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