European Journal of Cardiovascular Medicine

Introduction: Psoriasis is a chronic inflammatory skin disease associated with systemic manifestations including dyslipidemia and increased cardiovascular risk. This study aimed to investigate the correlation between dyslipidemia and psoriasis disease severity in Indian population. Materials & Methods: A case-control study was conducted including 100 psoriasis patients and 100 age-sex matched controls from a tertiary care center in Gujarat, India. Disease severity was assessed using Psoriasis Area and Severity Index (PASI). Fasting lipid profiles were analyzed, and derived atherogenic indices including Cardiac Risk Ratio, Atherogenic Index of Plasma, and Atherogenic Coefficient were calculated. Results: Dyslipidemia was significantly more prevalent in psoriasis patients (74%) compared to controls (45%) (p<0.001). Patients showed higher total cholesterol (209.6±38.5 vs 178.4±32.1 mg/dL), triglycerides (189.7±64.3 vs 142.2±48.5 mg/dL), LDL-C (128.4±34.2 vs 102.7±28.3 mg/dL), and lower HDL-C (41.8±8.6 vs 50.7±9.1 mg/dL). Progressive lipid parameter worsening was observed with increasing PASI scores (p<0.001). Conclusion: Dyslipidemia is significantly associated with psoriasis severity, indicating enhanced cardiovascular risk burden. Regular screening and comprehensive management strategies are essential for psoriasis patients.

Background: Inadequate sleep is a growing public health concern increasingly linked to cardiovascular disease (CVD). While chronic sleep loss is a known risk factor, the acute physiological consequences of a single night of insufficient sleep on a comprehensive set of cardiovascular parameters are not fully elucidated. Methods: We conducted a randomized, single-blind, crossover study with 32 healthy participants (16 female; mean age 24.5 ± 3.1 years). Each participant underwent two experimental conditions in a controlled laboratory setting, separated by a one-week washout period: an Adequate Sleep (AS) condition (8 hours time in bed) and a Sleep Restriction (SR) condition (4 hours time in bed). The morning after each condition, we measured resting brachial blood pressure, heart rate, 5-minute time-domain HRV parameters (SDNN, RMSSD), and serum concentrations of high-sensitivity C-reactive protein (hs-CRP) and Interleukin-6 (IL-6). Paired-samples t-tests were used to compare outcomes between the two conditions. Results: Compared to the AS condition, the SR condition resulted in significant elevations in systolic blood pressure (116.2 ± 8.1 mmHg vs. 123.5 ± 9.3 mmHg; p < 0.001) and diastolic blood pressure (74.8 ± 6.5 mmHg vs. 80.1 ± 7.2 mmHg; p < 0.001). Resting heart rate was also significantly higher after SR (64.3 ± 7.9 bpm vs. 71.8 ± 8.8 bpm; p < 0.001). Autonomic function was impaired, as evidenced by significant reductions in both SDNN (54.1 ± 12.3 ms vs. 45.7 ± 10.9 ms; p = 0.002) and RMSSD (46.2 ± 13.5 ms vs. 37.9 ± 11.8 ms; p = 0.001). Furthermore, the SR condition led to a significant increase in the inflammatory markers hs-CRP (1.12 ± 0.45 mg/L vs. 1.78 ± 0.61 mg/L; p < 0.001) and IL-6 (1.49 ± 0.52 pg/mL vs. 2.44 ± 0.73 pg/mL; p < 0.001).Conclusion: A single night of partial sleep restriction is sufficient to induce significant and adverse acute changes in hemodynamic, autonomic, and inflammatory parameters in healthy young adults. These findings highlight the immediate physiological stress imposed by sleep loss and underscore its potential role as a contributor to the initial stages of cardiovascular pathology.

Background: Pre-hypertension in young adults is associated with early vascular changes that may predispose to cardiovascular disease. Arterial stiffness and heart rate variability (HRV) are emerging non-invasive markers for detecting subclinical endothelial dysfunction. This study aimed to assess the predictive value of these parameters in young adults with pre-hypertension. Material and Methods: A cross-sectional analytical study was conducted on 123 young adults (18–35 years) with pre-hypertension. Demographic, anthropometric, and lifestyle data were recorded. Arterial stiffness was assessed using pulse wave velocity (PWV) and augmentation index (AIx), while HRV was evaluated via time-domain (SDNN, RMSSD) and frequency-domain (LF, HF, LF/HF ratio) parameters. Endothelial function was measured using brachial artery flow-mediated dilation (FMD). Correlations between arterial stiffness, HRV, and endothelial function were analyzed using Pearson or Spearman correlation and multivariate regression. Results: Mean age was 26.4 ± 4.3 years; 55.3% were male. Mean SBP/DBP was 128.3 ± 5.7 / 83.5 ± 4.8 mmHg. PWV and AIx were 7.1 ± 0.8 m/s and 26.5 ± 6.3%, respectively. HRV: SDNN 42.8 ± 10.5 ms, RMSSD 35.6 ± 9.4 ms, LF/HF 1.07 ± 0.25. FMD averaged 9.5 ± 2.4%, with 55.3% showing dysfunction. PWV and AIx correlated inversely with FMD (r = -0.48, -0.42; p < 0.001), while SDNN and RMSSD correlated positively (r = 0.36, 0.33; p ≤ 0.002). LF/HF ratio was negatively correlated (r = -0.29, p = 0.004). Multivariate regression identified higher PWV, AIx, LF/HF ratio, age, and BMI as independent predictors of endothelial dysfunction; greater HRV was protective. Conclusion: In young adults with pre-hypertension, increased arterial stiffness and reduced HRV are significantly associated with early endothelial dysfunction. Non-invasive assessment of these parameters may help identify individuals at elevated cardiovascular risk, allowing timely preventive interventions.

Background: Surgical procedures induce physiological stress, which, when coupled with anaesthetic interventions, can affect a patient's recovery and postoperative outcomes. Recent advances in perioperative care highlight the potential for personalized medicine, where treatments are tailored based on individual patient profiles. However, the integration of surgical stress physiology and anaesthetic modulation remains underexplored, particularly in the context of tailoring anaesthetic approaches to individual needs. Objective: This study investigates the integration of surgical stress physiology and anaesthetic modulation, with the aim of advancing personalized perioperative care. We focus on the role of individual variability in stress responses and the effectiveness of different anaesthetic agents in modulating these responses. Our goal is to develop a framework for personalized anaesthetic approaches that optimize patient outcomes in the perioperative period. Methods: A cohort of patients undergoing elective surgery was selected at the Career Institute of Medical Sciences and Hospital, Lucknow. Patient-specific data, including age, gender, comorbidities, and genetic predispositions, were collected preoperatively. Intraoperative anaesthetic management was tailored based on patient profiles, including the selection of anaesthetic agents and dosages. Physiological parameters such as heart rate, blood pressure, and stress hormone levels (cortisol and catecholamines) were measured during surgery to assess the response to anaesthetic modulation. Postoperative recovery, pain levels, and complications were monitored for 30 days following surgery. Results: The study demonstrated significant interpatient variability in surgical stress responses, influenced by both baseline health status and genetic factors. Personalized anaesthetic regimens, adjusted according to these individual factors, resulted in improved postoperative recovery times and reduced complications. Patients receiving personalized anaesthetic management showed lower levels of stress hormones during surgery, indicating more effective modulation of the stress response. Moreover, recovery outcomes, including pain management and the incidence of postoperative cognitive dysfunction, were significantly improved in the personalized care group compared to standard protocols. Conclusion: This study supports the integration of surgical stress physiology and anaesthetic modulation as a means to optimize perioperative care. Personalized anaesthetic strategies, based on individual patient characteristics, improve both intraoperative stress response and postoperative recovery. Further research, including larger clinical trials, is necessary to refine these strategies and establish standardized protocols for personalized perioperative medicine.

Introduction: Oral cavity lesions, both premalignant and malignant, constitute a significant public health problem in India, with Western India being a high-prevalence region due to tobacco and betel quid use. Understanding the sociodemographic and histopathological profiles of these lesions is essential for planning effective preventive and diagnostic strategies.  Aim: To evaluate the sociodemographic and histopathological profile of premalignant and malignant oral cavity lesions in Western India.  Materials and Methods: A prospective observational study was conducted at a tertiary care center in Western India from December 2020 to June 2022. A total of 88 biopsy-proven cases were included, comprising 26 premalignant and 62 malignant lesions. Detailed sociodemographic data, clinical presentation, and habit history were collected. Specimens were processed with standard histopathological techniques and classified according to WHO criteria. Statistical analysis was performed using chi-square and t-tests, with p<0.05 considered significant.  Results: The mean age of patients was 49.1 ± 7.2 years, with a male predominance (67.0%). Rural residence (58.0%) and illiteracy (65.9%) were common. Tobacco chewing (83.0%) and smoking (75.0%) were the most prevalent risk factors. The commonest presenting complaint was a non-healing ulcer (79.5%), and the buccal mucosa was the most frequently affected site (62.5%). Histologically, keratosis without dysplasia (42.3%) and oral submucous fibrosis (15.4%) were the leading premalignant lesions, while well-differentiated squamous cell carcinoma accounted for 77.4% of malignancies. Most malignant cases were diagnosed at T2N1 stage (72.6%). No statistically significant associations were found between sociodemographic factors and lesion type. Conclusion: Oral cavity lesions in Western India predominantly affect middle-aged rural males with high rates of tobacco use and low literacy. Buccal mucosa was the commonest site, and well-differentiated squamous cell carcinoma was the dominant malignancy. These findings emphasize the need for community-level awareness, tobacco cessation programs, and early screening to reduce oral cancer morbidity and mortality.

Introduction: This was a Prospective Cohort study of 50 Patients who were admitted to the N.S.C.B. Medical College Hospital, JABALPUR, with diagnosis of Acute Myocardial Infarction between 1st November 2013 to 31st October 2014.A control group of 100 normal subjects, matched according to age and sex, with the cases were also studied. Patients who fulfil the inclusion and exclusion criteria were enrolled for the study after getting written informed consent. ECG recordings were done on admission, day 2 & day 5. ECG was recorded with an ECG recorder speed of 25mm/sec. In the control group, ECGs were obtained after a 5 minutes resting period with the patients lying comfortably in the supine position.It showed QRS fragmentation is moderately sensitive and highly specific marker for identification of scar in myocardium irrespective of presence of q wave.

Introduction: Skin and soft tissue infections are infections involving the skin and the underlying muscles, the underlying fascia, or the underlying subcutaneous tissue. The severity of skin and soft tissue infections (SSTIs) varies, ranging from superficial epidermal infections to necrotizing fasciitis, a potentially fatal condition. It is often difficult to diagnose and treat infections that range from mild to severe because these infections show a variety of different presentations and because there is a lot of overlap in terms of presentation, etiology, and severity. Determining the degree of severity is therefore crucial to reducing the number of cases of illness or death and to guaranteeing that SSTIs are treated effectively and promptly. Aims And Objectives: To study the clinical profile of patients with community acquired skin and soft tissue infections (SSTIs) coming to a tertiary level hospital and identify factors responsible for extending the hospital stay and poor outcome in patients with SSTIs. Methodology: A case series study was conducted at Rajarajeswari Medical College and Hospital over a period of 18 months comprising of 125 patients diagnosed with skin and soft tissue infections (SSTIs) and results were drawn. All demographic data was tabulated and graphed and the inferential statistics were obtained using Chi-square test.  Results: Most common age group involved in skin and soft tissue infections were between the ages of 21-40 years (40%) and adult males were more affected with abscess formation being the most common clinical presentation (60%). Type 2 diabetes mellitus was the most common associated comorbidity. Staphylococcus aureus was the most common cultured organism (38%), followed by E. coli (26%).  90% of the SSTIs were managed surgically via incision and drainage or debridement followed by intravenous antibiotics administration.   Conclusion:SSTIs are divided into three severity levels according to the patient's clinical and demographic characteristics. Along with other risk factors like smoking and Type 2 Diabetes Mellitus, the most prevalent predisposing factor for SSTIs was found to be adult males from lower socioeconomic backgrounds who were more likely to experience trauma as a result of their living and working conditions. A severity stratification algorithm is developed that can assist in appropriately managing patients through medical or surgical intervention, thereby lowering the related morbidity and mortality.

Background: Acute hypoxic respiratory failure is a critical emergency requiring prompt respiratory support. High Flow Nasal Cannula (HFNC) and Non-Invasive Ventilation (NIV) are commonly employed modalities. Objective: To evaluate the comparative impact of HFNC versus NIV on clinical, physiological, and comfort-related parameters in patients presenting with acute hypoxemia. Material and Methods: In this prospective observational study conducted in the emergency department, patients over 18 years with acute dyspnea and hypoxemia were treated either with HFNC or NIV. Parameters including heart rate, respiratory rate, P:F ratio, dyspnea score, and patient discomfort were recorded at baseline, 12 hours, and 24 hours. Results: HFNC resulted in significantly faster improvement in respiratory and oxygenation parameters and significantly higher patient comfort than NIV. The majority of HFNC patients achieved mild dyspnea and low discomfort within 24 hours. Conclusion: This study demonstrates that High Flow Nasal Cannula (HFNC) therapy is associated with faster improvement in oxygenation, reduced respiratory effort, and superior patient comfort compared to Non-Invasive Ventilation (NIV) in cases of acute hypoxic respiratory failure.

Introduction: Regional anesthesia is increasingly favored for upper limb surgeries due to superior analgesia and avoidance of general anesthesia complications. Bupivacaine and ropivacaine are commonly used long-acting local anesthetics. Dexmedetomidine, a selective α2-adrenergic agonist, has shown potential to enhance nerve block characteristics. Materials and Methods: This prospective, comparative study was conducted on 60 patients (ASA I–II) undergoing elective upper limb surgeries. Group BD (n=30) received 30 ml of 0.25% bupivacaine with dexmedetomidine (1 mcg/kg), and Group RD (n=30) received 30 ml of 0.375% ropivacaine with dexmedetomidine (1 mcg/kg). Onset, duration, and quality of sensory and motor blockade were assessed, along with hemodynamic stability and adverse effects. Results: Mean onset of sensory and motor block was faster in Group RD (10.3 ± 2.1 min and 14.2 ± 2.6 min) compared to Group BD (13.7 ± 2.4 min and 17.8 ± 3.1 min, p<0.05). Duration of sensory and motor block was longer in Group BD (432.1 ± 45.6 min and 410.5 ± 42.2 min) versus Group RD (376.3 ± 38.7 min and 354.8 ± 36.4 min, p<0.05). Block quality and intraoperative conditions were comparable. Hemodynamics were stable, with no major adverse events. Conclusion: Ropivacaine–dexmedetomidine provides faster onset, while bupivacaine–dexmedetomidine ensures prolonged postoperative analgesia. Both combinations are safe and effective

Background: Acute post sternotomy pain in maximum on first post-operative day and may affect respiratory function of the patient leading to pulmonary complications.  Providing effective analgesia may improve respiratory function and hastens post-operative recovery. Aims and Objectives: To evaluate analgesic efficacy in terms of Numeric rating scale (NRS) for pain at rest and deep breathing and fentanyl requirement, and also to evaluate respiratory function of patients receiving Transverse thoracic nerve block in terms of arterial pO2 levels, and Incentive Spirometry volumes (ISV). Methods and results It is a prospective randomized study, conducted at UNMICRC, including 80 patients, undergoing cardiac surgery with midline sternotomy. Patients were randomly classified into two groups based on computer-based randomization as TTMPB(n=40) group or NO block(n=40) group. TTMPB group received USG guided Transverse Thoracic Muscle Plane Block (TTP/TTMPB) after shifting to ICU. NRS for pain at rest and deep breathing, Fentanyl requirement, pO2 level and ISV was assessed at different time points like on CPAP, at extubation, at 4, 8, 12 and 24hrs post extubation. Fentanyl was given in both the groups if NRS at rest/Deep breathing was ≥ 7. NRS on rest and deep breathing was significantly less in TTMPB group compared to NO block group upto 24 hours. The requirement of fentanyl was significantly less for upto 8 hours post extubation, whereas pO2 levels and ISV were significantly higher in TTMPB group for 12 hours post extubation. Conclusion: TTMPB resulted in decreased post-operative pain and decreased Fentanyl requirement, which resulted in improved respiratory parameter.

Background: Chronic Obstructive Pulmonary Disease (COPD) remains a leading global health burden, especially in low- and middle-income countries. In India, variations in prescribing practices for COPD treatment often diverge from internationally recognized guidelines such as those by GOLD (Global Initiative for Chronic Obstructive Lung Disease). Drug utilization studies (DUS) provide valuable insights into prescribing patterns, adherence to essential medicine lists, and cost-effectiveness in therapy management. Methods: A prospective cross-sectional observational study was conducted over 18 months at Narayan Medical College and Hospital, South Bihar, involving 108 COPD patients in the General Medicine outpatient department. Patient data—including demographics, clinical presentation, and drug prescriptions—were analyzed using WHO drug use indicators. The study assessed frequency and pattern of drug classes, prescribing behaviors (generic vs. branded), and cost burden, with statistical analysis performed using descriptive tools and chi-square tests. Results: COPD grade 2 was the most prevalent (50%), followed by grade 1 (36.11%). Male patients (56.5%) and individuals aged 41–60 years dominated the cohort. Chronic bronchitis was the predominant COPD type. The most common symptoms included shortness of breath (88.89%) and cough. Bronchodilators, mucolytics, and leukotriene antagonists (montelukast) were widely prescribed. WHO prescribing indicator analysis revealed an average of 6.67 drugs per encounter, only 13.49% prescribed by generic name, and 36.11% from the essential drug list. Notable deviations from GOLD guidelines were observed, including underuse of long-acting muscarinic antagonists (LAMAs) and over-reliance on oral agents over inhaled therapies. Conclusion: The study highlights irrational prescribing trends in COPD management, particularly excessive polypharmacy and low adherence to essential drug lists. Improving prescriber awareness, enhancing access to cost-effective inhalational agents, and reinforcing guideline-based therapeutic protocols are necessary steps toward rational COPD pharmacotherapy in tertiary care settings

Background: The clinical longevity of direct composite restorations is influenced by marginal adaptation and resistance to discoloration. Long-term follow-up is essential to assess their durability in routine practice. Objectives: To evaluate the marginal integrity and marginal discoloration of direct composite restorations in anterior and posterior teeth over a one-year period. Methods: This prospective observational study was conducted between March 2022 and February 2023 on 100 patients requiring direct composite restorations. Restorations were evaluated at baseline, 6 months, and 12 months using modified USPHS (United States Public Health Service) criteria. Parameters assessed included marginal integrity and marginal discoloration. Data were analyzed as frequencies and percentages. Results: At baseline, all restorations exhibited intact margins and absence of discoloration. After six months, 94% of restorations maintained intact margins, while 6% demonstrated minor defects without clinical significance. At 12 months, intact margins were observed in 88% of cases, minor defects in 10%, and major breakdown in 2% requiring replacement. No discoloration was observed at baseline or 6 months; however, at 12 months, 8% showed mild polishable discoloration and 2% displayed moderate discoloration necessitating replacement. Overall, 96% of restorations remained clinically acceptable at the one-year follow-up, while 4% required replacement due to unacceptable deterioration. Conclusion: Direct composite restorations demonstrated satisfactory clinical performance over one year, with high rates of marginal integrity and limited discoloration. The findings support the continued use of composite materials for both anterior and posterior restorations in routine clinical practice.

Background: Gallbladder cancer (GBC) is one of the most aggressive gastrointestinal malignancies, often diagnosed late due to vague clinical features. Imaging, particularly ultrasonography (USG), is widely used in the evaluation of gallbladder diseases, and gallbladder wall thickness (GBWT) has been identified as a potential marker of underlying malignancy. Aim: To assess the predictive value of gallbladder wall thickness in differentiating benign from malignant gallbladder diseases and to evaluate its correlation with histopathological findings. Methods: A prospective observational study was conducted at Government Medical College over a period of 18 months. Patients undergoing cholecystectomy for suspected gallbladder pathology were included. Preoperative ultrasonographic assessment of gallbladder wall thickness was documented. Based on USG findings, patients were stratified into normal (<3 mm), thickened (≥3 mm), and markedly thickened (>10 mm) categories. Final diagnoses were confirmed by histopathological examination (HPE). The diagnostic accuracy of GBWT was calculated, and associations with demographic and clinicopathological variables were analyzed. Results: A total of 76 patients were studied, with a mean age of 52.6 years; females constituted 68%. Among them, 59 cases were benign (chronic cholecystitis, xanthogranulomatous cholecystitis, adenomyomatosis), while 17 were malignant. Mean GBWT in malignant cases was significantly higher (12.4 ± 3.6 mm) compared to benign cases (5.2 ± 1.8 mm, p < 0.001). A cutoff of 10 mm yielded sensitivity of 82.3% and specificity of 88.1% for predicting malignancy. False positives were mainly due to xanthogranulomatous cholecystitis, which can mimic cancer radiologically. Conclusion: Gallbladder wall thickness on USG is a simple, cost-effective, and non-invasive marker that correlates significantly with gallbladder malignancy. While not definitive alone, its predictive accuracy improves when interpreted alongside clinical features and adjunctive imaging. It may serve as an important tool in early detection, particularly in high-risk populations.

Background: The Correlation between total serum calcium, ionic calcium, and the severity of birth asphyxia is an important area of research in neonatal care.  Birth asphyxia remains a significant contributor to neonatal morbidity and mortality. Among the various biochemical disturbances associated with hypoxic-ischemic events, calcium imbalance—especially hypocalcemia—plays a crucial role in worsening clinical outcomes. Aim: This study evaluates the correlation between total serum calcium, ionic calcium levels, in severity of birth asphyxia. Material and Methods: This prospective observational study was conducted over one year in the Department of Paediatrics at a tertiary care teaching hospital. A total of 80 term neonates were enrolled and divided into two groups: Group A (n=40) included neonates with birth asphyxia, and Group B (n=40) included healthy term neonates. Total serum calcium was measured using the Arsenazo III method, and ionized calcium was assessed using an ion-selective electrode technique. Blood samples were collected within six hours of life. Data were analyzed using SPSS version 25, with p<0.05 considered statistically significant. Results: The mean total serum calcium in the asphyxiated group was 7.12 ± 0.65 mg/dL, significantly lower than 8.42 ± 0.52 mg/dL in controls (p<0.001). Hypocalcemia (<7 mg/dL) was observed in 45% of Group A versus 5% in Group B. The mean ionized calcium level in Group A was 0.92 ± 0.14 mmol/L, significantly lower than 1.15 ± 0.12 mmol/L in Group B (p<0.001), with 60% of Group A showing ionized hypocalcemia compared to 10% in controls. A significant positive correlation was found between Apgar scores at 5 minutes and both total calcium (r=0.48, p=0.002) and ionized calcium (r=0.52, p<0.001). Conclusion:  Neonates with birth asphyxia exhibit significantly lower levels of both total and ionized calcium compared to healthy neonates. The high prevalence of hypocalcemia and its association with lower Apgar scores highlight the need for routine calcium monitoring and timely correction to improve neonatal outcomes.

Background: As insulin resistance frequently precedes overt diabetes, its early detection is crucial for preventing disease progression and associated complications such as cardiovascular disease. Elevated fasting C-peptide levels often indicate increased insulin secretion, usually as a compensatory mechanism for insulin resistance. Understanding the association between fasting C-peptide levels, insulin resistance, and anthropometric measures in diabetic patients helps in assessing disease severity and tailoring therapeutic interventions. Methods: This was an observational cross-sectional study conducted over a period of one year involving 216 patients above 18 years of age. 5000 patients were screened using random blood sugar and 216 patients were diagnosed as diabetics. Anthropometric measurements (weight, height, body mass index and waist-to-hip ratio) were recorded. Laboratory investigations including complete blood count, renal function test, serum electrolytes, HbA1c, fasting blood sugar, fasting C-peptide levels and lipid profile were performed. Results: The association between C-peptide and age was significant (p-value =0.001). A significant association was observed between C-peptide levels and BMI categories (X2: 51.355, df: 8, p=0.001). High C-peptide levels were associated with a high waist-to-hip ratio of >0.80 in both sexes. The relationship between C-peptide and peripheral signs of resistance was found to be significantly associated (p-value-0.001). The relationship between C-peptide and HbA1c levels was found to be significantly associated (P value-0.001) with a bidirectional effect wherein fasting C-peptide levels in the normal range actually had lower HbA1c levels with an increase as we move away from this group. There was a statistically significant difference in serum triglyceride levels among different fasting C-peptide levels with a p-value of 0.014. Serum VLDL levels and C-peptide levels had a significant association (p-value<0.05), whereas fasting C-peptide had no significant association with serum cholesterol, HDL and S. LDL levels (p-0.117, 0.102, 0.622 respectively). Conclusion: Fasting C-peptide level is strongly associated with insulin resistance and key anthropometric measures in patients with type 2 diabetes mellitus.

Introduction: Uterine fibroids are common benign smooth muscle tumors of the uterus, affecting up to 70% of women during their lifetime. While often asymptomatic, fibroids may complicate pregnancy, leading to adverse maternal and fetal outcomes. The relationship between fibroids and pregnancy outcomes remains inadequately understood, necessitating focused evaluation. Aim: To determine the prevalence and fetomaternal outcomes in pregnancies complicated by fibroids at SMGS Hospital, Jammu over a one-year period. Methods: A retrospective analysis was conducted from July 2022 to June 2023 in the Department of Obstetrics and Gynecology, SMGS Hospital, Jammu. Antenatal cases with fibroid-complicated pregnancies were identified from hospital records. Demographic characteristics, parity, gestational age, maternal complications, delivery mode, and neonatal outcomes were analyzed. Multiple registers including admission, OT, delivery, and NICU records were reviewed. Pregnancies with multiple gestations were excluded. Results: Out of 18,682 deliveries, 61 were complicated by fibroids, giving a prevalence of 0.3%. The mean maternal age was 29.1 ± 4.7 years, with primigravidas forming the largest group (54.1%). The mean gestational age at delivery was 36 weeks. Cesarean delivery occurred in 55.8% of cases, primarily due to previous cesarean section, non-progression of labor, fetal distress, and malpresentation. Common maternal complications included preterm labor (16.4%), preterm premature rupture of membranes (14.7%), blood transfusion requirement (13.1%), intrauterine growth restriction (11.5%), malpresentation (11.5%), and postpartum hemorrhage (9.8%). There were 59 live births (96.7%) and 2 intrauterine deaths (3.3%). Low birth weight (<2.5 kg) was seen in 31.2% of neonates, while 11.8% required NICU admission. Conclusion: Pregnancy complicated with fibroids constitutes a high-risk condition with increased rates of cesarean delivery, preterm birth, malpresentation, growth restriction, and NICU admissions. Careful antenatal, intrapartum, and postpartum surveillance is essential to optimize maternal and fetal outcomes.

Artificial intelligence (AI) is becoming an important part of modern healthcare, and anesthesiology is one of the fields where it can make a big difference. AI uses computer methods such as machine learning (ML), deep learning (DL), natural language processing (NLP), and computer vision to support doctors in their work. In anesthesia, these tools can improve patient safety, make drug delivery more accurate, reduce errors, and improve the efficiency of the operating room. AI can help before surgery by predicting risks, during surgery by monitoring depth of anesthesia, blood pressure, and breathing, and after surgery by predicting complications like nausea, delirium, or death. Closed-loop drug delivery systems, robotic airway management, and AI-based monitoring are new areas where progress is happening fast. Clinical decision support systems (CDSS) and AI-based intensive care monitoring also show promise. Despite many advantages, there are challenges. Data privacy, algorithm bias, medico-legal issues, high cost, and lack of training remain big concerns. For AI to be widely used, it must be safe, fair, cost-effective, and well-integrated into hospital systems. In the future, AI may allow fully personalized anesthesia, autonomous systems that can deliver anesthesia on their own, and the use of virtual and augmented reality for better guidance and training. Federated learning and continuous learning systems will also make AI safer and more reliable. With responsible use and teamwork between doctors, engineers, AI can make anesthesia safer, more effective, and more patient-centered.

Introduction: Diabetic retinopathy (DR), the most common microvascular complication of type 2 diabetes mellitus (T2DM), has been increasingly linked to macrovascular disease, particularly coronary artery disease (CAD). The retina provides a non-invasive marker of systemic vascular injury, but evidence from Indian cohorts using standardized DR grading and angiography-confirmed CAD is limited. This study aimed to assess whether DR severity is independently associated with CAD in T2DM. Materials and Methods: A cross-sectional study was conducted on 150 T2DM patients at the Department of General Medicine, Mamata Medical College, Khammam. Demographic and clinical data, including age, sex, diabetes duration, hypertension, smoking, and alcohol use, were recorded. Biochemical evaluation included fasting plasma glucose, HbA1c, lipid profile, and renal function tests. DR was graded using the Early Treatment Diabetic Retinopathy Study (ETDRS) classification. Cardiovascular evaluation included ECG, echocardiography, treadmill test, and coronary angiography. CAD was defined as ≥50% stenosis in a major epicardial coronary artery. Logistic regression assessed the association between DR severity and CAD after adjusting for confounders. Results: The mean age was 56.2 ± 9.1 years, with 61.3% males. DR was present in 48%: mild NPDR (12%), moderate NPDR (11.3%), severe NPDR (7.3%), PDR (12%), and DME (5.3%). CAD was diagnosed in 64 patients (42.7%), with prevalence rising from 31.2% in those without DR to 72.2% in those with PDR. Multivariate analysis confirmed significant associations for moderate NPDR (OR 2.35), severe NPDR (OR 2.98), PDR (OR 4.12), and DME (OR 3.54). Conclusion: DR severity is strongly and independently associated with angiography-confirmed CAD in T2DM. Advanced DR should be considered a marker for comprehensive cardiovascular evaluation.

Background Atrial fibrillation increases the postoperative morbidity and mortality after cardiac surgery. This study aimed to estimate the incidence of postoperative atrial fibrillation and to identify the risk factors in patients undergoing cardiac surgery. Methods This was a prospective cohort study carried out over a period of one year among 280 patients undergoing cardiac surgery. An independent t test was used to compare quantitative parameters between categories. The chi-square test was used to find association between categorical variables. ROC (Receiver Operating Characteristic) graphs were plotted and the area under the curve was calculated to assess diagnostic accuracy of CPB time and ACC time in detecting AF (Atrial Fibrillation) and to assess the optimal cut‑off scores. Multiple logistic regressions was used to predict independent risk factors of AF. For all statistical interpretations, p<0.05 was considered the threshold for statistical significance. Results The incidence of new-onset atrial fibrillation is 31.8%. The most common risk factors were RCA Stenosis 70%, lactate level > 4 mmol/L, use of CPB, CPB time > 116.5 mins, and aortic cross-clamp time > 64.5 mins.Incidence was higher in valve surgeries. Use of preoperative beta blockers reduced the incidence of new-onset AF. Abnormal serum electrolytes, pain, and hypoxia were also risk factors for the development of AF. Development of AF prolonged the time spent in ICU, time spent on a ventilator, and also time spent on inotropic supports. Subjects developing new-onset postop AF required antiarrhythmic medications at discharge. Conclusion There is a high incidence for developing atrial fibrillation after cardiac surgery. Significant RCA stenosis, long CPB time, and elevated lactate levels were the significant risk factors. POAF adversely affected the postoperative outcome

Introduction: Difficult visualization of the glottis during laryngoscopy can hinder successful endotracheal intubation. External laryngeal manoeuvres such as burp (backward-upward-rightward pressure), jaw thrust, and cricoid pressure are commonly used to enhance glottic view. However, limited comparative studies exist evaluating the effectiveness of these techniques during video laryngoscopy. Methods This comparative study was conducted over 6 months at the Department of Anaesthesiology and Critical Care, ACSR Medical College and Government General Hospital. A total of 120 adult patients (ASA grade I and II) undergoing elective surgery under general anaesthesia were randomized into four groups: Group I (standard technique), Group II (cricoid pressure), Group III (jaw thrust), and Group IV (BURP manoeuvre). Preoperative airway parameters were recorded, and each patient underwent video laryngoscopy using all three manoeuvres in random order, followed by tracheal intubation with the assigned technique. Glottic visualisation was graded using the modified Cormack-Lehane scale. Time to successful intubation was also measured. Results BURP manoeuvre (Group IV) significantly improved glottic visualisation compared to the standard technique and other manoeuvres. Group III (jaw thrust) also showed improved laryngeal view but was slightly less effective than BURP. Cricoid pressure showed minimal improvement and, in some cases, worsened the view. The BURP manoeuvre was associated with a higher incidence of Grade 1 views and the shortest mean intubation time. Conclusion Among the three manoeuvres studied, the BURP manoeuvre was the most effective in improving glottic visualisation and reducing intubation time during video laryngoscopy. The BURP manoeuvre should be considered as the first-line technique for managing anticipated difficult airways.

Introduction: Diabetic foot ulcer (DFU) is a serious complication of diabetes mellitus, affecting up to one-quarter of patients during their lifetime and often recurring within a year. Its development is multifactorial, involving neuropathy, peripheral arterial disease, immune impairment, and micro vascular changes from chronic hyperglycaemia. Persistent inflammation, poor angiogenesis, and deficient collagen deposition contribute to its chronic, non-healing nature, making DFU a major cause of morbidity and risk for amputation. Aims: The study aimed to compare the effectiveness of platelet-rich plasma (PRP) and vacuum-assisted closure (VAC) dressing in the management of diabetic foot ulcers, evaluating outcomes such as healing time, ulcer size reduction, pain relief, infection control, hospital stay, and treatment cost. Methods: This prospective, comparative, interventional study was conducted in the Department of General Surgery at a tertiary care hospital from May 2024 to June 2025. A total of 50 patients with diabetic foot ulcers were enrolled through consecutive sampling based on predefined inclusion criteria. Result: Baseline characteristics were comparable between the PRP and VAC groups, with similar mean age, gender distribution, smoking history, and duration of diabetes. Ulcer profiles, including size, duration, and Wagner grade distribution, were also similar, ensuring both groups were well matched for comparison. Conclusion: This study found that while baseline characteristics were similar between groups, PRP therapy outperformed VAC in reducing treatment sessions, healing time, ulcer size, pain, hospital stay, and cost. Although differences in epithelialization, infection, amputation, and readmission rates favored PRP, they were not statistically significant. Overall, PRP appears to be a safe, cost-effective option that accelerates healing and enhances patient comfort in diabetic foot ulcer management.

Background: Cardiac magnetic resonance (CMR) imaging, particularly late gadolinium enhancement (LGE), has become the gold standard for assessing myocardial viability in patients with ischemic cardiomyopathy and left ventricular dysfunction. CMR's ability to identify viable and non-viable myocardium is critical in making informed clinical decisions, especially in the context of myocardial revascularization procedures. This study investigates the role of CMR in evaluating myocardial viability and left ventricular function in patients with coronary artery disease (CAD) and metabolic syndrome. Methods: This prospective observational study was conducted over 18 months at Sri Aurobindo Medical College & PG Institute, Indore, Cardiology and Radiology Departments, involving 50 CAD patients diagnosed via coronary angiography. Metabolic syndrome was assessed based on International Diabetes Federation criteria, and myocardial viability was evaluated using CMR imaging with LGE, along with echocardiography for left ventricular ejection fraction (LVEF). Vascular blockages were assessed through coronary angiography.  Results: The study revealed a mean age of 58.5 years, with 70% male participants. The majority of patients had risk factors such as hypertension (40%), diabetes (30%), and smoking (25%). CMR findings demonstrated variable myocardial viability, with a greater percentage of viable myocardium correlating with better LVEF. The MRI findings were more detailed than echocardiography, identifying more viable tissue, while coronary angiography showed significant vascular blockages in 70% of patients. A personalized treatment plan was developed, with revascularization recommended for patients with more than 50% viable myocardium. Conclusion: This study underscores the importance of CMR in assessing myocardial viability and guiding treatment decisions in CAD patients. CMR provides a more detailed assessment of myocardial integrity compared to conventional methods like echocardiography, aiding in more accurate decision-making for myocardial revascularization. The results suggest that CMR should be integrated into routine clinical practice for better prognostic and therapeutic management of CAD.

Background: Accurate confirmation of endotracheal tube (ETT) placement is vital during anaesthesia and emergency airway management. Conventional auscultation has limited sensitivity, whereas point-of-care ultrasound (POCUS) has emerged as a promising alternative. Objective: To compare the diagnostic accuracy of POCUS and auscultation in confirming ETT placement. Methods: Ninety ASA I–II patients undergoing elective surgery under general anaesthesia were randomised into three groups (trachea, right main bronchus, left main bronchus). Independent blinded anaesthesiologists performed intubation, fibreoptic confirmation, auscultation, and ultrasound examinations. Diagnostic indices were calculated against fibreoptic bronchoscopy (gold standard). Results: Auscultation achieved sensitivity 68.8%, specificity 87.8%, and accuracy 84.7%. POCUS demonstrated sensitivity 92.5%, specificity 95.3%, and accuracy 94.7%. Haemodynamics and oxygen saturation remained stable, while EtCO₂ and airway pressures increased significantly with endobronchial intubations. Conclusion: POCUS is more accurate than auscultation for confirming ETT placement. It is a rapid, reliable, and non-invasive bedside tool with potential to complement or replace auscultation in clinical practice.

Purpose: Appendicitis remains one of the most frequent surgical emergencies worldwide, regardless of a country’s level of development. Its diagnosis can be challenging. Imaging techniques and clinical scoring systems are widely used to improve diagnostic accuracy. Ultrasound, being inexpensive and widely available, can sometimes provide more useful information than computed tomography (CT). The Modified Alvarado Score (MAS) relies on parameters that do not add extra financial strain to the patient. This study aimed to assess the diagnostic performance of combining MAS with ultrasound in detecting acute appendicitis. Methods: This prospective analytical study was carried out in a tertiary care hospital from January 2023 to December 2024. A total of 110 patients presenting with pain in the right lower abdomen were enrolled. All underwent ultrasound examination, and their MAS and combined MAS scores were calculated. The results were compared with histopathological findings after surgery. Results: Among the 110 patients who underwent emergency appendectomy based on clinical suspicion, 54 were male and 56 were female. Histopathological examination confirmed acute appendicitis in 100 cases. For MAS alone, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were 42%, 100%, 100%, 20.8% and 47.27%, respectively. For ultrasound alone, these values were 84%, 40%, 93.3%, 20% and 80%. When the scores were combined, sensitivity, specificity, PPV, NPV and accuracy were 98.18%, 0%, 90.7%, 0% and 89.09%, respectively.

Background: Oral ulcers are common mucosal lesions that cause significant pain, difficulty in mastication, and impaired quality of life. Conventional therapies include topical corticosteroids and analgesics, but their side effects and limited efficacy have led to the exploration of natural alternatives. Herbal formulations, rich in bioactive compounds with anti-inflammatory, antioxidant, and antimicrobial properties, are being increasingly evaluated for their role in accelerating ulcer healing. This study aimed to clinically assess the efficacy of herbal gel formulations in promoting healing of oral ulcers. Materials and Methods: A randomized controlled clinical study was conducted on 60 patients diagnosed with recurrent minor oral ulcers. Patients were randomly divided into two groups: Group A (n=30) received a standardized herbal gel containing aloe vera, turmeric extract, and licorice root, while Group B (n=30) received a placebo gel. Both groups applied the gel twice daily for 10 days. Parameters assessed included ulcer size reduction (mm), pain intensity using Visual Analogue Scale (VAS), healing time, and patient satisfaction scores. Data were analyzed using paired t-tests and chi-square tests, with p<0.05 considered statistically significant. Results: Group A demonstrated significant improvement compared to Group B. Mean ulcer size reduced from 5.8 ± 1.2 mm to 0.9 ± 0.4 mm in Group A, versus 6.0 ± 1.1 mm to 2.8 ± 0.7 mm in Group B by day 10. Pain scores decreased from 7.5 ± 1.0 to 1.8 ± 0.6 in Group A, compared to 7.6 ± 1.1 to 3.4 ± 0.8 in Group B. Average healing time was 6.2 ± 1.7 days in the herbal gel group and 8.4 ± 2.0 days in the placebo group (p=0.01). Patient satisfaction scores were also higher in Group A (p=0.02). Conclusion: Herbal gel formulations significantly accelerated the healing of oral ulcers, reduced pain, and improved patient satisfaction compared to placebo. Given their natural origin, safety profile, and clinical effectiveness, such formulations may serve as a promising alternative or adjunct to conventional therapies in the management of recurrent oral ulcers.

Introduction: A gradual and irreversible deterioration in kidney function, usually over months to years, is the characteristic of chronic kidney disease (CKD). Comorbid diseases including diabetes mellitus (DM) and hypertension (HTN), which are major contributors to chronic kidney disease (CKD), are frequently linked to it. In chronic kidney disease (CKD), the kidney's functional units, the nephrons, sustain extensive damage that causes compensatory hypertrophy and hyperfiltration in the remaining nephrons. Methodology: Cardiovascular autonomic reflex tests were used to evaluate autonomic function. Participants were fitted with ECG electrodes to track changes in their heart rates while performing particular tasks. For CAN detection, these tests also referred to as Ewing's score were reliable and valid. Ewing's overall score was calculated using the outcomes of five tests. Results: a tendency for people with diabetes who have had the disease for a longer period of time to have a larger prevalence of aberrant Valsalva responses, which is a sign of growing parasympathetic dysfunction over time. The duration of diabetes and impaired handgrip response did not statistically significantly correlate. Twenty-two (32.84%) of the 67 patients who had diabetes for less than ten years had normal autonomic function, 31 (46.27%) had early parasympathetic dysfunction, seven (10.45%) had definite parasympathetic involvement, and seven (10.45%) had both sympathetic and parasympathetic damage. It was discovered that there was a highly statistically significant correlation between CAN grade and the duration of diabetes. The association between CAN grade and diabetes duration was found to be highly statistically significant (p = 0.0003) Conclusion: Autonomic function clearly deteriorated as CKD stages increased, even though there was no statistically significant association with eGFR. Autonomic dysfunction was strongly and statistically significantly predicted by the length of diabetes mellitus, which had a particular impact on parasympathetic activity. For CKD patients, particularly those with chronic diabetes, early and regular screening for CAN is crucial to lowering cardiovascular risk. The patient prognosis can be improved and early detection facilitated by basic bedside diagnostics such as Ewing's cardiovascular reflex battery.

Introduction: Critically ill patients on mechanical ventilation experience catabolic stress and inflammation, predisposing them to malnutrition. Malnutrition worsens outcomes by prolonging ICU stay, increasing infection risk, and elevating mortality. The Nutritional Risk in Critically Ill (NUTRIC) score was designed specifically for ICU patients to identify those most likely to benefit from early nutrition therapy. This study evaluated nutritional risk using the NUTRIC score and its correlation with outcomes, with interleukin-6 (IL-6) assessed as a marker of systemic inflammation. Methods: An observational cross-sectional study was conducted in the ICU of Dr. D.Y. Patil Medical College, Kolhapur, over 18 months. Adults (≥18 years) requiring invasive mechanical ventilation were enrolled within 24 hours of intubation. Patients with burns, malignancy, AIDS, neuromuscular disorders, or readmissions were excluded. Demographic and clinical data, comorbidities, APACHE II and SOFA scores were collected. Serum IL-6 was measured by ELISA. NUTRIC scores (0–10) were calculated; scores ≥6 indicated high risk. Outcomes included ICU stay, ventilator days, time to weaning, and mortality. Correlations were analyzed statistically. Results: The cohort (mean age 59.5±16.1 years, male predominance) showed moderate-to-severe illness (APACHE II 26.46±8.0, SOFA 9.46±3.96). Mean IL-6 was 89.12±35.77 pg/mL, and mean NUTRIC score 5.06±1.87, with nearly half at high risk. Hypertension (46.9%) and neurological disorders (43.8%) were the most frequent comorbidities. Average ICU stay was 15.4 days, with 8.9 ventilator days and 8.0 days to weaning. High NUTRIC scores correlated positively with mortality (r=0.389, p<0.001) and IL-6 (r=0.319, p<0.001). Survivors were mainly low risk (88.6%), while more than half of non-survivors were high risk (p=0.001). High risk correlated negatively with ICU stay and ventilator duration due to early mortality. Sepsis and renal disease showed the strongest associations with high nutritional risk and elevated IL-6. Conclusion: The NUTRIC score is a simple and effective tool for identifying nutritional risk in ventilated ICU patients. High scores predicted increased mortality, greater inflammatory burden, and comorbidity impact. Early recognition of nutritionally vulnerable patients supports timely intervention and better utilization of ICU resources. Incorporating the NUTRIC score alongside illness severity indices can improve prognostication and guide personalized care.

Background: Pulmonary tuberculosis (TB) remains a significant global health concern, and despite achieving microbiological cure, a substantial proportion of survivors develop post-tuberculosis lung disease (PTLD), most notably tuberculosis-associated obstructive pulmonary disease (TOPD). Diabetes mellitus (DM) is independently associated with impaired lung function, and its coexistence with a history of treated tuberculosis may exacerbate pulmonary decline. However, evidence on spirometric alterations in TB survivors with concomitant diabetes mellitus (DM) remains limited, Aim of the study was to evaluate the impact of DM on spirometric parameters in adults with a history of treated pulmonary tuberculosis and to compare spirometric ventilatory patterns between diabetic and non-diabetic TB survivors. Material and Methods: In this cross-sectional observational study, 91 adults with prior treated pulmonary TB and persistent respiratory symptoms were recruited from a tertiary-care hospital in Bengaluru. Participants underwent pre- and post-bronchodilator spirometry according to ATS/ERS guidelines. Key indices included FVC, FEV₁,FEV3, FEV₁/FVC, FEF₂₅-₇₅, and PEF. Ventilatory patterns were classified as obstructive, restrictive, or mixed. Glycemic status was determined by HbA1c, and associations between DM and spirometric indices were analyzed using t-tests, chi-square tests, and Spearman’s correlation. Results: Of the 91 Patients, 51 had DM and 40 were non-diabetic controls. Obstructive ventilatory defects predominated in both groups and were more frequent among diabetics (70% vs. 50%). Spirometric volumes were significantly lower in diabetics across all parameters (p = 0.005-0.020). Post-bronchodilator testing confirmed persistent impairment. Bronchodilator response (BDR) positivity was observed in 54.9% of diabetics compared with 15.0% of non-diabetics (p = 0.04), although the mean absolute improvement in FEV₁ did not differ significantly (+70 mL vs. +80 mL; p = 0.65). Conclusions: Diabetes mellitus amplifies pulmonary impairment in TB survivors, with lower baseline lung volumes, a higher prevalence of obstructive defects, and increased bronchodilator response (BDR). These findings highlight the need for routine spirometric screening and integrated care for post-TB patients with diabetes to enable early detection and management of long-term respiratory sequelae.

Background: Periodontal disease has been increasingly recognized as a potential risk factor for adverse pregnancy outcomes. Poor maternal oral health may contribute to systemic inflammation, which in turn can negatively influence gestational outcomes. This study aimed to assess the association between maternal periodontal disease and pregnancy outcomes, with particular focus on preterm birth and low birth weight. Methods: The study was conducted in the Department of Oral and Maxillofacial Surgery, Desh Bhagat Dental College over a period of one year with effect from May 2024 to April 2025. A total of 78 pregnant women fulfilling the inclusion criteria were enrolled after obtaining informed consent. Maternal and neonatal parameters including gestational age, birth weight, and oral health indices were systematically recorded and analyzed. Results: The study group demonstrated significantly higher plaque index, gingival index, and bleeding on probing scores compared to controls (p < 0.001). Preterm delivery occurred in 63.5% of cases versus 10.8% of controls, while low birth weight (<2.5 kg) was observed in 73.0% of cases compared to 12.2% of controls. The mean birth weight of neonates in cases was 2.28 ± 0.517 kg, which was significantly lower than 3.17 ± 0.614 kg in controls (p < 0.001). These findings indicate a strong and statistically significant association between maternal periodontal disease and adverse pregnancy outcomes. Conclusion: Maternal periodontal disease is strongly associated with increased risk of preterm birth and low birth weight. The findings highlight the importance of routine oral health screening and periodontal care during pregnancy to improve both maternal and neonatal outcomes.

Primary headache disorders such as migraine, tension-type headache (TTH), and cluster headache significantly affect quality of life. This study aimed to evaluate the clinical profile of primary headache disorders and assess their impact using the SF-36 questionnaire. The study included 302 patients at SCB Medical College between October 2019 and September 2021. Among them, 69.86% had migraine, 28.14% had TTH, and 1.98% had cluster headache. Women were disproportionately affected, especially by migraine and TTH. SF-36 scores showed that patients with migraine had the most compromised health-related quality of life (HRQoL), especially in domains related to pain and emotional well-being. This article underscores the importance of early identification, classification, and targeted therapy in mitigating the personal and societal burden of these disorders.

Background: Subclinical hypothyroidism is a very common entity in Indian middle-aged population with a prevalence of around 6-15%, defined as increase in thyroid stimulating hormone (TSH) level without obvious rise in free triiodothyronine (FT3) and free thyroxine (FT4) level. However, most of the patients have an annual conversion of 5% into overt hypothyroidism. Replacement of thyroxine in these patients is always a controversial issue, deranged lipid profile is an important indication of thyroxine replacement in these patients. Mateials and Methods: Present study is conducted in P.G. Department of Medicine in S.N. Medical College, Agra. 100 diagnosed subclinical hypothyroid patients (Anti TPO antibody positive) and 100 control patients are included in this study. Patients taking antithyroid medication, hypolipidemic drugs, post thyroid surgery, end stage renal disease, congestive heart failure, diabetes mellitus, myocardial infarction are excluded from this study. Result:   In present study which is a case control study, we have observed improvement in lipid profile after thyroxine replacement in patients of subclinical hypothyroidism with deranged lipid profile.  Conclusion: In our study there is a significant improvement in total cholesterol, triglyceride, and LDL level without significant improvement in HDL level after thyroxine replacement.

Background: Intraoperative awareness under general anaesthesia, though rare, can lead to severe psychological consequences. This study compares the efficacy of propofol and dexmedetomidine in preventing intraoperative awareness in patients undergoing open cholecystectomy. Objectives: To evaluate and compare the incidence of intraoperative awareness and explicit recall using propofol versus dexmedetomidine infusions during open cholecystectomy surgeries under general anaesthesia, and to assess their effects on intraoperative hemodynamic parameters. Methods: A prospective, randomized, single-blind study was conducted on 60 ASA I & II patients aged 18–65 years undergoing open cholecystectomy in a resource-limited setting. Patients were randomized into two groups (n=30): Group P received propofol (2 mg/kg induction, 0.25 mg/kg/hr infusion), and Group D received dexmedetomidine (1 mcg/kg bolus over 10 minutes, followed by 0.5 mcg/kg/hr infusion). Hemodynamic parameters and intraoperative awareness were assessed using the Brice Questionnaire 24 hours post-extubation. Results: Intraoperative awareness was reported in three patients (two definite, one possible) in the propofol group and none in the dexmedetomidine group. Hemodynamic parameters (MAP, HR) were more stable in the dexmedetomidine group at key surgical milestones. Mild bradycardia occurred in three patients in Group D. Statistical analysis showed a significant difference in awareness incidence (p = 0.04) and MAP changes during intubation and incision (p < 0.005). Conclusion: Both dexmedetomidine and propofol reduce intraoperative awareness, but dexmedetomidine demonstrated superior effectiveness and hemodynamic stability. In resource-limited settings where BIS monitors are not available, tools like the Brice Questionnaire offer a viable and accessible method for assessing awareness.

Background: Lipoprotein(a) [Lp(a)] is an emerging biomarker for cardiovascular diseases, but its role in ischemic stroke among patients with type 2 diabetes mellitus (T2DM) remains understudied. This study aimed to assess the association between serum Lp(a) levels and ischemic stroke in T2DM patients compared to non-diabetic stroke patients. Methods: A case-control study was conducted on 122 ischemic stroke patients (61 with T2DM and 61 without T2DM). Demographic, biochemical, and Lp(a) levels were analyzed. Statistical significance was set at *p* < 0.05. Results: Mean Lp(a) levels were significantly higher in T2DM stroke patients (2.51 ± 0.69 g/L) than in non-diabetic stroke patients (1.48 ± 0.35 g/L; *p* < 0.001). Elevated Lp(a) (>1.60 g/L) was observed in 75.81% of T2DM patients versus 38.34% of non-diabetics. T2DM patients also exhibited higher triglycerides (140.19 mg/dL vs. 123.32 mg/dL; *p* = 0.039) and younger stroke onset (mean age 62.09 vs. 66.14 years; *p* = 0.005). Conclusion: Elevated Lp(a) is strongly associated with ischemic stroke in T2DM patients, suggesting its potential as a biomarker for stroke risk stratification. Routine Lp(a) screening and targeted therapies may improve stroke prevention in high-risk diabetic populations.

Introduction: Amniotic fluid acts as a protective layer which exerts a cushion-like effect for the growing fetus against mechanical and biological injury. Amniotic fluid may be regarded as the largest part of the fetal extracellular space, and it provides a more accessible means than fetal blood for investigation of the fetus and its environment. Amniotic fluid assessment is an integral part of the antenatal evaluation of pregnancies at risk for an adverse pregnancy outcome especially in the third trimester. 1, 2 Detecting the fetus at risk for in utero damage or death, quantifying, and balancing the fetal risk against the risk of neonatal complications from immaturity, and determining the optimal time and mode of intervention are the cornerstone of modern-day obstetrics care and perinatal medicine.3 Aim: Study of Amniotic fluid Index Measurements in High- Risk Pregnancies and Outcome OBJECTIVES: ● To Study the Patterns Of Changes In Amniotic Fluid Index From 32 Weeks Till Delivery In High Risk Pregnancies. ● To Study the Perinatal Outcome In Relation To APGAR Score. Materials and Methods: A prospective observational study conducted on 100 patients over a period of 18 months at GMC, Kadapa. Inclusion Criteria: Single ton pregnancy with gestational age > 32 weeks, Hypertensive disorders, Diabetes complicating pregnancy including Gestational diabetes, Intrauterine growth retardation, Past dates, Liquor abnormalities, Bad obstetric history Exclusion criteria: Pregnant women with GA< 32 weeks or in labour, Antepartum hemorrhage, Eclampsia, Multiple gestation, Ruptured membranes, Congenital anomalies, Intrauterine fetal death Results: This study was observational prospective study, 100 antenatal cases of >32 weeks gestation attending Government general hospital, Kadapa were included. The study individuals was divided into 4 categories based on AFI and the correlation between AFI and variables studied like NST, mode of delivery, colour of liquor, Apgar at 5mts, birth weight, Congenital malformations, NICU dmission of babies and neonatal death. Discussion: The study was prospective observational study, 100 antenatal cases of >32 weeks gestation attending Government general hospital, Kadapa were included. The study individuals was divided into 4 categories based on AFI and the correlation between AFI and variables studied like NST, mode of delivery, colour of liquor, Apgar at 5 mins, birth weight, IUGR, NICU admission of babies and neonatal death.

Introduction: Caesarean section is commonly performed surgery in obstetrics. As medical science and especially obstetrics has evolved over the recent years, there has been a parallel and steady increase in the rate of caesarean births. Primary caesarean section means first caesarean section done in the patients who had delivered vaginally once or more. Multipara means a women delivered at least once.1 Aims and Objectives: Primary: To evaluate the incidence of primary cesarean section among multiparous women with previous vaginal delivery. Secondary: To study maternal and fetal outcome. Inclusion Criteria: Multiparous women,       Who underwent cesarean section for the first time who had a vaginal delivery previously.        Term gestation.               Singleton pregnancy. Exclusion Criteria:  Previous cesarean section or hysterotomy, myomectomy or septal resection.     Multiple pregnancy.                Primigravida.    Gestational age <37 weeks Materials And Methods: This is a retrospective study of 160 cases of primary cesarean section in multiparous women from may 2022 to  july 2023, done in the Department of Obstetrics and Gynecology, Government General Hospital, Kadapa. Observation & Results: The frequency of primary cesarean section in multiparous women is 7.2% of total cesarean sections and 3.1 % of the total number of deliveries during the study period. Frequency of cesarean section among total multiparous women is 5.9%. Discussion: This is a prospective study undertaken to analyze 160 cases of caesarean section done for first time in multiparous women. There were 5173 deliveries, around 2208 caesarean section which represented 42.7% of all deliveries.Incidence of primary caesarean section in parous women is 3.1% of all deliveries and accounted for 7.2% of all sections done.

Background: Sensorineural hearing loss (SNHL) is an uncommon but increasingly recognized complication following non-otologic surgeries, including coronary artery bypass grafting (CABG). The pathophysiology remains unclear but may involve cochlear ischemia, microemboli, or hemodynamic fluctuations, especially in surgeries involving extracorporeal circulation. Objective: To evaluate audiological outcomes following CABG and compare the incidence of SNHL between on-pump and off-pump procedures. Methods: A prospective observational study was conducted on 210 patients aged 18–60 years undergoing primary CABG at a tertiary center in India. Pure Tone Audiometry (PTA) was performed preoperatively, and at 1 week, 1 month, and 3 months postoperatively. Patients were grouped into on-pump and off-pump categories, and PTA thresholds were compared over time. Comorbidities and intraoperative variables, such as hypotension, were analyzed for association with hearing loss. Results: Of the 210 patients, 3 (1.4%) developed postoperative SNHL—2 in the on-pump group (4.6%) and 1 in the off-pump group (0.6%). The hearing loss was mild in two cases and moderate in one, all of whom had comorbid conditions such as diabetes, hypertension, and smoking. No statistically significant difference in mean PTA thresholds was noted over time in either group. Intraoperative hypotension was significantly more frequent in the on-pump group (p = 0.017). Conclusion: CABG is largely safe with respect to auditory outcomes. However, on-pump procedures, particularly in patients with vascular comorbidities, may pose a higher risk of SNHL. Routine audiological screening should be considered in high-risk patients undergoing CABG.

Background: Atrial myxomas are the most common primary cardiac tumors but often present with nonspecific symptoms, leading to delayed diagnosis and potentially life-threatening complications. Case: We present a 45-year-old woman who initially presented with fever, cough, and hypoxia—presumed to be viral pneumonia due to RSV positivity. However, further imaging revealed a large, mobile left atrial mass prolapsing into the left ventricle. Transthoracic echocardiography confirmed a large atrial myxoma. The patient underwent successful surgical resection, with histopathology confirming a benign myxoma. Postoperatively, she developed atrial fibrillation managed with amiodarone and anticoagulation, and was discharged in stable condition. Conclusion: This case emphasizes the importance of maintaining a high index of suspicion for cardiac tumors in patients with unexplained systemic or cardiopulmonary symptoms. Multimodal imaging and timely surgical intervention are essential for optimal outcomes.

Introduction: Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease and end-stage renal failure. Early detection of renal hemodynamic changes is crucial as functional impairment often precedes overt biochemical derangements. Doppler ultrasound provides a non-invasive means of assessing intrarenal vascular resistance indices, particularly the resistive index (RI) and pulsatility index (PI). However, limited consensus exists on their diagnostic value in DKD when compared with conventional biochemical markers. Material and Methods: This cross-sectional study was conducted in the Department of Radiology, including 100 patients with type 2 diabetes mellitus and evidence of DKD. All participants underwent renal ultrasound and Doppler evaluation using a high-resolution machine with a 3.5–5 MHz curvilinear probe. RI and PI were measured in the main, segmental, and interlobar arteries. Biochemical investigations included fasting blood glucose, glycated hemoglobin (HbA1c), serum creatinine, blood urea, estimated glomerular filtration rate (eGFR, CKD-EPI), and urinary albumin excretion. Correlations between Doppler and biochemical parameters were analyzed using Pearson’s correlation. Results: The mean RI was 0.73 ± 0.06, and the mean PI was 1.35 ± 0.18. RI correlated positively with serum creatinine (r = 0.46, p < 0.001) and urinary albumin excretion (r = 0.42, p < 0.01), and negatively with eGFR (r = –0.41, p < 0.001). HbA1c showed a mild but significant correlation with RI (r = 0.32, p < 0.05). Violin and box plots demonstrated progressive increases in RI across albuminuria categories (normo-, micro-, macroalbuminuria) and CKD stages (G1–G5). Bland–Altman analysis confirmed good repeatability of RI measurement. Conclusion: Renal Doppler indices, especially RI, are strongly associated with key biochemical markers of renal function and disease severity in DKD. Doppler ultrasound offers a reliable, non-invasive adjunct to biochemical assessment and may facilitate earlier detection and monitoring of DKD progression. Larger longitudinal studies are warranted to establish prognostic thresholds and validate the role of RI/PI in risk stratification.

Background and Aim: Smoking is a well-established risk factor for cardiovascular disease, yet its effect on lipid profiles among young adults remains a subject of ongoing investigation. This study aims to evaluate the differences in lipid profiles between young smokers and non-smokers, and to analyze lipid alterations in relation to smoking intensity. Material and Methods: A prospective study was conducted including 200 participants, divided into 100 smokers and 100 non-smokers. Lipid parameters including total cholesterol, triglycerides, LDL, VLDL, and HDL were measured. Smokers were further categorized based on smoking intensity into mild, moderate, and heavy groups. Results: Smokers exhibited significantly elevated levels of total cholesterol, triglycerides, LDL, and VLDL, while HDL was markedly lower compared to non-smokers. A dose-dependent worsening in lipid profile was observed among heavy smokers. Conclusion: The study reinforces that smoking adversely alters lipid profiles in young adults, even at low intensities. The data suggest an urgent need for early cardiovascular risk screening and targeted smoking cessation initiatives

Background: Vitamin D, a prohormone crucial for calcium homeostasis and bone health, also plays a significant role in neuromuscular function. Deficiency of Vitamin D is a global health issue, and its link to non-specific musculoskeletal pain (MSP) is increasingly recognized. Medical students, due to their demanding indoor lifestyle and limited sun exposure, are a high-risk group for Vitamin D deficiency, yet data on its correlation with clinical symptoms in this population remain limited.

Methods: A cross-sectional analytical study was conducted on 80 medical students aged 18-24 years. Participants were recruited via convenience sampling. Data on demographics, sun exposure, and the presence of MSP (defined as persistent aching for >3 months) were collected using a structured questionnaire. A 3 mL venous blood sample was collected from each participant to measure serum 25-hydroxyvitamin D [25(OH)D] levels using a chemiluminescence immunoassay. Vitamin D deficiency was defined as a serum 25(OH)D level <20 ng/mL. Statistical analysis was performed using SPSS version 25.0, with the Chi-square test and Independent Samples t-test. A p-value <0.05 was considered significant. Results: The mean age of the participants was 21.2 ± 1.8 years. The prevalence of Vitamin D deficiency was 62.5% (n=50), with a mean serum 25(OH)D level for the entire cohort of 18.9 ± 6.1 ng/mL. The overall prevalence of MSP was 55.0% (n=44). A strong and statistically significant association was found between Vitamin D deficiency and MSP. The prevalence of MSP was significantly higher in the deficient group compared to the sufficient group (80.0% vs. 13.3%; p<0.001). The mean serum 25(OH)D level was also significantly lower in students reporting MSP compared to those without pain (15.2 ± 4.1 ng/mL vs. 23.5 ± 5.0 ng/mL; p<0.001). Conclusion: Vitamin D deficiency is highly prevalent among medical students and is strongly associated with the presence of chronic musculoskeletal pain. These findings highlight a significant, modifiable health issue that can impact the quality of life and academic performance of future physicians. Routine screening, health education on safe sun exposure, and dietary supplementation should be considered as preventative strategies in this at-risk population.

Background: Rheumatoid arthritis is a chronic polyarthritic condition which is a multisystem disorder that has an unknown etiology. Hearing loss is commonly seen in subjects with rheumatoid arthritis with a prevalence of 60-62% and CHL (conductive hearing loss) being more commonly seen compared to SNHL (sensorineural hearing loss). Aim: The present study was aimed to assess the prevalence and types of hearing loss in patients with rheumatoid arthritis and to assess its associations with age, gender, and disease duration. Methods:  The present study assessed 50 subjects with rheumatoid arthritis that were assessed against 50 controls without rheumatoid arthritis. In all subjects from both the groups, complete clinical examination was done followed by audiological assessment that included acoustic reflex, tympanometry, and PTA (pure tone audiometry) assessment. Results: The study results showed that in cases, hearing loss was seen in 66% subjects with 16% SNHL and 50% conductive hearing loss. Tympanometry showed that 18 subjects from 50 cases showed curve and 32 subjects had right side A type. A type and as type curve were seen in 36 and 14 subjects respectively on left side. Acoustic reflex was present, delayed, and absent in 14, 6, and 30 subjects respectively on right side and 16, 8, and 24 subjects on left side. All subjects from control group had hearing threshold of <25dB with acoustic reflex and A-type tympanogram in both the ears. Conclusion: The present study concludes that a large number of subjects with rheumatoid arthritis have involvement of ears presenting as hearing loss. Hence, it is vital to conduct auditory screening using PTA in subjects with rheumatoid arthritis which can help in early diagnosis and superior rehabilitation.

Background: Plasma exchange (PLEX) is an established treatment for Guillain-Barré syndrome (GBS), but its accessibility is limited in low-resource settings. Small volume plasma exchange (SVPE) may offer a cost-effective alternative. Objective: To evaluate the clinical effectiveness and safety of SVPE in patients with moderate to severe GBS. Methods: In this prospective cohort study, adult GBS patients received five SVPE sessions (800–1000 mL/session) on alternate days. The primary outcome was ≥1 grade improvement in GBS disability score at 4 weeks. Secondary outcomes included ventilation requirement, hospital stay, and complications. Results: Among 42 patients (mean age 39.8 ± 14.2 years), 76.2% achieved ≥1 grade improvement. Mechanical ventilation was required in 19%. Mean hospital stay was 14.3 ± 5.7 days. Minor adverse events occurred in 12% of patients. Conclusion: SVPE appears effective and safe in treating GBS in resource-limited settings. Further randomized controlled trials are needed.

Background: Ventilator-associated pneumonia (VAP) is defined as nosocomial pneumonia in patients on mechanical ventilation which develops more than 48 h after initiation of mechanical ventilation (MV). VAP arises when there is bacterial invasion of the pulmonary parenchyma in a patient on mechanical ventilation. As in the literature it has been found that there is considerable mortality due to delay in initiation of antibiotics therefore this study was planned to assess risk factor and clinico -microbiological profile of VAP patients. Methods: This was a cross-sectional study conducted between june 2021 to december 2022 in department of medicine icu (MICU), head injury icu (HICU) and respiratory medicine icu (RICU) of UPUMS, Saifai, Etawah. patients who were admitted to the RICU/MICU/HICU and developed pneumonia after 48 hours of initiation of invasive mechanical ventilation. Result: A total of 130 VAP patients were included in this study among which 92(70.8%) were male and 38(29.2%) were female. Out of 130 study participants bacterial growth seen in 114(88%) endotracheal aspirate sample while in 16(12%) sample no growth is seen. The primary underlying diagnosis and comorbidities were COPD (Chronic obstructive pulmonary disease) and Asthma in 39(30%) patients, hypertension in 30(23.1%) patients, Type 2 Diabetes mellitus in 26(20%) patients, post tb sequele in  15(11.5%) patients and head injury in 15(11.5%) patients . Gram-negative agents were the major pathogen (Pseudomonas accounting for 30.6%). The infection in 34 case (82.9%) was multi-drug resistant (MDR) pathogen. Pseudomonas MDR pathogens was associated with higher mortality rate compare with other MDR pathogens (p<0.01). Conclusion: Ventilator-associated pneumonia is a serious ICU complication that is associated with increased in hospital mortality. MDR Pseudomonas infection, underlying chronic obstructive pulmonary disease (COPD) are associated with increased risk in-hospital mortality in such patients. Identification of risk factor for in hospital mortality in such patents is important in term of further their modification and reduction of mortality rate

Background: Right-ventricular (RV) dysfunction contributes meaningfully to early risk after acute left-ventricular myocardial infarction (LVMI) through ventricular interdependence, yet it is under-assessed in routine care. Objectives: To quantify RV dysfunction in acute LVMI using a multiparametric echocardiographic approach and evaluate its association with in-hospital outcomes. Methods: In a single-centre, observational study at SAIMS, Indore, we enrolled 50 consecutive first-presentation STEMI patients. Exclusions included ECG/echo evidence of RV infarction and prior MI/CABG. All underwent 12-lead ECG, biomarkers, and transthoracic echocardiography at presentation and at discharge (~5 days). RV indices included RV end-diastolic diameter (RVEDD), tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), E/E′, RV myocardial performance index (RV-MPI), and adjunctive measures (TR-derived pulmonary pressures, IVC indices). Results: LV territory infarction (AWMI) comprised 68%. At presentation, abnormalities were frequent: TAPSE <17 mm 58%, FAC <35% 42%, E/E′ >6 54%, RV-MPI >0.55 60%, and LVEF <50% 78%. Partial improvement occurred by discharge (44%, 40%, 38%, 52%, and 64%, respectively). AWMI had lower TAPSE and longer length-of-stay than IWMI (9.5 ± 4.7 vs 6.6 ± 4.7 days; Δ = 2.9 days; p≈0.051), with a trend toward lower mean TAPSE (17.8 ± 4.6 vs 19.9 ± 3.6 mm; p≈0.088). Reduced RV systolic function identified a high-risk phenotype: TAPSE ≤ 18 mm vs > 18 mm showed higher MACE (38.9% vs 12.5%; risk ratio [RR] 3.11; 95% CI 1.05–9.20; p=0.041) and higher mortality (27.8% vs 6.3%; RR 4.44; 95% CI 0.96–20.62; p=0.083). Pharmacoinvasive or primary PCI predominated (54% and 24%); thrombolysis-only (18%) was associated with the least improvement in RV indices. Conclusions: In acute LVMI, RV dysfunction is frequent, incompletely reversible during the index admission, and strongly prognostic. Routine, early, and repeated multiparametric RV assessment—anchored by TAPSE—should inform triage, hemodynamic management, revascularization strategy, and discharge planning.

Background: Hypothyroidism, including its subclinical form, is known to impact cardiovascular function and exercise tolerance. While the association between hypothyroidism and cardiovascular disease is well established, dynamic assessments like treadmill testing (TMT) remain underutilized in this population. Objectives To evaluate the prevalence and predictors of positive TMT results in hypothyroid patients and examine associations with age, metabolic equivalents (METs), cardiovascular risk factors, and biochemical and echocardiographic parameters. Methods In this retrospective observational study, data from 109 hypothyroid patients with complete TMT and clinical information were analyzed. TMT outcomes (Positive, Negative, Inconclusive) were assessed in relation to age, gender, comorbidities, symptoms, lipid and thyroid profiles, echocardiographic findings, and exercise tolerance (METs, heart rate, blood pressure). Statistical analyses included ANOVA and Chi-square tests. Results TMT was positive in 32.1% of patients, with positivity increasing significantly with age (p<0.0001). Patients aged 55–65 years showed the highest TMT positivity (57.1%). TMT positivity was significantly associated with diabetes (45.7%), dyslipidemia (40.0%), and elevated triglyceride levels (p=0.041). Lower METs and reduced exercise tolerance were significantly linked to positive or inconclusive TMT outcomes (p<0.0001). Echocardiographic abnormalities (RWMA and reduced ejection fraction) were observed exclusively in TMT-positive patients (p<0.0001). Conclusions A significant proportion of hypothyroid patients, particularly older adults with cardiovascular risk factors and reduced exercise tolerance, exhibit positive TMT results. These findings support the role of TMT and METs assessment in cardiovascular risk stratification among patients with hypothyroidism.

Introduction: Maternal hypotension is a common complication of spinal anesthesia during cesarean section, potentially affecting both mother and fetus. Vasopressors such as phenylephrine and ephedrine are commonly used, but their comparative efficacy and safety remain debated. Aim: To compare the efficacy and safety of phenylephrine versus ephedrine in managing maternal hypotension during cesarean section under spinal anesthesia. Methods: A prospective, randomized comparative study was conducted in 200 parturients undergoing cesarean section under spinal anesthesia. Participants were randomly allocated into two groups: Group P (n=100) received intravenous phenylephrine 100 µg bolus for hypotension, while Group E (n=100) received intravenous ephedrine 6 mg bolus. Maternal hemodynamic parameters, side effects, and neonatal outcomes were assessed. Results: Phenylephrine maintained systolic blood pressure more effectively, with greater time within target range (86.7% ± 8.4 vs. 74.9% ± 10.6; p<0.001) and fewer hypotension episodes (1.1 ± 0.9 vs. 2.3 ± 1.2; p<0.001). Maternal nausea/vomiting occurred less frequently with phenylephrine (12.0% vs. 27.0%; p=0.007), but bradycardia was more common (16.0% vs. 6.0%; p=0.024). Neonates in the phenylephrine group had higher Apgar scores at 1 and 5 minutes (8.1 vs. 7.6, p<0.001; 9.1 vs. 8.8, p=0.0002) and higher umbilical arterial pH (7.29 vs. 7.25; p<0.001). NICU admission and acidosis rates were lower with phenylephrine but not statistically significant. Conclusion: Phenylephrine was superior to ephedrine in maintaining maternal hemodynamic stability and improving neonatal acid-base status, although it was associated with a higher incidence of bradycardia. It should be considered the vasopressor of choice for managing maternal hypotension during spinal anesthesia in cesarean sections

Introduction: Anticipating difficult laryngoscopy is a cornerstone of safe anesthetic practice. Although multiple bedside tests exist, their predictive accuracy remains variable. Aim: To evaluate the association between preoperative difficult airway predictors and Cormack-Lehane grades in surgical patients undergoing general anesthesia. Methods: A cross-sectional study was conducted on 160 adult patients undergoing elective surgery under general anesthesia with endotracheal intubation. Preoperative airway assessments included Mallampati classification, thyromental distance (TMD), sternomental distance (SMD), inter-incisor gap (IID), upper lip bite test (ULBT), neck mobility, BMI, short neck, and receding mandible. Direct laryngoscopy was performed after induction, and the glottic view was graded using the Cormack-Lehane classification. Association between predictors and difficult laryngoscopy (CL grade III/IV) was analyzed using chi-square tests, logistic regression, and diagnostic accuracy indices. Results: The overall prevalence of difficult laryngoscopy was 19.4%. Significant predictors included Mallampati III/IV (OR 3.01, p=0.0066), TMD <6.5 cm (OR 2.85, p=0.0098), IID <3.5 cm (OR 3.57, p=0.0042), ULBT class III (OR 3.12, p=0.0077), and limited neck extension (OR 2.75, p=0.0202). On multivariable analysis, Mallampati, TMD, IID, ULBT, and neck extension remained independent predictors. The risk of difficult laryngoscopy increased with multiple predictors, rising from 9.0% (0-1 predictors) to 40.0% (≥4 predictors) (p-trend = 0.0017). Conclusion: Difficult laryngoscopy was encountered in nearly one-fifth of patients. Mallampati, inter-incisor gap, thyromental distance, upper lip bite test, and neck extension were the strongest independent predictors. A composite airway assessment approach is superior to reliance on a single test in identifying patients at risk.

Background: Megaloblastic anemia (MA) is a significant cause of macrocytic anemia and pancytopenia in children, particularly in developing countries like India, where nutritional deficiencies in vitamin B12 and folate are prevalent. This study aimed to determine the prevalence, clinical presentations, and hematological profile of MA in children aged 1-14 years. Methods: This retrospective observational study was conducted at Department of pathology, MNR Medical College, Telangana, a tertiary care center in Telangana, India, from January 2023 to December 2024. Medical records of 150 children aged 1-14 years diagnosed with MA based on clinical features, peripheral blood smear (PBS), and bone marrow examination were reviewed. Data on demographics, clinical symptoms, hematological parameters (hemoglobin, mean corpuscular volume [MCV], white blood cell [WBC] count, platelet count), and vitamin levels were analyzed. Prevalence was calculated as a proportion of anemic patients, and associations were assessed using descriptive statistics. Results: Out of 150 patients (mean age 5.2 ± 2.8 years; 52% males), the prevalence of MA among anemic children was 28.6% (based on hospital anemia registry). Common clinical features included pallor (98%), anorexia (85%), generalized weakness (72%), and irritability (65%). Hyperpigmentation of knuckles was noted in 45%, and glossitis in 32%. Hematologically, macrocytic anemia (MCV >95 fL) was universal (100%), with mean hemoglobin 6.8 ± 1.5 g/dL. Pancytopenia was present in 68%, and hypersegmented neutrophils in 92% on PBS. Vitamin B12 deficiency was confirmed in 78%, folate in 15%, and combined in 7%. Nutritional inadequacy due to vegetarian diet was the primary cause (92%). Treatment with B12 and/or folate supplementation led to rapid hematological recovery in 95% within 4 weeks. Conclusion: MA is highly prevalent in Indian children, presenting with nonspecific symptoms and characteristic hematological findings. Early diagnosis through routine PBS and vitamin assays, coupled with nutritional counseling, is crucial for optimal outcomes. Fortification of staple foods should be prioritized as a public health measure.

Background and objectives: To study the effects of obesity on blood glucose levels in adolescents. Methods: Total 110 patients with 10-19 years of age, who were willing to participate in the study, were free from any substance abuse and were not under any long term medication, were included in this study.  Results: In our study, we noted that 59.1% were male and the rest were female with a mean age of 14.50±2.51 years adolescent subjects. 70.0% of adolescents had non-vegetarian dietaryhabits, 51.8 % were living in the rural living area and 48.2% were in middle socioeconomic status. We observed statistically significant higher fasting blood sugar and HbA1c in the obese group incomparison to the overweight and control group (P<0.05). We noted that >110mg/dl fasting blood sugar and >6.5g% HbA1c levelwere significantly higher in overweight and obese cases in comparison to a control group(p<0.001). Conclusion:  A higher body weight predisposes kids to severe obesity related issues and impaired glucose metabolism. Prompt intervention might result from appropriate risk stratification, which could help doctors identify overweight kids who are more likely to develop type 2 diabetes.

Introduction: Residual neuromuscular blockade following rocuronium administration can cause serious postoperative complications. Neostigmine has been the traditional reversal agent but is limited by slower onset and adverse muscarinic effects. Sugammadex, a novel selective relaxant binding agent, offers rapid and complete reversal. This study compared the recovery profile and adverse events between sugammadex and neostigmine. Aim: To compare sugammadex and neostigmine for reversal of rocuronium block with respect to recovery profile and adverse events. Methods: A prospective, randomized comparative study was conducted on 100 ASA I-II patients undergoing elective surgeries under general anesthesia. Patients were allocated into two groups (n=50 each): Group S received sugammadex 2 mg/kg, while Group N received neostigmine 0.05 mg/kg with glycopyrrolate 0.01 mg/kg at reappearance of the second TOF count. Primary outcome was time to TOF ratio ≥0.9. Secondary outcomes included extubation time, PACU stay, Aldrete recovery score, and adverse events. Data were analyzed using t-test, Chi-square/Fisher’s exact test, and results expressed with 95% confidence intervals. Results: Mean time to TOF ≥0.9 was significantly shorter in Group S (2.6 ± 0.8 min) compared to Group N (12.4 ± 3.1 min, p<0.0001). Extubation time and PACU stay were also reduced in Group S (6.9 ± 1.7 min vs 13.8 ± 3.4 min; 38.0 ± 9.0 min vs 52.0 ± 12.0 min; both p<0.0001). Adverse events occurred in 12% of Group S and 34% of Group N (p=0.0156). Residual paralysis and desaturation were observed only in the neostigmine group. Conclusion: Sugammadex provided rapid, reliable, and safer reversal of rocuronium block compared with neostigmine, with fewer adverse events and faster recovery. It may be particularly beneficial in high-risk patients where complete and prompt recovery is essential.

Background: Thyroid nodules are a common clinical finding, but only a small fraction are malignant. Conventional B-mode ultrasonography (US), often coupled with systems like the Thyroid Imaging, Reporting, and Data System (TI-RADS), is the primary imaging modality but has limited specificity, leading to a high number of unnecessary fine-needle aspiration (FNA) biopsies. Strain elastography (SE) is an adjunctive technique that assesses tissue stiffness, a property often altered in malignant lesions. Methods: This prospective, single-center study included 162 thyroid nodules in 148 patients who were scheduled for FNA or thyroidectomy. All nodules underwent a standardized examination including B-mode US (to assign a TI-RADS score) and SE. SE was evaluated using a 4-point qualitative elastography score (ES) and a quantitative strain ratio (SR), calculated by comparing the nodule to adjacent normal thyroid tissue. The diagnostic performance of B-mode US alone, SE alone, and their combination was assessed against the final histopathological diagnosis. Results: Of the 162 nodules, 125 (77.2%) were benign and 37 (22.8%) were malignant. Malignant nodules demonstrated significantly higher mean ES (3.5 ± 0.7 vs. 1.9 ± 0.8; p < 0.001) and mean SR (4.8 ± 1.4 vs. 2.1 ± 0.9; p < 0.001) compared to benign nodules. Using a receiver operating characteristic (ROC) curve analysis, an optimal SR cutoff of 2.95 was determined. The combination of B-mode US (TI-RADS ≥4) and SE (SR > 2.95) yielded a sensitivity of 94.6%, specificity of 91.2%, positive predictive value of 76.1%, negative predictive value of 98.3%, and an overall accuracy of 92.0%. This combined approach showed significantly higher accuracy compared to B-mode US alone (84.0%, p = 0.02) and SE alone (88.9%, p = 0.04). Conclusion: Strain elastography, particularly the quantitative strain ratio, is a valuable adjunct to conventional B-mode ultrasonography. Its integration into the diagnostic algorithm significantly improves the accuracy of differentiating benign and malignant thyroid nodules, holding the potential to reduce the rate of unnecessary invasive procedures.

Background: Acute coronary syndromes (ACS) without diagnostic ST-elevation can occasionally represent complete coronary artery occlusion, termed STEMI equivalents. Two such patterns, de Winter sign and N terminal wave, are associated with proximal left anterior descending (LAD) and left circumflex (LCX) artery occlusions, respectively. Early recognition is essential to avoid treatment delays. Objectives: To describe the clinical presentation, angiographic profile, and short-term outcomes of ACS patients with de Winter sign and N terminal wave patterns, and to compare their characteristics. Methods: This observational cross-sectional study was conducted at Government Medical College, Kozhikode, Kerala, from November 2023 to April 2025. Forty consecutive ACS patients with either de Winter sign or N terminal wave on 12-lead ECG were enrolled (20 in each group). Demographics, cardiovascular risk factors, clinical presentation, laboratory parameters, echocardiographic findings, and coronary angiographic data were collected. All patients underwent primary percutaneous coronary intervention (PCI). Outcomes were assessed in-hospital, at 1 month, and at 3 months. Results: Mean age was 57.35 ± 13.0 years in the N terminal wave group and 52.7 ± 14.6 years in the de Winter group. Male predominance was noted (70% vs. 90%). Diabetes mellitus was more prevalent in de Winter patients (50% vs. 25%), and LDL cholesterol was significantly higher (102.25 ± 29.4 mg/dL vs. 92.0 ± 45.0 mg/dL, p = 0.038). Angiographically, de Winter sign correlated with LAD culprit in 85% of cases, while N terminal wave correlated with LCX involvement in 60% (p < 0.001). Ejection fraction was higher in N terminal wave patients (56.65 ± 9.89% vs. 47.49 ± 17.4%). TIMI III flow post-PCI was achieved in 95% of N terminal wave and 90% of de Winter cases. In-hospital mortality was 5% in the de Winter group; survival at 3 months was 100% in both groups. Conclusion: De Winter sign and N terminal wave are distinct STEMI equivalent ECG patterns with strong territorial correlations and favourable outcomes when promptly revascularized. Their recognition should be integrated into ACS protocols to expedite reperfusion.

Introduction: A significant public health issue in both developed and developing countries is substance abuse. The door-to-door survey method has been used in numerous surveys to address the prevalence of substance abuse in India. Very few community-based researches have been carried out to determine the prevalence of substance use among adolescents. Aims and objectives: To determine the prevalence and pattern of substance use among adolescent males and its association with socio-demographic factors. Materials and methods: A community-based cross-sectional study was conducted among adolescent males fulfilling the inclusion criteria from the randomly selected households located in the field practice area of an urban health centre of Community Medicine department. Interviewer administered questionnaire was used and data was analysed to determine the prevalence, patterns and associated socio-demographic factors of substance use. Results: Out of total 246 participants, majority of them belonged to age group 15-18 years, comprising 187 (76%) participants. Alcohol use was most common with prevalence of 38%, followed by tobacco smoking in 76 (31%) participants, tobacco chewing in 51 (21%) participants, and Ganja (weed) smoking in 15 (6%) participants. Conclusion: This community-based study revealed a the pattern & prevalence of current substance use, where alcohol consumption & tobacco smoking being the most commonly used substance among adolescents. Therefore, it is essential to implement comprehensive prevention and control programs targeting teenagers and their parents within schools and the community. 

Early-onset coronary artery disease (CAD), typically defined as occurring before the age of 45 years in men and 55 years in women, is an emerging global health challenge. Although overall CAD mortality has declined, the incidence among young adults has remained stable or increased, with profound implications for public health and socioeconomic productivity. This systematic review synthesizes evidence from epidemiological, clinical, and mechanistic studies on early-onset CAD. Literature searches were conducted in PubMed, Scopus, and Web of Science up to June 2025, identifying 1,328 articles, of which 72 met the inclusion criteria. Findings indicate that early-onset CAD is strongly associated with traditional risk factors such as dyslipidemia, hypertension, diabetes, smoking, and obesity, but also with non-traditional determinants including genetic predisposition, psychosocial stressors, substance abuse, and inflammatory biomarkers. Premature CAD often presents with acute coronary syndromes, exhibits more aggressive angiographic profiles, and demonstrates poorer adherence to secondary prevention compared to older populations. Despite advances, young adults remain underdiagnosed and undertreated, underscoring the need for precision prevention, early screening, and lifestyle interventions. Future research must focus on genetic risk profiling, sex-specific factors, and cost-effective public health strategies tailored to younger populations.

Background: Pre-operative factors related to the rheumatic process and the presence of valve dysfunction (both mitral and tricuspid) can influence the development of early LV dysfunction after surgery. These include pre-operative conditions like pulmonary hypertension, atrial fibrillation, and a large left ventricular end-systolic dimension. Aim of the study is to identify factors associated with early left ventricular dysfunction after mitral and/or tricuspid valve surgery in RHD. Materials and Method: The present prospective observation study included all the patients with rheumatic heart disease having Mitral valve replacement with or without Tricuspid repair or replacement from March 2021 to February 2023. Their demographic data, risk factors, Échocardiographie paramètres, clinical data, pre & post-operative data were taken from all participants in the study. The study assessed Post-surgery LV function once patients were weaned off from ionotropic support. Result: The current study results show that Left Ventricular End Diastolic Diameter (p = 0.004/ OR = 0.89), left ventricular End Systolic Diameter (p =< 0.001/ OR = 0.78), Severe pulmonary artery hypertension (p = 0.002/ OR = 1.2) and severity of mitral regurgitation (moderate MR p = 0.03/ OR=0.86, severe MR p = 0.001/ OR = 0.93) were significantly associated for early postoperative LV dysfunction. Conclusion: Our study demonstrates that simple preoperative echocardiography measures allow prediction of LV dysfunction.  Pre-operative EDD and ESD, pre-operative severity of mitral regurgitation and severity of PAH were the predictors of early postoperative LV dysfunction.

Background & Objective: Effective postoperative pain management is essential for optimal surgical recovery, especially in facilitating early mobilization and reducing pulmonary complications. While epidural analgesia is widely used, it is associated with bilateral sympathetic blockade and potential hemodynamic and respiratory side effects. Paravertebral block (PVB), offering unilateral analgesia, may provide comparable pain relief with fewer systemic effects. This study aimed to compare the analgesic efficacy, hemodynamic stability, and respiratory-relevant outcomes of paravertebral versus epidural blocks following lower limb surgeries. Methods: This randomized controlled trial was conducted on 50 patients (ASA I–II, aged 18–70 years) undergoing lower limb surgery under spinal anesthesia at King George’s Medical University, Lucknow. Patients were randomized into two groups: •              Group E (Epidural): Lumbar epidural catheter at L2–L3 or L3–L4, receiving 10 ml 0.5% ropivacaine + 1 µg/kg fentanyl after 2 hours of spinal anesthesia, followed by 5 ml of the same combination every 3 hours for 24 hours. •     Group P (Paravertebral): Catheter placed 2 cm lateral to the L3 or L4 spinous process, with the same drug regimen. All patients received spinal anesthesia with 15 mg hyperbaric bupivacaine and 25 µg fentanyl. Hemodynamic parameters (MAP, SBP, DBP, HR, SPO₂), VAS Pain scores, and side effects including hypotension, nausea, vomiting, pruritus, and sedation were recorded. Oxygen saturation (SPO₂) trends were monitored as a surrogate marker for respiratory well-being. Results: Both techniques provided effective postoperative analgesia. Paravertebral block demonstrated superior hemodynamic stability, fewer adverse effects, and comparable pain scores. No patient in either group developed respiratory depression, and oxygen saturation remained stable in all cases. The unilateral nature of PVB allowed for earlier mobilization and reduced sedation, potentially lowering the risk of postoperative pulmonary complications. Conclusion: Paravertebral block is a safe, effective, and technically simpler alternative to epidural analgesia for lower limb surgeries. It offers excellent analgesia with greater hemodynamic and respiratory stability, making it particularly beneficial in elderly or high-risk patients where early mobilization and pulmonary function preservation are critical. Further large-scale studies should explore its role in reducing respiratory morbidity in postoperative care.

Introduction: Congenital heart diseases (CHD) are among the most common form of birth defects. The fetal cardiac screening by ultrasound can detect a high proportion of cases of CHD. Detection of cardiac anomalies can be challenging and is typically done by fetal cardiac ultrasound performed between 18 and 22 weeks. A transvaginal scan can detect anomalies even at 12–13 weeks. Early and precise detection of CHD can direct appropriate management. Objectives: To detect the incidence of congenital heart diseases at a tertiary care centre and to detect cardiac anomalies early, accurately, and help avail all the benefits of early prenatal diagnosis. Methods: A descriptive cross-sectional study, where 5,000 patients were screened over a period of 10 months who came for routine second trimester (16 to 24 weeks) obstetric evaluation. The fetal heart was evaluated and sequential segmental analysis was done using ultrasonography. Detailed biometric and structural evaluations of all fetuses were undertaken. In high-risk cases (17%), or in cases with positive cardiac findings, the extended fetal echocardiographic examination was performed at 16-20 weeks(850 cases). Follow-up scans were done at 24 weeks and post-natal periods to confirm the diagnosis. Out of 5,000 screened cases, 25 fetuses had CHD. The most common indication for extended fetal echo was maternal (59.2%) followed by fetal (40.2%). In maternal indications, the most common was advanced maternal gestational age (>35 years), followed by bad obstetric history and gestational diabetes. In fetal indications, the most common was abnormal obstetric Doppler findings favouring IUGR. Results: Of 5,000 cases examined by us, at 16 – 24 weeks using Color Doppler, and a high-end ultrasound machine, we could diagnose VSD in 3 cases, ASD in 2 cases, TOF in 2 cases, Transposition of great vessels in 2 cases, Hypoplastic left heart syndrome in 2 cases, Ebstein’s anomaly in 1 case and severe fetal hydrops with bradycardia in 1 case. On follow-up scan at 24 weeks, 2 additional VSD cases, 2 additional ASD cases, 2 new cases of TOF, and 1 new case of TGA were diagnosed. However, the number of cases of other pathologies remained the same. On post-natal scan additional cases of VSD, TOF and TGA diagnosed were 2, 1, and 2. Conclusion: An apparently normal appearance at any stage of pregnancy does not exclude a major heart defect, and it seems likely that some defects may be amenable to diagnosis only after birth. Hence follow-up scans with minute observation and technical expertise are need of the hour. Most of the CHDs in our region are missed, primarily because of poor socioeconomic status, lack of availability and awareness of diagnostic echocardiography. Spreading awareness and skill of fetal echocardiography is need of the hour. 

Background: Benign adnexal masses—comprising ovarian, tubal, and paraovarian lesions—constitute a prevalent spectrum of gynecological pathologies in women of reproductive and menopausal transition age groups. With the ascension of minimally invasive surgery, laparoscopy has increasingly supplanted conventional laparotomy owing to its demonstrable superiority in perioperative morbidity and convalescence metrics (Eskander et al., 2020¹; AlHilli et al., 2021²). Objectives: This study was designed to scrutinize the clinical efficacy and histopathological correlation of laparoscopic intervention in benign adnexal masses, delineating the operative nuances, pathological spectrum, and diagnostic concordance between preoperative imaging and definitive histology. Methods: A single-center, prospective observational study was conducted between July 2023 and December 2024 at the Department of Obstetrics and Gynaecology, CNMCH, Kolkata. A cohort of 38 patients, aged 15–50 years and diagnosed with benign adnexal lesions (<12 cm), underwent laparoscopic excision. Preoperative assessments included ultrasonography, CA-125 assays, and clinical evaluation. Outcomes were measured in terms of operative duration, blood loss, hospitalization span, complications, and histopathological verification. Results: The mean operative duration was 46.1 ± 9.31 minutes, with average intraoperative blood loss of 44.9 ± 8.42 mL. Concordance between imaging-based diagnosis and histopathological confirmation was observed in 84.2% of cases. The predominant histological entities included serous cystadenoma (39.5%), endometrioma (36.8%), and mature cystic teratoma (18.4%). The incidence of intraoperative complications was low, and postoperative recovery parameters were favorable. Statistically significant correlations were noted between mass complexity and surgical morbidity indicators (p < 0.001). Conclusion: Laparoscopic management of benign adnexal pathology is not only clinically efficacious and surgically safe but also exhibits a high concordance with histopathological outcomes. Nevertheless, definitive diagnosis mandates histological evaluation, given the risk of underdiagnosed borderline malignancies. This study reinforces laparoscopy as the modality of choice for adnexal mass excision in carefully selected patients.

Background: Dengue is a vector borne viral illness affecting millions globally. According to the World Health Organization (WHO) estimates, 50 million dengue infections are recorded annually, and more than 2.5 billion people who are living in endemic areas are at risk of dengue infection. It has wide spectrum ranging from asymptomatic to severe form like Dengue hemorrhagic fever and dengue shock syndrome. It is characterized by thrombocytopenia, leucopenia, elevation of transaminases and electrolyte disturbances. Confirmation is by ELISA which may not be accessible in remote areas. Identification of hematological and biochemical findings can aid in the diagnosis in such situation. Objectives: to determine the hematological and biochemical abnormalities in Dengue patients. Materials and methods: This study was conducted at Shadan institute of medical sciences, a tertiary care centre. Around 50 cases of Dengue positive by ELISA method (NS1, IgM ) were evaluated for certain clinical and biochemical parameters. Age and Sex matched Controls were taken from patients who were suffering from other febrile illnesses without localising signs. Patients with Thrombocytopenia due to other causes were excluded. Blood samples were collected and hematological and biochemical parameters were analysed. Comparison of wbc count, platelet count (Hematology) serum electrolytes, transaminases, blood urea and serum creatinine(biochemical) between cases and controls was done. Ethical clearance was obtained from the institutional ethics committee. Results: Among the 50 Dengue patients, there were 33(66%) males and 17(34%) females. The age ranged from 12 years to 70 years. We have observed a significant rise in hematocrit of more than 20% in 2 cases (4 %).  Thrombocytopenia was seen in 96% of dengue patients., leucopenia was seen in 88% cases. Mean platelet count progressively fell from the day 3 and gradually increased from day 7 onwards. The Wbc count fell from day 3 and recovered from day 5 onwards. Neutrophil count progressively declined and the lymphocyte count gradually increased with the disease progression.  There was also an increased percentage of atypical lymphocytes in dengue patients (82%) . The platelet count and wbc count on admission was significantly lower in cases when compared with controls. ( p value <0.0001).  Biochemical findings included a significant rise in serum Transaminases (p value <0.001) in cases compared to controls.  There was a significant lower mean value of serum sodium levels (134.5 mmol/L) in cases compared to controls (139.6 mmol/L). Mean potassium levels were also comparatively lower in cases (3.8 mmol/L) compared to controls (4.27 mmol/L) . Mean urea levels were significantly higher in cases (32.35 mmol/L ) when compared to controls (25 mmol/l) (p value<0.05). Conclusion: Dengue being a viral illness with potential to cause serious consequences in it’s severe form, early diagnosis and management is beneficial to the patient. Due to absence of ELISA in remote areas, hematological and biochemical parameters can serve as a useful guide for diagnosis and management of the patient.

Background: Gestational hypertension is a common complication of pregnancy, often requiring antihypertensive medication. Labetalol, a combined alpha- and beta-blocker, is frequently used. However, its use has been associated with potential neonatal complications, including hypoglycemia and bradycardia, due to its ability to cross the placenta. This study aims to investigate the prevalence and characteristics of neonatal hypoglycemia and bradycardia in newborns born to gestational hypertensive mothers treated with labetalol at Trichy SRM Medical College. Methods: This was an prospective observational study conducted at Trichy SRM Medical College by collecting data from newborns born to gestational hypertensive mothers. The study population included all newborns of mothers diagnosed with gestational hypertension, with a specific focus on those exposed to maternal labetalol therapy. Data on maternal demographics, gestational hypertension characteristics, labetalol usage (dose, duration), and neonatal outcomes (birth weight, APGAR scores, presence of hypoglycemia and bradycardia, levels, NICU admission, duration of stay) were collected and analyzed. Detailed descriptive statistics, including frequencies, percentages, means, and standard deviations, were calculated. Graphical representations were used to visualize key findings. Results: The study included 50 newborns born to gestational hypertensive mothers. Of these, 22 (44%) were exposed to maternal labetalol therapy1. Neonatal hypoglycemia was observed in 30 (60%) of the total newborns 2, with an average blood glucose of 37.84 mg/dL3. Neonatal bradycardia was present in 20 (40%) of the total newborns 4, with an average heart rate of 94.74 bpm5. In the labetalol-exposed group, 14 (63.6%) experienced hypoglycemia and 12 (54.5%) experienced bradycardias. Further detailed statistics are presented in the results section. Conclusion: The findings suggest a notable prevalence of neonatal hypoglycemia and bradycardia in newborns of gestational hypertensive mothers, including those exposed to maternal labetalol. While this observational study cannot establish causality, the observed trends warrant further investigation into the precise relationship between maternal labetalol use and these neonatal adverse events. Close monitoring of blood glucose and heart rate is recommended for newborns of mothers receiving labetalol for gestational hypertension.

Background: Dysmenorrhea is one of the most common gynecological problems among adolescents and young women, often leading to absenteeism, reduced academic performance, and impaired quality of life. Despite its high burden, the condition remains underreported and understudied in smaller urban centers in India. Methods: A cross-sectional study was conducted among 223 unmarried, nulliparous female college students aged 17–25 years in two colleges in Jhalawar city, Rajasthan. Data on demographic profile, menstrual characteristics, lifestyle habits, and family history were collected using a pre-tested structured questionnaire. Dysmenorrhea was graded using the Verbal Multidimensional Scoring System. Associations between potential risk factors and dysmenorrhea were analyzed using the Chi-square test. Results: The prevalence of dysmenorrhea was 84.18% (n = 188; 95% CI: 79.1–88.2%). Among affected students, 47.62% reported pain every month, and 49.58% experienced moderate-to-severe pain. Significant associations were found between dysmenorrhea and early menarche (≤12 years; p < 0.05), prolonged menstrual cycles (≥35 days; p = 0.0196), longer bleeding duration (≥7 days; p < 0.05), and a positive family history (p < 0.0001). No significant associations were observed with BMI, fast food consumption, physical activity, premenstrual symptoms, or stress. Class absenteeism due to pain was reported by 79.78% of dysmenorrheic students (p < 0.001). Conclusion: Dysmenorrhea is highly prevalent among college-going females in Jhalawar, with early menarche, prolonged cycles, extended bleeding, and family history identified as significant risk factors. These findings underscore the need for targeted menstrual health education, early screening, and timely interventions within college health programs.

Background: The development of biliary tract imaging since its inception for cholelithiasis and its complications has shown a significant change in the past few decades. Histopathology, serum bilirubin, and USG (ultrasonography) are unique as methods for detection of cholecystitis and cholelithiasis. Aim: The present study was aimed to assess the correlation between ultrasonography and histopathological efficacy in subjects with pathology of the gall bladder.  Methods: The present study assessed 208 subjects that underwent histopathological assessment and ultrasonographic abdominal scans. Clinical and demographic data were gathered along with the assessment of serum bilirubin levels. Data gathered were statistically analyzed for formulation of the results.  Results: There were higher number of females in the study with 162 and 46 subjects with cholelithiasis and cholecystitis respectively. In cholelithiasis, most common symptom was epigastric pain and nausea/vomiting, whereas in cholecystitis, most common symptoms were epigastric pain and dyspepsia. Almost perfect agreement was seen in ultrasonography and histopathology intraoperatively. Other than serum bilirubin and ultrasonography alone, serum bilirubin and ultrasonography showed a strong consistency. Conclusion: The present study concludes that serum bilirubin and ultrasonography as a combination marker approach presents a versatile tool for intervention guidance and quick decision-making tool in cases of biliary tract.

Background: Non-healing ulcers are chronic wounds that fail to progress through normal healing due to factors like poor circulation, infection, or underlying conditions. Freshly collected human amniotic membrane (HAM) has emerged as an effective biological dressing due to its anti-inflammatory, anti-microbial, and regenerative properties. Rich in growth factors and extracellular matrix components, HAM promotes tissue repair, reduces scarring, and accelerates healing, making it a promising treatment for managing non-healing ulcers Objective: The objective is to assess the role of freshly collected human amniotic membrane as a biological dressing in chronic non-healing ulcers by evaluating its impact on pro-angiogenic growth factor expression, endothelial and vascular markers, histopathological tissue regeneration, and modulation of cytokine levels. Method: Fresh human amniotic membrane was aseptically collected from consenting mothers undergoing elective cesarean section after screening for infections. The membrane was washed in sterile saline, trimmed, and immediately applied to chronic non-healing ulcers in 15 patients (study group). The control group (15 patients) received conventional dressing. All procedures followed ethical guidelines with informed consent from both donors and recipients, ensuring sterility and prompt application to preserve bioactivity. Healing outcomes were assessed through biochemical analysis, growth factor and cytokine profiling, and histological examination. Regular monitoring included pain score, wound size measurement, infection status, and duration of epithelialization. Results: After applying HAM as a biological dressing on chronic non-healing ulcers in 15 patients, significant improvements were observed compared to 15 control patients treated with conventional dressings. Clinically, the HAM group showed a greater wound size reduction (60% vs.30 %, p<0.01), enhanced granulation tissue formation, decreased pain scores, and reduced exudate levels.Histopathological analysis revealed increased neovascularization, demonstrated by higher microvessel density along with thicker epithelialization and reduced inflammatory infiltrate in the HAM group.VEGF levels in wound tissue and exudate were significantly elevated (4.2-fold increase, p<0.01) in the HAM group, alongside increased basic fibroblast growth factor (bFGF) and platelet-derived growth factor (PDGF), supporting enhanced angiogenesis and tissue regeneration.Blood parameters showed reduced systemic inflammation markers, including lower CRP and normalized white blood cell counts in the HAM group. These findings collectively indicate that fresh HAM promotes accelerated vascular regeneration and healing compared to conventional dressings. Conclusion: Fresh human amniotic membrane significantly improved healing outcomes in non-healing ulcer patients compared to conventional dressings. It accelerated wound closure, enhanced granulation tissue formation, and reduced pain and exudate. Improved histopathology and increased angiogenic growth factors like VEGF supported better vascular regeneration. Reduced inflammatory markers and normalized blood parameters further confirmed its effectiveness as a superior biological dressing.

Background: Hoarseness of voice is a common otolaryngological complaint, often reflecting a spectrum of underlying laryngeal lesions ranging from benign to malignant. Early identification of these lesions is critical for timely intervention and improved clinical outcomes. Aim: To evaluate the demographic profile, spectrum, site distribution, and clinical presentation of benign and malignant laryngeal lesions in patients presenting with hoarseness of voice. Materials and Methods: A cross-sectional observational study was conducted on 100 patients presenting with hoarseness of voice. All patients underwent detailed clinical examination, indirect laryngoscopy, and diagnostic confirmation using microlaryngoscopy and histopathology when indicated. Data were analyzed to determine the prevalence and distribution of benign and malignant lesions. Results: The majority of patients were between 41–60 years (46%), with a male predominance (62%). Benign lesions constituted 68% of cases, while malignant lesions accounted for 32%. Among benign conditions, vocal cord polyps (24%) and nodules (18%) were most frequent. Squamous cell carcinoma was the predominant malignant lesion (28%). The glottis was the most commonly affected site (56.3%), followed by the supraglottic region (28.1%). All patients presented with hoarseness (100%), while throat discomfort (38%), dysphagia (22%), odynophagia (16%), and dyspnea (8%) were additional symptoms. Conclusion: Benign lesions outnumber malignant ones among patients with hoarseness; however, a significant proportion harbors malignancy, with squamous cell carcinoma being the leading type. Glottic involvement is most common in malignancies. Comprehensive evaluation and early diagnostic workup are essential for prompt management and improved prognosis

Background: Tuberculosis (TB) and diabetes mellitus (DM) represent a growing syndemic of global health importance. Diabetes not only predisposes individuals to active TB but also alters its clinical, radiological, and pathological manifestations, thereby influencing treatment outcomes. Understanding these modifications is crucial for timely diagnosis and effective management. This study aimed to evaluate the pathological and radiological spectrum of pulmonary tuberculosis in association with diabetes mellitus and to establish correlations between these domains. Materials and Methods: This prospective, cross-sectional study was conducted at a tertiary care center in North Western India  over 12 months and included 216 patients with microbiologically or histopathologically confirmed pulmonary TB. Patients were divided into two groups: Group A (TB–DM, n=108) and Group B (TB-only, n=108). Demographic, clinical, and glycemic profiles were recorded. All patients underwent chest radiography, with HRCT performed where indicated. Radiological features assessed included lesion site, cavity characteristics, extent of disease, and associated findings. Biopsy and cytology samples were examined histopathologically for granuloma architecture, necrosis, fibrosis, and acid-fast bacilli. Statistical analysis was performed using SPSS, with correlation coefficients applied to evaluate radiological–pathological associations. Results: TB–DM patients were significantly older (mean age 52.4 vs 39.7 years; p < 0.001) and presented more often with hemoptysis (35.2% vs 19.4%; p = 0.01) and prolonged illness (8.9 vs 6.2 weeks; p < 0.001). Radiologically, lower lobe involvement (38.9% vs 17.6%; p = 0.001), thick-walled cavitary lesions (36.1% vs 16.7%; p = 0.002), and multilobar disease (40.7% vs 21.3%; p = 0.003) were more frequent in TB–DM patients. Pathologically, poorly formed granulomas (57.4% vs 34.3%; p = 0.001) and extensive caseous necrosis (65.7% vs 44.4%; p = 0.002) predominated, while healing fibrosis was reduced (17.6% vs 38.0%; p = 0.001). Radiological–pathological correlation showed strong associations between thick-walled cavities and necrosis (r = 0.62; p < 0.01), multilobar disease and poorly formed granulomas (r = 0.48; p = 0.02), and lower lobe lesions with impaired fibrotic response (r = 0.41; p = 0.03). Treatment outcomes were inferior in TB–DM patients, with lower sputum conversion at 2 months (66.7% vs 84.3%; p = 0.002) and higher relapse (13.0% vs 4.6%; p = 0.03). Conclusion: Diabetes mellitus significantly modifies the clinical, radiological, and pathological presentation of pulmonary tuberculosis and adversely impacts treatment outcomes. TB–DM patients are more likely to exhibit atypical lower lobe involvement, thick-walled cavitary lesions, disorganized granulomas, and extensive necrosis. Integrated pathological and radiological evaluation is essential for accurate diagnosis and tailored management in this high-risk population.

Background: Perinatal asphyxia is a major cause of neonatal morbidity and mortality, often associated with hypoxic-ischemic encephalopathy (HIE) and multi-organ dysfunction. Among affected organs, the kidneys are particularly vulnerable, leading to acute kidney injury (AKI). Aim: To evaluate renal function among term neonates with perinatal asphyxia and assess its correlation with the degree of HIE. Material and Methods: A prospective case–control study was conducted including 120 term neonates, of which 60 had perinatal asphyxia (cases) and 60 were healthy controls. Renal function was assessed using serum creatinine, creatinine clearance, urine output, and urinary indices. Data were analyzed to compare renal function parameters between groups and correlated with the severity of HIE. Results: Asphyxiated neonates demonstrated significantly reduced creatinine clearance and urine output compared to controls. Urinary indices including FeNa, renal failure index, and osmolality were markedly altered. Severity of renal dysfunction was positively correlated with the stage of HIE. Conclusion: Perinatal asphyxia significantly impairs renal function in term neonates, with dysfunction correlating with HIE severity. Early recognition and monitoring are crucial to reduce morbidity and prevent long-term renal complications.

Background: Dengue fever is a common mosquito-borne infection that may present with systemic and organ-specific complications. Cardiac manifestations, particularly electrocardiographic (ECG) changes, are increasingly recognized in patients with dengue. Correlation of these cardiac abnormalities with established warning signs may provide critical prognostic information. Aim: To study cardiac manifestations in patients presenting with dengue infection and to observe electrocardiographic changes, with special emphasis on correlation with warning signs of dengue. Material and Methods: This observational study included 120 patients with laboratory-confirmed dengue infection. Baseline clinical data, warning signs, and 12-lead ECGs were obtained and analyzed. ECG abnormalities were correlated with clinical warning signs using appropriate statistical tests. Results: The most frequent ECG abnormality was sinus bradycardia, followed by sinus tachycardia and conduction disturbances. ECG abnormalities showed significant correlations with abdominal pain, mucosal bleeding, fluid accumulation, shock, respiratory distress, and ARDS, whereas persistent vomiting, lethargy, and hepatomegaly did not show significant associations. Conclusion: ECG monitoring should be considered an essential part of the evaluation of dengue patients, especially those presenting with warning signs, as it can facilitate early identification of cardiac involvement and improve management outcomes.

Purpose: Timely identification of clinical deterioration in pediatric patients is crucial for improving outcomes and reducing mortality. Traditional scoring systems like PELOD, PRISM, and PIM are effective but require extensive laboratory tests, making them impractical in low-resource settings. To address this, simpler bedside-based tools like Pediatric Early Warning Score (PEWS) and quick Sequential Organ Failure Assessment (qSOFA) have been introduced. PEWS incorporates multiple vital signs, while qSOFA relies on just three parameters. Although qSOFA was initially developed for adults, an age-adapted version is now being explored for pediatric use. These tools enable rapid, objective assessment of illness severity. However, limitations such as variability in scoring and lack of standardization persist. This study aims to compare the predictive accuracy of PEWS and age-adapted qSOFA in pediatric patients regarding the outcome of patients, probable stay duration and requirements of oxygen therapy and ventilator.  Methods: We conducted a prospective observational study between April 2023 and August 2024 in the pediatric ICU of a tertiary hospital in Jaipur, Rajasthan. Children aged 1 month to 18 years admitted to the PICU were enrolled after obtaining guardian consent. The primary outcomes assessed were hospital stay duration, discharge or death, and need for oxygen therapy or mechanical ventilation. A total of 279 patients were included. PEWS and age-adapted qSOFA scores were applied to evaluate their effectiveness in predicting outcomes using AUROC (Area under receiver operating curve) analysis and scatter plots. Results: The study found that PEWS outperformed Age-Adapted qSOFA in predicting pediatric mortality, with an AUROC of 0.88 vs. 0.65. PEWS showed optimal accuracy at a threshold ≥8 (sensitivity 80%, specificity 81%), while qSOFA was less specific (42%) even at its best sensitivity. PEWS also correlated better with longer hospital stays (Spearman’s ρ = 0.284) compared to qSOFA (ρ = 0.221). For oxygen therapy prediction, PEWS achieved AUROC 0.89 at threshold ≥6 (sensitivity 78%, specificity 85%), whereas qSOFA had AUROC 0.61. PEWS effectively predicted mechanical ventilation needs (AUROC 0.88 at threshold ≥7), unlike qSOFA (AUROC 0.60), which had high sensitivity (90%) but low specificity (42%).   Conclusions: Overall, PEWS proved to be a more reliable and clinically useful tool in pediatric ICU settings for predicting outcome of patient, oxygen therapy requirement and ventilation requirement. None of the scores proved to be significantly useful in predicting hospital stay duration

Background: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder frequently complicated by cutaneous infections due to impaired immunity, poor glycemic control, and long disease duration. Understanding the prevalence and spectrum of dermatological manifestations in diabetics provides insights for early diagnosis and prevention. Aim: To evaluate the association between T2DM and cutaneous infections among patients attending a tertiary care hospital. Materials and Methods: A cross-sectional study was conducted on 100 patients with T2DM. Detailed demographic data, duration of diabetes, and glycemic status (HbA1c) were recorded. Dermatological examination was performed to identify cutaneous infections. Data were analyzed, and associations were tested using chi-square statistics. Results: The mean age of participants was 54.6 ± 11.2 years, with a male-to-female ratio of 1.3:1. Poor glycemic control (HbA1c ≥ 7%) was observed in 68% of patients. Cutaneous infections were detected in 74% of cases, with fungal infections being most common (40%), followed by bacterial (22%) and viral infections (8%). Mixed infections were observed in 4%. Patients with poor glycemic control demonstrated significantly higher prevalence of infections (85%) compared to those with adequate control (50%) (p < 0.05). A longer duration of diabetes was also strongly associated with infections, rising from 58% in patients with < 5 years of disease to 88% in those with > 10 years (p < 0.05). Conclusion: Cutaneous infections are highly prevalent among patients with T2DM, particularly in those with poor glycemic control and long-standing disease. Early recognition and strict glycemic management may reduce dermatological morbidity in this population.

Background & Objectives: Laparoscopic cholecystectomy is the preferred surgical approach for gallbladder removal due to its minimally invasive nature. Postoperative port-site pain remains a key concern, affecting recovery and hospital stay. Gallbladder extraction is performed through either the epigastric or umbilical port, with conflicting reports on pain intensity associated with each approach. This study aims to compare postoperative port-site pain following gallbladder retrieval through these two ports. Methods: A randomized controlled trial was conducted on 60 patients undergoing elective laparoscopic cholecystectomy. Patients were randomly assigned into two groups: Group A (gallbladder extraction through the umbilical port) and Group B (epigastric port). Pain was assessed using the Visual Analogue Scale (VAS) at 1, 6, 12, 24, and 36 hours postoperatively. Additional postoperative complications, including port-site infection and wound dehiscence, were recorded. Results: Preliminary analysis indicates that patients in the umbilical port extraction group reported lower VAS scores at multiple time intervals compared to the epigastric port group. Pain intensity was highest in the first 24 hours for both groups but declined thereafter. The incidence of port-site complications showed no significant difference between the groups. Interpretation & Conclusion: Gallbladder extraction through the umbilical port appears to be associated with reduced postoperative port-site pain compared to the epigastric port. These findings suggest that choosing the umbilical port for extraction may enhance patient comfort and recovery without increasing surgical risks

Background: The diagnosis and treatment of disorders affecting colon, rectum, anus and the surrounding tissues are dealt with in a specialized field of medicine called colorectal surgery. It includes benign and malignant diseases which require surgery. ERAS protocol was developed initially for colorectal surgeries, offer a multimodal approach to improving surgical outcomes and reducing recovery time. Name of Institution: ESIC MC & PGIMSR, BANGALORE. AIM- To evaluate the outcomes of implementing ERAS protocol in colorectal surgeries. Objective. •          Length of hospital stay. •               Post-operative complications. •        Readmissions. •   Time of tolerance of diet. Materials And Methods: A prospective descriptive study done in ESICMC & PGIMSR Rajaji Nagar and KIDWAI MEMORIAL INSTITUTE OF ONCOLOGY Bangalore from March2023-August 2025 in 62 patients belonging to different age groups and both sexes who were admitted for colorectal surgeries were included in the study. Preoperative, intra-operative data, postoperative follow up details were collected. Results: The implementation of ERAS protocol for colorectal surgeries significantly reduces hospital stay and accelerates recovery through early mobilization and enteral feeding without increasing complication rates. These findings indicate wider implementation of ERAS guidelines for patients having colorectal surgeries to enhance clinical outcomes and optimize resource utilization. Conclusion: The implementation of ERAS protocol in colorectal surgeries significantly reduced the complications, reduced length of hospital stay, accelerated early oral feeds and ambulation of the patient without increasing the complications. These findings advocate for wider implementation of ERAS protocol in colorectal surgeries to enhance clinical outcomes and optimise resource utilization

Background: Obstructive Sleep Apnoea–Hypopnoea Syndrome (OSAHS) is a prevalent sleep disorder characterized by repeated upper airway obstruction during sleep, leading to intermittent hypoxia, sympathetic activation, and sleep fragmentation. Recent studies have proposed a potential association between vitamin D deficiency (VDD) and the pathogenesis of OSAHS due to its immunomodulatory, metabolic, and neuromuscular roles. Objective: This study aimed to evaluate the correlation between serum 25-hydroxyvitamin D [25(OH)D] levels and the severity of OSAHS among adult patients in the Indian population. Methods: A cross-sectional observational study was conducted at Jain ENT Hospital, Jaipur, from May to October 2023, involving 100 adults recently diagnosed with OSAHS using overnight polysomnography. OSAHS severity was graded based on the Apnoea–Hypopnoea Index (AHI) as per AASM 2012 guidelines. Serum 25(OH)D levels were measured and classified into deficiency (<20 ng/mL), insufficiency (21–29 ng/mL), and sufficiency (≥30 ng/mL). Statistical analysis was performed using the chi-square test (SPSS v21), with a significance level of p < 0.05. Results: Among the participants, 62% were male and the majority (66%) were aged between 40–59 years. No statistically significant association was found between obesity class and vitamin D status (p = 0.828) or between OSAHS severity and vitamin D levels (p = 0.762). Conclusion: This study found no significant correlation between vitamin D deficiency and OSAHS severity. The findings suggest that VDD may not independently contribute to the pathogenesis or progression of OSAHS. Further large-scale longitudinal studies are warranted to validate these results.

Introduction: Myocardial infarction (MI) is a major global health concern and a leading cause of morbidity and mortality. It results from prolonged ischemia due to atherosclerotic plaque rupture and coronary thrombosis, leading to irreversible myocardial necrosis. Despite significant advances in acute management and secondary prevention, MI continues to be associated with substantial complications, hospital readmissions, and recurrent cardiovascular events. Aims: The study aims to assess the role and clinical impact of pharmacists in the prevention, management, and post-care optimization of myocardial infarction (MI) within a tertiary care hospital setting. Methods: The study will be carried out at Medicare Hospital and Ajara Hospital, two tertiary care centers with specialized cardiology and pharmacy departments that provide advanced cardiac care and clinical pharmacy services essential for managing myocardial infarction. Result: Among the 201 participants, chest pain was the most frequent symptom (80%), followed by shortness of breath (73%), radiating chest pain (45%), and sweating with chest pain (41%). Other symptoms included generalized weakness (53%), palpitations with anxiety (33%), nausea and vomiting (18%), body or back pain (18%), burning micturition (14%), and pedal edema (2.5%). Conclusion: In this study of 201 myocardial infarction patients, chest pain was the predominant symptom, followed by dyspnoea and radiating pain, reflecting the typical MI profile. Many patients also presented with weakness, autonomic features, and atypical symptoms, emphasizing the importance of vigilant diagnosis, particularly in elderly and female patients.

Introduction: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder requiring long-term pharmacotherapy. Polypharmacy is common in T2DM patients due to coexisting comorbidities, increasing the risk of adverse drug reactions, drug interactions, non-adherence, and reduced quality of life. Medication deprescribing, defined as the planned and supervised reduction or discontinuation of medications that may no longer be beneficial or may be causing harm, has emerged as an important strategy to optimize patient outcomes. Objectives: The primary objective of this study was to evaluate the prevalence, patterns, and outcomes of medication deprescribing among patients with T2DM. Secondary objectives included identifying barriers and facilitators to deprescribing and assessing the impact on glycemic control, adverse drug events, and patient satisfaction. Methods: This observational prospective study was conducted over a period of six months at Medicare Multi-Speciality Hospital, including a total of 200 patients diagnosed with type 2 diabetes mellitus. Patients were selected based on established diagnostic criteria for type 2 diabetes. Data were collected on key variables including age, gender, duration of diabetes, comorbidities, medications, dietary adherence, lifestyle factors, and treatment outcomes. The study aimed to assess patterns of medication use, deprescribing, adherence to diet and physical activity, and overall treatment success, providing insights into the management of type 2 diabetes in a real-world clinical setting. Results: Among 200 patients with type 2 diabetes mellitus (mean age 54.3 ± 11.3 years; 61.5% female), hypertension (48%), hypothyroidism (16%), and dyslipidemia (7%) were the most common comorbidities. Of 65 patients reviewed for deprescribing, sulfonylureas and insulin were most frequently deprescribed, while other antidiabetics were reduced to a lesser extent. Positive family history was noted in 28%, and 22% showed medication non-compliance. Most patients had no notable habits (73.5%), limited dietary adherence, and low to moderate physical activity. Treatment success was complete in 17%, partial in 15.5%, and absent in 7%, with 60.5% not applicable. Conclusion: Medication deprescribing in patients with T2DM is feasible, safe, and can improve medication adherence and overall patient satisfaction without adversely affecting glycemic control. Incorporating structured deprescribing strategies into routine clinical practice may enhance the quality of care and reduce medication-related complications in this population. Further large-scale studies are warranted to develop standardized deprescribing guidelines for T2DM

Background: AIBD (Autoimmune blistering disorders) lead to auto-antibodies formation against adhesion proteins from mucosa or skin and these antibodies are detected in bound form from tissues using DIF (direct immunofluorescence) or blood circulation using ELISA (enzyme-linked immunosorbent assay) or other methods. Aim: The present study was aimed to assess the concordance rate between ELISA and autoimmune bullous disorders assessed using DIF at an Indian healthcare Center. Methods: The present study assessed data retrospectively from the Department of Dermatology of the Institute using multivariant ELISA assay which could detect antibodies against collagen VII, envoplakin, BP230, BP180, desmoglein 3, and desmoglein1. Also, corresponding histopathological data were extracted from the records of the Institute. Final diagnosis was given considering histopathological features, clinical presentation, and corresponding DIF reports. Results: The study assessed 506 subjects where 388 subjects had Autoimmune blistering disorders and 118 subjects had non- Autoimmune blistering disorders. In AIBD group, 244 subjects had pemphigus and 144 subjects had pemphigoid respectively. The study results showed a good agreement level in final diagnosis and multivariant ELISA results with p<0.001. A good and moderate agreement was seen pemphigus vulgaris and non-autoimmune blistering disorders, bullous pemphigoid, and pemphigus foliaceous group with p<0.001. Fair agreement was seen in mucous membrane pemphigoid group with p<0.001. Conclusion: The present study concludes that there is a good agreement between gold standard diagnosis using histopathology, DIF, and clinical findings to the multivariant ELISA, hence, multivariant ELISA can be used to diagnose Autoimmune blistering disorders at places with limited resources where DIF is not available. Also, multivariant ELISA can help in improving etiological diagnosis for various AIBDs where target antigens are seen in multivariant panel.

Background: Hyperlipidaemia is a pathological condition of elevated lipid and cholesterol concentrations. Platelets have been shown to have a role in the thrombus formation as a consequence of atheromatous damage in hyperlipidaemic individuals. Platelet activity can be evaluated with platelet indices, including platelet distribution width and plateletcrit. Methods A cross-sectional analysis was conducted on 200 hyperlipidaemic patients in our hospital. Biochemical (Total Cholesterol, LDL, HDL, Triglycerides) and haematological (Platelet Count, PDW, P-LCR, PCT) parameters were taken from hospital records. Correlation analysis was employed to assess associations between lipid indices and platelet parameters. Results: The cohort comprised 52% males and 48% females, with the majority aged between 41–60 years (42.5%). The mean Total Cholesterol, LDL, HDL, and Triglycerides were 231.8 ± 25.9 mg/dL, 151.4 ± 28.4 mg/dL, 39.7 ± 14.9 mg/dL, and 146.5 ± 45.6 mg/dL respectively. Platelet Count and PDW averaged 291.7 ± 224.4 x10³/µL and 14.3 ± 3.2 respectively. All parameters show a statistically significant positive correlation with platelet count (p < 0.05), aligning with literature reporting enhanced platelet activity in hyperlipidaemic states. Conclusion: Present study indicates that PDWs are significantly higher in hyperlipidemic individuals. These indices are available without any additional cost to clinicians, pathologist and patients and hence can be used to assess the risk associated with hyperlipidaemia.

Background: Acute exacerbations of COPD (AECOPD) significantly impact patients. Up to 30% of AECOPD cases have unclear etiologies. Pulmonary embolism (PE), often underdiagnosed, is a crucial factor, with COPD being an independent PE risk. PE prevalence in AECOPD ranges from 12.72% to 23.57%, significantly higher than the general population. Overlapping symptoms with AECOPD lead to missed PE diagnoses, increasing mortality. This study aimed to determine PE incidence during AECOPD and describe clinical aspects. Methods: This prospective study included 50 AECOPD patients. COPD was confirmed via history, records, chest X-ray, and spirometry (post-bronchodilator FEV1/FVC < 0.70). AECOPD was defined as worsening respiratory symptoms beyond usual variation. All patients underwent Wells Score assessment. CT Pulmonary Angiography (CTPA) was performed for Wells Score >3. Results: Among 50 patients, 18 underwent CTPA, revealing PE in 6 (12% of total). PE was significantly associated with more severe GOLD classifications (p:0.0037), higher mean CRP levels (29.83 vs 14.0; p < 0.0001 and Wells score >3). Gender and age showed no significant association with PE. Conclusion: PE was detected in 12% of AECOPD patients, a significantly higher rate than in the general population. PE was significantly associated with severe GOLD classification, Wells Scores >3, and elevated CRP levels. Gender and age were not a predictor of PE.

Hypertension is a major public health challenge globally, particularly in India where control rates remain low. This case-control study aimed to identify socio-demographic factors determining hypertension control among patients registered in the NCD clinic at UHTC Ambalapuzha, Kerala. The study included 182 cases (hypertensive patients with controlled blood pressure) and 182 controls (hypertensive patients with uncontrolled blood pressure). Data on socio-demographic factors including age, gender, education, occupation, ration card type, and participation in self-help groups were collected. The mean age of cases was 64.27 ± 9.3 years and controls was 65.13 ± 9.16 years. The majority of participants were females (65.4% in cases, 58.8% in controls). Most participants had low education levels, with 38.5% of cases and 39% of controls having studied up to 8th-10th standard. Over half of the participants in both groups were unemployed, and more than three-fourths had BPL ration cards. No significant associations were found between hypertension control and age, gender, education, occupation, or ration card type. However, participation in self-help groups (Kudumbashree/Ayalkkoottam) was significantly associated with hypertension control (OR: 1.942, 95% CI: 1.145-3.292, p=0.013). The study concludes that while traditional socio-demographic factors may not significantly influence hypertension control in this population, community-based self-help groups appear to play a beneficial role and could be leveraged in hypertension control programs.

Background: Diabetes in elderly individuals often presents atypically, leading to delayed diagnosis and increased risk of complications. This study evaluates the spectrum of atypical presentations, complications, and hospitalisation burden of diabetes among elderly patients in Odisha, India. Methods: A retrospective observational study was conducted at Kalinga institute of medical sciences, Bhubaneswar, from APRIL 2023 to March 2024. Data from 710 elderly inpatients (≥65 years) were screened. Of these, 153 had diabetes mellitus (DM), and 100 patients underwent complete evaluation. Clinical history, laboratory data, and complications were analysed using SPSS v17.0. Findings: The prevalence of diabetes among hospitalised elderly patients was 21.5%. Atypical symptoms were common, including numbness, paraesthesia, and claudication (66.6%), altered mental status (58.3%), and nausea/vomiting (58.3%). Chronic complications were prevalent: peripheral neuropathy (54%), nephropathy (45%), retinopathy (24%). Macrovascular complications included CAD (34%) and CVA (25%). Cognitive decline (31%) and urinary incontinence (29%) were common geriatric issues. Infections (31%) and chronic diabetic complications (51%) were the leading causes of hospitalisation.  Interpretation: Diabetes in elderly patients commonly manifests with non-classical features and is frequently complicated by microvascular and macrovascular pathology, cognitive impairment, and recurrent infections. Enhanced clinical awareness and individualized care strategies are essential.

Introduction: The most popular regional blocks are neuraxial blocks, which comprise spinal and epidural blocks. This is because an anesthesiologist can create a dependable block with a single injection, and these blocks have well defined termination points.  Depending on the dosage, volume, and concentration of the local anesthetic used, each of these blocks results in motor, sensory, and sympathetic blockade. Aims: To compare following parameters among the two study groups: Group R (0.75% hyperbaric Ropivacaine) and Group L (0.5% hyperbaric Levobupivacaine) The level and onset of sensory and motor block. Materials & Methods: This was a prospective, randomized, double-blinded study conducted at the CB-UP Orthopaedic OT Complex of Medical College and Hospital, Kolkata, from December 2022 to November 2023. A total of 94 patients were enrolled in the study. Result: In our study, the mean time for onset of sensory block was longer in the Levobupivacaine group (8.36 ± 0.73 minutes) compared to the Ropivacaine group (4.53 ± 0.54 minutes, p < 0.001). Conversely, the onset of maximum motor block (Bromage score) was faster with Levobupivacaine (4.76 ± 0.66 minutes) than with Ropivacaine (8.51 ± 0.55 minutes, p < 0.001). Conclusion: We concluded that in this study, which compared 0.5% hyperbaric Levobupivacaine and 0.75% hyperbaric Ropivacaine for lower limb orthopaedic surgery, there were no statistically significant variations between the groups' demographic characteristics, such as gender and ASA physical status.

Background: Maternal anemia is highly prevalent in India and linked to adverse pregnancy outcomes. However, its impact on fetoplacental Doppler parameters remains underexplored. Objective: To evaluate the association between anemia severity and third-trimester Doppler changes, and their predictive value for perinatal outcomes. Methods: This cross-sectional study included 300 anemic pregnant women in the third trimester, grouped as mild (n=120), moderate (n=120), or severe (n=60) per WHO criteria. Doppler indices—umbilical artery (UA) S/D ratio, middle cerebral artery (MCA) pulsatility index (PI), and cerebroplacental ratio (CPR)—were assessed. Outcomes included birth weight, NICU admission, and perinatal mortality. Results: With increasing anemia severity, UA S/D ratio rose (2.71 to 3.52), while MCA PI (1.62 to 1.18) and CPR (1.18 to 0.72) declined (p<0.001). Abnormal Doppler waveforms occurred in 25% of severe anemia cases. Adverse outcomes increased with severity: low birth weight (15.0% to 45.0%), NICU admission (10.0% to 36.7%), and perinatal mortality (1.7% to 10.0%). Severe anemia independently predicted these outcomes, with adjusted odds ratios of 2.8, 3.4, and 3.1, respectively. Conclusion: Worsening maternal anemia is associated with significant Doppler changes and higher risks of neonatal complications. Routine Doppler assessment, especially CPR, may help identify high-risk foetuses and improve outcomes in pregnancies with moderate-to-severe anemia.

Background: Laparoscopic surgery has become the preferred approach in many procedures owing to advantages such as reduced postoperative pain, shorter recovery time, and improved cosmetic outcomes. Establishing carbon dioxide (CO₂) pneumoperitoneum, however, induces physiological changes that may affect coagulation and fibrinolysis. Conflicting evidence exists regarding whether these alterations predispose patients to venous thromboembolism (VTE). Aim: To evaluate the effects of CO₂ pneumoperitoneum on coagulation parameters in patients undergoing laparoscopic surgeries. Methods: This prospective observational study included 50 patients aged 18–60 years undergoing laparoscopic cholecystectomy at a tertiary care hospital. Patients with pre-existing coagulation disorders, comorbidities, or those receiving anticoagulants were excluded. Blood samples were collected preoperatively and 6 hours postoperatively to assess Prothrombin Time (PT), activated Partial Thromboplastin Time (aPTT), and D-dimer levels. Statistical analysis was performed using paired t-test, with p < 0.05 considered significant. Results: The mean preoperative PT was 11.91 ± 1.14 seconds compared to 11.78 ± 1.10 seconds postoperatively, a non-significant difference (p=0.5). Similarly, aPTT showed no significant change (27.53 ± 1.99 vs. 27.30 ± 1.94 seconds, p=0.5). In contrast, D-dimer levels increased significantly from 0.25 ± 0.04 µg/ml preoperatively to 0.69 ± 0.14 µg/ml postoperatively (p<0.0001), indicating a transient hypercoagulable state. No patient developed clinical or radiological evidence of deep vein thrombosis during the study period. Conclusion: Laparoscopic cholecystectomy with CO₂ pneumoperitoneum does not significantly alter PT or aPTT values but is associated with a significant postoperative rise in D-dimer levels. While these findings suggest biochemical evidence of hypercoagulability, the absence of thrombotic events highlights the need for individualized risk assessment rather than universal thromboprophylaxis. Larger multicentric studies with extended postoperative follow-up are warranted to establish definitive guidelines

Background: Diagnostic errors in internal medicine, particularly with complex multisystem conditions, remain a significant cause of patient morbidity and mortality. AI technologies, including machine learning, natural language processing, and clinical decision support systems, have the potential to reduce these errors and enhance diagnostic accuracy. Objective: This study aimed to evaluate the impact of AI tools on diagnostic accuracy, cognitive bias reduction, and time efficiency in internal medicine diagnoses, particularly focusing on multisystem and rare diseases. Methods: A prospective cohort study was conducted with 60 patients, focusing on those with complex conditions in internal medicine. Patients were diagnosed using traditional methods and AI-powered tools. AI tools included machine learning algorithms for diagnostic imaging, natural language processing for clinical notes, and clinical decision support systems integrated with electronic health records (EHR). Diagnostic errors, cognitive biases, and diagnostic times were assessed before and after AI integration. Results: Diagnostic Accuracy: The error rate decreased from 22% to 12% after AI tools were implemented, representing a 45% reduction in diagnostic errors, Cognitive Bias Reduction: 30% of clinicians overcame premature closure bias, and 25% overcame anchoring bias due to AI-driven suggestions. Disease-Specific Diagnostic Improvement: AI improved diagnostic accuracy in radiology (11% reduction in errors) and pathology (50% increase in cancer detection). Time Efficiency: The average time from consultation to diagnosis was reduced from 8.2 hours to 5.3 hours, a 35% reduction in diagnostic time. Rare Disease Diagnosis: AI flagged 8% of patients for potential rare diseases, with a 75% confirmation rate for these diagnoses. Conclusions: AI tools significantly enhance diagnostic accuracy, reduce cognitive biases, and improve time efficiency in internal medicine. AI is particularly effective in imaging and pathology, as well as diagnosing rare diseases. However, further research is needed to refine these technologies and address ethical, transparency, and data quality concerns.

Background: Acute myocardial infarction (AMI) remains a significant cause of cardiovascular mortality worldwide. In India, the age-standardized CVD death rate is 272 per 100,000—significantly above the global average. Early risk stratification is vital to guide treatment and improve prognosis. The Global Registry of Acute Coronary Events (GRACE) score is a validated tool to predict in-hospital mortality in acute coronary syndromes (ACS), including ST-elevation myocardial infarction (STEMI). Objective: To evaluate the prognostic accuracy of the GRACE risk score in predicting in-hospital outcomes among patients with STEMI. Methods: A prospective observational study was conducted on 44 patients admitted with STEMI to a tertiary care hospital. Diagnosis was based on clinical presentation, ECG, and cardiac biomarkers. GRACE scores were calculated at admission using eight clinical variables. Patients were stratified into low, intermediate, and high-risk groups and monitored for in-hospital outcomes. Results: The mean GRACE score was 134.9 ± 36.9. Of 44 patients, 6 (13.6%) died during hospitalization—all belonged to the high-risk GRACE category (>140). No mortality occurred in the low or intermediate groups. Higher GRACE scores, advanced Killip class, and lower systolic blood pressure were significantly associated with adverse outcomes. Conclusion: The GRACE score demonstrated strong predictive value for in-hospital mortality in STEMI patients. Its routine use at admission can aid clinicians in identifying high-risk patients, guiding interventions, and informing prognosis discussions.

Background: Paraproteinemia-associated renal diseases are a diagnostic challenge requiring integration of histopathology, immunofluorescence (IF), and serum studies. This study characterizes the renal lesions associated with paraproteinemia and highlights the diagnostic value of IF. Methods: A prospective analysis of 30 renal biopsies from patients with known or suspected paraproteinemia was conducted. Histopathological patterns were classified, and IF was used to detect light chain and complement deposition. Serum free light chain ratio and serum electrophoresis were correlated. Results: Light Chain Deposition Disease (LCDD) was the most frequent diagnosis (43.3%), followed by AL amyloidosis (23.3%), tubulointerstitial nephritis (TIN) with monoclonal light chains (20%), and myeloma cast nephropathy (MCN) (13.3%). Kappa restriction was observed in 70% of cases and lambda in 30%. IF positivity was high for light chains, especially in LCDD and TIN. Histological features included mesangial expansion, nodular sclerosis, and interstitial fibrosis. Mean serum creatinine was highest in TIN (3.4 mg/dL), followed by LCDD (3.13 mg/dL). Most patients had a skewed free light chain ratio (0.1 in 27 cases). Conclusion: Immunofluorescence, including paraffin-based IF when necessary, is essential in detecting monoclonal light chain deposition and differentiating paraproteinemia-related kidney diseases. Early and accurate diagnosis enables timely intervention to preserve renal function

Introduction: Psoriasis is a chronic inflammatory skin disorder affecting approximately 2% of the global population. It is characterized by rapid epidermal proliferation, inflammation, and aberrant keratinocyte maturation. Psoriasiform dermatitis shares similar histopathological features, often complicating the diagnosis. Accurate differentiation is essential for appropriate treatment planning. Immunohistochemical (IHC) markers such as Ki-67 (a proliferation marker), p53 (a tumor suppressor protein), and CD34 (a vascular marker) may aid in distinguishing these two entities.To evaluate the expression of Ki-67, p53, and CD34 in skin biopsies to differentiate psoriasis from psoriasiform dermatitis. Methods: A prospective observational study was conducted at MGM Medical College, Navi Mumbai, between June 2023 and December 2024. Thirty adult patients with suspected psoriasis or psoriasiform dermatitis were included after informed consent. Skin biopsies underwent routine H&E staining and IHC analysis using antibodies for Ki-67, p53, and CD34. Staining was graded based on the percentage of positive cells or vessels. Statistical analysis was performed, with p < 0.05 considered significant. Results: Of the 30 cases, 21 were diagnosed with psoriasis and 9 with psoriasiform dermatitis. The mean Ki-67 index was significantly higher in psoriasis (83.86%) than in psoriasiform dermatitis (62.18%) (p < 0.001). Similarly, p53 expression (28.31% vs. 10.39%) and CD34-positive vessel count (17.52 vs. 8.44) were significantly elevated in psoriasis (p < 0.001). Interpretation and Conclusion: Ki-67, p53, and CD34 are significantly overexpressed in psoriasis and can serve as reliable markers for distinguishing it from psoriasiform dermatitis.

Introduction: Acute poisoning remains a significant global public health concern, contributing substantially to morbidity and mortality in India with patterns shaped by agricultural practices, access to highly hazardous pesticides, and social determinants.  Understanding the patterns, predictors, and outcomes of acute poisoning cases is crucial for developing effective prevention strategies and improving patient management.  Materials & Methods: This hospital-based retrospective study analyzed 220 acute poisoning cases admitted to a tertiary care hospital in Gujarat. Data collected included socio-demographic details, type of poison, manner of poisoning, time since exposure, severity at admission, hospital stay duration, and outcome.  Results: Of 220 cases, young adults (21-30 years, 37.3%) and males (62.7%) were most affected, predominantly from rural (72.3%) and lower socio-economic backgrounds (42.7%). Pesticides were the leading agents (55%), with organophosphates (30%) and aluminum phosphide (16.4%) being common. Suicidal intent accounted for 76.4% of cases. Overall mortality was 6.8%. Severe poisoning at admission (aOR 6.5, p<0.001) and aluminum phosphide ingestion (aOR 4.8, p=0.002) were the strongest independent predictors for mortality. Conclusion: Acute poisoning in Gujarat disproportionately affects young adult males from rural, lower socio-economic strata, with pesticides being the primary agents, often with suicidal intent. Mortality is significantly influenced by the type of poison, severity at admission, and delayed presentation. Targeted interventions focusing on restricting access to highly toxic agents like aluminum phosphide, improving emergency medical services, and addressing socio-economic disparities are essential to reduce the burden of acute poisoning in the region

Background: Salivary gland lesions constitute a heterogeneous group of neoplastic and non-neoplastic disorders with wide histological diversity. Fine needle aspiration cytology (FNAC) serves as a rapid, cost-effective, and minimally invasive preoperative diagnostic tool. However, histopathological examination (HPE) remains the gold standard for final diagnosis. Objectives: To analyze the spectrum of salivary gland lesions in surgically resected specimens and to evaluate the diagnostic accuracy of FNAC by correlating cytological findings with histopathological outcomes. Materials and Methods: This prospective study was conducted in the Department of Pathology, Maharajah’s Institute of Medical Sciences, Nellimarla, Vizianagaram, from June 2010 to June 2014. A total of 34 surgically resected salivary gland specimens with prior FNAC reports were included. Relevant clinical data were recorded. Specimens were grossly examined, processed, and stained with Hematoxylin and Eosin for histopathological evaluation. Cytohistological correlation was carried out, and diagnostic accuracy parameters were calculated. Results: Of the 34 cases, benign neoplasms (67.65%) outnumbered malignant neoplasms (20.59%) and non-neoplastic lesions (11.76%). Pleomorphic adenoma was the most common benign tumor (55.88%), while adenoid cystic carcinoma and mucoepidermoid carcinoma were the predominant malignant tumors. The parotid gland (70.59%) was the most frequently involved site. FNAC showed a sensitivity of 87.5%, specificity of 100%, and overall diagnostic accuracy of 88.24% when compared with histopathology. Conclusion: Pleomorphic adenoma remains the most common salivary gland lesion, with the parotid gland being the principal site of involvement. FNAC proves to be a reliable first-line diagnostic tool with high specificity, but histopathology continues to be indispensable for definitive diagnosis, grading, and management planning.

Background & Objectives: Antinuclear autoantibodies (ANA) are key biomarkers in systemic autoimmune diseases. Indirect immunofluorescence assay (IIFA) on HEp-2 cells and line immunoassay (LIA) is widely used for ANA detection and profiling. Materials and Methods: In this prospective study (July 2023–December 2024), 50 adults with suspected systemic autoimmune disorders underwent ANA testing by IIFA (titre ≥1:80) and LIA (18-antigen strip). Patterns, titers, and band intensities were recorded. LIA sensitivity and specificity were calculated relative to IIFA. Results: ANA positivity by IIFA was 68% (34/50), with speckled (50%), nucleolar (29.4%), homogeneous (17.8%), and centromere (2.9%) patterns. LIA detected specific autoantibodies in 32% (16/50), most commonly anti-SSA/Ro-52 and anti-U1-snRNP, with clinical diagnoses of SLE (31.25%) and Sjögren’s syndrome (25%). LIA sensitivity was 44.12% and specificity 93.75%. Interpretation & Conclusion: IIFA provides a sensitive screening tool, while LIA offers high specificity and antigen-level resolution. A combined approach enhances diagnostic accuracy and immunological subclassification

Background: Anemia is the most common extraintestinal complication of Inflammatory Bowel Disease (IBD), significantly impairing patients' quality of life. It arises from a complex interplay of iron deficiency (ID), chronic inflammation, and micronutrient deficiencies. The prevalence and characteristics of anemia can vary based on disease type, activity, and patient population. Objective: This study aimed to determine the prevalence of anemia, characterize its subtypes, and identify associated clinical and biochemical risk factors in a cohort of IBD patients at a tertiary care center. Methods: A retrospective cross-sectional study was conducted on 250 adult patients (130 with Crohn's disease [CD], 120 with Ulcerative Colitis [UC]) diagnosed with IBD. Data on demographics, disease characteristics, and laboratory parameters including complete blood count, iron studies (ferritin, transferrin saturation [TSAT]), and C-reactive protein (CRP) were extracted from electronic medical records. Anemia was defined by WHO criteria (hemoglobin <13 g/dL for men, <12 g/dL for women). Anemia subtypes were classified as iron deficiency anemia (IDA), anemia of chronic disease (ACD), or mixed-type. Statistical analysis was performed using t-tests and chi-square tests, with p<0.05 considered significant. Results: The overall prevalence of anemia was 40.0% (100/250). Anemia was significantly more prevalent in patients with CD (47.7%) than in UC (31.7%; p=0.012). Anemic patients had a longer disease duration (8.9 ± 4.1 vs. 6.2 ± 3.5 years; p<0.001) and higher mean CRP levels (25.4 ± 12.1 mg/L vs. 8.2 ± 4.5 mg/L; p<0.001) compared to non-anemic patients. Among anemic patients, IDA was the most common subtype (55.0%), followed by mixed-type anemia (25.0%) and ACD (20.0%). Patients with active disease had a significantly higher prevalence of anemia compared to those in remission (65.8% vs. 21.3%; p<0.001). Conclusion: Anemia remains a significant burden in our IBD population, particularly among patients with Crohn's disease and active inflammation. Iron deficiency is the primary driver, but a substantial proportion of patients exhibit features of mixed or inflammatory-driven anemia. These findings underscore the necessity of routine screening and a comprehensive diagnostic approach that considers both iron status and inflammatory activity to guide appropriate management.

Background: Surgical Site Infections (SSI) are among the most common healthcare-associated infections and contribute significantly to morbidity, prolonged hospital stays, and healthcare costs. Aims and Objective: To assess the prevalence and associated risk factors of patients with Surgical Site Infections in a Tertiary Care Hospital of Arunachal Pradesh, India. Materials and method: A total of 2050 patients who underwent surgery were studied. Patients developing SSI (n=500) were analysed for demographic characteristics, surgical factors, comorbidities, BMI, antibiotic prophylaxis, and microbiological isolates. Results: The overall incidence of SSI was 24.4%. Females (54%) were slightly more affected than males (46%). Highest SSI prevalence was in age groups 22–29 years (24.8%) and >60 years (22.4%). Diabetes was present in 62.2% of SSI patients. Emergency operations accounted for 81.6% of SSIs. Dirty (47.8%) and contaminated (36.2%) wounds contributed to most cases. Longer duration surgeries (>2 hrs) had higher SSI rates (78.4%). Post-operative antibiotic administration was common (75.2%), contrary to guidelines. Among 161 culture-positive isolates, Pseudomonas aeruginosa (42.2%) and Staphylococcus aureus (29.8%) predominated. Both underweight (35.6%) and overweight/obese patients (52.4%) were at greater risk compared to normal BMI (12%). Conclusion: High SSI rates were associated with emergency surgeries, longer duration, diabetes, and inappropriate timing of antibiotic prophylaxis. Strengthening infection control measures, optimizing antibiotic use, and addressing modifiable patient risk factors are crucial to reducing SSI burden

Background: Clinical decision support systems based on artificial intelligence (AI-CDSS) are being widely adopted in medical specialties to enhance diagnostic precision, streamline workflows, and improve patient outcomes. Though potentially valuable, usability, trust, and integration issues are major hurdles to large-scale adoption. Objective: The objective was to conduct a synthesis of the latest evidence regarding the uses, effects, and impediments of AI-CDSS in multidisciplinary clinical practice, alongside comparing rates of adoption and clinician attitudes between care environments. Methods: A scoping review design was used, and literature searches were undertaken in PubMed, Scopus, and Web of Science between January 2020 and July 2025. Searches included studies reporting on the implementation or evaluation of AI-CDSS in clinical practice in primary care, oncology, emergency medicine, and community health. Data were extracted to a matrix and synthesized thematically. Results: Sixty-two studies were included, most published since 2021, demonstrating increasing interest. AI-CDSS for primary care enhanced diagnostic performance and consultation speed, whereas oncology applications demonstrated improvements in cancer diagnosis and treatment planning. Emergency medicine reported results highlighted the need for expeditious triage and workflow optimization, while community health applications highlighted the optimization of resource allocation. Inhibitors were limited transparency, clinician skepticism, alert fatigue, and integration complexities. Comparative results showed that institutional context, usability of the system, and perceived trust were highly influential for willingness to implement AI-CDSS. Conclusion: AI-CDSS show evident benefits across specialties but need explainable design, clinician buy-in, and compliance with regulation for sustainable incorporation into healthcare systems.

Background: Artificial intelligence (AI) has become more relevant in healthcare, especially in the management of chronic diseases, where precise diagnosis, long-term monitoring, and individualized interventions are paramount. Its potential aside, there are questions about how it would be integrated in clinical practice, within ethical considerations, and with equal access. Objective: This review sought to integrate current evidence concerning AI-supported diagnostic trends in chronic disease management, emphasizing technological developments, human aspects, and clinical implications. Methods: A narrative review approach was adopted, with literature sourced from PubMed, Scopus, and Web of Science. Studies published in the past decade were included if they evaluated AI applications in chronic illness diagnosis, decision support, or patient engagement. Data were thematically synthesized into domains of diagnostic accuracy, human–technology interaction, and access to care. Results: Evidence shows that AI models improve diagnostic accuracy across conditions including diabetes, hypertension, and cardiovascular disease, frequently outperforming traditional techniques. Clinical decision support systems enhanced workflow productivity and treatment customization. Conversational agents and remote monitoring devices improved patient engagement, especially in rural and under-resourced environments. Yet provider trust, transparency in systems, and ethical governance remain essential drivers of adoption. Comparative analysis with previous studies across oncology, osteoporosis, and pandemic response further affirmed AI’s cross-domain utility, while underscoring the importance of regulatory and methodological rigor. Conclusion: AI holds substantial promise in transforming chronic illness management, but its effectiveness will depend on transparent design, ethical integration, and alignment with human-centered care values.

Background: The Inferior Vena Caval Collapsibility Index (IVCCI) is a simple, non-invasive ultrasonographic tool to assess intravascular volume status and fluid responsiveness. In spinal anaesthesia (SA), hypotension is a common complication, often related to preoperative hypovolemia from fasting. Identifying fluid-responsive patients preoperatively may help prevent intraoperative hypotension. However, limited studies have evaluated IVCCI for this purpose. Aim: To evaluate preoperative IVCCI and correlate it with hemodynamic changes following spinal anaesthesia. Methods: An observational study was conducted on 80 ASA I and II patients undergoing elective surgery under SA. Preoperatively, an 18G IV line was secured, and inferior vena cava (IVC) diameters during inspiration and expiration were measured using a 2–6 MHz curvilinear probe in the subcostal long-axis view with M-mode ultrasound. IVCCI was calculated as: IVCCI = [(IVCₑₓ – IVCᵢₙ) / IVCₑₓ] × 100 Patients were then given 500 mL Ringer Lactate over 15 minutes, and IVC measurements were repeated. After SA, hemodynamic parameters (SBP, DBP, MAP, HR) were recorded every 10 minutes. Results: Pre-bolus mean IVCCI was 40.51% (SD 3.06), suggesting preoperative hypovolemia. Post-bolus IVCCI reduced to 36.37% (SD 2.17), indicating fluid responsiveness. A significant negative correlation was found between IVCCI and hemodynamic parameters, especially MAP (r = -0.2, p < 0.0001). Conclusion: IVCCI is a useful, bedside predictor of fluid status and responsiveness. A preoperative fluid bolus effectively reduces IVCCI and helps maintain intraoperative hemodynamic stability in patients undergoing spinal anaesthesia. Incorporating IVCCI assessment into routine preoperative evaluation may help anticipate and manage SA-induced hypotension.

Background: Peak expiratory flow rate (PEFR) is influenced by various anthropometric factors, with conflicting evidence regarding the relationship between body mass index (BMI) and respiratory function in children. Objective: To investigate the correlation between BMI and PEFR in healthy school-going children aged 8-15 years and assess the influence of demographic, anthropometric, and environmental factors. Methods: A cross-sectional study was conducted among 208 healthy school children aged 8-15 years in secondary schools of Hyderabad, India. Anthropometric measurements including height, weight, and BMI were recorded. PEFR was measured using Mini Wright's peak flow meter. Statistical analysis included Pearson correlation, simple linear regression, and multiple linear regression analyses. Results: The study population comprised 117 males (56.3%) and 91 females (43.8%) with mean age 9.53±1.34 years. Simple linear regression showed BMI had a weak positive correlation with PEFR (r=0.20, p<0.001). Height demonstrated the strongest correlation with PEFR (r=0.63, p<0.001), followed by age (r=0.54, p<0.001) and weight (r=0.47, p<0.001). In multiple regression analysis controlling for confounding variables, BMI's influence on PEFR became non-significant, while age, gender, and exposure to mosquito repellents remained significant predictors. Conclusion: BMI shows a weak positive correlation with PEFR in isolation, but this relationship is not significant when controlling for other variables. Height, age, and gender are stronger predictors of PEFR in children. The apparent BMI-PEFR relationship is likely mediated by other anthropometric and demographic factors

Stroke is a leading cause of morbidity and mortality worldwide, contributing substantially to global disease burden. Ischemic strokes account for nearly 85% of all stroke cases and are associated with substantial neurological deficits. Serum calcium plays a pivotal role in neuronal function, and its dysregulation during cerebral ischemia has been implicated in worsened neuronal injury. This study was conducted to investigate the relationship between serum calcium levels and infarct size among patients with acute ischemic stroke. Fifty patients aged above 40 years, diagnosed radiologically by CT scan, were included. Serum calcium and albumin were measured, and corrected calcium was calculated. Infarct size was estimated using the ABC/2 method. Statistical analysis revealed a significant negative correlation between serum calcium and infarct size (r = -0.2933, p = 0.04). Corrected calcium demonstrated a stronger inverse correlation (r = -0.6303, p = 0.01). These findings suggest that lower serum calcium levels are associated with larger infarct sizes, highlighting the potential role of serum calcium as a prognostic biomarker in acute ischemic stroke.

Background: Diabetes mellitus is a major risk factor for coronary artery disease (CAD), yet the relative angiographic severity of CAD across the glycemic spectrum—including pre-diabetes—remains incompletely defined. Methods: We conducted a cross-sectional observational study of 412 consecutive patients presenting with a first episode of acute coronary syndrome (ACS) who underwent coronary angiography. Patients were classified as diabetic (n = 213), pre-diabetic (n = 76), or non-diabetic (n = 123) according to ADA criteria. The severity of CAD was quantified using the Gensini scoring system. Associations between glycemic status, HbA1c, duration of diabetes, and angiographic severity were analyzed using ANOVA and Pearson’s correlation. Results: The mean Gensini score was 47.1 ± 31.1 in diabetics, 41.5 ± 25.1 in pre-diabetics, and 38.5 ± 33.9 in non-diabetics (p = 0.049). Triple-vessel disease was most prevalent in diabetics (29.1%) compared with pre-diabetics (14.5%) and non-diabetics (14.6%, p< 0.001). Duration of diabetes correlated strongly with CAD severity (r = 0.69, p< 0.001), with patients having >10 years’ diabetes showing the highest mean Gensini score (85.0) versus 34.5 in newly detected cases. In contrast, HbA1c stratification (<6.5%, 6.5–8.9%, >9%) showed no significant association with severity (p = 0.484). Low HDL cholesterol was the most common lipid abnormality across all groups (63–73%). Correlation analyses revealed significant associations between Gensini score and glycemic indices in diabetics (RBS p = 0.0001, FBS p = 0.0079, PPBS p = 0.0043), whereas in non-diabetics, FBS (p = 0.012) and PPBS (p = 0.008) also correlated with CAD burden. Conclusion: Diabetic patients with ACS exhibited the greatest angiographic severity of CAD, followed by pre-diabetics and non-diabetics. The duration of diabetes, rather than HbA1c at a single point in time, was the strongest determinant of severity. These findings emphasize the cumulative impact of chronic hyperglycemia on atherosclerotic burden and underscore the importance of early detection and aggressive management in both diabetes and pre-diabetes to reduce the risk of severe, multi-vessel coronary disease.

Background: Vitamin D, traditionally known for its role in bone metabolism, is now recognized as a pleiotropic hormone with significant immunomodulatory and metabolic functions. A growing body of evidence suggests a link between vitamin D deficiency and the pathogenesis and control of type 2 diabetes mellitus (T2DM). However, the prevalence and clinical correlates of this deficiency vary across populations. Methods: We conducted a cross-sectional study involving 412 adult patients with T2DM attending a tertiary care diabetes clinic. Data on demographics, duration of diabetes, and current medications were collected. Fasting blood samples were analyzed for serum 25-hydroxyvitamin D [25(OH)D] and glycated hemoglobin (HbA1c). Vitamin D status was categorized as deficient (<20 ng/mL), insufficient (20–29 ng/mL), or sufficient (≥30 ng/mL). Patients were also stratified by glycemic control (good: HbA1c <7.0%; moderate: HbA1c 7.0–8.0%; poor: HbA1c >8.0%). Results: The mean age of the cohort was 58.6 ± 10.2 years, with a mean diabetes duration of 11.4 ± 6.8 years. The overall mean serum 25(OH)D level was 21.3 ± 9.5 ng/mL. The prevalence of vitamin D deficiency was 46.1% (n=190), while 30.3% (n=125) were insufficient, yielding a combined prevalence of hypovitaminosis D of 76.4%. A significant inverse relationship was observed between vitamin D levels and glycemic control. The mean 25(OH)D level was significantly lower in patients with poor glycemic control (17.8 ± 7.2 ng/mL) compared to those with good control (26.5 ± 8.1 ng/mL; p<0.001). Furthermore, Pearson correlation analysis revealed a significant negative correlation between serum 25(OH)D and HbA1c (r = -0.42, p<0.001). Patients with a longer duration of diabetes (>10 years) also had significantly lower mean 25(OH)D levels than those with a shorter duration (<5 years) (18.9 ± 8.5 ng/mL vs. 24.1 ± 9.8 ng/mL; p=0.002). Conclusion: Vitamin D deficiency and insufficiency are highly prevalent among patients with T2DM. Lower vitamin D status is significantly associated with poorer glycemic control and longer disease duration. These findings suggest that screening for and potentially correcting vitamin D deficiency should be considered as part of the comprehensive management of patients with T2DM

Background: Ophthalmia neonatorum (ON) is an important cause of neonatal morbidity, ranging from conjunctivitis to corneal ulceration and blindness. Although preventive strategies exist, etiological patterns vary, with non–sexually transmitted bacteria now common. Prospective Indian data on maternal and perinatal risk factors remain limited. This study aimed to describe the clinical spectrum, microbiological profile, outcomes, and risk factors associated with severe ON. Materials and Methods: A prospective observational study was conducted in the Departments of Ophthalmology and Pediatrics, Mamata Medical College, Khammam, over 12 months. One hundred neonates (≤28 days) with conjunctivitis were enrolled. Maternal and perinatal histories were recorded, and ocular examination included laterality, discharge, congestion, lid edema, membranes, corneal involvement, and anterior chamber reaction. Conjunctival swabs were subjected to Gram stain and culture on blood agar, MacConkey, chocolate, and Thayer–Martin media. Antimicrobial susceptibility testing followed CLSI guidelines. Follow-up was performed at 48–72 hours, 7 days, and 14 days. Results: Of 100 neonates, 62% were delivered vaginally, 28% were preterm, and 22% had low birth weight. PROM was present in 20% and maternal infection in 18%. Clinically, mucopurulent discharge (65%) was most frequent; membranes, corneal involvement, and anterior chamber reaction occurred in 12%, 8%, and 3% respectively. Culture positivity was 76%; Staphylococcus aureus (32%) and coagulase-negative staphylococci (18%) predominated, while N. gonorrhoeae was isolated in 2 cases. Isolates showed high sensitivity to ciprofloxacin and ceftriaxone, with reduced sensitivity to erythromycin. Clinical improvement occurred in 62% by 72 hours, 85% by 7 days, and 94% by 14 days. Severe outcomes correlated with inadequate antenatal screening, PROM, and maternal infection. Conclusion: Staphylococcal species were the leading causes of ON, with gonococcal cases rare. Most neonates improved with timely therapy, but perinatal risk factors predicted severity. Strengthening antenatal care, infection control, and culture-guided management is vital to reduce morbidity.

Background: Congenital variations in coronary anatomy are uncommon, and complete absence of the left main coronary artery (LMCA) with a right coronary artery (RCA) supplying almost the entire heart is exceptionally rare. In such cases, the myocardium depends entirely on a single dominant vessel, so any blockage can cause extensive ischemia and carry a high risk of sudden death. Detecting this pattern early through modern imaging is important for accurate diagnosis and planning preventive or therapeutic interventions. Methods: A 47-year-old man experienced intermittent, non-radiating chest discomfort over ten days. Clinical evaluation was unremarkable. ECG showed a left bundle branch block, while cardiac enzyme levels were within normal range. Echocardiography revealed mild segmental wall motion changes in the left ventricle with preserved ejection fraction (~50%). Conventional coronary angiography suggested absence of LMCA with retrograde filling of left-sided branches from the RCA. Computed tomography (CT) coronary angiography was performed to clarify vessel anatomy, calibre, and distribution, and the findings were reviewed in relation to the Lipton–Yamanaka classification. Results: CT imaging demonstrated complete absence of the LMCA. The left coronary system arose as two small-calibre arteries from the left coronary sinus: a hypoplastic left anterior descending artery (1.3 mm diameter, containing a 3.8 cm segment of myocardial bridging, poorly visualized distally) and a hypoplastic left circumflex artery (1.1 mm diameter, non-dominant, continuing as obtuse marginal). The RCA originated from the right coronary sinus, measured 4.5 mm in diameter, and was superdominant, supplying the posterior descending artery, posterolateral ventricular branches, inferior wall, and most of the lateral wall. The vessel showed no signs of atherosclerosis. This anatomical combination did not match any existing Lipton–Yamanaka subtype. Conclusion: This case illustrates an extremely rare coronary configuration involving absent LMCA, markedly underdeveloped LAD and LCx, and a superdominant RCA supplying the majority of the myocardium. Such dependence on a single vessel greatly magnifies the consequences of any obstruction. The mechanism of symptoms in these anomalies may involve small vessel calibre, myocardial bridging, or altered flow dynamics rather than plaque disease. CT coronary angiography is invaluable for defining anatomy, assessing risk, and guiding safe management

Leptospirosis and scrub typhus, while significant causes of acute febrile illness in endemic regions, rarely lead to cardiac complications in children. This case report presents a unique instance of a 13-year-old previously healthy female who developed hypotension and sinus bradycardia during an episode of leptospirosis, which was successfully treated with doxycycline. However, the weeks following this initial episode saw the persistence of bradycardia, syncope, and left-sided chest pain, leading to a cardiology evaluation. Despite the absence of conduction block in serial ECGs and Holter monitoring, her symptoms continued until a second febrile episode—scrub typhus—again triggered symptomatic bradycardia. The patient responded well to doxycycline and a short course of corticosteroids, with complete resolution of symptoms and normalization of heart rate. This case highlights the potential of sequential tropical infections to precipitate functional sinus node disturbances in children and underscores the importance of including reversible infectious causes in the differential diagnosis of pediatric bradyarrhythmias.