by KOOS scores at baseline, 6 weeks, 3 months, and 6 months. Analgesic requirement reduction was also recorded. Results: Both groups showed significant pain reduction at early follow-up; however, PRP demonstrated superior long-term analgesic effect and functional improvement, with reduced analgesic dependence at 3 and 6 months compared to triamcinolone. Conclusion: PRP is a safe and effective biological alternative for knee osteoarthritis, offering sustained pain relief and better functional outcomes compared to corticosteroids injections. Keywords: Knee osteoarthritis, Platelet-rich plasma, Triamcinolone, Intra-articular injection.

Background: Osteoporosis is a major global health concern, particularly affecting postmenopausal women due to estrogen deficiency. Serum estradiol and bone turnover markers (BTMs) are reliable biochemical indicators for early changes in bone metabolism. While the individual effects of menopause and obesity on bone health have been studied, limited data exist on their combined impact on BTMs. This study aimed to assess serum estradiol and BTMs among lean and obese women, stratified by premenopausal and postmenopausal status. Materials and Methods: A cross-sectional, two-arm, parallel-group study was conducted from February 2019 to September 2020 in the Department of Biochemistry, Government Medical College. A total of 100 women were enrolled and divided equally into premenopausal (Group A) and postmenopausal (Group B) groups. Each group was further subdivided into lean (BMI 18.5–22.99 kg/m²) and obese (BMI >25 kg/m²) subgroups. Serum estradiol, ionized calcium, alkaline phosphatase, phosphorus, and albumin were measured using chemiluminescent immunoassay and standard biochemical methods. Data were analyzed using appropriate statistical tests. Results: Obese women showed significantly higher estradiol levels compared to lean women in both premenopausal (380.01 ± 24.81 vs. 291.08 ± 19.3 pg/mL, p=0.03) and postmenopausal (207.14 ± 11.29 vs. 84.83 ± 6.63 pg/mL, p<0.05) groups. Bone turnover markers including alkaline phosphatase, calcium, and phosphorus were also elevated in obese subgroups. Significant inverse correlations were found between estradiol and BTMs such as ionized calcium and phosphorus, particularly in postmenopausal women. Conclusion: Menopausal status and BMI significantly influence serum estradiol and BTMs. Obese postmenopausal women exhibit heightened bone turnover, underscoring the importance of early biochemical screening for osteoporosis prevention. Keywords: Estradiol, Bone Turnover Markers, Obesity, Menopause, Osteoporosis.

Background: Obesity is a major driver of metabolic and cardiovascular disorders. Body mass index (BMI) is widely used to assess obesity, but it fails to distinguish fat from lean mass. Body fat percentage may serve as a superior biomarker of metabolic risk, particularly with respect to lipid abnormalities. Objective: To investigate the association between body fat percentage and lipid profile parameters and to compare the predictive capacity of body fat percentage and BMI for dyslipidaemia. Materials and Methods: A cross-sectional study was conducted among 80 adults aged 30-50 years. Anthropometric measurements including BMI, waist-to-hip ratio (WHR), and body fat percentage were obtained. Fasting venous blood samples were analyzed for total cholesterol, LDL-C, HDL-C, and triglycerides. Dyslipidaemia was defined according to ATP III criteria. Statistical analysis included t-tests, Pearson correlation, ROC curve analysis, and logistic regression. Results: Participants with dyslipidaemia (n = 37) had significantly higher BMI (29.1 ± 3.6 vs. 26.8 ± 3.1 kg/m², p = 0.002), WHR (0.93 ± 0.07 vs. 0.89 ± 0.06, p = 0.010), and body fat percentage (33.1 ± 6.3% vs. 28.4 ± 5.7%, p = 0.001) compared to those without (n = 43). Body fat percentage correlated positively with total cholesterol (r = 0.46, p < 0.001), LDL-C (r = 0.49, p < 0.001), and triglycerides (r = 0.43, p < 0.001), and negatively with HDL-C (r = -0.38, p < 0.001). ROC analysis showed body fat percentage had higher discriminatory power for dyslipidaemia (AUC 0.79, 95% CI 0.69-0.88) than BMI (AUC 0.68, 95% CI 0.56-0.79, p = 0.018). Logistic regression indicated both BMI and WHR were associated with lipid abnormalities, but WHR showed stronger predictive value. Conclusion: Body fat percentage is more strongly associated with dyslipidaemia than BMI and provides superior predictive capacity for lipid abnormalities. Incorporating body fat percentage into cardiovascular risk assessment may enhance early detection and preventive strategies. Keywords: Body fat percentage. Dyslipidaemia. Cardiovascular risk.

Background: Cervical cancer is a leading cause of morbidity and mortality among women in developing countries. Conventional Pap smear (CPS) has been the cornerstone of screening but is limited by unsatisfactory smears and obscured cellular morphology. Liquid-based cytology (LBC) was developed to address these limitations. This study compares the diagnostic efficacy of LBC and CPS in detecting cervical intraepithelial neoplasia (CIN), with histopathology as the gold standard. Materials and Methods: A prospective comparative study was conducted on 60 women attending the gynecology outpatient department of a tertiary-care hospital. Each participant underwent both CPS and LBC, followed by colposcopically guided biopsy for histopathological correlation. Cytology was reported using the Bethesda System 2014. Diagnostic efficacy, smear adequacy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Statistical analysis included McNemar’s test, Chi-square, and odds ratios with 95% confidence intervals. Results: LBC detected ≥LSIL in 43.3% compared to 33.3% with CPS (p=0.210). Sensitivity and specificity of LBC were 86.4% and 81.6%, respectively, versus 72.7% and 89.5% for CPS. LBC significantly outperformed CPS in smear adequacy (95.0% vs 81.7%, p=0.021), presence of transformation zone component (76.7% vs 61.7%, p=0.035), and lower unsatisfactory rate (5.0% vs 18.3%, p=0.021). Association with histopathology was highly significant for both LBC (OR=28.05, p<0.000001) and CPS (OR=22.67, p<0.00001). Conclusion: Both LBC and CPS are effective in detecting CIN; however, LBC provides superior sample adequacy, morphology, and sensitivity. While CPS remains reliable and economical, wider implementation of LBC could enhance the quality of cervical cancer screening programs. Keywords: Liquid-based cytology, Conventional Pap smear, Cervical intraepithelial neoplasia

Background: Iron deficiency is the most prevalent micronutrient deficiency in children worldwide and often precedes the onset of anemia. Latent iron deficiency (LID) refers to iron depletion where hemoglobin remains within normal limits, yet biochemical and hematological markers suggest deficiency. If undetected and untreated, LID can lead to iron deficiency anemia (IDA) and long-term neurodevelopmental consequences. This study aimed to determine the prevalence of latent iron deficiency in children with normal hemoglobin levels and to evaluate associated hematological indices and nutritional status. Materials and Methods: A prospective observational study was conducted on 100 children aged 6 months to 12 years admitted to a tertiary care hospital in Navi Mumbai. Children with normal hemoglobin but with one or more abnormal red cell indices (low MCV, MCH, MCHC, or elevated RDW) were further evaluated with serum iron testing. A serum iron level of <50 mcg/dL was considered diagnostic of LID. Results: Out of 100 children with normal hemoglobin, 66% were found to have low serum iron levels. Additionally, 41% had low MCV, 38% had low MCH/MCHC, and 28% had elevated RDW. Most children (67%) had normal anthropometric status, suggesting that LID can exist independently of undernutrition. Conclusion: A significant number of children with normal hemoglobin levels have underlying latent iron deficiency. Reliance on hemoglobin alone may delay diagnosis and treatment. Incorporating red cell indices and serum iron analysis into routine screening could enable early intervention and prevent progression to anemia and associated developmental issues. Keywords: Latent iron deficiency, serum iron, pediatric anemia, red cell indices, MCV, MCH, RDW.

Background: Hip fragility fractures are a major cause of morbidity and mortality among the elderly, primarily resulting from osteoporosis and minor trauma. Vitamin D plays a crucial role in bone health and its deficiency has been implicated in osteoporosis & fracture severity. This study aimed to assess serum vitamin D levels and their association with osteoporosis & fracture site comminution in elderly patients with hip fractures. Materials and Methods: This prospective study was conducted at a tertiary care centre on 100 patients aged >60 years with hip fractures due to trivial trauma. Serum vitamin D levels were measured using an enzyme-linked fluorescent immunoassay (ELFA). Osteoporosis was classified using Singh’s Index, and fracture site comminution was assessed by plain radiograph. Results: Vitamin D deficiency (<20 ng/mL) was observed in 54% of patients, while 27% had insufficient levels (20–30 ng/mL). A significant association was found between vitamin D levels and Singh’s Index (p = 0.002), as well as between vitamin D deficiency and fracture site comminution (p ≤ 0.001). Conclusion: Serum vitamin D deficiency was significantly associated with osteoporosis severity and fracture site comminution in elderly hip fracture patients. Singh’s Index remains a useful tool for osteoporosis assessment in resource-limited settings. Early detection of osteoporosis and vitamin D deficiency is essential for timely intervention and fracture prevention. Keywords: Hip fractures, osteoporosis, vitamin D deficiency, Singh’s Index, fracture comminution, elderly patients.

Background: Lateral epicondylitis is characterized by chronic degeneration of the common extensor tendon attachment to the lateral epicondyle of the humerus. It is a prevalent overuse injury, frequently seen in primary care, affecting between 1% to 3% of the general population. This can result in a significant social and economic burden, as it often leads to lost workdays and may incapacitate some patients for several weeks. This study presents our experience in evaluating the clinical & functional outcomes following local administration of autologous platelet-rich plasma (PRP) injection supplemented with adjuvant dry needling for the management of chronic or recurrent idiopathic tennis elbow. Materials and Methods: The study was carried out over a period of 18 months at Maharaja Agrasen Medical College, Agroha, in 35 patients of age 18 years and above with lateral epicondylitis for more than 3 months and already managed with brace, analgesics, various physiotherapy modalities & with or without local injections. The patients were injected with a single dose of PRP with adjuvant dry needling. Assessment of the clinical and functional outcomes was done by the PRTEE (Patient-Rated Tennis Elbow Evaluation) score at the end of 4th week,12th week and 24th week. Results: Most participants were male, with mean age of 42.6±4.8 years. Most patients presented with involvement of the right side with average pain duration of 12.2 months. The assessment was done using the PRTEE score. Pain score decreased from mean of 40.6 to 5.4 (p-value <0.001) and functional score decreased from mean of 40.2 to 4.1 (p-value <0.001) over a 24-week follow-up period. There were no post procedure complications. Conclusion: This study underscores the considerable therapeutic potential of combining autologous platelet-rich plasma (PRP) injection with adjuvant dry needling in the management of chronic or recurrent idiopathic lateral epicondylitis of humerus. Significant improvements in clinical and functional outcomes were demonstrated by reduction in PRTEE score with no significant post procedure complications. Keywords: Chronic lateral epicondylitis, PRP (Platelet rich plasma), Dry Needling, PRTEE (Patient-Rated Tennis Elbow Evaluation) score, MTrPs (Myofascial trigger points).

Background: Trace elements such as copper and zinc play vital roles in oxidative balance and glucose metabolism. Their imbalance, particularly the copper/zinc ratio, may contribute to early glycemic dysregulation in type 2 diabetes mellitus (T2DM). This study evaluated the correlation between serum copper, zinc, and copper/zinc ratio with glycemic indices in newly diagnosed T2DM patients. Materials and Methods: A cross-sectional study was conducted from May 18th to August 14th at the Department of General Medicine, NRI Medical College & General Hospital, Chinakakani, Guntur. Eighty treatment-naïve patients aged 30–65 years with newly diagnosed T2DM were enrolled. Fasting blood glucose (FBG), postprandial glucose (PPG), HbA1c, and serum copper and zinc levels were measured. Copper/zinc ratios were calculated. Correlation analysis and quartile-based comparisons were performed using Pearson's r and ANOVA. Results: Mean serum copper and zinc levels were 112.5 ± 18.4 µg/dL and 72.3 ± 11.7 µg/dL, respectively. Copper/zinc ratio averaged 1.56 ± 0.24. Serum copper positively correlated with HbA1c (r = 0.43, p = 0.001), FBG (r = 0.36), and PPG (r = 0.31). Zinc showed negative correlations with HbA1c (r = -0.38, p = 0.007), FBG (r = -0.29), and PPG (r = -0.25). The copper/zinc ratio had the strongest correlation with HbA1c (r = 0.47, p < 0.001). Quartile analysis showed a progressive increase in glycemic indices across rising copper/zinc quartiles (p < 0.001). Conclusion: Copper/zinc imbalance is significantly associated with poor glycemic control in early-stage T2DM. The copper/zinc ratio may serve as a sensitive biomarker for metabolic dysfunction in newly diagnosed diabetic patients. Keywords: Copper, Zinc, Copper/Zinc Ratio, Type 2 Diabetes Mellitus, Glycemic Control, HbA1c.

Background: Recurrent respiratory infections (RRIs) are among the most frequent health problems in children and represent a major cause of morbidity, school absenteeism, and healthcare utilization. While most acute respiratory infections are self-limiting, a subset of children experience repeated episodes, raising concerns about underlying risk factors. Identifying these factors is crucial for guiding preventive strategies, timely interventions, and reducing the overall burden on families and healthcare systems. Aim: This study aimed to identify and analyze the risk factors associated with recurrent respiratory infections in children, with emphasis on demographic, environmental, nutritional, and clinical determinants. Materials and Methods: A case-control study was conducted involving children aged 1–12 years attending the pediatric outpatient department of a tertiary care hospital. Cases included children with a history of recurrent respiratory infections, defined as ≥6 episodes of upper respiratory tract infection per year or ≥2 episodes of pneumonia in 12 months. Controls were age- and sex-matched children without such history. Data were collected using structured questionnaires and medical records, focusing on sociodemographic characteristics, nutritional status, exposure to environmental risk factors (such as passive smoking, indoor air pollution, and overcrowding), birth history, breastfeeding practices, vaccination status, and presence of comorbidities. Statistical analysis was performed to identify significant associations between risk factors and recurrent infections. Results: The study found that recurrent respiratory infections were significantly associated with multiple risk factors. Malnutrition, lack of exclusive breastfeeding in the first six months of life, incomplete immunization, and micronutrient deficiencies (especially vitamin A and iron) were important contributors. Environmental factors such as household overcrowding, exposure to tobacco smoke, indoor cooking with biomass fuels, and poor ventilation were strongly linked to increased risk. Children with a history of prematurity, low birth weight, or underlying conditions such as allergic rhinitis and asthma were also more susceptible. Socioeconomic status and parental education were found to be indirect but significant determinants, influencing both nutrition and healthcare-seeking behavior. Conclusion: Recurrent respiratory infections in children are influenced by a complex interplay of biological, nutritional, environmental, and socioeconomic factors. Targeted interventions including nutritional supplementation, promotion of exclusive breastfeeding, complete immunization, reduction of indoor pollutants, and parental education can substantially reduce the incidence of recurrent infections. Early recognition of high-risk children and implementation of preventive measures at the community level are essential for reducing morbidity and improving child health outcomes. Keywords: Recurrent respiratory infections, Children, Case-control study, Risk factors, Malnutrition, Passive smoking, Indoor air pollution, Breastfeeding, Immunization, Socioeconomic determinants.

Background: Tibial plateau fractures are challenging intra-articular injuries that may result in long-term functional impairment if not optimally treated. While conservative management is sometimes advocated, surgical fixation using locking plates aims to restore articular congruity, provide stable fixation, and allow early mobilization. This study assessed the evaluational and functional outcomes of tibial plateau fractures managed with locking compression plates. Materials and Methods: This observational study included 30 adult patients aged 18–65 years with closed tibial plateau fractures classified according to Schatzker’s system. Open fractures and medically unfit patients were excluded. All patients underwent open reduction and internal fixation (ORIF) or minimally invasive percutaneous plate osteosynthesis (MIPPO) with locking compression plates. Postoperative rehabilitation included early knee mobilization. Patients were followed for 12–60 weeks, with outcomes assessed by fracture union, range of motion, complications, and functional grading. Results: ORIF was performed in 67% and MIPPO in 33% of cases. Mean union time was 14.6 weeks, with union duration significantly associated with fracture type (p<0.05). At final follow-up, outcomes were excellent in 63%, good in 33%, and poor in 3%. Functional range of motion >120° was achieved in 63%. Complications occurred in 16.7%, including valgus malalignment, instability, and knee stiffness. Conclusion: Locking compression plate fixation of tibial plateau fractures ensures stable osteosynthesis, early mobilization, and favorable functional outcomes, with minimal complications when performed using proper surgical technique. Keywords: Tibial plateau fracture, locking compression plate, functional outcome, internal fixation

Background: Inflammatory bowel disease (IBD) in children often leads to significant growth failure due to chronic inflammation, malnutrition, and treatment-related factors. Growth impairment is particularly concerning in Crohn’s disease (CD), but can also be seen in ulcerative colitis (UC). Objective: To assess the impact of IBD on growth parameters in children and adolescents and determine associations with disease severity and clinical profile. Materials and Methods: This descriptive observational study was conducted at a tertiary care centre. Children aged 1 month to 18 years with confirmed IBD were enrolled. Clinical, epidemiological, and anthropometric details were collected. Growth parameters were measured using WHO/IAP charts. Disease activity indices, laboratory parameters, and treatment details were recorded. Associations between growth impairment and clinical features were analysed. Results: Among 42 children with IBD, 88.1% had CD and 11.9% had UC. Growth impairment was significant: 35.7% of children had both stunting and low BMI (<3rd centile). Only 9.5% had normal height, and 14.3% adequate BMI. Loose stools were correlated significantly with stunting (p=0.04) and low BMI (p=0.007). Early-onset and very-early-onset IBD had a higher prevalence of growth failure compared to adolescents. Nearly all patients had anaemia (100%) and weight loss (97.6%). Biologics (mostly infliximab) were used in 52% of CD patients, especially those with severe disease and marked growth failure. Conclusion: Growth impairment is common in paediatric IBD in India, particularly in CD and in those with early disease onset. Frequent diarrhoea and severe disease activity were significantly associated with growth failure. Early recognition and aggressive management, including using biologicals when indicated, are essential to improve growth outcomes. Keywords: Paediatric IBD, Crohn’s disease, ulcerative colitis, growth failure, Anthropometry.

Background: Chronic Rhinosinusitis (CRS) is a common condition, and anatomical variations of the osteomeatal unit (OMU) are considered important predisposing factors. Identifying these variants is essential for diagnosis and surgical planning. The objective is to determine the prevalence of anatomical variations in the osteomeatal unit among patients with CRS without nasal polyposis and to assess their association with specific sinus involvement Materials and Methods: This cross-sectional observational study was conducted on 110 patients with clinically and radiologically diagnosed CRS without nasal polyposis. All patients underwent diagnostic nasal endoscopy and high-resolution computed tomography (HRCT) of the paranasal sinuses. Anatomical variations including deviated nasal septum (DNS), concha bullosa, agger nasi cells, paradoxical middle turbinate, Haller cells, and uncinate process variations were evaluated. Results: The most common variation was DNS (82.7%), followed by concha bullosa (35.5%), paradoxical middle turbinate (31.8%), and uncinate process hypertrophy (30%). Agger nasi cells (12.7%), Haller cells (8.2%), and pneumatized uncinate (3.6%) were less frequent. DNS showed a significant association with maxillary sinusitis (p = 0.042), while agger nasi cells were more frequently associated with frontal sinusitis (42.9%), though not statistically significant. Conclusion: Anatomical variations of the osteomeatal unit are highly prevalent in CRS patients without nasal polyposis, with DNS, concha bullosa being the most frequent. Recognition of these variants on preoperative CT scans is crucial for accurate diagnosis, prevention of complications, and improving surgical outcomes in functional endoscopic sinus surgery (FESS). Keywords: Chronic Rhinosinusitis, Osteomeatal unit, Anatomical variations, deviated nasal septum & Concha bullosa.

Background: Aim: To compare the period of stay, period of wound healing, time period to return to daily activities and cost factor between open fistulectomy and primary closure technique. Materials and Methods: Patients admitted in all surgical units of J.J.M Medical College and Hospital were included in the study without bias on a serial basis. This is a study comprising 50 patients (n =50) of Fistula in ano over a period of 26 months from May 2018 to July 2020. Results: Majority of parients in both groups presented with discharge and swelling in perianal region. There is significant difference between duration of stay of patients of open (11 days) and primary closure (7 days) (p value 0.0001). There is significant difference between duration of wound healing of open (27 days) and primary closure (9 days) (p value 0.0001). Patients who had undergone fistulectomy with primary closure had a mean VAS pain score of 5.2 while patients who had undergone open fistulectomy had a mean VAS pain score of 8.7 on the first post-operative day. Conclusion: The study proved that the primary closure after fistulectomy showed better results in terms of lesser pain management, short hospital stay and lesser period of wound healing as compared to the open fistulectomy. From this study it can be concluded that fistulectomy with primary closure is ideal for low level fistula in ano. Keywords: Primary closure, Open fistulectomy.

Background: Abnormal Uterine bleeding (AUB) is bleeding from the uterus that is longer than usual or occurs at an irregular time. Transvaginal Sonography (TVS) is the initial diagnostic modality in assessment of patients presenting with AUB. It is inexpensive, non- invasive way to visualize the endometrium and endometrial cavity. This study was undertaken to find out the diagnostic accuracy of TVS in diagnosing normal and abnormal endometrium in patients presenting with AUB, by comparing the ultrasound findings with histopathology, to measure endometrial thickness and pattern, to find out any intraluminal pathologies and to evaluate cut off values for endometrial thickness for identifying normal and abnormal endometrium. Materials and Methods: This prospective, comparative study is done over period of 2 years. A total of 196 women, above the age of 18 years presenting with complaints of abnormal bleeding uterine were included in the study. Any vaginal or cervical cause of bleeding, blood dyscrasias, pregnancy related causes of bleeding, patient with history of drug intake like anticoagulants and hormone replacement therapy were excluded. These women underwent clinical examination, investigations and TVS, followed by endometrial sampling/ pipelle sampling / hysteroscopy with biopsy or hysterectomy. Results: 120(61.22 %) of patients presented with HMB or menorrhagia as clinical symptom. By histopathology, 128 (65.3%) cases had normal endometrium and 68 (34.69%) had abnormal endometrium. TVS diagnosed endometrium as normal in 138 (70.4%) cases with Sensitivity, Specificity, PPV, NPV and diagnostic accuracy of 91.2%, 98.3%, and 89.7%, 84% and 87.7% respectively. TVS diagnosed endometrium as abnormal in 58 (29.6%) cases with Sensitivity, Specificity, PPV, NPV and Diagnostic Accuracy of. 79.1, 93.2%, 79.1% 93.2% and 89.7% respectively. Type A endometrium was seen in 127 (64.7%) cases and Type B in 71 (35.3%) cases. Type B was more associated with endometrial pathologies. A cut off value of 14mm of endometrial thickness on TVS has better Sensitivity, Specificity, PPV, NPV and diagnostic accuracy of TVS is 91.3%, 88.2%,86.8% , 90% and 88.7% (P value <0.001) as compared to a cut off value of 12mm on TVS with Sensitivity, Specificity, PPV, NPV and diagnostic accuracy of 84.1%, 64.5%,82.6% , 71.4 % and 71.4 % respectively. Conclusion: Transvaginal Sonography is the initial diagnostic modality in assessment of patients presenting with AUB. Transvaginal Sonography can predict normal and abnormal endometrium with overall Sensitivity, Specificity, PPV, NPV and diagnostic accuracy of 91.3%, 88.2%, and 86.8%, 90% and 88.7% respectively. Type B endometrium is more associated with endometrial abnormalities. A cut off value of 14mm gives better Sensitivity, Specificity, PPV and NPV and Diagnostic accuracy of 91.3%, 88.2%, and 86.8%, 90% and 88.7% respectively. Keywords: AUB, premenopausal, PALM COEIN, Histopathology, Transvaginal Sonography, Endometrial thickness, Endometrial Pattern, Cut off Values.

Background: Infants with low birth weight (LBW) are defined as those weighing under 2500 grams at birth, and are at higher risk of infections, feeding and growing problems, and hospitalization due to LBW during the first few days of life. These contribute to neonatal and infant morbidity in developing countries. Exclusive breastfeeding (EBF), defined operationally as infants receiving only breast milk (with no other liquids or solids) for the first six months, is endorsed and is the standard of care. Breast milk supplies complete nutrition with added anti-infective and immunological properties that may reduce the incidence of illness in LBW infants. The practice of EBF for LBW infants is frequently not done, and there are few prospective studies on exclusively breastfeeding LBW infants to prevent morbidity. Objectives: This study's purpose was to determine the impact of exclusive breastfeeding on morbidity patterns among LBW infants during the first six months of life. Specific objectives included comparing rates of diarrhoea diseases, acute respiratory infections, febrile illnesses, hospitalization status, and growth parameters between low birth weight infants who were exclusively breastfed and infants who were not exclusively breastfed. Materials and Methods: An observational study was carried out prospectively over twelve calendar months (July 2024 to June 2025) in Department of Paediatrics, Malabar Medical College Hospital and Research Centre, Ulliyeri, Kozhikode, Kerala, India. Following informed parental consent, 120 LBW infants were enrolled. Baseline maternal and infant data were collected, and infants were divided into two groups: those exclusively breastfed (the EBF group) and those mixed breastfed/formula fed (the non-EBF group). All infants were followed for the duration of six months with monthly visits until the infants reached six months of age. Information about feeding practices, morbidity episodes (diarrheal illness, respiratory infections, skin infections, and hospitalizations) and anthropometric measurements (weight and length) were collected. Results: Of the 120 infants, exclusively breastfed infants were 68 (56.7%) while non-exclusively breastfed infants were 52 (43.3%). The episodes of diarrhoea occurred significantly less in EBF infants than non-exclusive infants (p < 0.05). Acute respiratory infections were prevalent for fewer EBF infants compared to non-exclusive infants (p < 0.01). Fewer hospital admissions for infection were seen for EBF infants compared to non-exclusive infants (p < 0.05). Weight gain and linear growth trends were more favourable for EBF infants compared to the non-exclusive infants, however, the values were not statistically significant between the two groups. The cumulative morbidity burden was markedly lower for infants who were EBF compared to infants who were non-EBF. Conclusion: Exclusive breastfeeding is an important public health intervention to reduce morbidity in LBW infants during the first six months of life, especially associated with infections and hospitalizations. The findings underscore the need to continue to promote and support exclusive breastfeeding among LBW infants as an

Background: Medical interns are subjected to multifaceted stressors, including rigorous work schedules, clinical obligations, academic demands, and little time to relax. The emotional toll of patient care, a lack of work-life balance, and insufficient mentoring are additional pressures. All of these elements work together to cause mental exhaustion and burnout throughout the internship. The objective is to estimate the prevalence of stress among medical interns. To assess the coping strategies used by them. To analyse the association between stress levels and different coping strategies. To identify factors influencing stress and coping mechanisms in medical interns. Materials and Methods: A cross-sectional study was done amongst 228 medical interns of Chhatrapati Sambhajinagar, Maharashtra, wherein a questionnaire was given to them to determine the prevalence of stress along with its association with coping strategies. Results: The results indicate the majority of participants rated their stress level as 3 on Likert scale with overall 60% of them reporting recurring stress, with 37% often experiencing burnout. Notably, the primary source of stress reported by participants were long working hours (54%) and academic demands (48%). The most commonly reported coping strategies for managing stress among participants were social support from friends, family, orcolleagues (55%) and taking breaks or naps (50%). Also, a subset of participants (21%) reported engaging in maladaptive coping mechanisms, specifically substance abuse, highlighting a concerning trend in stress management among medical interns. Conclusion: The presence of stress among medical interns underscores the need for targeted interventions and support systems to foster resilience, self-advocacy, and effective coping strategies, ultimately enhancing their well-being and professional fulfilment. Keywords: COPE Inventory, Stress, Coping strategies, Interns, Burnout.

Background: Shoulder arthroscopy is a minimally invasive, day-care procedure used to diagnose and treat a wide range of glenohumeral and peri-articular disorders. Among regional techniques for shoulder surgery, the interscalene brachial plexus block (ISB) is most commonly used, as it provides superior postoperative analgesia and reduces opioid requirements. Hence, the present study was conducted for comparative evaluation of efficacy of postoperative analgesia of shoulder block versus interscalene block in arthroscopic shoulder surgeries at a tertiary care hospital. Materials & Methods: This study compared the analgesic efficacy of shoulder block (Group A) and interscalene block (Group B) in 40 patients undergoing elective unilateral arthroscopic shoulder surgery under general anaesthesia. Anaesthesia was induced with fentanyl, propofol, and vecuronium, then maintained with nitrous oxide and isoflurane, with supplemental fentanyl given if haemodynamics rose more than 20% above baseline. Sensory and motor block were graded, VAS scores recorded for 24 hours, and data analysed using SPSS with chi-square and t-tests. Results: In this study, patients were randomized to receive either shoulder block (SHB) or interscalene block (ISB), with both groups comparable in baseline demographics and surgical profiles. ISB was associated with a shorter block procedure, longer analgesic duration, and significantly lower VAS scores at 2 and 4 hours, while SHB showed similar outcomes at later intervals. Overall, ISB provided superior early postoperative analgesia, whereas SHB remained effective in the later postoperative period. Conclusion: Interscalene block demonstrated advantages over shoulder block by offering shorter procedure time, prolonged analgesia, and better early postoperative pain control. Both groups were comparable in demographics and safety outcomes, with no significant difference in complications. Thus, while ISB proved superior for early analgesia, SHB remained a safe and effective alternative with comparable late postoperative results. Key words: Shoulder Block, Interscalene Block, Arthroscopic Surgeries.

Background: Traumatic brain injury (TBI) is a major cause of long-term disability worldwide. In addition to cognitive and motor deficits, moderate to severe TBI can disrupt the hypothalamic-pituitary axis, resulting in pituitary dysfunction that often goes undetected. These hormonal deficiencies can significantly impair rehabilitation, mood, and quality of life. This study aims to assess the prevalence and extent of pituitary dysfunction in patients recovering from moderate and severe TBI. Materials and Methods: A retrospective observational study was conducted at Chandramma Dayanand Sagar Institute of Medical Education and Research, reviewing records of 100 patients (age 18–65 years) who sustained moderate (GCS 9–12) or severe (GCS ≤8) TBI between October 2023 and June 2025. Hormonal profiles were evaluated at the time of injury and again after 1 year. Functional outcomes were assessed using the Functional Independence Measure (FIM). Results: At injury, 42% had at least one pituitary hormone deficiency, including 18% with multiple pituitary hormone deficiency (MPHD). At 1-year follow-up, 48% had at least one deficiency, and 22% had MPHD. Dysfunction was significantly more common in severe TBI patients (60%) than moderate TBI (24%, p < 0.001). Patients with dysfunction had lower mean FIM scores (78.4 ± 9.2 vs. 90.6 ± 8.7; p = 0.002) and longer rehabilitation stays (32.5 vs. 21.3 days; p = 0.01). Conclusion: Pituitary dysfunction is a frequent and underrecognized complication of moderate and severe TBI, particularly in severe cases. It is associated with poorer functional outcomes and prolonged rehabilitation. Routine endocrine screening is essential for timely diagnosis and intervention. Keywords: Traumatic Brain Injury, Pituitary Dysfunction, Hypothalamic-Pituitary Axis, Multiple Pituitary Hormone Deficiency, Functional Independence Measure, Rehabilitation Outcomes.

Background: The aim of this study was to compare intravenous Magnesium sulphate and Dexmedetomidine for attenuation of pressor response to video laryngoscopy and intubation under general anaesthesia. Materials and Methods: The present study was a double blinded, prospective, randomized study conducted in Government general hospital, Kadapa during the period 2023-24. After obtaining institutional ethical committee approval and informed consent, 60 ASA I and II subjects in the age group of 20-60 years planned for elective surgeries were enrolled in this study. They were randomly allocated to one of the two study groups by using computer generated random numbers, Group D (Dexmedetomidine group) and Group M (Magnesium sulphate group). Results: The study aimed to determine the effectiveness of dexmedetomidine (1 μg/kg) and magnesium sulphate (30 mg/kg) in reducing video laryngoscopy-induced hemodynamic responses when using the King Vision device for subsequent endotracheal intubation. In the present study, both groups showed equivalent demographic profiles during baseline measurements since they had no substantial differences in age, sex, body weight, Mallampati classification and ASA physical status. The agents proved effective in reducing the hemodynamic changes that occur when using video laryngoscopy with the King Vision device before endotracheal intubation. Dexmedetomidine proved to control heart rate and blood pressure better than magnesium sulphate did after endotracheal tube intubation. Heart rate decreased by 17% below the baseline after dexmedetomidine administration while magnesium sulphate maintained a decrease of only 5.5%. The research data demonstrated significant differences between groups during both the intubation process and next three-minute period (p < 0.001). Dexmedetomidine showed better blood pressure control of systolic and diastolic pressure and mean arterial pressure (p < 0.05 across all parameters) which confirmed its strong sympatholytic properties in this context. Treatment with both agents revealed good results regarding safety conditions. Among the group receiving dexmedetomidine, 2 patients (6.7%) developed bradycardia while no such occurrences were observed in the patients treated with magnesium sulphate (p = 0.492). This difference was not statistically significant. Dexmedetomidine produced significantly higher sedation (RSS 2.80 ± 0.48) than Magnesium Sulphate (RSS 2.07 ± 0.69; p < 0.001). Conclusion: The randomized controlled trial evidence shows dexmedetomidine together with magnesium sulphate provides efficient stabilization of the hemodynamic response occurring during video laryngoscopy and endotracheal intubation procedures. Dexmedetomidine controls heart rate and blood pressure better than magnesium sulphate does initially after intubation yet magnesium provides gentle stabilization benefits. Keywords: Dexmedetomidine, Laryngoscopy, Endotracheal intubation, Magnesium sulphate, Hemodynamic parameters

Background: The present study attempts to study the tissue based Desarda technique in terms of postoperative pain, complications and recurrence, with the study of Desarda technique done worldwide. Materials and Methods: This is a prospective and interventional study examining Desarda‘s inguinal hernia repair technique in adults. Patients fulfilling the inclusion criteria were taken in the study. Clinical profile of the participants and postoperative factors like postoperative pain, time required to return to basic activity, time required to return to home activity, incidence of chronic groin pain, and recurrence rate were studied. Results: The peak age incidence of hernia was seen in the age group of 51-60 years [23.33%] followed by 31-40 years [20.66%]. There was a male preponderance in the total number of cases. Right sided hernia patients were commonly seen. Around 82% of patients had an indirect type of inguinal hernia, which was dominant in the group. 21.66% were chronic smokers and 12.5% patients had chronic cough in this group. Hypertension, diabetes, and urinary obstructive symptoms were seen in 34.16% 14.16% and 18.3% patients. The mean operative time was 60 Min [40-80min]. Post-operative pain score according to visual analogue scale on Day 1, 7 and 30 was 3.35, 0.95 and 0.008, respectively. Time taken to return to basic activities was 24 hours which is significantly less. Out of 120 patients, cord oedema [5%] was commonly seen complication following seroma [2.5%], surgical site infection. Conclusion: Desarda‘s inguinal hernia repair technique can be considered in adults with a lesser complication rate. Keywords: Inguinal hernia, Desarda‘s inguinal hernia repair technique , Complications, Post-operative pain.

Background: This study was conducted with an aim to assess the utility of CT attenuation values in differentiating enostosis from untreated osteoblastic metastases using mean and maximum Hounsfield Unit (HU) measurements. Materials and Methods: This prospective observational study included 78 patients divided equally into two groups—enostosis and osteoblastic metastasis—based on clinical and radiologic criteria. CT examinations were performed using a 16-slice CT scanner (GE Revolution). For each lesion, four-quadrant ROI measurements were taken to calculate mean and maximum attenuation values. Statistical analysis included t-tests, chi-square tests, and ROC curve analysis to determine diagnostic performance. Results: Mean CT attenuation was significantly higher in the enostosis group (1053.91 ± 73.59 HU) compared to the metastasis group (938.41 ± 56.96 HU) (p < 0.001). Similarly, maximum attenuation values were higher in enostosis (1171.41 ± 58.00 HU vs. 999.23 ± 56.69 HU, p < 0.001). ROC curve analysis demonstrated excellent diagnostic accuracy, with visually estimated AUCs exceeding 0.95 for both parameters. A cutoff of approximately 885 HU for mean and 1060 HU for maximum attenuation yielded high sensitivity and specificity, aligning with published literature. Conclusion: CT-based attenuation values, especially the maximum and mean HU measurements, differentiate the enostosis from osteoblastic metastases. Incorporating these measurements into day-to-day CT interpretation aids in enhancing diagnostic accuracy. Abbreviations: CT =Computed tomography, HU= Hounsfield units, ROC = receiver operating characteristics, AUC= Area under curve Key words: Enostosis, Bone Island, Osteoblastic Metastasis, CT Attenuation, Hounsfield Unit, ROC Curve, Bone Lesions.

Background: Tuberculosis (TB) remains a significant public health issue in India, with high disease burden, stigma, and poor awareness, especially in rural communities. Adolescents represent an underutilized target group for community-based awareness initiatives. This study evaluates the effectiveness of a structured school-based health education intervention on TB-related knowledge, stigma, and practices among secondary school students in a rural setting. Objectives: To assess the effectiveness of a health education intervention in improving TB knowledge, reducing stigma, and enhancing preventive practices among students. Materials and Methods: A single-group pre-post interventional study was conducted among 157 students (grades 7–10) from a rural secondary school in Koproli Village, Uran, and Maharashtra. A validated, pre-tested questionnaire measured knowledge, stigma, and practice domains before and immediately after a structured TB health education session. Data were analyzed using paired t-tests in SPSS v25.0; p < 0.05 was considered statistically significant. Results: post-intervention scores significantly improved across all domains. The mean total score increased from 11.66 ± 3.01 to 14.04 ± 2.43 (p = 0.0001). Knowledge scores rose from 7.91 ± 2.18 to 9.73 ± 1.76 (p = 0.0001). Stigma scores decreased from 1.10 ± 0.70 to 0.81 ± 0.63 (p = 0.0001), and practice scores improved from 2.59 ± 0.82 to 3.50 ± 0.71 (p = 0.0001). Subgroup analysis showed greater stigma reduction among younger students and stronger behavioural improvement in older students. Conclusion: The health education intervention was effective in enhancing TB awareness, reducing stigma, and promoting preventive practices. Integrating TB education into school curricula in rural India can empower adolescents as informed health advocates and support national TB elimination goals. Keywords: Tuberculosis, Health Education, School-based Intervention, Adolescents, Public Health, Stigma Reduction, Preventive Practices, Rural Health.

Background: Menstrual Hygiene Management (MHM) is a culmination of various strategies adopted by women to maintain cleanliness, acquire appropriate menstrual absorbents, use them, clean & safe reuse and appropriate disposal during menstruation. Menstrual Hygiene depends upon these strategies adopted during monthly periods. The methods girls and women have developed for management of menstruation varies across as well as within countries. The variations can largely be attributed to an individual’s personal preferences, availability, accessibility, affordability, local traditions, cultural beliefs, and most importantly knowledge Interplay of a multitude of factors channelizes the appropriateness of choices made by women. The objective is to assess the knowledge and the practices of menstrual hygiene among rural school going adolescent girls. Materials and Methods: It is a community based cross sectional observational study involving girls of standard 8th to 10th from the randomly selected Government school from rural field practice area of Latur district during the study period from June to August 2023. Results: Majority of the girls attained the menarche at the age of 13-14 years i.e. 73.5%. Majority of them had blood flow of duration 3-5 days i.e. 65.9%. Menstrual hygiene practices revealed that 76.5% girls use sanitary pads. Majority of them were disposing the absorbent material in dust bin i.e. 72%. Not a single participant worshiping the God during the period of menstruation. Conclusion: Menstrual hygiene practices revealed that 76.5% girls use sanitary pads. Majority of them were disposing the absorbent material in dust bin i.e. 72%. Keywords: Knowledge, Practices, Menstrual Hygiene, Rural, Adolescent Girls.

Background: Aim: To study clinical, laboratory and imaging markers of patients of dengue fever and to correlate severity of disease with early presentation (NS1 Antigen positive) and late presentation (IgM Antibody positive). Materials and Methods: The study was performed on patients with Dengue fever admitted in medicine department of a tertiary care teaching hospital. A total of 200 dengue positive patients were evaluated. The study was conducted during the period between May 2023 to July 2024. This was an observational descriptive study. Results: In our study of 200 dengue patients, laboratory and imaging evaluation proved pivotal for early diagnosis and risk assessment. NS1 antigen positivity showed a significant positive correlation with radiological findings, particularly ascites, pleural effusion, and gallbladder wall thickening detected by ultrasonography and chest radiography, underscoring its value in identifying plasma leakage. However, NS1 positivity alone did not reliably predict complications such as bleeding, shock, or multi-organ dysfunction. Conclusion: This study shows dengue severity correlates with early NS1 positivity, warning signs, and imaging abnormalities. Young adults, especially males, were more affected. Combining chest radiography, ultrasonography, and laboratory findings provides a cost-effective strategy for early detection, risk stratification, and improved outcomes, thereby reducing dengue-related morbidity and mortality. Keywords: NS1 Antigen Levels, Dengue, Imaging Markers, clinical and laboratory.

Background: Diabetes mellitus is a chronic metabolic disorder frequently complicated by microvascular and macrovascular manifestations. Alterations in hematological parameters are increasingly recognized as potential indicators of disease progression and risk of complications. This study investigates the association between routine hematological indices and the presence of complications in patients with type 2 diabetes mellitus (T2DM). Materials and Methods: A hospital-based cross-sectional pilot study was conducted at Madha Medical College, enrolling 24 adults with confirmed T2DM. Participants were divided into two groups: those with diabetes-related complications (n=12) and those without complications (n=12). Demographic, clinical, and laboratory data including white blood cell (WBC), red blood cell (RBC), and platelet indices were collected and analyzed. Group comparisons employed independent samples t-tests, with p<0.05 considered statistically significant. Results: The complication group exhibited significantly higher hemoglobin (11.95 ± 1.82 g/dL vs. 9.98 ± 2.19 g/dL, p=0.026) and hematocrit (35.76 ± 5.54% vs. 29.63 ± 7.31%, p=0.030). WBC counts trended lower in the complication group (p=0.056). Platelet indices showed no significant intergroup differences, though subtle shifts were noted. Conclusion: Significant elevations in hemoglobin and hematocrit were identified among patients with diabetes-related complications, while other hematological indices demonstrated suggestive, but non-significant, trends. These findings imply that standard hematological parameters may provide supplementary information for identifying T2DM patients at increased risk for complications. Larger, longitudinal studies are warranted to validate these pilot findings and explore their clinical utility. Keywords: Diabetic complications, Hematology, RBC parameters, WBC parameters, Platelet parameters, Hemoglobin, Hematocrit, PDW.

Background: Hepatitis E virus (HEV) is a major cause of acute viral hepatitis in developing countries, with significant public health implications due to its waterborne transmission and potential for outbreaks. Despite improvements in sanitation, HEV remains underdiagnosed, especially in tertiary care centers where patients often present with acute hepatitis of unknown etiology. Understanding the seroprevalence of HEV among clinically suspected cases is essential for guiding diagnostic strategies and public health interventions. Materials and Methods: This cross-sectional observational study was conducted in the Department of Medicine from January 2024 to December 2024. A total of 180 patients with clinical suspicion of acute viral hepatitis were enrolled. Serum samples were tested for anti-HEV IgM antibodies using enzyme-linked immunosorbent assay (ELISA). Demographic, clinical, and biochemical data were collected. Statistical analysis was performed using chi-square and Student’s t-test, with p < 0.05 considered significant. Results: Of 180 patients, 35 (19.4%) were seropositive for HEV. The mean age of HEV-positive patients was 32.6 ± 10.8 years, and seropositivity was most common in the 21–40 years age group (42.9%). No significant differences were observed with respect to age, gender, or residence, although a numerical predominance was noted in rural areas (71.4%). Clinical symptoms, including jaundice and fatigue, were common in both groups, but none showed statistical significance. Biochemical analysis revealed significantly higher ALT (632.5 ± 211.3 U/L vs. 418.6 ± 187.9 U/L, p = 0.001) and AST (588.7 ± 198.5 U/L vs. 402.1 ± 176.4 U/L, p = 0.002) levels in HEV-positive patients, while bilirubin and alkaline phosphatase levels did not differ. Conclusion: HEV accounted for nearly one-fifth of acute viral hepatitis cases in this cohort. Elevated transaminase levels were the most consistent biochemical feature, while clinical and demographic factors did not show significant associations. These findings support the inclusion of HEV IgM testing in diagnostic panels for acute hepatitis and highlight the importance of preventive strategies such as safe water access and community awareness in endemic regions. Keywords: Hepatitis E virus, acute viral hepatitis, seroprevalence, ELISA, tertiary care, India.

Background: Acne vulgaris is a common inflammatory skin disorder of adolescence, influenced by hormonal, genetic, microbial, and environmental factors. Vitamin D3, known for its immunomodulatory and anti-inflammatory properties, has been implicated in skin health. However, its association with acne severity in Indian adolescents remains underexplored. This study aimed to assess the relationship between serum vitamin D3 levels and the severity of acne vulgaris in adolescents attending a tertiary care hospital in North India. Materials and Methods: A prospective cross-sectional study was conducted in the Department of Dermatology in collaboration with the Department of Biochemistry at a tertiary care teaching hospital in North India from March 2024 to April 2025. A total of 139 adolescents aged 10–19 years with clinically diagnosed acne vulgaris were enrolled. Acne severity was graded using the Global Acne Grading System (GAGS). Serum vitamin D3 (25-hydroxyvitamin D) levels were estimated using a Chemiluminescence Immunoassay (CLIA) analyser. Data were analysed using SPSS version 21.0, with p < 0.05 considered statistically significant. Results: Of the 139 participants, 72 (51.8%) were females and 67 (48.2%) were males, with the majority (66.9%) in the 15–19 years age group. Acne severity distribution was mild in 30.2%, moderate in 36.7%, and severe in 33.1% of cases. Mean serum vitamin D3 levels were significantly higher in males (23.5 ± 4.8 ng/mL) than in females (20.6 ± 4.5 ng/mL; p = 0.004). Vitamin D3 levels showed a significant decreasing trend with increasing acne severity—26.0 ± 2.1 ng/mL in mild, 24.5 ± 2.0 ng/mL in moderate, and 17.8 ± 1.7 ng/mL in severe acne (p = 0.001). A negative correlation was observed between serum vitamin D3 levels and GAGS scores in severe acne cases (r = –0.047, p = 0.003). Conclusion: Lower serum vitamin D3 levels were significantly associated with increased severity of acne vulgaris in adolescents. These findings suggest that vitamin D status assessment and correction could be considered as an adjunctive strategy in acne management. Keywords: Acne vulgaris, Vitamin D3, Adolescents, GAGS score, Acne severity, India.

Background: A common and potentially hazardous side effect after coronary artery bypass graft (CABG) surgery is postoperative atrial fibrillation (AF). Numerous factors have been proposed to raise the risk of post-operative AF following CABG. Estimating the percentage of patients who experience AF following off-pump CABG (OPCABG) and identifying potential predictors of AF following OPCABG were the goals. Materials and Methods: A fixed sample size of 328 was chosen since the incidence of postoperative atrial fibrillation after CABG was 23%, according to a research by Arribas-Leal et al. Results: The proportion of patients who developed post-operative atrial fibrillation was 56 (17.07%). The mean age was 61.38±10.24 years and there were 67 (20.42%) females and 261 (79.57%) males. While 32 developed AF on the third postoperative day, 19 developed it on the 2nd day, 03 developed AF on the first day and 02 developed it on the 4th post-operative day. Preoperative, postoperative, and demographic characteristics of the AF and non-AF groups were compared. Conclusion: Our research revealed that after OPCABG, older age was an independent predictor of atrial fibrillation. The incidence of AF following OPCABG was linked to males, large atrial size, low ejection fraction, and prolonged hospital and intensive care unit stays. Keywords: Predictor, Postoperative Atrial fibrillation, Intensive care units, Off pump CABG and Prognosis.

Background: The clinical manifestation of Vitiligo, an acquired pigmentary condition, is depigmented macules brought on by melanocyte loss. Although there are many other treatment options, fractional carbon dioxide (CO2) lasers, which operate on the basis of photothermolysis, have lately been tested with positive results. Objective: To evaluate the effectiveness of topical 0.1% tacrolimus ointment plus fractional CO2 laser versus topical 0.1% tacrolimus ointment alone in non-segmental vitiligo. Materials and Methods: Eighty patients with stable non-segmental vitiligo were enrolled in this interventional prospective study conducted over a period of two years. They were divided into two groups of forty patients each. For three months, Group A received topical 0.1% tacrolimus twice daily and fractional CO2 laser treatments every month while Group B received only 0.1% topical tacrolimus twice daily. Re-pigmentation was evaluated clinically and dermoscopically at monthly intervals for the first three months and again at the conclusion of six months. Results: Of the eighty patients in this study, thirty-two were males, and forty-eight were females. Group A's mean age was 33.25 ± 11.8 years, while group B's was 31.98 ± 11.13 years. In both groups, the average duration of disease was 4.8 ± 4.83 years. According to the Quartile Grading Scale (QGS), at six months, there was a statistically significant difference (p < 0.05) in QGS with fifteen patients (60%) in Group A and nine patients (27.2%) in Group B showing more than 50% re-pigmentation. On dermoscopic evaluation at the end of six months, eighteen patients (72%) in Group A and fourteen patients (42.4%) in Group B showed moderate to good response in DAG which was statistically significant (p < 0.05). Conclusion: Both clinical and dermoscopic assessments demonstrated that re-pigmentation was significantly enhanced with the combination of fractional CO₂ laser and topical tacrolimus 0.1%. These findings suggest that fractional CO₂ laser may serve as an effective therapeutic option for the management of stable vitiligo. Keywords: Fractional CO2 laser, 0.1% Tacrolimus, Vitiligo.

Background: The advantages of the FNA procedure include a fairly precise diagnosis, exceptional patient acceptance, and also a minimal to no morbidity so this was compared with gold standard Histopathology for its accuracy of Diagnosis. Materials and Methods: After approval from institutional ethical committee this cross-sectional study was carried out in the patients who were referred to Department of Pathology for FNAC. Study period – from sept 2016 to April 2017. during this period total 160 cases were studied. Age range was from from 14 yrs to 70 yrs. Out of the 160 cases 40 were available for histopathological examination. All the FNAC slides and Biopsy slides were fixed and stained by standard pathological protocols. All details of the patients like age, FNAC and Histopathological diagnosis etc. was noted. Cyto-histo correlation was done by calculating the sensitivity and Specificity, Positive predictive value and negative predictive value of FNAC calculated by Medcalc software. Results: The majority of the patients were in the age group of 21-30 were 33.75%. The majority of the patients were Female i.e. 97.50% followed by Male 2.50%. The majority of the Patients were with the location of left side i.e. 52.50 Lump was the most common symptom i.e. in 100%, followed Pain in 75%, Fever in 68%, Nipple discharge in 59%. the majority of the patients were Benign i.e. 33(20.62%), Malignant were 20(12.50%), Inflammatory lesions were 5 (3.13%), Unsatisfactory were 8 (5.00%). Sensitivity was 100.00% (CI-39.76% to 100.00%), Specificity - 97.22 % (CI-85.47% to 99.93%), Positive Predictive Value was 80.00% (CI-36.67% to 96.51%), Negative Predictive Value- 100.00%. Conclusion: It can be concluded from our study that the FNAC is a rapid, accurate, safe, reliable and cost effective method for preoperative diagnosis of breast lesions. It is having high sensitivity and specificity. Hence FNAC should be used as a routine diagnostic procedure to provide effective healthcare to patients. Among breast lesions benign lesions are more common than malignanat ones. Benign lesions are more common in younger age group and malignant lesions are more common in older age group. Keywords: Cytomorphological study, Breast lesions, FNAC (Fine Needle Aspiration Cytology), Ca-Breast.

Background: Gallstone disease remains one of the major causes of morbidity and mortality throughout the world. Gallstone Disease is a frequent health problem in developing countries. It is a chronic recurrent hepatobiliary disease as an effect of impaired metabolism of cholesterol and Bile acids resulting in bile stone formation. Materials and Methods: The present study was a single-center, observational Study conducted on all the patients admitted, diagnosed and managed with Cholelithiasis above age of 12 years in the department of General Surgery for a period 2 years. Prior to initiation of the study, ethical and research Committee approval has been obtained. During the present study a total of 61 Patients were reviewed in surgical out patient department among which 50 patients were enrolled for the study according to the inclusion criteria and 11 patients were excluded to the exclusion criteria. Results: There is an increased incidence of cholelithiasis in the 3rd and 4th decade with the peak in the 2nd decade of life. Among 50 cases group, 32% were male and 68% were female. The female to male ratio is 2.1:1. In present study pain was the commonest symptom presenting in 40% patients, 32% patients had dyspepsia and 14 patients had other symptoms. Ultrasonography of the abdomen showed 40% patients had solitary stone and 60% patients had multiple stones. The percentage of patients who underwent laparoscopic cholecystectomy was 94% and open cholecystectomy 6%. Overall prevalence of Prolonged Ileus postoperatively was 22%. Of the 3 open surgeries, one patient had Prolonged Ileus and with Laparoscopic surgeries 10 had Prolonged Ileus. Of 3 open surgeries 1 (33%) patient had wound infection and with Laparoscopic surgeries 1 (2%) had wound infection postoperatively. Overall incidence of wound infection was 4%. Conclusion: In my study the youngest patient was 12 years and the oldest patient was 66 years old. The present study shows cholelithiasis as a more common problem in female population. Pain was the predominant symptom. Ultrasonography of the abdomen was done in all the patients, where 40% had solitary stone and 60% had multiple stones. Keywords: cholelithiasis, gallbladder, Laparoscopic surgery, Magnetic Resonance Cholangiopancreatography, Magnetic Resonance Cholangiopancreatography.

Background: Non-alcoholic fatty liver disease (NAFLD) is a prevalent liver condition, often linked with metabolic disorders, while hypothyroidism is a common endocrine disorder characterized by insufficient thyroid hormone production. Both conditions have significant implications for overall health. The objective is to investigate the presence of NAFLD in individuals with overt and subclinical hypothyroidism at a tertiary care centre in South India. Materials and Methods: This prospective observational study was conducted among 160 patients aged 18 years and older with overt or subclinical hypothyroidism. Patients with excessive alcohol consumption, BMI greater than 25 kg/m², pre-existing liver disease, diabetes mellitus, chronic kidney disease and other factors were excluded. Data collected included thyroid function tests (T3, T4, TSH), liver function tests (LFTs), anthropometric measurements, and abdominal ultrasonography for NAFLD diagnosis. Results: The study population's mean age was 48.9 years, with a significant female predominance (94.4%). The prevalence of NAFLD in hypothyroid patients was 60.6%. Patients with NAFLD had significantly higher mean TSH levels and lower mean T3 levels compared to those without NAFLD (p<0.001). While there was no significant difference in T4 levels, AST levels were significantly higher in the NAFLD group (p<0.001). Conclusion: This study demonstrates a high prevalence of NAFLD in hypothyroid patients and identifies distinct associations between thyroid hormone levels and NAFL. These results underscore the importance of considering NAFLD in the management of hypothyroid individuals. Keywords: Hypothyroidism, Non-alcoholic fatty liver disease, Thyroid hormones, Liver function tests, NAFLD.

Background: Malnutrition in under-five children is a critical public health concern, particularly in rural India, where socioeconomic factors significantly influence nutritional status. This study aims to identify the factors contributing to malnutrition among under-five children in rural Indore. Materials and Methods: A cross-sectional study was conducted involving 300 children aged 6 months to 5 years, assessing demographic characteristics, dietary intake, cultural practices, and maternal education. Nutritional status was evaluated using weight-for-age, height-for-age, and weight-for-height z-scores. Statistical analyses, including multivariate logistic regression, were performed to determine the relationship between various factors and malnutrition prevalence. Results: The study found that 55% of the children were malnourished, with the highest prevalence in the 24–35 months age group (25%). Significant associations were observed between malnutrition and maternal education (p < 0.001) and family income (p < 0.001). Inadequate dietary intake was prevalent, particularly in protein-rich foods (60%) and vitamin A-rich vegetables (55%). Cultural practices, such as delayed introduction of complementary foods (35%) and dietary restrictions, also contributed to malnutrition. Conclusion: Malnutrition among under-five children in rural Indore is influenced by a combination of inadequate dietary intake, socioeconomic factors, and cultural practices. Targeted interventions addressing these factors, alongside improved maternal education and income, are essential for reducing malnutrition rates in this vulnerable population. Keywords: Malnutrition, under-five children, dietary intake, socioeconomic factors, rural India, maternal education, cultural practices.

Background: Objective: To study the Vitamin B12 and folate deficiency in anemic children of age group 6 months to 5 years attending the tertiary care pediatric hospital. Materials and Methods: Present study was a cross-sectional observational hospital-based study. It was done in patients admitted in Pediatric department of Deen Dayal Hospital Upadhyay Hospital, Delhi in 2015-2017 of age group 6 month to 5 years. Total 252 children were included in present study. Out of the 252 children 112 (44.5%) were female and 140 (55.56%) were male. In each group male outnumber the female except in 37-60 month. Maximum number of children 121(48%) were present in age group 13-36 month. Out of total 252 children, 184 (73.01%) were Lower lower socioeconomic class and 68(26.98%) were upper lower Results: In our study out of the 252 children the Pure or mixed vitamin B12 deficiency was seen 95(37.7%). Pure or mixed folate deficiency was found in 37(14.7%) children. vitamin B12 deficiency 74 (29.3%) and folate deficiency 22(8.7%) alone or combination 4 (1.5%) was seen in our study. Conclusion: The prevalence of vitamin B12 is more common in age group in 6-12 months anemic children who were on breast fed, the reason may be maternal deficiency of vitamin B12. So, there is a strong need to supplement the Vitamin B12 in infancy for the normal development and healthy life of children. We recommend in policy making in fortification of food to prevent nutritional anemia secondary to vitamin B12 and folate deficiency. Keywords: National Family Health survey [NFHS], nutritional anemia, vitamin B12 and folate deficiency.

Background: Neonatal Respiratory Distress Syndrome (RDS) is a leading cause of neonatal morbidity and mortality. Early and accurate diagnosis is essential to initiate prompt treatment. Traditionally, chest X-ray has been the standard imaging modality; however, concerns regarding radiation exposure in neonates have prompted investigation into alternative imaging techniques such as lung ultrasound (LUS). Objective: To evaluate the diagnostic value of lung ultrasound in RDS in newborn infants and its correlation with X-ray imaging in assessing disease severity. Materials and Methods: This was a hospital-based prospective observational study conducted over one year (April 2015–March 2016) in the NICU of Government Medical College, Srinagar. A total of 59 newborns with suspected RDS were enrolled based on clinical features. All underwent both chest X-ray and lung ultrasound within 24 hours of admission. The severity of RDS was staged using respective imaging criteria. Statistical analysis included sensitivity, specificity, predictive values, diagnostic accuracy, and correlation assessment. Results: Lung ultrasound showed a sensitivity of 100%, specificity of 93.33%, PPV of 97.78%, NPV of 100%, and diagnostic accuracy of 98.31%. Significant correlation was observed between LUS and chest X-ray in staging RDS, though LUS could not differentiate between stage III and IV. Conclusion: Lung ultrasound is a highly accurate and non-invasive diagnostic tool for neonatal RDS. It offers a reliable alternative to chest X-ray and has the potential to reduce radiation exposure in neonates. Keywords: Lung ultrasound, Neonatal RDS, NICU, Diagnostic imaging, Chest X-ray.

Background: Type 2 diabetes mellitus (T2DM) is a progressive metabolic disorder characterized by insulin resistance and β-cell dysfunction, often leading to inadequate glycemic control and long-term complications. Timely initiation of insulin therapy has been proposed as a strategy to overcome therapeutic inertia, improve glycemic control, and reduce the risk of diabetes-related complications. However, the clinical impact of early versus delayed initiation of insulin therapy in newly diagnosed patients remains debated. Aim: This study aimed to compare the effects of early versus delayed initiation of insulin therapy in patients with newly diagnosed T2DM in terms of glycemic control and the occurrence of diabetes-related complications. Materials and Methods: A comparative observational study was conducted at a tertiary care hospital, enrolling 96 newly diagnosed T2DM patients. Participants were divided equally into two groups: early initiation (insulin started within one month of diagnosis) and delayed initiation (insulin introduced only if glycemic targets were not achieved with lifestyle and oral hypoglycemic agents). Baseline demographic, clinical, and biochemical parameters were recorded. Glycemic control (fasting plasma glucose [FPG], postprandial plasma glucose [PPG], glycated hemoglobin [HbA1c]) and complications were evaluated. Data were analyzed using SPSS version 26.0, with a p-value <0.05 considered statistically significant. Results: Baseline characteristics, including age (51.23 ± 8.45 vs. 52.18 ± 9.12 years, p = 0.64), BMI (27.56 ± 3.12 vs. 28.04 ± 3.28 kg/m², p = 0.48), and HbA1c (8.92 ± 1.12 vs. 8.87 ± 1.15%, p = 0.81), were comparable between groups. At 6 months, early initiation significantly improved glycemic outcomes: FPG (118.54 ± 18.62 vs. 134.78 ± 20.41 mg/dL, p = 0.001), PPG (162.43 ± 28.17 vs. 181.64 ± 30.22 mg/dL, p = 0.002), and HbA1c (6.82 ± 0.72% vs. 7.34 ± 0.85%, p = 0.004). Target HbA1c <7% was achieved in 70.83% of early patients versus 47.92% in delayed (p = 0.02). Hypoglycemia (12.50% vs. 6.25%, p = 0.30) and weight gain (+1.24 vs. +0.72 kg, p = 0.19) were slightly higher with early insulin. Complications, though not statistically significant, were lower in the early initiation group. Conclusion: Early initiation of insulin therapy in newly diagnosed T2DM provides superior glycemic control and trends toward fewer complications, supporting its role as a proactive strategy in diabetes management. Keywords: Type 2 diabetes mellitus; insulin initiation; glycemic control; hypoglycemia; complications.

Background: Anaemia is a major global health concern with significant clinical and socioeconomic consequences, often presenting in adults as a common finding in general medicine clinics. It is associated with reduced quality of life, impaired productivity, and increased morbidity, particularly when coexisting with chronic illnesses. Understanding its prevalence and clinical profiles in outpatient populations is crucial to guide timely diagnosis and targeted management. Aim: The present study aimed to determine the prevalence of anaemia and to assess the associated clinical and laboratory profiles among adults attending general medicine outpatient clinics in a tertiary care hospital. Materials and Methods: This hospital-based observational study included 98 adult patients (aged ≥18 years) attending the general medicine outpatient department who fulfilled the inclusion criteria. Patients with recent blood transfusion, ongoing hematinic therapy, bleeding disorders, or pregnancy were excluded. Clinical history and demographic details such as age, sex, occupation, socioeconomic status, and comorbidities were recorded. Laboratory investigations included complete blood count, peripheral smear, and, where indicated, iron profile, vitamin B12, and folate levels. Anaemia was defined and graded using World Health Organization (WHO) criteria. Data were analysed using SPSS version 26.0, with descriptive statistics and appropriate tests of association applied; p <0.05 was considered significant. Results: The overall prevalence of anaemia was 63.27% (62/98 patients). Among anaemic individuals, 24.49% had mild, 26.53% moderate, and 12.24% severe anaemia. Females demonstrated a higher prevalence (69.23%) compared to males (56.52%), though the association was not statistically significant (p=0.214). Prevalence increased significantly with age (p=0.041), being 45.45% in 18–30 years, 58.82% in 31–50 years, and 76.19% in >50 years. Mean haemoglobin (9.82 ± 1.45 g/dL), haematocrit, MCV, and MCH values were significantly lower in anaemic patients compared to non-anaemic counterparts (p<0.001 for all), while platelet counts showed no significant difference (p=0.342). Conclusion: Anaemia is highly prevalent in adults attending tertiary care outpatient clinics, with greater burden among females and older age groups. The significant proportion of moderate and severe cases underscores the need for routine screening, early etiological evaluation, and prompt management to reduce morbidity and improve patient outcomes. Keywords: Anaemia, prevalence, adults, clinical profile.

Thyroid storm is a rare but life-threatening endocrine emergency, often triggered by systemic infections. Fournier’s gangrene, a rapidly progressive necrotizing fasciitis of the perineum, has a high mortality rate, particularly in uncontrolled diabetes mellitus. The coexistence of thyroid storm with Fournier’s gangrene is exceptionally rare and poses significant diagnostic and therapeutic challenges. A case is presented of a 53-year-old male with uncontrolled type 2 diabetes mellitus (HbA1c 9.5%) who was admitted with high-grade fever (102°F), altered sensorium, and atrial fibrillation with rapid ventricular response (150 bpm), intubated for respiratory failure and admitted to the ICU. Laboratory investigations revealed severe thyrotoxicosis (TSH 0.21 µIU/mL, FT4 2.73 ng/dL, FT3 6.34 pg/mL), hyperglycemia, and markedly elevated procalcitonin (13.6 ng/mL), indicating severe bacterial sepsis. Local examination demonstrated extensive necrotic perineal lesions, and Fournier’s gangrene was confirmed, prompting urgent surgical debridement. Based on a Burch-Wartofsky Point Scale score of 100, a diagnosis of thyroid storm was established. The patient underwent prompt multidisciplinary management with antithyroid agents, beta-blockers, corticosteroids, insulin infusion, and broad-spectrum antibiotics, with procalcitonin levels guiding risk assessment and antimicrobial adjustments. This case emphasizes the need for vigilance for endocrine emergencies in critically ill patients, as the coexistence of thyroid storm, Fournier’s gangrene, and uncontrolled diabetes markedly elevates morbidity and mortality. Early recognition, biomarker-driven evaluation, and timely surgical and medical intervention are essential to improve outcomes in such complex presentations. Keywords: Thyroid Storm, Thyrotoxicosis.

Background: Lung carcinoma is one of the most common malignancies in the industrialized countries and now a leading cause of death in developing countries like India. There are different methods to diagnose lung carcinoma. Broncho-alveolar lavage cytology, bronchial brush cytology and bronchial biopsy are three important techniques which are becoming more popular. Aim & Objectives: 1. To assess diagnostic utility of BAL, bronchial brushings cytology and lung biopsy in diagnosing various pulmonary lesions. 2. To compare the bronchoalveolar lavage and brush cytology with biopsy in patients with lung diseases. Materials and Methods: This is a Hospital based observational study carried out tertiary care centre in known patients with lung cancer, during a period of 18 months from January 2023 and June 2024.The materials obtained from Broncho-alveolar lavage, bronchial brushings and bronchial lung biopsy are studied and their efficacy in diagnosing lung malignancy is compared. Results: The present study showed that sensitivity of Broncho-alveolar lavage and Bronchial brushings are 65.4%, 80.2% respectively. Whereas specificity are 83% and 91.4% respectively. Conclusion: This study suggests that the biopsy along with bronchial brush gives better cellularity and yield when compared to BAL. The probability of finding the histological sub types is higher in biopsy when compared with brushings and BAL samples. Keywords: Lung cancer, BAL, bronchial brushings cytology, Sensitivity, Specificity, Biopsy.

Background: The conventional cardiovascular risk factors and inflammatory pathways have been shown to contribute to the development of acute myocardial infarction (AMI). The objective is to compare serum fibrinogen and conventional coronary artery disease (CAD) risk factors between AMI patients and healthy controls. Materials and Methods: A cross-sectional study was conducted in Aurangabad, including 60 participants: 30 AMI patients and 30 age- and sex-matched controls free of CAD risk factors. The study parameters included serum fibrinogen, lipid profile [triglycerides, low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C)], obesity, smoking, alcohol, hypertension, and diabetes. Results: Serum fibrinogen was markedly elevated in AMI patients (497.17 ± 57.31 vs 167.87 ± 13.19 mg/dL, p<0.001). Conventional risk factor prevalences in AMI were: hypertriglyceridemia 50%, LDL-C 33%, hypercholesterolemia 20%, low HDL-C 17%, obesity 50%, smoking 43%, alcohol 40%, hypertension 17%, and diabetes 17%; all controls were risk-free by design. Conclusion: AMI patients exhibited clustering of inflammatory and metabolic risk factors, underscoring the multifactorial and inflammatory basis of AMI. Keywords: Acute myocardial infarction, fibrinogen, dyslipidaemia, obesity, smoking, systemic inflammation