European Journal of Cardiovascular Medicine

Background: Pediatric poisoning remains a significant but underreported public health problem in low-income urban settlements. Children living in urban slums are disproportionately exposed to hazardous household substances due to overcrowding, unsafe storage practices, and limited caregiver awareness. Objectives To describe the epidemiological and forensic profile of pediatric poisoning cases in urban slums and to identify household-level risk factors associated with poisoning events. Methods A mixed-methods study was conducted comprising a retrospective forensic case series of pediatric poisoning deaths and a cross-sectional household risk-factor survey in selected urban slum communities. Forensic records were reviewed to document demographic characteristics, toxic agents involved, and manner of poisoning. A structured household questionnaire assessed storage practices, caregiver knowledge, and environmental risks. Results The majority of poisoning incidents occurred in children under five years of age and were accidental in nature. Common toxic agents included kerosene, household cleaning chemicals, pesticides, and pharmaceutical products. Unsafe storage practices, low caregiver literacy, and absence of child-resistant containers were significantly associated with poisoning risk. Conclusions Pediatric poisoning in urban slums is largely preventable and driven by modifiable household risk factors. Integrating community education, safer packaging, and regulatory interventions into urban health programs can substantially reduce poisoning-related morbidity and mortality among children

Background: Assault-related penetrating trauma constitutes a significant clinical and medico-legal burden in India, with abdominal and thoracic stab injuries contributing to substantial morbidity. Early recognition, prompt resuscitation, appropriate imaging, and timely surgical intervention are crucial to prevent life-threatening complications. This case series describes four grievously injured assault victims managed at the Trauma Care Center (TCC), Gulbarga Institute of Medical Sciences (GIMS), Kalaburagi.  Methods: A retrospective analysis of four consecutive stab injury cases presenting to TCC between March 2025and April 2025 was conducted. Clinical details, hemodynamic status, imaging findings, operative notes, blood transfusion requirements, postoperative course, and complications were recorded from hospital records. Results: Four patients (three males, one female; age range 25–45 years) presented with multiple penetrating stab wounds involving the abdomen, chest, and back. Two patients were under alcohol influence at presentation. Major injuries included Grade IV liver laceration with diaphragmatic rupture, mesenteric tears, duodenal perforations, pneumothorax, hemothorax, and deep muscular arterial bleeding. All patients required exploratory laparotomy; two required intercostal drain insertion. Blood transfusion requirements ranged from 1 to 6 units. Postoperative complications included surgical site infections in two cases, which resolved with antibiotics and regular dressings. No neurological deficits or mortality were reported. All patients showed gradual clinical improvement and were discharged between postoperative days 8 and 15.  Conclusion: This case series highlights the critical role of rapid triage, early imaging, aggressive resuscitation, and timely surgical management in improving outcomes in grievous stab injuries. Multidisciplinary coordinated care in a dedicated Trauma Care Center significantly reduces morbidity and ensures favourable recovery even in complex penetrating injuries.

Introduction: Acute intestinal obstruction is a common surgical emergency and occurs in all age groups. 12% to 16% of acute abdominal emergencies may be contributed to intestinal obstruction Aim: ‘’Evaluation and management of bowel obstruction in adults at tertiary health care center’’ Methods: Present study was carried out in the Dept. of Surgery, Sardar Patel medical college & A G of Hospital Bikaner. This is a prospective descriptive study and was carried out between january 2022 to january 2024. During the study period, 100 consecutive adult patients (Patients with 18 years and above 18 years of age) admitted with clinical and radiological evidence of acute dynamic intestinal obstruction, undergoing surgical intervention, regardless of gender were included. After obtaining permission from institution research board the present study was conducted data was collected from under study population through a pretested and semi-structured schedule. Results: In our present prospective study most common age group of patients presented with intestinal obstruction was 51-60 years consisting of 29% patients.   Mean age of our study population is 50.3 years. Out of 100 patients, 64 were males and 36 were females. Male to female ratio is 1.77:1. Out of total 100 patients 78 patients presented with small bowel obstruction and 22 patients presented with large bowel obstruction. External hernia (34%) is the commonest cause of Intestinal obstruction. Average hospital stay of patients in our study is 9.3 days. Wound infection, septicemia and wound dehiscence were most common complication. The overall survival rate and mortality rate in our study is 88% and 12%, respectively. Conclusion: Early diagnosis of obstruction, careful selection of cases for surgery, skillful operative management, proper technique during surgery and intensive post- operative treatment yields grateful results. Poor socioeconomic status, malnutrition, old age, delayed presentation of patients leading to delayed diagnosis and treatment, associated systemic co- morbid conditions adversely affects the final surgical outcome of the patients.

Introduction: The percentage of caesarean deliveries carried out under spinal anaesthesia has greatly increased over the last 20 years. Maternal hypotension due to preganglionic sympathetic block occurs in 60-70% of the cases,  and may lead to adverse maternal outcomes.  Objective: The aim of the study is, to determine the optimal dose of norepinephrine infusion in management of spinal anaesthesia induced hypotension in elective caesarean section. Methods: The study is a randomized clinical trial in which 120 parturients undergoing caesarean delivery under spinal anaesthesia were randomly allocated into three groups (30 patients in each group) as  Group A patients  received norepinephrine 5μg/kg/h as intravenous infusion, group B patients received norepinephrine 8μg/kg/h as intravenous infusion, group C received norepinephrine 10μg/kg/h as intravenous infusion and group D received normal saline as intravenous infusion. Results: Intergroup comparison of Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) showed less significant changes between Group A, B and C at all time points, even though significant changes were observed when study groups (A,B,C) were compared with  control group (D). Maximum changes were observed in between group C and group D. The fetal parameters were within the normal range for the groups and there were no incidence of fetal acidosis. Side effects like nausea , vomiting and shivering were not significant among groups. Conclusion: Prophylactic norepinephrine infusion doses of 10 µg/kg/hr recorded lower incidence of hypotension as compared with other groups receiving either normal saline or norepinephrine infusion of 5µg/kg/hr and 8µg/kg/hr. Thus, prophylactic infusion doses of norepinephrine 10µg/kg/hr  can be used to prevent spinal anaesthesia induced hypotension in patients undergoing elective lower segment caesarean section.

Background: Bacillary dysentery, caused by Shigella species, remains a significant cause of morbidity and mortality, particularly among children in developing countries. The rise of antimicrobial resistance has made treatment increasingly difficult, often resulting in irrational antibiotic use. To address this, the World Health Organization introduced the “P-drug” (personal drug) concept. This approach encourages clinicians to develop a personal formulary that supports rational, safe, effective, and cost-efficient prescribing practices. Aim: To develop a personal formulary for the treatment of bacillary dysentery among pharmacology residents.  Materials and Methods: This cross-sectional study was conducted within the Department of Pharmacology. Residents assessed antibiotics using a weighted scoring system (β) combining efficacy (0.4), safety (0.3), cost (0.2), and convenience (0.1), assigning each drug a 1 to 10 (α) score per parameter to derive a total value (γ = α × β) that identified the most suitable P-drug. Conclusion: Ciprofloxacin emerged as the preferred first-line P-drug for bacillary dysentery in adults as well as children due to its high total score, reflecting an optimal balance of high efficacy, acceptable safety, low cost, and good availability. Levofloxacin was identified as a suitable alternative with the advantage of once-daily dosing to enhance compliance. Azithromycin served as an effective second-line option, particularly for cases with fluoroquinolone resistance or in special populations like children and pregnant women. Ceftriaxone was reserved for severe cases requiring parenteral therapy. The study demonstrates that the systematic P-drug approach provides a rational framework for antibiotic selection, encouraging prescribing that is evidence-based, patient-centered, and cost-effective.

Medical students frequently struggle with mental health issues like depression and anxiety, which are linked to both poor academic performance and a lower quality of life. Students' psychosocial well-being is frequently negatively impacted by the stressful environment of medical school. It is essential to comprehend how students cope with psychological suffering. Objectives: To determine the prevalence and identify the predictors of mental stress among undergraduate medical students. Methodology: Cross-sectional survey was conducted among Medical undergraduate students of tertiary care medical college situated in north part of the Karnataka. Students were interviewed by using structured proforma containing questions about socio-demographic details, details of habits and stress assessment by using perceived stress scale (PSS). Results: Around 310 students enrolled in to the study and analysis found about 84.9% reported low stress levels, 9% had moderate stress, and 6.1% experienced high stress. Tight schedule of the course, little recreation and exams were found the predictors of the mental stress. Conclusion: Medical students deal with particular pressures, like acclimating to unfamiliar surroundings, learning a new language, and rigorous coursework, all of which greatly raise stress levels.

Background: Gestational diabetes mellitus (GDM) is associated with adverse maternal and neonatal outcomes. Lifestyle modification, particularly medical nutrition therapy, is the first-line management, but evidence on structured dietary interventions in routine antenatal care is limited. Objective: To assess the effectiveness of a modified diet chart and lifestyle intervention in controlling blood glucose levels among women with GDM. Methods: This randomized open-label study included 200 pregnant women diagnosed with GDM after 24–28 weeks of gestation at a tertiary care hospital. Participants were randomized to receive either a structured modified diet chart with lifestyle modification or routine dietary advice. Fasting and post-prandial blood glucose levels were assessed at baseline and during follow-up. Results: Both groups showed significant reductions in glycaemic levels (p<0.001). The modified diet group demonstrated a greater reduction in fasting and post-prandial glucose levels and a higher rate of vaginal delivery (p=0.02). Conclusion: A structured modified diet and lifestyle intervention significantly improves glycaemic control in women with GDM and should be integrated into routine antenatal care

Background:  Accurate cardiac output assessment is central to the management of critically ill cardiac patients, yet the invasive Fick method limits routine use. Non-invasive estimation using venous oxygen saturation requires validation against Fick-derived measurements. Objectives: To measure cardiac output by invasive indirect Fick’s principle and correlate it with non- invasive estimation methods, and to assess the prognostic significance of venous oxygen saturation in hospitalized cardiac patients. Methods: This cross-sectional observational study included 385 adult patients admitted to a tertiary cardiac care centre. Cardiac output was calculated using Fick’s principle with oxygen consumption estimated using LaFarge, Krovetz-Goldbloom, and Bergstra equations. Apart from hemodynamic parameters, Arterial and venous blood gas analyses were performed. Statistical analysis included correlation coefficients, regression analysis, and ROC curves. Results: Mean age was 59.06 ± 12.37 years. Cardiac output calculated using invasive indirect Fick’s method showed a significant positive correlation with non-invasive CO estimation (r = 0.71, p < 0.001). The Krovetz–Goldbloom equation showed the strongest correlation (r = 0.58, R² = 0.34; p < 0.0001), followed by LaFarge (r = 0.55, R² = 0.30) and Bergstra, which demonstrated an inverse correlation (r = −0.43, R² = 0.33). Venous oxygen saturation demonstrated a strong correlation with cardiac index (r = 0.68, p < 0.001). VBG Value of <0.4 Predicted Mortality with 88.6% Sensitivity and 43.1% Specificity and AUC= 0.673, P=<0.0001. A threshold of <66%, derived using the Youden index, identified patients at higher risk of adverse outcomes. Conclusion: Non-invasive cardiac output estimation, particularly using the Krovetz–Goldbloom equation, correlates well with invasive Fick-derived measurements. Venous oxygen saturation is a prognostic marker for cardiac output and in hospital outcome, offering a practical bedside tool for hemodynamic assessment.

Background: Maternal mortality and morbidity remain significant public health concerns in developing countries, largely attributable to delays in recognizing and responding to obstetric danger signs. Adequate knowledge, positive attitudes, and appropriate practices among pregnant women are essential for timely health-seeking behavior. Objectives: The present study aimed to assess the level of knowledge, attitude, and practices regarding danger signs of pregnancy among antenatal mothers attending a rural tertiary care teaching hospital. Methods: A hospital-based cross-sectional Knowledge–Attitude–Practice study was conducted among 75 antenatal mothers attending the antenatal clinic of Ashwini Rural Medical College, Hospital and Research Centre, Kumbhari, District Solapur, from January 2025 to November 2025. Data were collected using a pretested structured questionnaire covering socio-demographic variables and obstetric danger signs. Descriptive and inferential statistics were applied. Results: The study revealed varying levels of awareness regarding danger signs of pregnancy. While a majority of participants demonstrated moderate knowledge and favorable attitudes, gaps were observed in translating knowledge into appropriate practices, particularly regarding early healthcare utilization during emergencies. Conclusion: Although antenatal mothers exhibited reasonable awareness of certain danger signs, deficiencies persist in comprehensive knowledge and proactive practices. Strengthening antenatal education and counseling services is essential to improve maternal outcomes.

Background: Mitral valve disease remains a major cause of cardiovascular morbidity, particularly in developing countries where rheumatic heart disease is still prevalent. Progressive valvular damage often leads to severe mitral stenosis or regurgitation, and in many cases the extent of pathology makes valve repair unfeasible. Under such circumstances, mitral valve replacement (MVR) becomes the definitive surgical treatment to relieve symptoms and improve survival.  Although advances in surgical techniques and perioperative care have improved early outcomes, assessment of MVR success cannot be limited to perioperative morbidity and mortality alone. A comprehensive evaluation requires assessment of postoperative clinical status, including symptom relief and improvement in functional class. Echocardiography provides objective information on prosthetic valve function, transvalvular gradients, ventricular remodeling, and pulmonary pressures. Aim: To compare clinical, echocardiographic, and functional outcomes in patients before and after mitral valve replacement . Material and Methods: A prospective observational before–after study was conducted in a tertiary care teaching hospital over 12–18 months. Fifty adult patients undergoing isolated MVR were enrolled using consecutive sampling. Clinical assessment was performed using New York Heart Association (NYHA) functional class. Echocardiographic evaluation included left ventricular ejection fraction (LVEF), left ventricular end-systolic dimension (LVESD), and left atrial diameter. Assessments were done preoperatively and repeated at 3–6 months postoperatively. Statistical analysis was performed using paired tests, with p < 0.05 considered significant. Results: Preoperatively, 64% of patients were in NYHA class III–IV, which reduced to 20% postoperatively, while NYHA class I–II increased from 36% to 80%. Mean LVEF improved from 52.6 ± 9.4% to 58.9 ± 8.7%, LVESD decreased from 42.8 ± 6.2 mm to 38.4 ± 5.9 mm, and left atrial diameter reduced from 5.6 ± 0.8 cm to 4.9 ± 0.7 cm. Greater functional improvement was observed in patients with preserved preoperative LVEF. Conclusion: Mitral valve replacement resulted in significant early improvement in clinical, echocardiographic, and functional outcomes, emphasizing the importance of timely surgical intervention and integrated postoperative assessment.

Background: Lower urinary tract symptoms (LUTS) are a common cause of outpatient consultations among women and are frequently misattributed to urinary tract infection (UTI). Even in the presence of normal urine dipstick findings that effectively exclude infection, many patients continue to expect antibiotic therapy and resist further evaluation for non-infectious causes. This misinterpretation contributes to inappropriate antibiotic demand and undermines antimicrobial stewardship. Objectives: To assess patient perceptions regarding UTI diagnosis and antibiotic necessity among women presenting with LUTS and normal urine dipstick findings, to evaluate willingness for further etiological investigation, and to determine the impact of sequential counselling on modifying these perceptions. Methods:              This prospective observational study was conducted over 12 months in the General Medicine outpatient department of a tertiary care center in North India. A total of 180 adult women aged 18–65 years presenting with one or more LUTS, normal urine dipstick results, and no systemic signs of infection were enrolled. Following physician consultation, antibiotics were withheld, and further evaluation was advised. Patient perceptions regarding antibiotic need and acceptance of further investigations were assessed sequentially by two counsellors. Changes in perceptions were analyzed statistically. Results: The mean age of participants was 58.6 years, and 90% were postmenopausal. Urinary frequency (62.2%), urgency (53.3%), and nocturia (41.1%) were the most common symptoms, with 56.1% reporting multiple symptoms. Despite normal dipstick findings, 78.9% of patients initially believed antibiotics were necessary, and 71.1% were reluctant to undergo further evaluation. After structured counselling, antibiotic expectation decreased to 46.7% and reluctance for further investigation declined to 34.4%, representing a statistically significant improvement (p < 0.001). However, nearly half of the patients continued to associate LUTS exclusively with UTI. Conclusion: Misinterpretation of LUTS as UTI despite normal urine dipstick findings is common among women and strongly drives inappropriate antibiotic expectations and resistance to further diagnostic evaluation. Physician reassurance alone is often insufficient. Repeated, structured counselling plays an important role in modifying patient perceptions and should be integrated into strategies aimed at rational management of LUTS and effective antimicrobial stewardship.

Background: Succinylcholine  chloride  introduced in 1951 was a synthetic depolarising  muscle relaxant.  Succinylcholine with its adverse effects like hyperkalemia, raised intracranial, intraocular, intragastric pressures. Though  many NDMR drugs were introduced, Rocuronium bromide introduced in 1994 became first competitor for succinylcholine.  Rocuronium bromide when given in three times the ED95 doses is said to produce excellent to good  intubating  conditions in 60 seconds and devoid of adverse effects that are seen with succinylcholine.  Materials and Methods: This prospective, randomized study was conducted at the Department of Anaesthesia, Government Medical College and Hospital, Ongole after obtaining institutional ethical  committee approval. A total of 60 adult patients (aged 18–60 years) undergoing  elective surgeries under general anaesthesia were randomly assigned to either the Rocuronium bromide group (Group R, n = 30) or the Succinylcholine group (Group S, n = 30).The onset of neuromuscular blockade was assessed using a single twitch stimulation of 0.1Hz every 10sec after administration of either of the neuromuscular blocking agents.Jaw relaxation, vocal cord movement and Cormack Lehane grading were assessed at the time of intubation. Hemodynamic response to intubation was assessed by recording the preinduction,  and postintubation HR,SBP,DBP and MAP. Results: Incidence of Jaw relaxation was comparable between the two without statistical significance. Absence of vocal cord movements was comparable between the two groups without any statistical significance(Group R and Group S moving  P=0.21), (not moving Group R and Group S P=0.23). Cormack Lehane grading, no statistical significant difference between two groups. There is statistically significant difference in the onset of action of neuromuscular blockade between the two groups, with faster onset action in group S with P value 0.00001. Conclusion: Present study showed Succinylcholine showed an early onset muscle relaxation than Rocuronium. No difference in jaw relaxation and vocal cord movement at the intubation in two groups. There was no difference in hemodynamic response to intubation between the two drugs expect for more increase in pulse rate with rocuronium group.

Background- Kabaddi is a traditional outdoor game played with minor variations in all regions of India and most parts of Asia. Kabaddi requires tremendous physical stamina, agility, individual proficiency, neuromuscular coordination, lung capacity, quick reflexes. Kabaddi is an intermittent type of sport, it requires both aerobic, anaerobic endurance with a well-built physique. This study was planned to evaluate and compare the aerobic capacity (VO2max) and the anaerobic capacity (blood lactate level) in Kabaddi players with that of controls. Material & Method-Total 100 participants were included in the study. Fifty of them were kabaddi players and fifty were controls with normal lifestyle. All the 100 people from the study group were males in the age group of 18 to 24 years. VO2max and plasma lactate values of kabaddi players and controls were estimated and compared. Result-The mean values for the age, body weight, height and body mass index in kabaddi players were 21.38 ±1.9 years, 60.4 ± 2.69 kg, 174.7± 2.72 cm and 19.79 ± 0.99 kg/ m2 respectively. The mean values for age, body weight, height and body mass index in controls were 21.28 ±1.78 years, 61.6 ± 3.46 kg, 173.88 ± 4.78 cm and 20.43 ± 1.78 kg/m2 respectively. The mean VO2 max was 59.08 ± 3.3 ml/kg/min in kabaddi players and 42.65 ± 3.20 ml/kg/min in controls. The difference was statistically highly significant (‘p’ value less than 0.001). The mean plasma lactate values was 105.1 ± 9.54 mg/dl in kabaddi players and 66.74 ± 7.18 mg/dl in controls. The difference was statistically highly significant (‘p’ value less than 0.001). Thus, the kabaddi players showed a superior aerobic capacity (VO2max) as well as anaerobic capacity (plasma lactate values). Conclusion- The kabaddi players showed a superior aerobic capacity (VO2max) as well as anaerobic capacity (plasma lactate values). Although, all that is required in a competition to succeed and can not always be measured in a lab, more research in the area of sports is needed in India to study the physical and physiological characteristics of Indian kabaddi players and compare it with international standards.

Background: Sepsis remains a major contributor to morbidity and mortality in intensive care units, and early identification of patients at risk for adverse outcomes is essential for timely escalation of care. Objectives: The primary objective of this study was to evaluate the predictive value of the lactate–albumin ratio for a composite adverse outcome, defined as intensive care unit mortality or the requirement for mechanical ventilation, vasopressor or inotrope support, or renal replacement therapy, and to examine its correlation with disease severity as assessed by the Sequential Organ Failure Assessment score, including determination of optimal cut-off values for predicting this composite outcome in patients with sepsis. Methods: This prospective observational cohort study was conducted in the intensive care unit of a tertiary care teaching hospital over a three-month period. Seventy-five consecutive adult patients fulfilling Sepsis-3 criteria were enrolled. Serum lactate and albumin levels obtained at ICU admission were used to calculate the lactate–albumin ratio. Patients were followed until ICU discharge or death. The association between LAR and Sequential Organ Failure Assessment (SOFA) score was analysed using Pearson correlation. Results: The mean age of the cohort was 56.72 ± 18.30 years, and the mean SOFA score at admission was 7.13 ± 3.65. Mechanical ventilation was required in 44.0% of patients, vasopressor or inotrope support in 42.7%, renal replacement therapy in 12.0%, and overall ICU mortality was 33.3%. The mean admission lactate–albumin ratio was 1.18 ± 1.00. LAR demonstrated a significant positive correlation with SOFA score (r = 0.569, p < 0.001). On unadjusted analysis, higher LAR values were significantly associated with ICU mortality (OR 8.24, 95% CI 2.71–25.03; p < 0.001), requirement of mechanical ventilation (p < 0.001), and vasopressor or inotrope support (p < 0.001), but not with renal replacement therapy. The area under the receiver operating characteristic curve for LAR in predicting adverse outcomes was 0.84 (95% CI 0.75–0.93; p < 0.001). Conclusion: The lactate–albumin ratio measured at ICU admission is a simple and readily available biomarker that demonstrates good predictive ability for major intensive care interventions and mortality in patients with sepsis.

Objective: Arthroscopic knee surgery is frequently performed as a day-care procedure; however, inadequate postoperative analgesia may delay mobilization, rehabilitation, and discharge. Intra-articular administration of local anaesthetics with adjuvants is an effective strategy for improving postoperative pain control. This study aimed to compare the analgesic efficacy and hemodynamic stability of intra-articular dexmedetomidine and tramadol when used as adjuvants to ropivacaine in patients undergoing arthroscopic knee surgery under spinal anaesthesia during the early postoperative period. Methodology: This prospective, randomized, double-blind, controlled study included 60 adult patients aged 18–60 years with ASA physical status I or II scheduled for elective arthroscopic knee surgery. All patients received low-dose spinal anaesthesia. Participants were randomly allocated into three groups: Group I received intra-articular ropivacaine with dexmedetomidine, Group II received ropivacaine with tramadol, and Group III received ropivacaine with normal saline. Postoperative pain was assessed using the visual analogue scale (VAS) at 0, 2, 4, 6, 12, and 24 hours. Time to first rescue analgesia, total rescue analgesic requirement, haemodynamic parameters, sedation scores, and adverse effects were recorded and analysed statistically. Results: Demographic characteristics and baseline haemodynamic variables were comparable among the three groups. The time to first rescue analgesia was significantly prolonged in the dexmedetomidine group compared with the tramadol and control groups (p < 0.001). VAS scores were significantly lower in patients receiving dexmedetomidine during the early postoperative period. Total rescue analgesic consumption was also significantly reduced in this group. Haemodynamic parameters remained stable across all groups, and no clinically significant adverse effects were observed. Conclusion: Intra-articular dexmedetomidine, when used as an adjuvant to ropivacaine, provides superior and prolonged postoperative analgesia with reduced rescue analgesic requirements compared to tramadol, without increasing adverse effects. It represents a safe and effective option for postoperative pain management following arthroscopic knee surgery under spinal anaesthesia.

Background: Iron deficiency anemia (IDA) during pregnancy remains a major public health problem and is associated with significant maternal and fetal morbidity. Oral iron therapy is frequently limited by poor gastrointestinal tolerance and inadequate absorption. Ferric carboxymaltose (FCM) is a newer intravenous iron formulation that permits rapid, high-dose iron replacement with a favorable safety profile. Objective: To evaluate the safety and efficacy of intravenous ferric carboxy maltose in pregnant women with iron deficiency-associated moderate anemia, with particular emphasis on changes in hemoglobin (Hb), serum ferritin, mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH). Methods: This prospective interventional study included 120 pregnant women (14–28 weeks’ gestation) diagnosed with iron deficiency (serum ferritin <15 µg/L) and moderate anemia (Hb 7–9.9 g/dL) as defined by World Health Organisation (WHO). Participants received weight-adjusted intravenous ferric carboxymaltose. Hematological parameters were assessed at baseline and at 6 weeks and 12 weeks post-infusion. Results: Mean hemoglobin increased significantly from 8.02 ± 0.55 g/dL at baseline to 13.8 ± 0.6 g/dL at 6 weeks and 12.9 ± 0.5 g/dL at 12 weeks (p < 0.001). Serum ferritin rose from 9.8 ± 2.5 µg/L to 136.2 ± 18.4 µg/L at 6 weeks and remained elevated at 124.6 ± 16.9 µg/L at 12 weeks (p < 0.001). Significant improvements were observed in MCV (71.8 ± 3.6 fl to 89.9 ± 3.1 fl) and MCH (23.7 ± 1.8 pg to 30.1 ± 1.6 pg) at 12 weeks (p < 0.01). No serious adverse reactions were reported. Conclusion: Ferric carboxymaltose is a safe and highly effective therapy for rapid correction of iron deficiency anemia in pregnancy, resulting in sustained improvement of hemoglobin, iron stores, and red cell indices.

Background and Objectives Cardiovascular disease is a major global health challenge, with blood pressure and myocardial remodeling exerting significant influence on coronary artery structure. Coronary artery luminal diameter, reflects vascular adaptation to hemodynamic load, while left ventricular (LV) wall thickness, mirrors myocardial responses to pressure overload. This study explores the association between coronary luminal diameter, blood pressure parameters in patients with non critical CAD, and LV wall thickness to better understand early vascular and myocardial adaptations. Method A prospective, observational, cross-sectional study was conducted over 18 months. Adult patients aged 30–75 years undergoing diagnostic coronary angiography with <70% luminal stenosis in all major epicardial arteries were included. Data encompassing clinical, echocardiographic and angiographic profile were collected and analyzed. Results  A total of 100 patients were studied, with mildly elevated blood pressure (SBP 144.04±10.03 mmHg, DBP 79.85±8.89 mmHg). Echocardiography showed mean interventricular septal thickness of 10.43 mm and posterior wall thickness of 10.76 mm, with a moderate LV mass index of 106.69 g/m². Coronary angiography showed average luminal diameters ranging from 2.1 mm to 4.4 mm across major arteries. Bivariate analysis revealed strong negative correlations between SBP and luminal diameters of LMCA. DBP also correlated negatively, though less strongly. LV wall thickness positively correlated with proximal coronary diameters. Interpretation and Conclusion The findings confirm that elevated blood pressure is linked to smaller coronary artery diameters. Whereas, greater LV wall thickness correlates with proportionally larger arteries. This emphasize that blood pressure control preserves coronary caliber. and even angiographically “normal” arteries may show remodeling, underscoring the need for combined functional and structural risk assessment.

Introduction: Cardiovascular diseases, particularly coronary artery disease (CAD), are the leading cause of death globally. Smoking is a major modifiable risk factor for both the development and progression of CAD, contributing to plaque formation and instability. In India, tobacco use remains widespread, particularly in rural areas, exacerbating the CAD burden. This prospective observational study aims to assess smoking patterns, addiction levels, demographic correlations and angiographic features among CAD patients, comparing outcomes in smokers versus non-smokers. The findings will guide targeted interventions and improve rehabilitation efforts. Methods: A prospective observational study was conducted on 240 patients with angiographically confirmed obstructive CAD (≥70% stenosis in major epicardial arteries or ≥50% in the left main artery) which were recruited from inpatient departments. Patients were classified as current, past, or never smokers. Detailed demographic, clinical, angiographic, and smoking histories were collected, alongside nicotine dependence assessment using the Fagerström Test. A follow-up over 12 months evaluated smoking behaviour and cardiovascular outcomes including new onset angina, acute coronary syndrome/ STEMI, stent thrombosis, repeat revascularisation and mortality. Statistical analyses included multivariate logistic regression and Cox proportional-hazard modelling. The aim of this study is to investigate the impact of smoking on coronary artery disease (CAD) severity, coronary angiographic characteristics, to compare rate of mortality, MI and repeat revascularization between smoker and nonsmokers in 1 year follow up along with smoking behaviour on follow up. Results: The study findings reveal marked intergroup differences. Current smokers exhibited the highest nicotine dependence (Fagerstrom score 7.95 ± 1.45) and longest smoking duration (21.62 ± 4.71 years), compared to past smokers (4.8 ± 0.79; 15.31 ± 5.48 years) and never smokers (0; 0 years). Risk factor analysis showed significant associations, with hypertension (p=0.004) and dyslipidaemia (p<0.01) more prevalent in current smokers, while diabetes (p<0.01) was greatest in past smokers and family history of CAD (p<0.01) in never smokers. Smoking behavior re-evaluation also showed highly significant group differences (χ²=435.78, p<0.01), with persistent smoking in current smokers and notable relapse among past smokers. Conclusion: The study concluded that smoking as a significant risk factor for coronary artery disease (CAD), with current smokers experiencing more severe disease and higher rates of adverse outcomes.

Background: Artificial intelligence (AI) has emerged as a revolutionary force in cardiovascular imaging, enabling automated data interpretation, precise quantification, and accelerated workflow efficiency. Despite exponential growth in AI-related studies, the clinical translation of these tools across imaging modalities remains unclear. This systematic review synthesizes current evidence on diagnostic, prognostic, and workflow enhancements achieved through AI in cardiac imaging. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines, with protocol registration in PROSPERO. Comprehensive searches of PubMed, Scopus, and Web of Science were performed for studies published between January 2018 and June 2025 using predefined MeSH terms related to artificial intelligence, machine learning, deep learning, and cardiac imaging. Eligible studies included those assessing AI algorithms in echocardiography, cardiac CT, MRI, or nuclear imaging that reported at least one diagnostic or prognostic performance metric. Data extraction, quality assessment (QUADAS-2, PROBAST), and narrative synthesis were performed independently by two reviewers. Statistical analyses included t-tests, ANOVA, regression models, and meta-analytic pooling using the DerSimonian–Laird method. Results: A total of 126 studies (n = 42,583 participants) were included. Deep learning predominated (72%), with echocardiography (34%) and MRI (29%) as the most common modalities. Pooled diagnostic accuracy was 91.7% ± 5.2%, with mean AUC = 0.94 (95% CI 0.89–0.98). AI outperformed human readers across all modalities (t = 7.83; p < 0.001). Prognostic models achieved mean C-statistic = 0.87, surpassing traditional scores (ΔC = 0.09; p < 0.001). Workflow efficiency improved by 47%, with reduced analysis time (15 min → 30 sec; p < 0.001) and enhanced reproducibility (ICC = 0.93 vs 0.81; p < 0.001). Meta-regression identified dataset size, multimodal integration, and deep learning architecture as significant performance predictors (p < 0.01). Conclusion: AI significantly enhances diagnostic precision, prognostic prediction, and workflow efficiency in cardiac imaging. Deep learning and multimodal frameworks outperform conventional analysis, offering scalable and reproducible solutions. However, limited external validation, heterogeneity, and interpretability barriers underscore the need for multicentric, transparent, and ethically grounded AI implementation in future cardiac imaging research

Background: One odd aspect of PCOD is that people with high BMI and obesity typically have high AMH levels. Therefore, increased AMH release from a greater number of tiny antral follicles can be the cause of elevated AMH levels in females with PCOD.  Aim: The purpose of this study was to assess the association between blood AMH (anti-mullerian hormone) levels and BMI (bone mass index) in infertile women with and without PCOD (polycystic ovarian disease). Methods: 400 female visitors to the Institute during the specified study period were evaluated for this study. Gynecological evaluation and basic infertility tests, including BMI, were performed on each participant. After the AMH levels of all females were measured, the individuals were split into two groups: those with PCOD and those without. Results: The study's total AMH level was found to be 4.84±4.42 ng/ml. AMH and BMI levels in females without PCOD did not significantly correlate (p>0.05). However, AMH and BMI levels showed a strong inverse connection with p<0.05 in PCOD individuals.  Conclusion: The current study reveals that among infertile females without PCOD, there is no meaningful relationship between AMH and BMI levels. However, there is a strong negative relationship between blood AMH levels and BMI in females with PCOD

Background: Colonoscopy is widely used for evaluating lower gastrointestinal symptoms, but several colorectal conditions share overlapping endoscopic appearances. Histopathological examination of colonoscopic biopsies is therefore essential for confirming diagnosis, categorizing lesions, and identifying premalignant and malignant change. Objectives: To describe the demographic profile, anatomical distribution, and histopathological spectrum of colorectal lesions in colonoscopic biopsies. Methods: A hospital-based observational study was conducted in the Department of Pathology, RVM Institute of Medical Sciences & Research Center, Mulugu, Siddipet, Telangana, India, from January 2024 to November 2024. One hundred colonoscopic biopsy specimens were processed routinely and stained with hematoxylin and eosin. Lesions were grouped as non-neoplastic or neoplastic, and adenocarcinomas were graded on routine histological criteria. Results: The largest age group was 51–60 years (28%), and males comprised 58% of participants. Rectum was the commonest site (38%), followed by sigmoid colon (26%). Non-neoplastic lesions constituted 56%, dominated by chronic non-specific colitis (28%). Neoplastic lesions comprised 44%, with adenocarcinoma being the most frequent diagnosis (26%). Among adenocarcinomas (n = 26), moderately differentiated tumors were most common (53.8%). Conclusion: Colonoscopic biopsies revealed a wide range of inflammatory and neoplastic lesions, with a notable proportion of colorectal carcinoma. Systematic biopsy sampling and timely histopathological reporting support early detection and appropriate clinical decision-making.

Background: Small incision cataract surgery (SICS) is widely performed in developing countries. Anesthesia plays a crucial role in patient comfort, surgical ease, and safety. Subconjunctival lignocaine and topical paracaine supplemented with intracameral lignocaine are commonly used anesthesia techniques, but comparative evidence remains limited. Aim: To compare the efficacy, patient comfort, intraoperative pain control, surgical conditions, and complications of subconjunctival lignocaine versus topical paracaine with intracameral lignocaine in patients undergoing SICS. Materials and Methods: This prospective comparative clinical study included 120 patients undergoing SICS, randomly allocated into two groups. Group A received subconjunctival lignocaine anesthesia, while Group B received topical paracaine with intracameral lignocaine. Pain scores were assessed using the Visual Analog Scale (VAS). Surgeon comfort, need for supplemental anesthesia, intraoperative complications, and postoperative outcomes were evaluated. Results: Mean intraoperative pain scores were significantly lower in Group A compared to Group B (p < 0.05). Surgeon comfort was better in Group A, whereas Group B demonstrated faster visual recovery and reduced chemosis. No significant difference was observed in postoperative complications between the groups. Conclusion: Subconjunctival lignocaine provides superior intraoperative analgesia and surgical comfort, while topical paracaine with intracameral lignocaine offers a needle-free alternative with acceptable pain control and faster postoperative recovery. Both techniques are safe and effective for SICS, with selection depending on patient and surgeon preference.

Background: Breastfeeding is a cornerstone of infant and maternal health, yet optimal breastfeeding practices remain suboptimal in many settings despite widespread awareness. Understanding maternal knowledge, attitude, and practices related to breastfeeding and the factors influencing them is essential for designing effective interventions. Objectives: To assess the knowledge, attitude, and breastfeeding practices among postnatal mothers and to identify the association between socio-demographic factors and breastfeeding knowledge, with a focus on the knowledge–practice gap. Methods: A hospital-based cross-sectional study was conducted among 200 postnatal mothers admitted to the postnatal wards of a tertiary care teaching hospital in South India over a two-month period. Data were collected using a pre-designed, structured, and pre-tested questionnaire covering socio-demographic characteristics, obstetric details, and domains of knowledge, attitude, and breastfeeding practices. Data were analyzed using SPSS version 26.0. Descriptive statistics were used to summarize variables, and the chi-square test was applied to assess associations, with p < 0.05 considered statistically significant. Results: The majority of mothers demonstrated satisfactory knowledge regarding early initiation of breastfeeding (80%), colostrum feeding (75%), avoidance of prelacteal feeds (89.5%), and exclusive breastfeeding for six months (72%). However, only 34.5% initiated breastfeeding within one hour of birth, revealing a substantial knowledge–practice gap. Positive attitudes toward breastfeeding were observed, with 71.5% considering breast milk as the best food for newborns. Maternal education, socioeconomic status, parity, and receipt of antenatal counseling were significantly associated with adequate breastfeeding knowledge (p < 0.05). Conclusion: Despite adequate knowledge and favorable attitudes, significant gaps exist between breastfeeding knowledge and actual practices. Strengthening antenatal and postnatal breastfeeding counseling and addressing behavioral and systemic barriers are essential to improve optimal breastfeeding practices.

Background: Laparoscopic surgeries performed under general anaesthesia are associated with significant hemodynamic fluctuations due to carbon dioxide pneumoperitoneum along with sympathetic stimulation during laryngoscopy and endotracheal intubation. Attenuation of these responses is essential for perioperative cardiovascular stability. Dexmedetomidine, an α2-adrenergic agonist, has sympatholytic, analgesic, and sedative properties. This study evaluated its efficacy in attenuating perioperative hemodynamic responses during laparoscopic surgeries. Aim: This study aimed to evaluate the efficacy and safety of dexmedetomidine in attenuating perioperative hemodynamic changes during laparoscopic surgery under general anaesthesia. Methods: This prospective, randomised, double-blind controlled study was conducted in 90 ASA physical status I–II patients aged 18–50 years undergoing elective laparoscopic surgery. Patients were randomised into two groups: Group D received dexmedetomidine (loading dose 1 µg•kg⁻¹ over 10 min followed by 0.5 µg•kg⁻¹•h⁻¹ infusion till end of surgery and Group C received normal saline in the same dose. Standardised balanced general anaesthesia was administered to all patients. Hemodynamic parameters were recorded at predefined perioperative time points. Postoperative pain was assessed using the Visual Analogue Scale and sedation was evaluated using the Ramsay Sedation Scale. Results: Demographic variables and baseline hemodynamic parameters were comparable between the groups. Dexmedetomidine significantly attenuated increase in heart rate, systolic blood pressure and diastolic blood pressure associated with intubation, pneumoperitoneum, and extubation compared to the control group (P < 0.05). Postoperative pain scores were significantly lower in the dexmedetomidine group at all measured intervals (P < 0.05). Although immediate postoperative sedation was higher with dexmedetomidine, recovery was smooth without prolonged sedation or respiratory compromise. Conclusion: Dexmedetomidine as an adjuvant in general anaesthesia for laparoscopic surgeries provided stable haemodynamic profile in the perioperative period and effectively attenuates laryngoscopy and intubation responses, provides superior postoperative analgesia and ensures a favourable sedation profile during laparoscopic surgery. It is a safe and effective adjuvant to general anaesthesia for maintaining perioperative cardiovascular stability.

Aim: The study aimed at assessing serum sodium levels as a prognostic factor in “decompensated liver disease” (DCLD). Methods: The study was conducted in the General Medicine Department of SGT Hospital, utilizing the inpatient (IPD) settings over a period of 18 months. Patients presenting with clinical symptoms of decompensated cirrhosis, such as ascites, hepatic encephalopathy, and gastrointestinal bleeding, were screened and enrolled in the study. A total of 60 patients diagnosed with decompensated liver disease were included in the study.  Results: The mean age of participants was 46.3 ± 6.8 years, with an age range spanning from 18 to 55 years, reflecting the inclusion criteria. A significant proportion of patients, approximately 55%, were aged 41 to 55 years, while 40% were within the 30 to 40 years category. Gender distribution revealed a marked male predominance, with 78.3% (47/60) of the patients being male, while 21.7% (13/60) were female. A significant proportion (20%) belonged to the lower class group, while 45% were from the lower middle class group. A significant proportion (20%) belonged to the lower class group, while 45% were from the lower middle class group. Only 15% of the patients belonged to the middle class category, with 3% in upper middle and 1.6% in upper class category. In this study, alcohol consumption emerged as the most prominent risk factor, with 70% (42/60) of patients having a documented history of chronic alcohol use.  Conclusion: In conclusion, this study provides compelling evidence that serum sodium is an independent and reliable predictor of disease severity, complications, and mortality in decompensated liver disease. The strong associations observed between hyponatremia and adverse outcomes reinforce the need for early detection, continuous monitoring, and targeted therapeutic interventions. The integration of serum sodium assessment into routine liver disease management and transplantation evaluation has the potential to enhance risk stratification, guide therapeutic decision-making, and ultimately improve patient outcomes.

: Introduction: Interference is the major source of sample-specific bias in clinical laboratory and may lead to significant errors. Bilirubin is a known interferent in various biochemical assays including total cholesterol estimation. This study aimed to evaluate the presence, magnitude and dose-dependent quantification of bilirubin interference on serum total cholesterol measurement. Material and methods: This study was conducted as per CLSI EP07-A2 guidelines at a tertiary care hospital laboratory. Low, medium, and high total cholesterol pooled sera were prepared using leftover patient samples with total bilirubin concentration less than 1 mg/dL. Control and bilirubin spiked test pools were analysed for total cholesterol. Interference screening was performed using paired difference testing, followed by a five-level dose-response experiment to characterise the quantification of interference effect of bilirubin on total cholesterol estimation. Results: Significant negative interference of bilirubin was observed across all cholesterol levels. At bilirubin levels of approximately 30 mg/dL, mean negative bias in total cholesterol measurement was −12.5%, −9.8%, and −15.8% for low, medium, and high cholesterol pools, respectively, exceeding pre-defined cut-off values. Dose-response analysis demonstrated a linear, concentration-dependent interference with regression slopes of −0.42, −0.64, and −1.52 mg/dL cholesterol per mg/dL bilirubin for low, medium, and high cholesterol pools, respectively (p < 0.05). Conclusion: Bilirubin produces clinically significant, dose dependent negative interference in serum total cholesterol estimation. Laboratories should independently evaluate interference characteristics for their analytical systems and interpret cholesterol results cautiously in hyperbilirubinemic patients. Incorporation of interference assessment into routine quality assurance programs is essential to ensure reliable patient results.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology marked by symmetric, peripheral polyarthritis. RA has a prevalence of 1-2% in the general adult population. The inflammatory process usually leads to progressive joint destruction and ligamentous laxity, with resultant instability and subluxation in the cervical spine. Both the upper cervical spine (C1 and C2, with the atlantoaxial, atlanto-odontoid and atlanto-occipital joints) and the subaxial cervical spine may be involved. Aim: Study of involvement of cervical spine in rheumatoid arthritis by magnetic resonance imaging and it’s correlation with severity of disease. Materials and methods: This cross-sectional study was done at a Tertiary Care Centre in North West Rajasthan to include 50 consecutive RA patients attending the outpatient clinic of our rheumatology department. We include all patients of rheumatoid arthritis above 16 years of age diagnosed as per 2010, American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) revised the 1987 ACR classification criteria for RA were included in the study. Results: All the patients with MRI findings, had a positive X-ray hand-findings except 1 each patient who had AAS and Anterior subarachnoid space narrowing had no findings of X-ray hand. The prevalence of AAS was 26% (13 patients out of 50) in our population VS 52-75% in previous studies. AAS was found in 81.25% of all 16 positive cases, AAS was present in 13 patients and out of them 4 and 9 belonged to <40 and >40 years of age group. Subaxial subluxation is common abnormality at the lower cervical spine, found in 5 patients (10%) with a prevalence of 5–55% in other studies.  Conclusion: The patients of RA, especially those with advanced age, long duration of disease and associated comorbidity, should be screened for involvement of cervical spine as complications of RA using X-ray cervical spine and MRI cervical spine as early treatment is associated with a lower rate of cervical spine involvement.

Background: Optimisation of glottic visualisation is a key determinant of successful endotracheal intubation. Although videolaryngoscopy improves laryngeal exposure, external airway manoeuvres such as jaw thrust and backward–upward–rightward pressure (BURP) are frequently employed to further enhance the glottic view. Evidence comparing these manoeuvres during McGrath videolaryngoscopy remains limited. Materials and Methods: This prospective, randomised study employed a mixed design, with within-subject repeated-measures assessment of glottic visualisation under conventional, jaw thrust, and BURP manoeuvres using the McGrath videolaryngoscope, and parallel-group comparison of intubation characteristics. A total of 135 adult patients (ASA physical status I–II) undergoing elective surgery under general anaesthesia were randomised into three groups. MCL grade, POGO score, laryngoscopy time, intubation time, and ease of insertion were analysed. Results: Within-subject analysis demonstrated that both jaw thrust and BURP manoeuvres significantly improved glottic visualisation compared with the conventional technique, as reflected by improved MCL grades and higher POGO scores (p < 0.0001). No significant difference in glottic visualisation was observed between the two manoeuvres. Mean intubation time was significantly shorter in Group J (13.49 ± 1.63 s) and Group B (12.22 ± 1.24 s) compared with Group C (24.36 ± 3.73 s) (p < 0.0001). Ease of insertion was significantly better in Groups J and B than in Group C (p = 0.003). Laryngoscopy time, haemodynamic responses, and airway trauma were comparable among the groups. Conclusion: Jaw thrust and BURP manoeuvres significantly enhance glottic visualisation and improve intubation characteristics during McGrath videolaryngoscopy in adult patients with anticipated normal airways undergoing elective surgery, with comparable effectiveness and safety.

Background: Peripheral nerve blocks have emerged as effective regional anesthesia techniques for lower limb surgeries, offering excellent intraoperative conditions and prolonged postoperative analgesia. The popliteal nerve block is particularly advantageous for below-knee procedures. This study aimed to compare the efficacy of 0.5% levobupivacaine alone versus 0.5% levobupivacaine combined with fentanyl in ultrasound-guided popliteal blocks for below-knee surgeries. Methods: This prospective randomized clinical trial enrolled 114 patients (ASA grades I-II, aged 18-60 years) undergoing elective below-knee surgeries. Patients were randomly allocated into two groups: Group A (n=57) received 20 ml of 0.5% levobupivacaine with 1 ml normal saline, while Group B (n=57) received 20 ml of 0.5% levobupivacaine with 50 mcg fentanyl (1 ml). Primary outcomes included onset and duration of sensory and motor blockade. Secondary outcomes encompassed hemodynamic parameters, postoperative pain scores using Visual Analog Scale, and adverse effects. Results: Demographic characteristics were comparable between groups. Group B demonstrated significantly faster onset of sensory blockade (7.3 ± 1.4 minutes versus 12.3 ± 1.5 minutes; p = 0.01) and prolonged duration of sensory analgesia (890.1 ± 99.1 minutes versus 573.7 ± 72.9 minutes; p = 0.01). Postoperative VAS scores were significantly lower in Group B (1.7 ± 0.6 versus 3.1 ± 0.5; p = 0.01). Hemodynamic parameters remained stable in both groups throughout the observation period. No adverse effects were recorded. Conclusion: The addition of fentanyl to levobupivacaine in ultrasound-guided popliteal blocks significantly accelerates sensory blockade onset, prolongs analgesia duration, and improves postoperative pain control without compromising hemodynamic stability or increasing adverse effects

Background: Unforeseen painful laryngoscopy and intubation are still relevant challenges in the anaesthetic practice and bring significant morbidity to the airways. It is crucial that proper airway examination during the pre-operation phase is conducted instead of the prevention of hypoxic complications. WWW - The Modified Mallampati classification (MMC) is a bedside examination instrument, it is used when the difficult larynx look is to be pre-empted, and it is conventionally performed with patients seated. However, its appropriateness in the supine position, which is the most appropriate in certain operating/emergency setting, is contentious as well. This was to be achieved through researching the impact of Mallampati grade in upright anatomical position and supine position to forecast tricky laryngoscopy and intubation. Methods: The proposed study was a cross-sectional study that was carried out through the prospective analysis of 30 adult ASA I2 patients (18 years old onwards) who were to receive elective surgical operations under general anaesthesia. Mallampati evaluation in upright and supreme positions was performed on all of the participants before induction. It was an airway examination conducted by a seasoned anaesthesiologist who was conservative with regard to laryngoscopy. The standard of reference was Cormack Lehane grade that was established as the direct laryngoscopy. Modern-day difficult laryngoscopy was considered that of Cormack -Lehane grade III and IV. Both of the positions were bargained towards the gaining of the diagnostic indices of sensitivity, specificity, positive and negative predictive (PPV, NPV) and accuracy. Statistical measure was represented in SPSS v22 where Chi-square and Student t tests were taken as the developed measures. Results: Problematic laryngoscopy found in 3 ( 10% ) patients; among them, only external laryngeal positioning allowed them to be intubated. The supine position (26.6) compared to the upright position (20) showed Mallampati class III-IV more often. The supine test had superior specificity (92.6) and PPV (60) to predict a challenging laryngoscopy and the upright had a modest higher sensitivity (66.7) and NPV (96):. Concordance rates between Mallampati class and the view of laryngoscopy were greater in the supine position (κ = 0.42) as compared to the upright (κ = 0.33) position. Conclusion: The upright position used in Mallampati assessment has limitations as it may not be practical in supine position since it has both similar sensitivity and high in predicting challenging laryngoscopy. Supine examination can therefore prove useful on patients who cannot tolerate the sitting position.

Introduction: Chronic total coronary occlusions (CTOs) represent one of the most complex subsets of coronary artery disease and are frequently encountered during coronary angiography. Despite their prevalence, optimal management strategies remain controversial, particularly regarding the role of revascularization versus medical therapy. Understanding the clinical profile, angiographic characteristics, and short-term outcomes of CTO patients is essential for informed decision-making. This study aimed to assess the clinical profile of patients with chronic total occlusion, evaluate outcomes with optimal medical therapy with or without percutaneous coronary intervention (PCI), describe angiographic characteristics, and assess short-term prognosis using two-dimensional echocardiography and left ventricular ejection fraction (EF). Methods: This prospective observational study was conducted at a tertiary cardiac care center between January 2016 and December 2018. A total of 75 patients with angiographically confirmed CTO (TIMI 0 flow, duration ≥3 months) were enrolled. Demographic data, cardiovascular risk factors, clinical presentation, angiographic findings, and management strategies were recorded. Baseline and three-month follow-up echocardiographic assessments were performed to evaluate EF and mitral regurgitation. Statistical analysis included descriptive and inferential methods, with significance assessed at p < 0.05. Results: The mean age of the study population was 55.85 ± 11.17 years, with a male predominance (76%). Hypertension (49.3%), diabetes mellitus (46.7%), and tobacco smoking (46.7%) were the most common risk factors. Fatigue on exertion (41.3%) and chest pain (38.7%) were the predominant presenting symptoms. Inferior wall myocardial infarction was the most frequent diagnosis (37.3%). The right coronary artery was the most commonly involved vessel (56%), and triple-vessel disease was observed in 36% of patients. Most patients were managed with optimal medical therapy (84%), while PCI and CABG were performed in 5.3% and 10.7%, respectively. At three-month follow-up, left ventricular function remained stable in 94.7% of patients, with EF improvement noted in a small proportion. Conclusion: Patients with CTO constitute a high-risk population with significant comorbidity and extensive coronary disease. In the absence of high-risk features, optimal medical therapy resulted in stable short-term outcomes for most patients. Careful patient selection remains crucial when considering revascularization strategies.

Background: Determining drowning as the cause of death remains a diagnostic challenge in forensic practice, particularly when classical autopsy findings are absent, equivocal, or altered by postmortem changes. This study aimed to evaluate the prevalence, distribution, and patterns of paranasal sinus fluid in drowning deaths compared with other asphyxial deaths. Materials and Methods: This autopsy-based comparative observational study was conducted in a tertiary care government medical college in South India over an 18-month period. A total of 150 medicolegal autopsies were included, comprising 75 confirmed drowning deaths and 75 deaths due to other asphyxial causes such as hanging, strangulation, and smothering. Data were analyzed using SPSS version 25 software, with a p value <0.05 considered statistically significant. Results: Paranasal sinus fluid was identified in 82.7% of drowning cases compared to 28.0% of non-drowning asphyxial deaths (p <0.001). Maxillary sinus involvement was most frequent, followed by sphenoid, ethmoid, and frontal sinuses. Bilateral fluid distribution and involvement of multiple sinuses showed a strong and statistically significant association with drowning. Conclusion: The presence of paranasal sinus fluid, particularly when bilateral and involving multiple sinuses, is strongly associated with deaths due to drowning. Although not pathognomonic, careful evaluation of sinus fluid provides valuable supportive evidence and should be incorporated into routine autopsy examination in suspected drowning cases.

Background: Young-onset hypertension associates with oxidative stress, endothelial dysfunction, and hypercoagulability. This study evaluates serum D-dimer levels and their correlations with oxidative stress markers (MDA, Ox-LDL) and DNA repair efficiency (breaks/cell, CBMN frequency) in young hypertensives versus controls. Materials and Methods: Cross-sectional study of 100 participants (18-39 years): 50 hypertensives, 50 age/sex-matched controls. D-dimer by immunoturbidimetry; MDA calorimetrically; Ox-LDL by ELISA; DNA repair via bleomycin-induced breaks/cell and CBMN assays. t-tests and Pearson correlations (SPSS v16.0, p<0.05). Results:                Hypertensives showed elevated D-dimer (0.96±0.88 vs 0.12±0.08 mg/L; t=4.717, p<0.001), MDA (3.07±0.38 vs 1.26±0.52 U/L; t=35.828, p<0.001), Ox-LDL (47.15±20.05 vs 20.12±6.15 U/mL; t=6.562, p<0.001), breaks/cell (0.813±0.081 vs 0.664±0.041; t=19.773, p<0.001), CBMN (12.72±0.85 vs 9.94±0.54; t=33.688, p<0.001). D-dimer correlated with MDA (r=0.430, p=0.001), breaks/cell (r=0.282, p=0.016), CBMN (r=0.437, p=0.001), Ox-LDL (r=0.658, p=0.001). ROC: D-dimer AUC 0.968 (cutoff 0.23 mg/L, sensitivity 91.67%, specificity 88%). Conclusion: D-dimer elevations strongly correlate with oxidative stress and DNA repair deficits in young hypertensives, indicating early thrombotic and genomic instability risks.

Introduction: Pleural effusion represents an abnormal accumulation of fluid within the pleural space and laboratory assessment plays a pivotal role in establishing the diagnosis, determining the underlying etiology, and guiding management. AIM: To evaluate the laboratory findings, and etiological spectrum of pleural effusion in patients. Methodology: The present study was conducted in the Department of Medicine at S.P. Medical College and P.B.M. Associated Group of Hospitals, Bikaner, over a defined study period. Result: The study found a male predominance with bilateral pleural effusion being most common, showing significant associations with chronic kidney disease, selective hematological and biochemical variations, and predominantly lymphocytic pleural fluid with elevated ADA supporting tubercular etiology. Conclusion: Comprehensive clinical and laboratory evaluation of pleural effusion is essential, as bilateral involvement is common and underlying systemic diseases and pleural fluid parameters play a key role in determining etiology and management.

Introduction: Skin diseases constitute a significant proportion of outpatient and inpatient visits in tertiary care hospitals and represent a wide spectrum of pathological entities ranging from inflammatory and infectious conditions to benign and malignant neoplasms. Aim: To evaluate the incidence, histopathological spectrum, and age- and sex-wise distribution of neoplastic skin lesions in patients. Methodology: The study was conducted in the Department of Pathology, Sardar Patel Medical College and Associated Group of Hospitals, Bikaner, as a hospital-based prospective study. It included cases of benign neoplastic skin lesions received for histopathological examination during the study period. Result: The study showed a predominance of cutaneous tumors in young and middle-aged adults, with benign lesions being more common than malignant ones.Epidermal cyst was the most frequent benign lesion, while malignant tumors increased with advancing age, particularly after the fifth decade.Squamous cell carcinoma was the most common malignant tumor, followed by basal cell carcinoma, indicating a predominance of keratinocytic malignancies. Conclusion: Cutaneous tumors predominantly affected the economically productive age group, with benign lesions being more common in younger individuals and malignant lesions increasing with age.Epidermal and keratinocytic tumors, especially squamous cell carcinoma, constituted the majority of malignant cases.Early clinical suspicion and histopathological evaluation are essential for accurate diagnosis and timely management of cutaneous tumors.

Introduction: Skin is the largest organ of the body and reflects both local and systemic health, serving as an important site for the development of a wide spectrum of neoplastic conditions. Among these, benign skin neoplasms constitute a significant proportion of dermatological and pathological practice.AIM:To study the histopathological features, incidence, and age- and sex-wise distribution of non-neoplastic skin lesions in patients .Methodology: The study was conducted in the Department of Pathology, Sardar Patel Medical College and Associated Group of Hospitals, Bikaner, as a hospital-based prospective study. It included cases of non-neoplastic skin lesions received for histopathological examination during the study period. Result: The study observed a male predominance with the highest incidence of skin lesions in the 21–30 year age group. Non-neoplastic lesions were more common than neoplastic lesions, with infectious dermatoses—particularly leprosy—being the most frequent diagnosis. Among benign neoplasms, epidermal and keratinocytic tumors predominated, with warts as the commonest lesion. Conclusion: The study concludes that skin lesions show a clear male predominance and commonly affect young and middle-aged individuals, with infectious dermatoses forming the largest group among non-neoplastic lesions. Leprosy was the most frequent diagnosis, while epidermal and keratinocytic tumors, particularly warts, constituted the majority of benign neoplastic lesions. Histopathological examination remains essential for accurate diagnosis and appropriate management of the wide spectrum of skin lesions.

Introduction: Pleural effusion is a common clinical problem encountered in both inpatient and outpatient settings and usually presents with symptoms such as progressive shortness of breath, cough, chest pain, or chest heaviness. AIM: To evaluate the clinical profile and radiological features of pleural effusion in affected patients. Methodology: The present study was conducted in the Department of Medicine at S.P. Medical College and P.B.M. Associated Group of Hospitals, Bikaner. Result: The study found a hospital prevalence of pleural effusion of 1.92%, with the highest incidence in the 21–40-year age group; breathlessness and fever were the most common presenting symptoms, and bilateral pleural effusion was frequently associated with raised systolic and diastolic blood pressure (p < 0.01). Tubercular pleural effusion was the commonest aetiology, followed by dengue fever, with significant associations observed for tuberculosis, chronic liver disease, chronic kidney disease, severe anaemia, and malignant pleural effusion across effusion types (p < 0.05).Conclusion: The study concludes that tuberculosis remains the leading cause of pleural effusion in India despite control programs, with emerging etiologies such as dengue fever and increasing malignant effusions, highlighting the need for a comprehensive clinical, radiological, and sonographic approach for accurate diagnosis.

Background: Type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) frequently coexist and together substantially increase cardiovascular morbidity and mortality. Data from tertiary care settings in India remain limited. Objectives: To determine the prevalence of MetS among T2DM patients, also evaluate the association between MetS and demographic, anthropometric, and biochemical parameters. Methods: A hospital-based cross-sectional study was conducted over 12 months among 70 patients aged >35 years with diagnosed T2DM attending outpatient and inpatient services of a tertiary care hospital. MetS was diagnosed using standard criteria. Anthropometric indices, blood pressure, glycaemic parameters, lipid profile, and liver function tests were recorded. Statistical analysis was performed using SPSS v21. Results: MetS was present in 39 (55.7%) patients. Smoking status showed a significant association with MetS (p=0.048). Patients with MetS had significantly higher BMI (30.5±2.6 vs. 27.8±2.4 kg/m², p<0.001), waist circumference (101.2±5.3 vs. 94.4±9.8 cm, p<0.001), hip circumference (93.1±7.2 vs. 87.6±16.9 cm, p=0.026), waist–hip ratio (1.09±0.07 vs. 0.98±0.13, p<0.001), and fasting blood sugar (150.1±64.8 vs. 119.8±42.5 mg/dL, p=0.016). No significant association was observed with age, gender, area of residence, alcohol intake, duration of diabetes, HbA1c, PPBS, or liver enzymes. Conclusion: More than half of patients with T2DM had coexisting MetS. Obesity and central adiposity were the strongest correlates. Routine screening and aggressive management of MetS components in patients with T2DM are essential to reduce cardiovascular risk

Background: Consultation-liaison psychiatry plays a vital role in addressing psychiatric morbidity among patients admitted to general hospital settings. In rural India, the integration of mental health services within general healthcare remains suboptimal due to limited resources, shortage of trained professionals, and prevailing social stigma. Understanding referral patterns is essential for improving psychiatric service delivery in resource-limited settings. Methods: This retrospective observational study reviewed medical records of all inpatients referred to the Psychiatry Department from various hospital departments between January and June 2024. Data were collected using a semi-structured proforma, and diagnoses were classified according to ICD-10 criteria. Statistical analysis was performed using chi-square tests and independent t-tests, with significance set at p < 0.05.Ethical approval was obtained from the Institutional Ethics Committee. Results: A total of 543 patients were analyzed, with a mean age of 40.34 ± 18.86 years. Males (67.2%) outnumbered females (32.8%). The majority were married (84.8%) and employed (68.7%). Socioeconomic assessment revealed that the majority belonged to lower socioeconomic strata (55.4%). The Medicine department contributed the highest referrals (37%), followed by Orthopedics (25.2%) and Casualty (14.7%). Mental and Behavioral Disorders due to Psychoactive Substance Use (30.4%) was the most common diagnosis, followed by Intentional Self-Harm (20.8%).Significant associations were found between gender and diagnostic categories (p < 0.001). Conclusion: This study highlights the substantial burden of substance use disorders and self-harm cases in rural hospital settings, predominantly affecting individuals from lower socioeconomic backgrounds. Enhanced interdisciplinary collaboration and mental health training for non-psychiatric physicians are essential for improving psychiatric care integration.

Background: Viral infections have always been linked to abortions as well as increased pregnancy complications. The study aims to determine the burden of viral infections like CMV, HSV-2, rubella and COVID-19 in women with recent history of spontaneous abortion and the socio-demographic factors related to it. Methods: A prospective case control study was conducted in the department of Microbiology from January to June 2022 at a tertiary care hospital in India Cases included 75 women with recent history of spontaneous abortion. Equal number (75) of healthy postpartum women with normal pregnancy were selected as controls. About 8-10ml of blood was collected from both cases and controls under aseptic measures. ELISA test was performed to detect IgM antibodies against CMV, HSV-2 and Rubella and RT PCR was done in blood samples to detect the presence of COVID-19 virus. Results: In the study group,6(8%) subjects were seropositive for anti-IgM CMV and1(1.33%) subject was positive for anti-IgM HSV-2. IgM antibody was not detected for rubella virus. In the control group, IgM antibody was absent for CMV, HSV-2 and Rubella.Covid-19 was not detected in study group but 1(1.33%) control was positive for Covid-19 by RT PCR.As far as age is concerned, highest seropositivity to anti IgM CMV and HSV-2 in study group was seen in age less than 25 years and it was statistically significant for CMV(OD: 24.14, P=0.03).Rural residence, crowding and gestational age were also significantly associated with anti-IgM CMV. Conclusion: As viral infections are considered as one of the important causes of abortion, knowledge about regional seroprevalence data of viruses would help in raising awareness and increased prenatal screening thus preventing adverse pregnancy outcomes.

Introduction: Diabetes mellitus markedly increases cardiovascular morbidity and mortality due to the combined effects of hyperglycemia, insulin resistance, hypertension, obesity, and dyslipidemia, which accelerate atherosclerosis and vascular dysfunction. Diabetic patients often develop silent myocardial ischemia, leading to late presentation with severe cardiac events. Chronic subclinical elevation of cardiac biomarkers such as CK total, CK-MB, and LDH in diabetes suggests ongoing myocardial injury. This study evaluates the association of these biomarkers with cardiovascular risk factors in type 2 diabetes compared with non-diabetic individuals. Material and methods: This cross-sectional study was conducted at a tertiary care hospital in Surat, India. Serum creatine kinase total (CK total), CK-MB, and lactate dehydrogenase (LDH) were analyzed in 149 diabetic and 149 non-diabetic individuals using an Erba XL-640 fully automated chemistry analyzer. Height and weight were recorded to calculate body mass index (BMI). Statistical analysis was performed using SPSS version 16. Result and discussion: We had observed significantly (p<0.001) higher level of CK total (158 ± 75.10 U/l) in diabetic and non-diabetic (127.5 ± 73.9 U/l) individuals. We had observed significantly (p<0.001) higher level of CK-MB (41.18 ± 14.6 U/l) in diabetic and non-diabetic (29.19 ± 19.1 U/l) individuals. We had observed significantly (p<0.001) higher level of LDH (687 ± 180 U/l) in diabetic and non-diabetic (428 ± 197 U/l) individuals. We had also observed significant higher level of CK total, CK-MB and LDH in all age and BMI groups in diabetic subjects compared to non-diabetic individuals.  Conclusion: This study demonstrates that, Serum CK total, CK-MB, and LDH are significantly elevated in type 2 diabetes mellitus, reflecting early, subclinical myocardial injury driven by chronic hyperglycemia, oxidative stress, and metabolic inflammation. Despite the availability of high-sensitivity troponins, CK-MB and LDH remain reliable, cost-effective markers of cardiac stress and respond to metabolic control and antioxidant therapy. Routine monitoring of these enzymes, alongside glycemic and lipid parameters, can facilitate early cardiovascular risk detection and guide preventive strategies to reduce future cardiac events in diabetic patients.

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with significant morbidity, including heart failure and thromboembolic events. In developing countries, the etiological profile of AF differs from Western populations due to the persistent burden of rheumatic heart disease. The present study aimed to evaluate the clinical profile, etiological factors, and complications of atrial fibrillation in patients admitted to a tertiary care center. Methods: This hospital-based observational study included 100 patients diagnosed with atrial fibrillation. Diagnosis was established using clinical evaluation and 12-lead electrocardiography. Transthoracic echocardiography was performed in all patients to assess structural heart disease, left atrial size, and associated abnormalities. Data were analyzed using descriptive statistics and expressed as frequencies and percentages. Results: Females constituted 72% (n = 72) of the study population, with males accounting for 28% (n = 28). The majority of patients were elderly, with 30% in the 60–69 year age group and 26% in the 50–59 year group. Permanent AF was the most common subtype, observed in 46% of patients, followed by persistent AF in 34% and paroxysmal AF in 20%. Valvular heart disease was the leading etiology, accounting for 42% of cases, followed by hypertensive heart disease (26%) and ischemic heart disease (14%). Palpitation was the most common presenting symptom (56%), followed by dyspnea (45%). Heart failure was the most frequent complication (22%), while cerebrovascular accident occurred in 8% of patients. Left atrial enlargement was present in 75% of cases, with moderate dilation (4–5 cm) observed in 58% and severe dilation (>5 cm) in 17%. Conclusion: Atrial fibrillation in this tertiary care setting predominantly affected elderly females and was commonly associated with rheumatic valvular heart disease. The high prevalence of permanent AF and left atrial enlargement underscores the need for early detection, appropriate etiological evaluation, and optimal anticoagulation to reduce AF-related complications.

Background: The circle of Willis (CoW) is the principal intracranial arterial collateral pathway. Anatomical variants are common and can influence collateral adequacy and the interpretation of neurovascular imaging. Objectives: To describe overall CoW morphology and document anterior and posterior circulation variations in adult cadaveric brains. Methods: A cadaver-based observational study was conducted over three years. One hundred adult formalin-fixed brains were examined by standard basal dissection. The CoW was classified as classical complete and symmetrical, complete but asymmetrical, or incomplete. Segmental variations (hypoplasia/aplasia) in ACoA, A1 segment and PCoA, and fetal-type PCA configuration were recorded. Results: Classical complete and symmetrical circles were observed in 54% of specimens; 18% were complete but asymmetrical and 28% were incomplete. Any anterior circulation variation occurred in 34% (most commonly hypoplastic ACoA, 16%). Any posterior circulation variation occurred in 30% (most commonly hypoplastic PCoA, 18%); fetal-type PCA was seen in 4%. Variations were unilateral in 31%, bilateral in 15%, and multiple in 14%. Conclusion: Non-classical CoW configurations were frequent, and communicating artery hypoplasia/aplasia predominated. Awareness of these patterns supports safer anatomical orientation and operative planning at the skull base.

Background: Sexual assault is a major medico-legal and public health concern. Documentation of injuries in survivors is important for clinical care and legal corroboration, though absence of injuries does not exclude sexual assault. Objectives: To study the pattern and distribution of injuries among female survivors of natural sexual offences examined at a tertiary care centre in Assam. Materials and Methods: A descriptive cross-sectional study was conducted from March 2023 to February 2024. A total of 110 eligible female survivors were included. Data on age, hymenal status, genital and bodily injuries, tenderness or bleeding, and treatment provided were analysed descriptively. Results: Most survivors belonged to the 16–20-year age group (39.09%). Old hymenal tears were seen in 85.45% of cases, with tears most commonly located between the 6 and 9 o’clock positions. Bodily injuries were present in 15.45% of cases, and genital injuries most frequently involved the labia majora and minora. Tenderness or bleeding was noted in 18.18% of cases. Conclusion: The majority of sexual assault survivors showed no significant injuries. Injury patterns varied widely, reinforcing the need for meticulous, trauma-informed medico-legal examination.

INTRODUCTION:HIV is a virus that attacks the immune system, especially CD4 cells. It leads to progressive immunodeficiency and can result in AIDS if untreated. HIV spreads through blood, sexual fluids, and from mother to child. HIV infection often causes skin, hair, nail, and mouth problems early on. Mucocutaneous manifestations may indicate HIV infection and disease severity. Opportunistic infections like bacterial, viral, and fungal infections are common in HIV. Non-infectious skin conditions, drug reactions, and malignancies are also seen.This study focuses on identifying mucocutaneous lesions in HIV patients in relation to CD4 lymphocyte count as a marker of immune status. AIM: The study aims to correlate the CD4 counts with occurrence of mucocutaneous manifestations in HIV patients.MATERIALS AND METHODS: This is a cross-sectional study which includes 140 HIV-positive patients visiting OPD of Department of Dermatology a nd Venereology at Government General Hospital, Ananthapuramu from April 2023 to Oct 2024.  RESULTS: Among 140 HIV patients with mucocutaneous manifestations, there were 44 males and 56 females, most commonly aged 31–40 years. Heterosexual transmission was the predominant route (94%), and the mean CD4 count was 462.9 cells/µl, with 46% in WHO stage 2 and 8% severely immunosuppressed (CD4 <200). Non-infectious dermatoses were slightly more prevalent, with Pruritic Papular Eruption (PPE) being the most common (n=19, mean CD4 379), followed by Xanthelasma palpebrarum and vitiligo. Infectious manifestations included oral candidiasis (n=17), tinea corporis, tinea versicolor, vulval candidiasis, HPV warts, molluscum contagiosum, leprosy, and furunculosis. Nail changes (longitudinal melanonychia), hair changes (chronic telogen effluvium), and drug reactions (FDE, lichenoid eruptions) were also observed. Infectious skin conditions like tinea and scabies occurred in patients with moderate to preserved immunity (CD4 >490), whereas severe infections such as oral candidiasis and genital herpes were associated with advanced immunosuppression (CD4 <200), highlighting their role as clinical markers of immune status. These findings underscore the importance of regular dermatological assessment in HIV care, particularly in resource-limited settings, as mucocutaneous manifestations can aid early diagnosis, monitoring, and evaluation of HAART effectiveness. CONCLUSION: Cutaneous and mucosal lesions are key clinical indicators of HIV infection. These manifestations can occur at any stage and correlate with immunological status. Certain dermatoses are associated with profound immunosuppression, suggesting advanced HIV disease. Common dermatological conditions may present with atypical morphology or increased severity in HIV-positive patients.Unusual or recalcitrant presentations can complicate diagnosis, particularly in undiagnosed individuals.

Introduction: Acute bronchiolitis (AB) is a leading cause of hospitalization in children under two years. In majority the disease is benign but, in some cases, severe disease may develop into serious cardiopulmonary complications. Vitamin D has immunomodulatory and cardioprotective roles, yet its relationship with cardiopulmonary involvement in acute bronchiolitis remains poorly understood. Aim: To evaluate the correlation between serum vitamin D levels and cardiopulmonary status in children aged 2 months to 2 years admitted with acute bronchiolitis. Materials and Methods: This prospective observational study was conducted in the Paediatric Intensive Care Unit of Dr. B. C. Roy PGIPS, Kolkata, from January 2023 to June 2024. 96 children aged 2 months to 2 years with acute bronchiolitis were enrolled. Serum vitamin D levels were categorized as deficient (<20 ng/mL) or sufficient (≥20 ng/mL). Clinical features, duration of symptoms, PICU stay, respiratory support requirements, biochemical parameters, cardiac biomarkers (NT-proBNP, ferritin), electrocardiography (ECG), and echocardiography were evaluated. Results: Among 96 subjects,58(60.4%) and 38(39.6%) patients were male and female respectively, 44(45.8%) patients were found vitamin D deficient. A significant negative correlation was noted between serum vitamin D levels and PICU stay duration (r=−0.673, p<0.001). Deficient children had significantly higher NT-proBNP (5306.73±3727.02 pg/ml), ferritin levels (507.52±441.43 ng/ml) compared to those with sufficient vitamin D levels (NT-proBNP level 1687.27±1743.51 pg/ml, ferritin level 222.96±146.13 ng/ml) (p<0.001), with a higher prevalence of moderate-to-severe pulmonary hypertension and left ventricular dysfunction (p<0.001). Severe left ventricular dysfunction was observed exclusively in the vitamin D deficient group (18.2%, p<0.001). All 4(4.1%) mortalities occurred in the vitamin D–deficient group. Conclusion: Vitamin D deficiency in acute bronchiolitis is linked to severe disease, cardiopulmonary involvement, prolonged PICU stay, and increased mortality; early assessment may identify high-risk children.

Background: Caesarean section using spinal anaesthesia is not an exception and a significant proportion of women continue to experience moderate to severe postoperative pain that may delay the pace of recovery and maternal-neonatal bonding. Past reports have defined a variety of risk factors (e.g. BMI, length of incision, preoperative anxiety) which are nevertheless incongruent. This study was a cross-sectional study aimed at determining the level of postoperative pain and the related predictors in the context of caesarean section under spinal anaesthesia in a tertiary hospital.  Methods: Our cross-sectional study was among n = 60 women aged ≥18 years undergoing caesarean section under spinal anaesthesia with ASA I -II. Face to face interview and review of the chart were used to collect data. To assess pain, Numerical Rating Scale (NRS, 010) (at baseline (preoperative), 30 minutes after analgesic, 12 hours after analgesic) was used. Age, height, weight, BMI, education, preoperative anxiety score, length of operation, type and length of incision, number of previous operations, number of people in OR, type of analgesic/frequency, and satisfaction with pain control were included as the predictor variables. The analyses were performed on the data through the descriptive statistics, Pearson or Spearman correlation, chi-square/Fisher exact tests (SPSS v21.0). Results: The average age of the participants was 29.8 and SD 4.2 years of age, mean body mass index was 27.1 and SD 3.8 kg/m². The average baseline (preoperative) pain was 4.2. Mean NRS (30 min post-analgesic) was 3.84 ± 1.7 and 12 hours post-analgesic was 5.14 ± 2.0. Approximately 45 percent (27/60) of the women were having moderate to severe pain (NRS ≥ 4) at 12 hours. There were significant positive correlations between the 12-hour pain intensity and the BMI (r = 0.32, p = 0.014), the duration of the operation (r = 0.35, p = 0.008), and the length of the incision (r = 0.29, p = 0.025). The level of preoperative anxiety was associated with greater postoperative pain among women ( 0.31 = 0.017, p). The proportion of moderate-to-severe pain was higher on account of those who already had an abdominal surgery ( 2 = 4.2, p = 0.041). The 12h pain had an inverse relationship with satisfaction with pain control (x 2 = 5.7, p = 0.017). Conclusion: Among this cohort, there was a large percentage of women who had moderate to severe levels of postoperative pain 12 hours after analgesia. The most significant predictors were increased BMI, increased length of surgeon, length of incision and increased preoperative anxiety. Psychological preparation before the surgery and specific multimodal analgesics regimens are justified as they enhance the results in pain.

INTRODUCTION: Proximal femoral fractures constitute a major public health problem and are among the most common causes of hospitalization following trauma, particularly in the elderly population. AIM: To evaluate the functional outcome and complications following treatment of proximal femoral fractures using proximal femoral nailing. METHODOLOGY: This prospective observational study was conducted in the Department of Orthopaedics at a tertiary care teaching hospital over a period of 1 yr, from oct 2024 to sept 2025. RESULT: The majority of patients with proximal femoral fractures achieved satisfactory radiological union and functional outcomes, with most fractures uniting within 16 weeks and excellent to good Harris Hip Scores observed in a large proportion of cases, while postoperative complications remained low. CONCLUSION: Appropriate and timely surgical management of proximal femoral fractures results in favorable functional recovery, high union rates, and an acceptable complication profile, emphasizing the importance of early stabilization and rehabilitation.

Background: Ibuprofen and indomethacin have got approval for pharmacological closure of hsPDA (hemodynamically significant patent ductus arterious) in preterm infants. Recent works have shown that PCM (paracetamol) can also be used. However, recent literature data has shown that further studies are needed concerning their safety and efficacy. Aim: The present study aimed to assess the efficacy of ibuprofen and paracetamol in treating hemodynamically significant patent ductus arteriosus in preterm infants. Methods: The study assessed subjects for hsPDA (hemodynamically significant patent ductus arteriosus) using 2D echo and clinical findings. After the final inclusion of the study subjects, 200 subjects were assigned to PCM (paracetamol) and IBU (ibuprofen) groups in a 3-day course. Following clinical and echocardiographic assessment, when needed second same drug course was given. Outcomes assessed were adverse events, safety of the drugs, and rate of ductal closure. Results: The study results showed closure rates of 75% and 76.25% in ibuprofen and paracetamol groups with a significantly higher rate of closure in the first course with 16.25% versus 45%. The mean closure time was 4 and 4.54 days for ibuprofen and paracetamol respectively. A higher closure rate was seen in the paracetamol group in subjects with low birth weight and subjects with below-normal platelet counts. Concerning the safety aspect, no significant difference was seen between the two groups. Conclusions: The present study concludes that paracetamol can be given as the first-line treatment in hemodynamically significant patent ductus arteriosus cases in preterm infants and is a superior choice in subjects with low platelet counts and comorbidities.

Background: The addition of new techniques in MRI (magnetic resonance imaging) can help differentiate orbital masses into benign and malignant lesions. However, existing literature data is scarce concerning this. Aim: The present study aimed to evaluate the efficacy of the utility of advanced magnetic resonance techniques in the improvement of the diagnostic ability for differentiation in malignant and benign orbital masses. Methods: The present study assessed 52 subjects 24 males and 28 females with a mean age of 34.6 years that presented with the orbital masses to the Institute within the defined study period. In all the subjects, MRI was done using advanced techniques such as dynamic (DCE)< MRS, and DWI on a 1.5T scanner. The data gathered were statistically analyzed.  Results: The study showed specificity, sensitivity, positive predictive value, and negative predictive value of 75%, 72.2%, 86.6%, and 54.5% respectively. Lesions having P=Tp<141.5 s showed a sensitivity and specificity of nearly 94.4% and 87.5% respectively and positive and negative predictive values of 94.4% and 87.5% respectively for malignancy. The lesions having slope >0.47 depicted a specificity and sensitivity of nearly 78% and 100% respectively and positive and negative predictive values of 66.6% and 100% respectively for malignancy. Also, a significant difference was seen in type I and III curves with p=0.002. Chlorine peak presence depicted a specificity, sensitivity, negative predictive value, and positive predictive value of 94.4%, 62.5%, 83.3%, and 85% respectively.  Conclusions: The present study concludes that advanced MRI (magnetic resonance imaging) with the inclusion of perfusion parameters, MRS, and DW can significantly improve radiologists' diagnostic performance in differentiating malignant and benign orbital masses

Objective: To compare clinical, functional (Olerud-Molander Ankle Score, OMAS), and radiological outcomes of tension band wiring (TBW) versus malleolar screw fixation in displaced medial malleolar fractures. Methodology: Prospective randomized controlled trial (2022–2025) at Government Medical College, Kadapa enrolled 60 patients (≥18 years, closed displaced transverse/oblique fractures). Randomized 1:1 to TBW (n=30) or malleolar screw (n=30). Outcomes: OMAS (0–100, higher=better), VAS pain (0–10), ankle ROM, radiological union (weeks), complications. Assessed pre/postop, 3/6/9 months. Analyzed by chi-square/t-tests (SPSS). Results: Demographics comparable (age 31–50 years predominant, 75% male, p>0.05). TBW union faster (8.32±1.61 vs 10.69±3.35 weeks, p<0.05). OMAS: TBW 90% good/excellent vs screw 80% (p=0.612). Complications: TBW 10% (2 SSI, 1 skin necrosis) vs screw 6.7% (1 SSI/implant failure/skin necrosis, p=0.399). Mean hospital stay 8.9 days (TBW 8.55±1.90 vs screw 9.25±1.62). Fracture types: SER 57.5%, RTA 40% predominant. No non-unions; full weight-bearing at 6 weeks both groups. Conclusion: TBW achieved faster union with comparable functional outcomes and low complications versus screws, favoring TBW for small/osteoporotic fragments in medial malleolar fractures.

Background: Over the past few decades, there has been a growing interest in low-flow anaesthesia because of its perceived benefits of improved hemodynamic stability, decreased use of anaesthetic gases and faster recovery after surgery. However, many practitioners remain concerned about the potential risks, adequacy of depth of anaesthesia and recovery characteristics associated with low-flow techniques, which has limited its utilisation in routine practice. Objective: The goal of this study was to compare the effects of low-flow anaesthesia versus conventional anaesthesia on the hemodynamic stability during surgery and on recovery following elective surgical procedures done with general anaesthesia. Methods: This study was a comparative, prospective study that took place over 12 months at our hospital. A total of 120 patients (ASA I–II), all of whom were scheduled for elective surgical procedures under general anaesthesia, were recruited into this study and assigned to one of the two treatment groups (low-flow anaesthesia and conventional anaesthesia) equally (60 patients in each group). The sample size for this study was determined to be large enough to detect a clinically important difference between the two groups based on confidence intervals with a sample size that would provide a minimum of 80% power and 5% significance level to account for dropouts from the study. The same anaesthetic regimen was used for both groups except for the flow rates of fresh gas after induction. Intraoperative hemodynamic measurements including heart rate, systolic and diastolic blood pressure, and mean arterial pressure were measured at predetermined times. The recovery characteristics of both groups were evaluated using time until awakening, extubation time, and modified Aldrete score for recovery. Results: Intraoperative hemodynamic stability between groups receiving Low Flow Anaesthesia (LFA) and those receiving Conventional Anaesthesia (CA) was similar, with no statistically significant differences in heart rate or blood pressure at most study endpoints (deltatimes). Patients receiving LFA had better recovery profiles than those receiving CA based on faster eye-opening time, shorter extubation periods, and overall higher Aldrete Scores during the first 24 hours. There were no significant adverse events or episodes of hypoxic or hypercapnic events in either anaesthesia group. Conclusion: In elective surgical procedures, low-flow anaesthesia is as safe and effective a method as traditional, or baseline, methods and will provide comparable hemodynamic stability, plus some improved early recovery characteristics. The use of low-flow anaesthesia in routine practice may enhance recovery for patients and improve anaesthetic practices without risking additional safety issues.

Background: Caffeine is widely consumed, yet its acute effects on cardiac autonomic regulation remain incompletely understood. Heart rate variability (HRV) provides a sensitive, non-invasive method to assess autonomic balance and detect subtle neural cardiovascular effects. Objectives: To evaluate the short-term effects of moderate caffeine intake on cardiac autonomic function in healthy young adults using time-domain and frequency-domain HRV analysis, with assessment of sex-related differences and effect sizes. Methods: In this cross-sectional interventional study, 100 healthy young adults underwent baseline HRV and hemodynamic assessment under resting conditions. HRV was recorded for 5 minutes before and 60 minutes after oral caffeine administration (3 mg/kg body weight). Time-domain and frequency-domain HRV parameters were analysed according to standard guidelines. Sex-based comparisons and effect sizes were calculated. Results: Caffeine intake resulted in a significant increase in parasympathetic HRV indices, including NN50 and high-frequency (HF) power, along with a significant reduction in the LF/HF ratio, indicating a shift toward parasympathetic predominance. These changes were associated with small-to-moderate effect sizes. Hemodynamic parameters, including heart rate and blood pressure, remained clinically stable. Sex-specific analysis revealed a greater increase in NN50 among females, while other autonomic responses were comparable between sexes. Conclusion: Moderate acute caffeine intake enhances cardiac parasympathetic modulation without adverse hemodynamic effects in healthy young adults.

Background: Acute coronary syndrome (ACS) remains a leading cause of cardiovascular mortality globally, particularly in developing nations like India. Risk stratification at presentation is crucial for optimizing treatment strategies and resource allocation. While established scores like GRACE require laboratory values and complex calculations, the PADMA (PADjadjaran Mortality in Acute Coronary Syndrome) score offers a simpler alternative using only clinical examination findings. Objectives: To assess the predictive capability of the PADMA score for in-hospital mortality in ACS patients and compare its performance with other established risk scores including GRACE, C-ACS, and ProACS. Methods: This prospective observational study included 84 consecutive ACS patients (STEMI and NSTEMI) admitted to a tertiary care center. PADMA, GRACE, C-ACS, and ProACS scores were calculated at admission for each patient. The primary outcome was in-hospital mortality. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminatory power of each score, with Youden's index employed to determine optimal cutoff values. Results: The study population had a mean age of 63.63 ± 12.944 years with 63.1% males. Overall in-hospital mortality rate was 14.3% (12/84). The PADMA score demonstrated strong discriminatory ability with an AUC of 0.825 (95% CI: 0.73-0.92), sensitivity of 91.7%, and specificity of 66.7% at a cutoff of 8.5. PADMA scores were significantly higher in non-survivors (11.67 ± 3.80 vs. 6.57 ± 3.90, p<0.001). Comparative analysis showed GRACE score AUC of 0.837, C-ACS AUC of 0.751, and ProACS AUC of 0.694. Mortality was significantly associated with female gender (OR 4.26, p=0.021), Killip class III-IV (p=0.001), and elevated shock index (1.06 vs 0.76, p<0.001). No significant mortality difference was observed between STEMI and NSTEMI (p=0.788). Conclusion: The PADMA score demonstrated excellent efficacy in predicting in-hospital mortality in ACS patients with discriminatory ability comparable to the more complex GRACE score. Its high sensitivity (91.7%) makes it particularly valuable for identifying high-risk patients requiring urgent intensive care. The simplicity of the PADMA score—requiring only clinical assessment parameters—offers substantial practical advantages in resource-constrained settings where laboratory data may be delayed or unavailable

Chronic cutaneous ulcers represent a persistent clinical problem due to impaired healing and frequent recurrence despite standard wound care practices. This prospective comparative study assessed the effectiveness of autologous platelet-rich plasma (PRP) in the treatment of chronic non-healing cutaneous ulcers. Ninety patients were randomly allocated into a PRP group (n = 45), which received local autologous PRP injections, and a control group (n = 45), managed with conventional 10% povidone-iodine dressings. Patients were followed until complete epithelialization or the requirement for surgical intervention. Wound culture findings were comparable between the two groups, with Staphylococcus aureus being the most commonly isolated organism and no statistically significant difference observed (p = 0.5737). Despite similar microbial profiles, PRP-treated patients demonstrated faster and more complete wound healing than those receiving conventional treatment. These findings indicate that autologous PRP is a safe, cost-effective, and effective adjunct in the management of chronic non-healing cutaneous ulcers.

Background: Infants of diabetic mothers (IDM) are at increased risk of neonatal hypoglycemia, contributing to interventions and NICU admissions.Objectives: To estimate the incidence of hypoglycemia in IDM, identify predictors, and describe timing and short-term outcomes.Methods: Prospective observational study (18 months) at SSPM Medical College and Lifetime Hospital, Padve, Maharashtra. Consecutive IDM (n=220) underwent scheduled glucose screening (2, 6, 12, 24, 48, 72 hours and if symptomatic). Hypoglycemia was defined using Indian guideline–based operational thresholds. Predictors were assessed using bivariate analysis and multivariable logistic regression.Results: Hypoglycemia occurred in 69/220 (31.4%) (95% CI 25.6–37.8). First episodes were most frequent at 6 hours (43.5%) and 12 hours (27.5%). Among affected neonates, 36.2% were symptomatic, 20.3% had severe hypoglycemia (<25 mg/dL), and 7.2% had recurrent episodes. IV dextrose was required in 37.7% and NICU admission was higher with hypoglycemia (40.6% vs 23.2%, p=0.009). On multivariable analysis, HbA1c (aOR 1.67, p=0.062) and LGA status (aOR 2.13, p=0.063) showed borderline association with hypoglycemia.Conclusion: Nearly one-third of IDM developed hypoglycemia, predominantly within the first 12 hours, with increased need for IV therapy and NICU admission. Early feeding and protocol-based monitoring are essential.

Background: Vitamin D deficiency is common in children and may adversely affect linear growth, yet regional data from coastal western India are limited.Objectives: To estimate the prevalence of vitamin D deficiency and examine its association with growth parameters among children aged 1–10 years in Sindhudurg, Maharashtra.Methods: A hospital-based cross-sectional study was conducted over 6 months at SSPM Medical College and Lifetime Hospital, Padve. In 400 children (1–10 years), serum 25-hydroxyvitamin D [25(OH)D] was measured and categorized as deficient (<20 ng/mL), insufficient (20–29 ng/mL), or sufficient (≥30 ng/mL). Anthropometry was used to derive HAZ, WAZ, and BAZ; determinants and growth associations were assessed using multivariable regression.Results: Vitamin D deficiency was present in 40.3% (161/400), insufficiency in 25.3%, and sufficiency in 34.5%. Deficient children had lower mean HAZ than sufficient children (−1.06 ± 1.07 vs −0.73 ± 1.17; p=0.028). In adjusted linear models, deficiency remained associated with lower HAZ (β −0.37, 95% CI −0.64 to −0.10; p=0.008) and WAZ (β −0.29, 95% CI −0.55 to −0.04; p=0.024), with no association with BAZ. Higher sun exposure was independently protective against deficiency (aOR 0.77 per hour/day, 95% CI 0.60–0.99; p=0.042). Conclusion: Nearly two-thirds of children had suboptimal vitamin D status, and deficiency was independently associated with lower linear growth indices. Improving effective sun exposure and appropriate supplementation may reduce deficiency burden and support child growth.

The global and Indian demographic trend shows that, with passage of time, countries have experienced ageing of population with increase in proportion of older persons, thus creating a burden on the working age group. Census 2011, Sample Registration System, and other studies, have shown following demographic changes in India. Objective of The Study: 1. To assess morbidities amongst the elderly in the study area. 2. To determine the nutritional status by the elderly in the rural areas. 3. To study the socio demographic factors influencing the health care seeking behaviour amongst the elderly. Material and Methods: Study Type: Community-based, Cross-sectional study. Study Population: Elderly Population above 60 years of age. Study Area: Villages under Titaguri,Dotma & Balajan, kokrajhar Study Duration: November 2024 to January 2025. Sample Size calculation: Sample size was calculated based on study named Barua K, Borah M, Deka C, Kakati R. Morbidity pattern and health-seeking behavior of elderly in urban slums: A cross-sectional study in Assam, India. J Fam Med Prim Care. 2017;6(2):345–50 ,Taking the prevalence of diabetes mellitus (24%), among the elderly in urban settlements from a study in Assam in 2017, 95% confidence interval, and absolute error as 5%, the sample size is calculated to be 291.84. The sample size was rounded off to300. This community-based cross-sectional study was conducted among persons aged 60 years and above, in rural areas in the Kokrajhar district, Assam. Consent: Informed consent will be taken from all the participants before data collection and confidentiality will be maintained. Results and Observations: On the basis of their history, clinical assessment, laboratory test reports, and doctors' prescriptions, it had been noted that out of 300 elderly people, 37% had hypertension, 32.33% had diabetes mellitus, 40.33% had musculoskeletal disorders, 36.67% had dental problems, 12.33% had urogenital disorders, 11% had sleep disorders, 10.33% had geriatric depression,8.33%had accidents and injuries and 6.66%had dementia. Ocular disorders(83.67%) were observed to be the most frequent morbidity followed by musculoskeletal disorders (40.33%) and hypertension (37%). Conclusion; A significant association with increasing age was seen with different morbidities including ocular disorders, hearing disorders, musculoskeletal disorders, urinary system disorders, dementia, dental problems, sleep disorders, and multimorbidity.

Background:Hypertension is highly prevalent in patients with chronic kidney disease (CKD) and is a major contributor to cardiovascular morbidity and progression of renal dysfunction. Accurate assessment of blood pressure (BP) in CKD patients is challenging due to altered circadian BP patterns and poor reliability of office blood pressure measurements. Ambulatory blood pressure monitoring (ABPM) provides comprehensive evaluation of BP variability, nocturnal BP behavior, and overall BP burden, which may have important clinical implications in CKD.Objectives:To study various blood pressure parameters obtained by ambulatory blood pressure monitoring in patients with chronic kidney disease, to compare office blood pressure monitoring with ambulatory blood pressure monitoring, to determine the prevalence of resistant, masked, and white-coat hypertension, and to evaluate altered circadian BP patterns and their association with CKD stages and target organ damage.Methods:This hospital-based observational cross-sectional study was conducted among 88 hospitalized CKD patients aged more than 12 years admitted to the general medicine wards of Government Medical College, Kozhikode, between January 2022 and December 2022. Office BP was measured using a mercury sphygmomanometer, and all participants underwent 24-hour ABPM using a validated device. Ambulatory parameters including daytime and nighttime systolic and diastolic BP, nocturnal dipping status, hyperbaric index, percent time elevation, and BP phenotypes were analyzed. Data were expressed as mean ± standard deviation and percentages.Results:Hypertension was detected in 80.7% of patients by ABPM compared to 76.1% by office BP measurement. Resistant hypertension was observed in 34.1% of the study population and in 44.7% of hypertensive patients, with prevalence increasing with advancing CKD stage. A high prevalence of nocturnal non-dipping pattern was noted (73.9%), and all patients with resistant hypertension were non-dippers. Nighttime hyperbaric index and percent time elevation were significantly higher than daytime values, particularly in advanced CKD stages. Target organ damage was common, with left ventricular hypertrophy present in 44.5% and hypertensive retinopathy in 37.5% of patients, while resistant hypertension patients showed markedly higher prevalence of these complications.Conclusion:Ambulatory blood pressure monitoring provides superior diagnostic and prognostic information compared to office BP measurement in hospitalized CKD patients. ABPM enables accurate identification of resistant and masked hypertension, detects abnormal nocturnal BP patterns, and reveals increased nighttime BP burden associated with target organ damage. Routine use of ABPM in CKD patients may improve blood pressure management, risk stratification, and prevention of cardiovascular complications.

Background: Myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide. Arrhythmias are common complications following acute MI, particularly after thrombolytic therapy, and significantly influence clinical outcomes. Objectives: To evaluate the demographic and clinical profile of patients with acute MI, assess the incidence and pattern of arrhythmias following thrombolytic therapy, and analyze their association with infarct location, comorbidities, and in-hospital mortality. Methods: This prospective observational study included 160 patients with acute MI admitted to a tertiary care center. Demographic variables, comorbid conditions, type and site of MI, occurrence and type of arrhythmias after thrombolysis, and clinical outcomes were recorded and analyzed. Results: The majority of patients were aged 46–60 years, with a mean age of 54.54 ± 11.09 years, and males constituted 65% of the study population. Hypertension and diabetes mellitus were the most common comorbidities. Anterior wall MI was the predominant infarct type. Arrhythmias occurred in 63.13% of patients, with ventricular premature complexes (22.77%), sinus tachycardia (19.80%), and idioventricular rhythm (14.85%) being the most frequent. Ventricular arrhythmias were associated with higher mortality. The overall in-hospital mortality rate was 13%, predominantly observed in patients with anterior and anteroinferior wall infarctions. Conclusion: Arrhythmias are common following thrombolytic therapy in acute MI, particularly in patients with anterior wall involvement and associated comorbidities. Early detection, continuous cardiac monitoring, and timely management of arrhythmias, along with effective control of cardiovascular risk factors, are essential to improve patient outcomes and reduce mortality.

Background: Recurrent pregnancy loss (RPL), defined as two or more failed pregnancies, affects 10–15% of women. Endocrine factors contribute to approximately 8–12% of cases, with growing evidence implicating subclinical hypothyroidism (SCH) and thyroid autoimmunity (TAI) in adverse pregnancy outcomes. However, data on their role in early pregnancy loss remain limited. Objectives: To analyse the association between subclinical hypothyroidism and anti-thyroid peroxidase (anti-TPO) antibodies in women with recurrent pregnancy loss, and to estimate the prevalence of SCH and anti-TPO positivity in this population. Methods: This prospective, descriptive observational study was conducted from July 2023 to December 2024 at a tertiary care centre in Kolkata. A total of 166 multigravida women with ≥2 pregnancy losses were enrolled after excluding anatomical and chromosomal causes. Clinical data, biochemical parameters, and thyroid profiles (TSH, free T4, anti-TPO antibodies) were analysed using SPSS version 25. Associations were assessed using Fisher’s exact test. Results: The mean age was 28.09 ± 5.62 years. Of the study population, 44.0% had subclinical hypothyroidism and 54.8% were euthyroid. Anti-TPO antibody positivity (≥35 IU/ml) was observed in 59.6% of women. A statistically significant association was found between subclinical hypothyroidism and anti-TPO antibody positivity (p = 0.0028), as well as between overt hypothyroidism and anti-TPO positivity (p = 0.0018). Most miscarriages (89.1%) occurred during the first trimester. Conclusion: Subclinical hypothyroidism in the presence of thyroid autoimmunity is significantly associated with recurrent pregnancy loss. Routine screening for thyroid dysfunction and anti-TPO antibodies may facilitate early intervention and improve reproductive outcomes.

Background: Invasive fungal infections (IFIs) are associated with high morbidity and mortality, particularly among immunocompromised and critically ill patients. Timely and accurate diagnosis is essential for improving outcomes. Histopathology and microbiological methods, including culture and molecular diagnostics, remain the principal modalities for diagnosing IFIs; however, their relative diagnostic yield and concordance vary across studies. Objective: To systematically compare the diagnostic yield of histopathology versus microbiological methods in invasive fungal infections and to evaluate their complementary roles in establishing proven infection. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed/Medline, Embase, Scopus, and PubMed Central were searched from inception to January 2025 for studies reporting paired histopathology and microbiological findings on tissue or sterile site specimens from patients with suspected IFIs. Data on diagnostic yield, concordance, and the contribution of molecular techniques were extracted. Due to heterogeneity in study design, specimen types, and reporting of diagnostic accuracy measures, results were synthesized narratively, with quantitative tabulation where feasible. Results: Forty-two studies met the inclusion criteria. Histopathology consistently demonstrated a higher diagnostic yield for detecting fungal elements and tissue invasion compared with fungal culture alone, particularly in patients with prior antifungal exposure and in infections caused by fastidious organisms. Microbiological culture showed variable sensitivity but remained essential for species identification and antifungal susceptibility testing. Molecular diagnostic methods significantly enhanced detection rates and improved concordance with histopathology, especially in culture-negative cases. Considerable variability in concordance between histopathology and microbiology was observed across studies. Conclusion: Histopathology remains indispensable for establishing invasive fungal infection through demonstration of tissue invasion, while microbiological and molecular methods are critical for etiological identification and therapeutic guidance. An integrated diagnostic approach combining histopathology, culture, and molecular techniques provides the highest diagnostic yield and should be considered the standard strategy for the diagnosis of invasive fungal infections.

Background: Coronary arterial dominance describes which coronary artery gives rise to the posterior descending artery (PDA) and largely perfuses the inferior interventricular septum and adjacent diaphragmatic myocardium. Objectives: To document the dominance pattern and related morphological features of the PDA and crux cordis in adult human hearts. Methods: A descriptive cross-sectional study was conducted on 80 adult human hearts examined in the Department of Anatomy, Government Medical College, Karimnagar, Telangana, India (February–November 2025). The right coronary artery (RCA) and left circumflex artery (LCx) were traced to identify the origin of the PDA, the vessel reaching/crossing the crux cordis, and the predominant inferior ventricular supply. Dominance was categorized as right, left, or co-dominant. Results: Right dominance was observed in 70% of hearts, left dominance in 20%, and co-dominance in 10%. The PDA arose from the RCA in 70% and from the LCx in 20%, while dual contribution was seen in 10%. At the crux cordis, the RCA crossed the crux in 70% and the LCx reached the crux in 20%; both vessels reached the crux in 10%. Inferior wall supply was predominantly by the RCA in 70%, by the left coronary system in 20%, and balanced in 10%. Conclusion: Right coronary dominance predominated, with consistent correspondence between dominance category, PDA origin, crux reach, and inferior ventricular supply. These baseline data support safer interpretation of coronary imaging and procedural planning in the regional context

CIN  is the impairment of renal function gauged as either a 25% rise in serum creatinine from baseline or an increase of 0.5 mg/dL (44 µmol/L) in absolute serum creatinine value within 48-72 hours following intravenous contrast administration.The renal impairment that is linked with the administration of contrast is acute, usually occurring within 2-3 days. However, it has been recommended that renal impairment developing up to seven days post-contrast administration should be considered CIN if it is not attributable to any other possible cause of kidney failure.The incidence of contrast-induced nephropathy is calculated to be more than 2% in the general population. However, in high-risk groups with risk factors for kidney disease, the incidence is as high as 20% to 30%. It is reported that there is a lower risk of contrast-induced nephropathy when low osmolar contrast media is used.Additionally, it decreases water reabsorption, causing an increase in interstitial pressure.The study aimed to predict the CIN after PCI in comparision with Meharan score. METHODS A cross-sectional study was conducted in the Department of Cardiology at a multispecialty teaching hospital. A total of 300 patients were taken undergoing PCI including  elective and emergency PCI , were creatinine was done at admission and at 48hrs after PCI.survivors of a first episode of AMI who returned for follow-up one month after discharge were included. .  Data were analyzed using SPSS version 26. Descriptive statistics, z-test, Chi-square test, Spearman’s correlation, and binary logistic regression were applied. A p-value < 0.05 was considered statistically significant. RESULTS A total of 300 study participants based on inclusion and exclusion criteria were included in the study. Majority of the study participants were between the age group of 51-70 constituting to 61.3% (n=184), followed by 20.3% (n=61) in 31-50 years, 18% (n=54) in 71-90 years and 0.3% (n=1) in 18-30 years group. Among the study participants, 70.3% (n=211) were male and 29.7% (n=89) were female.The Very High modified score group shows a spread: ~57% remain Low, ~31% shift to Moderate, and ~12% distribute into High/Very High by the original score.This indicates that the Modified Mehran Score reclassifies higher-risk patients more aggressively, while the original Mehran Score tends to under-classify risk.Almost all patients with High or Very High original scores are classified as Very High by the modified score.Patients with Low original scores are spread across Moderate, High, and Very High modified categories, highlighting some reclassification. CONCLUSIONS  Our study showed a significant positive results with modified mehran score for better prediction of CIN and its complications.Most patients classified as Moderate or High by the modified score fall almost entirely into the Low risk category of the original Mehran score.The Very High modified score group shows a spread: ~57% remain Low, ~31% shift to Moderate, and ~12% distribute into High/Very High by the original score

Background: Type 2 diabetes mellitus (T2DM) is frequently associated with metabolic syndrome (MS), a constellation of metabolic abnormalities that significantly increases cardiovascular morbidity and mortality. Gamma-glutamyl transferase (GGT), traditionally regarded as a hepatic enzyme, has emerged as a potential biomarker of oxidative stress and metabolic risk. Elevated GGT levels have been linked to individual components of MS and cardiovascular disease, even in the absence of overt liver pathology. Aim & Objective: To evaluate serum Gamma-glutamyl transferase levels in patients with Type 2 diabetes mellitus with metabolic syndrome and to assess its association with metabolic syndrome in comparison with T2DM patients without metabolic syndrome and healthy controls. Materials & Methods: This cross-sectional analytical study was conducted at a tertiary care hospital in Tamil Nadu from April to July 2024. A total of 105 participants aged 30–60 years were enrolled and divided into three groups: healthy controls (n=35), T2DM patients without metabolic syndrome (n=35), and T2DM patients with metabolic syndrome (n=35), diagnosed using NCEP-ATP III criteria. Anthropometric measurements, blood pressure, fasting and postprandial glucose, lipid profile, and serum GGT levels were assessed. Statistical analysis was performed using SPSS version 16.0, with ANOVA and Bonferroni post-hoc tests applied. A p-value <0.05 was considered statistically significant. Results: Serum GGT levels were significantly higher in T2DM patients with metabolic syndrome (52.58 ± 48.10 U/L) compared to T2DM patients without metabolic syndrome (24.97 ± 14.62 U/L) and healthy controls (20.16 ± 8.37 U/L) (p < 0.001). Waist circumference, systolic and diastolic blood pressure, total cholesterol, and triglyceride levels were also significantly elevated in the metabolic syndrome group. No statistically significant difference in GGT levels was observed between T2DM patients without metabolic syndrome and healthy controls. Conclusion: Serum Gamma-glutamyl transferase levels are significantly elevated in T2DM patients with metabolic syndrome. Incorporating GGT estimation into routine evaluation of patients with Type 2 diabetes mellitus may facilitate early identification of metabolic syndrome and help reduce future cardiovascular morbidity and mortality.

Background: The foramen magnum (FM) is a key osteological landmark at the craniovertebral junction. Its dimensions and contour influence surgical corridors and inform radiologic and forensic interpretation. Objectives: To describe FM morphometry and shape patterns in adult skulls from Telangana, and to evaluate sex-related differences in FM dimensions. Methods: This cross-sectional observational study examined 80 adult dry human skulls (42 male, 38 female) from the Department of Anatomy, GMC Karimnagar, Telangana, India (February 2025–November 2025). Anteroposterior diameter (basion–opisthion) and transverse diameter (maximum width) were measured using a digital vernier caliper. FM index was calculated as (transverse/anteroposterior)×100, and FM area was estimated using an ellipse-based formula. FM shape was categorized as oval, round, tetragonal, pentagonal, or irregular. Results: Mean anteroposterior and transverse diameters were 34.8±2.6 mm and 29.6±2.4 mm, respectively; mean FM index was 85.1±6.9 and mean area was 810.5±98.7 mm². Oval shape was most frequent (45.0%), followed by round (27.5%). Males had larger diameters and area than females, with statistically significant differences. Conclusion: FM morphometry in this sample showed clear sexual dimorphism, with oval and round shapes predominating. These regional baseline data support skull-base surgical planning and provide context for imaging and forensic applications

Background: Chronic serous otitis media associated with Eustachian tube dysfunction (ETD) is commonly managed with long-term ventilation tube (grommet) insertion. Balloon Eustachian tuboplasty (BET) has emerged as a novel therapeutic option aimed at improving Eustachian tube function. This study compares the outcomes of BET alone versus BET combined with grommet insertion in patients with chronic serous otitis media and ETD. Aim and Objectives: To evaluate and compare the effectiveness of Balloon Eustachian Tuboplasty (BET) alone and BET combined with grommet insertion in patients with chronic serous otitis media associated with Eustachian tube dysfunction (OME-ETD). Methods: This prospective comparative study included 72 patients with OME-ETD treated between October 2024 and November 2025. Patients were divided into two groups: BET group (n = 36) and BET + Grommet group (n = 36). Postoperative outcomes assessed at 6 and 12 months included air-bone gap (ABG), Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), Eustachian tube inflammation scale, Chronic Otitis Media Outcome Test-15 (COMOT-15), Valsalva maneuver results, and patient satisfaction. Results: Postoperative ABG improvement was significantly greater in the BET + Grommet group compared to the BET group at both 6 and 12 months. The ETDQ-7, Eustachian tube inflammation scale, and COMOT-15 scores showed a significant reduction in the BET + Grommet group at follow-up intervals. The proportion of patients able to perform a positive Valsalva maneuver was significantly higher in the BET + Grommet group at both 6 and 12 months. Overall patient satisfaction was also superior in the combination therapy group. Conclusion: Balloon Eustachian Tuboplasty combined with grommet insertion demonstrates superior efficacy compared to BET alone in patients with OME-ETD. The combined approach results in better hearing outcomes, improved Eustachian tube function, reduced inflammation, and enhanced quality of life

Background: Diabetes mellitus is a major chronic health condition associated with significant morbidity, mortality, and healthcare burden worldwide. Achieving optimal glycaemic control is critical to preventing complications, and adherence to prescribed antidiabetic medications plays a pivotal role in this process. Despite the availability of effective therapies, poor adherence remains a leading cause of uncontrolled diabetes and adverse outcomes. Objective: This study examines the interaction between controlling blood sugar levels and taking diabetes medicines as prescribed in Type 2 Diabetes Mellitus patients from India, attending the Medicine Department, Central Hospital, Kalla. Methods: From June 2024 to June 2025, EMR records from 100 adults with diabetes were used in a retrospective observational study. For type 2 diabetes, six months of diabetes medicine and HbA1c statistics were required. Patients' adherence was rated as high, average, or low by the Medication Possession Ratio (MPR). HbA1c numbers (<7%, ≥7%) show the way glucose levels are controlled. For statistical research, we used SPSS and Pearson's coefficient (p < 0.05) to find correlations. Results: Patient adherence was 46% strong, 32% moderate, and 22% poor. Lower HbA1c levels were associated with higher adherence, decreasing the connection between poor glycaemic management (p < 0.05). Conclusion: Higher blood sugar results with better medicine adherence. Patient education, follow-ups, and adherence-monitoring technology are needed to improve diabetic management in India.

Macro Creatine Kinase (CK) is a rare cause of elevated serum CK levels that can mimic myocardial injury. We present a case of a 56-year-old male with persistently elevated CK-MB by immunoinhibition method, initially raising concerns for silent myocardial ischemia. Extensive cardiac evaluation revealed normal coronary anatomy and cardiac function. Further testing ultimately identified Macro CK Type 1 as the etiology, highlighting the importance of considering macroenzymes in the differential diagnosis of elevated CK-MB levels without clinical correlation.

Background: The cardiovascular diseases are the primary cause of morbidity and death globally. A significant increase in obesity rates has been linked to the accelerating increase in cardiovascular disease around the world. Excessive body fat accumulation is the hallmark of obesity, a metabolic illness that is closely linked to cardiovascular disease.  Material & Methods: The study was conducted in a sample of 113 healthy medical students age between 18 and 24 years. Evaluation of body composition (weight, BMI and body fat percentage—BFP) was done by using Omron HBF 375 body composition analyser. Two measurements were taken for each subject, and mean BFP was calculated. A twelve-lead ECG monitor was used for recording of ECG ventricular parameters (HR, QT, QTc, TQ, TQc, RR, TQ/QT, RR/ TQ, TQc/QTc and RRc/TQc). Correlation analysis was done between the body composition parameters and ECG parameters. Linear Regression Analysis was done for the variables with relevant associative relationships.  Results and Discussion: The results of the study revealed that the regression models for BFP (independent variable) and the dependent variables weight, QTc, TQc and TQc/QTc, were statistically significant (p < 0.01). The regression models for BFP (independent variable) significantly predicted each dependent variable: QTc, TQc, TQc/QTc. QTc interval has positive association with BFP whereas TQc and TQc/QTc showed negative association with BFP. Conclusion:  Ventricular electrical activity in young adults is influenced by the body composition, which implies the risk for ventricular impairment in medical students with high body composition and suggests for an early intervention.

Background: Seizures are common neurological emergencies in children, with febrile seizures (FS) being the most frequent, particularly in those aged below five years. While generally benign, FS may recur and contribute to later epilepsy in some children. Zinc, an essential trace element, plays a crucial role in neuronal excitability and GABA synthesis. Reduced zinc levels have been implicated in lowering seizure thresholds; however, the evidence remains inconsistent. This study aimed to evaluate serum zinc levels in children with seizures compared to febrile controls without seizures. Methods: A hospital-based case-control study was conducted in the Department of Paediatrics in a tertiary care Centre. A total of 80 children aged 5 months to 12 years were enrolled, including 40 cases with seizures (simple febrile, atypical febrile, and other types) and 40 age- and sex-matched febrile controls without seizures. Three millilitres of venous blood were collected, and serum zinc levels were estimated using the colorimetric method. Data were analyzed using SPSS software, and p < 0.05 was considered statistically significant. Results: Most participants were between 1–5 years of age, with a male predominance (60%). Simple febrile seizures were the most common (57.5%), followed by atypical febrile seizures (27.5%). The mean serum zinc level in seizure cases was 59.6 µg/dl compared to 101.4 µg/dl in controls (p < 0.0001). Zinc deficiency was observed in 52.5% of cases versus 10% of controls. Both simple and atypical febrile seizure groups showed significantly lower zinc levels compared with controls, whereas other seizure types did not demonstrate significant differences. Conclusion: Serum zinc levels are significantly reduced in children with febrile seizures compared to febrile controls, suggesting zinc deficiency may play a role in seizure pathogenesis. Larger multicentric studies are recommended, and zinc supplementation could serve as a cost-effective preventive measure in susceptible pediatric populations.

Background: Background: Varicose veins are increasingly recognized as an occupational health issue, particularly among professionals with prolonged standing hours. Medical residents, due to long working hours and extended duty shifts, may be at heightened risk. Aim: To assess the incidence and contributing factors of varicose veins among newly joined residents in clinical branches at a tertiary care institute. Materials and Methods: This retrospective study analyzed data collected from 50 newly joined residents (January 2023–June 2025) at Vilasrao Deshmukh Government Medical College, Latur, using a structured questionnaire assessing demographics, work hours, lifestyle, preventive awareness, and symptoms of varicosities. Results: Out of 50 residents, 6 (12%) showed symptoms suggestive of varicose veins. The majority reported prolonged standing (>8 hours/day) and extended working shifts. Three affected residents were from the Pediatrics discipline. Awareness of varicose vein prevention was noted in 70% of participants; however, only 20% practiced preventive measures such as limb elevation or compression stocking use. Conclusion: The incidence of varicose veins among newly joined residents was 12%, with prolonged standing hours and inadequate preventive practices identified as key contributing factors. Occupational modifications, awareness programs, and preventive strategies should be implemented to safeguard the vascular health of residents.

Background: Early and accurate diagnosis of Acute Coronary Syndrome (ACS) remains crucial for optimal outcomes. While cardiac Troponin I (cTnI) is the gold standard biomarker, its delayed rise limits early diagnosis. Heart-type Fatty Acid-Binding Protein (H-FABP) is a promising early marker, with potential diagnostic and prognostic utility. Aim: To evaluate the diagnostic and prognostic significance of H-FABP in ACS and compare its performance with cTnI and NT-proBNP across ACS subtypes and severities. Methods: This prospective observational study included 130 patients with ACS. H-FABP and cTnI were measured at 0 and 6 hours post-admission; NT-proBNP was analyzed once. Echocardiography assessed left ventricular ejection fraction (LVEF), and coronary angiography quantified disease extent using SYNTAX score. Statistical analyses included ROC curves, logistic regression, and correlation tests. Results: H-FABP positivity (>9 ng/mL) was observed in 100% of STEMI and NSTEMI and 6.9% of unstable angina cases (p < 0.001). H-FABP (0h and 6h) showed excellent diagnostic accuracy for left ventricular dysfunction (AUC = 0.937 and 0.949), outperforming Troponin I (AUC = 0.768 and 0.756). HFABP correlated significantly with SYNTAX score (r = 0.320, p < 0.001). NT-proBNP also showed strong predictive performance (AUC = 0.948). Conclusion: H-FABP demonstrates superior early diagnostic accuracy and prognostic significance in ACS compared to Troponin I and performs comparably to NT-proBNP. Its integration with conventional biomarkers may enhance early risk stratification and management in ACS.

Background: Many Local anaesthetics have been tried and tested to enhance the safety and efficacy in subarachinoid block. From previous studies, bupivacaine is widely used because of its excellent motor blockade but because of its side effects of cardiotoxicity and neurotoxicity, there is a search for a better alternative which provides similar effects with significantly reduced cardiotoxicity and neurotoxicity. Objectives: To study and compare the effects of equal volume of 0.75% Hyperbaric Ropivacaine with 0.5% Hyperbaric Bupivacaine for lower abdominal surgeries. Materials & Methods: A Prospective randomized double-blind study. Control study done on 60 patients in the Department of Anaesthesiology, Khaja Banda Nawaz Teaching and General Hospital, Kalaburagi.  Patients were randomly divided into 2 groups of 30 each. Group A: Hyperbaric Ropivacaine 0.75% 3ml, Group B: Hyperbaric Bupivacaine 0.5% 3ml.  Results: Ropivacaine significantly produced slower onset but shorter time to peak effect (4.01 ± 0.83, 13.43 ± 0.77) than bupivacaine (3.06 ± 0.69, 14.36 ± 0.99); however, level of sensory block achieved was similar and duration of sensory block was significantly lesser with ropivacaine (154.93 ± 6.45 min).The onset of pinprick analgesia at T10 was more rapid in bupivacaine Group B than in ropivacaine Group A. (P <0.001) However, the time to (peak) maximum extent of cephalad spread and the level achieved were similar in both groups. The mean duration of sensory block was shorter in Group A (154.93 ± 6.45) than in Group B (190.00 ± 7.20). (P<0.001) The time to maximum motor blockade was statistically similar Conclusion: Ropivacaine is comparable to the hyperbaric 0.5% bupivacaine in terms of quality of block, but with a shorter recovery profile, it is a useful agent for Spinal Anaesthesia for intermediate duration of surgeries.

Background: Early recognition of sepsis remains a major clinical challenge. Conventional clinical scoring systems such as qSOFA, SOFA, SIRS, and NEWS have limited sensitivity for early detection. Machine learning (ML)–based early warning systems have been increasingly developed to leverage electronic health record data for earlier and more accurate sepsis . Objectives: To systematically evaluate and quantitatively synthesize the diagnostic performance of ML-based early warning systems for early sepsis prediction in hospitalized adult patients. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Scopus, Web of Science, and related databases were searched for studies published between 2015 and 2025 that evaluated ML-based models for early sepsis prediction in adult populations. Pooled estimates of sensitivity, specificity, area under the receiver operating characteristic curve (AUC), accuracy, precision, and F1 score were calculated using random-effects models. Risk of bias was assessed using the ROBINS-I tool. Results: Thirty studies encompassing approximately 5.5–6.0 million adult patient encounters were included. ML-based early warning systems demonstrated high pooled sensitivity (0.89), specificity (0.87), and overall accuracy (0.88). Discriminative performance was excellent, with a pooled AUC of 0.93. Precision and F1 score indicated balanced diagnostic performance but showed substantial heterogeneity across studies, largely driven by differences in sepsis prevalence, clinical settings, and model thresholds. Most studies exhibited a moderate risk of bias, primarily related to retrospective design. Conclusions: ML-based early warning systems demonstrate robust and superior diagnostic performance for early sepsis prediction compared with conventional clinical scoring tools. While heterogeneity across studies remains substantial, the consistency of pooled estimates supports the potential clinical value of ML-driven approaches. Prospective validation and context-specific calibration are essential for successful real-world implementation.

Background: Postoperative pain remains a significant clinical challenge that affects recovery, mobility, and overall patient outcomes. Although opioids have historically served as the primary analgesic agents, their adverse effects including respiratory depression, nausea, ileus, and potential for dependency have prompted a shift toward multimodal analgesia (MMA). Incorporating anesthetic interventions such as peripheral nerve blocks and neuraxial (epidural or spinal) anesthesia into MMA regimens offers an opportunity to improve analgesic efficacy while reducing opioid consumption. Methods: This systematic review was conducted following PRISMA 2020 guidelines. A comprehensive search of PubMed, the Cochrane Library, and ScienceDirect databases identified studies published between 2015 and 2025 that evaluated multimodal analgesia protocols including anesthetic techniques for postoperative pain control. Eligible studies included randomized controlled trials, cohort studies, and meta-analyses assessing pain intensity, opioid use, and functional recovery. Data were synthesized narratively due to heterogeneity in protocols and outcome measures. Results: Eight key studies were included, comprising randomized trials, cohort analyses, and systematic reviews across orthopedic, abdominal, and spinal surgeries. Consistently, MMA protocols that integrated anesthetic methods such as adductor canal, transversus abdominis plane, erector spinae, and epidural blocks resulted in significantly lower pain scores and reduced opioid consumption. For instance, epidural local anesthetics provided superior analgesia and faster gastrointestinal recovery compared to systemic opioids, while adductor canal block preserved mobility with comparable analgesic efficacy. In ERAS-based cohorts, structured MMA bundles reduced median opioid use by up to 70%. Additionally, improved patient satisfaction, earlier ambulation, and shorter hospital stays were observed. Discussion: Regional and neuraxial anesthesia enhances multimodal analgesia by blocking nociceptive transmission and reducing central sensitization. When combined with non-opioid agents—such as acetaminophen, NSAIDs, gabapentinoids, ketamine, and dexamethasone these techniques provide synergistic pain relief while minimizing opioid-related complications. Despite consistent benefits, variability in study design and dosing regimens highlights the need for procedure-specific standardization and further trials on long-term outcomes such as chronic postsurgical pain and sustained opioid abstinence. Conclusion: Evidence strongly supports the integration of anesthetic techniques into multimodal analgesia for effective postoperative pain control. These strategies reduce opioid requirements, enhance functional recovery, and align with ERAS principles of patient-centered and opioid-sparing care. Future research should focus on optimizing multimodal combinations, evaluating continuous versus single-shot techniques, and developing individualized analgesic pathways to maximize efficacy and safety across diverse surgical populations.

Background: Intraabdominal infections remain one of the most serious postoperative complications following gastrointestinal surgery, contributing significantly to morbidity, prolonged hospital stay, and mortality. Early diagnosis is often challenging as clinical signs may be nonspecific in the immediate postoperative period. Biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) have been increasingly studied for their role in the early detection of infective complications. Aim: To evaluate the role of serum C-reactive protein and procalcitonin levels in the early diagnosis of intraabdominal infections in patients undergoing gastrointestinal surgery. Materials and Methods: This prospective observational study was conducted at Government Medical College, Kadapa, over a period of one year. Adult patients undergoing elective or emergency gastrointestinal surgery and requiring postoperative intensive care monitoring were included. Serum CRP and PCT levels were measured at 1^st, 24^th, 48^th, and 72^nd postoperative hours. Patients were monitored clinically and radiologically for the development of intraabdominal infections such as anastomotic leaks and intraabdominal abscesses. Diagnostic accuracy of CRP and PCT was assessed using sensitivity, specificity, and receiver operating characteristic (ROC) curve analysis. Results: A significant proportion of patients developed postoperative intraabdominal infections. Both CRP and PCT levels were significantly higher in infected patients compared to non-infected patients, particularly at 48 and 72 hours postoperatively. Procalcitonin demonstrated higher sensitivity and specificity than CRP at these time points, indicating superior predictive value for early diagnosis of intraabdominal infections. Conclusion: Serial measurement of serum procalcitonin and C-reactive protein is valuable in the early detection of postoperative intraabdominal infections. Procalcitonin, especially at 48 and 72 hours, is a more reliable biomarker than CRP and can aid clinicians in early diagnosis and timely intervention.

Background: Sleep disturbances are increasingly recognized as an important factor influencing glucose metabolism and metabolic control in patients with Type 2 Diabetes Mellitus (T2DM). While HbA1c reflects average glycemic control, glycemic variability provides additional insight into short-term glucose fluctuations that contribute to diabetic complications. Objectives: To evaluate the association between sleep quality and glycemic variability in patients with Type 2 Diabetes Mellitus. Methods: This prospective observational study was conducted over one year at PDU Medical College and attached group of Hospital (Dedraj Bhartiya Hospital -Churu). A total of 100 patients with T2DM were enrolled. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and patients were categorized into good and poor sleep quality groups. Glycemic variability was evaluated using fasting blood glucose, standard deviation of glucose values, coefficient of variation, and mean amplitude of glycemic excursions. HbA1c was measured to assess overall glycemic control. Statistical analysis was performed to determine the association between sleep quality and glycemic variability. Results: Poor sleep quality was observed in 54% of the study participants. Patients with poor sleep quality demonstrated significantly higher fasting blood glucose levels, greater glycemic variability, and higher HbA1c compared to those with good sleep quality. Increased glycemic variability was present in a substantially higher proportion of patients with poor sleep quality, indicating a strong association between impaired sleep and glucose instability. Conclusion: Poor sleep quality is common among patients with Type 2 Diabetes Mellitus and is significantly associated with increased glycemic variability and suboptimal glycemic control. Routine assessment of sleep quality may serve as an important component of comprehensive diabetes management and may help identify patients at higher risk for glycemic instability and related complications.

Background: Type 2 Diabetes Mellitus (T2DM) is a major public health problem and is frequently associated with microvascular and macrovascular complications that significantly increase morbidity and mortality. Magnesium plays an essential role in glucose metabolism, insulin action, and vascular function. Hypomagnesemia is commonly observed in patients with T2DM and has been implicated in the development of diabetic complications. Objectives: To evaluate serum magnesium levels in patients with Type 2 Diabetes Mellitus and to assess their role in predicting the presence of diabetic complications. Methods: levels were This prospective observational study was conducted over a period of one year at PDU Medical College and attached group of Hospital (Dedraj Bhartiya Hospital -Churu). A total of 100 patients with Type 2 Diabetes Mellitus were enrolled. Serum magnesium measured at baseline, and patients were assessed for the presence of diabetic microvascular and macrovascular complications using standard clinical and laboratory criteria. Data were analyzed to determine the association between serum magnesium levels and diabetic complications using appropriate statistical tests, with a p-value of <0.05 considered statistically significant. Results: Hypomagnesemia was observed in 37% of the study participants. Diabetic complications were present in 54% of patients and were significantly more common among those with low serum magnesium levels. The prevalence of hypomagnesemia was markedly higher in patients with complications compared to those without complications. Mean serum magnesium levels were significantly lower in patients with complications than in those without. A significant association was also observed between longer duration of diabetes and the presence of complications, while gender showed no significant association. Conclusion: Hypomagnesemia is common in patients with Type 2 Diabetes Mellitus and is significantly associated with diabetic complications. Serum magnesium estimation may serve as a simple and cost-effective tool for early identification of patients at higher risk for complications, supporting its inclusion in routine diabetic evaluation and management.

Background: In obstetric critical illness, distinguishing hypoperfusion from venous congestion is challenging. VExUS-based POCUS and endothelial biomarkers may support individualized hemodynamic decisions, but feasibility data are limited. Objectives: To assess feasibility of integrating VExUS POCUS with endothelial biomarkers in critically ill obstetric patients and explore early management and organ-outcome signals. Methods: Prospective 1-year feasibility study (N=50) at Mahabodhi Medical College & Hospital, Bihar. Within 6 hours of ICU/HDU admission, participants underwent IVC, hepatic, portal, and intrarenal venous Doppler to assign VExUS grade (0–3) and biomarker sampling (syndecan-1; sFlt-1/PlGF where available). Feasibility endpoints were completion rate, scan time, biomarker acquisition, and documented management changes attributable to findings. Exploratory outcomes included KDIGO-AKI and fluid balance. Results: POCUS protocol completion was 47/50 (94%) with median scan time 15 min (IQR 12–17); biomarkers were obtained in 46/50 (92%). Management change attributed to POCUS/biomarkers occurred in 29/50 (58%), most often diuretics (13/29, 44.8%) or fluid restriction (11/29, 37.9%). VExUS 2–3 occurred in 24/50 (48%). AKI occurred in 16/50 (32%), higher in VExUS 2–3 vs 0–1 (45.8% vs 19.2%; OR 3.55). Fluid balance differed at 24 h (+0.81 L vs −0.81 L) and 48 h (+0.74 L vs −1.15 L). Syndecan-1 correlated with VExUS grade (ρ=0.48, p=0.0008). Conclusions: Combined VExUS POCUS and endothelial biomarker integration was feasible and frequently influenced hemodynamic decisions. Higher congestion aligned with greater AKI and distinct fluid balance patterns, supporting larger validation studies.

Introduction: Hypothyroidism is one of the most common endocrine disorders in India, with varying clinical and biochemical presentations. It remains underdiagnosed, especially in peripheral regions such as Jammu & Kashmir.

Objectives: To evaluate the clinical profile and biochemical patterns of hypothyroidism and to assess the association of anaemia, obesity, and menstrual irregularities with disease severity. Methods: A descriptive cross-sectional study was conducted among 500 newly diagnosed hypothyroid patients attending the Medicine Department of a district hospital in Jammu and Kashmir from January 2023 to December 2024. Detailed history, clinical examination, and laboratory evaluation including serum TSH, T4, and haemoglobin levels were performed. Patients were classified as subclinical or overt hypothyroidism based on biochemical criteria. Statistical analysis was done using SPSS v26.0, with p < 0.05 considered significant. Results: Of 500 patients, 370 (74%) were females and 130 (26%) males, with a mean age of 38.9 ± 11.6 years. Subclinical hypothyroidism constituted 64.4% and overt 35.6%. Common symptoms were fatigue (78.4%), weight gain (71%), and dry skin (62.4%). Anaemia was found in 27.4% and obesity in 22.2%, both significantly associated with overt disease (p=0.002 and p=0.03, respectively). Menstrual irregularities occurred in 40% of females (p=0.001). Conclusion: Hypothyroidism predominantly affects middle-aged females. Early screening, especially in women with menstrual or metabolic symptoms, is essential for timely diagnosis and treatment.

Background: The clinical profile and outcomes of severe COVID-19 vary across regions and health-care settings. We evaluated the clinico-demographic characteristics and in-hospital outcomes of patients with severe COVID-19 pneumonia admitted to a tertiary hospital in North India. Methods: We performed a prospective observational study of RT-PCR–confirmed COVID-19 patients meeting severity criteria (respiratory rate >24/min, SpO₂ <94% on room air, or organ dysfunction) over seven months. Demographics, symptoms, comorbidities, laboratory tests, and HRCT findings were recorded. Outcomes included in-hospital mortality. Results: Of 179 severe cases, 95 were men (53.1%) and 100 were from rural areas (55.9%). Fever was the most common symptom, followed by cough and breathlessness; universal hypoxaemia was documented on admission. Tachycardia occurred in 89.4%, tachypnoea in 50.3%, bradycardia in 7.3%, and hypotension in 1.7%. Hypertension (48.0%) and diabetes (9.5%) were the leading co-morbidities; one-third had none. Lymphopenia was seen in 19.0% and leukocytosis in 11.2%; HRCT showed a CT severity index >6 in all patients. Overall mortality was 13.4% (24/179) and was higher in males (62.5% of deaths), in those ≥60 years (58.3%), with comorbidities (66.7%), and from rural areas (75%). Conclusion: Severe COVID-19 pneumonia at our centre was characterised by fever with hypoxaemia, frequent hypertension and lymphopenia, and a moderate fatality rate. Male sex, older age, rural residence, co-morbidities, lower SpO₂, and higher CT severity were associated with death, underscoring the need for early risk stratification and intensified management in these subgroups.

Background: The fibular incisura of the distal tibia is essential for ankle stability and proper syndesmotic function. Variations in its morphology can affect ankle biomechanics and the management of ankle fractures. As morphometric data from the Eastern Indian population are limited, this study aimed to evaluate the dimensions of the fibular incisura in adult tibiae and to assess sex-wise and side-wise differences for clinical relevance. Materials And Methods: A cross-sectional observational study was carried out on 60 adult human dry tibiae of known gender. The sample comprised equal numbers of male and female tibiae, with both right- and left-sided specimens included, but not paired. Only well-preserved tibiae with intact distal ends and without any deformity or pathological changes were selected. Morphometric parameters of the fibular incisura, including width, depth, height, and the lengths of the anterior and posterior tubercles, were measured using a digital vernier calliper with an accuracy of 0.01 mm. All measurements were recorded in millimetres following standard anatomical landmarks. The data were analysed using SPSS software, and sex-wise and side-wise comparisons were performed using the unpaired Student’s t-test. A p-value of less than 0.05 was considered statistically significant. Results: Among the 60 adult tibiae studied, males showed significantly larger dimensions of the fibular incisura than females. The mean width was 23.6 mm in males and 21.0 mm in females, while the mean depth was 3.30 mm and 3.05 mm, respectively. The height of the fibular incisura was also greater in males (31.9 mm) compared to females (29.5 mm). The anterior tubercle length showed a significant gender difference, whereas the posterior tubercle did not show statistical significance. No significant differences were observed between right and left sides for any parameter, indicating bilateral symmetry of the fibular incisura. Conclusion: The present study demonstrates significant sexual dimorphism in most morphometric parameters of the fibular incisura, with male tibiae showing greater dimensions than female tibiae. In contrast, no significant side-wise differences were observed, indicating bilateral symmetry. These findings provide useful baseline anatomical data that may assist in the interpretation of imaging, surgical planning, and management of ankle and syndesmotic injuries.