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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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