European Journal of Cardiovascular Medicine

Background: Aim: The aim of the present study was to assess modified technique for large left atrial reduction in valvular heart surgery. Methods: The present study was conducted in the Department of cardiothoracic and vascular surgery, LPS Institute of cardiology, GSVM Medical college, Kanpur from January 2017 to December 2018 A total of 36 cases in MVR and 24 cases in DVR were included in the study. Results: There was no significant (p>0.05) difference in the age between the groups showing the comparability of the groups in terms of age. There was no significant (p>0.05) difference in the gender between the groups showing the comparability of the groups in terms of gender. LA size was insignificantly (p>0.05) lower in patients of MVR than DVR at both pre and post-operative. Both Aortic cross clamp time and CPB time were significantly (p=0.0001) lower in patients of MVR than DVR. There was no significant (p>0.05) association of post-operative AF, thromboembolic complications, post-operative low cardiac output and post-operative respiratory failure with groups. Conclusion: LA reduction surgery not only facilitated sinus rhythm recovery but also helped restore LA mechanical functions and facilitated LA reverse remoulding even in patients with long standing AF and LA enlargement. Moreover, if the associated mitral procedure of choice is valvuloplasty or the implantation of a mitral biological prosthesis, it will be possible to achieve the end point: to maintain the patient free of anticoagulant use.

Aim: To assess technical difficulties and procedure complications of DPLs in previous cesarean sections. Materials: Laproscopic sterilization procedures were held at tertiary care centre in Vijayawada from February 2023 to July 2023 and a total of 110 cases were done. The technical difficulties and complications are analysed. Results: Complications of procedure, failure to do, bleeding from port site, tubes cut by instruments, dense adhesion, Proceeded to laparotomy. Conclusion: Double puncture laparoscopic sterilization using Fallope rings is safer, simpler, and more efficient than minilaparotomy, with fewer complications and faster recovery. It is a suitable method for large-scale sterilization in tertiary care centers.

Background: Type-2 Diabetes Mellitus (T2DM) is a chronic condition that has reached epidemic proportions worldwide, affecting millions of individuals and representing a significant public health burden. The ratio of serum uric acid to creatinine (SUA/Cr ratio) has been proposed as a novel marker for assessing the risk of kidney damage and other metabolic disturbances, including in diabetic patients. Elevated SUA/Cr ratios have been linked to the early stages of diabetic nephropathy, including proteinuria, and may help identify individuals at risk before significant kidney dysfunction develops. Objectives: To estimate the correlation between serum uric acid to creatinine ratio and proteinuria in Diabetes Mellitus patients Methods: It’s a cross-sectional study conducted on 60 Diabetic patients visiting to K R Hospital, Mysuru from April 2023 to October 2024. Serum uricacid and creatinine ratio, proteinuria will be measured and then correlating these values with diabetic patients. Results

The analysis revealed a positive correlation (r = 0.42) between the serum uric acid to creatinine ratio and proteinuria in patients with type 2 diabetes mellitus, with a statistically significant p-value of 0.05. This suggests that as the serum uric acid to creatinine ratio increases, the level of proteinuria also tends to rise, indicating a potential link between this biochemical ratio and renal involvement in diabetic individuals. Conclusion: This study highlights the importance of early detection and monitoring of kidney disfunction in individuals with Type-2 DM particularly by using SUA/Cr ratio and proteinuria as a potential marker and demonstrates clear relationship between SUA/Cr ratio and proteinuria.

Background: Cholelithiasis with associated common bile duct (CBD) stones is a frequent indication for endoscopic retrograde cholangiopancreatography (ERCP) followed by cholecystectomy. However, residual CBD stones despite ERCP may contribute to postoperative complications. This study evaluates the impact of residual CBD stones on postoperative outcomes in patients undergoing cholecystectomy after ERCP. Materials and Methods: This retrospective cohort study included 180 patients who underwent laparoscopic cholecystectomy following ERCP for CBD stones at a tertiary care hospital. Patients were categorized into two groups: Group A (n=90) with confirmed clearance of CBD stones post-ERCP and Group B (n=90) with residual CBD stones identified intraoperatively or postoperatively. Postoperative complications, including biliary leakage, pancreatitis, wound infection, and length of hospital stay, were recorded and analyzed using SPSS v26. Chi-square and t-tests were employed for statistical comparisons, with p<0.05 considered significant. Results: Residual CBD stones were associated with significantly higher postoperative complications. Biliary leakage occurred in 14.4% of Group B compared to 3.3% in Group A (p=0.01). Postoperative pancreatitis was observed in 11.1% of Group B versus 2.2% in Group A (p=0.02). Mean hospital stay was prolonged in Group B (6.7 ± 2.1 days) compared to Group A (4.3 ± 1.6 days) (p<0.001). Wound infections were slightly more frequent in Group B (8.9%) than in Group A (4.4%), though not statistically significant (p=0.19). Conclusion: The presence of residual CBD stones following ERCP significantly increases the risk of postoperative complications, including biliary leakage, pancreatitis, and prolonged hospitalization. Thorough CBD clearance verification during ERCP is crucial to optimize outcomes post-cholecystectomy.

Background: Cirrhosis is a chronic liver condition characterized by hepatic fibrosis, anatomical distortion, and compromised liver function. Autonomic dysfunction (AD) is a significant concern due to its impact on cardiovascular stability, hemodynamic modulation, and patient prognosis. AD is characterized by irregularities in heart rate variability, impaired blood pressure management, and abnormal reflex reactions, which can increase the risk of cardiac events. Cirrhotic cardiomyopathy, characterized by compromised ventricular contractility and electromechanical dysfunction, is linked to autonomic abnormalities. ECG and ECHO are vital tools for assessing heart function in cirrhosis patients, revealing anatomical and functional heart alterations. Objective: This study aims to evaluate autonomic dysfunction in individuals with liver cirrhosis, its impact on ECG abnormalities, heart rate variability, blood pressure regulation, and cardiovascular reflexes, and its influence on various Child-Pugh and MELD score groups. It also seeks to identify potential predictors of autonomic dysfunction in cirrhosis, which could aid in early risk assessment and therapeutic management. Methods: A retrospective analysis was performed on clinical data from 100 patients admitted with cirrhosis over an 18-month period, from May 2023 to December 2024, at Shri B M Patil Medical College and Research Center, Vijayapura, where the data was collected. The information gathered included the patient's demographics, clinical conditions at admission, ECG results (QTc interval), echocardiographic results, and signs of autonomic dysfunction. Results: The study examined the age distribution and physiology of patients with heart conditions, focusing on 20-60-year-olds. Pulse rates were categorized into three ranges: 81-100 bpm, 60-80 bpm, and 101-130 bpm. The Valsalva maneuver showed a similar distribution, with 52% falling in the 81-100 bpm range and 36% in the 60-80 bpm range. Blood pressure was measured using a blood pressure cuff, with higher pressure indicating a higher risk of heart failure. The study also examined blood pressure readings under three conditions: Supine BP (lying down), Standing BP, and Hand Grip BP. The Child-Pugh classification assessed the severity of chronic liver disease, with the mean age group mostly middle-aged. The study found a strong link between autonomic dysfunction, cardiovascular abnormalities, and liver disease progression. Conclusion: The study reveals a significant gender disparity in the population, with 95% being males. Cardiovascular assessments show normal physiological responses, but some individuals show signs of autonomic dysfunction. ECG analysis reveals abnormalities in sinus rhythms, highlighting the need for continuous monitoring. Liver function assessments reveal a high prevalence of severe liver disease, necessitating urgent medical interventions. Early detection and management of these health issues are crucial for improving health outcomes. Future research should focus on lifestyle modifications, targeted treatments, and long-term monitoring.

Background: Chronic stress is known to dysregulate the hypothalamic–pituitary–adrenal (HPA) axis, leading to altered cortisol secretion and immune system dysfunction. Disruption in diurnal cortisol rhythms has been implicated in various stress-related disorders. This study aimed to evaluate HPA axis function in individuals with chronic stress by analyzing salivary cortisol profiles and circulating immune biomarkers. Materials and Methods: A cross-sectional study was conducted involving 60 participants aged 25–45 years, divided equally into two groups: chronic stress (n=30) and healthy controls (n=30). Stress levels were assessed using the Perceived Stress Scale (PSS). Salivary cortisol samples were collected at four time points: upon awakening, 30 minutes post-awakening, mid-afternoon, and bedtime. Serum levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) were measured using ELISA. Data were analyzed using independent t-tests and Pearson correlation coefficients. Results: Participants with chronic stress exhibited a significantly flattened diurnal cortisol slope compared to controls (mean slope −0.18 ± 0.03 vs. −0.31 ± 0.02; p<0.001). Morning cortisol levels were markedly lower in the stress group (8.2 ± 1.1 ng/mL) than in controls (13.6 ± 1.3 ng/mL; p<0.001). Elevated levels of IL-6 (4.8 ± 0.6 pg/mL vs. 2.3 ± 0.4 pg/mL), TNF-α (6.5 ± 0.9 pg/mL vs. 3.2 ± 0.7 pg/mL), and CRP (2.9 ± 0.5 mg/L vs. 1.1 ± 0.3 mg/L) were observed in the stressed group (p<0.01 for all). A significant negative correlation was found between cortisol slope and IL-6 levels (r = −0.62, p<0.01). Conclusion: Chronic stress is associated with HPA axis dysregulation, characterized by blunted cortisol rhythms and elevated pro-inflammatory immune markers. These findings underscore the role of stress-induced neuroendocrine-immune interactions in disease susceptibility.

Background: Patients presenting with upper abdominal pain may harbor pathologies that extend beyond the abdominal cavity into the thoracic region. Conventional abdominal imaging often overlooks thoracic findings that may influence clinical management. This study aims to evaluate the diagnostic utility of computed tomography (CT) of the thorax in detecting concurrent thoracoabdominal pathologies in such patients using a multimodality imaging approach. Materials and Methods: A prospective observational study was conducted over a period of 12 months at a tertiary care hospital. A total of 120 adult patients (aged 20–70 years) presenting with upper abdominal pain were enrolled. All patients underwent routine ultrasonography (USG) abdomen and contrast-enhanced CT (CECT) abdomen. In addition, CECT thorax was performed in all patients to evaluate for concurrent thoracic pathology. Radiological findings were analyzed by two independent radiologists. Pathologies were categorized as abdominal-only, thoracic-only, or combined thoracoabdominal. Results: Out of 120 patients, 82 (68.3%) had identifiable abdominal pathology on USG/CECT abdomen. CT thorax revealed additional thoracic pathologies in 36 patients (30%), of which 21 cases (17.5%) were clinically significant and altered the diagnostic impression and management plan. Detected thoracic abnormalities included pleural effusion (n=12), basal consolidation (n=10), lower lobe pulmonary embolism (n=3), and pericardial effusion (n=4). Notably, 14 patients with non-specific abdominal findings were ultimately diagnosed with thoracic pathology as the primary cause of pain. The inter-observer agreement for CT thorax findings was high (κ = 0.89). Conclusion: CT thorax serves as a valuable adjunct in the evaluation of upper abdominal pain, especially when initial abdominal imaging is inconclusive. A multimodality imaging protocol that includes thoracic assessment enhances diagnostic yield and guides comprehensive patient management in cases with overlapping thoracoabdominal symptomatology.

Background: Inflammation and metabolic dysregulation have been implicated in the pathophysiology of Major Depressive Disorder (MDD). C-reactive protein (CRP) and lactate dehydrogenase (LDH) are peripheral biomarkers with emerging relevance in mood disorders, yet their diagnostic and prognostic utility remains underexplored. Methods: We conducted a retrospective case–control study at Vilasrao Deshmukh Government Medical College, Latur, analyzing 145 participants (72 MDD patients, 73 age- and sex-matched healthy controls) from March 2022 to March 2024. Serum CRP and LDH levels were measured using turbidimetric immunoassay and NADH oxidation method, respectively. Group comparisons were performed using independent samples t-tests, while correlations with Hamilton Depression Rating Scale (HDRS) scores and suicidal ideation were assessed via Pearson’s and Spearman’s coefficients. Receiver operating characteristic (ROC) analysis was used to evaluate predictive performance. Results: CRP levels were significantly elevated in MDD cases compared to controls (5.82 ± 1.42 mg/L vs. 2.61 ± 1.03 mg/L, p < 0.00001), while LDH levels were significantly reduced (158.0 ± 18.0 U/L vs. 182.1 ± 15.0 U/L, p < 0.00001). However, neither biomarker correlated significantly with HDRS scores (CRP: r = 0.08; LDH: r = 0.06) or suicidal ideation (CRP: AUC = 0.57; LDH: AUC = 0.56). Effect sizes for group differences were large (Cohen’s d = 2.30 for CRP, –1.41 for LDH). Conclusions: CRP and LDH may serve as accessible diagnostic biomarkers for distinguishing MDD from healthy states, but their limited association with symptom severity and suicidal ideation restricts their utility in risk stratification. Broader, multimodal biomarker frameworks are needed for clinical application in personalized psychiatry.

Background: The present study is conceived to reveal the relationship between serum acid and HDL-C in depression and to explore the role of uric acid to HDL –C ratio (UHR) in depression.  In humans, uric acid is the end product of purine metabolism. Uric acid is associated with different functions such as regulation of blood pressure, protection of DNA, acts as anti- aging factor and antioxidant. High-density lipoprotein cholesterol (HDL-C) is the most important lipoprotein in the human brain. It promotes removal of dietary cholesterol through the reverse cholesterol transport pathway and possesses anti-inflammatory and antioxidant properties, regulates neurodegeneration, and affects brain function. Considering the varied role played by uric acid and (HDL-C, it attracts to explore their role in depression.  Methods: This case control study includes the Diagnosed and drug naive depressive patients aged between 20 to 60 years, attending the psychiatry OPD at Vilasrao Deshmukh Government Medical College, Latur between 2021 to 2023. Concentration of uric acid and HDL-C  in serum of both control and cases, were quantified using uricase peroxidase coupled method and direct HDL method.The data thus obtained was analyzed by using SPSS -20 software, one way ANOVA and chi- square test.  Result: In this study, lower levels of uric acid and HDL –C were found to be related to the prevalence of depressive symptoms. The study also found that UHR is significantly associated with a higher risk of depression. Conclusion: Although the impact of UHR levels on risk of depression is complex. UHR may have a potential role in the occurrence of depression.

Vibrio cholerae, a Gram-negative bacterium inhabiting aquatic environments, remains a significant global health concern, particularly in regions with inadequate sanitation. This paper delves into the intricate pathogenesis of cholera, focusing on the key virulence factors that enable V. cholerae to colonize the human intestine and elicit the characteristic profuse watery diarrhea. We explore the diverse epidemiological patterns of cholera outbreaks, highlighting the roles of environmental reservoirs, transmission routes, and the emergence of new serotypes and antibiotic resistance. Finally, we discuss current challenges and future perspectives in cholera prevention and control, including advancements in vaccine development, sanitation strategies, and our understanding of bacterial evolution.

Background: Congenital heart disease (CHD) frequently requires early surgical correction under cardiopulmonary bypass (CPB), which is known to disrupt thyroid hormone balance, leading to non-thyroidal illness syndrome (NTIS). Thyroid hormones are vital for cardiac performance, metabolism, and hemodynamic stability, especially in infants. This study evaluates the role of perioperative oral thyroid hormone supplementation in improving thyroid profiles and clinical outcomes in infants undergoing open-heart surgery for CHD. Material and Methods: A prospective, randomized, double-blinded controlled trial was conducted from June 2022 to June 2024 at U.N. Mehta Institute of Cardiology, Ahmedabad. A total of 100 infants (≤1 year) undergoing CHD surgery under CPB were randomized into two groups: Group T (n=50) received oral thyronorm (10 mcg/kg preoperatively and 5 mcg/kg daily postoperatively for 4 days), and Group P (n=50) received placebo. Serum levels of T3, T4, and TSH were measured preoperatively and at 6, 24, 48, and 72 hours postoperatively. Secondary outcomes included vasoactive inotropic score (VIS), cardiac function, time to extubation, and ICU stay. Results: Thyronorm supplementation significantly elevated serum T3 and T4 levels postoperatively at 24, 48, and 72 hours (p < 0.001) compared to the placebo group. However, there was no statistically significant difference between groups in TSH levels, VIS, cardiac function, duration of mechanical ventilation, or ICU length of stay (p > 0.05 for all comparisons). Conclusion: Perioperative oral thyronorm effectively restored thyroid hormone levels in infants undergoing cardiac surgery under CPB. However, it did not significantly improve clinical outcomes such as inotropic requirement, extubation time, or ICU stay. Routine use may be unnecessary in low-risk infants but could be explored further in complex or high-risk surgical categories.

Background: Postoperative pain and edema are common challenges that impair recovery and patient comfort following surgical procedures. Corticosteroids like dexamethasone, known for their anti-inflammatory properties, have been increasingly used to minimize these adverse outcomes. This study aims to evaluate the effectiveness of a single preoperative dose of intravenous dexamethasone in reducing postoperative pain and facial edema in patients undergoing elective surgeries under general anesthesia. Materials and Methods: A prospective, randomized clinical trial was conducted on 60 patients aged 18–60 years scheduled for elective surgeries. Participants were randomly divided into two groups: Group A (n=30) received 8 mg IV dexamethasone preoperatively, and Group B (n=30) received a placebo (normal saline). Pain intensity was measured using a Visual Analog Scale (VAS) at 6-, 12-, and 24-hours post-surgery. Facial edema was assessed using standardized linear facial measurements at baseline, 24 hours, and 48 hours postoperatively. Statistical significance was set at p<0.05. Results: Group A showed significantly lower pain scores at 6, 12, and 24 hours (mean VAS scores: 3.2, 2.5, 1.7 respectively) compared to Group B (mean VAS scores: 5.4, 4.7, 3.9; p<0.01). Similarly, edema was markedly reduced in the dexamethasone group with a mean increase in facial measurements of 3.5 mm at 24 hours and 1.2 mm at 48 hours, compared to 6.8 mm and 3.7 mm respectively in the placebo group (p<0.05). Conclusion: A single preoperative dose of intravenous dexamethasone significantly reduces postoperative pain and edema. This intervention is simple, cost-effective, and enhances postoperative comfort, advocating its routine use in anesthesia protocols for elective surgeries.

Background: Dietary habits significantly influence lipid metabolism and are associated with varying risks of cardiovascular diseases. Vegetarian diets, often low in saturated fat and high in dietary fiber, are hypothesized to have a favorable effect on serum lipid profiles. This study aimed to compare the serum lipid parameters between vegetarian and non-vegetarian individuals to evaluate their potential impact on cardiovascular risk. Materials and Methods: A cross-sectional comparative study was conducted involving 100 participants, equally divided into two groups: vegetarians (n = 50) and non-vegetarians (n = 50), aged between 25 and 55 years. Participants were recruited from urban health centers after informed consent. Fasting venous blood samples were collected, and serum lipid profiles, including Total Cholesterol (TC), Triglycerides (TG), Low-Density Lipoprotein Cholesterol (LDL-C), and High-Density Lipoprotein Cholesterol (HDL-C), were estimated using an automated enzymatic colorimetric method. Statistical analysis was performed using the Student’s t-test with a significance level set at p < 0.05. Results: The mean serum Total Cholesterol level in vegetarians was 162.4 ± 24.1 mg/dL, significantly lower than 193.6 ± 30.2 mg/dL in non-vegetarians (p = 0.001). LDL-C was also reduced in vegetarians (98.5 ± 18.7 mg/dL) compared to non-vegetarians (121.7 ± 21.5 mg/dL; p = 0.003). Mean HDL-C was higher among vegetarians (52.3 ± 6.4 mg/dL) than non-vegetarians (46.1 ± 7.1 mg/dL; p = 0.015). Triglyceride levels were lower in vegetarians (102.6 ± 19.3 mg/dL) than in non-vegetarians (138.9 ± 26.7 mg/dL; p = 0.002). Conclusion: The study indicates that individuals following a vegetarian diet exhibit a more favorable lipid profile compared to non-vegetarians, suggesting a potentially lower risk of developing cardiovascular diseases. Adopting plant-based dietary patterns may serve as a preventive strategy in lipid-associated disorders.

Background: Sleep plays a critical role in maintaining physiological homeostasis, including the regulation of oxidative stress. Disruption in sleep patterns has been linked to altered levels of antioxidant defense enzymes, which may predispose individuals to various health conditions. This study aimed to estimate and compare the levels of key antioxidant enzymes—superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx)—in individuals with regular and irregular sleep habits. Materials and Methods: A cross-sectional analytical study was conducted on 60 healthy adult participants aged 18–40 years, divided into two groups based on their sleep patterns: Group A (n=30) included individuals with regular sleep patterns (7–8 hours of consistent sleep per night), and Group B (n=30) comprised individuals with irregular sleep patterns (sleep duration <6 hours or variable sleep schedules). Blood samples were collected and analyzed for serum levels of SOD, CAT, and GPx using standard spectrophotometric methods. Statistical comparisons between the groups were performed using an independent t-test, with a significance level set at p<0.05. Results: The mean serum SOD level was significantly higher in Group A (4.8 ± 0.6 U/mL) compared to Group B (3.1 ± 0.5 U/mL). Similarly, CAT levels were elevated in Group A (32.4 ± 4.2 kU/L) versus Group B (21.6 ± 3.8 kU/L). GPx levels also followed a similar trend, with Group A recording 56.9 ± 6.5 U/L and Group B showing 39.2 ± 5.7 U/L. All differences were statistically significant (p<0.01), indicating reduced antioxidant activity in individuals with irregular sleep patterns. Conclusion: The study highlights a significant reduction in antioxidant enzyme levels among individuals with irregular sleep habits, suggesting a potential link between poor sleep and increased oxidative stress. Promoting healthy and consistent sleep patterns may be crucial in preserving antioxidant defense mechanisms and overall health.

Background and Objectives: Accurate imaging of the upper airway is essential for both pre-anaesthetic assessment and the diagnosis of laryngeal pathologies. This study evaluates the role of different imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound in assessing airway patency, anatomical variations, and laryngeal lesions. Materials and Methods: A prospective study was conducted on 100 patients undergoing pre-anaesthetic evaluation or presenting with symptoms suggestive of laryngeal disorders. All patients underwent standard airway examination followed by imaging with CT, MRI, or ultrasound as appropriate. The imaging results were compared with clinical examination and intraoperative findings where applicable. Results: CT provided excellent detail of bony and cartilaginous structures and was most effective in identifying tracheal narrowing and subglottic lesions. MRI was superior in soft tissue contrast and helpful in evaluating neoplastic lesions of the larynx. Ultrasound was a valuable, non-invasive tool for assessing vocal cord mobility and thyroid cartilage integrity in cooperative patients. Imaging changed clinical management in 28% of cases. Conclusions: Imaging of the upper airway plays a vital role in enhancing the safety and accuracy of pre-anaesthetic evaluation and in diagnosing laryngeal afflictions. Each modality offers distinct advantages, and the choice should be tailored based on clinical indications and resource availability

Background and Objectives: Breast lesions are a common diagnostic challenge. While B-mode ultrasound is widely used for initial evaluation, ultrasound elastography (UE) has emerged as a complementary technique to differentiate benign from malignant lesions based on tissue stiffness. This study aims to assess the diagnostic utility of strain and shear wave elastography in characterizing focal breast lesions. Materials and Methods: This prospective observational study included 100 female patients with palpable or imaging-detected breast lesions referred for sonographic evaluation. Each underwent B-mode ultrasound followed by elastography. Lesions were categorized using BI-RADS and elastography scoring systems. Histopathology or FNAC was used as the reference standard. Diagnostic parameters including sensitivity, specificity, PPV, NPV, and accuracy were calculated. Results: Of the 100 lesions evaluated, 68 were benign and 32 were malignant on histopathology. Elastography showed significantly higher stiffness values in malignant lesions (mean elasticity score: 4.3 ± 0.5) compared to benign ones (2.1 ± 0.6, p < 0.001). The sensitivity and specificity of elastography were 91% and 85%, respectively, with a diagnostic accuracy of 88%. A cut-off strain ratio of >3.0 yielded the best discriminatory value. Ultrasound elastography changed management decisions in 27% of cases. Conclusions: Ultrasound elastography is a valuable adjunct to conventional B-mode imaging in differentiating benign from malignant breast lesions. It enhances diagnostic confidence and may reduce unnecessary biopsies when interpreted alongside clinical and sonographic findings

Background: Total hip replacement (THR) is commonly used to manage neck of femur fractures in the elderly, aiming to reduce pain and restore function. This study compares intraoperative blood loss among cemented, uncemented, and hybrid THR techniques to assess whether the fixation method impacts bleeding. Understanding these differences can help guide surgical decisions and improve patient outcomes. Materials and Methods: A prospective comparative study was conducted on 90 patients aged 60–85 years with femoral neck fractures undergoing elective total hip replacement (THR) under subarachnoid block at the Department of Orthopaedics, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. Patients were divided into three equal groups: cemented THR, hybrid THR, and uncemented THR. Inclusion and exclusion criteria ensured a homogeneous sample. Intraoperative blood loss was measured using gravimetric and suction methods. Postoperative drain output was recorded for 24 hours. Hemodynamic parameters and laboratory values (hemoglobin and hematocrit) were monitored pre- and postoperatively. Statistical analysis was performed with significance set at p < 0.05. Results: The study participants were distributed across three groups (cemented, hybrid, and uncemented THR) with comparable baseline demographics, including age, gender, side of involvement, and BMI (p > 0.05). Mean perioperative blood loss was 1106.16 ± 113.82 mL in the cemented group, 1116.69 ± 173.65 mL in the hybrid group, and 1087.34 ± 264.56 mL in the uncemented group. Statistical analysis showed no significant difference in blood loss among the three groups (p = 0.839). Conclusion: This study found no significant difference in blood loss between cemented, uncemented, and hybrid total hip replacements for neck of femur fractures. Therefore, blood loss should not be a primary factor in choosing the fixation method. The choice should be based on individual patient factors such as bone quality, age, implant longevity, and risk of cement-related or periprosthetic complications.

Background: Aim: The study was conducted to find out the temporal relationship of administration of these two drugs to establish if there exists a significant reduction in required Propofol dose and if it further decreases the associated side effects of Propofol. Methods: This was a randomized prospective clinical study conducted on patients aged >18 and <60 years belonging to American Society of Anaesthesiologists (ASA) status 1 and 2 and undergoing elective oncosurgeries under general anaesthesia. After obtaining approval from the ethics committee, data was collected from patients who were admitted to Kidwai Memorial Institute of Oncology from February 2021 to December 2021.  Results: Most of the study subjects belonged to the age group of 51-60 years (45%). All 3 groups were comparable in terms of mean age and weight. The incidence of hypotension was compared between the 3 groups and it was found that hypotension was seen in the least in Group C with a statistical significance of p=0.048. Requirement of additional Propofol doses was found to be least among subjects of Group C (p<0.00001) which was a highly significant statistical finding. The baseline values between the three groups showed no statistical significance, compared to Group A and B, Group Chad least fluctuation in MAP with statistical significance (p values<0.05). The heart rate (HR) was also found to be comparable between the groups A and B in the induction period.  Conclusion: Our study found that Propofol administered 5 min after administering Fentanyl in a dose of 1 μg/kg was most effective in attenuating the hemodynamic response to laryngoscopy as well as skin incision. We also found that additional doses of Propofol required for induction of anaesthesia was significantly reduced when administered after Fentanyl. There was no significant respiratory depression, bradycardia, oxygen desaturation or respiratory complications in any of the groups. There were no serious complications encountered in our study.

Background: Cholelithiasis, or gallstone disease, is a prevalent digestive disorder affecting approximately 20 million individuals in the U.S., with a rising prevalence in India due to changing dietary habits. It is characterized by episodic biliary colicky pain and can lead to serious complications in 20–25% of cases. While open cholecystectomy was the traditional treatment, laparoscopic cholecystectomy (LC) has become the preferred method due to its advantages, including reduced surgical trauma and quicker recovery. However, challenges such as prolonged operative time and potential complications necessitate understanding predictive factors to enhance surgical outcomes and patient safety.  Objectives: To explore the epidemiological trends, clinical manifestations, and therapeutic advancements in cholelithiasis while emphasizing the importance of understanding predictive variables that influence the difficulty of laparoscopic cholecystectomy. Materials & methods: The present study was a prospective study conducted at the Government Medical College, Patiala, involving 75 cases who were admitted for elective LC. Informed written consent was obtained from all participants. A comparison of preoperative factors and intraoperative difficulty levels was conducted to enhance understanding of surgical outcomes. Data analysis was performed using SPSS software to interpret the results. Results: This study evaluated laparoscopic cholecystectomy difficulty among 75 participants, revealing that 54.7% underwent "Easy" procedures, 30.7% "Difficult," and 14.7% "Very Difficult." Key factors influencing surgical complexity included older age, male gender, prolonged pain, and recent acute attacks. Ultrasound findings showed significant associations with gallbladder condition, stone characteristics, and wall thickness affecting difficulty levels. The majority had normal gallbladders, and most surgeries lasted under an hour, with a minimal conversion rate to open surgery (8%). Recognition of these factors aids in optimizing surgical approaches and enhancing patient outcomes. Conclusion: The study revealed significant correlations between surgical difficulty in laparoscopic cholecystectomy and factors such as older age, male gender, prolonged mild pain, and recent acute attacks. Ultrasound findings indicated that over-distended gallbladders, single large stones, stones in the neck, and increased gallbladder wall thickness contributed to surgical challenges. Recognizing these factors can aid surgeons in optimizing their approach, potentially reducing operative times and complications, thus improving patient outcomes.

We report the case of a 70-year-old male smoker who presented with inferior ST-elevation myocardial infarction (STEMI). Coronary angiography revealed total occlusion of the proximal right coronary artery (RCA). Primary percutaneous coronary intervention (PCI) was performed, including thrombus aspiration and drug-eluting stent implantation, achieving TIMI III flow. However, post- deployment angiography revealed a distal stent fracture and the presence of an underlying myocardial bridge, previously obscured by vessel occlusion and tortuosity. A second drug-eluting stent was successfully deployed across the fractured segment, with good final angiographic outcomes. The patient's hospital course was uneventful, and he was discharged in stable condition. This case highlights the unique and challenging scenario of myocardial infarction complicated by myocardial bridging and subsequent stent fracture. It underscores the importance of recognizing anatomical variants like myocardial bridges that can predispose to mechanical stress and stent failure, even in primary PCI settings. Careful lesion assessment, stent optimization, and high clinical vigilance are critical in managing such complex interventions

Background: Ocular physiology plays a central role in the detection and progression of many eye diseases. Physiological parameters such as intraocular pressure (IOP), tear film break-up time (TBUT), central corneal thickness (CCT), ocular blood flow (OBF), and pupillary reflex responses offer objective metrics essential for accurate diagnosis and patient monitoring. This study aims to assess the clinical utility of these parameters in diagnosing glaucoma, dry eye syndrome, and optic neuritis. Materials and Methods: A hospital-based, cross-sectional study was conducted on 200 subjects categorized into four groups: glaucoma, dry eye syndrome, optic neuritis, and healthy controls (n=50 each). Each participant underwent detailed ophthalmic evaluation, including IOP measurement, TBUT testing, pachymetry, ocular blood flow assessment via color Doppler imaging, and pupillary reflex testing. Statistical analysis was performed using SPSS v26.0 with ANOVA and Pearson’s correlation tests. Results: Significant intergroup differences were observed. Glaucoma patients exhibited the highest mean IOP (23.32 mmHg) and lowest OBF (9.06 cm/s). Dry eye patients showed markedly reduced TBUT (5.98 seconds). Central corneal thickness was thinnest in glaucoma (519.03 µm), while optic neuritis patients had the most prolonged pupillary reflex times (351.52 ms). Control subjects had normal physiological ranges across all parameters. Conclusion: Physiological parameters are vital tools in diagnosing and managing ocular disorders. Integrating these objective measures into routine clinical assessments can enhance early detection, guide treatment, and improve patient outcomes.

Background: Anatomy education, especially the head and neck module, poses significant learning challenges due to its complexity and clinical relevance. Traditional lecture-based methods often result in passive learning and limited retention. The flipped classroom model, which shifts foundational learning to pre-class preparation and uses in-class time for active learning, has shown promise in improving engagement and academic performance. This study evaluates the impact of flipped classroom teaching on student performance and perception in head and neck anatomy among Phase I MBBS students. Methods: A quasi-experimental, crossover study was conducted among 100 Phase I MBBS students at A.S.J.S.A.T.D.S. (A.S.M.C.) Medical College, Fatehpur (U.P.). The cohort was split into two groups, alternating between traditional lectures and flipped classroom sessions over four weeks. Pre-recorded videos, reading materials, and quizzes were shared prior to flipped sessions. Academic performance was assessed using pre- and post-tests. Student perceptions were captured through validated questionnaires and qualitative feedback. Statistical analyses included paired t-tests and repeated measures ANOVA. Results: Ninety-eight students completed the study (98% response rate). The flipped classroom group showed a greater mean score improvement (18.2%) compared to the traditional lecture group (12.5%). Post-crossover analysis confirmed superior performance with the flipped model. Student perception data revealed high engagement (82%), improved understanding (76%), and enhanced assessment preparedness (68%). Qualitative feedback emphasized appreciation for peer discussions, initial reluctance, and eventual adaptation to the flipped format. Conclusion: The flipped classroom approach significantly enhances learning outcomes and student engagement in head and neck anatomy compared to traditional lectures. While implementation requires careful planning, it offers a scalable and effective strategy for medical education reform. Future studies should focus on long-term retention and subject-specific adaptations.

Background: To assess the prognostic utility of plasma NT-proBNP levels in predicting 28-day mortality in patients diagnosed with acute respiratory distress syndrome (ARDS) admitted to the intensive care unit (ICU). Methodology: This prospective observational study was conducted over 11 months in the medical and surgical ICUs of a tertiary care hospital in Thiruvananthapuram. A total of 80 adult patients diagnosed with ARDS as per the Berlin Definition and admitted to the ICU were enrolled. Plasma NT-proBNP levels were measured within 24 hours of ARDS diagnosis. Clinical data including APACHE II and SOFA scores, comorbidities, and outcomes were recorded. The primary outcome was 28-day mortality. ROC analysis was performed to determine the predictive value of NT-proBNP. Results: Of the 80 patients, 38 (47.5%) died within 28 days. The median NT-proBNP level was significantly higher in non-survivors (4330.50 pg/mL; IQR: 3140.25–8240.75) compared to survivors (995.50 pg/mL; IQR: 654–2729.25), with a p-value < 0.001. ROC curve analysis showed that NT-proBNP had an area under the curve (AUC) of 0.868 (95% CI: 0.790–0.947), with a cut-off of 2491.50 pg/mL providing a sensitivity of 86.5% and specificity of 76.7% for predicting mortality. Conclusion: Elevated plasma NT-proBNP levels are significantly associated with 28-day mortality in ARDS patients and demonstrate strong prognostic accuracy. NT-proBNP may serve as a valuable biomarker for early risk stratification and outcome prediction in critically ill ARDS patients.

Background: National initiatives have emphasized the use of autogenous arteriovenous fistulas (AVFs) for hemodialysis, but their purported benefits have been questioned. Objective To examine AVF short-term patency rates over 6 months in a Tertiary Care center. Materials and Methods This was a prospective study conducted at Tertiary Care center (Government Medical College and Hospital, Aurangabad) in Maharashtra to identify factors associated with AVF maturation. A total of 32 participants were enrolled (all with chronic kidney disease [CKD]) whom AV Fistula was created and patents were followed 1 month, 3 month and 6 month and fistula patency was assed manually and by USG. Results: Out of patients evaluated (n = 32) were men (22 [68.75%]) and 10 were female. In 24 patients AV fistula was created at wrist (Radio-Cephalic AV Fistula) and remaining 8 AV fistula was created at elbow (Brachio-Median Cuboital / Basilic AV Fistula). The AVF patency rates for CKD participants were 32% at 1 month, 69% at 3 months, and 81% at 6 months. The median time from access creation to maturation was 81 days. Conclusions: The findings of this study suggest that AV Fistula remains an accepted and important option as an access for hemodialysis with good patency rates.

Introduction: The prevalence of chronic kidney disease is rising globally because of numerous contributing variables, such as lower urinary tract blockage, urinary stones, co-morbidities, and sepsis. Monitoring is required for several indicators, including blood pressure, blood sugar, renal function tests, etc. The high mortality rate of urosepsis in CKD necessitates the early identification of the sepsis-causing organisms and the determination of antibiotic sensitivity to identify resistant species. Taking this into consideration, the study was conducted accordingly. Aim and Objectives: To study the microbiological spectrum, antimicrobial-resistant pattern, and treatment involved in urosepsis of CKD patients. Materials and methods: A total of 100 CKD patients were included in the study; detailed history was obtained, and clinical examination was done. Blood and urine samples were collected and sent to the microbiology laboratory for further processing. After culture sensitivity, empirical treatment was accordingly changed, and results were observed. Results: The most often isolated organism in blood and urine cultures was E. coli. The most frequent organism that caused death was Candida. The common drugs to which the patients responded were cefeperozone-sulbactum and meropenem. Conclusion: In conclusion, microbiological tests such as blood and urine cultures are crucial for the early detection of urosepsis in patients with chronic kidney disease (CKD) and the precise delivery of antibiotics.

Background: Levonorgestrel releasing intrauterine device (Mirena) is a 52 mg device which is used for various gynecological condition beside contraception like heavy menstrual bleeding, dysmenorrhea and endometrial hyperplasia and can be used effectively rather than hysterectomy. Studies have suggested IUD expulsion of 2-10 %. there is an increased rate of expulsion in when used for gynecological conditions compared to when used for contraception. Material and method: A prospective study of 56 patients for rate of levonorgestrel IUD expulsion when inserted for gynecological conditions and factors contributing to the expulsion of IUD. Result: Out of 56 patients inserted with levonorgestrel IUD, 9 patients had IUD expulsion accounting for 16% and 5 patients had it removed voluntarily. The rate of expulsion is more in cases of fibroids compared to other gynecological condition. Conclusion: In the study conducted overall rate of expulsion was 16.07% within 6 months of insertion. The levonorgestrel IUD is an effective treatment for various gynecologic conditions.

Background: Helicobacter pylori–induced chronic inflammation plays a central role in gastric carcinogenesis, yet the progression from histologic precursors to gastric adenocarcinoma remains under-characterized in semi-urban Indian populations. Methods: We conducted a prospective cohort study of 80 patients with biopsy-confirmed H. pylori infection at Government Medical College, Jangaon, Telangana, from August 2023 to August 2025. Patients underwent serial endoscopic and histopathologic evaluations every 6 months. Histological features, including inflammation, intestinal metaplasia, and dysplasia, were recorded. The primary outcome was the development of gastric adenocarcinoma at 24 months. Logistic regression and Kaplan–Meier analyses were performed using SPSS v27. Results: At baseline, 26.2% of patients had intestinal metaplasia and 11.2% had dysplasia. Over 24 months, 6.2% (n=5) developed gastric adenocarcinoma. Patients with baseline dysplasia had a fivefold higher relative risk of progression (RR=5.26; 95% CI, 1.01–27.37; p=0.17). Logistic regression identified both dysplasia (OR=17.04; p=0.057) and metaplasia (OR=22.21; p=0.053) as strong, near-significant predictors of malignancy. Kaplan–Meier analysis showed lower cancer-free survival in patients with dysplasia, with clear curve separation after 12 months. Conclusions: Histological dysplasia and intestinal metaplasia at baseline significantly increased the risk of gastric cancer in H. pylori–positive patients. Targeted surveillance based on early histologic markers may be critical for preventing malignant transformation in endemic settings.

Background: -This study aimed to evaluate the effectiveness and side effects of methylene blue injection into the perianal skin of patients with chronic refractory idiopathic pruritus ani (IPA). Traditional treatments, such as topical steroid ointments, antihistamines, and sedatives, are often ineffective in the long term due to high recurrence rates. Methylene blue, known for its neurolytic properties, may help disrupt the itch-scratch cycle by targeting nerve endings. If proven effective with minimal side effects, this approach could offer a promising alternative for managing IPA. Methods: -This study included patients with idiopathic pruritus ani (IPA) who did not respond to standard perianal skin care advice and treatment of associated conditions. A total of 15 mL of 1% methylene blue solution was injected intradermally into the affected perianal area, extending up to the dentate line, using a 10 mL syringe with a 22-gauge needle. Symptom severity was evaluated using a patient symptom score ranging from 1 to 5, with 1 indicating the worst symptoms Results: -From June 2023 to September 2024, 20 patients with idiopathic pruritus ani (IPA) were included in the study. In all cases, symptoms resolved within four weeks. Temporary numbness of the perianal area and tattooing disappeared within 3–4 weeks, with no instances of skin necrosis or anaphylaxis observed. The median follow-up period was six months. Anal itching recurred in 12 patients, with six reporting a less severe recurrence and the other six experiencing no change in symptom severity. Overall, 10 out of 20 patients reported significant improvement or complete resolution of pruritus ani. Conclusion: -The intradermal injection of a 1% methylene blue solution had a positive effect on idiopathic pruritus ani (IPA), with all patients experiencing mild sensory cutaneous innervation side effects within the first four weeks. At six months, the treatment achieved a 20% success rate.

Background: Mammary analogue secretory carcinoma (MASC) is defined as a rare lump of salivary gland that most generally affects the parotid gland, followed by the submandibular gland and also other minor salivary glands. Since 2017, MASC has been included in the World Health Organization's ( WHO) Bracket of Head and Neck Tumors. It's a  veritably rare subtype of  malignancy of salivary gland. Here we report a case of a 13 yr old female who presented to ENT OPD with right side parotid swelling, managed surgically and diagnosed as secretory carcinoma parotid on HPE.

Background: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are significant global public health threats, often remaining asymptomatic until advanced disease stages. Dental procedures, due to their invasive nature and exposure to blood and saliva, present a potential risk for transmission of these bloodborne pathogens. This study aimed to determine the incidence of HBsAg and HCV positivity among patients undergoing routine blood screening before dental procedures at a tertiary care center in Bihar. Methods: A retrospective study was conducted by reviewing archived blood investigation records of dental outpatients at the Dental Department of Nalanda Medical College & Hospital, Patna. The records of 500 patients were randomly selected who underwent routine blood investigations including CBC, RBS, BT, CT, PT, INR, and viral markers (HIV 1 & 2, HBsAg, and HCV). Descriptive statistics were used to report prevalence. Results: Among 500 screened patients, 3 (0.6%) were HBsAg positive, and 1 (0.2%) was HCV positive. No HIV cases were detected. Males accounted for the majority of positive cases. Conclusion: The study highlights the need for mandatory viral screening in dental settings to ensure patient and staff safety. Early detection can support timely referral and reduce transmission risk.

Background: Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2, exhibits a broad spectrum of clinical presentations, from asymptomatic infection to severe disease requiring intensive care. Hematological and biochemical parameters are valuable tools for assessing disease severity and guiding clinical management. Objective: To evaluate and compare hematological and biochemical parameters in COVID-19 positive patients based on gender and admission status (ICU vs  Non - ICU). Methods: A retrospective observational study was conducted on 477 COVID-19 RT-PCR positive patients admitted at Rajiv Gandhi Super Speciality Hospital (RGSSH) , OPEC , Raichur Institute of Medical Sciences (RIMS) , Raichur, a tertiary care hospital between June 2021 and May 2022. Demographic, hematological, and biochemical data were collected and analyzed using descriptive statistics and independent t-tests. Results: Of the 477 patients, 61% were male and 39% female. ICU admissions accounted for 44.9% of cases. ICU patients had significantly higher neutrophil-to-lymphocyte ratio (NLR), total leukocyte count (TLC), and neutrophil percentage, and lower lymphocyte and monocyte percentages compared to Non-ICU patients (p < 0.05). Liver function parameters, including bilirubin, transaminases, albumin, and LDH, did not show statistically significant differences between ICU and Non-ICU patients or between genders. Conclusion: Hematological parameters, especially NLR, TLC, and Differential Counts, showed significant variations with disease severity, supporting their role as accessible prognostic markers. Liver function parameters did not significantly correlate with disease severity or gender in this cohort.

Background: The COVID-19 pandemic, caused by SARS-CoV-2, has been associated with a wide range of clinical presentations, ranging from asymptomatic cases to severe respiratory failure. Inflammatory biomarkers such as C-reactive protein (CRP), D-dimer, and Ferritin have been recognized as important indicators of disease severity and prognosis. This study is aimed to evaluate the levels of these biomarkers in COVID-19-positive patients and correlate them with demographic parameters and clinical outcomes. Methods: A Retrospective Observational Study was conducted in the Department of Pathology, Central Laboratory, RGSSH, OPEC, RIMS, Raichur, from June 2021 to May  2022. A total of 400 COVID-19-positive patients were included. Data on CRP, D-Dimer, and Ferritin levels were collected and analyzed concerning gender, age group, and clinical outcome (ICU vs. ward admission). Results: Of the 400 patients, 58.3% were male and 41.7% were female. The majority belonged to the age group of 41–60 years. Statistically significantly higher levels of CRP (p = 0.02) and D-dimer (p < 0.001) were observed in ICU patients compared to ward patients, while the difference in ferritin levels was not statistically significant (p=0.142). There was no significant association of biomarker levels with gender. However, D-dimer levels showed a significant correlation with age (p = 0.004), with the highest levels in patients above 80 years. Conclusion: Elevated CRP and D-dimer levels are significantly associated with severe COVID-19 infection and ICU admission. These biomarkers may serve as valuable tools for the early identification of high-risk patients, aiding in timely clinical decision-making. Regular monitoring of these markers is recommended to improve patient outcomes.

Introduction: reproductive and sexual health is one of the topics which is scarcely discussed in india. Increasing age gap between the age of puberty and marriage, early sexual activity and inadequate knowledge might lead to risk of STD and unwanted pregnancy Objective – this study was done to know the extent of awareness about reproductive health, contraception and STD’s  among adolescent girls aged between 11-19yrs  Methods- it’s a prospective observational study carried out among 400 girl students between age 11-19yrs using a structured pre designed multiple choice questionnaire , analysis was done using spss software Results- among 400 participants 26.5% were sexually active , 62%knew about condoms, more than 2 methods of contraception was known to 22% of girls. In our study 47.5% of girls didn’t have an idea about routes of transmission of STD’s. among all participants who were having knowledge of STD’s HIV was most commonly known.in our study 72.25% didn’t have an idea of HPV vaccine Conclusion- poor knowledge in girls about reproductive health contraception and STD’s is of serious concern. Therefore, education about contraception should be incorporated in the curriculum which should be given through teaching, interpersonal communication, television, health camps and specialists.

Introduction: Hydatid disease, caused by Echinococcus granulosus, remains a significant public health concern in endemic regions. This study aimed to evaluate the prevalence, organ involvement, clinical presentation, and diagnostic patterns of hydatid disease in a tertiary care setting in northern Chhattisgarh. Methods: A cross-sectional study was conducted over 18 months among 35 patients diagnosed with hydatid disease at a tertiary hospital. Data on demographics, exposure history, clinical presentation, organ involvement, diagnostic modalities, and statistical associations were recorded and analyzed. Results: The mean age of patients was 41.86 ± 18.17 years, with a slight female predominance (54.3%). Most patients (80%) were from rural areas and 51.4% reported contact with street dogs. The liver was the most commonly affected organ (74.29%), followed by the lungs (5.7%) and several rare sites (each ~2.9%). Abdominal pain and hepatomegaly were the most common symptoms. Ultrasonography was the primary diagnostic tool in 57.1% of cases, with CT used in 40%. No significant association was found between organ involvement and sex, or between dog contact and demographic variables. Conclusions: Hydatid disease remains prevalent in rural populations of India, with liver involvement predominating. Routine imaging, public education, and integrated control strategies remain essential for effective management and prevention.

Introduction: In order to reduce recurrence, mesh is the standard of care for ventral hernia repairs, which are among the most common operations performed globally. The usage of biologic meshes, which are considerably more expensive and have questionable performance, is growing in order to reduce the problems connected with synthetic mesh. Before recently, the majority of data that backed the use of biologic meshes came from retrospective cohorts that were highly biased and heterogeneous.V Our objective was to present a prospective interventional randomized case study that contrasted the results of biologic and synthetic mesh in elective open ventral hernia repair procedures. Methods: To compare biologic and synthetic mesh in elective open ventral hernia repairs, a case database of surgeries performed at RSDKS GMC hospital during the previous five years was gathered and evaluate the postoperative outcomes. Results: The study comprised 130 patients in total. Based on the Wound Classification I to IV, 58% of the patients had contaminated wounds. Biologic mesh patients had significantly higher risks of surgical site infections (P<0.3) and hernia recurrence (P <.00001). Both groups experienced comparabl rates of seroma, hematoma, and mesh removal. Conclusions: The use of biologic meshes was associated with a higher incidence of surgical site infections and hernia recurrences against synthetic mesh. As of right now, the best implant for elective open ventral hernia repair is macroporous, uncoated synthetic mesh; even in contaminated instances, this type of mesh should be taken into consideration.

Introduction: Objective: Determining the feasibility of early extubation in patients undergoing Intracardiac repair for congenital heart disease with severe pulmonary hypertension (PAH). Materials and methods- prospective study of 37 patients undergoing Intracardiac repair for congenital heart disease, with moderate to severe PAH from June 2023 to January 2025, with extubation time < 4 hours, operated in Government Medical College and Hospital, Chh. Sambhajinagar. Peri-operative use of PDE5 inhibitors and milrinone with intra-operative ultrafiltration. Results- Out of 37 cases: 19 (VSD+PAH); 9 (ASD+VSD+PAH); 8 (VSD+PDA), 1 (SUB-AORTIC MEMBRANE); 27 - Severe PAH; 10 - mild to moderate PAH; Age (3 months - 5 years) mean age - 2.1 yrs; Weight (2.2 kg - 19 kg) mean - 8.4 kg; Extubation time (50 min - 785 min) mean-121min. Conclusions: Peri-operative use of PDE5 inhibitors, milrinone, ultrafiltration, short CPB and cross-clamp time is effective in early extubation of pediatric cardiac patients, thereby resulting in early recovery, reduced ventilator-related complications, and decreased cost of patient care.

Introduction: Cardiovascular disease (CVD) remains a leading global health challenge. Dietary patterns, particularly vegetarian versus non-vegetarian diets, are known to influence cardiovascular risk factors through modulation of blood biomarkers. This study aimed to compare blood biomarkers associated with cardiovascular health in individuals adhering to vegetarian and non-vegetarian diets. Methods: A cross-sectional comparative study was conducted on 140 adults (70 vegetarians and 70 non-vegetarians) matched for age and gender. Anthropometric data, lipid profiles (total cholesterol, LDL, HDL, triglycerides), inflammatory markers (hs-CRP, homocysteine), blood pressure, and cardiovascular risk scores (Framingham Risk Score) were measured. Statistical comparisons between groups were performed using t-tests and chi-square tests with significance set at p < 0.05. Results: Vegetarians exhibited significantly lower BMI (23.9 vs. 26.3 kg/m²; p<0.001), total cholesterol (172.4 vs. 194.7 mg/dL; p<0.001), LDL cholesterol (101.8 vs. 123.2 mg/dL; p<0.001), triglycerides (115.7 vs. 141.9 mg/dL; p=0.0005), hs-CRP (1.72 vs. 3.15 mg/L; p<0.001), and homocysteine levels (8.95 vs. 11.30 µmol/L; p<0.001) compared to non-vegetarians. HDL cholesterol was higher in vegetarians (52.6 vs. 44.9 mg/dL; p<0.001). Blood pressure and Framingham Risk Scores were significantly lower among vegetarians. The prevalence of metabolic syndrome was also reduced (8.6% vs. 21.4%; p=0.023). Conclusion: Vegetarian diets are associated with improved cardiovascular biomarker profiles and reduced estimated cardiovascular risk. These results support the promotion of plant-based diets as a preventive strategy for cardiovascular disease.

Background: Benign Prostatic Hyperplasia (BPH) is a prevalent urological condition in aging men, often resulting in lower urinary tract symptoms (LUTS) such as urinary frequency, urgency, nocturia, and weak stream. Alpha-blockers like Tamsulosin improve urinary flow by relaxing smooth muscles, while 5-alpha-reductase inhibitors like Finasteride reduce prostate volume. This study aimed to evaluate the efficacy of combination therapy with Tamsulosin and Finasteride compared to monotherapy in improving LUTS in BPH patients. Materials and Methods: A total of 120 male patients aged 50–80 years with moderate to severe LUTS (IPSS ≥ 8) and prostate volume ≥30 mL were enrolled and randomly assigned into two groups. Group A (n=60) received Tamsulosin 0.4 mg daily, while Group B (n=60) received Tamsulosin 0.4 mg + Finasteride 5 mg daily. International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and post-void residual urine volume (PVR) were measured at baseline, 6 months, and 12 months. Statistical analysis was performed using paired t-test and ANOVA, with significance set at p<0.05. Results: At 12 months, Group B (combination therapy) showed a greater reduction in mean IPSS (from 21.3 ± 3.8 to 9.4 ± 2.6) compared to Group A (from 20.9 ± 4.2 to 13.1 ± 3.0) (p<0.01). Qmax improved significantly in Group B (from 9.8 ± 1.5 to 16.2 ± 2.3 mL/s) versus Group A (from 10.1 ± 1.7 to 13.8 ± 2.5 mL/s) (p=0.03). PVR was reduced more in Group B (from 85.5 ± 20.1 to 38.2 ± 14.6 mL) than in Group A (from 83.2 ± 22.3 to 52.9 ± 17.1 mL) (p=0.04). No serious adverse effects were reported in either group. Conclusion: Combination therapy with Tamsulosin and Finasteride significantly improves LUTS in BPH patients compared to Tamsulosin monotherapy. It leads to better symptom relief, improved urinary flow, and reduced post-void residual urine, supporting its use in patients with larger prostate volumes and moderate to severe LUTS.

Background: Tumor-infiltrating lymphocytes (TILs) represent a crucial component of the tumor microenvironment and play a significant role in antitumor immunity. Their presence has shown prognostic and predictive relevance across various epithelial cancers. This study aimed to perform a cross-sectional, quantitative assessment of TILs across major epithelial malignancies using AI-driven digital pathology algorithms. Materials and Methods: A total of 300 formalin-fixed, paraffin-embedded tissue sections from patients with histologically confirmed epithelial malignancies—including breast, lung, colorectal, and head & neck cancers—were retrospectively analyzed. Digitized whole-slide images (WSIs) were processed using a validated deep learning-based TIL quantification algorithm. TIL densities were calculated as the number of lymphocytes per mm² of stromal area. Statistical comparisons were made using one-way ANOVA followed by Tukey’s post hoc test, with p-values <0.05 considered statistically significant. Results: Among the 300 tumor samples, the mean TIL density (cells/mm²) was highest in triple-negative breast cancer (432.5 ± 65.3), followed by head and neck squamous cell carcinoma (387.4 ± 52.8), non-small cell lung carcinoma (296.8 ± 48.9), and colorectal adenocarcinoma (215.1 ± 41.2). Statistically significant differences in TIL densities were observed across tumor types (p < 0.001). The algorithm demonstrated high reproducibility with an inter-rater reliability (ICC) of 0.91. Increased TIL density was associated with early-stage tumors in breast and lung cancer cohorts. Conclusion: Digital quantification of TILs using AI-based pathology tools provides a consistent and scalable method for comparative immunological profiling across epithelial malignancies. The observed variability in TIL distribution highlights the importance of tumor-specific immune landscapes in prognostic and therapeutic stratification.

Context/Background: The reproductive health of women is a crucial aspect of overall health and plays a key role in human development with services utilization playing a key role in reducing maternal morbidity and mortality. Despite global efforts to improve maternal health outcomes, the utilization of maternal health services remains suboptimal in many regions. Aims/Objectives: To assess the utilization of maternal and child health services and their children and factor influencing in the Chargawan block of Gorakhpur district. Methodology: A community based cross-sectional multistage study was conducted among recently delivered women in the Chargawan block of Gorakhpur district. The study participants were 400 recently delivered women and their children up to 24 months who reside in Chargawan block A pre-tested and pre-designed questionnaire was used to collect data on sociodemographic characteristics, and utilization of maternal and child health (MCH) services, including ANC, delivery, postnatal care (PNC), family planning, immunization, and childcare and factors influencing access utilization of MCH services. Statistical package for social sciences, version‑26 (SPSS‑26, IBM, Chicago, USA) was used for data analysis. P <0.05 was considered statistically significant. Results: The overall registration for ANC services in the study area was 96.50%. Most women who avail ANC services primarily visit the nearest Primary Health Center (36.50%), and 19.00% of RDWs prefer private clinics or hospitals for receiving ANC services. the majority (41.00%) had more than four ANC visits. The majority (95.75%) of RDWs opted for institutional deliveries. The family services availed by RDWs was 60.25%. the complete immunization by their children was 76.2%. The findings highlight the significant role of education, spouse’s occupation, and socio-economic status in shaping maternal health service utilization. Conclusions: To improve utilization addressing socio-economic disparities, enhancing awareness of maternal health, and improving healthcare access.

Background: Postoperative sore throat (POST) is a frequent complication of endotracheal intubation, impacting patient comfort. Nebulized ketamine, clonidine, and dexmedetomidine show promise in prevention. Methods: PubMed, EMBASE, and Cochrane Library were searched for RCTs comparing nebulized ketamine, clonidine, dexmedetomidine, or combinations against placebo or active controls in adults undergoing general anaesthesia with intubation. Primary outcomes were POST incidence and severity at 1, 2, 6, 12, and 24 hours. Secondary outcomes included adverse effects. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using random-effects models. Bayesian network meta-analysis ranked interventions.  Results: Twenty RCTs (n=2,346) were included. Dexmedetomidine reduced POST incidence at 2 hours (RR 0.52, 95% CI 0.41–0.66) and 6 hours (RR 0.44, 95% CI 0.32–0.60). Ketamine reduced POST at 24 hours (RR 0.45, 95% CI 0.37–0.54). Ketamine + clonidine outperformed ketamine alone (RR 0.16, 95% CI 0.07–0.36 at 24 hours). Dexmedetomidine ranked highest for early prevention. Adverse effects were minimal.  Conclusion: Dexmedetomidine is optimal for early POST prevention, while ketamine + clonidine offer sustained benefits.

Background: Spontaneous Breathing Trials (SBTs) are pivotal in assessing readiness for extubation during weaning from mechanical ventilation. The ideal weaning strategy remains debatable and often varies based on individual patient conditions. This study aimed to compare the effectiveness of high-flow oxygen and T-piece ventilation in patients primarily intubated for respiratory distress or low Glasgow Coma Scale (GCS). Materials and Methods This was a randomized prospective, double-blinded controlled trial conducted between July 2023 and January 2025 among patients aged above 18 years with respiratory distress admitted in the ICU of BLDE(DU) SBMPMCH, Vijayapura. A total of 110 patients requiring mechanical ventilation for over 12 hours and meeting standard weaning criteria were randomly assigned to undergo SBT using either high-flow oxygen or T-piece ventilation (55 patients in each group). SBT was conducted for 30–60 minutes. In the high-flow group, FiO₂ was 0.4 with a flow of 60 L/min; in the T-piece group, FiO₂ ranged from 0.21 to 1.00. Parameters such as arterial blood gas, heart rate, oxygen saturation, and mean arterial pressure were recorded. Results High-flow oxygen patients had a significantly shorter ICU stay (5.49 days) compared to the T-piece group (7.29 days) (p = 0.019). Post-extubation, a significant rise in PaO₂ (141.11 to 193.60 mmHg, p = 0.001) and PaCO₂ (35.12 to 38.54 mmHg, p = 0.035) was observed in the high-flow group, indicating improved oxygenation and ventilation adjustment. T-piece patients showed no significant post-extubation change. Dyspnea was the leading intubation cause in the high-flow group, while low GCS dominated the T-piece group (p = 0.000). No major adverse events or deaths were reported during the assessment period. Conclusion High-flow oxygen therapy is an improved alternative to conventional T-piece ventilation in reducing ICU stay and enhancing post-extubation oxygenation, particularly in patients with respiratory distress.

Aim: The aim of the present study was to compare the expression of p53 and Ki-67 in cervical intraepithelial neoplasia and different histological types and grade of cervical cancer. Methods: The study was an observational study conducted during a period of one and half years in the Department of Pathology and Department of Obstetrics and Gynaecology, Government Medical College and Rajindra Hospital, Patiala, Punjab. 100 cases were included in the study. Results: In present study, we found that most of the patients were in 41-60 years of age group. In present study, we have 49 % cases in post-menopausal state, while 29 (29%) cases in Peri menopausal 22 (22%) cases in pre-menopausal state. In present study we found that 88% cases had a history of OCP/HRT while 12% cases had no history of OCP/HRT. Most of the patients had parity between 3-5, showing 77% positivity followed by >5 showing 18% and the least number of patients showing 5%. This study showed that 75% of patients showing ulceroproliferative growth which is an exophytic growth in cervix that completely replaces cervix. In present study we found that squamous cell carcinoma was most common cervical neoplasia seen in 92% of cases, while adenocarcinoma was second most common type seen in 4% cases. Conclusion: In conclusion, p53 and Ki-67 expressions were directly associated with severity of cervical lesions. The highest expression of both markers was found in invasive carcinoma and CIN2/3 and lower in descending order for CIN 1. The significant differences in these markers’ expression may be useful in equivocal histologic features among the cervical intraepithelial lesions.  So, our study indicates that p53 and Ki-67 are powerful prognostic markers.

Background: Stroke is a condition that results in high mortality rates and severe disabilities. Stroke is expected to be the second most important cause of mortality worldwide by 2020.  Most stroke survivors can and do experience improvements in their functional abilities, but the amount, rate, timing, pattern, type, and ultimate outcome of the improvements differ across patients and situations. Stroke severity and patient age are the main predictors of stroke outcome in the acute phase. Additional important predictors include functional status prior to stroke, presence of comorbid medical conditions, etiologies and the vascular territories affected. Materials and Methods: This single centre, descriptive, case–control study was carried out on inpatients admitted to department of General Medicine, SRI CHAMUNDESHWARI MEDICAL COLLEGE HOSPITAL AND RESEARCH INSTITUTE, Channapatna for a period of 4 months from December 2024 to March 2025.All the patients of both genders ≥18 years of age were included in the study. Results: Comparison between individuals with diabetes and without diabetes with stroke: values are presented as mean ± SD. BMI, body mass index; BSF, blood sugar fasting; DBP, diastolic blood pressure; HbA1c, glycated haemoglobin; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; SBP, systolic blood pressure; TC, total cholesterol; TGL-C, triglyceride Conclusion: Severity of stroke correlates with the glycaemic status of the patients in diabetics and non-diabetics. Hyperglycaemia, an important risk factor in non-diabetic patients after acute stroke is a stress response reflecting more severe neurological damage. Management of hyperglycaemia in patients with diabetes and non-diabetes is an important aspect of the emergency management of stroke.

Background: This study consisted of 30 patients with idiopathic normal pressure hydrocephalus (iNPH) who underwent lumbosubarachnoid-lumboepidural (L-L) shunting under local anesthesia in accordance with our surgical indications of L-L shunting. (1) CSF absorption within the lumbar epidural space and shunt clearance were confirmed in all patients after operation. (2) Shunt responders (R) were 25 of 30 cases (83.3%) 3 months after surgery. Among the R, symptom exacerbation was confirmed in three patients (12%) within the follow-up period (mean, 25.1 months). In each of these patients, shunt function were maintained and remained unchanged even with pressure resetting, the cause being an intracranial/extracranial disease other than iNPH. (3) The initial pressure setting for this method was 8 cmH2O, with gradual change to higher pressures, such that the setting for Patient 11 and thereafter became 20 cmH2O. (4) As postsurgical complications, subcutaneous cerebral spinal fluid collection (SCC) was confirmed in five patients (17.2%). In high-pressure resetting and follow-up observation, SCC was not observed in all patients. Epidural catheter displacement was confirmed in three patients (10.3%). No recurrence was noted after the secure fixation of the catheter at the fascia insertion portion and 2 days’ postsurgical bed rest. Hence, L-L shunting is an effective shunt therapy for iNPH.

Background: As we know that the prevalence of hyponatremia in subarachnoid hemorrhage (SAH) was 30-55%. There was lack of evidence about predictive factors and clinical outcomes of hyponatremia in SAH patients. This study aimed to evaluate factors associated with hyponatremia following SAH and to review the clinical outcomes and treatment of hyponatremia in SAH patients.  Method: This was a retrospective cohort study. SAH patients presented during January 2023 to January 2025 were reviewed. They were divided into 2 groups: SAH with normonatremia and SAH with hyponatremia. Clinical data, laboratory profile, aneurysm characteristics and clinical outcomes were recorded and analyzed. Result: A total number of 200 patients with SAH were included, 100 patients in each group. The populations were female 66% with mean age of 56 years old and mean serum sodium (Na) level 132 mmol/L. Aneurysm location associated with hyponatremia; anterior cerebral artery (ACA) (OR 4.2, 95%CI 1.4-13.0, p-value 0.009) and posterior cerebral artery (PCA) (OR 3.7, 95%CI 1.2-11.5, p-value 0.017). Aneurysms clipping procedure was also associated with hyponatremia (OR 4.0, 95%CI 1.8-8.8, p-value < 0.001). Conclusion: ACA and PCA aneurysms and aneurysms clipping procedure were risk factors for hyponatremia following SAH. Mild hyponatremia was not associated with morbidity and mortality in SAH patients.

Background: Central venous catheter insertion is commonly performed procedure in intensive care units and operation theatres for various indications. Confirmation of catheter tip in normal position is very important, and chest x ray is considered as a gold standard method. Echocardiographic Bubble test with ultrasonography is a newer method which can confirm catheter tip placement quickly and precisely. This method can be used in perioperative and emergency settings, where performing chest x ray in not feasible or can delay lifesaving interventions. Material and methods: This prospective study was conducted in 103 patients, either in intensive care unit or in operation theatre. All the CVC placements were performed under ultrasound guidance. After CVC insertion chest x ray was advised and echocardiographic bubble test was performed in subcostal four chambers view to look for appearance for microbubbles to in right atrium. Time taken for both the methods was noted. Sensitivity, specificity, positive predictive value, negative predictive value of both the methods for catheter tip placement were calculated. Result: Out of 120 enrolled patients, 103 patients were selected for the study after excluding 17 patients. Mean time taken for chest x ray availability after advising was 60.3 ± 11.844 minutes whereas time taken for echocardiographic bubble test was 8.106 ± 2.028 minutes. Positive predictive value, negative predictive value, sensitivity and specificity for echocardiographic bubble test was 96.808%, 88.888%, 98.91% and 72.72%. In 99 patients out of 103 patients, there was concordance between chest radiography and echocardiographic bubble test finding for catheter tip location. Conclusion: We conclude that, echocardiographic bubble test is suitable as a screening method to confirm CVC tip position in routine and can be relied upon for emergency situations in ICU and in operation theatre, where performing chest x ray immediately is not feasible.

Background: Vascular access is the cornerstone of effective maintenance hemodialysis. While autogenous arteriovenous fistulas (AVFs) are preferred per the Kidney Disease Outcomes Quality Initiative (KDOQI) due to superior patency, many patients have unsuitable vasculature resulting from comorbidities or repeated access failures. In such scenarios, prosthetic arteriovenous grafts (AVGs), especially those made from expanded polytetrafluoroethylene (ePTFE), become a vital alternative despite higher risks of thrombosis and infection. Preoperative duplex ultrasonography (DUS), patient-specific graft configuration (e.g., loop vs. straight), and meticulous surgical technique play key roles in AVG success. Loop grafts offered better cannulation options and patency. Postoperative complications were manageable with prompt interventions. Innovations such as HePTFE grafts demonstrated promise in reducing thrombosis, although long-term benefits remain debated. Lower extremity grafts may be viable alternatives in select cases, though avoided in our series due to infection risks. Comparatively, AVGs have lower primary patency than AVFs but serve as life-saving options when autogenous routes are not feasible.

Background: This cross-sectional study investigated the clinical profile, risk factors, etiology, and prognosis of Cerebrovascular Accident (CVA) patients in Ahmedabad, Gujarat, India. Conducted at Smt. Shardaben General Hospital from August 2023 to July 2024, the study prospectively enrolled 100 adult patients (aged ≥18 years) hospitalized with suspected new-onset stroke and confirmed by CT or MRI brain. Data were collected via a predefined proforma, including detailed medical history, clinical examination (with NIHSS scoring), and radiological findings. Statistical analysis involved Student's t-tests and Chi-Squared tests to compare continuous and categorical data, respectively, with significance set at p<0.05. Results : Among the 100 participants (57 male, 43 female; mean age 62.1 years), 91% had ischemic stroke and 9% had hemorrhagic stroke. Weakness of limbs was the most common symptom (92%), but change/loss of consciousness and speech, and headache were significantly more prevalent in hemorrhagic stroke (p<0.05). Hemorrhagic stroke patients also presented with significantly higher blood pressure, lower Glasgow Coma Scale (GCS) scores, and higher NIHSS scores (p<0.05). Hypertension was the most common risk factor (51% overall), observed in 8 out of 9 hemorrhagic CVA patients. Prognosis, assessed by the modified Rankin Scale (mRS), indicated that the majority of patients (91%) experienced moderate to severe disability (mRS scores 3-5), highlighting the significant burden of CVA.

Background: The global surge in cesarean section rates has ignited a heated debate within the medical community. While cesarean sections can be life-saving when medically indicated, a growing number of these procedures are being performed at the maternal request, devoid of any clinical necessity cesarean delivery on maternal request (CDMR) refers to a primary Pre-Labor cesarean delivery performed in the absence of fetal and maternal medical indications. This phenomenon, often shrouded in misconceptions and personal preferences, calls for a deeper understanding of the underlying motivations. Why are so many women choosing cesarean births. What fears, beliefs, and experiences drive this decision. Aim: To explore the maternal reasons for elective caesarean sections without medical indications at LD Hospital Srinagar. Maternal and neonatal outcomes in females undergoing CDMR. Methodology: We performed a retrospective chart review of the indications of all CS performed at LD hospital Srinagar.Conclusion: The study demonstrated a significant increase in CS on maternal request, especially in case of previous CS. The findings of this study support the need for specific counseling strategies for women requesting delivery by CS

Background: Metabolic syndrome (MetS) is a growing cardiovascular risk factor in India, particularly among patients presenting with acute coronary syndrome (ACS). Understanding the prevalence and clinical implications of MetS in ACS is essential for early risk stratification and improved outcomes. Methods: This prospective observational study was conducted at a tertiary care hospital in Rajasthan, India, over 18 months. A total of 100 patients diagnosed with ACS were enrolled. Metabolic syndrome was defined using the revised NCEP ATP III criteria. Patients were evaluated for clinical symptoms, metabolic components, 2D echocardiographic findings, and in-hospital outcomes. Comparative analysis between MetS and non-MetS groups was performed using chi-square and independent t-tests. Results: Metabolic syndrome was present in 65% of patients with ACS. The most common components were increased waist circumference (66%), elevated triglycerides (62%), and low HDL cholesterol (59%). Patients with MetS were significantly older (60.75 ± 10.61 vs. 55.63 ± 10.92 years, p = 0.022) and more likely to be male (76.9% vs. 57.1%, p = 0.040). Diabetes and hypertension were also more prevalent in this group. In-hospital mortality was significantly higher in the MetS group (27.7%) compared to 0% in non-MetS patients. The majority of MetS patients had four or more metabolic abnormalities, suggesting a dose-response relationship with adverse outcomes. Conclusions: Metabolic syndrome is highly prevalent in Indian patients with ACS and is associated with worse in-hospital outcomes, particularly among those with multiple metabolic abnormalities. Early identification and management of MetS components may reduce mortality and improve cardiovascular prognosis.

Background: Pre-pregnancy body mass index (BMI) is a crucial determinant of maternal and neonatal health, significantly influencing the mode of delivery, maternal complications, and neonatal outcomes. With the increasing prevalence of maternal obesity and undernutrition, obstetricians face challenges in managing pregnancy-related risks. Obesity has been linked to gestational diabetes mellitus (GDM)1, hypertensive disorders, macrosomia, prolonged labor4, and an increased likelihood of cesarean delivery, while underweight mothers are more prone to intrauterine growth restriction (IUGR)6, low birth weight (LBW), and neonatal intensive care unit (NICU) admissions8. Understanding the relationship between BMI and delivery outcomes is essential for improving antenatal care, risk stratification, and maternal-fetal health management. Materials And Methods: This study was conducted as a prospective observational study at the Department of Obstetrics and Gynecology, Kempegowda Institute of Medical Sciences, Bangalore, from August 1, 2024, to October 31, 2024. A total of 40 term pregnant women were categorized into four BMI groups based on the WHO classification: underweight (<18.5 kg/m²), normal (18.5–24.9 kg/m²), overweight (25–29.9 kg/m²), and obese (≥30 kg/m²). Data collection included patient demographics, obstetric history, mode of delivery, maternal complications, and neonatal outcomes. Statistical analysis was performed using SPSS v23, with chi-square tests, logistic regression, and Pearson’s correlation coefficient applied to evaluate associations between BMI and pregnancy outcomes. A p-value <0.05 was considered statistically significant. Results: The results revealed that cesarean section rates increased with maternal BMI, with 100% of obese women undergoing cesarean delivery, compared to 62.5% in overweight women, 25% in normal BMI women, and 16.7% in underweight women. Vaginal delivery was most frequent in normal BMI (75%) and underweight (83.3%) women, whereas obese women had the highest incidence of labor complications, including prolonged labor (50%) and gestational diabetes (50%). Hypertensive disorders were significantly higher in overweight (37.5%) and obese (50%) women, indicating an increased risk of metabolic and vascular dysfunction in these groups. Neonatal outcomes were also significantly affected by maternal BMI. Low birth weight (50%) was most common in underweight mothers, suggesting nutritional insufficiency and placental insufficiency99. Conversely, macrosomia (25%) was prevalent in obese women, aligning with higher rates of gestational diabetes and excessive fetal growth1010. NICU admissions were highest in underweight (3.3%) and obese (50%) neonates, emphasizing the importance of BMI regulation before pregnancy to minimize neonatal morbidity. Statistical analysis confirmed that BMI was positively correlated with cesarean section rates (p < 0.001, OR = 4.2), while underweight mothers had a significantly higher risk of delivering low birth weight neonates (p < 0.001). Additionally, gestational diabetes was strongly associated with obesity (p < 0.001), reinforcing the need for early glucose screening in overweight pregnancies. Conclusion: In conclusion, this study demonstrates that both underweight and obese women face increased pregnancy-related risks, emphasizing the importance of achieving an optimal BMI before conception. Obese women are at a significantly higher risk of cesarean delivery, gestational diabetes, and hypertensive disorders, while underweight women are more likely to deliver low birth weight infants and experience increased NICU admissions. These findings highlight the need for preconception weight management programs, targeted antenatal monitoring, and early interventions for high-risk pregnancies. Future research should explore larger-scale studies to evaluate long-term neonatal outcomes and assess the effectiveness of maternal weight optimization programs in reducing pregnancy-related complications.

Introduction: Postoperative delirium (POD) is a prevalent and serious complication in elderly patients following orthopedic surgeries, leading to increased morbidity, extended hospital stays, and long-term cognitive decline. Dexmedetomidine, a selective alpha-2 adrenergic agonist, has shown potential in reducing the incidence of delirium due to its sedative and neuroprotective properties. This study aimed to compare the effectiveness of dexmedetomidine versus midazolam, a commonly used benzodiazepine, in reducing POD in geriatric patients undergoing elective orthopedic procedures. Materials and Methods: This prospective, double-blind, randomized controlled trial included 100 patients aged ≥65 years scheduled for elective hip or knee arthroplasty under regional anesthesia. Patients were randomly allocated into two groups (n=50 each): Group D received a continuous infusion of dexmedetomidine (0.2–0.7 µg/kg/hr) intraoperatively, while Group M received midazolam (0.03–0.1 mg/kg/hr). Delirium was assessed using the Confusion Assessment Method (CAM) at 6, 12, 24, and 48 hours postoperatively. Secondary outcomes included sedation level (RASS score), hemodynamic stability, and length of hospital stay. Results: The incidence of POD was significantly lower in the dexmedetomidine group (12%) compared to the midazolam group (30%) (p=0.02). The median onset time of delirium was delayed in Group D (18 ± 4 hours) vs. Group M (10 ± 3 hours). Sedation scores were comparable, but Group D showed better hemodynamic stability and reduced need for rescue analgesics. The mean hospital stay was shorter in Group D (5.2 ± 1.1 days) compared to Group M (6.8 ± 1.4 days) (p=0.01). Conclusion: Dexmedetomidine demonstrated superior efficacy over midazolam in reducing the incidence and severity of postoperative delirium among elderly orthopedic patients. Its use was also associated with better perioperative hemodynamic stability and shorter hospital stays. These findings support the preferential use of dexmedetomidine for sedation in geriatric surgical patients to mitigate POD risk.

Background: Stapled hemorrhoidopexy is an increasingly preferred alternative to conventional haemorrhoidectomy due to reduced postoperative pain and faster recovery. However, concerns persist regarding symptom recurrence, particularly due to inadequate or asymmetrical mucosal resection. Methods: This prospective observational study included 28 patients with Grade III and IV haemorrhoids undergoing stapled hemorrhoidopexy at a tertiary care centre. Circumferential mucosectomy length was measured at 3, 7, and 11 o’clock positions in the relaxed state. Patients were followed at 3, 6, and 12 months for recurrence of pain, bleeding, or prolapse. Statistical analyses included Mann–Whitney U tests for mucosectomy length and recurrence, and chi-square tests for categorical associations. Results: Pain and bleeding resolved in all patients by 6 months. However, prolapse persisted in 21.4% of patients at 12 months. The mean mucosectomy length was shortest at 3 o’clock (2.76 ± 0.59 cm) compared to 7 and 11 o’clock. Mann–Whitney analysis showed no significant difference in mucosectomy length between recurrence and non-recurrence groups at any position (p > 0.05). However, chi-square analysis revealed that 83.3% of patients with inadequate resection at the 3 o’clock position experienced recurrence (p = 0.04). No such association was seen at other positions. Conclusions: While stapled hemorrhoidopexy provides effective symptom relief, inadequate mucosectomy at specific anatomical sites—particularly the anterior 3 o’clock position—may contribute to recurrence. Intraoperative attention to resection adequacy at key points may improve surgical outcomes.

Background: The Circle of Willis (CoW) is a critical arterial anastomotic system at the base of the brain that ensures collateral circulation. Anatomical variations in the CoW can significantly influence the pathophysiology and prognosis of cerebrovascular diseases. This study aimed to examine the morphological variations of the Circle of Willis in cadaveric brains and assess their clinical relevance. Objectives: To determine the prevalence of anatomical variations in the Circle of Willis among human cadavers and evaluate the potential implications for cerebral collateral circulation. Materials and Methods: A cross-sectional study was conducted over a period of 16 months using 50 formalin-fixed human cadaveric brains obtained from a medical college anatomy department. Standard dissection techniques were employed to expose and examine the components of the Circle of Willis. Observations were recorded regarding completeness, component integrity, variation types, and laterality. Results: A complete Circle of Willis was observed in 60% of specimens, while 40% showed incomplete configurations. Posterior communicating arteries exhibited the highest variability (44% hypoplastic or absent). The most common variation type was Type II (hypoplastic/absent PCoA, 20%). Unilateral variations were noted in 28% of cases, and bilateral variations in 12%. These findings suggest that a significant proportion of individuals may possess anatomical patterns that compromise collateral circulation. Conclusion: Anatomical variations of the Circle of Willis are common and may have important clinical implications in the context of cerebrovascular accidents and neurosurgical planning. Preoperative vascular imaging is recommended for optimal management.

Background: Precise localization of the mandibular foramen is critical for the success of the inferior alveolar nerve block (IANB), a commonly administered dental anesthesia technique. Anatomical variations in the foramen’s position can lead to procedural failure or complications. Aim: To evaluate the morphometric parameters of the mandibular foramen and assess their clinical relevance for enhancing the accuracy of the IANB. Materials and Methods: This cross-sectional observational study was conducted on 100 mandibular sides (50 left and 50 right) from adult human dry mandibles. Four parameters were measured using digital calipers: (1) distance from the mandibular foramen to the anterior border of the ramus (MF–AB), (2) posterior border of the ramus (MF–PB), (3) mandibular notch (MF–MN), and (4) mandibular base (MF–MB). Descriptive statistics were computed, and side-wise comparisons were made using the independent t-test. Results: The mean MF–AB and MF–PB distances were 15.24 ± 2.11 mm and 11.76 ± 1.94 mm, respectively. The vertical measurements MF–MN and MF–MB were 20.32 ± 2.38 mm and 21.85 ± 2.60 mm. No statistically significant differences were found between the left and right sides for any parameter (p > 0.05). These findings suggest a relatively symmetrical location of the mandibular foramen bilaterally. Conclusion: The mandibular foramen is typically positioned posterior and superior to the midpoint of the mandibular ramus. These morphometric insights can assist clinicians in improving the precision and success rate of IANB.

Background: Subtrochanteric femur fractures are complex injuries that pose significant challenges due to high biomechanical stress and anatomical variability in the proximal femur. Timely and effective surgical fixation is essential to restore function and reduce complications. Among the available options, intramedullary nails and extramedullary plates are commonly used, but their relative efficacy remains a topic of ongoing debate. This study aims to compare the clinical outcomes and complication rates associated with these two fixation methods. Materials and Methods: A retrospective study was conducted on 100 patients at the Department of Orthopaedics, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. Patients were categorized into two groups based on the type of implant used. Group A included those treated with intramedullary (IM) devices, such as intramedullary femoral nails or proximal femoral nails. Group B comprised patients who received extramedullary (EM) implants, specifically 95° condylar plates or locked anatomical proximal femoral plates. The study evaluated multiple parameters, including patient age, gender, side of hip fracture, mechanism of injury, type of anesthesia administered, preoperative waiting time, duration of follow-up, fracture classification, Harris Hip Score (HHS), and any mechanical complications. Statistical analysis was performed using GraphPad software, version 8.4.3. Results: This comparative study analyzed 100 patients with subtrochanteric femur fractures, divided into intramedullary nail (Group A; n=55) and extramedullary plate (Group B; n=45) fixation groups. Both groups had similar baseline demographics (age, gender, fracture side, preoperative time; p > 0.05). The average follow-up period was 18.65 months. The most common fracture etiology was falls, with Seinsheimer type 2b being predominant.  In terms of postoperative complications, Group A (IM) had slightly higher rates of delayed union (21.82% vs. 17.78%), non-union (5.45% vs. 2.22%), malalignment (14.54% vs. 11.11%), implant failure (10.91% vs. 4.44%), and limb shortening (9.09% vs. 8.89%) compared to Group B (EM), though differences were not statistically significant (p > 0.05). No cases of infection were recorded in Group A, only 2 patients (4.44%) in Group B experienced postoperative infections, with a proximal femoral locking plate, which was treated by removing the implants. Malalignment did not significantly influence outcomes (p = 0.665). Functional assessment via Harris Hip Score showed comparable results (mean 86.5) between groups, suggesting no superiority of one fixation method over the other in terms of clinical outcomes. Conclusion: Intramedullary and extramedullary fixation methods both offer effective outcomes for subtrochanteric fractures, each with distinct advantages and limitations. While IM fixation minimizes soft tissue damage, EM fixation allows better anatomical alignment. Our study found both techniques to be comparably effective, though the ideal choice remains subject to further research.

Introduction: The evolving health systems in India are increasingly focusing on Non-Communicable Diseases (NCD), which are a significant public health challenge. This study assesses the diabetes surveillance system under the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) in Darbhanga district, India.  Methods: A descriptive cross-sectional study was conducted from January to December 2023. Two blocks were randomly selected. Data were collected from key persons at district, block, and sub-block level levels. The study utilized interviews and secondary data analysis from the national NCD portal. Results: The study results showed staff vacancies, with 77% of Medical Officer positions and more than 50% of ANM and CHO positions. Sensitivity was low, with 21% of the target population enrolled in the Population Based Survey, 19% screened, and 0.3% referred for diagnosis. No diabetes cases were diagnosed in the study blocks. The study found an overall sensitivity score of 10%, simplicity 72%, flexibility 24%, acceptability 36%, and stability 57%. Conclusion: The diabetes surveillance under NP-NCD’s system attributes of simplicity and stability were assessed as moderate, while sensitivity, flexibility, and acceptability were poor in Darbhanga district. The study concludes that the NP-NCD surveillance system is not sufficiently sensitive for effective population screening, early diagnosis, and management of diabetes. Recommendations include filling staffing vacancies, enhancing training programs, ensuring the availability of essential logistics, and improving data reporting and review mechanisms.

Background: Catheter angiography (CAG) is widely regarded as the gold standard for diagnosing coronary artery disease. The key advantage of CAG is that therapy may be delivered at the same session as the test process. However, about 50% of all CAG tests are not followed by later interventional or surgical therapy and are performed solely for diagnostic purposes and to confirm the existence and severity of CAD. Non-invasive coronary CT angiography has been getting more attention as an alternate imaging method for stable individuals suspected of having CAD. Objective: In this study, we highlight the role of coronary CT angiography with Conventional Angiography in patients with CAD. Methodology: This cross-sectional study was conducted in the Department of Radiodiagnosis and the Department of Cardiology at PGIMER and Dr. Ram Manohar Lohia Hospital, Delhi. A total of 30 patients of either sex were included in the study. Patients were evaluated on 40 -slice Philips scanner and subsequently, the patients were subjected to Conventional Angiography on a Philips system within 15 days. Result: 39 segments having significant stenosis were included for final comparison. In comparison with CAG, on per segment basis analysis, CT coronary angiography on 40 slice Philips scanner had an overall sensitivity of 87.2% (34 of 39), specificity of 98.8% (408 of 413), positive predictive value of 87.2% (34 of 39) and negative predictive value of 98.8% (408 of 413) with invasive catheter angiography as gold standard. Per vessel diagnostic accuracy, sensitivity, specificity, PPV, and NPV obtained in our study on vessel-based analysis were 98.4% (24 of 25), 94.7% (71 of 75), 85.7% (24 of 28) and 98.6% (71 of 72) respectively. Conclusion: To summarize, 40-slice CCTA provides sufficiently high diagnostic accuracy in terms of sensitivity, specificity, PPV, and NPV to rule out significant stenosis in patients suspected of having CAD in a non-invasive manner. However, further studies with larger cohorts of patients are needed

Background: Primary open angle glaucoma has been characterized by its adult onset, IOP >21mmHg at some point in the course of the disease, open angles on gonioscopy, glaucomatous visual field changes and glaucomatous optic nerve damage. Methods: This case control study was conducted to determine whether diabetes stands as a risk factor in development of glaucoma. The selected patients were divided into 3 groups based on inclusion and exclusion criteria. They were subjected to complete ocular examination including gonioscopy and perimetry. Results: The 16 patients from 50 of the diabetic group (28%) were found to have POAG. The p value was <0.005 which was statistically significant. Also, no correlation was found between blood sugar and IOP levels in these patients.  Conclusions: These data show a significant correlation between diabetes and glaucoma. Further studies are warranted to determine its actual role in pathogenesis of glaucoma

Background: Amblyopia, commonly referred to as "lazy eye," is a developmental visual disorder characterized by reduced vision in one or both eyes not correctable by glasses or contact lenses and not attributed to any eye disease. It typically arises from abnormal visual experience during early childhood and is the leading cause of monocular visual impairment in children and young adults. Early diagnosis and treatment are crucial for optimal visual outcomes. Methods: This analytical cross-sectional study was conducted in the Department of Ophthalmology at Peoples College of Medical Science and Research Center, Bhopal, over a period of 16 months. A total of 1000 patients under 18 years of age presenting to the ophthalmology OPD were randomly selected. A comprehensive ocular examination was carried out, including visual acuity assessment, refraction, cover test, slit lamp examination, ophthalmoscopy, Worth’s four-dot test, and synoptophore testing. Patients with known causes of reduced visual acuity or prior ocular surgery were excluded. Data were collected using an Excel sheet and a structured questionnaire and analyzed using SPSS v22. Results: Among the 1000 children examined, amblyopia was identified in a significant subset. The types of amblyopia diagnosed included anisometropic, strabismic, ametropic, and deprivation amblyopia, with anisometropic amblyopia being the most prevalent. The condition was slightly more common in males and in rural populations. Risk factors observed included high refractive errors, strabismus, and poor parental awareness. Early diagnosis was noted to impact treatment success. Conclusion: The prevalence and pattern of amblyopia observed in this study align with regional and global trends, highlighting the impact of uncorrected refractive errors and strabismus in childhood. The study underscores the importance of routine vision screening in school-aged children. Increased awareness, timely detection, and appropriate interventions can significantly reduce the burden of amblyopia and prevent long-term visual disability.

Background: Pterygium is a common ocular surface disorder characterized by fibrovascular proliferation extending onto the cornea. Conjunctival autografting is the preferred surgical approach to prevent recurrence, with graft fixation methods including sutures, fibrin glue, and autologous blood. While sutureless methods offer advantages such as reduced inflammation and faster recovery, comparative data between fibrin glue and autologous blood for graft fixation remain inconclusive. Methods: This interventional study was conducted at the Department of Ophthalmology, People’s College of Medical Sciences and Research Centre, Bhopal, over 18 months. A total of 150 patients with primary pterygium were enrolled and divided into two equal groups: Group A (conjunctival autograft using autologous blood) and Group B (conjunctival autograft using fibrin glue). Baseline demographic data and pterygium characteristics were recorded. Postoperative outcomes, including graft stability, complications, and recurrence, were assessed on follow-up at days 1, 7, 30, and 180. Results: Both groups showed comparable age and gender distribution. Graft stability on day 1 was higher in Group B. However, recurrence rates were higher in Group A at six months; however, autologous blood was associated with a higher rate of graft retraction, though without need for re-intervention. Conclusion: Autologous blood presents a cost-effective and suture less alternative for graft fixation, and fibrin glue offers better surgical outcomes with fewer complications and more stable graft adherence in the early postoperative period.

Background: Cataract is a leading cause of preventable blindness in India, and diabetes mellitus is a known contributor to early cataract formation. The corneal endothelium, critical for maintaining corneal transparency, is vulnerable to surgical trauma and systemic metabolic stress in diabetics. While phacoemulsification is widely used, SICS (Small Incision Cataract Surgery) remains more accessible in resource-limited settings. The effect of SICS on corneal endothelial health in diabetic versus non-diabetic patients warrants further investigation. Methods: This prospective observational study included 100 patients (50 diabetics and 50 non-diabetics) aged over 40 years undergoing SICS at People’s College of Medical Science and Research Center, Bhopal. Pre-operative, and postoperative evaluations at 1 and 6 weeks included specular microscopy (Tomey EM 4000) for ECD (Endothelial Cell Density), CV (Coefficient of Variation), hexagonality (6A), and CCT (entral Corneal Thickness). Statistical analysis was conducted using SPSS version 25.0, with a significance threshold of p < 0.05. Results: The mean ECD decreased in both groups postoperatively, with diabetics showing slightly higher endothelial cell loss (11.03% in diabetic vs. 8.01% in non-diabetic patients at 6 weeks), though not statistically significant. CV and CCT were higher, and 6A was lower in diabetics at all follow-ups, indicating increased morphological stress, but again without statistical significance. However, baseline CCT was significantly higher in diabetics (p = 0.003). Conclusion:Although the observed postoperative corneal endothelial changes were not statistically significant between the groups, diabetics showed consistent trends of greater cell loss, increased corneal thickness, and altered cell morphology. This suggests lower functional reserve in diabetic corneas. Preoperative endothelial assessment and careful intraoperative technique are recommended for diabetic patients undergoing SICS.

Aim: The aim of the present study was to compare the expression of p53 and Ki-67 in cervical intraepithelial neoplasia and different histological types and grade of cervical cancer. Methods: The study was an observational study conducted during a period of one and half years in the Department of Pathology and Department of Obstetrics and Gynaecology, Government Medical College and Rajindra Hospital, Patiala, Punjab. 100 cases were included in the study. Results: In present study, we found that most of the patients were in 41-60 years of age group. In present study, we have 49 % cases in post-menopausal state, while 29 (29%) cases in Peri menopausal 22 (22%) cases in pre-menopausal state. In present study we found that 88% cases had a history of OCP/HRT while 12% cases had no history of OCP/HRT. Most of the patients had parity between 3-5, showing 77% positivity followed by >5 showing 18% and the least number of patients showing 5%. This study showed that 75% of patients showing ulceroproliferative growth which is an exophytic growth in cervix that completely replaces cervix. In present study we found that squamous cell carcinoma was most common cervical neoplasia seen in 92% of cases, while adenocarcinoma was second most common type seen in 4% cases. Conclusion: In conclusion, p53 and Ki-67 expressions were directly associated with severity of cervical lesions. The highest expression of both markers was found in invasive carcinoma and CIN2/3 and lower in descending order for CIN 1. The significant differences in these markers’ expression may be useful in equivocal histologic features among the cervical intraepithelial lesions.  So, our study indicates that p53 and Ki-67 are powerful prognostic markers.

Background: Metabolic syndrome is characterized by a cluster of conditions including obesity, hypertension, and dyslipidaemia and insulin resistance often leading to cardiovascular complications. Micro albuminuria and hyperuricemia have been identified as potential markers of renal and metabolic dysfunction in these patients. Aims: Hyperuricemia is an independent risk factor for kidney dysfunction in diabetic patient. On the other hand micro albuminuria is considered as the predictor of early stages of diabetic nephropathy. We investigated the correlation between hyperuricemia and albuminuria in patients with Metabolic Syndrome. The aim of this study is to evaluate the association between serum uric acid & urinary Albumin to Creatinine Ratio (ACR) among patients with Metabolic Syndrome. Materials and methods: This study is a hospital-based, observational (cross-sectional) study to evaluate serum uric acid level & urinary Albumin Creatinine Ratio (ACR) in patients of Metabolic Syndrome in both younger & older age group (40 to 80 years). The study also evaluated the relation between normo albuminuria (ACR <30 ug/ mg), micro albuminuria (ACR between 30 ug/mg & 299 ug/mg) & macro albuminuria (ACR ≥ 300ug/mg) with serum uric acid levels. Although we have contemplated a study both in younger & older age group but eventually this was not done as the number of patients with Metabolic Syndrome in younger age group was inadequate and those who are younger than 40 years were excluded. Result: It is revealed that the patient group macroalbuminuria percentage is 19%, microalbuminuria percentage is 32 % and normalbuminuria percentage is 49 %, the patients, hyperuricemia percentage is 44 %, normouricemia percentage is 56 %, the patients with  Anti lipid therapy YES percentage is 48 %, No percentage is 52 %. Conclusion: We conclude that, the patients with Metabolic Syndrome showed a strong correlation between hyperuricemia and FBG, LDL, and triglycerides. Age, sex, weight, height, BMI, hypertension, and HDL were not shown to be significantly correlated with hyperuricemia. In individuals with Metabolic Syndrome, urinary ACR strongly linked with FBG, LDL, and triglycerides. There was no discernible relationship between urine ACR and BMI, HDL, age, sex, weight, height, or hypertension. Serum uric acid level and urine albumin creatinine ratio strongly associated in patients with metabolic syndrome. According to this study, individuals with Metabolic Syndrome who have hyperuricemia are more likely to have albuminuria, and patients with type 2 diabetes mellitus have serum uric acid as an independent predictor of urine ACR.

Background: Several histological scoring systems are used to evaluate chronic viral hepatitis. This study was undertaken to determine the correlation between the Ishak system (modified histological activity index, HAI) and the METAVIR system, in Indian patients with chronic viral hepatitis. Aims: To evaluate and compare the histopathological features of chronic hepatitis B and chronic hepatitis C based on liver biopsy specimens Materials and Methods: This study was conducted in the Department of Pathology, Gouri Devi Medical College and Hospital, Durgapur, a tertiary care institution catering to patients primarily from West Bengal and surrounding regions in eastern India 100 Patients were included in this study. Results: HBV infection accounted for 64.6% of cases, and HCV for 35.4%; 91.3% of patients had minimal or mild hepatitis. The necroinflammatory scores of the Ishak and METAVIR systems correlated moderately well (weighted kappa 0.627), while there was excellent correlation with regard to fibrosis (weighted kappa 0.998). Similar concordance was found when HBV and HCV cases were analyzed separately. HAI showed poor correlation with serum transami- nases (weighted kappa 0.21). Micronodular cirrhosis, lymphoid aggregates, bile duct damage, bile ductular prolifera- tion and steatosis were significantly more common in HCV biopsies compared to HBV. Conclusions: Concordance between Ishak and METAVIR scoring systems is good for necroinflammatory change, and excellent for fibrotic change. q 2002 European Association for the Study of the Liver. Published by Elsevier Science B.V. All rights reserved.

Background: Postoperative nausea and vomiting (PONV) is a common complication following general anesthesia, especially in laparoscopic surgeries. Objective: To determine the incidence and evaluate the risk factors associated with PONV in patients undergoing laparoscopic surgeries. Methods: A prospective observational study was conducted over 6 months in the Department of Anesthesiology, Assam Medical College and Hospital, Assam, India. 150 patients aged 18- 60 years undergoing elective laparoscopic surgeries under general anesthesia were included. Demographic and perioperative data were collected. Results: Female gender was significantly associated with PONV (p-value 0.001). Intraoperative use opioid was strongly associated with PONV (p-value 0.012). The association of PONV was also significant with the duration of surgery, with incidence of 90.5% when surgery lasted for more than 60 minutes (p-value 0.002). Conclusion: Female gender, prolonged surgery and opioid use are significant predictors of PONV. Identifying high risk patients can guide prophylactic strategies.

Background: The introduction of Competency-Based Medical Education (CBME) by the National Medical Commission (NMC) in India emphasizes student-centered learning approaches, including Self-Directed Learning (SDL). SDL encourages lifelong learning through learner autonomy, facilitated guidance, and active engagement. This study explores the effectiveness of SDL implemented via role play in Biochemistry for Phase I MBBS students. Aim: To evaluate the effectiveness of SDL through role play on the topic of Oral Glucose Tolerance Test (OGTT) among first-year MBBS students. Methods: The study was conducted at Government Medical College, Anantapuramu, Andhra Pradesh, with 138 first-year MBBS students. The SDL session included a lecture on OGTT, followed by a student-led role play simulating clinical scenarios involving OGTT. Assessment included pre- and post-tests using structured VSAQs and feedback through a structured questionnaire. Satisfaction index and qualitative feedback were analyzed to gauge perceptions. Results: The mean ± SD for the pre-test was 11.6 ± 2.3 and post-test was 16.3 ± 1.85, with a statistically significant improvement (p < 0.001). Feedback analysis revealed high satisfaction with the SDL activity. The highest satisfaction index was for increased self-awareness in learning, while the lowest was for improved analytical ability. Qualitative responses highlighted the usefulness of SDL, with suggestions for more interactive strategies and adequate guidance. Conclusion: SDL using role play is an effective teaching-learning strategy in Biochemistry, enhancing knowledge acquisition, engagement, and learner autonomy. It aligns well with CBME goals and is well-received by students and faculty. Further refinement and integration into the curriculum are recommended.

Background: Autonomic function plays a critical role in maintaining physiological homeostasis, and its dysregulation is linked to various diseases. Yogic breathing, an integral component of yoga, has been widely studied for its potential to enhance autonomic function. However, further research is needed to elucidate its specific effects on autonomic reactivity and cardiovascular parameters. Aim: To assess the impact of a five-week yogic breathing intervention on autonomic function parameters in healthy young adults. Methods: This randomized controlled study was conducted over 18 months in the Department of Physiology, NIMS Medical College, Jaipur, with 37 participants aged 18-34 years. Baseline and post-intervention autonomic function tests were performed under standardized conditions, including assessments of resting heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), E:I ratio, 30:15 ratio, and SBP/DBP responses to standing. Participants engaged in daily 15-minute yogic breathing sessions comprising Nadi Shuddhi, Kapalabhati, Bhattarika, Sheetali, and OM chanting. Data were analyzed using paired t-tests, with significance set at p < 0.05. Result: The intervention significantly reduced resting heart rate (p = 0.0118) and SBP response to standing (p = 0.016). Improvements in parasympathetic measures, such as the 30:15 ratio and E:I ratio, were observed but were not statistically significant. Conclusion: A five-week yogic breathing intervention demonstrated significant benefits in autonomic function, particularly in reducing resting heart rate and SBP reactivity. This suggests that short-term yogic breathing can improve cardiovascular and autonomic health.

Background: Wearable cardiovascular monitoring devices have emerged as promising tools for real-time arrhythmia detection and patient-managed care. Their diagnostic value, usability, and impact on clinical outcomes remain areas of active investigation. Objective: To systematically evaluate the diagnostic accuracy, clinical utility, and user acceptability of wearable devices in detecting arrhythmias, particularly atrial fibrillation (AF). Data Sources: A systematic search was conducted in PubMed (2018–2025) using terms related to “wearables,” “arrhythmia,” and “cardiac monitoring.” Filters applied included free full-text availability and original human studies. Study Selection: Studies were included if they assessed wearable, non-invasive devices (e.g., smartwatches, ECG patches) for arrhythmia detection and reported diagnostic performance or clinical outcomes. Data Extraction and Synthesis: Twelve studies were included. Data on study design, population, device type, diagnostic accuracy, intervention changes, and usability were extracted and narratively synthesized. Main Outcomes and Measures: Primary outcomes were AF detection rate, sensitivity, specificity, and clinical intervention changes. Results: Wearables demonstrated sensitivity ranging from 84% to 95% and specificity up to 93%. Intervention changes occurred in up to 35% of cases. High patient satisfaction and adherence were reported. Conclusions and Relevance: Wearable cardiac monitors provide accurate, patient-friendly arrhythmia detection and support timely clinical intervention, reinforcing their role in modern cardiovascular care.

Background: The dual burden of type 2 diabetes mellitus (T2DM) and hypertension is a major contributor to cardiovascular morbidity and mortality. Integrated care models are essential for effective management. With the growing adoption of digital health technologies, telehealth has emerged as a potential alternative to conventional care. This study aimed to evaluate the clinical effectiveness of telehealth versus in-person care in the co-management of T2DM and hypertension. Materials and Methods: A total of 120 patients diagnosed with both T2DM and hypertension were randomly assigned into two groups: the Telehealth Group (n=60) and the In-Person Care Group (n=60). Inclusion criteria included age between 30–65 years, HbA1c ≥ 7%, and systolic BP ≥ 140 mmHg at baseline. The telehealth group received virtual consultations via a dedicated platform every 2 weeks, with remote monitoring of blood glucose and BP. The in-person group attended physical consultations at similar intervals. Primary outcomes were change in HbA1c and systolic blood pressure at 6 months. Secondary outcomes included medication adherence, patient satisfaction, and frequency of emergency visits. Results: At the end of 6 months, the telehealth group showed a mean reduction in HbA1c from 8.5% ± 1.1 to 7.2% ± 0.9 (p < 0.001), while the in-person group improved from 8.4% ± 1.0 to 7.5% ± 0.8 (p < 0.01). The reduction in systolic BP was also significant in both groups: from 148.2 ± 7.5 mmHg to 132.6 ± 6.3 mmHg in the telehealth group (p < 0.001), and from 147.9 ± 8.1 mmHg to 135.4 ± 7.1 mmHg in the in-person group (p < 0.01). Medication adherence was slightly higher in the telehealth group (92% vs. 87%, p = 0.04), and patient satisfaction scores were also greater (mean 4.5 vs. 3.9 on a 5-point Likert scale). No significant difference was observed in the number of emergency visits between the groups. Conclusion: Telehealth is a feasible and effective modality for the co-management of diabetes and hypertension, showing comparable or slightly superior outcomes in glycemic and blood pressure control compared to traditional in-person care. Improved adherence and satisfaction highlight the potential of remote monitoring in chronic disease management, particularly in resource-limited or rural settings.

Background: Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), is characterized by persistent symptoms affecting multiple organ systems beyond the acute phase. These include respiratory dysfunction, neurological deficits, and psychological disturbances, severely impairing quality of life. The complexity of this syndrome necessitates a multidisciplinary approach for effective diagnosis and management. This study aimed to evaluate the clinical outcomes of an integrated care model involving pulmonology, neurology, and psychological assessment in patients with Long COVID. Materials and Methods: A total of 120 patients (aged 20–65 years) diagnosed with Long COVID (symptoms persisting >12 weeks post-infection) were enrolled. Participants underwent comprehensive evaluations: pulmonary function tests (spirometry, DLCO), neurological assessments (cognitive function via MoCA scale, neuropathy screening), and psychological evaluation (using GAD-7 and PHQ-9 scores). Patients were then managed with individualized multidisciplinary interventions for 12 weeks, including pulmonary rehabilitation, neurocognitive therapy, and psychological counseling. Clinical outcomes were assessed at baseline and after 12 weeks. Results: At baseline, 72% of patients had reduced DLCO values (<80%), 58% demonstrated mild cognitive impairment, and 66% showed moderate to severe anxiety/depression symptoms. After 12 weeks of integrated care, 80% of patients exhibited significant improvement in DLCO (>10% increase, p < 0.001), 67% showed improvement in MoCA scores by an average of 3 points (p = 0.002), and 74% reported reduced GAD-7 and PHQ-9 scores (p < 0.001). Patient-reported quality of life (measured via EQ-5D-5L) improved significantly in 82% of cases. Conclusion: Multidisciplinary management of Long COVID, incorporating pulmonary, neurological, and psychological interventions, significantly improves clinical and functional outcomes. This approach highlights the importance of integrative care in addressing the complex, multisystemic nature of post-COVID syndromes.

Background: Serum chemerin, an adipokine that has been identified to play a role in inflammation and metabolism, has recently emerged as a potential biomarker for metabolic syndrome (MetS). This study sought to measure serum chemerin levels in MetS patients and explore its relationship with metabolic parameters and its diagnostic utility. Methods: This study used a case-control design with 126 participants, including 63 patients with MetS and 63 healthy controls. Clinical and biochemical parameters were examined, and serum chemerin was measured by ELISA. Correlation studies and ROC curve analysis were performed for statistical analysis. Results: Serum chemerin levels were significantly higher in the MetS group (50.13±12.50ng/ml) compared to controls (25.21±12.95ng/ml), p < 0.001). Chmerin levels positively correlated with waist circumference (r = 0.56), fasting glucose (r = 0.49), triglycerides (r = 0.41), and blood pressure (r = 0.38) and negatively with HDL cholesterol (r = -0.32, p < 0.001).  Conclusion: Elevated serum chemerin levels reflect the inflammatory and metabolic disturbances of MetS, with potential as a diagnostic biomarker. Further studies are needed to explore its prognostic and therapeutic implications.

Background: Pericardial effusions can be life-threatening medical emergencies. Pericardial effusions can occur secondary to pericarditis, infections, post pericardiotomy syndrome, rheumatologic causes, malignancy, bone marrow transplant, and additional causes. Colchicine has been an approved therapy for pericarditis in adults. Its usage in pediatrics is limited and extrapolated from adult literature. We report a case of a patient with a history of Acute Myeloblastic Leukemia (AML), status post a second bone marrow transplant (BMT), with recurrent pericardial effusions treated with Colchicine. Our patient, SG, was diagnosed with AML with bilateral ocular involvement at 4 years of age. His initial treatments (chemotherapy) were prior to coming to our institution, in an international setting. He had relapsed following initial treatment and required reinduction therapy with chemotherapy and radiation (for ocular disease) prior to undergoing his first bone marrow transplant on June 21, 2024. After developing graft failure post first transplant, he underwent a second bone marrow transplant on August 14, 2024. His treatment at our institution included chemotherapies (Asparaginase, Busulfan, Cyclophosphamide, Cytarabine, Fludarabine, Mesna, Methotrexate, Methylprednisolone, rabbit anti-thymocyte globulin, and prednisone), bilateral orbital radiation (905cGY), and total body irradiation (300cGY).

Background: Placenta Accreta Spectrum (PAS) represents a range of severe obstetric complications characterized by abnormal placental adherence, leading to significant maternal morbidity. Early and accurate prenatal detection is crucial for optimal management. A low-lying placenta (LLP) is a known risk factor for PAS. This study aimed to investigate the correlation between maternal serum alpha-fetoprotein (MS-AFP) levels and the presence of PAS in pregnant women with LLP, and to evaluate its potential as a predictive marker. Methods: This was conducted at Lalla Ded hospital, a tertiary care centre in Srinagar, J&K, between August 2023 and January 2025. Pregnant women with gestation >=28 weeks, diagnosed with LLP via ultrasound , who underwent MS-AFP screening were included. MS-AFP levels were measured using and expressed as Multiples of the Median (MoM). An MS-AFP level of >=2.5 MoM was considered elevated. The diagnosis of PAS was confirmed by intraoperative findings and/or histopathological examination. Statistical analysis included descriptive statistics,, correlation analysis, and calculation of diagnostic accuracy metrics. Results: A total of 250 women with LLP were included. PAS was confirmed in 38 (15.2%) participants. The mean MS-AFP level was significantly higher in women with PAS (>=2.5 MoM) compared to those without PAS ( <2.5 MoM) (P<0.05). A significant positive correlation was observed between MS-AFP levels and the presence of PAS (P<[0.05]). Elevated MS-AFP (>=[2.5] MoM) demonstrated a sensitivity of [86.8]%, specificity of [72.1]% for the detection of PAS in this observational study.  Conclusion: Elevated second-trimester MS-AFP levels are significantly correlated with an increased risk of PAS in women with LLP. While not a standalone diagnostic tool, MS-AFP may serve as a valuable, non-invasive adjunct for risk stratification, prompting enhanced surveillance and timely referral for specialized management in this high-risk population.

Background: Diabetic foot ulcers (DFUs) are a serious complication of diabetes mellitus and a leading cause of hospital admissions, infection, and limb loss. The microbial profile of these ulcers and their relationship to glycemic control and clinical outcomes varies geographically and remains underreported in central India. Methods: This prospective observational study was conducted over 12 months at a tertiary care hospital in Chhattisgarh, India. A total of 100 adult patients with diabetic foot ulcers were enrolled. Clinical evaluation included Wagner grading, ulcer measurement, and HbA1c analysis. Wound specimens were collected for aerobic culture and antimicrobial sensitivity testing. Patients received standard medical and surgical care, and outcomes were tracked during follow-up. Associations between microbiological profile, ulcer severity, glycemic control, and surgical intervention were analyzed using ANOVA and chi-square tests. Results: The majority of patients were male (62%), with a mean age of 54.38 ± 11.61 years. Most ulcers were Wagner grade 2 (63%). Poorer glycemic control was significantly associated with higher Wagner grades (p < 0.05). Culture positivity was observed in 82% of cases, with Escherichia coli (26.8%) as the most common isolate, followed by Pseudomonas spp. and coagulase-negative staphylococci (17.1% each). Gram-negative organisms predominated. Antibiotic resistance to commonly used agents was high, but most isolates were sensitive to gentamicin, imipenem, and amikacin. Debridement was performed in 73% of patients; minor and major amputations were required in 22% and 5%, respectively. A statistically significant association was found between Wagner grade and the extent of surgical intervention (p = 0.001). Conclusions: The study revealed a predominance of gram-negative infections in DFUs, with significant antibiotic resistance patterns. Glycemic control and Wagner grade were strong predictors of infection severity and surgical outcome. Early microbiological diagnosis and targeted therapy remain essential for limb salvage in diabetic foot management.

Background: Lumbar spine surgeries are among the most frequently performed neurosurgical and orthopedic procedures today. These surgeries often result in intense postoperative pain, particularly in the initial 12 hours following surgery. Aims: The aim of this study was to compare the efficacy of local infiltration into paraspinal muscles with bupivacaine plus magnesium sulfate versus bupivacaine plus dexamethasone. Methods: This comparative study received ethical clearance and patient consent prior to commencement. Forty patients undergoing lumbar spine surgery under general anesthesia were randomized into two groups (n=20 each). Group BM received 50 mg of bupivacaine combined with 500 mg of magnesium sulfate, diluted to 20 mL with normal saline. Group BD received 50 mg of bupivacaine combined with 4 mg of dexamethasone, also diluted to 20 mL with normal saline. Statistical analysis included mean and 95% confidence intervals, tests of normality (Kolmogorov-Smirnov and Shapiro-Wilk), and analysis of variance for continuous variables, with categorical comparisons made using Pearson Chi-square, continuity correction, likelihood ratio, and Fisher’s exact test. A significance level of P < 0.05 was adopted. Results: The study found significantly lower Visual Analogue Scale (VAS) scores in the group receiving bupivacaine with magnesium sulfate compared to the group receiving bupivacaine with dexamethasone, indicating more effective postoperative pain control. Conclusions: Paraspinal muscle infiltration with bupivacaine and magnesium sulfate provided a longer duration of postoperative analgesia compared to bupivacaine with dexamethasone. This suggests that magnesium sulfate may enhance the analgesic efficacy of bupivacaine in the acute postoperative setting following lumbar spine surgeries.

Background: Nasal obstruction is considered as the most common complaint encountered during a rhino logical practice and the most common cause for this symptoms is either allergic or deviated nasal septum or both. Objective: to assess the effect of septoplasty on the clinical course of allergic rhinitis with DNS and improvement in quality of life by ARCT questionnaire Methods: This prospective observational study was conducted in the Department of ENT & Head and Neck Surgery, SMGS GMC Jammu for a period of one year w.e.f. 1st August 2023- 31st July 2024. Study was conducted after approval from Institutional Ethical Committee, Govt Medical College, Jammu. The study included all the patients of allergic rhinitis with deviated nasal septum who required septoplasty. Result: In our study sneezing and rhinorrhoea was the most common presenting symptoms recorded in all 54 (90 %) patients. In this study average preoperative NOSE score of 60 patients was found to be 13.20 out of 60.After septoplasty there is a decrease in the score found at the end of 6 months which was 5.90.  In this study average ARCT score of 60 patients during the study was found to be 9.81 out of 60. After septoplasty there is a increase in the score found at the end of 6 months which was 19.41. In this study average preoperative SNOT-22 score was 42.02.Postoperative average SNOT-22 score at one month after surgery was 10.73, average SNOT-22 score at 3 months after surgery was 7.48 and the average SNOT -22 score at 6 months after surgery was 5.28. In this study at operation nasal endoscopy using 0* endoscopy (2.7mm) endoscope revealed osteomeatal complex was blocked in 25(41.66%) patients, purulent nasal discharge was seen in 52(86.66%) patients, DNS was observed in 60 (100%) patients, DNS with septal spur was observed in 42(70%) patients and hypertrophied inferior turbinate was present in 47(78.33) patients. allergic rhinitis patients with DNS undergoing septoplasty tend to more satisfied post-operatively than medical managements. Conclusion: Septoplasty alone seems to be a good management choice for allergic rhinitis patients when they have deviated septum.  

Background: Preeclampsia is a transient but potentially dangerouscomplication of pregnancy. Most current assumption regarding the pathophysiologic mechanisms of preeclampsia point to trophoblastic dysfunction. Aim: The present study was conducted to evaluate the relationship between serum total testosterone (TT) with mean arterial blood pressure and risk of cardiovascular disease in patients withpreeclampsia. Methods: A case-control study designed with fifty preeclamptic patients that randomly selected from gynecology ward were studied for estimation of serum TT. Serum TT determined by means of chemiluminescent immunoassay methodbase Immulite 1000 analyzer.  Results: The statistical analysis of study group of preeclampsia compared with normotensive control group, showed significant (p< 0.001)increase in serum TT concentrations in patients with preeclampsia. Positive and highly significant correlation (r = 0.528, P < 0.001) was observed between serum TT compared with mean blood pressure in preeclampsia. Conclusion: The concentrations of the potent total testosterone were significantly higher in women with preeclampsia than in normotensive women with similar gestational and maternal ages. This change may indicate a role of the testosterone in the pathogenesis of preeclampsia.The present study found a significant association between serum TT and mean blood pressure as a risk factor for cardiovascular disease (CVD) and trophoblastic dysfunction in preeclampsia.

Introduction: Cardiovascular diseases are the leading global cause of mortality, accounting for 31% of deaths, and AMI is responsible for 85% of fatalities. Acute myocardial infarction (AMI) in very young individuals is an emerging clinical concern with distinct risk factor profiles and presentations compared to older patients. This study aimed to compare the clinical characteristics and risk factor profile between very young (≤30 years) and older (≥50 years) patients presenting with first acute MI. Methods: This cross-sectional observational study was conducted Department of Cardiology of Dhaka Medical College & Hospital, Sir Salimullah Medical College & Mitford Hospital, National Institute of Cardiovascular Diseases (NICVD), Bangladesh Specialized Hospital (BSH), Dhaka, Bangladesh. This study was carried out from July 2022 to December 2023. In this study, we included 160 patients and divided them into two equal groups: Group I (very young, n = 80) and Group II (older, n = 80). Result: Males predominated in both groups with no significant difference in gender distribution (p = 0.137). Older patients had significantly higher frequencies of epigastric pain and nausea/vomiting (p < 0.05). Blood pressures were significantly higher in the older Group (SBP: p = 0.004, DBP: p = 0.029). Younger patients had a significantly higher prevalence of smoking, dyslipidemia, obesity, positive family history of CAD, and substance abuse (p < 0.05), while hypertension and diabetes mellitus were more common in older patients (p < 0.05). Cardiogenic shock and complete heart block were more frequent in younger patients, with cardiogenic shock reaching statistical significance (p = 0.008). Independent predictors for AMI in the very young included smoking (OR = 12.0), dyslipidemia (OR = 8.89), obesity (OR = 21.89), family history of CAD (OR = 17.69), substance abuse (OR = 4.34), and elevated CRP levels (OR = 1.08). In older patients, diabetes mellitus (OR = 12.69), hypertension (OR = 26.62), and low vitamin D levels (OR = 1.11) were significant predictors (all p < 0.001). Conclusion: This study showed that very young patients exhibited more typical clinical features, higher complication rates, and a greater prevalence of certain risk factors such as smoking, obesity, dyslipidemia, and family history of CAD. But older patients had more atypical symptoms with predominant conventional risk factors.

Background: Aim: To use cord blood TSH as a marker for screening congenital hypothyroidism in term neonates. Methodology: It was a prospective observational study. The study was conducted on all term inborn delivered in hospital from over a period of 18 months from May 2023 to October 2024. The study was conducted at Department of  Paediatrics, Gayathri Vidya Parishad Institute of Health care and Medical Technology, Visakhapatnam. Results:  A total of 625 study subjects out of which 53.1% (n=332) were female and 46.9% (n=293) were male subjects showing a female predominance. Out of 625 subjects 13 patients were suspected for congenital hypothyroidism. When the maternal history was recorded in mothers with suspected patients it came out to be 5 multiparous mothers and 8 primiparous mothers. In our study 65.8% (n=411) mothers undergone Caesarean Section and 34.2% (n=214) have Normal Vaginal Delivery. Our study has revealed that the mean body weight of the study cases born was 2.89 kg ranging from 2.5kg to 3.3kg. The mean body weight in 68.96% (n=431) study subjects ranged between 2.51kg to 3.00kg, whereas, 31.04% (n=194) subjects weighed between 3.01-3.50 kg. In the suspected subjects the mean body weight is 2.79 kg ranging from 2.5kg to 3.3 kg. As far as maternal age is concerned it is noticed in our study that the mean age of all the mothers was 28.29 years, ranging from 21 years to 34 years, and the mean age of mothers of suspected patients is 29.54 years, ranging between 27 years to 32 years.The mean TSH at 3rd day after birth is noted to be 3.5 mU/L, ranging from 5 to 7.6 mU/L. As we have considered the cut of TSH value to be greater than 20 mU/L, our study resulted in 0/625 patients with congenital hypothyroidism.  Conclusion: To conclude, we can safely use a cutoff of cord blood TSH value of >20 mU/L for the purpose of screening for congenital hypothyroidism. Large population-based studies are required to establish normative values for cord blood TSH in our country.

Background: Aim: The aim of the present study is to find out Iron status in children presenting with febrile seizures of age group 6 months to 5 years. Methodology: This case-control study enrolled 75 children to each group with febrile seizures (case) and febrile illness without seizure (control) meeting inclusion criteria over a period of 18 months from July 2023 to December 2024. Hemoglobin, Ferritin, Serum iron levels, TIBC were compared between the two groups. Results: Simple febrile seizure was among majority of cases (88%) and complex febrile seizure was in 12% cases. First episode was among majority of cases (80%). Second and third episode was in 16% and 4% cases respectively. Hb was between 7-9.9 gm/dl among 38.7% of cases and in 18.7% of controls. Hb was <7gm/dl among 26.7% of cases and in 6.7% of controls. There was significant (p=0.0001) difference in Hb between cases and controls. 26.7% of cases were severely anemic in contrast to 6.7% of controls. This study found that Ferritin was <12 among 54.7% of cases and in 18.7% of controls. There was significant (p=0.00001) difference in ferritin between cases and controls. Serum iron was <50 among 61.3% of cases and in 32 % of controls. There was significant (p=0.0001) difference in serum iron between cases and controls. TIBC was >400 among 61.3 % of cases and in 41.3% of controls. There was significant (p=0.01) difference in TIBC between cases and controls. Conclusion: From our current hospital based observational study we have found that Hemoglobin, Ferritin, Serum iron levels, TIBC are significantly lower in children with febrile seizures suggesting that low iron status may be a risk factor for development of febrile seizures. So, screening for Iron deficiency should be considered in all children presented with first episode of febrile seizure. Early detection and iron supplementation in these children might prevent simple febrile seizures.

Background: Hypertension has become one of the leading cause of cardiovascular diseases and thus one of the most prevalent cause of death in high risk individual. It is multi factorial complicated disease contributing to immense caseload and increasing burden on society. Magnesium is the fourth most abundant mineral in the human body. Its role in various conditions has been studied by many authors and most of them showed its deficiency can lead to variety of metabolic abnormalities and its clinical presentations. The association of magnesium ions with blood pressure has been studied well among hypertensive patients, many of them found positive association but some of them also found negative association. In the present study, the primary objective of this study is to determine the association of serum magnesium level with hypertensive patients admitted in medicine ward. Objectives: Assessment of serum Magnesium levels among hypertensive hospitalized male and female patients in tertiary care hospital at Dahod district, Gujrat. Design of study: An Observational Cross-sectional Study. Setting: The study was conducted in admitted hypertensive 34 female patients of age 35 years to 65 years from female medicine ward and 51 male hypertensive patients of age group 35 to 65 years from male medicine ward. Their serum Magnesium level was measured. For that, blood sample collected and processed to the central clinical laboratory from male and female medicine wards for routine tests were utilized for magnesium level estimation using Erba XL 640 integrated system with Xylidyl Blue method. Result:3.92% male patients with hypertension admitted in medicine ward and 8.82 % female patients with hypertension admitted in female medicine ward had serum magnesium levels less than 1.70 mg/dl means below normal level. Conclusion: In this observational cross sectional study, a  very low incidence (3.92%) of magnesium ion deficiency was found in male hypertensive in patients and low incidence (8.82%) was found in female hypertensive in patients.

Background: Recurrent Pregnancy Loss (RPL), particularly Unexplained RPL (URPL), represents a significant reproductive challenge, causing considerable distress to affected couples. Adequate uterine perfusion is fundamental for successful implantation and pregnancy maintenance. Impaired uterine artery blood flow, detectable by Doppler ultrasonography, has been implicated in the pathophysiology of URPL. This study aimed to compare uterine artery blood flow parameters in non-pregnant Kashmiri women with URPL to those with histories of normal term pregnancies. Methods: A prospective case-control study was conducted involving 40 Kashmiri women aged 20-40 years with a history of two or more unexplained first-trimester pregnancy losses (URPL group) and 40 age-matched Kashmiri women with at least one normal term pregnancy and no history of miscarriage (control group). Abdominal Doppler ultrasonography was performed in the mid-luteal phase of the menstrual cycle to assess bilateral uterine artery Pulsatility Index (PI) and Resistance Index (RI). Endometrial thickness was also measured. Results: The mean uterine artery PI was significantly higher in the URPL group (2.2 \pm 0.7) compared to the control group (1.5 \pm 0.9; p < 0.001). The mean uterine artery RI was non-significantly elevated in women with URPL (0.9 \pm 0.2) versus controls (0.8 \pm 0.3; p < 0.083). There was a statistically significant difference in endometrial thickness between the two groups (9.3 \pm 0.2 mm for URPL vs. 11.1 \pm 0.4 mm for controls; p = 0.001). Conclusions: Kashmiri women with URPL exhibit significantly increased uterine artery impedance compared to women with normal pregnancy histories. These findings suggest that impaired uterine perfusion may be a contributing factor to URPL in this population, highlighting the potential diagnostic value of uterine artery Doppler assessment.

Background: Miliary patterns on chest radiographs, characterized by numerous small nodules diffusely distributed across both lungs, pose significant diagnostic challenges due to their association with a broad spectrum of diseases. While miliary tuberculosis remains the most frequently reported cause, other differentials include malignancies, hypersensitivity pneumonitis, sarcoidosis, fungal infections, and occupational lung diseases. Given the limitations of sputum microscopy in many cases, this study aimed to assess the etiological spectrum and evaluate the diagnostic utility of fiberoptic bronchoscopy (FOB) in patients with miliary patterns on chest radiographs. Materials and Methods: A hospital-based cross-sectional observational study was conducted in the Department of Pulmonary Medicine, S.C.B. Medical College, Cuttack, from August 2017 to August 2018. Fifty adult patients (18–60 years) with sputum smear-negative miliary patterns on chest X-ray were included. All patients underwent clinical evaluation, laboratory tests, chest X-ray, HRCT thorax, and fiberoptic bronchoscopy, including BAL, bronchial washings, TBNA, and biopsy when indicated. Data were analyzed to determine diagnostic yield and final diagnoses. Results: The study population had a mean age of 46.16 ± 12.47 years, with 58% male and 42% female participants. The most common symptoms were cough (84%) and fever (64%). HRCT revealed micronodules in 100% of cases, with symmetrical involvement of all lung zones in 82%. BAL analysis showed a lymphocytic predominance in 70% of cases, and BAL was positive for MTB in 50% of cases, with CBNAAT yielding the highest positivity (44%). Histopathological examination confirmed adenocarcinoma in 20% and tuberculosis in 12% of EBB samples. TBNA cytology revealed caseating granulomas in 14% of cases. The overall diagnostic yield of bronchoscopy was 86%. Miliary tuberculosis was the most common diagnosis (50%), followed by lung adenocarcinoma (14%) and miliary metastases (10%). Conclusion: Fiberoptic bronchoscopy, supplemented with BAL, TBNA, and biopsy, plays a crucial role in diagnosing patients presenting with a miliary pattern on chest radiographs. This minimally invasive approach offers high diagnostic yield, especially in sputum smear-negative cases. Early bronchoscopy is recommended in such patients to facilitate timely diagnosis and management.

Background: MMR is an important indicator in assessing the development of a country. In India, MMR in 2020 statistics is 97 per 1 lakh live births. It used to be 384 per 1 lakh live births in 2000 and is declining now. MMR in south india is less compared to northern counterparts. Andhra Pradesh ranks 4th in lowest MMR rates. Most Common Cause of maternal deaths is hemorrhage followed by COVID pneumonia followed by sepsis. The decline in MMR is contributed to significant betterment in health care facilities and multidisciplinary approach. The recommended SDG goals is 70 per 1 lakh by 2030 1,5. So, it is essential to identify the lacunae and causative factors to take appropriate measures to real our goal. Aim: Analysis of incidence of different causes of maternal mortality and their declining trend. Objective: To address the declining trends in Maternal Mortality Rates in a Teritiary care hospital , Government General Hospital, Kakinada Assess incidence of different causes of maternal deaths Methodology: It is a retrospective observational study conducted in the Department of OBG, Government General Hospital attached to Rangaraya Medical College for a period of 60 months from December 2019 to December 2024. Results: A total of 171 maternal deaths which occured from november 2019 to november 2024 are studied and categorized into different causative factors.The most common cause of maternal deaths is hemorrhage i.e. 69 cases(40.3%) followed by covid pneumonia 34 cases(19.8%) followed by sepsis 30 cases(17.5%). The most common cause of maternal deaths due to hemorrhage is atonic PPH followed by ectopic pregnancy. Primigravida are more susceptible to these adverse events. Conclusion: Hemorrhage still remains as the most leading cause of death in pregnant women, while the overall mortality rate has been reduced due to improved health care, adequate availability of blood and blood products and prompt referral.

Background: Acute decompensated heart failure (ADHF) and community acquired pneumonia may have similar presentation of acute dyspnea initially and hence making a definitive diagnosis of primary cause can be difficult. Patients are concurrently treated for suspected pneumonia. Present study was aimed to find out the rational use of antibiotic given in acute heart failure as well as study of total duration and de-escalation of antibiotics in acute heart failure. Material and Methods: This was prospective observational study conducted in patients of Age >18 to 75 years, who presented to emergency room with dyspnea, suspected or known heart failure. Results: In present study, among 100 patients, most common age of presentation in the study was 51-55 years (31%), proportion of males and females in the study were almost equal which was 52% and 48% respectively. Oxygen requirement at admission and after 48 hours of admission were found to be statistically significant. P value <0.0001. A significant fall was noted in TLC/(mm)3 when compared at admission and after 48 hours of admission, difference was statistically significant. It was observed that maximum duration of antibiotic given to the patients were of 8 days and minimum of 2 days. The observed mean of total duration of antibiotic was 5.37±2.62 days. It was observed that there was no restarting of antibiotic in patients who were stopped after 48 hours. It was observed that maximum duration of hospital stay in patients were of 9 days and minimum duration of 3 days. The observed mean of hospital stay was 5.64±1.21 days. Out of 100 patients included in study were 90 were discharged, 10 patients expired. Conclusion: All patients despite low probability of infection received antimicrobial therapy. The mean duration of antibiotic study patients was of 5 days.

Background: The anaesthesiologists and obstetricians encounter specific challenges while managing pregnant patients with congenital complete heart block (CCHB) who require cesarean delivery due to pregnancy-induced physiological changes which requires precise planning to ensure maternal and fetal hemodynamic stability and better outcome. The case involves a 20-year-old primigravida patient weighing 52 kg and measuring 141 cm in height who was pregnant at 38 weeks and 2 days while maintaining a stable fixed heart rate between 48 and 53 bpm due to congenital complete heart block. The patient underwent pacemaker implantation as a past medical procedure before experiencing an infection, which led to the device removal. An emergency LSCS under spinal anaesthesia required the patient to undergo surgery, while the anaesthesiologists anticipated and effectively treated complications of bradycardia and hypotension by using close monitoring and pre-emptive transcutaneous pacing support, targeted fluid therapy and vasopressor use. A 2.6 kg healthy female baby received good Apgar scores during delivery. The patient demonstratedfew sustained episodes of bradycardia during the perioperative period, which were successfully managed because of effective preoperative planning between multiple disciplines, as well as constant monitoring during surgery and after delivery to ensure the wellbeing of patients with congenital cardiac conduction disorders.

Background: Non-communicable diseases (NCDs) are a major cause of morbidity and mortality globally, with increasing prevalence in developing countries due to lifestyle transitions. Early detection and preventive measures are key to reducing their burden. Objective: To assess the prevalence and risk factors associated with NCDs among individuals attending a tertiary care hospital and to evaluate their knowledge and practices related to NCD prevention. Materials and Methods: A cross-sectional study was conducted among 200 patients aged ≥30 years at a tertiary care hospital. Data were collected through a structured questionnaire covering sociodemographic details, medical history, lifestyle factors, and knowledge about NCDs. Anthropometric measurements and blood pressure readings were recorded. Results: Hypertension (32.5%) and diabetes (28.5%) were the most prevalent NCDs. Risk factors included sedentary lifestyle, unhealthy diet, obesity, and tobacco use. Knowledge regarding NCDs was moderate, but preventive practices were inadequate in most participants. Conclusion: There is a high prevalence of NCDs and associated risk factors among the study population. Health education and lifestyle modification interventions are urgently needed to curb the rising burden of NCDs.

Background: Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent airflow limitation and episodic exacerbations. Identifying reliable biomarkers to predict exacerbations is crucial for optimizing clinical management. Elevated blood eosinophil counts and serum Immunoglobulin E (IgE) levels have been proposed as potential predictors of COPD exacerbations. Methods: We conducted an observational cross-sectional study at a tertiary care center in Jaipur, India, recruiting 96 COPD patients (both OPD and IPD). Participants underwent clinical evaluation, spirometry, and laboratory tests, including absolute eosinophil count (AEC) and serum IgE measurement. COPD severity was classified according to GOLD stages. Exacerbations were identified using Anthonisen’s criteria. Statistical analyses included descriptive statistics, comparative tests (Chi-square, t-tests, ANOVA), and correlation analyses. Results: Of the 96 participants, 70.83% were male and 29.17% were female, with a mean age of 60.3 ± 8.5 years. The mean AEC progressively increased from GOLD stage A (468 ± 102.26) to stage B (696.5 ± 234.59) and stage E (832.24 ± 115.05) (p < 0.0001). Similarly, serum IgE levels were significantly higher in stage E (1641.84 ± 580.50) than in stages A (271.15 ± 86.44) and B (778.86 ± 468.30) (p < 0.0001). A strong positive correlation (r = 0.793, p < 0.0001) was observed between AEC and serum IgE. Patients with higher eosinophil counts and elevated IgE had more frequent and severe exacerbations, lower mean FEV₁%, and a higher prevalence of advanced COPD (GOLD stage E). Conclusion: Our findings suggest that elevated blood eosinophil counts and serum IgE levels are associated with increased frequency and severity of COPD exacerbations. Routine assessment of these biomarkers could aid in identifying high-risk patients and tailoring pharmacological interventions.

Background: The term macrosomia is a foetal growth abnormality is defined on basis of weight above 4000g.Other weight cut offs like 4100g,4500g are also used. Large for gestational age(LGA):is defined as one whose weight is above the 90th percentile for gestational age. Aims: The Aim is to study the correlation of fetal weight with gestational age in Non diabetic mothers. The Aim is to study the causes causing fetal macrosomia in non diabetic mothers. Materials & Methods: The present study was a retrospective study. This Study was conducted done from 2019 to 2022. Total 100 patients were included in this study. Result: Quantitative variables presented as mean ± SD, nominal variables as number (percent), P < 0.05 = Significant, P < 0.001 =highly significant, P > 0.05 = Not significant. Quantitative variables presented as mean ± SD, nominal variables as number (percent), P < 0.05 = Significant, P < 0.001 =highly significant, P > 0.05 = Not significant. Conclusion: Both macrosomic infants of diabetic and non-diabetic mothers are at risk for neonatal complications especially infants of diabetic mothers and male babies in the short term period, especially hypoglycemia, respiratory morbidity, caesarean section delivery, and NICU admission.

Background: The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).  Aims: To understand the correlation of early chest ct scan with recovery of covid 19 positive patients. To know the importance of chest ct scan in Managing the severity of covid 19 infection. Materials & Methods: The present study was a Retrospective and prospective case control study. This Study was conducted from Twenty four months, Assam. Total 243 patients were included in this study. Result: In our study, 144 (59.3%) patients had Bilateral and 99 (40.7%) patients had unilateral lung involvement. In our study, 172 (70.8%) patients had negative antigen test and 172(70.8%) patients had positive antigen test. In our study, 70 (28.8%) patients had negative RTPCR and 173(71.2%) patients had positive RTPCR. Conclusion: This study highlights the diverse CT patterns observed in COVID-19 patients, with ground-glass opacities (GGO), crazy paving patterns, and GGO with consolidation being the most common abnormalities.

Background: The complex range of conditions known as pregnancy-related hypertensive diseases has a significant negative impact on people's health in both developed and developing countries worldwide.  They play a significant role in maternal and infant mortality and morbidity.  Five to ten percent of pregnancies worldwide are affected by hypertension diseases. Aims: To Assess The Role Of Pigf At 11-14 Weeks In Early Prediction Of Pre-Eclampsia. Materials & Methods: The DARBHANGA MEDICAL COLLEGE AND HOSPITAL. This hospital is a tertiary care referral centre in eastern India. Prospective observational study and total sample size 100 patients Result: In our study, among patients with pre-eclampsia, 6 patients (17.14%) had normal values (>1.16), while 26 patients (40%) had abnormal values (<1.16). This difference was statistically significant (p = 0.01), indicating a potential association between abnormal values and pre-eclampsia. Conclusion: Pregnancy-related hypertensive diseases are a complicated group of problems that have a significant negative impact on people's health in both developed and developing countries worldwide.  They are a major contributor to maternal and infant mortality and morbidity.  Around the world, hypertension disorders affect five to ten percent of pregnancies.

Background: In Preeclampsia and IUGR, the problem begins in the placenta itself. Normally cytotrophoblastic cells of the chorionic villi invades into the decidua basal is which further invades the spiral arterioles and superficial myometrium leading to progressive dilatation of the vessels and thereby reducing the uterine artery resistance and maintaining the perfusion of placenta along with the fetus. Aims: This study is undertaken to evaluate the association between Uterine Artery Resistance Index (R.I.) performed between 10-14 weeks of gestation to predict Intra Uterine Growth Restriction and Pre-eclampsia at later stages in pregnancy. Materials & Methods: Prospective Cohort study. 150 antenatal patients were included in the study done from December 2021 to November 2022. The age of the women varies between 19-33 years. Result: In our study, diastolic notch was present in both uterine arteries in 81 patients (54.0%), present in one artery in 28 patients (18.7%), and absent in both arteries in 41 patients (27.3%). This distribution was statistically significant, with a p-value of < .00001.  Conclusion: First-trimester uterine artery Doppler resistance index (RI) is a valuable predictive tool for identifying pregnancies at risk for intrauterine growth restriction (IUGR) and pre-eclampsia. Elevated RI values are significantly associated with impaired placental perfusion, which contributes to these adverse outcomes. Early identification through Doppler screening enables closer surveillance and timely interventions, potentially improving maternal and fetal outcomes.

Background: An exploratory analysis of data showed that the chance of atherosclerosis was more than 10 times higher in the 40– 49 years age group than in the younger group, and that this chance was even higher in people aged 50 years or over.6 Atherosclerotic vascular disease begins in childhood and progresses over decades.7 Symptomatic, clinical cardiovascular disease (CVD) events generally occur when atherosclerosis progresses to flow limiting disease that causes ischemia, or when a thrombus forms on an existing plaque as a result of rupture or erosion Material and methods: This was an observational study. The present study was carried out on 120 individuals in the department of Radio-diagnosis. Inclusion criteria were -Age criteria for study are 40 years and above both sexes and all patients and volunteers, otherwise asymptomatic (No known H/O CVA, STROKE, IHD, MI) above 40 years of age. Results: Smoking was found to be the most powerful risk factor in males responsible for development of atherosclerotic plaque in carotid arteries.

Following risk factors are overlapping.

• Only Hypertensive = Non-diabetic, non-smoker and non-alcoholic.
• Only Diabetic = Normotensive, non-smoker and non-alcoholic.
• Only Smoker = Normotensive , non-diabetic and non-alcoholic.

Conclusion: Considering individual risk factors in asymptomatic individuals, hypertension was found to be the most powerful risk factor in males as well as females responsible for development of plaque in carotid arteries..

Background: Sepsis is a major cause of morbidity and death in the neonatal period. The diagnosis and management of shock in the new-born presents many challenges to neonatologists. Functional echocardiography is rational, noninvasive, readily available, performed at the bedside, and provides information in real time, making it an ideal tool to evaluate hemodynamics and to acquire physiological and anatomical information in critically-ill patients. This study was conducted with the aim to assess correlation of functional echocardiography with clinical parameters in neonates with septic shock.  Material and Methods: This was a Single centric Prospective cross-sectional type of study conducted among 140 neonates. It was conducted in the Department of Neonatology (NICU), GMC Aurangabad. Study population included all the newborns in NICU, GMCH, Aurangabad who developed septic shock as diagnosed by signs and symptoms of sepsis and confirmed by clinical and lab parameters. Neonates with diagnosed or suspected congenital and/ or cardiac mal-formation, those diagnosed with shock of etiology other than septic shock and those already on inotropic support were excluded from the study. Results: The gestational age of the neonates ranged from 27 to 41 weeks, with a mean of 33.08 ± 3.17 weeks. The most frequent blood culture finding was K. pneumoniae (24.29%). Total Leukocyte Count was lower than normal in 70% neonates. Pearson’s correlation test was used to assess the correlation of the hemodynamic parameters with cardiac function at the time of diagnosis, after resuscitation with inotropes at 2 hours, and after stabilization.  Conclusion: Functional echocardiography aids in the clinical evaluation of neonatal shock and aids in monitoring the effectiveness of treatment.

D-transposition of great arteries (D-TGA) is one of the most common cyanotic congenital heart diseases diagnosed at birth. The pathophysiology of D-TGA is ventriculoarterial discordance leading to parallel circulation. The survival of the neonate depends on the intercirculatory mixing of oxygenated and deoxygenated blood at various levels through atrial septal defect, ventricular septal defect or patent ductus arteriosus. Few patients survive beyond the first year of life. A case of D-TGA with ventricular septal defect and left ventricular outflow obstruction survived till six years of age and underwent successful arterial switch operation. Arterial switch operation (ASO) was performed as it was substantiated by echocardiographic and angiographic findings. The patient’s perioperative course was uneventful and was discharged on the 8^th postoperative day. The present case, which is one of the advanced ages at which arterial switch operation for TGA/Ventricular Septal Defect/Left Ventricular Outflow Tract Obstruction was performed among previously reported cases, is used to discuss late Arterial Switch Operation and its anaesthetic management in this case report.

Background: Chronic ulceration of lower leg including the foot is a frequent condition causing pain, social discomfort and generating considerable costs. The incidence of leg ulcers is widely recorded to range from 0.18% to 1%.The primary    etiologies of lower extremity ulcers include diabetes, venous insufficiency, arterial disease, and neuropathy. Chronic wounds are distinguished by a prolonged inflammatory phase that obstructs the process of regenerative wound healing. The objective of wound care for chronic leg ulcers is to promote healing and prevent lower limb amputations by implementing standardised protocols for wound management. Methods: The primary objective of this study was to assess the safety and effectiveness of autologous platelet-rich plasma (PRP) in the treatment of chronic skin ulcers, as compared to conventional skin dressings. Single centre, Prospective randomized controlled trial study with two parallel groups. Results: Wound Contraction: Cases showed significantly greater wound contraction compared to controls, highlighting the effectiveness of targeted interventions like PRP. Duration of Wound Contraction: The duration of wound contraction was significantly shorter in cases, indicating faster healing in the intervention group. Conclusion: The study highlights the need for integration of advanced wound care modalities, such as PRP, with standard diabetic foot care protocols to enhance healing rates, reduce treatment duration, and improve the quality of life for patients with diabetic foot ulcers(DFUs).

Introduction Patients with end-stage kidney disease (ESKD), especially those on dialysis have high inflammatory load leading to endothelial dysfunction which results in high cardiovascular morbidity and mortality. There are very few studies comparing inflammatory markers in children on peritoneal dialysis (PD) and haemodialysis (HD). The primary objectives of this study were to measure inflammatory marker levels in children with ESKD on maintenance dialysis and compare the levels in those undergoing HD and PD.  Methods This was a cross-sectional hospital-based study involving children aged 1-18 years on maintenance HD or PD for at least 3 months. The inflammatory marker levels (Fibroblast Growth Factor 23 (FGF23), high sensitivity C-Reactive Protein (hsCRP) and Interleukin-6 (IL-6)) were measured in all children on maintenance dialysis and compared between the two groups as well as correlated with clinical and laboratory parameters.  Results A total of 16 children were included in the study (10 on PD and 6 on HD). The mean hsCRP was 3.20±0.69 mg/L in all dialysis patients, 3.14±0.59 mg/L in HD group and 3.28±0.87 mg/L (p=0.515) in PD group. The mean IL-6 was 1.69±0.46 pg/ml in all dialysis patients, 1.81±0.37 pg/ml in HD group and 1.50±0.56 pg/ml in PD group (p=0.913). The mean FGF 23 was 811.54±128.6 ng/ml in all dialysis patients, 821.7±137.9ng/ml in HD group and 794.6±121.6 ng/ml in PD group (p=0.233). IL-6 showed positive correlation with dialysis vintage (R=0.509, p=0.044) and FGF23 levels (R=0.547, p=0.028). Conclusion hsCRP and FGF23 were increased in children on dialysis. There was no difference in inflammatory markers in children on HD versus PD. IL-6 levels positively correlated with dialysis vintage and FGF23 levels.

Background: Despite advancements in laboratory automation, reporting errors—especially in the pre- and post-analytical phases—remain a major quality concern. Objective: To audit reporting errors over a 10-year period in a NABL-accredited Clinical Biochemistry Laboratory and implement corrective strategies aligned with ISO 15189 standards. Methods: A retrospective audit (2015–2024) was conducted to classify errors, perform root cause analysis (RCA), and assess clinical impact. CAPA measures were initiated for continuous quality improvement. Results: Out of 4.72 million samples, 200 errors were identified: 65% post-analytical (all typographical), 19% pre-analytical, and 16% analytical. Clinical impact was noted in 23.5% of cases. Auto-verification rates improved from 35% to 62% over the study period, contributing to a decline in manual errors. Conclusion: Post-analytical errors dominate despite automation. Strengthening LIS integration, staff training, and RCA-driven CAPA measures are critical for improving laboratory quality and patient safety.

Background: The ABO system is the most important blood group system in transfusion therapy and was the first blood group system to be discovered. In modern medicine, the need for blood group frequency and prevalence study is multipurpose, as besides its importance in evolution, their relation to disease and environment is becoming increasingly important. Knowledge of the distribution of pattern of different blood groups is very crucial for blood centres and blood transfusion services, which significantly contribute to the health system of the nation and to maintain the donor registry. Aim: The study is aimed to know the frequency of ABO and Rh blood group in a population of western Maharashtra, India which is essential for effective management of blood inventory and to maintain blood donor registry. Material and method: The present study was conducted at the Government Medical College and Hospital Blood Centre, Miraj.  A total of 13858 blood donors were selected and accepted for blood donation as per the blood Donor selection guidelines of the Drug and cosmetics Act ,1940 Result: Out of 13858 donors, 13440 (96.98%) were males and 418 (3.02%) were females. The majority of donors belong to the age group 30 to 40 years. The commonest A B O group present was B+ 29.55% followed by O+ 28.33%, followed by A+ + 27.48%, and AB+ 9.54% while 13155(94.92%) donors were Rh Positive, and 698 (5.03%) donors were Rh Negative. Conclusion: Knowledge of the distribution of patterns of different blood groups is very crucial for blood centers and blood transfusion services, which significantly contribute to the health system of the nation. Blood group distribution is important for clinical studies, geographical information and forensic studies in general population. It also helps to maintain the donor registry, which is useful in a blood crisis.

Coronary artery disease (CAD) is a leading cause of mortality worldwide, particularly affecting younger adults with symptomatic atherosclerosis. This case report details a 44-year-old male patient presenting with chest pain and dyspnea, leading to a diagnosis of triple vessel disease (TVD). His medical history included hypertension and tobacco use, with a coronary angiogram revealing 100% occlusion in the left anterior descending artery (LAD) and right coronary artery (RCA), along with significant stenosis in other major vessels. Surgical intervention through coronary artery bypass grafting (CABG) was deemed necessary to restore blood flow. The surgery was conducted under general anesthesia with cardiopulmonary bypass, successfully utilizing both saphenous vein and internal thoracic artery grafts. Post-operative recovery was uneventful, and the patient was extubated within four hours. This case underscores the complexity of CABG in patients with TVD, highlighting the importance of tailored surgical strategies and meticulous technique to optimize outcomes and improve quality of life. The successful revascularization illustrates the potential benefits of CABG in high-risk patients with significant coronary blockages.

Background: We aimed to analyse the correlation between types of chronic otitis media with sensory hearing loss and to compare the severity of sensorineural hearing loss in both types of chronic otitis media. We also aimed to study the correlation between sensorineural hearing loss and chronic otitis media. Methodology: This study was conducted as a cross sectional observational study on patients with COM seeking care at tertiary care center during the study period of 18 months.Detailed history was obtained and ontological examination was done. Type and severity of hearing loss was assessed based on tuning fork tests and pure tone audiometry.  Results: Sensorineural hearing loss was observed in significantly higher proportions of ears with squamosal COM (58.1%) as compared to patients with mucosal COM (21.2%; p<0.05). Also, the severity of SNHL was higher in squamosal COM (p<0.05). Conclusions:Chronic otitis media (COM) is a common condition for which patients seek care at our ENT outpatient department. While conductive hearing loss is a hallmark of COM, sensorineural hearing loss (SNHL) of varying severity is also frequently observed. SNHL is more commonly associated with the squamous type of COM; however, some cases of mucosal COM may also exhibit this condition. This indicates that SNHL can develop due to either squamous or mucosal CSOM. Since the severity of SNHL has been found to correlate with squamosal COM, early and effective treatment can help minimize the risk of SNHL and its associated complications.

Background: Chronic Otitis Media (COM) is a persistent inflammatory condition of the middle ear and mastoid cavity that significantly impacts patients quality of life. While clinical attention is often focused on the affected ear, the contralateral ear (CLE), defined as the asymptomatic or less affected ear, also plays a crucial role. The objective of this study was to assess and correlate the findings of status of the CLE in cases of COM and evaluate its clinical implications. Methodology: This cross-sectional observational study was conducted after obtaining approval from the institutional ethical committee. A total of 120 individuals diagnosed with unilateral COM were included. Patients with an intact tympanic membrane (TM) in the CLE from all age groups were enrolled. Exclusion criteria included prior ear surgery, head/ear trauma, or refusal to participate. Results: Among the 120 patients, 69 (57.50%) were male, and 51 (42.50%) were female. The primary symptoms were ear discharge and hearing impairment. The mean age of patients 37.48±12.13.   Otoscopic examination revealed large central perforation (LCP) in 34.2% of cases and medium central perforation  (MCP) in 25%. Posterior Superior Quadrant (PSQ) with Attic Retraction was observed in 6.70% of cases. The CLE showed Grade 1 TM retraction in 25% of cases and tympanosclerotic patches in 15.00%, followed by Grade 2 TM retraction in 12.5%. The pure tone audiometry (PTA) findings revealed 117 patients (97.5%) had conductive hearing loss in the diseased ear, with an average hearing loss of 43.65 ± 14.16 dB. In CLE showed, 84 patients (70%) had normal hearing while, 28.3% had mild hearing loss. Conclusion: This study highlight the significant impact of chronic otitis media (COM) on both the diseased and contralateral ears and evaluation  of both ears is essential for accurate diagnosis, disease monitoring, and timely therapeutic intervention. Regular assessments help determine the progression and potential impact of COM on the contralateral ear, allowing for early management and better patient outcomes. Proper patient education and continuous monitoring are crucial for effective treatment planning and prevention of further deterioration.

Background: Pruritus represents a distressing but often neglected comorbidity of type 2 diabetes mellitus (DM2) with possible impacts on quality of life (QoL), glycemic management, and psychological status. However, there is a dearth of Indian clinical data on this entity. The present study was designed to find out the prevalence, severity and clinical as well as psychological correlates of pruritus among adult DM2 patients in a tertiary care hospital in India. Methodology: This is a cross-sectional study that was performed from February 2023-22 at the College of Medicine, a tertiary care hospital, in which 354 adult DM2 patients were thpatient: 1). Itch was evaluated according to the Numerical Rating Scale (NRS) and Four-Item Itch Questionnaire (4IIQ). Diabetic neuropathy was evaluated by Katzenwadel scale. ItchyQoL, Hospital Anxiety and Depression Scale (HADS). Metabolic indicators including HbA1c and FPG were compared among patients with and without pruritus. Results: One hundred and thirty-nine (39.3%) of the patients reported pruritus. Mild, moderate and severe itch accounted for 27.3%, 48.2%, and 24.5% of them, respectively. Patients with pruritus had higher HbA1c levels (8.6 ± 1.2 vs. 7.9 ± 1.0; p = 0.003) and FPG (165.2 ± 28.6 vs. 151.8 ± 25.9 mg/dL; p = 0.012). Psychologic assessment demonstrated higher levels of anxiety (9.3 ± 2.1), depression (8.1 ± 1.9), and stigmatization scores (5.4 ± 1.6) in pruritic patients. Conclusion: Pruritus is a prevalent and burdensome symptom in Indian patients with DM2, significantly associated with poor glycemic control, and diabetic neuropathy. It also imposes substantial psychosocial stress, highlighting the need for integrated dermatologic and psychological evaluation in routine diabetes management.

Background: A Rising Health Challenge in Andhra Pradesh. Chronic kidney disease (CKD) represents a major global health concern, with its increasing prevalence creating substantial challenges for healthcare systems worldwide. In Andhra Pradesh, a southern state in India, CKD is becoming an escalating public health issue. This study was conducted to evaluate the clinical profile of CKD patients attending Government Medical College, Kadapa, Andhra Pradesh. Specific objectives included identifying the underlying etiologies of CKD, assessing associated comorbid conditions, and examining the clinico-hematological correlation between risk factors and complications in individuals affected by chronic kidney disease. Materials and methods: Study design: Prospective observational study.  Study period: 1 year. Place of study: Department of General Medicine, Government General Hospital, Kadapa. Source of data: OPD and IPD admissions in General Medicine Department (GMC), GGH Kadapa. Sample size: 100 patients. Patients presenting to the Department of General Medicine were evaluated through a structured questionnaire, followed by a comprehensive history-taking and physical examination. Key clinical parameters recorded included a history of diabetes mellitus, hypertension, smoking habits, and alcohol consumption. Vital signs and systemic examination findings were documented. Relevant investigations were carried out.  Results: Alcohol use is strongly linked to progressive CKD (Stages 3A-5). Non-alcoholics are more common in Stage 2 (early CKD) but also present in late stages, indicating alcohol exacerbates kidney damage.  Diabetes is a major driver of CKD progression, with most cases in advanced stages (3B-5). Non-diabetics are rare, suggesting diabetes is a primary risk factor in this population.  Hypertension is strongly associated with late-stage CKD (stages 4-5). Non-hypertensive individuals are more common in early stages (2-3B), but hypertension dramatically increases the risk of kidney failure (Stage 5). Conclusion: This study highlights chronic kidney disease (CKD) as a major health issue in Andhra Pradesh, driven primarily by diabetes (69%) and hypertension (56%). Most patients were middle-aged, rural, and economically disadvantaged, with late-stage diagnosis (66% in Stages 3B–5). Key risk factors included smoking, alcohol use, and groundwater consumption, while contracted kidneys (81%) and severe albuminuria indicated advanced disease. 

Background: Preterm birth (PTB), defined as delivery before 37 weeks of gestation, remains a leading cause of neonatal morbidity and mortality globally. Emerging evidence suggests that alterations in the vaginal microbiome during early pregnancy may influence PTB risk. A predominance of non-Lactobacillus species and microbial dysbiosis has been linked to adverse pregnancy outcomes. This study aims to investigate the association between early pregnancy vaginal microbiome profiles and the risk of spontaneous preterm birth. Materials and Methods: This prospective cohort study was conducted among 200 pregnant women recruited before 14 weeks of gestation from a tertiary care hospital. Vaginal swabs were collected during the first trimester and analyzed using 16S rRNA gene sequencing to determine microbiome composition. Participants were followed throughout pregnancy, and delivery outcomes were recorded. Microbiome diversity indices (Shannon and Simpson), community state types (CSTs), and relative abundance of bacterial taxa were compared between women who delivered preterm (<37 weeks) and those who had term deliveries. Multivariate logistic regression was used to identify independent microbial predictors of PTB after adjusting for known confounders. Results: Out of 200 participants, 38 (19%) experienced spontaneous PTB. Women who delivered preterm had significantly higher microbial diversity (mean Shannon index: 2.8 ± 0.3 vs. 1.6 ± 0.4, p < 0.001) and were more likely to exhibit CST IV, characterized by low Lactobacillus and high abundance of Gardnerella, Atopobium, and Prevotella. Logistic regression revealed that CST IV was associated with a 3.5-fold increased risk of PTB (adjusted OR: 3.5; 95% CI: 1.8–6.9; p = 0.002). Lactobacillus crispatus dominance was significantly protective against PTB (adjusted OR: 0.4; 95% CI: 0.2–0.9; p = 0.021). Conclusion: Our findings suggest that early pregnancy vaginal microbiome composition is significantly associated with the risk of spontaneous preterm birth. Dysbiotic microbiota with reduced Lactobacillus dominance and increased anaerobic diversity may contribute to an unfavorable intrauterine environment. Targeted microbial screening and interventions during early gestation may help mitigate PTB risk.

Diabetes Mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycaemia and is a major global health concern. Type 2 Diabetes Mellitus (T2DM) is associated with an increased risk of cardiovascular diseases, particularly Coronary Artery Disease (CAD), which often progresses silently in diabetic patients. Early detection of asymptomatic CAD is crucial to prevent severe outcomes. The Treadmill Test (TMT) is an effective non-invasive screening tool for detecting CAD in these patients. Aim & Objective: The aim of this study is to detect coronary artery disease early in asymptomatic patients of Type 2 DM. Methods: This hospital-based, cross-sectional study was conducted over one year at J.L.N Medical College, Ajmer and included 80 newly diagnosed (within 6 months) Type 2 DM patients aged 30-60 years. Patients were divided into two groups: Group 1 (normal ECG, no symptoms of CAD) and Group 2 (ECG changes but no symptoms). Various biochemical, clinical and TMT parameters were analyzed to assess the presence of CAD. Results: The study revealed that patients with abnormal ECG and positive TMT results had higher levels of HbA1c, fasting blood sugar, and postprandial blood sugar. Lipid profiles, including cholesterol, triglycerides, and LDL levels, were also elevated in this group. TMT showed positive results in 7 patients from Group 1 and 15 patients from Group 2. The mean BMI, pulse rate, and blood pressure were also higher in those with positive TMT results. Conclusion: T2DM significantly increases the risk of CAD and the Treadmill Test is a useful, non-invasive tool for early detection of asymptomatic CAD in diabetic patients. Early screening can help identify silent myocardial ischemia, enabling timely interventions to prevent severe cardiac events and reduce mortality.

Background: Inadequate cobalamin levels (VB12D) within the Indian subcontinent constitute a meaningful dietary health issue, largely resulting from poor public health prioritization, dietary patterns, and limited intake of animal products. This synthesis of pooled evidence integrates results from 20 key Indian studies to assess VB12D frequency and distribution in demographic groups. Objectives: We reviewed the literature and also synthesized the pooled evidence that came from 20 selected Indian studies published between the years 2001 and 2023. Our purpose was to determine the pooled frequency with which levels of inadequate cobalamin occurred in the Indian population. Twenty peer-reviewed studies were selected according to predefined inclusion criteria focusing on Indian populations. These studies included antenatal screening as well as community-based and hospital-based cohorts. A calculation used a variance-accommodating approach. The result was a pooled frequency of occurrence. Subgroup analyses used age group, gender, geographic location, and physiologic status, like pregnancy. Results: In the 20 chosen articles, including 18,750 participants, the pooled frequency of inadequate cobalamin levels occurred in 51% (95% CI: 44%–57%). Vegetarians in 65% of cases, females in 55% of cases, adolescents in 49% of cases, and pregnant women in 67% of cases showed a higher frequency of occurrence. This was notably seen among vegetarians as well as among pregnant women. Differences existed that were inconsistent in rural and urban areas. The data reveal inadequate cobalamin levels burdening the Indian subcontinent, especially women, vegetarians, and youth. These findings support health strategies being critically necessary, so programs must supplement, fortify food, and screen routinely in maternal health.

Background: Acute appendicitis is one of the most frequent causes of abdominal pain requiring surgical intervention in emergency departments. Early and accurate diagnosis remains a challenge, especially in atypical presentations. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential biomarker for inflammatory conditions, including appendicitis. This study aimed to evaluate the predictive value of NLR in diagnosing acute appendicitis in emergency settings. Materials and Methods: A cross-sectional observational study was conducted over six months in the emergency department of a tertiary care hospital. A total of 150 patients presenting with right lower quadrant abdominal pain were enrolled. Blood samples were taken prior to imaging and surgical intervention to calculate the NLR. Diagnosis was confirmed intraoperatively and by histopathological examination. Patients were divided into two groups: appendicitis confirmed (n=110) and not confirmed (n=40). Statistical analysis was done using ROC curve analysis, and sensitivity, specificity, and predictive values were calculated. Results: The mean NLR in patients with confirmed acute appendicitis was significantly higher (8.5 ± 2.3) compared to those without appendicitis (4.1 ± 1.7), with a p-value < 0.001. Using a cutoff NLR value of 6.0, the sensitivity was 84.5%, specificity 75.0%, positive predictive value 90.1%, and negative predictive value 63.2%. The area under the ROC curve was 0.852, indicating good diagnostic accuracy (Table 1). Conclusion: The neutrophil-to-lymphocyte ratio is a simple, inexpensive, and readily available parameter that shows good predictive value in diagnosing acute appendicitis. It can be a useful adjunct to clinical evaluation and imaging in emergency settings to aid in early diagnosis and decision-making.

Background: Pelvic floor dysfunction (PFD) is a significant concern following childbirth, affecting a woman’s quality of life and long-term pelvic health. Instrumental vaginal delivery (IVD), involving forceps or vacuum assistance, has been hypothesized to increase the risk of PFD compared to spontaneous vaginal delivery (SVD). However, limited longitudinal data exist comparing the incidence and progression of PFD between these two modes of delivery. Materials and Methods: This prospective longitudinal cohort study included 240 primiparous women who underwent vaginal delivery at a tertiary care hospital. Participants were divided into two groups: those who had spontaneous vaginal delivery (n=120) and those who had instrumental vaginal delivery (n=120). Pelvic floor function was assessed using the Pelvic Floor Distress Inventory (PFDI-20) and pelvic organ prolapse quantification (POP-Q) at 6 weeks, 6 months, and 12 months postpartum. Additional data on urinary incontinence, fecal incontinence, and sexual dysfunction were collected through standardized questionnaires. Results: At 6 weeks postpartum, 48.3% of women in the IVD group reported moderate to severe pelvic floor symptoms compared to 26.7% in the SVD group (p<0.01). At 12 months, 35.8% of the IVD group continued to report persistent symptoms versus 18.3% in the SVD group (p=0.02). POP-Q measurements showed a higher incidence of stage II prolapse in the IVD group at 12 months (27.5%) compared to the SVD group (10.8%). Urinary incontinence was the most commonly reported symptom, followed by pelvic pressure and dyspareunia. Conclusion: Instrumental vaginal delivery is associated with a significantly higher risk and persistence of pelvic floor dysfunction up to one year postpartum compared to spontaneous vaginal delivery. Early screening and postpartum rehabilitation should be prioritized, especially for women undergoing IVD, to mitigate long-term complications

Background: First-episode psychosis (FEP) is often associated with alterations in the hypothalamic-pituitary-adrenal (HPA) axis and immune system dysfunction. Cortisol, a key stress hormone, along with inflammatory biomarkers such as interleukin-6 (IL-6) and C-reactive protein (CRP), have been implicated in the pathophysiology of psychotic disorders. Understanding these alterations may aid in early identification and intervention strategies for psychosis. Materials and Methods: This cross-sectional study involved 60 participants, comprising 30 patients diagnosed with first-episode psychosis and 30 age- and sex-matched healthy controls. Blood samples were collected between 8:00 and 9:00 AM to measure serum cortisol, IL-6, and CRP levels. All participants underwent clinical evaluation using the Positive and Negative Syndrome Scale (PANSS). Data were analyzed using independent t-tests and Pearson correlation coefficients. Results: The FEP group showed significantly elevated mean cortisol levels (21.8 ± 6.2 µg/dL) compared to controls (14.5 ± 4.3 µg/dL, p < 0.001). Similarly, IL-6 (5.6 ± 1.8 pg/mL vs. 2.9 ± 1.2 pg/mL, p = 0.002) and CRP levels (4.1 ± 1.5 mg/L vs. 1.7 ± 0.9 mg/L, p = 0.003) were higher in FEP patients. Positive correlations were observed between cortisol and PANSS total score (r = 0.42, p = 0.01), and between IL-6 and CRP (r = 0.53, p < 0.001). Conclusion: Patients with first-episode psychosis exhibit significant dysregulation in both cortisol secretion and inflammatory responses. These findings support the hypothesis of HPA axis hyperactivity and immune activation in early psychosis, highlighting the potential role of these biomarkers in the pathophysiological assessment and management of psychotic disorders.

Background: Vitamin D deficiency is increasingly recognized as a global health issue and has been implicated in the development of several chronic metabolic conditions. Emerging evidence suggests a potential link between low serum vitamin D levels and components of metabolic syndrome (MetS), including central obesity, dyslipidemia, hypertension, and insulin resistance. This study aimed to evaluate the prevalence of vitamin D deficiency and its association with metabolic syndrome among urban adults. Materials and Methods: A cross-sectional study was conducted among 200 adults aged 25–60 years residing in an urban area. Participants were selected through stratified random sampling. Anthropometric measurements, blood pressure, and fasting blood samples were collected to assess serum 25-hydroxyvitamin D [25(OH)D], fasting glucose, triglycerides, and HDL cholesterol. Metabolic syndrome was defined using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Serum vitamin D levels were categorized as sufficient (≥30 ng/mL), insufficient (20–29 ng/mL), and deficient (<20 ng/mL). Statistical analysis was performed using chi-square and logistic regression tests. Results: Among the 200 participants, 62% were found to have vitamin D deficiency, 24% had insufficient levels, and only 14% had sufficient vitamin D levels. The overall prevalence of metabolic syndrome was 38%. A significantly higher prevalence of metabolic syndrome was observed in individuals with vitamin D deficiency (49%) compared to those with sufficient vitamin D levels (18%) (p < 0.01). Logistic regression analysis showed that vitamin D deficiency was independently associated with increased odds of metabolic syndrome (OR: 2.7; 95% CI: 1.4–5.3, p = 0.003), even after adjusting for age, gender, and BMI. Conclusion: This study highlights a high prevalence of vitamin D deficiency in urban adults and suggests a significant association between low vitamin D levels and metabolic syndrome. Early identification and correction of vitamin D deficiency may be beneficial in reducing the risk of metabolic syndrome and related complications.

Background: PPROM, occurring in 2–4.5% of pregnancies, is a major contributor to preterm births and perinatal mortality, with microbial invasion increasing maternal and neonatal risks. CRP, an inflammatory biomarker, may help predict adverse outcomes in PPROM cases. Methodology: A prospective observational study of 78 PPROM cases analyzed CRP levels and their association with maternal and neonatal outcomes, categorizing participants into CRP-positive and CRP-negative groups. Results: Elevated CRP levels correlated with higher maternal complications (sepsis, UTI, atonic PPH), increased neonatal morbidity (lower APGAR scores, perinatal depression), and longer NICU stays, with more C-sections and labor inductions in the CRP-positive group. Conclusion: While CRP is a useful inflammatory marker, its predictive value for chorioamnionitis remains uncertain, and routine serial monitoring may not significantly alter clinical management. Further research is required to refine its role in PPROM care.

Background: Peripheral nerve blocks, particularly supraclavicular brachial plexus block, provide effective anesthesia and analgesia for upper limb surgeries. Various adjuvants have been used with local anesthetics to enhance block characteristics. This study compared dexmedetomidine versus dexamethasone as adjuvants to bupivacaine in ultrasound-guided supraclavicular block for forearm surgeries. Methods: In this prospective, randomized, double-blind study, 72 patients scheduled for forearm surgeries under supraclavicular block were randomly allocated into two groups of 36 each. Group A received 0.5% bupivacaine (20ml) with dexmedetomidine (1µg/kg), while Group B received 0.5% bupivacaine (20ml) with dexamethasone (4mg). Block characteristics (onset and duration of sensory and motor block), duration of analgesia, postoperative pain scores, analgesic consumption, hemodynamic parameters, and adverse effects were compared between the groups. Results: The onset of sensory block (8.72±1.86 vs 11.44±2.08 minutes) and motor block (12.14±2.22 vs 15.36±2.48 minutes) was significantly faster in the dexmedetomidine group compared to the dexamethasone group (p<0.001). Duration of sensory block (13.68±1.92 vs 11.86±1.74 hours), motor block (11.94±1.68 vs 10.26±1.52 hours), and analgesia (16.42±2.18 vs 14.28±1.96 hours) were significantly longer in the dexmedetomidine group (p<0.001). Total analgesic consumption was significantly lower in the dexmedetomidine group (82.64±24.86 vs 112.38±30.42 mg, p<0.001). The dexmedetomidine group had significantly lower heart rates and blood pressure values during the intraoperative period. Adverse effects, particularly bradycardia (11.11% vs 0%), were more common in the dexmedetomidine group (p=0.024). Conclusion: Both dexmedetomidine and dexamethasone are effective adjuvants to bupivacaine in supraclavicular block for forearm surgeries. Dexmedetomidine provides faster onset, longer duration of block and analgesia, and reduced analgesic requirements compared to dexamethasone, albeit with a higher incidence of hemodynamic adverse effects, particularly bradycardia.

Background: Peripheral nerve blocks, particularly supraclavicular brachial plexus block, provide effective anesthesia and analgesia for upper limb surgeries. Various adjuvants have been used with local anesthetics to enhance block characteristics. This study compared dexmedetomidine versus dexamethasone as adjuvants to bupivacaine in ultrasound-guided supraclavicular block for forearm surgeries. Methods: In this prospective, randomized, double-blind study, 72 patients scheduled for forearm surgeries under supraclavicular block were randomly allocated into two groups of 36 each. Group A received 0.5% bupivacaine (20ml) with dexmedetomidine (1µg/kg), while Group B received 0.5% bupivacaine (20ml) with dexamethasone (4mg). Block characteristics (onset and duration of sensory and motor block), duration of analgesia, postoperative pain scores, analgesic consumption, hemodynamic parameters, and adverse effects were compared between the groups. Results: The onset of sensory block (8.72±1.86 vs 11.44±2.08 minutes) and motor block (12.14±2.22 vs 15.36±2.48 minutes) was significantly faster in the dexmedetomidine group compared to the dexamethasone group (p<0.001). Duration of sensory block (13.68±1.92 vs 11.86±1.74 hours), motor block (11.94±1.68 vs 10.26±1.52 hours), and analgesia (16.42±2.18 vs 14.28±1.96 hours) were significantly longer in the dexmedetomidine group (p<0.001). Total analgesic consumption was significantly lower in the dexmedetomidine group (82.64±24.86 vs 112.38±30.42 mg, p<0.001). The dexmedetomidine group had significantly lower heart rates and blood pressure values during the intraoperative period. Adverse effects, particularly bradycardia (11.11% vs 0%), were more common in the dexmedetomidine group (p=0.024). Conclusion: Both dexmedetomidine and dexamethasone are effective adjuvants to bupivacaine in supraclavicular block for forearm surgeries. Dexmedetomidine provides faster onset, longer duration of block and analgesia, and reduced analgesic requirements compared to dexamethasone, albeit with a higher incidence of hemodynamic adverse effects, particularly bradycardia.

Background: Medical abortion has become an increasingly accessible method for early pregnancy termination. While highly effective and safe under medical supervision, the widespread availability of abortion pills without prescription raises concerns about self-administration and potential complications. This study aimed to assess the impact of self-administered abortion pills on women presenting to a tertiary care hospital in Bengaluru, India, focusing on the complications arising from this practice and the subsequent burden on healthcare services. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynecology at Kempegowda Institute of Medical Sciences(KIMS), Bengaluru, over a 12-month period (October 2023 – September 2024). The study population comprised pregnant women who sought medical attention due to complications following self-administration of medical abortion pills without prior medical consultation, up to 24 weeks of gestation. Data were collected through patient records, surveys, and interviews after obtaining informed consent. Clinical history, ultrasound examinations, and physical assessments were performed to determine outcomes and associated risks. Results: A total of 74 women were included in the study. The most common age group was 21-25 years (37.8%), and most women were multigravida (67.5%). The majority presented with bleeding per vagina (66.21%) and passage of products of conception (16.21%). A significant proportion exhibited anemia, with 50% having moderate anemia (Hemoglobin 7-9.9 g/dL). Incomplete abortion was the most frequent outcome (81%), followed by missed abortion (10%). The primary interventions required were suction and evacuation (75.67%) and anemia correction (33.7%). Conclusion: Self-administration of abortion pills is associated with a high rate of complications necessitating tertiary care intervention, predominantly incomplete abortion and bleeding. This study underscores the importance of medical supervision for medical abortion and highlights the need for public health interventions to ensure safe abortion practices, including improved access to supervised services and enhanced public education regarding the risks of unsupervised self-medication.

Background: Coronary artery disease is one of the leading cause of morbidity & mortality in females especially postmenopausal women. The main aim of this study is to know about the clinical profile of coronary artery disease in postmenopausal women and also to learn about the major risk factors.The incidence of CAD in post menopausal women can be directly attributed to lack of estrogen and it’s direct and indirect cardioprotective effects. The advantage of protection by hormones is lost in postmenopausal females & so incidence equals to male counterparts.Hypertension, Type 2 Diabetes mellitus, Dyslipidemia, Smoking and Usage of Oral contraceptive pills etc are found to be major risk factors. Aims & objectives:

• To study the clinical profile of CAD in postmenopausal women visiting tertiary care centre.
• To study risk factors of coronary artery disease in post menopausal women.

Methods:

This Cross sectional study includes data collected from 100 post menopausal females visiting OPD of Krishna Rajendra Hospital, Mysore during the period of April 2022 to October 2022, without previous history suggestive of heart disease. The data was analysed by SPSS software version 2.0,and chi-square tests was applied for qualitative variables. Results: The study was conducted among 100 post menopausal women. The study showed almost equal distribution of subjects in the age group of 53-56yrs, 57-60yrs and 65-68yrs with each age group contributes about 26%, and the mean age was 60.3yrs. Among the presenting complaints studied, 35 % subjects presented with chest pain, 45 % presented to OPD with giddiness, 12% presented with dyspnoea and rest 8 % presented with palpitation. Risk factors like HTN, T2DM and Dyslipidemia was also analysed among study subjects and majority of the study subjects were hypertensives contributing about 46 %, 35 % of the study subjects had dyslipidemia and 9 % had T2DM. ECG was done for all patients, and 55% of study subjects had a normal  ECG  findings. Among the abnormal ECG findings, 18 % showed features suggestive of LVH in ECG, 19% had T inversions, 1 % showed ST depression, and 3% showed pathological Q waves, 4 % showed poor r wave progression. 2D Echo was also done among all patients, 53% had normal findings, 18% had LVH, 13%  had IHD with EF>50%, 9% had IHD with EF< 50% and 7 % had LV Diastolic dysfunction. Therefore a significant correlation was found about the occurrence of CAD in postmenopausal women. Conclusion: Coronary artery disease in the postmenopausal women is a great challenge to deal with unstable angina, which was the most common presentation. The occurrence of CAD was significantly associated with age, HTN, diabetes, dyslipidemia and significant correlation was found. Hence the study concluded that an early regular medical routine check- ups, awareness about occurrence of each clinical symptom is crucial in a postmenopausal women for early detection and prevention of coronary artery disease.

Background: To evaluate the reliability of non-contact tonometry (NCT) compared to Goldmann applanation tonometry (GAT) for measuring intraocular pressure (IOP) in patients with myopic astigmatism and healthy controls, and to assess correlations between IOP, central corneal thickness (CCT), and keratometry values. Methods: A prospective comparative study was conducted at Vydehi Institute of Medical Sciences, involving 50 patients with myopic astigmatism (-0.25D to -3.50D) and 50 healthy controls (200 eyes total). IOP was measured using NCT (Reichert 7 Auto Tonometer) and GAT (Appasamy AATM-5001) between 9 and 11 am. CCT was measured using a Konan Specular Microscope, and keratometry values were obtained with a Unicos URK-800F. Statistical analysis was performed using IBM SPSS version 25, with Pearson’s correlation and unpaired t-tests (p ≤ 0.05). Results: Mean IOP in the myopic astigmatism group was 15.26 mmHg (right eye, RE) and 14.91 mmHg (left eye, LE) with NCT, and 14.58 mmHg (RE) and 14.62 mmHg (LE) with GAT. In controls, mean IOP was 14.49 mmHg (RE) and 14.49 mmHg (LE) with NCT, and 14.52 mmHg (RE) and 14.56 mmHg (LE) with GAT. NCT and GAT measurements were significantly correlated (p < 0.001) in both groups. No significant correlations were found between IOP and CCT or keratometry values. Conclusion: NCT is a reliable alternative to GAT for IOP measurement in myopic astigmatism (≤3.0D), facilitating glaucoma screening.

Background: Pulmonary embolism (PE) is a life-threatening condition with nonspecific clinical presentations, making early diagnosis challenging. Clinical prediction rules (CPRs), such as the Wells Score and the Revised Geneva Score, are widely used to assess pretest probability and guide diagnostic evaluation. This study aimed to evaluate and compare the diagnostic accuracy of these two CPRs in predicting confirmed cases of PE. Methods: A prospective observational study was conducted at tertiary care centers, one in Chhattisgarh and other in Maharashtra, India, over 14 months. A total of 120 adult patients presenting with symptoms suggestive of PE were included. Each patient was evaluated using both the Wells Score and Revised Geneva Score, followed by D-dimer testing and CT pulmonary angiography (CTPA) or alternative imaging, as appropriate. Diagnostic accuracy was assessed through sensitivity, specificity, predictive values, and ROC curve analysis. Results: Among 120 patients, PE was confirmed in 46 cases. The Wells Score categorized 25.8% of patients as high risk, while the Geneva Score classified 22.5% in this category. Both scores showed a clear correlation with confirmed PE: 77.4% (Wells) and 81.5% (Geneva) in high-risk groups. The Wells Score demonstrated slightly higher sensitivity (84.3%) and specificity (71.4%) compared to the Geneva Score (82.3% and 69%, respectively). ROC analysis yielded AUCs of 0.842 (Wells) and 0.821 (Geneva), both statistically significant. Conclusion: Both the Wells and Revised Geneva Scores are effective in stratifying PE risk. However, the Wells Score showed marginally better diagnostic performance and may be preferred in emergency settings when clinical judgment is feasible.

Background: Hypertension is a major global health concern, with increasing prevalence and significant morbidity and mortality. Effective management requires adherence to clinical guidelines and rational drug utilization. Understanding prescribing patterns across different healthcare levels can help optimize treatment strategies and improve patient outcomes. Objective: This study aims to analyze the utilization patterns of antihypertensive drugs in primary, secondary, and tertiary healthcare centers in eastern India.  Methods: A cross-sectional, observational study was conducted across multiple healthcare centers, including urban and rural settings. Data were collected through prescription audits, patient interviews, and medical record reviews. Antihypertensive drugs were categorized based on therapeutic class, and adherence to JNC-8 guidelines was assessed. Statistical analysis was performed to evaluate prescribing trends, drug utilization, and adverse effects. Results: Calcium channel blockers (34.34%) and angiotensin receptor blockers (31.33%) were the most prescribed drug classes. Monotherapy was predominant in primary care (70.1%), while combination therapy increased in tertiary care (45.01%). Adherence to JNC-8 guidelines improved with higher healthcare levels, with tertiary care achieving better blood pressure control (69.94%). Adverse drug reactions, including ankle edema and dry cough, influenced prescribing decisions. Conclusion: The study highlights variations in antihypertensive prescribing patterns and adherence to guidelines across healthcare levels. Addressing dosing inaccuracies, promoting rational drug use, and enhancing clinician education can improve hypertension management and patient outcomes.

Introduction: Diabetic Peripheral Neuropathy (DPN) is a common yet often underdiagnosed complication of diabetes, leading to significant morbidity, including pain, sensory loss, and an increased risk of foot ulcers. This study aims to assess the prevalence of DPN and identify its key risk factors, aiding in early detection and effective management strategies. Material and Methods: This single-center, cross-sectional study at MGM Medical College, Navi Mumbai, assessed 160 Type 2 Diabetes Mellitus patients for Diabetic Peripheral Neuropathy (DPN) prevalence and risk factors. Ethical approval and informed consent were obtained. Evaluation included the Michigan Neuropathy Scale, Vibration Perception Threshold (VPT) assessment, and blood tests for HbA1c, glucose levels, lipid profile, and renal function. Data analysis was conducted, with a p-value <0.05 considered statistically significant. Results: Hypertension was present in 35% of subjects, and 85% were overweight (p<0.05). Smoking and alcohol consumption were observed in 10.6% and 3.8% of participants, respectively. The overall prevalence of Diabetic Peripheral Neuropathy (DPN) was 30.6% (MNSI) and 36.9% (VPT), with higher rates among overweight individuals, smokers (76.5%, p<0.01), hypertensive patients (39.3%, p<0.01), and those with prolonged diabetes (p<0.01). Elevated HbA1c, cholesterol, uric acid, and liver enzymes were significantly associated with DPN (p<0.01). The sensitivity and specificity of MNSI were 88.12% and 62.71%, with an accuracy of 78.75%. Conclusion: Diabetic Peripheral Neuropathy (DPN) is prevalent among Type 2 Diabetes Mellitus patients, with significant associations observed with hypertension, obesity, smoking, prolonged diabetes duration, and elevated metabolic markers.

Background: Postmenopausal women frequently have subclinical hypothyroidism (SCH), which is defined by high blood thyroid-stimulating hormone (TSH) with normal free thyroxine (T4). Objectives: This study aims to (1) assess the prevalence of SCH in postmenopausal women, (2) explore its association with metabolic syndrome, and (3) compare cardiovascular risk between SCH and euthyroid individuals. Methods: A hospital-based case-control study was conducted at KR Hospital, Mysore, involving 100 postmenopausal women—50 with SCH and 50 euthyroid controls. Data were collected using structured interviews and laboratory evaluations. Statistical analyses included frequencies, proportions, bar and pie charts, and comparative analysis using SPSS trial version. Results: SCH was associated with significantly higher rates of metabolic syndrome and elevated cardiovascular risk parameters including dyslipidemia, elevated blood pressure, and increased waist circumference. Conclusion: SCH in postmenopausal women is significantly associated with increased cardiovascular risk, emphasizing the need for routine screening and preventive strategies in this population.

Background: With cesarean section (CS) rates rising globally, concerns about complications like uterine scar dehiscence (USD) have also increased. USD, where a previous cesarean scar weakens or separates, can pose serious risks to both mother and baby. This study explores how intraoperative scar conditions relate to maternal and fetal outcomes in women with a previous lower-segment cesarean section (LSCS) and scar tenderness. Aims & Objectives: To assess intraoperative uterine scar conditions (intact, thinned out, dehiscence, or rupture) in women with previous LSCS presenting with scar tenderness and to analyze the associated maternal and fetal outcomes to improve clinical management strategies. Methodology: This prospective observational study included 46 women with a history of LSCS and clinically assessed scar tenderness over 12 months. Scar tenderness was evaluated by gently palpating the suprapubic area. During surgery, scars were categorized as intact, thinned-out, dehiscent, or ruptured, and these findings were linked to maternal and fetal outcomes. Results: Most women (65.2%) were between 26 and 35 years old, and 76.08% delivered at term. Scar thinning (17.9%) and dehiscence (5.6%) were more common in those with multiple prior LSCS, though no cases of rupture occurred. Women with two prior LSCS had a higher rate of complications, including urinary issues (38.9%) and wound infections (27.8%). Among newborns, 19.5% had meconium-stained fluid, 6.5% had an APGAR score below 7, and 30.4% required immediate NICU admission. These findings suggest that repeat LSCS increases risks for both mother and baby, especially after multiple surgeries. Conclusion: Scar tenderness can serve as an important warning sign for complications in women with a history of LSCS. Most had intact scars, suggesting a trial of labor could be an option when there is no strong reason for another cesarean. However, thinned-out scars were linked to higher maternal and newborn risks, highlighting the need for close monitoring and timely decisions. Larger studies are needed to strengthen these findings and improve care for mothers and babies.

Background: Hypertensive heart disease (HHD) results from prolonged systemic hypertension and leads to structural and functional cardiac changes such as left ventricular hypertrophy (LVH), concentric remodeling, and subclinical systolic dysfunction. Echocardiography remains the primary imaging tool for evaluating cardiac structure and function, while chest X-ray (CXR) provides supportive information on cardiac size and pulmonary congestion. This study aimed to assess echocardiographic and chest X-ray findings in patients with HHD and examine their correlation with clinical parameters including duration of hypertension, blood pressure control, comorbidities, and biochemical markers. Materials and Methods: A prospective observational study was conducted on 100 hypertensive patients at the Departments of Medicine and Radiology, Mamata Medical College, Khammam. All participants underwent detailed clinical evaluation, laboratory investigations, transthoracic echocardiography, and standard posteroanterior chest X-ray. Key imaging parameters included left ventricular mass index (LVMI), global longitudinal strain (GLS), ejection fraction (EF), cardiothoracic ratio (CTR), pulmonary vascular congestion, and aortic unfolding. Statistical analysis involved correlation, group comparison, and regression analyses to explore associations with clinical variables. Results: The mean LVMI was 110 ± 15 g/m², GLS was -17 ± 1.5%, and EF was preserved at 55 ± 5%, indicating early systolic dysfunction. Chest X-ray findings showed cardiothoracic ratio >0.50 in 40% of patients, pulmonary congestion in 28%, and aortic unfolding in 35%. Duration of hypertension showed a strong correlation with LVMI (r = 0.68, p < 0.001). GLS was significantly lower in smokers (p = 0.02), and patients with diabetes and dyslipidemia had higher LVMI and lower EF. BMI was identified as a predictor of reduced EF (p = 0.02), and systemic abnormalities were more frequent in patients with prolonged hypertension and comorbidities. Conclusion: Echocardiography and chest X-ray are effective, accessible tools for evaluating hypertensive heart disease. Clinical variables such as long-standing hypertension, poor blood pressure control, diabetes, dyslipidemia, and smoking are closely associated with structural and functional cardiac alterations. Early identification of subclinical dysfunction through these imaging modalities can guide timely interventions to prevent progression to heart failure.

Background: Migraine is a prevalent neurological disorder affecting millions worldwide, yet it remains underdiagnosed and undertreated, particularly in low-resource settings. Healthcare professionals (HCPs) play a crucial role in migraine management, but gaps in knowledge, attitude, and practice (KAP) may hinder optimal care. Objective: This study aimed to assess the KAP regarding migraine among HCPs (physicians, neurologists, and general practitioners) in Eastern India. Methods: A cross-sectional survey was conducted among 300 HCPs using a validated KAP questionnaire. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression to identify factors influencing migraine management. Results: Preliminary findings indicate moderate knowledge (65%), positive attitudes (72%), but suboptimal practice (58%) in migraine care. Significant differences were observed between specialists and non-specialists (p < 0.05). Conclusion: Educational interventions and standardized guidelines are needed to improve migraine management among HCPs in Eastern India.

Background: Congenital uterine anomalies, such as septate, arcuate, unicornuate, and bicornuate uterus, can lead to adverse perinatal outcomes. This study aims to evaluate the incidence of uterine anomalies in cesarean section patients and their associated fetal and neonatal outcomes. Methods: This retrospective case series analyzed 460 cesarean section patients from February 2023 to January 2024 at KIMS & RF, Amalapuram. Out of the 460 patients, 14 (3.04%) were diagnosed with uterine anomalies during surgery. Data were collected regarding the type of uterine defect, fetal presentation, perinatal outcomes (low birth weight, preterm delivery, intrauterine growth restriction), and Apgar scores. Descriptive statistics were used to summarize the findings. Results: The most common uterine anomaly was septate uterus (35%), followed by arcuate uterus (28%), unicornuate uterus (21%), and bicornuate uterus (14%). Fetal presentation included 42% cephalic, 28% podalic, 14% transverse lie, and 14% oblique lie. Perinatal outcomes showed that 71% of neonates had low birth weight and 64% were preterm. Intrauterine growth restriction (IUGR) was noted in 35% of cases. Apgar scores were favorable, with 72% of neonates scoring excellent (10-8) and 28% having average scores (7-5). No poor scores were recorded. Conclusion: Uterine anomalies in cesarean section patients were associated with a high incidence of low birth weight, preterm delivery, malpresentation, and intrauterine growth restriction. Despite these challenges, the majority of neonates had satisfactory Apgar scores. Early detection and management of uterine anomalies may improve perinatal outcomes.

Background: Postoperative sore throat is one of the most undesirable postoperative complaints after general anaesthesia. To assess the incidence and severity of postoperative sore throat at 1 hour, 6 hours and 24 hours post-surgery. To assess coughing, hoarseness of voice and dysphonia if any at 1 hour,6 hours and 24 hours post-surgery. Materials And Methods: Patients were randomized into two groups using sealed envelope technique. Group A – Intra-cuff Tramadol 2mg/Kg, Group B – Intra-cuff Air. Results:  All the demographic data was comparable between the two groups and there is no statistically significant difference between the two groups. There was a highly statistically significant difference between the groups pertaining to cough,  19 patients (39.6%) in the air group had cough immediate extubation lasting for less than 15 seconds whereas none of the patients in the tramadol group had cough immediate post extubation. Only 3 patients (6.3%) out of 48 in the tramadol group had minimal sore throat in the 1st hour whereas 35 patients (72.9%) had minimal sore throat and 9 patients (18.8%) had moderate sore throat in the air group. Conclusion: We conclude that intracuff tramadol used in doses of 2mg/kg significantly reduces postoperative sore throat in the 1st hour and 6 hours post-surgery. It is also found to significantly reduce the cough immediate post extubation providing smoother emergence as well as postoperative cough and hoarseness

Background: Myocardial infarction (MI) is a life-threatening manifestation of ischemic heart disease and remains a major cause of global morbidity and mortality. Arrhythmias are common in the early phase of MI and contribute significantly to adverse outcomes, including sudden cardiac death. Early recognition and management are essential for improving survival and prognosis. Aim and Objective: To evaluate the prevalence and types of arrhythmias in the first 24 hours of MI and examine their association with electrocardiography (ECG) findings, and clinical outcomes. Materials & Methods: This prospective observational study was conducted in the Department of Medicine at Rajshree Medical Research Institute, Bareilly, from August 2023 to July 2024. A total of 100 patients aged 18 years and above, diagnosed with acute MI within 24 hours of symptom onset, were included. Patients were monitored with continuous ECG, and data were analyzed using appropriate statistical tools. Results: Sinus rhythm was most frequent (44%), followed by bundle branch blocks (10%) and sinus bradycardia (7%). Anterior wall MI (AWMI) was most prevalent (50%). Overall mortality was 3%, with the highest rates amongst patients developing Left-BBB (LBBB). Blood pressure instability showed a strong association with arrhythmias like atrial fibrillation (AFib) and ventricular tachycardia (VT) with p-value < 0.0001. Conclusion: Early arrhythmia detection in MI patients is vital for improving outcomes. While most demographic and risk factors were not predictive of adverse events and type of arrhythmia, hemodynamic instability showed significant prognostic value.

Background and Aim: Febrile thrombocytopenia is a common presentation in tropical regions and may involve subclinical cardiac complications. Early detection of these abnormalities is crucial for timely intervention. the present study was undertaken to evaluate cardiac abnormalities in adult patients with febrile thrombocytopenia using handheld 2-D echocardiography in a tertiary care institute in India. Material and Methods: A prospective observational study was conducted on 100 adult patients admitted with febrile thrombocytopenia to a tertiary care hospital in India from January to December 2023. Bedside 2-D echocardiography was performed within 24 hours of admission to assess cardiac function. Results: Cardiac symptoms were present in 19% of patients, while echocardiographic abnormalities such as pericardial effusion and myocarditis were observed in 22% and 4%, respectively. Cardiac involvement was more frequent in patients with Dengue Shock Syndrome compared to those with Dengue Hemorrhagic Fever. Conclusion: Bedside 2-D echocardiography is an effective tool for early detection of cardiac abnormalities in febrile thrombocytopenia. Its routine use could enhance clinical management, especially in resource-limited settings.

Background: Adolescents experience significant changes in sleep patterns, often leading to insufficient or poor-quality sleep. Emerging evidence suggests a strong association between sleep parameters and mental health outcomes in this age group. Understanding these relationships is critical for developing targeted mental health interventions for adolescents. Materials and Methods: A cross-sectional population-based study was conducted among 800 adolescents aged 13–18 years, randomly selected from 12 schools in an urban district. Sleep duration and quality were assessed using the Pittsburgh Sleep Quality Index (PSQI). Mental health status was evaluated using the Strengths and Difficulties Questionnaire (SDQ). Data on sociodemographic characteristics, screen time, and academic stress were also collected. Statistical analysis included Pearson correlation, independent t-tests, and multiple linear regression models to explore associations between sleep variables and mental health outcomes. Results: The mean sleep duration was 6.2 ± 1.3 hours per night, with 63.5% (n = 508) of participants reporting poor sleep quality (PSQI >5). Adolescents with poor sleep quality had significantly higher total SDQ scores (Mean = 19.8 ± 5.7) compared to those with good sleep quality (Mean = 14.3 ± 4.1; p < 0.001). A moderate negative correlation (r = –0.42, p < 0.001) was observed between sleep duration and emotional symptoms subscale scores. Regression analysis revealed that shorter sleep duration, greater screen time, and higher academic stress were significant predictors of emotional distress and peer relationship problems (adjusted R² = 0.31, p < 0.001). Conclusion: The findings indicate a high prevalence of poor sleep quality and reduced sleep duration among adolescents, both of which are significantly associated with adverse mental health outcomes. Public health programs must prioritize sleep education and lifestyle modifications to improve adolescent well-being

Background: Hypertension is a major contributor to global cardiovascular morbidity and mortality, with rising prevalence in both urban and rural populations, particularly in low- and middle-income countries like India. Understanding its epidemiological pattern at the district level can inform local health strategies. Methods: A descriptive cross-sectional study was conducted over 18 months (Nov 2022–Jul 2024) in District Jalaun, Uttar Pradesh, among 1600 adults aged 30–60 years (800 each from urban and rural areas). Participants were selected using simple random sampling and surveyed through house-to-house visits. Data on socio-demographics, dietary patterns, and blood pressure (measured using JNC 8 criteria) were collected using a pretested semi-structured questionnaire. Data analysis was done using SPSS, with significance set at p<0.05. Results: Among the participants, 45.3% were pre-hypertensive, 16.3% hypertensive, and only 38.3% had normal BP. Hypertension was more prevalent in urban (18%) than rural (14.6%) areas, though not statistically significant (p=0.0677). However, BP classification distribution showed a significant urban–rural difference (p=0.03), with urban residents more likely to have elevated BP. Non-vegetarian diet, high salt intake (>5g/day), and use of extra salt were significantly associated with higher BP levels (p=0.001). Conclusion: The study highlights a high burden of pre-hypertension and hypertension among mid-life adults in District Jalaun, especially in urban settings. Lifestyle factors like excess salt intake and non-vegetarian diet are key modifiable risks and warrant targeted interventions in both rural and urban populations

Background: Tuberculosis (TB) remains a major public-health threat in rural India, where poverty, distance and stigma undermine therapy. This study assessed treatment compliance and outcomes among drug-sensitive TB patients in rural Jalaun District, Uttar Pradesh. Methods: A descriptive cross-sectional survey in Jalaun Block enrolled all NI-KSHAY-notified, drug-sensitive patients (n = 134) starting treatment between 1 January and 30 June 2023. Participants were interviewed within four weeks using a validated questionnaire covering socio-demographics, perceived stigma and pill-taking over 30 days. Participants were predominantly male (55 %) with a mean age of 34.7 years. Most belonged to lower socio-economic classes III and IV. Compliance—defined as ingesting ≥ 90 % of prescribed doses—was analysed alongside treatment outcomes; associations used χ², Fisher’s exact or t-tests at p < 0.05. Results: Compliance reached 92.5 % (124/134). Cure or treatment completion occurred in 86.6 %, while failure, death and default were 4.4 %, 5.2 % and 3.8 %, respectively. Non-compliance (7.5 %) was tied to being unmarried (70 % vs 24.2 %), illiterate (50 % vs 37.1 %), stigmatised (80 % vs 28.3 %), experiencing side-effects (80 % vs 44.4 %), living farther from the facility (11.1 km vs 4.1 km) and longer waiting time (17.2 vs 11.6 min) (all p < 0.05). Age, weight and BMI showed no significant difference. Conclusion: Rural Jalaun’s Tuberculosis Unit achieved adherence and cure rates exceeding national targets, yet a vulnerable subgroup bore disproportionate mortality and default. Targeted stigma-reduction counselling, travel support and proactive side-effect management could close this gap and accelerate End-TB progress in similar settings.

Background: Ectopic pregnancy remains a significant obstetric challenge, contributing to maternal morbidity and mortality. Despite advancements in diagnostic modalities, the condition continues to pose a serious threat due to its unpredictable nature and potential for life-threatening complications. This study aimed to assess the risk factors, clinical presentations, and outcomes of ectopic pregnancies in a tertiary care hospital in Kashmir. Methods: A retrospective observational study was conducted over a 20-month period (January 2022–August 2023) at the Department of Obstetrics and Gynecology, GMC Srinagar, Jammu & Kashmir. A total of 153 cases of ectopic pregnancies were identified through a records review. Data on sociodemographic characteristics, clinical presentations, risk factors, management modalities, and outcomes were collected. Statistical analysis was performed using SPSS v.22, with Chi-square and t-tests applied to assess associations. Results: The highest incidence of ectopic pregnancy was observed in women aged 25–30 years (52.9%), with a majority being multiparous (56.2%). The most common risk factors included previous lower segment cesarean section (39.2%), prior abortions (14.4%), and prior ectopic pregnancy (9.2%). Abdominal tenderness (89.5%) and vaginal bleeding (57.5%) were the most frequent clinical presentations. Surgical management was required in 61.5% of cases, while 11.8% were managed medically. Rupture was observed in 39.2% of cases, with significant associations found with adnexal mass (p < 0.001), cervical motion tenderness (p < 0.001), and bleeding per vaginum (p = 0.004). Conclusion: Ectopic pregnancy continues to present significant diagnostic and therapeutic challenges. Previous cesarean section and abortions emerged as major risk factors. The findings highlight the importance of early diagnosis and tailored management strategies to reduce morbidity and improve patient outcomes.

Background: Biofilm formation is increasingly recognized as a major contributor to the persistence, treatment resistance, and recurrence of healthcare-associated infections (HAIs). In resource-limited hospital settings, the prevalence and antimicrobial implications of biofilm-forming organisms remain underexplored. Objectives: To determine the prevalence of biofilm formation among bacterial isolates from HAIs, evaluate its association with multidrug resistance (MDR), and assess its impact on clinical outcomes in a tertiary care setting in India. Methods: A prospective observational study was conducted over one year at GSL General Hospital and Medical College, Rajahmundry, Andhra Pradesh. A total of 100 culture-positive samples from patients with HAIs were evaluated. Biofilm detection was performed using the Congo red agar and microtiter plate assays. Antimicrobial susceptibility testing was conducted by standard CLSI guidelines. Statistical analyses included Chi-square tests, logistic regression, and comparisons of mean hospital stay durations, with a significance threshold of p < 0.05. Results: Biofilm formation was detected in 63% of the isolates. Strong biofilm formation was significantly associated with increased rates of MDR (p = 0.003, Cramer’s V = 0.42). Among strong biofilm producers, 84% were MDR. Patients with infections due to strong biofilm producers had significantly longer hospital stays (mean 12.4 ± 2.9 days) compared to those with weak or non-biofilm-forming isolates (mean 8.6 ± 2.2 days, p < 0.001, Cohen’s d = 1.42). Logistic regression identified Enterococcus faecalis as an independent predictor of strong biofilm formation (OR 4.72, 95% CI 1.61–13.87, p = 0.005). Conclusion: Biofilm formation is highly prevalent among HAI pathogens and strongly correlates with antimicrobial resistance and prolonged hospitalization. Routine screening for biofilm-forming capacity and targeted infection control measures are warranted to improve patient outcomes in high-risk hospital environments.

Background: Postanesthesia shivering (PAS) is a common, distressing experience. Ondansetron, the classical 5HT3 antagonist has been in use for its prevention since long. Palonosetron, a newly introduced potent antiemetic drug with better pharmacodynamics is currently in use by clinicians. Hence, a study was conducted to compare the efficacy of ondansetron and palonosetron in preventing PAS in patients undergoing elective lower segment caesarean section (LSCS) under spinal anaesthesia. Methods: A total of 84 patients scheduled for elective LSCS under spinal anesthesia were randomly allocated to one of the two study groups (Group O & P). Accordingly, 8 mg of ondansetron or 0.075 mg palonosetron was administered in the same volume intravenously 30 min preoperatively. Sublingual temperature was recorded regularly. All patients were observed for 90 min postspinal for PAS. Observations were analyzed statiscally. Results: No statistically significant intergroup difference was observed in the duration of surgery, and sublingual temperature. However, statistically significant difference was recorded for PAS (23.8% in ondansetron group, 9.5% in palonosetron group). Conclusion: Prophylactic administration of palonosetron significantly reduced incidence of PAS compared to ondansetron. However, further studies with larger sample size and more heterogeneous groups are suggested.

: Background: Optic neuritis is when inflammation in your optic nerve causes pain, vision loss and other symptoms. This condition has strong links to chronic conditions like multiple sclerosis and other autoimmune diseases. Timely diagnosis and treatment may help optic neuritis and limit or delay more severe long-term effects or conditions.  Optic neuritis is swelling of the eye’s Optic Nerve. The optic nerve carries light signals from the back of your eye to your brain so you can see. If the optic nerve is swollen, damaged or infected, you cannot see clearly. It causes inflammation, which affects the myelin lining of the optic nerve. Aim of this study was to identify study the optic nerve characteristics in patients with optic neuritis in a tertiary care centre. Aims& Objective: Objective of this study was to evaluate the optic nerve characteristics in patients with optic neuritis among general population and its prevalence among multiple sclerosis. Materials and Methods: The study was conducted in a tertiary hospital. After obtaining institutional ethical committee approval It was a Observational prospective study conducted on 35 patients with optic neuritis in the department of Ophthalmology, at a tertiary care centre, from May2024 to November 2024. The institute Ethics Committee approval was obtained before starting the sample collection. Detailed history of systemic diseases and its duration, medication were noted. Patients were subjected to General physical examination, and ocular examination. Components of optic nerve studied includes, visual acuity, colour vision, contrast sensitivity, visual fields, visual evoked potential and magnetic resonance imaging (MRI). Results: Optic neuritis is more common in females than males (60%). Most common age group is 25 to 35 years (43% followed by 45 to 55 age group whose percentage is 29 in optic neuritis. In this study females are significantly more likely to be affected than males, with a female-to-male ratio of approximately 5.76 :1. Here odds ratio is 5.76 with %of CI [1.3 to 25.4] This means that for every one man affected, about 5 women are affected it has been also shown that optic neuritis patient in female gender are more chance to develop multiple sclerosis as compare to male patient. Conclusion: Optic neuritis most commonly affects young adults, typically between 20 and 50 years old, with an average age of onset around 32. The incidence is also linked to geographic location, with higher rates observed in temperate climates and lower rates in regions near the equator, correlating with the distribution of MS. And women are more prone to develop Multiple sclerosis as compared to male among optic neuritis . females are significantly more likely to be affected than males,. This means that for every 1 man affected, about 5 women are affected. Most cases of optic neuritis resolve spontaneously, with vision gradually returning to normal within weeks or months . steroid medications may be used to reduce inflammation and potentially speed up recovery.

Background: Chronic Fatigue Syndrome (CFS), or Myalgic Encephalomyelitis (ME), is a debilitating disorder characterized by extreme fatigue that is not improved with rest and worsens with physical or mental exertion. Recent studies suggest a potential role of micronutrient deficiencies, particularly Vitamin D, in the pathophysiology and symptomatology of CFS. Objective: To assess the prevalence of Vitamin D deficiency in adults diagnosed with Chronic Fatigue Syndrome. Methods: A cross-sectional study was conducted involving 100 adult patients (aged 18–60 years) diagnosed with CFS based on CDC criteria. Serum 25-hydroxyvitamin D levels were measured, and deficiency was defined as <20 ng/mL. Demographic data, fatigue severity, and comorbidities were recorded and analyzed. Results: Among the 100 participants, 68% were found to have Vitamin D deficiency, 22% had insufficiency (20–30 ng/mL), and only 10% had sufficient levels (>30 ng/mL). A significant association was found between Vitamin D deficiency and higher fatigue severity scores (p<0.01). Conclusion: Vitamin D deficiency is highly prevalent among adults with Chronic Fatigue Syndrome. Screening for and correcting this deficiency may be a valuable adjunct in managing fatigue symptoms.

Background: Brachial plexus anaesthesia has been an indispensable tool in the anaesthesiologist’s armamentarium. Clinical studies have shown that levobupivacaine and ropivacaine have fewer adverse effects on the cardiovascular and central nervous system making them more advantageous in regional anaesthesia techniques. Less information is available regarding their comparable clinical data. Only a few studies have compared levobupivacaine and ropivacaine for brachial plexus blocks; hence, this study was aimed to compare the analgesic effectiveness and nerve block characteristics of ropivacaine and levobupivacaine in supraclavicular brachial plexus blocks in upper limb surgeries. Methods: Patients with American Society of Anaesthesiologists physical status I or II coming for elective upper limb surgeries were included in the study. Total numbers of 62 patients were randomly allocated into two groups, group A and group B. Group A received 25 mL of 0.75% ropivacaine, and group B received 25 mL of 0.5% levobupivacaine. The duration of analgesia, onset of block, duration of sensory, and motor blockade were studied and compared. Results: The mean duration of analgesia in group ropivacaine was 8.33 hours and in group levobupivacaine was 10.23 hours which was statistically significant. Ropivacaine had a faster sensory onset compared to levobupivacaine (5.22 vs. 6.88 minutes). The duration of sensory and motor blockade was longer with levobupivacaine than ropivacaine (sensory-8.64 vs. 10.29 hours, motor-8.32 vs. 9.8 hours). Conclusion: Levobupivacaine had longer duration of analgesia. The sensory and motor blockade was also longer with levobupivacaine.

Background: Intra-operative anaesthesia management should be optimised to reduce the occurrence of postoperative nausea and vomiting in high-risk patients; however, a single intervention may not effectively reduce postoperative nausea and vomiting in such patients. This study assessed the effect of an optimised anaesthetic protocol versus a conventional one on postoperative nausea and vomiting in patients who underwent laparoscopic sleeve gastrectomy.  Methods:  A single-centre randomised trial was conducted at a tertiary hospital from January 2023 to December 2024. Among 168 patients who underwent laparoscopic sleeve gastrectomy, 116 qualified, and 103 completed the study with available data. Patients were categorized into the conventional group (received sevoflurane and standard fluids) and the optimised group (underwent propofol-based anaesthesia and was administered goal-directed fluids). The primary endpoints were postoperative nausea and vomiting incidence and severity within 24 h.  Results:  Postoperative nausea and vomiting assessment at 0-3 h post-surgery revealed no significant differences between groups. However, at 3-24 h, the optimised anaesthetic protocol group showed lower postoperative nausea and vomiting incidence and severity than those of the conventional group (P = 0.005). In the conventional group, 20 (37.04%) patients experienced moderate-to-severe postoperative nausea and vomiting, compared to six (12.25%) patients in the optimised group (odds ratio = 0.237; 95% CI = 0.086, 0.656; P = 0.006). No significant differences were noted in antiemetic treatment, moderate-to-severe pain incidence, anaesthesia recovery, post-anaesthetic care unit stay, or postoperative duration between the groups. While the total intra-operative infusion volumes were comparable, the optimised group had a significantly higher colloidal infusion volume (500 mL vs. 0 mL, P = 0.014) than that of the conventional group. Conclusion:  The incidence and severity of postoperative nausea and vomiting 3-24 h postoperatively in patients who underwent laparoscopic sleeve gastrectomy were significantly lower with propofol-based total intravenous anaesthesia and goal-directed fluid therapy than with sevoflurane anaesthesia and traditional fluid management. Total intravenous anaesthesia is an effective multimodal antiemetic strategy for bariatric surgery.

Background: Spinal anaesthesia has been reported as an alternative to general anaesthesia for performing laparoscopic cholecystectomy (LC). Study aimed to evaluate efficacy, safety and cost benefit of conducting laparoscopic cholecystectomy under spinal anaesthesia (SA) in comparison to general anaesthesia(GA) Methods:  A prospective, randomised study conducted over a two year period at a hospital in India from January 2023 to December 2024. Patients meeting inclusion criteria were randomised into two groups. Group A and Group B received general and spinal anaesthesia by standardised techniques. Both groups underwent standard four port laparoscopic cholecystectomy. Mean anaesthesia time, pneumoperitoneum time and surgery time defined primary outcome measures. Intraoperative events and post operative pain score were secondary outcome measure. Results:  Out of 235 cases enrolled in the study, 114 cases in Group A and 110 in Group B analysed. Mean anaesthesia time appeared to be more in the GA group (49.45 vs. 40.64, P = 0.02) while pneumoperitoneum time and corresponding the total surgery time was slightly longer in the SA group. 27/117 cases who received SA experienced intraoperative events, four significant enough to convert to GA. No postoperative complications noted in either group. Pain relief significantly more in SA group in immediate post operative period (06 and 12 hours) but same as GA group at time of discharge (24 hours). No late postoperative complication or readmission noted in either group. Conclusion:  Laparoscopic cholecystectomy done under spinal anaesthesia as a routine anaesthesia of choice is feasible and safe. Spinal anaesthesia can be recommended to be the anaesthesia technique of choice for conducting laparoscopic cholecystectomy in hospital setups in developing countries where cost factor is a major factor.

Background: The induction of anaesthesia, laryngoscopy, tracheal intubation and surgical stimulation evoke cardiovascular responses leading to alteration in heart rate, cardiac rhythm and blood pressure. The response starts in 5 seconds, peaks within 1-2 minutes and returns to baseline in 5 minutes. The goal is to compare the effectiveness of Esmolol and Magnesium Sulphate for attenuation of haemodynamic stress response to laryngoscopy and intubation. Materials and Methods: After approval from the ASRAMS Institutional Ethics Committee, the procedure was clearly explained to patients and informed written consent was obtained. The study was conducted during the period, April 2024- March 2025 at ASRAM General and Super-Specialty Hospital, Eluru, Andhra Pradesh. 90 patients of age group 15 to 60 yrs of ASA physical status I and II who underwent elective ENT surgery under general anesthesia were selected and randomly allocated into 3 groups. Baseline heart rate and blood pressure was measured. They were premedicated with Inj. Glycopyrrolate 0.2mg and Inj. Midazolam 0.04mg/kg intramuscular 45 minutes before surgery. Patients were then shifted into the theatre. Inj. Fentanyl 2µg/kg was given 5 minutes before intubation to all patients. They were induced with Inj. Propofol 2mg/kg and Vecuronium 0.1mg/kg. Group M received Inj. Magnesium Sulphate 50mg/kg in 100ml of normal saline infusion over 10 minutes before induction. Group P received 15ml of normal saline 5 minutes before induction. Group E received Esmolol 1.5mg/kg in 15ml normal saline over 15-20 seconds one minute after vecuronium and intubation was done after 2 minutes.  Group P received 15ml of normal saline 5 minutes before induction. The heart rate, systolic and diastolic blood pressure and mean arterial pressure were recorded baseline, after premedication, one min after test drug, after induction, immediately after intubation, thereafter 1, 3 and 5 minutes following intubation. Laryngoscopy duration was noted. Results: 1) Group E showed maximum attenuation of heart rate and blood pressure. 2) Group M also showed significant attenuation of blood pressure response but produced tachycardia on infusion of the drug. Heart rate response was not statistically significant compared to group E. 3) All patients recovered well.  4) Incidence of side effects was not significant between the groups. Conclusion: From this study, it is concluded that hemodynamic changes to laryngoscopy and intubation can be attenuated by giving intravenous Esmolol 1.5mg/kg. Esmolol is effective in blunting the response followed by Magnesium Sulphate which blunts the hypertensive response but produces tachycardia during infusion of the drug. Placebo was ineffective in blunting hemodynamic stress response to laryngoscopy and intubation..

Background: The electrocardiogram remains a crucial tool in the identification and management of acute myocardial infarction. Acute risk stratification in myocardial infarction is still based on simple clinical parameters, laboratory markers and 12 lead electrocardiography. The electrocardiogram has been a preliminary screening and one of the most useful diagnostic investigations in myocardial infarction. This study evaluates the role of electrocardiography (ECG) in identifying the culprit vessel in acute ST-elevation myocardial infarction (STEMI) and correlates it with coronary angiography. ECG remains a crucial tool for early diagnosis, risk stratification, and guiding revascularization decisions by analyzing ST-segment elevation patterns and infarct-related arteries. Aim: To determine the culprit artery in the case of acute-myocardial infarction with electrocardiogram and to compare with coronary angiogram. Material and methods: This prospective observational study analyzed 50 acute myocardial infarction (AMI) cases over two years. Patients with chest pain >30 minutes and ST elevation on ECG who underwent coronary angiography within seven days were included. Exclusions were prior MI, CABG, congenital heart disease, LVH, LBBB, or Prinzmetal angina. ECG and cardiac enzyme tests (CK, CK-MB, troponins) were performed, and AMI cases were classified as anterior or inferior wall infarctions. Culprit vessels were identified via ECG and angiography. Data were analyzed using SPSS 23, with χ2 tests and a significance threshold of p<0.05. Sensitivity and specificity were also calculated. Results: The study assesses ECG parameters for occlusion site identification. ST elevation in V1 >2.5mm and aVR showed high specificity for proximal S1 occlusions. Q wave in aVL had 100% sensitivity for proximal D1. Distal S1 and D1 occlusions showed strong diagnostic markers, emphasizing ECG’s role in precise occlusion localization. Conclusion: Proximal LAD occlusion in anterior MI causes severe myocardial damage, while grade III ischemia or ST depression in V4–V6 in inferior MI indicates high-risk multivessel disease. Early ECG recognition is crucial for risk assessment and timely intervention.

Background: Non-invasive prenatal testing (NIPT) has emerged as a safer alternative to invasive prenatal diagnostic procedures (IPDPs) like amniocentesis and chorionic villus sampling (CVS) for detecting fetal chromosomal abnormalities. However, its diagnostic performance compared to traditional methods warrants further exploration. Objective: To perform a meta-analysis comparing the diagnostic performance of NIPT versus IPDPs in detecting common fetal chromosomal abnormalities, focusing on accuracy, sensitivity, specificity, and predictive values. Methods: A retrospective cohort study was conducted at Gouri Devi Institute of Medical Science, Durgapur, West Bengal, India, with a sample size of 50 cases over a 1-year period (January 2023 to December 2024). Data from patients who underwent both NIPT and invasive procedures for trisomy 21, trisomy 18, and trisomy 13 were analyzed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using standard formulas. Statistical analysis included t-tests, chi-square tests, and calculation of standard deviation and p-values for assessing diagnostic accuracy. Results: The sensitivity for NIPT in detecting trisomy 21 was 98%, with specificity at 95%. Invasive procedures showed a sensitivity of 92% and specificity of 97%. The PPV for NIPT was 91%, while for IPDPs it was 89%. NIPT demonstrated a significantly lower false-negative rate (p < 0.05) compared to invasive procedures. The standard deviation for sensitivity across studies was 3.2%, with a p-value of 0.02, indicating statistically significant differences in performance. Furthermore, the positive likelihood ratio for NIPT was 19.6, compared to 14.4 for IPDPs (p < 0.01). The negative likelihood ratio for NIPT was 0.02, while IPDPs had a higher value of 0.08, indicating superior diagnostic certainty with NIPT. Conclusion: NIPT shows higher sensitivity, lower false-negative rates, and superior diagnostic certainty compared to invasive procedures, making it a reliable first-line screening method for fetal chromosomal abnormalities.

Background: NAFLD is a global public health problem with more than 10% of fat accumulation in the liver cells and Prevalence is 18% in adolescents and young adults. There are no studies in Indian scenario regarding health education among adolescents with focus group discussion technique on NAFLD, so study was conducted to assess awareness on Fatty Liver Disease, risk factors, its prevention and management. Methods: A Quasi Experimental - Pre and Post evaluation study conducted from Septemer 2022 to March 2023 among degree college students in Ongole, Prakasam District, Andhra Pradesh. Total 12 Mentors with good communication, training and moderating capabilities were identified and selected, and a introduction was given to them about the objectives and purpose of this study. They were trained regarding conducting and moderating a focus group discussion Results: Total 111 First year Degree College students were participated in the focus group discussion on Non Alchoholic Fatty Liver Disease (NAFLD ) and out of them, 42.3% were males and 57.7% were females ,36.7% were heard about NAFLD. A significant improvement was noticed on awareness of prevention and management regarding weight loss goal (22.9% to 50.5%), anti-diabetic drugs (24.8% to 90.8%), statins (35.8% to 95.4%),vitamin E (36.7% to 95.4%) and anti oxidants (37.6% to 95.2%) with focus group discussion (P<0.01). Conclusions:Health Education awareness programme on NAFLD need to be strengthened initially for Medical fraternity followed by general population . Specific Health intervention tools need to be used for prevention, early detection, and treatment .

Background: Foods provide energy and support growth, development, and overall health, including cognitive functions.  Specific nutrients can impact cognitive abilities at various ages.  Nutrient deficiencies can lead to cognitive dysfunctions and dementia. Hence establishing the relationship between Indian dietary practices in young adults and cognitive performance was the objective of the present study. This cross-sectional study included 121 participants between the ages of 16 and 49. Individuals were assigned to one of the five diet groups based on a dietary questionnaire. The primary measures used in the study were the Broadbent Cognitive Failures Questionnaire (CFQ) form was used to measure memory performance. The statistical analysis confirmed that there was no significant(p>0.05) difference in participants with plant based diets compared to participants with animal-based diet in terms of cognitive performance as measured by Broadbent Cognitive Failures Questionnaire (CFQ). In conclusion, the current study discovered no notable difference in cognitive performance between individuals following plant-based diets and those adhering to animal-based diets. Additional research is necessary to completely grasp the specific impacts of dietary choices on various cognitive areas among different groups. Consequently, a more comprehensive study with a larger participant pool would be advantageous in resolving the scientific ambiguities related to the connection between diet, memory, and other neurological functions. Future investigations are essential to thoroughly understand the fundamental mechanisms that clarify the enduring effects of dietary practices on brain health. Moreover, research examining the effects of particular nutritional therapy , such as plant-based or animal-based diets, on brain health is required.

Background: For brachial plexus block, when local anaesthetics are used along with adjuvants result in extension of duration, longer analgesia with lesser side effects. In this study, we have compared effect of Dexmedetomidine and Fentanyl as an adjuvant with Lignocaine and Bupivacaine combination using Peripheral Nerve Stimulator for Supraclavicular block. Material And Method: In tertiary care medical college and hospital, this cross sectional and observational comparative study was conducted in 80 patients who were having elective forearm orthopedic surgeries. Patients were allotted in 2 groups with computer based random method. Same anesthetist has administered Inj. Lignocaine 2% 10 ml + Inj. Bupivacaine 0.5% 20 ml along with Inj. Dexmedetomidine 1µg/kg in Group D and Inj. Fentanyl 1µg/kg in Group F. In both groups, onset and duration of sensory and motor block, hemodynamic and respiratory parameters, sedation score, rescue analgesia and complication were compared. Result: The demographic characteristics of the two groups were not statistically significant.  The mean onset of sensory and motor block was faster in group D (5.5 ± 0.93 min, 7.58 ± 0 .9 mins respectively) compared to Group F (9.83 ± 2.24 mins,15.43 ± 1.96 mins, p < 0.001) . the mean duration of sensory block was longer in Group D (13.60 ± 0.67 hours) compared to Group F (11.14 ± 0.81 hours, p < 0.001) During intraoperative period in 60 to 120 mins, heart rate was lower in Group D (60 to 67 per min) compared to Group F. Mean sedation score was higher , time of rescue analgesia was longer in Group D. Conclusion: Dexmedetomidine shortens the onset time and prolongs the duration of sensory and motor block with better post operative analgesia without any significant side effects compared with Fentanyl when used in an adjuvant to Lignocaine and Bupivacaine combination in Supraclavicular brachial plexus block.

Background: Anemia is a widespread public health concern, particularly among young adults, including medical students who may neglect their health due to academic stress and irregular dietary habits. Identifying the prevalence and associated risk factors of anemia in this population is essential to promote early intervention and preventive measures. Materials and Methods: A cross-sectional study was conducted among 300 undergraduate medical students aged 18–25 years at a tertiary care teaching institution. Participants completed a structured questionnaire assessing dietary habits, menstrual history (for females), and lifestyle factors. Hemoglobin levels were measured using an automated hematology analyzer. Anemia was classified according to WHO guidelines. Statistical analysis was performed using SPSS version 25. Chi-square tests and logistic regression were used to identify significant associations. Results: Out of 300 participants, 120 (40%) were found to be anemic, with a higher prevalence among females (60%) compared to males (20%). Mild anemia was observed in 85 students (70.8%), moderate anemia in 30 students (25%), and severe anemia in 5 students (4.2%). Key risk factors significantly associated with anemia included inadequate dietary iron intake (p<0.01), irregular meal patterns (p=0.02), heavy menstrual bleeding in females (p<0.05), and high stress levels (p=0.03). Conclusion: Anemia is highly prevalent among undergraduate medical students, with nutritional and lifestyle factors playing a significant role. Awareness campaigns, routine screenings, and dietary interventions are recommended to address this issue at an early stage.

Background: Diabetic foot ulcers (DFUs) represent a significant complication of diabetes mellitus, often leading to prolonged infections, hospitalizations, and amputations [1]. The emergence of multidrug-resistant organisms, particularly extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, poses a major clinical challenge [2]. This study aimed to detect ESBL-producing Proteus species in DFU wound infections using phenotypic methods and to evaluate their antibiotic susceptibility patterns. A total of 27 Enterobacteriaceae isolates, comprising Proteus mirabilis (66.66%) and Proteus vulgaris (33.33%), were identified from 92 diabetic foot swab samples. ESBL production was confirmed in 63% of isolates using the Potentiated Disc Diffusion Test. High resistance was observed against Ampicillin, Cefotaxime, and Ciprofloxacin, while better sensitivity was noted for Amikacin, Imipenem, Meropenem, and Piperacillin-Tazobactam. The findings highlight the urgent need for routine screening of ESBLs in DFU patients and suggest that empirical therapy should be guided by susceptibility testing to prevent treatment failure and associated complications [3][4].

Background: A biomarker is a characteristic that is objectively measured and evaluated as an Indicator of normal biologic processes, pathogenic processes or pharmacologic responses to therapeutic intervention. Biomarkers may be prognostic predictive, pharmacodynamics or suggest clinical endpoint or Surrogate endpoint. The former ones are biomarkers Type 1, while the latter is biomarkers type 2. Serum cystatin C is a definitive biomarker indicating progression of disease and cardiovascular involvement. This is a type 1 biomarker, showing ESRD as the end point. Plasma levels of Transforming Growth Factor Receptor (TGFR-1) and Endothelial Growth Factor (EGF) are surrogate end point indicators and are examples of type 2. In the absence of advanced biochemical or genetic assays, clinical biochemistry offers effective alternative to indicate susceptibility, initiation and progression of kidney disease. In this study, serum Parathormone, serum uric acid along with serum creatinine levels were compared with indicators of right ventricular function such as RVSP and TAPSE to evaluate the effectiveness of the former as biomarkers of right ventricular dysfunction. Aims And Objectives: To evaluate serum levels of Parathormone, uric acid and creatinine as markers of right ventricular dysfunction in ESRD. To predict the severity of disorder by correlating the markers with RVSP, TAPSE and hemoglobin. Materials And Methods: Study: Retrospective analysis Study population: All patients with ESRD who presented for preanaesthetic check for renal transplantation.Study period: Dec ’24 to March ’25. Study place: DSMCH, Siruvachur, PERAMBALUR. Study sample: 30 Parameters Age, Gender, hemoglobin, RVSP (right ventricular systolic pressure), TAPSE (tricuspid annular plane systolic excursion), uric acid, creatinine, parathormone Methods: The preanaesthetic assessment charts along with routine work-up charts of thirty patients were analysed for the aforesaid parameters. The results were tabulated and compared. Results: A total of 30 patients who underwent successful renal transplantation in the above study period were examined for the aforesaid parameters. Most of them were in the age group of 35–40 years of age. The haemoglobin of males ranged from 7 to 9.5 g/dl and in females from 8.2 to 8.4 g/dl. The right ventricular systolic pressure was inversely proportional to the haemoglobin levels. The lowest hemoglobin of 6.4 g/dl had an RVSP of 58 mm Hg. From the scatter plot diagram below, we may appreciate more number of patients’ hemoglobin between 7.0 g/dl and 9.0 g/dl had RVSP between 30 to 50 mm Hg which is mild to moderate pulmonary hypertension (p = 0.185). TAPSE, which is more sensitive of right ventricular dysfunction, showed p of 0.123 with hemoglobin levels. Parathormone levels were more sensitive and statistically significant indicator of RVSP (right ventricular systolic pressure) (p = 0.132) than uric acid (p = 0.63) or creatinine (p = 0.53). Serum creatinine showed significant probability variation with TAPSE (0.177). Conclusion: Left ventricle is the earliest to be involved in chronic kidney disease, initially show as hypertrophy then progresses to left ventricular dilated cardiomyopathy. In End stage Renal disease, the severity, progression and cardiac dysfunction secondary to renal disorders is reflected as right ventricular dysfunction described in terms of RVSP and TAPSE by echocardiogram. A high serum parathormone level appears to signify pulmonary hypertension as increase in right ventricular systolic pressure (p = 0.132) and serum creatinine levels seems to be a sensitive indicator of right ventricular dysfunction by ablation of TAPSE (p = 0.177).

Background: The proximal femur, crucial for weight-bearing and mobility, exhibits anatomical variations influenced by ethnicity and lifestyle. Total hip arthroplasty is one of the surgeries that are commonly performed nowadays. There are regional and racial variations in the stature of the population worldwide. So, there is always a need for population-specific data for making best-fit prostheses. This study analyzes proximal femoral morphometry using direct and digital measurements to improve implant design for better surgical outcomes.  Materials And Methods: This cross-sectional study was conducted on 50 adult dry femora (25 right-sided and 25 left-sided) of unknown age and sex, obtained from the Department of Anatomy, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. Morphometric parameters assessed included femoral length, head diameter, neck length, neck diameter, neck thickness, and the cervico-diaphyseal angle. Measurements were taken using a measuring tape, osteometric board, goniometer, and a digital vernier caliper with a sensitivity and least count of 0.01 mm. Data were expressed as mean ± standard deviation, and statistical analysis was performed using GraphPad Prism version 9. A p-value of <0.05 was considered statistically significant. Results: Morphometric evaluation of the proximal femur showed no statistically significant differences between the right and left sides for femoral length (42.65 ± 2.57 cm vs. 42.48 ± 3.02 cm; p = 0.764), femoral head diameter (42.32 ± 2.94 mm vs. 42.01 ± 3.58 mm; p = 0.525), femoral neck length (44.64 ± 8.02 mm vs. 44.27 ± 5.96 mm; p = 0.908), and femoral neck thickness (22.81 ± 2.08 mm vs. 23.92 ± 2.96 mm; p = 0.598). However, the femoral neck diameter was significantly greater on the right side (34.12 ± 3.78 mm) compared to the left (31.46 ± 3.21 mm; p = 0.007), and the cervico-diaphyseal angle was significantly more obtuse on the left (130.41 ± 3.12°) than the right (127.24 ± 4.38°; p = 0.002). Conclusion:  These parameters can be used for designing the prosthesis and plates for hip joint reconstructive surgeries suitable for the Indian population.

Background: Vasoplegic syndrome, a common complication following cardiopulmonary bypass (CPB), is characterized by refractory hypotension, low systemic vascular resistance, and high vasopressor requirements, contributing to increased morbidity. Vitamin C, with its roles in catecholamine synthesis, endothelial protection, and antioxidant activity, may mitigate vasoplegia by addressing oxidative stress and inflammation induced by CPB. Despite promising findings in sepsis, robust evidence for vitamin C in post-CPB vasoplegia remains limited. This randomized controlled trial evaluates the efficacy of high-dose intravenous vitamin C in reducing noradrenaline requirements and improving outcomes in cardiac surgery patients. Materials and Methods: This prospective, randomized, double-blind, placebo-controlled trial enrolled 88 patients undergoing elective mitral or aortic valve replacement under cardiopulmonary bypass (CPB) at a tertiary care center. Participants were randomized to receive either intravenous vitamin C (2 g at CPB weaning and 2 g on postoperative day 1) or placebo (normal saline). Inclusion criteria comprised adults (20–60 years) with postoperative vasoplegia requiring noradrenaline, while exclusion criteria excluded complex surgeries, severe cardiac dysfunction (LVEF <30%), or vitamin C supplementation. Statistical analysis was performed using GraphPad with significance set at p<0.05. Results: The vitamin C group showed significantly reduced vasopressor requirements (38.6% vs 68.2%, p=0.004) and faster vasoplegia resolution (14.4±4.6 vs 24.6±7.2 hours, p<0.001) compared to placebo. Vitamin C recipients achieved higher post-CPB mean arterial pressure (93.2±22.8 vs 81.1±28.6 mmHg, p=0.035) and shorter ICU stays (4.1±1.8 vs 5.2±2.3 days, p=0.017). Mortality did not differ significantly (1 vs 2 cases, p=0.555). Conclusion: Targeted therapies play a vital role in improving outcomes in post-cardiopulmonary bypass (CPB) vasoplegia. Among these, vitamin C has emerged as a promising adjunct, particularly in refractory cases. Its administration has been associated with enhanced patient outcomes, including reduced reliance on postoperative inotropic support (such as norepinephrine) to maintain a mean arterial pressure (MAP) above 65 mmHg, as well as shorter ICU stays.

Background: Body mass index (BMI) is a widely accepted indicator of body fatness and has been associated with various cardiovascular risk factors. Elevated BMI is often linked to increased blood pressure (BP), which can predispose individuals to hypertension and related complications. This study aimed to evaluate the correlation between BMI and both systolic and diastolic blood pressure among young adults. Materials and Methods: A cross-sectional study was conducted among 100 young adults aged 18–25 years. Participants’ height and weight were measured to calculate BMI (kg/m²), which was categorized based on WHO criteria. Blood pressure was measured using a calibrated sphygmomanometer in a seated position after 5 minutes of rest. The average of two readings was recorded. Pearson correlation coefficient was used to assess the relationship between BMI and systolic blood pressure (SBP) and diastolic blood pressure (DBP). A p-value <0.05 was considered statistically significant. Results: The mean BMI was 24.1 ± 3.8 kg/m². Mean systolic and diastolic blood pressures were 122.6 ± 12.5 mmHg and 78.4 ± 9.2 mmHg, respectively. A statistically significant positive correlation was observed between BMI and SBP (r = 0.48, p = 0.001), as well as BMI and DBP (r = 0.42, p = 0.003). Participants in the overweight and obese categories showed notably higher mean blood pressure levels compared to those with normal BMI (p < 0.05). Conclusion: The findings indicate a moderate positive correlation between BMI and both systolic and diastolic blood pressure in young adults. These results highlight the importance of maintaining a healthy body weight to reduce the risk of early-onset hypertension.

Background: Pre-eclampsia, affecting approximately 5% of pregnancies, is characterized by hypertension and proteinuria after 20 weeks of gestation. It results in maternal and foetal morbidity and mortality during antenatal and postnatal period. In numerous studies it is observed that, plasma levels of anti-angiogenic factors such as soluble FMS like tyrosine kinase-1 was elevated in second trimester of pregnancies. Excess of sFlt-1 binds to placental growth factors and vascular endothelial growth factor and thus, have a pathogenic role in pre- eclampsia. Aims and objectives: To find the association of sFlt-1 with pre-eclampsia among pregnant women. Materials and Method: The study was conducted by taking 110 patients who were categorized into 2 groups of pre-eclamptic participants and healthy participants. Their serum samples were taken and was assayed for serum sFlt-1 levels in ELISA (Sandwich Technique) along with other investigations like LFT and RFT. Results: This study infers that, the cases with pre-eclampsia had significantly higher values of sFlT-1 (5798.2±107.1pg/ml) in contrast to that of controls who had sFlT-1values of (2584.5±181.2pg/ml) with a p value of <0.001. Conclusion: The circulating levels of this anti-angiogenic factor can help in detection of Pre- eclampsia and in further antenatal screening.

Background: A Purpose This study was designed to evaluate the reliability of preoperative ultrasonography (USG) to detect tractional retinal detachment (TRD) in vitreous hemorrhage (VH) due to proliferative diabetic retinopathy. Methods: This was a retrospective, descriptive study. The medical records of patients with VH who underwent A- and B-scan ultrasonography prior to a vitrectomy between January 2023 to December 2024 were reviewed in this retrospective study. All of the patients were assessed using USG before surgery with 4-quadrant transverse and 1-quadrant longitudinal scans whether to determine if the VH was accompanied by TRD. The USG results were compared with the vitrectomy findings. Results:  A total of 111 eyes of 106 patients with VH were evaluated. Twenty-three eyes were excluded from the study due to non-diabetic diagnoses, such as retinal vein-artery occlusion, trauma, intraocular mass, choroidal neovascular membrane, or macroaneurysm. The remaining 88 eyes with diabetic VH were included in the study. Preoperatively, VH alone was observed in 65 eyes (73.8%) and VH accompanied with TRD was determined in 23 eyes (26.2%) using USG. TRD was not found during the operation in 2 eyes (2.2%) diagnosed as VH with TRD by USG (false positive), and in 8 eyes (9.1%), TRD was detected during surgery though VH alone had been recorded based on the USG results (false negative). Conclusion:  USG is a reliable diagnostic tool that will provides accurate preoperative information about the presence of TRD in diabetic VH; however, in some cases TRD may go undetected, especially in eyes with peripherally localized or small TRD.

Purpose: The aim of this study is to assess the relationship between computed tomography (CT) findings in open globe injuries (OGIs) in pediatric patients and the pediatric ocular trauma score (POTS) and OTS in pediatric ocular trauma. Methods: In 34 pediatric patients with OGI, CT findings were categorized into nine main categories: Scleral irregularity, lens dislocation, abnormal vitreous density, choroid-retinal layer thickening, preseptal thickness increase, intraocular foreign body and air, vitreous hemorrhage, retinal detachment, and perforation. The relationship between different types and numbers of CT findings and the POTS and OTS was evaluated.  Results: The mean age of trauma was 6.6±3.1. Of the patients, 9 (26.5%) were female and 25 (73.5%) were male. The most common CT findings are scleral irregularity and increased preseptal thickness (47.1%). In univariate analysis, a P<0.05 was found between 16 patients with 1 or less CT findings (median POTS value 80 [71.25–90.0]) and 11 patients with 2 or 3 CT findings (median POTS value 60 [15–70]). A P<0.05 was found between 16 patients with 1 or less CT findings (median POTS value 80 [71.25–90.0]) and 7 patients with 4 or more CT findings (median POTS value 45 [25–80]). A P > 0.05 was found between 11 patients with 2 or 3 CT findings (median POTS value 60 [15–70]) and 7 patients with 4 or more CT findings (median POTS value 45 [25–80]). No significant difference was found between the number of CT findings and OTS stages. While POTS was significant (P<0.05) in patients with abnormal vitreous density (median 45 [30–69.6]), OTS value was not significant (P>0.05). There was no significant difference between POTS and OTS in other CT findings. Conclusion: The number of CT findings may assist in predicting POTS and, consequently, estimating visual prognosis in pediatric patients with OGI. In emergency situations where, sufficient clinical data are unavailable, the objective findings from CT may help in assessing the severity of ocular trauma and potentially predicting long-term visual outcomes.

Background: Hypothyroidism, a condition characterized by insufficient thyroid hormone production, is commonly caused by autoimmune thyroiditis, particularly Hashimoto’s thyroiditis. Vitamin D deficiency has been increasingly recognized as a factor in the development and progression of autoimmune diseases, including hypothyroidism. Despite growing evidence of a potential relationship between vitamin D levels and thyroid function, the exact correlation between vitamin D deficiency and hypothyroidism remains inconclusive. Objective: The objective of this study was to investigate the relationship between vitamin D deficiency and thyroid function in patients with primary hypothyroidism, specifically examining the association between serum vitamin D levels and thyroid-stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4). Materials and Methods: This was a study conducted between January  2023 and December  2024 at Andhra   medical college, King George hospital , Visakhapatnam. A total of 221 patients, aged 20-60 years, diagnosed with primary hypothyroidism were included. The study excluded patients undergoing treatment for hyperthyroidism, those receiving thyroid hormone replacement therapy, and individuals on medications affecting thyroid function. Participants underwent clinical examinations, and laboratory tests were performed to measure TSH, T3, T4, and 25-hydroxyvitamin D (vitamin D) levels. Vitamin D levels were categorized as deficient (<20 ng/ml), insufficient (20-30 ng/ml), and sufficient (>30 ng/ml). The relationship between vitamin D levels and thyroid function was assessed using Pearson's correlation coefficient. Results: Among the 221 patients, 69.64% were vitamin D deficient, 16.74% had insufficient levels, and 13.62% had sufficient levels. A significant negative correlation was found between vitamin D deficiency and TSH (r = -0.336), with lower vitamin D levels associated with higher TSH, particularly in patients with overt hypothyroidism. Pearson’s correlation analysis also indicated a positive correlation between vitamin D deficiency and T3 (r = 0.248) and T4 (r = 0.291), suggesting a potential regulatory effect of vitamin D on thyroid hormones. Conclusion : The study confirmed a high prevalence of vitamin D deficiency in patients with primary hypothyroidism, with a significant negative correlation between vitamin D levels and TSH. The findings suggest that vitamin D deficiency may contribute to the progression of hypothyroidism, particularly in more severe forms.

Background: To prospectively evaluate the impact of laparoscopic ovarian drilling  on ovarian reserve, hormonal changes, ovulation, and menstrual regularity in women with polycystic ovarian syndrome (PCOS) resistant to clomiphene citrate therapy. Methods: This prospective study included 48 women diagnosed with PCOS according to the Rotterdam criteria, who previously failed treatment with clomiphene citrate. Participants underwent laparoscopic ovarian drilling using electrocautery to create multiple ovarian punctures. Hormonal profiles (Anti-Mullerian Hormone [AMH], luteinizing hormone [LH], follicle-stimulating hormone [FSH], and testosterone) were assessed at baseline and at 3 and 6 months after surgery. Ovulation was confirmed through serum progesterone levels and ultrasound follicular monitoring, while menstrual regularity was tracked over 6 months. Statistical analysis was performed using paired t-tests or Wilcoxon signed-rank tests, with p-values <0.05 considered statistically significant. Results: Post ovarian drilling, significant reductions were observed in AMH levels (16% at 3 months, 25% at 6 months), LH levels (28% at 3 months, 35% at 6 months), and testosterone levels (30% at 3 months, 33% at 6 months). FSH levels remained relatively stable throughout the follow-up. Ovulation was restored in 78% of patients, and menstrual regularity returned in 72% of participants within 6 months post ovarian drilling. Conclusion: Laparoscopic ovarian drilling significantly improves hormonal balance, ovulatory function, and menstrual regularity in clomiphene resistant PCOS patients. However, the procedure is associated with a considerable reduction in ovarian reserve markers, particularly AMH, indicating a trade-off between immediate reproductive benefits and potential long-term fertility implications. Therefore, patient counseling regarding potential impacts on ovarian reserve is crucial when considering laparoscopic ovarian drilling  as a treatment option.

Background: A comparative research of lipid profiles in umbilical cord-blood can provide critical insights in the intrauterine environment and neonatal health, potentially serving as indicators for the early detection of metabolic disorders and guiding interventions to improve long-term child health outcomes. The lipid content in neonatal cord-blood, including distinct lipoprotein fractions, can be affected by prenatal nutritional deficits and the gestational age at birth. Objective: This research determined the standard values of cord-blood triglycerides, low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL),high-density lipoprotein (HDL),and total cholesterol in 3157 neonates in India. Materials and Methods: This cross sectional study was conducted in regional tertiary care medical hospital of Andhra Pradesh, India. A total number of 3157 samples in which 225Preterm, 2886 Term, and 82 Post-term newborns were studied. Fully Automated Biochemistry Analyser (bio systems A-25-spain)used to estimate the parameters like Total cholesterol, triglycerides, low-density lipoprotein-cholesterol(LDL-C), high-density lipoprotein-cholesterol(HDL-C),and very low density lipoproteins(VLDL)were analyzed. Results: No Significant differences existed between cord-blood concentrations of triglycerides, total cholesterol, HDL LDL and VLDL in the term,Post-term and Preterm infants(P < 0.05). Conclusion: This conclude that the standard cord-blood lipid profile of term(>37 to 41 weeks)babies(Tab.V) and normal birth weight( ≥ 2500 gms to 4000 gms )babies(Tab.8)The study also showed the fluctuations of lipid profile in Preterm and Post-term neonates(Fig no-3)indicates the risk of obesity and CVDs in comparison with literatures. Preventive measures to minimize the low birth weight labor/Preterm with adequate nutritional supplementations to the mothers during the gestational age and life style modifications of mothers.

Background: Laryngoscopy and intubation induce significant physiological stress responses, including hemodynamic fluctuations such as increases in heart rate (HR) and blood pressure. These responses are particularly concerning in patients undergoing laparoscopic surgeries, where hemodynamic stability is crucial. Various pharmacological strategies have been employed to mitigate these responses, with intranasal dexmedetomidine and lignocaine being among the most widely studied.Objective: This study aimed to compare the effects of intranasal dexmedetomidine alone versus a combination of intranasal dexmedetomidine and lignocaine spray in attenuating the stress response to laryngoscopy and intubation in patients undergoing elective laparoscopic surgery. Methods: A prospective, randomized study was conducted with 120 adult patients (age 18–60 years) of ASA physical status I and II, scheduled for elective laparoscopic surgery. Patients were randomly allocated into two groups: Group D (n = 60), which received intranasal dexmedetomidine 1 mcg/kg, and Group DL (n = 60), which received intranasal dexmedetomidine 1 mcg/kg combined with 10% lignocaine spray (1.5 mg/kg). Hemodynamic parameters, including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), were recorded at baseline, pre-induction, immediately after intubation, and at 1, 3, 5, and 10 minutes post-intubation. Results: Both groups demonstrated a significant reduction in the hemodynamic response compared to baseline values. However, Group DL exhibited significantly more effective attenuation of HR, SBP, DBP, and MAP compared to Group D, particularly in the immediate post-intubation period (p < 0.05). The differences between the two groups were statistically significant at several time points post-intubation, with Group DL showing lower HR and BP values overall. There were no significant differences in oxygen saturation (SpO₂) between the groups, and both groups maintained stable levels throughout the perioperative period. Conclusion: The combination of intranasal dexmedetomidine and lignocaine spray is more effective in attenuating the hemodynamic response to laryngoscopy and intubation than intranasal dexmedetomidine alone. This combination approach provides a simple, non-invasive, and reliable strategy to enhance perioperative hemodynamic stability, particularly in laparoscopic surgeries.