European Journal of Cardiovascular Medicine

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder with multisystem involvement and variable clinical severity, where early recognition of organ involvement and immunological markers is crucial for prognosis. The present study aimed to evaluate the clinical and immunological profile of patients with systemic lupus erythematosus (SLE) at a tertiary care center in Central India. Methods: Eighty-one adult patients (≥18 years) with confirmed SLE based on the 2019 ACR–EULAR criteria were enrolled. Demographic, clinical, biochemical, and immunological data were collected, and disease activity was assessed using SLEDAI scores. Mortality predictors were analyzed using logistic regression and ROC analysis. Results: All patients were female, with a mean age of 29.4 years; 73.9% were aged 21–35 years. Common complaints included fatigue (93.8%), swelling (88.9%), breathlessness (86.4%), and joint pain (77.8%). Pallor (53.1%), pedal edema (42%), nail changes (48.1%), and alopecia (34.6%) were frequent findings. Severe anemia occurred in 50.6%, thrombocytopenia in 53.1%, and leukopenia in 21.3%. Renal involvement was significant, with 45.7% exhibiting nephrotic-range proteinuria. Hyponatremia (39.5%), low HDL (72.8%), and dysglycemia (44.4%) were common. ANA IFA showed nuclear (38.3%) and homogeneous (28.4%) patterns, with anti-dsDNA and RNP antibodies most frequent. High disease activity (SLEDAI 11–19) was observed in 59.3%. Mortality was 7.4%, associated with high SLEDAI, lupus nephritis (LN) Class 4 and 5, and basal crepitations. Logistic regression confirmed these as independent predictors, with LN Class 4 showing the highest predictive ability (AUC 0.81). Conclusion: Fatigue, swelling, breathlessness, and joint pain were predominant. Renal involvement and high SLEDAI strongly predicted mortality. ANA patterns and specific antibodies reflected active autoimmunity, while LN Class 4, high SLEDAI, and basal crepitations were key prognostic markers.

Background: Transurethral resection of prostate (TURP) is commonly performed in elderly individuals who often present with cardiovascular instability. For TURP, a sensory block extending to the T10 dermatome is generally adequate and helps avoid excessive sympathetic blockade. However, administering low-dose levobupivacaine alone may not consistently provide optimal surgical conditions. The addition of intrathecal adjuvants can potentially enhance block quality and duration. Objective: To evaluate and compare the efficacy of intrathecal dexmedetomidine and fentanyl when combined with low-dose levobupivacaine for spinal anaesthesia in TURP procedures. Methods This prospective, randomized, double-blind study enrolled 60 patients classified as ASA I–III undergoing TURP. Participants were divided equally: Group D: 5 μg dexmedetomidine + 10 mg (2 mL) 0.5% isobaric levobupivacaine Group F: 25 μg fentanyl + 10 mg (2 mL) 0.5% isobaric levobupivacaine Primary outcomes included onset and duration of sensory and motor block. Secondary outcomes comprised intraoperative haemodynamics and postoperative analgesic requirements. Results: Baseline demographic variables were comparable between groups. Both groups achieved a peak sensory level of T8. The mean time to achieve T10 sensory block was shorter in Group D (10.7 ± 2.24 min) compared to Group F (11.8 ± 1.75 min). Duration of motor blockade was significantly prolonged in Group D (197.03 ± 12.71 min) versus Group F (187.8 ± 8.23 min). The interval before first rescue analgesic was longer in Group D (212.03 ± 15.07 min) compared to Group F (200.67 ± 7.44 min). Hemodynamic profiles remained comparable in both groups. Conclusion: The addition of 5 μg intrathecal dexmedetomidine to low-dose levobupivacaine results in faster onset, prolonged sensory and motor block, and extended postoperative analgesia compared to fentanyl, without compromising hemodynamic stability.

Background: Stroke is increasingly affecting young adults under 45 years, resulting in significant morbidity, mortality, and socioeconomic impact. This hospital-based prospective observational study  aimed to evaluate the clinical profile and risk factors associated with stroke in young patients less than or equal to 45 years. Methods: A total of 100 patients aged 15–45 years with confirmed ischemic or hemorrhagic stroke on CT/MRI and abrupt-onset neurological deficits lasting >24 hours were included. Detailed history, clinical examination, NIHSS scoring, laboratory investigations (CBC, LFT, KFT, electrolytes, lipid profile, HbA1c, coagulation profile, blood culture, CSF if indicated), and imaging studies (ultrasound, 2D echocardiography, CT, MRI, DSA, carotid Doppler) were performed. Data were analyzed using SPSS, with p<0.05 considered significant. Results: The mean age was 33.3±7.4 years, with 57% males. Common presenting symptoms included altered sensorium (70%), hemiparesis (65%), seizures (34%), headache (35%), and vomiting (39%). Ischemic stroke was the most frequent subtype (61%), followed by hemorrhagic stroke (39%),. Stroke severity by NIHSS  19% mild(0-4),32% moderate(5-15),15% moderate to severe stroke(16-20),34% severe (21-42)strokes. Mortality was highest among patients with NIHSS >20 (91%), chronic kidney disease (78%), hypertensive emergency (60%), hemoglobin <8 g/dL (75%), tachycardia >100 bpm (64%), and tachypnea >20/min (61%). Right-sided hemiparesis (77% discharged), anticoagulation therapy (85% discharged), and rheumatic heart disease (93% discharged) were associated with favorable outcomes. Overall, 64% were discharged and 36% expired. Conclusion: Stroke in young adults shows distinct clinical patterns, with ischemic stroke predominating. High NIHSS score, hemodynamic instability, anemia, and kidney disease are independent predictors of poor prognosis, emphasizing the need for early recognition, risk factor management, and targeted interventions.

Introduction: Head and neck squamous cell carcinoma (HNSCC) represents a significant global health burden, with tobacco and alcohol as major risk factors. Poor oral hygiene has been suggested as a potential independent risk factor, particularly for oral cavity and oropharyngeal cancers, but evidence remains limited. Alterations in oral bacterial flora may also contribute to carcinogenesis, highlighting the importance of studying oral health in HNSCC patients. Aims: To evaluate the association between oral hygiene status, oral bacterial flora, and head and neck cancers, and to assess whether poor oral hygiene acts as an independent risk factor after adjusting for tobacco and alcohol use. Materials and methods: A cross-sectional study was conducted on 180 patients with pathologically confirmed HNSCC attending the ENT outpatient department at IPGME&R and SSKM Hospital, Kolkata. Oral hygiene was assessed using a scoring system based on denture use, gum disease, tooth brushing frequency, missing teeth, and dental visits. Patients were categorized as very poor, average, or good oral hygiene. Multivariate logistic regression was performed to evaluate independent associations with head and neck cancer. Result: Oral cavity (43.3%) and oropharynx (25.6%) were the most common cancer sites. Very poor oral hygiene was observed in 53.3% of patients, most frequently in oral cavity and oropharyngeal cancers. Very poor oral hygiene was independently associated with HNSCC (adjusted OR = 2.9; 95% CI: 1.4–5.6; p = 0.003). Smoking and alcohol were also strong independent risk factors. Conclusion: Poor oral hygiene is highly prevalent and independently associated with head and neck cancers, highlighting the need for preventive oral health strategies.

Aims& Objectives: To evaluate role of NACT followed by Interval debulking Surgery (IDS) in epithelial ovarian cancer. To assess and compared its outcomes, mortality & morbidity with primary debulking surgery. Place of study: Department of Obstetrics and Gynecology, IPGMER -SSKM Hospital, Kolkata, West Bengal, India.Broad  area : Clinical, Research, Academic.Specific  Area: Gynecology-Oncology.Type of Study/ Study Design- Prospective, Interventional & RCT. Duration of Study:  March 2021-August 2022. Methods & Materials:- As per statistical formula  the sample size consists of 60( Sixty) cases selected in our study among the 60( Sixty) patients selected for the study as per inclusion and exclusion criteria, of which Gr-A( 30) underwent 6 cycles of chemotherapy with Paclitaxel and Carboplatin followed by Interval Debulking Surgery while Gr-B(30) underwent Primary Debulking surgery.P- Patients the 60( Sixty)  having Epithelial Ovarian Cancer. I- Gr-A( 30) underwent 6 cycles of chemotherapy with Paclitaxel and Carboplatin followed by Interval Debulking Surgery. C-Gr- Gr-B(30) underwent Primary Debulking surgery. O- To evaluate role, to assess and compared its outcomes , mortality & morbidity in both the groups. T-Time(March 2021-August 2022.) Result and Analysis:- The Overall Survival and Progression Free Survival were no statistical significance in NACT group & in PDS group. The six cycles of chemotherapy(Paclitaxel+ Carboplatin) was completely delivered in FIGO stage 3&4,age-50-60 yrs(48%), post menopausal(96%) and positive for M-cells(75%).In NACT group revealed more  reduction of omental caking, peritoneal nodules with  optimal cytoreduction and lower the incidence of recurrence. In NACT showed statistically significant (p<0.001) lower level of the CA125 but associated with anaphylaxis, neutropenia and anemia. The Overall Survival in both groups was dependent on the stage of tumor, existing co-morbidities, histological type and grade of tumor. Conclusion- Though overall survival are same in both the groups but NACT has beneficial in respect to better margin resection omental caking , peritoneal deposits and other factors.

Background and Aim: Open inguinal hernia repair is a common surgical procedure frequently associated with significant postoperative pain. Regional nerve blocks play a key role in multimodal analgesia to optimize pain control. This study primarily aimed to compare the duration of analgesia provided by the Transversus Abdominis Plane (TAP) block and the Transversalis Fascia Block (TFB). The secondary objective was to compare the total postoperative analgesic requirements between the two groups. Study Design: Randomized, double-blind clinical study. Methods: Forty-six patients undergoing open inguinal hernia surgery were enrolled after meeting inclusion and exclusion criteria. They were randomly allocated into two groups: Group A received a TAP block, and Group B received a TFB block at the end of surgery. Each block was performed using 20 mL of 0.25% bupivacaine with adrenaline (5 µg/mL). Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 4-hour intervals over 24 hours. The time to first rescue analgesic and total 24-hour analgesic consumption were recorded. Statistical analysis was performed using SPSS version 28 and G*Power 3.1.9.4 software. Results: The mean time to first rescue analgesic was 10.9 ± 5.64 hours in Group A and 14.2 ± 5.04 hours in Group B, showing a statistically significant difference (p = 0.019). The total 24-hour analgesic requirement was significantly lower in Group B compared to Group A (1.0 vs. 1.52 doses, p = 0.006). Conclusion: TFB provided a longer duration of analgesia and reduced postoperative analgesic requirements compared to the TAP block in patients undergoing open inguinal hernia surgery, making it a more effective 

Introduction - Laryngoscopy and tracheal intubation causes significant sympathetic response resulting in hypertension and tachycardia. A variety of anaesthetic techniques and drugs have been studied and are available to control the hemodynamic response to laryngoscopy and intubation. The present study is performed to compare the hemodynamic changes for lignocaine administered in two forms  that is Mckenzie technique and nebulization in patients  requiring general anesthesia with endotracheal intubation. OBJECTIVES -To compare the haemodynamic changes to direct laryngoscopy after administering nebulized lignocaine (4%) and   Mckenzie technique with (4%) lignocaine in patients scheduled for elective  surgical procedures. MATERIAL AND METHODS - After obtaining written informed consent ,120 patients were randomly allocated to one of the two groups. GROUP A – will  receive   4% lignocaine (4ml)  spray using Mckenzie technique 15 mins before direct laryngoscopy.GROUP B- will   receive   4 ml of 4% lignocaine(4ml) nebulization  15 mins before direct laryngoscopy. Hemodynamic changes(Heart rate ,Mean arterial pressure,ECG) will be monitered and documented at   1min,2min,5min,10min,15min,30min,60min,120min after intubation and  0min,1min,5min,10 min post extubation .Post extubation cough and sore throat  will  be documented. RESULTS -The study demonstrated that Group A (McKenzie technique) exhibited significantly better control over heart rate and blood pressure compared to Group B (4% lignocaine nebulization)  . Specifically, Group A showed a lower heart rate at 1, 5, 10, 15, 30, 60, and 120 minutes post-intubation, with p-values less than 0.05 at each time point, indicating statistically significant differences. Furthermore, SBP and DBP were considerably lower in Group A at multiple time points, indicating a greater dampening of the hemodynamic stress response to intubation in this group. CONCLUSION - The McKenzie technique demonstrated superior efficacy in maintaining haemodynamic stability throughout both intubation and extubation phases. Group A, employing the McKenzie technique, consistently exhibited lower, (SBP) systolic and diastolic blood pressures, mean arterial pressures & heart rates compared to Group B, which received nebulized lignocaine. These differences were statistically significant, underscoring the McKenzie technique's ability to mitigate perioperative stress responses effectively.

Introduction: Confirming a secure airway before induction of general anaesthesia is critical to prevent life threatening situations such as “can't intubate, can't ventilate,” particularly in patients with difficult airways. Awake fiberoptic bronchoscope-assisted nasotracheal intubation (FOI) is recommended for such cases. Effective airway anaesthesia requires thorough knowledge of airway anatomy and innervation, achieved through topical and regional techniques. Topical anaesthesia methods include sprays and nebulizers, while nerve blocks, though more challenging, provide superior anaesthesia when performed by experienced anaesthesiologists. Materials and Methods: A single blinded randomized controlled trial was performed with 50 adult patients (>18 years) undertaking elective surgeries under general anaesthesia requiring FOI. Randomization done on 50 patients with 1:1 allocation using block randomization with unequal block size into nerve block (N) group and topicalization (T) group. Standard pre-, intra-, and post-operative care was provided to both groups. Continuous variables were compared using an independent t- test, with p<0.05 considered statistically significant. Results: The groups were clinically alike terms of gender, age, comorbidity (DM, hypertension, and hypothyroidism), INR status, heart rate, MAP, SpO2, and respiratory rate (p>0.05). The variance in MAP between the two clusters was high by 8 mm HG at 12 minutes and 10 mm HG at 15 minutes. The mean respiratory rate at 15 minutes was meaningfully different (Mean difference 4 min) between the two groups. The cough and GAG score was relatively high (score 3) in the T group than the N group. The intubation score, comfort score, ease of intubation was better in the N group, and the variance was statistically significant. While 16 patients (64%) in the group N took 6 minutes or less for intubation, only 7 (28%) patients took 6 minutes or less for intubation in the T group (p=0.04). No adverse events were reported. Conclusion: This study emphasizes that both topicalization and airway nerve blocks are safe and effective for awake FOI. However, airway nerve blocks provide superior patient comfort, ease of intubation, duration for intubation, and control of cough and gag reflexes, along with a more stable hemodynamics.

Background: Dyspnea in pregnancy and the postpartum period is a critical symptom that may indicate underlying life-threatening cardiac or respiratory disorders. This study aimed to evaluate the clinical and laboratory characteristics of pregnant and postpartum women admitted with acute onset dyspnea at a tertiary care center. Methods: A cross-sectional study was conducted on 112 women presenting with acute dyspnea (NYHA/MMRC grade II–IV) admitted to the Medicine ward and MICU. Detailed demographic, obstetric, clinical, biochemical, radiological, and echocardiographic data were collected, hospital course, final outcomes, fetal outcomes were noted. Results: The mean age of patients was 27.18±5.17 years. Most patients were young (20–30 years) with high rates of overweight/obesity and anemia. Hypertensive disorders with pulmonary edema and eclampsia were the leading causes, followed by ARDS and sepsis. ARDS (51.8%) and pulmonary edema/CHF (22.3%) accounted for nearly three-fourths of cases. Common abnormalities included tachypnea, tachycardia, hypoxemia, anemia, thrombocytopenia, hyperkalemia, and renal dysfunction. Maternal mortality was 33%, mainly due to ARDS and hypertensive pulmonary edema, with postpartum women showing higher fatality. Adverse neonatal outcomes such as preterm births and NICU admissions were frequent in critically ill mothers. Conclusions: Acute dyspnea in pregnancy is a sentinel event signaling high maternal and perinatal risk. Postpartum women are particularly vulnerable. Simple bedside and laboratory markers can aid early detection in resource-limited settings. Prompt triage, multidisciplinary management, and improved antenatal screening for hypertension, anemia, and infections are vital to reducing maternal mortality.

Background: Pediatric stroke remains a significant cause of neurological morbidity and mortality with a diverse range of underlying etiologies. Cardiac conditions represent a critical, though sometimes under-recognized, subset of these associated conditions. Identification of specific cardiac findings is paramount for guiding further diagnostic evaluation and multidisciplinary management and improving long-term patient outcomes. Methods: This retrospective observational study analyzed clinical data from a tertiary care center, specifically focusing on pediatric stroke patients admitted between January 2023 and December 2025. Medical records of children aged 1 month to 18 years diagnosed with stroke and who underwent cardiac evaluation (electrocardiography, echocardiography) and neuroimaging were reviewed and included. Children with transient ischemic attacks, primary central nervous system infections, or trauma were excluded. Results: Echocardiographic evaluation demonstrated a heterogeneous spectrum of cardiac findings, with multiple abnormalities coexisting in individual patients. Patent foramen ovale (PFO) and atrial septal defect (ASD) were identified in n = 3 (37.5%) each. Isolated PFO and small ASD were analyzed separately and were not categorized as significant   heart disease. Hemodynamically significant heart disease was present in n = 3 (37.5%). Mitral and/or tricuspid regurgitation was documented in n = 2 (25.0%), and moderate pulmonary arterial hypertension was identified in n = 1 (12.5%1) associated with the hemodynamically significant heart disease. Neuroimaging consistently revealed acute infarcts (n = 6), most commonly involving Middle Cerebral Artery (MCA) territory (n = 4), with various sites including the frontal, parietal/temporal, and deep grey and white matter. Associated findings like mass effects (n = 2) and hydrocephalus (n = 2) were also noted. Conclusion: Children with stroke demonstrate a wide range of associated cardiac abnormalities, often with overlapping findings. While isolated intracardiac shunts such as PFO and small ASD were frequently identified, complex heart disease were less common but clinically significant. These findings highlight the importance of cardiac evaluation as part of the diagnostic workup of pediatric stroke and underscore the need for a multidisciplinary approach to optimize management and outcomes.

Introduction:  Lung atelectasis is a commonly encountered post-operative problem in patients who undergo general anaesthesia, particularly for upper abdominal and thoracic surgeries. Atelectasis is the partial or complete collapse of lung units, which hinders gas exchange and can potentially lead to serious respiratory problems. Positive end-expiratory pressure (PEEP) is a crucial strategy for preventing atelectasis, particularly in high-risk patients. Though PEEP offers benefits, its use is not without potential drawbacks. Objectives:  The primary objective was to compare the effect of PEEP in patients undergoing general anaesthesia for open abdominal surgeries on postoperative atelectasis during the 30 minutes in the PACU. The study also aimed to determine the incidence and degree of hypotension during intraoperative mechanical ventilation and estimated the increased airway pressures during intraoperative mechanical ventilation. Methods:  A prospective randomized controlled trial was conducted in the Department of Anaesthesiology, in Sri Devaraj Urs Medical College, Tamaka, Kolar in Karnataka between January 2023 and May 2024 among adult patients (>18 years) who were posted for open abdominal surgeries as per inclusion and exclusion criteria. Assessment of postoperative atelectasis was done using the modified lung ultrasound score. A total of 50 patients were randomized equally into two groups- one group (PEEP 4) received PEEP of 4cm of H2O & the other group (PEEP 8) received PEEP of 8 cm of H2O.  Results:  The mean age of participants was 41.7 years. The two groups’ baseline characteristics were similar. None of the two groups developed post-operative atelectasis in our study, 30 minutes in the postoperative anaesthesia care unit (PACU). In the postoperative period, 30 minutes after shifting to Post postoperative anaesthesia care unit (PACU), only 2 (4%) patients developed an ultrasound lung score of 1, which signifies only a small loss of aeration. These two patients belonged to group A. Intraoperative hypotension was noted in total of 7 patients. Out of these, 1 (4%) participant belonged to the PEEP 4 group, and 6 (24%) belonged to the PEEP 8 group. The difference was statistically significant (p=0.04). Conclusion:  PEEP might have a direct role in preventing postoperative atelectasis. PEEP 4 has a greater hemodynamic advantage than PEEP 8. Individual pre-operative assessment is important while deciding between PEEP 4 and PEEP 8

Direct laryngoscopy done for intubation is associated with hemodynamic responses like tachycardia and increased blood pressure. Background: In order to avoid undesirable outcomes during laryngoscopy and intubation, hemodynamic response must be attenuated. Dexmedetomidine is an excellent drug used to manage the pressor response. Various routes of administration have been documented with paucity of studies on the nebulized dexmedetomidine. Aim: The purpose of this research was to compare the hemodynamic responses to intubation with intravenous and nebulized dexmedetomidine Materials and Methods: Among 98 patients ranging in age from 18 to 60 years old and classified as ASA-I or II, a prospective comparison research was carried out. They were split into two groups: one that received dexmedetomidine by nebulization (N = 49) and another that received it intravenously (N = 49). SBP, DBP, MAP, and HR were measured before induction (at baseline and 10 minutes) and after induction (1st, 3rd, 5th, 7th, and 10th minutes). The agent was given 15 minutes before to induction. Intubation time was also recorded.  Results. No statistically significant differences in hemodynamic indicators were seen between the groups up to the third minute. Results showed that the nebulized group's diastolic blood pressure (BP) and HR remained significantly elevated until the tenth minute. The duration of intubation was similar. Conclusion: The results show that all hemodynamic parameters are dramatically reduced after 3 minutes of intubation and laryngoscopy when nebulized dexmedetomidine is administered. However, post 3 minutes, nebulized dexmedetomidine could successfully attenuate only SBP and MAP and failed to attenuate DBP and HR.

Background: Postoperative pulmonary complications are frequent postoperative problems that occur following abdominal surgery and are linked to elevated morbidity and mortality, as well as, the utilization of hospital resources One of the potentially adjustable variables affecting the occurrence of early respiratory events is the extubation position, which is still a normal practice in most operating rooms in the traditional flat supine position. The positioning of Semi Fowler (head-up) can increase diaphragmatic mechanics, gas exchange and airway protection than supine positioning . Methods: It is a sample of 150 adults (18 to 65 years) undergoing elective abdominal surgery with general anesthesia randomized either with extubation and early recovery in the PACU in the supine position (0 degree) or the semi-Fowler position (head-of-bed elevation to 30 degree). The primary outcome in 30 minutes was airway obstruction requiring intervention (jaw thrust/oropharyngeal airway), assisted ventilation and persistent tachypnea with accessory muscle effort or increase in rescue oxygen demand to maintain SpO2 promoted to greater than 94%. Hypoxemia (SpO2 below 92 percent throughout over 30 seconds) and hypothetical aspiration were considered as secondary safety observations (observations descriptive). Results: All the randomized subjects were assessed (75 each). There were no differences in baseline demographics, ASA class, type and length of surgery between groups. In the supine group (18.7% vs. 5/75 (6.7%)) versus the semi-Fowlers group (risk ratio [RR] 0.36; 95% CI 0.140.94; p=0.03): in the supine group it was 14/75 (18.7%), vs. 5/75 (6.7%), respiratory distress. Mean PACU SpO2 PACU positions were more preferential to semi-Fowlers position (6/75 [8.0%] versus 12/ 75 [16.0%]) and had less incidences of hypoxemia. Suspected aspiration was rare (0 vs 2) cases. Conclusion: Semi-Fowler’s positioning (30°) during extubation and early recovery significantly reduced early respiratory distress after abdominal surgery and showed favorable descriptive trends for reduced hypoxemia. This low-cost intervention is readily implementable in routine PACU workflows.

Background: Adenoid cystic carcinoma is a rare epithelial tumor of Salivary glands and comprises about 1% of all malignant tumors of the head and neck region. They are commonly detected in the major salivary gland, oral cavity, pharynx, and paranasal sinus where it presents as a slow growing firm nodular mass. The aim of this case is to highlight the unique presentation of adenoid cystic carcinoma as a large ulceroproliferative mass over the cheek.

Background: The mandibular canal (MC) and mental foramen (MF) are critical anatomical landmarks of the mandible that house the inferior alveolar neurovascular bundle. Accurate identification of their morphology, position, and course is essential for safe dental and maxillofacial surgical procedures. Variations in these structures have been documented across populations, necessitating region-specific morphometric data.  Aim: To evaluate the morphology, course, length, and positional variations of the mandibular canal and mental foramen in the South Indian population of Telangana using digital orthopantomograms (OPGs). Materials and Methods A retrospective cross-sectional radiographic study was conducted using 400 high-quality digital OPGs collected from a private diagnostic center in Telangana. Subjects aged 20–75 years were divided into two age groups: Group A (20–40 years) and Group B (41–75 years). Measurements were performed using E-Soft Dent 2.0 software. Statistical analysis was done using SPSS version 26.0. Descriptive statistics, Kolmogorov–Smirnov test, Mann–Whitney U test, and Chi-square test were applied. Results The majority of mental foramina evaluated belonged to Group A (20–40 years) constituting 54.5% of the study population, whereas Group B (41–75 years) accounted for 45.5%. Out of 400 mental foramina evaluated, 203 (50.7%) were from males and 197 (49.3%) were from females. On the right side, the mental foramen was predominantly round in shape (98.5%), while only 1.5% were oval. On the left side, the mental foramen was predominantly round (98.5%), with only 1.5% presenting an oval shape. The mental foramen was predominantly round in shape on both right and left sides (98.5%), while only 1.5% were oval. No significant side-wise variation was observed. Conclusion

The study highlights significant age-related and morphological variations in the mandibular canal and mental foramen. Accurate localization is crucial to prevent neurovascular injury during dental procedures. Population-specific anatomical data enhances surgical safety and implant planning in the Telangana region.

Introduction: Sepsis is a life-threatening condition with high morbidity and mortality, requiring early identification of patients at risk of poor outcomes. Red cell distribution width (RDW), a routinely measured hematological parameter, has emerged as a potential prognostic marker in critical illnesses.  Aim: This study aims to evaluate the association between RDW levels and clinical outcomes in patients with sepsis admitted to a tertiary care center in Eastern India. Materials and Methods: This is a retrospective study conducted at Nalanda Medical College and Hospital, Patna, Bihar, over a duration of nine months from 1st February 2025 to 31st October 2025. The study will include 200 adult patients (≥18 years) diagnosed with sepsis and admitted during this period. Patients with hematological disorders, chronic liver disease, malignancy, or recent blood transfusions will be excluded. Relevant data, including demographics, RDW at admission, comorbidities, and clinical outcomes, will be collected retrospectively from hospital records. Results: Among 200 sepsis patients, those with RDW >14% had significantly worse outcomes compared to patients with RDW ≤14%. Elevated RDW was associated with older age, longer ICU stay, higher need for mechanical ventilation, and increased in-hospital mortality (p < 0.001). Laboratory parameters showed higher WBC counts and serum creatinine with lower haemoglobin levels in the high-RDW group. On multivariate analysis, RDW >14% emerged as an independent predictor of mortality. Conclusion: RDW, an inexpensive and readily available laboratory parameter, may serve as a valuable prognostic marker in sepsis. Early identification of patients with elevated RDW could aid in risk stratification and guide timely interventions. Further prospective studies are warranted to validate these findings and explore the underlying pathophysiological mechanisms.

Background: Post-operative pain and post-anaesthetic shivering are the major concerns during the post-operative period. Post-operative pain management is of utmost importance as it prevents patient discomfort, anxiety, prolonged hospital stay. 2-10% of the acute post-operative pain if not treated adequately will go into chronic post-surgical pain. Shivering is a common complication of regional anesthesia due to impaired thermoregulation which in turn leads to increase in oxygen consumption, arterial hypoxemia, and lactic acidosis and is specifically detrimental in cardiac patients. Methodology: A randomized prospective single-blind case-control study with the objective to compare the incidence of post-anesthetic shivering with the use of magnesium sulfate in both groups and also to compare the effectiveness of magnesium sulfate in reducing postoperative pain for 24 hours. The study was conducted with sample size of 350, patients were randomized by chit selection method, all even numbers taken into study group and odd numbers into control group. Group M (n=175) received magnesium sulfate as an infusion, and Group S(n=175) received normal saline as an infusion. ASA grade1 patients undergoing lower abdominal and lower limb surgery under subarachnoid block, age group of 20-60years were included. Patients with severe cardiovascular and musculoskeletal disorders, history of any drug allergy, Bradyarrhythmia, those on calcium channel blockers and with renal disease were excluded. Infusion of magnesium sulfate was started intra operatively and was continued for total 6 hours. Shivering and pain score was assessed post operatively at 2nd, 4th,6th,12th,18th and 24th hour respectively. The observations were tabulated, results derived and thus concluded that low dose infusion of magnesium sulfate helps in prolonging the duration of analgesia also decreases the incidence of post anesthetic shivering in patients undergoing surgeries under spinal anesthesia. RESULTS- In the magnesium group, requirement of analgesics were reduced and the incidence of shivering was also comparatively lesser than those patients among the control group. CONCLUSION- Magnesium sulfate when given as a low dose infusion intraoperatively and immediate post-operative period is effective in decreasing the requirement of analgesics also incidence and severity of post-anesthetic shivering.

Background: Acute Coronary Syndrome (ACS) is a group of heart conditions caused by a sudden decrease in blood flow to the heart muscle. Although ACS was once mainly seen in older adults, more young people (aged 40 and under) are now being affected. This trend is linked to modern lifestyle changes and a growing number of risk factors like smoking, obesity, and unhealthy cholesterol levels. Objectives: This study aimed to investigate the risk factors, clinical characteristics, and laboratory parameters associated with ACS in patients aged less than 40 years. Methods: Researchers followed 61 patients under 40 years old who were diagnosed with ACS at Aakash Healthcare Super Speciality Hospital, New Delhi, between February 2024 and October 2025. The team collected and analyzed information about each patient’s medical history, risk factors, lab tests, ECG results, and heart scans. Results: The mean age of the study population was 35.00 ± 4.36 years, with a strong male predominance (81.97%). ST-Elevation Myocardial Infarction (STEMI) was the most common presentation (80.33%), with Anterior Wall MI (AWMI) being the most frequent ECG finding (59.18%). Smoking was the leading risk factor (55.74%), followed by dyslipidemia (52.46%). Multiple risk factors were present in 68.85% of patients. Angiographic patterns predominantly showed single-vessel disease. Conclusion: ACS in young adults is characterized by a high prevalence of modifiable risk factors, particularly smoking and dyslipidemia. The presentation is predominantly STEMI with significant myocardial dysfunction. Early risk stratification and aggressive lifestyle management are crucial for this demographic