European Journal of Cardiovascular Medicine

Background: Cervical cancer remains a leading cause of cancer-related morbidity among women in low- and middle-income countries. Persistent infection with high-risk human papillomavirus (HPV), particularly types 16 and 18, is the principal etiological factor. Histopathological evaluation of cervical lesions, along with HPV detection, is essential for early diagnosis and risk stratification. Objective: To assess the histopathological spectrum of cervical lesions and determine their correlation with HPV infection in women attending a tertiary care hospital. Materials and Methods: A hospital-based cross-sectional study was conducted over 24 months. A total of 200 women aged ≥21 years undergoing cervical evaluation (Pap smear/colposcopy-directed biopsy) were included. Histopathological examination was performed on cervical biopsy specimens, and HPV DNA detection was carried out using PCR-based methods. Lesions were categorized as chronic cervicitis, cervical intraepithelial neoplasia (CIN I–III), and invasive carcinoma. Statistical analysis included chi-square test and correlation analysis; p < 0.05 was considered significant. Results: Among 200 cases, 45% had chronic cervicitis, 25% CIN I, 15% CIN II, 8% CIN III, and 7% invasive carcinoma. Overall HPV positivity was 18%. HPV detection increased with lesion severity: cervicitis (5%), CIN I (12%), CIN II (30%), CIN III (56%), and carcinoma (71%) (p < 0.001). HPV 16 was the predominant genotype, followed by HPV 18. A strong association was observed between high-grade lesions and HPV positivity. Conclusion: A clear increasing trend of HPV positivity with severity of cervical lesions was observed. Integration of histopathology with HPV testing enhances early detection and risk stratification, supporting effective cervical cancer screening programs.

Background: Combined spinal–epidural (CSE) anaesthesia is widely used for lower abdominal, pelvic, and lower limb surgeries due to its rapid onset, reliable block, and flexibility for prolonged procedures. However, hypotension remains a common complication following neuraxial blockade. Patient positioning during administration of CSE may significantly influence haemodynamic stability by altering the spread of local anaesthetic and sympathetic blockade. Aim To evaluate the impact of different patient positions on haemodynamic parameters during combined spinal–epidural anaesthesia. Materials and Methods: This prospective, randomized study was conducted in the department of Anaesthesiology of  The Oxford Medical College, Hospital & Research Center, Bangalore, Karnataka, India. Sixty adult patients undergoing elective lower abdominal or lower limb surgery under CSE anaesthesia were allocated into two groups based on patient positioning during spinal drug administration: Group S (sitting position) and Group L (lateral decubitus position). Haemodynamic parameters including heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were recorded at baseline and at regular intervals after subarachnoid block. Results: The incidence and severity of hypotension were significantly higher in the sitting position group compared to the lateral position group. Patients positioned laterally demonstrated better haemodynamic stability with lesser vasopressor requirement. Conclusion: Patient positioning during CSE anaesthesia significantly influences haemodynamic responses. Lateral decubitus positioning offers better haemodynamic stability compared to the sitting position and may be preferred in patients at risk of hypotension

Background: Epidural analgesia is widely regarded as the most effective method for pain relief during labor, yet its impact on labor duration and mode of delivery remains a subject of debate. Concerns have been raised regarding its potential to prolong labor and increase the incidence of instrumental or cesarean deliveries. This study aimed to evaluate the effects of epidural analgesia on labor duration and mode of delivery in women.  Material and Methods: A prospective comparative study was conducted on 70 women in active labor. Participants were divided into two groups: Group I (n=35) received epidural analgesia with low-dose local anesthetic and opioid combination, while Group II (n=35) did not receive epidural analgesia. Maternal demographic data, labor duration (first and second stages), mode of delivery (normal vaginal, instrumental, or cesarean), and neonatal outcomes (Apgar scores at 1 and 5 minutes) were recorded. Statistical analysis was performed using Student’s t-test and Chi-square test, with p<0.05 considered significant. Results: The mean duration of the first stage of labor was significantly longer in the epidural group compared to the non-epidural group (p<0.05).  The second stage of labor was also prolonged in the epidural group, though the difference was not statistically significant. Vaginal delivery rates were comparable between groups; however, the incidence of instrumental delivery was slightly higher in the epidural group, while cesarean section rates did not differ significantly. Neonatal Apgar scores at 1 and 5 minutes were similar in both groups, with no adverse effects attributable to epidural analgesia. Conclusion: Epidural analgesia was associated with a modest prolongation of the first stage of labor but did not significantly influence the second stage duration or cesarean delivery rates in women. While instrumental deliveries were somewhat more frequent, neonatal outcomes remained unaffected. These findings suggest that epidural analgesia provides effective pain relief without substantially increasing risks to maternal or neonatal outcomes.

Background: Diseases of the ear, nose, and throat (ENT) remain common worldwide across all age groups. They often lead to considerable morbidity (e.g. hearing loss, chronic infections, discomfort), absenteeism, and health system burden. Drug therapy—especially antimicrobials, anti‐inflammatory agents, analgesics, antihistaminics, etc.—is the mainstay of treatment in many ENT conditions. It is imperative to evaluate and monitor the drug use patterns from time to time and make suitable modifications in prescribing patterns to increase the therapeutic benefit and decrease the adverse effects to optimize the medical services to the patients. Keeping this scenario in mind, the present study was undertaken.  Aims and Objectives: To evaluate pattern of drug use in ENT (ear, nose, throat) outpatient department (OPD) of a rural tertiary care teaching hospital using WHO core drug prescribing indicators. Material and Methods: A prospective study was carried for 3 months in the ENT OPD of Santosh Medical College & Hospital, Ghaziabad. Data were collected from the prescriptions written by treating surgeons and interviewing patients regarding their understanding of dosage forms. Results: A total of 3342 drugs were prescribed through 855 prescriptions with average number of drugs per prescription being 3.90 and average number of 2.5 drugs dispensed per prescription. Majority (59.64%) of the patients were male. Antibiotics were the most frequently prescribed drugs (24.86%) followed by nonsteroidal anti-inflammatory drugs (23.60%), gastroprotective agents (22.55%), and antihistaminics (19.92%). Antibiotics were prescribed in 831 prescriptions (97.19%). Most common route of drug administration was oral (97.75%) followed by topical. Drugs were mostly (80%) prescribed by brand names. Conclusion: The present study highlights the problems of polypharmacy, overuse of brand names, and symptomatic rather than definitive approach toward patient management. Interventions to rectify overprescription of antibiotics, use of brand names, inadequate labeling of drugs are necessary to improve rational drug use. Standard treatment guidelines, hospital formulary, and educational intervention become essential to modify this behavior to benefit the patient.

Background: Regional anesthesia techniques, such as epidural and peripheral nerve blocks, are increasingly used in pediatricorthopedic surgery to provide effective pain relief and reduce opioid consumption. However, the comparative efficacy of these techniques remains understudied in children. Objective: To compare the efficacy of epidural anesthesia and peripheral nerve blocks in pediatric patients undergoing orthopedic surgery, focusing on pain control, opioid consumption, and postoperative complications. Methods: A prospective, randomized controlled trial was conducted with 120 pediatric patients aged 2–12 years. Patients were randomized to receive either epidural anesthesia or peripheral nerve blocks. Primary outcomes included postoperative pain scores (using the FLACC scale) and opioid consumption. Secondary outcomes included time to ambulation and incidence of complications. Results: Both techniques provided effective pain relief, with no significant difference in FLACC scores at 6 hours (epidural: 2.1 ± 1.3 vs. nerve block: 2.3 ± 1.2, p=0.45). Opioid consumption was lower in the nerve block group (0.2 ± 0.1 mg/kg) compared to the epidural group (0.4 ± 0.2 mg/kg, p<0.01). Time to ambulation was shorter in the nerve block group (8.2 ± 2.1 hours) compared to the epidural group (12.5 ± 3.4 hours, p<0.001). Complications were rare in both groups. Conclusion: Peripheral nerve blocks offer comparable pain relief to epidural anesthesia but are associated with lower opioid consumption and faster recovery. Both techniques are safe and effective for pediatricorthopedic surgery.

Background – Cirrhosis of the liver is a frequently encountered disease. The commonly available tests used in assessing the severity of cirrhosis have certain drawbacks. The estimation of serum cholinesterase is useful to assess the severity and prognosis of the disease. Aim – The aim of the study is to compare the level of serum cholinesterase in patients with cirrhosis with other tests of liver function like serum albumin, serum bilirubin, PT INR, MELD and Child Pugh score. Materials and Methods – This was a hospital based observational study conducted for six months between March to August 2016 at Apeksha Critical care and multispecialty hospital private limited Nanded. Patients who were diagnosed with cirrhosis both clinically and by ultrasound were included in the study. The assay for serum cholinesterase was done in all patients. The correlation between the values of serum cholinesterase and serum albumin, bilirubin, INR, Child Pugh and MELD score were analysed. Results – A total of 100 patients were studied. The majority were males ( 80%) in the age group of 41to 50 years.(40%). The most common aetiological factor in this study was alcohol (68%). Of the clinical signs studied 83% had ascites, 72% had icterus, 63% had splenomegaly and 31% had hepatic encephalopathy. On analysis of the laboratory parameters, 71% had a bilirubin level more than 3 and 73% had an INR less than 1.7. The majority of the patients were in Child Pugh class B ( 41%) and 64% had MELD score greater than 15. On analyzing the correlation between serum cholinesterase and other tests of liver function, it was found that there was significant correlation with albumin, bilirubin, INR levels, Child Pugh and MELD score. Conclusion – A significant correlation was found between serum cholinesterase levels and the severity of Cirrhosis.