European Journal of Cardiovascular Medicine

Background: Spinal anaesthesia is the technique of choice for caesarean section due to its rapid onset, reliability, and favourable maternal–neonatal outcomes. Hyperbaric bupivacaine is commonly used but is associated with significant hypotension. Hyperbaric ropivacaine has emerged as an alternative with potentially better haemodynamic stability and faster motor recovery. Aim: To compare the haemodynamic effects, sensory and motor block characteristics, and duration of action of hyperbaric bupivacaine and hyperbaric ropivacaine in spinal anaesthesia for caesarean section. Methods: This prospective, randomized, double-blind comparative study was conducted on 60 ASA grade II parturients undergoing elective caesarean section. Patients were allocated into two groups: Group B received 10 mg of 0.5% hyperbaric bupivacaine and Group R received 15 mg of 0.75% hyperbaric ropivacaine intrathecally. Sensory block onset, maximum sensory level, duration of sensory and motor block, haemodynamic parameters, and time to first rescue analgesia were recorded and analysed. Results: The onset and duration of sensory block were comparable between the two groups. Motor block onset was significantly faster and duration significantly longer in the bupivacaine group (p < 0.05). Ropivacaine demonstrated better haemodynamic stability with significantly less hypotension during the intraoperative period. The time to first rescue analgesia was comparable between groups. Conclusion: Both hyperbaric bupivacaine and hyperbaric ropivacaine provide effective spinal anaesthesia for caesarean section. However, hyperbaric ropivacaine offers superior haemodynamic stability and faster motor recovery, making it a safer and favourable alternative in obstetric patients where cardiovascular stability and early mobilisation are desired.

Background: Hepatitis B virus (HBV) infection is a major occupational hazard among health care workers (HCWs). Although vaccination is effective, a proportion of vaccinated individuals fail to develop protective immunity, highlighting the need for post-vaccination serological assessment. Objectives: To evaluate the immune response to Hepatitis B vaccination among health care workers in a tertiary care hospital in Kerala and to identify factors associated with inadequate seroprotection. Methods: A cross-sectional analytical study was conducted among 202 HCWs between January and March 2022. Participants who had completed a three-dose Hepatitis B vaccination schedule were included. Anti-HBs antibody titres were measured using enzyme immunoassay, with seroprotection defined as anti-HBs ≥10 mIU/mL. Associations between seroprotection and demographic and clinical variables were analysed using Chi-square and Fisher’s exact tests. Results: Overall, 171 (84.7%) HCWs achieved seroprotective antibody levels, while 31 (15.3%) didn’t. Seroprotection was significantly higher among HCWs aged <40 years compared to those ≥40 years (89.9% vs 70.4%; p = 0.001). Lower seroprotection was observed in participants with BMI ≥25 kg/m² (72.6%; p = 0.001) and in those with diabetes mellitus (p = 0.003). Gender, smoking, and alcohol consumption were not significantly associated with immune response. Conclusion: A notable proportion of HCWs failed to achieve protective immunity following Hepatitis B vaccination. Older age, higher BMI, and diabetes mellitus were significant predictors of poor immune response, underscoring the need for routine post-vaccination antibody testing and targeted revaccination strategies.

Background: Laryngoscopy, tracheal intubation, and pneumoperitoneum during laparoscopic surgery provoke significant sympathetic stimulation, resulting in tachycardia and hypertension. Pharmacological attenuation of this hemodynamic stress response is essential to improve perioperative stability. This study compared dexmedetomidine and fentanyl for their effectiveness in controlling hemodynamic responses during these critical periods. Material and methods: This prospective, randomized, double-blind study included 100 adult patients of ASA physical status I and II undergoing elective laparoscopic surgery under general anaesthesia. Patients were randomly allocated into two groups (n = 50 each). Group D received dexmedetomidine (1 µg/kg loading dose followed by 0.2 µg/kg/h infusion), while Group F received fentanyl in an equivalent dosing regimen. Heart rate, systolic, diastolic, and mean arterial blood pressure, and oxygen saturation were recorded at baseline, during airway manipulation, throughout pneumoperitoneum, at extubation, and during the postoperative period up to 6 hours. Demographic variables were also compared. Results: Baseline demographic characteristics and initial hemodynamic parameters were comparable between the two groups. Dexmedetomidine produced a significantly greater attenuation of heart rate and blood pressure responses following the loading dose, during laryngoscopy and intubation, throughout pneumoperitoneum, and at extubation compared with fentanyl. The differences were most pronounced during periods of maximal surgical stress. Hemodynamic parameters gradually returned toward baseline values in both groups during late postoperative monitoring, with no significant intergroup differences at 3 and 6 hours. Oxygen saturation remained stable and comparable between the groups at all time points. Conclusion: Dexmedetomidine provides superior control of hemodynamic stress responses compared with fentanyl during laparoscopic surgery, without compromising oxygenation. Its use contributes to improved perioperative hemodynamic stability during airway manipulation and pneumoperitoneum

BACKGROUND: Surface epithelial tumors constitute the majority of ovarian neoplasms and exhibit a wide histological spectrum ranging from benign to highly aggressive malignant lesions. Accurate differentiation between benign, borderline, and malignant tumors is essential for prognosis and management. Conventional histopathology alone may be insufficient in borderline cases. Immunohistochemical biomarkers such as p53, a tumor suppressor gene product, and Ki-67, a marker of cellular proliferation, have emerged as valuable tools in assessing tumor behavior, aggressiveness, and prognosis. MATERIALS AND METHODS: This prospective observational study was conducted in the Department of Pathology in collaboration with the Department of Obstetrics and Gynecology at Rangaraya Medical College, Kakinada, from November 2022 to November 2024. A total of 150 surface epithelial ovarian tumors were analyzed after histopathological confirmation. Tumors were classified according to the WHO 2020 classification into benign, borderline, and malignant categories. Immunohistochemistry for p53 and Ki-67 was performed in 31 selected cases of borderline and malignant tumors using standard peroxidase–antiperoxidase techniques. The expression patterns of p53 and the Ki-67 labeling index were evaluated and correlated with tumor subtype, grade, and FIGO stage. Statistical analysis was performed using the chi-square test.RESULTS: Surface epithelial tumors constituted 91.4% of all ovarian neoplasms, with serous tumors being the most common, followed by mucinous and endometrioid tumors. Benign tumors predominated overall. Borderline tumors consistently demonstrated wild-type p53 expression with a low Ki-67 index, indicating low proliferative activity. In contrast, malignant serous and mucinous tumors showed mutant p53 expression (overexpression, null, or cytoplasmic patterns).  A High Ki-67 index was significantly associated with malignant serous tumors and advanced FIGO stage (p < 0.001), reflecting aggressive tumor behavior.CONCLUSION: The combined assessment of histomorphology with p53 and Ki-67 immunohistochemistry provides valuable diagnostic and prognostic information in surface epithelial ovarian tumors. p53 mutations and a high Ki-67 index reliably correlate with malignancy and tumor aggressiveness, aiding in differentiation between borderline and malignant lesions and supporting improved clinical decision-making.

High Air Quality Index (AQI) reflects elevated ambient pollution levels (typically driven by particulate matter such as PM₂.₅/PM₁₀ and gaseous pollutants), and growing evidence indicates that even short-term excursions into “moderate” to “unhealthy” AQI ranges can produce measurable, clinically relevant decrements in pulmonary function test (PFT) parameters. This systematic review synthesizes observational and experimental evidence on the association between higher AQI (or its component pollutants) and spirometry outcomes, including forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC), FEV₁/FVC ratio, peak expiratory flow (PEF), and mid-expiratory flow indices. Consistent patterns emerge: acute pollution spikes are linked with transient reductions in FEV₁ and FVC and increased airway reactivity—particularly in children, older adults, and individuals with asthma/COPD—while long-term exposure is associated with lower baseline lung function and accelerated decline. Studies explicitly using AQI categories demonstrate lower lung function when exposure falls in higher AQI bands compared with “good” AQI days, reinforcing the practical value of AQI as a population-facing risk metric. Methodological heterogeneity remains substantial (varying exposure windows, pollutant mixtures, spirometry protocols, and confounder control), but the directionality of effect is largely consistent. Standardized spirometry methodology and careful exposure assessment are essential to strengthen causal inference. Overall, the evidence supports integrating AQI alerts into respiratory preventive care and prioritizing exposure reduction strategies for high-risk groups, while future research should focus on multi-pollutant modeling, repeated-measures designs, and clinically meaningful thresholds linking AQI shifts to PFT decline.

Introduction: Anemia is a frequent laboratory abnormality with diverse etiologies. Correlating clinical features with hematological patterns helps in targeted diagnosis and resource-appropriate work-up. From a pathology perspective, anemia is not a single disease but a laboratory phenotype that must be interpreted in the context of red cell morphology, indices, and the patient’s clinical profile. Materials and Methods: A hospital-based cross-sectional study was conducted in a tertiary care pathology laboratory over 12 months. Consecutive patients with anemia (Hb <13 g/dL in males, <12 g/dL in females) underwent clinical evaluation and hematological work-up including CBC with indices, peripheral smear, reticulocyte count, iron profile, vitamin B12/folate (when indicated), renal function, inflammatory markers, and Hb electrophoresis/HPLC (selected cases). Morphological patterns were categorized by MCV and smear. Etiology was assigned using standard laboratory criteria and clinico-radiological correlation. Results: Among 300 anemic patients, the commonest pattern was microcytic hypochromic anemia (46.0%), followed by normocytic normochromic (38.0%), macrocytic (12.0%), and dimorphic (4.0%). Iron deficiency anemia (IDA) was the leading etiology (44.0%), followed by anemia of inflammation/chronic disease (AI/ACD) (24.0%), megaloblastic anemia (14.0%), hemoglobinopathies (8.0%), chronic kidney disease (CKD)-related anemia (6.0%), and others (4.0%). Microcytosis strongly correlated with low ferritin and low transferrin saturation, while macrocytosis correlated with low B12/folate. Conclusion: Morphological typing with CBC indices and smear, combined with focused biochemistry, provides high-yield etiological classification in tertiary care. IDA and AI/ACD remain the major contributors and require systematic evaluation for underlying sources such as nutritional deficiency, chronic inflammation, and occult blood loss.

Background: SARS-CoV-2 infection, declared a pandemic by WHO, predominantly affects the lungs and causes significant morbidity and mortality. Although autopsy studies worldwide have described the lung pathology of COVID-19, there is limited data from South India. Objectivesl:• To describe the histopathological features in lung tissues of patients who died with pulmonary pathology during the COVID-19 pandemic. • To assess the expression of SARS-CoV-2 immunohistochemistry (IHC) marker and correlate findings with histopathological patterns. Methods: A descriptive cross-sectional study was conducted in the Department of Pathology, Government Medical College, Manjeri, on 70 autopsy lung specimens (March 2020–April 2021). H&E-stained slides were examined for diffuse alveolar damage (DAD), vascular, interstitial, and mixed injury patterns. IHC using monoclonal antibody to SARS-CoV-2 spike protein was performed. Results: The study included 44 males (62.9%) and 26 females (37.1%), mean age 45 years. DAD was the predominant finding (40%), with 23 cases in the acute phase and 5 in the organizing phase. Vascular changes, mainly microthrombi, were seen in 17 cases (24.3%). Mixed patterns were noted in 21 cases (30%), including bronchopneumonia and lobar pneumonia. IHC positivity was observed in 25 cases (35.7%), with staining in alveola macrophages, interstitial macrophages, and type II pneumocytes, but not in endothelial cells. Conclusion: DAD is the central histopathological feature in COVID-19 lung injury, often associated with vascular damage and secondary infections. IHC findings confirm viral involvement of macrophages and pneumocytes, with selective cell tropism.

Introduction: Implantation failure remains a major challenge in assisted reproductive technology. Successful implantation requires coordinated endometrial–embryo cross-talk mediated by clinical, embryological, and molecular factors. Aim: To evaluate clinical parameters, IVF-related variables, and molecular markers of endometrial receptivity associated with implantation outcomes. Methods: A prospective observational study was conducted among 100 women undergoing IVF, divided into implanted (n = 45) and non-implanted (n = 55) groups. Clinical history, IVF parameters, and endometrial biomarkers (LIF, IL-6, integrin αvβ3, HB-EGF, Glycodelin A) were assessed. Statistical comparisons and correlation analyses were performed. Results: Baseline demographic and infertility-related parameters did not differ significantly between groups. Endometrial thickness (10.1 ± 1.5 vs. 9.4 ± 1.6 mm, p = 0.03), blastocyst transfer rate (73% vs. 53%, p = 0.04), and embryo quality (≥ grade B: 89% vs. 66%, p = 0.01) were significantly higher in the implanted group. Molecular markers were elevated in the implanted group, including LIF (152.4 ± 28.6 vs. 128.7 ± 26.9 pg/mL, p = 0.001), IL-6 (34.2 ± 7.5 vs. 28.9 ± 6.8 pg/mL, p = 0.006), integrin αvβ3 (2.8 ± 0.6 vs. 2.3 ± 0.5 AU, p = 0.005), HB-EGF (87.5 ± 15.2 vs. 74.1 ± 14.7 pg/mL, p = 0.003), and Glycodelin A (42.7 ± 9.4 vs. 36.5 ± 8.7 ng/mL, p = 0.03). Correlation analysis confirmed significant associations, with LIF showing the strongest correlation (r = 0.34, p = 0.001). Conclusion: Implantation success is determined by a combination of endometrial receptivity and embryo quality. Elevated cytokines, adhesion molecules, and growth factors create a favorable molecular milieu, while clinical parameters such as endometrial thickness and blastocyst transfer further enhance outcomes. Integrated assessment of these factors may improve prediction and optimization of IVF success.

Background: Hyperglycemia, even in non-diabetic patients, has been associated with adverse outcomes in acute medical conditions like acute coronary syndromes (ACS). However, the relationship between admission blood glucose levels and clinical outcomes in ACS patients, irrespective of diabetic status, is not well characterized. Methods: This retrospective observational study included 60 patients with ACS (ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, or unstable angina) admitted to a tertiary care hospital. Patients were stratified based on admission capillary blood glucose levels into normoglycemia, mild hyperglycemia, and severe hyperglycemia groups. The primary outcome was a composite of cardiogenic shock, heart failure, arrhythmias, and cardiovascular mortality. Secondary outcomes included major adverse cardiovascular events (MACE) and long-term cardiovascular mortality at 12 months. Results: Patients with severe hyperglycemia had a significantly higher incidence of the primary composite outcome (40.9% vs 10% in normoglycemia, p=0.01), driven by increased rates of cardiogenic shock. They also had longer hospital stays, higher 12-month MACE rates (36.4% vs 15%, p=0.02), and higher cardiovascular mortality at 12 months (18.2% vs 5%, p=0.04) compared to the normoglycemia group, independent of diabetic status. Conclusion:  Severe hyperglycemia at admission is associated with worse in-hospital and long-term adverse cardiovascular outcomes in patients with ACS, irrespective of diabetes status. These findings highlight the importance of early glycemic control in the management of ACS patients to potentially improve clinical outcomes.

Background: Computed tomography (CT) of the chest is indispensable for diagnosing pulmonary pathologies, yet radiation exposure remains a significant concern, particularly for patients requiring serial imaging. Iterative reconstruction (IR) techniques offer potential for substantial radiation dose reduction while maintaining diagnostic image quality. This study aimed to evaluate the effectiveness of low-dose chest CT protocols utilizing advanced iterative reconstruction algorithms compared to standard-dose filtered back projection (FBP) reconstruction. Methods: This prospective comparative study enrolled 248 patients undergoing clinically indicated chest CT examinations. Patients were randomly assigned to four protocols: standard-dose FBP (Group A, n=62), standard-dose IR (Group B, n=62), low-dose IR at 50% reduction (Group C, n=62), and ultra-low-dose IR at 75% reduction (Group D, n=62). Radiation dose parameters, objective image quality metrics (noise, signal-to-noise ratio, contrast-to-noise ratio), and subjective quality scores assessed by two blinded radiologists were compared across groups. Results: Mean effective dose was significantly reduced across groups: 5.82 ± 1.24 mSv (Group A), 5.78 ± 1.18 mSv (Group B), 2.94 ± 0.68 mSv (Group C), and 1.52 ± 0.42 mSv (Group D; p<0.001). Despite 75% dose reduction, ultra-low-dose IR maintained acceptable image noise (18.4 ± 3.2 HU vs. 12.8 ± 2.4 HU for standard-dose FBP; p<0.001). Subjective image quality scores remained diagnostically acceptable in Group D (3.8 ± 0.6 vs. 4.4 ± 0.5 for Group A on 5-point scale; p=0.002). Diagnostic confidence for pulmonary nodule detection showed no significant difference between Groups A and C (94.2% vs. 91.8%; p=0.284). Conclusion: Low-dose chest CT protocols utilizing iterative reconstruction achieve radiation dose reductions of 50-75% while preserving diagnostically acceptable image quality. Implementation of IR-based protocols should be prioritized to minimize patient radiation exposure without compromising diagnostic accuracy

Background: Hypertensive disorders of pregnancy (HDP) contribute substantially to maternal and perinatal morbidity and mortality worldwide. Early diagnosis and protocol-based care reduce progression to severe complications. Objectives: To describe the spectrum of HDP and assess maternal and perinatal outcomes among women admitted with HDP. Methods: This hospital-based observational study was conducted at Late Bisahu Das Mahant Memorial Medical College, Korba, Chhattisgarh, India (March 2023-March 2024). Consecutive pregnant women with HDP (n=100) were included. HDP subtypes were classified using standard criteria. Maternal complications, mode of delivery, and neonatal outcomes were recorded and summarized descriptively. Results: Gestational hypertension was the commonest subtype (44%), followed by preeclampsia without severe features (26%), preeclampsia with severe features (20%), eclampsia (6%), and chronic hypertension with superimposed preeclampsia (4%). Severe HDP comprised 30%. Cesarean delivery occurred in 56%, mainly for non-reassuring fetal status (32.1%) and maternal indications (25.0%). Maternal complications included abruptio placentae (7%), HELLP syndrome (6%), acute kidney injury (4%), postpartum hemorrhage (9%), ICU admission (10%), and maternal mortality (1%). Perinatal outcomes showed preterm birth (40%), low birth weight (42%), NICU admission (28%), and perinatal mortality (7%). Conclusion: One in three women had severe HDP with notable maternal complications and neonatal morbidity. Strengthening antenatal detection, timely referral, and standardized intrapartum management can improve outcomes.

Background: Early identification of individuals at risk for paroxysmal atrial fibrillation (PAF) remains challenging, particularly when conventional electrocardiography (ECG) demonstrates sinus rhythm. Artificial intelligence (AI)–enabled ECG analysis has emerged as a novel approach to detect subclinical electrical signatures predictive of future atrial fibrillation. Methods: A systematic review and meta-analysis of external validation studies was conducted to evaluate the performance of AI-based ECG models applied to sinus rhythm ECGs for predicting incident PAF. Studies reporting diagnostic performance metrics were included. Pooled estimates of accuracy, precision, recall, and F1 score were calculated using random-effects restricted maximum likelihood models. Between-study heterogeneity was assessed using the I² statistic. Results: Six external validation studies were included. The pooled accuracy was 72.32% (95% CI: 59.96–84.67), precision was 72.32% (95% CI: 60.79–83.85), recall was 77.53% (95% CI: 70.49–84.56), and the pooled F1 score was 67.22% (95% CI: 51.11–83.33). Substantial heterogeneity was observed across all analyses (I² > 99%), reflecting variability in study populations, ECG acquisition methods, and AI model architectures. Conclusions: AI-enabled ECG analysis in sinus rhythm demonstrates moderate predictive performance for future PAF but is characterized by marked heterogeneity across studies. Standardized reporting, robust external validation, and prospective clinical impact studies are required before widespread clinical adoption.

Background: Midgut volvulus caused by intestinal malrotation is a common surgical emergency in children, mostly presenting within the first year of life. In adults, it is extremely rare, accounting for only 0.2–0.5% of cases, with symptomatic midgut volvulus accounting for just 15% of these cases. Case Presentation: We present a case of a 23-year-old woman experiencing recurrent episodes of severe vomiting, diarrhoea, and electrolyte disturbances over three weeks. Despite multiple hospitalizations and conservative management for presumed acute gastroenteritis, her symptoms persisted. Computed tomography showed midgut volvulus with the characteristic "whirlpool sign." Surgical intervention via laparotomy confirmed clockwise torsion of the midgut with Ladd's bands. A Ladd procedure was successfully performed, and the patient recovered without complications. Conclusion: This case underscores the diagnostic difficulties of midgut volvulus in adults and stresses the need to stay alert for recurrent, unexplained vomiting. Prompt diagnosis and surgical treatment are vital to avoid serious complications like bowel ischemia and necrosis.

Background: Midgut volvulus caused by intestinal malrotation is a common surgical emergency in children, mostly presenting within the first year of life. In adults, it is extremely rare, accounting for only 0.2–0.5% of cases, with symptomatic midgut volvulus accounting for just 15% of these cases. Case Presentation: We present a case of a 23-year-old woman experiencing recurrent episodes of severe vomiting, diarrhoea, and electrolyte disturbances over three weeks. Despite multiple hospitalizations and conservative management for presumed acute gastroenteritis, her symptoms persisted. Computed tomography showed midgut volvulus with the characteristic "whirlpool sign." Surgical intervention via laparotomy confirmed clockwise torsion of the midgut with Ladd's bands. A Ladd procedure was successfully performed, and the patient recovered without complications. Conclusion: This case underscores the diagnostic difficulties of midgut volvulus in adults and stresses the need to stay alert for recurrent, unexplained vomiting. Prompt diagnosis and surgical treatment are vital to avoid serious complications like bowel ischemia and necrosis.

Background: The foramen vesalius is a small and inconstant opening in the sphenoid bone of the middle cranial fossa that transmits an emissary vein between the cavernous sinus and the pterygoid venous plexus. Because of its close proximity to the foramen ovale, variations in its presence, shape, and size are clinically important, especially during neurosurgical and percutaneous procedures involving the skull base. Inadvertent injury to this foramen may lead to serious complications such as cavernous sinus damage. However, data on its morphological and morphometric variations are limited, particularly from eastern India. Therefore, the present study was undertaken to analyse the incidence, morphology, and dimensions of the foramen vesalius in adult human dry skulls. Materials And Methods: A cross-sectional observational study was conducted on 60 adult human dry skulls (120 sides) obtained from the Department of Anatomy, Indira Gandhi Institute of Medical Sciences, Patna, Bihar. Skulls with intact middle cranial fossae were included. Each skull was examined for the presence, laterality, shape, and duplication of the foramen vesalius. Patency was confirmed using a thin copper wire. The maximum diameter was measured using a digital vernier calliper. Data were analysed using SPSS version 14.0. Descriptive statistics were applied, side-wise comparisons were performed using the Chi-square test and Student’s t-test, and a p-value ≤0.05 was considered statistically significant. Results: The foramen vesalius was present in 45 out of 120 sides (37.5%). Unilateral presence was more common than bilateral occurrence. The foramen was observed more frequently on the right side than the left, with a statistically significant side-wise difference (p = 0.024). The mean maximum diameter was 0.95 ± 0.60 mm on the right side and 1.05 ± 0.65 mm on the left side, with no significant difference (p = 0.53). Round shape was the most common morphology (66.67%), followed by oval (24.44%) and irregular shapes (8.89%), with no significant side-wise variation (p = 0.296). Conclusion:  The foramen vesalius shows considerable variation in its presence, laterality, shape, and size. Awareness of these variations is essential for anatomists and clinicians to minimise procedural complications involving the middle cranial fossa.

Background: Acute hepatitis is a heterogeneous clinical syndrome with diverse etiologies ranging from viral infections to drug-induced, autoimmune, and vascular causes. In India, hepatitis A and E remain endemic, while non-viral causes such as drug-induced liver injury and Budd–Chiari syndrome are increasingly recognised. The clinical course and outcomes vary significantly depending on etiology, underscoring the need for systematic evaluation in tertiary care settings. Materials and Methods: This prospective observational study was conducted in the Department of Gastroenterology and Hepatology at a tertiary care teaching hospital in India from 2023 to 2025. Patients presenting with an acute onset of jaundice, anorexia, malaise, or abdominal discomfort with biochemical evidence of hepatocellular injury were enrolled. Exclusion criteria included chronic liver disease and acute-on-chronic liver failure. Clinical, biochemical, and serological data were collected, and outcomes including recovery, chronicity, complications, and mortality were assessed. Statistical analysis was performed using GraphPad v8.4.3, with p <0.05 considered significant. Results: A total of 93 patients were studied. Viral hepatitis accounted for 68.8% of cases, with hepatitis A being the most common etiology (50.5%), followed by hepatitis B (15.1%). Non-viral causes comprised 31.2%. Patients with viral hepatitis were significantly younger (mean age 25.5 vs. 40.4 years, p<0.0001) and had higher transaminase levels. Clinical outcomes differed markedly: recovery was higher in viral hepatitis (90.6% vs. 62.1%), while non-viral etiologies had greater chronicity (27.6% vs. 9.4%) and mortality (10.3% vs. 0%). Conclusion: Viral hepatitis, predominantly hepatitis A, remains the leading cause of acute hepatitis in India, affecting younger patients and generally following a favourable course. In contrast, non-viral etiologies are associated with older age, higher bilirubin, distinctive biochemical patterns, and significantly worse outcomes, including chronicity and mortality. Early etiological differentiation is critical for prognosis and targeted management

Background: According to the World Health Organization (WHO), cancer is the second leading cause of death worldwide. Oral cavity cancer is the most common among men in India, accounts for over one-third of the global incidence and mortality from oral cancer. Methods: This prospective study was conducted from November 2022 to June 2024 for a period of 20 months at a tertiary referral centre. This study included 65 clinically suspected oral and oropharyngeal lesions that were evaluated using brush cytology and histopathology. Results: Of the 65 patients, 24 (37%) were clinically premalignant and 41(63%) were clinically malignant. On evaluation for brush cytology, the results were normal (29%), reactive (17%), atypical probably reactive (3%) atypia probably high grade (5%), HSIL (8%), squamous cell carcinoma (35%), and inadequate ( 3%). Histopathology correlation was available for 50 cases. Among these, 33 were true positive, 12 were true negative, 05 were false negative with no false positives. This study showed a sensitivity of 87%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 71%. The diagnostic accuracy was 90%. Conclusion: Brush cytology is very effective in in inoperable cases and in individuals who are unwilling to undergo biopsy.  The advantages of brush cytology are that it is non-invasive, painless, and less expensive and requires minimal technical skill. It also has high specificity and high positive predictive value. The drawbacks are that it has low sensitivity and low negative predictive value

Background: Diabetes mellitus is an established cause of subclinical myocardial involvement, frequently manifesting as left ventricular diastolic dysfunction (LVDD) before the onset of overt cardiovascular disease. Diabetic cardiomyopathy is characterized by impaired myocardial relaxation and increased ventricular stiffness, leading to elevated filling pressures while systolic function remains preserved. As this condition often remains asymptomatic for prolonged periods, early identification of LVDD is essential to prevent progression to heart failure with preserved ejection fraction. Despite the high prevalence of diabetes in India, region-specific data from central India on echocardiographic assessment of diastolic dysfunction remain limited. Objectives: To evaluate left ventricular diastolic function in patients with type 2 diabetes mellitus using transthoracic echocardiography and to determine the prevalence, grades, and independent predictors of diastolic dysfunction at a tertiary care centre in Nagpur. Methods: This hospital-based cross-sectional study was conducted over one year at a tertiary care centre in Nagpur and included 220 adult patients with type 2 diabetes mellitus and preserved systolic function. Patients with ischemic heart disease, significant valvular disease, cardiomyopathy, arrhythmias, or left ventricular ejection fraction <50% were excluded. All participants underwent clinical evaluation, laboratory assessment including HbA1c, and transthoracic echocardiography. Left ventricular diastolic function was assessed using Doppler and tissue Doppler parameters and graded according to the 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines. Results: Left ventricular diastolic dysfunction was identified in 95 patients (43.2%). Grade I diastolic dysfunction was the most common pattern (26.4%), followed by Grade II (11.4%) and Grade III (5.4%). Patients with LVDD were significantly older and had a longer duration of diabetes, higher body mass index, higher prevalence of hypertension, and poorer glycaemic control compared to those with normal diastolic function (p < 0.05). Left ventricular ejection fraction was preserved and comparable between groups. On multivariate analysis, advancing age, longer duration of diabetes, hypertension, HbA1c ≥8%, and increased body mass index emerged as independent predictors of diastolic dysfunction. Conclusion: Diastolic dysfunction is common among patients with type 2 diabetes mellitus despite preserved systolic function. Routine echocardiographic screening in high-risk diabetic patients may enable early detection and targeted intervention, potentially reducing progression to symptomatic heart failure

Background: Epilepsy is one of the most common chronic neurological disorders in children requiring long-term anti-epileptic drug (AED) therapy. Enzyme-inducing AEDs (EIAEDs) can accelerate vitamin D metabolism, leading to hypovitaminosis D and bone health concerns. This study compares serum vitamin D levels in children with first-episode unprovoked seizures and those on AED therapy for over 12 months. Methods: A cross-sectional comparative study was conducted in the Department of Paediatrics, Hassan Institute of Medical Sciences, Karnataka. One hundred children aged 2–18 years were enrolled: Group A (first-episode unprovoked seizures, n=50) and Group B (on AED therapy >12 months, n=50). Serum vitamin D, calcium, phosphorus, and alkaline phosphatase (ALP) levels were measured and analyzed using independent t-test and chi-square test, with p<0.05 considered significant. Results: Mean serum vitamin D levels were 30.28 ± 5.94 ng/mL in Group A and 31.00 ± 6.15 ng/mL in Group B (p=0.55). Serum calcium, phosphorus, and ALP levels showed no significant difference. Levetiracetam was the most common drug in Group A, while phenytoin predominated in Group B. No significant differences were found in demographic or vital parameters. Total leukocyte count was significantly higher in Group A (p=0.001), indicating postictal stress response. Conclusion: Long-term AED use did not significantly affect serum vitamin D or bone metabolism markers. Routine monitoring of vitamin D levels is advisable in children on chronic AED therapy, though current regimens appear metabolically safe and well-tolerated.

Background: Neonatal sepsis remains a major cause of morbidity and mortality especially in developing countries, with varied clinical presentation and bacteriological patterns. It’s important to identify risk factors, bacteriological spectrum and laboratory parameters of these neonates for management of these cases. This study aimed at identifying clinical profile, laboratory determinants  and bacteriological profile of neonates with sepsis in our tertiary care centre. Materials and Methods: This prospective study included 400 neonates with suspected or confirmed sepsis admitted to the NICU of the Department of Pediatrics, Hassan Institute of Medical Sciences , Karnataka. Demographic details, risk factors, clinical features, laboratory parameters, and blood culture results were recorded. Statistical analysis was done using descriptive statistics. Results: Among the 400 neonates admitted with sepsis , early-onset sepsis accounted for 216 (54%) cases whereas late onset sepsis accounted for 184( 46 %)of the cases. Among the risk factors, low birth weight and prematurity was the most common 305 (76.25%) followed by birth asphyxia 120 cases (30%) , prolonged labor 95 cases (17.7%), meconium stained liquor 61 cases (15.25%) and premature rupture of membranes 59 cases(14.75%).  With respect to total Leukocyte count, leukopenia was found in 192 (48%) of cases and leukocytosis in 40(10%) cases. Absolute neutrophil count was deranged in 88 cases ( 22%) in which neutropenia was observed in 7(1.5%) and neutrophilia was found in 81(19.7%). CRP was elevated in 336(84%) and NLR in 266 cases(66.75%) . Abnormal peripheral smear (shift to left, toxic granules, vacuolations) was found in 118( 29.5%) cases. Blood culture was positive in 108(27%), with Acinetobacter baumannii, Klebsiella pneumoniae, and Staphylococcus aureus being common isolates. CSF proven meningitis was found in 11 (2.75%) cases. Mortality rate was 7%(28 cases).Conclusion: Early-onset sepsis and gram-negative predominance were observed in our setting. CSF proven meningitis accounted for 2.75% of cases. Observed overall mortality rate highlights the need for early recognition and timely treatment.

Introduction: Waiting for Coronary Artery Bypass Graft (CABG) surgery is crucial for patients with coronary artery disease (CAD) as progression during the waiting period, which may worsen their condition. Objective: This research aimed at exploring the lived experiences of the patients waiting for CABG surgery. Material and Methods: A phenomenological research design was used to explore the lived experiences of patients waiting for CABG surgery. The study was conducted at the CTVS OPD, Advanced Cardiac Centre, a tertiary care hospital in India. People with CAD, waiting for CABG surgery for more than 3 months were selected purposely. Data were obtained from the participants using a validated in-depth interview guide. Saturation was achieved after interviews with the 17 participants. Interviews were audio recorded and transcribed into verbatim. Analysis occurred concurrently with data collection.    Results: Analysis was performed using the Colaizzi method. The various themes generated were, “Physical impact of the disease, psychological impact of the disease, Aggravating factors/stressors of the disease, Effect on daily routine, financial constraints and arrangement, Impact on social and recreational activities, Effect on family life, job, and income, and Support system and Coping strategies”.Conclusions: The findings indicated that these patients experienced various difficulties while waiting for surgery and required regular contact and nursing care.

Background: Critical limb-threatening ischemia (CLTI) poses a high risk of limb loss and mortality. This study aimed to evaluate clinical outcomes following below-knee bypass in CLTI patients, stratified by SVS WIfI and GLASS classifications. Methods: A prospective cohort of 23 patients undergoing below-knee bypass between February 2021 and February 2024 was evaluated. Baseline and post-operative WIfI scores were recorded at discharge, 6 months, and 1 year. Patients were stratified by GLASS stage. Functional improvement, limb salvage, and correlation between WIfI scores and limb outcomes were analyzed using non-parametric statistical methods. Results: The median baseline WIfI composite score was 5 (IQR 4–6), which significantly decreased to 2 (IQR 1–2) at 1 year (p < 0.001), reflecting a 60% reduction in composite threat. All three WIfI components—wound, ischemia, and foot infection—showed statistically significant improvement (p < 0.001). One patient (4.3%) required major amputation, resulting in a limb salvage rate of 95.7%. Spearman’s correlation between baseline WIfI score and limb salvage was weak and not statistically significant (ρ = –0.32, p = 0.14). Patients with GLASS III lesions had worse baseline anatomy but showed comparable improvement in WIfI scores at 1 year. Conclusion: Below-knee bypass remains a valuable revascularization strategy in appropriately selected CLTI patients. Significant improvements in all WIfI components were observed, with high limb salvage and low major amputation rates, regardless of GLASS stage. The WIfI classification system remains a useful tool to monitor limb threat and guide treatment response over time.

Background: Covid-19 disease, which is a global pandemic because of rapid human-to-human transmission, can cause mild to fatal respiratory, cardiovascular and neurological diseases. The outbreak of  the  coronavirus  disease  can be managed efficiently  by determining the early and effective predictors of clinical outcomes. Aims and Objectives: We aim to observe the dynamic relation of D-dimer and prothrombin time levels with clinical features and covid-19  disease outcomes. Material and Methods: This is a retrospective study where in patients that were admitted over a period of 6 months from 1st January to 30th June 2021 were included in the study. The D-dimer and Prothrombin time levels of the patients from isolation ward and ICU which were received in the clinical pathology section of department of Pathology were included in the study. Result and Conclusion: Covid-19 disease is known to cause a hypercoaguable state and in the recent outbreak of novel coronavirus infection, the risk of thrombosis and bleeding has attracted much attention. D-dimer and prothrombin time levels are the lab parameters to determine the hypercoaguable state. We conducted this study to find out the direct relationship between D-dimer and prothrombin time levels with the various outcomes of the disease so that timely intervention, like aggressive anticoagulant therapy can be made available to these patients at the earliest.

Background: Cardiovascular disease is the leading cause of morbidity and mortality among patients with chronic kidney disease (CKD), particularly those receiving maintenance hemodialysis. Structural and functional cardiac abnormalities often remain subclinical until advanced stages. Transthoracic echocardiography provides a non-invasive method to detect these abnormalities early and to stratify cardiovascular risk in this vulnerable population.

Objectives: To evaluate echocardiographic structural and functional changes among patients with chronic kidney disease on maintenance hemodialysis and to assess their association with hypertension, anemia, duration of hemodialysis, and severity of left ventricular dysfunction. Methods: A hospital-based cross-sectional study was conducted among 100 adult CKD patients undergoing maintenance hemodialysis at a tertiary care centre in Tiruppur. Demographic and clinical data were recorded, and all participants underwent standardized two-dimensional transthoracic echocardiography during the interdialytic period. Structural and functional echocardiographic parameters were analyzed, and their associations with clinical variables were assessed using appropriate statistical tests. Results: The mean age of the study population was 47.2 ± 12.5 years, with a male predominance (68%). Left ventricular hypertrophy was the most common structural abnormality (56%), while left ventricular diastolic dysfunction was the most frequent functional abnormality (49%). Left ventricular systolic dysfunction was observed in 32% of patients. Hypertension and anemia were significantly associated with left ventricular hypertrophy and systolic dysfunction. Longer duration of hemodialysis was associated with a higher prevalence of echocardiographic abnormalities. A progressive increase in biventricular dysfunction, pulmonary hypertension, and pericardial effusion was noted with worsening severity of left ventricular dysfunction. Conclusion: Echocardiographic abnormalities are highly prevalent among CKD patients on maintenance hemodialysis. Routine echocardiographic surveillance and optimal management of modifiable risk factors are essential to reduce cardiovascular morbidity in this high-risk population.

INTRODUCTION: Children who have a familial predisposition to metabolic or cardiovascular disorders are more likely to develop these conditions later in life. Detecting early signs—such as disturbances in lipid levels or irregular BMI—can support timely preventive measures and early management. AIMS AND OBJECTIVES: To study the lipid profile and BMI in children aged between 5-15 years, born to parents having ischemic heart disease (IHD) and/or diabetes mellitus (DM) and/or hypertension (HTN). METHODS: This is a case control study conducted with total of 130 children with parental history of ischemic heart disease (IHD) and/or diabetes mellitus (DM) and/or hypertension (HTN) (Cases group; n=65). Children having no parental history of IHD and/or DM and/or HTN were grouped in Control group (n=65). BMI was calculated according to standard methods, and lipid profiles were measured by enzymatic colorimetric method in the blood sample of study subjects. RESULTS: There was no statistically significant difference in distribution of patients between groups with regards to age (p = 0.600) and gender (p = 0.720). However, consumption of junk food ≥3 times/week by patients in cases group was relative higher proportion than those in control group (84.6% vs. 23.1%; p<0.0001). Among the case group, majority of the study subjects i.e., 46.1% were born to hypertensive father followed by diabetic father (27.7%), diabetic mother (13.8%), and hypertensive mother (12.3%). The lipid profile such as total cholesterol (p<0.0001), triglycerides (p<0.0001), LDL-C (p = 0.001), and VLDL-C (p<0.0001) were significantly at higher levels in cases group compared to control group. The HDL-C levels were significantly (p = 0.036) at lower levels in cases group compared to control group. The was slight increase in ratio of TG/HDL in cases group than in control group (4.09 vs. 3.68; p = 0.241). The mean BMI in the cases and control groups was non-significant (18.33 kg/m2 vs.18.09 kg/m2; p = 0.198). CONCLUSION: Among the lipid profile, the triglycerides, VLDL, and LDL were higher, and HDL values were lower in the children with a family history of HTN and/or DM, and/or IHD without significant difference in BMI among cases and controls. The derangement of lipid profile in children with a parental history of HTN and/or DM and/or IHD could be suggestive of genetic predisposition. This study findings highlight the importance of early interventions to address modification of lifestyle factors in children at risk of developing metabolic disorders due to genetic predispositions.

ABSTRACT: The aim of this study was to evaluate the effectiveness of of Levobupivacaine with Dexamethasone in Supraclavicular brachial plexus block.

METHODOLOGY: This study was done carried out prospectively in Department of Anesthesiology in a tertiary care hospital after getting approval from ethical committee of institution during period November 2022-September 2025. The total population of 70 patients of age 18 to 60 years scheduled for elective upper limb surgeries e.g. Fracture radius, fracture ulna, fracture both bone forearm, distal 1/3rd humerus etc. were included in the study.

OBSERVATIONS AND RESULTS: In our study we observed that the mean (±SD) onset time of sensory block in Levobupivacaine + Dexamethasone group was 3.64(±0.858) minutes and in Levobupivacaine   group was 6.26(±1.03) minutes. The mean (±SD) time for complete sensory block in Levobupivacaine + Dexamethasone group was 7.12(±1.165) minutes and Levobupivacaine in  group was 11.58(±1.309) minutes. The mean (±SD) total duration sensory block in Levobupivacaine + Dexamethasone group was 1027.71(±78.930) minutes and in Levobupivacaine group was 800 (±49.110) minutes. The mean (±SD) onset time of motor block in in Levobupivacaine + Dexamethasone was 5.72(±1.269) minutes and in Levobupivacaine group was 8.15(±1.3) minutes. The mean (±SD) time for complete motor block in Levobupivacaine + Dexamethasone group was 10.67(±2.432) minutes and in Levobupivacaine group was 14.17(±1.532) minutes. The mean (±SD) total duration motor block in Levobupivacaine + Dexamethasone group was 818.57(±73.370) minutes and in Levobupivacaine group  was 679.71(±39.294) minutes. The mean (±SD) total duration of analgesia in Levobupivacaine + Dexamethasone group was 1217.43(±90.597) minutes and in Levobupivacaine group was 955.14(±41.683) minutes.

Background: Paediatric pneumonia remains a major cause of morbidity in India. Chest X-ray (CXR) has practical limitations in children, while lung ultrasound (LUS) offers a bedside, radiation-free alternative. We evaluated the diagnostic accuracy of LUS for early diagnosis of paediatric pneumonia and its ability to assess disease severity using a composite reference standard. Methods: In this 6-month prospective diagnostic accuracy study at the Indian Institute of Medical Sciences and Research, Badnapur (Jalna), children aged 1 month to 12 years presenting with suspected pneumonia underwent LUS and CXR. The reference standard was a composite of CXR plus final clinical diagnosis. LUS diagnostic accuracy (sensitivity, specificity, PPV, NPV, accuracy) was calculated with 95% confidence intervals (CI). Severity assessment was evaluated using an LUS score (0–24) in relation to clinical severity and oxygen requirement; discrimination was assessed by ROC analysis. Results: A total of 150 children were enrolled; 90/150 (60.0%) were classified as pneumonia by the composite reference. LUS was positive in 95/150 (63.3%). Against the composite reference, LUS demonstrated 94.4% sensitivity (85/90; 95% CI 87.6–97.6) and 83.3% specificity (50/60; 95% CI 72.0–90.7), with PPV 89.5% (95% CI 81.7–94.2), NPV 90.9% (95% CI 80.4–96.1), and overall accuracy 90.0% (95% CI 84.2–93.8). Agreement between LUS and CXR was moderate (κ = 0.54). LUS scores increased with clinical severity (median [IQR]: mild 2 [1–9], moderate 8 [2–14], severe 14 [4–16]; p<0.001). LUS score predicted oxygen requirement with an AUC of 0.766. Conclusion: LUS showed high sensitivity and good overall accuracy for diagnosing paediatric pneumonia using a CXR-plus-clinical composite reference standard and demonstrated clinically meaningful severity discrimination. LUS may support early diagnosis and bedside risk stratification while reducing reliance on radiography in resource-constrained settings.

Background:Accuracy ,precision , sensitivity, specificity, and repeatability are important parameters used to assess the quality of a Clinical Biochemistry Laboratory. Along with these, timeliness expressed as turn around time (TAT) is also important as clinicians commonly use this as benchmark of a Laboratory’s performance. TAT  in a clinical Biochemistry Laboratory is defined as the time taken from the point of sample collection until the lab results are dispatched to the patient. Objective:The objective of the study is to measure TAT & analyse turn around time for different phases of Clinical Biochemistry Laboratory and to find the causes for delay in order to take appropriate measures to improve the performance of the lab. Materials and Method: The time taken for different phases of Clinical Biochemistry Laboratory  are noted and turn around time (TAT) is calculated for IP, OP and emergency samples . After careful observation , the root cause for delay is noted. Results and conclusions: TAT was calculated from sample collection to dispatch of reports. The average TAT was found to be 180 minutes (3 hrs), 240 min (4hrs) &110 min for IP, OP & emergency samples. Pre analytical phase contributed to 49, 37.5 & 31.8 % of total TAT  in IP, OP & emergency samples. Analytical phase took 17, 8.3 & 13.7 % of TAT in IP, OP & emergency samples. The analysis of IP,OP & emergency samples revealed that the post analytical phase contributed to 34, 54.1 & 54.5 % of TAT.Conclusion: From our study , we conclude that time consumed by analytical phase is less compared to pre & post analytical phase. We need to focus on pre & post analytical phases mainly to reduce TAT for timely diagnosis , effective clinical decisions & improved patient outcome.

We report a case of chemical pneumonitis in a 41-year-old female resident of Rajasthan, following brief inhalation exposure to 31% concentrated hydrochloric acid (HCl) fumes while cleaning her bathroom floor. She presented with acute onset of shortness of breath, blood tinged sputam and cough. On admission, SpO2 was 89% on room air, pulse rate 124 bpm, and blood pressure 126/84 mmHg, with bilateral middle and lower zone crepitations and rhonchi. Chest x-ray revealed bilateral middle and lower zone opacities and HRCT s/o diffuse alveolar hemorrhage. She was treated with humidified oxygen via nasal prongs at 6 L/min (FiO2 44%), nebulization with bronchodilators, intravenous methylprednisolone, and prophylactic antibiotics. Clinical and radiological improvement was noted by day 7. This case highlights the importance of prompt supportive care with steroids and antibiotics in HCl-induced chemical pneumonitis.1,2

Background: The Bentall procedure remains a cornerstone operation for combined aortic root and valve pathology despite increasing adoption of valve-sparing techniques. Methods: This retrospective single-center study analyzed 15 consecutive Bentall procedures performed between 2014 and 2024. Demographic variables, indications, operative parameters, early outcomes, and mid-term follow-up results were evaluated. Results: Mean age was 53.1 ± 12.8 years, with male predominance (80%). Aortic root aneurysm with severe aortic regurgitation was the most common indication (53%). Mechanical composite grafts were used in 67% of patients. Thirty-day mortality was 6.7%. At a mean follow-up of 4.6 ± 2.4 years, overall survival was 93% with no reoperations. Conclusion: The Bentall procedure continues to provide excellent early and mid-term outcomes and remains a reliable option for complex aortic root disease.

Background:  Non-communicable diseases are the leading cause of morbidity and mortality in India, accounting for a substantial proportion of premature deaths among adults. Early identification of individuals at high risk is a key strategy under the National Programme for Prevention and Control of Non-Communicable Diseases, which promotes the use of the Community-Based Assessment Checklist as a simple screening tool at the primary care and community level. Objective: To assess the distribution of non-communicable disease risk and its association with selected demographic, behavioural, and clinical factors among adults aged 30 years and above attending an urban primary health centre. Methods: A cross-sectional study was conducted from January to March 2023 among 306 adults attending the outpatient department of an Urban Primary Health Centre in Vadodara, Gujarat. Participants were screened using the Community-Based Assessment Checklist administered in the local language after obtaining informed consent. Data on socio-demographic characteristics, lifestyle factors, anthropometric measurements, and blood pressure were collected. Risk categorization was based on checklist scores. Data were analysed using appropriate descriptive statistics and inferential tests to assess associations. Results: More than half of the participants were females, with a mean age of 52 years. A substantial proportion of participants demonstrated elevated risk scores. Increasing age, tobacco use, physical inactivity, and positive family history of non-communicable diseases were significantly associated with higher risk scores. Obesity and increased waist circumference were common, particularly among females. Elevated blood pressure was significantly associated with age, gender, physical inactivity, and higher body mass index. Conclusions: A considerable proportion of adults attending urban primary care settings are at elevated risk for non-communicable diseases. The Community-Based Assessment Checklist is an effective and feasible tool for early risk identification. Strengthening routine screening and targeted lifestyle interventions at the primary care level may help reduce the future burden of non-communicable diseases.

Background: Extracorporeal membrane oxygenation (ECMO) is an established rescue therapy for refractory cardiac and respiratory failure. In India, aluminum phosphide (ALP) poisoning and severe acute respiratory distress syndrome (ARDS) constitute major indications for ECMO, where outcomes are critically dependent on timely initiation and appropriate modality selection. Long-term multicentric data describing ECMO utilization patterns and outcomes from high-volume Indian critical care units remain limited. Objectives: To analyze utilization patterns and clinical outcomes of ECMO modalities in adult patients over a 9-year period, with emphasis on the role of early veno-arterial (VA) ECMO initiation in aluminum phosphide poisoning and prolonged veno-venous (VV) ECMO support in severe respiratory failure. Methods: This multicentric observational study was conducted from January 2017 to December 2025 across high-volume critical care units in South Gujarat, India. A total of 200 adult patients who received ECMO support were included using consecutive sampling. Data regarding demographics, primary indication, ECMO modality, duration of ECMO support, complications, decannulation status, and hospital outcomes were collected retrospectively. Survival to hospital discharge was the primary outcome. Results: Among the 200 patients, 122 patients (61.0%) received veno-arterial (VA) ECMO, while 78 patients (39.0%) were managed with veno-venous (VV) ECMO. Aluminum phosphide poisoning accounted for 110 patients (55.0%), all of whom required VA ECMO for severe cardiogenic shock. Survival among aluminum phosphide poisoning patients supported with VA ECMO was 55.0% (61/110) when ECMO was initiated within 4–6 hours of ingestion. ARDS constituted 78 patients (39.0%); survival with VV ECMO in this group was 40.0% (31/78) and declined to 22.0% during the COVID-19 period (2020–2023). Overall, 98 patients (49.0%) survived to hospital discharge, while 102 patients (51.0%) died during hospitalization. ECMO decannulation was achieved in 102 patients (51.0%), of whom 98 survived to discharge and four died after decannulation due to ongoing critical illness. Hybrid or transition ECMO (VA-V) was required in two patients, and both expired. Inter-hospital transport ECMO was performed in five patients on VV ECMO support; among them, one patient survived to hospital discharge, while four patients died. VA ECMO runs were typically short (4–6 days), whereas VV ECMO required prolonged support ranging from 3 to 8 weeks. Conclusion: This 9-year multicentric Indian study demonstrates that early initiation of VA ECMO in aluminum phosphide poisoning results in favorable survival despite profound cardiogenic shock. VA ECMO showed better survival compared to VV ECMO due to timely initiation in reversible toxin-induced myocardial dysfunction. VV ECMO remains an effective modality for severe ARDS but requires prolonged support and is associated with higher mortality, particularly in viral pneumonia and COVID-era cohorts. These findings highlight the critical importance of early referral, rapid ECMO initiation, and etiology-specific ECMO strategies to optimize outcomes in Indian critical care settings.

Background: Tonsillectomy is one of the most commonly performed otorhinolaryngological procedures, traditionally carried out using conventional cold dissection techniques. Coblation tonsillectomy has emerged as an alternative technique aimed at reducing tissue trauma, operative time, and postoperative morbidity. Objective: To compare intraoperative parameters and postoperative outcomes between coblation tonsillectomy and conventional tonsillectomy in patients with chronic tonsillitis. Methods: A prospective comparative study was conducted at a tertiary care centre over a period of 18 months. Sixty patients diagnosed with chronic tonsillitis were equally divided into two groups: coblation tonsillectomy (n=30) and conventional tonsillectomy (n=30). Intraoperative parameters assessed included duration of surgery and blood loss. Postoperative outcomes evaluated were pain using Visual Analog Scale, tonsillar fossa healing, time to return to normal diet and activity, and postoperative bleeding. Results: The coblation group demonstrated significantly shorter operative time and reduced intraoperative blood loss compared to the conventional group (p<0.001). Postoperative pain scores were consistently lower in the coblation group at all assessed time intervals. Tonsillar fossa healing was superior, and patients returned to normal diet and activity significantly earlier in the coblation group. No postoperative hemorrhage was observed in either group. Conclusion: Coblation tonsillectomy offers clear advantages over conventional tonsillectomy with reduced surgical morbidity and faster postoperative recovery, making it a favorable technique for managing chronic tonsillitis.

Background: Bladder cancer, the most prevalent urological cancer, is often treated with transurethral resection of the bladder tumor (TURBT). Although spinal anesthesia is frequently used, it does not block the obturator nerve, which can lead to muscle contractions and complications like bladder perforation. This study underscores the benefits of using an obturator nerve block (ONB) to improve surgical techniques and enhance patient safety. Methods: We conducted a prospective, randomized controlled study involving 82 patients undergoing transurethral resection of the bladder tumor (TURBT). The patients were randomly assigned to two groups: Group A received spinal anesthesia alone, while Group O received spinal anesthesia combined with an obturator nerve block (ONB) using 10 ml of 0.5% ropivacaine. Our evaluation focused on intraoperative outcomes, the incidence of adductor muscle contractions, and surgeon satisfaction. The findings from these evaluations were significant. Result: The incidence of adductor muscle contraction was significantly lower in Group O (14.6%) compared to Group A (41.5%) (P=0.006). Surgeon satisfaction scores were higher in Group O, with 87.81% reporting a "pleased and calm" experience compared to 58.54% in Group A (P=0.008). Importantly, no cases of bladder perforation were observed, reinforcing the safety and efficacy of the procedure. Conclusion: Spinal anesthesia combined with ONB using 0.5% ropivacaine significantly reduces obturator nerve reflex, improves surgical conditions, and enhances surgeon satisfaction without increasing complications. ONB should be considered for TURBT procedures, especially in cases involving lateral wall tumors.

Background: Pediatric septic shock is a serious condition with high risk of morbidity and mortality, especially in lower-resource settings. Recognizing factors associated with mortality is critical to improving management outcomes.  Objective: To identify demographic, clinical, and laboratory factors associated with mortality in children with septic shock admitted to a tertiary care hospital in Eastern India. Methods: Over one year, we conducted a prospective observational study in which we enrolled 125 children aged from one month to twelve years with septic shock. Clinical and laboratory parameters were collected including Glasgow Coma Scale (GCS), initiation of vasoactive medications, need for mechanical ventilation, acute kidney injury (AKI) and hematologic parameters. Statistical analysis was performed to assess the associations and independent predictors of mortality. Results: A total of 125 patients with clinically diagnosed septic shock were included with 64.8% of participants being under the age of five years. The overall rate of mortality was 34.4%. Pneumonia was found to be the most prevalent etiology (42.4% of cases). Independent, strong predictability of mortality included GCS less than or equal to 8 at admission, use of vasoactive medication, use of mechanical ventilation, AKI, and thrombocytopenia (p <0.05). While higher leukocyte counts were associated with worse outcomes, blood culture positivity was not statistically associated with outcome. Discussion: The findings affirm earlier research that recognized neurologic impairment, organ dysfunction, and cardiovascular instability as strong predictors of mortality in pediatric septic shock. The signs of pneumonia and organ dysfunction emphasize the importance of identifying and treating these cases early and with aggressive resuscitation in the emergency department.  Conclusion: Early identification of pediatric septic shock patients within high-risk categories using clinical assessment markers such as GCS, organ dysfunction, and need for hemodynamic support may help guide the implementation of intensive care interventions that may improve survival in resource-limited settings.

Objective: Subclinical hypothyroidism (ScH), has been increasingly explored for its potential lipometabolic and vascular implications. Evidence remains inconsistent, with some studies suggesting adverse effects on lipid metabolism and vascular function, while others show no significant associations.. With regional variation in thyroid disorder prevalence and metabolic patterns across India, this study evaluated lipometabolic and related clinical markers in individuals with ScH in Kashmir. Methodology: A cross-sectional study was conducted on fifty patients with ScH and fifty age- and gender-matched euthyroid controls attending a tertiary care centre in Srinagar. Standardized procedures were used for anthropometry, blood pressure measurement, and biochemical analysis, including thyroid profile, lipid parameters, and fasting glucose. Statistical analysis employed independent t-tests, chi-square tests, and Pearson’s correlations, with p < 0.05 considered significant.

Results: Baseline demographics were similar between groups. Mean systolic and diastolic blood pressures in the ScH group were not significantly different from controls(p>0.05). Lipid and glycaemic parameters—including fasting glucose, triglycerides, HDL, and LDL—also showed no significant differences.(p > 0.05)  Wide variability in BMI, triglyceride and LDL levels suggested notable inter-individual differences. Findings indicate that ScH did not produce measurable alterations in the lipometabolic profile within this cohort. Conclusion: ScH was not associated with significant changes in blood pressure, lipid parameters, or BMI in this Kashmiri sample. Although these results support studies reporting minimal metabolic impact, conflicting evidence elsewhere highlights the importance of ongoing monitoring. Larger longitudinal studies are needed to clarify whether progression of ScH contributes to future lipometabolic risk. 

Background: Cirrhotic cardiomyopathy (CCM) represents a significant yet often overlooked complication of advanced liver disease, characterized by subclinical cardiac dysfunction that manifests under physiological stress. Early detection through electrocardiography (ECG) and echocardiography (TTE) combined with biomarkers may improve patient outcomes. Objectives: To characterize electrocardiographic and echocardiographic abnormalities in chronic liver disease (CLD) patients and correlate findings with hepatic dysfunction severity. Methods: A prospective observational study enrolled 73 consecutive CLD patients presenting to a tertiary care hospital. Participants underwent 12-lead ECG, 2D transthoracic echocardiography, and NT-proBNP measurement. Findings were correlated with Child-Pugh class and Model for End-Stage Liver Disease (MELD) score. Results: Among 73 patients (mean age 42.7 ± 8.2 years, 78% male), alcohol-related liver disease was the most common etiology (78.8%), followed by metabolic-associated steatotic liver disease (12.3%). ECG abnormalities included sinus tachycardia (21.9%), prolonged QT interval (21.9%), and low-voltage QRS complexes (9.6%). Echocardiographic findings revealed diastolic dysfunction in 54.8% of patients, with progressive severity correlating with Child-Pugh class ( = 0.001) and MELD score ( = 0.002). Elevated NT-proBNP (≥125 pg/mL) was found in 56.2% of patients, with progressive elevation across disease severity strata. Notably, stress echocardiography (6-minute walk test) demonstrated blunted left ventricular response in 100% of Child-Pugh C patients tested, compared to 28.6% of Class B patients. Conclusions: Cardiac dysfunction is highly prevalent in CLD patients across disease severity stages. Diastolic dysfunction was present even in early compensated cirrhosis, while combined systolic-diastolic dysfunction and pulmonary hypertension occurred exclusively in advanced disease. Stress testing effectively unmasked latent contractile reserve impairment. These findings underscore the importance of systematic cardiac evaluation in all CLD patients, particularly those scheduled for liver transplantation or interventions requiring cardiovascular adaptation.

Background: Supraglottic airway devices (SADs) are critical in airway management, especially in scenarios where tracheal intubation is challenging or impossible. The Fastrach™-laryngeal mask airway (FT-LMA) and Ambu Aura-i are two prominent SADs designed to facilitate both ventilation and tracheal intubation. The FT-LMA, while effective, has limitations such as its rigid airway tube and non-availability for pediatric use. The Ambu Aura-i, with its preformed curvature and availability in various sizes, offers a modern alternative with reported success in difficult airway management. This study aims to comparatively evaluate these two devices in anticipated difficult airway management in adults. Aim: To compare the effectiveness of Fastrach™ LMA and Ambu Aura-i in tracheal intubation in adults with anticipated difficult airway management. Materials and Methods: This randomized, interventional, two-group, comparative prospective clinical study involved 50 adult patients undergoing scheduled surgeries requiring tracheal intubation under general anesthesia. Patients, aged 18 to 60 years, with ASA physical status I or II, were randomly assigned to two groups: Group A (Fastrach™ LMA) and Group B (Ambu Aura-i). Data on success rates, number of attempts, duration of successful attempts, and adverse events were recorded. Hemodynamic parameters were monitored throughout the procedure. Results: Both groups showed comparable baseline characteristics including age, gender distribution, ASA grade, and physical parameters. There was no significant difference in heart rate, systolic and diastolic blood pressure, mean arterial pressure, or oxygen saturation between the groups. However, Group A (Fastrach™ LMA) required significantly shorter tracheal tube insertion time (16.1±2.0 sec vs. 19.1±1.9 sec; p<0.05) and fewer attempts for successful intubation compared to Group B (Ambu Aura-i). The incidence of blood on SAD and sore throat was higher in Group B but not statistically significant. Conclusion: The Fastrach™ LMA demonstrated marginally superior performance over the Ambu Aura-i in terms of shorter tracheal tube insertion times and fewer attempts required for successful intubation. Both devices are effective in managing difficult airways, but the Fastrach™ LMA offers advantages in ease and efficiency, making it a potentially more effective option for critical scenarios requiring rapid and reliable tracheal intubation.

Background: Malignancy is a well recognized prothrombotic state that is frequently complicated by intravascular coagulation and fibrinolysis (ICF). Coagulation parameters such as prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, D-dimer and platelet counts have emerged as accessible prognostic tools in oncologic practice. Aim: To evaluate coagulation profile abnormalities in newly diagnosed solid malignancies and to assess the prevalence and pattern of ICF across different tumor types and clinical characteristics. Methods: This prospective observational study was conducted over 18 months at a tertiary care center in Surat, India, and included 150 indoor patients of all ages and both sexes with histopathologically or cytologically confirmed solid malignancies. Hematologic malignancies, known bleeding diathesis and hemorrhagic stroke were excluded. Coagulation profile included PT, APTT, fibrinogen, D-dimer, fibrin degradation products (FDP) and platelet counts. ICF categories were defined using D-dimer and platelet levels as no ICF, overcompensated, compensated and decompensated ICF. Associations with tumor site, histology, metastasis and lesion size were analyzed using ANOVA, chi-square test and correlation analysis, with p < 0.05 considered statistically significant. Results: The most frequent cancer sites were gastrointestinal (23.3%), head and neck (17.3%), female reproductive tract (13.3%), respiratory system (11.3%) and breast (10.7%). Prolonged PT and APTT were observed in 25.3% and 34.7% of patients respectively. Elevated D-dimer (>243 ng/mL) occurred in 60.0%, abnormal fibrinogen levels in 39.3% (low 14.0%, high 25.3%), FDP positivity in 32.7% and thrombocytopenia in 14.0%. Metastatic disease (18% of patients) was associated with significantly higher PT, APTT, D-dimer and fibrinogen levels, and higher FDP positivity (p < 0.01 for all). Lesion size correlated positively with fibrinogen (r = 0.265, p = 0.001). Based on ICF classification, 40.0% had no ICF, 7.3% overcompensated, 41.3% compensated and 11.3% decompensated ICF. Conclusion: Coagulation abnormalities are highly prevalent among patients with solid malignancies and are more pronounced in metastatic and aggressive histologic subtypes. D-dimer and fibrinogen levels, together with platelet counts, are useful markers of subclinical ICF and may assist in risk stratification for thrombo-hemorrhagic complications. Routine coagulation profile assessment at diagnosis can aid early recognition and supportive management in oncology practice.

Background: Hypoglycaemia remains a major limitation in insulin-treated diabetes despite advances in continuous glucose monitoring (CGM). AI-predictive CGM systems aim to reduce hypoglycaemia by forecasting impending low glucose events and enabling earlier preventive interventions. The overall effectiveness of these technologies has not been comprehensively synthesized. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials comparing AI-predictive CGM with standard CGM or usual care. Electronic databases were searched from inception to the final search date. Primary outcomes included hypoglycaemia burden (time below range), with secondary outcomes comprising severe hypoglycaemia, time in range, HbA1c, mean glucose, and CGM wear duration. Random-effects meta-analyses using REML were performed. Risk of bias was assessed using RoB 2.0, and certainty of evidence was evaluated using GRADE. The review was prospectively registered in PROSPERO (CRD420251270444). Results: Eleven randomized trials involving 1,164 participants were included. AI-predictive CGM significantly reduced hypoglycaemia burden and severe hypoglycaemia events compared with comparators. Improvements were also observed in time in range, HbA1c, and mean glucose levels, without a consistent effect on CGM wear duration. Substantial heterogeneity was noted across outcomes, but the direction of effect consistently favored AI-predictive CGM. Conclusions: AI-predictive CGM is associated with clinically meaningful reductions in hypoglycaemia and improved overall glycaemic control. These findings highlight the added value of predictive intelligence beyond conventional CGM and support its role in contemporary diabetes management.

Introduction: Functional dyspepsia (FD) is a common disorder with varied symptom subtypes and management practices. Prokinetics, including itopride, are widely used despite variable evidence. Material and Methods: A survey of clinicians assessed perceptions, diagnostic strategies, and treatment practices for FD with emphasis on prokinetic use. Data were analyzed descriptively. Results: Clinicians frequently encounter chronic FD symptoms and rely on detailed history and Rome IV criteria for diagnosis. Prokinetic therapy, particularly itopride, was commonly prescribed for post-prandial symptoms, with perceived benefits in symptom relief. Evidence from recent meta-analyses indicates variable relative efficacy across prokinetic agents, with metoclopramide and cinitapride showing higher efficacy rates in some studies, while overall evidence quality remains modest. Conclusion: Prokinetics remain an integral part of FD management in India, with clinician preferences influenced by symptom patterns and safety profiles. High-quality RCTs are needed to clarify relative efficacy and guide evidence-based prescribing

Introduction :Cardiac tumours are rare entities that require due diligence during evaluation to differentiate benign from the malignant masses. Most patients  remain asymptomatic in the initial stages and require investigation when the masses grow larger in size. Most of these tumours are benign in nature and  cause symptoms due to their position, number, friability and attachment to  vital structures. As they grow in size, they may cause compressive symptoms, shower  emboli, causevalvar dysfunction or even arrhythmias. 2D echocardiography  is the first modality of investigation whichprovides information about the size, number, location and attachment of the cardiac masses describing them in detail. Computer Tomography Scan or Cardiac Magnetic Resonance  Imaging may be needed to ascertain diagnosis and stage malignancies. Positron Emission Tomography with FluorodeoxyGlucose may also be needed to confirm and stage the malignancies. However, a definitive diagnosis  is established only after tumour excision and subjecting it for  histopathological evaluation. Secondary metastasis is more common rather  than primary carcinomas; secondaries arise from most commonly,the lung  and breast carcinoma, melanoma, soft-tissue sarcoma, and renal cell carcinoma.       

BACKGROUND:  Cardiac autonomic imbalance exist in hypothyroidism, which is the second most common endocrine disorder in the Indian population. Orexins, neuropeptides synthesized by hypothalamic neurons, are known to regulate energy metabolism, temperature regulation, food intake behaviour and memory. Emerging evidence suggests that orexins also play a key role in the hypothalamic-pituitary-thyroid (HPT) axis. We aimed to investigate whether the HPT axis influences cardiac autonomic activity and whether this relationship can be assessed through serum orexin levels and autonomic function tests in patients with overt hypothyroidism. AIM: To estimate the changes in serum orexins and its impact on the variations in autonomic function tests in patients diagnosed with hypothyroidism. MATERIAL AND METHODS: 30 clinically diagnosed hypothyroid patients and 30 clinically healthy normal individuals were tested for their clinical profile, serum orexins and assessment of heart rate variability. Cardiac autonomic function was studied with resting HRV, isometric hand grip test and Valsalva maneuver. The variations in time domain variables (mean RR, SDNN, RMSSD, pNN50) and frequency domain variables (LFnu, HFnu and LF/HF) were tested for its association with the serum orexin levels. RESULTS: Serum orexins were elevated in hypothyroid patients. A significant negative association was found between serum orexin and HRV-variables that reflect the parasympathetic activity on heart(SDNN, RMSSD, pNN50,HFnu) in hypothyroid patients, indicates the possibility of vagal modulation and an impaired parasympathetic activity in hypothyroids.  CONCLUSION: Association exists between the serum orexin levels, the time domain variables and frequency domain variables of cardiac autonomic function tests, implying the a sympatho-vagal imbalance amongst the hypothyroid patients.

Introduction: Neonatal sepsis refers to the presence in a newborn baby of a blood stream infection (BSI) in the setting of fever. Aim: To assess the relationship between Vitamin D levels and early onset neonatal sepsis in term neonates. Methodology: The study was a hospital-based cross-sectional comparative study conducted at the Department of Pediatrics, Sardar Patel Medical College and PBM Hospital, Bikaner, over a one-year period from December 2023 to November 2024.Result: In this study, neonates with early onset sepsis had significantly lower Vitamin D levels and higher mortality rates compared to non-septic neonates, with significant differences in clinical presentation and outcomes. Conclusion: Early onset neonatal sepsis (EONS) was associated with vitamin D deficiency

Background: Tuberculous meningitis (TBM) is the most severe manifestation of neuro-tuberculosis and remains associated with high morbidity and mortality. Magnetic resonance imaging (MRI) plays a vital role in detecting characteristic abnormalities; however, the correlation between MRI findings and clinical severity at presentation has not been fully established. The objective was to evaluate the relationship between key MRI abnormalities and clinical severity in patients with TBM using the British Medical Research Council (BMRC) staging system. Materials and Methods: A hospital-based cross-sectional study was conducted over 24 months and included 100 consecutive adults diagnosed with TBM based on clinical features, CSF analysis, and supportive MRI findings. All patients underwent contrast-enhanced brain MRI using standardized protocols (T1, T2, FLAIR, DWI/ADC, post-contrast T1, and MRA/MRV when indicated). MRI abnormalities assessed included basal meningeal enhancement, hydrocephalus, infarcts, tuberculomas, cranial nerve enhancement, and parenchymal edema. Patients were categorized into Stage I (mild), Stage II (moderate), and Stage III (severe) TBM. Statistical analysis included Chi-square test, ANOVA, Kruskal–Wallis test, and Spearman correlation, with p < 0.05 considered significant. Results: The mean age of the study was 42.7 ± 15.3 years, with severity increasing significantly with age (Stage I: 36.4 ± 12.1 years; Stage III: 50.6 ± 16.3 years; p = 0.003). Sex distribution showed no significant association with severity (p = 0.29). Basal meningeal enhancement (Stage III: 96.3%), hydrocephalus (85.2%), infarctions (74.1%), cranial nerve enhancement (55.5%), and parenchymal edema (70.4%) demonstrated strong, progressive associations with increasing clinical severity (all p < 0.01). Tuberculomas showed borderline significance (p = 0.059). The mean MRI burden score increased stepwise across severity stages (Stage I: 1.4 ± 0.9; Stage III: 3.8 ± 1.3), showing a strong positive correlation with clinical severity (Spearman ρ = 0.62, p < 0.001). Conclusion: MRI abnormalities—particularly hydrocephalus, infarctions, parenchymal edema, basal meningeal enhancement, and cranial nerve involvement—were significantly associated with clinical severity in TBM. The cumulative MRI burden score strongly correlated with BMRC staging, supporting the use of MRI as an important adjunct for early risk stratification and prognostication. Identifying these radiological markers may aid in timely therapeutic decisions and improved clinical management of TBM.

Background: Metabolic syndrome (MetS) is a major driver of premature atherosclerotic cardiovascular disease, particularly in South Asian populations. Conventional risk scores often fail to detect early or subclinical coronary disease in high-risk individuals. Coronary CT angiography (CCTA) enables direct visualisation and quantification of coronary plaque, including high-risk morphology. This study evaluates the role of CCTA in detecting subclinical atherosclerosis among adults with high-risk MetS. Methods: This cross-sectional observational study included 100 adults diagnosed with MetS (NCEP-ATP III criteria) and classified as high-risk based on ≥4 MetS components, long-standing MetS, or additional atherosclerotic risk enhancers. All participants underwent contrast-enhanced CCTA on a ≥64-slice CT scanner. Plaque presence, type, burden (segment involvement score, SIS), stenosis severity, high-risk plaque features, and coronary artery calcium score (CACS) were assessed. Metabolic parameters were correlated with plaque burden. Results: Subclinical coronary atherosclerosis was detected in 72% of patients. Plaque prevalence rose significantly with MetS severity (40.9% in mild vs 92.5% in severe; p < 0.001). Calcified (22.7% vs 60%; p = 0.004) and non-calcified plaques (9.1% vs 42.5%; p = 0.008) increased across severity categories. High-risk plaque features were present in 32.5% of severe MetS subjects compared with 4.5% in mild (p = 0.003). Median CACS (42 to 152; p < 0.001) and mean SIS (0.9 ± 0.7 to 3.0 ± 1.4; p < 0.001) also increased markedly. Luminal stenosis ≥50% occurred in 40% of severe MetS patients but was absent in mild cases. Plaque burden showed significant correlations with fasting glucose (r = 0.42), triglycerides (r = 0.38), waist circumference (r = 0.36), BMI (r = 0.29), and HDL (r = –0.31). MetS severity score demonstrated the strongest association (ρ = 0.55; p < 0.001). Conclusion: Subclinical coronary atherosclerosis is highly prevalent in high-risk MetS patients, with plaque burden and high-risk features rising sharply with metabolic severity. CCTA offers substantial value in early detection and risk stratification, surpassing traditional clinical and biochemical markers. Incorporating CCTA into evaluation algorithms for high-risk MetS populations may facilitate earlier preventive interventions. Prospective studies are required to determine the impact of CCTA-guided management on long-term cardiovascular outcomes

Background: Chronic kidney disease (CKD) represents a growing global health burden, often accompanied by multiple endocrine and metabolic abnormalities. Among these, thyroid dysfunction is a frequently under-recognized comorbidity that can significantly influence patient outcomes. The kidney plays an essential role in the metabolism, degradation, and excretion of thyroid hormones. As renal function deteriorates, alterations occur in thyroid hormone metabolism and hypothalamic-pituitary-thyroid axis regulation which in turn affects the regulation of body metabolisms. Aim:To evaluate the thyroid hormone profile among CKD patients and to assess the association between thyroid dysfunction and disease severity. Methods: This hospital-based cross-sectional study was conducted in the Department of General Medicine and Nephrology at Government Medical College, Ernakulam, between November 2022 and May 2024. A total of 154 patients diagnosed with CKD were included using consecutive sampling. Thyroid function tests (FT3, FT4, TSH) were performed, and patients were staged as per KDIGO guidelines. Data were analyzed using SPSS version 26 with appropriate statistical tests including chi-square and independent t-test; p < 0.05 was considered significant. Results: Out of 154 CKD patients, 26.6% exhibited thyroid dysfunction. Overt hypothyroidism (15.6%) was the most prevalent abnormality, followed by subclinical hypothyroidism (7.8%), subclinical hyperthyroidism (2.6%), and overt hyperthyroidism (0.6%). Thyroid dysfunction showed a positive correlation with CKD stage, being most common among stage 5 patients (29.5%). Conclusion: Thyroid dysfunction, particularly hypothyroidism, is a common endocrine disturbance in CKD and increases with disease severity.Routine screening of thyroid function in CKD patients is recommended to facilitate early detection and management, thereby improving clinical outcomes and delay the progression of CKD to later stages.

Background: Diabetic retinopathy (DR) is a long-term complication of diabetes characterized by progressive damage to the small blood vessels of the retina, which can ultimately threaten vision. Glycated hemoglobin (HbA1c) is widely recognized as a reliable marker for monitoring long-term glycemic control and may serve as an early indicator for identifying individuals at higher risk of developing DR. Aim: To evaluate the correlation between HbA1c level and grade of diabetic retinopathy, to study the awareness of diabetic retinopathy in diabetic patients and to identify the systemic risk factors associated with diabetic retinopathy. Materials and methods: This study was designed as a cross-sectional, hospital-based study. A total of 206 individuals attending the non-communicable disease (NCD) clinic at a tertiary care hospital in Kalaburagi. Data collection was carried out over a 12-month period, from November 2023 to November 2024.  Results: In our study, Out of the 206 participants, diabetic retinopathy was detected in 133 patients, giving a prevalence of 64.5%. The condition was observed more frequently in males, with the highest proportion of cases falling in the 50–60 year age group. Distribution by severity revealed that 53 patients (25.75%) had mild non-proliferative DR (NPDR), 32 (16.47%) had moderate NPDR, 4 (1.94%) showed severe NPDR, and 6 (2.91%) had very severe NPDR. Proliferative DR (PDR) was present in 8 patients (3.88%), another 8 (3.88%) showed advanced diabetic eye disease, and 22 (10.7%) exhibited clinically significant macular edema (CSME). A progressive increase in HbA1c levels was noted with higher grades of retinopathy, and correlation analysis confirmed a significant positive relationship (r = 0.523, 0.687, 0.872; p < 0.05). Awareness about DR was generally poor, with nearly two-thirds of patients (67.48%).  Conclusion: This study demonstrates a clear positive association between elevated HbA1c levels and the severity of diabetic retinopathy. Limited awareness about the condition among patients appears to contribute to delayed detection, resulting in advanced retinal changes and substantial visual impairment. These findings highlight the importance of regular eye screening, better patient education, and effective control of both blood glucose and blood pressure in reducing the burden of diabetic retinopathy.

Background: Inhalation devices are still the most common way to treat asthma and chronic obstructive pulmonary disease (COPD) on a regular basis and in an emergency. However, best outcomes depend not just on prescriptions but also on patients' understanding of devices, positive attitudes toward their usage, and correct practices (technique, adherence). This study sought to assess the knowledge, attitude, and practice (KAP) on the utilization of inhalational devices among individuals with asthma and COPD. Materials and Methods: A cross-sectional design was employed. Adult patients (≥ 18 years) diagnosed with asthma or COPD and utilizing one or more inhalational devices for a minimum of three months were interviewed using a standardized, pre-tested questionnaire. The questionnaire covered three areas: information (illness, devices, inhaler purpose), attitude (beliefs, concerns, stigma, preference), and practice (device technique, adherence, regularity of follow-up). Demographic and disease-related information was gathered. Descriptive analysis was conducted on the data, and correlations between KAP scores and specific variables (age, sex, education, disease type) were investigated. Results: A total of N = 200 patients (asthma n = 70; COPD n = 130) participated. There were big gaps in knowledge of inhalers, the difference between controller and relief devices, and how to use them correctly. A significant number of people said they were afraid of adverse effects, worried that inhalers would be "addictive," and embarrassed to use inhalers in public. In practice, a large percentage of people used the wrong technique, and it was typical for people to not follow the rules. A higher level of education and past inhaler demonstration were strongly correlated with improved understanding and practice (p < 0.05). Conclusion: In this tertiary-care setting in North Maharashtra, asthma and COPD patients have significant gaps in their knowledge, poor attitudes, and incorrect ways of using inhalers. To optimize clinical outcomes, patients need targeted education, training on how to use the device, and ongoing reinforcement of how to use the inhaler correctly.

Background: Preterm infants are at high risk of brain injury and subsequent neurodevelopmental impairment. Cranial ultrasound is widely used for bedside neuroimaging, but its prognostic value in resource-limited settings requires further clarification. Objectives: To assess the association between cranial ultrasound findings and neurodevelopmental outcome at one year corrected age in preterm neonates, and to examine outcomes according to specific lesion types. Methods: This prospective cohort study was conducted in the NICU and high-risk follow-up clinic of the Indian Institute of Medical Science and Research, Badnapur, Jalna, over a 6-month period. Preterm neonates (<37 weeks) admitted within 72 hours of birth who underwent cranial ultrasound were enrolled and followed until one year corrected age. Cranial ultrasound findings were categorized as normal, Grade I–II intraventricular hemorrhage (IVH), Grade III–IV IVH, periventricular leukomalacia (PVL), ventriculomegaly or other lesions. Neurodevelopmental assessment at one year corrected age included Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) and neurological examination. Adverse neurodevelopmental outcome was defined as Bayley-III Cognitive Composite score <85 and/or cerebral palsy and/or significant visual or hearing impairment and/or global developmental delay. Results: Of 152 preterm infants admitted, 140 met inclusion criteria and completed follow-up. Cranial ultrasound was normal in 78 infants (55.7%) and abnormal in 62 (44.3%): Grade I–II IVH 15 (10.7%), Grade III–IV IVH 8 (5.7%), PVL 16 (11.4%), ventriculomegaly 13 (9.3%) and other lesions 10 (7.1%). The mean Bayley-III Cognitive score for the cohort was 89.1 ± 13.5; 53 infants (37.9%) scored <85. Overall, 64 infants (45.7%) had an adverse neurodevelopmental outcome, including 18 (12.9%) with cerebral palsy and 7 (5.0%) with significant visual/hearing impairment. Adverse outcome occurred in 23.1% of infants with normal ultrasound versus 74.2% with abnormal ultrasound (χ² = 36.4, p < 0.001; odds ratio ≈ 9.6). Mean Cognitive scores were higher with normal versus abnormal ultrasound (98.5 ± 8.1 vs 79.1 ± 12.1; p < 0.001). Severe lesions (Grade III–IV IVH, PVL and ventriculomegaly) were associated with the highest rates of adverse outcome (76.9–100%). Conclusion: In this preterm cohort, abnormal cranial ultrasound findings—particularly high-grade IVH, PVL and ventriculomegaly—were strongly associated with adverse neurodevelopmental outcome at one year. Routine cranial ultrasound, coupled with structured follow-up and early intervention, is a valuable tool for early risk stratification of preterm infants in resource-limited settings.

Background: Early diagnosis of acute appendicitis and timely identification of appendiceal perforation remain challenging despite advances in imaging and laboratory investigations. Hyperbilirubinemia has emerged as a potential marker for complicated appendicitis. This study aimed to evaluate the diagnostic value of serum bilirubin in acute appendicitis and appendiceal perforation and to compare its performance with white cell count (WCC) and C-reactive protein (CRP). Material and Methods: This retrospective observational study was conducted at a tertiary care centre over a period of one year and included 65 patients who underwent emergency appendectomy for suspected acute appendicitis. Demographic details, preoperative serum bilirubin, WCC, and CRP levels were collected from hospital records. Histopathological examination of the resected appendix served as the gold standard. Patients were categorised into normal appendix, non-perforated appendicitis, and perforated appendicitis. Diagnostic accuracy parameters were calculated, and statistical analysis was performed using SPSS. Results: Non-perforated appendicitis was observed in 73.8% of patients, perforated appendicitis in 15.4%, and a normal appendix in 10.8%, resulting in a negative appendectomy rate of 10.8%. Mean serum bilirubin levels increased significantly with disease severity (p < 0.001). Hyperbilirubinemia was present in 70.0% of patients with perforated appendicitis. Serum bilirubin demonstrated high specificity for diagnosing both non-perforated and perforated appendicitis, while WCC and CRP showed higher sensitivity. Elevated bilirubin levels were strongly associated with appendiceal perforation. Conclusions: Serum bilirubin is a highly specific and reliable adjunctive marker in the diagnosis of acute appendicitis and a strong predictor of appendiceal perforation. Its routine assessment, in conjunction with clinical evaluation and other laboratory markers, may aid in early identification of complicated appendicitis and reduce diagnostic uncertainty.

Background: Many risk factors have been implicated in causation of Cerebro-Vascular accidents. Serum Homocysteine is speculated as one of the risk factor for the same in many epidemiological studies. This study is aimed to investigate whether Homocysteine is an independent risk factor for Cerebro-Vascular accidents. Methods: A cross sectional study in which 96 Stroke patients between 18-80 years have been studied from one and a half year, in Shri Chamarajendra hospital HIMS Hassan, Karnataka. SPSS software was used for statistical analysis of the data and P value less than 0.05 was considered significant. Results: Out of 96 cases participated in the study, 66 were male, with mean age of 51.9848 ± 13.93887.30 were Females with mean age 64.7333 ± 16.29879. Among males 40(60.7%) had elevated levels of Homocysteine,26(39.3%)had values within normal range. Among Females 18(60%) subjects had normal levels and 12(40%) had elevated Homocysteine levels. Out of 96 subjects,52 had raised levels of Homocysteine,44 subjects had normal levels.8 out 9 patients with CVT had raised levels of  S.Homocysteine. Out 70 subjects with Ischemic stroke,36 had raised levels of  S.Homocysteine. Only 5 out of 14 subjects with Haemorrhage had raised levels of  S.Homocysteine.Male preponderance is noted with respect to Hyperhomocysteinemia. There is  no significant difference with respect to Hyperhomocysteinemia in patients with and without comorbidities. Significant association is found between Hyperhomocysteinemia and stroke. Conclusion: The current study revealed that Hyperhomocysteinemia appears to be an important risk factor for Cerebrovascular accidents. Therefore it becomes pertinent to investigate serum homocysteine in all cases of Cerebrovascualar Accidents

Background: Organophosphate poisoning is a major public health concern in developing countries, often leading to high morbidity and mortality. This study explores serum creatine phosphokinase (CPK) and amylase as accessible, cost-effective surrogate markers for assessing severity and predicting outcomes, along side the Peradeniya Organophosphorus Poisoning Scale (POPS). Aim: To evaluate OP poisoning severity via the POP scale and correlate serum CPK and amylase levels with clinical severity and outcomes. Methods: A prospective observational study was conducted on 100 confirmed OP poisoning patients at Fortis Escorts Hospital, Jaipur. Demographic and clinical data were recorded. Severity was assessed using the Peradeniya Organophosphorus Poisoning (POP) scale, and serum CPK and amylase levels were measured to correlate with poisoning severity and clinical outcomes. Results: Among 100 OP poisoning patients, most were young rural males with suicidal ingestion. Higher POP scores correlated with elevated CPK and amylase levels, predicting severity, prolonged hospital stay, and mortality. ROC analysis confirmed strong diagnostic accuracy, especially for day-3 measurements. Conclusion: This study confirms serum CPK and amylase as reliable markers correlating with POP score severity, predicting outcomes in organophosphate poisoning, with ROC analysis validating their diagnostic value, especially on day 3.

Background: Pituitary adenomas are common intracranial tumors with diverse clinical presentations ranging from hormonal dysfunction to mass effects. Non-functioning adenomas often present late, while pituitary apoplexy represents a rare, acute emergency. Advances in imaging and biochemical evaluation have improved detection, yet optimal diagnostic and management strategies remain challenging. Aim: This study aims to evaluate the demographic characteristics, clinical presentations, and hormonal and biochemical profiles of patients diagnosed with pituitary adenoma. Result: Most patients were aged 41–50 years with female predominance. Headache was the commonest symptom, and non-functioning adenomas predominated. Cardiovascular and neurological manifestations were frequent. Fatigue and visual disturbances were common across adenoma subtypes, with distinct clinical and hormonal correlations among growth hormone–secreting, non-functioning and prolactinomas. Method: This descriptive observational study was conducted at Fortis Escorts Hospital, Jaipur, including 25–30 patients with pituitary adenoma. Data on demographics, clinical features and biochemical profiles were collected from patient records and hormonal assay reports after thorough review of clinical and laboratory findings. Conclusion: Our findings corroborate demographics, clinical and biochemical features, risk factors and tumor types reported in large pituitary apoplexy series. Headache commonly persisted for over one day, and many patients had preceding endocrine dysfunction. These observations emphasize the need for prospective randomized trials to guide optimal timing of surgical versus conservative management

Background: Examination of the fundus is a vital part of clinical examination in subjects that have medical emergencies. Fundus examination is done as a part of bedside assessment with a portable direct ophthalmoscope. DFP (Smartphone fundus photography) is a novel and ideal technique for imaging the retina. Aim: The present study was aimed to assess the smartphone fundus photography use by physicians in the medical emergencies and compared them with the findings of DO (direct ophthalmology) by the ophthalmologist. Methods: The present study assessed 364 subjects that presented to the medical emergencies of the Institute within the defined study period with indicated fundus examination. The smartphone fundus photography was done by the physician in all the subjects and findings were recorded in a preformed structured proforma and were compared to the direct ophthalmology findings by the ophthalmologists. Results: Among 364 subjects assessed in the study, 61% (n=222) subjects were assessed using the smartphone fundus photography and 52% by direct ophthalmology. Most common findings seen in study subjects was papillodema seen in 21% subjects followed by hemorrhages in 20% and Roth spots in 12.5% study subjects respectively. Direct ophthalmology did not assess the findings of early papillodema in the peripheral retina.  Conclusions: The present study concludes that smartphone fundus photography has equal efficacy when compared to direct ophthalmology in the assessment of the retinal findings in subjects that have medical emergencies and can be done as the bedside examination by the physicians in the emergency.

Background: Extra-articular distal tibial fractures are difficult to manage due to poor soft tissue coverage, precarious blood supply, and a high risk of complications such as malunion and non-union. Among the available fixation options, intramedullary nailing (IMN) and minimally invasive plating are commonly used, but their relative superiority remains debated. This study compared the radiological and functional outcomes of these two techniques. Methodology: A hospital-based prospective observational study was conducted in the Department of Orthopaedics, MKCG Medical College and Hospital, Berhampur, Odisha, from March 2023 to February 2025. Forty adult patients (>18 years) with extra-articular distal third tibial fractures (closed or Type I open) were randomly allocated into two groups: Group A – plating (n=20) and Group B – intramedullary nailing (n=20). Patients were followed for 9 months. Radiological union time, time to weight bearing, perioperative parameters, complications, and functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Data were analyzed using R software, with p<0.05 considered significant. Results:
The mean age of patients was 38.25 years, and 82.5% were males. Road traffic accidents were the most common cause of injury (87.5%). Mean operative time and hospital stay were comparable between groups (p>0.05). Mean union time was significantly shorter in the nailing group (19.2 ± 2.88 weeks) than in the plating group (23.8 ± 3.43 weeks) (p<0.01). Partial weight bearing was initiated by 8–10 weeks in most cases. Complication rates were low and statistically similar between the two groups. Functional outcome assessment showed excellent to good results in 90% of IMN and 85% of plating cases (p=0.59). Discussion: Both IMN and plating achieved satisfactory union and function, though IMN demonstrated faster union, earlier rehabilitation, and fewer superficial infections. These findings align with previous studies suggesting that IMN provides a biological advantage by preserving periosteal circulation and promoting secondary bone healing, while plating offers superior control in metaphyseal comminution. Hence, the choice of fixation should be individualized based on fracture pattern and soft tissue condition. Conclusion: Intramedullary nailing and minimally invasive plating are effective for extra-articular distal tibial fractures. However, IMN offers earlier union and recovery with comparable functional outcomes and complication rates, making it a preferable option in suitable patients.

Background: Mechanical prosthetic valve thrombosis (PVT) is a serious condition with high morbidity and mortality. While emergency surgery has long been the standard treatment, thrombolytic therapy (TT) using agents like streptokinase has become a valuable alternative—particularly for patients with high surgical risk or in resource-limited settings, showing variable success across different populations. Objective: To evaluate the effectiveness and safety of thrombolytic therapy in patients with mechanical prosthetic valve thrombosis at a tertiary care center. Methods: This retrospective study included 27 mechanical PVT patients diagnosed via clinical assessment, echocardiography, and fluoroscopy. All received intravenous streptokinase. Demographics, clinical features, causes, and outcomes were documented. Thrombolysis success was defined by clinical improvement and imaging resolution. Complications such as embolism, bleeding, and mortality were assessed. Results Among the 27 patients (mean age 48.1 ± 14.1 years; 77.8% female), the mitral prosthesis was most commonly affected. The leading cause of PVT was non-compliance with oral anticoagulation and subtherapeutic INR levels. Thrombolysis was successful in 85.2% of patients, with restoration of valve function and clinical recovery. Complications included minor bleeding and embolic events and mortality in 7.4% (2 patients). Prognostic analysis indicated worse outcomes in older patients and in those presenting with severe NYHA functional class. Conclusion: Thrombolytic therapy with streptokinase is a safe and effective treatment for mechanical prosthetic valve thrombosis, especially in settings where surgical intervention is not immediately available. Strict anticoagulation monitoring and patient compliance are critical to prevention.

Background Metformin is the first-line therapy for type 2 diabetes mellitus, but its long-term use is associated with vitamin B12 deficiency, a condition with potential hematological and neurological consequences. This study aims to determine the prevalence of vitamin B12 deficiency in long-term metformin users, identify key predictive factors, and evaluate its association with adverse clinical outcomes. Methods We conducted a retrospective cohort study using electronic health records from a multi-center diabetic clinic. The study included 850 patients with type 2 diabetes who had been using metformin continuously for at least two years. Data on demographics, metformin dose and duration, concurrent medication use (e.g., proton pump inhibitors), and laboratory values (serum B12, hemoglobin, Mean Corpuscular Volume) were extracted. The primary outcome was vitamin B12 deficiency, defined as a serum level <150 pmol/L. Secondary outcomes included peripheral neuropathy and macrocytic anemia. Logistic regression was used to identify predictors of deficiency. Results The overall prevalence of vitamin B12 deficiency (<150 pmol/L) was 22.4%, with an additional 31.5% having borderline levels (150-220 pmol/L). In the multivariate logistic regression analysis, significant independent predictors for B12 deficiency included a longer duration of metformin use (OR 1.15 per year, 95% CI 1.08-1.22), a higher daily dose (OR 1.88 per 1000 mg/day increase, 95% CI 1.45-2.43), older age (OR 1.03 per year, 95% CI 1.01-1.05), and concurrent use of proton pump inhibitors (OR 2.10, 95% CI 1.55-2.85). Clinically, deficient patients had a significantly higher prevalence of peripheral neuropathy (35.8% vs. 14.7%, p < 0.001) and macrocytic anemia (11.6% vs. 3.9%, p < 0.01) compared to patients with sufficient B12 levels. Conclusion Vitamin B12 deficiency is highly prevalent among long-term metformin users and is strongly associated with dose, duration, age, and PPI use. Given the significant link to adverse neurological and hematological outcomes, routine screening for vitamin B12 levels should be considered a standard of care for this patient population.

Background:Preoperative anxiety in paediatric patients triggers a neuroendocrine stress response, elevating catecholamines and cortisol, potentially affecting cardiovascular stability. Midazolam is a standard premedication but may cause paradoxical agitation and respiratory depression. Intranasal dexmedetomidine offers anxiolysis with stable hemodynamic.Objective:To compare intranasal dexmedetomidine and oral midazolam for preoperative anxiolysis in children, focusing on cardiovascular parameters, sedation, and postoperative analgesia. Methods: In this prospective, randomized, double-blind study, 60 ASA I–II children (5–12 years) scheduled for elective surgery were allocated to: Group I (oral midazolam 0.5 mg/kg + intranasal saline) or Group II (intranasal dexmedetomidine 0.8 µg/kg + oral placebo). Heart rate (HR), systolic blood pressure (SBP), SpO₂, anxiety (mYPAS), sedation (Ramsay scale), and postoperative analgesic requirement were recorded.Results: Baseline demographics and HR/SBP were comparable. Significant reductions in HR and SBP were observed in Group II at 40 min, 60 min, and postoperatively (p < 0.05). SpO₂ remained >95% in all patients. mYPAS scores were lower in Group II at the same time points (p < 0.05). Sedation scores were comparable between groups. Postoperative fentanyl requirement was lower in Group II (p < 0.05). No significant adverse events occurred.Conclusion:Intranasal dexmedetomidine provides superior anxiolysis and cardiovascular stability compared to oral midazolam, without compromising sedation or safety, making it a suitable alternative for paediatric premedication with potential benefits in cardiovascular outcomes.

Background: Post-operative cognitive dysfunction (POCD)—now subsumed under the 2018 consensus term “perioperative neurocognitive disorders” (PND)—comprises measurable declines in memory, attention, or executive function after anaesthesia and surgery, particularly in older adults. Despite its clinical impact, POCD/PND remains variably recognized in perioperative pathways internationally. Indian data on anaesthesiologists’ awareness and practices are scarce, especially outside academic centres. Methods: We designed a cross-sectional, nationwide, web-based questionnaire targeting anaesthesiologists practicing in India (medical colleges and freelancers). The instrument covered demographics, knowledge (definition, risk factors, diagnosis, prognosis), attitudes (perceived importance, consent), and practices (screening, prevention, follow-up). Face/content validity was established by a 6-member expert panel; internal consistency was assessed by KR-20 for knowledge items. The primary outcome was “adequate knowledge” (≥70% correct). Secondary outcomes included routine use of cognitive screening tools, discussion of POCD in consent, and adoption of evidence-based preventive strategies. We planned descriptive statistics, χ² testing, and multivariable logistic regression. Results : Among 512 respondents (61.9% medical-college affiliated; 38.1% freelancers), the median age was 38 years; 56.6% had ≥10 years’ experience. Adequate knowledge was observed in 62.7% (95%CI 58.4–66.8); median knowledge score 14/20 (IQR 12–16; KR-20=0.78). Only 27.9% reported routine pre-operative cognitive screening (MMSE/MoCA), 18.2% documented POCD risk in consent, and 35.5% used structured delirium screening post-operatively. Correctly distinguishing POCD from delirium was achieved by 68.8%. In multivariable modelling, academic affiliation (adjusted OR 1.74, 95%CI 1.22–2.49), ≥10 years’ experience (aOR 1.41, 1.01–1.98), and prior continuing-medical-education exposure to POCD/PND (aOR 2.16, 1.52–3.08) were associated with adequate knowledge. Conclusion: In this nationwide sample, two-thirds of Indian anaesthesiologists demonstrated adequate factual knowledge about POCD/PND, yet translation into practice—screening, consent, and structured prevention—was limited, especially among freelancers. Targeted CME, standardized cognitive screening, and explicit consent language may bridge the knowledge-practice gap.

Introduction:Poisoning is a significant public health problem and one of the major causes of hospitalization. Insecticides particularly OP compounds are extensively used in agriculture and are responsible for a significant number of poisoning incidents. High prevalence of poisoning-related admissions highlights the critical need for implementing efficient prevention and treatment measures. Organophosphorus compounds (OPCs) are extensively used in eliminating pests, but they pose danger to humans, being a frequent cause of acute poisoning. OBJECTIVES OF THE STUDY: Primary objective: :To study the proportion of patients with elevated serum amylase levels in patients admitted with organophosphorus poisoning in Government Medical College Hospital Ernakulam during the study period. Secondary objective: To study the association of elevated serum amylase levels and severity of organophosphorus poisoning among the study subjects.Methods: Study design: A hospital-based, cross-sectional study. Study period- 18 months from date of final approval by IEC and IRB and clearance of study by the KUHS.Study area and setting: Government Medical College Hospital, Ernakulam. Study population: The study will be done among in-patients of Department of General Medicine presenting with history of organophosphorus poisoning. RESULTS AND OBSERVATIONS: The study was conducted among 76 patients with OP poisoning, showing a predominance of males (83%) with 45.7 years as the average age. The distribution of age showed that individuals above 51 years constituted 55.3% of the study group. A key finding of our research was the high prevalence of elevated levels of serum amylase, detected in 52.6% of the patients. The mean serum amylase level was 253.18 ± 227.660 U/L, with a range from 23 to 907 U/L. This elevation suggests substantial pancreatic involvement, which could be a direct consequence of the toxic effects of OP compounds or an inflammatory response. These findings also signify that serum amylase may be a useful biomarker for evaluating pancreatic damage and guiding treatment strategies. Our study has showed prominent associations between high serum amylase levels and severe clinical manifestations of OP poisoning. Patients with high levels of serum amylase were more likely to exhibit persistent bradycardia, hypotension, coma, convulsions, and respiratory failure requiring mechanical ventilation. These associations underscore the potential of serum amylase as a crucial marker for assessing the critical nature of OP poisoning. The study also reported a high mortality rate of 46.1%, emphasizing the severity of organophosphate poisoning and the need for timely and proper medical intervention The strong link between elevated serum amylase levels and mortality further emphasizes the prognostic significance of this biomarker, suggesting that subjects with high serum amylase levels face a significantly higher risk of adverse outcomes. Conclusion The study emphasizes the frequent occurrence of elevated serum amylase levels in patients with OP poisoning and their strong link with severe clinical consequences. Elevated serum amylase levels can serve as an efficient and valuable biomarker for assessing the severity of OP poisoning, guiding clinical management, and predicting patient outcomes.Future studies should emphasise on developing standardized protocols for using serum amylase levels in managing organophosphate poisoning. Furthermore, public health initiatives should work to raise awareness, enhance education, and implement preventive strategies to decrease the occurrence and impact of organophosphate poisoning. Improved early detection and timely treatment can help lower mortality rates and enhance patient outcomes.

Background: Objective: To evaluate & compare Transmitral Doppler (TMD) with Tissue Doppler (TD) in hypertensive patients with Left Ventricular (LV) diastolic dysfunction. Material & Method: 2000 patients with 1120 male and 880 female, underwent analysis with the help of TMD and TD at baseline, during increased preload and during increased afterload. Result:We have found a stastically significant difference on comparing the 2 variables percentage change (Δ%) at 3 different times as the p value was <0.05.Conclusion: In patients with LV adaptation to Systemic Hypertension, TD index E′ showed less change than the TMD index E after a preload increase maneuver. This finding indicates that E′ is less dependent on preload variations and supports its broader clinical use for evaluating LV diastolic function through ECHO. 

Background: Peripartum cardiomyopathy (PPCM) is a significant contributor to maternal morbidity and mortality. Thus, in our study we have assessed  the predictors for PPCM outcome. Material & Method: 100 patients with PPCM  within 5 months  postpartum were given anticoagulation with heparin followed by vitamin K antagonists, and oral bromocriptine (2.5 mg twice daily  for 2 weeks). Hemodynamic stabilization involved inotropes (dobutamine, Noradrenaline)  and vasodilators (Nitroglycerin). Dobutamine was infused at 5– 10 µg/kg/min. Patients were followed  at 15 days, 1 month, 3 months and 6 months, with periodic clinical assessments, treatment adjustments, and echocardiographic evaluations.   Result: We found that, for univariate regression, higher baseline left ventricular volumes (LVEDVi, LV-ESVi) and lower LVEF at 6 months were strongly associated with non-recovery as the p value was 0.004,<0.001 and 0.001 respectively. While for multivariate regression, baseline LVEF and LV volumes are independent predictors, while mitral E/A and LAVi contributed to risk stratification but lacked statistical significance. Conclusion: We concluded that, ECHO parameters are the key predictors for early identification of individuals at risk for poor recovery and adverse outcomes during follow-up. 

INTRODUCTION;Hypertensive crisis (HC) is a life-threatening emergency characterized by severely elevated blood pressure, which can lead to organ damage, stroke, heart failure, and acute renal failure. These patients often require ICU admission for intensive monitoring and immediate intervention.  Aims and objectives: This study aims to evaluate the clinical profile of hypertensive crisis patients admitted to the ICU, including demographic factors, clinical presentations, and management strategies. Materials and Methods: A cross-sectional, descriptive study was conducted in the Intensive Care Unit of St. Stephens Hospital, Delhi, from February 2023 to July 2024. The study included 81 patients admitted with hypertensive crisis. Key variables examined included age, systolic and diastolic blood pressure, and diagnoses such as acute coronary syndrome (ACS), acute kidney injury (AKI), acute decompensated heart failure (ADHF), hypertensive retinopathy, and acute ischaemic stroke. Results: The majority of patients were middle-aged to elderly, with 28% in the 51–60 age group and 27% in the 61–70 age group. Blood pressure improved significantly, with systolic blood pressure decreasing from 198.29 mm Hg at 0 hours to 131.25 mm Hg at discharge. Ventilation needs varied, with 32 patients requiring non-invasive ventilation (NIV) and 17 requiring intravenous (IV) support. Conclusion: Hypertensive crisis is a severe condition requiring ICU care. Elderly patients with comorbidities like chronic hypertension and renal disease are at higher risk. Early recognition and aggressive management with intravenous antihypertensive therapy are critical for improving outcomes and preventing complications. Future research should focus on optimizing treatment protocols and targeting high-risk patients.

Background Acute ST-elevation myocardial infarction (STEMI) remains a leading cause of morbidity and mortality worldwide. Platelet activation plays a critical role in the pathogenesis of STEMI, and mean platelet volume (MPV) has emerged as a potential biomarker reflecting platelet function and cardiovascular risk. Aims and objectives: This study aimed to evaluate mean platelet volume (MPV) as a biomarker in ST-elevation myocardial infarction (STEMI) by comparing its levels with healthy controls and correlating it with risk scores and clinical severity. Materials and methods:  The present study was a hospital-based prospective Observational study, which was conducted from 1^st March, 2022 to 30^th September, 2022 (6 months) at Department of General medicine and Department of Cardiology, Silchar medical college and hospital, Silchar, Assam. It included 100 cases of acute ST-elevation Myocardial Infarction and 100 age and sex matched controls. Results: The mean age of STEMI patients was 50.4 ± 10.2 years, comparable to controls (57.8 ± 9.6 years; p = 0.62). MPV was significantly higher in STEMI patients (10.2 ± 1.1 fL) compared to controls (8.5 ± 0.9 fL, p < 0.001). Higher MPV values were observed with increasing TIMI risk categories (low: 9.5 ± 0.8 fL, intermediate: 10.1 ± 0.9 fL, high: 11.0 ± 1.0 fL; p < 0.001) and Killip class (Class I: 9.8 ± 0.9 fL to Class IV: 11.2 ± 1.2 fL; p = 0.002). A strong positive correlation was noted between MPV and TIMI score (r = 0.62, p < 0.001). Higher MPV values were also associated with increased cardiac complications, need for ICU admission and in- hospital mortality. Conclusion: MPV is significantly elevated in STEMI and correlates with risk scores and clinical severity. As a simple, cost-effective hematological parameter, MPV can serve as a valuable prognostic biomarker for early risk stratification in STEMI patients.

Background: Coronary artery disease is a leading cause of mortality in India. Technological advances in cardiac imaging have enabled the use of computed tomographic angiography (CTA) for non-invasive evaluation of coronary artery bypass grafts (CABG). While earlier generations of multidetector CT scanners have demonstrated reasonable diagnostic performance, clinical evidence regarding the utility of newer 256-slice CT scanners in post-CABG assessment remains limited in the Indian context. Aim: To evaluate the diagnostic performance, image quality, and radiation parameters of 256-slice CTA in assessing graft patency in post-CABG patients, using invasive coronary angiography (ICA) as the reference standard. Methods: Ninety-nine patients who had undergone CABG at least one year earlier underwent 256-slice CT Angiography. Graft image quality was assessed segment-wise, and patency was categorized as patent, stenosed, or occluded. A subset of 20 patients underwent invasive coronary angiography for comparison. Radiation dose, contrast volume, heart rate, and heart rate variability were analyzed. Results: Among 276 grafts evaluated, 193 (69.9%) were patent, 11 (4.0%) were stenosed and 72 (26.1%) were occluded. Of 606 graft segments analyzed, 77.1% had excellent, 22.1% had good and 0.8% had moderate image quality. None of the segments were graded poor quality or non-diagnostic. CTA demonstrated a sensitivity and negative predictive value of 100%, and specificity of 96.67%. Distal graft segments showed lower image quality, significantly influenced by heart rate variability. Radiation dose with CTA was higher than ICA while contrast volume was significantly lower for CTA as compared to ICA. Conclusion: 256-slice CTA provides excellent image quality and high diagnostic accuracy for post-CABG graft assessment, outperforming earlier CT technologies and offering a reliable non-invasive alternative in the Indian clinical setting.

Background: Surgical site infection is an infection that occurs after surgery within 30 days or within 1year after implant surgery, in the part of the body where surgery took place.  Malnutrition is an important secondary cause and is present in majority of patients presenting in a government setup in India. Hence this study was taken to find association of the incidence of SSI in relation to Total cholesterol level. Very low levels of total cholesterol are more frequently found in polytrauma patients, after extensive surgeries, in life threatening infections and hypovolemic shock. In this, we attempt to create awareness to recognize hypocholesterolemia as a risk factor for development of SSI particularly in a government setup, where patients who present are usually undernourished and should be taken under consideration.

Aims and objectives: To determine the relationship of serum cholesterol with surgical site infections.

Materials and methods: The study was conducted on patients undergoing Emergency and Elective laparotomies in Karnataka medical college and research institute. For these patients, serum cholesterol levels were analyzed on day 0 and post op day 3 and post op day 5 and these data were analyzed to predict their association with development of surgical site infection. Results: A statistically significant association was observed between serum levels of cholesterol in developing SSI, with 48.2% (40/83), 58% (40/69), 75.4% (46/61) of patients with hypocholesterolemia developing SSI on day 0, 3, 5 respectively (p < 0.001). The percentage of patients who developed SSI was higher in emergency surgeries (75%) compared to elective surgeries (25%). Conclusion: This study demonstrates compelling evidence for a significant association between lower levels of cholesterol (total) in the perioperative period and an increased risk of SSI. These findings contribute to our understanding of the factors influencing SSI development and to plan future strategies for risk stratification and prevention.

Background: Perforative peritonitis remains one of the most common surgical emergencies in tertiary care centres in developing countries and is associated with considerable morbidity and mortality. The etiological spectrum and outcomes vary widely depending on the underlying cause, delay in presentation, and management strategies. To study the etiological spectrum, clinical profile, surgical management, and outcomes of patients presenting with perforative peritonitis at a tertiary care centre. Methods: This hospital based observational study included patients diagnosed with perforative peritonitis who underwent emergency laparotomy. Data on demographic characteristics, clinical presentation, site and cause of perforation, surgical procedures performed, postoperative complications, duration of hospital stay, and mortality were collected. Data analysis was performed using descriptive statistics. Results: Perforative peritonitis was more common in males, accounting for approximately 70 percent of cases, and predominantly affected patients aged 40 to 60 years. Abdominal pain was reported in nearly all patients, followed by fever in about 65 percent and vomiting in around 55 percent. Duodenal perforation accounted for roughly 35 percent of cases, followed by ileal perforation in 30 percent, appendicular perforation in 20 percent, and colonic perforation in 15 percent. Peptic ulcer disease emerged as the leading etiology, followed by enteric fever and appendicitis. Primary closure with omental patch was performed in nearly 40 percent of cases, resection and anastomosis in about 30 percent, and stoma formation in 20 percent. Postoperative complications occurred in approximately 45 percent of patients, with surgical site infection being the most common. The overall mortality rate was around 10 percent, with higher mortality observed among patients presenting after 48 hours and those with significant comorbidities. Conclusion: Perforative peritonitis commonly affects middle aged males, with peptic ulcer disease as the predominant cause. Early diagnosis, prompt surgical intervention, and optimized postoperative care remain key determinants of favorable outcomes in tertiary care settings.

Background: Etomidate is one of the most preferred agents for induction of the anesthesia in the subjects that are unstable hemodynamically. It is vital to prevent the EIM (etomidate‑induced myoclonus) in subjects undergoing anesthesia induction with etomidate. Aim: The present study was aimed to comparatively assess the efficacy of three techniques for administering etomidate in prevention of myoclonus induced by etomidate. Methods: The present study assessed 592 study subjects where general anesthesia was induced using etomidate following the randomly allocated groups as control, priming, slow, and priming with slow injection. The grade, time of onset, and incidence of myoclonus was noted in all the subjects. The effect on various hemodynamic parameters and pain on injection grading was noted. Data gathered were analyzed statistically.  Results: The study results showed that incidence of myoclonus was significantly highest in control group followed by priming, slow, and priming with slow injection with p=0.001. Priming with the slow injection technique was most effective in prevention of etomidate‑induced myoclonus and decreasing the intensity of myoclonus. In priming with slow injection group, grade 3 myoclonus incidence was seen in 6.76% (n=10) subjects compared to 52.7% (n=78) subjects from control group with p=0.0001. Conclusion: The present study concludes that priming and slow injection techniques are similar concerning the incidence of etomidate‑induced myoclonus. However, using the combination of priming and slow technique is one of the most effective techniques in reducing the incidence of etomidate‑induced myoclonus.

Background and Objective: Chronic Obstructive Pulmonary Disease is heterogenous lung condition associated with systemic inflammation and hematological alterations. Mean Platelet Volume, Platelet-to-Lymphocyte Ratio, and Platelet Distribution Width are emerging inflammatory biomarkers. This study aims to compare variation of platelet indices between COPD patients and controls and study their associations with age, smoking status, pack years of smoking, baseline FEV1, SpO2, and GOLD stage. The correlations between platelet indices and various outcomes like exacerbation frequency, number of hospitalisations and need for supplemental oxygen are also obtained in the study. Methods: A hospital-based observational case-control study was conducted on 152 COPD patients and matched healthy controls. Platelet indices were measured and analysed against demographic variables, smoking history, lung function parameters, and disease severity as per GOLD classification. Statistical analyses, including t- tests, correlation coefficients and regression models were employed to assess the relationships between variables. Results: COPD patients exhibited significantly altered levels of MPV, PLR, and PDW compared to healthy controls (p < 0.05). Independent t-test reveal significant differences of platelet indices ,age, pack years, GOLD staging, baseline FEV1 and SpO2 between the two groups(p <0.001).Significant relationship between platelet indices and disease severity markers like exacerbation frequency, number of hospitalisations and need for supplemental O2 were found out by correlation study.  Conclusion: MPV, PLR, and PDW are raised in COPD patients than healthy controls and correlate with disease severity and lung function parameters. These markers can serve as potential adjunctive biomarkers for COPD diagnosis and prognosis. Further longitudinal studies are required to validate their predictive value in disease progression and treatment outcomes.

Background: Fragmented QRS (fQRS) complexes represent myocardial conduction delays and have emerged as valuable electrocardiographic markers in acute coronary syndrome (ACS). While standard electrocardiography remains the cornerstone of initial ACS evaluation, the correlation between fQRS and angiographic findings remains incompletely understood. Objectives: To evaluate the prevalence of fQRS in ACS patients and determine its correlation with coronary angiographic findings including the identification of culprit lesions, severity of coronary artery disease, and short-term clinical outcomes. Methods: This prospective observational study enrolled 147 consecutive ACS patients at Karnataka Institute of Medical Sciences, Hubballi, between 2023-2024. All patients underwent standard 12-lead electrocardiography, transthoracic echocardiography, cardiac biomarker assessment, and coronary angiography. fQRS was defined as presence of various RSR' patterns without typical bundle branch block in two or more contiguous leads. Patients were followed for 30 days to assess clinical outcomes. Results: fQRS was detected in 81 patients (55.1%). Patients with fQRS demonstrated significantly higher prevalence of triple vessel disease (42.0% vs 12.1%, p<0.001), elevated troponin I levels (mean 18.87±12.69 vs 6.73±7.42 ng/ml, p<0.001), and worse clinical outcomes. The presence of fQRS showed significant correlation with the extent and severity of coronary artery disease on angiography. Mortality rate was substantially higher in the fQRS group (16.0% vs 1.5%, p=0.006). Location-specific fQRS patterns demonstrated good correlation with corresponding coronary territories affected on angiography. Conclusion: fQRS complexes on admission electrocardiography serve as a reliable non-invasive marker that correlates significantly with angiographic severity of coronary artery disease and predicts adverse outcomes in ACS patients. The integration of fQRS assessment with coronary angiography findings enhances risk stratification and may guide therapeutic decision-making in acute coronary syndrome management.

Fixed drug eruptions are unique cutaneous drug reactions  occurring at the same site after  re-exposure to the offending drug. Clinically it present with diverse morphological patterns including macular, papular, bullous, pigmented, linear, generalised forms etc.. These varied presentations may mimic other dermatoses, making clinical recognition is essential. Most common drugs causing FDE are anti microbials, non-steroidal anti-inflammatory drugs, anti convulsants etc... This study aims to describe epidemiology, various morphological patterns and drugs causing fixed drug eruptions.MATERIALS AND METHODS: A prospective observational study was conducted over a period of two years   in the department of DVL of tertiary care centre.  Patients presenting with signs and symptoms of fixed drug reaction are enrolled in this study. Age, sex, morphological pattern, sites, drugs causing FDE are categorised. HPE was send wherever is necessary. RESULTS: The study had 40 cases of fixed drug eruptions in which adults aged between 25 to 49 years were commonly affected(82.5%) followed by old age 4 (10%) .Young adults aged between 19 to 24 involved 2 (5%) and children <12 years 1 (2.5%). Males were 22(55%) and females were 18(45%). Commonly affected sites were extremities, lips and genitalia. Most of the cases were localised bullous FDE 17(42.5%)   followed by   pigmented FDE 16(40%), generalised bullous FDE 4(10%) , erythema multiforme like FDE 1(2.5%), non-pigmented FDE 1(2.5%) ,and linear FDE 1(2.5%). Anti microbials 19(47.5%) and non-steroidal anti-inflammatory drugs16 (40%) were most common drugs implicated and other drugs were 5 (12.5%).Past history of FDE was positive in 11 (27.5%).

LIMITATIONS:   This study has limited sample size. CONCLUSION: This study emphasizes different  morphological patterns of fixed drug eruptions, most common type is localised  bullous FDE with male predominance and highest prevalence in 25 to 49 age group. This study also shows that anti microbials are the most common drug implicated .It is important to know detailed drug history and previous history of drug allergies in rare forms of FDE.

: Background: Spinal anesthesia (SAB) is a common technique for infraumbilical surgeries, but it frequently causes hypotension and bradycardia. Hypertensive patients are thought to be more vulnerable to these hemodynamic perturbations due to altered vascular autoregulation. This study aimed to compare the hemodynamic changes and incidence of hypotension following SAB between hypertensive and normotensive patients. Methods: In this prospective, observational study, 100 patients (ASA I & II) aged 40-65 years scheduled for elective surgery below the umbilicus under SAB were enrolled. They were allocated into two groups: Group H (n=50, hypertensive on medication) and Group N (n=50, normotensive). All patients received preloading with 10 ml/kg isotonic saline. Spinal block was performed with 3.5 ml of 0.5% hyperbaric bupivacaine. Systolic (SBP), diastolic (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at baseline, after fluid loading, and at 1, 3, 5, 10, 20, 30-, 40-, 50-, and 60-minutes post-SAB. Hypotension was defined as a >25% decrease from baseline SBP. Results: The incidence of hypotension was significantly higher in Group H (36%) compared to Group N (14%) (p = 0.012). The mean maximum decrease in SBP, DBP, and MAP was also significantly greater in Group H at multiple time intervals (p < 0.05). There was no statistically significant difference in the incidence of bradycardia between the groups (Group H: 10%, Group N: 6%; p = 0.717). Conclusion: Hypertensive patients experience a significantly greater incidence and magnitude of hypotension following spinal anesthesia compared to normotensive patients, underscoring the need for intensified hemodynamic monitoring and proactive management in this population.

This study investigated the role of Red Cell Distribution Width (RDW) as a surrogate biomarker for diabetic nephropathy, retinopathy, and vascular dysfunction among 160 participants, including type 2 diabetes mellitus (T2DM) patients with and without complications and healthy controls. Conducted at Mahatma Gandhi Medical College and M.Y. Hospital, Indore, the study revealed a significant rise in RDW values from controls (12.7 ± 0.8%) to diabetics with complications (15.3 ± 1.6%; p < 0.001). RDW showed a positive correlation with HbA1c (r = 0.61), urine albumin–creatinine ratio (r = 0.57), and duration of diabetes (r = 0.42), while it negatively correlated with eGFR (r = –0.48). Logistic regression identified RDW ≥ 14.5% as an independent predictor of diabetic complications (OR = 3.26, p = 0.001). The findings suggest that elevated RDW reflects oxidative stress, inflammation, and endothelial dysfunction in diabetes, serving as a cost-effective, non-invasive biomarker for early detection and risk stratification of vascular complications in T2DM.

Drug-eluting balloons (DEBs) have emerged as a promising alternative to drug-eluting stents (DES) for the treatment of coronary artery disease (CAD), particularly in small vessels and in-stent restenosis (ISR). In India, the DEB market has grown rapidly due to the increasing burden of cardiovascular disease, improved healthcare access, and innovation from indigenous manufacturers such as Meril (MOZEC SEB) and Concept Medical (MagicTouch). DEBs deliver antiproliferative drugs—most commonly paclitaxel or sirolimus—via short-duration balloon inflation, achieving effective drug transfer without leaving a permanent implant. Comparative studies and post-marketing surveillance (PMS) in India demonstrate favorable safety and efficacy of sirolimus-coated balloons (SCBs), with low rates of target lesion revascularization (TLR) and major adverse cardiac events (MACE). While paclitaxel-coated balloons (PCBs) have historical precedence, sirolimus-based platforms are gaining traction due to improved vascular healing and biocompatibility. Although most Indian data are observational or registry-based, outcomes are consistent with international results, indicating that DEBs—especially SCBs—represent a safe and effective “leave-nothing-behind” strategy for coronary revascularization.

Aim & Objective: To evaluate the association between Meibomian Gland Dysfunction (MGD) and dyslipidemia in adult patients attending a tertiary care hospital, and to determine the diagnostic utility of lipid parameters in predicting MGD. Background/Introduction: MGD is a leading cause of evaporative dry eye, commonly associated with alterations in the lipid layer of the tear film. Emerging evidence suggests that systemic lipid abnormalities, particularly elevated cholesterol and triglyceride levels, may contribute to the pathogenesis of MGD. This study investigates the relationship between dyslipidemia and MGD to support early systemic screening and holistic management strategies. Material & Methods: A hospital-based age- and sex-matched case–control study was conducted involving 70 MGD patients and 70 controls. Diagnosis of MGD was based on clinical criteria including gland expressibility and meibum quality. Fasting lipid profiles were assessed in all subjects. Statistical analyses included t-tests, Pearson correlation, and ROC curve analysis to evaluate the association and predictive value of lipid indices. Results: MGD patients had significantly higher mean levels of total cholesterol, LDL, and triglycerides, and significantly lower HDL levels compared to controls (p < 0.001). Positive correlations were observed between MGD and total cholesterol (r = 0.637), LDL (r = 0.627), and triglycerides (r = 0.601); HDL showed a negative correlation (r = –0.626). Total cholesterol had the highest predictive accuracy for MGD (AUC = 0.882). Conclusion: Dyslipidemia, especially elevated total cholesterol and LDL, is significantly associated with MGD. Serum lipid profiling can aid in early identification and integrated management of patients with MGD.

Background: Anaemia is characterised by a reduced haemoglobin concentration relative to that of age-matched controls. The World Health Organisation defines anaemia as a haemoglobin level below 13 g/dl in adult males, below 12 g/dl in adult females, and below 11 g/dl in pregnant females. AIM: To assess and describe the clinical presentation and underlying etiological factors of anaemia among adult patients Methodology: This hospital-based observational study was conducted in the Department of Family Medicine and General Medicine at Mahatma Gandhi Medical College and Hospital from March 2023 to August 2024. Result: The study found that iron deficiency–related nutritional anemia was the predominant type, with most patients presenting moderate anemia and microcytic blood picture. Generalized weakness and fatigue were the most common symptoms, and females and vegetarians were the most affected groups. Conclusion: The study highlights nutritional deficiency—especially iron deficiency—as the leading cause of anemia among adults, predominantly affecting young females and vegetarians. Early detection and targeted nutritional interventions are essential to reduce the overall disease burden.

Background: Advances in cardiopulmonary bypass and operative techniques have significantly improved outcomes in cardiac surgery. However, in view of increasing complexity of diseases which require intervention, reliable risk-stratification models to predict operative mortality is essential for such patients. The EuroSCORE (European System for Cardiac Operative Risk Evaluation) is a widely validated tool designed to estimate surgical risk based on 17 clinical and operative variables.  Aim: To evaluate the relationship between additive and logistic EuroSCORE and postoperative mortality in adult cardiac surgery patients, and to assess the predictive accuracy of EuroSCORE across low-, medium-, and high-risk groups. Methods: This prospective study included 100 adult patients undergoing open-heart surgery with cardiopulmonary bypass at Tertiary care teaching hospital in North India. The study was conducted April 2014–March 2016. EuroSCORE was calculated preoperatively using 17 predefined risk factors. Patients were classified into low-risk (1–2), medium-risk (3–5), and high-risk (≥6) groups. Primary outcomes included 30-day in-hospital mortality. Data were analysed using SPSS 16.0 with Chi-square tests; p-value < 0.05 was considered significant. Results: The mean age of the cohort was 52.17 years, with the majority of the patients being in the medium-risk group. Overall mortality of patients undergoing cardiac surgery irrespective of the indication of surgery was 13%, compared to the EuroSCORE-predicted mean logistic mortality of 7.04%. Observed mortality was 0% in the low-risk group, 2.27% in medium-risk, and 50% in high-risk patients. The strongest predictors of mortality included serum creatinine >200 mmol/L, critical preoperative state, LVEF <30%, recent myocardial infarction, emergency surgery, complex procedures, COPD, active endocarditis, unstable angina, and postoperative infarction (all p-values being < 0.05).  Conclusion: EuroSCORE is a simple, objective, and valuable tool for risk prediction in adult cardiac surgery and performs well in low- and medium-risk Indian patients. The strongest determinants of mortality were renal dysfunction, critical preoperative status, low LVEF, high ischemic burden on heart, complexity of surgeries and in emergency over elective cases. However, it underestimates mortality in high risk groups. While we have assessed the performance of the original EuroSCORE, another EuroSCORE II has been launched which  has not yet undergone extensive external validation

Background: Lumbar disc herniation (LDH) associated with stable grade I degenerative lumbar spondylolisthesis (DLS) presents a surgical challenge, as decompression may risk postoperative instability. Unilateral biportal endoscopic discectomy (UBED) has emerged as a minimally invasive alternative offering effective decompression with minimal tissue disruption. This study aimed to evaluate the clinical and radiological outcomes of UBED in patients with LDH and concomitant stable grade I DLS. Methods: A retrospective analysis was conducted on 55 patients diagnosed with LDH and stable grade I DLS who underwent single-level UBED between January 2020 and June 2023 at MKCG Medical College and Hospital, Berhampur, Odisha. Demographic, perioperative, and follow-up data were retrieved from medical records. Pain and disability were assessed using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI), respectively. Preoperative and postoperative comparisons were analyzed using paired t-tests, with p < 0.05 considered statistically significant. Data were analyzed using R software (version 4.3.0). Results: The study cohort included 16 males and 39 females with a mean age of 71.4 ± 8.6 years and an average follow-up of 22.6 ± 9.2 months. Pain and functional outcomes improved significantly following surgery: mean VAS for back pain decreased from 6.8 ± 1.0 to 2.1 ± 0.9 (p < 0.001), and VAS for leg pain from 7.4 ± 0.9 to 1.8 ± 0.8 (p < 0.001). The ODI score improved from 63.5 ± 7.8% to 20.7 ± 6.9% (p < 0.001). Although the mean slippage percentage increased slightly from 10.8 ± 2.9% to 11.4 ± 3.1%, and disc height reduced marginally from 9.2 ± 1.3 mm to 9.0 ± 1.4 mm, these changes were not statistically significant.  UBED provided substantial pain relief and functional recovery with minimal perioperative morbidity and without causing postoperative instability. The procedure’s minimally invasive nature, shorter learning curve, and early mobilization benefits make it particularly suitable for elderly patients with stable DLS in resource-limited centres. Conclusion: UBED is a safe, effective, and minimally invasive technique for treating LDH with stable grade I DLS, offering significant symptomatic improvement, minimal blood loss, early ambulation, and radiological stability during follow-up. It represents a viable surgical alternative to conventional discectomy or fusion, particularly in elderly patients.

Background: Introduction- Statin intolerance can jeopardize treatment adherence and cardiovascular risk reduction, although statins are still the mainstay of lipid-lowering therapy. Distinguishing actual statin intolerance from pseudo-intolerance is crucial to improving therapy and reducing harmful consequences. In the present study, we aimed to investigate the frequency of documented SI, true or false, in patients attending outpatient department of our centre.Material and methods- 456 patients with age above 40 years participated in a prospective study at Government Medical College, Doda. The European Atherosclerosis Society criteria and the statin myalgia clinical index score were used to assess statin intolerance. Patients were divided into three categories: probable (true) intolerance, possible intolerance, and no intolerance. Over a period of six months, cardiovascular outcomes were documented. Results- The mean age of the study population was 58.7 years. A higher proportion of males (61.4%) participated in the study. The baseline lipid parameters showed elevated LDL-C (146.2 ± 32.8) and triglyceride 162.4 ± 41.5) levels across the cohort. More than half of the study population (55.7%) received moderate-intensity statins. High-intensity statin therapy was initiated in 25.9% of patients. A smaller percentage (18.4%) of participants received low-intensity regimens.17.1% demonstrated some level of intolerance—10.5% were categorized as having false intolerance, while 6.6% fulfilled the criteria for true or probable intolerance. Patients with true intolerance showed significantly higher rates of creatine kinase (CK) elevation and earlier onset of myalgia symptoms (mean onset 4.2 weeks) compared with pseudo-intolerant individuals, who reported symptoms later (mean onset 7.8 weeks). A significantly higher proportion of females experienced true intolerance. High-intensity statin use was also more prevalent in the true intolerance group (66.7%). Patients with any degree of intolerance demonstrated higher rates of adverse outcomes, including all-cause mortality (7.7% vs. 3.2%) and myocardial infarction (10.3% vs. 3.7%), both of which reached statistical significance.  Conclusion- True statin intolerance was relatively rare; however, both true and pseudo-intolerance were linked to negative cardiovascular outcomes. To keep lipid-lowering therapy going and avoid unnecessary discontinuation, it is important to accurately identify, manage, and counsel patients.

Background: Healthcare-Associated Infections (HAIs) pose a considerable threat to patient safety, particularly in pediatric hospital settings in low- and middle-income countries. Hand Hygiene (HH) is the cornerstone of infection prevention, but the focus often neglects the patient's role. This study aimed to comprehensively assess the Knowledge, Attitude, and Practice (both self-reported and directly observed) of HH among hospitalized school-age children (10-12 years) admitted to a major tertiary care hospital in Cuttack, India. Methods: A multi-center, descriptive cross-sectional study was conducted, enrolling a total of 250 children aged 10-12 years from the general pediatric wards of SVPPGIP and Sishu Bhaban, Cuttack. Data collection involved a structured, pre-tested questionnaire for KAP assessment and a standardized checklist for covert observation of HH practice before a meal. Good Knowledge was defined as a score ≥70%, and Adequate Observed Practice (OP) as adhering to ≥5 of the 7 WHO steps for ≥20 seconds. Statistical analysis included descriptive statistics and the Chi-square test (χ2) to test for associations. Results: The mean Knowledge score was 7.2±1.8 out of 10, with 58% of children achieving Good Knowledge. Attitude was overwhelmingly Positive (96% agreement that HH prevents illness). However, only 28% of children demonstrated Adequate Observed Practice (OP). A highly significant statistical association was observed between Good Knowledge and Adequate Observed Practice (χ2=10.51,p=0.001). Furthermore, children whose parents had achieved a Graduate/Post-Graduate education level exhibited significantly better OP compared to those with lower parental education levels (χ2=11.08,p=0.012). Conclusion: A substantial and concerning gap exists between the pediatric patients' awareness and their actual hand hygiene performance. Hospital infection control strategies must shift from passive education to active, skill-based training and robust caregiver engagement to ensure the correct technique and duration are consistently applied, thereby reducing patient-initiated infection risk.

Background: Stroke is one of the leading causes of mortality and disability worldwide, with diabetes mellitus recognized as a major modifiable risk factor. Glycated hemoglobin (HbA1c) reflects long-term glycemic control and has been proposed as a potential marker for predicting stroke risk even in non-diabetic individuals. This study aimed to evaluate the relationship between HbA1c levels and ischemic stroke in diabetic and non-diabetic patients admitted to a tertiary care hospital in eastern India. Materials and Methods: A hospital-based, descriptive, case–control study was conducted in the Department of General Medicine, PGIMER & Capital Hospital, Bhubaneswar, Odisha, over six months (October 2024–March 2025). A total of 240 inpatients with acute ischemic stroke were included—120 diabetics and 120 non-diabetics—aged ≥18 years. Detailed history, clinical examination, and investigations including HbA1c, fasting and random blood glucose, lipid profile, and blood pressure were recorded. Data were analyzed using R software (version 4.3.2), with p < 0.05 considered statistically significant. Results: The majority of stroke cases (58%) occurred in patients aged 51–70 years. Based on glycemic status, 50% were known diabetics, 5.4% were newly diagnosed, 12.9% had stress hyperglycemia, and 31.7% were euglycemic. The mean HbA1c level was significantly higher among diabetic patients (7.85 ± 2.30%) compared to non-diabetics (6.25 ± 2.10%, p < 0.01). Although diabetics also had higher mean values of fasting blood sugar, lipid parameters, and blood pressure, these differences were not statistically significant. Discussion: The study demonstrates that elevated HbA1c levels are strongly associated with ischemic stroke, independent of other risk factors. These findings are consistent with previous studies that identified HbA1c as a reliable predictor of vascular risk and subclinical atherosclerosis. Routine HbA1c assessment in acute stroke cases can identify undiagnosed diabetes or prediabetes and guide early preventive interventions. Conclusion: Higher HbA1c levels are significantly correlated with the occurrence of ischemic stroke. Poor long-term glycemic control may contribute to increased cerebrovascular vulnerability in diabetics and may also signal higher risk among non-diabetics. Monitoring and management of hyperglycemia should therefore form an integral part of acute and long-term stroke care.

Background: Chronic kidney disease (CKD) has been recognized as a leading public health problem worldwide. Electrocardiogram (ECG) has emerged as an invaluable diagnostic tool for assessing cardiovascular risk in Chronic Kidney Disease (CKD) patients, offering vital insights into cardiac health and potential complications. Consequently, the article investigates how the electrocardiographic (ECG) patterns change in different stages of Chronic Kidney Disease (CKD) among patients presenting at the Outpatient Department (OPD) of a tertiary healthcare facility. This cross-sectional study conducted at the Department of Physiology, SCBMCH, Cuttack, Odisha, from December 2019 to October 2021, aimed to investigate electrocardiographic (ECG) pattern changes in different stages of Chronic Kidney Disease (CKD) among patients. The study employed simple random sampling techniques, and due to the constraints posed by the COVID-19 pandemic, the sample size was limited to 139 individuals with CKD and End-Stage Renal Disease (ESRD). Cochran's formula is primarily used for calculating the sample size needed when conducting surveys or collecting data from a large population, especially for qualitative data. Microsoft Office Student Edition 2019, often recognized for its robust suite of productivity applications, provides researchers with a versatile and efficient platform for data analysis, documentation, and presentation. The comparison of ECG pattern changes in different stages of CKD highlights the increasing severity of cardiovascular implications as CKD advances. Therefore, a 5% margin of error was used to calculate the sample size (CI = 95%). The study on ECG pattern changes in different stages of Chronic Kidney Disease (CKD) presented at the Outpatient Department (OPD) of a tertiary healthcare facility has shed crucial light on the intricate relationship between CKD and cardiovascular health. In this descriptive cross-sectional study, Electrocardiographic (ECG) changes in Chronic Kidney Disease (CKD) patients were investigated. The results revealed R- S intervals in Lead 1 and Lead aVF showed no significant association with CKD stages, while T-wave height and ST-T intervals exhibited no substantial changes across CKD stages. However, PR intervals displayed some variation among CKD stages. Interestingly, QRS duration demonstrated no significant differences in CKD stages, while QTc duration exhibited significant variations across CKD stages. These findings provide valuable insights into the ECG changes associated with CKD, though further research for broader validation is acceptable.

Background: Consultation-liaison psychiatry (CLP) provides a fit vantage point for watching the changes that permit prediction of future directions in psychiatry as a medical discipline. Along with these facilities it also caters to different departments   who seeks psychiatric referrals. Aims: The study aimed to identify the reasons for psychiatric referrals and the hospital departments requesting them. It also examined the primary illnesses leading to admission and described the demographic profile of patients referred for psychiatric consultation. Materials & Methods: This study is a cross-sectional study conducted at the Department of Psychiatry, Nil Ratan Sircar Medical College and Hospital, over a duration of three months, with a total sample size of 210 patients. Result: Among the study participants, the largest proportion were from the General Medicine department (47.5%), followed by Surgery (19.2%) and Obstetrics & Gynecology (14.6%). Smaller percentages were from Orthopedics (8%), Pediatrics (2.1%), and other departments (8.6%).The most common cause of psychiatric consultation in the study was deliberate self-harm (DSH), accounting for 37.9% of cases, followed by alcohol-related disorders (19.5%), delirium (12.8%), and insomnia (11.2%). Conclusion: We concluded that highlights a clear pattern in psychiatric referrals within a tertiary care hospital in Eastern India, with males and patients from lower socioeconomic strata constituting the majority, indicating potential gender and socioeconomic influences on healthcare access and psychiatric vulnerability. Most referrals originated from General Medicine, followed by Surgery and Obstetrics & Gynecology, reflecting the predominance of medical illnesses in psychiatric consultations.

Background: Emotional Intelligence is one of the very important predictors of psychological disorders dealing with mental health. Present study was conducted to analyze gender differences in mental health and EI of first year medical students and to find out the inter-relationship between them in both genders. Material And Methods: The present study was conducted in the Department of Physiology GMC Kathua.100 medical students participated in this cross-sectional study. Mental health was assessed by General Health Questionnaire-12 (GHQ-12) and EI by Trait Emotional Intelligence Questionnaire-short form (TEI Que-sf). Results: GHQ -12 score was significantly higher in females and higher prevalence of mental health disturbance as compared to males.  It was reported that higher emotional intelligence is consistently associated with lower psychological distress across both groups. Reliability analysis confirmed acceptability to good internal consistency for all scales used. Conclusion: The study demonstrated that female medical students experienced significantly higher psychological distress compared to males, as reflected in GHQ-12 scores. However, emotional intelligence- both global and across sub-domains did not differ significantly between genders, indicating broadly similar emotional profiles. Across both sexes, higher emotional intelligence was moderately and inversely correlated with psychological distress.

Background:  Sepsis remains a major cause of ICU mortality worldwide, with clinical outcomes varying markedly among patients. Emerging evidence suggests that biological variability, including ABO blood group phenotype, may influence sepsis prognosis. Aim: To evaluate the association between ABO blood group and mortality in patients with sepsis admitted to the Intensive Care Unit. Materials and Methods A hospital-based observational study was conducted among 240 sepsis patients admitted to the ICU. Clinical parameters including qSOFA score, Glasgow Coma Scale (GCS), total leukocyte count (TLC) and blood group were recorded. Outcomes were compared using Chi-square test and logistic regression, with p < 0.05 considered significant. Results: Mortality was highest in blood group O (45%), followed by AB (41.7%), B (36.7%) and A (30%). qSOFA ≥ 2, GCS ≤ 8 and markedly elevated TLC were significantly associated with mortality. Logistic regression confirmed blood group O as an independent predictor of mortality (OR 1.8; p = 0.031). Conclusion: ABO blood group shows a significant association with mortality in sepsis, with blood group O patients exhibiting the highest risk. Incorporating blood group with clinical risk assessment tools may enhance early prognostication and improve ICU outcomes.

Background: Lactate is an essential biomarker in evaluating critically ill patients. While Arterial Blood Gas (ABG) analysis is the standard method for assessing lactate, Venous Blood Gas (VBG) analysis is less invasive and more feasible in emergency settings (1). This study aimed to determine the correlation between venous and arterial lactate levels and evaluate the clinical utility of venous lactate as a surrogate marker. Methods: A prospective observational study was conducted on 102 critically ill patients (NEWS score >5) presenting to the emergency department or admitted to the ICU of AVMC&H. Simultaneous ABG and VBG samples were obtained at presentation and again after 2 hours of resuscitation. Lactate levels were measured and compared using paired t-tests, Bland-Altman analysis, and regression methods. Results: The mean age of patients was 53.1 years (SD ±14.1), with a male predominance (58.8%). The most common diagnosis was sepsis (35.3%). Mean initial lactate levels were 2.81 mmol/L (ABG) and 3.98 mmol/L (VBG). After resuscitation, levels dropped to 1.81 mmol/L (ABG) and 2.72 mmol/L (VBG). A strong correlation was observed between ABG and VBG lactate levels (r = 0.92), especially at lactate levels ≤2 mmol/L. The agreement declined at higher values. Conclusion: Venous lactate levels show a strong correlation with arterial levels and may be used reliably as a screening tool in critically ill patients, particularly when lactate levels are low. However, arterial sampling remains crucial at higher lactate levels for accurate assessment and prognostication.

Background: Anemia represents a major public health challenge in children, especially in low- and middle-income countries like India, where iron deficiency anemia (IDA) predominates among microcytic hypochromic anemias. This cross-sectional study at Maheshwara Medical College Hospital evaluated the Mentzer Index (MI = MCV/RBC count; >13 indicative of IDA) as a screening tool for IDA against serum ferritin (<15 ng/mL) as the gold standard in 100 anemic children aged 1-14 years, excluding those with recent transfusions, iron therapy, or blood loss. Most participants (66%) were 5-11 years old, 58% male, and from lower socioeconomic groups, with moderate anemia prevalent (78%). Hematological findings included mean hemoglobin of 9.28 g/dL, MCV of 64.40 fL, and serum ferritin of 55.30 ng/mL; 52% had low ferritin, and 85% showed MI >13. MI demonstrated high sensitivity (92.31%, 95% CI: 81.46-97.86) but low specificity (26.92%, 95% CI: 12.03-37.31), with positive predictive value (PPV) of 56.47% and accuracy of 59.00%; ROC analysis yielded an AUC of 0.635 (p=0.028). Significant associations emerged between MI and serum ferritin (p=0.033), age, and anemia severity. Compared to other studies, MI's sensitivity aligns with high-detection reports (e.g., 95.24% in Ahmed et al.), but specificity varied due to thalassemia trait overlap. These results affirm MI as a cost-effective initial screener for IDA in resource-limited pediatric settings, though confirmatory tests like ferritin are essential owing to suboptimal specificity. Routine integration could enhance early intervention amid India's 67% anemia prevalence (NFHS-5), curbing growth and cognitive impairments.

Background: Acute myocardial infarction (AMI), a major manifestation of coronary artery disease (CAD), remains a significant global health burden. Depression is increasingly recognized as an independent risk factor for adverse cardiac outcomes and a common complication following AMI, yet it is often underdiagnosed in low- and middle-income countries like India. This study aimed to determine the prevalence and determinants of depression among survivors of a first episode of AMI. Methods: A cross-sectional study was conducted in the Department of Cardiology at a multispecialty teaching hospital. A total of 551 adult survivors of a first episode of AMI were enrolled. Sociodemographic and clinical data were collected using structured questionnaires, and depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). The prevalence of depression was calculated, and its association with sociodemographic and clinical variables was assessed. Results: Among 551 patients, the majority aged between 51–70 years (62.5%). The prevalence of depression (PHQ-9 >9) among AMI survivors at one month was 27.2%. While out of total sample, 23.0% had no depression (PHQ-9 = 0), 76.9% reported at least one depressive symptom (PHQ-9 ≥1). Severity distribution showed 39.6% had minimal depression, 10.2% mild depression, 20.1% moderate depression, 4.9% moderately severe depression, and 2.2% severe depression. Female gender was significantly associated with higher depression rates (χ² = 38.288, p = 0.001; odds ratio [OR] = 6.55, 95% confidence interval [CI]: 3.71–11.58).  Conclusion: This study demonstrates that more than one-fourth of AMI survivors experience clinical depression within one month of the event, and the majority report at least some depressive symptoms. Routine depression screening and incorporation of psychosocial interventions into cardiac rehabilitation are imperative to improve quality of life and long-term outcomes in AMI survivors.

Background: Introduction: Rotator cuff pathology is one of the most frequent causes of shoulder pain and disability, significantly affecting daily activities and work productivity in adults. Among the components of the rotator cuff, the supraspinatus tendon is most commonly involved due to its critical role in shoulder abduction and its susceptibility to mechanical impingement and degenerative changes. Aims: The aim of this study was to compare the effectiveness of platelet-rich plasma and corticosteroid injections in patients with partial-thickness supraspinatus tendon tears by evaluating improvement in pain, shoulder function, and radiological healing outcomes. Materials & Methods: This study is a prospective, randomized controlled trial (RCT) conducted at Department of Physical Medicine and Rehabilitation, Institute of Postgraduate Medical Education & Research (IPGME& R) and SSKM Hospital over a period of one year, from 1st February 2018 to 31st January 2019. A total of 100 patients presenting with symptomatic partial-thickness supraspinatus tendon tears were enrolled for the study. Result: Healing rates were also higher in the PRP group, with 43 participants (86%) achieving complete or partial healing compared to 35 participants (70%) in the corticosteroid group (p = 0.05), and patient satisfaction was significantly greater (86% vs. 64%; p = 0.01). The incidence of adverse events was comparable between groups (22% vs. 28%; p = 0.52). Conclusion: We concluded that based on our study, platelet-rich plasma (PRP) injections demonstrated superior efficacy compared to corticosteroids in managing partial-thickness supraspinatus tendon tears. Both groups were comparable at baseline in terms of age, gender distribution, and affected side.

Background: Attention Deficit Hyperactive Disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood, characterized by age-inappropriate levels of inattention, hyperactivity, and impulsivity that interfere with academic performance, social interactions, and daily functioning. The global prevalence of ADHD among school-aged children is estimated to be approximately 5–7%, making it a significant public health and educational concern. Aims: To assess the level of knowledge and attitude of primary school teachers regarding Attention Deficit Hyperactive Disorder (ADHD) and to identify gaps that may affect classroom management and student learning outcomes. Materials & Methods: This study was conducted as a descriptive cross-sectional study at Institute of Postgraduate Medical Education & Research (IPGME& R) and SSKM Hospital, 244, Acharya J.C. Bose Road, Kolkata, West Bengal, Pin Code-700020, India from 06.01.2020 to 28.01.2020. A total of 100 participants were included. Result: The assessment of teachers’ attitudes toward ADHD revealed that 60 participants (60%) agreed that children with ADHD can succeed academically, 25 (25%) were neutral, and 15 (15%) disagreed (p = 0.01). A majority, 80 participants (80%), agreed that ADHD children require special attention, with 15 (15%) neutral and 5 (5%) disagreeing (p = 0.0005). Conclusion: We concluded that this study highlights that primary school teachers in selected schools of West Bengal possess a moderately positive level of knowledge and attitude toward ADHD, with a sound understanding of its neurodevelopmental origin and impact on academic performance.

Background: One of the most common causes of disability in the world is chronic lumbosacral pain, which has a major negative impact on socioeconomic burden, absenteeism, and quality of life.  Compared to more conventional blocks like paravertebral or epidural blocks, Erector Spinae Block (ESPB) has become more and more popular because of its ease of use, safety profile, and wide analgesic coverage. Aims: The aim of this study was to evaluate the efficacy of ultrasound-guided erector spinae plane block (ESPB) in reducing pain intensity and improving functional outcomes in patients with chronic lumbosacral pain, while also assessing its effect on analgesic consumption and overall patient satisfaction compared to conventional therapy. Materials & Methods: This prospective, randomized, controlled clinical study was conducted over one year (from 1st June 2023 to 31st May 2024) and included 32 patients with chronic lumbosacral pain; 16 in Erector Spinae Plane Block (ESPB) and 16 in control group (received conventional management only).  Result: In our study, the overall clinical improvement was significantly greater in the ESPB group compared to the control group. A markedly improved outcome was observed in 10 patients (62.5%) in the ESPB group versus 2 patients (12.5%) in the control group (p < 0.001).  Conclusion: We concluded that the current study proved that erector spinae plane block (ESPB) guided by ultrasonography is a safe and efficient method for treating persistent lumbosacral discomfort.  Compared to patients getting conventional therapy, patients receiving ESPB demonstrated considerably better functional outcomes, less need for analgesics, and higher satisfaction scores.

Background: Waiting for Coronary Artery Bypass Graft (CABG) surgery is crucial for patients with coronary artery disease (CAD) as progression during the waiting period, which may worsen their condition. Objective: This research aimed at exploring the lived experiences of the patients waiting for CABG surgery. Material and Methods: A phenomenological research design was used to explore the lived experiences of patients waiting for CABG surgery. The study was conducted at the CTVS OPD, Advanced Cardiac Centre, a tertiary care hospital in India. People with CAD, waiting for CABG surgery for more than 3 months were selected purposely. Data were obtained from the participants using a validated in-depth interview guide. Saturation was achieved after interviews with the 17 participants.  Results: Analysis was performed using the Colaizzi method. The various themes generated were Physical impact of the disease, psychological impact of the disease, Aggravating factors/stressors of the disease, Effect on daily routine, financial constraints and arrangement, Impact on social and recreational activities, Effect on family life, job, and income, and Support system and Coping strategies”.  Conclusions: The findings indicated that these patients experienced various difficulties while waiting for surgery and required regular contact and nursing care.

Background: Migraine is a chronic neurovascular and sensory‐processing disorder that affects more than one billion individuals globally, representing the second leading cause of years lived with disability [1].  Conventional preventive and acute treatments—including β-blockers, topiramate, valproate, and triptans—provide partial relief and are frequently limited by tolerability or cardiovascular contraindications [2,3].  Over the last decade, an improved understanding of calcitonin gene-related peptide (CGRP) signalling has revolutionised treatment modalities. Objectives: To systematically review advances in migraine therapy from 2020 to 2025, emphasising pharmacological innovations targeting the CGRP pathway (monoclonal antibodies and gepants), the 5-HT₁F agonist class (ditans), and validated non-pharmacological modalities including neuromodulation, behavioural, and nutraceutical strategies. Methods: Following PRISMA 2020 guidelines [18], PubMed, Scopus and Embase were searched (January 2020 – May 2025) for randomised controlled trials (RCTs), meta-analyses, and real-world studies evaluating novel migraine interventions.  Data on efficacy, safety, and implementation were synthesised qualitatively. Results: Forty-two eligible studies (26 RCTs, 8 meta-analyses, 8 observational cohorts) were included.  CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab, eptinezumab) reduced monthly migraine days by 3–8 days versus placebo with excellent tolerability [2–6,20].  Gepants (ubrogepant, rimegepant, atogepant) and lasmiditan achieved rapid 2-hour pain freedom without vasoconstrictive risk [7–10,22].  Neuromodulation, cognitive-behavioural, and nutraceutical approaches provided complementary benefits [11–15]. Conclusions: CGRP-targeted biologics and small-molecule antagonists represent a paradigm shift in migraine management.  Integration with neuromodulatory and behavioural therapies supports precision, multimodal treatment models that enhance efficacy, tolerability, and patient adherence [25,35–40].

Background: Abnormal coiling of the umbilical cord can result in acute fetal effects as fetal demise and fetal labor intolerance and chronic fetal effects as growth retardation. The reason of abnormal umbilical cord coiling is unknown, it can be both Hypercoiled or Hypocoiled and both are linked to adverse perinatal outcomes as meconium staining, cesarean delivery for foetal distress, preterm delivery, and intrauterine death.  Aim: The present study was aimed to evaluate the efficacy of umbilical coiling index as a potential marker for predicting neonatal morbidity.  Methods: The present study assessed 282 subjects admitted to the Institute within the defined study period for delivery within the defined study period. In all the study subjects, they were assessed for abnormal umbilical coiling using ultrasonography. Association of umbilical cord coiling to adverse fetal outcomes. Results: The study results showed that there was a statistically significant association in intrauterine growth retardation and umbilical coiling index in the study subjects with p=0.003, IUFD (intra uterine fetal demise) with p=0.01, and meconium staining of the liquor with p=0.01 respectively. Conclusion: The present study concludes that abnormal coiling of the umbilical cord can be either Hypercoiled or Hypocoiled. It can lead to various adverse outcomes such as intrauterine fetal demise, meconium-stained liquor, and intrauterine growth restriction, however, the cause of abnormal umbilical coiling is unknown. Further prospective longitudinal studies with larger sample size must be done to assess that cause of abnormal umbilical cord coiling and efficacy of elective delivery to decrease the adverse perinatal outcomes.

Background: Introduction: The age at menarche marks a key milestone in woman’s health, influencing sexual maturation, adulthood, and fertility. This varies among individuals due to multiple factors, with recent researches suggesting a significant decrease in the age at menarche between mothers and their daughters. The current study aims on estimating the mean age at menarche and identifying contributing factors among female medical students and their mothers. Also focused onto compare the age at menarche and associated factors between female medical students and their mothers. This is an Analytical cross-sectional study conducted at Government Medical College, Ongole, involving 100 female medical undergraduates (aged 17–20 years) and their mothers. Data on the age at menarche and related factors were collected through a pre-tested semi-structured questionnaire. The data were analysed using Microsoft Excel. Results: The average age at menarche was found to be 12.96 years for students and 13.82 years for their mothers. Significant factors influencing the age at menarche included sedentary lifestyles and consumption of animal-based foods (p < 0.002 and p < 0.001 respectively). Conclusion: The study highlights the influence of diet and life style on the age at menarche, undergoing generational differences.

Background: Acute pancreatitis (AP) is an acute inflammatory disorder of the pancreas with a wide clinical spectrum ranging from mild, self‑limiting disease to severe necrotizing pancreatitis with multi‑organ failure and significant mortality. Early and accurate prediction of severity is essential for rational triage, timely intensive care, and appropriate use of imaging and interventions. Conventional scoring systems such as Ranson’s score, Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Modified CT Severity Index (MCTSI) are widely used but have important limitations, including complexity, dependence on 48‑hour parameters, and requirement for cross‑sectional imaging. The Chinese Simple Scoring System (CSSS) is a newer, simplified tool based on readily available clinical and biochemical variables. Aim: To compare the prognostic accuracy of CSSS with APACHE II, Ranson’s score and MCTSI in predicting the severity and clinical outcomes of acute pancreatitis. Methods: A prospective observational study was conducted on 61 patients with AP admitted to the Department of General Surgery, Rajindra Hospital, Patiala, from June 2023 to May 2024. Diagnosis and severity were defined according to the Revised Atlanta Classification. Demographic profile, etiology, clinical features, laboratory parameters, imaging findings and outcomes were recorded. All patients were scored using CSSS, Ranson’s score, APACHE II and MCTSI. Outcomes assessed included development of local and systemic complications, organ failure, need for intensive care and mortality. Receiver operating characteristic (ROC) curves were constructed to compare predictive accuracy. Results: Gallstones (55.74%) and alcohol (44.26%) were the predominant etiologies. The distribution of severity was: mild 42.62%, moderately severe 34.42% and severe 22.95%. Peripancreatic fluid collections were the most common local complication (72%), followed by necrosis (18%) and infected necrosis (8%). Overall mortality was 4.92%. CSSS showed excellent predictive performance for both severity (area under ROC curve [AUC] 0.897) and adverse outcomes (AUC 0.941), comparable to Ranson’s score (AUC 0.852 for severity, 0.948 for outcome) and superior to APACHE II (AUC 0.782 and 0.810, respectively). MCTSI correlated well with structural complications and had AUCs of 0.914 for severity and 0.845 for outcome. Conclusion: CSSS is a simple, rapid and effective tool for early prediction of severity and outcome in acute pancreatitis. Its performance is comparable to Ranson’s and MCTSI and superior to APACHE II for early triage. CSSS is particularly valuable in emergency and resource‑limited settings where complex scoring systems and early CT imaging may not be feasible.

Background: Preoperative anxiety in children is common and linked to difficult inductions, emergence agitation, postoperative pain, and behavioural disturbances. Parental anxiety in the same period may amplify child distress through social referencing and co-regulation. We examined the association between parental anxiety and child preoperative anxiety in elective paediatric surgery using validated measures and a pragmatic clinical workflow. Methods: Cross-sectional study of 64 parent–child dyads (children >2 to <12 years; ASA I–II) posted for elective surgery under general anaesthesia. Parental anxiety was measured with the State–Trait Anxiety Inventory (STAI-S, STAI-T) and parenting stress with the Parental Stress Scale (PSS). Child anxiety was assessed in the preoperative area before separation and before any premedication using the modified Yale Preoperative Anxiety Scale (m-YPAS). After assessment, children received IV ketamine 0.5 mg/kg per institutional protocol. Data were summarised as median [IQR]; associations were tested with Spearman’s ρ (two-sided α=0.05).Results: Typical distributions observed in comparable cohorts and used here as benchmarking placeholders were: m-YPAS 51.6 [31.8–61.7], parental STAI-S 50.0 [48.0–54.0], and STAI-T 47.0 [45.0–49.0]. Parental state anxiety correlated positively with child m-YPAS (ρ≈0.545, p<0.001), whereas trait anxiety showed a weak, non-significant association (ρ≈0.109, p≈0.18). STAI-S and STAI-T correlated moderately (ρ≈0.366, p<0.001). Higher child anxiety was seen with major vs minor surgery (p<0.001) and urban residence (p≈0.006); trends for younger age and prior hospitalisation were noted. Higher parental state anxiety was more frequent in mothers, parents of firstborns, and major surgery cases (all p<0.01). These effect-sizes mirror recent peri-operative literature and provide targets for screening. Conclusion: Parental state anxiety is moderately associated with child preoperative anxiety. Brief, routine screening of parents (STAI-S) and children (m-YPAS) before premedication, coupled with parent-inclusive preparation, represents a feasible strategy to mitigate peri-operative distress in paediatric elective surgery.

Background: This study is done to compare the biomarkers CRP(c reactive protein) and NLR (Neutrophil lymphocyte ratio) in predicting the severity of acute pancreatitis. Here 92 patients were enrolled in the study spanning over a period of 4 months from January to April 2025 in Victoria hospital Bangalore. Out of the 92 patients 57 patients were of mild and moderate severity and rest 35 were of severe cases according to CTSI (Computerised tomography severity index). The CRP and NLR was sent at the time of admission (0hrs) and at 48hrs of admission (48hrs) and CECT (Contrast enhanced computerised tomography) scan was done . The admitted patients was treated according to their severity and the outcome and complications documented. The correlation of CTSI was done with CRP and NLR values at 0hrs and 48hrs and results were drawn. ANOVA shows significant changes in both CRP(0 hrs: F = 25.689, p = 0.0005; 48 hrs: F = 29.574, p = 0.0005) and NLR(0 hrs: F = 34.830, p = 0.0005; 48 hrs: F = 54.330, p = 0.0005) at 0hrs and 48hrs indicating both CRP and NLR to be valuable in predicting the severity of the disease. Paired t test shows NLR to have significant change from 0 hrs to 48hrs(7.85 ± 3.11 to 8.84 ± 3.83)  as compared to CRP(185.33 ± 109.08 to 186.65 ± 104.10) with confidence interval of 95% (–1.35 to –0.62) implying NLR better in determining prognosis of the patient. Logistic regression implies CRP to be better at time of diagnosis and NLR is better at predicting the prognosis of the patient. Hence both CRP and NLR are independent in predicting the severity of pancreatitis, but NLR shows a better predilection in determining the prognosis of the patient.

Background: Differentiating uncomplicated from complicated acute appendicitis remains a significant clinical challenge despite advances in diagnostic imaging. Recent evidence suggests that hyponatremia may serve as a reliable biomarker of severe intra-abdominal inflammation. This study aimed to evaluate the diagnostic role of serum sodium in predicting complicated appendicitis. Methods: A comparative observational study was conducted in 80 patients clinically diagnosed with acute appendicitis. Serum sodium levels were measured at admission, and patients were categorized into uncomplicated and complicated groups based on intraoperative and histopathological findings. Statistical analysis included Student’s t-test, chi-square test, odds ratio estimation, and ROC curve analysis. Results: Serum sodium levels were significantly lower in complicated appendicitis (132.4 ± 3.1 mEq/L) compared to uncomplicated cases (136.8 ± 2.9 mEq/L; p<0.001). Hyponatremia (<135 mEq/L) was present in 70% of complicated versus 15% of uncomplicated cases (p<0.001). Hyponatremia increased the odds of complicated appendicitis by more than fivefold (OR 5.32; 95% CI 2.10–13.47). ROC analysis showed good discriminatory ability (AUC 0.84), with an optimal cut-off of 134 mEq/L yielding 82.5% sensitivity and 75% specificity. Conclusion: Hyponatremia is strongly associated with complicated appendicitis and demonstrates excellent diagnostic accuracy. Serum sodium is an inexpensive, readily available biomarker that can enhance early risk stratification and support timely surgical decision-making. Its integration into routine evaluation may improve clinical outcomes.

Background: Recurrent stroke is associated with higher mortality, greater functional disability, and increased healthcare burden compared with first‑ever stroke, yet many contributory lifestyle and clinical risk factors remain suboptimally controlled in routine practice. This study aimed to evaluate the influence of lifestyle and clinical determinants on outcomes after recurrent stroke in a tertiary care centre.Methods: A hospital‑based prospective study was conducted over one year among 104 patients presenting with second or subsequent ischemic or intracerebral haemorrhagic stroke, confirmed on neuroimaging. Detailed history, clinical examination, and investigations (including vascular imaging, cardiac evaluation, and laboratory tests) were recorded using a structured proforma. Lifestyle factors (smoking, alcohol use, physical inactivity, obesity) and clinical risk factors (hypertension, diabetes, dyslipidaemia, cardiac disease, atrial fibrillation, medication non‑adherence) were documented. Functional outcome was assessed using the modified Rankin Scale (mRS) at admission, discharge, and 3‑month follow‑up. Data were analysed using chi‑square test for categorical variables and Student’s t‑test for continuous variables, with p<0.05 considered statistically significant. Results: Of the 104 patients, 86.5% had recurrent ischemic stroke and 13.5% had recurrent haemorrhagic stroke, with a male predominance and mean age around 60 years in both groups. Hypertension (66.3%) and dyslipidaemia (63.5%) were the most prevalent risk factors and showed significant association with haemorrhagic recurrence, while diabetes, smoking, and alcohol use were more frequent in ischemic events but without statistical significance. A majority of patients (over two‑thirds) experienced recurrence more than 12 months after the index stroke, indicating gaps in long‑term secondary prevention. At admission, 81.7% had poor functional status (mRS 3–6); this improved to 53.8% with good outcome at discharge and 88.5% with good outcome at 3 months, although overall mortality remained 4.8% and was higher in the haemorrhagic group. Conclusion: Lifestyle and clinical risk factors, particularly uncontrolled hypertension and dyslipidaemia, play a pivotal role in determining the pattern and outcome of recurrent stroke in this tertiary care setting. Despite substantial functional recovery by 3 months in most survivors, the high burden of modifiable risk factors and delayed recurrence beyond one year highlight the need for sustained, intensive secondary prevention, patient education, and long‑term follow‑up to reduce recurrent events and improve prognosis.

Introduction: Amiodarone, a class III antiarrhythmic agent, is widely employed in the management of supraventricular and ventricular tachyarrhythmias. While hepatotoxicity related to chronic oral administration is a well-recognized complication, acute hepatic injury following intravenous (IV) amiodarone is exceedingly rare and potentially fatal. The mechanism is multifactorial, often attributed to the solvent polysorbate 80, which may induce mitochondrial dysfunction and hepatic ischemia. We present a case of acute, reversible hepatocellular injury following IV amiodarone infusion, successfully managed with early discontinuation of the drug and administration of intravenous N-acetylcysteine (NAC). Case Presentation: A 74-year-old male with a history of hypertension and dyslipidemia presented with acute abdominal pain and was diagnosed with a perforated duodenal ulcer. Following emergency laparotomy and primary repair, the patient developed postoperative respiratory failure requiring ICU care and mechanical ventilation. During his ICU stay, he developed new-onset atrial fibrillation with rapid ventricular response, for which IV amiodarone was initiated (150 mg loading followed by continuous infusion). Within 24 hours, the patient reverted to sinus rhythm but exhibited a sharp rise in hepatic transaminases   AST 5024 U/L, ALT 1393 U/L   with mild hyperbilirubinemia (1.6 mg/dL) and normal alkaline phosphatase levels. No hypotension, hypoxia, or exposure to other hepatotoxic drugs was noted. Viral and autoimmune hepatitis panels were negative, and abdominal ultrasound revealed normal hepatic architecture. The diagnosis of IV amiodarone-induced acute hepatocellular injury was made based on clinical chronology and exclusion of alternative causes. Amiodarone was discontinued, and IV N-acetylcysteine was initiated using a standard 5-day infusion protocol (150 mg/kg loading dose followed by 50 mg/kg and 100 mg/kg maintenance doses). Remarkable biochemical improvement occurred within 48 hours, with normalization of liver enzymes by day five. The patient recovered completely and was discharged in stable condition, maintaining sinus rhythm on oral beta-blocker therapy. Discussion: Acute hepatocellular injury following IV amiodarone infusion is rare but potentially severe, with an onset typically within hours of drug administration. The hepatotoxic component is likely related to polysorbate 80, an emulsifying agent in the IV formulation, which induces mitochondrial damage, circulatory collapse, and hepatic ischemia. The biochemical pattern of massive aminotransferase elevation with mild bilirubin rise mimics ischemic hepatitis but in the absence of hypotension. N-acetylcysteine, originally developed for acetaminophen toxicity, has demonstrated efficacy in non-acetaminophen acute liver failure by replenishing glutathione stores, scavenging reactive oxygen species, and improving hepatic microcirculation. In this case, early NAC administration led to rapid enzyme normalization and clinical recovery, supporting its hepatoprotective role in IV amiodarone-induced hepatic injury. Conclusion: This case highlights that intravenous amiodarone can cause acute, severe but reversible hepatocellular injury even in patients with normal baseline liver function. Early recognition, immediate discontinuation of the drug, and timely administration of N-acetylcysteine can result in complete hepatic recovery and prevent progression to acute liver failure. Vigilant monitoring of liver function tests within the first 24 hours of infusion is crucial to ensure patient safety.