European Journal of Cardiovascular Medicine

Introduction: Mid-face defects resulting from trauma, tumor excision, or infection pose a significant reconstructive challenge due to the complex anatomical and aesthetic considerations involved. The forehead flap remains a cornerstone in facial reconstruction due to its robust vascularity and tissue characteristics. Objectives: To evaluate the effectiveness and outcomes of the forehead flap technique in reconstructing mid-face defects. Methods: A prospective observational study was conducted on 25 patients with mid-face defects treated using forehead flap reconstruction at Deccan College of Medical Sciences, Princess Esra Hospital, between May 2022 and May 2025. Clinical evaluation, aesthetic outcomes, patient satisfaction, and complication rates were assessed. Results: Infection (8%), trauma (24%), and oncologic resections (68%), accounted for the majority of errors. Eighty percent of patients had excellent cosmetic results, with just two cases of flap congestion and one case of wound dehiscence. There was no flap loss noted. Eighty-eight percent of patients were satisfied. Conclusion: The forehead flap is a reliable and aesthetically favorable option for reconstructing mid-face defects, with a high rate of patient satisfaction and low complication rates.

Background: The aim of this study was to determine whether different concentrations of intratympanic (IT) injection of dexamethasone at a dose of 4 and 10 mg/mL have an effect on hearing outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Results: Our study was conducted on 30 adult patients with unilateral ISSNHL who failed to respond or had contraindications to systemic steroids. Patients were categorized into two groups; each one included 15 patients. IT injection of 4 mg/mL dexamethasone was done in one group (IT dexamethasone (Dex) 4 mg/mL), while 10 mg/mL dexamethasone was administered intratympanically in the other group (IT Dex 10 mg/mL). IT injection was performed twice weekly for two successive weeks. PTA thresholds were assessed at 0.5, 1, 2 and 4 kHz before and 1 month after the treatment.

In the group with IT Dex 10 mg/mL, the average PTA improved significantly from 75.50 ± 12.59 to 49 ± 24.04 dB with an average gain of 26.50 ± 14.25 (p = 0.0007). In the group with IT Dex 4 mg/mL, there was a significant change of PTA from a pretreatment value of 76.92 ± 11.89 dB to a post-treatment value of 59.27 ± 92.10 dB with an average gain of 17.65 ± 8.36 dB.

A comparison of the post-treatment gain of PTA in both groups showed better improvement of hearing in the group treated by IT Dex 10 mg/mL compared with 4 mg/mL. Conclusion: This study demonstrated that IT injection of dexamethasone at a dose of 10 mg/mL was associated with better hearing outcomes compared with 4 mg/mL for the treatment of ISSNHL.a

Introduction: Sepsis is a serious kind of life-threatening complications arising out of extreme reaction induced in the body to fight infection. Materials And Methods: This retrospective study was conducted from the data available at the records of Assam Medical College Dibrugarh during the period of January 2024 to December 2024. Results: Total 80 numbers of patients were included in the study comprising patients with age group from >18 years to 77 years. The patients were grouped into sepsis and severe sepsis. Conclusion: The study concluded that both PCT and NLR can be used for early diagnosis of bacterial sepsis however, the individual performance of PCT is better than NLR

The landscape of undergraduate medical education is undergoing a transformation with the integration of advanced technologies such as Artificial Intelligence (AI) and Virtual Reality (VR). These innovations offer new ways of delivering content, assessing competencies, and enhancing student engagement. This review explores recent trends, applications, and the pedagogical impact of AI and VR in medical education, especially in undergraduate training. It emphasizes the role of Medical Education Units (MEUs) in facilitating this digital transformation through faculty development, curricular integration, and institutional research. The review also addresses challenges, including infrastructure needs, faculty resistance, ethical concerns, and the necessity for rigorous outcome-based evaluation. Finally, the article provides future directions for sustainable and scalable technology adoption. 

Background: Respiratory distress remains one of the leading causes of neonatal morbidity and mortality, particularly in preterm infants. Bubble Continuous Positive Airway Pressure (CPAP) is a simple, cost-effective, and non-invasive ventilation strategy widely used in resource-limited settings. This study aimed to evaluate the clinical profile and outcomes of neonates treated with bubble CPAP for respiratory distress at a tertiary care hospital in South India. Objective: To assess the clinical characteristics and treatment outcomes of neonates with respiratory distress managed using bubble CPAP at KIMS and RF General Hospital, Amalapuram. Methods: This was a prospective cohort study conducted over one year, enrolling 100 neonates admitted to the NICU with respiratory distress. Neonates with Downes scores between 3 and 6 were initiated on bubble CPAP. Relevant clinical data, including gestational age, gender, mode of delivery, diagnosis, PEEP levels, duration of CPAP, Downes score, antenatal steroid exposure, complications, and outcomes were recorded. Statistical analysis was performed using SPSS v30.0, with p-values <0.05 considered significant. Results: Of the 100 neonates studied, 56% were female and 44% were male. Respiratory Distress Syndrome was the most common diagnosis (38%), followed by meconium aspiration syndrome (25%). A total of 62% responded to CPAP therapy, while 38% required mechanical ventilation. Better outcomes were significantly associated with higher gestational age (p=0.001), vaginal delivery (p<0.001), complete antenatal steroid administration (p<0.001), and lower Downes scores (p<0.001). Complications were noted in 43% of cases, the most common being nasal injury and pneumothorax. Conclusion: Bubble CPAP is an effective and safe initial modality for managing respiratory distress in neonates. Favorable outcomes are associated with timely initiation, antenatal steroid use, and lower disease severity.

Background: Diabetes mellitus is one of the most common chronic diseases has been related to various liver illnesses such as liver enzyme derangements, non-alcoholic fatty liver disease, hepatocellular carcinoma, and cirrhosis. There has been increased interest on the contribution of liver enzymes to prediction of diabetes and glycemic control.  Aims and Objectives: The aim is study was to correlate liver enzymes with type 2 diabetes mellitus (T2DM) and non-diabetic individuals.  Materials and Methods: Diabetic patients seen on Outpatient Department basis or admitted as inpatients are included in this study. Information is collected and detailed history is taken using pre-formed proforma at the time of admission. Liver function tests are measured to all participants, and HbA1C value is measured. Liver enzymes are correlated with HbA1C values. Results: Majority of the participants were males (64% in cases & 60% in control). The mean age among cases was 53.5 ± 9.3 and among control was 49.8 ± 5.6 years. The mean duration of diabetes is 7.86±5.38, mean HbA1c is 8.48±3.25. Mean fasting blood sugar and post-prandial blood sugar were 169.5±91.3 and 242.3±133.6, respectively. Liver enzymes like Aspartate transferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) were statistically significantly raised in diabetes mellitus cases (p<0.05) as compared to non-diabetic cases Conclusion: We have found significant association among AST, ALT, ALP and GGT with type 2 diabetes mellitus; all were negatively correlated with HbA1C level, Hence the monitoring the liver function tests in uncontrolled T2DM patients was essential.

Background: Percutaneous transluminal coronary angioplasty (PTCA) is a cornerstone procedure in the treatment of coronary artery disease. Guidewire technique selection plays a critical role in procedural success, especially in complex lesions. This study compares the efficacy and safety of the double wire technique versus the conventional single wire method. Methods: A prospective study was conducted on 1000 patients undergoing PTCA. Of these, 392 underwent the double wire technique, while 608 were treated with the single wire approach. Key procedural endpoints included total procedure time, guide support and stent crossing time (left and right coronary systems), and complication rates such as vessel dissection and wire perforation. Results: The double wire technique significantly reduced procedural time in both coronary systems—45 minutes vs. 1.2 hours in the left system and shorter stent crossing times in the right. Complications such as left main dissection and wire perforation were markedly lower in the double wire group. Fewer guide adjustments and easier balloon/stent delivery were noted. Conclusion: The double wire technique offers superior procedural efficiency and safety compared to the single wire method. Its technical simplicity supports broader adoption, especially in complex cases and among less experienced operators, enhancing overall PTCA outcomes.

Background: Chronic Kidney Disease (CKD) is a progressive condition characterized by gradual loss of kidney function and is associated with multiple systemic complications. Obstructive Sleep Apnoea (OSA), a disorder involving recurrent episodes of partial or complete upper airway obstruction during sleep, has been increasingly recognized as a common yet underdiagnosed comorbidity among CKD patients. The pathophysiological relationship between OSA and CKD is complex and bidirectional, with emerging evidence suggesting that OSA may exacerbate renal dysfunction through mechanisms such as intermittent hypoxia, oxidative stress, and sympathetic activation. Objective: This study aimed to determine the prevalence of OSA among patients with CKD and to evaluate the clinical correlations and risk factors associated with OSA in this patient population. Methods: A two-year cross-sectional observational study was conducted at Jawaharlal Nehru Medical College, Aligarh Muslim University, enrolling 70 CKD patients. Each patient underwent comprehensive overnight polysomnography (PSG) to diagnose OSA. Detailed clinical and demographic data, including comorbidities, body mass index (BMI), and CKD stage, were systematically collected and analysed. Results: The prevalence of OSA in the studied CKD population was found to be 54.3%. The occurrence of OSA progressively increased with CKD severity, from 28.6% in Stage 3, 57.1% in Stage 4, to 85.7% in Stage 5, showing a significant association (p < 0.01). Patients diagnosed with OSA had statistically higher BMI values and significantly greater prevalence of hypertension and diabetes mellitus compared to those without OSA (p < 0.05). Conclusion: OSA is highly prevalent in CKD patients, especially in advanced stages. Routine screening and timely management of OSA in this vulnerable group could potentially improve clinical outcomes and mitigate progression of renal impairment

Background: Contraceptive use remains suboptimal in rural India despite ongoing public health initiatives. Understanding patterns of awareness, use, and preferences is crucial for addressing gaps in reproductive health access. Objectives: To assess contraceptive awareness, continuity, and preferences among women in a rural population of North 24 Parganas, West Bengal. Methods: A cross-sectional study was conducted over one year among 300 women attending the College of Medicine and Sagore Dutta Hospital. Data were collected on socio-demographic factors, contraceptive knowledge, continuity of use (≥90 days), and preferences across age groups. Descriptive statistics and cross-tabulations were used for analysis. Results: The majority of participants were aged 20–30 years, with primary education being the most common educational level. Age of marriage was below 20 years in 66% of participants. Awareness of oral pills and condoms was high (>80%) across most age groups, but awareness of methods such as PPIUCD, Chhaya, and Antara was low, especially among women under 20. Continuity of use was highest for condoms and PPIUCD among the 21–30 age group. Willingness to use long-acting methods remained limited. A significant proportion (47%) had undergone more than one MTP, indicating gaps in effective contraceptive use. Conclusions: While awareness of basic contraceptive methods exists, uptake of modern and long-term methods remains inadequate. Strengthening reproductive health education and access—particularly among adolescents and low-literate populations—is essential for improving contraceptive behaviour in rural India.

Background: Spinal anaesthesia has become a cornerstone of modern obstetric anaesthesia with ongoing research and development aiming to optimize its use and reduce any potential complications. Objective: to compare 2 doses of phenylephrine i.e. 75mcg and 50mcg in prevention of oxytocin induced hemodynamic changes in caesarean section under spinal anesthesia Methods: A randomized controlled trial was carried out on 64 patients, aged 20-40 years, classified as ASA grade II, scheduled for elective or emergency lower segment caesarean section. The study received approval from the Ethical Committee of Rohilkhand Medical College and Hospital, Bareilly. The 64 participants were randomly assigned to two groups, Group 1 and Group 2, with 32 patients in each group. Result: The differing hemodynamic responses to the two phenylephrine doses. The 75mcg bolus dose of phenylephrine was more effective in stabilizing blood pressure, including systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), especially during the critical period after oxytocin administration and cord clamping. Statistically significant differences were observed at various time points. For example, at 2 minutes post-cord clamping, phenylephrine demonstrated a significant advantage in SBP (p=0.019), and this trend continued at 4 minutes (p=0.037), 6 minutes (p=0.007), 8 minutes(p=0.005) and 10 minutes (p=<0.001). Similarly, phenylephrine consistently maintained higher MAP values, with significant differences at 1 minute (p=0.002), 2 minutes (p<0.001), and 3 minutes (p=0.0023) post-cord clamping. These results underscore 75mcg phenylephrine’s efficacy as a vasopressor that provides robust blood pressure control in the perioperative period. Conclusion: phenylephrine 75mcg is better suited for ensuring hemodynamic stability during the perioperative period, particularly for blood pressure control. These results provide valuable insights for anesthesiologists in tailoring intraoperative management strategies for caesarean sections under spinal anesthesia.

Background: Cervical vertebrae are distinguished by the presence of foramen transversarium, which transmits the vertebral artery, vein, and sympathetic nerves (except in C7). Variations in its number, size, or shape can alter the course of vertebral vessels, potentially leading to vertebrobasilar insufficiency. As the inner ear is supplied by these arteries, such changes may also cause hearing or balance disturbances along with neurological symptoms. This study aimed to investigate the incidence of double foramen transversarium in dried cervical vertebrae from the population of Bihar. Materials And Methods: A cross-sectional osteological study was conducted on 150 human cervical vertebrae, including 100 typical (C3–C6) and 50 atypical (C1, C2, C7) vertebrae, collected from medical institutions in Bihar, India. Each vertebra was examined macroscopically for the presence, number, laterality, and morphology of double foramina transversaria. Data were statistically evaluated with GraphPad Prism 9; p < 0.05 was considered significant. Results: Out of the total 150 cervical vertebrae studied, a double foramen transversarium was observed in 23 vertebrae (15.33%). Among these, 15 vertebrae (10%) were identified as typical cervical vertebrae, while 8 vertebrae (5.33%) were atypical. Unilateral double foramen transversarium was more frequently observed than bilateral, with a total of 14 cases on the right side (9.33%) and 6 cases on the left side (4%), whereas bilateral occurrence was noted in only 3 vertebrae (2%). Although typical vertebrae showed a higher frequency of double foramina transversaria, the difference between typical and atypical cervical vertebrae was not statistically significant. Conclusion: Double foramen transversarium can alter the path of vertebral vessels and nerves, leading to clinical implications during diagnosis or surgery. Its recognition is important for surgeons, radiologists, anatomists, and anthropologists to avoid complications and ensure accurate assessments.

Introduction: Polycystic Ovary Syndrome (PCOS) is a common endocrine-metabolic disorder characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. Insulin resistance (IR) plays a central role in PCOS pathogenesis. Fetuin-A, a hepatic glycoprotein, negatively regulates insulin signaling and has been linked to IR and metabolic syndrome. This study aims to compare serum Fetuin-A levels in women with PCOS and healthy controls, and explore its association with metabolic parameters. Materials and Methods: A comparative study was conducted from January 2021 to June 2022 at a Tertiary care centre, including 180 women aged 18–40 years: 90 with PCOS (Rotterdam criteria) and 90 healthy controls. Clinical assessments, anthropometry, and laboratory investigations including fasting/postprandial glucose and insulin, lipid profile, HOMA-IR, and serum Fetuin-A (via ELISA) were performed. Data were analyzed using SPSS v25 with p < 0.05 considered significant. Results: Demographic parameters including age and BMI were comparable between groups (p > 0.05). Women with PCOS showed significantly elevated fasting/postprandial glucose, insulin levels, HOMA-IR, cholesterol, triglycerides, and LDL (p < 0.05). Serum Fetuin-A levels were significantly higher in PCOS cases (8.3 ± 4.3 µg/mL) than controls (3.1 ± 3.2 µg/mL, p < 0.001). Fetuin-A levels correlated positively with fasting glucose, insulin, HOMA-IR, cholesterol, triglycerides, and LDL in PCOS patients, indicating strong association with metabolic dysfunction. Conclusion: Serum Fetuin-A levels are significantly elevated in women with PCOS and strongly correlate with markers of insulin resistance and dyslipidemia, suggesting its potential role as a biomarker in PCOS-related metabolic disturbances.

Left ventricular diastolic dysfunction (LVDD) is a common and early manifestation of hypertensive heart disease, often preceding systolic impairment. While echocardiography remains the gold standard for evaluating diastolic function, increasing interest has been placed on electrocardiographic (ECG) markers such as Tpeak-Tend interval, Ventricular Activation Time (VAT), P-terminal force in V1 (PTFV1), and P-wave dispersion (PWD) due to their accessibility, non-invasiveness, and cost-effectiveness. This article explores the diagnostic and prognostic potential of these ECG parameters in comparison to echocardiographic findings in hypertensive patients with suspected diastolic dysfunction

Introduction: The use of smokeless tobacco (ST) is a global phenomenon and represents a major health threat, mainly to the cardiovascular/ haematological system. Its negative effects on heart rate and blood pressure are well-known but whether antioxidants like Vitamin C will counteract these effects or not, is unknown .This study was conducted to observe the effects of smokeless tobacco on cardiovascular (heart rate, blood pressure, Valsalva  ratio, sustained hand grip) parameters and haematological (white blood cell, platelet, red blood cell indices) parameters before and after the supplementation of 1 gm Vitamin C daily for 45 days. Methodology: A case-control design was conducted experimentally on 220 controls and 180 ST chewers, aged between 31-60 yrs. Inclusion criteria consisted of participants with experience of chewing smokeless tobacco for less than or equal to one year. Control group consisted of people with similar age and sex who have never smoked or chewed smokeless tobacco before. Exclusion criteria include participants with the history of cardiovascular disease, diabetes, cancer, liver illness, endocrinological problems, neurological problems, alcoholism or any medication. The effects of ST use and Vitamin C supplementation on the parameters were evaluated by statistical analysis, including unpaired t-tests, one way ANOVA and Pearson’s correlation.  Results: ST chewers had significantly greater heart rate (73.21 ± 5.69), increased systolic (123.35 ± 8.35) and diastolic blood pressure (82.06 ± 6.31) compared with controls (71.98 ± 5.13, 121.52 ± 6.30, 78.20 ± 7.57) respectively. ST chewers had elevated white blood cell counts (7851±1204) as compared to control (7568±1369) and lower platelet counts (2.31±0.64) as compared to control (2.63 ± 0.55) on haematological analysis. Vitamin C supplementation significantly decreased diastolic (80.64 ± 8.32) blood pressure in ST chewers as compared to the diastolic (77.52 ± 6.12) blood pressure of control. Serum Cotinine was positively correlated with heart rate (r-value 0.16) and inversely correlated with the Valsalva ratio (r-value -0.18); Valsalva ratio (r-value 0.24) was positively correlated with Serum Vitamin C. Conclusion: In conclusion, active smokeless tobacco use has been associated with significant cardiovascular and haematological effects, including inflammation as increase in heart rate, blood pressure and total leucocyte counts were observed in ST chewers. Although vitamin C supplementation can help to lower blood pressure level in ST users, it may be able to alleviate some of the cardiovascular effects induced by smokeless tobacco. Longer supplementation and larger sample sizes are required to confirm these findings.

Background: Chronic suppurative otitis media (CSOM), with or without cholesteatoma, often leads to ossicular destruction, resulting in conductive hearing loss. Ossiculoplasty aims to restore the auditory mechanism after complete eradication of middle ear disease. In this study, a ventilation grommet was utilized as a partial ossicular replacement prosthesis (PORP) for ossicular chain reconstruction, particularly in cases with a mobile stapes. The objective was to evaluate the degree of hearing improvement following the use of a grommet as PORP in type III tympanoplasty. Methods: This observational study was conducted from July 2023 to July 2024 and included 20 patients with CSOM undergoing canal wall up or canal wall down mastoidectomy. All patients had intraoperative ossicular chain erosion with an intact stapes suprastructure. Postoperative hearing gain and graft uptake were assessed at the third month using pure tone audiometry. Results: Of the 20 patients, 15 underwent canal wall up mastoidectomy and 5 underwent canal wall down procedures, all with type III tympanoplasty. Ossicular erosion involved the incus in 17 cases, the malleus in 2 cases, and both the incus and malleus in 1 case. The mean preoperative air-bone gap was 38 dB, with a mean hearing improvement of 12 dB at the three-month follow-up. Conclusions: The grommet tube, when used as a PORP, appears to be a cost-effective and efficient alternative for ossicular chain reconstruction in type III tympanoplasty, demonstrating satisfactory hearing outcomes.

Electrical storm is a rare, life-threatening condition characterized by recurrent ventricular arrhythmias requiring immediate and aggressive management. We report the case of a 46-year-old female presenting with multiple episodes of ventricular tachycardia (VT), leading to cardiac arrest and an electrical storm. Despite 60 minutes of cardiopulmonary resuscitation (CPR), the patient was successfully resuscitated using early defibrillation, dual sequential external defibrillation (DSED), and overdrive pacing. Remarkably, she recovered without neurological deficits and was discharged within a week.  This case highlights the importance of persistent resuscitative efforts and advanced techniques in managing refractory ventricular arrhythmias.

Hypertension is one of the most important risk factors for cardiovascular diseases (CVD), particularly ischemic heart disease and stroke (sequelae of hypertension). By compromising endothelial function and encouraging atherosclerosis, inflammatory markers like C-reactive protein (CRP), interleukins (ILs), and tumour necrosis factor-alpha (TNF-α) have been associated with a poor prognosis in individuals with hypertension in CVD studies. A straightforward, affordable, and generally available haematological measure, the neutrophil-to-lymphocyte ratio (NLR) has garnered increasing attention in recent years. Neutrophils and lymphocytes make up NLR, which represents a balance between immunological responses and inflammation. While lymphocytes play a significant role in controlling immunological responses, neutrophils are crucial for the acute inflammatory response. There is no study available about Neutrophil to lymphocyte ration in newly detected hypertension patient. In addition to this correlation of NL Ratio is never studied with Staging of Hypertension hence this is an area of interest. Material and Methods: The present cross-sectional study was conducted from May 2023 to November 2024 in the Department of General Medicine, School of Medical Sciences & Research, Sharda Hospital, Greater Noida, Uttar Pradesh among 100 newly detected hypertensive patients as per inclusion and exclusion criteria, with Age & Sex matched 100 controls.  Results: Of the individuals in the case and control groups, 56% and 4%, respectively, had left ventricular hypertrophy (LVH) was seen amongst 56% of cases and 4% of controls which was statistically significant with p-value <0.01 when the chi square test was used. The case group had higher mean neutrophil %, lymphocyte %, and NLR than the control group. Mean NLR in stage 1 and stage 2 hypertension showed statistically significant increase in value as the BP rises. Hence mean NLR was significantly more in stage 2 hypertension as compared to stage 1 hypertension as p-value=0.007. The Pearson correlation test revealed a substantial positive link between NLR and hypertension staging (r=0.44, p<0.01), meaning that when NLR increases, so do SBP and DBP.  Conclusion: Our study demonstrated a rise in NLR levels as the severity of hypertension increases. Our findings suggest that neutrophils and lymphocytes may be implicated in inflammation, which may be a significant factor in the development of hypertension. These results could be helpful in elucidating the pathophysiological process of hypertension and in the creation of novel treatment strategies that target low-grade inflammation in order to manage hypertension and hypertensive damage.

Introduction: WHO defines QOL as individuals’ perception of their position in life in the context of culture in which they live and interaction to their goal, expectation, standard and concerns.  Numerous variables separated from physical and mental wellbeing like business status, age, sexual orientation, wage, education, HIV stage, seriousness of HIV disease, etc. are found to encroach on the QOL of PLHIV. Quality of life (QOL) of HIV/AIDS patients is becoming an important component of overall assessment of health care and management in health care settings. It is one of the indicators effectiveness of management of PLHIV.  Materials And Methods: This is a Descriptive and Cross-sectional study. Data was collected from patient file available in ART centre as mentioned in annexure 1 and Quality of Life was assessed by WHO questionnaire as mentioned in annexure 2. Study was initiated after approval was obtained from the institutional ethics committee. Study related procedures and enrolment of eligible subjects was done only after obtaining an informed consent from the patient. Confidentiality of patient’s details was maintained at all levels using appropriate coding. Results: Domain 1 is 16.93 indicating good QOL Domain 2 is 13.428 indicating good QOL Domain 3 is 13.20 indicating good QOL Domain 4 is 8.39 indicating poor QOL. Domain 5 is 14.349 indicating good QOL Domain 6 is 11.93 indicating average QOL. p-value is 0.474 indicates no statistical significance of smoking with quality of life.  P-value is 0.027 is significant statistically; indicates statistically significant association of number of years on ART with quality of life. This implies that increased number of years on ART is associated with better quality of life. Range of deviation of Domains 1, 2,3,4,5, 6 was between 11-20, 8-17, 9-16, 7-11, 13-16.5 and 8-16 respectively. Conclusion: In our study Major age group affected are between age 31-40 years. Overall quality of life assessed by WHO in QOL bref scale is 13.04 which indicates good overall quality of life. Except sexual activity & social inclusion in domain 4 is low otherwise remaining domain (1, 2, 3, 5 & 6) carry good QOL.

Background: To study the impact of ultrasound-assessed Diaphragmatic impairment on predicting the need for invasive mechanical ventilation in patients with Acute Exacerbations of Chronic Obstructive Pulmonary disease (AECOPD) and also, its impact on duration of invasive mechanical ventilation, length of ICU stay and outcome. Methodology: A total 95 patients with AECOPD requiring NIV support in the Intensive care unit (ICU) were included in the study in our hospital from April 2023 to November 2024. This was a prospective observational study. Ultrasound-assessed Diaphragm Thickness Fraction (DTF) was done to assess the Diaphragmatic Impairment (DI). Either the patient was weaned off from NIV or put on IMV based on clinical condition and ABG analysis. Results: Receiver operating characteristic (ROC) curve analysis of diaphragmatic thickness fraction on the Right & Left-side gives a cut off <31.88% and <28.2% with 100% sensitivity and 20.9% specificity for the need of Invasive mechanical ventilation (IMV). Out of 43 patients that were put on IMV, 34 were below and 9 were above this cut-off. Mean Duration of IMV was significantly higher in deceased patients compared to patients who survived. (8.56+/-2.11 vs 2.78+/-0.83 days). Mean Duration of ICU stay was also significantly higher in deceased patients compared to survived patients. (9.95+/-2.46 vs 5.37+/-1.17 days). Conclusion: we conclude that ultrasound-assessed Diaphragmatic thickness fraction is a good indicator in determining the diaphragmatic impairment and predicting the need for invasive mechanical ventilation in AECOPD patients with 100% sensitivity and 20.9% specificity. DI as assessed by DTF can be used as a prognostic factor for determining Invasive Mechanical Ventilator days, ICU stay and Outcome of the patient.

Background: Drug-resistant epilepsy (DRE) remains a significant clinical challenge, with approximately 30% of patients not achieving adequate seizure control despite optimal pharmacotherapy. Vagus nerve stimulation (VNS) has emerged as a neuromodulatory option for such patients. This multicenter prospective study aimed to evaluate the impact of VNS on seizure frequency and health-related quality of life (HRQoL) in individuals with DRE. Materials and Methods: A total of 120 patients diagnosed with DRE were enrolled across four tertiary care centers. All participants underwent VNS implantation and were followed for 12 months post-implantation. Seizure frequency was recorded using patient diaries, and HRQoL was assessed using the QOLIE-31 questionnaire at baseline, 6 months, and 12 months. Statistical analysis was conducted using paired t-tests and repeated measures ANOVA, with significance set at p<0.05. Results: At the 12-month follow-up, 78 patients (65%) exhibited ≥50% reduction in monthly seizure frequency. The mean seizure frequency declined from 12.4 ± 3.1 episodes/month at baseline to 5.2 ± 2.8 episodes/month post-intervention (p<0.001). Additionally, QOLIE-31 scores improved significantly, from a mean of 48.7 ± 6.5 at baseline to 69.2 ± 5.8 at 12 months (p<0.001). Adverse effects were generally mild, with hoarseness (9%) and throat discomfort (6%) being the most commonly reported. Conclusion: Vagus nerve stimulation appears to be an effective and well-tolerated adjunctive therapy for seizure control in patients with drug-resistant epilepsy. It also significantly enhances quality of life, underscoring its utility in comprehensive epilepsy management strategies.

Acute chest pain is a common and potentially life-threatening presentation in emergency medical settings. Early recognition and appropriate management are crucial to reduce morbidity and mortality, especially when associated with cardiac etiology. We report the case of a 56-year-old Hindu male who presented with acute onset chest pain persisting for two days, accompanied by shortness of breath for one day. The chest pain was sudden in onset, retrosternal, diffuse, heavy, and constricting in nature, with radiation to the jaw and left upper limb. The pain was unrelieved by rest, positional changes, or forward bending, and was associated with nausea, diaphoresis, and a sense of restlessness. Notably, there were no symptoms suggestive of respiratory infection, gastrointestinal reflux, or neurological involvement. On the second day, the patient developed exertional dyspnea (NYHA Class II) and occasional palpitations, with no features of orthopnea, paroxysmal nocturnal dyspnea, or peripheral edema. The patient had no prior history of ischemic heart disease, diabetes, hypertension, thyroid dysfunction, or other chronic illnesses. He denied previous episodes of similar chest pain and had no history of prior hospitalizations or surgeries. The clinical presentation was highly suggestive of a cardiac origin of chest pain, necessitating urgent evaluation and management. This case highlights the importance of comprehensive symptom analysis and prompt referral in patients with atypical chest pain, especially in the absence of prior comorbidities.

Introduction: Granular cell tumours are rare, usually benign neoplasms that can be located anywhere in the body. They are usually found in the oral cavity (40%), skin and subcutaneous tissue (30%), breast (15%), or respiratory tract (15%).1 In the gastrointestinal tract, the most common site being the esophagus. Involvement in other gastrointestinal locations such as the duodenum, anus, stomach, biliary tree, and colon4 are much more uncommon. Case Presentation: We report a unique case of Granular cell tumour located in the hepatic flexure of colon. A 70-year-old male presented with complaints of altered bowel habits to gastroenterology OPD. Colonoscopy was done which revealed a polyp in ascending colon and hepatic flexure of colon. Histopathological examination showed the polyp in ascending colon as tubular adenoma with low grade dysplasia and the polyp in hepatic flexure as Granular cell tumour. Immunohistochemistry (IHC) for S100 was done, which was positive. The tumour was completely excised and the patient was asymptomatic during the follow-up period of 6 months. Discussion: Granular cell tumours are rare, benign neoplasms that occur rarely in the gastrointestinal tract. They are most commonly found in stomach and small intestine. Colonic granular cell tumours, particularly located in hepatic flexure of colon are exceedingly rare. The diagnosis is solely based on histopathologic examination and confirmation by immunohistochemistry. Management involves complete surgical excision. Conclusion: Granular cell tumours of colon are rare and can present as a diagnostic challenge. Even though it is a benign entity, it has a potential for malignant transformation. Hence awareness about this condition and its histopathological features are needed for arriving at a correct diagnosis and management.

Introduction: Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality globally, with an increasing incidence in developing countries like India. Tumour microenvironment, especially the desmoplastic reaction (DR), plays a crucial role in cancer invasion, progression, and prognosis. Histological evaluation of DR offers an accessible and cost-effective prognostic marker, especially in resource-limited settings. Aims and Objectives: To assess the histopathological characteristics of desmoplastic reaction in colorectal cancer specimens and to correlate them with clinicopathological parameters and patient outcomes. Methodology: This prospective study was conducted at a tertiary care hospital in Andhra Pradesh over 2 years. A total of 62 cases of resected colorectal adenocarcinoma were included. Tumour sections were evaluated for DR and categorized into mature, intermediate, and immature patterns based on the presence of keloid-like collagen and myxoid stroma. Correlations with tumor grade, depth of invasion, lymphovascular invasion, lymph node status, and TNM stage were statistically analyzed. Results: Among the 62 cases, mature DR was observed in 46%, intermediate in 36%, and immature in 18%. Immature DR significantly correlated with higher tumor grade (p<0.01), lymphovascular invasion (p=0.03), deeper invasion (p<0.01), and advanced TNM stage (p=0.02). Mature DR was associated with favorable histopathological parameters. Conclusion: Desmoplastic reaction grading provides valuable prognostic insight in colorectal cancer and should be routinely incorporated in histopathological reporting. Its simplicity and reproducibility make it especially suitable for low-resource settings.

Background: The HIV infection burden is increasing day by day, especially in women of reproductive age groups. This subgroup of people is the potential candidates for whom effective ART in pregnancy can prevent mother-to-child transmission and decrease the new cases of neonatal HIV infection.  This study aims to observe the incidence of HIV infection in pregnancy and its effect on maternal and fetal outcomes.   Methods: This is a retrospective case record analysis of 31 HIV-positive pregnant patients during a period of five years from 2019 to 2024 in the Govt. Medical College, Kathua. Results: 31 patients were included in the study, and the incidence was 0.14%. The mean age of patients was 25.06 years, and 45.1% of patients were aged 26-30 years. The majority of patients had at least primary school education (67.7%), while serodiscordance was seen in 25.8% of couples. About 58.1% of patients were new cases detected during pregnancy, with the highest detection rate in the third trimester (29%). Primigravida was more common (48.4%) in the study. LSCS rate was about 55%. Preterm birth and low birth weight were seen in 3.2% and 25.5% of the babies. Neonatal mortality was 6.8%. No case of mother-to-child transmission was noted.  Conclusion:  HIV infection had adverse effects on pregnant women in terms of low-birth-weight newborns, prematurity, and neonatal deaths. All these contribute to neonatal morbidity, which predisposes to increased chances of mother-to-child transmission.

Introduction: Digital media is rapidly penetrating the lives of young children owing to increased accessibility resulting in increased screen time. According to WHO guidelines the recommended daily screen time for the ages 2 to 5 years is not more than an hour a day and discourage screen time for children less than 2 years. Objectives: This study was conducted to assess the problematic device usage and its association with behavioral changes in children of 2 to 5 years age. Methods: This is a community-based cross-sectional study conducted for 2 months from February 2023 to April 2023 among children of 2-5 years of age residing in Balaji Nagar which is an urban field practice area of Government Medical College, On gole. Results: Out of 116 children, 66 (56.9%) were males and 50 (43.1%) are females and the mean age of the children was 3.5  1.2 years. 39(33.62%) of the children have both parents who were working either part-time or full time. The association between Age, mother’s Education, Mother’s occupation, father education, working parents with PMUM present found to be significant (P<0.05). 55% children were watching television for 2 hours or more in week days and 77.5% weekend time. 63.2% children were involved with mobile phone for 2 hours or more in week rime and 81.6% weekend time. Mean screen time was found to be 102.46 ± 14.7 minutes and 18% of the parents were always co-viewed with the Children. PMUM presence seen with screening time more than 1 hour among 50% of Children and its association found to be significant (P<0.05). Over all Positive association (P<0.0000017) was noticed between Problematic media and SDQ scale total score. Problematic device usage and behavioral problems were found to be moderate to strongly positive (high positive correlation), with r (114) =0.6825 and P value <0. 001.Conclusions: This study findings will be helpful for better understanding of the relationship between screen time and behavioral changes and to provide effective community-based awareness interventions.

Background: Anterior cruciate ligament (ACL) injuries are prevalent among competitive athletes, often necessitating surgical reconstruction for optimal recovery and return to sport. Autografts (patient's own tissue) and allografts (donor tissue) are commonly used graft options. The efficacy of these grafts in terms of isokinetic muscle strength recovery remains a topic of ongoing research. This study aims to compare the isokinetic strength recovery outcomes following ACL reconstruction using autografts versus allografts in competitive athletes. Materials and Methods: A prospective cohort study was conducted on 60 competitive athletes (aged 18–30 years) undergoing primary ACL reconstruction. Participants were equally divided into two groups: Group A (n=30) received autograft (hamstring tendon), and Group B (n=30) received allograft (tibialis anterior). Isokinetic strength testing of quadriceps and hamstrings was performed at 60°/sec and 180°/sec using a dynamometer at 3, 6, and 12 months postoperatively. Peak torque to body weight ratio and limb symmetry index were calculated. Statistical analysis was performed using repeated measures ANOVA and independent t-tests, with significance set at p<0.05. Results: At 3 months, Group A demonstrated higher quadriceps strength (peak torque/body weight ratio: 1.37 ± 0.12) compared to Group B (1.21 ± 0.15; p=0.018). At 6 months, hamstring strength recovery was significantly better in Group A (1.45 ± 0.10) than Group B (1.28 ± 0.11; p=0.009). By 12 months, both groups showed comparable limb symmetry indices (Group A: 92.3%; Group B: 90.7%; p=0.42). However, a faster recovery trajectory was observed in the autograft group. Conclusion: Autografts facilitate a more rapid isokinetic strength recovery in the early postoperative period compared to allografts in competitive athletes following ACL reconstruction. Although long-term outcomes converge, early rehabilitation milestones favor autograft use for athletes aiming for quicker return to sports.

Background: A quick and easy method of estimation of foetal weight in utero is an obvious benefit to the clinician practicing modern obstetrics as the perinatal mortality and morbidity is affected not only by foetal age but also by the foetal weight Materials and Methods: symphysiofundal height (SFH) and abdominal girth (AG) was measured in 196 pregnant women attending the OPD or Maternity ward at term. The station of the head was found and various methods of calculation of baby weight was used to estimate the baby weight. The actual weight of the baby was measured at the time of birth and statistical analysis done. Results: All the method of clinical estimation of foetal weight, overestimated the actual birth weight by 1 to 2 gms / 100gms (table I). Estimation of foetal weigh by different method shows that the clinical method is the best method (table ii, & table iii). 38% of babies could be estimated within 100 gms of their actual birth weight (table ii) and 64% of foetuses could be estimated within 10% of their actual birth weight (table iii). This was better than that obtained by Tivari and Sood (1989) ⁷ which was 59% by the same method, where the correct was not defined as within 10% of actual birth weight. Conclusion: The sample comprised of 195 patients. The age group of the patients were from 18 to 38 yrs. There were 38 primigravidas, 56 second gravidas, and 4 grand multiparas. Height varied from 141 cm to 168 cm, weightwas between 44 kg to 72 kgs. Of the 195 gravidae studied, the mean actual birth weight of their babies was 2781 grams. Which was lower than mean birth weight estimated by various clinical methods. All the clinical estimation of the birth weight overestimated the actual birth weight by 1 to 2 gm/100gms.

Background: Peripheral arterial pseudoaneurysms (PAPs) are vascular anomalies that frequently result from iatrogenic trauma, especially following catheter-based interventions. Given the rising prevalence of such procedures, a systematic evaluation of PAPs is warranted to guide optimal management strategies, particularly in resource-constrained settings. Methods:  This retrospective study was conducted at two tertiary care centres in Eastern India and included 43 patients diagnosed with PAPs between January 2020 and December 2023. Demographic, clinical, etiological, and management data were collected using a structured proforma. Diagnosis was confirmed via Doppler ultrasound and CT angiography. Treatment modalities included conservative management for small, uncomplicated lesions and surgical repair for larger or symptomatic cases. Outcomes were assessed over a 6-month follow-up period. Results: The mean age was 55 years, with a male predominance (72.1%). Iatrogenic injury, primarily post-catheterization, accounted for 95.3% of PAPs, with femoral (72.1%) and radial (27.9%) arteries being the most affected sites. The most frequent presentation was a pulsatile mass (97.7%), followed by pain (65.1%) and thrill (14%). Eight patients with pseudoaneurysms <3 cm were managed conservatively, with success in six. Surgical intervention was required in total number (8+42) is more than n (43), with primary repair being the most common technique. There were no postoperative mortalities or cases of limb ischemia. 3 patients presented with skin necrosis. Follow-up data were available for 60.5% of the cohort, with no late complications observed. Conclusion: Iatrogenic pseudoaneurysms, especially following endovascular procedures, constitute many PAPs in tertiary care settings. Prompt diagnosis, size-based stratification, and appropriate intervention whether conservative or surgical yield excellent outcomes with minimal complications. This study reinforces the value of protocol-driven management and highlights the need for increased vigilance as interventional procedures become more common.

Diabetes mellitus, the most common endocrine disorder is characterised by metabolic abnormalities and long-term microvascular and macrovascular complications. Diabetic nephropathy is first recognized as proteinuria. The reason for performing the test for proteinuria is for the early detection of diabetic nephropathy in a patient with diabetes for many years.  Aim and Objectives: 1. Screening of microalbuminuria in patients with diabetes mellitus. 2. To correlate microalbuminuria with the duration of diabetes mellitus and association with other microvascular and macrovascular complications of diabetes mellitus. Materials and Methods: 82 patients were selected randomly selected from outpatient and medical wards of a tertiary care hospital. Patients will be considered diabetic as per WHO criteria for diagnosis of diabetes mellitus All patients were evaluated in detail along with the testing for microalbuminuria with dipsticks (Micral). Results: The overall occurrence of microalbuminuria was 41.41 %. The occurrence of microalbuminuria showed a direct relationship with increasing age and increasing duration of diabetes since diagnosis. An HbA1c value above 7% is associated with 50% or higher incidence of microalbuminuria. The incidence of microalbuminuria is significantly associated with the presence of retinopathy, peripheral neuropathy, ischemic heart disease and hypertension.  Conclusions: Screening for Microalbuminuria in diabetic patients is essential for intervention and prevention of further complications like end stage renal disease and other cardiovascular risk factor.  By Early detection of Microalbuminuria in diabetic patients, various complications can be prevented by good control of sugar.

Background: AIM: To retrospectively find the different pathologies of heart disease in the cases examined at Mortuary of Bundelkhand Medical College, Sagar, M.P and district hospital Sagar M.P. Objectives: To find the incidence of heart disease in different age groups and different sex To find the incidence of different pathologies of heart   Materials And Methods: 2250 autopsies were performed during the time period of July. 2023 to Dec. 2024 out of that 83 cases of cardiac deaths were found. Deaths due to non-cardiac causes, such as trauma were excluded.  Study design – Cross sectional study, retrospective, Study area – Sagar Bundelkhand region, Study population – All autopsy cases which came to Bundelkhand medical college mortuary  and district hospital Sagar during the time period of July 2023 – December 2024.  Results: Out of total 2250 autopsies conducted  83 cases of heart disease deaths were recorded. Among them 81.93% were due to coronary artery disease (CAD). 59.04% cases had cardiomegaly and heart weight was more (>420 gms) in 59.04 % cases. Among 83 cases of cardiac deaths 92 % victims were males and 8 % were females. The peak incidence of heart diseases was found to be in the age group of 40-49 yrs (27.71 %) followed by 50-59 yrs (26.51%). Least incidence were found in the age group below 19.  Conclusion: Most of the heart disease deaths examined were due to coronary artery disease (CAD). Majority of victims were males. Hence this data shows us the quintessential requirement of intervention in the prevention of heart diseases 

Background: Aim: The aim of the present study was to optimize the off pump coronary artery bypass grafting by the use of graft flow meter based on transit time flow principle and revision of grafts when the values are abnormal and there is associated haemodynamic instability as seen on TEE, ECG changes and rise in Trop I levels. Methods: 75 patients undergoing isolated off-pump CABG at LPS Institute of Cardiology and Cardiac Surgery were included in the study from January 2017 to June 2018. The study was conducted on all the cases who were admitted for CABG and who met the inclusion criteria. Results: Out of 75 patients undergoing off pump CABG, 67 were males and 8 were females. The majority of patients (37.3%) were in the age group of 51 – 60 years followed by 32% patients in the age group of 61 - 70 years. Out of the 75 patients 18 were suffering from Diabetes, 28 from hypertension, 12 were both diabetic as well as hypertensive, 3 had previous PTCA, 5 were suffering from COPD. Out of the total 75 patients 46 had triple vessel disease, 22 had double vessel disease and 7 had single vessel disease. 6 had significant LMCA disease. The mean flow with standard deviation in the left coronary territory was 35.54 + 16.35 ml/min and in the right coronary territory was 31.05 +15.12 ml/min with a p value of 0.4 which is not significant. The Pulsatility index (PI) in the left coronary territory was 1.99 + 0.75 and in right coronary territory was 1.94 + 0.81 with a p value of 0.06 which is not significant. Conclusion: The present study concluded that transit time flow measurement is simple, reliable and easy to perform. Low flow and raised PI require reexploration of the anastomosis unless severe spasm of the conduit or poor runoff is strongly suspected. Redoing the distal anastomosis leads to significant improvement in flow and decreases pulsatility index in the presence of anastomotic failure. Mean graft flow of >10 ml/min can be considered satisfactory in Indian population where the native coronary size ranges between 1- 2mm , whereas in Western population it is between 3 to 4mm, cutoff value of >20 ml/min has been described. In this light, heamodynamic stability as assessed by intraoperative ECG and TEE, is important as low flow per se does not signify graft failure.

Background: Connective tissue disorders (CTDs) are systemic autoimmune diseases that frequently involve the lungs, leading to interstitial lung disease (ILD), which is a major cause of morbidity and mortality. High-resolution computed tomography (HRCT) has emerged as a critical tool for the non-invasive assessment of ILD patterns and severity. This study aims to evaluate the HRCT imaging spectrum of CTD-associated ILD and correlate imaging findings with pulmonary function test (PFT) results.Objectives: To determine the predominant HRCT patterns in ILD associated with CTDs, quantify fibrosis severity using a scoring system, and correlate these scores with spirometric parameters. Methods: A prospective observational study was conducted at the Departments of Respiratory Medicine and Radiodiagnosis at Government Medical College and Hospital, Nizamabad and Nirmal. A total of 40 patients diagnosed with CTDs and suspected ILD underwent HRCT imaging. Fibrosis severity was scored based on zonal involvement (upper, middle, lower zones). PFTs were performed, and parameters such as FVC, FEV₁, and FEV₁/FVC ratio were recorded. Pearson’s correlation was used to assess relationships between HRCT scores and PFT values. Results: Among the 40 participants, systemic sclerosis (42.5%) and rheumatoid arthritis (37.5%) were the most common CTDs. NSIP was the predominant HRCT pattern, seen in 80% of cases. Quantitative fibrosis scores averaged 26.5 in systemic sclerosis and 28.8 in rheumatoid arthritis. A weak to moderate positive correlation was observed between fibrosis scores and FEV₁/FVC ratio (r = 0.43), suggesting that HRCT grading reflects pulmonary functional impairment. Conclusion: HRCT is a reliable tool for detecting and classifying ILD in CTD patients, with NSIP being the most common radiological pattern. The fibrosis scoring system offers a semi-quantitative method to estimate disease burden and demonstrates correlation with functional parameters. These findings support HRCT’s role in disease monitoring and prognosis in CTD-associated ILD.

Background: Stroke remains one of the foremost causes of mortality and long-term disability worldwide, with hypertension serving as the most significant modifiable risk factor. Carotid artery intima-media thickness (CIMT) is a validated non-invasive marker of subclinical atherosclerosis and has shown potential in predicting future cerebrovascular events. Methods: A hospital-based case-control study was conducted at a tertiary care center in Kanpur, North India, involving 200 hypertensive patients—100 with acute stroke (cases) and 100 without stroke (controls). CIMT was measured using B-mode ultrasonography. Statistical analyses were performed using SPSS version 26, and a p-value <0.05 was considered significant. Results: CIMT was significantly higher in ischemic stroke patients (1.03 ± 0.11 mm) compared to haemorrhagic stroke patients (0.98 ± 0.13 mm; p = 0.040). Elevated CIMT (>0.9 mm) was strongly associated with dyslipidaemia—total cholesterol (p = 0.0022), triglycerides (p = 0.018), LDL (p = 0.024)—as well as diabetic markers such as fasting blood glucose (p = 0.015), postprandial glucose (p = 0.004), and HbA1c >10% (p = 0.022). Longer duration of hypertension (>10 years) and higher blood pressure stages were also significantly linked with increased CIMT values. Conclusion: CIMT is a reliable early indicator of atherosclerotic vascular changes in hypertensive patients, especially those with coexisting diabetes and dyslipidaemia.

Background: Antimicrobial resistance (AMR) is a growing global health concern, largely driven by irrational and inappropriate antibiotic prescribing. Assessing the knowledge, awareness, and prescribing behavior among healthcare professionals, especially medical interns and practicing clinicians, is crucial for designing targeted antimicrobial stewardship programs (ASPs). Materials and Methods: A cross-sectional, questionnaire-based study was conducted over three months in a tertiary care teaching hospital. The study included 100 participants: 50 medical interns and 50 practicing clinicians. A validated semi-structured questionnaire assessed knowledge on AMR, attitude towards antimicrobial prescribing, and adherence to treatment guidelines. Data were analyzed using SPSS version 25. Descriptive statistics and Chi-square tests were used to compare responses between the two groups, with p<0.05 considered statistically significant. Results: Among interns, 68% demonstrated adequate knowledge about AMR, compared to 84% of practicing clinicians. However, only 40% of interns adhered consistently to institutional antibiotic guidelines, whereas 72% of clinicians followed the guidelines. Notably, 54% of interns admitted to prescribing antibiotics based on senior advice rather than clinical judgment, while 26% of clinicians did the same. Awareness regarding the WHO’s AWaRe classification was significantly higher among clinicians (60%) compared to interns (28%) (p<0.01). Conclusion: Practicing clinicians exhibited higher awareness and better prescribing practices regarding antimicrobials than medical interns. The study highlights the need for structured antimicrobial stewardship education in undergraduate and internship training programs to bridge the knowledge-practice gap and combat the AMR threat.

Background: The supratrochlear foramen (STF) is a common anatomical variation at the distal humerus formed by perforation of the septum between the olecranon and coronoid fossae. Though once considered an anatomical curiosity, STF holds clinical relevance due to its potential to complicate intramedullary nailing and mimic pathological lesions radiologically. This study aimed to analyze the prevalence, shape, and dimensions of STF in humeri from the Indian population, highlighting its surgical and diagnostic importance. Materials And Methods: A cross-sectional study was conducted on 100 adult dry humeri (50 right, 50 left) of unknown age and gender from Indian populations, collected from anatomy departments in Jaipur and Patna, India. The presence and shape of the supratrochlear foramen (oval, round, irregular) were recorded. Transverse and vertical diameters were measured twice using a digital vernier caliper (0.01 mm sensitivity), and averages were analyzed. Data were statistically evaluated with GraphPad Prism 9; p < 0.05 was considered significant. Results: Out of 100 humeri examined, the supratrochlear foramen (STF) was present in 29% of specimens, with a higher occurrence on the left side (17%) compared to the right (12%). Three STF shapes were identified: round (48.27%), oval (41.38%), and irregular (10.35%), with no significant side-wise variation. The mean transverse diameter was significantly greater on the right side (4.64 ± 1.02 mm) than the left (3.23 ± 0.89 mm; p < 0.0001), while the vertical diameter showed no significant difference between sides (p = 0.248). Conclusion:  The supratrochlear foramen (STF), often overlooked clinically, is important for orthopaedic surgeons in distal humerus fracture management and for radiologists to differentiate from pathological lesions. Understanding the STF benefits anatomists, anthropologists, and clinicians alike.

Background: Laparoscopic cholecystectomy demands effective airway management due to the physiological changes caused by pneumoperitoneum. While endotracheal intubation (ETT) is the gold standard, the I-gel a second-generation supraglottic airway device, offers a potentially less invasive alternative. Since its introduction has become common modality of airway management in short duration surgeries. It does not only provide adequate ventilation, oxygenation and delivery of anesthetic agents but also lowers risk of respiratory adverse events. Objectives: To determine the efficacy of I-gel compared to ETT in terms of ease of insertion, hemodynamic changes as well as ventilation efficacy in adults undergoing elective laparoscopic cholecystectomy under general anesthesia. Methods: A hospital based observational study was conducted under Department of Anesthesiology, Assam Medical College, Dibrugarh for 2 months. Sixty ASA I-II patients aged 20-60 years scheduled for elective laparoscopic cholecystectomy were randomized into two groups: Group A (I-gel) and Group B (ETT). The insertion time, number of attempts, ease of insertion, hemodynamic parameters, and End-tidal CO₂ (EtCO₂) were compared between the two groups. Statistical significance was determined using appropriate tests. Results: Mean insertion time was significantly shorter in I-Gel (11.73±1.62 sec) than ETT (16.50±1.07 sec, p<0.0001). Ease of insertion was significantly better with I-gel (96.6% vs. 80%, p=0.0444). I-gel was also associated with higher first attempt success rate (96.67% vs 86.67%). Hemodynamic responses (HR and MAP) at 1minute post-insertion were significantly higher in the ETT group (p=0.011 and 0.02). EtCO₂ values were comparable between both groups. Conclusion: I-gel offers faster, easier insertion with less hemodynamic changes than ETT. We conclude that I-Gel can be a suitable alternative in short-duration laparoscopic surgeries in healthy adults.

Congenital common origin of the left circumflex artery and right coronary artery (RCA) from right coronary sinus is an extremely rare coronary anomaly, but can have significant clinical implications. Therefore, early detection, correct diagnosis, and appropriate treatment are important. We present a unique case of a 44-year-old male presenting with chief complaints of chest pain and breathlessness. CT coronary angiography findings typically demonstrate origin of left circumflex artery (LCX) from right coronary sinus following a retroaortic course and supplying its territory and absent left main coronary artery (LMCA).

Background: Anemia during pregnancy is a major public health concern, particularly in developing countries, and is associated with adverse maternal and fetal outcomes. Iron deficiency is the leading cause of anemia in pregnancy. Oral iron therapy remains the conventional treatment, but intravenous iron preparations, particularly ferric carboxymaltose (FCM), have gained attention due to better compliance and rapid hemoglobin improvement. Materials and Methods: This prospective, randomized comparative study was conducted at a tertiary care hospital over a 12-month period. A total of 120 pregnant women (gestational age between 14–28 weeks) with moderate iron deficiency anemia (hemoglobin 7–9.9 g/dL) were enrolled and randomly assigned into two groups: Group A (n=60) received intravenous ferric carboxymaltose (1000 mg in a single infusion), and Group B (n=60) received oral ferrous sulfate tablets (100 mg elemental iron twice daily) for 6 weeks. Hemoglobin (Hb), serum ferritin, and patient-reported gastrointestinal side effects were evaluated at baseline and after 6 weeks. Results: At 6 weeks, the mean rise in hemoglobin was significantly higher in Group A (3.2 ± 0.6 g/dL) compared to Group B (2.1 ± 0.5 g/dL) (p < 0.001). Serum ferritin levels also increased markedly in Group A (from 12.4 ± 3.8 ng/mL to 56.3 ± 9.7 ng/mL), compared to Group B (from 13.2 ± 4.1 ng/mL to 32.7 ± 6.5 ng/mL). Gastrointestinal side effects were significantly less in the FCM group (10%) compared to the oral iron group (38%). Conclusion: Ferric carboxymaltose is more effective than oral iron in rapidly correcting hemoglobin and improving iron stores in pregnant women with moderate anemia. It is also associated with better tolerability and fewer gastrointestinal adverse effects, suggesting its suitability as a preferred option in antenatal anemia management.

Background: Culture-negative sepsis refers to cases where patients exhibit clinical signs of sepsis, but no causative pathogens are identified through standard microbiological cultures4. This complicates clinical decision-making and may influence outcomes. Objective: To compare the clinical outcomes between culture-positive and culture-negative sepsis patients. Methods: A six-month observational study at Assam Medical College and Hospital included 80 adult patients with sepsis, divided into culture-positive and culture-negative groups. Outcomes assessed were ICU admission, mechanical ventilation, vasopressor use, and mortality. Results: Of 80 patients, 33 were culture-positive and 47 were culture-negative. Mortality was higher in the culture-positive group (75.8% vs 42.5%), while ICU admission, mechanical ventilation and vasopressor uses were similar between the groups. Conclusion: Culture-negative sepsis carries comparable severity to culture-positive cases, highlighting the need for early, aggressive management regardless of culture results.

Background: Noncommunicable diseases (NCDs), particularly cardiovascular disease (CVD), have become a predominant global health burden, and WHO/International Society of Hypertension (WHO/ISH) non-laboratory-based risk assessment tool predict major cardiovascular events over 10 years. Hence the present study aims to Assessing cardiovascular risk among individuals aged 40 years   Methodology: The study employed a cross-sectional design to evaluate cardiovascular risk among adults aged over 40 years attending the Government General Hospital in Ongole, Andhra Pradesh, using the WHO non-laboratory-based cardiovascular disease risk assessment tool. Data collection involved 365 eligible participants, with measurements including blood pressure, BMI, and smoking status, and the results indicated significant gender differences in cardiovascular risk profiles  Results: Among the participants, 39.0% were categorized as having <5% risk, 30.1% presented a 5-10% risk, and 27.4% had a moderate risk (10-20%), with males showing a higher prevalence of smoking (52.8%) compared to females (5.3%) and a higher history of diabetes (35.6% vs. 26.5%) and also there is a Results indicated significant gender differences in cardiovascular risk profiles. Conclusion: The study highlights significant gender differences and behavioral influences on cardiovascular disease risk and emphasizes the need for targeted interventions and gender-sensitive strategies to mitigate cardiovascular risk.

Background: Recovery heart rate (HRR), the rate at which the heart returns to baseline after exercise, serves as a practical, low-cost indicator of cardiovascular fitness and autonomic function. Faster HRR is typically observed in physically active individuals and reflects superior cardiac health. Given the growing sedentary tendencies in university populations, HRR provides a simple yet effective means to assess cardiovascular status in this age group. Objective: This study aimed to evaluate the efficacy of recovery heart rate as a physiological marker of cardiovascular fitness among physically active and inactive male students. Methodology: A comparative cross-sectional design was used over one year, involving 150 healthy male students aged 18–25. Participants were classified into physically active (n = 75) and inactive (n = 75) groups based on activity levels. All underwent a standardized submaximal exercise protocol, with heart rate measurements taken at rest, immediately post-exercise, and at one- and two-minute recovery intervals. Exclusion criteria included pre-existing medical conditions, use of cardioactive medications, and professional athletic training. Data analysis was conducted using IBM SPSS Statistics, with significance set at p < 0.05. Results: Physically active individuals demonstrated significantly lower resting heart rates and faster recovery post-exercise compared to inactive peers (p < 0.001). The mean reduction in heart rate during the first recovery minute was greater in the active group (45.7 ± 7.2 bpm) versus the inactive group (31.5 ± 6.9 bpm). A strong positive correlation (r = 0.721) was found between physical activity and HRR, and a negative correlation (r = –0.603) between physical activity and resting heart rate. Conclusion: Regular physical activity is associated with improved cardiovascular responsiveness and autonomic recovery. Recovery heart rate is an effective, field-friendly measure of cardiovascular fitness, reinforcing the need for structured physical activity programs in university settings.a

This case report details the 6-year follow-up of a 75-year-old woman with chronic rheumatic heart disease (CRHD) with severe aortic stenosis (AS) who underwent trans-catheter aortic valve replacement (TAVR) with a 23 mm Myval™ trans-catheter heart valve (THV). She underwent mitral valve replacement (MVR) few years ago. She has co-morbid conditions like obesity, obstructive sleep apnea (OSA), hypertension, and hypothyroidism. Considering her advanced age and multiple co-morbid conditions with prohibitive surgical risk, TAVI was offered after discussing with the heart team. Significant improvement in her symptoms was observed following TAVR. This case shows the feasibility, durability and effectiveness of TAVI in severe rheumatic aortic stenosis [AS].

Substance use among construction workers has emerged as a significant public health concern, especially in developing countries like India. This study aimed to assess the prevalence and patterns of substance use among construction workers in North India and explore its implications on occupational health and safety. A cross-sectional descriptive study was conducted among 500 construction workers using structured questionnaires. The study revealed high rates of alcohol and nicotine use, particularly among young, male, and less-experienced workers. Findings underscore the need for targeted workplace interventions and policy reforms.

: Introduction: Respiratory tract infections are commonly encountered in clinical practice and are often complicated by the presence of underlying comorbidities such as Chronic Obstructive Pulmonary Disease, Bronchial asthma, and Diabetes Mellitus. These can alter the respiratory microbiological profile. Moraxella catarrhalis, considered a commensal organism of human upper respiratory tract, has emerged as a notable pathogen in lower respiratory tract infections, particularly in individuals with chronic respiratory diseases. Understanding the relationship between specific comorbidities and the isolation of Moraxella catarrhalis can help improve clinical management and targeted therapy. Objectives: This study aimed (1) To establish the pathogenicity of Moraxella catarrhalis through microbiological identification using microscopy, culture, and biochemical reactions (2) To assess the incidence of Moraxella catarrhalis and to analyse the association between comorbidities like Chronic Obstructive Pulmonary Disease & Bronchial Asthma (3) To determine its antibiotic susceptibility profile to various antibiotic classes. Methodology: A cross-sectional study was conducted involving 250 bacteriologically significant respiratory samples. Participants were categorized based on the presence of no comorbidity, with Chronic Obstructive Pulmonary Disease, Bronchial Asthma, or Diabetes Mellitus. The isolates were identified conventionally and antibiotic susceptibility testing done with various classes of antibiotics. Results: Out of the 250 bacteriologically significant respiratory sample, 38 clinically significant Moraxella catarrhalis were isolated and accounted for 15.2% of total isolates. Antibiotic susceptibility testing showed 100% resistance to ampicillin and 100% sensitivity to amoxicillin -clavulanic acid correlating with the production of beta-lactamase enzyme by the isolates. Moraxella catarrhalis was isolated predominantly among Chronic Obstructive Pulmonary Disease patients (26.8%) followed by, Bronchial Asthma patients (17.1%). The Chi-square test showed a significant association between comorbid conditions and bacterial isolates (χ² = 14.92, p = 0.002). Conclusion: Moraxella catarrhalis should be considered as a lower respiratory tract pathogen especially in elderly patient with underlying comorbidity like Chronic Obstructive Pulmonary Disease & Bronchial Asthma.

Background: Hepatitis B virus (HBV) is a major global public health concern, particularly in intermediate endemic regions like India. Early detection through preoperative screening helps prevent intra-hospital transmission and informs appropriate clinical management. Objectives: To estimate the seroprevalence of hepatitis B surface antigen (HBsAg) among preoperative patients in a rural tertiary care centre. Methods: A retrospective cross-sectional study was conducted over one year (May 2023 to April 2024), involving 11,131 patients undergoing elective surgeries across multiple departments. Serum samples were screened for HBsAg using a rapid immunochromatographic test. Demographic data and coinfections with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) were also assessed. Statistical analysis was performed using Chi-square tests, with P ≤ 0.05 considered significant. Results: The overall HBsAg seroprevalence was 2.07% (231/11,131). Among these, 170 (73.6%) were males and 61 (26,4%) were females, with gender-based seroprevalence of 2.42% and 1.48%, respectively. The highest seropositivity was observed in the 21–40 years age group (37%), followed by 41–60 years (33%), >60 years (24%), and 0–20 years (6%). None of the seropositive individuals presented with clinical signs or symptoms of hepatitis; all were asymptomatic and incidentally detected during routine preoperative screening. Most seropositive patients were married, illiterate, and engaged in agricultural work. Coinfections included 2 cases with HCV (1.29%) and 1 case with HIV (0.4%). Conclusion: Preoperative screening for HBV is essential in identifying asymptomatic carriers and minimizing occupational and nosocomial transmission. The results highlight the need for continued surveillance and enhanced HBV vaccination and awareness programs, especially in rural populations.

Background: Dengue fever is a widespread mosquito-borne viral illness that poses a significant global health challenge. While primarily self-limiting, it can progress to severe forms such as dengue hemorrhagic fever and dengue shock syndrome. Hepatic dysfunction is a frequently observed complication, present in up to 90% of hospitalized cases, and may serve as an early prognostic marker for disease severity. Methods: This prospective observational study included 100 adult patients (≥18 years) with laboratory-confirmed dengue fever at a tertiary care center in central India over six months. Clinical presentation, liver function tests (AST, ALT, bilirubin, albumin), hematological parameters (WBC, platelet count, hematocrit), and ultrasound findings were recorded. Hepatic involvement was defined as elevated transaminases (>2× upper limit of normal), hyperbilirubinemia, or clinical signs of liver dysfunction. Patients were stratified by severity using WHO dengue classification criteria. Results: Elevated AST and ALT levels were noted in 88% and 81% of patients, respectively, with AST predominance. Hepatomegaly was seen in 26%, and jaundice in 8% of cases. Thrombocytopenia (91%) and leukopenia (76%) were prevalent hematological abnormalities. According to WHO criteria, 12% developed severe dengue, while 42% had warning signs. Elevated transaminases and low platelet counts showed significant correlation with severe disease. Conclusion: Hepatic dysfunction is a common and early feature in dengue infection, with elevated transaminases—particularly AST—and thrombocytopenia serving as key indicators of severity. Early identification of these abnormalities can facilitate risk stratification and timely intervention, potentially improving clinical outcomes.