European Journal of Cardiovascular Medicine

Background: Ischemic heart disease (IHD) remains a leading cause of morbidity and mortality worldwide. Elevated homocysteine levels and dyslipidemia are considered significant risk factors. This study aims to evaluate the correlation between serum homocysteine, lipid profile parameters, and IHD. Methods: A case-control study was conducted with 84 participants (42 IHD patients and 42 healthy controls). Serum homocysteine, total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) were measured. Statistical analysis was performed using Pearson’s correlation and Student’s t-test. Results: Homocysteine levels were significantly higher in IHD patients (18.7 ± 4.2 µmol/L) compared to controls (10.3 ± 2.8 µmol/L) (p < 0.001). LDL and TC were elevated in IHD patients, while HDL was significantly lower (p<0.05). A positive correlation was found between homocysteine and LDL (r = 0.52, p<0.01) and TC (r = 0.46, p<0.01). Conclusion: Elevated homocysteine and dyslipidemia are strongly associated with IHD. Screening for these biomarkers may aid in early risk stratification and preventive strategies

Background & Objectives: Inguinal hernia repair is among the most common surgical procedures in men worldwide. Epidural anaesthesia is widely utilized, but conventional dosing can lead to hemodynamic instability, particularly in elderly patients. This clinical study evaluated the safety and efficacy of low-dose segmental epidural anaesthesia, targeting only the surgical field to minimize complications. Methods: A prospective study was conducted on 60 patients (ASA I & II), aged 18–70 years, undergoing elective inguinal hernia repair. Segmental epidural block was performed with 5–6 mL of 0.5% Bupivacaine at the L1–L2 space. The onset, duration, and quality of analgesia were assessed along with pre- and postoperative sensory block levels and hemodynamic parameters (heart rate, systolic and diastolic blood pressure). Adverse effects such as shivering, sweating, bradycardia, and hypotension were also recorded. Results: The mean onset of analgesia was 7.8 minutes, and the mean duration was 162.25 minutes (range: 120–240 minutes). Analgesic quality was rated as Excellent in 34 patients, Good in 17, Fair in 7, and Poor in 2 cases. Hemodynamic stability was maintained in all patients. Complications were minimal, with shivering observed in 5 cases and sweating in 9. Conclusion: Segmental epidural anaesthesia using 5–6 mL of 0.5% Bupivacaine provides effective and safe analgesia for inguinal hernia repair, with minimal complications and limited block spread. It is especially advantageous in elderly patients where hemodynamic changes must be minimized.

Background: Intracranial space-occupying lesions (ICSOLs) comprise a diverse array of neoplastic and non-neoplastic pathologies, often presenting with nonspecific neurological symptoms. While conventional magnetic resonance imaging (MRI) offers excellent anatomical detail, it frequently lacks the specificity needed to distinguish between lesion types. Magnetic Resonance Spectroscopy (MRS) provides complementary metabolic data, which may enhance diagnostic confidence and reduce reliance on invasive procedures. This study evaluates the diagnostic utility of combining conventional MRI with MRS in characterizing ICSOLs. Materials and Methods: A prospective, cross-sectional observational study was conducted at the Department of Radiodiagnosis, Heritage Institute of Medical Sciences, from November 2022 to May 2024. A total of 107 patients with suspected ICSOLs underwent MRI and MRS using a 3.0 Tesla scanner. Imaging protocols included standard anatomical sequences along with single-voxel and multi-voxel proton MRS. Spectroscopic analysis assessed key metabolites—choline (Cho), N-acetylaspartate (NAA), creatine (Cr), lactate, and lipids. Lesion characterization was performed based on morphology, location, enhancement patterns, and metabolite ratios. Final diagnoses were confirmed via histopathology or clinical follow-up. Statistical analysis included calculation of sensitivity, specificity, and diagnostic accuracy. Results: Among the 107 patients, neoplastic lesions were more prevalent (74.76%), with glioblastoma multiforme (GBM) being the most common (16.82%), followed by meningioma (14.02%) and metastasis (13.08%). Non-neoplastic lesions included tuberculomas (9.35%), pyogenic abscesses (6.54%), and neurocysticercosis (4.67%). MR Spectroscopy revealed characteristic metabolic profiles for different lesion types—elevated Cho/Cr and Cho/NAA ratios in high-grade tumors, alanine peaks in meningiomas, and dominant lipid-lactate peaks in infective lesions. MRI alone had a diagnostic accuracy of 83.18%, which improved significantly to 94.39% when combined with MRS. Sensitivity and specificity also increased from 86.15% and 77.78% (MRI alone) to 96.92% and 88.89%, respectively, with MRS. Conclusion: The integration of MRS with conventional MRI significantly enhances the diagnostic accuracy in evaluating ICSOLs, offering reliable differentiation between neoplastic and non-neoplastic lesions, as well as between benign and malignant tumors. This non-invasive approach provides valuable metabolic insights, improves preoperative planning, and reduces the need for stereotactic biopsy in selected cases. Routine implementation of MRS is recommended in comprehensive neuroimaging protocols, particularly in diagnostic dilemmas

Background: Tension band wiring still worldwide used management for transverse patella fracture or reconstructable comminuted patella fractures. However, it is associated with large number of implant related complications like wire breakage, loosening, nonunion and extension lag. The present study focuses on modified TBW technique using double cerclage wires intertwined with each other and passed in figure-of-eight loop. It had shown improved outcomes and fewer implant related complications. Methods: This prospective study was conducted at a tertiary care centre on 35 patients aged >18 years with two part or constructable communited transverse patella fractures. Diagnosis made using plain radiographs. Fracture was classified using descriptive classification, treated by standard AO technique of TBW using double cerclage wire intertwined with each other. The functional outcomes were assessed using Reich and Rosenberg Scale and radiological outcomes were assessed using serial radiographs at follow up. Results:  Age of patients ranged from 18-70years with mean age of 40.6 years. Out of 35 patients with male predominance. Right knee was involved in 23 cases. About 28 cases attained fracture due to indirect trauma.The  average union time was 12.74 weeks. All of patients showed excellent or good results according to Reich and Rosenberg scale.There were no complications in any of patients up to 24 week follow up reagarding fixation & no implant failure. Conclusion: MTBW had found to be a robust fixation in our study with no implant related complications. It is cost effective & shows excellent clinical and radiological outcomes.The study provides impetuous to advocate for its continued use and broader adoption in orthopaedic practice.

Congenital heart disease accounts for nearly one-third of all congenital birth defects and, therefore, the focus on congenital heart disease is integral to eliminating preventable child deaths and NCDs in the SDG era. Nine-tenths of the world's children born with congenital heart disease live in locations with little to no care and where mortality remains high. After informed consent thorough history and clinical examination of infants done. ECG & X-ray was taken, NADAS criteria applied. In those whom NADAS criteria was suggestive of CHD, submitted for 2D ECHO. Based on 2D echo results, pattern of CHD was noted down in different age group of infants, and also pattern among normal and dysmorphic children compared. Analysis was done using appropriate statistical tests. In our study, complex CHDs ASD+PDA, were more commonly seen in dysmorphic infants compared to phenotypically normal infants, which is statistically highly significant (p value, 0.001). There was not much difference between phenotypically normal and dysmorphic infants with respect to ASD, VSD, PDA, TOF, TAPVC. In our study, Complex CHDs seen are scimitar syndrome, common atrium with severe PAH with bilateral SVC, common ventricle, hypoplastic left heart syndrome.

As a common congenital anomaly, CHD not only contributes to a significant morbidity and mortality but also causes a tremendous psychological stress and economical burden to the whole family. However, if the problems are recognized at earlier age, the chance of long term complications are less and the outcome is better. As a result of improved medical and surgical management, more children with CHD are surviving into adolescence and adulthood. After informed consent thorough history and clinical examination of infants done. ECG & X-ray was taken, NADAS criteria applied. In those whom NADAS criteria was suggestive of CHD, submitted for 2D ECHO. In our study, in ≤28 days age group hurried breathing is most common presenting symptom seen in 48(88.9%), followed by cyanosis seen in 34 (18.5%), and forehead sweating seen in 6(11.1%). Cyanosis disappeared after treatment in 51 (62.9%) cases suggesting respiratory cause and cyanosis persisted in 30 cases (37%). In 29 days -6 months age group, hurried breathing is most common symptom, seen in 41(78.8%), followed by cough seen in 36 (69.3%) and cyanosis seen in 28 (28.8%) In 7-12 months age group, hurried breathing seen in 36 (81.8%), cough seen in 33 (75.0%) and fever seen in 26 (59.1%).

Introduction: Timely identification of reversible causes is crucial for improving outcomes in cardiac arrest. Standard Advanced Cardiac Life Support (ACLS) assessment relies on clinical and biochemical evaluation, whereas Point-of-Care Ultrasound (POCUS) provides rapid bedside imaging. This study compared POCUS with standard ACLS in detecting reversible causes during cardiac arrest. Methods: A prospective, comparative, cross-sectional study was conducted over 18 months in the emergency department of a tertiary care hospital. Eighty adult patients with cardiac arrest were randomized into two groups: Group A (ACLS only, n=40) and Group B (ACLS + POCUS, n=40). Diagnostic yield, accuracy, time to identification, interventions, and outcomes were analyzed. Results: POCUS identified reversible causes in 72.5% of cases versus 42.5% with ACLS (p=0.0044). Sensitivity and overall accuracy were higher with POCUS (87.5% and 82.5%) than ACLS (56.5% and 62.5%) (p=0.0121 and 0.0398, respectively). POCUS reduced mean time to cause identification (3.9 vs. 6.6 minutes, p<0.0001) and intervention (5.2 vs. 8.3 minutes, p<0.0001). It also prompted more management changes (67.5% vs. 37.5%, p=0.0049) and facilitated critical procedures (32.5% vs. 12.5%, p=0.0274). While ROSC (57.5% vs. 37.5%) and survival to admission (47.5% vs. 27.5%) favored POCUS, survival to discharge did not differ significantly. Conclusion: POCUS enhances diagnostic accuracy, accelerates decision-making, and increases identification of reversible causes compared to ACLS alone. Its integration into resuscitation protocols represents a valuable adjunct, though outcomes beyond survival to discharge remain inconclusive.

Background: Acute pulmonary embolism (PE) is a leading cause of cardiovascular mortality, where rapid and accurate risk stratification is paramount for guiding therapeutic strategies. Computed Tomography Pulmonary Angiography (CTPA) is the diagnostic gold standard, with an expanding role in providing immediate prognostic data through quantitative markers like the right ventricular to left ventricular (RV/LV) diameter ratio and the Qanadli obstruction index. This study evaluates the diagnostic and prognostic utility of these CTPA-derived markers and their implications for selecting patients for advanced therapies. Methods: In this prospective, observational study, 70 consecutive patients with clinically suspected PE underwent 128-slice CTPA at a tertiary care hospital. Key quantitative parameters, including the RV/LV diameter ratio and the Qanadli obstruction index, were systematically measured and analyzed alongside clinical and laboratory data. Multivariate logistic regression was performed to identify independent CT-based predictors for the presence of PE. Results: PE was confirmed in 40 of the 70 patients (57.1%). The mean RV/LV ratio was significantly higher in patients with PE compared to those without (1.06±0.2 vs. 0.86±0.10, p<0.001). A strong, statistically significant positive correlation was observed between the Qanadli index and the RV/LV ratio (r=0.505, p=0.008), quantitatively linking anatomical clot burden to its hemodynamic consequence. Multivariate logistic regression identified both an increased RV/LV ratio (Odds Ratio = 1.238, p=0.001) and an elevated Qanadli index (OR = 1.412, p=0.005) as significant independent predictors for the presence of PE. Conclusion: Quantitative CTPA provides indispensable prognostic information at the point of diagnosis. The anatomical clot burden (Qanadli index) and its direct hemodynamic consequence (RV/LV ratio) are robust, easily derivable metrics that are critical for immediate risk stratification. These findings serve as a crucial bridge to modern therapeutic decision-making, helping to identify high-risk and intermediate-risk patients who may benefit from advanced interventions delivered by interventional radiology and guiding multidisciplinary Pulmonary Embolism Response Teams (PERTs).

Introduction Accurate estimation of a child’s weight is the critical first step in the management of pediatric emergencies, because most pediatric drug dosing and equipment sizes are determined using body weight. Given the impracticality of weighing children during emergencies, weights are often estimated. The Broselow Tape was developed using height/weight correlations from Western data. This validated tape estimates weight of the supine child based on length. The tape has a series of colour coded zones (boxes) with details of all necessary doses and sizes for emergency interventions. Materials And Methods This is a Descriptive study was conducted in the Department of Paediatrics, Mallareddy institute of Medical sciences, Hyderabad from September 2023 to August 2024. Children aged 1 month to 12 years attending pediatric OPD and admitted in pediatric ward for minor illness. After obtaining informed consent from parent/guardian, various patient demographic characteristics, history, clinical details, was entered in a pre- structured proforma. The weight was measured by using a digitalized weighing scale to the nearest 0.1kg. Prior to measurement, weighing machine was caliberated as per the manual and after making sure the read displayed ‘0’ the footwear and heavy clothing was removed and weight was recorded. Results The first group, 1-6 months, consists of 90 individuals, making up 17.6% of the total population. The second group, 7-12 months, includes 73 individuals, accounting for 14.3%. Males constitute 251 of the participants, accounting for 49.2% of the total population. Females make up the remaining 259 participants i.e, 50.8%. The distribution is as follows: Grey: 40 individuals (7.8%), Pink: 68 individuals (13.3%), Red: 50 individuals (9.8%), Purple: 3 individuals (0.6%), Yellow: 47 individuals (9.2%), White: 74 individuals (14.5%), Blue: 18 individuals (3.5%), Orange: 151 individuals (29.6%), Green: 59 individuals (11.6%). The largest group is coded Orange, representing 29.6% of the population, indicating that a significant portion of the children fall into this category. The smallest group is Purple, with only 3 participants (0.6%). Conclusion Though the overall precision of broselow pediatric tape was statistically significant, more accuracy was seen in lower weight corresponding colour zones. It showed a mean difference of around 10% in children above 18kgs.

Introduction: Meconium-stained amniotic fluid (MSAF) is a common obstetric complication associated with increased risk of adverse perinatal outcomes, including meconium aspiration syndrome (MAS), low Apgar scores, neonatal intensive care unit (NICU) admissions, and perinatal morbidity and mortality. The incidence of MSAF increases with gestational age, but it may also occur in preterm pregnancies. Understanding its impact across term, preterm, and postterm pregnancies is essential for timely obstetric interventions. Aims: To evaluate the perinatal outcomes of MSAF in term, preterm, and postterm pregnancies and to determine the association of MSAF with mode of delivery, MAS, Apgar scores, and neonatal morbidity. Materials and Methods: This was a prospective, comparative study conducted over one year, from 1st December 2019 to 30th November 2020, in the Department of Obstetrics and Gynecology at MR Bangur Hospital, Tollygunge, and Kolkata, which serves both rural and urban populations of South 24 Parganas district. The study included 108 booked antenatal cases attending the hospital’s antenatal clinic, enrolled according to predefined inclusion and exclusion criteria. Results: In our study, there was no statistically significant difference between cases and controls in terms of maternal age and gravidity (p = 0.546 and p = 0.841, respectively). However, birth weight and fetal heart rate showed significant differences between the two groups. A higher proportion of cases had birth weight <2 kg compared to controls (20.4% vs. 3.7%, p = 0.015). Similarly, fetal heart rate distribution differed significantly, with more cases having heart rate >120/min and fewer cases with heart rate <100/min compared to controls (p = 0.023). Conclusion: MSAF is associated with adverse perinatal outcomes, particularly in postterm pregnancies. Close fetal monitoring, timely obstetric intervention, and preparedness for neonatal resuscitation are crucial to improve neonatal outcomes. Early recognition and management of MSAF can reduce the risk of MAS and other complications

Background: Type 2 diabetes mellitus (T2DM) requires effective glycemic control to prevent complications. Combining agents with complementary mechanisms may improve outcomes. Objective: To evaluate the safety and efficacy of the repaglinide plus voglibose combination in T2DM patients over one year. Methods: A prospective study was conducted involving 180 T2DM patients receiving repaglinide plus voglibose. Glycemic parameters, including fasting blood glucose (FBG), postprandial blood glucose (PPBG), and HbA1c, were measured at baseline and after 12 months. Safety was assessed by monitoring adverse events and hypoglycemic episodes. Results: Significant reductions were observed in mean FBG (156.8 ± 28.5 to 120.5 ± 22.3 mg/dL), PPBG (240.3 ± 35.7 to 170.7 ± 28.1 mg/dL), and HbA1c (8.2 ± 0.7 to 6.9 ± 0.6%) after 12 months (p < 0.001 for all). The combination was well tolerated, with mild hypoglycemia reported in 6.7% of patients and mild gastrointestinal side effects. Conclusion: Repaglinide plus voglibose combination therapy is effective and safe for improving glycemic control in T2DM patients, offering a viable option for optimizing diabetes management.

Background: Prolonged sitting is linked to adverse metabolic outcomes, including elevated postprandial glucose and insulin levels. Interrupting sitting time with physical activity may improve these parameters, but the comparative effectiveness of different interruption strategies remains unclear. Objective: To evaluate and rank the effects of various sitting interruption interventions on postprandial glycemia and insulin responses through a network meta-analysis. Methods: A systematic review and network meta-analysis of randomized controlled trials involving fewer than 200 participants over one year was conducted. Interventions included standing breaks, light walking, and moderate walking. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated for postprandial glucose and insulin outcomes. Results: Moderate walking interruptions significantly reduced postprandial glucose (SMD = -1.00; 95% CI: -1.30 to -0.70) and insulin levels (SMD = -0.85; 95% CI: -1.10 to -0.60) compared to uninterrupted sitting. Light walking and standing breaks also showed beneficial effects but to a lesser extent. Ranking analysis indicated moderate walking as the most effective intervention. Conclusion: Interrupting prolonged sitting, particularly with moderate walking breaks, effectively improves postprandial metabolic responses. These findings support incorporating movement breaks in sedentary routines to reduce cardiometabolic risk.

Background: Coracoacromial ligament is a triangular band that extends between the acromion and coracoid process and altogether they form arch above humeral head protecting during abduction. It is also vital for gleno-humeral stability. It can be seen as thick anterolateral bundle and a posteromedial bundle having triangular base and often seen with anatomical variations as straight, quadrangular, or Y-shaped. Coracoacromial ligament release for managing shoulder impingement syndrome is advocated in surgeries.  Aim: The present study was aimed to study various types of coracoacromial ligaments in Indian cadavers and their role in shoulder joint biomechanics and surgical significance.   Methods: The study assessed 80 upper limbs that were procured from the cadavers of Medical colleges of Hyderabad and Bangalore that had intact shoulder joints. The cadavers were embalmed using 10% formalin. Dissection was then done, skin was reflected and deltoid was exposed. For further dissection, middle and anterior fibers of deltoid muscle were cut. Superior surface of coracoid process and acromian process were exposed for visualization of coracoacromial ligament. Results: The study results showed that upper limbs were dissected meticulously in the study subjects to assess various shapes of coracoacromial ligament. Types of coracoacromial ligaments seen in the cadavers were tripartite, bipartite, Y-shaped, rectangular, and trapezoid forms. Conclusion: The present study concludes that advancements in understanding of coracoacromial ligament via research outcomes can help in contributing to higher intraoperative decision making for the surgeons performing arthroscopic surgeries.

Background: Acute stroke, previously known as a cerebrovascular accident (CVA), is a critical medical emergency characterised by the sudden onset of acute neurological deficits in a specific vascular area, resulting from underlying cerebrovascular conditions. Objective: to evaluate serum C-reactive protein (CRP) as a short- term prognostic indicator in individuals with acute ischaemic stroke Methods: This single-center prospective study was carried out among 100 Patients attending Department of Medicine OPD, Governement General Hospital, Srikakulam. Duration of study was 18 Months (June 2023- December 2024). Result: One hundred individuals were assessed based on clinical, biochemical, and neurological criteria. CRP levels were significantly elevated in people with poor neurological outcomes, as evaluated by the Glasgow Coma Scale. Furthermore, elevated CRP levels correlated with unfavourable lipid profiles (increased TC, reduced HDL, and elevated TC/HDL ratio), hence reinforcing its use as a prognostic indicator.  Conclusion: It is concluded that the use of CRP as a simple, accessible biomarker for evaluating the short-term prognosis of ischaemic stroke patients.

Background: Acute kidney injury (AKI) is also known as acute renal failure. Globally, AKI were estimated to be 13.3 million cases reported annually in low-income countries, while co-infections are common among AKI patients ^[1]. The death related to AKI increases to 3-6-fold compared to patients without AKI, Objective: to identify the etiological factors of AKI and assess their outcomes. Methods: This hospital based Cross sectional Study was conducted among 150 Patients with Acute Kidney Injury at Government General Hospital, Srikakulam. Duration of Study was June 2023 - December 2024. Ethical approval for the study was secured from the Institutional Ethics Committee of GMC Srikakulam. Result: The most commonly involved age groups are 26-35 and 46-55. The most common clinical presentation is fever and oliguria. The most common etiology in our study is sepsis, followed by poisoning and snake bite. The patients are categorized based on AKIN criteria and classified into three stages. All the patients in AKIN stage 1 recovered with conservative management. All the patients in AKIN stage 2 recovered, although 10.8% required dialysis.89.2% of AKIN stage 2 patients recovered with conservative management. In AKIN stage 3, 81.6% of patients were treated with dialysis, while 18.4% of patients recovered with conservative management. Conclusion: In present study, 42 patients (42.85 %) died, all of them were in the third stage of AKIN. In this study, out of 42 patients, 22 patients died due to poisoning. Poisoning was the predominant cause of mortality, succeeded by sepsis.

Introduction: Venous thromboembolism (VTE), encompassing both deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant postoperative complication in patients undergoing major oncologic surgeries, particularly those involving microvascular free flap reconstruction. Head and neck cancer patients are considered at elevated risk due to prolonged operative times, malignancy-associated hypercoagulability, and perioperative immobilization. However, the incidence of VTE in this specific surgical subset within the Indian population remains underreported. Objective: To evaluate the incidence of VTE in patients undergoing free flap reconstruction for head and neck cancer in a tertiary care institution in Eastern India, and to identify potential risk factors associated with its occurrence Methods: This retrospective observational study was conducted over a period of one year, from January 2024 to January 2025, at the Department of Head & Neck Surgery, IPGMER and SSKM Hospital, Kolkata, West Bengal, India. A total of 50 patients who underwent oral oncologic surgery with simultaneous reconstruction were included in the study. Clinical, surgical, and postoperative data were collected and analyzed to evaluate the incidence and associated risk factors for venous thromboembolism (VTE) in this high-risk surgical population. Results: The comparative analysis between VTE-positive (Group 1) and VTE-negative (Group 2) patients revealed no statistically significant differences in demographic, oncologic, or surgical variables. Although Group 1 showed slightly higher mean age, BMI, and rates of comorbidities, smoking, alcohol use, and prior VTE, none of these reached statistical significance. Tumor site, TNM stage, histological type and grade, as well as prior chemotherapy or radiotherapy, were also comparable between the groups. Surgical factors—including type of free flap used, duration of surgery, intraoperative blood loss, transfusion requirement, and number of vascular anastomoses—did not differ significantly between the two groups. However, certain postoperative factors showed significant associations with VTE occurrence. The use of DVT prophylaxis was significantly lower in Group 1 (p = 0.002), and postoperative mobility was also reduced (p = 0.035). Additionally, ICU stay was significantly longer in VTE-positive patients (p = 0.029). Although postoperative complications were more frequent in Group 1 and hospital stay was longer, these differences were not statistically significant. The mean time to VTE diagnosis was 6.1 ± 3.2 days postoperatively, underscoring the importance of early monitoring. Conclusion: This institution-based study highlights a notable incidence of VTE (5.9%) in patients undergoing free flap reconstruction for head and neck cancer. The findings underscore the need for vigilant perioperative thromboprophylaxis, early mobilization, and high clinical suspicion for early detection and management of VTE in this high-risk surgical cohort. Tailoring VTE prevention protocols based on individualized risk assessment may further reduce associated morbidity.

Background: Postoperative pain management is critical for recovery, patient satisfaction, and reduction of complications. Paracetamol and tramadol are widely used analgesics with distinct efficacy and side-effect profiles. This study compared their effectiveness and tolerability in patients undergoing elective open abdominal surgery. Methods: A single-center, single-blind comparative study was conducted on 124 adult patients (62 per group) undergoing elective open abdominal surgery. Group A received intravenous paracetamol and Group B received intravenous tramadol. Pain was assessed using the Visual Analog Scale (VAS) at baseline (0 hr), 8 hr, 16 hr, and 24 hr postoperatively. Vital signs, additional analgesic requirements, side effects, patient satisfaction scores, and clinician comments were recorded. Statistical comparisons were made using chi-square tests and p-values were reported for group differences. Results: Baseline demographics (age, sex) and initial pain scores were comparable (p > 0.05). At 8, 16, and 24 hours, tramadol provided significantly lower pain scores than paracetamol (p = 0.035, 0.002, and 0.003 respectively). Fewer patients in the tramadol group required rescue analgesia (29.0% vs. 21.0%; p = 0.003). Side effects were more frequent with tramadol, particularly nausea (19 vs. 12 cases) and vomiting (6 vs. 3 cases), with overall incidence significantly higher than paracetamol (p = 0.002). Conclusion: Tramadol achieved superior short-term postoperative analgesia compared to paracetamol in elective open abdominal surgery, with higher patient satisfaction and reduced need for additional analgesia. However, tramadol was associated with more gastrointestinal side effects. Paracetamol remains a safer, better-tolerated option, especially in patients at risk for nausea or vomiting

Introduction: Efficient wound closure following Modified Radical Mastectomy (MRM) is vital to ensure optimal healing, reduce surgical site infection (SSI), and improve cosmetic outcomes. Traditionally, skin sutures have been widely used; however, skin staples are increasingly favoured for their rapid application and potential to reduce operating time. This study aims to compare the outcomes of skin staples and skin sutures in MRM closure in terms of wound complications, operative time, and patient satisfaction at AGMC and GBP Hospital. Aims and Objectives: This study aims to evaluate and compare the efficacy of skin staples versus conventional sutures for skin closure in patients undergoing Modified Radical Mastectomy (MRM). Key parameters assessed include wound-related complications such as infection, dehiscence, hematoma, and seroma; the time required for skin closure; postoperative pain levels and scar appearance; and overall patient satisfaction. By analyzing these factors, the study seeks to determine the more efficient and patient-friendly method for skin closure following MRM. Materials and Methods: This prospective comparative study was conducted on patients undergoing Modified Radical Mastectomy for breast malignancy at AGMC and GBP Hospital. Patients were randomly allocated into two groups: Group A (skin staples) and Group B (skin sutures). Closure time, postoperative pain (VAS score), wound complications, duration of hospital stay, and scar evaluation (using validated scales like the Vancouver Scar Scale) were recorded and analyzed statistically. Results: The staple group showed significantly reduced closure time compared to the suture group (p<0.05). Rates of wound complications such as infection and seroma were comparable between the two groups. Postoperative pain was marginally lower in the staple group on early postoperative days. At follow-up, cosmetic outcomes favored sutures in terms of scar appearance, but the difference was not statistically significant. Patient satisfaction was higher in the staple group due to perceived convenience and quicker procedure. Conclusion: Skin staples provide a faster method for skin closure in MRM with comparable rates of wound complications to skin sutures. While sutures may offer slightly better cosmetic outcomes, the use of staples is associated with reduced operative time and improved patient convenience. Both methods are safe and effective; choice may depend on surgeon preference, resource availability, and patient factors.

Background: Adjuvant agents are usually added to the local anesthetic agents during the use of subarachnoid block for prolongation of subarachnoid block for prolongation of both analgesic and anesthesia duration.  Aim: The present study was aimed to comparatively assess the efficacy of two different doses of 30 µg and 50 µg intrathecal clonidine as an adjuvant to the hyperbaric ropivacaine in subjects undergoing lower limb surgeries.  Methods: The present study assessed 180 subjects that were randomly divided into two groups of 90 subjects each where Group I subjects were given 3ml of 0.75% hyperbaric ropivacaine along with 30µg clonidine which was diluted with normal saline for total of 3.5mL volume. Group II subjects were given 50 µg clonidine with 3ml of 0.75% hyperbaric ropivacaine diluted with normal saline for total of 3.5mL volume. The study compared hemodynamic changes, complications, side-effects, sensory and motor blockade, and analgesia duration. Results: The study results showed that 30µg clonidine took longer time to reach highest spinal level with 12.4±1.24 minutes compared to 50µg clonidine that took 11.6±1.4 minutes with p=0.003. For two segment regression, time was significantly longer with 50µg clonidine compared to 30µg clonidine with p<0.001. Durations for motor and sensory block was also higher with 50µg clonidine compared to 30µg clonidine with p<0.001. Analgesia duration was significantly longer in 50µg clonidine group with p<0.001. Higher incidence of hypotension and bradycardia was seen with 50µg clonidine that were managed using standard interventions. Conclusion: The present study concludes that 50µg of intrathecal clonidine provides higher analgesic effects in comparison to 30µg clonidine. However, it is linked with a higher risk of hypotension and bradycardia. Timely interventions and careful watch and monitoring are vital when clonidine is used in higher dose compared to a low dose.

Background: Optimum status of the immune system is usually a result of physically active lifestyle and a good and balanced nutrition which ensure a normal BMI (body mass index) in a subject. This issue requires more focus in college going students of India as they are potential subjects for affected BMI from non-balanced nutrition resulting in inadequate BMI.   Aim: The present study was aimed to explore the influence of immune boosting foods consumption on the BMI of college going medical students. Methods: The study assessed 422 subjects that were medical college going and in the age range of 18-30 years. The subjects were assessed using a preformed structured proforma to gather data concerning anthropometric data and food frequency concerning the use of immune boosting foods including intake of turmeric, garlic, ginger, and tea. The data gathered were crucially analyzed for results formulation. Results: The study results showed that BMI in normal range of 18.5-24.9kg/m2 was seen in 62% subjects, whereas there were 3% obese and 13% overweight study subjects with BMI in the range of 25-29.9 and >30 kg/m2. WHR (waist hip ratio) was above normal in 41% females and 19% male subjects. Garlic was used thrice a week and daily in 34% and 38% subjects with BMI in normal range which was significant with p<0.05. Turmeric was used thrice a week and daily in 34% and 38% subjects with BMI in normal range 24% and 54% subjects, ginger by 40% subjects daily and 31% thrice a week with normal BMI. Statistically significant results were seen for tea, ginger, and turmeric. Conclusion: The present study concludes that regular intake of immune boosting foods by the college going subjects from India including garlic, ginger, and turmeric can have an influence on the Body mass Index (BMI) and needs consideration.

Introduction: Coronary artery bypass graft (CABG) surgery is a vital intervention for advanced coronary artery disease, but it often results in significant postoperative pain. Effective pain management is essential to improve recovery and minimize complications. Traditional opioid-based analgesia has limitations, including adverse effects and dependency risks. Regional anesthesia techniques, such as Erector Spinae Plane (ESP) and Serratus Anterior Plane (SAP) blocks, offer promising alternatives for targeted pain relief with fewer side effects. Objective: This study aimed to compare the efficacy of ESP and SAP blocks in reducing opioid consumption and enhancing recovery quality in CABG patients. Secondary objectives included evaluating adverse events and postoperative recovery outcomes. Methods: A prospective, randomized observational study was conducted on 120 CABG patients, with 58 in ESP and 62 in SAP groups. Patients received 20 ml of 0.25% bupivacaine bilaterally. Intraoperative and postoperative opioid requirements were recorded, and quality of recovery was assessed 24 hours postoperatively using the QoR-15 scale. Adverse events and hospital stay durations were also analysed. Results: The ESP block group demonstrated lower fentanyl consumption (mean: 295.8 mcg) compared to the SAP group (mean: 384.2 mcg). Adverse events were comparable, with slightly higher arrhythmias and infections in the ESP group and more delayed extubation in the SAP group. The ESP group showed higher QoR-15 scores (297 vs. 256), indicating better recovery quality than SAP. Hospital stay durations were similar, with a marginal advantage for the ESP group (6.52 vs. 6.89 days). Conclusion: Both ESP and SAP blocks effectively manage postoperative pain in CABG, with the ESP block excelling in analgesic efficacy and the SAP block promoting better recovery quality. These findings underscore the importance of individualized pain management strategies to optimize patient outcomes.

Introduction: Meconium-stained liquor (MSL) is a frequent intrapartum complication associated with increased risks of fetal distress, neonatal morbidity, and operative interventions. Intrapartum amnioinfusion has been proposed as a simple, safe, and cost-effective method to dilute meconium and alleviate cord compression, thereby improving outcomes. Aim: To evaluate the maternal and fetal outcomes of intrapartum trancervical amnioinfusion in pregnancies with meconium-stained liquor Methods: This prospective comparative study was conducted on 300 women in active labor with MSL. Participants were divided into two groups: Group A (n=150) underwent intrapartum amnioinfusion with normal saline, while Group B (n=150) received standard care without amnioinfusion. Maternal outcomes (mode of delivery, complications) and fetal outcomes (fetal distress, Apgar scores, NICU admissions, neonatal mortality) were analyzed using appropriate statistical tests. Results: Cesarean section rates were significantly lower in Group A compared with Group B (24.7% vs 51.3%, p<0.000001). Fetal distress was reduced (32.0% vs 56.7%, p<0.00001), and neonates in the amnioinfusion group had better Apgar scores at 1 minute (28.0% vs 42.7%, p=0.0072) and 5 minutes (4.0% vs 12.0%, p=0.0098). NICU admissions were fewer in Group A (32.0% vs 54.7%, p=0.000047). Neonatal mortality was lower in the amnioinfusion group (0.7% vs 2.0%), though not statistically significant (p=0.62). Maternal complications were minimal and included uterine hyperstimulation (2.7%) and chorioamnionitis (2.0%). Conclusion: Intrapartum amnioinfusion significantly improves maternal and neonatal outcomes in cases of meconium-stained liquor by reducing cesarean deliveries, fetal distress, and NICU admissions with minimal maternal risk. It should be considered a valuable intervention, particularly in resource-constrained settings

Objective: This study aimed to evaluate left ventricular (LV) systolic function in heart failure patients by assessing the correlation between Mitral Annular Plane Systolic Excursion normalized to LV length (MAPSE/L) and Global Longitudinal Strain (GLS). The hypothesis proposed that MAPSE/L could serve as a practical and reliable echocardiographic parameter for LV function assessment. Methods: A prospective observational study was conducted on 42 adult patients with LV dysfunction admitted to the Cardiac ICU, Emergency Room, or Cardiac OPD. Echocardiographic measurements included MAPSE, LV diastolic length, ejection fraction (EF), and GLS. MAPSE/L was calculated by dividing MAPSE by LV length. Pearson correlation analysis was performed using SPSS 26.0 to examine the relationship between MAPSE/L and GLS. Results: The study population comprised predominantly males (83.3%), with a majority aged 51–60 years (42.9%). LV dysfunction severity was distributed as mild (40.5%), moderate (38.1%), and severe (21.4%). MAPSE/L demonstrated a strong correlation with GLS (correlation coefficient: 0.778, p < 0.001). Similarly, MAPSE alone showed a strong correlation with GLS (correlation coefficient: 0.80, p < 0.001). The average MAPSE/L value was 0.13 ± 0.03, with variations observed across different MAPSE ranges. EF also correlated well with GLS (correlation coefficient: 0.70, p < 0.001). Conclusion: The findings indicate a robust correlation between MAPSE/L and GLS, suggesting that MAPSE/L is a viable and straightforward parameter for assessing LV longitudinal systolic function in heart failure patients. Despite advancements in echocardiographic technologies, MAPSE/L remains a valuable tool for routine clinical evaluation due to its simplicity and reliability

Introduction: Inherited cardiomyopathies are a diverse group of myocardial disorders that primarily affect the structure and function of the heart muscle. These include hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmogenic cardiomyopathy (ACM), and restrictive cardiomyopathy (RCM), which often result from mutations in genes encoding sarcomeric, cytoskeletal, desmosomal, or mitochondrial proteins.  Aims: The primary aim of this review is to explore the current role and clinical relevance of genetic testing in inherited cardiomyopathies. It seeks to assess how genetic insights contribute to diagnosis, influence clinical management, and improve familial risk assessment, while also addressing the limitations and ethical concerns surrounding genetic testing in this context. Objectives: This review aims to evaluate the current role and clinical relevance of genetic testing in inherited cardiomyopathies. It highlights the diagnostic benefits, implications for patient care, family cascade screening, reproductive counseling, and the integration of genetic information into personalized medicine approaches. Methods: An extensive literature review was conducted using PubMed, Scopus, and relevant clinical guidelines from the American Heart Association (AHA), European Society of Cardiology (ESC), and Heart Rhythm Society (HRS). Emphasis was placed on studies addressing the diagnostic yield, clinical impact, and ethical considerations of genetic testing in cardiomyopathy patients. Results: In this study of 100 patients with inherited cardiomyopathies, the average age was 42.6 years, with a slight male predominance. A positive family history was present in 37% of patients, strongly associated with mutation detection (p = 0.001). Hypertrophic cardiomyopathy (HCM) was the most common subtype (40%), and had the highest mutation rate (70%, p = 0.002), mainly involving MYH7 and MYBPC3 genes. At 12-month follow-up, ICD implantation was significantly higher in mutation-positive patients (p = 0.045), while sudden cardiac death and heart failure hospitalizations were not significantly different. Conclusion: Genetic testing plays a pivotal role in the modern evaluation and management of inherited cardiomyopathies. It enables precision diagnostics, improves family risk assessment, and facilitates early interventions. To maximize its clinical utility, integration of genetic testing into cardiology practice requires a multidisciplinary approach involving genetic counselors, cardiologists, and molecular pathologists. Future research into genotype-phenotype correlations and long-term outcome studies is essential to further personalize care and expand our understanding of these complex disorders.

Leprosy as medical malady presents with different clinical spectra from tuberculoid to lepromatous profile in typical presentations. However, sometimes leprosy can be considered as a dissimulated disease, mainly when presented as atypical cases leading to mistaken diagnosis and causing dilemma for clinicians. In this case series our objective was to report case series of six patients who came to mycobacteriology laboratory for slit skin smear with partial diagnosis of acute myocardial infarction and arterial and venous thrombosis and with chronic neurological symptoms; the sixth patient was referred with a suspicion of infected skin ulcer. Positive findings in these patients included hypo-aesthetic patches, claw hand, madarosis and ulcers.Unfortunately, in many patients, leprosy was often misdiagnosed as other medical conditions like sarcoidosis, syphilis and other dermato-neurological conditions for long periods, thus delaying initiation of specific treatment. This current case series is intended to increase physicians’ awareness to recognize unusual and atypical leprosy cases which are presented as unusual forms, so that these can be timely diagnosed, promptly treated and sequelae or debilitation can be prevented

This single blind randomized controlled trial was undertaken to compare the effectiveness of infusion Phenylephrine and infusion Norepinephrine in elective caesarean section in maintaining maternal haemodynamics and its effects on new born. 80 pregnant patients of 36 weeks or more gestational period, aged 18-40 years, ASA I and II, selected for elective caesarian delivery were divided into two equal groups. Group N (N=40) received norepinephrine 6 ug/ml/hr infusion and Group P (N=40) received phenylephrine 100 ug/ml/hr infusion immediately before injection of spinal anaesthesia medication. A standardized spinal anaesthesia consisting of hyperbaric (0.5%) bupivacaine 10-12 mg and fentanyl 20 mcg was administered by a 25-gauge spinal needle (Quinckes needle) in sitting position at L2-L3 or L3-L4 intervertebral space in both groups.  Documentation of SBP, DBP, MAP, HR was done in a regular interval. After delivery of the baby, 10u oxytocin was given slow iv and umbilical cord was collected and sent for ABG analysis at 0 and 5 minutes along with APGAR score recording. Hemodynamics and any side effects if present were observed for 4 hrs. There is a significant statistical improvement not only in the maternal PR, SBP, DBP and MBP taken over time but also the pH, Hco3 and lactate readings taken at 0 and 5 mins of the new born babies in the Group N compared to the Group P. To conclude, norepinephrine effectively prevents maternal hypotension and improves fetal acidosis in comparison to phenylephrine in elective caesarean section under spinal anaesthesia.

Introduction: Every year more than 10 million people are affected by traumatic brain injuries (TBIs). Despite efforts being made to improve TBI care, it remains a public health problem, continuing to cause high mortality and morbidity in a young population. Aims: To determine the Incidenceof TBI following RTAs in the rural population served by PCS Govt Medical College and Hospital.To identify the causes and risk factors associated with TBI following RTAs in the rural population.To assess the outcomes of TBI following RTAs in terms of mortality, morbidity, and disability. Materials & methods: This is a prospective observational study study place PCS Govt Medical College & Hospital, Arambagh, Hooghly, West Bengal. The study was conducted over a period of one year, from 1st August to 31st July. And total number of patient was 216. Result: In our study of 216 TBI patients, two-wheeler accidents were the leading cause (50.0%), followed by four-wheelers (22.2%), pedestrian hits (16.7%), and others like falls or animal hits (11.1%). The mean age was 36.9 years, patient of two-wheeler group are younger than the four wheeler group showing a significant age variation (p = 0.002). Most patients were male (75.0%), with no significant gender distribution difference across injury mechanisms (p = 0.981). Conclusion: We concluded that this study shows that one of the major public health concerns in rural areas is traumatic brain injury (TBI) after road traffic accidents (RTAs). The most common cause, which primarily affected younger boys, was two-wheeler accidents. The most common presentation was mild TBI, although four-wheeler and pedestrian collisions were more likely to result in severe TBI and negative outcomes such neurological impairments and death

Background: Hypothyroidism is common and influences the heart and vessels by altering myocardial performance, systemic vascular tone, and lipid handling. Cardiovascular abnormalities, if undetected, may predispose patients to long-term morbidity, though many are reversible with timely thyroid hormone therapy. Objectives: To evaluate the spectrum of cardiovascular manifestations in hypothyroid patients and to assess the associations of thyroid dysfunction with clinical, biochemical, and echocardiographic parameters. Methods: A hospital-based cross-sectional study was conducted over one year at the Department of General Medicine, Sri Venkateswara Medical College, Tirupati. Ninety adult hypothyroid patients (≥18 years) were enrolled. Clinical examination, ECG, echocardiography, and biochemical tests including thyroid profile and lipid parameters were performed. Data were analyzed using SPSS v25, with Mann–Whitney U test, Kruskal–Walli’s test, correlation, and regression analysis applied where appropriate. Results: The study population was predominantly female (93.3%), with a mean age of 31.3 years. Most participants had normal ECG (96.7%) and echocardiography (88.9%) findings, though a minority showed sinus tachycardia (3.3%), dilated cardiomyopathy (3.3%), concentric LVH (2.2%), and moderate aortic stenosis (3.3%). Dyslipidemia was common, with wide variation in triglycerides (mean 161.8 ± 89.7 mg/dl). Significant sex-based differences were observed in systolic BP, PPBS, T3, T4, LDL, creatinine, and calcium. Age group analysis revealed significant variation in PPBS, TSH, HDL, LDL, and calcium. Correlation analysis showed strong associations between age, thyroid profile, glucose, and lipid parameters. Regression analysis identified age as an independent predictor of total cholesterol (p=0.001), while thyroid hormone levels were not. Conclusion: Hypothyroidism is associated with subtle but clinically relevant cardiovascular manifestations, including dyslipidemia, metabolic disturbances, and occasional structural heart abnormalities. Female predominance was reaffirmed, and age emerged as an independent predictor of cholesterol levels. These findings highlight the importance of routine cardiovascular evaluation in hypothyroid patients for early detection and prevention of long-term complications.

Background: TEM (Transanal Endoscopic Microsurgery) refers to en-bloc removal of polyps from the rectum. Complications and recurrence rates vary among subjects, and the appropriate surveillance program is not well-defined. Aim: The present study aimed to assess the complications and recurrence following polyp removal to assess the efficacy of transanal endoscopic surgery.  Methods: The present study assessed 224 subjects who underwent TEM at the Institute within the defined study period for spectroscopic microsurgical excision of pathological tissue in the rectum. For all the subjects, data were gathered retrospectively from previous records, and outcomes assessed were histopathological recurrence assessed at early check-up of 5 months following TEM, and complications were identified as early when they were seen within 30 days postoperative and late when seen after 30 days of surgery. Results: During the study period 224 subjects underwent TEM where 194 subjects attended early check up after a mean of 126 days. In 7.2% (n=14) subjects, recurrence was seen, however, no recurrence was cancer. Among these 14 subjects, 12 had free resection margins. In two subjects, TEM resection was done again and 14 subjects were endoscopically managed. In 27% (n=60) subjects, complications were encountered where there were 44 early complications including postoperative bleeding, urinary retention, and primary bowel incontinence. In 16 subjects, late complications were seen as primarily flatus or fecal incontinence. Conclusion: The present study concludes that TEM is an efficacious and secure method for removing rectum polyps, concerning both complications and recurrence rates. A low recurrence rate and fewer complications are seen following TEM for polyp removal. It demands an early checkup irrespective of the status of the resected margins. Also, TEM quality is ensured by no recurrence cases of cancer

Introduction: Accurate measurement of biochemical serum analytes is essential for diagnostic precision and research validity. Pre-analytical factors such as storage temperature and duration play a pivotal role in analyte stability, potentially leading to misleading results if not standardized. Aim: To evaluate the effect of different storage temperatures (−20°C, 4°C, 25°C) and durations (24h–1 week) on the stability of selected biochemical serum analytes in healthy adults. Methods: A prospective experimental study was conducted on 100 healthy adults. Serum samples were analyzed for urea, creatinine, AST, ALT, total protein, albumin, sodium, and potassium. Baseline values were established immediately after collection. Samples were stored at −20°C, 4°C, and 25°C and reassessed at 24h, 48h, 72h, and 1 week. Analyte stability was determined using standard biochemical methods, and statistical analysis was performed using paired t-test and ANOVA. Results: Urea and creatinine showed consistent stability under refrigerated and frozen conditions but declined slightly at room temperature. AST and ALT demonstrated significant enzymatic degradation, particularly at 25°C by 72h. Total protein and albumin were moderately affected by room temperature, while sodium and potassium showed variability due to hemolysis and evaporation. Freezing preserved analytes most effectively, followed by refrigeration, while room temperature storage led to notable deterioration over time. Conclusion: Storage temperature and duration critically influence serum analyte stability. Freezing is the most reliable method for long-term preservation, while refrigeration is suitable for short-term storage. Standardized storage protocols are essential to ensure diagnostic accuracy and maintain research integrity.

Introduction: Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly and may be a component of complex cardiac pathologies. While it is often asymptomatic, it can lead to significant problems such as arrhythmias and cyanosis in conditions associated with various congenital heart anomalies. The aim of this study was to assess the prevalence of persistent left superior vena cava (PLSVC) in patients with all types of congenital heart defects and to determine the association with congenital heart anomalies accompanying PLSVC. Methodology: The present study is based on a retrospective review of 33 children who were found to have Persistent Left Superior Vena Cava, diagnosed on the basis of 2D echocardiography reports and history of the patients. Study was conducted under the variables: type of CHD, Age, Gender, Birth weight, Height/Length, SpO2 levels, physical examination findings, auscultatory findings, mother’s age at conception, gestational age of the child and parental consanguinity. Adequate resources were used to compare and correlate this study with previously performed ones in the most recent years. Medical records were used to access the history of the patients regarding physical and systemic examination. Results: The most common associations found were patent ductus arteriosus, ventricular septal defects, atrial septal defects and other congenital anomalies. The male to female ratio was almost 1:1, inkling slightly towards one gender in some cases. Children with PLSVC were found to born prematurely and had low birth weight. The SpO2 levels in a few cases were low and the child required oxygen support for the same. Physical and Auscultatory findings varied with the associated CHD in the patient. There is no direct relation between parental consanguinity and PLSVC observed in this research. Conclusion: The results of this study suggest that there is an increased incidence of PLSVC in cases associated with congenital heart diseases and the physical as well as auscultatory findings vary with the associated CHD. These associated conditions may lead to mild to severe symptoms in a child suffering from the same. Hence, early diagnosis and treatment of the condition is of utmost importance to eliminate risk factors such a condition could pose in the future

The evolution of cardiovascular pharmacotherapy and interventional strategies has significantly shaped patient outcomes over the past two decades. This review synthesizes evidence from pivotal clinical trials assessing statins, drug-eluting stents (DES), bare-metal stents (BMS), and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i). Early trials demonstrated the mortality benefit of statin therapy, while subsequent investigations highlighted mixed outcomes with DES compared to BMS. Large-scale randomized controlled trials, reinforced the role of statins in reducing major adverse cardiovascular events. More recent studies provided robust evidence for PCSK9 inhibitors in reducing cardiovascular risk and mortality. Risk of bias assessments revealed overall moderate-to-low bias across included studies, strengthening the validity of findings. Further analysis confirmed consistent benefits of lipid-lowering therapies, particularly statins and PCSK9 inhibitors, while outcomes with DES versus BMS remained variable. This review underscores the progressive advancement in cardiovascular therapeutics and emphasizes the importance of evidence-based decision-making in clinical practice.

Background: Abnormal uterine bleeding (AUB) has a variety of histopathological patterns, and pathologists report endometrial biopsies and help distinguish non-neoplastic from neoplastic lesions, detect precursor lesions, and rule out malignancy. Aim- This study will examine endometrial patterns in women with AUB and connect them with age.  Materials and Methods:110 endometrial biopsies with AUB from the gynaecology department were processed, stained with haematoxylin & eosin, and histopathologically examined.  Results: The 41-50 age group has the highest incidence.  Most histomorphological patterns are disorganised proliferative.  20 instances (18.20%) indicate endometrial hyperplasia, 8 of which are atypia and 12 of which are non-atypical; 5 cases of endometrial carcinoma were documented, most of which were postmenopausal. Premenopausal and postmenopausal women had pill endometrium, and 8 women had atrophic endometrium, mostly in the postmenopausal age group. Conclusion: AUB causes anaemia and lowers women's quality of life.  Thus, histological investigation is essential for early endometrial disease diagnosis and gynaecological therapy

Background: The supratrochlear foramen (STF) is an anatomical variation at the distal humerus, formed by perforation of the septum between the olecranon and coronoid fossae. Though often overlooked, it has clinical relevance as it may complicate intramedullary nailing and mimic pathological lesions on radiographs. This study evaluates the prevalence, shape, and dimensions of STF in the population of Bihar, underscoring its surgical and diagnostic importance. Materials And Methods: A cross-sectional study was carried out on 100 adult dry humeri (50 right and 50 left) of unknown age and gender, in the Department of Anatomy, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Bihar. The presence and shape of the supratrochlear foramen (classified as oval, round, or irregular) were documented. Transverse and vertical diameters were measured twice using a digital vernier caliper with 0.01 mm accuracy, and the mean values were used for analysis. Statistical evaluation was performed using SPSS, version 25.0, with a p-value < 0.05 considered significant. Results: Out of 100 humeri examined, the supratrochlear foramen (STF) was present in 31% of specimens, with a slightly higher incidence on the left side, though not statistically significant (p = 0.279). Three morphological types were noted: round (51.6%), oval (35.5%), and irregular (12.9%), with no significant side variation (p = 0.864). The mean transverse diameter was significantly larger on the right side (4.88 ± 1.18 mm) than the left (3.41 ± 1.00 mm, p < 0.0001), whereas the vertical diameter showed no significant difference between sides (p = 0.700). Conclusion:  The supratrochlear foramen (STF), though often underrecognized, has important clinical implications in orthopaedic and radiological practice and holds value for anatomical and anthropological research.

Background: Thalidomide, an immunomodulatory agent used in hematologic malignancies, is known to increase thrombotic risk. Arterial thrombosis, including acute myocardial infarction (AMI), is a rare but potentially life-threatening complication. Case presentation: We describe a case of a 49-year-old man with peripheral T-cell lymphoma who developed an ST-elevation myocardial infarction (STEMI) shortly after initiating thalidomide-based chemotherapy. He had a prior history of hypertension and diabetes mellitus. Coronary angiography demonstrated thrombotic occlusion of the distal left anterior descending artery (LAD) and the proximal posterior descending artery (PDA). Thalidomide was discontinued, and the patient was treated as per standard ACS protocols. Conclusions: This case highlights the risk of arterial thrombosis with thalidomide, particularly in patients with preexisting cardiovascular disease. Clinicians should exercise caution when initiating thalidomide in high-risk individuals and maintain vigilance for early cardiac symptoms

Background: Physical activity is widely recognized for its benefits on cardiovascular health; however, its effects on blood pressure in adolescents remain unclear and may differ based on activity intensity. Understanding this relationship is critical for developing effective interventions to promote cardiovascular health in youth. Methods: In this cross-sectional study, 480 adolescents were classified into low, moderate, and high physical activity (PA) groups conferring to scores from the International Physical Activity Questionnaire (IPAQ). Anthropometric data, resting blood pressure, heart rate, and lifestyle behaviors, including hours spent studying, in sports, and in hobbies, were collected. Physical activity energy expenditure was quantified using metabolic equivalents (METs) across walking, moderate, and vigorous activity domains. Group differences were analyzed with ANOVA and chi-square tests, while correlations between METs and clinical or behavioral variables were assessed using Pearson correlation coefficients. Results: Adolescents with high PA demonstrated knowingly higher systolic blood pressure (p=0.025) and pulse pressure (p<0.001) associated to those with low PA, along with lower heart rates (p=0.003). The high PA group also showed the greatest prevalence of prehypertension and hypertension. Increased PA corresponded with greater time in sports and hobbies and decreased study time. Vigorous METs correlated positively with systolic blood pressure, pulse pressure, hobbies, and leisure time, and negatively with heart rate, gender (reflecting higher activity in males), and study hours. Similar patterns were observed for total METs. Conclusion: Vigorous physical activity in adolescents is related with elevated systolic blood pressure & pulse pressure, alongside favorable reductions in heart rate and increased active leisure. These results highlight a complex relationship between exercise intensity and cardiovascular indicators in youth and underscore the need for longitudinal research to better understand how different PA levels affect adolescent cardiovascular health

Introduction: Dengue fever, a mosquito-borne viral illness, varies from dengue fever (DF) to dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). This prospective study examines 80 dengue cases to explore associations between demographic factors, laboratory parameters, clinical severity, and outcomes. Materials and Methods: Prospectively 80 patients with confirmed dengue (NS1 and/or IgM positive) at a hospital. Data included age, gender, ABO blood group, fever duration, platelet count, haematocrit, severity, bleeding, hospital stay, and outcome. Severity was classified per WHO guidelines. Comparative analysis evaluated links between severity, bleeding, platelet count, haematocrit, and blood group. Trends in laboratory markers were assessed across severity groups. Results: 80 patients (53.75% male, 46.25% female, mean age 34.4 years), 47 had DF, 23 had DHF, and 10 had DSS. DSS cases had the lowest platelet counts (mean 28.8x10³/µL) and highest haematocrit (mean 51.4%). Bleeding occurred in all DHF and DSS cases but none in DF. DSS required the longest hospital stays (mean 11.9 days). Blood group distribution showed O (37.5%), A (28.8%), B (22.5%), and AB (11.2%), with more severity in O blood group and association (DSS 40% O, 30% A, 20% B, 10% AB). 1 DSS patient (age 85, female) died due to coronary heart disease; others recovered. Conclusion: Low platelet counts, high haematocrit, and bleeding strongly predicted dengue severity. Blood group O showed more severity. Prospective monitoring of key markers can guide early interventions, reducing severe outcomes, including mortality tied to comorbidities like coronary heart disease.

Background: Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. Diabetes mellitus (DM) is a major independent risk factor, often associated with diffuse, calcified, and asymptomatic coronary lesions. The advent of 128-slice multidetector computed tomography coronary angiography (CTCA) has enabled non-invasive assessment of coronary anatomy and calcium burden using the Agatston coronary artery calcium score (CACS). Objectives: To evaluate the role of 128-slice CTCA in detecting CAD and quantifying CACS in diabetic and non-diabetic subjects, and to assess the incidence and severity of disease across age, gender, and other cardiovascular risk factors. Secondary objectives included comparing CACS between patients with and without hypertension or smoking history, and evaluating its relationship with single- and multi-vessel disease. Methods: A cross-sectional study was conducted on 100 patients undergoing CTCA at Bharat Education and Research Foundation, Chennai. Demographic data, cardiovascular risk factors, and baseline investigations were recorded. CTCA was performed on a 128-slice scanner, with CACS measured using the Agatston method. Significant stenosis was defined as ≥50% luminal narrowing. Statistical analysis included chi-square tests, ANOVA, and multiple regression. Results: The cohort comprised 53 diabetics and 47 non-diabetics, with 67% aged >60 years and 91% male. Diabetes, hypertension, smoking, and family history were significantly associated with higher CACS and greater vessel involvement (p < 0.05), while gender was not. Severe calcification was more prevalent in diabetics (87%) and in patients with multivessel disease (82.6%). Multiple regression identified diabetes and hypertension as the strongest predictors for both CACS and vessel involvement. Conclusion: CTCA with CACS is an effective non-invasive tool for early detection of CAD, especially in patients with diabetes, hypertension, smoking, or family history of CAD. CACS correlates strongly with vessel involvement and can enhance cardiovascular risk stratification.

Introduction: Myasthenia Gravis (MG), an archetypal autoimmune neuromuscular junction disorder, is frequently associated with thymic pathologies, particularly thymoma. The intricate immunopathological axis between the thymus and the development of MG necessitates an integrated clinical and surgical approach. This study explores the spectrum of presentations, diagnostic frameworks, and surgical outcomes of patients with MG and/or anterior mediastinal masses in a high-volume cardiothoracic surgical centre in Eastern India. Aims and Objectives: To clinically evaluate patients presenting with thymic mass and/or MG. To determine diagnostic strategies for accurate identification of thymic abnormalities and neuromuscular dysfunction. To assess the role of pharmacotherapy in perioperative stabilization. To evaluate intraoperative management and postoperative recovery in thymectomy. To document post-thymectomy outcomes and relapse patterns during follow-up. Methodology: A prospective observational analysis was conducted from 2021–2024 at IPGME&R and SSKM Hospital, Kolkata. Patients presenting with clinical features of MG and radiologically confirmed thymic masses were included. Diagnostic modalities comprised serological testing (AChR and MuSK antibodies), pulmonary function testing, CT thorax, and FNAC/biopsy. Surgical interventions (thymectomy) were performed where indicated, and outcomes were tracked over a minimum of 6 months postoperatively. Results: The cohort exhibited a male predominance with a peak incidence in the fourth decade. Clinical features such as ptosis, diplopia, dysphagia, and respiratory difficulty were prevalent. CT imaging revealed anterior mediastinal lesions suggestive of thymoma in a substantial number. Surgical resection (thymectomy) was associated with significant reduction in symptom burden and AChR antibody titres. Postoperative extubation was successful within 3 days for most, and over 70% achieved Minimal Manifestation Status (MMS) at follow-up. Conclusion: The study reaffirms the central role of thymectomy in the management of thymic mass and MG, supported by preoperative immunological stabilization. Early surgical intervention coupled with vigilant postoperative care yields durable symptomatic and immunological remission in a significant proportion of patients. A multidisciplinary, evidence-informed paradigm is essential for optimizing outcomes in this complex immunosurgical domain.

Background: Acute kidney injury (AKI) is a heterogeneous syndrome with significant morbidity and mortality in hospitalized patients. Indian data on the clinical spectrum of AKI remain limited. Objectives: To describe the demographic, clinical, biochemical, and metabolic features of hospitalized AKI patients and assess the association of KDIGO stage and urine albumin with renal replacement therapy (RRT). Methods: This prospective observational study included 74 adults diagnosed with AKI as per KDIGO criteria at a tertiary care hospital. Demographic, clinical, and laboratory data were recorded. Patients were staged by KDIGO classification, and outcomes such as the need for RRT were analyzed using chi-square, ANOVA, and logistic regression. Results: The mean age of the cohort was 54 years, with a male predominance (71.6%). The mean hemoglobin was 9.6 g/dl, urea 121.7 mg/dl, creatinine 5.0 mg/dl, sodium 135.7 mmol/L, and potassium 4.2 mmol/L. KDIGO staging revealed 45.9% in G2, 41.9% in G3, and 12.2% in G4. Urine albumin was absent in 71.6%, mild in 20.3%, and moderate in 8.1%. Nine patients (12.2%) required RRT, with no significant association between RRT and KDIGO stage (p=0.48) or urine albumin (p=0.744). Higher KDIGO stages showed significantly higher postprandial blood sugar (p=0.022) and urea (p=0.006). Correlation analysis demonstrated strong associations between creatinine, urea, and potassium, and an inverse relationship between sodium and sodium grading. Conclusion: Most AKI patients were middle-aged men with hypertension and diabetes as common comorbidities. While the majority presented with moderate AKI, only a minority required dialysis. KDIGO stage and urine albumin did not predict RRT, whereas hyperglycemia and elevated urea were linked with more advanced AKI. These findings highlight the need for early detection, strict glycemic control, and integrated risk stratification models to optimize AKI management in tertiary care settings.

Objectives: To evaluate the diagnostic performance of ultrasound (USG) in characterizing adnexal lesions and correlate the findings with magnetic resonance imaging (MRI) to enhance diagnostic accuracy. Methods: A prospective cohort study was conducted on 96 women with clinically suspected pelvic lesions diagnosed as adnexal pathology on USG, who subsequently underwent MRI. Assessed parameters included lesion content, presence of nodules, ascites, lesion classification (benign vs. malignant), and imaging characteristics. Diagnostic performance of USG was evaluated using MRI as the reference standard. Results: The mean age of participants was 35.37 ± 12.00 years, with the majority aged 21–40 years. Lesion content was identical across both modalities, with 79.17% cystic and 20.83% solid-cystic (P = 1.000). Nodules were detected in 17.71% of USG scans and 20.83% of MRI scans (P = 0.5846), while ascites was seen in 13.54% (USG) and 15.63% (MRI) (P = 0.6824). Lesion classification showed 76.04% as benign and 23.96% as malignant by both USG and MRI (P = 1.000). USG demonstrated a sensitivity of 86.96%, specificity of 95.89%, positive predictive value of 86.96%, negative predictive value of 95.89%, and diagnostic accuracy of 93.75%. MRI provided additional insight, identifying enhancement in 22.92% and omental deposits in 15.63% of lesions, indicative of advanced disease. Conclusion: Ultrasound is a dependable first-line imaging tool for adnexal lesion evaluation. MRI adds diagnostic value in complex or suspicious cases and is useful for staging and surgical planning. Combined use of USG and MRI facilitates accurate diagnosis and optimal management of adnexal masses

Background: Type II diabetes mellitus (T2DM) is a major risk factor for cardiovascular disease (CVD), with dyslipidemia and subclinical myocardial dysfunction contributing significantly to morbidity and mortality. Early detection of structural and functional cardiac changes in asymptomatic patients is crucial for timely intervention. The study aimed to evaluate the prevalence of dyslipidemia and echocardiographic abnormalities in patients with T2DM and to analyze their correlation with glycemic indices and metabolic risk factors. Methods: A cross-sectional study was conducted on 136 T2DM patients at Sri Aurobindo Medical College, Indore. Demographic, anthropometric, biochemical, and lipid parameters were recorded. All participants underwent 2D echocardiography, including LVEF, LVMI, E/A ratio, and GLS assessment. Correlations between metabolic markers and echocardiographic parameters were analyzed using Pearson’s correlation coefficient. Results: The mean age of participants was 52.18 ± 9.62 years; males constituted 55.9%. Overweight (51.5%) and obesity (32.4%) were highly prevalent. Dyslipidemia was common, with elevated TC, LDL-C, and TG and reduced HDL-C (P < 0.0002). Echocardiography showed preserved mean LVEF (56.2 ± 4.8%), increased LVMI (178.4 ± 21.3 g/m²), reduced E/A ratio (0.85 ± 0.19), and impaired GLS (–18.5 ± 2.1), indicating early structural and functional changes. HbA1c correlated strongly with E/A ratio (r = –0.792) and GLS (r = –0.681), while TC correlated moderately with LVMI (r = 0.541). BMI showed only weak associations with cardiac indices. Conclusion: Subclinical echocardiographic abnormalities and dyslipidemia are common in asymptomatic T2DM patients. Poor glycemic control and dyslipidemia are the strongest predictors of diastolic dysfunction and ventricular remodeling. Incorporating advanced echocardiographic techniques, alongside aggressive management of glycemia and lipid levels, may aid in early identification and prevention of diabetic cardiomyopathy and progression to overt heart failure

Background: High-risk surgical patients frequently experience intraoperative haemodynamic fluctuations, which increase perioperative morbidity and mortality. Closed-loop anaesthesia delivery systems (CLADS), which automatically titrate anaesthetic drugs based on real-time feedback, are increasingly studied as tools to improve haemodynamic stability compared to conventional manual administration. However, evidence in high-risk populations remains limited. Materials and Methods: This prospective, randomized controlled trial included 120 high-risk surgical patients (ASA III–IV) undergoing major abdominal and thoracic procedures. Patients were divided into two groups: Group A (n=60) managed with CLADS, and Group B (n=60) managed with manual anaesthesia delivery. Haemodynamic parameters (mean arterial pressure [MAP], heart rate [HR]), intraoperative hypotensive episodes, total vasopressor requirement, anaesthetic drug consumption, and recovery times were recorded. Data were analyzed using Student’s t-test and chi-square test, with p<0.05 considered statistically significant. Results: Patients in Group A had significantly fewer episodes of hypotension (2.1 ± 1.4 vs. 5.7 ± 2.3 per case; p<0.001) and reduced vasopressor use (12.6 ± 4.3 mg vs. 24.2 ± 6.5 mg; p<0.01) compared to Group B. Mean MAP deviations from baseline were smaller in Group A (8.5 ± 3.2 mmHg) versus Group B (15.4 ± 5.8 mmHg; p<0.001). Anaesthetic drug consumption was lower in CLADS patients (propofol: 540 ± 110 mg vs. 670 ± 150 mg; p=0.02). Recovery times were shorter in Group A (12.4 ± 4.1 min vs. 18.7 ± 6.3 min; p=0.03). No major adverse events were noted. Conclusion: Closed-loop anaesthesia delivery systems significantly improved intraoperative haemodynamic stability, reduced vasopressor requirements, and shortened recovery time in high-risk surgical patients compared to conventional manual techniques. These findings support wider clinical adoption of CLADS to optimize outcomes in vulnerable patient populations

Background: The superior transverse scapular ligament (STSL) bridges the suprascapular notch to form the foramen for the suprascapular nerve. Ossification of the ligament, though uncommon, may predispose to nerve entrapment. Its incidence varies across populations, but data from Eastern Uttar Pradesh are scarce. This study aims to assess the incidence of STSL ossification in this region and analyze the morphometry of the suprascapular foramen. Materials and methods: A total of 200 dried human scapulae (100 right, 100 left) were examined for complete ossification of the superior transverse scapular ligament (STSL). In ossified cases, the suprascapular foramen dimensions and ligament thickness were measured with a digital caliper. Data were analyzed using SPSS v25.0, with p < 0.05 considered significant.  Results: Complete ossification of the STSL was found in 26 of 200 scapulae (13%), more often on the right (8%) than the left (5%), though the side difference was not significant (p=0.207). The mean vertical diameter of the suprascapular foramen was 9.19±1.01 mm with no significant side difference, while the transverse diameter showed a significant variation (p=0.005). The mean thickness of the ossified ligament was 2.37±0.59 mm, significantly greater on the right side (p<0.0001). Conclusion: Ossification of the STSL is a clinically relevant variation that may predispose to suprascapular nerve entrapment and shoulder dysfunction. Awareness of this condition is essential for accurate diagnosis and safe surgical or anaesthetic procedures, preferably performed under ultrasound guidance

Background: Caudal epidural anaesthesia (CEA) is a technique in which medications are administered into the epidural space to achieve analgesia and anaesthesia for various clinical procedures. The success of this procedure relies entirely on the accurate localization of the sacral hiatus, which serves as the entry point to the epidural space. Detailed knowledge of the anatomical variations of the sacral hiatus is therefore essential for improving the efficacy and safety of caudal epidural block. The aim of the present study was to examine the anatomical variations and morphometric characteristics of the sacral hiatus in the population of Bihar, with a focus on their clinical relevance in caudal epidural anaesthesia. Materials and Methods: The present study was conducted on 100 undamaged adult human sacra, with age and sex not predetermined. Only fully ossified, dried, macerated, and thoroughly cleaned sacra, complete in all respects, were included to ensure accurate observations, while specimens showing deformities or pathological changes were excluded. Various morphometric parameters were measured using a digital vernier caliper, and the different shapes of the sacral hiatus were also recorded. Statistical analysis of the data was performed using Statistical Package for the Social Sciences (SPSS), version 25.0.  Results: In the present study, the most common shape of the sacral hiatus was the inverted U type (43%), followed by the inverted V type (36%). The bifid type was the least common (4%), while absence of the sacral hiatus was noted in 2% of cases. The apex of the sacral hiatus was most frequently observed at the level of the fourth sacral vertebra (71%), whereas the base was commonly located at the level of the fifth sacral vertebra (79%). The mean length of the sacral hiatus was 25.82 ± 11.81 mm. The mean transverse width at the base was 11.84 ± 2.75 mm, and the mean anteroposterior diameter at the apex measured 6.33 ± 2.24 mm. Conclusion: Variations in the shape and size of the sacral hiatus should always be considered during caudal epidural anaesthesia and analgesia, as they can directly influence the outcome of the procedure. Such variations may be attributed to underlying genetic and racial factors

Background: Rheumatoid Arthritis (RA) is an autoimmune disorder that is chronic, and the prevalence of this health condition among adult population is 0.5-1 percent with most cases occurring in women. In many cases, RA is also linked to the autoimmune thyroid disease (AITD), where thyroid dysfunction was observed in a considerable number of RA patients. RA is highly linked to Td, especially hypothyroidism and there is common ground based on genetic and immunod pathways of the two diseases. It researches the issue of prevalence of thyroid disorders in patients with RA and discusses the comorbidity of RA with autoimmune thyroid disease. Methods: This observational study was carried on 65 patients diagnosed with Rheumatoid Arthritis of the Sri Aurobindo Medical College and Post Graduate Institute-Indore (SAMC&PGI). The information was gathered through pre-structured proforma and the respondents were clinically examined, as well as laboratory tests were undertaken to include Complete Blood Count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RA factor), thyroid function tests (FT3, FT4, TSH), and anti-thyroid peroxidase antibodies (anti-TPO Ab). The statistical analysis was carried out by means of chi-square tests and descriptive statistics. Results: The experience revealed that the average age of RA patients was of 49.2o11.6 years, and there was strong female dominance (84.6%). Hematological evidence consisted of hematocrit of 68 percent cases with anemia and 18 percent cases with thrombocytosis. Test of thyroid functions showed that 35.4 percent of the RA patients had some dysfunction of the thyroid with 20 percent and 12.3 percent having subclinical and overt hypothyroidism respectively. Anti-thyroid peroxidase antibodies were found in 29.2 percent of patients and illustrate the presence of an autoimmune overlap. The inflammation markers and ESR (84%) and CRP (76 %) were raised in majority of the patients and RA factor was positive in 80 %. Conclusion: The research paper emphasizes on the prevalence of thyroid dysfunction among patients with Rheumatoid Arthritis particularly subclinical and overt hypothyroidism. These results provide evidence on the need to perform routine thyroid screening in RA patients in order to control possible thyroid-related comorbidity. Such an imbrication of autoimmune thyroid disease with RA commends the importance of coordinated care in providing better outcomes to patients.

Background - Chronic burn wounds are a worldwide challenge leading to morbidity and mortality in patients thus adding a great amount of socio-economic burden. Conventional dressing in chronic burn wounds intends to reduce the exudation of fluids and electrolyte loss but lack of cell therapy-based support function. In such scenario, freshly collected human amniotic membrane (HAM) possessing progenitor cells, cytokines, and growth factors support may enhance regenerative capacity. Objective - To focus on markers and mediators of wound healing thus evaluating the sequential histological, biochemical, and cytokine changes in chronic burn wounds treated with freshly collected HAM, and to correlate these findings with phases of wound healing. Method - In this study, placentas are collected from sero-negative mothers after proper consent. Freshly collected amniotic membrane was applied on 10 non – diabetic patients (Sample group) after having institutional ethical permission and proper informed consent and 10 patients were placed under the Control group who received conventional burn wound dressing. Investigations including biochemical and inflammatory markers studies, cytokines profiling and histology were being conducted to study the healing outcomes. Pain and wond closure assessment, wound infection if any, wound size measeurement and  duration of epithelialization were routinely monitored. Result - Dressing with freshly collected amniotic membrane showed a decrease in wound size, rapid epithelialization, lowering of pain score, and rare graft rejection. Histology demonstrated a clear transition from inflammation-rich granulation tissue without epidermal covering, to early/mid proliferation with active angiogenesis and fibroblast activity, late proliferation with organized collagen synthesis, and finally early remodeling with complete epithelialization. Serum albumin increased from 36→43.5 g/L and wound fluid albumin from 16→26 g/L; total protein rose in serum from 66.5→79.8 g/L and in wound fluid from 30→47 g/L. Wound fluid LDH (Lactate Dehydrogenase) decreased from 3820→2650 U/L, indicating reduced local tissue injury. TGF-β1 (Transforming Growth Factor – beta – 1) peaked mid-phase, supporting fibroblast proliferation, while IL-1β (Interleukin beta – 1) declined markedly by three months, reflecting inflammation resolution. Overall freshly collected amniotic membrane considered to be hypo-antigenic contains great potential to improve chronic burn wounds by regeneration with minimal scarring.  Conclusion - Sequential histology, combined with biochemical and cytokine markers, provided objective evidence of progressive healing in chronic burn wounds treated with HAM. The observed modulation of inflammatory and regenerative pathways supports HAM’s role as an effective, low-cost, and biologically active dressing, particularly beneficial in resource-limited settings. This integrated assessment approach may serve as a valuable model for monitoring chronic wound healing

Introduction: Acute Coronary Syndrome (ACS) is a major cause of morbidity and mortality worldwide, with its prevalence steadily increasing across all age groups. While ACS traditionally affects older adults, there is a concerning rise in its incidence among younger individuals. Identifying and comparing cardiovascular risk factors in younger (<40 years) and older (>60 years) patients with ACS can help tailor age-specific preventive strategies. Objectives: To compare the prevalence and profile of cardiovascular risk factors in patients aged <40 years and >60 years admitted with ACS. Methods: This analytical, cross-sectional study was conducted in the indoor wards (male, female) and intensive cardiac care unit (ICCU) of the Department of Cardiology, Nilratan Sircar Medical College and Hospital, Kolkata, over a period of 18 months from 1st March 2023 to 31st August 2024. The study was divided into four phases: a preparatory phase (4 months), data collection phase (8 months), data compilation and analysis phase (4 months), and a final report writing and submission phase (2 months).  Results: In this study involving 192 patients with Acute Coronary Syndrome (ACS), key age-related differences were observed across clinical, lifestyle, and risk factor profiles. Younger patients (<40 years) had a marked male predominance (84%) and were more commonly affected by Inferior Wall Myocardial Infarction (IWMI), while NSTEMI was most prevalent among the elderly (>60 years). BMI was similar across groups, though younger individuals had slightly higher waist circumference. Elderly patients had significantly greater cumulative smoking exposure (pack-years), while current smoking was more common among the younger group. No significant differences were found in job patterns or shift types. Sleep duration showed a statistically significant difference, with younger individuals more likely to achieve optimal sleep (6–9 hours). Older patients had higher prevalence of hypertension, diabetes, and dyslipidemia, while younger patients had stronger family histories of ACS and premature atherosclerosis. Dietary patterns revealed greater trans-fat consumption among younger individuals and higher salt intake among the elderly. Other factors, such as intake of saturated fats, fast food, red meat, fruits, vegetables, and tobacco product use, did not differ significantly. Conclusion: This study highlights distinct cardiovascular risk profiles in ACS patients based on age. Younger patients with ACS are more likely to have modifiable lifestyle-related risk factors such as smoking and positive family history, whereas older patients present with more traditional risk factors like hypertension, diabetes, and dyslipidemia. These findings underscore the need for targeted screening and prevention strategies tailored to different age groups.

Background: Late preterm infants (34⁰–36⁶ weeks) are at increased risk of respiratory morbidity and other complications compared to term neonates. Antenatal corticosteroids have proven efficacy in improving neonatal outcomes in early preterm births, but their role in late preterm deliveries remains an area of active investigation. Objective: To evaluate the impact of antenatal corticosteroid administration on neonatal and maternal outcomes in women at risk of late preterm delivery. Methods: This prospective observational study included 120 women with late preterm pregnancies, divided into two groups: those who received a complete course of dexamethasone (n = 60) and those who did not (n = 60). Maternal and neonatal characteristics were recorded, and outcomes were compared using appropriate statistical tests. Results: Neonates exposed to corticosteroids required significantly less respiratory support (11.7% vs. 18.3%, p = 0.0022) and had fewer NICU admissions (11.7% vs. 20.0%, p = 0.018) compared with the non-steroid group. However, the incidence of neonatal hypoglycemia was higher in the corticosteroid group (23.3% vs. 15.0%, p = 0.0048). No significant differences were observed in neonatal resuscitation, surfactant use, APGAR scores, sepsis, or maternal complications such as chorioamnionitis. Mode of delivery was unaffected by corticosteroid use. Conclusion: Antenatal corticosteroid administration in late preterm pregnancies significantly reduces neonatal respiratory morbidity and NICU admissions but increases the risk of hypoglycemia. The therapy appears safe for mothers and should be considered in clinical practice, with appropriate neonatal glucose monitoring

Background: Dyslipidemia is a significant concern associated with alcohol consumption, despite its known effect of increasing high-density lipoprotein (HDL) cholesterol. Observational studies have consistently shown that alcohol consumption is linked to elevated levels of low-density lipoprotein (LDL) cholesterol and triglycerides, which can have detrimental effects on morbidity and mortality. This study aims to investigate the distribution of lipid profiles in chronic alcoholics, with a focus on identifying potential lipid abnormalities that may contribute to increased health risks. So that early interventions can be implemented to mitigate the adverse effects of alcohol consumption on cardiovascular health and reduce the overall health burden in our set up. Research question: What is the influence of alcohol on the distribution of lipids in chronic alcoholics? Methods: A six months observational study was conducted at the Department of General Medicine, Guntur Medical College, Guntur, from January 2025 to June 2025. About thirty chronic alcoholic patients and thirty non alcoholics attending the General Medicine OPD were included in the study. Socio-demographic profiles like age & weight, h/o Hypertension and Diabetes, distribution of lipid profiles in association with hypertension, diabetes, type & duration of alcoholism etc; were studied. Results: Similar distribution was observed among both the groups related to age & weight and majority about 56 % of alcoholics were observed between 36 – 45 years of age with the mean age 49 years and more number of alcoholics were present between 61 – 70 kg of weight with the mean 66.5 kg in this study. And no significant (P>0.01) difference observed between the two groups related to mean blood pressure distribution in this study. there was a highly significant (P<0.01) difference observed among alcoholics Vs non alcoholics related to distribution of  Lipid profile with reference to moderate rise of total cholesterol (190 Vs 150), triglycerides (206 Vs 111), HDL (43 Vs 37) and VLDL (41 Vs 22) and mild rise of LDL (106 Vs 98) observed among alcoholics. With regard to Duration of alcoholism, there was a significant (P<0.05) difference observed between alcoholics of <10 years & >10 years of duration  related to distribution of  Lipid profile viz. total cholesterol, triglycerides & LDL which were increased among alcoholics of prolonged duration. In addition to this with reference to type of alcoholic there was highly significant (P<0.01) difference observed between alcoholics of moderate drinkers and heavy drinkers related to distribution of Lipid profile viz. among heavy drinkers there was significant increased levels of total cholesterol (214 Vs 154), triglycerides (254 Vs 132), LDL (123 Vs 80) and VLDL (51 Vs 26) except HDL (40 Vs 47) in which mild decreased was observed.

Background: Left Ventricular Hypertrophy (LVH) is a common consequence of chronic hypertension and other cardiovascular diseases, significantly increasing the risk of adverse cardiovascular events. Electrocardiography (ECG) and Echocardiography (ECHO) are both used to diagnose LVH, but their diagnostic accuracy differs. The study aimed to evaluate the correlation between ECG findings and ECHO findings in LVH patients, as well as the diagnostic performance of ECG criteria (Sokolow Lyon Index and Talbot’s Criteria) in detecting LVH. Methods: This cross-sectional analytical study was conducted at Sri Aurobindo Medical College & PG Institute, Indore, from June 2023 to November 2024. A total of 382 patients with LVH diagnosed by ECHO were included. The ECG was performed using the 12-lead technique, and ECHO was conducted using the PHILIPS iE33 echocardiography machine. ECG findings were evaluated using the Sokolow Lyon index and Talbot criteria. The study assessed the sensitivity and specificity of these ECG criteria compared to ECHO findings, which were based on interventricular septal thickness and other structural abnormalities. Results: The majority of patients (80%) were aged between 41 and 60 years. Common ECG findings included increased QRS duration (120 patients), left axis deviation (90 patients), and ST-T changes (110 patients). ECHO findings revealed increased left ventricular wall thickness in 200 patients, and 130 patients had left ventricular diastolic dysfunction. The correlation between ECG and ECHO findings showed that increased QRS duration on ECG correlated with increased left ventricular wall thickness on ECHO in 80 patients. Both Sokolow Lyon Index and Talbot’s Criteria demonstrated high sensitivity (85% and 90%, respectively) in detecting LVH, though specificity was slightly lower. Conclusion: LVH is predominantly observed in middle-aged and elderly hypertensive patients. ECG and ECHO findings correlate strongly, with ECG serving as a useful screening tool in resource-limited settings and ECHO providing a more detailed structural assessment. Both Sokolow Lyon Index and Talbot’s Criteria show high sensitivity in diagnosing LVH. Future studies should focus on multi-center validation of ECG criteria and the development of newer diagnostic approaches.

Background and Aims: Accurate endotracheal tube (ETT) size selection in pediatric patients is crucial for safe airway management. Traditional formula-based predictions often fail in anatomically diverse children. This study aimed to evaluate and correlate age-based, height-based, and ultrasound-guided subglottic diameter estimation methods with actual ETT size used. Methods: A prospective observational study was conducted on 150 children aged 1–10 years undergoing elective surgery requiring intubation. ETT size was estimated using Cole’s formula, a height-based equation, and ultrasonographic subglottic diameter. The clinically appropriate ETT was confirmed via minimal leak technique. Correlation coefficients and prediction accuracies were analyzed. Results: Ultrasound demonstrated the highest correlation with actual ETT size (r = 0.91), followed by height-based (r = 0.84) and age-based (r = 0.76) formulas. Correct prediction rates were 90.7% for ultrasound, 74.0% for height-based, and 63.3% for age-based methods (p < 0.001). Conclusion: Ultrasound-guided subglottic diameter measurement is the most reliable and accurate method for selecting ETT size in children, outperforming conventional predictive formulas.

Introduction: Fertility-sparing surgery (FSS) is increasingly considered a viable option for young women with early-stage epithelial ovarian cancer (EOC) who desire future fertility. However, the role and impact of adjuvant chemotherapy following FSS remain controversial, with limited data on oncologic outcomes and reproductive safety. Objective: This multicenter retrospective study aimed to evaluate the survival outcomes and safety of adjuvant chemotherapy in young women undergoing fertility-sparing surgery for early-stage epithelial ovarian cancer. Methods: In this retrospective study conducted at R G Kar Medical College over a period of one year, a total of 150 young women diagnosed with early-stage epithelial ovarian cancer who underwent fertility-sparing surgery were included. Data were collected from medical records, focusing on key study variables such as age, FIGO stage, histologic subtype, type of surgery performed, adverse effects, and fertility outcomes. All patients met the inclusion criteria of being young women with histopathologically confirmed early-stage epithelial ovarian cancer and having undergone fertility-sparing surgical procedures. The collected data were systematically analyzed to assess the clinicopathological characteristics, treatment-related outcomes, and reproductive performance following surgery. Results: A total of 150 patients were analyzed, with 90 receiving adjuvant chemotherapy and 60 under surveillance. The groups were similar in age, but the chemotherapy group had more advanced stage IC and high-grade tumors. Surgical staging and type of fertility-sparing surgery were comparable. Median follow-up was about 4 years for both groups. The chemotherapy group showed significantly lower recurrence rates (8.9% vs. 20%) and higher 5-year disease-free survival (91% vs. 80%), though overall survival differences were not statistically significant. Fertility outcomes, including pregnancy attempts, success rates, time to conception, and miscarriage rates, were similar between groups. Chemotherapy-related adverse effects were mostly mild, with alopecia being the most common, and over half of patients experienced no serious side effects. Conclusions: Adjuvant chemotherapy after fertility-sparing surgery in young women with early-stage epithelial ovarian cancer appears to improve oncologic outcomes, particularly in patients with high-risk features, without compromising fertility potential. These findings support a tailored approach to adjuvant treatment, balancing oncologic safety and reproductive goals

Background: OM meditation is a form of mind–body practice shown to influence autonomic function and cardiovascular health. This study aimed to evaluate the effect of 8-week OM meditation on cardiovascular parameters in healthy adults. Material and Methods: A total of 60 healthy participants aged 25–60 years were randomly assigned to either an OM meditation group (n = 30) or a control group (n = 30). The intervention consisted of daily 20-minute OM meditation sessions over 8 weeks. Primary outcomes included systolic and diastolic blood pressure, heart rate, and heart rate variability (HRV), measured at baseline, 4 weeks, and 8 weeks. Blood pressure and heart rate were recorded using a digital sphygmomanometer, and HRV was assessed via a validated portable HRV monitor (SDNN, ms). Data were analyzed using repeated measures ANOVA; p < 0.05 was considered statistically significant. Results: Baseline characteristics were comparable between groups. In the OM meditation group, systolic BP decreased from 120.8 ± 6.5 mmHg at baseline to 118.2 ± 6.0 mmHg at 4 weeks and 116.5 ± 5.7 mmHg at 8 weeks (p < 0.001). Diastolic BP declined from 78.6 ± 5.0 mmHg to 76.4 ± 4.7 mmHg at 4 weeks and 75.2 ± 4.5 mmHg at 8 weeks (p < 0.001). Heart rate reduced from 72.4 ± 6.2 bpm to 70.1 ± 5.8 bpm at 4 weeks and 68.7 ± 5.5 bpm at 8 weeks (p < 0.001). HRV increased from 40.2 ± 5.5 ms at baseline to 43.5 ± 5.7 ms at 4 weeks and 46.8 ± 5.9 ms at 8 weeks (p < 0.001). The control group showed minimal changes in all parameters. Conclusion: Eight weeks of OM meditation significantly improves cardiovascular parameters in healthy adults, suggesting its potential role as a non-pharmacological strategy for enhancing autonomic and cardiovascular function

Background: Hypothyroidism is a prevalent endocrine disorder often associated with menstrual irregularities in women of reproductive age, potentially leading to complications such as infertility and anemia. This study aimed to evaluate the prevalence of hypothyroidism among women presenting with menstrual irregularities at a tertiary care center in India. Methods: A prospective cross-sectional study was conducted at the Department of Medicine, Kanti Devi Medical College Hospital and Research Center, Mathura, from June 2024 to April 2025. A total of 150 women aged 18–45 years with menstrual irregularities (oligomenorrhea, menorrhagia, or amenorrhea) were included. Thyroid function tests (TSH, free T4, and free T3) were performed, with hypothyroidism defined as TSH >4.5 mIU/L (subclinical if free T4 normal; overt if free T4 <0.8 ng/dL). Exclusion criteria encompassed pregnancy, known thyroid disorders, or other endocrine conditions. Results: Of the 150 participants, 36 (24%) had hypothyroidism: 22 (14.7%) subclinical and 14 (9.3%) overt. The mean age was 29.4 ± 6.2 years in hypothyroid women versus 27.8 ± 5.9 years in euthyroid women. Menorrhagia was the predominant irregularity in hypothyroid cases (55.6%). Conclusion: With a 24% prevalence, hypothyroidism is a significant contributor to menstrual irregularities, warranting routine thyroid screening to mitigate associated risks

Introduction: Human Immunodeficiency Virus (HIV) infection in children is associated with a broad spectrum of mucocutaneous manifestations, which are often the first clinical indicators of underlying immunodeficiency. These manifestations range from common infections to neoplastic and inflammatory conditions and significantly affect quality of life, morbidity, and sometimes mortality in pediatric patients. Early recognition of these skin and mucous membrane lesions is crucial for timely diagnosis, initiation of antiretroviral therapy (ART), and prevention of further complications. Methods: This prospective study was conducted over a period of one year at the Calcutta School of Tropical Medicine. A total of 60 patients with confirmed Human Immunodeficiency Virus (HIV) infection presenting with mucocutaneous manifestations were included. Relevant demographic and clinical data, including age, gender, and body mass index (BMI), were recorded. Detailed evaluation of associated endocrine disorders, including thyroid, adrenal, pituitary disorders, and polycystic ovarian syndrome (PCOS), was performed. Comprehensive dermatological examination was carried out to document the type of skin manifestations and specific skin features. All data were systematically collected, compiled, and analyzed to assess the pattern and association of mucocutaneous lesions with clinical and laboratory parameters. Results: In this study of 60 HIV-infected children, most were aged 6–10 years, with no significant age or gender differences. Seventy percent were on ART, and shorter ART duration was significantly associated with higher lesion prevalence. Oral candidiasis was the most common mucocutaneous manifestation, followed by seborrheic dermatitis, bacterial infections, molluscum contagiosum, and herpes zoster. Lower CD4 counts and shorter ART duration were significantly linked to higher rates of oral candidiasis and other lesions. Conclusion: Mucocutaneous manifestations are highly prevalent in children with HIV infection and often reflect the degree of immunosuppression. Recognizing these lesions can aid in early diagnosis, monitoring disease progression, and guiding timely initiation of antiretroviral therapy. Pediatricians and dermatologists should maintain a high index of suspicion for HIV in children presenting with recurrent or atypical mucocutaneous lesions.

Introduction: Hypopigmented skin lesions are a frequent dermatological concern in the pediatric population, often eliciting significant parental anxiety due to cosmetic implications and fears of underlying systemic illness. These lesions can represent a wide spectrum of conditions, ranging from benign developmental variants to manifestations of more serious dermatological or systemic disorders. Therefore, a comprehensive clinico-epidemiological evaluation is crucial for accurate diagnosis and appropriate management.  Objectives: To study the clinical patterns, epidemiological factors, and associated conditions of hypopigmented skin lesions in children attending dermatology outpatient departments. Methods: A hospital-based cross-sectional study was conducted over a period of one year in the Dermatology Department of a tertiary care center. A total of 150 pediatric patients (aged 0–18 years) presenting with hypopigmented skin lesions were enrolled. Detailed history taking and thorough clinical examinations were performed for each patient. Wood's lamp examination and relevant laboratory investigations were carried out as indicated. Diagnoses were primarily based on clinical criteria and confirmed by histopathological evaluation where necessary. Results: The most commonly affected age group was 6–10 years (45%), with a slight male preponderance (male:female ratio of 1.2:1). Pityriasis Alba was the most frequently observed lesion (40%), followed by vitiligo (25%), post-inflammatory hypopigmentation (15%), and nevus depigmentosus (10%). Less common conditions included tuberous sclerosis, leprosy, and idiopathic guttate hypomelanosis. A significant association was observed between pityriasis Alba and a history of atopy. Vitiligo exhibited familial aggregation in 18% of cases. Socioeconomic and nutritional factors were also found to influence the prevalence and distribution of certain hypopigmented lesions. Conclusion: Pityriasis Alba and vitiligo emerged as the leading causes of hypopigmented skin lesions in children. Early and accurate diagnosis through clinical evaluation is essential to avoid unnecessary investigations and to alleviate parental anxiety. Awareness of the diverse etiologies and epidemiological patterns is vital for dermatologists and pediatricians to ensure prompt recognition, appropriate management, and effective counseling.

Background: Type 2 Diabetes Mellitus (T2DM) management often requires combination therapy to achieve and maintain glycemic targets when metformin monotherapy is insufficient. Sodium-glucose cotransporter-2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors are two widely used second-line agents, but direct comparative data on their comprehensive metabolic effects are still evolving. Objective: This study aimed to evaluate and compare the efficacy and safety of adding empagliflozin (an SGLT2 inhibitor) versus sitagliptin (a DPP-4 inhibitor) to the treatment regimen of T2DM patients inadequately controlled with metformin monotherapy. Methods: We conducted a 24-week, prospective, randomized, open-label, parallel-group controlled trial at a single tertiary care center. A total of 150 T2DM patients with a glycated hemoglobin (HbA1c) level between 7.5% and 10.0% while on a stable dose of metformin (≥1500 mg/day) were randomized (1:1:1) into three groups: Metformin Monotherapy (MET Mono; uptitrated dose), Metformin + Sitagliptin 100 mg/day (MET+SITA), or Metformin + Empagliflozin 10 mg/day (MET+EMP). The primary endpoint was the change in HbA1c from baseline to week 24. Secondary endpoints included changes in fasting blood glucose (FBG), postprandial glucose (PPG), body weight, body mass index (BMI), and lipid profile. Key Findings: At 24 weeks, both combination therapies resulted in a significantly greater reduction in HbA1c compared to the metformin monotherapy group. The mean change in HbA1c from baseline was -0.7% ± 0.6% for MET Mono, -1.3% ± 0.5% for MET+SITA, and -1.5% ± 0.4% for MET+EMP (p<0.001 for both combinations vs. monotherapy). The reduction in the MET+EMP group was significantly greater than in the MET+SITA group (p=0.041). The MET+EMP group demonstrated a significant mean weight reduction of -2.8 ± 1.5 kg, compared to a minimal change in the MET+SITA group (-0.4 ± 1.2 kg) and MET Mono group (+0.2 ± 1.3 kg) (p<0.001). Genitourinary infections were reported more frequently in the MET+EMP group (8%) than in the MET+SITA (2%) and MET Mono (2%) groups, but no cases were severe. Conclusion: In T2DM patients inadequately controlled with metformin, the addition of either empagliflozin or sitagliptin is an effective strategy for improving glycemic control. Empagliflozin provided statistically superior reductions in both HbA1c and body weight compared to sitagliptin, suggesting it may be a preferred second-line agent for overweight or obese patients.

Background: The increasing prevalence of screen-based devices has led to heightened concerns about their impact on children’s physical and psychological health. Excessive screen time has been linked to sedentary behaviors, disrupted eating patterns, and heightened emotional responses, potentially increasing the risk of emotional eating and childhood obesity. This study aims to evaluate the association between screen time, emotional eating behaviors, and obesity risk among school-aged children. Materials and Methods: A cross-sectional study was conducted on 300 children aged 8–12 years, selected from three urban schools. Data on daily screen time (TV, smartphones, tablets), emotional eating patterns (measured using the Children’s Eating Behaviour Questionnaire), and anthropometric measures (height, weight, BMI) were collected. Participants were categorized based on screen time: low (<2 hours/day), moderate (2–4 hours/day), and high (>4 hours/day). BMI percentiles were calculated based on WHO growth charts. Statistical analysis was performed using SPSS v25 with significance set at p < 0.05. Results: Children in the high screen time group (>4 hours/day) showed significantly higher emotional eating scores (mean 4.2 ± 0.6) compared to the low screen time group (mean 2.8 ± 0.4, p < 0.01). The prevalence of overweight and obesity was highest in the high screen time group (43%) versus the low screen time group (11.7%). A positive correlation was observed between screen time and BMI (r = 0.41, p < 0.01), and between screen time and emotional eating (r = 0.47, p < 0.001). Conclusion: Prolonged screen time is associated with increased emotional eating behaviors and a higher risk of obesity in school-aged children. Interventions aimed at reducing screen exposure and promoting mindful eating may help mitigate obesity risks in this population.

Background: Despite anterior and posterior circulation stroke sharing most pathophysiological mechanisms, it is concerning that there are significant differences in risk factors and clinical profile of anterior and posterior circulation strokes which warrants their further exploration. Aim: The present study was aimed to comparatively assess the risk factors and clinical profile in subjects with Anterior and Posterior circulation ischemic stroke. Methods: The study included 208 subjects where 60 had posterior circulation stroke and 148 subjects had anterior circulation stroke. For all the included subjects, detailed history was recorded followed by comprehensive clinical examination in subjects with Transient ischemic stroke (duration less than 24 hr) and Hematological investigations done at N.S.C.B. Medical College, Jabalpur. Data for study subjects was collected using structured schedule Results: In study subjects with  posterior circulation stroke, coronary artery disease was seen in 20.27% (n=30) and 26.67% (n=16) subjects with anterior and posterior circulation stroke with p=0.474, atrial fibrillation was seen in 4.05% (n=6) and 6.67% (n=4), alcohol intake was positive in 28.38% (n=42) and 16.67% (n=10), diabetes mellitus in 32.43% (n=48) and 33.3% (n=20), systemic hypertension in 62.16% (n=92) and 66.67%v (n=40), and smoking in 35.14% (n=52) and 46.67% (n=28) subjects with anterior and posterior circulation stroke with p=0.623, 0.209, 0.927, 0.664, and 0.271 respectively. However, significantly higher plasma lipid levels were seen in 33.33% (n=20) subjects with posterior circulation stroke compared to 12.16% (n=18) subjects with anterior circulation stroke and p=0.01 Conclusion: The present study concludes that that PCS and ACS have similar etiology. Risk factors are also similar for PCS and ACS. The current study initially compared the frequency of neurological deficits between the 2 groups and found a similar distribution among the most common symptoms and signs between PC and AC stroke, we assessed the ability of a single neurological deficit to discriminate PCS from ACS, and we observed that despite some symptoms and signs are specific for diagnosing PCS, symptoms/signs with a higher predictive value had a very low prevalence.

Background: Premature coronary artery disease (CAD), defined as myocardial infarction occurring in individuals aged ≤40 years, is an increasingly recognized clinical entity with distinct risk factors, presentation, and angiographic features compared to older patients. Early identification and intervention in this population are essential to reduce long-term morbidity and mortality. Objectives: To evaluate the clinical, biochemical, and angiographic profile of young patients presenting with acute myocardial infarction and assess the prevalence of conventional and non-conventional risk factors. Materials and Methods: This was a prospective observational study conducted over one year in the Intensive Coronary Care Unit of a tertiary care center. A total of 69 patients aged ≤40 years presenting with acute coronary syndrome (STEMI or NSTEMI) were included. Data on demographics, risk factors, echocardiographic findings, and coronary angiographic patterns were collected. Logistic regression was used to identify predictors of left ventricular (LV) dysfunction. Results: The study population consisted predominantly of males (86.95%), with the majority aged between 31–40 years. Smoking (53.6%), dyslipidemia (29%), and diabetes (24.6%) were major conventional risk factors. A striking 49.3% had prediabetes irrespective of gender, income, or residence. STEMI was the most common presentation (72.5%). Echocardiography showed normal LV function in 78.25%, while 21.7% had LV dysfunction. Coronary angiography revealed single-vessel disease in 62.3%, with LAD involvement in 47.8%. Logistic regression identified diabetes, elevated LDL (>100 mg/dL), hyperhomocysteinemia, and STEMI presentation as independent predictors of LV dysfunction. Conclusion: Premature myocardial infarction in young adults is strongly associated with modifiable risk factors, especially smoking, dyslipidemia, and prediabetes. Early metabolic screening, lifestyle intervention, and timely revascularization are critical for improving outcomes in this population. The findings call for urgent public health measures focused on primary prevention and equitable access to cardiac care for young individuals at risk

Background: Biochemical hepatic dysfunction in pregnancy, whilst relatively rare, has potentially serious consequences for maternal and fetal health. Liver disease in pregnancy encompasses a spectrum of diseases encountered during gestation and the postpartum period that result in abnormal liver parenchymal and hepatobiliary dysfunction or both. Hence the aim of this study is to find out maternal and fetal outcome and to evaluate clinical profile, complications in relation with hepatic dysfunction in pregnancy.  Materials and Methods: This study was a Prospective Observational Study, here total 100 pregnant patients were included of which 50 pregnant patients attending OPD or getting admitted in Tertiary Care Hospital with biochemical hepatic dysfunction and 50 without biochemical hepatic dysfunction. Results: Maternal mortality was high in patients from rural areas with p value 0.044 was statistically significant. Significant difference was found that 60% patients with hepatic dysfunction were unbooked compared 36 % of pts without hepatic dysfunction P value 0.0272 was statistically significant. Almost all maternal mortality was occurred in unbooked pts, p value 0.008 was statistically significant. Out of 50 patients with hepatic dysfunction 32 (64%) patients were delivered by LSCS. P value was less than 0.0001 was statistically significant Conclusion: LSCS was required in majority of pts with hepatic dysfunction. Liver failure and ascitis were the most common complication of hepatic dysfunction, while multiorgan dysfunction was the most serious complication with highest maternal and fetal mortality. Maternal mortality was highest in pts with Child Pugh score C. There is no significant difference of APGAR score in pts with hepatic & without hepatic dysfunction.

Background: Endotracheal intubation is routinely practiced to secure the airway during general anesthesia. Even well-experienced anesthesiologists can encounter challenges during unanticipated difficult intubation that can lead to failed intubation, which may increase morbidity and mortality.  Aim: Analysing various ultrasound parameters for airway assessment during surgery under general anaesthesia. Materials and methods: 200 patients aged between 18 and 70 years belonging to ASA classes I, II, and III scheduled for elective surgery requiring general anesthesia under endotracheal intubation was included in the study. Clinical parameters such as body mass index, neck circumference, modified Mallampati grading, thyromental distance, and ultrasound parameters such as anterior neck soft tissue thickness at the level of the thyrohyoid membrane (ANS-TM) and anterior neck soft tissue thickness at the level of vocal cord (ANS-VC) were obtained preoperatively. After intubation, the CL grading was noted and categorized into two groups: easy (classes 1 and 2) and difficult (classes 3 and 4).  Results: Ultrasound-guided measurements of ANS-TM and ANS-VC are independent predictors of difficult laryngoscopy compared with clinical screening tests. Of the two parameters, we found that ANS-TM has a better diagnostic value for predicting a difficult airway with an area under the ROC curve (AUC) of 92% compared with ANS-VC, which has an AUC of 85%. Of the clinical parameters, the modified Mallampati grading has an AUC of 82%, leading to better diagnostic value in the prediction of a difficult airway. Conclusion: Our study demonstrated that ANS-TM and ANS-VC are independent predictors of a difficult airway. ANS-TM has a better correlation with CL grading. Clinical screening tests should be combined with ultrasound measurements to aid in the better prediction of difficult laryngoscopy.

Background: Tinnitus is a widespread condition that affects millions of subjects globally, including in India, and has a substantial effect on the quality of life of the affected individuals. However, existing literature data is scarce concerning tinnitus in Indian subjects. Aim: The present study aimed to assess the prevalence of tinnitus in Indian subjects, its effect on quality of life, and their approach to seeking medical management.  Methods: The present study assessed 8832 subjects using the survey approach. All the subjects were assessed using the Indian version of the THI (Tinnitus Handicap Inventory) questionnaire to assess the prevalence of tinnitus, its effect on quality of life, and the approach to seeking medical treatment. The data gathered were analyzed statistically to formulate the results.  Results: The study results showed that among 8832 subjects that were assessed on the survey, the prevalence of tinnitus was found to be 37.6% (n=3324). Medical support was sought by 39.7% of the affected subjects. The mean THI score in the study subjects was 16.5 which suggests mild handicap status. The study results showed a statistically significant association in age, gender, tinnitus duration, and the emotional subscale of the THI with p=0.01, 0.01, and <0.001 respectively. Also, persistence, type, laterality, tinnitus duration, and age showed a statistically significant association with getting medical support with p<0.001. Conclusions: The present study concludes that the prevalence of tinnitus in Indian subjects is significantly high with a high occurrence in females and a higher association with advancement in age. While tinnitus has a detrimental effect on the quality of life, a significant proportion is restricted from seeking medical support.

Background: Echocardiography (Echo.), through transthoracic (TTE) and transoesophageal (TEE) approaches, is a pivotal bedside tool in the intensive care unit (ICU) for rapid diagnosis and monitoring of cardiovascular emergencies. Its ability to provide real-time anatomical and functional assessment supports early recognition of life-threatening conditions and timely therapeutic interventions. Methods: A qualitative secondary data analysis was conducted using peer-reviewed literature, clinical guidelines, and retrospective case reports on ICU or high-dependency patients (≥18 years) evaluated with Echo. for suspected myocardial infarction. Data on echocardiographic findings, clinical presentation, and management outcomes were synthesised to assess diagnostic yield, therapeutic impact, and detection of post-MI complications.  Results: Echo. identified key pathologies including LV systolic dysfunction, segmental wall motion abnormalities, acute valvular lesions, pulmonary embolism, and pericardial tamponade. ACS evaluation frequently revealed LAD territory hypokinesia, prompting urgent interventions. Clinical management changed in 51.2% of studies, with immediate changes in 41.5%. Interventions included fluid therapy adjustment, vasoactive drug titration, urgent cardiac procedures, and pericardiocentesis. No procedure-related complications occurred.  Conclusion: Echo. enables early diagnosis of MI in ICU patients by detecting SWMAs and mechanical complications before clinical or biochemical confirmation. Its real-time integration into decision-making significantly influences treatment strategies, improving timeliness and precision of care

Background: Hypertension is a leading modifiable risk factor for cardiovascular diseases (CVDs). Mean platelet volume (MPV) has emerged as a potential marker of platelet activation and cardiovascular risk. This study aimed to investigate the association between MPV and established cardiovascular risk factors in hypertensive patients. Methods: A cross-sectional study was conducted on 280 hypertensive patients aged ≥18 years at a tertiary care hospital in Bengaluru, Karnataka, between July 2023 and December 2024. Demographic, clinical, and biochemical parameters—including BMI, smoking status, diabetes mellitus, lipid profile, and hypertension grade—were recorded. MPV was measured using an automated haematology analyser. Associations between MPV and risk factors were analysed using correlation, regression, and odds ratio analysis. Results: The mean age was 54.3 ± 14.7 years, with a male predominance (55%). Elevated MPV was significantly associated with higher grades of hypertension (p < 0.001), increased BMI (p < 0.001), smoking (p = 0.003), and diabetes (p < 0.001). MPV showed a positive correlation with total cholesterol, triglycerides, and LDL, but a negative correlation with HDL (r = −0.215). Multivariate regression identified hypertension grade, BMI, and HbA1c as independent predictors of elevated MPV. Conclusion: MPV is a simple, inexpensive marker that correlates with multiple cardiovascular risk factors in hypertensive patients. Incorporating MPV into routine risk assessment may enhance early detection of high-risk individuals and improve prevention strategi

Background: Type 2 Diabetes Mellitus (T2DM) is a major public health issue globally and a leading cause of cardiovascular complications. Subclinical cardiac dysfunction often remains undetected in asymptomatic diabetic patients. Myocardial Performance Index (MPI) and N-terminal pro B-type Natriuretic Peptide (NT-pro BNP) are two promising markers for early cardiac dysfunction. This study aims to assess the correlation between MPI and serum NT-pro BNP levels in asymptomatic T2DM patients. Methods: A cross-sectional observational study was conducted on 80 asymptomatic T2DM patients aged ≥18 years attending the tertiary care centre. MPI was measured using Doppler echocardiography, and serum NT-pro BNP levels were assessed using standardized biochemical methods. Correlations between MPI, NT-pro BNP, age, and glycaemic indices (HbA1c and fasting plasma glucose) were analysed using appropriate statistical tools.  Results: The study population had a mean age of 57.3±8.4 years with a male (60%) predominance. A statistically significant positive correlation was found between MPI and NT-pro BNP (r =0.926, p < 0.001). MPI also showed positive correlation with age (r=0.782) and HbA1c levels (r=0.854). Receiver Operating Characteristic (ROC) analysis indicated that NT-pro BNP is a reliable predictor of abnormal MPI (≥0.40).  Conclusion: MPI serves as a simple and non-invasive tool to detect the early systolic and diastolic Left ventricular dysfunction in patients with type 2 diabetes mellitus

Background: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory condition characterized by systemic manifestations. Fibrinogen, an acute-phase protein, has been implicated as a potential biomarker of systemic inflammation and disease severity in COPD patients. This study aimed to investigate the association between serum fibrinogen levels and clinical severity in COPD patients. Methods: This cross-sectional study included 60 COPD patients aged 40 years and above, diagnosed according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Serum fibrinogen levels were measured, and their relationship with lung function, symptom burden, and COPD severity was assessed. Correlation analyses and multivariable linear regression models were employed to evaluate the associations while adjusting for potential confounders. Results: Serum fibrinogen levels were significantly higher in patients with more severe COPD (p < 0.001). Fibrinogen levels were inversely correlated with forced expiratory volume in 1 second (FEV1%) predicted (r = -0.62, p < 0.001) and positively correlated with the COPD Assessment Test (CAT) score (r = 0.48, p < 0.001). After adjusting for age, gender, smoking status, and comorbidities, serum fibrinogen remained independently associated with COPD severity (β = 0.37, p = 0.002). Each 1 g/L increase in serum fibrinogen was associated with a 6.8% decrease in FEV1% predicted (95% CI: -10.2% to -3.4%, p < 0.001). Conclusion: Elevated serum fibrinogen levels are associated with more severe COPD, characterized by lower lung function, increased symptom burden, and a higher degree of airflow limitation. Serum fibrinogen shows potential as a marker of clinical severity in COPD patients.

Background: Regular exercise elicits profound cardiovascular adaptations, spanning molecular signaling, structural remodeling, and functional enhancements, which collectively improve aerobic capacity, vascular health, and resilience against cardiovascular diseases. These adaptations vary significantly by training modality—endurance (e.g., running, cycling), resistance (e.g., weightlifting), high-intensity interval training (HIIT), or combined approaches—due to distinct hemodynamic and metabolic demands. Despite growing research, a comprehensive synthesis comparing these modalities in humans, particularly integrating molecular mechanisms with structural and functional outcomes, is limited. This systematic review aims to elucidate modality-specific effects to guide evidence-based exercise prescriptions for healthy and clinical populations, such as those with heart failure or hypertension. Methods: We conducted a systematic review following PRISMA 2020 guidelines, searching PubMed, Scopus, Web of Science, and Google Scholar from inception to August 2025. Inclusion criteria encompassed peer-reviewed randomized controlled trials (RCTs) or meta-analyses in English, involving human adults (>18 years), with exercise interventions lasting ≥4 weeks, comparing at least two training modalities (endurance, resistance, HIIT, or combined), and reporting molecular (e.g., gene expression), structural (e.g., hypertrophy), or functional (e.g., VO2max) cardiovascular outcomes. Exclusion criteria included animal studies, acute exercise protocols, non-cardiovascular outcomes, and non-comparative studies. Meta-analysis was planned using random-effects models if data homogeneity permitted. Results: From 1,256 unique records, 842 were screened by title and abstract, 156 full-texts assessed, and 28 human studies included (22 RCTs, 6 meta-analyses; ~4,500 participants). Endurance training induced eccentric left ventricular hypertrophy (LV mass increase of 15–25%), upregulated PGC-1α (30–50%), and improved flow-mediated dilation (FMD; 20–30%). Resistance training promoted concentric hypertrophy (wall thickness ↑10–20%), activated PI3K/Akt (15–25%), and reduced blood pressure (3–5 mmHg). HIIT enhanced VO2max (20–30%) and AMPK activation (SMD 1.5–2.0). Combined training reduced vascular stiffness (pulse wave velocity ↓1–2 m/s) and amplified eNOS expression (SMD 1.3–1.9). Molecularly, endurance and HIIT increased miR-222 (25–40%), while resistance reduced C/EBPβ. Structurally, endurance and HIIT increased capillary density (10–15%). Functionally, cardiac output rose 4–8-fold, with resting bradycardia (↓30–40 bpm) and stroke volume ↑10–20%. HIIT outperformed endurance in heart failure (ejection fraction ↑5–10%). Males showed greater hypertrophy; females had better vascular responses.

Introduction: Urticaria is a common mast cell–mediated skin disorder characterized by transient wheals, angioedema, or both. Acute urticaria (AU) often follows infections or drug exposure, whereas chronic urticaria (CU) may persist for months to years, frequently with associated comorbidities and few identifiable triggers such as physical stimuli. Data comparing AU and CU in the same population are limited, particularly in Indian tertiary care settings. Study was aimed to assess and compare the demographic profile, clinical history, triggers, comorbidities, laboratory findings, disease activity, and clinical patterns of AU and CU patients. Material and Methods: A descriptive, cross-sectional study was conducted over 18 months, enrolling 100 patients each with AU (<6 weeks’ duration) and CU (≥6 weeks’ duration) attending the Department of Dermatology, Venereology, and Leprosy (DVL), Mamata Academy of Medical Sciences, Hyderabad. Detailed history was recorded, including triggers, frequency, nocturnal variation, recurrence, medication use, and family history of atopy/autoimmunity. Physical examination assessed active lesions, angioedema, dermographism, and inducible patterns. Baseline investigations included CBC, ESR/CRP, fasting glucose, and lipid profile. CU disease activity was assessed using the Urticaria Activity Score over 7 days (UAS7).  Results: Mean age was 34.8 ± 14.2 years in AU and 36.9 ± 13.7 years in CU, with a female predominance (60% and 65%, respectively). Infections were the most common AU trigger (46%), while unidentifiable triggers were most common in CU (70%). Drugs accounting to 10%. Inducible urticaria was rare in AU (6%) but occurred in 26% of CU patients. Angioedema was observed in 28% of AU and 42% of CU. Comorbidities were more frequent in CU: atopic disorders (32% vs 18%), autoimmune diseases (16% vs 4%), metabolic syndrome components (22% vs 10%), and psychiatric symptoms (20% vs 8%). Laboratory findings showed higher ESR, CRP, and dyslipidemia rates in CU. UAS7 scoring in CU revealed 18% well-controlled, 26% mild, 34% moderate, and 22% severe disease activity. Conclusion: CU patients in this cohort exhibited higher rates of no identifiable triggers inducible patterns, angioedema, comorbidities, and elevated inflammatory/metabolic parameters compared to AU. These findings align with global literature and highlight the need for comprehensive evaluation, comorbidity screening, and individualized management in CU.

Introduction: Early detection of inflammatory progression in hospitalized patients is vital for timely intervention. Serum ferritin and C-reactive protein (CRP) are key acute-phase reactants, but the prognostic value of their serial measurements is underexplored. To assess the utility of serial ferritin and CRP measurements in predicting inflammatory progression during hospitalization. Methods: A prospective observational study was conducted among 73 adult inpatients with inflammatory conditions. Patients were classified into progression (n = 25) and no-progression (n = 48) groups based on clinical outcomes. Serum ferritin and CRP levels were measured on Days 1, 3, and 5. Intergroup comparisons, temporal trends, and independent predictors were analyzed using repeated measures statistics and logistic regression. Results: Baseline ferritin and CRP levels were significantly higher in the progression group (median [IQR]: 418.0 [184.8–549.5] ng/mL and 88.2 [62.2–103.3] mg/L) than in the no-progression group (128.6 [71.8–226.9] ng/mL and 23.1 [16.4–27.9] mg/L; p < 0.001 for both). CRP percent change from Day 1 to Day 5 showed excellent discrimination for progression (AUC 0.996; sensitivity 96%; specificity 100%; cut-off +33.6%). Logistic regression identified baseline CRP (OR 14.45, 95% CI 3.00–69.61, p = 0.001) and ferritin (OR 4.17, 95% CI 1.28–13.58, p = 0.018) as independent predictors. Conclusion: Serial monitoring of ferritin and CRP enhances early detection of inflammatory progression. A >33.6% CRP increase over five days is a strong predictor, warranting closer surveillance and potential intervention.

Introduction: Congenital Heart Disease (CHD) is the one of the most common malformations.The incidence of CHD has remained fairly constent over years. There has been increase in Incidence in recent years.Recognition of CHD in newborn period is important as some of the CHDs have significant mortality and morbidity. Aims and objectives

Aim: To determine the incidence of congenital heart disease (CHD) among intramural live born neonates.

Objectives:

1. To study the clinical presentation of the neonates with CHD
2. To establish the relation between the symptoms /signs suggestive of CHD with echocardiographic finding.
3. To identify the common extra cardiac manifestations associated with CHD
4. To evaluate the influence of echo cardio graphic examination in the clinical management of the sick neonate suspected to have CHD

Materials and Methodology: All babies born in the hospital suspected to have CHD formed the subjects. An informed consent was taken from parents after explaning the procedure of the study and same was given in print. INCLUSION CRITERIA: Inborn babies and EXCLUSION CRITERIA: Outborn neonates. STUDY DESIGN: Prospective observational study. Results: Congenital heart diseases (CHD) among total 1819 deliveries comprised of 37 cases (2%). Incidence of 20.3|1000 Live birth was obtained for CHD. Asymptomatic murmur was the most common clinical presentation (67%). In those babies who had symptoms in addition to murmur, the number of ECHO proved CHDs were found to be high (75%)., 13% of the babies with CHD were found to have some extra-cardiac malformations; Conclusions: Incidence of Congenital heart disease is high in our study. VSD and PDA are the commonest CHDs Symptomatic murmur had a higher yield of CHD on echocardiogram. Clinical follow-up is needed for babies who presented with murmurs without symptoms. Early diagnosis by combined clinical examination and Echocardiography helps in planning effective treatment thereby reducing morbidity and mortality

Introduction: Endoscopic sinus surgery (ESS) is frequently performed under general anesthesia, where intraoperative bleeding can impair visualization and surgical precision. Controlled hypotension using agents like dexmedetomidine or remifentanil may improve surgical field quality and patient outcomes. Objective: To compare the efficacy of continuous infusions of dexmedetomidine and remifentanil in optimizing surgical field quality, surgeon satisfaction, hemodynamic stability, anesthetic requirements, prevention of emergence agitation, and incidence of postoperative nausea and vomiting (PONV). Methods: In this prospective, randomized, double-blinded controlled trial, 60 patients (ASA physical status I–II, aged 18–60 years) undergoing ESS for chronic sinusitis or nasal polyposis were randomized into two groups (n=30 each): Group D (dexmedetomidine infusion at 0.4 mcg/kg/h) and Group R (remifentanil infusion at 0.05 mcg/kg/min). Anesthesia was induced with fentanyl (2 mcg/kg) and propofol (2 mg/kg), and maintained with isoflurane. Hemodynamic parameters (mean arterial pressure [MAP] and heart rate [HR]), surgical field quality (6-point scale), surgeon satisfaction (5-point scale), emergence agitation scores, and PONV incidence were assessed. Data were analyzed using Student's t-test or chi-square test, with p < 0.05 considered significant. Results: Baseline characteristics were comparable between groups. Group R exhibited significantly lower intraoperative MAP and HR at 30-, 60-, and 90-minutes post-incision (p < 0.05), but Group D showed greater hemodynamic stability and lower emergence agitation scores (1.2 ± 0.3 vs. 2.0 ± 0.4; p < 0.05). Surgical field scores (2.0 ± 0.5 vs. 1.8 ± 0.6; p = 0.12) and surgeon satisfaction (4.5 ± 0.4 vs. 4.6 ± 0.3; p = 0.42) were similar. PONV incidence was 10% in Group D and 16% in Group R (p = 0.45). Anesthetic requirements were lower in Group D. Conclusion: Both agents effectively enhance surgical field quality in ESS. Dexmedetomidine provides superior hemodynamic stability and reduced emergence agitation, while remifentanil offers faster hypotension onset. Selection should consider patient-specific factors

Introduction: A common clinical appearance of blunt force injury to the head is a post-traumatic scalp hematoma, which is frequently accompanied by localized inflammation, discomfort, and swelling of soft tissues. Aims: To compare the efficacy and safety of systemic enzyme therapy (Trypsin-Bromelain-Rutoside) versus Paracetamol-Ibuprofen combination in the treatment of post-traumatic scalp hematoma. The study aims to evaluate reduction in swelling, pain relief, and overall patient recovery. Materials & methods: A prospective, randomized, open-label, active-controlled clinical trial study. Place of Study were Barasat Government Medical College and hospital. The study was conducted over a period of one year, from 1st January to 31st December and a total of 100 patients with post-traumatic scalp hematoma were included in this study, Result: In our study, both groups showed a progressive reduction in hematoma volume over time; however, Group A demonstrated a significantly faster resolution compared to Group B. At baseline, hematoma sizes were comparable (12.8 ± 2.1 vs. 13.1 ± 2.4 cm³; p = 0.47). By Day 3, Group A showed a significantly smaller mean hematoma volume than Group B (9.1 ± 2.0 vs. 10.6 ± 2.2 cm³; p = 0.002). This difference became more pronounced on Day 7 (5.2 ± 1.6 vs. 7.4 ± 1.9 cm³; p < 0.001) and Day 14 (1.1 ± 0.8 vs. 3.8 ± 1.3 cm³; p < 0.001) Conclusion: This randomized active-controlled study shows that trypsin-bromelain-rutoside systemic enzyme therapy is superior to paracetamol-ibuprofen for treating post-traumatic scalp hematoma.  At every follow-up point, Group A patients showed improved edema scores, increased pain reduction, and noticeably quicker hematoma clearance

Introduction: One popular surgical procedure used to treat gallstones is cholecystectomy. In certain situations, though, it might be difficult, which raises morbidity and mortality. Objective of this study is to assess the risk variables for challenging cholecystectomy. Gallstone disease, also known as cholelithiasis, is one of the most common biliary ailments in the world and has a major effect on public health. Aims: To evaluate the prevalence of difficult cholecystectomy. To identify the predictive factors for difficult cholecystectomy. To evaluate the relationship between these factors and the outcome of the surgery. Materials & methods: This is a prospective observational study study place PCS Govt Medical College & Hospital, Arambagh, Hooghly, West Bengal. The study was conducted over a period of one year, from July 2024 to June 2025. And total number of patients are 272. Result: In our study of 272 patients, 152 (55.9%) had a total preoperative score of 0–2 indicating an easy laparoscopic cholecystectomy, 88 (32.4%) had a score of 3–4 indicating difficult surgery, and 32 (11.7%) had a score ≥5 suggesting a very difficult procedure or conversion to open surgery, with the distribution being statistically significant (p < 0.001). Conclusion: We concluded that numerous laparoscopic cholecystectomies were found to be challenging in this study, which are included in our 272 patients.  Several important preoperative predictors were found. Increased surgical difficulties was linked to factors such advanced age, male sex, high body mass index, history of acute cholecystitis, palpable gallbladder, impacted stone in Gall bladder neck.

Introduction: Type 2 diabetes mellitus (T2DM) is among the most common forms of chronic metabolic disorders, accounting for about 90% of all people with diabetes. Carotid intima-media thickness (CIMT) is related to cardiovascular risk factors and diseases, and its measurement by means of ultrasound makes it possible to detect thickening in the initial phases of atherosclerosis. Methodology: It was an observational cross-sectional study. It included 120 patients according to inclusion criteria. The study was approved by institutional ethical committee and all participants signed informed consent forms before enrolment. It was an observational cross-sectional study. It included 120 patients according to inclusion criteria. The study was approved by institutional ethical committee and all participants signed informed consent forms before enrolment. patint were enrolled according to inclusion and exclusion criteria.  Result: Majority patients were within the 51-60 years age group (34.2%), followed by the 61-70 years (28.3%) and 41-50 years (15.8%) age groups. A significant proportion of patients (37.5%) had normal or near-normal right CIMT values (≤0.80 mm). However, a combined 55% of patients exhibited increased CIMT values, with 25% in the 0.81-1.00 mm range and 30% in the 1.01-1.20 mm range, suggesting subclinical atherosclerosis., more than half of the patients (64.2%) showed increased CIMT values, with 25.8% in the 0.81-1.00 mm range, 30.0% in the 1.01-1.20 mm range, and 8.3% with values exceeding 1.21 mm. Conclusion: We find that patients with poorly controlled type 2 diabetes (DM2) who have macrovascular disease show more severe vascular dysfunction, as indicated by non-invasive markers of subclinical atherosclerosis. Additionally, patients who have been diagnosed with diabetes for less than 5 years tend to have a significantly better vascular profile.

Background: Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality worldwide, with risk factors often beginning early in life. Understanding the prevalence of these risk factors and assessing knowledge among school children is essential for effective preventive strategies. Aims & Objectives: To assess the prevalence of cardiovascular risk factors among school children and to evaluate their knowledge regarding these risk factors. Materials & Methods: A prospective cross-sectional observational study with a mixed-methods design was conducted from January 2024 to December 2024 in Singur Anandanagar (A Rural area of West Bengal). The study population comprised school children aged 10 to 16 years, with a total sample size of 250 students. Stratified random sampling was employed to ensure adequate representation across various age groups, genders, and rural schools. Results: This cross-sectional study involved 250 school students aged 11–15 years, with a mean age of 12.7 ± 1.2 years. The age distribution was found to be statistically significant (p=0.031). Among the participants, 130 (52%) were boys and 120 (48%) were girls, and this gender difference was not statistically significant (p=0.457). Conclusion: This study highlights a significant prevalence of cardiovascular risk factors among school children in rural West Bengal, with gender-based differences in BMI, blood pressure, physical activity, and dietary habits

Background: Cardiac autonomic neuropathy (CAN) is a common but underdiagnosed complication of type 2 diabetes mellitus (T2DM), associated with increased morbidity and mortality. QTc interval and QT dispersion (QTd) are potential non-invasive markers for detecting CAN early in its course. Aim: To calculate QTc prolongation and QT dispersion in patients with T2DM, compare findings between those with and without CAN, and evaluate the diagnostic significance of these parameters. Material and Methods: A total of 120 T2DM patients underwent electrocardiographic assessment and cardiac autonomic function tests. QTc intervals were calculated using Bazett’s formula, and QT dispersion was determined from 12-lead ECGs. Data were analyzed to correlate QT metrics with CAN presence and severity. Results: Patients with CAN had significantly higher QTc intervals and QTd values. A higher prevalence of microvascular complications was also observed in these patients. QT abnormalities correlated well with the severity of CAN as determined by Ewing’s tests. Conclusion: QTc prolongation and QT dispersion are valuable non-invasive indicators for detecting cardiac autonomic neuropathy in diabetic patients. Their integration into routine screening may facilitate early diagnosis and improved clinical outcomes.

Background:  One of the most important of the five senses in human beings is hearing. It plays an important role in the development of speech, cognitive and communication skills. The decrease in length, quality of life and depletion of social networks can be caused by hearing impairment. Therefore, the sense of hearing, perception of sound and its biological purposes, can’t be lightly dismissed. Diabetes mellitus is a common metabolic disorder that causes impairment in various systems of the body. One of the complications of diabetes mellitus is hearing impairment and tinnitus which in turn leads to decreased quality of life in affected individuals. Aims and Objectives: 1. To detect Hearing loss, among patients with Type 1 Diabetes Mellitus based on age, gender and duration of diabetes and glycemic control. 2. To assess hearing loss corelation with the duration of the disease.  Materials and Methods: A total of 100 patients with type 1 diabetes, aged 35 to 70 years, were randomly selected to participate. All patients underwent clinical ear examinations and were referred for full audiological evaluation.  Results: Of the 100 patients with diabetes, 61% of patients are in the age group of 45-65 with male preponderance. 70 patients had SNHL, out of which 63.3% had moderate-moderately severe severity of hearing loss 63% of patients had diabetes duration of more than 15 years. Conclusion: Hearing loss is an underestimated comorbid condition in diabetic patients that needs frequent audiometric assessments and management. Early detection and treatment of diabetes and strict glycemic control prevent SNHL. Audiometry should be considered a routine test for diabetic patients by healthcare workers. Interventions should be aimed at controlling factors that may cause morphological and functional changes in the cochlea are critical in managing diabetic hearing damage.

Background: Salivary gland lesions present a diagnostic challenge due to their complex histomorphological spectrum and cytological overlap between benign and malignant entities. Fine-needle aspiration cytology (FNAC) is widely used as a minimally invasive, cost-effective, and efficient tool for preoperative evaluation. However, issues such as sampling errors and interpretative pitfalls can impact its diagnostic accuracy. This study aimed to assess the diagnostic performance of FNAC in salivary gland lesions by correlating cytological findings with histopathological outcomes. Materials And Methods A retrospective study was conducted at the Department of Pathology, Government Medical College, Srikakulam, over a two-year period (January 2023 to December 2024). A total of 93 cases with salivary gland swellings underwent FNAC, out of which 44 cases had subsequent histopathological evaluation following surgical excision. Demographic details, anatomical site, FNAC diagnosis, and histopathological findings were analyzed to determine sensitivity, specificity, and concordance rates. Results Among the 93 patients, the majority were male (55.91%) with a mean age of 35.42 years. The parotid gland was most frequently affected (72.04%). FNAC diagnoses included 41.93% non-neoplastic, 43.01% benign neoplasms, and 15.05% malignant lesions. Cytohistological correlation was available in 44 cases, showing a concordance rate of 93.18%, with discrepancies noted in three cases. FNAC demonstrated a sensitivity of 66.7%, specificity of 95.2%, positive predictive value of 80%, and negative predictive value of 90.9%. Conclusion: FNAC is a reliable initial diagnostic modality for salivary gland lesions, particularly when interpreted by experienced cytopathologists. Despite some limitations in cystic and low-grade malignant tumors, its high specificity and strong negative predictive value make it invaluable in clinical decision-making. Image-guided FNAC and continuous diagnostic training are recommended to further enhance its accuracy.

Background: The diagnosis of acute appendicitis is mainly based on clinical assessment. Despite its high prevalence, the diagnosis of appendicitis remains challenging. Different diagnostic modalities have been developed to facilitate surgical decisions and avert negative appendectomy. To date, many inflammatory markers have been used for the diagnosis of acute surgical conditions, including acute appendicitis.  Leucocyte count and C-reactive protein (CRP) are the most commonly used laboratory tests.  AIM: To evaluate the diagnostic accuracy of C-reactive protein and leucocyte count in operated cases of suspected acute appendicitis. Methods: A prospective study was conducted on 50 patients operated on an emergency basis for suspected acute appendicitis admitted in the department of general surgery, Mamata general hospital, during October 2020 – September 2022. After obtaining institutional ethical committee clearance, informed consent was taken from the patients. Apart from taking detailed history all the patients were subjected to routine investigations including complete blood picture (CBP) and CRP. CRP >6mg/dl and Total Leucocyte count (TLC) >11000/mm3 were considered positive. TLC and CRP levels were correlated with postoperative histopathological diagnosis to determine their diagnostic accuracy in acute appendicitis. Results: In the present study, there is male predominance (52%) and the maximum number of cases were in the age group of 11-29 years (62%). Histopathology confirmed acute appendicitis in 41 cases (82%). CRP, TLC and neutrophil percentage were raised in 73.18% (30 of 41), 75.6% (31 of 41) and 87.89% (36 of 41) of HPE positive cases respectively. All the three parameters were normal in HPE negative cases. Conclusion: Normal preoperative serum CRP levels, TLC & Differential Count (DC) in patients with clinically suspected acute appendicitis are most likely associated with a normal appendix. By avoiding surgeries in such cases, we can avoid negative appendectomy rates.

Introduction: Acute cerebral venous thrombosis (CVT) is an uncommon but treatable cerebrovascular disorder with heterogeneous presentations and imaging patterns. Functional outcomes in modern cohorts are generally favorable, with 80–90% achieving independence at follow-up; nevertheless, a subset suffers persistent headaches, cognitive or mood symptoms, epilepsy, or visual deficits, underscoring the importance of structured follow-up and rehabilitation. Contemporary data suggest improving outcomes with timely diagnosis and anticoagulation, including direct oral anticoagulants (DOACs). Materials & Methods: We conducted a prospective, single-center observational study of consecutive adults with radiologically confirmed acute CVT over 24 months. Demographics, risk factors, clinical features, neuroimaging, treatment, and outcomes—modified Rankin Scale (mRS) at discharge and 3 months—were recorded. A standardized case-record form captured demographics, vascular risk factors, hormonal exposures, peripartum status, infection, dehydration, malignancy, and thrombophilia testing (protein C/S deficiency, antithrombin, factor V Leiden, prothrombin G20210A, antiphospholipid antibodies), when clinically indicated. Presenting features included headache characteristics, seizures, focal deficits, papilledema, altered sensorium, and blood pressure.  Results: Among 120 patients (mean age 32.8±10.6 years; 68% women), headache (82%), seizures (38%), and focal deficits (33%) predominated. Superior sagittal (61%) and transverse sinuses (49%) were commonly involved; 28% had cortical vein thrombosis. Parenchymal lesions occurred in 41% (venous infarct 29%, hemorrhage 22%). All received heparin followed by vitamin-K antagonists or DOACs; 46% were discharged on DOACs. In-hospital mortality was 2.5%. Favorable functional outcome (mRS 0–2) occurred in 78% at discharge and 88% at 3 months. Conclusion: Most patients with acute CVT are young women with headache-predominant presentations and multisinus involvement. Early anticoagulation—often transitioned to DOACs—is associated with high rates of good functional recovery.

Background: Critically ill patients in the intensive care unit (ICU) face a high risk of mortality, and early, accurate prognostication is essential to guide management decisions. While the Sequential Organ Failure Assessment (SOFA) score is a widely accepted prognostic tool, its predictive ability may be enhanced by incorporating additional biomarkers such as serum albumin. This study aimed to assess the prognostic utility of serial serum albumin levels and their correlation with SOFA scores in predicting ICU outcomes. Methods: A prospective observational study was conducted over 12 months in the ICU of Sri Aurobindo Medical College & PG Institute, Indore, involving 100 critically ill adult patients. SOFA scores and serum albumin levels were measured on Days 0, 3, and 5. Patients were categorized into three groups based on albumin levels (>3.5, 3.5–2.0, and <2.0 g/dL). Clinical outcomes, including ICU stay duration and mortality, were recorded. Logistic regression, ROC analysis, and Kaplan–Meier survival curves were used to evaluate prognostic performance. Results: The overall mortality rate was 26%. Non-survivors had significantly lower serum albumin and higher SOFA scores at all time points (p<0.001). Hypoalbuminemia was significantly associated with comorbidities, elevated lactate, and organ dysfunction. The SOFA + albumin composite score consistently outperformed SOFA or SOFA + lactate models in predicting mortality, with Day 5 AUC reaching 0.738. A score ≥21 on Day 5 predicted >90% mortality. Kaplan–Meier analysis confirmed significant survival stratification based on SOFA + albumin scores. Conclusion: Serial serum albumin levels, when combined with SOFA scoring, serve as a reliable and cost-effective prognostic tool in critically ill patients, enabling improved risk stratification and resource allocation in the ICU.

Introduction: When an individual passes away in a large, densely populated, and diverse country like India, identifying the deceased is a critical task with significant legal implications. Forensic pathologists face a considerable challenge in this environment, as the rapid rate of decomposition and other post-mortem changes can quickly degrade a body. However, skeletal remains, particularly bones, are more resistant to these processes and can provide valuable evidence for a longer period. Stature is one of the most important data for identification, necessitated by medico-legal experts or medical jurisprudence as well as in anthropological research. Given the different factors influencing human development (e.g., racial factors, dietary habits, occupational status, etc.), this study will attempt to establish a relationship between human stature and percutaneous ulnar and radius length on both sides, as well as to correlate with sex. In the current study, an attempt has been made to determine the linear relationship between stature and percutaneous length of Right Radius of male students studying in 2nd and 3rd Phase of MBBS Examination in a Government College of West Bengal Materials And Methods: After getting institutional ethical committee clearance, the study was conducted over the 122 Male Undergraduate Students screened through the inclusion and exclusion criteria. Results: In the current study, the study population comprises of 122 Male undergraduate students of 2nd and 3rd phase of MBBS Curriculum, selected through the complete enumeration method. This study was conducted to establish a correlation and linear regression between the percutaneous lengths of the right radius with stature. The mean height of male subjects was 171.37 ± 5.726 cm. The mean percutaneous length of the right radius was 27.29 ± 1.340 cm. The radius also showed a strong correlation with stature: Right radius: r = 0.818, p < 0.0001. Regression analysis was performed to derive equations for estimating stature from right radial lengths: Right radius: Y=3.30X+81.17Y = 3.30X + 81.17. Conclusion: The morphometrical determination of stature from right radial length will help to reduce the subjective variation to an extent that can be modified and sophisticated later through more thorough detailing.

Introduction: Acute cerebral venous thrombosis (CVT) is an uncommon but treatable cerebrovascular disorder with heterogeneous presentations and imaging patterns. Functional outcomes in modern cohorts are generally favorable, with 80–90% achieving independence at follow-up; nevertheless, a subset suffers persistent headaches, cognitive or mood symptoms, epilepsy, or visual deficits, underscoring the importance of structured follow-up and rehabilitation. Contemporary data suggest improving outcomes with timely diagnosis and anticoagulation, including direct oral anticoagulants (DOACs). Materials & Methods: We conducted a prospective, single-center observational study of consecutive adults with radiologically confirmed acute CVT over 24 months. Demographics, risk factors, clinical features, neuroimaging, treatment, and outcomes—modified Rankin Scale (mRS) at discharge and 3 months—were recorded. A standardized case-record form captured demographics, vascular risk factors, hormonal exposures, peripartum status, infection, dehydration, malignancy, and thrombophilia testing (protein C/S deficiency, antithrombin, factor V Leiden, prothrombin G20210A, antiphospholipid antibodies), when clinically indicated. Presenting features included headache characteristics, seizures, focal deficits, papilledema, altered sensorium, and blood pressure.  Results: Among 120 patients (mean age 32.8±10.6 years; 68% women), headache (82%), seizures (38%), and focal deficits (33%) predominated. Superior sagittal (61%) and transverse sinuses (49%) were commonly involved; 28% had cortical vein thrombosis. Parenchymal lesions occurred in 41% (venous infarct 29%, hemorrhage 22%). All received heparin followed by vitamin-K antagonists or DOACs; 46% were discharged on DOACs. In-hospital mortality was 2.5%. Favorable functional outcome (mRS 0–2) occurred in 78% at discharge and 88% at 3 months. Conclusion: Most patients with acute CVT are young women with headache-predominant presentations and multisinus involvement. Early anticoagulation—often transitioned to DOACs—is associated with high rates of good functional recovery.

Background and Objectives: The relationship between diabetes and hearing loss has been widely studied over the years. However, limited research has focused on this association within our local population. This study aimed to determine the prevalence of hearing loss in individuals with type 2 diabetes mellitus compared to healthy, non-diabetic controls using pure tone audiometry. It also analyzed the influence of age and duration of diabetes on hearing ability.  Methods:  A comparative study was conducted at the Department of ENT, Andhra Medical College, from March to July 2025. The study population was divided into two groups: Group A comprised 50 individuals diagnosed with type 2 diabetes, while Group B included 50 healthy controls matched for age and gender, with no history of diabetes. All participants underwent pure tone audiometry to assess the type and severity of hearing impairment. The prevalence of hearing loss was expressed as a percentage. The relationships between age and hearing loss, as well as diabetes duration and hearing loss, were analyzed using the chi-square test. A p-value less than 0.05 was considered statistically significant.  Results:  Among the 50 diabetic participants, 33 (66%) had bilateral, mild sensorineural hearing loss. A prevalence of 66% of SNHL was found among diabetics, compared to 4% in the control group. Sensorineural hearing loss (SNHL) was most prevalent among participants with a diabetes duration exceeding 10 years (95%), followed by those with 5 to 10 years of diabetes (87.5%). Notably, none of the individuals with diabetes for less than five years exhibited SNHL.  Conclusion:  Hearing loss is common among individuals with type 2 diabetes mellitus, primarily presenting as bilateral, mild SNHL. The likelihood of developing sensorineural hearing loss (SNHL) rises significantly after five years of type 2 diabetes mellitus, reaching its peak among individuals with a disease duration of more than ten years. These findings underscore the importance of early audiological screening using pure tone audiometry in diabetic patients, particularly as the duration of the condition progresses.  

Background: Surgical Site Infections (SSIs) remain a significant cause of postoperative morbidity, especially following emergency abdominal surgeries. This study aimed to compare the incidence, risk factors, microbial profile, and clinical features of SSIs in emergency versus planned abdominal surgeries in a tertiary care hospital. Methods: A total of 82 patients were included, with 41 undergoing emergency and 41 planned surgeries. Data on patient demographics, comorbidities, type and duration of surgery, wound classification, microbial isolates, and clinical signs were collected and analyzed. The incidence of SSIs, contributing risk factors, and organism profiles were compared between groups. Results: SSIs were significantly more frequent in emergency surgeries 17 (41.46%) compared to planned surgeries 6 (14.63%). The highest SSI rate in the emergency group was observed in the 31–45 years age group 7/12 (58.33%), while in the planned group, the ≥60 years group had the highest rate 3/8 (37.50%). Diabetes, anemia, and smoking were strongly associated with higher SSI incidence, particularly in emergency cases. Procedures such as intestinal perforation peritonitis repair 6/9 (66.67%) and peptic perforation repair 3/5 (60.00%) showed the highest infection rates. Dirty and contaminated wounds in emergency surgeries were associated with the greatest risk, whereas no infections occurred in similar wound categories in the planned group. Longer operative duration (≥60 minutes) was also linked to increased SSI rates in both groups. Escherichia coli was the most commonly isolated organism in emergency surgeries 10/17 (58.82%), while Staphylococcus aureus was more prevalent in planned cases 3 (50.00%). Clinical signs such as tachycardia, wound discharge, and fever were more commonly observed in emergency SSIs. Conclusion: Emergency abdominal surgeries are associated with a significantly higher risk of SSIs due to factors such as comorbidities, contaminated or dirty wound status, and longer operative durations. Implementation of targeted infection prevention strategies, timely prophylactic antibiotic use, optimization of patient health, and adherence to aseptic protocols are essential, particularly in emergency settings. Knowledge of local microbial patterns can further guide effective empirical treatment and improve surgical outcomes.

Pulmonary arterial hypertension (PAH) is a progressive condition characterized by elevated pulmonary artery pressure, which can lead to right heart failure if left untreated. Emerging evidence suggests a potential link between PAH and hematological deficiencies, particularly iron deficiency anaemia (IDA) and vitamin B12 deficiency anaemia. This study aims to evaluate the prevalence of PAH among patients diagnosed with IDA and vitamin B12 deficiency anaemia. Through a systematic analysis of clinical data, we assess the impact of these deficiencies on pulmonary vascular physiology. The findings may provide insights into potential pathophysiological mechanisms and suggest considerations for early intervention. Our study evaluated 850 patients diagnosed with IDA and vitamin B12 deficiency. A total of 500 patients had IDA, and 350 had vitamin B12 deficiency. The prevalence of PAH was found to be significantly higher in the anaemic cohort than in the general population. PAH was diagnosed in 17% of IDA patients and 12% of vitamin B12 deficient patients. The study also identified significant gender-based differences, with females exhibiting a higher prevalence of PAH. Additionally, statistical correlations between haemoglobin levels, ferritin, and pulmonary arterial pressures further support a mechanistic relationship between anaemia and PAH.

According to the findings of this research, mesoporous nanoparticles have the potential to be utilized in the evaluation of the efficacy of a mesoporous carrier for a pharmaceutical candidate that is extremely water insoluble. Mesoporous nanoparticles were selected on the basis of their ability to deliver drug candidate that has a low water solubility. It was via the use of SEM, IR, DSC, and PXRD that we were able to explain the properties of mesoporous nanoparticles. The size of MSNs found to be in range of  98–100 nm. with 322 m²/g surface area and 3.07 nm pores diameter. AZM MSNs having hardness (3.10–4.44 kg/cm²) and friability (<0.42%), and its faster disintegration (112–170 sec). The 82% drug loading was found in mesoporous silica nanoparticles. AZM-MSNs were 6.5 times more soluble at pH 1.2 (F11 batch) compared with pure drug.  A method known as in-vitro dissolution will be utilized to determine the proportion of drug release. The encapsulation of a hydrophobic amorphous drug candidate within mesoporous materials provides a practical method for improving and increasing the dissolution of active pharmaceutical ingredients (API). This is because in-vitro dissolution is strongly connected with bioavailability. By altering the parameters of the synthesis process, it is possible to alter the shape, pore size, volume, and particle size of mesoporous nanoparticles. As a result of their exceptional characteristics, which include a highly mesoporous structure, a considerable pore volume, an adjustable pore size, improved biocompatibility, and thermal stability, mesoporous materials are utilized as drug carriers.

Background: Decompensated chronic liver disease (DCLD) is linked to an imbalance in water regulation, resulting in abnormalities in sodium levels, known as dysnatremias. Hyponatremia occurs when water and sodium are imbalanced, with an excess of water relative to sodium. It is the predominant electrolyte abnormality observed in individuals who are hospitalized, particularly those with DCLD. Hypernatremia is a rare condition in individuals with DCLD, often caused by the use of osmotic diuretic medications and upper gastrointestinal (UGI) hemorrhage, which is associated with higher mortality rates. Research Question: What is the distribution and association of serum sodium levels among decompensated chronic liver disease patients in relation to clinico-sociodemographic factors in our setup?  Methods: An observational study was conducted from Jane 2025 to July 2025 on approximately 100 DCLD patients admitted to the Department of General Medicine at Government Medical College/Government Teaching General Hospital, Rajamahendravaram. The study analyzed socio-demographic profiles, serum sodium levels, and their association with Child-Pugh score, MELD score, alcohol consumption, HBV infection, clinical features, complications and mortality. Results: The study found that: The disease burden was higher among  individuals aged 50-70 years (53%), with a mean age of 56 years.- Morbidity was significantly higher among males (98%) compared to females (2%).- Approximately 40% of study subjects had serum sodium levels between 131-135 mEq/L, 32% had levels ≥136 mEq/L, and 28% had levels ≤130 mEq/L.- Patients with high MELD scores were significantly associated with low serum sodium levels.- Complications such as ascites and portal hypertension were significantly associated with hyponatremia compared to hypernatremia.- A mortality rate of 15% was observed among study subjects who developed hyponatremia.

Background: Peripheral arterial disease (PAD) leads to significant morbidity and mortality in Diabetic population due to the development of “Diabetic Foot Syndrome”. Peripheral Arterial Disease (PAD) is underdiagnosed, undertreated, poorly understood and much more common than thought.  Despite its high morbidity and mortality, PAD remains underdiagnosed and undertreated. The ideal screening test for PAD should be inexpensive, non-invasive, accurate, easily administered and universally acceptable. Aims and Objective: To evaluate the effectiveness of Pulse Oximetry and Ankle Brachial Pressure Index (ABPI) in detecting Peripheral Arterial Disease (PAD) among patients with Diabetic Foot Ulcers. Materials and method: A hospital-based cross-sectional study was conducted in the Department of Surgery, Regional Institute of Medical Sciences (RIMS), Imphal, over a period of two years (December 2020 – November 2022). Patients with diabetic foot ulcers were assessed using both Pulse Oximetry and ABPI. Data were analysed using SPSS version 26.0 (IBM Inc.), with a p-value < 0.05 considered statistically significant. Results: Pulse Oximetry demonstrated an accuracy of 92.87%, with sensitivity of 88.88%, specificity of 96.87%, positive predictive value (PPV) of 94.11%, and negative predictive value (NPV) of 93.93%. ABPI showed an accuracy of 91.31%, sensitivity of 88.88%, specificity of 93.75%, PPV of 88.88%, and NPV of 93.75%. Conclusion: Both Pulse Oximetry and ABPI are effective, non-invasive screening tools for diagnosing PAD in diabetic foot ulcer patients. Pulse Oximetry, with its high specificity and ease of use, may serve as a valuable point-of-care diagnostic method, particularly in primary and resource-limited settings. Early identification and intervention can significantly reduce the risk of limb-threatening complications.

Background: Hypertension is a major public health problem, and uncontrolled blood pressure is strongly linked to end-organ damage, including coronary artery disease (CAD), congestive heart failure (CHF), left ventricular hypertrophy (LVH), stroke, and peripheral vascular disease. Microalbuminuria is common in established hypertension and serves as an early predictor of cardiovascular dysfunction. Screening for urinary albumin excretion enables early identification of high-risk individuals, facilitating timely interventions to reduce cardiovascular risk. Objectives: To determine the prevalence of microalbuminuria in non-diabetic essential hypertensive patients, evaluate its association with left ventricular mass index (LVMI), and assess correlations with duration of hypertension. Methods: This cross-sectional descriptive study included 100 patients attending the OPD and IPD of the Department of General Medicine, MIMS, Mandya, who met the inclusion and exclusion criteria. Baseline investigations, including urine microalbumin estimation and echocardiography, were performed. Statistical analyses were conducted to assess associations and correlations. Results: Microalbuminuria was present in 32% of participants, with a 90.6% prevalence among those with LVH. Duration of hypertension was significantly associated with microalbuminuria (p < 0.001). LV mass showed a strong positive correlation with microalbuminuria (r = 0.639, p = 0.017). Urinary creatinine levels were significantly higher in patients with microalbuminuria (p = 0.001). The albumin-to-creatinine ratio (ACR) demonstrated a strong positive correlation with microalbuminuria (r = 0.718, p < 0.001). Conclusion: Microalbuminuria shows a strong association with LVH, duration of hypertension, urinary creatinine, and ACR, indicating its potential as an early marker for predicting cardiovascular risk and related complications in essential hypertension.

Objective - To evaluate and compare the efficacy of microneedling with dermaroller and cryoroller as a single modality of treatment for post acne atrophic scars. Also, evaluate the objective and subjective improvement in post acne scars. Methodology - A prospective, analytical, comparative study was conducted on patients with post acne atrophic scars on face, presenting to DVL department, Government Medical College Ananthapur, Andhra Pradesh over a period of 17 months. The study was conducted after taking approval from the institutional ethics committee and informed consent from patients. Detailed history and clinical examination were done for all 30 patients. 6 sittings were performed at an interval of 3 weeks and followed up for 6 months. Grading was done by the blind observer using the Goodman and Baron qualitative and quantitative grading scale.  The patients were then randomized into two groups Microneedling and Cryoroller.  Results – Statistically significant difference was found between the pre and post procedure values. Maximum change was found in microneedling group from grade 4 to 2 in 2 patients, 3 to 1 in 2 patients. No change of grade in 2 patients. In cryoroller group, significant change was found from grade 4 to 2 in 3 patients, 3 to 1 in 2 patients. No change of grade in 2 patients. On comparing microneedling vs cryoroller on a quantitative scale, the cryoroller indicated a greater mean percentage of improvement. Conclusion - Both microneedling and cryoroller were an effective modality of treatment for post acne atrophic scars on face. Cryoroller was more effective in an atrophic scars and boxcar scars compared to microneedling. Cryoroller was a better technique than microneedling in the treatment of post acne atrophic scars on face. Microneedling was effective for icepick scars than cryoroller.

Background: The calcaneum is the largest tarsal bone and plays a pivotal role in weight transmission and subtalar joint stability through its articulation with the talus. Variations in the morphology of calcaneal talar facets influence subtalar joint mechanics and may predispose individuals to joint instability and arthritis. This study examines the prevalence and clinical significance of these facet patterns in the North Indian (Haryanvi) population. Methodology: A total of 104 dry human calcanei of unknown sex were examined in the Department of Anatomy, PGIMS Rohtak. Only fully ossified and undistorted specimens were included. The calcanei were categorized into five recognized talar facet patterns based on their morphology, and the incidence of each pattern was recorded. Results: Three out of the five recognized patterns were identified. Pattern I (a continuous facet on the sustentaculum tali) was the most prevalent (67%), followed by Pattern II (two separate facets—27%) and Pattern III (single facet with no anterior component—4%). Patterns IV and V were not observed. These findings mirror those reported in the Egyptian population. Literature suggests Pattern III provides greater subtalar joint stability and lower arthritic risk. Conclusion: The predominance of Pattern I in the Haryanvi population may contribute to a higher risk of ligamentous laxity and arthritic changes due to reduced subtalar joint constraint. Understanding calcaneal facet morphology is crucial for orthopedic diagnosis, surgical planning, and rehabilitation of foot disorders

Background: Acute coronary syndromes (ACS) are an emerging epidemic in India, driven by the rising prevalence of risk factors such as obesity, diabetes, hypertension, and dyslipidemia. Elevated red cell distribution width (RDW) has been identified as a strong predictor of mortality and major adverse cardiac events (MACE) in patients with acute myocardial infarction. Objectives: To determine RDW levels in patients with ACS and evaluate their association with mortality and major adverse cardiac events. Methods: This prospective study included 100 patients with ACS admitted to the Department of General Medicine, MIMS, Mandya. Baseline evaluation included a detailed history, risk factor assessment, clinical examination, and laboratory investigations—RDW, complete hemogram with peripheral smear, creatine phosphokinase-MB, troponin I, fasting lipid profile, liver and renal function tests, random blood sugar, and thyroid function tests—along with electrocardiography and echocardiography. Patients were followed for three months, during which repeat hospitalizations, mortality, and post-ACS cardiac status were recorded. Survivors underwent repeat electrocardiography and echocardiography. Results: Chest pain was the most common presenting symptom. The major risk factors identified were diabetes, hypertension, dyslipidemia, smoking, and alcohol use. Of the 100 patients, 31 had STEMI, 55 had NSTEMI, and 14 had unstable angina. Among 36 patients with arrhythmia, 32 had elevated RDW. All 36 patients who experienced repeat angina had elevated RDW. Of 38 patients with heart failure, 37 had high RDW. All three patients who died during follow-up had elevated RDW. Conclusion: RDW is a simple, cost-effective, and readily available parameter that can serve as a valuable adjunct in diagnosing ACS and predicting prognosis. Elevated RDW levels are strongly associated with adverse outcomes, including arrhythmia, recurrent angina, heart failure, and mortality, and may help guide timely medical or surgical interventions.

Introduction: Right ventricular (RV) function is the principal driver of symptoms and outcomes in pulmonary hypertension (PH), but whether RV phenotype differs systematically between cardiac (left-heart disease) and non-cardiac causes in routine practice remains clinically relevant. Objectives: To compare RV size and function between cardiac versus non-cardiac PH using standardized echocardiographic and clinical assessments, and to identify parameters that best discriminate etiology. Methods: We conducted a hospital-based cross-sectional study (n=100; cardiac PH n=51; non-cardiac PH n=49). Transthoracic echocardiography followed ASE/EACVI recommendations. Conventional indices (TAPSE, S′, FAC, RA area, PASP) and speckle-tracking RV free-wall longitudinal strain (RVFWLS) were measured by blinded readers. Functional status (WHO class, 6MWD) and NT-proBNP were recorded. Between-group comparisons used Welch t/χ² tests; multivariable logistic regression and ROC analyses assessed etiologic discrimination. Results: Cardiac PH had lower TAPSE (17.1±3.2 vs 18.8±2.4 mm; p=0.003) and S′ (9.6±1.7 vs 10.8±1.5 cm/s; p<0.001), larger RA area (25.8±5.9 vs 22.3±4.2 cm²; p=0.001), and less negative RVFWLS (−17.7±3.6% vs −19.6±3.7%; p=0.012) than non-cardiac PH, with similar PASP (61.7±12.1 vs 65.5±11.5 mmHg; p=0.105). NT-proBNP was higher in cardiac PH (1909±1282 vs 1162±827 pg/mL; p=0.001). Impaired RVFWLS (>−20%) was more frequent in cardiac PH (74.5% vs 53.1%; OR 2.59; p=0.043). In adjusted models, higher TAPSE favored non-cardiac PH (OR 0.81 per 1 mm; p=0.009) and larger RA area favored cardiac PH (OR 1.14 per 1 cm²; p=0.004). ROC AUCs for single predictors were 0.681 (TAPSE) and 0.687 (RA area); a combined model with TAPSE, RA area, PASP, and RVFWLS achieved AUC 0.755 (95% CI 0.652–0.850). Conclusions: RV longitudinal mechanics and RA remodeling are more adversely affected in cardiac-cause PH despite comparable pulmonary pressures. TAPSE and RA area are practical single-marker discriminators of etiology, and a simple multimarker panel further improves classification. These findings endorse multiparametric RV assessment to refine phenotyping and clinical decision-making in PH.

Introduction: Sickle cell anaemia (SCA) is a hereditary haemoglobin disorder characterized by abnormal haemoglobin S (HbS), leading to chronic haemolysis, Vaso-occlusion, and a variety of systemic complications. The urinary albumin-to-creatinine ratio (ACR) is a sensitive marker for detecting microalbuminuria, a precursor to overt kidney disease. In this study we have determined urinary ACR in adults with both sickle cell disease (SCD) and trait (SCT) and compare the values between these two groups. Materials And Methods: In this cross-sectional study total 40 spot urine samples (20 trait and 20 disease) of patients attending outpatient department (OPD) /In patient department (IPD) of medicine in Assam Medical College and Hospital were collected over a period of 6 months. Spot urine micro albumin, urine creatinine analysis done on Vitros 5600 Autoanalyzer. Results: Mean ± SD of urinary ACR (61.04±42.79) in patients with SCD is significantly (p value is 0.0023) higher than that of patients with SCT (26.33±20.74). Additionally, the urinary ACR is higher in patients aged 31–40 (71.66±50.96) than in those aged 21–30 (41.74±6.83), or in those aged ≤20 (19.00±6.73) for all the study participants. Conclusion: Urinary ACR serves as a valuable marker for assessing renal dysfunction in adults with sickle cell disease and trait. Since ACR increases with age, it could be a useful monitoring tool in adults with sickle cell related hemoglobinopathies. Monitoring Urinary ACR in such patients may improve the overall management of patients affected by sickle cell-related renal complications.

Background: Pretransfusion compatibility testing involves matching donor blood with the recipient's blood (ensuring correct ABO and Rh typing) to prevent adverse reactions during transfusion. A match is considered compatible when no visible immunological reaction occurs between the donor and recipient blood. Since the discovery of the ABO blood group system by Landsteiner in 1900 and the development of the antiglobulin (Coombs) test in 1945, serological testing in transfusion medicine has evolved significantly. Aim and Objective:  To compare the effectiveness of the gel card technique with the conventional tube method for pretransfusion compatibility testing. Materials and Methods: This retrospective data-based study of samples received between 1st January 2022 to 31st March 2022, included 1048 samples referred for crossmatching to a tertiary care hospital's blood bank. Blood grouping of both donor and recipient samples was confirmed using antisera A, B, and RhD. Following confirmation, crossmatching was performed using both the saline tube method and the gel card method. Results: Out of 1048 cases, majority cases were female 68% and 32% were male. The sensitivity of all three crossmatch methods is 100% but specificity of Conventional Tube Technique without AHG (Saline method) is 99.8% and while that of gel card and Conventional Tube Technique with AHG is 100%. The average time taken by Gel card method was 30 minutes for a single compatibility test whereas in conventional tube method with the use of AHG (IAT), average time required was 68 minutes and without AHG it was 45 minutes. Conclusion: The gel card method offers clear advantages over the conventional tube method. It provides more accurate and reproducible results, with reduced risk of false positives and false negatives. Interpretation is more objective, less time-consuming, and better suited for documentation. Conversely, although the tube method remains sensitive, it is more labor-intensive, subjective in interpretation, and not ideal for long-term record-keeping.

Background: Hyponatremia, defined as serum sodium <135 mEq/L, is one of the most common electrolyte disturbances encountered in emergency settings. Its diverse clinical presentation, ranging from nonspecific symptoms to life-threatening neurological manifestations, underscores the need for prompt diagnosis and etiological evaluation, particularly in resource-constrained settings like India where data are limited. The aim of the study was to assess the clinico-etiological profile of hyponatremia in patients presenting to the emergency department of a tertiary care hospital, and to identify the predominant symptom patterns, volume status, and contributing factors. Material & Methods: This was a single-centre, observational study conducted at Index Medical College Hospital and Research Centre, Indore, from April 2023 to March 2024. One hundred adult patients presenting with serum sodium <135 mEq/L were included. Detailed clinical assessments, volume status evaluation, and laboratory investigations (serum sodium, osmolality, urine sodium/osmolality) were performed. Patients were classified based on symptom severity, volume status, and etiology. Statistical analysis was performed using SPSS 22.0 and R 3.2.2. Results: Of the 100 patients enrolled, 59% were male and the mean age was 62.5 ± 12.4 years. Euvolemic hyponatremia was the most common subtype (71%), followed by hypovolemic (15%) and hypervolemic (14%). Lethargy (78%) and nausea/vomiting (77%) were the most common presenting symptoms. Diuretic use was the leading etiology (48%), with most diuretic-induced cases being euvolemic. Severe symptoms were not always associated with lower sodium levels (P = 0.012), highlighting the role of chronicity and cerebral adaptation. Serum sodium levels were significantly lower in patients with severe symptoms (P < 0.001). Hypertension was the most prevalent comorbidity (60%). Conclusion: Diuretic-induced hyponatremia, particularly among euvolemic patients, emerged as the most common cause of hyponatremia in this study. The lack of correlation between serum sodium levels and symptom severity emphasizes the importance of clinical evaluation over sole reliance on laboratory values. Judicious use of diuretics, especially in the elderly, and a symptom-focused diagnostic approach are crucial for improving patient outcomes.

Background: Chlorhexidine (CHX) is considered the gold standard in chemical plaque control; however, its long-term use is associated with adverse effects such as tooth staining and altered taste. Botanical alternatives containing plant-derived antimicrobials may provide similar efficacy with fewer side effects. Methods: A randomized, double-blind, parallel-group clinical trial was conducted with 60 systemically healthy participants exhibiting mild to moderate gingivitis. Participants were randomly assigned into two groups (n = 30 each): Group A—botanical oral rinse, Group B—0.12% CHX. Baseline Plaque Index (PI) and Gingival Index (GI) scores were recorded, and mouthwashes were used twice daily after brushing for 21 days. Outcomes were assessed on day 7, day 14, and day 21. Data were analyzed using repeated measures ANOVA and independent t-tests. Key Findings: Both groups showed significant reductions in PI and GI from baseline to day 21 (p < 0.001). At day 21, PI reduction was 41.8% in Group A (from 1.92 ± 0.22 to 1.12 ± 0.20) and 44.5% in Group B (from 1.95 ± 0.24 to 1.08 ± 0.19), with no significant intergroup difference (p = 0.14). GI reduction was 39.7% in Group A (from 1.82 ± 0.18 to 1.10 ± 0.16) and 42.3% in Group B (from 1.84 ± 0.19 to 1.06 ± 0.15), with no significant intergroup difference (p = 0.12). Conclusion: The botanical oral rinse demonstrated comparable efficacy to 0.12% CHX in reducing plaque and gingivitis over 21 days, suggesting it may be a viable herbal alternative for routine oral hygiene.

Background: Halitosis in children, often caused by intra-oral factors such as poor oral hygiene, dental caries, or gingivitis, can influence social interactions and parental concern. Parental awareness and knowledge regarding children’s halitosis are essential for timely intervention and improved oral health outcomes. Methods: A cross-sectional descriptive study was conducted with 200 parent–child pairs attending the inpatient and outpatient pediatric dentistry services. A structured questionnaire assessed awareness of halitosis occurrence, knowledge of intra-oral etiological factors (dental caries, tongue coating, gingivitis), and actions taken. Data were summarized as mean scores (knowledge score: range 0–10) ± SD, percentages, and analyzed for associations with parental education level using t-tests and chi-square tests. Key Findings: Mean parental knowledge score was 6.2 ± 1.8 out of 10. Overall, 68% of parents recognized dental caries as a cause, 59% identified tongue coating, and 45% associated gingivitis (p < 0.001 across categories). Only 36% of parents reported having noticed halitosis in their child. Parents with university education demonstrated higher knowledge scores (6.8 ± 1.5) compared to those with high school or below (5.7 ± 1.9; p = 0.002). Among aware parents, 52% had taken steps to improve oral hygiene, while 24% sought professional dental care. Conclusion: Parental awareness of children’s halitosis due to intra-oral causes is moderate, and knowledge is modestly aligned with education level. Educational interventions targeting oral hygiene and common intra-oral causes of halitosis are warranted.

Background: Removal of fiber posts from endodontically treated teeth is often required during retreatment. However, the choice of removal technique can influence the amount of remaining root dentin, affecting structural integrity. Methods: Ninety extracted single-rooted human premolars were randomly assigned to three groups (n = 30 each): Group U (ultrasonic), Group R (rotary), Group L (laser). Fiber posts were cemented with resin cement, then removed after 7 days. Pre- and post-removal micro-CT scans quantified dentin volume removed (mm³). Data are reported as mean ± SD. Statistical analysis used one-way ANOVA and post-hoc Tukey tests. Key Findings: Mean dentin volume removed was 12.8 ± 2.1 mm³ (Group U), 15.3 ± 2.6 mm³ (Group R), and 10.5 ± 1.9 mm³ (Group L). Group L removed significantly less dentin than Group R (p = 0.001) and Group U (p = 0.015); Group U also removed significantly less than Group R (p = 0.022). Percentage dentin loss relative to total root dentin volume was 8.7% ± 1.4% (U), 10.4% ± 1.8% (R), and 7.1% ± 1.3% (L). Conclusion: Laser-assisted post removal preserved the most root dentin in vitro, followed by ultrasonic retrieval; rotary drilling removed the most dentin. Clinicians should consider laser techniques when dentin conservation is critical.

Background: Surgical site infections (SSIs) are a significant cause of postoperative morbidity and healthcare burden. Preoperative skin antisepsis is a key preventive measure, with povidone-iodine and chlorhexidine being the most widely used agents. However, comparative evidence in the Indian surgical setting remains limited. Materials and Methods: This prospective comparative study was conducted in the Department of General Surgery, Government Siddhartha Medical College & General Hospital, Vijayawada, from July 2024 to June 2025. Adult patients undergoing elective clean or clean-contaminated surgeries were randomly assigned to receive preoperative skin preparation with either 10% povidone-iodine (Group A) or 2% chlorhexidine in 70% isopropyl alcohol (Group B). SSI occurrence within 30 days postoperatively was assessed using CDC criteria. Demographic data, comorbidities, operative duration, wound classification, and SSI rates were recorded. Statistical analysis was performed using chi-square and independent t-tests, with p < 0.05 considered significant. Results: A total of 240 patients were included (120 in each group). The overall SSI rate was 9.6% in Group A and 3.3% in Group B (p = 0.042; relative risk = 2.91, 95% CI: 1.01–8.37). In clean surgeries, SSI incidence was 5.0% for povidone-iodine vs 1.7% for chlorhexidine (p = 0.18), whereas in clean-contaminated surgeries, rates were 14.3% vs 5.7% respectively (p = 0.049). No adverse skin reactions were noted in either group. Conclusion: Chlorhexidine-based skin preparation significantly reduced SSI rates compared to povidone-iodine, particularly in clean-contaminated procedures. Adoption of chlorhexidine as the preferred preoperative antiseptic may improve postoperative outcomes in similar surgical settings.

Background: Coronary artery disease (CAD) may coexist with valvular heart disease (VHD) and alter surgical strategy. Indian data on CAD prevalence and predictors in patients undergoing preoperative coronary angiography (CAG) before valve replacement surgery are limited.  Objective: To determine the prevalence, angiographic patterns, and independent predictors of CAD among patients undergoing screening CAG prior to valve surgery in a tertiary care setting.  Methods: This prospective observational study enrolled 150 consecutive adult patients aged ≥ 40 years undergoing CAG before valve replacement via open heart surgery. Baseline demographics, major cardiovascular risk factors, valve lesion etiology, procedural access route, and angiographic findings were recorded.  Results: The mean age was 60.6 ± 12.1 years, with 99 (66.0%) male patients. Valvular etiologies included degenerative/calcific in 63 (42.0%) patients, rheumatic 48 (32.0%)paients, bicuspid aortic valve 30 (20.0%) patients, and mitral valve prolapse in 9 (6.0%) patients. Hypertension (64.0%) was the most prevalent risk factor, followed by smoking (30.0%), diabetes (20.0%), dyslipidemia (18.0%), family history of CAD (16.0%). A history of angina on effort (AOE) was present in 34.0% patients. Radial access was used in 102 (68.0%), femoral in 33 (22.0%) , with crossover from radial to femoral in 15 (10.0%) of patients. On angiography, 108 (72.0%) patients had normal coronaries, while 33 (22.0%) patientshad significant CAD (≥50% stenosis): single-vessel disease in 18 (12.0%), double-vessel disease in 9 (6.0%), and triple-vessel disease in 6 (4.0%) of patients. Age ≥60 years (OR 3.15, 95% CI 1.42–6.97, p=0.004), male sex (OR 2.40, 95% CI 1.05–5.48, p=0.037), and presence of degenerative/calcific valve disease were independent predictors of CAD.  Conclusions: CAD was present in over one-fifth of patients undergoing preoperative CAG before valve surgery. Older age, male sex and presence of calcific/degenerative valve disease independently predicted CAD, supporting guideline-based selective screening in high-risk subgroups.

Background: Laparoscopic cholecystectomy is a widely performed surgical procedure, favored for its minimally invasive nature and faster recovery. However, the physiological stress response triggered by surgery and anesthesia can impact hemodynamic stability. Dexmedetomidine, a selective alpha-2 adrenergic agonist, has shown efficacy in attenuating the perioperative stress response by reducing serum catecholamine levels. This study evaluates the effect of two different low-dose dexmedetomidine infusions on intraoperative hemodynamics and postoperative analgesia. Methods: Fifty ASA Physical Status I and II patients undergoing elective laparoscopic cholecystectomy were randomized into two groups. Group A received dexmedetomidine infusion at 0.2 mcg/kg/hr, while Group B received 0.4 mcg/kg/hr. No loading dose was given. Hemodynamic parameters, including heart rate and MAP (Mean Arterial Pressure) were recorded at baseline, 15 minutes after infusion initiation, post-induction, post-intubation, post-pneumoperitoneum creation, and post-extubation. Postoperative pain was assessed using the VAS (Visual Analogue Scale), and time to first rescue analgesia (tramadol) and total 24-hour analgesic requirement were documented. Results: Both dexmedetomidine infusion rates maintained stable intraoperative hemodynamics. However, the 0.4 mcg/kg/hr group showed better control of heart rate and MAP at key surgical milestones. Additionally, patients in this group experienced prolonged pain relief and required significantly less cumulative analgesia in the first 24 hours postoperatively. Conclusion: Continuous low-dose dexmedetomidine infusion without a bolus effectively blunts the perioperative stress response during laparoscopic cholecystectomy. A higher infusion rate of 0.4 mcg/kg/hr provides superior intraoperative hemodynamic control and enhanced postoperative analgesia compared to 0.2 mcg/kg/hr.

Background: Newer-generation ultrathin strut sirolimus-eluting stents (SES) improve clinical outcomes compared with second-generation everolimus-eluting stents (EES). Randomized controlled trials have shown that variations in stent strut thickness correlate with clinical outcomes. This study aimed to perform an updated systematic review and meta-analysis of randomized controlled trials (RCTs) comparing clinical outcomes between ultrathin strut and conventional second-generation EES in the treatment of coronary artery disease. Methods: We pooled individual participant data from 10 randomized clinical trials including 10,328 patients, comparing newer-generation ultrathin strut SES (defined as strut thickness <70 µm) versus thicker strut EES. A one-stage meta-analysis was conducted using a comprehensive meta-analysis software. The prespecified primary outcomes included target lesion failure (TLF), target vessel failure (TVF), myocardial infarction (MI), stent thrombosis (ST), cardiac death, repeat revascularization, cardiac death, and all-cause mortality (including cardiac and non-cardiac death). Results: Ten randomized controlled trials from various regions met the inclusion criteria and contributed individual participant-level data, totalling 10,328 patients. The ultrathin strut SES evaluated were M’SURE-S (59μm), Orsiro (60μm), Supraflex (60μm), MiStent (64μm), and BioMime (65μm), compared against second-generation EES. The mean follow-up period was 36.6 months. The ultrathin strut SES were associated with a lower risk of TLF and TVF compared to conventional second-generation EES [Odds Ratio 0.75 & 0.77, 95% confidence interval (CI), P=0.017 & P=0.019]. This establishes an insignificant difference in risk for myocardial infarction and a lower significant risk for stent thrombosis in comparison to conventional second-generation EES [Odds Ratio 1.09 & 0.69, P>0.05, P=0.05]. The ultrathin-strut SES were also associated with a lower risk for repeat revascularization and insignificant risk for mortality in comparison to conventional second-generation EES [Odds Ratio 0.75 & 0.91, 95% confidence interval (CI), P=0.018 & P=0.63]. They also showed a lower risk of cardiac death and non-cardiac death in comparison to conventional second-generation EES and were statistically non-significant [Odds Ratio 0.90 & 1.12, 95% confidence interval (CI), P=0.081 & P=0.63]. Conclusion: In the present meta-analysis of 10 trials randomizing 10,328 patients and with a mean follow-up of 3.5 years, ultrathin strut sirolimus-eluting stents were associated with a significantly lower risk of TLF, TVF, stent thrombosis, and repeat revascularization compared with conventional second-generation everolimus-eluting stents. There was no significant difference in risks associated with myocardial infarction and mortality.

Background: The ratio of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) less than 70% is widely used as reference for diagnosis of airflow obstruction in chronic obstructive pulmonary disease (COPD) individuals. The effort to empty the lung completely to reach FVC, can be particularly difficult for patients with airway obstruction and they often fail to meet the end of test criteria defined by less than 20 ml change in final 2 seconds of the spirometric manoeuvre, resulting in underestimation of FVC. Forced expiratory volume in 6 seconds (FEV6) can be used as an effective alternative to FVC for diagnosing airflow obstruction in a faster and reliable manner. Aim: To study the reliability of FEV1/FEV6 as a marker of airway obstruction in patients diagnosed with COPD by FEV1/FVC criteria. The correlation of FEV6 and FVC with increasing severity of the disease and their effective change with bronchodilator therapy. Methods: It was a cross-sectional study at a tertiary care centre in India. FEV1/FEV6 manoeuvre was performed in 111 patients who were diagnosed as COPD based on their history, symptoms and spirometry as per the Global Initiative for Chronic Obstructive Lung diseasse (GOLD) guidelines. Results: The sensitivity of FEV1/FEV6 ratio towards identifying obstructive cases with respect to FEV1/FVC was 97.3% with a range of 92.3 to 99.44%. Pearson’s correlation coefficient showed a strong correlation between FEV6 and FVC (0.99 for both pre and post bronchodilator values) in all severities of disease. We carried out the correlation analysis of the change in FVC and change in FEV6 after bronchodilator use, it showed a strong Pearson’s correlation coefficient of 0.96 (interval of 0.94 to 0.97), demonstrating a parallel trend throughout the study population. Conclusion: FEV6 can be used as a reliable tool to diagnose patients with airflow obstruction and to assess the change with bronchodilator therapy who cannot reach the end of test criteria for FVC. Categories: Internal Medicine, Pulmonology

Background: Peripheral arterial disease (PAD) is one of the macrovascular complications of type 2 Diabetes Mellitus (DM). Patients with peripheral arterial disease, even in the absence of a history of myocardial infarction or ischemic stroke, have approximately the same relative risk of death from cardiovascular causes. Objective: A cross-sectional study of 150 cases to evaluate the association of asymptomatic PAD with degree and duration of hyperglycemia as well as with coronary artery disease (CAD). Methods: All the patients were subjected to detailed history, thorough clinical examination and laboratory investigations which included examination of risk factors and detailed assessment of peripheral arterial system. Patients were also examined for coronary artery disease and microvascular complications of Type 2 Diabetes Mellitus. Statistical software SPSS 23.0 was used for the analysis of data to find the association of CAD, degree and duration of Diabetes with asymptomatic PAD. Results: In the present study of total 150 cases the Prevalence of PAD was 16%. Mean HbA1c value with SD was 7.9±1.4 %, mean duration of DM with SD was 7.1 ± 5.6 years.Prevalence of Hypertension was 68% while that of CAD 27.33%.There was strong statistically significant association of Duration of DM with PAD which was observed with the Chi square value 29.128 and p value 0.000 which was much less than 0.05. Statistically significant association of HbA1c level with PAD was also observed with the Chi square value 6.406 and p value 0.011.We found that strong statistically significant association of presence of CAD with PAD and the Chi square value 13.824 and p value 0.000 for the same. Conclusion: The Prevalence of asymptomatic PAD also increased in presence of Hypertension and CAD. The Prevalence of PAD in study cases increased with increased duration of DM. There was statistically significant correlation of PAD with HbA1c. 

Introduction: The high proportion of unexplained stillbirths hinders accurate understanding of their cause, which consequently affects targeted healthcare interventions to reduce its incidence.10Currently in 25-40% of stillbirths, the underlying cause cannot be determined and only approximately 20% of stillbirths are potentially predictable in early pregnancy. India accounts for the majority of global stillbirths due to high population, with 5921000 out of a total of 206 million of such births across the world: Materials And Methods: This observational cross-sectional study was conducted over a period of 1 year at labour room at department of obstetrics and gynaecology in Eden hospital, Medical College and hospital,Kolkata after getting approval from Institutional Ethical Committee. We had selected all the stillborn cases occurring in our duty hours in eden, MCH.Then we had selected same number of live born cases in LRO. Result In Still Birth group, 8 (10.0%) patients were ≤20 years old, 37 (46.3%) patients were 21-25 years old and 35 (43.8%) patient were 26-30 years old.Association of Age between the two groups was not statistically significant (p=0.7514). Conclusion: For identification of the precise causes of stillbirth,Further studies are required involving larger sample size of the  factors that influence stillbirth which  are postmortem evaluation, genetic and molecular testing, microbiology, and fetal blood or urine culture.

Background: Head lice infestation (pediculosis capitis) is a common yet often neglected public health concern among school-going children, particularly in resource-limited settings. This study aimed to determine the prevalence, associated risk factors, and diagnostic accuracy of different methods in detecting head lice infestation in children aged 5 to 12 years. Methods: A cross-sectional study was conducted among 200 children from primary schools in Amalapuram, Andhra Pradesh. Participants were selected using stratified random sampling. Data were collected through structured parental interviews and clinical examination. Risk factors such as hygiene, sharing habits, family size, and previous infestation history were evaluated. Diagnostic methods including visual inspection, wet combing, and microscopic examination were applied, and their sensitivity and specificity were analyzed using standard statistical tools. Results: The highest proportion of children (38.5%) were aged 8–10 years. Females comprised 61.5% of the total sample. Close contact at school (75%) and sharing of combs/hats (66.7%) were the most prevalent risk factors, followed by poor hygiene (58.3%) and large family size (50%). Previous lice infestation was reported in 41.7%. Microscopic examination showed the highest diagnostic accuracy (sensitivity: 95%, specificity: 93%), followed by wet combing (91%, 88%). Visual inspection had the lowest accuracy (75%, 70%). Conclusion: Head lice infestation among primary school children is significantly associated with modifiable behavioral and environmental factors. While microscopy remains the gold standard for diagnosis, wet combing offers a practical alternative in field settings. School-based hygiene education and routine screening are essential to reduce the infestation burden.

Background: Hypothyroidism is a common endocrine disorder characterized by reduced thyroid hormone levels, affecting multiple organ systems, including the central nervous system (CNS). Neurological manifestations can range from subtle cognitive changes to more evident sensory deficits, such as visual disturbances. The visual pathway, particularly the optic nerve, is sensitive to metabolic changes associated with thyroid dysfunction. Visual Evoked Potential (VEP) is a non-invasive electrophysiological technique used to assess the functional integrity of the visual pathway. Evaluating VEP changes in hypothyroid patients may help detect early CNS involvement. Correlating these findings with thyroid hormone levels can guide timely diagnosis and management. Aim To assess the correlation between thyroid function tests and VEP parameters in patients with hypothyroidism. Materials and Methods This descriptive study was conducted on 51 hypothyroid patients and 51 euthyroid subjects. By simple random sampling patients were selected from General medicine and Endocrinology departments with TSH more than 5μU/mL or free T4 less than 0.7ng/dL. Correlation of the serum levels of TSH, free T4 and freeT3 with the continuous variables (VEP latency) were assessed by Pearson product moment correlation coefficient. A p value < 0.05 was taken as statistically significant. Results Significant positive correlation was found between TSH with latency of P100 (r= 0.881) and N75 (r=0.861) and FreeT4 with amplitude of P100(r =0.762). Significant negative correlation was found with TSH and amplitude of P100(r -0.811) and free T4 and latency of P100 (r =-0.843) and N75 (r =-0.851). Conclusion The study shows VEP changes correlate with thyroid hormones, indicating CNS involvement in hypothyroidism. VEP can serve as an early marker, enabling timely intervention to help prevent further neurological complications in affected patients

Background: Postoperative complications such as surgical site infections, deep vein thrombosis (DVT), and respiratory distress remain a major source of morbidity, prolonged hospitalization, and unplanned ICU admissions. Standard ward monitoring, performed intermittently, may miss early signs of deterioration. Advances in wearable sensor technology enable continuous, multiparameter monitoring, potentially allowing earlier recognition and intervention. Objective: To evaluate the efficacy of continuous wearable health-monitoring devices compared with standard intermittent monitoring in detecting early postoperative complications, and to assess their impact on clinical outcomes. Methods: This single-center, prospective, randomized controlled trial enrolled 200 adult postoperative patients undergoing major surgery. Participants were randomized 1:1 to wearable continuous monitoring (heart rate, respiratory rate, SpO₂, skin temperature, activity) or standard intermittent monitoring every 4–6 hours. The primary outcome was early complication detection rate. Secondary outcomes included time from physiological change to recognition, length of stay, ICU transfers, and 30-day readmissions. Results: Wearable monitoring nearly doubled overall early complication detection compared to standard care (30% vs 13%, p=0.01), with significant increases for surgical site infection (14% vs 7%, p=0.04), DVT (8% vs 3%, p=0.05), and respiratory distress (12% vs 5%, p=0.03). Mean detection was 7–11 hours earlier across complications (p<0.001). Wearable devices detected abnormal heart rate (+14 bpm), respiratory rate (+5 bpm), SpO₂ (-4%), and skin temperature (+1.2°C) several hours before clinical recognition. The wearable group had shorter hospital stays (5.6 ± 1.8 vs 7.4 ± 2.1 days, p=0.002), fewer ICU transfers (6% vs 14%, p=0.04), and fewer readmissions (8% vs 16%, p=0.03). Mortality differences were not statistically significant. Conclusions: Continuous wearable monitoring significantly improves early detection of postoperative complications, provides a substantial lead time for intervention, and is associated with reduced ICU transfers, readmissions, and hospital stay

Background: Heart disease in pregnancy is a major contributor to maternal and perinatal morbidity and mortality, especially in low- and middle-income countries. Pregnancy-related cardiovascular changes can precipitate decompensation in women with pre-existing heart disease. Methods: This retrospective observational study was conducted at Lalla Ded Hospital, Srinagar, Jammu and Kashmir, India, over a 2-year period. Sixty-one pregnant women with known or newly diagnosed heart disease were included. Maternal outcomes assessed included ICU admission, mechanical ventilation, cardiovascular complications, and delivery mode. Perinatal outcomes included preterm birth, NICU admission, and mortality. Data were analysed descriptively. Results: The majority of women were aged 25–29 years (49.18%). Rheumatic heart disease was the most common lesion (32.78%). ICU admission was required in 36.06% and mechanical ventilation in 14.75%. Cardiovascular complications occurred in 18%. Preterm birth rate was 16.4%, NICU admissions 16.4%, stillbirths 3.3%, and no congenital heart defects were detected. Conclusions: Pregnancies complicated by heart disease are associated with significant maternal morbidity and moderate perinatal risk. Early diagnosis, mWHO-based risk stratification, vigilant antenatal surveillance, and multidisciplinary care at tertiary centres can improve outcomes. (95% CI for ICU admission: 24.2%–48.6%).

Background: Post-operative sore throat (POST) is a frequent, distressing complication after tracheal intubation, with reported incidence ranging from 21–65%. Magnesium sulphate has anti-inflammatory and membrane-stabilizing properties, and nebulization before induction may reduce mucosal injury and subsequent sore throat. Aim: To evaluate the effect of preoperative magnesium sulphate nebulization on the incidence and severity of POST in adult surgical patients undergoing general anaesthesia with endotracheal intubation. Methods: This is a Prospective and randomized study was conducted in the Department of Anaesthesiology at Tertiary Care Teaching Hospital from please mention the period of study  from January 2023 to June 2024 in 120 ASA I–II adult patients scheduled for elective surgeries under general anaesthesia. Patients were randomized into two groups: Group M (magnesium sulphate 225 mg in 5 mL saline nebulization) and Group C (5 mL saline nebulization) 15 min before induction. Incidence and severity of POST were assessed at 1, 6, 12, and 24 hours post-extubation using a 4-point scale. Results: Percentage of patients with POST at 1 h, 6 h, 12 h, and 24 h after extubation. Group M consistently has fewer patients with POST than Group C at 1, 6, and 12 hours (p-values < 0.05). At 24 h, the difference is not statistically significant. The incidence of POST at 6 hours was significantly lower in Group M compared to Group C (18.3% vs 43.3%, p<0.01). Severity scores were also reduced at all time points. No significant adverse events were observed. Conclusion: Preoperative nebulization with magnesium sulphate effectively reduces the incidence and severity of POST without notable side effects.

Background: Cardiovascular diseases, particularly myocardial infarction (MI), are global leading causes of death, often accompanied by psychological complications like depression. Post-MI depression is linked to poorer recovery, reduced quality of life, and increased mortality risk. Demographic factors also influence post-MI depression, especially among vulnerable groups. Aims: To assess the influence of demographic factors on the prevalence and severity of depression in post-myocardial infarction patients. Materials and methods: The present study was a Institution based, Cross Sectional, Observation study. This Study was conducted for 18 months at Department of Psychiatry OPD & IPD, Medicine OPD & IPD and Cardiology OPD & IPD of KPC Medical College and Hospital, Kolkata, West Bengal and Ramakrishna Mission Seva Pratishthan, Vivekananda Institute of Medical Sciences, Kolkata, and West Bengal. Study population was 130.  Result: Out of the total 130 study population 32.3 % presented with depressive symptoms (n = 42) and 67.7 % (n= 88) did not exhibit any symptoms of depression. The value of z is 5.7056. The value of p is < .00001. The result is significant at p < .05. Conclusion: our study found that 32.3% of post-myocardial infarction patients exhibited depression, but demographic factors such as age, gender, and education did not significantly influence depression status. This suggests that depression in these patients may be influenced by complex, multifactorial factors beyond demographic characteristics. A holistic approach to mental health care is essential for this group.

Background: Caesarean section has classically been defined as an operative procedure performed for the delivery of the fetus through a surgical incision made on the abdominal wall and an intact uterine wall after the period of viability. Aims: Analysis of leading groups contributing to the high caesarean section rates in a tertiary care hospital of West Bengal near Sundarbans area based on Modified Robson Ten Group Classification System (MRTGCS) Materials & Methods: The present study was conducted at Diamond Harbour Government Medical College and Hospital, West Bengal, over a period of 18 months, comprising 12 months of data collection followed by 6 months dedicated to data analysis. It was designed as an observational descriptive cross-sectional study, aiming to capture a snapshot of relevant clinical and demographic parameters within the study population at a single point in time. This design facilitated the assessment of prevalence and distribution patterns without manipulating study variables, thereby ensuring a comprehensive and unbiased representation of the existing scenario. Result: In our study, 8 (0.12%) patients had all abnormal lies (including previous Caesarean section but excluding breech), in Spontaneous labour 3 (0.04%) patients had all abnormal lies (including previous Caesarean section but excluding breech) in Induced labour, 14 (0.22%) patients had Caesarean section before labour, who had all abnormal lies (including previous Caesarean section but excluding breech). Association of All abnormal lies (including previous Caesarean section but excluding breech) with Group was statistically significant (p<0.0001). Conclusion: Enhanced antenatal counseling, standardized labor management, and adherence to clinical guidelines can help optimize caesarean delivery rates. This classification system proves to be a valuable tool in monitoring, auditing, and guiding clinical practices to improve maternal and neonatal outcomes

Background: Ultrasound-guided arterial catheterization is a widely used technique in critical care and anesthesia. Two primary approaches, in-plane (IP) and out-plane (OP), differ in visualization and needle orientation. This prospective clinical study compares the success rates, procedural efficiency, and complications associated with these two methods. Materials and Methods A total of 100 adult patients requiring arterial catheterization were enrolled and randomly assigned to either the IP group (n=50) or the OP group (n=50). The primary outcomes included first-attempt success rate, total procedure time, and complication rates. Secondary outcomes assessed operator ease and patient discomfort. All procedures were performed by experienced anesthesiologists using a high-frequency linear probe. Statistical analysis was conducted using the chi-square test and Student's t-test, with significance set at p < 0.05. Results The first-attempt success rate was significantly higher in the IP group (90%) compared to the OP group (75%) (p = 0.02). The mean procedure time was shorter in the IP group (45 ± 10 seconds) than in the OP group (60 ± 12 seconds) (p = 0.01). Complication rates, including hematoma and arterial spasm, were lower in the IP group (8%) compared to the OP group (15%), though not statistically significant (p = 0.08). Operator ease was rated higher for the IP approach, with 85% of clinicians reporting a preference for this technique. Conclusion The in-plane ultrasound-guided technique for arterial catheterization demonstrated higher success rates, shorter procedure times, and fewer complications compared to the out-plane approach. These findings suggest that the in-plane technique may be preferable for routine clinical practice. Further studies with larger sample sizes are warranted to confirm these results

Background: Incidence rate of breast cancer has been rising for most countries in transition over last decades with rapid increase occurring in countries like South America, Africa and Asia. Triple negative breast cancer (TNBC) refers to the breast cancer phenotype where the estrogen and progesterone receptor are negative, as assessed by immunohistochemistry (IHC) and there is a lack of overexpression of HER2 as assessed by IHC or the absence of its gene amplification as assessed by fluorescence in situ hybridization technique. Materials and Methods This is an Observational study was conducted in the Department of General Surgery at Tertiary Care Teaching Hospital from January 2019 to August 2020. Approximately small breast cancer tissues pieces of not less than 50 patients will be required for successful establishment of primary breast cancer cell line and perform our further studies. All the female patients with histologically proven triple negative breast malignancies admitted in general surgery wards, except those meeting the exclusion criteria. Tumor specimens obtained from consenting patients will be received in the Laboratory within 30 minutes of surgery and immediately mechanically disaggregated.  Results The tumor was right sided in 51%, left sided in 47%, and 2% had bilateral cancer at presentation. Clinically, T2 was the most common (58%) followed by T3 (18.2%), T4 (13.2%), and T1 (10.6%). Nodal involvement was seen in 58% patients. N1, N2, and N3 disease was seen in 26.7%, 16.1%, and 15.1% patients, respectively. A modified radical mastectomy was done in 76.7%, and 18.2% underwent breast conservation surgery. Adjuvant chemotherapy was given to 79.2%, while 15.6% patients received both neoadjuvant and adjuvant chemotherapy (NACT). Of the patients who received NACT, pathological complete response (pCR) was seen in 25.8% patients. Postmastectomy radiation therapy, as part of adjuvant treatment, was given to 52.6% patients. Conclusion TNBCs are a distinct subtype of breast cancers with unique pathological and clinical behavior. They have a rapid clinical course and early recurrences inspite of timely medical intervention, which reflects the aggressive tumor biology. This warrants further studies on the intensification of chemotherapy and identification and development of targeted therapy aimed at decreasing recurrences and improving survival in this patient population.

Background: Aortic stenosis is a prevalent valvular heart disease, particularly in the elderly. With advances in medical technology, treatment has evolved from traditional Surgical Aortic Valve Replacement (SAVR) to less invasive approaches such as Transcatheter Aortic Valve Replacement (TAVR). Despite the increasing use of TAVR, particularly among high- and intermediate-risk patients, SAVR continues to be recommended for younger, low-risk individuals due to the longer-term durability of surgical bioprosthetic valves. This study aims to compare the clinical outcomes, procedural risks, and long-term benefits of TAVR versus SAVR. Materials and Methods: This prospective and observational study included patients diagnosed with severe aortic stenosis between January 2024 and June 2025. A total of 420 patients was included. Patients were divided into two groups based on the intervention received: Surgical Aortic Valve Replacement (SAVR, n=230) and Transcatheter Aortic Valve Replacement (TAVR, n=190). All patients underwent comprehensive preoperative assessment including echocardiography, cardiac catheterization, and CT angiography when applicable. Inclusion criteria included age >65 years, symptomatic aortic stenosis, and eligibility for either procedure. Exclusion criteria involved active endocarditis, bicuspid valves, or prior valve replacement. Results: AVR patients were significantly older (81.4 vs 73.2 years, p<0.001). STS Score: Higher in TAVR group (8.1% vs 4.5%, p<0.001), meaning higher surgical risk. Much shorter for TAVR (90 vs 150 min, p<0.001). ICU Stay & Hospital Stay: Both significantly shorter for TAVR (ICU 1.2 vs 3.6 days; total stay 4.8 vs 9.1 days, p<0.001). Conversion to surgery: Rare in TAVR (2.1%). No significant difference (Mortality 3.7% vs 4.3%, Stroke 2.6% vs 2.2%). Acute Kidney Injury: No difference (p=0.49). Major Bleeding: Significantly lower in TAVR (5.3% vs 9.6%, p=0.03). Higher in TAVR (12.1% vs 4.3%, p<0.001). Paravalvular Leak: Higher in TAVR (6.8% vs 1.3%, p<0.001). Valve Malposition: More frequent in TAVR (2.9% vs 0.4%, p=0.02). Conclusion: Both TAVR and SAVR offer significant benefits, and patient selection is critical. TAVR is favorable in high-risk surgical patients, whereas SAVR remains the standard for low-risk younger populations.

Background: COPD is predicted to be the third leading cause of death worldwide by 2020. Recent studies have reported that an emphysematous lung was associated with acute exacerbation of COPD and co-morbidities including atherosclerosis and osteoporosis. The present study was undertaken to evaluate clinico-radiological, spirometry, diffusion capacity, ECG, echocardiographic and biochemical parameters in chronic obstructive pulmonary disease. Material & Methods: The study conducted in the department of Pulmonary Medicine, Kamineni Institute of Medical Sciences, Sreepuram, Narketpally from October 2015 to September 2017. Study design:  Cross- sectional study. Study Population: All COPD patients attending OPD and inpatient admissions in Pulmonology Department. Study subjects: Inclusion criteria:1. Patients diagnosed to have COPD as per GOLD criteria.2. Patients between 35 to 80 years. 3. Both male and female patients. 4. Patients with h/o Smoking (current smokers and quitters of smoking) and biomass exposure. Exclusion Criteria: 1. Patients with HTN, DM, Ischemic heart disease, severe anemia, renal and liver disease. 2. Patients who are Critically ill, unable to perform spirometry, pulmonary tuberculosis, lung malignancies, bronchiectasis and patients with bronchial asthma. Data entry was done using M.S. Excel and analysed by using Statistical package for social sciences (SPSS Version 16) Results: The maximum number of study subjects were among the age group 61 to 70 years constituting 44% and minimum being 41to 50 years constituting 12%.Among the study subjects maximum age 79 years and the minimum age 41 years. The mean age of the patients was 62 ± 9.545 years. Majority had acidosis cases (62.5%), patients with (25%) RVD N PHTN, and all DLCO <80% patients were significantly associated with Fev1% <30% (P<0.05). Conclusion: Computerized spirometry with DLCO, 2D-ECHO and ABG are very useful investigations in the management of chronic obstructive pulmonary disease and to diagnose as well as to assess the severity of the disease.

Background: Acute ischemic stroke (AIS) is a major cause of morbidity and mortality worldwide. Inflammatory markers play a crucial role in stroke pathophysiology, and serum ferritin has emerged as a potential prognostic biomarker. Objective: This study evaluates the prognostic value of serum ferritin in predicting functional outcomes and stroke-related disability in patients with acute ischemic stroke, using the modified Rankin Scale (mRS). Methods: This prospective observational study was conducted on 120 patients with radiologically confirmed AIS admitted to a tertiary care hospital. Serum ferritin levels were measured at admission, on day 7, and at discharge or death. Functional outcomes were assessed using the modified Rankin Scale (mRS), and patients were categorized into three groups: Group A (mRS 0–2: good outcome), Group B (mRS 3–5: moderate-to-severe disability), and Group C (mRS 6: death). Statistical analysis was performed to determine the correlation between serum ferritin levels and mRS scores across the three time points. Results: Higher serum ferritin levels were significantly associated with worse functional outcomes. At discharge, mean ferritin levels were 96.24 ng/mL in Group A, 188.65 ng/mL in Group B, and 348.29 ng/mL in Group C (p < 0.001). A progressive rise in ferritin levels corresponded with increasing disability and mortality, as reflected by higher mRS scores. Conclusion: Elevated serum ferritin levels are associated with worse functional outcomes, higher mortality, and increased stroke severity, making it a valuable prognostic biomarker in AIS.

Background: Early and accurate diagnosis of acute coronary syndrome (ACS) is critical for guiding timely intervention and improving clinical outcomes. While high-sensitivity cardiac troponin I (hs-TnI) remains the diagnostic cornerstone, emerging biomarkers such as copeptin and soluble ST2 (sST2) may offer added value during the early “troponin-blind” phase of myocardial infarction. Objective: To compare the diagnostic accuracy of copeptin and sST2 with that of hs-TnI in patients presenting with suspected ACS. Methods: In this single-centre, prospective observational study, 125 adults with chest pain suggestive of ACS were enrolled; 84 were adjudicated as ACS and 41 as non-ACS. Blood samples were collected at presentation, and biomarker concentrations were measured (hs-TnI by Abbott ARCHITECT; copeptin and sST2 by ELISA). Diagnostic performance was evaluated via receiver operating characteristic (ROC) analysis (AUC), and correlations with TIMI and GRACE risk scores were assessed using Spearman’s ρ. Results: hs-TnI demonstrated the highest diagnostic accuracy (AUC = 0.98), followed by copeptin (AUC = 0.88) and sST2 (AUC = 0.83). At optimal cut-offs, hs-TnI (≥40 ng/L) yielded 99% sensitivity and 100% specificity; copeptin (≥40 pmol/L) 83%/83%; sST2 (≥30 ng/mL) 86%/88%. Combining hs-TnI with copeptin and/or sST2 further increased sensitivity in early presenters (<3 h). hs-TnI correlated strongly with TIMI (r = 0.63) and GRACE (r = 0.62) scores (p < 0.0001), while copeptin and sST2 showed moderate associations. Conclusion: hs-TnI remains the most accurate biomarker for ACS diagnosis. Copeptin and sST2 provide complementary diagnostic and prognostic information, particularly in early presentations. A multi-marker approach may enhance diagnostic confidence and streamline emergency triage. Limitations: Single-centre design, modest sample size, and single-time-point biomarker sampling may limit generalizability. Larger, multicentre studies with serial measurements are warranted.

Background: Hypertension is a leading contributor to global morbidity and mortality. While its vascular complications are well-documented, alterations in hematological parameters among hypertensive individuals remain under-explored. Objective: To compare hematological parameters between hypertensive and normotensive individuals and identify any statistically significant differences. Methods: A retrospective observational study was conducted at Medical college and Hospital, Tertiary care centre, Samayapuram, Tiruchirapalli. Medical records of 420 individuals (215 hypertensive and 205 normotensive) from April 2021 to November 2022 and June 2024 to March 2025 were analyzed. Complete blood count (CBC) reports, including hemoglobin (Hb), total leukocyte count (TLC), platelet count, red cell distribution width (RDW), and mean corpuscular volume (MCV), were extracted and compared between groups using independent t-tests and chi-square tests (significance at p < 0.05). Results: Hemoglobin levels were lower in hypertensives (12.4 ± 1.5 g/dL) compared to controls (13.6 ± 1.3 g/dL, p < 0.001). RDW was significantly elevated in hypertensives (15.1 ± 1.2%) versus normotensives (13.4 ± 1.0%, p < 0.001). Mean platelet count was slightly higher among hypertensives (285.4 ± 70.2 ×10³/μL) than normotensives (270.3 ± 65.8 ×10³/μL, p = 0.032). No significant difference was noted in MCV or TLC. Conclusion: Hypertensive individuals demonstrate significant alterations in hemoglobin and RDW levels, suggesting a potential link between hypertension and subclinical inflammation or erythropoietic dysregulation. These hematological variations warrant further longitudinal evaluation to assess their clinical implications.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a significant risk factor for postoperative pulmonary complications (PPCs). These complications can result in extended hospital stays, increased morbidity, and mortality This study was designed to evaluate the incidence of PPCs in COPD patients undergoing elective non-cardiac surgery and to identify key risk factors associated with poor outcomes. Aim: To evaluate the incidence, risk factors, and outcomes of postoperative pulmonary complications (PPCs) in patients with Chronic Obstructive Pulmonary Disease (COPD) undergoing surgery. Objectives: To determine the incidence of postoperative pulmonary complications in COPD patients following various surgical procedures. Materials and Methods: A prospective observational study was conducted in the Department of Respiratory Medicine, and Anaesthesiology, Sapthagiri Institute of Medical Sciences and Research Centre from April 2024 to March 2025. Patients were monitored for PPCs during the postoperative period using standardized clinical criteria. Variables such as age, type of surgery, anesthesia modality, comorbidities, and preoperative pulmonary function were analyzed. All enrolled patients underwent thorough preoperative evaluation including medical history, physical examination, chest radiograph, ECG, and baseline laboratory investigations. Pulmonary function tests (PFTs) were conducted in all cases to assess FEV₁, FVC, and FEV₁/FVC ratio. Arterial blood gases were also obtained when clinically indicated. Results: In Table 1, Patients who developed PPCs were significantly older (mean age 66.1 ± 6.3 years vs. 61.2 ± 7.1 years; p = 0.013) with a male-to-female ratio of approximately 3:1. There was also a higher prevalence of comorbidities such as diabetes and hypertension among those with PPCs. patients with FEV₁ < 50% predicted had a significantly higher incidence of PPCs (p < 0.01). Mean FEV₁ in patients with complications was 47.6% compared to 62.3% in those without. Regional anesthesia was associated with a lower PPC rate (22%) compared to general anesthesia (46%) with a statistically significant difference (p = 0.021). Longer surgical duration (>3 hours) and higher estimated blood loss (>500 mL) were independently associated with higher PPCs. Displays postoperative variables. Patients who developed PPCs had longer hospital stays (mean 9.4 ± 2.3 days) compared to those without (5.6 ± 1.8 days), with a significant p value < 0.001. Conclusion: COPD patients are at considerable risk for PPCs. Identifying high-risk individuals preoperatively and optimizing their pulmonary status may reduce complications.

Background: Postpartum depression (PPD) and anxiety (PPA) are major public health concerns that can significantly affect maternal wellbeing and infant development. Despite growing awareness, these conditions often remain underdiagnosed, particularly in low- and middle-income countries like India. Objective: This study aimed to determine the prevalence of postpartum depression and anxiety and to identify psychosocial factors associated with these conditions among postpartum women attending a tertiary care hospital in India. Methods: A hospital-based cross-sectional study was conducted between January 2023 and June 2024 at a tertiary care center in India. A total of 600 women aged 18–40 years, between 4 weeks to 6 months postpartum, were systematically sampled. The Edinburgh Postnatal Depression Scale (EPDS) and the Zung Self-rating Anxiety Scale (SAS) were used to assess depression and anxiety, respectively. 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 prevalence of postpartum depression (EPDS ≥10) was 28.0%, and postpartum anxiety (SAS ≥45) was 34.0%. Significant psychosocial correlates of both depression and anxiety included unplanned pregnancy, low education level, lack of partner support, unemployment, and the loss of a parent or sibling (p < 0.001 for all associations). Conclusion: A substantial proportion of postpartum women suffer from depression and anxiety, with distinct psychosocial determinants

Background: Excessive electronic device and social media use among adolescents is a growing concern, often linked to physical, academic, social, and emotional disturbances. Understanding usage patterns and their multifaceted impacts is essential for designing preventive strategies. Objectives: To assess the patterns of electronic device and social media use among adolescents and examine their associated physical, academic, social, and emotional consequences. Methods: A descriptive cross-sectional study was conducted among 118 adolescents aged 11–19 years using a structured, self-administered questionnaire. The survey collected data on demographic characteristics, device and social media usage patterns, and related health, academic, and psychosocial effects. Descriptive statistics were applied for analysis. Results: Most participants were aged 17–19 years (66.1%) and male (54.2%). Daily device use exceeded 3 hours in over 78% of adolescents, and 43.2% reported using social media for 1–2 hours daily. A significant proportion (66.1%) checked social media first thing in the morning, and 70.3% had attempted to quit or reduce usage. Reported physical effects included eye strain (34.7%), sleep disturbances (24.6%), and headaches (16.1%). Academic decline (66.9%) and reduced family interaction (74.6%) were common. Emotional issues such as anxiety (21.2%), loneliness (20.3%), and social isolation (16.1%) were also prevalent. Conclusion: The findings highlight a high prevalence of excessive screen time and its broad-ranging impacts among adolescents. Targeted digital hygiene education, parental supervision, and mental health support are recommended to mitigate adverse outcomes

Background: Rheumatologic joint disorders such as rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus often present with subtle, early symptoms like joint stiffness, fatigue, or swelling, which are frequently overlooked or misattributed in low-awareness, resource-limited settings. In hilly regions like Himachal Pradesh, India, where cold climates, limited specialist access, and health misconceptions prevail, timely recognition and intervention are especially challenging. This study aimed to assess public awareness, beliefs, and misconceptions regarding early rheumatologic joint disorders among the adult population of Himachal Pradesh. Materials and Methods: A descriptive, cross-sectional survey was conducted over three months (May–July 2025) using a structured, bilingual Google Form. The questionnaire, validated by subject experts, assessed socio-demographic characteristics, symptom recognition, diagnostic understanding, and treatment beliefs through 20 multiple-choice questions. A total of 400 residents aged ≥18 years were recruited via convenience sampling across digital platforms. Responses were analyzed using SPSS software; Chi-square tests assessed associations between knowledge scores and demographic variables. Results: Among 400 participants, 56% were female, 59% resided in rural areas, and 34.5% were aged 46 years and above. While 71.8% identified morning stiffness as an early symptom and 71.5% recognized the risk of joint deformity from delayed care, only 58% knew that rheumatologic conditions could affect internal organs, and 60.8% correctly refuted the need for universal steroid use in early stages. Overall, 30% scored “Very Good” (17–20), 35.5% “Good” (13–16), 22.5% “Fair” (9–12), and 12% “Poor” (0–8) in knowledge assessment. Education (p < 0.001), age (p = 0.020), and residence (p = 0.027) were significantly associated with knowledge levels, while gender was not (p = 0.244). Conclusion: Despite moderate awareness of key symptoms, critical misconceptions persist regarding systemic involvement, diagnosis, and treatment of early rheumatologic disorders—particularly among older adults, rural dwellers, and individuals with lower education levels. These findings call for terrain-specific health education initiatives, early screening integration into primary care, and greater digital engagement to bridge awareness gaps and promote early intervention in vulnerable populations of Himachal Pradesh.

Background: Lateral epicondylitis (LE), or “tennis elbow,” is a degenerative tendinopathy characterized by pain and impaired upper-limb function. While corticosteroid injections are widely used for their rapid symptomatic relief, their long-term efficacy for functional recovery remains limited. Hypertonic dextrose prolotherapy, a regenerative treatment, has shown promise in improving tendon structure and function. This study compares the functional improvement of LE patients treated with dextrose versus corticosteroid injections, using the PRTEE Functional Disability Subscale as the primary outcome. Materials and Methods: A prospective, randomized clinical study was conducted on 60 patients diagnosed with LE, allocated equally into two groups. Group A received a single injection of 25% hypertonic dextrose, and Group B received a single corticosteroid (methylprednisolone 40 mg/mL) injection at the point of maximal tenderness. Functional outcomes were evaluated using the PRTEE Functional Disability Subscale at baseline, 1 week, 6 weeks, and 3 months. Statistical analysis was performed using paired t-tests for intragroup comparisons and independent t-tests for intergroup differences, with significance set at p < 0.05. Results: Both groups showed significant intragroup improvement in PRTEE Functional Disability scores (p < 0.001 at all intervals). However, Group A (dextrose) demonstrated earlier and superior functional recovery, with significantly lower scores compared to Group B at 1 week (27.53 ± 3.75 vs. 30.00 ± 3.33; p = 0.009), 6 weeks (19.90 ± 3.64 vs. 23.33 ± 3.51; p < 0.001), and 3 months (11.93 ± 3.32 vs. 16.16 ± 3.63; p < 0.001). The mean functional improvement from baseline to 3 months was greater in the dextrose group (18.03 points) compared to the steroid group (18.73 points), with dextrose showing a more consistent recovery trajectory. Conclusion: Both injection therapies improved upper-limb function, but hypertonic dextrose provided earlier onset, greater magnitude, and sustained functional recovery compared to corticosteroids. The results support dextrose prolotherapy as a superior intervention for functional restoration in patients with chronic lateral epicondylitis

The common haematological condition known as iron deficiency anaemia IDA is characterised by low iron stores that prevent the generation of enough red blood cells, which lowers haemoglobin levels and impairs oxygen transport. The aim of this study is to address the gap in existing research by investigating the clinical, ECG, and echocardiographic parameters in patients with iron deficiency anemia. Investigation such as Hemogram, peripheral smear, red cell indices, Serum ferritin, Electrocardiogram and Echocardiography was done. Patients with iron deficiency anemia underwent 2D ECHO evaluation, determining parameters like LV mass, relative wall thickness, concentration and eccentric hypertrophy, HFrEF and HFpEF. Iron deficiency anemia IDA is more prevalent in females and has a greater influence on left ventricular mass. Severe IDA leads to increased left ventricular mass with eccentric hypertrophy more common. Echocardiography shows hemodynamic changes associated with IDA which improves oxygen delivery. Severe IDA causes high heart rate and stroke volume leading to increased cardiac output. Anemia and systolic blood pressure are the most modifiable risk factors for LV hypertrophy.

Background: Systemic hypertension is significantly associated with changes in retinal vasculature, leading to hypertensive retinopathy, which includes signs like narrowed arterioles, arteriovenous (AV) nicking, microaneurysms, and hemorrhages. These changes result from damage to the retinal blood vessels and are indicators of broader systemic damage, with more severe retinopathy correlating with poorly controlled hypertension and an increased risk of stroke and other cardiovascular events. Advanced imaging techniques such as OCT-A are increasingly used to detect subclinical microvascular alterations associated with hypertension. The objectives of the study were to estimate the association, and severity of hypertensive retinal changes among patients with other target organ damage (TOD) such as cardiovascular or cerebrovascular or renal morbidities.  Material and Methods: A cross-sectional descriptive observational study was carried out after doing systemic random sampling involving 416 study participants having a history of hypertensive cerebrovascular, cardiovascular, and renal damages include history of stroke, acute coronary syndromes, left ventricular hypertrophy, and chronic kidney disease which were examined by direct ophthalmoscopy findings and classified according to the Scheie classification throughout the past 1 year in OPD of Rama Medical College, Hospital & Research Centre, Hapur , Uttar Pradesh. Results:  Hypertensive retinopathy was present in 259 patients (62.25%) out of 416 participants (Grade I: 13.5%, Grade  II: 26.9%, Grade III: 18.5%, and Grade IV: 3.4%). Among the variables associated with hypertensive retinopathy, it was seen that 209 (63.3%) subjects present with features of hypertensive retinopathy are more than 50 years of age. No significant association was found between hypertensive retinopathy and presence or absence of cardiovascular morbidities, cerebrovascular morbidities, and renal morbidities. However, the subgroup analysis shows that significant association was found between Grade IV hypertensive retinopathy with renal morbidities (odds ratio [OR] = 5.83 at 95% CI, P = 0.002) and Grade I retinopathy with cerebrovascular morbidities (OR = 7.09 at 95% CI, P = 0.000). Conclusion:  Severe grades of retinopathy can be an indicator of renal morbidity, whereas earlier grades of retinopathy can be predictor of acute cerebrovascular events. Physicians should adopt holistic approach to evaluate TODs and screen them adequately in all hypertensives.

Background: The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has had a significant global impact, particularly in critically ill patients requiring intensive care unit (ICU) admission. In India, the second most populated country, COVID-19 has resulted in millions of infections and hundreds of thousands of deaths. This study aims to analyze the clinical profile and outcomes of critically ill COVID-19 patients admitted to a tertiary health care center in central India, specifically at Atal Bihari Vajpayee Government Medical College, Vidisha (M.P.). Materials and Methods: This retrospective observational study was conducted on critically ill COVID-19 patients admitted to the COVID ICU at ABVGMC Vidisha from September 2020 to December 2020. Patients aged 18 years and above, who tested positive for COVID-19 via RT-PCR and met the criteria for critical illness (e.g., respiratory rate >30 cycles/min, tachycardia >120/min, hypotension BP <90/60 mmHg, SpO2 <95%), were included. Data on patient demographics, clinical characteristics, laboratory findings, treatment protocols, and outcomes were collected from medical records. Statistical analysis was performed using SPSS, with categorical variables compared using the chi-square test and continuous variables analyzed using the Student’s t-test. Results: A total of 150 critically ill COVID-19 patients were included in the study. The mean age of the patients was 58 ± 12 years, with 65% being male. The most common comorbidities were hypertension (45%) and diabetes mellitus (38%). On admission, 85% of patients presented with dyspnea, 70% with fever, and 60% with cough. Laboratory findings showed lymphocytopenia in 55% of patients and elevated D-dimer levels in 60%. The overall mortality rate in the ICU was 35%, with the remaining patients either recovering or continuing to receive care. Factors associated with poor outcomes included older age, presence of comorbidities, and higher levels of inflammatory markers. Conclusion: The study highlights the severe impact of COVID-19 on critically ill patients, with a significant mortality rate observed in the ICU. Identifying key clinical features and outcomes can aid in better management and resource allocation in similar settings. This study is the first of its kind in Vidisha district and provides valuable insights for improving patient care in the region.

Background: Difficult airway management remains a leading cause of anaesthesia-related morbidity in obstetric practice. Physiological changes during pregnancy and labour may increase the risk of airway compromise, but the extent and timing of these changes in the Indian population have not been well described. This study aimed to evaluate serial changes in Mallampati classification among pregnant Indian women during late gestation, labour, and the early postpartum period, and to identify clinical predictors of these changes. Methods: Ninety pregnant women (>21 years) at 32–34 weeks gestation were prospectively enrolled at a tertiary centre in Odisha, India. Mallampati class was assessed at four time points: 32–34 weeks gestation, on admission for labour, 2–4 hours post-delivery, and 48–72 hours postpartum. Demographic data, body mass index (BMI), gestational weight gain, comorbidities, duration of labour, intravenous fluid administration, and gravida status were recorded. Changes in Mallampati classification were analyzed using the Wilcoxon signed-rank test and correlation statistics.  Results: Mallampati class increased significantly during the peripartum period. At baseline, 62.2% of women had Mallampati I, but this declined to 3.3% post-delivery and 2.2% at 48–72 hours postpartum. The proportion of women with Mallampati III or IV rose from 15.5% at baseline to 68.9% at 48–72 hours postpartum. Overall, 64% of women demonstrated a transition from Mallampati I/II to III/IV. Higher BMI, greater gestational weight gain, and larger volumes of intravenous fluids were significantly associated with increases in Mallampati class (p < 0.001). Age and parity were not significant predictors. Conclusions: Airway changes, as reflected by an increase in Mallampati class, are frequent during labour and may persist for at least 72 hours postpartum in Indian women. Obesity, excessive gestational weight gain, and higher intrapartum fluid administration are significant risk factors for difficult airway. Vigilant airway assessment should be emphasized throughout the peripartum period, particularly in women with these risk factors.

Background: Providing information and skills training in basic life support (BLS) is essential for all citizens. Sudden cardiac arrest demands immediate action, as survival rates improve dramatically when cardiopulmonary resuscitation (CPR) and defibrillation are administered within the first 3 to 5 minutes. Therefore, it is vital that the general public is equipped to recognize cardiac emergencies and deliver BLS promptly, sustaining the patient until professional medical help arrives. Objectives: This study aimed to:1) Assess the baseline knowledge of CPR among degree college students. 2) Implement an educational intervention on CPR techniques. 3) Evaluate post-intervention knowledge and practical performance related to CPR. Materials and Methods: This cross-sectional study was conducted at Government College for Men, B-Camp, Kurnool City, Andhra Pradesh, India, between October 1 and December 31, 2019. Ethical clearance was obtained from the Institutional Ethics Committee, and informed consent was secured from all participants. Out of 550 male students, 200 voluntarily participated in the CPR education and training session. The educational intervention included theoretical instruction and hands-on training on CPR and Basic Life Support (BLS) techniques. Results: Post-intervention analysis revealed a statistically significant improvement in the participants’ knowledge of heart attack symptoms, recognition of various types of chest pain, understanding of CPR procedures, and accuracy in performing CPR steps. Conclusion: CPR and BLS are critical life-saving skills. Educating young adults, particularly college students, can empower them to respond effectively in emergencies such as cardiac arrest, drowning, or trauma-related incidents. The educational intervention demonstrated a notable improvement in knowledge, skills, and attitudes towards emergency response among the participants.

Introduction: Tracheoesophageal fistula (TEF) repair in neonates presents significant anesthetic challenges due to airway abnormalities, associated cardiac defects, and pulmonary complications. This study retrospectively analyzes anesthetic management, intraoperative difficulties, and outcomes over five years. Methods: A retrospective observational study was conducted on 44 neonates undergoing TEF repair under general anesthesia from April 2013 to April 2018 at seven pediatric superspecialty hospitals. Data on demographics, airway management, intraoperative complications, postoperative morbidity, and mortality were collected and analyzed. Results: The cohort comprised 54.55% males and 45.45% females, with a mean birth weight of 2.42 kg. Difficult intubation occurred in 11.36% of cases, and desaturation during intubation was observed in 18.18%. Postoperative pneumonitis was prevalent (70.45% moderate, 22.73% severe). Mortality rate was 6.82%, primarily in neonates weighing less than 2 kg and with cardiac anomalies. Early surgery (≤3 days) was associated with better outcomes. Statistical analysis revealed birth weight and cardiac anomalies as significant predictors of morbidity and mortality (p < 0.05). Conclusion: Effective anesthetic management and multidisciplinary perioperative care significantly improve survival in neonates undergoing TEF repair. Low birth weight and cardiac anomalies remain key risk factors. Early intervention and NICU support are crucial to reduce morbidity and mortality.

Background: Difficult airway management remains a major contributor to anaesthesia-related complications during elective surgeries. Simple, non-invasive tools like the Modified Mallampati Classification (MPC) and Thyromental Distance (TMD) are commonly used for preoperative airway assessment, but their predictive accuracy varies across populations, warranting local validation against standard grading systems. Objective: To evaluate the predictive accuracy of the Modified Mallampati Classification and Thyromental Distance—individually—for anticipating difficult laryngoscopy and intubation in patients undergoing elective surgery under general anaesthesia. Methodology: This diagnostic study included 300 ASA I–II patients (18–65 years) undergoing elective surgery under general anaesthesia at a tertiary hospital. Preoperative MPC and TMD assessments were compared with intraoperative Modified Cormack-Lehane grades to identify difficult intubations. Sensitivity, specificity, PPV, NPV, and accuracy were analysed using SPSS v20. Results: Among the 300 patients, 20 (6.7%) had difficult laryngoscopy per CL grading. •Modified Mallampati Classification predicted difficult intubation in 20 patients. It demonstrated a sensitivity of 95%, specificity of 99.6%, positive predictive value (PPV) of 95%, negative predictive value (NPV) of 99.6%, and overall accuracy of 99.3%. •Thyromental Distance predicted 18 cases as difficult, with sensitivity of 90%, specificity of 100%, PPV of 100%, NPV of 99.3%, and accuracy of 99.3%. Both assessments were found to be excellent standalone predictors of difficult laryngoscopy, although TMD had a slightly lower sensitivity. Conclusion: The Modified Mallampati Classification and Thyromental Distance are reliable, simple, and cost-effective bedside screening tools for predicting difficult laryngoscopy and intubation. Both demonstrated high diagnostic accuracy in this study, validating their routine use in preoperative airway assessment. However, clinical judgment should complement their application, particularly in high-risk or borderline cases

Introduction: The number of individuals with chronic HCV all over the world is approximately 185 million In the last few years, antiviral therapy for HCV has been rapidly evolving with the introduction of direct-acting antiviral (DAA) therapies. Hepatitis C virus (HCV) infection is one of the most common chronic viral infections worldwide and in many cases leads to end-stage liver disease, liver transplantation, or death. HCV infection is also associated with the development of several extrahepatic manifestations, including chronic kidney disease (CKD). Public interest in HCV is growing, especially since the virus can also induce extrahepatic manifestations (in 40–70% of cases. the introduction of direct acting antiviral (DAA) agents has changed the treatment landscape of HCV, with highly efficacious treatment and few difficult to treat populations, patients with advanced renal disease were not among those who initially benefitted from these therapeutic options. Aims and objectives: to study the Virological response among hepatitis C infected patients treated with DAA with CKD and without CKD Materials and methods - after obtaining ethical clearance, 100 subjects were selected for the study. The study was conducted in the Department of Medicine, Silchar Medical College and Hospital, Silchar, Assam. Data from patients attending indoor and outdoor presenting with HCV infection with and without CKD was collected. Pretreatment and post treatment blood levels of liver enzymes, (ALT, AST) Platelet, Hemoglobin, WBC, Bilirubin, Albumin, Serum Creatinine, HCV RNA, eGFR, APRI, FIB 4 SCORE, USG W/A, PT -INR Was recorded. INCLUSION CRITERIAHCV infection with CKD who have completed treatment with DAA for 12 weeks, HCV infection without CKD who have completed treatment with DAA for 12 weeks, Age more than 18years & EXCLUSION CRITERIA-Malignancies, Coinfection with other viruses, Organ failure, those who have not completed DAA Statistical analysis - Data was entered using Microsoft Excel and exported to SPSS version 26.0. Results and observation – A total of 100 adults commenced direct–acting antiviral therapy; 50% had CKD. Median age was 42 years (IQR 25) and 82% were male. Creatinine and eGFR remained stable after therapy, and ALT and AST reductions were consistent across CKD stages Discussion – In our study we find that DAA administered CKD patients show no worsening of renal function. We did not find any AKI event in CKD related to DAA. In non-CKD patients SVR is 82% and in CKD patients it is 80% A previous study that suggested higher rates of “worsening renal function” in patients with CKD treated with DAA. Previous studies also did not attempt to attribute cause or determine reversibility of AKI events Conclusion: In our study we find that DAA administered CKD patients show no worsening of renal function. We did not find any AKI event in CKD related to DAA.

Purpose:  Although splenectomy is standard for hemodynamically unstable patients, the specific criterion for non-operative management continues to be debated. Thus, the aim of this study was to identify specific characteristics of patients with blunt splenic injuries admitted in a resource limited setting in central India. Methods: This study was conducted as retrospective observational study done at our hospital from January 1, 2023, to December 31, 2024. Trauma patients ≥ 18 years who had a blunt splenic injury were included. A total of 50 patients were enrolled in the study. The sampling technique adopted was convenience sampling, allowing the inclusion of patients who met the inclusion criteria and were available during the study period. Results: A total of 50 patients were studied with a mean age of 28 years of which 34 were males and 16 were females. Among the causes of injury, bike accident was 42% in. majority followed by motor vehicle accident (30%) and fall (22%). 30% were smokers and 10% had hypertension followed by 6% having diabetes found from records. The AIS >3 was found 56% in the head or neck area and 44% in the chest area. 90% patients underwent splenectomy as compared to 10% who were managed by non-operative methods. (NOM). Among the clinical characteristics, almost all patients i.e. 97.7% who had haemodynamic instability were operated.  Median stay in hospital was 5 days in cases of operated patients and 3 days in cases of those managed by non-operative methods.

Purpose: This study was conducted to explore the etiogical and clin profile of GI perforation in a tertiary care center located in a tribal region of Central India. Methods: A prospective observational study was conducted at the Department of Surgery in a tertiary hospital in Central India between January, 2024 to December, 2024 on patients who presented with GI perforation. Patients underwent detailed clinical evaluation, relevant investigations, surgical intervention, and postoperative monitoring. Data were analyzed using chi-square, Fisher’s exact test, and Student’s t-test to determine statistical significance. Results: A total of 105 patients were included in the study. The most affected age group was 21–30 years, and 76.2% of patients were male. Common etiologies included peptic ulcer (60%) and appendicitis (32.4%). The most frequent sites of perforation were prepyloric and appendicular regions. Conclusion: GI perforations remain a major surgical challenge in tribal populations, with peptic ulcers and appendicitis as leading causes

Introduction: Diabetic retinopathy (DR) is a microvascular complication of type 2 diabetes mellitus (T2DM) that may reflect systemic vascular damage. This study aimed to investigate the relationship between Diabetic retinopathy severity and cardiovascular risk factors, including glycemic control, lipid profile, hypertension, and electrocardiographic (ECG) changes. Methods: An analytical cross-sectional study was conducted on 126 patients with type 2 diabetes mellitus and Diabetic retinopathy. Diabetic retinopathy severity was classified as mild, moderate, or severe non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). Data on duration of diabetes, HbA1c, serum cholesterol, blood pressure, and ECG findings were collected and analyzed using appropriate statistical tests. Results: A significant correlation was observed between Diabetic retinopathy severity and age (p<0.001), duration of diabetes >10 years (p<0.001), HbA1c >8.5% (p<0.001), and serum cholesterol>200 mg/dL (p=0.033). Among patients with PDR, 70% had ECG changes, compared to only 23.3% in mild non-proliferative diabetic retinopathy, indicating a progressive increase in cardiac abnormalities with worsening Diabetic retinopathy. Hypertension was present in 29 patients, of whom 72% exhibited ECG changes (p<0.001). Tobacco use and family history of coronary artery disease did not show significant associations with Diabetic retinopathy severity or cardiac changes. Conclusion: Diabetic Retinopathy severity is significantly associated with poor glycemic control, hypercholesterolemia, prolonged diabetes duration, and cardiac abnormalities. These findings highlight the importance of using diabetic Retinopathy as a clinical marker for cardiovascular risk stratification in diabetic patients. Comprehensive management addressing both ocular and cardiovascular health is essential to reduce systemic complications.

Background: Sepsis, a life-threatening condition marked by dysregulated host response to infection and organ dysfunction, remains a leading cause of mortality worldwide. Among critically ill patients, sepsis-associated acute kidney injury (SA-AKI) significantly worsens prognosis. While conventional scoring systems like SOFA and qSOFA are used for prognostication, their limited predictive performance underscores the need for more accurate biomarkers. The lactate-to-albumin ratio (LAR) has emerged as a promising prognostic marker by capturing both metabolic and inflammatory derangements. Methods: This observational prospective cohort study was conducted over 18 months in the Medical ICU of Sri Aurobindo Institute of Medical Sciences, Indore. A total of 348 critically ill sepsis patients were enrolled. LAR was calculated within 24 hours of ICU admission. qSOFA, SOFA, APACHE II, and SAPS2 scores were recorded.  Results: Non-survivors had significantly higher LAR (2.50 ± 1.43) compared to survivors (0.64 ± 0.43, p<0.001). The optimal LAR cut-off of 1.2 provided the highest diagnostic accuracy (85.9%), with 81.9% sensitivity and 88.7% specificity. LAR showed moderate to strong correlation with SOFA (r=0.476), qSOFA (r=0.286), lactate (r=0.305), and albumin (r=–0.355). LAR demonstrated superior prognostic performance (AUC=0.932) compared to SOFA (AUC=0.857) and qSOFA (AUC=0.726). Conclusion: LAR is a robust, cost-effective prognostic biomarker for mortality in sepsis-associated AKI, surpassing traditional scoring systems in predictive accuracy. Its integration into ICU protocols could enhance early risk stratification and guide timely interventions. Further prospective validation and clinical standardization are warranted for widespread adoption.

Chronic myeloid leukaemia (CML) is a clonal myeloproliferative neoplasm marked by uncontrolled myeloid cell growth in the bone marrow. Tyrosine kinase inhibitors (TKI) are the primary treatment for CML but can cause side effects, including thyroid function test abnormalities. AIM: This study aimed to evaluate the thyroid function abnormality produced by the drug TKI in patients of CML and whether the thyroid function abnormality has a potential role to serve as a biomarker for clinical tumour response. Methods: Diagnosed patients of CML receiving TKI and who were in remission, i.e. patients in molecular response, were taken as the study group and were subjected to thyroid function tests. The thyroid function test results were observed and were associated with the molecular response pattern. Results: The study group was about 100 patients diagnosed with CML on TKI in molecular response, both major and deep molecular response. In the study group, 61/100 patients were in deep molecular response (DMR), and 39/100 patients were in major molecular response (MMR), with 65/100 patients receiving imatinib and 35/100 patients receiving nilotinib. The thyroid function test done on the study group showed that 75/100 patients had thyroid function abnormality, with hypothyroidism (70/100) being the most common abnormality. A statistically significant association was found between S.TSH levels (p<0.001) and S. free T3 level (p=0.047) with the molecular responses. also, a statistically significant association was found between hyperthyroidism (p=0.008) and a normal thyroid function test (p=0.013) with the molecular responses [p value <0.05 was considered statistically significant]. Conclusion: Our study confirms that tyrosine kinase inhibitors (TKIs) affect thyroid function, particularly in patients with chronic myeloid leukemia (CML). Hypothyroidism is one of the most common abnormalities observed.

Background: Conventional teaching methods in medical education, such as didactic lectures, often lead to passive learning, information overload, and limited critical thinking skills. Case-Based Learning (CBL) has emerged as an interactive alternative that promotes active engagement, reasoning, and clinical application of knowledge. This study aimed to compare the effectiveness of CBL with didactic lectures in teaching Community Medicine and to explore students’ perceptions of CBL. Methodology: An interventional study was conducted among 85 third-year MBBS students at a private medical college, Patna. Participants attended a didactic lecture on non-communicable diseases, followed by a pre-test. Subsequently, they engaged in structured CBL sessions using validated case scenarios on hypertension and diabetes mellitus. A post-test was administered using the same Multiple-Choice Questions. Student perceptions were recorded through a 10-item Likert scale feedback form. Median scores were calculated both in pre-test and post-test and Box and whisker plot was generated. Improvement in test scores was analysed using Wilcoxon Signed Rank Test (p < 0.05 was considered significant). Results: The median test score improved from 6.0 (pre-test) to 7.0 (post-test), with the difference being statistically significant (p < 0.001). Most students (>90%) reported that CBL enhanced critical thinking, application of knowledge, and motivation for deeper learning. Although 35% felt CBL took more time, 95% recommended applying it to other Community Medicine topics. Conclusion: CBL significantly improved student performance, interest, and motivation compared to didactic lectures. By integrating real-life scenarios, CBL helps prepare students for their roles as primary care physicians. Further studies are needed to evaluate its long-term impact and to optimize its integration into the curriculum.

Background: The hallmark of acute ischaemic stroke (AIS) is the abrupt cessation of blood flow to a region of the brain, usually in a vascular territory, which causes a concomitant decline in neurologic function. Traditionally an iron-storing protein, serum ferritin also serves as an acute-phase reactant and is one of the prognostic markers that have attracted a lot of clinical attention lately. Objective: By examining its relationship to stroke severity and clinical outcomes, this study sought to determine the predictive value of blood ferritin levels in AIS patients. Methods: At a tertiary care hospital, 120 AIS patients who had been verified by neuroimaging participated in a prospective observational study. Levels of serum ferritin were assessed upon admission, day 7, and discharge.Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Statistical analysis was performed using IBM SPSS Version 26.0. Results: The mean ferritin levels were significantly higher in non-survivors compared to survivors at all time points—admission (353.76 vs. 127.42 ng/mL, p=0.002), day 7 (343.19 vs. 128.56 ng/mL, p<0.001), and discharge (348.29 vs. 130.15 ng/mL, p<0.001). A consistent positive correlation was observed between ferritin levels and stroke severity. Patients with severe strokes (NIHSS 21–42) had the highest ferritin concentrations throughout hospitalization. The mortality rate was 9.2%, and the majority of survivors showed clinical improvement over time. Conclusion: In individuals with acute ischaemic stroke, elevated blood ferritin levels are substantially linked to both increased mortality and greater stroke severity. Ferritin might be a useful, reasonably priced prognostic biomarker for better AIS management and early risk classification. It is advised to do additional multicenter validation

Introduction: The fallopian tubes were first described in 16th centuary and named after anatomist Gabriele Falloppio. In surgical histopathology, the fallopian tubes are one of the most encountered specimens and these tubes are mainly removed for lesions in other gynecological organs.As they are distinguished from adenomyosis by their sharp demarcation from surrounding normal tissues and  from leiomyomas by the presence of endometrial glands and stroma(10). As Hemangioma are tumors of vascular origin and they are mostly observed in soft tissue and skin. Vascular tumor of pelvic organs are very rare and they are detected incidentally. Capillary hemangioma of fallopian tube is a very rare neoplasm. Rupture of this hemangioma can be lethal (11). As it is a benign sporadic vascular tumor , only 16 documented cases available in literature(12). Due to potential for these lesions to manifest as surgical emergencies, it is very important for surgeons to recognize these lesions immediately and appropriately managedAs they are distinguished from adenomyosis by their sharp demarcation from surrounding normal tissues and  from leiomyomas by the presence of endometrial glands and stroma(10). As Hemangioma are tumors of vascular origin and they are mostly observed in soft tissue and skin. Vascular tumor of pelvic organs are very rare and they are detected incidentally. Capillary hemangioma of fallopian tube is a very rare neoplasm. Rupture of this hemangioma can be lethal(11). As it is a benign sporadic vascular tumor , only 16 documented cases available in literature(12). Due to potential for these lesions to manifest as surgical emergencies, it is very important for surgeons to recognize these lesions immediately and appropriately managed.

Aim: To evaluate the efficacy and safety of adding clonidine to ropivacaine in supraclavicular brachial plexus block by comparing postoperative analgesia duration, incidence of hemodynamic changes (hypotension, bradycardia), sedation levels, and other adverse effects between the two groups. Methodology: This prospective case series study was conducted over a period of three months in the Department of Anesthesiology, Government Medical College, Thiruvananthapuram, following approval from the institutional ethics committee. A total of 110 ASA I–III patients undergoing forearm or hand orthopedic surgeries were enrolled after obtaining informed consent. Patients were randomly allocated into two groups: Group A received 0.5% Ropivacaine with 150 µg clonidine, and Group B received 0.5% Ropivacaine with saline via supraclavicular brachial plexus block under nerve stimulator guidance. Result: The addition of clonidine to ropivacaine significantly prolonged the duration of postoperative analgesia (734.45 ± 28.28 minutes vs. 504.82 ± 21.84 minutes, p < 0.05) in patients undergoing supraclavicular brachial plexus block. Although hypotension and bradycardia were more frequent in the clonidine group (7.3% and 9%, respectively) compared to the control group (1.8% and 3.6%), these differences were not statistically significant (p > 0.05). Sedation scores were significantly higher in the clonidine group (p < 0.05), though sedation was mild and self-limiting. No major adverse effects such as respiratory depression or fainting were observed in either group. Conclusion: The present study confirms that the addition of clonidine (150 µg) to 0.5% ropivacaine in supraclavicular brachial plexus block significantly enhances the duration of postoperative analgesia compared to ropivacaine alone. Patients in the clonidine group also exhibited mild sedation without significant hemodynamic changes such as hypotension or bradycardia. Furthermore, no major adverse effects were observed, indicating a favorable safety profile. These findings support the efficacy and safety of clonidine as an adjuvant to ropivacaine, offering improved analgesic outcomes and patient comfort with minimal risk.

Background: Tuberculosis is a global health challenge further amplified by the emergence of drug-resistant tuberculosis (DR-TB). Rapid diagnosis is a necessity for initiating early treatment. Xpert MTB/RIF assay is a highly sensitive and specific tool that can detect both TB and rifampicin resistance within two hours.  Aims and Objectives: The aim of this study is to determine the prevalence of Rifampicin resistant pulmonary tuberculosis in presumptive pulmonary tuberculosis patient attending our institute. Materials and Methods: A cross-sectional study was conducted in our tertiary care centre from June 2024 to November 2024. Presumptive pulmonary tuberculosis patients attending chest and respiratory medicine Department of our hospital were subjected to Xpert MTB/RIF assay. Results: A total of 829 presumptive pulmonary tuberculosis patients were included in the study. The prevalence of pulmonary tuberculosis was 24.84% and prevalence of Rifampicin-resistant tuberculosis (RR-TB) among diagnosed TB cases was 3.39%. Rifampicin resistance was observed in 2.59% of male participants and 5.76% of female participants. RR-TB was more among alcoholics and previously treated patients(p<0.05). Conclusion: Rifampicin is a predictor for MDR-TB. The study highlights the importance of Xpert MTB/RIF assay in early diagnosis which will bring down morbidity and mortality due to DR-TB to a great extent.

The Bezold-Jarisch reflex (BJR) is a cardiac reflex triggered by cardiac mechanoreceptors, following underfilling of ventricles, resulting in vasodilation, hypotension and bradycardia. We present a case report of a 30-year-old female patient who developed bradycardia and asystole during the administration of combined spinal-epidural anaesthesia for exploratory laparotomy. She was resuscitated, given appropriate post-cardiac arrest care and recovered to baseline vital parameters within 24 hours.

Background: Cardiovascular disease (CVD) remains the leading cause of mortality worldwide. Nutritional supplements or Nutraceuticals such as fish oil and garlic pearls have been studied for their lipid-lowering and cardioprotective properties. This study evaluates the effects of combined supplementation with fish oil and garlic pearls on lipid profile parameters and inflammatory markers in adults at risk of cardiovascular disease. Methods: This is a poststudy interventional study done in a tertiary care setting with 60 subjects attending cardiology outpatient clinic. Lipid markers namely Total Cholesterol, LDLc (low density Cholesterol), VLDL (Very Low Density Cholesterol), HDLc(high Density Cholesterol), Triglycerides(TGL)  and Inflammatory markers such as High Sensitive C-reactive protein(Hs-CRP), Homocysteine and Fibrinogen, were assessed before and after 12 weeks supplementation of Fish oil and Garlic pearls.  Results: Statistically significant improvements in the levels were observed in Total cholesterol, LDLc, VLDL, HDLc, Triglycerides (TGL) and Inflammatory markers such as high-sensitivity C-reactive protein (Hs-CRP), homocysteine and fibrinogen levels post-supplementation (p < 0.001). Conclusions: The findings suggest that combined supplementation may serve as a valuable adjunctive therapy in mitigating the effect of cardiovascular risk factors, thereby potentially reducing the cardiovascular morbidity and mortality.

Background: Despite the importance of recognising coronary artery anomalies (CCAs) due to its many therapeutic implications and regional variations, limited studies are reported from India using 256 multi slice CT angiography. Objective: To estimate the prevalence and type of CCAs and variants among adults undergoing routine health checkup.  Methods: A total of 612 consecutive 256-MSCTCA scans were prospectively reviewed & interpreted based on Angelini classification by two radiologists independently at a tertiary care hospital with a cardiac referral service. The study included adult cardiac patients over 18 years old from April 2023 to April 2024. Frequency of CAA and type of anomaly or variants were recorded. Results: The average age of the study cohort was 49.0±6.1 years. The prevalence of CAAs including myocardial bridge (MB) was seen in 39 (6.3%). Among CAAs, 19 (3.1%) and 18 (2.9%) were related to course and to origin respectively. Common variants observed were codominance (15.3%), type 3 Left anterior Descending (LAD) artery (64%) and Shepherd crook Right CA (RCA) (0.5%). Common anomalies detected were anomalous RCA origin (1.1%), Left Circumflex (LCx) origin from RCA (0.5%) and separate origin of LAD and LCx with absent LMCA. Prevalence of MB was 2.6%. Conclusion: The prevalence of CAAs including MB in present study is consistent with established ranges found in different studies. Though most of the CAAs are benign, association of some of them with difficult coronary intervention and sudden death underscores the importance of differentiation between hemodynamically serious and relatively benign anomalies. MSCTCA is helpful non-invasive modality in defining coronary artery anatomy, including origin, course, and termination.

Background: Purpose: Acute appendicitis can lead to perforation which can be lethal. The present study assessed the outcomes of laparoscopic appendectomy versus open appendectomy in patients with perforated appendicitis. Methods: A comparative study was conducted at the Department of Surgery in a tertiary hospital in Central India between January, 2024  to December, 2024. Patients were allocated to either open appendectomy (Group A) or laparoscopic appendectomy (Group B). The data gathering proforma recorded demographics, surgical findings, operating room (OR) time, length of inpatient care, requirement of analgesic, and any adverse events following surgery.  Results: A total of 170 patients were included in the laparoscopic appendectomy group, while 202 cases were included in the open appendectomy group. The use of analgesics thrice a day to manage the postoperative pain was significantly associated with the open appendectomy (p < 0.0001). Moreover, the postoperative length of hospitalization was substantially greater in patients who underwent open appendectomy than those who underwent laparoscopic procedure (p < 0.0001). Wound-related complications were considerably lower in patients who had laparoscopic appendectomy as compared to those who had open appendectomy (23.53% versus 40.5%; p = 0.013.

Background: This case report describes a rare instance of coinfection with leptospirosis and scrub typhus in a previously healthy 23-year-old male sales worker from a middle-class family in North-eastern India. The patient presented with a seven-day history of high-grade fever with altered kidney and liver function as evidenced by rise of blood parameters accompanied by severe headache. Initial symptomatic management failed due to persistent fever and onset of hypotension, prompting referral to a tertiary care institute. Clinical Findings: Upon evaluation, investigations revealed leucocytosis, thrombocytopenia, kidney and liver dysfunction, as well as elevated C-reactive protein levels. Serological tests confirmed the presence of both Leptospira IgM and Orientia tsutsugamushi (scrub typhus) IgM antibodies, indicating coinfection. Such dual infections are infrequently documented in this region, highlighting the diagnostic challenge. Management and Outcome: Based on clinical suspicion and laboratory confirmation, the patient was promptly started on doxycycline alongside broad-spectrum antibiotics like injectable third generation cephalosporin. This timely intervention led to significant clinical improvement, preventing the progression to severe complications that are commonly associated with delayed treatment in such cases. Conclusion: Coinfections involving leptospirosis and scrub typhus, although rare, should be considered in patients presenting with undifferentiated febrile illnesses, especially in endemic and agricultural regions. Early recognition and appropriate antibiotic therapy are essential to reduce morbidity and prevent mortality.

Background: Effusion cytology plays a pivotal role in the early diagnosis and management of patients with suspected malignant involvement of serous cavities. The International System for Reporting Serous Fluid Cytopathology (ISRSFC), by International Academy of Cytologists (IAC) guidelines, offers a standardized five-tier framework for categorizing cytological findings and estimating the associated risk of malignancy (ROM). Materials and Methods: A retrospective review of 784 effusion cytology samples collected from January 2022 to December 2023 was conducted for duration of one year by Department of Pathology in Lt. Baliram Kashyap Memorial Government Medical College, Jagdalpur. All cases were reclassified according to ISRSFC guidelines. Cell block preparations and immunohistochemistry were performed in selected cases. Clinical, radiologic, and histopathological follow-up data were used for diagnostic correlation. Results: The study included 416 female and 368 male patients, with a mean age of 52.8 years (range: 1–88 years). Among the fluids analyzed, 395 (50.38%) were pleural, 289 (36.8%) peritoneal, 39 (4.9%) pericardial, 37 (4.6%) CSF and 24 (3.06%) synovial fluid. Based on ISRSFC classification, 21 (2.7%) cases were non-diagnostic (ND), 532 (67.9%) were negative for malignancy (NFM), 28 (3.6%) were atypical (AUS), 47 (6%) were suspicious for malignancy (SFM), and 156 (19.9%) were positive for malignancy. The ROM was calculated as follows: 14.2% for ND, 18.6% for NFM, 51.4% for AUS, 75.9% for SFM, and 93.5% for the malignant category. Lung and gastrointestinal malignancies were most commonly associated with pleural and peritoneal effusions, respectively. Conclusion: The application of the ISRSFC classification system is feasible and effective in routine cytological evaluation of serous effusions. This standardized approach improves diagnostic reproducibility and provides meaningful prognostic information by stratifying malignancy risk across diagnostic categories.

Background: Atherosclerosis, once considered a disease of older individuals, is increasingly prevalent among young adults. Emerging evidence suggests that psychosocial stress and sedentary behavior are key modifiable risk factors contributing to early vascular changes and plaque formation. Understanding their role is crucial in developing preventive strategies aimed at reducing the burden of cardiovascular disease in this demographic. Materials and Methods: A cross-sectional observational study was conducted among 200 young adults aged 20–35 years in a metropolitan population. Participants were assessed for psychosocial stress using the Perceived Stress Scale (PSS) and for physical activity levels using the International Physical Activity Questionnaire (IPAQ). Carotid intima-media thickness (CIMT), a surrogate marker of subclinical atherosclerosis, was measured using high-resolution B-mode ultrasonography. Serum lipid profiles and high-sensitivity C-reactive protein (hs-CRP) were also evaluated. Statistical analysis involved Pearson correlation and multiple linear regression to determine associations between variables. Results: Participants with high stress scores (PSS ≥ 20) had significantly increased mean CIMT values (0.72 ± 0.12 mm) compared to those with low stress (0.61 ± 0.09 mm; p < 0.01). Similarly, individuals with low physical activity reported higher CIMT (0.75 ± 0.11 mm) versus active individuals (0.60 ± 0.08 mm; p < 0.01). Elevated hs-CRP and LDL levels were observed in both high-stress and sedentary groups. Regression analysis confirmed psychosocial stress (β = 0.31, p = 0.002) and sedentary lifestyle (β = 0.29, p = 0.004) as independent predictors of CIMT. Conclusion: Psychosocial stress and lack of physical activity are significantly associated with early atherosclerotic changes in young adults. These findings highlight the importance of early lifestyle interventions focusing on mental well-being and physical activity to prevent premature cardiovascular events.

Background: Rapid Sequence Intubation (RSI) is a critical procedure in emergency medicine for securing the airway quickly and safely, especially in patients at risk of aspiration. Conscious sedation, involving the administration of sedative agents without complete loss of consciousness, is increasingly utilized to optimize patient cooperation and physiological stability during RSI. This study aims to retrospectively evaluate the role and outcomes of conscious sedation in RSI among emergency department (ED) patients. Materials and Methods: A retrospective analysis was conducted using medical records of 240 patients who underwent RSI in the ED. Patients were divided into two groups: those who received conscious sedation prior to RSI (Group A, n=120) and those who underwent standard RSI with deep sedation (Group B, n=120). Sedative agents included midazolam, fentanyl, and ketamine. Data on intubation success rate, hemodynamic parameters, incidence of complications (e.g., hypotension, desaturation), and time to intubation were collected and analyzed using SPSS v26. Statistical significance was set at p<0.05. Results: First-pass intubation success was higher in Group A (94.2%) compared to Group B (88.3%) (p=0.043). Incidence of post-intubation hypotension was lower in the conscious sedation group (12.5%) than in the deep sedation group (21.7%) (p=0.031). Mean time to successful intubation was 43.7 ± 8.6 seconds in Group A versus 47.9 ± 10.1 seconds in Group B (p=0.022). No significant difference was observed in oxygen desaturation episodes between groups (p=0.41). Conclusion: The use of conscious sedation in RSI appears to improve intubation outcomes and minimize hemodynamic complications in emergency settings. Conscious sedation may serve as a safer alternative to deep sedation in select emergency patients, warranting further prospective trials for validation.

Background: Diabetes Mellitus, a chronic metabolic disorder  characterised by elevated blood glucose values, due to decreased insulin secretion and increased resistance to action of Insulin in peripheral tissue. T2DM is associated with decreased 25-OH Vit D compared to controls Vit D deficiency in diabetes is also associated with poor glycaemic control.    Ferritin, one of the key proteins regulating iron homeostasis, is a widely available clinical biomarker to evaluate iron status and especially important for detecting iron deficiency.  Aim: To  assess Serum Vit D  ,  Serum Vit B 12  and Ferritin levels in type 2 Diabetes mellitus patients  and to compare them with healthy controls  to understand the prevalence of Vit D deficiency, Vit B12 deficiency and Hyperferritinaemia  and correlate to Glycated Hemoglobin, Glycaemic status marker in diabetic patients attending our hospital.  Material and Methods :A comparative  cross sectional study was conducted in the Department of Biochemistry,  24 hrs Laboratory- RMC , KKD over a period of 6  months, March  2024-  August 2024. Grouping newly diagnosed Diabetic patients in group I and normoglycemic controls  in group II as controls. 50 newly diagnosed type 2 DM  patients  constitute group I, 50 age and sex matched Healthy individuals are enrolled in group II. Study participants are advised to be on overnight fast and blood sample is collected in morning  in labelled red topped  vacutainer for  Fasting Plasma Glucose (FPG),  Serum Vit B12, Serum Vit D ,  Serum  Ferritin) and violet topped vacutainer for glycated Hemoglobin  and also in Post Prandial conditions ( 1 hr 30 min  after breakfast for Post Prandial Plasma Glucose  under strict aseptic conditions. Results: The mean age of diabetic patients was significantly higher (44.5 ± 12.7 years) compared to controls (34.43 ± 11.05 years), with a p-value of 0.018, indicating a statistically significant difference. Fasting Plasma Glucose (FPG) levels were markedly elevated in the diabetic group (134.1 ± 50.1 mg/dL) compared to controls (75.3 ± 19.8 mg/dL), with a highly significant p-value of 0.0001. Similarly, Postprandial Plasma Glucose (PPPG) was significantly higher among diabetic patients (217.8 ± 60.1 mg/dL) than in controls (120.1 ± 21.5 mg/dL), also with a p-value of 0.0001. Additionally, HbA1c levels—a marker of long-term glycemic control—were substantially elevated in the diabetic group (11.2 ± 3.1%) versus the control group (5.1 ± 0.7%), with a p-value of 0.0001, further validating the diagnosis of chronic hyperglycemia. Serum Vitamin D levels were significantly lower in diabetics (23.9 ± 15.4 ng/mL) compared to controls (33.9 ± 16.6 ng/mL), with a p-value of 0.0187. This finding supports existing evidence linking Vitamin D deficiency with insulin resistance and impaired glucose metabolism. Conclusion Elevated fasting and postprandial glucose levels, along with increased HbA1c, reaffirm the hyperglycemic state characteristic of diabetes. Importantly, the study also revealed significant deficiencies in Vitamin D and Vitamin B12, as well as reduced ferritin levels in diabetic individuals—even before the initiation of any pharmacological treatment..

Background: Chronic obstructive pulmonary disease (COPD) is a prevalent and progressive respiratory disorder often complicated by coexisting cardiovascular conditions such as left ventricular failure (LVF). The clinical overlap in symptoms between acute exacerbation of COPD (AECOPD) and heart failure poses diagnostic challenges. N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) has emerged as a potential biomarker for distinguishing cardiac involvement in such patients. Objectives: To assess serum NT-pro-BNP levels in elderly patients with AECOPD and compare levels between those with and without concurrent LVF, and to explore the relationship of NT-pro-BNP with COPD severity. Materials and Methods: A prospective observational study was conducted over one year in the internal medicine department of SMS Hospital, Jaipur. Eighty patients aged ≥60 years were enrolled and divided into two groups: AECOPD with LVF (cases, n=40) and AECOPD without LVF (controls, n=40). All patients underwent spirometry, NT-pro-BNP testing, and echocardiography. Clinical, biochemical, and pulmonary function data were analyzed using appropriate statistical tools, with significance set at p<0.05. Results: The mean age of cases and controls was comparable (66.1 ± 3.45 vs. 66.2 ± 4.6 years; p=0.9882). NT-pro-BNP levels were significantly higher in cases (13,373.8 ± 8,319.7 pg/mL) compared to controls (1,135.15 ± 986.4 pg/mL; p<0.0001). Severe pulmonary restriction was more prevalent in cases (57.5%) than in controls (37.5%) though not statistically significant (p=0.1458). Most patients with elevated NT-pro-BNP were in GOLD stage 2 (87.88%) or stage 3 (12.12%) of COPD. Conclusion: Serum NT-pro-BNP levels are significantly elevated in elderly AECOPD patients with LVF, supporting its role as a useful biomarker for identifying cardiac dysfunction in this population. NT-pro-BNP may aid in disease severity assessment and guide early intervention strategies in clinical practice.

Early detection of pulmonary nodules in smokers is crucial for the timely diagnosis of lung cancer. Low-dose computed tomography (LDCT) has been proposed as a screening tool with reduced radiation exposure compared to standard-dose CT. This study aimed to evaluate the diagnostic accuracy of LDCT in identifying pulmonary nodules in chronic smokers. Materials and Methods: A prospective observational study was conducted at a tertiary care center involving 150 chronic smokers aged 45–75 years with a smoking history of ≥20 pack-years. All participants underwent LDCT screening followed by standard-dose chest CT (SDCT) within 72 hours as a reference standard. Pulmonary nodules detected by both modalities were compared for size, location, and number. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of LDCT were calculated. Results: LDCT detected pulmonary nodules in 102 out of 150 participants (68%). When compared with SDCT, LDCT showed a sensitivity of 92.4%, specificity of 88.3%, PPV of 90.1%, and NPV of 90.8%. The mean size of nodules detected on LDCT was 5.8 ± 1.6 mm, closely matching those found on SDCT (6.0 ± 1.5 mm, p = 0.27). No significant difference was found in nodule localization between the two methods (p = 0.34). Conclusion: LDCT demonstrates high accuracy in detecting pulmonary nodules in high-risk smoker populations, with excellent sensitivity and specificity. It serves as a reliable, low-radiation screening tool and may significantly enhance early detection of lung malignancies.

Introduction: Right ventricular dysfunction (RVD) is increasingly recognized in heart failure with preserved ejection fraction (HFpEF) and may impact prognosis. This study was aimed to assess the prevalence of RVD in HFpEF patients and its association with clinical outcomes. Methods: The current prospective observational study was done on of 100 HFpEF patients. Clinical, biochemical, and echocardiographic parameters, including TAPSE, FAC, and PASP, were evaluated. Patients were categorized into RVD and non-RVD groups and compared for clinical features, hospital stay, and one-month mortality. Results: RVD was present in 41% of patients. Age, gender, BMI, and comorbidities were similar between patients with and without RVD. RVD patients had lower EF, TAPSE, and FAC, and higher PASP. RVD was associated with longer hospital stay (7.3 vs. 5.4 days) and more mortality (8 of 13 deaths). Conclusion: RVD is common in HFpEF and is linked to worse short-term outcomes. Routine assessment of RV function may aid in risk stratification and management of HFpEF.

Surgical site infections are dreadful and hence this study was undertaken to study the risk factors for surgical site infections in patients admitted under general surgery in a tertiary hospital in Central India. Methods: This study was conducted as a prospective, randomized, single-blind observational study done at our hospital from January 1, 2023, to December 31, 2024. A total of 180 post-operative patients who developed wound infections during the course of their post-surgical care were enrolled in the study. The sampling technique adopted was convenience sampling, allowing the inclusion of patients who met the inclusion criteria and were available during the study period. Results: A total of 180 patients were studied of which 122 were males and 58 were females. The largest age group undergoing surgery was 51-60 years (31.11%), followed by 41-50 years (22.22%). The youngest group (0-10 years) comprised 6.11%, while the 11-20 age group was 5.56%. The majority of surgeries were contaminated (56.11%), followed by clean-contaminated (23.89%) and clean surgeries (18.89%). Dirty surgeries accounted for only 1.11%. Patients with HB < 11 g/dL were at increased risk of deeper infections. Higher values were significantly associated with deep SSIs, highlighting its value as an infection marker. Increased with SSI severity. Patients with organ-space SSIs had the longest hospitalization (mean ~25.5 days), compared to 16.5 days for deep and 12.9 days for superficial infections. Contaminated and emergency procedures carried the highest burden of SSI, stressing the importance of intraoperative vigilance and strict sterilization