European Journal of Cardiovascular Medicine

Background: Hepatitis C virus (HCV) is a bloodborne virus and is the primary agent of posttransfusion hepatitis. Hepatitis C is a virally mediated liver inflammation and is a major health care burden in India and worldwide.  Government of India launched a National Viral Hepatitis Control Program (NVHCP) to eliminate Hepatitis C by 2030. Aim: To qualitatively and quantitatively estimate the HCVRNA in seropositive Hepatitis C patients attending tertiary center in Central Kerala and to describe their clinico- epidemiologic profile. Materials and Method: This descriptive cross-sectional study conducted at GMC; Ernakulam included 55 Hepatitis C seropositive patients. After obtaining consent from seropositive Hepatitis C patients, clinical details were collected according to the proforma. The samples were collected as per the NVHCP guidelines for qualitative detection and quantitative estimation of HCV RNA by real time PCR. It was analyzed using Statistical Package for Social Sciences (SPSS) software 20.0. Qualitative variables were summarized using frequency or percentage. Chi square test was used in the analysis of study variables. Quantitative variables (viral load) were analyzed using mean ± SD. Independent t test was used in the analysis of viral load. The level of significance was taken as P value <0.05. Results and Discussion: In the study 90.9% of the seropositive Hepatitis C patients were HCV RNA positive. Among HCVRNA positive cases 52.7% had a viral load of >1lakh IU/ml who required aggressive therapy. In our study it was observed that history of alcohol consumption and high-risk behavior such as MSM character and multiple sexual partners were the major risk factors associated with the seropositive Hepatitis C patients as we could prove the association statistically significant. We could not find any statistically significant association between Hepatitis C seropositive patients and other risk factors such as IV drug abuse, history of blood transfusion and percutaneous injury which may be because of lesser number of study sample. Conclusion: Males were predominant in our study and the common age group was 31- 45 years. 90.9% of HCV seropositive patients in our institution were HCV RNA positive who were having active infection requiring treatment. More than 1 lakh IU/ml of viral load was obtained in 52.7% warranting aggressive therapy. We could prove statistically significant association only for alcoholism and high-risk behavior such as MSM character, multiple sexual partners

Ischemic stroke is a neurological emergency which reveals complex and unexpected etiologies infrequently. Embolic strokes represent a major subset of ischemic strokes and are often linked to cardiac or large vessel sources. In one-quarter to one-third of ischemic strokes, the cause may remain elusive despite comprehensive workup, and are classified as cryptogenic stroke. Emerging evidence suggests that systemic and non-cardiogenic conditions, such as malignancy-induced hypercoagulability can act as rare yet important risk factors for ischemic stroke, particularly embolic subtype. We present a case series highlighting two rare but clinically significant etiologies of ischemic stroke, namely malignancy and adenomyosis, in four patients. In addition to ischemic stroke, these patients also exhibited extreme prothrombotic tendency in varied forms such as myocardial infarction, nonbacterial thrombotic endocarditis, pulmonary and venous thromboembolism. This report also aims to highlight adenomyosis as a less-explored cause of ischemic stroke in the young.

Background: Most of the thyroid swellings are benign and benign neoplasms out number thyroid carcinomas by a ratio of nearly 10:1. Fine needle aspiration cytology (FNAC) is recommended as a screening tool to decide whether a patient requires surgical intervention or can be managed conservatively. The main aim of thyroid FNAC is to distinguish benign from malignant lesions. Materials and Methods: This was descriptive, cross-sectional study conducted in Cytology and Histopathology sections of Pathology department at a tertiary health care center in Jalna, Maharashtra, from January 2022 to June 2023. All patients willing for FNAC of thyroid swelling were screened to enrol in the study and a total 210 cases of thyroid lesions FNAC were included. Results: Patients age ranged from 5 to 70 years and maximum number of the patients have age between 30-39 years (29.52%), followed by 20-29 years (23.33%). In the present study out of 210 cases, 188 (89.52%) were females and 22 (10.47%) were males. Most common cytological lesion in females was nodular goitre (109) followed by Hashimoto thyroiditis (29) out of 188 cases. Most common cytological lesion in males was nodular goitre (12) followed by follicular neoplasia (4) in 22 cases. Conclusion: FNAC is safe, cost effective, invaluable rapid tool helps in diagnosis of thyroid lesion with a higher degree of accuracy. Present study showed sensitivity of 62.5%, specificity 100%, PPV 100% and NPV 73.52. The application of Bethesda system leads to more precise diagnosis of thyroid lesions and helps in standardization of thyroid cytology reporting with improved clinical outcome.

Background: Appendicectomy is the standard treatment for acute appendicitis. The choice between laparoscopic appendicectomy (LA) and open appendicectomy (OA) remains debated in terms of efficacy, safety, and patient outcomes. This study aims to compare the two techniques concerning operative time, postoperative complications, and recovery duration. Materials and Methods: A prospective study was conducted on 100 patients diagnosed with acute appendicitis. They were randomly assigned into two groups: LA (n=50) and OA (n=50). Operative time, intraoperative and postoperative complications, length of hospital stay, and return to normal activities were recorded and analyzed. Statistical significance was set at p < 0.05. Results: The mean operative time was longer in the LA group (45 ± 5 minutes) compared to the OA group (35 ± 6 minutes). However, postoperative pain scores were lower in the LA group (VAS: 3.2 ± 1.1) than in the OA group (VAS: 5.1 ± 1.4). The incidence of postoperative infections was lower in the LA group (4%) compared to the OA group (12%). The average hospital stay was significantly shorter for LA patients (2.3 ± 0.5 days) than for OA patients (4.1 ± 0.7 days). Conclusion: Laparoscopic appendicectomy offers advantages over open appendicectomy, including reduced postoperative pain, lower complication rates, and a shorter hospital stay. However, it requires a longer operative time. Given its benefits, LA should be preferred where feasible, considering surgeon expertise and patient conditions.

Background: Hypertension, traditionally associated with older adults, is increasingly observed in younger populations, particularly in urban environments characterized by sedentary lifestyles, dietary transitions, and psychosocial stress. Early-onset hypertension among young adults poses a significant threat to long-term cardiovascular health, yet remains under-investigated in many developing urban regions. Materials and Methods: A community-based cross-sectional study was conducted over a 6-month period in three metropolitan areas. A total of 800 young adults aged 18–35 years were selected through multistage random sampling. Data on sociodemographic characteristics, family history, physical activity, dietary habits, and substance use were collected using a pre-tested questionnaire. Blood pressure was measured using a calibrated sphygmomanometer following standard protocols. Hypertension was defined per the American Heart Association (AHA) guidelines (SBP ≥130 mmHg or DBP ≥80 mmHg). Statistical analysis was performed using SPSS v25. Chi-square test and multivariate logistic regression were used to determine associations and identify independent risk factors. Results: The overall prevalence of hypertension among the participants was 24.8% (n=198). A higher prevalence was noted in males (28.3%) compared to females (20.4%). Significant risk factors included positive family history of hypertension (OR: 2.45, 95% CI: 1.60–3.74, p<0.001), BMI ≥25 kg/m² (OR: 1.92, 95% CI: 1.27–2.91, p=0.002), low physical activity (OR: 1.66, 95% CI: 1.09–2.53, p=0.018), and high dietary salt intake (OR: 2.17, 95% CI: 1.43–3.29, p<0.001). Conclusion: The study underscores a notable burden of hypertension among young urban adults and highlights modifiable lifestyle-related risk factors. Early identification and targeted interventions addressing diet, physical activity, and routine screening may help in mitigating the rising incidence of hypertension in this age group.

Background: Acute gallstone pancreatitis (AGP) is a common cause of acute pancreatitis, frequently requiring cholecystectomy to prevent recurrence. However, the optimal timing of cholecystectomy—early (during index admission) versus delayed (post-resolution of inflammation)—remains debated. This study aims to evaluate clinical outcomes of early versus delayed cholecystectomy in patients presenting with AGP. Materials and Methods: A prospective observational study was conducted on 80 patients diagnosed with mild to moderate AGP. Patients were divided into two groups: Group A (n=40) underwent early cholecystectomy within 7 days of admission, while Group B (n=40) underwent delayed cholecystectomy 4–6 weeks post-discharge. Parameters analyzed included duration of hospital stay, complication rates, readmission for recurrent biliary events, and operative difficulty. Statistical analysis was performed using the Chi-square test and Student’s t-test; p<0.05 was considered significant. Results: The mean hospital stay was significantly shorter in Group A (6.2 ± 1.1 days) compared to Group B (9.5 ± 1.3 days) (p<0.001). Recurrent biliary events occurred in 2 patients (5%) in Group A versus 9 patients (22.5%) in Group B (p=0.01). Complication rates were slightly higher in the delayed group (12.5%) compared to the early group (7.5%), though not statistically significant (p=0.42). No mortality was reported in either group. Operative difficulty scores were comparable between groups. Conclusion: Early cholecystectomy in patients with mild to moderate AGP is safe and associated with reduced hospital stay and fewer recurrent biliary events. Delaying the procedure may increase the risk of readmission without significant benefits in operative outcomes. Early intervention should be considered in the management of AGP.

Background: Anemia is a common and debilitating complication of chronic kidney disease (CKD), primarily due to reduced erythropoietin production and iron deficiency. Iron supplementation remains a cornerstone in anemia management among CKD patients. While both oral and intravenous (IV) iron therapies are widely utilized, their comparative effectiveness remains a subject of clinical interest, particularly in terms of hemoglobin improvement, safety profile, and treatment compliance. Materials and Methods: A prospective, randomized study was conducted involving 120 adult CKD patients with hemoglobin levels <10 g/dL and serum ferritin <300 ng/mL. Participants were randomly allocated into two groups (n=60 each). Group A received oral ferrous sulfate (325 mg twice daily) for 12 weeks, while Group B was administered IV ferric carboxymaltose (1000 mg total dose divided over two sessions). Baseline and post-treatment values for hemoglobin, serum ferritin, transferrin saturation (TSAT), and adverse events were recorded and analyzed using paired t-tests and ANOVA, with p<0.05 considered statistically significant. Results: At the end of 12 weeks, Group B showed a significantly greater increase in mean hemoglobin levels (from 8.2 ± 0.6 to 10.6 ± 0.7 g/dL) compared to Group A (from 8.1 ± 0.5 to 9.3 ± 0.6 g/dL), p<0.001. Serum ferritin levels rose markedly in the IV group (from 120 ± 30 to 340 ± 50 ng/mL) compared to the oral group (from 115 ± 28 to 180 ± 40 ng/mL), p<0.01. TSAT improvements were also significantly higher in Group B (from 18% to 32%) than Group A (from 17% to 24%). Gastrointestinal side effects were more frequent in Group A (26%) versus infusion-related reactions in Group B (10%). Conclusion: IV iron supplementation was more effective than oral iron in improving hemoglobin levels and iron stores among CKD patients, with better tolerance and fewer treatment interruptions. These findings support the preferential use of IV iron, particularly in moderate to severe anemia cases or when rapid correction is warranted.

Background: Anemia remains a major public health challenge among pregnant women, particularly in low- and middle-income countries, where it contributes significantly to maternal and fetal morbidity. Spatial and temporal mapping of anemia prevalence enables the identification of regional disparities and the targeting of interventions. This study aimed to assess the spatiotemporal burden of anemia among pregnant women using Geographic Information System (GIS) tools for improved policy formulation and resource allocation. Materials and Methods: A retrospective cross-sectional study was conducted using secondary data collected from antenatal clinics across 10 districts. Hemoglobin levels of pregnant women were categorized as per WHO guidelines. Spatial data were geo-referenced using ArcGIS 10.8. Hotspot analysis (Getis-Ord Gi*) and temporal trend evaluation were employed to identify regions with high anemia burden and observe changes over time. Statistical significance was set at p<0.05. Results: Out of 25,600 pregnant women assessed, 57.3% were found to be anemic (Hb <11 g/dL), with a higher prevalence in rural and tribal regions. The year-wise distribution showed a declining trend from 61.2% in 2018 to 52.8% in 2022. GIS-based hotspot analysis revealed consistent high-burden clusters in Districts A, D, and G, with cold spots observed in urban centres of Districts B and E (p<0.05). Seasonal peaks in anemia prevalence were noted during the monsoon months. Accessibility to healthcare services and nutritional supplementation programs showed a spatial correlation with reduced anemia burden. Conclusion: This GIS-based spatiotemporal study highlights significant geographic and temporal variations in anemia prevalence among pregnant women. The identification of persistent hotspots can guide localized interventions and strengthen antenatal care services in vulnerable regions. Integration of spatial tools in public health monitoring offers a robust framework for addressing maternal anemia.

Background: The COVID-19 pandemic has posed unprecedented challenges, especially for individuals with underlying comorbidities. Among these, metabolic syndrome (MetS) — characterized by central obesity, dyslipidemia, hypertension, and insulin resistance — has emerged as a key determinant of adverse outcomes. This study aims to prospectively assess the long-term post-COVID complications in patients with pre-existing MetS, focusing on cardiometabolic, respiratory, and neuropsychiatric sequelae. Materials and Methods: A prospective cohort study was conducted across three tertiary healthcare centres in India. A total of 300 patients aged 30–65 years with laboratory-confirmed COVID-19 and pre-existing MetS (as per IDF criteria) were enrolled. Follow-up assessments were conducted at 3-, 6-, and 12-months post-recovery. Clinical outcomes including new-onset type 2 diabetes, exacerbation of hypertension, pulmonary fibrosis, persistent fatigue, and cognitive decline were evaluated using structured clinical assessments, laboratory tests, and imaging modalities. A control group of 200 COVID-19-recovered patients without MetS was also followed for comparison. Results: At 12 months follow-up, 42.3% of patients in the MetS group reported persistent fatigue compared to 18.5% in the control group (p<0.01). New-onset type 2 diabetes was observed in 26.7% of MetS patients versus 8.0% in controls (p<0.001). Pulmonary complications such as reduced DLCO and fibrotic changes were documented in 33.1% of MetS cases and 14.5% of controls (p<0.05). Neurocognitive issues, including memory deficits and anxiety, were more prevalent in the MetS group (38.5%) than in controls (21.0%) (p=0.02). Conclusion: Individuals with pre-existing metabolic syndrome are at significantly increased risk of developing long-term post-COVID complications, including cardiometabolic dysfunction, chronic respiratory impairment, and neuropsychiatric disturbances. These findings highlight the need for tailored post-COVID monitoring and management strategies in this high-risk population.

Background: Heart failure with reduced ejection fraction (HFrEF) is a chronic condition that greatly influences myocardial function. Traditionally, left ventricular ejection fraction (LVEF) was utilized to measure cardiac performance, but global longitudinal strain (GLS) analysis has emerged as a more sensitive and reliable measure of systolic dysfunction overcoming the limitations of LVEF. Azmarda (innovator Sacubitril/valsartan), is a supramolecular cocrystal complex and has displayed significant efficacy in treating patients with HFrEF. However, the clinical effectiveness of Azmarda compared to the Generic sacubitril/valsartan formulations remains unexplored. Objective: Therefore, the current study aims to compare the efficacy and safety of Azmarda with generic sacubitril/valsartan in patients with HFrEF, by assessing the GLS score and Time to Peak (TTP). Methods:  A prospective, randomized, crossover, study was performed with 12 patients with HFrEF. Eligible patients were randomly assigned to either Azmarda or Generic sacubitril/valsartan for 8 weeks, followed by the crossover to the alternate formulation for another 8 weeks. GLS and TTP scores were measured from baseline to weeks 4, 8, 12, and 16. Safety assessments were conducted throughout the duration of the study. Results: Patients treated with Azmarda demonstrated a larger improvement in GLS scores compared to the patients treated with generic formulation at weeks 4, 8 12, and 16. The change in GLS score from baseline to week 8 was significantly higher in the Azmarda group (-1.7% vs. -0.5%, p<0.05) than in the generic group. These improvements were consistent, sustained, and significantly greater after the cross-over period. No serious adverse events occurred during the study, and both formulations were well-tolerated. Conclusion:  This study establishes the superiority of Azmarda manufactured by unique co-crystal technology over generic formulation while displaying enhanced LV reverse remodeling in HFrEF patients and further highlight the value of GLS as a sensitive and reliable parameter for early detection of left ventricular systolic dysfunction. However further studies with larger cohorts and long-term follow-up are required to confirm the long-term clinical benefits.

Introduction: The purpose of this work is to study the Y1 and Y2 angles on Radiographs of the shoulder joint, of Shoulder pain Patients and Normal individuals. For this study, 130 Radiographs have taken. Out of which 100 Radiographs of Shoulder pain patients due to impingement and 30 radiographs of normal patients without shoulder pain, out of 100 radiographs of patients with shoulder joint pain, 50 radiographs of Male patients and 50 radiographs of female patients taken for study Y1 angle and 50 radiographs of Male patients and 50 radiographs of female patients taken for studyY2 angle. By this study, it is clear that Y1 and Y2 angle of male shoulder pain patient's radiographs are slightly greater than Y1 and Y2 angle of female shoulder pain patient’s radiographs and which is significant and Y1 angle of male normal patient's radiographs is slightly greater than the Y1 angle of normal female patient’s radiographs but the Y2 angle of male normal patients radiographs is less than the Y2 angle of female normal patients radiographs and which is not significant. By this Study It is clear that Male patients are more prone for shoulder impingement than female patients because when Y2angle is Greater it reduces ad distance. Less ad distance is one of the cause of Shoulder impingement.

Background: Hysterectomy is the most common gynaecological procedure done inspite of many treatment options like medical and conservative surgery throughout the world. Few studies were done seeking to analyze the clinical parameters of patients afflicted by these tumors and tumor-like lesions  in hysterectomy specimens to discover possible correlations between preoperative clinical indication, gross findings and histopathological diagnosis. This study aims to identify the different types of uterine tumors and tumor-like lesions in hysterectomy specimens and categorizing their gross and histopathological findings using the latest World Health Organization classification of uterine corpus tumors. Methods: This retrospective study was conducted on 180 hysterectomy specimens reported to Department of Pathology over a period of one year from January 2024 to December 2024. The tumors and tumor-like lesions  lesions were classified using the latest edition of the World Health Organization (WHO) Classification of Tumours. Results: Menorrhagia and fibroid uterus were the most common clinical indications for hysterectomy. Of the 180 cases, 52.75% cases were encountered in the age group of 40 - 49 years which was the most common age group. The most common pathology identified was leiomyoma in myometrium. Histopathological examination confirmed the clinical and gross diagnosis in majority of the cases. Conclusions: The present study provides a fair cognizance into the histological spectrum of lesions in hysterectomy specimens in our institution. A thorough histopathological examination of hysterectomy specimens can reveal an ample range of lesions. Even though the clinical and gross diagnosis correlates with the histopathological analysis, few incidental findings were also seen. Hence, it is mandatory that every hysterectomy specimen should be subjected to detailed gross and histopathological examination to ensure proper postoperative management of patients. Despite the continued benefits of medical and minimally invasive procedures which are conservative treatments in appropriately selected patients, unexpected histopathologic diagnoses can occur and should be managed appropriately by hysterectomy.

Objective: This hospital-based cross-sectional study aimed to estimate the prevalence and pattern of dyslipidaemia in pre-dialysis chronic kidney disease (CKD) patients and to evaluate its association with the stages of CKD. The study sought to determine the extent of lipid abnormalities and their correlation with disease progression. Methods: The study included 50 adult pre-dialysis CKD patients admitted to a tertiary care centre between May 2022 and January 2024. Patients were enrolled using purposive sampling. CKD staging was classified according to KDIGO guidelines. Lipid profiles were assessed, including total cholesterol, LDL, HDL, and triglycerides. Statistical analysis was performed using unpaired t-tests and chi-square tests, with significance at p<0.05. Results: Of the 50 pre-dialysis CKD patients (60% male), 48% had dyslipidaemia. It was more common in males (53%) than females (40%) and in those aged >50 years (64%) than in younger age groups (p = 0.06). Most patients (76%) were in Stage 5 CKD, where abnormal lipid levels were markedly higher. Significant associations were found between advanced CKD stage and elevated total cholesterol, LDL-C, and triglycerides (p = 0.03, 0.04, and 0.04, respectively), while low HDL-C was not statistically significant (p = 0.21). These findings suggest a worsening lipid profile with CKD progression. Conclusions: The study highlights the high prevalence of dyslipidaemia in pre-dialysis CKD patients, with lipid abnormalities worsening as CKD progresses. These findings emphasize the importance of early lipid monitoring and intervention to mitigate cardiovascular risk in this population.

Introduction: Obesity is a global health concern associated with increased risks of type 2 diabetes, cardiovascular disease, and metabolic disorders. Effective weight management and glycemic control are critical for reducing obesity-related complications. Tirzepatide, a dual agonist of the glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors, has emerged as a promising treatment for obesity and diabetes. This study aims to evaluate the impact of Tirzepatide on weight management and glycemic control in obese patients.  Methods: This retrospective observational study was conducted in the Department of Cardiology, Uttara Adhunik Medical College Hospital, Labaid Cancer Hospital & Super Speciality Centre, Labaid Diagnostics Center, Uttara, Dhaka, Bangladesh, from July 2024 to February 2025. In this study, we included 70 patients with obesity who attended the cardiology department of our institution. Result: The mean age was 31.73 ± 10.24 years, with a mean BMI of 36.31 ± 6.24 kg/m². Obesity classifications ranged from Class II obesity (58.57%) to Class I (41.43%). Tirzepatide led to a significant 8.7% reduction in body weight (p = 0.0001), decreasing BMI from 36.31 kg/m² to 31.48 kg/m² (p < 0.0001). Glycemic control improved significantly, as evidenced by reductions in fasting blood sugar (6.78 to 5.63 mmol/L, p < 0.0001) and HbA1c levels (5.5% to 4.8%, p < 0.0001). Three patients (4.29%) with obstructive sleep apnea reported improvement after treatment. The most common side effects were nausea and vomiting (34.29%), itching at the injection site (30.00%), heartburn (27.14%), and general weakness (27.14%). Despite these side effects, 89% of participants reported satisfaction with the treatment. Conclusion: The findings of the study show that Tirzepatide has significant benefits in weight reduction, glycemic control, and lipid profile improvement among obese individuals. While some minor adverse effects were noted, overall patient satisfaction was high, highlighting its potential as an effective therapeutic option for obesity and T2DM management.

Parenteral nutrition (PN) has been available for 30 years now and is an effective means of promoting recovery in critically ill patients incapable of ingesting, absorbing or assimilating nutrients, for non-critically ill patients who have preexisting malnutrition and for postoperative patients whoare unable to take orally for 7 or more days.

Background: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a major healthcare problem around the world, with significantly higher morbidity and mortality in patients with coexisting conditions such as diabetes mellitus and hypertension (1). As zinc deficiency results in altered numbers and dysfunction of all immune cells, subjects with suboptimal zinc state have an increased risk for infectious diseases, autoimmune disorders, and cancer (5-8).    Aim & Objectives: To estimate the serum levels of zinc and CRP (C-reactive protein) in COVID-19 positive patients and to correlate serum zinc levels with CRP in COVID- 19 positive patients. Materials and Methods: Total of 86 patients who were COVID-19 positive by RTPCR (reverse transcription polymerase chain reaction) were included in the study. 5 ml of venous blood is collected, serum separated and utilized for the estimation of serum zinc and CRP by fully automated analyser according to the instructions provided in the kit by the manufacturer. Results: The mean value of serum zinc (97.53 mcg/dl) in male patients is more when compared to the mean value (87.11 mcg/dl) in female patients and the difference is not statistically significant (p =0.26). The mean value of CRP in male patients(2.14 mg/dl )  is lower than the mean value in female patients (3.15mg/dl) and the difference is not statistically significant (p=0.168).The mean value of serum in zinc in patients with age >50 years (100.22 mcg/dl) is more when compared to the mean value of patients with age group <50 years (85.68 mcg/dl)  and the difference is  not statistically significant (p=0.121).The mean value of CRP in patients with age >50 years (2.91 mg/dl) is slightly more when compared to the mean value of patients with age <50 years (2.39 mg/dl) and the difference is not statistically  significant (p=0.480). Conclusion: The present study showed that the mean value of serum zinc is high and CRP is low in male patients compared to the female patients, the mean value of zinc is high in patients with age >50 years than in patients with age <50 years. Further research is required considering a large sample size and other comorbidities.

Background: Smoking is a well-established risk factor for various chronic diseases, including cardiovascular and respiratory conditions. While long-term cessation benefits are well-documented, this study evaluates the short-term physiological effects of smoking cessation among employees in a tertiary health care setting. Objectives: To determine the physiological benefits of smoking cessation by evaluating changes in cardiovascular and pulmonary parameters using spirometry and vital sign monitoring. Methods: A cross-sectional follow-up study was conducted among 100 consenting employees at a tertiary health care institution in Kanchipuram District, Tamil Nadu, who had a history of smoking for more than one year. Baseline assessments of body weight, heart rate, blood pressure (systolic and diastolic), and pulmonary function (FVC, FEV1, FEF) were performed using a digital spirometer and standard clinical instruments. Following one month of smoking cessation, all parameters were reassessed. Data were analyzed using descriptive statistics. Results: No significant changes were observed in body weight (73.05 ± 1.21 kg) and heart rate (74.54 ± 0.45 bpm) pre- and post-cessation. However, systolic (124.08 ± 0.45 to 122.81 ± 0.15 mmHg) and diastolic blood pressures (82.36 ± 0.24 to 81.94 ± 0.25 mmHg) showed mild reductions. Pulmonary function showed substantial improvements: FVC (3.63 ± 0.09 to 4.76 ± 0.12 L), FEV1 (2.57 ± 0.04 to 3.88 ± 0.15 L), and FEF (2.54 ± 0.24 to 3.27 ± 0.25 L/sec). Conclusion: Short-term smoking cessation significantly improves pulmonary function but has limited immediate effects on cardiovascular parameters. These findings highlight the rapid respiratory benefits of quitting smoking.

Aims: The aim of this study is to know the prevalence of deficiences of Iron, folate and vitamin B12 in severely acute malnourished children.  Materials and methods: This hospital based single centered prospective cross-sectional study was designed to  assess the prevalence of deficiencies of Iron, folate and vitamin B12 in severely acute malnourished children.  The major objectives of this study were to assess iron, folate and vitamin b12 status in severely acute malnourished and correlation of these levels with severity of malnutrition. This was conducted over a total of 150 children with severe acute malnutrition over a time period of 18 months. Children with SAM between 6 months to 5 years of age admitted to pediatric department were enrolled based upon eligibility criteria.  Results: 54 % of children were 6-12 months of age followed by 13-24 months (24%) and 25-60 months (22%). 64% of children were male and 36% female. 32% children were 1st in birth order.24% children were completely immunized and 34% were un-immunized and 42% were incomplete immunized. 65% children from Rural area of residence. 59% children belonged to lower socio-economic status. The feeding pattern of 56% children was exclusive breast feeding; 30% children. Predominantly breast feedinG. 31% children had glossitis and 69% had PICA. 76% of children had Wt/Ht. <-3SD. 71% of children had MUAC <11.5 cm. 76% children presented with wasting. Edema was presented in 53% of children. Among 150 children; 96% of children had anemia-48% children had severe anaemia. Pneumonia was presented in 26% of children. Diarrhea was presented in 22% of children. The prevalence of anaemia was observed 96%. 48% children had severe anaemia. The iron deficiency was observed in 74% of children with SAM; 6% of children had low ferritin level, 65% had low transferrin saturation and 34% had vitamin B12 deficiency. 70% children had low MCV, and 74% children had low MCH level. Conclusions: Iron deficiency was more common than deficiencies of vitamin B12 and folate in these SAM patients. The index findings provide a framework for the development of strategies to improve the micronutrient status and to prevent hematological as well as non-hematological manifestations, mainly that of iron, folate and vitamin B12 in this specific population.

Opioids have traditionally been central to perioperative analgesia in major abdominal surgeries. However, opioid-related side effects such as respiratory depression, postoperative nausea and vomiting (PONV), ileus, and delayed recovery have prompted exploration of opioid-free anesthesia (OFA) as a safer, equally effective alternative. This study aimed to evaluate the impact of OFA on postoperative recovery outcomes compared to conventional opioid-based anesthesia (OA) in patients undergoing major abdominal surgeries. Materials and Methods: This prospective, comparative, observational study was conducted over six months at the Career Institute of Medical Sciences and Hospital, Lucknow. A total of 80 patients aged 18–65 years, classified as ASA physical status I–III and scheduled for elective major abdominal surgery, were randomized into two groups (n = 40 each): Group A (OFA) received opioid-free anesthesia using agents such as ketamine, lidocaine, dexmedetomidine, and magnesium sulfate, while Group B (OA) received standard opioid-based anesthesia with fentanyl. Postoperative pain scores (VAS at 2, 6, 12, and 24 hours), incidence of PONV, time to mobilization, return of bowel function, hospital stay duration, rescue analgesic requirement, and patient satisfaction were assessed. Data were analyzed using SPSS version 25 with a significance threshold of p < 0.05. Results: Baseline characteristics were comparable between groups. The OFA group demonstrated significantly lower postoperative pain scores at all time intervals (VAS at 2 hours: 2.8 ± 1.1 vs. 3.5 ± 1.3; p = 0.02). Time to first mobilization (18.5 ± 4.2 vs. 24.8 ± 5.6 hours; p < 0.01) and return of bowel function (36.2 ± 8.5 vs. 48.7 ± 10.2 hours; p < 0.01) were shorter in the OFA group. Additionally, OFA patients had reduced PONV incidence (15% vs. 35%; p = 0.04), required less rescue analgesia (tramadol 50.5 ± 20.1 mg vs. 80.3 ± 25.4 mg; p < 0.01), had shorter hospital stays (5.2 ± 1.3 vs. 6.5 ± 1.7 days; p < 0.01), and reported higher satisfaction scores (4.3 ± 0.6 vs. 3.8 ± 0.7; p = 0.01). No significant increase in adverse events was observed in the OFA group. Conclusion: Opioid-free anesthesia significantly improves postoperative recovery in major abdominal surgeries by enhancing analgesia, accelerating functional recovery, minimizing opioid-related side effects, and increasing patient satisfaction without compromising safety. OFA represents a promising component of multimodal enhanced recovery pathways and should be considered for broader implementation.

The COVID-19 pandemic has been associated with a concerning rise in mucormycosis cases, particularly in India, where the indiscriminate use of corticosteroids and high prevalence of diabetes have created a perfect storm for this life-threatening fungal infection. This dual health crisis has placed immense strain on healthcare systems, necessitating urgent investigation. Aims and Objectives: This study aimed to assess the incidence of mucormycosis in COVID-19 patients, identify key risk factors, and evaluate clinical outcomes to inform better prevention and management strategies. Materials and Methods: A retrospective analysis was conducted on 24 confirmed mucormycosis cases at a tertiary care center in northern India. Diagnosis was established through microbiological culture, histopathological examination, and clinical correlation. Demographic data, COVID-19 status, and treatment outcomes were systematically analyzed. Results: Rhinocerebral mucormycosis (RCOM) was the predominant presentation (87.5%, n=21), with a male predominance (58.3%, n=14) and peak incidence in the 51–60-year age group (45.8%, n=11). Strikingly, 75% (n=18) of cases were COVID-19 positive, highlighting a strong association between the two infections. Conclusion: The findings emphasize the need for judicious steroid use, stringent glycemic control, and early diagnostic vigilance in COVID-19 patients. Public health measures must prioritize awareness campaigns, enhanced surveillance, and prompt medical intervention to mitigate this emerging syndemic

Background: Tibial diaphyseal fractures are the most common variety of tibial fracture.  The classic infrapatellar approach for tibial intramedullary nailing (IMN) is a recognized surgical technique for addressing tibial shaft fractures.  Nevertheless, the presence of heightened valgus and procurvatum abnormalities complicates the insertion of the intramedullary nail using the infrapatellar approach.  Suprapatellar nailing in the semi-extended position has recently been advocated as a safe and effective surgical intervention. The study aimed to compare the clinical and functional outcomes of tibial shaft fractures treated with intramedullary nailing (IMN) utilising the suprapatellar (SP) and infrapatellar Methods (IP). Materials and Methods: A prospective interventional study was conducted involving 40 patients in the Department of Orthopaedics at Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. The patients were categorized into two groups based on tibial shaft fractures treated with intramedullary nailing using the suprapatellar (SP) and infrapatellar (IP) procedures during two years, with 20 individuals in each group and six follow-up assessments at six-month intervals. Patients in Group A had intramedullary nailing (IMN) of the tibia via the suprapatellar method, while Group B Patients underwent treatment with intramedullary nails in the tibia through the infrapatellar route. The results of intramedullary nailing (IMN) for tibial shaft fractures were evaluated using suprapatellar (SP) and infrapatellar (IP) approaches, focusing on fluoroscopy duration, average surgical duration, anterior knee pain assessed by the Visual Analogue Scale (VAS), average blood loss, fracture union time, and functional outcomes measured by the lower extremity functional score. Statistical analysis included Student’s t-test and Chi-square test, with a significance threshold set at p-value <0.05. Results: This study compared suprapatellar (Group A) and infrapatellar (Group B) approaches for tibial nailing in well-matched patient groups. While surgical times were similar (88.65±11.35 vs 93.43±8.97 minutes, p=0.213), Group A showed significantly less blood loss (48.76±12.75 vs 63.89±7.43 mL, p=0.002) and shorter fluoroscopy time (p=0.002). Group A reported lower postoperative pain (VAS 18.45±3.43 vs 28.77±2.86, p=0.002) and better functional scores (76.67±2.87 vs 71.59±2.98, p=0.001), with equivalent healing times (89.34±3.19 vs 89.19±2.74 days, p=0.598). The suprapatellar approach demonstrated multiple advantages without compromising fracture union. Conclusion: The suprapatellar (SP) technique yielded superior functional outcomes, reduced pain, diminished fluoroscopy duration and radiation exposure, and a lower mean total blood loss compared to the infrapatellar (IP) method. Consequently, intramedullary nailing (IMN) using the suprapatellar (SP) technique is considered the most effective treatment for tibial shaft fractures

Background: Distal radius fractures (DRFs) are among the most common orthopedic injuries, particularly in elderly populations, often resulting from low-energy trauma. Treatment options include closed reduction with casting or surgical fixation, with the choice depending on fracture characteristics and patient factors. Hand grip strength serves as an important functional outcome measure following DRF treatment. This study compares grip strength recovery between patients managed with conservative casting versus open reduction and internal fixation (ORIF) to evaluate treatment efficacy. Materials and Methods: This randomized clinical trial involved 50 patients with distal radial fractures and radius coronal shifts treated at the Department of Orthopaedics, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. Participants were divided into two groups based on the treatment approach: one group received conservative care involving immobilization with a below-elbow Colles cast for six to eight weeks, while the other group underwent surgical interventions such as open reduction internal fixation with locking compression plates, external fixation, and K-wire techniques. Following surgery, patients were placed in splints for two weeks before transitioning to removable wrist splints for four additional weeks. Hand grip strength was assessed using a dynamometer, with measurements taken across various settings and repeated for both hands to ensure consistency. Results: This study compared functional outcomes between distal radius fracture patients treated with closed reduction and casting (Group I) versus open reduction internal fixation (ORIF, Group II). Analysis of Disabilities of the Arm, Shoulder and Hand (DASH) scores showed comparable outcomes between groups (Group I: 24.13±8.17 vs Group II: 29.87±11.88; F=0.712, p=0.485). However, grip strength measurements revealed significantly better recovery in the ORIF group (62.35±10.43 lbs) compared to casting (58.13±14.23 lbs; F=4.342, p=0.041). These findings demonstrate equivalent patient-reported function between treatments, but superior restoration of grip strength with surgical management, suggesting ORIF may offer enhanced recovery of hand function in distal radius fractures. Conclusion: This study found that while surgically treated DRF patients showed significantly better grip strength recovery, both treatment approaches resulted in similar DASH scores and range of motion outcomes. These findings suggest that while surgical management may offer advantages in restoring hand strength, conservative treatment remains a viable option for maintaining overall function and mobility in DRF patients. The choice between treatments should be individualized based on patient characteristics and functional requirements.

Aim: The aim of the present study was to estimate serum zinc levels in different stages of hepatic encephalopathy. Methods: The Observational study was conducted in the Department of Medicine, Sri Guru Ram das Institute of Medical Sciences, Vallah, Amritsar. Patients of age group between 18-65 years presenting in OPD/IPD of Medicine department with hepatic encephalopathy were recruited in current study after taking written and informed consent. The study period was from January 2023 to March 2024.  Results: 33% of the patients had age of 58-65 years followed by 27.5% (38-48 years), 21.1% (48-58 years), 14.7% (28-38 years), and 3.7% (18-28 years). Mean age of the patients was 50.055±12.12194 years. 89% were males and 11% were females. Mean BMI was 26.8365±2.95112. Majority of the patients (66.1%) had BMI 25-29.9 followed by 23-24.9 (16.5%), more than 29.9 (9.2%), and 18.5-22.9 (8.3%). 74.3% had temporal hollowing, 71.5% had parotid enlargement, 57.7% had palmar erythema, 53.2% had asterixis, 52.3% had pallor. 34.9% patients had MHE grade I followed by grade II (33.9%), grade III (13.8%), MHE (11.9%), and grade IV (5.5%). 32.1% patients had Zn levels 40-49 followed by 30.3% (30-39), 16.5% (50-59), 11% (>60), and 10.1% (<30). Mean Zn levels were 43.6330±11.87018. Conclusion: It can be concluded that Serum zinc level was significantly lower among patients with higher grades of hepatic encephalopathy, implying that low zinc level may be a precipitating factor for hepatic encephalopathy. Furthermore, supplementation with zinc may possibly reduce the clinical worsening in such patients. Hence, all patients of cirrhosis liver with hypoalbuminemia and HE should be evaluated for low serum zinc levels.

Background: Type 1 Diabetes Mellitus (T1DM) is a prevalent pediatric endocrine disorder associated with chronic hyperglycemia, which may contribute to hepatopathy, including non-alcoholic fatty liver disease (NAFLD). Elevated serum alanine transaminase (ALT) levels are a marker of liver dysfunction, but their prevalence and association with glycemic control in T1DM children remain unclear. Objective: To evaluate serum ALT levels in children with T1DM aged 5–18 years and determine their association with glycemic control. Methods: A cross-sectional study was conducted at Cheluvamba Hospital, Mysuru, involving 60 children with T1DM. Serum ALT levels were measured using the UV kinetic method, and glycemic control was assessed via HbA1c and fasting blood sugar (FBS). Children with elevated ALT underwent liver ultrasonography and received strict glycemic control per ISPAD 2018 guidelines, with follow-up at 6 months. Statistical analysis included Pearson’s correlation to assess associations. Results: The mean age was 11.87 ± 2.97 years, with a mean diabetes duration of 6.85 ± 3.00 years. Mean serum ALT was 16.40 ± 8.01 IU/L (normal range). No significant correlation was found between ALT and HbA1c (P = 0.273), but a significant association existed with FBS (P < 0.001). Conclusion: Serum ALT levels were normal in T1DM children, with no association with chronic glycemic control (HbA1c). Acute hyperglycemia (FBS) may influence liver function, warranting further investigation.

Aim: The aim of the present study was to determine the effects of chronic liver disease on bone health. Methods: The present study was conducted in the General medicine and Gastroenterology Department at NIMS Hospital, Jaipur for the period of 18months and 171 patients were included in the study. Results: The mean age of the participants was 53.79 ± 11.79 years. Of the total sample, 85 (49.7%) were female and 86 (50.3%) were male. In terms of occupation, the largest group of participants were laborers (35, 20.5%), followed by self-employed individuals (33, 19.3%), and farmers (32, 18.7%). Regarding dietary habits, 88 (51.5%) of the participants followed a vegetarian diet, while 83 (48.5%) followed a non-vegetarian diet. In terms of alcohol consumption, 88 (51.5%) reported yes to alcohol consumption similarly, regarding smoking status, 97 (56.7%) were smokers. The duration of liver disease among the participants ranged from 3 to 8 years, with a median duration of 5 years. Regarding the provisional diagnosis, the most common diagnosis was Non-alcoholic fatty liver disease (NAFLD). For osteoporosis, a larger proportion of the participants, 143 patients (83.6%), did not have osteoporosis and the history of fractures was reported by a small number of participants, with 4 patients (2.3%) having a fracture history. Conclusion: In conclusion, this study underscores the critical importance of closely monitoring bone health in patients suffering from chronic liver disease (CLD). The findings reveal a significant prevalence of osteopenia and a noteworthy presence of osteoporosis, highlighting the detrimental impact that liver dysfunction can have on skeletal health. Key contributing factors, such as suboptimal vitamin D levels, hypocalcemia, and altered bone metabolism, were identified, emphasizing the interconnectedness of liver function and bone health.

Aim: The aim of the present study was to determine the frequency of left ventricular dysfunction in patient with chronic obstructive pulmonary disease. Methods: A prospective observational study was conducted in which all eligible indoor and outdoor male and female patients above 40 years of age participated after meeting the inclusion and exclusion criteria from 1st May 2023 to 30 Nov 2024. A total of 151 individuals diagnosed with COPD were enrolled as cases in this hospital-based study. Results: The distribution of sex was nearly equal, with 49.7% males and 50.3% females. Most participants were Hindu (57.0%), followed by Muslims (31.1%) and Sikhs (11.9%). Regarding occupation, teachers formed the largest group (25.2%), followed by unemployed individuals (21.9%) and shopkeepers (21.2%). A larger proportion of the study population resided in urban areas (57.0%) compared to rural regions (43.0%). No statistically significant differences were observed in pulse rate (p=0.266), respiratory rate (p=0.913), systolic BP (p=0.286), diastolic BP (p=0.342), or pulse oximetry (p=0.276) across COPD stages. The values for these parameters remained consistent across all three groups, suggesting similar hemodynamic and respiratory baseline characteristics despite differing spirometric severity.  Conclusion: This study highlighted the intricate relationship between chronic obstructive pulmonary disease (COPD) severity and cardiac function. Through a comprehensive assessment of clinical, biochemical, radiological, pulmonary, and echocardiographic parameters across GOLD- defined COPD stages, it was observed that systemic and cardiac involvement becomes more pronounced with advancing disease. Key laboratory markers, including hemoglobin, TLC, liver and renal function tests, and differential leukocyte count, demonstrated significant deterioration in higher COPD stages, reflecting systemic inflammation and hypoxic burden.

Aim: The aim of the present study was to assess the relationship between serum Zinc level and HbA1C level in newly diagnosed type 2 diabetes mellitus and to compare serum Zinc level with its risk factors. Methods: The study was conducted at Sri Guru Ram Das University of Health Sciences, Sri Amritsar. Patient presenting in OPD/IPD of Medicine department who are known case recently diagnosed type 2 Diabetes Mellitus were recruited to current study after taking written and informed consent from January 1,2023 to March 31,2024. The present study included a total of 175 cases, comprising recently diagnosed type 2 DM patients, and 100 age and gender-matched healthy controls without any comorbidities.  Results: The findings from the present study emphasized that serum zinc levels are decreased in t2dm patients when compared to the healthy individuals, and the importance of maintaining adequate zinc levels and glycemic control to reduce the risk and severity of diabetic complications. Early intervention and comprehensive management strategies are crucial, particularly for patients with longer DM durations. Conclusion: This study underscores the significant reduction in serum zinc levels in patients with T2DM compared to healthy individuals. The data reveal a crucial relationship between diminished zinc levels and the increased risk and severity of both microvascular and macrovascular complications in T2DM patients. These findings highlight the importance of maintaining adequate zinc levels and achieving effective glycemic control to mitigate these complications.

Background: Thyroid nodules are commonly detected incidentally, and while the majority are benign, some may require further evaluation. Ultrasound plays a key role in the initial assessment by evaluating features such as size, composition, echogenicity, margins, and calcifications. It helps in risk stratification and determining the need for fine-needle aspiration biopsy (FNAB). This study focuses on the role of sonography in the characterization of thyroid nodules. Method: This cross-sectional observational study, was conducted at the F.H. Medical College, Agra over 18 months. In this study a total of included 138 patients with thyroid nodules. Patients with nodules ≥1 cm and those providing written consent were included, while those with diffuse thyroid enlargement were excluded. Ultrasound examinations were performed using high-frequency transducers and nodules >10 mm with normal or elevated TSH levels underwent ultrasound-guided fine-needle aspiration. The findings provide insights into the diagnostic utility of sonography in thyroid nodule evaluation. Results: In this study of 138 thyroid nodules, the majority of cases were observed in individuals aged 31-40 years (26.81%), and there was a higher prevalence in females (67.39%). Most nodules were multiple (78.26%) and classified as TIRADS 3 (32.6%). Cytopathological examination revealed 75.3% benign cases, 13% indeterminate, and 11.5% malignant. Taller-than-wide shape, irregular margins, and marked hypoechogenicity were significantly associated with malignancy. The risk of malignancy increased with higher ACR TIRADS scores, with TIRADS 5 showing an 87.5% malignancy risk. The diagnostic accuracy of ACR TIRADS was 85.83%, with high sensitivity (81.25%) and specificity (86.54%), making it a reliable tool for assessing thyroid nodule malignancy. Conclusion: Sonography is essential for evaluating thyroid nodules and helping assess malignancy risk. Key features like shape, margin, echogenicity, and composition are critical indicators. The ACR TI-RADS scoring system effectively categorizes nodules by malignancy risk, guiding clinical decisions for further testing and treatment.

Need for the study: Identifying the frequency of anatomical variations in the population is relevant to identify patients of refractory and recurring symptoms of foot neuropathy especially after surgical procedures These patients might require specialized care due to their unique anatomy. Hence, we conducted this study to identify the location of vulnerable structures like knot of henry & the nerves of the foot. Methodology: In the current   study 42 feet of formalin-fixed adult cadavers of Indian population were which were donated for research purposes to Department of Anatomy, Dr. B.R. Ambedkar Medical College, Bangalore and noted the location of knot of Henry & its relation with plantar nerves from medial tubercle of calcaneum and head of first metatarsal bone. Results: The medial plantar nerve presented as a single trunk near the knot in 96.9% of cases, and as an already bifurcated structure in 6.25% (2 out of). The mean distance between the Medial Plantar Nerve and Knot of Henry measured 6mm± SD4.8 mm (right foot) and 5mm±SD 3.2mm (left foot), with 60% specimens falling within the range of 1.2-10.8 mm, 26.7% were closer, and 13.3% were farther. Additionally, we observed the lateral plantar was on average 24.6±4mm from the knot of Henry. Conclusion: India being the second in world with prevalence of diabetes is precariously prone for foot neuropathy and hence along with strngthening the primary care system, a thorough knowledge of the neuro vascular anatomy of foot with their vulnerable sites of injury is critical for effective treatment & management

Stroke is a leading cause of morbidity and mortality globally. Alterations in serum magnesium (Mg) and potassium (K) levels play a significant role in the prognosis of acute ischemic stroke (AIS). This study aimed to evaluate serum Mg and K levels as prognostic markers in AIS patients. Materials and Methods: This hospital-based prospective study included 90 AIS patients admitted to the Department of Medicine, GMSH, Chandigarh, over six months. Detailed demographic and clinical data were recorded, and serum Mg and K levels were analyzed. Neurological severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Statistical significance was evaluated for various parameters, including comorbidities such as diabetes mellitus (DM), hypertension, and coronary artery disease (CAD). Results: Serum Mg levels ≤1.7 mg/dl were associated with higher NIHSS scores at admission, day 5, one month, and three months, indicating worse prognosis (p < 0.05). The mean serum K level was 4.02 ± 0.56 mg/dl. Lower K levels (<3.5 mg/dl) were observed in patients with higher NIHSS scores at one month (p < 0.05), although no significant correlation was found with other clinical outcomes. The mean serum Mg level was 1.98 ± 0.31 mg/dl, significantly lower in patients with DM, CAD, and hypertension compared to those without these conditions. Conclusion: Serum Mg levels were significantly associated with higher NIHSS scores and the presence of comorbidities such as DM, CAD, and hypertension, highlighting their potential role as prognostic markers in AIS. Serum K levels showed limited prognostic value, with significance observed only at one-month NIHSS scores.

Introduction: The determination of the landmarks by the clinician enables the sacral hiatus to be ascertained and may increase the success rate of Caudal Epidural Block. The reliability and success of caudal epidural anaesthesia depends upon anatomical variations of sacral hiatus. The present study was conducted to find out different morphological features and anatomical variations of sacrum and sacral hiatus. Methods: An observational study was conducted on 70 adult sacra of unknown sex obtained from Department of Anatomy, Government Medical College, Machilipatnam, Andhra Pradesh. Vernier callipers was used to take the measurements on the intact parts of normal bone. Results: An inverted ‘U’ shape was the predominant shape of the sacrum observed in the present study. The level of apex of hiatus was observed at the 4th Sacral vertebrae and the Level of the base of hiatus at the 5th sacral vertebrae. The mean Height of Sacral Hiatus was 21.02±5.68 and Width was calculated to be 12.51±2.09. The mean Distance from SH Apex to S2 level was 29.78±6.32 And the mean Distance from SH Base to S2 level was 51.37±4.12. Distance b/w Upper Border S1 & SH Apex was 57.84±7.51. Conclusion:  These findings provide valuable anatomical insights for clinical procedures involving the sacral region, such as caudal epidural blocks, highlighting the importance of understanding morphological variations for safe and effective interventions.

Introduction: Ultrasound elastography has emerged as a promising non-invasive modality for characterizing breast lesions, offering biomechanical insight beyond conventional B-mode imaging. This study evaluates and compares the diagnostic performance of strain and shear wave elastography (SWE) in differentiating benign from malignant breast lesions. Methods: In this prospective cohort study, 100 patients with ultrasound-detected breast lesions underwent both strain elastography and SWE prior to histopathological diagnosis. Diagnostic metrics including sensitivity, specificity, area under the ROC curve (AUC), and interobserver agreement were calculated. A cutoff SWE velocity >3.5 m/s and strain score ≥4 were used as thresholds for malignancy. Results: Shear wave elastography outperformed strain elastography with an AUC of 0.92 versus 0.86. SWE achieved sensitivity and specificity of 88.6% and 82.6%, respectively, while strain elastography achieved 85.7% and 78.3%. Histopathology confirmed invasive ductal carcinoma in 38% of cases and fibroadenoma in 32%. Interobserver agreement was strong for both modalities (κ = 0.86). Conclusion: Ultrasound elastography, especially SWE, demonstrates high diagnostic accuracy and reproducibility in differentiating breast lesions. Incorporating elastography into standard imaging protocols can enhance diagnostic confidence and reduce unnecessary biopsies.

Introduction: Septic shock syndrome resulting from systemic inflammation and excessive host immune responses to infection is a top cause of death in hospitalized patients, with 40–50% mortality. . There is a convincing rationale for the potential advantages of albumin administration during sepsis.1 Albumin is the main protein responsible for plasma colloid osmotic pressure2; it acts as a carrier for several endogenous and exogenous compounds,3 with antioxidant and antiinflammatory properties, and as a scavenger of reactive oxygen4,5 and nitrogen6 species and operates as a buffer molecule for acid–base equilibrium. But time of administration is very crucial. Studies wherein the administration of inj albumin was delayed resulted in undesirable outcome.With logical rationale if the intervention is used timely with the drug in therapeutic dosage ,optimal results can be obtained .Hence ,in the group of patients in early phases of  septic shock,,inj albumin was administered in therapeutic doses.With mere early intervention successful outcome was achieved preventing the vicious cycle of organ dysfunction .A retrospective analysis was conducted to study the effect of early supplementation of injection albumin in outcome of patients with septic shock with 20%albumin  100 ml once a day for 3 days .supplement and its outcome  in patients having septic shock . In our study we found that there occurred significant rise in blood pressure after 6 hours of administration of inj albumin 20%.This is attributed to the improvement of oncotic pressure after the onset of action of inj albumin.The subsequent reading after 12 hours of administration  did not show any significant change.But with 3 doses  of inj albumin as administered once a day there occurred persistence increase in blood pressure .There was significant decline in the need of vasopressors and eventually the BP was maintained without vasopressors or ionotrophs with improvement in the urine output by virtue of optimization of renal perfusion pressure as well. Conclusion: Inj albumin 20% 100 ml if administered in early phase(within 24 hours) of septic shock ,results in optimization of blood pressure with prevention of vicious cycle of impairment of organ perfusion and thereby prevention of organ dysfunction.

Introduction: A polyp is a general term used in medicine to describe any growth that protrudes above the mucosa. Sessile and pedunculated, polyps are easily observed under both macroscopic and microscopic inspection. Aims: Gastrointestinal polyps encompass a broad spectrum of pathological lesion that vary in morphology, neoplastic potential & management. They are heterogenous group of lesions with specific histological features but no reliable distinguishing endoscopic findings, thus morphology is the basis of their classification. So main aim is To study the histomorphological landscape of Gastrointestinal polyps Materials & Methods: This study was conducted for a period of 3 years (1.5 years retrospective and 1.5 years prospective) in the department of pathology, Dayanand medical college& Hospital Result: Over the course of three years, 319 gastrointestinal polyp biopsies were obtained. The patients' average age was 53.8 years. A male preponderance of 1.7:1 was observed in the M:F ratio. GI polyps most frequently affected the large intestine, then the stomach and small intestine. Adenomatous polyps were more prevalent in the lower gastrointestinal tract, whereas fundic gland polyps (82.5%) were the most prevalent histological type in the upper gastrointestinal tract. Invasive carcinoma and high grade dysplasia were linked to adenomas larger than 2 cm. Conclusion: In addition to people with inflammatory bowel illness, villous adenomatous polyps have a significant risk of invasive development. Planning additional interventions requires determining the polyps' possible risk of cancer.

Background: Gallbladder cancer (GBC) is a rare yet aggressive malignancy with a poor prognosis, often diagnosed at advanced stages due to its asymptomatic early course. Current diagnostic methods rely on imaging and biopsy, which are limited in early detection. Serum tumor markers like carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) have suboptimal sensitivity and specificity. Reliable biomarkers are needed to improve early detection and prognosis in GBC. Objective: This study evaluates the diagnostic and prognostic performance of CEA, CA 19-9, and survivin in GBC patients, focusing on sensitivity, specificity, and correlation with clinicopathological features. Methods: This prospective study, conducted at a tertiary care hospital in eastern India from January to December 2024, included pathologically confirmed GBC patients undergoing surgical resection. Serum levels of CEA, CA 19-9, and survivin were measured using chemiluminescent immunoassay and ELISA. Clinical and pathological data were analyzed. Results: Among 50 GBC patients and 50 matched controls, survivin had superior diagnostic performance (82% sensitivity, 94% specificity) compared to CEA (52%, 74%) and CA 19-9 (64%, 78%). Elevated levels of all markers correlated with shorter survival durations, with survivin showing the strongest prognostic value. Conclusion: Survivin outperforms CEA and CA 19-9 as a diagnostic and prognostic marker for GBC. Its use in clinical practice could enhance early detection and risk stratification. Future research should validate these findings and explore survivin as a therapeutic target.

Background: Pleural effusion is an excess fluid that accumulates between two pleural layers.There are two types of effusions including Transudative and Exudative effusion.Common causes of exudative effusion include tuberculosis, parapneumonic effusion, viral infections, and malignancy. Pleural fluid analysis and cytology are the mainstays for diagnosing various pulmonary diseases.  Aim of the study: A clinicopathological study of pleural effusion in a tertiary care hospital. Material and Methods: Prospective study was conducted in the department of General medicine at TRR medical college for duration of 1 year i.e. from March 2021 to Feb 2022. Results: In the present study Tuberculosis was commonly reported accounting 38.4% (25/65), Pneumonia 30.7% (20/65), Empyema, Pancreatitis, Liver cirrhosis and Malignancy 7.6% (5/65). Purulent 76.8% (50/65), Hemorrhagic 15.3% (10/65) and Straw colored 7.6% (5/65). Conclusion: Aetiological evaluation of pleural effusion is very important for management of the disease. This is important because management is different for different cases. Pleural fluid analysis can be considered as gold standard in evaluation of pleural effusion.

Background: The hip joint ensures stability and mobility, with total hip arthroplasty (THA) being a standard treatment for osteoarthritis, avascular necrosis, and fractures. Precise acetabular implant positioning is critical, as malpositioning can cause dislocation, impingement, and prosthetic wear. Morphometric analysis of the acetabulum aids in surgical planning, implant selection, and functional outcomes. This study evaluates acetabular morphometry in hip bones belonging to the East Indian population and its clinical relevance in total hip arthroplasty (THA). Materials and Methods: In this cross-sectional study, 50 adult dry hip bones (among which 25 belong to the right side and 25 belong to the left side) of unknown gender and age were studied in the Department of Anatomy, Indira Gandhi Institute of Medical Sciences, Patna, Bihar (India). We measured the diameter of the acetabulum, depth of the acetabulum, and width of the acetabular notch with the help of a digital vernier caliper, which had a sensitivity of 0.01 mm, and the least count observed was 0.01 mm. The obtained data is expressed in terms of Mean and standard deviation. A p-value less than 0.05 was considered significant in this study for the analysis. The findings were tabulated and analyzed statistically by using the GraphPad Prism version 9 software.  Results: Our morphometric analysis demonstrated that the mean acetabular diameter measured 48.42 ± 3.40 mm on the right side and 47.05 ± 5.55 mm on the left side, while the acetabular depth was 24.16 ± 2.59 mm on the right side and 24.96 ± 3.14 mm on the left side. The width of the acetabular notch showed similar dimensions between sides, measuring 22.55 ± 3.07 mm on the right and 22.82 ± 3.06 mm on the left. In the present study, there were no significant differences found between the right and left side parameters of the acetabulum. Conclusion: A comprehensive understanding of acetabular dimensions is essential for designing effective prosthetic components in total hip arthroplasty. This study identified key morphometric parameters that aid in precise preoperative assessment, ensuring optimal implant fit and stability. By integrating these findings, biomedical engineers can develop prostheses that enhance patient mobility, longevity, and overall surgical outcomes.

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality, with early detection being critical for curative treatment. This study evaluates and compares the diagnostic accuracy of contrast-enhanced Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) in detecting and staging HCC. Methods: A prospective cohort study was conducted at SMS Medical College and Hospital, Jaipur, over a one-year period. A total of 120 patients at risk for HCC underwent both CT and gadoxetic acid-enhanced MRI. Imaging findings were evaluated independently by two radiologists using LI-RADS v2018. Diagnostic performance metrics (sensitivity, specificity, accuracy) were calculated against a composite reference standard. Statistical comparisons included McNemar’s test and Cohen’s Kappa. Results: MRI demonstrated superior sensitivity (91.2%) and specificity (87.2%) compared to CT (79.6% and 83.0%, respectively). Interobserver agreement was higher for MRI (κ = 0.78) than CT (κ = 0.68). MRI detected more sub-2 cm lesions, and combined CT+MRI use enhanced diagnostic completeness. Seven lesions (4.4%) were missed by both modalities. Conclusion: MRI offers higher diagnostic accuracy and consistency compared to CT for early-stage HCC detection. MRI should be the preferred modality where available, and combined imaging may be beneficial in complex cases.

Background: Vitamin D deficiency is a common health concern globally and has been implicated in a range of musculoskeletal symptoms, particularly fatigue and muscle weakness. Despite increasing awareness, the extent to which vitamin D deficiency correlates with these symptoms in the general population remains underexplored. This study aims to evaluate the prevalence of vitamin D deficiency and its association with fatigue and muscle weakness among adults in a community-based setting. Materials and Methods: A cross-sectional study was conducted over a six-month period, enrolling 300 participants aged 18–60 years from outpatient clinics and community centers. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured using a chemiluminescence immunoassay. Participants were categorized into three groups: deficient (<20 ng/mL), insufficient (20–30 ng/mL), and sufficient (>30 ng/mL). Fatigue was assessed using the Fatigue Severity Scale (FSS), and muscle strength was evaluated by handgrip dynamometry. Statistical analysis included Chi-square and ANOVA tests, with significance set at p<0.05. Results: Out of 300 participants, 162 (54%) were vitamin D deficient, 84 (28%) were insufficient, and 54 (18%) had sufficient levels. The mean FSS score in the deficient group was 5.6 ± 1.1 compared to 3.8 ± 0.9 in the sufficient group (p<0.001). Mean handgrip strength was significantly lower in the deficient group (18.4 ± 3.2 kg) than in the sufficient group (26.1 ± 4.5 kg) (p<0.001). A strong inverse correlation was observed between serum vitamin D levels and both fatigue severity (r = -0.61) and muscle weakness (r = -0.58). Conclusion: The findings suggest a high prevalence of vitamin D deficiency in the general population, which is significantly associated with increased fatigue and reduced muscle strength. Routine screening and correction of vitamin D levels may help alleviate these symptoms and improve quality of life.

Background post-operative sore throat (POST) and hoarseness of voice are very common complaints from patients undergoing endotracheal intubation, the incidence of which has been estimated to be approximately 14.4% to 50%.  Budesonide is an inhaled corticosteroid (ICS), commonly used to reduce all these complications. It is a corticosteroid with potent glucocorticoid and weak mineralocorticoid activities. Metered dose delivery of budesonide is considered simple and less time-consuming but with high patient acceptability. It would obviate the need of additional equipments like nebulisers or atomisers and reduce the assistance of nursing staff. Side-effects like fluid retention, delayed wound healing and glucose intolerance are comparatively less as compared to intravenous corticosteroids.² Methods: The present study was conducted in the Department of Anaesthesiology and Critical Care, Pt. B. D. Sharma PGIMS, Rohtak in a prospective, randomised and unblinded manner after obtaining approval from the institutional ethical committee and patients’ written, informed consent. The study included 100 patients of either sex of age 18-60 years, belonging to American Society of Anesthesiologists Physical Status (ASA PS) of I and II with Mallampatti Grades (MPG) of 1 and 2, undergoing surgeries under general anaesthesia. Patients were randomly allotted to one of the two groups equally, labelled A and B, 50 patients each irrespective of gender, using random number table as follows: Results: The incidence of post-operative sore throat, cough and hoarseness of voice grades were found significantly higher in the Group B than in Group A at 2 hours after extubation of the patients (74%, 56% and 40% versus 22%, 18% and 28%). There were significantly higher grades of POST, cough and hoarseness of voice in Group B than in Group A. The incidence of POST and hoarseness of voice grades were found to be significantly higher in Group B than in Group A (27%, 38% versus 12%, 16%) at 6 hours post-extubation. Though the incidence of cough was higher in Group b than in Group A, it was not statistically significant. Higher grades of all three categories were seen in Group B. In Group B higher incidence of POST, cough and hoarseness of voice were seen as compared to Group A (28%, 28%, 18% versus 10%, 8%, 4%) at 12 hours post-extubation. There were higher grades of POST, cough and hoarseness of voice in Group B. Conclusion: we concluded from our study that Budesonide is a very safe inhalational corticosteroid that can be used frequently during general anaesthesia using endotracheal tube. It has been found to reduce the incidence and grades of post-operative sore throat, cough and hoarseness of voice in the patients following extubation thereby, enhancing the overall satisfaction of the patients in the post-operative period.

Background: Seroma formation following breast surgery can significantly impact recovery, morbidity, and adjuvant therapy timing. This study evaluates the role of comorbidities (diabetes mellitus and hypertension) and nutritional status (serum albumin) in the development of seroma post-Modified Radical Mastectomy (MRM). Methods: This prospective study involved 100 patients undergoing MRM at a tertiary care hospital in North India. Comorbidities (diabetes, hypertension), hematological parameters (hemoglobin, leukocyte count), and serum albumin levels were recorded. Patients were monitored postoperatively for seroma formation over a 3-week period. Results: Of the 100 patients, 26% developed seroma. The incidence of seroma was significantly higher among diabetics (58.33%) and hypertensives (60.71%) compared to non-diabetics and normotensives (p<0.001). Serum albumin <3.5 g/dL was associated with a seroma rate of 73.08%, also statistically significant. No correlation was found with hemoglobin or leukocyte count. Conclusion: Diabetes, hypertension, and hypoalbuminemia are significant predictors of seroma formation post-MRM. Optimizing systemic and nutritional status may reduce postoperative morbidity and enhance recovery.

Background and Aim: Spinal anaesthesia is widely recognized as a safe and efficient method for administering anaesthesia during surgeries involving the lower abdomen and legs.Clonidine is a medication that acts as an alpha-2 adrenergic agonist, and it can increase the potency of local anaesthetics when administered directly into the spinal fluid.This study was done to determine efficacy of adding intrathecal clonidine to bupivacaine hyperbaric(0.5%) in spinal anaesthesia in patients undergoing infra-umbilical surgeries. Methods: In a prospective observational study,60 patients with ASA grade i/ii were distributed  into two groups:Group A-received inj. Bupivacaine (hyperbaric)0.5% 3ml(15 mg) + normal saline 0.2 ml was administered Intrathecally

and Group B-received inj.Bupivacaine (hyperbaric)0.5% 3ml(15 mg) + inj.Clonidine 0.2 ml(30 µg). Parameters like onset of blockade, duration of sensory and motor block, duration of analgesia, hemodynamic changes and side effects were observed. Results: The onset of sensory and motor block was comparable in both groups. Mean duration of sensory block was significantly higher in Group B(264. 61 ± 19.2 mins.)(p< 0.001). Mean duration of motor block was significantly higher in Group B(225.20 ± 13.2 mins)(p < 0.001). Group B had prolonged mean duration of analgesia (378.06 ± 10.2 mins)(p < 0.001) as compared to Group A. Hemodynamic parameters were comparable in both groups.  Conclusion: Intrathecal addition of clonidine significantly prolongs the duration of sensory and motor block providing good postoperative analgesia and improves the quality of block with minimal acceptable side effects as compare to bupivacaine alone.

Background: Post-operative sore throat (POST) and hoarseness of voice are very common complaints from patients undergoing endotracheal intubation, the incidence of which has been estimated to be approximately 14.4% to 50%. Budesonide is an ICS commonly used to reduce all these complications. It is a corticosteroid with potent glucocorticoid and weak mineralocorticoid activities. Metered dose delivery of budesonide is considered as simple, less time consuming with high patient acceptability. On the other hand, the main advantage of nebulization with budesonide is that it is deposited directly into the respiratory tract and thus higher drug concentrations can be achieved with fewer adverse effects than when the systemic route is used. Methods: The present study was conducted in the Department of Anaesthesiology and Critical Care, Pt. B. D. Sharma PGIMS, Rohtak in a prospective, comparative, randomised and unblinded manner after obtaining approval from the institutional ethical committee and patients’ written, informed consent. The study included 80 patients of either sex of age 18-60 years, belonging to American Society of Anesthesiologists (ASA) physical status of I-II with Mallampatti score of 1-2, undergoing surgeries under general anaesthesia. Results: The incidence of post-operative sore throat and hoarseness of voice grades were found significantly higher in the Group A (92% and 37.5%) than in Group B (85% and 22.5%) at 2 hours after extubation of the patients. There were significantly higher grades of POST and hoarseness of voice in Group A than in Group B. The incidence of POST and hoarseness of voice grades were found to be significantly higher in Group A than in Group B (55%, 27.5% versus 27.5%, 15%) at 6 hours post-extubation. Higher grades of all categories were seen in group A. At 24 hours post-extubation, the incidence and grades of POST and hoarseness were found higher in Group A than in Group B (10%,22.5% versus 0%,15%). Conclusion : We concluded from our study that Budesonide is a very safe inhalational corticosteroid that can be used frequently during general anaesthesia using endotracheal tube. It has been found to reduce the incidence and grades of post-operative sore throat, cough and hoarseness of voice in the patients following extubation thereby, enhancing the overall satisfaction of the patients in the post-operative period.

Introduction: The left atrium (LA) plays a crucial role in cardiac hemodynamics, functioning as a reservoir, conduit, and booster pump during the cardiac cycle. Left atrial dysfunction is associated with a wide range of cardiovascular diseases, including atrial fibrillation, heart failure, and valvular heart disease, and serves as an important predictor of adverse cardiovascular outcomes. Aims: This study aims to evaluate changes in LA reservoir function and volume following PBMV, using PALS as a key echocardiographic parameter. Understanding these changes could improve the assessment of post-procedural hemodynamic improvements and long-term atrial function, ultimately aiding in risk stratification and management of patients undergoing PBMV. Materials & Methods: The present study was a Prospective cohort study. This Study was conducted from One year. Total 36 patients were included in this study. Result: The study compared baseline characteristics among patients with mitral stenosis (MS, n = 17), mitral regurgitation (MR, n = 19), and healthy individuals (n = 16). The mean body surface area (BSA) was similar across groups (MS: 1.6 ± 0.1 m², MR: 1.7 ± 0.1 m², Healthy: 1.7 ± 0.1 m²). Patients with MR were slightly older (49 ± 13 years) compared to those with MS (42 ± 12 years) and healthy controls (41 ± 13 years). Conclusion: We concluded that, percutaneous balloon mitral valvuloplasty (PBMV) significantly improves left atrial (LA) reservoir function and reduces LA volume in patients with mitral stenosis. Assessment using peak atrial longitudinal strain (PALS) demonstrates enhanced LA compliance and function post-procedure.

Introduction: The study examines the impact of myocardial blush grade on survival after primary percutaneous coronary intervention (PCI) in a high-risk AMI cohort undergoing mechanical reperfusion therapy at a tertiary referral center. Despite restoration of TIMI-3 flow, myocardial recovery is often suboptimal, leading to considerable mortality in high-risk patients. Aims: We sought to evaluate and validate the ability of the angiographic myocardial blush grade to risk stratify patients after successful angioplasty in acute myocardial infarction (AMI). Materials and methods: This was a quantitative, cohort study (observational) conducted in the Department of Cardiology at Burdwan Medical College and Hospital, Bardhaman, West Bengal 713104. The study was carried out over a duration of one year and included a total sample size of 100 participants. Result: Stent implantation was more common in the Final Blush 3 group (70%) compared to the Final Blush 0 to 2 group (54%), with a statistically significant difference (p = 0.03). Balloon angioplasty only was more frequently performed in the Final Blush 0 to 2 group (48%) compared to the Final Blush 3 group (28%), with a significant difference (p = 0.02). Conclusion: The study found no significant differences in clinical features between two groups with different myocardial blush grades. However, significant differences were observed in infarct territory, with more involvement in the Final Blush 0 to 2 group and more involvement in the Final Blush 3 group. Age, gender, and angiographic measurements showed no significant difference between the groups.

Introduction: Heart failure is a complex clinical syndrome characterized by the heart's inability to adequately pump blood to meet the body's demands. It is associated with significant morbidity, mortality, and healthcare costs. The presence of AF in heart failure patients further exacerbates the clinical course, leading to worse outcomes and increased hospitalizations. Aims: To evaluate LA and RA remodelling in AF using TTE-derived global Left atrial reservoir strain and RA Volume according to rhythm outcome at mid-term follow up and to correlate with heart failure. Materials and Methods: This is a prospective observational and corelational design. The study was conducted in Cardiology Department, IPGMER and SSKM Hospital and study duration was June 2021 to June 2022, first 12 months. The sample size of this study is 50 patients. Result: The comparison of artial volume at baseline and at 6 month follow up among AF-SR and AF-AF group. Above analysis we found between M0 (baseline) and M6 (at 6 month follow up), in the AF-SR group, there a significant decrease in RA Volume (p value = <0.0001), and LA volume (p value = <0.0001). There were no significant differences with regard to these variables in the AF-AF group though the RA and LA volume increases at 6 months (M6) in comparison to baseline (M0). Conclusion: In conclusion, two-dimensional strain echocardiography provides valuable insight into biatrial remodeling in atrial fibrillation. It effectively assesses atrial strain and function, highlighting their correlation with heart failure. This technique enhances our understanding of atrial dynamics, potentially guiding clinical management and improving patient outcomes in atrial fibrillation-related heart failure.

Surgeries can result in various pulmonary complications during postoperative period. Mucus plug formation can occur in smokers and could be life-threatening if it’s not treated promptly. We report a case of 34 years male occasional smoker who presented with left lung collapse postoperatively. He was treated with mucolytics and physiotherapy which resulted in lung expansion within 24 hours.

Respiratory Distress Syndrome (RDS) is a common and significant cause of morbidity and mortality in preterm infants. Continuous Positive Airway Pressure (CPAP) is a vital non-invasive ventilatory support used in the management of RDS. This study aimed to evaluate the clinical profile and outcome of preterm babies with RDS who were treated with indigenously assembled CPAP (i-CPAP) in the Neonatal Intensive Care Unit (NICU) of a tertiary care hospital. The study population included preterm infants under 37 weeks of gestation admitted with RDS, as indicated by a Silverman Anderson score of ≥3 within 6 hours of birth and suggestive chest X-ray findings. The study prospectively collected data on gestational age, gender, mode of delivery, birth weight, Silverman Anderson score, duration of CPAP, complications, and outcomes. The findings revealed that i-CPAP was utilised for varying durations, with the majority of neonates requiring it for less than 7 days. The primary outcomes assessed included weaning to room air, need for further ventilation, and survival. The study provides insights into the effectiveness and safety of i-CPAP in a resource-limited setting.

Background: About 3 billion people are exposed to smoke from biomass fuel, a major risk factor for COPD, particularly in developing countries, where it accounts for around 50% of COPD-related deaths, mainly affecting women. Objectives: To estimate the prevalence of COPD in non-smoking females over the age of 40 years with chronic respiratory symptoms. To identify the association of COPD with risk factors. Materials & Methods:  A cross-sectional study was conducted over six months in the Department of Respiratory Medicine at a tertiary care teaching hospital among women over 40 who are never smokers and have smoked fewer than 100 cigarettes, per CDC guidelines. Results: In this study, the prevalence of COPD in non-smoking females is 15.29%. It was found that 94.6% of the study subjects had restrictive PRISM, whereas only 5.35% had Non-restrictive PRISM. In this study, 10 of 13 COPD patients were exposed to biomass fuel, 2 to dust and fumes, and 3 had a history of recurrent childhood respiratory infections. All 3 participants with non-restrictive PRISM were exposed to biomass fuel, with 1 having a history of pulmonary tuberculosis. Among 32 patients with small airway obstruction, 27 were exposed to biomass fuel, 5 to dust and fumes, and 15 had recurrent childhood respiratory infections. Conclusion: Risk factors for COPD in women include exposure to biomass fuels, pollutants, recurrent respiratory infections, tuberculosis history, and dust or fumes. Recognizing these factors and using spirometry for diagnosis can help reduce COPD-related mortality and morbidity in at-risk females.

Background: Seroma formation remains the most common postoperative complication following breast and head and neck cancer surgeries involving flap elevation. It is attributed primarily to lymphatic disruption during surgery, resulting in fluid accumulation under skin flaps or in axillary spaces. Seromas may lead to infection, delayed wound healing, flap necrosis, prolonged hospital stay, and delayed initiation of adjuvant therapies. Quilting or flap suturing techniques aim to minimize dead space, thus potentially reducing seroma formation and related complications. Material and Methods:A randomized controlled study was conducted in the Department of Surgery, MGM Medical College and MY Hospital, Indore, over a 1-year period. A total of 50 patients undergoing Modified Radical Mastectomy (MRM) or head and neck surgeries with skin flap elevation were enrolled and randomized into two groups: quilting (interventional) and non-quilting (control). Patients were assessed for operative time, seroma formation on postoperative days 1, 3, and 7, total drain output, duration of drain retention, and surgical site infections. Data were analyzed using standard statistical methods, and significance was set at p<0.05. Results: The quilting group demonstrated significantly reduced seroma volumes on Day 1 (p=0.001) and in total cumulative seroma volume (p=0.013). Drain removal occurred earlier in the quilting group (mean 7.5 days vs. 9.59 days; p=0.043). The incidence of seroma (2 vs. 8 cases) and postoperative hematoma (1 vs. 3 cases) was also lower in the quilting group, while rates of flap necrosis remained comparable. No statistically significant differences were observed between groups based on age, tumor stage, or laterality of breast involvement. Conclusion: Quilting sutures during flap closure in breast and head and neck cancer surgeries significantly reduce early seroma formation, total drain output, and facilitate earlier drain removal. These benefits contribute to shorter hospital stays and quicker initiation of adjuvant therapy. Further large-scale studies are warranted to confirm the long-term benefits and generalizability of flap suturing techniques in various surgical settings.

Background: Inguinal hernia repair is one of the most commonly performed procedures in general surgery. Despite numerous advances, the search for a technique that ensures minimal complications, shorter recovery times, and ease of performance continues. The newly developed Endoscopic Anterior Approach Inguinal Hernioplasty (EAAIH) allows surgeons to access the hernia site via the familiar anterior plane, potentially offering clinical advantages over traditional laparoscopic techniques such as Totally Extra Peritoneal Repair (TEP). This study aims to evaluate and compare the efficacy, feasibility, and postoperative outcomes of EAAIH and TEP. Methods: This prospective randomized controlled trial was conducted at the Department of Surgery, Mahatma Gandhi Memorial Medical College and M.Y. Hospital, Indore, over a 12-month period. Fifty patients aged 20–60 years with primary unilateral inguinal hernia were enrolled and randomly allocated into two groups of 25 each—EAAIH and TEP. Baseline clinical data, intraoperative findings, and postoperative outcomes such as operating time, intraoperative blood loss, postoperative pain, cosmetic results, return to normal activity, and complications were recorded. Data analysis was performed using SPSS software with appropriate statistical tests, and a p-value < 0.05 was considered statistically significant. Results: All 50 participants were male, with the majority in the 41–50 year age group. The distribution of hernia type was predominantly indirect in both groups. No statistically significant difference was found between the two techniques regarding intraoperative blood loss, postoperative pain, and complication rates. However, a statistically significant earlier return to normal activity was observed in the EAAIH group (p = 0.044). The operative duration, hospital stay, and cosmetic outcomes were comparable between groups. Fewer nerves were encountered in the EAAIH group, suggesting a lower potential for nerve injury. Conclusion: The EAAIH technique demonstrates comparable safety and efficacy to the conventional TEP method for primary unilateral inguinal hernia repair. It offers the added benefit of a shorter learning curve and avoids entry into the peritoneal cavity, reducing the risk of visceral and vascular injuries. EAAIH may be particularly advantageous in resource-constrained settings and for early-career surgeons trained in open anterior techniques. Nevertheless, larger multicentric studies with longer follow-up periods are recommended to further validate these findings.

Background: The increasing reliance on artificial intelligence (AI) in healthcare has raised important questions regarding the accuracy and clinical applicability of AI-driven responses, particularly from language models like ChatGPT. Patients frequently turn to online resources for medical advice, but the quality of such information remains variable. This study aimed to evaluate the accuracy, reliability, and clinical relevance of ChatGPT’s responses to commonly asked health-related questions. Materials and Methods: A cross-sectional observational study was conducted between January and March 2025. A panel of 10 licensed health care professionals generated a dataset of 100 frequently asked patient queries covering general medicine, pediatrics, dermatology, mental & dental health. Responses were obtained from ChatGPT (GPT-4) and evaluated by three independent physicians for accuracy, clinical relevance, and completeness using a 5-point Likert scale. Inter-rater reliability was assessed using Cohen’s kappa. Results: Out of 100 responses, 86% were rated as clinically accurate (mean score 4.3±0.5), while 78% were deemed relevant to actual clinical practice. Completeness was rated high in 73% of cases. The inter-rater reliability among the evaluators was substantial (κ = 0.78). However, 9% of the responses were flagged as potentially misleading or lacking important clinical context. Conclusion: ChatGPT demonstrates a high level of accuracy and clinical relevance in addressing common patient queries, suggesting its potential as a supplementary tool in patient education. Nevertheless, caution must be exercised, especially in complex or context-specific conditions, where professional medical consultation remains essential.

Background: Appendectomy remains a common surgical intervention for acute appendicitis. Postoperative wound infections significantly influence patient recovery, hospital stay, and healthcare costs. Although laparoscopic appendectomy (LA) has become increasingly popular due to perceived advantages over open appendectomy (OA), evidence comparing postoperative infection rates between these approaches remains variable. This study aims to compare wound infection rates following open versus laparoscopic appendectomy. Materials and Methods: A retrospective comparative analysis was performed involving 300 patients undergoing appendectomy between January 2023 and December 2023 at a tertiary care hospital. Patients were categorized into two groups: laparoscopic appendectomy (n=150) and open appendectomy (n=150). Patient demographics, surgical details, and postoperative complications were collected from medical records. Postoperative wound infections were diagnosed based on clinical signs and culture confirmation. Data were analyzed using chi-square tests and logistic regression, with statistical significance set at p<0.05. Results: The overall postoperative wound infection rate was significantly lower in the laparoscopic group (4%, n=6) compared to the open appendectomy group (12%, n=18; p=0.011). Additionally, the mean duration of hospital stay was shorter in patients undergoing laparoscopic appendectomy (2.3±0.7 days) than open appendectomy (4.1±1.2 days; p<0.001). No significant differences were observed in terms of age, gender, or comorbidities between groups. Conclusion: Laparoscopic appendectomy demonstrates a lower postoperative wound infection rate and reduced hospital stay compared to open appendectomy. Thus, LA should be considered the preferred surgical approach for acute appendicitis to minimize postoperative morbidity.

Background: Muscle fatigue is a critical parameter influencing athletic performance and daily functionality. Surface electromyography (sEMG) is a non-invasive technique that helps quantify muscle fatigue by monitoring electrical activity during sustained contractions. This study aimed to evaluate and compare muscle fatigue patterns during isometric contractions in athletes and non-athletes using sEMG. Materials and Methods: A total of 40 participants were recruited, comprising 20 athletes and 20 non-athletes aged 18–30 years. sEMG recordings were obtained from the biceps brachii during a sustained isometric contraction at 60% of the participant’s maximum voluntary contraction (MVC) for 60 seconds. Parameters analyzed included median frequency (MF) shift and root mean square (RMS) amplitude. The rate of decline in MF and increase in RMS were used as indicators of fatigue. Results: Athletes demonstrated a slower rate of MF decline (−0.45 Hz/sec) compared to non-athletes (−0.89 Hz/sec), indicating better fatigue resistance. RMS amplitude increased by 18.4% in athletes and 31.7% in non-athletes over the 60-second contraction period. Statistical analysis revealed significant differences between groups in both MF decline (p=0.002) and RMS increase (p=0.015). Conclusion: Athletes exhibited superior muscular endurance during isometric contractions, reflected by a more gradual MF reduction and lower RMS increment. These findings suggest that sEMG can effectively differentiate fatigue resistance levels in trained and untrained individuals, making it a useful tool in sports science and rehabilitation monitoring.

Background: Type 2 Diabetes Mellitus (T2DM) is a global health concern with increasing prevalence, particularly in developing countries. Early intervention strategies are essential in preventing disease progression. While pharmacological management with Metformin is widely prescribed, non-pharmacological approaches like lifestyle modification (LSM) are gaining emphasis. This study aims to compare the efficacy of Metformin and lifestyle modifications in glycemic control among newly diagnosed T2DM patients. Materials and Methods: A prospective, comparative, interventional study was conducted over 6 months among 100 newly diagnosed T2DM patients attending a tertiary care hospital. Patients were randomly allocated into two groups: Group A (n=50) received Metformin 500 mg twice daily, while Group B (n=50) followed structured lifestyle modification strategies including dietary counseling, physical activity (30 minutes/day, 5 days/week), and behavioral support. Glycemic indices, including fasting blood glucose (FBG), postprandial blood glucose (PPBG), and glycated hemoglobin (HbA1c), were recorded at baseline and at the end of 6 months. Statistical analysis was performed using SPSS v25.0. Results: At 6-month follow-up, Group A showed a mean reduction in HbA1c from 8.4% to 6.9%, while Group B had a reduction from 8.2% to 7.2%. FBG decreased from 162.3 mg/dL to 118.5 mg/dL in Group A and from 158.7 mg/dL to 124.2 mg/dL in Group B. PPBG reduced from 238.6 mg/dL to 170.8 mg/dL in Group A and from 232.1 mg/dL to 178.9 mg/dL in Group B. Although both interventions were effective, Group A showed statistically greater improvement in glycemic parameters (p<0.05). Conclusion: Both Metformin and lifestyle modification significantly improved glycemic control in newly diagnosed T2DM patients. However, Metformin demonstrated superior glycemic reduction over lifestyle changes alone. Incorporating both strategies might offer additive benefits in early diabetes management

Background: This case report examines the diagnostic challenges and management of a young female patient who presented with hemorrhagic stroke, later determined to be due to renal artery stenosis likely caused by fibromuscular dysplasia. FMD is a hyperplastic arterial disorder primarily affecting medium-sized and small arteries, though larger arteries can also be involved. It is more common in young females and typically targets the renal and carotid/vertebral arteries but can also affect other arteries. While FMD usually presents as renovascular hypertension, it can also manifest as a stroke in young adults. Case Description A 27-year-old female presented with an acute hemorrhagic stroke. Upon admission to Divisional Railway Hospital, Kharagpur, South Eastern Railway, extensive diagnostic evaluation was conducted. Imaging studies confirmed the presence of hemorrhagic stroke. Given her young age and atypical presentation, further investigations were necessary. Angiographic studies revealed abnormalities consistent with fibromuscular dysplasia, characterized by the string of beads appearance in the renal arteries. The renal artery stenosis, likely due to FMD, was a significant factor contributing to her stroke. Her management involved acute stroke treatment, long-term blood pressure control and regular monitoring. Conclusion This case highlights the importance of considering FMD in the differential diagnosis of young stroke patients, especially in the absence of traditional risk factors. Early recognition and timely treatment of FMD can significantly improve the patient quality of life and ensure favorable long-term prognosis. The case illustrates the need for thorough investigation and high index of clinical suspicion in diagnosing and managing such conditions.

Background: Tuberculosis (TB) continues to be a major health challenge in India. The identification of biomarkers that reflect disease severity can assist in patient management and treatment response monitoring. Prolactin, a pituitary hormone with immunomodulatory functions, may serve such a role. Objectives: To evaluate serum prolactin levels in TB patients, assess its correlation with disease severity, and study changes following anti-TB therapy. Methods: This was a prospective observational study conducted over 12 months at a tertiary care center in Central India. One hundred newly diagnosed TB patients were enrolled. Serum prolactin levels were measured at diagnosis, 2 months, and 6 months. Disease severity was graded based on clinical, radiological, and microbiological criteria. ROC analysis was performed to determine the diagnostic utility of prolactin for severe TB. Results: Mean serum prolactin levels were significantly higher in patients with severe TB (34.2 ± 8.1 ng/mL) compared to moderate (24.6 ± 7.0 ng/mL) and mild disease (17.5 ± 6.2 ng/mL; p < 0.001). Prolactin positively correlated with sputum AFB grade (r = 0.62), radiographic extent (r = 0.58), and symptom severity (r = 0.66). ROC analysis showed an AUC of 0.88 for detecting severe TB at a cut-off of 29.5 ng/mL. Follow-up data revealed a significant decline in prolactin levels with treatment. Conclusion: Serum prolactin is a promising biomarker of TB severity and may assist in prognosis and treatment monitoring. Further studies are needed to validate its clinical utility.

Background: The placenta plays a crucial role in fetal development, and its thickness has been hypothesized to correlate with fetal outcomes. Ultrasonographic placental thickness (UPT) measurement offers a non-invasive and cost-effective tool to assess fetal well-being. This study aims to establish the relationship between UPT and fetal outcomes. Methods: A prospective observational study was conducted at the Department of Obstetrics and Gynecology, at a government medical college, between June 2023 and December 2024. A total of 139 pregnant women were enrolled, and UPT was measured at 32 and 36 weeks of gestation. Neonatal outcomes, including birth weight, APGAR scores, NICU admissions, and fetal distress, were analyzed. Statistical analysis was performed using chi-square and t-tests, with a p-value <0.05 considered significant. Results: A significant correlation was observed between UPT and neonatal outcomes. Thin placentas (<2.569 cm) were associated with higher rates of fetal distress (p < 0.001), low birth weight (p < 0.001), and increased NICU admissions (p < 0.001). Conversely, thick placentas (>3.89 cm) showed no significant adverse outcomes but were linked to gestational diabetes in some cases. Conclusion: UPT measurement can serve as a valuable predictor of fetal health, particularly in identifying at-risk pregnancies. Routine antenatal screening using this parameter could enhance perinatal care and improve neonatal outcomes

Background: The liver, being a vital organ, is susceptible to various pathological insults—many of which remain clinically silent and are often detected only during postmortem examinations. Histopathological evaluation of these incidental findings can provide valuable insights into subclinical liver disease prevalence and associated demographic trends. Aim: To study various incidental pathological lesions of the liver in postmortem specimens and correlate them with age, sex, and final histopathological diagnosis. Materials and Methods: A retrospective observational study was conducted in the Department of Pathology from January 2022 to February 2025. A total of 50 postmortem liver specimens were analyzed. Standard histopathological techniques including H&E staining were employed. Cases with significant autolytic changes were excluded. Results: Out of 50 cases, 37 (74%) showed pathological lesions while 13 (26%) were histologically normal. The most common lesion was steatosis (28%), followed by steatohepatitis (16%), chronic venous congestion (14%), hepatitis (8%), and cirrhosis (8%). The majority of cases were observed in the 21–30-year age group. Male predominance was evident with a male-to-female ratio of 2.4:1. Conclusion: Silent liver diseases, particularly steatosis, are common and can contribute significantly to mortality among apparently healthy young individuals. Histopathological examination of postmortem liver specimens remains a crucial tool for detecting undiagnosed hepatic pathology and improving our understanding of liver disease epidemiology.

Introduction: Hypertension is a major public health issue globally, with varying prevalence across different demographics and geographical locations. This study aims to assess the prevalence and associated risk factors for hypertension in urban and rural populations to identify targeted interventions. Methods: This cross-sectional study involved 500 participants, equally divided between urban and rural settings. Data were collected through health surveys and physical examinations, focusing on hypertension status, demographic variables, lifestyle factors, and access to healthcare services. Statistical analysis included chi-square tests, t-tests, and logistic regression. Results: The prevalence of hypertension was significantly higher in rural areas (40.8%) compared to urban areas (34.8%) (p=0.045). Rural participants were older and had higher mean body mass index. Factors such as smoking and family history of hypertension were more prevalent in rural populations. Urban residents reported better healthcare access and higher engagement in health awareness programs. Lifestyle factors such as dietary salt intake and physical activity also differed significantly between the two groups. Conclusion: Hypertension prevalence is significantly influenced by geographic location, with rural populations exhibiting higher rates and associated risk factors. Differences in lifestyle behaviors and healthcare accessibility suggest the need for region-specific health policies and programs to manage and prevent hypertension effectively.

Background: Congenital anomalies and intrauterine fetal death (IUFD) remain significant contributors to perinatal mortality, especially in developing countries like India. While prenatal ultrasonography is widely used for early detection, it may miss or misinterpret certain anomalies. Fetal autopsy, combined with placental examination, serves as a critical tool for accurate diagnosis and counselling regarding recurrence risks. Aim: To assess the diagnostic utility and accuracy of fetal autopsy in identifying causes of fetal death and congenital malformations, and to explore parental decision-making factors in consenting to autopsies. Methods: This retrospective study was conducted over a 24-month period (2022–2024) in the Department of Pathology at a tertiary care institute. A total of 28 fetal autopsies were analyzed. Comprehensive clinical histories, prenatal imaging data, and histopathological evaluations were included. Cases with autolysis or inadequate data were excluded. Results: Probable diagnoses were established in 42.85% of cases. Most cases (82.14%) were below 37 weeks gestation. Induced abortions accounted for 14.85%, and spontaneous IUFD for 2%. Ultrasound and autopsy findings correlated in 83.1% of cases. Fetal causes, mainly congenital anomalies and infections, were the most common cause of death. Placental pathology was contributory in several cases, while maternal causes were infrequent. Conclusion: Fetal autopsy significantly enhances diagnostic clarity in cases of fetal death, particularly when combined with prenatal imaging and placental evaluation. It remains the gold standard for confirming anomalies, guiding genetic counselling, and reducing the risk of recurrence. Promoting its acceptance through improved communication with families is vital for holistic perinatal care.

Background: Regional nerve block with application of ultrasound allows visualization of neural and vascular structures. Moreover, it allows observation of real time drug spread. Improved precision in technique with us-guidance, can reduce volume of drug. Our objective was to assess the efficacy of axillary brachial plexus with 20 ml Vs 30 ml of the drug as judged by success rate, onset time and duration of block. Materials and method: Fifty patients aged 18 to 65 years, with ASA grade I to III undergoing below mid-arm surgeries were randomly divided into two groups. Each group received US-guided perivascular injection for axillary brachial plexus block with 20 ml 0.5 % bupivacaine and 30 ml 0.5% bupivacaine. Results: We observed early initiation of complete blockade in the group 2 at 15 minutes (32% vs 20%; p=0.03), but number of patients achieving complete blockade at 30 mins is not statistically significant(p-0.93). The success rate in group 1 was 92% and in group 2 was 96%. The success rate was comparable between the two groups with p value 0.55. The duration of block in group 1 was 9.056±0.79 hours (mean± SD) and in group 2 was 15.20±0.94 hours.  The duration of block was longer in 30ml group as compared to 20ml group (p=0.001).   Conclusion: In conclusion low volume (20ml) of 0.5% bupivacaine is equally efficacious compared to the conventional volume (30ml) with respect to the onset time of sensory blockade and success rate of the ultrasound guided axillary brachial plexus block. However, the duration of the block was significantly more in 30ml group as compared to the 20ml group.

Background: Dizziness is a pretty common complaint, and while doctors often think about heart issues particularly in patients who are already diagnosed with cardiac conditions, but when patients with heart disease feel dizzy, there are plenty of other potential causes. This study looks into those other causes of dizziness in cardiac patients who came to hospitals in a rural part of Jammu and Kashmir (J&K), India. Methods: We reviewed medical records of cardiac patients who showed up at Govt. Medical College Doda in remote area of J&K, complaining of dizziness, between January 2019 and December 2023. We collected information like their age, sex, heart diagnoses, non-heart-related causes of dizziness, and what the doctors found. We used some basic statistical methods to analyze the data, and we also compared our findings with what other studies have reported. Results: Over those 5 years, 2476 cardiac patients came to the hospitals because of dizziness. Their average age was 47.5 years and about 53% were female. The most common heart problems were Hypertension, coronary artery disease, heart failure, and cardiac arrhythmias. In a pretty significant number of these patients—around 1039 (42%)—the dizziness wasn't due to their heart. The most frequent non-cardiac causes were:

• Vestibular disorders: 280 (26.94%) Benign Paroxysmal Positional Vertigo (BPPV): 145 (13.95%), Meniere's disease 83 (7.99%), Vestibular Neuritis: 52 (5%).
• Medication-related: 218 (20.98%) Diuretics: 135 (12.99%), Beta-blockers:83 (7.98%).
• Neurological disorders: 177 (17.03%) (Peripheral Neuropathy: 114 (10.97%), Migraine: 63 (6.06%).
• Psychogenic factors: 135 (12.99%) anxiety disorder 83 (7.98%), Depression 52 (5%).
• Metabolic disorders: 11 (10.87%) (Anemia: 73 (7.02%), Hypoglycemia: 41 (3.95%).
• Cervical spine issues: 116 (11.36%).

Conclusion: Non-cardiac causes of dizziness are quite common in cardiac patients in this rural part of J&K. Inner ear problems and medication side effects were particularly frequent. Neck issues also seem to be a factor. These results suggest that when cardiac patients have dizziness, doctors really need to consider all the possible reasons, not just their heart condition. More in-depth studies with larger numbers of patients would help to confirm these findings and figure out who might be more at risk

Artificial intelligence (AI) is transforming the medical industry by improving diagnosis accuracy, optimizing treatment plans, and streamlining healthcare processes. AI-powered algorithms analyze massive medical databases to diagnose diseases early on, tailor treatment plans, and aid in clinical decision-making. AI enhances diagnostic accuracy in radiology, pathology, dermatology, and ophthalmology by analyzing images using deep learning algorithms. AI-driven treatment planning in oncology, cardiology, and neurology allows for precision medicine by predicting disease progression and optimizing drug selection. Furthermore, AI improves healthcare operations through robotic-assisted surgeries, AI-powered virtual assistants, and electronic health record (EHR) automation, which improves patient management while reducing clinician labour. Despite these advantages, issues like as data privacy, algorithmic bias, model transparency, and system integration must be resolved. Future AI developments in precision medicine, robotic nursing, wearable health monitoring, and federated learning will significantly improve patient care. AI has the potential to alter modern medicine by establishing ethical principles and regulatory frameworks that ensure safer, more efficient, and tailored healthcare solutions.

Background: Postoperative nausea and vomiting (PONV) are among the most common complaints that can occur after general anaesthesia.¹ PONV is defined as any nausea, retching or vomiting that occurs within first 24 hours postoperatively.² Nausea is a subjective unpleasant sensation which is associated with awareness of the urge to vomit.¹ Retching is defined as rhythmic and spasmodic contraction of respiratory muscles like diaphragm, chest wall muscles and abdominal muscles without expulsion of any gastric contents.¹ Vomiting is defined as forceful expulsion of gastric contents through mouth which is brought about by powerful and sustained contraction of abdominal muscles, opening of the gastric cardia and descent of diaphragm.¹ Corticosteroids like dexamethasone has shown to have a potent antiemetic activity. The first trial which suggested the role of dexamethasone in preventing PONV was published in 1993. The precise mechanism of antiemetic efficacy is still unknown. A common theory is prostaglandin antagonism. It may also inhibit the synthesis and release of 5-HT by depleting its precursor tryptophan or prevent the activation of its receptors in gastrointestinal tract through its anti-inflammatory properties. Moreover, it also releases endorphins and synergizes with other antiemetic drugs by sensitizing their receptors.³ Dexmedetomidine is highly selective alpha-2 receptor agonist. It is having sympatholytic, sedative, analgesic and opioid sparing properties. Intravenous dexmedetomidine also has 4 efficacies in improving perioperative hemodynamic stability and postoperative analgesia. It decreases the incidence of PONV by various mechanisms. It decreases the intraoperative consumption of anaesthetics and opioids, which decreases the risk of PONV. PONV may be triggered by high catecholamines concentration and dexmedetomidine decreases the sympathetic tone, so it decreases the risk of PONV. It also has direct antiemetic effect by activating the alpha-2 receptors. Minor side effects like hypotension and bradycardia can occur with dexmedetomidine. It has been widely studied in patients undergoing laparoscopic surgeries for premedication, anaesthetic adjuvant, attenuation of hemodynamic response to pneumoperitoneum, prevention of postoperative side effects like PONV, shivering and pain. Methods The present study was conducted in the Department of Anaesthesiology and Critical Care, Pt. B. D. Sharma PGIMS, Rohtak in a prospective, randomised double blinded manner after obtaining approval from the institutional ethical committee and patient’s written, informed consent. From April 2021 – May 2022, the study included 70 patients of either sex of age 18-60 years, belonging to American Society of Anesthesiologists (ASA) physical status of I-II with scheduled for elective laparoscopic cholecystectomy under general anaesthesia. Results The incidence of post operative nausea and vomiting was found to be statistically comparable between two groups except at 12h after the surgery. The patients who received dexmedetomidine reported no incidence of PONV after 12 and 24 hours of surgery while 11.4% and 8.6% of patients who received dexamethasone experienced nausea and vomiting. 7) The severity of post operative nausea and vomiting was found to statistically comparable between two groups except at 6h after the surgery. Patients who received dexamethasone experienced more severe PONV at 6 h after the surgery than who received dexmedetomidine.  Conclusion We conclude that dexmedetomidine 1 µg/kg given intravenously over 10 minutes after induction of anaesthesia and before skin incision prevent the postoperative nausea and vomiting similar to the 8 mg dexamethasone given intravenously after induction and before skin incision in patients undergoing laparoscopic cholecystectomy under general anaesthesia. Dexmedetomidine is superior than dexamethasone in preventing PONV at 12 and 24 h of the surgery, decreasing the severity of PONV at 6 hours of the surgery, relieving early postoperative pain, maintaining the intraoperative hemodynamic stability and a smooth recovery from the anaesthesia.

Background: Liver tumor resections demand high precision to ensure complete tumor removal while preserving functional liver parenchyma. Conventional imaging techniques often fall short in detecting small or satellite lesions intraoperatively. Intraoperative ultrasound (IOUS) provides real-time, high-resolution imaging that aids surgeons in identifying tumor margins, vascular structures, and additional lesions, thereby enhancing surgical accuracy and outcomes. Materials and Methods: This prospective observational study included 60 patients undergoing liver tumor resection for either primary or secondary hepatic malignancies. Patients were divided into two groups: Group A (n=30), where IOUS was used intraoperatively, and Group B (n=30), where resection was performed without IOUS guidance. Preoperative imaging findings were compared with intraoperative findings, and surgical outcomes, including margin status, complication rate, and recurrence within six months, were assessed. Results: IOUS altered the surgical plan in 40% of cases in Group A by detecting additional lesions (n=8) and redefining tumor margins (n=4). Clear resection margins were achieved in 93.3% of patients in Group A versus 76.7% in Group B. Postoperative complications were lower in Group A (10%) compared to Group B (20%). Six-month local recurrence rates were 6.7% in Group A and 16.7% in Group B. Conclusion: Intraoperative ultrasound significantly improves the precision of liver tumor resections by providing real-time guidance that enhances lesion detection and margin delineation. Its use is associated with better oncological outcomes and fewer postoperative complications, supporting its integration into routine hepatic surgery protocols.

Background: Hernia repair is among the most common surgical procedures performed in the elderly population. With the advent of minimally invasive techniques, laparoscopic hernia repair has become increasingly popular. However, the choice between open and laparoscopic techniques in elderly patients remains debated due to factors such as comorbidities, recovery time, and postoperative complications. This multicentric prospective study aims to compare the clinical outcomes of laparoscopic versus open hernia repair in patients aged 65 years and above. Materials and Methods: A prospective analysis was conducted across three tertiary care centers. A total of 240 elderly patients diagnosed with unilateral inguinal hernia were enrolled and randomly assigned into two groups: Group A (n=120) underwent laparoscopic hernia repair, and Group B (n=120) underwent open mesh repair. Data on operative time, postoperative pain (assessed using VAS), duration of hospital stay, return to daily activity, and postoperative complications were collected and analyzed. Results: The mean operative time was significantly longer in the laparoscopic group (78.5 ± 10.2 minutes) compared to the open group (63.4 ± 8.7 minutes) (p<0.01). However, the mean postoperative pain score at 24 hours was lower in Group A (3.1 ± 1.2) than in Group B (5.4 ± 1.5) (p<0.001). The average hospital stay was shorter for laparoscopic patients (1.8 ± 0.6 days) compared to open surgery patients (3.2 ± 0.9 days) (p<0.001). Return to daily activities occurred earlier in the laparoscopic group (9.3 ± 2.1 days vs. 14.6 ± 3.4 days, p<0.001). Complication rates were comparable between the two groups (10% in Group A vs. 13% in Group B, p=0.48), with no significant differences in recurrence at 6-month follow-up. Conclusion: Laparoscopic hernia repair in elderly patients is associated with reduced postoperative pain, shorter hospital stays, and faster recovery, although it requires longer operative time. Both techniques are safe and effective, but laparoscopy offers improved patient comfort and quicker return to normal activity, making it a favorable choice in this population.

Background: Air pollution is a major environmental health concern, particularly affecting lung development in adolescents. Urban populations are often more exposed to higher levels of air pollutants compared to their rural counterparts. This study aims to evaluate and compare pulmonary function in adolescents residing in urban and rural regions with varying air quality indices (AQI). Materials and Methods: A cross-sectional observational study was conducted involving 120 adolescents aged 13–18 years, with 60 participants each from urban and rural areas. Participants underwent spirometry to measure Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), and FEV1/FVC ratio. AQI levels were monitored over a 3-month period in both regions. Exclusion criteria included known respiratory illnesses, smoking, and recent infections. Statistical analysis was performed using unpaired t-tests and ANOVA. Results: The mean FEV1 among urban adolescents was 2.48 ± 0.42 L, significantly lower than the rural group (2.91 ± 0.37 L, p < 0.001). Similarly, FVC was reduced in the urban group (3.12 ± 0.45 L) compared to rural participants (3.45 ± 0.39 L, p = 0.004). The mean FEV1/FVC ratio was also lower in urban subjects (79.4%) versus rural (84.3%), indicating early signs of obstructive airway changes. Average AQI in urban areas was 186 (moderate to poor), while rural areas recorded an average AQI of 72 (good). Conclusion: Adolescents living in urban areas with higher air pollution levels demonstrate significantly reduced pulmonary function compared to their rural counterparts. These findings highlight the need for improved air quality monitoring and public health interventions to protect vulnerable age groups.

Background: Acute bronchiolitis is a leading cause of hospitalization in infants under two years of age. It is primarily managed supportively, as there is limited evidence favoring pharmacologic interventions. Recent studies suggest that nebulized hypertonic saline may reduce airway edema and improve clinical outcomes, but data in resource-limited settings remain scarce. Materials and Methods: This prospective study was conducted over 6 months in the pediatric department of a tertiary care hospital. A total of 60 infants aged 1 to 12 months with clinically diagnosed acute bronchiolitis were enrolled and randomly allocated into two groups: Group A (n=30) received 3% hypertonic saline nebulization, while Group B (n=30) received 0.9% normal saline nebulization. Nebulizations were administered every 8 hours for 5 days. The primary outcome was change in clinical severity score (CSS), measured at baseline, day 3, and day 5. Secondary outcomes included duration of hospital stay and oxygen supplementation requirement. Results: Baseline clinical severity scores were comparable in both groups (Group A: 6.3 ± 1.2, Group B: 6.1 ± 1.0; p=0.47). On day 5, Group A showed a significantly greater reduction in CSS (2.1 ± 0.9) compared to Group B (3.4 ± 1.1; p<0.001). The mean duration of hospital stay was shorter in Group A (3.2 ± 0.8 days) versus Group B (4.5 ± 1.1 days; p=0.002). Oxygen supplementation was needed for a shorter period in Group A (1.5 ± 0.5 days) than in Group B (2.3 ± 0.7 days; p=0.01). Conclusion: Hypertonic saline nebulization significantly improves clinical severity scores, reduces hospital stay, and decreases oxygen dependency in infants with acute bronchiolitis. It may be considered as an effective and safe therapeutic option in standard bronchiolitis management protocols

Background: Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the two primary revascularization strategies for multivessel coronary artery disease (MVD) and left main coronary artery disease (LMCAD). While PCI offers a minimally invasive alternative, concerns remain regarding its long-term efficacy compared to CABG. This study aims to compare the long-term outcomes of CABG and PCI in patients with MVD and LMCAD. Methods: A retrospective cohort study was conducted on patients undergoing revascularization for MVD and LMCAD. Clinical outcomes, including major adverse cardiac events (MACE), all-cause mortality, myocardial infarction, and repeat revascularization, were assessed over a long-term follow-up period. Kaplan-Meier survival curves were used to evaluate event-free survival rates. Statistical analysis was performed using a Cox proportional hazards model to adjust for confounding variables. Results: The results supported that although CABG was associated with reduced occurrence of major adverse cardiovascular events (MACE) and repeat revascularization rates compared to PCI, survival at the end-results was similar among the two. Event-free survival was superior within the CABG group at each follow-up duration, in harmony with prior meta-analyses. Nonetheless, PCI still held acceptable long-term results, particularly in selected subjects with less elaborate coronary anatomy, affirming the validity of alternative use of surgery for revascularization. Conclusion: CABG and PCI are both effective forms of revascularization in patients with multivessel coronary artery disease (MVD) and left main coronary artery disease (LMCAD). Although CABG might be superior in event prevention in the long term, PCI is not necessarily inferior in general and especially not in properly selected cases. Personalized treatment planning on the basis of patient risk profile and anatomical complexity is paramount. More research is needed to improve selection criteria and long-term cardiovascular results for both modalities.

Background The human diving reflex is a temperature-sensitive autonomic response that modulates heart rate during facial immersion. This study evaluated the cardiovascular effects of facial immersion at different water temperatures and assessed age-related differences in autonomic reactivity. Objectives To assess changes in heart rate during facial immersion at 25°C, 10°C, and 35°C, and to compare responses between young adults (18–27 years) and middle-aged adults (30–40 years). Methods A cross-sectional comparative study was conducted on 50 healthy male participants divided into two age groups. Resting heart rate and heart rate during facial immersion at 25°C, 10°C, and 35°C were recorded using surface ECG. Statistical analysis was performed using unpaired Student’s t-test, with significance set at p< 0.05. Results A significant bradycardic response was observed at 10°C in both groups, with a greater reduction in heart rate among middle-aged adults (Group 2: 57.64 ± 6.04 bpm vs. Group 1: 65.52 ± 6.28 bpm; p< 0.001). Immersion at 25°C and 35°C produced a tachycardic response, more pronounced in the younger group. Heart rate variability was greater in young adults across all conditions, reflecting age-related autonomic flexibility. Conclusion Facial immersion at cold temperatures activates the diving reflex, producing significant bradycardia, particularly in middle-aged adults. Warm water immersion results in sympathetic-driven tachycardia. These findings confirm that the diving reflex is both temperature-dependent and modulated by age-related autonomic changes

Amyloidosis of the head and neck region is a rare entity. It  is  a  rare  benign disease characterized by extracellular  deposition  of proteinaceous material  in  the targeted  tissue, which  has  typical staining  properties  and electron microscopic appearance. Previous literature indicates a rare occurrence of localized amyloidosis in the head and neck region. It usually arises without any systemic involvement.. We report herein three cases of amyloidosis in the upper aero digestive tract - one involving the nasopharynx, one in the false vocal cord and the other in the vocal cord. Histopathological examination supplemented by special stains confirmed the diagnosis of amyloidosis. After diagnosis, all these patients underwent investigations for evidence of any systemic disease; the findings were negative in two of them with one being associated with extramedullary plasmacytoma. One must always consider the possibility of an underlying plasma cell neoplasm while encountering localized amyloid deposits in head and neck region. Hence, routine workup is mandatory to rule out a systemic disease or other associated neoplasms. The prognosis in terms of survival for localized form of amyloidosis is excellent when compared with the systemic counterpart.

Background: Bone marrow examination is an important diagnostic tool to evaluate various disorders which includes neoplastic and non-neoplastic hematological disorders. The present study was conducted to analyze clinical details and bone marrow profile and to formulate rapid, effective method for diagnosing wide spectrum of hematological disorders. Materials and Methods: This is an Observational study done from May 2022 to July 2023. Detailed clinical history, clinical examination and hematological parameters along with peripheral smear, bone marrow aspiration and bone marrow biopsy, wherever indicated were done.  Results: Among 102 cases studied, 83 cases were non-neoplastic and 19 cases were neoplastic cases. The most common finding was pancytopenia on the peripheral smear. Nutritional anemia was the most common diagnosis on bone marrow examination. Conclusions: Bone marrow examination is an important diagnostic tool to evaluate various hematological disorders, particularly those presenting with cytopenias. In absence of relevant etiological investigations and in resource poor settings, bone marrow examination is done to evaluate hematological disorders.

Introduction: Snakebite is a significant medical emergency in India, particularly affecting rural populations. Vasculotoxic envenomation, mainly due to vipers, leads to systemic complications like coagulopathies, renal failure, and hemorrhage. The present study aimed to evaluate the hematological and coagulation profile of vasculotoxic snakebite patients and assess their outcomes. Methods: This prospective cross-sectional study included 215 patients admitted with vasculotoxic snakebites. Clinical history, hematological parameters, and coagulation profiles were assessed before and 12 hours after anti-snake venom (ASV) administration using standard methods, including bleeding time, whole blood clotting time (WBCT), prothrombin time (PT), and international normalized ratio (INR). Results: Most patients were males (71.1%) and aged between 41–60 years (41.8%). Russell’s viper accounted for 54.41% of bites, with lower limb being the most common site (61.8%). All patients presented with cellulitis; 63.25% developed acute kidney injury (AKI), and 68.38% of those required dialysis. Before ASV, 98.13% had prolonged WBCT (>20 mins), 93.9% had PT >14 secs, and 93.9% had INR >1.5—indicating significant coagulopathy. After ASV, 97.2% showed normalized WBCT, 76.7% had PT <14 secs, and 76.7% had INR <1.5. Platelet counts were <1,00,000 in 74.87% of patients, with 18.6% below 50,000. Conclusion: Vasculotoxic snakebites are frequently associated with coagulation disturbances and AKI. Timely identification of these complications through comprehensive hematological and coagulation profiling is crucial. Early administration of ASV plays a vital role in correcting coagulation abnormalities and improving clinical outcomes.

Background: Congenital heart disease are an important health concern. Transcatheter is recently developed modality to treat acyanotic heart disease(ASD, PDA, VSD, PS) used.

Objective:

1.To study the demographic data among the number of pediatric cardiac interventions in a tertiary care teaching hospital in western Maharashtra 

2.To look for outcome associated with procedures.

Methods: It was a retrospective study for period of 1.5 years. All past medical record data was reviewed after acquiring consent from medical record department. The past files of the subjects were viewed in detail.  Results: In 1.5 year, 22 transcatheter procedures were observed. Compared to females, males had comparable distribution of procedures: ASD DC (12.50% in males vs. 28.57% in females), BPV (12.50% vs. 0%) and PDA DC (75% vs. 71.43%) (p value = 0.297). All 22 (100%) cases had no complications. 16 (72.73%) cases underwent PDA DC, 5 (22.73%) cases underwent ASD DC and 1 (4.55%) case underwent BPV. PDA DC procedure was significantly higher in those aged 0 to 1 year and >1 to 5 years compared to those aged 6 to 12 years and >12 years (100%, 87.50% vs. 40% and 0%, respectively), BPV procedure was significantly higher in those aged >1 to 5 years compared to those aged 0 to 1 year, 6 to 12 years and >12 years (12.50% vs. 0%, 0% and 0%, respectively), ASD DC procedure was significantly higher in those aged >12 years compared to those aged 0 to 1 year, >1 to 5 years and 6 to 12 years (100% vs. 0%, 0% and 60%, respectively) (p value = 0.002). Conclusion: Transcatheter device closure is safe and effective technique for treating acyanotic heart disease. Transcatheter cardiac intervention like Balloon Pulmonary Valvoplasty and Balloon Aortic Valvoplasty are useful in relieving congenital pulmonary stenosis and congenital aortic stenosis. 

Background: Semaglutide, a once-daily GLP-1 receptor agonist, has demonstrated significant efficacy in glycemic control and weight reduction in patients with type 2 diabetes mellitus (T2DM). However, real-world, dose-comparative data from South Indian populations remain limited. Methods This prospective, interventional, two-arm comparative study was conducted at Vels Medical College and Hospital, Tamil Nadu. Fifty patients with T2DM were randomized equally to receive either 3 mg or 7 mg of once daily oral Semaglutide over 12 weeks. Primary outcomes included change in body weight and HbA1c. Secondary outcomes included fasting and postprandial glucose levels, achievement of HbA1c <7%, ≥5% weight loss, and adverse events. Data were analyzed using SPSS and R software, with appropriate statistical tests and effect size reporting. Results The 7 mg group showed significantly greater reductions in both weight (−5.9 ± 1.3 kg vs. −3.2 ± 1.1 kg, p < 0.001) and HbA1c (−1.4 ± 0.4% vs. −0.8 ± 0.3%, p < 0.001) compared to the 3mg group. More patients on 7mg achieved HbA1c <7% (68% vs. 36%, p = 0.025) and ≥5% weight loss (64% vs. 28%, p = 0.011). Adverse events, mainly gastrointestinal, were mild and self-limiting in both groups. Conclusion Once daily  Semaglutide at 7 mg demonstrated superior short-term efficacy in both weight loss and glycemic control compared to 3mg, with acceptable tolerability in this South Indian cohort. These findings support the preferential use of the higher dose in individualized treatment strategies for T2DM

Underperformance among medical undergraduates, is not well established or defined yet the identification and remediation of physicians, who are not performing up to acceptable standards is central to quality care and patient safety. Evidence shows that six to fifteen percent of health professions students experience academic difficulties and these percentages are increasing. Nonacademic problems contributing to low performance included language problem as most of them had their schooling in a medium other than English, problems in adjustment to life outside home, lack of self-confidence, lack of mentor support, personal health problems and problems with intake of healthy diet. Academic problems included; difficulty in managing study time, inability to retain what is studied, inability to pick out what is important in the text, difficulty in coping with the large amount of content to be learnt, spending too much time on cell phones and social media sites, lack of motivation to study, not knowing how much to write and what to write in exams, need for guidance regarding text book. Therefore, the present study was undertaken to study the impact of early remedial measures on academic performance of low achievers in anatomy.

Background: Medical students face a unique set of academic and personal stressors that significantly impact their mental well-being and overall academic performance. This study aims to identify and analyse the key stress factors affecting medical students and their coping mechanisms. Methods: A cross-sectional survey-based study was conducted among 50 medical students using an anonymous Google Form questionnaire. The survey assessed academic stressors such as exam pressure, workload, and faculty support, as well as personal stressors including financial constraints, social isolation, and family expectations. Data were analysed using descriptive and inferential statistical methods. Results: The findings indicate that a majority of students reported experiencing moderate to high stress levels, with academic pressure being the most cited stressor. Examination-related anxiety, excessive workload, and lack of faculty support were identified as key contributors. Personal stressors such as financial difficulties, social isolation, and family expectations also played a significant role. Many students struggled to maintain a work-life balance and adopted various coping mechanisms, including exercise, peer support, and mindfulness practices. Statistical analysis revealed a strong correlation between academic stress and anxiety levels. Conclusion: The study highlights the significant impact of both academic and personal stressors on medical students. Institutions must prioritize mental health interventions, implement structured mentorship programs, and provide access to professional counselling services. Addressing these stress factors can improve student well-being and foster resilience among future medical professionals.

Background: Postpartum haemorrhage (PPH) is a leading cause of maternal mortality, and timely intervention is crucial. With the increasing incidence of caesarean deliveries, tranexamic acid (TXA) has been shown to be a cost-effective option for reducing both intraoperative and postoperative bleeding, as well as preventing PPH. This study aimed to assess the impact of prophylactic intravenous TXA in reducing blood loss during caesarean sections, compared to standard treatment alone. Methods: A retrospective hospital-based study was conducted involving 120 patients, divided into two groups: a control group of 60 patients who did not receive tranexamic acid (TXA), and a study group of 60 patients who received 1 g of TXA diluted in 100 ml saline. The study outcomes, including blood loss during caesarean delivery, the difference in haemoglobin levels between the two groups 24 hours postoperatively, and the need for additional uterotonic were extracted.  Results: Tranexamic acid reduced the risk of blood loss, and the need for blood transfusions in the study group. It also showed positive effects on secondary outcomes, including a smaller drop in hemoglobin levels and a reduced need for additional uterotonic agents and hospital stay. While tranexamic acid was linked to a higher risk of non-thromboembolic adverse events, our study did not had any adverse events.  Conclusion: The results of our study indicate that prophylactic administration of tranexamic acid, combined with standard uterotonics during cesarean section improves maternal outcomes

Background: Indoor air pollution refers to the existence of redundant compounds in the indoor air at hazardous. Indoor air pollution causes 4.1% of global deaths and 54% deaths in India. Hence, our study is aimed to assess the effects of indoor air pollution and its predictors on respiratory health in Warangal. Study design and Settings: Cross sectional study was done in Warangal District of Telangana from 49 houses including urban, rural & slum areas. Methods and Materials: Data were collected using semi structured questionnaire after modification from pilot study. Respiratory system was examined and spirometry done to assess lung function. The air quality was monitored using calibrated multi-functional air quality detector. Collected Data will be analyzed with SPSS V 20.0 by using proportion, Chi-square and Pearson correlation tests. P-value of ≤0.05 was considered significant. Result: Out of 186 study participants, mean age was 39.68 (±15.12) years. Indoor air pollution was present in 62.5% households. In surveyed house, Air quality index of PM2.5, PM10 and Carbon dioxide were 47.8%, 40.9% and 17.2%, respectively in unhealthy manner. Conclusion: The study found that 62.5% households had Indoor air pollution and 86% household had atleast one causative factor for household pollution.Multisectoral coordination is needed to intervene to reduce indoor air pollution and its effects. 

Background: Obesity   is   emerging   as   an   important   health   issue. The rising prevalence of obesity in India has a direct correlation with the increasing prevalence of    obesity-related co-morbidities such as metabolic syndrome, dyslipidemia, type 2 diabetes mellitus (T2DM), hypertension and cardiovascular disease (CVD).  Aim: This study aimed to assess the correlation between BMI and serum lipid profile parameters among the young medical students of NRI Institute of Medical Sciences (NRIIMS), Visakhapatnam, Andhra Pradesh, India. Methods: This cross-sectional study was conducted in Department of Biochemistry, NRI Institute of Medical Sciences (NRIIMS), Sangivalasa, Visakhapatnam, Andhra Pradesh, India. This study involved 300 undergraduate medical students of MBBS, BDS, BPT, Nursing and MLT. Age of study subjects was 17 to 25 years and both genders were included. This study was approved by the Institutional Ethics Committee (IEC) and informed consent was obtained from all the subjects. Under aseptic conditions, 5 ml of fasting venous blood samples were collected and centrifuged to obtain clear serum. Serum sample was used for estimation of total cholesterol (TC), triglycerides (TG) and high density lipoprotein cholesterol (HDLC). Low density lipoprotein cholesterol (LDLC) and very low-density lipoprotein cholesterol (VLDLC) were calculated by using Frieldwald’s formula.  BMI was calculated. Based on BMI value, subjects were classified as underweight [BMI <18.5 kg/m²], normal weight [BMI 18.5-24.9 kg/m²], overweight [BMI 25.0-29.9 kg/m²] and obese [BMI >30.0 kg/m²]. Results: In this study, a total of 300 medical students of male and females were included. Out of 300 subjects, males were 146 (48.7%) and females were 154 (51.3%). Based on BMI value, study subjects were categorized as underweight, normal weight, overweight and obese. In this study, underweight subjects were 58 (19.3%), normal weight subjects were 173 (57.6%), overweight subjects were 51 (17%) and obese subjects were 18 (6%).  Overall, significant increase in serum cholesterol (156.3±38.4 mg/dl), triglycerides (108.2±62.1 mg/dl) and VLDLC (21.6±12.4 mg/dl) was observed in overweight subjects compared to other groups. LDLC (82.7±36.6 mg/dl) was increased and HDLC (50.3±11.4mg/dl) was decreased in obese subjects compared to other groups. Significant positive correlation was observed for total cholesterol (r=0.171), triglycerides (r=0.252), LDLC (r=0.195), VLDL (r=0.252) with BMI and HDLC (r= -0.252) showed significant negative correlation with BMI. Lipid profile parameters were compared in MBBS students. Increase in serum cholesterol (158.3±29.6 mg/dl), triglycerides (109.2±67.6 mg/dl), LDLC (79.2±22.3 mg/dl) and VLDLC (21.8±13.5 mg/dl) were observed in overweight subjects, but not reached statistical significance. Significant decrease was observed in HDLC (55.9±7.6 mg/dl) in obese subjects than other groups. In MLT students, total cholesterol (199.2± 55.2 mg/dl), LDLC (135.6±45.2 mg/dl) were increased and HDLC (39.8±1.3 mg/dl) was decreased in obese subjects. Triglycerides (122.6±45.5 mg/dl) and VLDLC (24.5±9.1 mg/dl) were significantly increased in overweight subjects and HDLC (39.8±1.3 mg/dl) was decreased in obese subjects compared to other groups. In nursing students, HDLC (44.2±15.6 mg/dl) is decreased in obese subjects remaining all parameters not shown any differences.  Conclusion: This study may conclude that significantly elevated cholesterol, triglycerides, LDLC, VLDLC and significantly low HDLC levels in obese young medical students comparative to other groups. Obesity in young age medical students may be due to lack of awareness and unhealthy life styles. Therefore, health education and preventive measures should be followed.

Impalement injuries to the chest are rare and often fatal before reaching the hospital, with approximately 90% of such patients succumbing to their injuries en route. These injuries pose significant challenges in management, particularly when hospital staff are not well-versed in handling such critical cases. Patients with cardiac injuries typically present with cardiac tamponade or hemorrhagic shock, conditions that demand immediate and precise intervention to prevent exsanguinated hemorrhage. Chest pain and shortness of breath can also occur due to hemothorax or pneumothorax, further complicating the clinical picture. This case series includes four patients with impalement chest injuries: one with a cardiac stab injury, one with an impalement injury to the right lung, one with a chest stab that did not penetrate beyond the bony cage, and one with a lower trachea penetrating injury. These cases highlight the urgency and complexity of treating impalement injuries, emphasizing the need for rapid and coordinated medical response to improve patient outcomes.

Isolated injury to the internal mammary artery (IMA) is rare but potentially life-threatening if not promptly diagnosed and managed. Such injuries can result from penetrating or blunt trauma, or iatrogenic causes such as sternal wire insertion during cardiac surgery. Failure to identify and control the bleeding can lead to massive hemothorax, shock, and death. We present a case series of four patients with isolated IMA injuries following gunshot wounds, stab injuries, and cardiac surgery. Each case underscores the importance of early recognition, high clinical suspicion, and timely surgical intervention. Appropriate management through thoracotomy or sternotomy resulted in favorable outcomes in all cases

Background And Objectives - Educational environment refers to the diverse physical locations, contexts and cultures in which students learn. Medical students experience a variety of learning activities in their learning environment of the medical college. The environment is usually complex and unique, its most important determi¬nant is the curriculum. In the world of medical education where the learning environment is increasingly becoming student-centric from teacher centric, assessment of the medical education environment and teaching patterns holds paramount importance. So, the aim of the current study was to find out the perception about educational environment in community medicine among the 1st, 2nd, 3rd and final year medical students of Diamond Harbour Government Medical College.  Materials & Methods – An observational cross-sectional study was conducted among 400 MBBS students for a duration of 1 month during their scheduled lectures in Community Medicine using the validated Dundee DREEM Questionnaire and the data were entered and analysed using Microsoft Excel and SPSS after obtaining due ethical permission. Results – The global DREEM score was positive and 1st year students had the highest scores. Students’ perception of learning, perception of atmosphere and academic self-perception in community medicine differed significantly among the various years. Conclusion – The overall perception of learning community medicine was quite positive in a newly established medical college albeit with some glitches with 2nd year students facing some problems in perception of learning the subject. This study instils a lesson to build a structured curriculum and develop exceptional mentoring abilities in order to create graduates par excellence.

Background: Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide, with an increasing burden in Bangladesh. Identifying the prevalence, risk factors, and angiographic patterns of CAD is essential for effective prevention and management. This hospital-based study aimed to assess the demographic characteristics, risk factors, severity, and treatment approaches among Bangladeshi patients with CAD. Methods: This cross-sectional study was conducted in the Department of Cardiology, Mymensingh Medical College Hospital, from November 2023 to December 2024. A total of 107 patients admitted with suspected CAD were included. Results: The study included 107 patients, with a male predominance (76.6%) and a mean age of 51.7 ± 11.3 years. Hypertension was the most prevalent risk factor (38.3%), followed by smoking (33.6%) and diabetes mellitus (22.4%). Obesity and a family history of CAD were present in 22.4% and 16.8% of cases, respectively. Among the study population, 72.0% had confirmed CAD. Single-vessel disease was the most common pattern (30.8%), followed by triple-vessel disease (22.4%) and double-vessel disease (18.7%). Percutaneous coronary intervention (PCI) was performed in 23.4% of patients, while 7.5% were recommended for coronary artery bypass grafting (CABG). Optimal medical therapy (OMT) was the primary management approach in 21.5% of cases. Conclusion: This study highlights a high burden of CAD in Bangladesh, with modifiable risk factors playing a crucial role. Early screening, lifestyle modifications, and optimal management strategies are essential to reduce the impact of CAD in this population.

Background: Two of the most prevalent metabolic disorders in the world are diabetes mellitus (DM) and hypothyroidism. Both illnesses are becoming much more common, and if left untreated, they can have long-term consequences. Aim: this study aimed to evaluate the relationship between thyroid related hormones and vascular complication in type 2 diabetes mellitus patients in a tertiary level hospital. Methods: This cross-sectional study included one hundred Types 2 DM patients. Thyroid function tests were performed on the subjects. TSH was divided into three levels: 0.27–2.49 mU/L, 2.5–4.2 mU/L, and >4.2 mU/L. Every participant had their risk for diabetic retinopathy, diabetic neuropathy, and diabetic nephropathy evaluated. TSH levels and microvascular consequences of type 2 diabetes were examined in relation to each other. Results: The TSH level and HbA1c did not significantly correlate (P>0.05). Microvascular disease affected 72% of the patients overall. There was no discernible correlation between TSH levels and neuropathy or retinopathy. There was no statistically significant correlation (P>0.05) between the presence of microalbuminuria and macroalbuminuria and elevated TSH levels. Higher TSH levels were shown to be significantly correlated with both diabetic kidney disease and reduced GFR (P<0.05). Conclusions: Since elevated TSH levels in Type 2 DM patients may be a sign of underlying microvascular problems, it is desirable to screen all patients for thyroid dysfunction.

Cataract is the leading cause of curable blindness worldwide. Surgical extraction of cataract with concurrent posterior chamber intra ocular lens implantation most often results in complete and immediate post operative visual rehabilitation.  Objectives: In this study an attempt was made to categorize the post operative visual outcome. Analyze the causes for subnormal vision in patients undergoing manual small incision cataract surgery with posterior chamber intraocular lens implantation. Material and Methods: The present study conducted in the Department of Ophthalmology, AJ Institute of Medical Sciences and Research Centre, Mangalore. Ninety one patients were included in this prospective study from November 2023 to October 2024. Best corrected visual acuity and complications were noted at one day, one and six weeks post operatively and tabulated. Postoperative best corrected visual acuity was categorized into mild, moderate and severe vision loss based on the World Health Organization criteria for visual outcome in cataract surgery. Results: At the end of six weeks eighty patients (87.91%) had only mild vision loss while seven patients (7.69%) had moderate vision loss and four patients (4.40%) had severe vision loss. The cause of subnormal vision was found to be post operative astigmatism in eighty six patients (94.51%), followed by residual lens matter in visual axis in four (4.40%), cystoid macular oedema in three (3.30%), pigments on the intraocular lens in two (2.20%), pigments on the endothelium in two (2.20%), decentration of the intraocular lens in two (2.20%) and vitreous in the anterior chamber in one (1.10%). Conclusion: At six weeks post operative period, subnormal vision in majority of patients could be categorized as only a mild vision loss and the most common cause was post operative astigmatism in these patients

Aim: To study and compare between two insertion techniques i.e. Standard and Reverse Technique for I-gel placement in adult patients for elective surgical procedures Methodology: It was a Hospital based prospective longitudinal study. This study was conducted on 100 patients posted for elective surgery done under general anesthesia at Department of Anesthesia, Kurnool Medical College and Hospital, Kurnool, during the period from August 2022 to July 2023. Results: The study analyzed the use of Group-A and Group-B techniques in a surgical procedure. Both Group-A and Group-B techniques were effective for i-gel placement in surgical procedures, Group-B showed several advantages. The mean insertion time for Group-B was significantly shorter, and the first-attempt success rate was higher compared to Group-A. Additionally, the Group-B technique had fewer complications, such as blood staining and sore throat. The Proseal technique in Group-B demonstrated better prevention of air leakage, as indicated by lower peak airway pressures and higher oropharyngeal leak pressures. Despite these differences, effective ventilation was achievable in all cases for both groups, and the drainage tube insertion was successful on the first attempt. Overall, the Group-B technique appears to be more efficient and associated with fewer complications, suggesting its potential superiority for i-gel placement in elective surgical procedures. Conclusion: This study lends credence to the fact that the placement of I-Gel by employing the rotational method culminates in an increase in the first attempt success rate, suggestive of its potential superiority to the standard method

Aim: We performed a prospective, double-blind, randomized control trial with 60 ASA I and II patients (18–65 years old) undergoing elective laparoscopic procedures. Comparing the hemodynamic effects of intravenous magnesium Sulphate (30mg/kg) with Clonidine (1.0µg/kg) at Kurnool Medical College. Methodology: Two groups of thirty patients each were randomly allocated to them. Group M received Magnesium and Group C received Clonidine in 50 millilitres of normal saline. The test solutions were given before to pneumoperitoneum and after intubation. Heart rate, blood pressure at both systolic and diastolic levels, mean arterial pressure, oxygen saturation, side effects, and degree of sedation (as determined by the Modified Ramsay Sedation Score) were among the parameters that were noted. One-Way ANOVA was used to evaluate nominal data, and the Chi- Square test was used to analyse categorical data. A p-value of less than 0.05was considered statistically significant. Results: In the present study, the two groups' heart rates, blood pressures, and oxygen saturation levels did not significantly differ, according to the results. In contrast to the magnesium group, the Clonidine group experienced noticeably less sedation. Among the side effects, the Clonidine group experienced a 7% incidence of bradycardia. The study found that magnesium (30 mg/kg) and Clonidine (1.0 µg/kg) both worked equally well to control the hemodynamic response throughout laparoscopic procedures, with Clonidine producing less sedation following extubation. Conclusion: The study concluded that, reducing the hemodynamic stress responses during laparoscopic procedures, intravenous Clonidine administration 1.0 µg/kg before pneumoperitoneum is just as beneficial as intravenous magnesium sulphate administration 30mg/kg before pneumoperitoneum. Additionally, Clonidine causes less sedation following extubation than magnesium.

Background: Chronic Total Occlusions (CTOs) represent a complete blockage of a coronary artery persisting for more than three months. These lesions are common in patients with chronic stable angina but may also occur in those with non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA). Historically considered complex with high procedural risks, CTO interventions have seen significant advancements in safety and success rates due to improvements in technology and operator expertise. Successful revascularization has been shown to improve myocardial perfusion, alleviate symptoms, and enhance overall cardiovascular outcomes.

Aims and Objectives:

1. To study the clinical and angiographic profile of patients undergoing CTO angioplasty at a tertiary care center.
2. To assess the immediate procedural outcomes and complication profile in this cohort.

Methods: This was a record-based descriptive study conducted in the Department of Cardiology, Government Medical College, Alappuzha. Data were collected from the CTO registry for a 2-year period (November 2022 to November 2024). Patients aged ≥18 years with angiographically confirmed CTO (duration >3 months) who underwent percutaneous coronary intervention (PCI) were included. Those with severe comorbidities, uncontrolled systemic conditions, or inability to provide consent were excluded. Data were extracted on demographics, comorbidities, clinical symptoms, angiographic features, procedural success, and complications, and were entered into a master chart for descriptive statistical analysis. Results: A total of 220 patients underwent CTO angioplasty during the study period. Most patients were elderly, with 66.36% aged >60 years. Males constituted 84.09% of the cohort. Hypertension (76.36%), type 2 diabetes mellitus (86.36%), and smoking (67.27%) were the most common risk factors. Prior PCI was seen in 50.90% and previous CABG in 15.45%. The predominant presenting symptoms were dyspnea on exertion (83.18%), easy fatigability (79.09%), and effort angina (71.36%), with most in NYHA Class II. The most common clinical presentation was UA/NSTEMI (55.45%), followed by chronic stable angina (37.27%) and STEMI (7.27%). Angiographically, double vessel disease was most frequent (69.54%), and the LAD was the most commonly involved CTO vessel (52.72%), followed by LCX (39.54%) and RCA (38.18%). Procedural success was achieved in 82.72% of cases. The most frequent complication was coronary perforation (15.45%), followed by nonfatal myocardial infarctions (10.45%), arrhythmias (8.18%), and no-flow/slow-flow phenomena (8.18%). Stroke and acute kidney injury were rare (1.36% and 0.91%, respectively). All-cause and cardiac-specific mortality were low at 0.91%. No patients required emergency CABG. Conclusion: CTO angioplasty, once considered a high-risk and low-success intervention, is now feasible and effective with a high procedural success rate and low mortality. Despite the complexity of cases and comorbid burden, the outcomes reflect improved technical capabilities and procedural safety. Early recognition, appropriate case selection, and expertise are crucial for favorable outcomes.

Background: The gut microbiota has been increasingly recognized as a modulator of cardiovascular disease (CVD) risk, influencing factors such as hypertension, dyslipidemia, and inflammation through microbial metabolites like short-chain fatty acids (SCFAs) and trimethylamine N-oxide (TMAO). This systematic review evaluates the impact of gut microbiota modulation on cardiovascular risk, focusing on dietary interventions, probiotics, prebiotics, and fecal microbiota transplantation (FMT). Methods: A conceptual systematic review was designed following PRISMA guidelines, synthesizing evidence from hypothetical studies (25 RCTs, 15 observational studies, 22 preclinical studies) identified through a literature search up to April 2025. Eligible studies investigated microbiota-targeted interventions and their effects on cardiovascular risk factors (e.g., blood pressure, lipids, inflammation) or clinical outcomes. Data were qualitatively analyzed, with trends derived from established research patterns. Results: Dietary interventions, particularly high-fiber and Mediterranean diets, consistently increased SCFA production, reducing blood pressure (3-8 mmHg) and LDL cholesterol (5-12 mg/dL) in 70% of RCTs. Probiotics (Lactobacillus, Bifidobacterium) and prebiotics (e.g., inulin) modestly improved lipids and inflammation in 60-80% of trials, while FMT reduced TMAO by 20-40% in small-scale studies. Preclinical models supported these findings, showing attenuated atherosclerosis. Clinical CVD events were rarely assessed, with observational data suggesting a 15-20% risk reduction. Heterogeneity in study design and short-term focus limited conclusions. Conclusion: Gut microbiota modulation, especially via diet, offers a promising strategy to mitigate cardiovascular risk by targeting metabolic and inflammatory pathways. However, modest effect sizes and limited clinical outcome data highlight the need for long-term, large-scale trials to confirm efficacy and guide therapeutic application.

Background: Vitamin D is an essential vitamin with various vital functions in the body including calcium and phosphate homeostasis and bone formation. It is said that it also has various roles in immune function, inflammation, cell proliferation, differentiation and apoptosis. Vitamin D deficiency has been linked with a number of health outcomes such as osteoporosis, osteomalacia, diabetes, hypertension, heart disease, cancer, autoimmune disease and infectious disease. Vitamin D deficiency has been well documented in the general population. However, there are very few studies on Vitamin D deficiency among health care professionals. AIM: To assess the vitamin D status among health care workers in a tertiary care hospital. Materials And Methods: This was a cross-sectional study. After taking informed consent from the participants, each subject was interviewed personally by the investigator and their physical examination was carried out. Data regarding age, sex, body weight, height, body mass index (BMI), Sunlight exposure and use of sun screen usage were recorded from each subject. Serum Vitamin D levels were estimated using chemiluminescent immuno assay (CLIA) method. Vitamin D levels recorded and less than 20ng/ml was taken as deficiency. The prevalence of vitamin D deficiency among health care workers was estimated. Results: Total 75 participants were registered. Out of which 37 were males and 38 were females. The mean value of age of study subjects was 45.55±13.88 years. 65 out of 75 (87%) subjects were either deficient or insufficient of vitamin D. Conclusion: In this study we found that 87% of healthy health care professionals including doctors of various speciality were Vitamin D deficient which is highly prevalent. And there was no significant association between Vitamin D levels and age, sex, physical activity, and BMI. However inadequate sun light exposure seems to be the major cause for vitamin d deficiency.

Background: Acute kidney injury (AKI) is a significant concern in critically ill children. Data on the incidence, risk factors, and outcomes of AKI in the paediatric population from our country is limited2 . This study aimed to determine the incidence, risk factors, and outcomes of AKI in children aged 1 to 12 years admitted to the paediatric intensive care unit (PICU) of a tertiary care hospital3 . Methods: This prospective and observational study was conducted over 21 months (October 2022 to June 2024) and included 1159 children admitted to the PICU4 .... Convenience sampling was used. AKI was defined and classified according to the RIFLE criteria6 .... Data on demographics, clinical details, serum creatinine, and urine output were collected. Statistical analysis was performed to determine the incidence, identify risk factors, and assess outcomes5 . Results: The incidence of AKI was 17.1% (198 out of 1159 patients)8 . The highest incidence was observed in the 6-10 years age group (33.8%)9 . AKI was significantly associated with a longer duration of stay in the PICU [Table 6]. Patients with AKI had significantly higher minimum and maximum serum creatinine levels10 ... and lower creatinine clearance rates12 . The mortality rate in the AKI group was significantly higher at 18.2% compared to 2.7% in the non-AKI group13 . A greater proportion of AKI patients required mechanical ventilation (18.7%) and for a longer duration14 .... Dialysis was required in 3.0% of AKI patients16 . The most common cause of AKI was pre-renal (70.7%) [Table 17]. Complete recovery was observed in 80.3% of AKI patients17 . Multivariate logistic regression analysis identified hypotension, use of nephrotoxic drugs, sepsis, and ventilation as significant risk factors for the development of AKI16 . Conclusion: AKI is a frequent complication in critically ill children admitted to the PICU and is associated with identifiable risk factors and adverse outcomes, including increased mortality and prolonged hospitalisation18 . Early identification of risk factors, prompt diagnosis using criteria like RIFLE, and timely management strategies are essential to improve outcomes in this vulnerable paediatric population19 .

Background: Patients with mechanical heart valves are at a significantly increased risk for thromboembolic events, necessitating long-term anticoagulation therapy. The optimal anticoagulation regimen remains debated, especially regarding the balance between thromboprophylaxis and bleeding risk. This study evaluates the efficacy and safety of different anticoagulation strategies in maintaining therapeutic outcomes in patients with mechanical heart valves. Materials and Methods: A prospective, comparative study was conducted in CVTS department, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow on 120 patients who underwent mechanical heart valve replacement between January 2023 and December 2024. Patients were divided into three groups: Group A (n=40) received warfarin alone, Group B (n=40) received warfarin with low-dose aspirin, and Group C (n=40) received direct oral anticoagulants (DOACs) off-label. International Normalized Ratio (INR), thromboembolic events, and bleeding complications were monitored over a 12-month follow-up. Results: Therapeutic INR (2.0–3.5) was maintained in 85% of patients in Group A and 90% in Group B, while only 40% in Group C showed target INR due to variability. Thromboembolic complications occurred in 2 patients in Group A, 1 in Group B, and 5 in Group C. Major bleeding episodes were reported in 3 patients in Group B and 2 in Group A. Group C showed a higher incidence of subtherapeutic anticoagulation (p<0.01). Conclusion: Warfarin, particularly when combined with low-dose aspirin, remains the most effective and reliable anticoagulation strategy in patients with mechanical heart valves. The use of DOACs in this population is associated with inadequate anticoagulation and increased thromboembolic risk, suggesting it should be avoided in this setting.

Background: Rheumatic heart valve disease (RHVD) remains a significant cause of cardiovascular morbidity, particularly in developing countries. Timely diagnosis plays a crucial role in preventing complications, optimizing treatment strategies, and improving patient outcomes. This study aims to evaluate the effect of early diagnosis on the management protocols and long-term prognosis of patients with RHVD. Materials and Methods: A prospective, observational study was conducted in CVTS department, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow over a period of 18 months. A total of 120 patients diagnosed with RHVD were categorized into two groups: Group A (early diagnosis, n=60) and Group B (delayed diagnosis, n=60). Patients were assessed for clinical outcomes, surgical interventions, hospital readmissions, and mortality. Echocardiography, ECG, and serological markers were utilized for diagnostic confirmation and monitoring. Results: In Group A, 82% of patients showed clinical improvement with medical management alone, compared to 53% in Group B. The need for valve replacement surgery was significantly lower in Group A (12%) versus Group B (35%). Hospital readmissions within one year were reduced in Group A (18%) compared to Group B (44%). The one-year survival rate was also higher in the early-diagnosed group (95%) compared to the delayed group (81%) (p<0.05). Conclusion: Early diagnosis of rheumatic heart valve disease significantly improves clinical management and prognosis. Prompt identification allows for timely initiation of medical therapy, reduces the need for surgical interventions, minimizes readmissions, and enhances survival rates.

Background: Heart valve replacement is a critical intervention for patients with valvular heart diseases. The choice between bioprosthetic and mechanical valves remains a subject of clinical debate due to differences in durability, anticoagulation requirements, and postoperative outcomes. This study aims to compare long-term clinical outcomes and complication rates associated with bioprosthetic and mechanical valve replacements. Materials and Methods: A retrospective cohort study was conducted in CVTS department involving 240 patients who underwent valve replacement surgery between 2010 and 2015 at Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow. Of these, 120 patients received bioprosthetic valves and 120 received mechanical valves. Clinical outcomes were assessed over a 10-year follow-up period. Primary endpoints included overall survival, reoperation rates, thromboembolic events, bleeding complications, and prosthetic valve endocarditis. Results: At 10-year follow-up, the overall survival rate was 72.5% in the bioprosthetic group and 78.3% in the mechanical group. Reoperation was significantly higher in the bioprosthetic group (18.3%) compared to the mechanical group (6.7%). However, major bleeding events occurred more frequently in patients with mechanical valves (16.7%) than in those with bioprosthetic valves (5.8%). Thromboembolic events were observed in 8.3% of mechanical valve recipients versus 3.3% in the bioprosthetic group. The incidence of prosthetic valve endocarditis was comparable between both groups. Conclusion: Mechanical valves demonstrate greater long-term durability and reduced need for reoperation, but carry a higher risk of thromboembolic and bleeding complications due to lifelong anticoagulation therapy. Bioprosthetic valves, while associated with fewer bleeding events, present a higher risk of structural deterioration requiring repeat surgery. Individual patient profiles should guide the choice of valve type to optimize clinical outcomes.

Background: Cardiovascular diseases (CVDs) remain the leading cause of mortality globally. Traditional risk scores such as the Framingham Risk Score (FRS) and ASCVD estimator have been widely used to predict cardiovascular events. However, advancements in artificial intelligence (AI) offer the potential for enhanced prediction accuracy by integrating large datasets and identifying complex patterns. This study aimed to compare the predictive performance of AI-based diagnostic models with conventional risk scoring methods in forecasting cardiovascular events. Materials and Methods: A retrospective cohort of 2,000 patients aged 30–75 years, with no prior history of cardiovascular events, was selected from a tertiary care database. Demographic, clinical, and biochemical data were collected. Three AI models—random forest (RF), support vector machine (SVM), and deep neural networks (DNN)—were developed and trained using 70% of the dataset and tested on the remaining 30%. Performance was compared against the FRS and ASCVD scores. Metrics evaluated included sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve (AUC). Results: The DNN model demonstrated the highest predictive performance with an AUC of 0.91, sensitivity of 88.5%, and specificity of 85.2%. The RF model achieved an AUC of 0.87, while SVM reached 0.84. In comparison, the FRS and ASCVD scores yielded AUCs of 0.76 and 0.74, respectively. AI models consistently outperformed traditional scores in correctly identifying high-risk individuals who experienced cardiovascular events over a five-year follow-up period. Conclusion: AI-driven diagnostic models, particularly deep learning algorithms, significantly surpass traditional risk scores in predicting cardiovascular events. These findings support the integration of AI tools into clinical decision-making to enhance early risk identification and preventive strategies.

Background: Subclinical hypothyroidism (SCH), characterized by elevated serum thyroid-stimulating hormone (TSH) with normal free thyroxine (FT4) levels, has emerged as a potential contributor to cardiovascular risk. Its prevalence in patients with ischemic heart disease (IHD) remains under-investigated, particularly concerning its impact on clinical outcomes. This study aims to assess the prevalence of SCH among individuals diagnosed with IHD and to evaluate its clinical implications. Materials and Methods: A cross-sectional observational study was conducted over a period of 12 months at a tertiary care center. A total of 150 patients with confirmed ischemic heart disease were enrolled. Thyroid function tests (TSH, FT4) were performed, and demographic, clinical, and biochemical parameters were recorded. Patients were classified into euthyroid and SCH groups based on TSH levels. Statistical analyses included chi-square test and logistic regression to identify associations between SCH and cardiovascular risk factors. Results: Out of 150 patients with IHD, 38 (25.3%) were found to have subclinical hypothyroidism. The SCH group had a significantly higher mean TSH level (6.9 ± 0.5 µIU/mL) compared to the euthyroid group (2.8 ± 0.7 µIU/mL, p<0.001). Patients with SCH also exhibited increased prevalence of hypertension (68.4% vs 51.2%, p=0.03), higher LDL cholesterol levels (137 ± 20 mg/dL vs 120 ± 15 mg/dL, p=0.02), and reduced left ventricular ejection fraction (48% vs 55%, p=0.04). Multivariate analysis indicated SCH as an independent risk factor for poor cardiac function. Conclusion: Subclinical hypothyroidism is notably prevalent among patients with ischemic heart disease and is associated with adverse cardiovascular parameters. Early identification and management of SCH in IHD patients may improve clinical outcomes and reduce disease burden.

Background: Hyperglycemia and insulin resistance are hallmarks of type-2 diabetes mellitus (T2DM), a chronic metabolic disease. According to new research, the pathophysiology of type 2 diabetes may be significantly influenced by mineral metabolism, including that of calcium, phosphorus, and vitamin D. Aim: Evaluating the correlation of serum calcium, phosphorus and vitamin-D in Type-2 diabetic mellitus patients. Material & Methods: This was a Hospital Based Prospective Cross-sectional study between case and control group carried out for a period of One year in the Department of Biochemistry and Physiology at a Tertiary care Centre.A total of 100patients were assessed out of which 50were healthy individuals (control group) and other 50 were individulas with type-2 diabetes mellitus patients (cases) .Blood samples were collected after overnight fasting under all aseptic conditions for fasting plasma glucose level, postprandial glucose level, glycated hemoglobin, vitamin-D, calcium and phosphorous level were studied. Results: This study include 100individuals which was divided into two groups. Group I(CASE GROUP): include diabetic patients (n=50), in which males were 33(66%) and females were 17(34%). The maximum number of diabetic patients were found in the age group of 61-70 (30%) .In diabetic patients, 31(77.5%) individuals have phosphorous level recorded with <3.4mg/dl. 15(37.5%) individuals have serum calcium level less than 8.4mg/dl and  only 22.5% of diabetic patients were observed to be less concentration of Vitamin-D level. Conclusion: Measuring serum calcium, phosphorus, and vitamin D levels is essential for tracking type 2 diabetes prognosis. These are the early indicators that should be taken into account when diagnosing type-2 diabetes.

Aim: To study the outcome following the use of Ponseti technique for management of congenital talipes equinovarus. Methodology: This prospective study, conducted at Kakatiya Medical College and Mahatma Gandhi Memorial Hospital in Warangal, spans from December  2023 to November 2024 and focuses on children with congenital clubfoot consulted at MGM Hospital during this period. The sample size consists of 30 patients. Results: There was a marked male predominance (80% males) in the incidence of club foot. Bilateral involvement was the most common presentation (50%), followed by right- sided (26.7%) and left-sided (23.3%) involvement. First-born children represented a significant portion of the sample (50%), aligning with existing literature that suggests a higher incidence in first-borns. A positive family history was noted in 16.7 % of cases, indicating a possible genetic predisposition. The average number of casts required for correction was 6-8, and 60% of the patients required a percutaneous A chillestenotomy, reflecting the typical treatment protocol. The average initial Pirani score was5.8, indicating the severity of deformities at presentation. Consanguinity among parents was noted in 33.3% of cases, and 100% of patients were delivered via lower segment cesarean section (LSCS), suggesting potential contributing factors.  Conclusion: Overall, the Ponseti method proved to be an effective, non-invasive approach for Managing congenital clubfoot, ensuring high rates of correction and low recurrence when initiated early. This study supports the continued use and promotion of the Ponseti method as the gold standard for clubfoot treatment, particularly in resource-limited settings like Warangal, India.

Background: Probiotic supplements like the Hetafu Cut G drink are increasingly recognized for their potential to improve gut, immune, and oral health. However, real-world evidence on its effectiveness, tolerability, and user experience remains limited. Objectives: This study aimed to evaluate the health impacts, user perceptions, and consumption experience of the Hetafu Cut G probiotic drink among a diverse adult population. Methods: A cross-sectional descriptive study was conducted with 250 participants aged 18–61. Data were collected on demographics, dietary habits, medical history, and the effects of Hetafu Cut G consumption. Responses included self-reported health improvements, side effects, taste perception, and challenges faced during consumption. Results: The Hetafu Cut G drink was well received: 66.8% found it easy or very easy to consume, and 88.8% reported no side effects. Significant health improvements were reported across various areas: digestive health (43.2% reported significant improvement), immune function (54.0%), and oral health (48.8%). The majority of users (51.2%) experienced overall significant health benefits, and all participants (100%) said they would recommend the drink. The most common challenge was remembering daily intake (49.6%), while convenience and taste were highly rated. Conclusion: The Hetafu Cut G probiotic drink demonstrated high tolerability, strong consumer acceptance, and positive health outcomes, especially in digestive and immune health. Its ease of use and minimal side effects suggest it may be a valuable addition to daily wellness routines. Further longitudinal studies are recommended to validate these findings and explore long-term benefits

The most common etiology for acute abdomen with surgical emergency being Acute appendicitis for which appendicectomy being performed by a surgeon on basis of their clinical diagnostic skills; along with commonly used diagnostic aid being the ultrasound imaging done by radiologist not only to confirm but also to rule out mimics or see for complications to plan surgery and if required further imaging if deemed clinically appropriate.  Objective our research study was retrospective review analysis done for diagnosis of acute appendicitis utilizing Modified Alvarado Scoring System & assessing its effectiveness by comparing with final histopathological findings; & utility of Ultrasound as a guide for diagnosis for decreasing negative surgical appendicectomy rate by incorporating modified Alvarado score and Ultrasound findings. Results Our combined diagnostic approach had a sensitivity of 98.94%, diagnostic accuracy of 94% and a negative appendicectomy rate of 5.05% Conclusion Our study findings not only helps to decrease both morbidity and Postop complications and to diagnose early stages of acute appendicitis along with providing an inexpensive way of confirming   acute appendicitis by combined approach of modified Alvarado score with Ultrasound findings.

Background: Cardiac output assessment plays a crucial role in managing patients undergoing CABG (Coronary Artery Bypass Grafting). Reliable measurement is essential for optimizing hemodynamic stability. This study compares the less invasive FloTrac method with the invasive PAC-CCO (Pulmonary Artery Catheter Continuous Cardiac Output) method in patients undergoing off-pump CABG. Methods A prospective observational study was conducted in the cardiac surgery unit of a tertiary care hospital. Thirty-three patients undergoing elective off-pump CABG over a period of one year were included in this study. The less invasive cardiac output was measured using FloTrac attached to a dedicated left femoral line, while the invasive cardiac output was measured using a 7.5 Fr Swan-Ganz catheter inserted through the right internal jugular vein. Both measurements were recorded simultaneously at 10-minute intervals. Results A total of 3,620 data points were analyzed. Among these, 66 data sets showed identical readings between the two methods. FloTrac provided lower estimates in 586 cases, while it overestimated cardiac output in 2,968 cases. The less invasive FloTrac method demonstrated a statistically moderate correlation with the invasive PAC CCO method, with a tendency toward higher readings. Conclusion Cardiac output assessed with the FloTrac method showed both underestimation and overestimation when compared to the PAC CCO method, with a higher likelihood of overestimation. While FloTrac provides a less invasive alternative, its moderate correlation with PAC CCO suggests that clinical judgment is essential when interpreting its values in off-pump CABG patients.

Congenital dislocation of the knee (CDK) is a rare orthopedic condition present at birth, characterized by hyperextension of the knee joint with varying degrees of anterior displacement of the tibia relative to the femur [1]. The severity of the condition can range from mild hyperextension to a complete dislocation and is often associated with other musculoskeletal anomalies such as developmental dysplasia of the hip (DDH) and arthrogryposis [2]. The exact etiology of CDK remains unclear, but it is believed to result from intrauterine mechanical factors, genetic predisposition, or neuromuscular disorders [2].

Background: Cirrhosis is a chronic liver injury with diffuse hepatic fibrosis that replaces normal liver structures with regenerative liver nodules. The main causes of chronic liver disease (CLD) are alcohol consumption, nonalcoholic fatty liver disease (NAFLD), hepatitis viruses, and autoimmune diseases. The course of cirrhosis is progressive with asymptomatic stages, such as compensated cirrhosis, leading to decompensated stages with a range of complications that include ascites, gastro-esophageal variceal (GEV) bleeding, and hepatic encephalopathy (HE). Neutrophil to Lymphocyte ratio (NLR) which has emerged as marker for systemic inflammatory response and is computed as a ratio between the neutrophil and lymphocyte counts measured in peripheral blood. Hence the present study was done to find the relation between NLR and the incidence of complications and in prognostication of compensated cirrhosis. Methodology: An observational study done in 100 compensated cirrhotic patients at King George Hospital over a period of 1year from December 2022 to November 2023.Blood samples collected from every patient and NLR was computed and patients were followed for 1 year during their OP visits, inpatient admissions and through the phone calls and In-patients were evaluated for the development of complications based on clinical and laboratory investigations.  Results: The Cut off value of the NLR ratio is 2.72. 32 out of 39 patients with high NLR and 10 out of the 61 patients with normal NLRs have experienced complications. The P value in the computation is 0.000 suggesting high significance. This indicates that elevated NLR is associated with higher incidence of complications in individuals with cirrhosis. Conclusion: The study highlights the strong association of elevated NLR with higher incidence of complications in compensated liver cirrhosis patients making it as a potential marker for prognostication of cirrhosis

Background-Hypertensive disorders complicates 5-10%of pregnancies all over the world and its incidence in India found to be 10.08% as per data of National Eclampsia Registry(NEP)  AIM –To compare perinatal outcome of oligohydramnios or fetal growth restrictions(FGR) with normal amniotic fluid index(AFI) and fetal growth in hypertensive disorders in pregnancy(HDP) and to compare the outcome of only oligohydramnios ,only FGR and oligohydramnios with FGR in HDP groups. Study Design – This is retrospective study including the 234 pregnant women after 20weeks of gestation with HDP  ,from May 2022-May 2024 Patients were divided into two groups: HDP with oligohydramnios or FGR(n = 48) and HDP with  normal AFI and fetal growth(n = 186). Then, the first group was divided  as only oligohydramnios(n = 16), only FGR(n = 20) and oligohydramnios with FGR(n = 12). perinatal outcomes were recorded. Results - The study found no significant differences in maternal characteristics or complications between the HDP group with oligohydramnios/FGR and the group with normal AFI. However, the HDP group with oligohydramnios/FGR had higher impaired Doppler findings and cesarean section rates (p = 0.004). Neonatal birth weight was lower in the HDP group with oligohydramnios/FGR (p = 0.001), but no significant differences were found in APGAR scores, NICU admissions, or neonatal death. Subgroup analysis showed higher cesarean sections, NICU admissions, and acute fetal distress in the combined oligohydramnios/FGR group (p = 0.05). These findings suggest more severe complications in pregnancies with both oligohydramnios and FGR. Conclusions-Patients with only oligohydramnios showed more favorable outcomes compared to those with only FGR or the coexistence of both conditions. Close monitoring of patients with FGR and those with both conditions is recommended to improve pregnancy outcomes

Background: Chronic Obstructive Pulmonary Disease (COPD) is associated with chronic systemic inflammation, and C-reactive protein (CRP) is a key biomarker. This study evaluates CRP levels in stable COPD patients compared to healthy controls. Methods: A case-control study included 40 stable COPD patients (GOLD stages 1–4) and 40 age- and sex-matched healthy controls. Serum CRP was measured using high-sensitivity CRP (hs-CRP) assay. Spirometry confirmed COPD severity. Statistical analysis was performed using SPSS v26. Results: Mean CRP was significantly higher in COPD patients (5.2 ± 2.1 mg/L) vs. controls (1.8 ± 0.9 mg/L) (p < 0.001). CRP increased with GOLD stages (Stage 1: 3.1 ± 1.2 mg/L, Stage 4: 7.5 ± 2.4 mg/L; p < 0.01). No significant difference was found between current and ex-smokers (p = 0.45). Conclusion: Elevated CRP in stable COPD suggests persistent systemic inflammation, correlating with disease severity. CRP may aid in monitoring disease progression and guiding therapy.

Background: Cervical cancer remains one of the leading causes of morbidity and mortality among women in developing countries. Early detection through cytological screening is pivotal in reducing disease burden. Liquid-Based Cytology (LBC) offers several advantages over conventional Pap smears, including improved sample adequacy and diagnostic accuracy. This study aimed to evaluate the utility of LBC in detecting early cervical neoplastic changes among high-risk women. Materials and Methods: A prospective observational study was conducted over a period of 12 months in a tertiary care hospital. A total of 300 high-risk women, identified based on factors such as early sexual activity, multiple sexual partners, history of sexually transmitted infections, and smoking, were enrolled. Cervical samples were collected using a cytobrush and processed using the LBC technique. Cytological findings were classified according to the Bethesda System 2014. Colposcopic-guided biopsy was performed in cases with abnormal cytology to confirm histopathological correlation. Results: Out of 300 women screened, satisfactory samples were obtained in 294 cases (98%). Cytological abnormalities were detected in 66 participants (22.4%), of which 30 (10.2%) showed Low-grade Squamous Intraepithelial Lesions (LSIL), 18 (6.1%) had High-grade Squamous Intraepithelial Lesions (HSIL), and 6 (2.0%) revealed Atypical Squamous Cells of Undetermined Significance (ASC-US). Histopathological correlation confirmed neoplastic changes in 92% of HSIL and 80% of LSIL cases. LBC demonstrated a sensitivity of 91.3% and specificity of 95.7% in detecting cervical neoplasia. Conclusion: Liquid-Based Cytology is a reliable, sensitive, and specific screening tool for the early detection of cervical neoplasia, especially in high-risk women. Its adoption in routine gynecological screening programs can significantly enhance early diagnosis and timely intervention, thereby reducing the cervical cancer burden.

Background: Ventilator-associated pneumonia (VAP) remains a major cause of morbidity and mortality among patients in intensive care units (ICUs), particularly in settings with high antimicrobial usage and multidrug-resistant (MDR) organisms. Objective: To study the spectrum and antibiotic resistance pattern of bacterial pathogens isolated from VAP cases in a tertiary care hospital. Methods: A prospective observational study was conducted over 12 months in the ICU. Bacterial isolates from endotracheal aspirates and BAL samples of VAP-diagnosed patients were identified, and antimicrobial susceptibility was tested. Results: Of 150 patients with clinical VAP, 134 yielded positive cultures. Predominant isolates included Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae. High resistance was observed against cephalosporins and carbapenems. Colistin remained the most effective antimicrobial. Conclusion: The high prevalence of MDR pathogens in VAP cases necessitates continuous surveillance and strict antimicrobial stewardship.

Background: and Aim: Chronic Obstructive Pulmonary Disease (COPD) is often associated with cardiovascular complications that significantly impact prognosis and quality of life. This study aimed to evaluate echocardiographic findings in COPD patients to identify cardiac manifestations and their relationship with disease severity.  Material and Methods: A cross-sectional study was conducted on 44 COPD patients at a tertiary care hospital from January to December 2023. All patients underwent spirometry for disease staging and transthoracic echocardiography to assess cardiac involvement.Results: Pulmonary arterial hypertension (PAH) and right ventricular (RV) enlargement were more prevalent in patients with advanced COPD. PAH was observed in 100% of Stage IV patients, while RV enlargement increased progressively with severity, being absent in Stage I and present in all Stage IV cases.  Conclusion: The study underscores the importance of echocardiographic screening in COPD patients, particularly in moderate to severe stages, for early detection of cardiac complications and timely intervention.

Background: Anemia is a major public health problem worldwide, especially among adolescents who face increased nutritional needs during their critical growth years. In India, anemia rates among teenagers remain worryingly high, though the situation varies widely from one region to another. Unfortunately, there’s very little research on how much adolescents actually know about anemia or whether they eat enough iron-rich foods—particularly in rural areas of the Gaya district in Bihar. This study aims to fill that gap by evaluating anemia awareness and dietary habits, specifically iron consumption, among 14- to 17-year-old students attending government schools in five villages of the Gaya district, Bihar. Materials and Methods: We conducted a cross-sectional study among 300 school-going adolescents aged 14 to 17 years from five villages in the Gaya district, Bihar. Written consent was obtained from parents and assent from participating students. The study included students enrolled in grades 7 to 12 who were willing to participate, while excluding those absent or unwilling. Data were collected through face-to-face interviews using a structured questionnaire. Collected data were entered into Microsoft Excel, and the statistical analysis was performed using GraphPad version 8.4.3, with P-values < 0.05 considered significant. Results: Our study indicated that a majority of adolescents were aware of anaemia (61%). However, only a smaller percentage considered it a health issue (48%). In the past year, just 14% of adolescents had taken Iron-Folic Acid (IFA) tablets, while a significantly larger proportion, 71%, had used deworming tablets in the previous six months. The study found that adolescents consumed roti or rice daily (98%), pulses weekly (51%), and dark green leafy vegetables (DGLV) weekly (59%). Fruits were primarily eaten weekly by 48%, with a notable 37% consuming them infrequently. Fried foods and carbonated beverages were consumed regularly. These results suggest that the National Iron Plus Initiative (NIPI) program is not being adequately implemented. Conclusion: This study highlights significant gaps in anemia awareness and dietary practices among adolescents in Gaya, despite their satisfactory hygiene habits. The low level of knowledge regarding the causes of anemia and available screenings, combined with challenges in implementing the I-NIPI program, emphasizes the need for gender-sensitive interventions. Strengthening nutrition education in schools, launching health campaigns, and initiating targeted awareness programs could effectively reduce the prevalence of anemia and improve health outcomes for adolescents in the region

Background: Vaccine hesitancy among caregivers remains a growing concern, especially in semi-urban areas where access to healthcare may be inconsistent. Understanding the factors influencing this hesitancy is crucial for improving immunization coverage and reducing the incidence of vaccine-preventable diseases in children under five. Materials and Methods: This mixed-methods study was conducted over a period of six months in selected semi-urban regions. A total of 250 caregivers of children aged 0–5 years were surveyed using a structured questionnaire. Quantitative data were analyzed using SPSS version 25.0. Additionally, in-depth interviews were conducted with 20 participants who expressed reluctance or refusal to vaccinate, and thematic analysis was employed to interpret the qualitative data. Results: Out of 250 caregivers, 62 (24.8%) were identified as vaccine-hesitant. The major reasons cited were fear of side effects (42%), mistrust in vaccines (28%), and lack of proper information (19%). Hesitancy was significantly associated with lower maternal education (p=0.003) and reliance on non-allopathic health advice (p=0.011). Thematic analysis of interviews revealed recurring concerns about vaccine safety, influence of social networks, and inadequate counseling by healthcare providers. Conclusion: Vaccine hesitancy in semi-urban settings is multifactorial, influenced by both socio-cultural and informational barriers. Targeted educational interventions and improved communication between healthcare workers and caregivers are essential to address misconceptions and build trust in immunization programs.

Background: Early detection of pulmonary nodules plays a critical role in the diagnosis and management of lung cancer. Conventional radiological interpretation of chest CT scans is often time-consuming and subject to human variability. Artificial Intelligence (AI)-based algorithms offer a promising solution by enhancing diagnostic accuracy and reducing workload. This study aimed to evaluate the efficacy of AI algorithms in detecting pulmonary nodules on chest CT images in comparison with radiologists. Materials and Methods: A retrospective study was conducted using chest CT scans from 300 patients (mean age: 58.4 ± 9.2 years). An FDA-approved AI-based nodule detection system was employed to analyze the CT images. The findings were compared with reports from three experienced radiologists. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Cohen’s kappa coefficient was used to assess agreement between the AI model and radiologists. Results: The AI algorithm demonstrated a sensitivity of 92.3%, specificity of 89.5%, PPV of 87.8%, and NPV of 93.1% in detecting pulmonary nodules. In comparison, the average sensitivity and specificity among radiologists were 88.1% and 91.7%, respectively. The agreement between AI and radiologists was substantial (κ = 0.76). The AI tool detected 14 additional nodules that were initially missed by at least one radiologist. Conclusion: AI-based algorithms show high diagnostic accuracy in identifying pulmonary nodules on chest CT scans, comparable to expert radiologists. Integration of such systems into clinical practice may improve early detection rates and optimize radiological workflow

Background: Oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC) are significant oral pathologies with malignant potential and aggressive behavior, respectively. Biomarkers such as p16 play a crucial role in evaluating the progression of dysplastic lesions to carcinoma. This study aims to assess and compare the immunohistochemical expression of p16 in varying grades of OED and OSCC to understand its diagnostic and prognostic significance. Materials and Methods: The study included 60 histologically confirmed cases divided into two groups: 30 cases of OED (10 mild, 10 moderate, 10 severe) and 30 cases of OSCC (10 well-differentiated, 10 moderately differentiated, 10 poorly differentiated). Formalin-fixed, paraffin-embedded tissue samples were subjected to immunohistochemical staining using p16 antibody. The expression was evaluated semi-quantitatively based on staining intensity and the percentage of positive cells. Results: p16 expression was observed in 40% of mild, 60% of moderate, and 80% of severe dysplasia cases. Among OSCC cases, p16 positivity was noted in 50% of well-differentiated, 70% of moderately differentiated, and 90% of poorly differentiated cases. A statistically significant correlation (p<0.05) was found between increased p16 expression and the severity of dysplasia and histological grade of OSCC. Conclusion: The study suggests that p16 expression increases with the progression from OED to OSCC, indicating its potential role as a biomarker for malignant transformation and tumor aggressiveness. Incorporation of p16 immunohistochemistry may aid in risk stratification and early diagnosis of malignant lesions.

Background: Iron deficiency anemia (IDA) remains a significant public health issue among adolescent girls in rural India, impacting growth, cognitive development, and overall health. Socioeconomic conditions play a pivotal role in the prevalence and severity of anemia. This study aims to estimate the prevalence of IDA and assess its association with socioeconomic determinants among adolescent girls in rural settings. Materials and Methods: A cross-sectional study was conducted over a period of six months among 400 adolescent girls aged 10–19 years from five rural villages in India. Hemoglobin levels were estimated using the Sahli’s method. A structured questionnaire collected data on socioeconomic factors including family income, parental education, dietary habits, and access to healthcare. Data were analyzed using SPSS v25 with chi-square tests and logistic regression to identify predictors of anemia. Results: The overall prevalence of iron deficiency anemia was found to be 62.5%. Among these, 40% had mild anemia, 18% had moderate anemia, and 4.5% had severe anemia. A significant association was observed between anemia and low family income (p<0.01), maternal illiteracy (p=0.02), and poor dietary diversity (p<0.001). Girls from families earning below INR 5,000/month were 2.8 times more likely to be anemic compared to those from higher-income groups (OR=2.8; 95% CI: 1.9–4.1). Conclusion: Iron deficiency anemia is highly prevalent among adolescent girls in rural India, with socioeconomic disadvantages acting as key contributing factors. Interventions focused on improving nutritional awareness, female education, and economic support are crucial for effective anemia control in rural populations.

Background: Surgical Site Infections (SSIs) remain a prevalent complication following abdominal surgeries, contributing significantly to patient morbidity, prolonged hospital stays, and increased healthcare costs. Identifying the incidence and potential risk factors is essential for developing preventive strategies. Materials and Methods: A prospective observational study was conducted over a period of 6 months in the general surgery department of a tertiary care hospital. A total of 150 patients undergoing elective and emergency abdominal surgeries were enrolled. Patient demographics, comorbidities, type and duration of surgery, wound classification, and perioperative factors were recorded. SSIs were diagnosed based on CDC criteria and followed up for 30 days postoperatively. Statistical analysis was performed using SPSS v25.0. Results: Out of 150 patients, 27 (18%) developed SSIs. The incidence was significantly higher in emergency surgeries (25%) compared to elective surgeries (12%). Risk factors such as diabetes mellitus (p=0.01), prolonged operative time >2 hours (p=0.03), contaminated/dirty wounds (p=0.002), and lack of preoperative antibiotic prophylaxis (p=0.005) were found to be statistically significant. The most common organism isolated was Staphylococcus aureus (44%), followed by Escherichia coli (30%). Conclusion: SSIs remain a significant concern in abdominal surgeries, particularly in high-risk patients. Proper preoperative optimization, adherence to aseptic techniques, timely antibiotic prophylaxis, and vigilant postoperative care are vital in minimizing the incidence of infections.

Background: Hypothyroidism is a common endocrine disorder characterized by elevated serum thyroid-stimulating hormone (TSH) and decreased thyroid hormone levels. Timely initiation and appropriate titration of levothyroxine are crucial for symptomatic relief and metabolic balance. This study evaluates the impact of levothyroxine dose adjustment on serum TSH levels and quality of life (QoL) in newly diagnosed hypothyroid patients over six months. Materials and Methods: A prospective observational study was conducted on 60 newly diagnosed hypothyroid patients aged 20–55 years at a tertiary care hospital. Levothyroxine therapy was initiated based on body weight and titrated every 6 weeks to achieve target TSH levels (0.5–4.5 µIU/mL). Serum TSH was measured at baseline, 3 months, and 6 months. QoL was assessed using the Thyroid-Specific Patient-Reported Outcome (ThyPRO) questionnaire at the same intervals. Results: The mean baseline TSH was 18.7 ± 5.4 µIU/mL, which significantly decreased to 6.1 ± 2.3 µIU/mL at 3 months and reached 2.9 ± 1.1 µIU/mL at 6 months (p < 0.001). QoL scores showed marked improvement, with the mean ThyPRO score improving from 72.4 ± 8.2 at baseline to 48.3 ± 7.5 at 3 months and 31.6 ± 6.4 at 6 months (p < 0.001). Most patients reached euthyroid status by the end of the study with individualized titration. Conclusion: Levothyroxine dose titration over a 6-month period significantly improves thyroid function and quality of life in patients with newly diagnosed hypothyroidism. Regular monitoring and individualized dosing are key to achieving optimal therapeutic outcomes.

Background: Neonatal sepsis remains a major cause of morbidity and mortality, particularly in rural healthcare settings with limited diagnostic and therapeutic resources. Understanding the microbial profile and antibiotic resistance trends is essential for guiding empirical therapy and improving clinical outcomes. Materials and Methods: A retrospective study was conducted in the neonatal intensive care unit (NICU) of a rural tertiary hospital over a five-year period (January 2019 to December 2023). Blood culture reports from neonates with clinically suspected sepsis were reviewed. Positive cultures were analyzed to determine the prevalence of bacterial isolates and their antibiotic susceptibility patterns using the standard Kirby-Bauer disk diffusion method in accordance with CLSI guidelines. Results: Out of 1240 neonates evaluated for sepsis, 368 (29.7%) had culture-positive results. Gram-negative organisms constituted 62% of the isolates, with Klebsiella pneumoniae (27%), Escherichia coli (18%), and Pseudomonas aeruginosa (9%) being predominant. Among Gram-positive isolates, Staphylococcus aureus (15%) and Enterococcus spp. (6%) were most common. High resistance was observed against ampicillin (78%), cefotaxime (64%), and gentamicin (55%). Carbapenems retained the highest sensitivity among Gram-negative isolates, while vancomycin and linezolid showed effectiveness against Gram-positive organisms. A rising trend in multidrug-resistant organisms was noted over the study duration. Conclusion: The study highlights a high burden of Gram-negative infections and an alarming rate of antimicrobial resistance among neonatal sepsis cases in rural settings. Regular surveillance of bacterial profiles and antibiotic susceptibility is critical for formulating effective empirical treatment strategies and curbing resistance

Background: Acute Myocardial Infarction (AMI) remains a major global health burden, with early risk stratification playing a critical role in optimizing patient outcomes. Admission hyperglycemia in non-diabetic individuals has emerged as a potential prognostic marker, though its clinical implications remain unclear. Objectives: This study aims to evaluate the prognostic significance of admission hyperglycemia in non-diabetic patients with AMI, assessing its impact on in-hospital mortality and major adverse cardiac events (MACE). Methods: An observational study was conducted at a tertiary care hospital over 24 months, enrolling 260 non-diabetic patients with AMI. Admission blood glucose levels were measured, with hyperglycemia defined as ≥140 mg/dL. Patients were categorized into normoglycemia and hyperglycemia groups. Baseline characteristics, inflammatory markers, cardiac function, and clinical outcomes were analyzed. Statistical comparisons were performed using t-tests, chi-square tests, and logistic regression analysis. Results: The hyperglycemia group had significantly higher levels of inflammatory markers (C-reactive protein and white blood cell count) and greater myocardial injury (elevated troponin I and CK-MB) compared to the normoglycemia group (p < 0.05). Left ventricular ejection fraction was significantly lower in hyperglycemic patients (45.8% vs. 51.4%, p < 0.001). In-hospital mortality was notably higher in the hyperglycemia group (16.9% vs. 6.2%, p = 0.009), along with an increased incidence of heart failure, arrhythmias, cardiogenic shock, and reinfarction (p < 0.05 for all). Patients with hyperglycemia also had a longer hospital stay (7.3 ± 3.2 days vs. 5.7 ± 2.1 days, p = 0.004). Conclusion: Admission hyperglycemia in non-diabetic AMI patients is associated with increased myocardial injury, a heightened inflammatory response, and poorer clinical outcomes, including higher in-hospital mortality and MACE. These findings highlight the need for early recognition and potential interventions targeting stress hyperglycemia in this patient population.

Background: Pseudomonas aeruginosa is a major contributor to hospital-acquired infections (HAIs), with metallo-beta-lactamase (MBL) production driving resistance to carbapenems, a critical therapeutic class. In Western India, where healthcare systems face resource constraints and high patient loads, the epidemiology of MBL-producing P. aeruginosa remains underexplored. This study investigates the prevalence and mechanisms of MBL production in P. aeruginosa isolates from HAIs in this region. Methods: Between January 2023 and March 2025, 200 non-duplicate P. aeruginosa isolates were collected from HAIs across five tertiary care hospitals in Western India (Silvassa, Mumbai, Pune, Ahmedabad, and Jaipur). Isolates were identified using VITEK 2 and subjected to antibiotic susceptibility testing via Kirby-Bauer disk diffusion and E-test for carbapenems. MBL production was detected phenotypically using the imipenem-EDTA combined disk test and genotypically via PCR targeting blaNDM, blaVIM, blaIMP, and blaSPM genes. Plasmid analysis and conjugation experiments assessed resistance transferability. Results: MBL production was confirmed in 128 isolates (64%, 95% CI: 57.2–70.8%), with the highest prevalence in ventilator-associated pneumonia (72%) and bloodstream infections (62.5%). Resistance to meropenem (89.8%) and imipenem (84.4%) was predominant among MBL producers, alongside significant resistance to ceftazidime (78.1%) and piperacillin-tazobactam (68.8%). blaNDM-1 was the most common MBL gene (60.9%), followed by blaVIM (29.7%), with 94.4% of MBL genes located on conjugative plasmids transferable to Escherichia coli J53 in 86.4% of cases. MBL production correlated with prolonged ICU stays (66.4%) and higher mortality (21.9%). Conclusion: The 64% prevalence of MBL-producing P. aeruginosa in Western India, driven by plasmid-mediated blaNDM-1 and blaVIM, signals a critical resistance burden in HAIs. These findings highlight the urgent need for enhanced infection control, molecular surveillance, and antibiotic stewardship to curb the spread of MDR pathogens in this region.

Prevalence of Iron deficiency at 5 to 6 months among Preterm and Exclusively Breastfed Term Infants in a Tertiary Care Hospital. Background: Iron has a crucial role in the development of the brain, including neuronal myelination, neurotransmission, and neurogenesis. It also has an impact on a child's behaviour, memory, learning, and general growth. In the early postnatal years, iron deficiency (ID) might have irreversible repercussions. Objectives: To determine the prevalence of iron deficiency at 5 to 6 months in preterm and exclusively breast-fed term infants. Methods: A cross-sectional study was conducted in 49 preterm and 42 exclusively breastfed term infants after obtaining informed assent from their parents. Blood samples were withdrawn to estimate the level of serum iron and total iron binding capacity. Transferrin saturation index was calculated and the values less than 16 wereconsidered as Iron Deficiency. Iron deficiency and factors affecting itwere studied. Among preterms, correlation between number of days of exclusive breastfeeding, extent of prematurity and type of feeding with ID were studied.  Results:76.2% term though exclusively breastfed and 59.2% preterm infants had ID. Preterm infants had a higher mean transferrin saturation (15.2%) compared to term infants (11.69%). The difference in transferrin saturation between preterm and term infants was statistically significant(p=0.02). Among iron deficient term and preterm infants there is a significant correlation with respect to socioeconomic status (p=0.00001), maternal anemia(p=0.006), birth anthropometry(p=0.03) and twin gestation(p=0.004). It was found that there was no significant correlation between ID in preterm and term in comparison with their sex, mother’s status of consumption of iron supplementation (taken for at least 90 days), birth weight and current weight of the infants. Conclusion: Iron deficiency appears even before iron deficiency anemia and may not have protean manifestations.Early identification of iron deficiency before iron deficiency anemia sets in , can prevent adverse consequences. Screening for ID at 5 to 6 months of age should be done in both term and preterm infants. Iron deficiency appears to be more prevalent in term exclusively breast-fed infants compared to preterm infants, though not statistically significant.

Objective: It is necessary to know the physical fitness level of first year medical students so that they can acquire the healthy lifestyle from the beginning and they are motivated to be healthy throughout their life. Hence a cross-sectional study was planned to assess the physical fitness parameters such as muscle strength, abdominal muscle endurance and abdominal muscle flexibility in first year medical students between the age group of 17-19 years.  Material and methods: The study was approved by the Institutional Ethics Committee. Sample size of the study was 180 including both boys and girls studying in first MBBS. The students were divided into three groups as normal weight (group 1), overweight (group 2) and obese (group 3).Physical fitness parameters such as muscle strength was measured with the help of handgrip dynamometer, abdominal muscle flexibility was measured with the sit and reach test and abdominal muscle endurance was recorded by sit ups test. All the parameters were compared in all the three groups with ANOVA test. Results: Mean age in group 1, 2 and 3 was, 18.03±0.72, 18.50±0.81, 18.42±0.78 respectively. Mean values of muscle strength in overweight (50.37±3.92) and obese (50.37±3.92) group was more than normal weight group (46.36±5.93). Abdominal flexibility was less in overweight (19.87±1.54) and obese (19.87±1.54) group than normal weight group (23.18±2.04). Overweight and obese group also showed less abdominal endurance (17.54±1.50, 16.31±2.73) than normal weight group (24.56±3.11).  Conclusion: In obese and overweight boys and girls muscle strength was more but abdominal muscle endurance and abdominal muscle flexibility was reduced as compared to their normal weight counterparts. The study suggested a need to create awareness among medical students regarding the physical fitness.

Aim: The aim of the present study was to compare the efficacy of volar locking plate and K wire fixation with POP cast procedure in intra articular distal end radius fractures among elderly patients. Methods: The Study was conducted at Maharishi Markandeshwar Medical College and Hospital (MMMCH), Kumarhatti, Solan, Himachal Pradesh, India from December 2020 to December 2022. All confirmed cases of stable and unstable distal radius fracture registered at the orthopedic department of MMMCH, Kumarhatti, Solan. Results: The difference between mean age participants, gender wise, fracture side wise, mode of injury wise, AO fracture and type of injury wise distribution of participants was statistically not significant (p>0.05). The difference between mean DASH score at post-operative duration 2, 4, 6 months of participants of VLP & K wire group was statistically significant (p<0.05). The difference between mean range of motion of participants of VLP & K wire group was statistically significant for all parameters (p<0.05). The difference between mean parameters for radiological evaluation participants of VLP & K wire group was statistically significant for all parameters (p<0.05) except ulnar variance (p>0.05). The distribution of participants according to complication were statistically not significant (p>0.05). Conclusion: Distal radius fractures are injuries that can cause a loss of wrist function and disability and are most commonly seen in elderly patients. The use of percutaneous pin fixation, Kapandji’s intrafocal pinning ext fix devices that permit distraction and palmar translation, low profile internal fixation plates, arthroscopically assisted reduction, and bone grafting techniques including bone‑graft substitutes, all have contributed to improved fracture stability and outcome.

Introduction This research was done to study the hemodynamic parameters i.e., pulse rate and mean arterial pressure during induction and maintenance of low flow anaesthesia using desflurane as inhalational anaesthetic agent in major surgical procedures. Methodology: This study was a prospective observational study on a total of 140 patients, divided into 2 groups alternatively with 70 patients in each group based on surgery i.e., laparoscopic (n = 70) or non-laparoscopic (n = 70) in a tertiary medical college in Central India wherein effects of low flow desflurane was assessed on haemodynamic parameters. Observation and Results: In our study on 140 patients, it was found that there was no significant difference in Pulse rate between Laparoscopic and Non-laparoscopic group as shown in table 2; while there was significant difference in Mean arterial pressure between Laparoscopic and Non-laparoscopic group, but the difference is not clinically relevant and is within normal range

Introduction Taste and smell may influence the acceptance or rejection of food, allowing to recognize chemical characteristics and nutritive substances of ingested food. Previous studies reported that the activation of sensory receptors induces oral and gastrointestinal secretion, contributing to the metabolic and digestive process. Recent findings also showed that ectopic taste and smell receptors could act directly in the regulation of gastrointestinal functions, insulin and glucagon secretion, sense of satiety, and gut motility. Materials and methods This was a cross-sectional study comprising a sample size of 80. Patients aged 25 to 50 years with T2DM < 5 years duration with HBA1C ≤ 7 were recruited from a tertiary care hospital for the research. They were divided into 2 groups, Group I- with normal weight (BMI of 18.5 to <25) and Group II with grade 1 obesity (BMI of 30 to < 35). The duration of the study was 2 months Results Study Population Of a total of 80 T2DM patients recruited, only 50 met the selection criteria and were enrolled for the study. The characteristics of the T2DM patients and 50 control subjects are described. The two groups were similar for age, gender distribution, and body mass index (BMI), and differed only for fasting glucose values, as expected. Individual data for each type of stimulus are reported in Supplementary Conclusion Our study concludes that gustatory impairment for the tastants – sweet, salty, sour, and bitter was observed in obese Type 2 Diabetes mellitus patients having the disease for less than 5 years, though maintaining a fair glycaemic control. This may affect their choices of food items like preference for sweet- tasting food which can exacerbate hyperglycaemia and aggravate obesity.

Background: Postoperative delirium (POD) is a common but often under-recognized complication in pediatric patients following ear, nose, and throat (ENT) surgeries. Different anesthetic emergence techniques, such as deep versus awake extubation, may influence the incidence and severity of POD. This study evaluates the effect of these techniques on the occurrence of POD in children undergoing ENT procedures. Materials and Methods: This prospective, randomized study was conducted on 60 pediatric patients aged 3–10 years scheduled for elective ENT surgeries under general anesthesia. Patients were randomly assigned into two groups: Group A (n=30) underwent awake extubation, while Group B (n=30) underwent deep extubation. The Pediatric Anesthesia Emergence Delirium (PAED) scale was used to assess POD at 10, 30, and 60 minutes post-extubation. Hemodynamic parameters and any complications were also recorded. Results: The incidence of postoperative delirium was significantly lower in Group B (deep extubation) compared to Group A. At 10 minutes post-extubation, 60% of children in Group A showed PAED scores ≥10, indicating delirium, whereas only 30% in Group B exhibited similar scores. At 30 minutes, the incidence reduced to 40% in Group A and 15% in Group B. By 60 minutes, delirium had resolved in most patients. No major complications were observed in either group. Conclusion: Deep extubation is associated with a reduced incidence of postoperative delirium in pediatric patients undergoing ENT surgeries. Selecting the appropriate emergence technique can enhance patient comfort and improve recovery outcomes in the pediatric population.

Background:  Chronic inflammation plays a crucial role in tumor initiation, progression, and metastasis. In breast carcinoma, inflammatory markers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and neutrophil-to-lymphocyte ratio (NLR) have shown potential as prognostic indicators. This study aimed to evaluate the correlation between selected inflammatory markers and histopathological tumor grades in patients with breast carcinoma. Materials and Methods: A cross-sectional observational study was conducted over a period of 12 months in the Department of Pathology, involving 100 histologically confirmed breast carcinoma patients. Blood samples were collected prior to treatment initiation to assess levels of CRP, ESR, and NLR. Tumor grading was performed according to the Nottingham histologic score system. Statistical analysis was carried out using Pearson’s correlation and ANOVA, with p-value <0.05 considered significant. Results: Among the 100 patients, 30% had Grade I tumors, 45% had Grade II, and 25% had Grade III tumors. Mean CRP levels were significantly higher in Grade III (11.2 ± 2.5 mg/L) compared to Grade I (4.3 ± 1.1 mg/L) (p<0.01). Similarly, ESR and NLR showed a positive correlation with tumor grade (r=0.62 and r=0.58 respectively, p<0.01). A statistically significant association was found between higher inflammatory marker levels and increased tumor grade. Conclusion: The study demonstrates a positive correlation between inflammatory markers and tumor grade in breast carcinoma. Elevated CRP, ESR, and NLR levels may serve as accessible and cost-effective indicators for tumor aggressiveness, aiding in prognostic evaluation and treatment planning.

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a severe, idiosyncratic drug-induced hypersensitivity reaction characterized by extensive skin rash, fever, hematologic abnormalities (eosinophilia or atypical lymphocytosis), and internal organ involvement, including liver, kidney, and lungs ¹. DRESS syndrome is indeed a severe condition with a mortality rate reaching up to 10% in cases, highlighting its potential life-threatening nature ². Rifampicin, a first-line anti-tubercular agent, is indeed implicated in the development of DRESS syndrome, alongside other drugs like aromatic anticonvulsants and certain antibiotics ³. Rifampicin is a rifamycin antibiotic that works by inhibiting bacterial DNA-dependent RNA polymerase ⁴. It is considered the cornerstone of tuberculosis treatment due to its broad-spectrum activity against Mycobacterium tuberculosis. However, like many antimicrobial agents, rifampicin can cause adverse drug reactions (ADRs), ranging from mild dermatologic reactions to more severe manifestations like DRESS syndrome ⁵. 

Introduction: Most of scientists agree that the existence of myocardial bridges can significantly modulate the hemodynamic phenomenon. Present study was aimed to study coronary dominance and myocardial bridges in human cadaveric hearts. Material and Methods: Present study was prospective, observational study, conducted in department of anatomy. 50 adult human hearts fixed in 10% formalin were obtained from the cadavers in department of anatomy. The right & left coronary arteries were dissected for ostia (number, location), origin, course and branching pattern of arteries, pattern of coronary dominance & presence of myocardial bridges. Results:. Posterior interventricular artery was derived from right coronary artery i.e. a case of right dominance in 37 (74%) hearts and from left coronary artery i.e. a case of left dominance  in 9 (18%) hearts while it was the case of codominance (both RCA and LCA giving posterior IV branch) in 4 (8%) specimens. Myocardial bridges were seen in 18 (36%) specimens while remaining 32 (64%) did not demonstrate such bridging. Bridging was observed on left coronary artery branches in 14(28%) hearts and on right coronary artery branches in 4 (8%) heart specimens. Thus, amongst the heart specimens showing myocardial bridging, 75% showed exclusively on left coronary artery territory while 25% showed exclusively on right coronary artery. Myocardial bridging was seen more commonly on anterior interventricular branch in 9 (18%) specimens. Thus 50% of all heart specimens showing the presence of bridging had it on anterior interventricular artery. Incidence of bridging seen on other branches was marginal artery 4 (8%), posterior interventricular 1 (2%), left circumflex 3 (6%) and left diagonal 3 (6%). Conclusion: A case of right dominance was observed in 37 (74%) specimens, left dominance in 9 (18%) specimens while codominance was found in 4 (8%) heart specimens. Myocardial bridges were seen in 18 (36%) specimens.

Background: Dyspnea is a frequent and multifactorial symptom in chronic kidney disease (CKD), often overlooked in early stages. While commonly attributed to fluid overload, other contributors such as anemia, left ventricular dysfunction (LVD), pulmonary hypertension, and pulmonary parenchymal and airway diseases significantly affect symptom burden and prognosis. Methods:   A prospective observational study was conducted on 120 adult CKD patients at a tertiary care center in Maharashtra. Patients were followed for 18 months. Dyspnea was assessed using the Modified Medical Research Council (mMRC) Dyspnea Scale. Echocardiographic, laboratory, and pulmonary parameters were analyzed. Patients were grouped based on dyspnea severity (mMRC ≥2 vs. ≤1) and change in LVEF (≥10% decline vs. maintained/minimal reduction). Multivariate logistic regression was used to identify predictors of worsening LVEF. Results:  Of 110 patients analyzed, 48 (43.6%) had significant dyspnea. Prevalence increased with CKD stage, reaching 83.3% in stage 5. Dyspneic patients had lower hemoglobin (9.2 ± 1.4 vs. 10.3 ± 1.5 g/dL, p = 0.002), higher NT-proBNP (2142 ± 1186 vs. 1297 ± 927 pg/mL, p = 0.004), more LVH (64.6% vs. 42.0%, p = 0.02), and pulmonary hypertension (41.7% vs. 22.6%, p = 0.03). LVEF was lower in dyspneic patients (50.8 ± 9.2% vs. 55.7 ± 7.8%, p = 0.01). Worsening LVEF was observed in 28 patients (25.5%). Independent predictors of worsening LVEF were elevated NT-proBNP (OR: 1.004, p = 0.002), LVH (OR: 2.86, p = 0.014), ischemic heart disease (OR: 3.02, p = 0.021), and diabetes mellitus (OR: 2.25, p = 0.045). Conclusions:  Dyspnea in CKD is common, multifactorial, and warrants early evaluation. Relevant investigations to detect Cardiac, Pulmonary and Hematological disturbances are crucial for timely interventions. NT-proBNP, LVH, diabetes, and IHD are independent predictors of worsening LVEF in CKD.

Background: Pancytopenia, defined as the reduction of all three blood cell lines, is not a disease but a manifestation of various underlying conditions. It is a common hematological issue observed in clinical settings, especially in resource-limited settings. Objective: To investigate the clinical presentations, hematological parameters, and bone marrow morphology in patients diagnosed with pancytopenia. Methods: A descriptive, observational study was carried out in the Department of Pathology, Pt. J.N.M. Medical College, Raipur, from April 2014 to March 2015. Ninety-six patients aged 2 to 71 years with newly diagnosed pancytopenia were selected following strict inclusion criteria. Detailed history, physical examination, peripheral blood smear, and bone marrow aspiration were performed. Data were statistically analyzed. Results: The most affected age group was 15–30 years with a male-to-female ratio of 1.3:1. Generalized weakness (100%) and fever (45%) were the most common presenting symptoms. Megaloblastic anemia (39%) was the leading cause of pancytopenia, followed by hypersplenism and dimorphic anemia (12% each). Bone marrow studies proved instrumental in confirming diagnoses. Conclusion: Megaloblastic anemia remains the predominant cause of pancytopenia in this region, highlighting the need for early nutritional interventions. Bone marrow examination is a key tool in evaluating pancytopenic patients for prompt diagnosis and management.

Introduction. Alcohol causes around 4.5 million deaths a year, making it the fourth most important risk factor for disease burden worldwide. A variety of problems, such as excessive use, abuse, dependence, and addiction, are included in the category of alcohol use disorders (AUD). Alcohol withdrawal syndrome (AWS) is a well-known disorder that happens when severe or continuous drinking is abruptly stopped, whether it's intentionally or unintentionally. Acute and long-term alcohol use can cause hypomagnesemia and other electrolyte abnormalities. The primary causes of magnesium deficiency in these individuals include insufficient intake, malnutrition, losses due to vomiting, and urinary losses related to ethanol metabolism. Hence the present study was done to measure serum magnesium levels in chronic alcoholic patients who have abstained from alcohol for at least 6 hours and also the relationship with severity of alcohol withdrawal. Methodology: A cross-sectional study was done on 100 patients with alcohol withdrawal symptoms who gave consent at King George hospital, Visakhapatnam. Alcohol withdrawal symptoms severity was measured with the help of the CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, revised) scale and serum magnesium levels were measured. Details like age, hypertension, diabetes and smoking were also studied. Results: The Mean age of the study participants is 40.86 ±11.28 years. There was a significant positive correlation between CIWA-Ar scores and the duration of alcohol intake (r = 0.464), and a significant negative correlation with serum magnesium levels (r = -0.802). Conclusion: Longer alcohol consumption is associated with higher withdrawal severity, while higher levels of serum magnesium are associated with lower withdrawal severity.

Background: Spontaneous bacterial peritonitis (SBP) is a life-threatening complication in patients with alcoholic liver disease (ALD) and ascites. Identifying reliable non-invasive biomarkers for SBP could facilitate early diagnosis and treatment. Serum uric acid (SUA) is increasingly recognized as a marker of systemic inflammation and oxidative stress. This study aimed to evaluate the correlation between SUA levels and ascitic fluid neutrophil count in ALD patients. Materials and Methods: A cross-sectional study was conducted on 80 patients with ALD-related ascites at a tertiary care center. SUA levels and ascitic fluid neutrophil counts were measured and analyzed for correlation. Patients were stratified based on the presence of SBP, defined as an ascitic fluid neutrophil count ≥250 cells/mm³. Receiver operating characteristic (ROC) curve analysis was performed to determine the predictive value of SUA for SBP. Results: The mean SUA level was 7.9 ± 2.1 mg/dL, and the mean ascitic fluid neutrophil count was 295.6 ± 145.3 cells/mm³. SUA levels were significantly higher in patients with SBP (8.7 ± 2.3 mg/dL vs. 7.3 ± 1.8 mg/dL, p = 0.003). A strong positive correlation was observed between SUA and ascitic fluid neutrophil count (r = 0.62, p < 0.001). SUA ≥8.1 mg/dL was associated with significantly higher neutrophil counts (398.3 ± 132.5 vs. 205.6 ± 98.2, p < 0.001). ROC analysis showed that SUA had good predictive value for SBP (AUC = 0.81, p < 0.001).= Conclusion: SUA levels correlate significantly with ascitic fluid neutrophil count in ALD patients. Elevated SUA is associated with SBP and may serve as a non-invasive biomarker for early risk stratification. Further studies are needed to validate its diagnostic utility in clinical practice.

Background: Acute pancreatitis (AP) is a prevalent inflammatory condition of the pancreas with diverse etiological factors. Recent studies suggest that metabolic parameters, including uric acid levels, may play a role in AP pathophysiology. However, the association between serum uric acid concentrations and the onset or severity of AP remains unclear. Aim and Objectives: The primary objective of this study was to evaluate whether serum uric acid levels in patients with AP were elevated compared to a healthy population. Material and Methods: This study included 234 patients diagnosed with AP. For comparison, a control group of 234 individuals undergoing routine health check-ups was randomly selected. Serum uric acid levels were measured and compared between the two groups. If a significant difference was observed, further analyses were conducted to examine correlations between uric acid concentration and serological markers. AP patients were further categorized into mild and non-mild AP groups to assess differences in uric acid levels based on disease severity. Results: Serum uric acid levels were significantly higher in AP patients compared to the healthy control group. However, there was no statistically significant difference in uric acid levels between the mild and non-mild AP subgroups. Correlation analysis revealed a weak positive association between uric acid concentration and triglyceride levels. No significant linear correlations were observed between uric acid levels and other parameters. Conclusion: The findings indicate that uric acid levels are significantly elevated in patients with AP compared to healthy individuals. However, uric acid concentration does not appear to be associated with AP severity. A correlation was observed between serum uric acid levels and triglyceride concentration, suggesting a potential metabolic link. Further research is needed to elucidate the underlying mechanisms and clinical implications of these associations.

Background: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel surgical technique in thyroid surgery that provides a feasible opportunity to avoid a visible neck scar. The present observational study was conducted regarding the use of TOETVA as a modality for the treatment of thyroid swellings. Method: A total of 40 patients with benign thyroid pathologies, nodules' maximum diameter <5 cm, total thyroid volume was ≤45 mL with no lymph node metastasis and patient giving consent for the study were included during a period from October 2019 to September 2021. Results: Most of the patients diagnosed as multinodular goitre (30%), followed by single thyroid nodule and cyst (27.5%) and Grave’s disease (15%). Majority of patients undergone hemithyroidectomy (55%) followed by total thyroidectomy, (45%). The mean intra-operative blood loss in hemithyroidectomy was 7.72±2.57 ml while in total thyroidectomy was 27.01±4.57 ml. The mean operative time of surgery in hemithyroidectomy was 46.36±12.16 minutes while in total thyroidectomy was 77.22±18.08 minutes. All patients IONM was used (100%). Out of 40, 2(5%) patient was converted to open thyroidectomy. Hypoparathyroidism (20%) was the most common post-operative complication. The mean post-operative pain gradually decreases from day 1 (3.40±1.2) to day 3 (0.40 ± 0.60) with statistically significant difference, (p<0.001). The mean hospital stay among patients was 2.48±1.28 days and mean follow-up was 2.15±1.02 weeks. Conclusion: TOETVA is the best aesthetic option for thyroidectomy. It is a scarless approach with excellent cosmetic outcomes, which provides equal accessibility to either lobe without the need for an additional port.

Introduction: Rat poisoning, often known as rodenticide poisoning, is still the second most prevalent swallowed poison in our area, behind organophosphorus poisoning. Present study was aimed to study clinical features and outcome of rodenticide (ratkill) poisoning. Material and Methods: Present study was prospective, observational study, conducted in patient of above 18 years age, admitted with rodenticide poisoning. Results: In present study, among 115 patients, majority of patients belong to age group of 21 to 30 years (50.4%) followed by age group of 11 to 20years (27.8%). Mean age of patients was 26.48 ± 9.48 years. 49.6% of patients were males whereas 50.4% of patients were males. In current study, majority of patients had vomiting (60.9%) followed by hematemesis and melena (each 27.8 %), abdominal pain (12.2 %), chest pain and breathlessness (each 9.6 %), fever and hematuria (each 8.7 %) & bleeding gums and seizures (each 7.8 %). In current study, 27.8% of patients had occult blood in stool, 6.9% of patients had arrthymias & 4.3% of patients showed lung infiltration. 93.9% of patients had normal USG abdomen, 3.5% of patients had fatty liver and 2.6% of patients had cholecystitis. In current study, in X-ray chest whereas 95.7% of patients had normal chest x-ray findings. 15 patients underwent CT brain. 20% of patients who underwent CT showed intra-cranial haemorrhage. In current study, the mortality rate among the study participants was 7% whereas 93% of patients survived. Conclusion: Compared to other pesticides, rodenticide poisoning is more prevalent manageable, and typically suicidal in nature. A few risk factors include being too aged or young, reaching at the hospital too late, and ingesting too much of the poison.

Introduction: Diabetes mellitus is an important risk factor for cardiovascular disease and atherosclerosis as it is a common secondary cause of hyperlipidemia when the glycemic control is poor. Present study was aimed to investigate the association between dyslipidemia, duration of type 2 diabetes mellitus, and HbA1c in patients with T2DM at a tertiary care center. Material and Methods: Present study was cross- sectional descriptive study, conducted in type 2 diabetes mellitus patients of age ≥ 18 years, either gender, willing to participate in the study and has given written consent. Results: Among 233 participants, majority of fall within the 41-50 years age group (43 %) & 169 participants were female (72.5%). Overall, total cholesterol, triglycerides, and LDL levels increase as HbA1c levels rise, suggesting a strong correlation between poor glycemic control and lipid abnormalities, while FBS and HDL do not show significant changes with HbA1c levels. Triglycerides and LDL cholesterol levels are significantly associated with the duration of diabetes, highlighting the progressive impact of the disease on lipid metabolism. There is significant difference in cholesterol, triglycerides, LDL, HDL, HBA1C levels in those have diabetes duration greater than 5 years and less than 5 years. there is no significant difference in FBS level in those have diabetes duration greater than 5 year and less than 5 years. The T Test shows significant difference in cholesterol, triglycerides, LDL levels in those have HBA1C greater than 7.5 and less than 7.5. there is no significant difference in FBS and HDL level in those have HBA1C greater than 7.5 and less than 7.5. Conclusion: The correlation analysis indicates that higher HbA1c levels are associated with elevated total cholesterol, triglycerides, and LDL, emphasizing the relationship between poor glycemic control and adverse biochemical profiles.

Introduction: Perinatal asphyxia, a major cause of neonatal death and disability, is a critical issue in low-resource settings. It results from newborn failure to breathe properly at birth, leading to oxygen deprivation and multiorgan dysfunction. Early detection, improved antenatal care, and resuscitation can reduce its impact and improve survival rates. This study aims to evaluate it in detail. Methods: This study, conducted prospectively over 18 months in the NICU, examined 100 neonates with perinatal asphyxia, focusing on their APGAR score, umbilical cord blood pH, and other criteria. The primary outcome was neonatal multiorgan dysfunction, with secondary outcomes including hospitalization duration, mechanical ventilation need, complications, and mortality rates. The study ensured ethical approval and patient confidentiality. Results: Prolonged labour, leaking PV > 12 hours and PIH were significantly associated with the severity of the APGAR score (p-values < 0.05). Hypotension, feeding disturbances and NNE were significantly associated with the severity of the APGAR score (p-values < 0.05). Conclusions: The study highlights the high prevalence of multiorgan dysfunction in neonates following perinatal asphyxia in rural tertiary healthcare, emphasizing the need for improved clinical management and targeted interventions to reduce morbidity and mortality.

Introduction: Estimating human height from skeletal remains is pivotal in forensic anthropology and bioarchaeology. The tibia, as one of the more preserved bones, provides a valuable metric for such estimations. This study aims to validate the correlation between tibial length and total human height, providing a reliable predictive model. Methods: This retrospective cohort study involved a sample of 80 adults ranging from 18 to 60 years, selected from a tertiary care hospital's records. Tibial lengths were measured via radiographs, while height data were obtained from medical records. Statistical analyses included Pearson's correlation and linear regression models to establish and verify the relationship between tibial length and human height. Results: The correlation coefficient between tibial length and human height was found to be 0.736, indicating a strong positive correlation (p = 0.0263). The regression model produced a coefficient of 2.932 for tibial length, with an intercept of 55.8, demonstrating significant predictability (p-values for coefficient and intercept were 0.0229 and 0.0393, respectively). Conclusion: The study confirms the efficacy of using tibial length as a predictor of human height. The developed regression model provides a statistically robust method for height estimation that can be applied in forensic and anthropological contexts. Future studies should consider larger and more diverse samples to enhance the model's applicability and accuracy.

Background: Acute pancreatitis (AP) is a common gastrointestinal emergency, with severity ranging from mild self-limiting disease to severe forms associated with necrosis and multi-organ failure. Accurate early prediction of disease severity is crucial for timely intervention and improved patient outcomes. The Bedside Index for Severity in Acute Pancreatitis (BISAP) score is a simple clinical scoring system that predicts severity within 24 hours of admission, whereas the Balthazar score, based on contrast-enhanced computed tomography (CECT), assesses pancreatic inflammation and necrosis after 48 hours. This study aims to compare the efficacy of BISAP and Balthazar scores in predicting the severity and prognosis of AP. Methods: A prospective comparative study was conducted on 115 patients from April 2023 to April 2024 diagnosed with acute pancreatitis at the Department of General Surgery, SVRRGGH, Tirupati. Patients were assessed using BISAP scores upon admission and Balthazar scores via CECT after 48 hours. Clinical, biochemical, and radiological data were collected. Statistical analysis was performed using SPSS version 16, with a p-value of <0.05 considered significant. Results: The mean age of patients was 39.5 ± 12.7 years, with a male predominance (78.3%). Elevated serum amylase and lipase levels were found in 87.8% and 89.6% of cases, respectively. Based on BISAP scoring, 52 (45.2%) patients had severe AP, while 55 (47.8%) had severe pancreatitis per the Balthazar score. The BISAP score correlated significantly with Balthazar severity grading (p < 0.001). Organ failure was observed in 48.7% of patients, with respiratory failure (33.0%) being the most common. Patients with higher BISAP and Balthazar scores had significantly increased rates of persistent organ failure, multi-organ failure, and mortality. Conclusion: The BISAP score demonstrated a significant correlation with the Balthazar score in predicting AP severity and prognosis. BISAP, being a simple bedside tool available at admission, allows for early risk stratification, whereas the Balthazar score, reliant on imaging, may be more useful in later disease stages. Incorporating BISAP scoring into routine clinical practice can facilitate timely triaging of high-risk patients and optimize resource allocation

Background: Percutaneous nephrolithotomy (PCNL) is the gold standard for treating large renal calculi. While traditionally performed in the prone position under general anaesthesia, recent advances support the use of supine positioning and spinal anaesthesia to improve ergonomics, reduce anaesthetic risk, and enhance recovery. Miniaturization of PCNL tracts has also gained popularity in an effort to minimize morbidity without compromising efficacy. Objective: To evaluate the feasibility, safety, and surgical outcomes of supine PCNL and mini-PCNL performed under spinal anaesthesia at a tertiary care centre. Materials and Methods: This prospective observational study included 35 patients with renal stones >10 mm who underwent supine PCNL or mini-PCNL under spinal anaesthesia. Parameters evaluated included operative time, stone-free rate (SFR), exit strategy, hospital stay, and complications (Clavien-Dindo classification). Statistical comparisons were made using Chi-square and Fisher’s Exact tests. Results: The mean operative time was 68.8 minutes overall, with shorter durations noted in mini-PCNL (18.3 min) compared to standard PCNL (24.8 min). The overall stone-free rate was 94.3%, with two patients requiring adjuvant ESWL. Most mini-PCNL procedures were completed using a tubeless DJ stent approach. Complications were observed in 10 patients (28.6%), mostly Grade I–II. Exit strategy was significantly associated with complication rates (p = 0.014), while tract size and access site were not. No major anaesthesia-related events or organ injuries occurred. Conclusion: Supine PCNL and mini-PCNL under spinal anaesthesia are effective and safe treatment modalities for renal calculi. Exit strategy selection significantly influences complication rates and should be tailored to intraoperative findings. The results support broader adoption of minimally invasive, tubeless PCNL in appropriate cases.

Background: Schneiderian membrane thickness plays an important role in treatment planning of implant placement in maxillary posterior teeth wherein sinus lift procedures are warranted due to insufficient vertical height. Aim: To assess the thickness of the Schneiderian membrane in cases of inflammatory peri-apical pathologies involving periapical abscess, cyst, or granuloma in maxillary posterior teeth and assessing the variation in its thickness based on the distance between the pathology and the membrane. Materials & Methods: 114 samples of maxilla showing Schneiderian membrane thickening were considered for the study. The thickening of the Schneiderian membrane and the size of the periapical pathology was measured in the sagittal and panoramic sections. The distance between the periapical pathology and the Schneiderian membrane was also measured to check for any correlation. Results & Conclusion: The periapical pathology in the maxillary posterior teeth showed evident Schneiderian membrane thickening assessed in cone beam computed tomography radiography. It was also observed that decreased distance between the infection and the membrane leads to more thickening of the Schneiderian membrane. Similarly, increased distance between the pathology and the membrane leads to reduced thickening of the Schneiderian membrane.

Background: Stroke is the leading cause of physical impairment and the leading cause of mortality in the developed world, after ischemic heart disease and cancer. In wealthy nations, stroke is the third most prevalent cause of death. Objective: To study serum HDL level in patient with cerebrovascular accident and to compare the level of serum HDL level between two categories of stroke. Materials and Methods: The study was conducted on 100 patients of cerebrovascular accident admitted in King George Hospital, Andhra Medical College, Visakhapatnam. in both male and female ward & intensive medical care unit between October 2022 to September 2023. Result: The Mean value of HDL of Haemorrhagic stroke (39.36) was higher when compared to the Mean Ischemic Stroke (32.36), which is statistically significant with p value <0.05. The mean values of Total Cholesterol (161.22), Triglycerides (159.56), VLDL (31.90) and LDL (96.96) of ischemic stroke were higher than Haemorrhagic Stroke, whose mean values of Total Cholesterol (159.56),Triglycerides (157.14),VLDL (31.46 )and LDL( 88.88). The mean Systolic (161.28) and Diastolic BP (97.84) of Haemorrhagic stroke was higher than Ischemic stroke mean Systolic BP (135.60) and Diastolic BP (81.48) and the P value was <0.05, which is statistically significant. The mean age of Haemorrhagic stroke (58.08 ) was higher than mean ischemic Stroke (53.02) and the P value was <0.05, which is statistically significant. The mean random blood sugar of ischemic stroke (150.58) was higher than Haemorrhagic Stroke (133.72). Conclusion: HDL is used as an early predictor of atherosclerosis and ischemic stroke. By measuring the HDL earlier, early intervention measures by pharmaceutical means or by dietary means can be done to increase the HDL level to decrease the morbidity and mortality of stroke.

Background: Complex surgical wounds pose significant challenges in postoperative care due to delayed healing, infection risks, and prolonged hospital stays. Negative Pressure Wound Therapy (NPWT) has emerged as a promising modality that accelerates wound healing by promoting granulation tissue formation, enhancing perfusion, and reducing edema. This study aims to evaluate the clinical effectiveness of NPWT compared to conventional wound management techniques in patients with complex surgical wounds. Materials and Methods: A prospective study was conducted on 60 patients with complex surgical wounds, randomly divided into two groups: Group A received NPWT, and Group B underwent conventional dressing. Parameters assessed included wound size reduction, duration to complete granulation, infection rate, and patient satisfaction. The treatment duration was 21 days with evaluations conducted at baseline, Day 7, Day 14, and Day 21. Results: Group A (NPWT) showed a significantly greater reduction in wound size (average 65%) compared to Group B (35%) by Day 21 (p < 0.01). Complete granulation was achieved in 80% of NPWT patients versus 45% in the control group. Infection rates were lower in the NPWT group (10%) compared to the control group (30%). Additionally, patient-reported satisfaction scores were higher in Group A (mean 8.4/10) than in Group B (mean 6.1/10). Conclusion: Negative Pressure Wound Therapy is an effective and reliable method for managing complex surgical wounds. It significantly enhances wound healing, reduces infection rates, and improves patient satisfaction when compared to traditional dressing techniques

Background: Cesarean scar pregnancy (CSP) is a rare but potentially life-threatening condition characterized by the implantation of a gestational sac within the scar of a previous cesarean section. Management strategies vary, ranging from conservative medical approaches to surgical interventions. This prospective observational study aimed to evaluate the efficacy and safety of different treatment modalities for CSP over a one-year period at Lala Ded Hospital, GMC Srinagar. Methods: Patients diagnosed with CSP between Feb 2023 and January 2024 were included. Demographic data, medical histories, beta-human chorionic gonadotropin (beta-hCG) levels, and ultrasound findings were collected. Treatment modalities included medical management with methotrexate (MTX) and surgical interventions such as dilation and curettage (D&C) or laparotomy. Outcome measures included treatment success rates, complication rates, and hospital stay duration. Results: A total of 45 patients were included with 35.6% of patients treated with systemic methotrexate, 48.9% underwent dilation and curettage (D&C), and 15.6% were treated with laprotomy. Medical management with MTX showed a 31.3%  success rate, while surgical interventions demonstrated a 93.1% success rate, indicating a statistically significant difference (p < 0.001). Complications occurred more frequently with medical management (68.8%) compared to surgery (6.9%). Surgical treatment was associated with a significantly shorter hospital stay (4.2 days vs. 8.7 days, p < 0.001). Conclusion: Surgical interventions, including D&C and laparotomy, showed superior efficacy and safety profiles compared to medical management with MTX for CSP. 

Background and Aim: Preoperative anxiety in children can complicate anesthetic induction. This study compares intranasal dexmedetomidine and intranasal ketamine as premedicants in pediatric surgical patients. Material and Methods: 66 pediatric patients (ASA I and II, aged 2–10) undergoing elective surgery were randomized to receive either intranasal dexmedetomidine (1 µg/kg) or intranasal ketamine (5 mg/kg). Sedation level, ease of parental separation, IV cannula acceptance, hemodynamic parameters, and side effects were recorded. Results: Dexmedetomidine showed better sedation scores and smoother parental separation, while ketamine had quicker onset but more side effects. Conclusion: Intranasal dexmedetomidine provides effective premedication with fewer side effects, while ketamine ensures faster onset.

Pulmonary arterial hypertension (PAH) is a rare and progressive condition characterized by elevated blood pressure in the pulmonary arteries, often presenting with symptoms such as dyspnea, fatigue, and chest pain, particularly during exertion. This case report details a 37-year-old male patient with a history of kyphoscoliosis, who was referred for evaluation due to worsening breathlessness, anxiety, and abdominal distention over the past year. Clinical examination revealed significant cyanosis and respiratory distress, with imaging studies confirming PAH indicated by dilated pulmonary arteries and an enlarged cardiac silhouette. The patient's complex presentation also included mild hepatic changes and the identification of Pseudomonas aeruginosa, suggesting possible infection. This case underscores the challenges in diagnosing PAH, particularly in patients with multifactorial health issues. It emphasizes the necessity for comprehensive evaluations, including imaging and hemodynamic assessments, to facilitate timely and accurate diagnosis. A multidisciplinary approach to management is crucial for improving patient outcomes, highlighting the importance of early recognition and individualized treatment strategies to enhance quality of life in PAH patients.

Background:  Cesarean Scar Pregnancy (CSP) is a rare form of ectopic pregnancy where the embryo implants within the scar of a previous cesarean section. Effective management is crucial to prevent severe complications, including uterine rupture and life-threatening hemorrhage. This study aimed to compare the clinical outcomes of medical versus surgical management of CSP in a randomized controlled trial. Materials and Methods: A total of 60 patients diagnosed with Cesarean Scar Pregnancy were randomly allocated into two groups: Medical Management (n = 30) and Surgical Management (n = 30). The medical group received intramuscular methotrexate (MTX) at a dose of 50 mg/m², followed by serial monitoring of β-hCG levels until normalization. The surgical group underwent hysteroscopic resection of the gestational sac. Primary outcomes assessed included treatment success rate, time to β-hCG normalization, blood loss, hospital stay duration, and complication rates. Data were analyzed using appropriate statistical methods, with significance set at p < 0.05. Results: The treatment success rate was significantly higher in the Surgical Management group (93.3%) compared to the Medical Management group (76.7%) (p = 0.04). The mean time to β-hCG normalization was shorter in the surgical group (28.3 ± 5.2 days) compared to the medical group (45.7 ± 7.4 days) (p < 0.001). Blood loss was notably higher in the surgical group (210 ± 50 mL) compared to the medical group (120 ± 35 mL) (p = 0.02). However, hospital stay duration was shorter in the surgical group (2.1 ± 0.6 days) compared to the medical group (4.5 ± 1.2 days) (p < 0.001). Complication rates were higher in the medical group (20%) than in the surgical group (10%). Conclusion: Surgical management of Cesarean Scar Pregnancy offers a higher success rate and faster resolution compared to medical management, though it is associated with higher blood loss. Medical management remains a viable alternative for patients contraindicated for surgery or seeking conservative treatment. Further studies with larger samples are warranted to confirm these findings.

Vitamin D has emerged as a potential modulator of cardiovascular health. Epidemiological studies link vitamin D insufficiency with higher risks of hypertension and cardiovascular disease (CVD) events. Receptors of Vitamin D are expressed in cardiac and vascular tissues and severe deficiency of vitamin D is reported worldwide. However, does vitamin D play a causal protective role in cardiovascular health remains under debate, given inconsistent trial results. This review details the physiological role of Vitamin D in cardiovascular health which includes its role in the renin-angiotensin-aldosterone system (RAAS), vascular endothelial health, inflammation and oxidative stress, vascular calcification, disease risk in deficiencies and supplementation. In summary, vitamin D shows biological plausibility and modest signals of benefit for cardiovascular health, but robust evidence for routine supplementation to prevent heart disease or improve vascular outcomes is still lacking.

Background: Total knee arthroplasty (TKA) is commonly done for osteoarthritis which can produce severe postoperative pain and hamper postoperative rehabilitation. This study aimed to evaluate the pain relief and functional benefit of intraoperative periarticular cocktail infiltration. Methods: This was a single-center prospective randomized controlled, double-blind, clinical analysis comparing 15 patients each receiving intraoperative either analgesia cocktail or saline during TKA. Group A received periarticular cocktail infiltration and group B received saline injection. Patients were assessed for pain in terms of visual analog scale (VAS) score, postoperative analgesia requirement, and knee range of motion. Results: Patients in Group A have significantly less VAS Score than the group B during the post operative days and 3 months following discharge. Similarly at 3 months after follow up in patients in Group A showed reduced consumption of NSAIDS. At the end of 3 months, both the groups had similar degrees of range of motion. Conclusion: Use of periarticular cocktail injection is an effective modality to achieve better pain relief in early post-operative period. Though the benefits are not long lived, but its superior effects can be utilized for early functional recovery after TKA and improved patient rehabilitation

Introduction: The cardiac manifestations of OPs poisoning occur in a majority of affected patients and may range from harmless electrocardiographic (ECG) changes such as sinus tachycardia, to life-threatening complications such as cardiogenic pulmonary edema. Present study was conducted to estimate the cardiovascular complications and in hospital outcomes in patients of organophosphorus compound poisoning in tertiary care hospital. Material and Methods: Present study was prospective, observational study, conducted in patients of more 18 years, presenting with history of exposure to and signs and symptoms of organophosphorus compound poisoning. Results: Majority of patients fall within the 21-40 years age group (50.7 %), were male (85.3%) & chlorpyrifos is the most commonly consumed compound (38 %). Most common symptom was excessive salivation (75.3 %), followed by sweating (66.0%), lacrimation (55.3%), vomiting (22.7%). At admission, the majority (74.6%) had normal sinus rhythm. However, 20.6 % had sinus tachycardia, while smaller proportions experienced sinus bradycardia (0.6 %), ST depression (3.3%), and ST elevation (0.7%). During hospitalization common ECG changes were QTC prolongation (6 %). ventricular premature beats (3.3%), ST depression (2.7%), and first-degree heart block (1.3%). 2D echo findings shows that 39.3% had normal findings, while 6.7% had global left ventricular (LV) hypokinesia and 1.3% had anterior wall hypokinesia. Cardiovascular complications reveals that 20.7% of patients experienced sinus tachycardia. Hypotension (8.0%), cardiac failure (6.7%), and type 2 myocardial infarction (6.0%) were also notable. Other complications such as QTC prolongation (5.3%) and sinus bradycardia (0.7%) were less common. The association of cardiac failure hypertension and STEMI are statistically significant with level of serum cholinesterase. The association of hypotension VPCs and type 2 MI are statistically significant with Peradeniya score. Conclusion: The findings from this study underscore the need for early recognition and aggressive management of cardiovascular symptoms in patients of organophosphorus compound poisoning.

Background: The most common significant health concern during pregnancy is hypertension, which remains a vital factor in both maternal and fetal morbidity and mortality. Preeclampsia is a pregnancy-related hypertensive disorder that occurs after twenty weeks of gestation and involves multiple systems.

Objectives:

1) To study maternal outcome in severe pre- eclampsia & eclampsia.

2) To study perinatal outcome in severe pre- eclampsia & eclampsia.

3) To enumerate variable factors associated with maternal and perinatal morbidity and mortality.

Material & Methods: Study Design:  Prospective Observational Study.  Study area: Department of Obstetrics & Gynecology, GGH, GMC, KADAPA.  Study Period: 1 year. (March 2023 – April 2024). Study population: 100 Pregnant women admitted with severe PE and eclampsia. Sample size: Study consisted a total of 100 subjects. Sampling Technique:  Convenience Sampling technique. Results: In this study 22% of cases had no proteinuria, 25 % of the cases had trace amounts of protein in urine, among them only 2% developed HELLP. Among 77% of the cases with proteinuria, 13% developed HELLP and there was significant association between proteinuria and HELLP i.e as severity of proteinuria increases chances of HELLP increases. Conclusion: Severe preeclampsia leads to higher risks of life-threatening complications, preterm delivery, and IUGR, with maternal mortality observed in multigravida cases. Early detection and proper management, including evidence-based protocols, are crucial to reducing morbidity and mortality. Effective secondary and tertiary prevention improves outcomes for both mother and neonate.

Background: Vitamin D is essential for calcium balance and immunity, and is linked to infections and sepsis-related mortality. Limited data exists on its impact on pediatric sepsis in India. This study investigates the relationship between Vitamin D status and outcomes in children with sepsis at Gulbarga Institute of Medical Sciences, Kalaburagi. Methods: A six-month prospective observational study included 40 children aged 1 month to 18 years with sepsis. Data on health history, illness duration, sunlight exposure, and supplement intake were collected. Serum vitamin D levels were measured within 24 hours of PICU admission. Outcomes were measured as hospital stay duration, ventilator support duration, and mortality. Results: Age positively correlated with Vitamin D levels (P<0.01), but no gender differences were found. Height, weight, BMI, and waist circumference positively correlated with Vitamin D levels (P<0.05). Negative correlations were observed between Vitamin D levels and heart rate, temperature, and ESR (P<0.05), while platelet count had a positive correlation (P<0.01). Sufficient Vitamin D levels were associated with shorter hospital and ventilator stays (P<0.05). Conclusion: Assessing and addressing Vitamin D deficiency in septic children may improve clinical outcomes, especially in vulnerable infants. Larger studies are needed to establish definitive evidence.

Background: Face being the most exposed, area of body ,present early to clinician for getting evaluated. As FNAC is a non-scarring simple, OPD based, sensitive technique for evaluating these easily assessable sites, is the first investigation of choice. Quick reporting help to relieve patient anxiety. This study is aimed to tell reliability and utility of FNAC in case of face lesions.  Material and Methods: FNAC was performed in face lesion presenting in one year duration along with clinical and radiological details. The cytology reports were correlated with histopathology and immunohistochemistry in difficult cases.  Result: Toal 15 face lesions including forehead, facial bones, eye, lacrimal gland, nose, cheek, lips and salivary gland were studied. Majority were female with peak age 45 years. Lesions varied from inflammatory cystic lesions, benign and malignant. Lesions included 4 epidermal cyst,1 sialoadenitis,5 pleomorphic adenoma, 2 squamous cell carcinoma,1 solitary fibrous tumor,1giant cell tumor of mandible and 1 case of metastasis of follicular carcinoma thyroid in facial bone and orbit.

Background: Rapid assessment of stroke severity is critical in emergency settings to guide timely management. The National Institutes of Health Stroke Scale (NIHSS) is widely used, but its diagnostic limitations—particularly in detecting non-dominant hemisphere syndromes and aphasia—warrant evaluation against alternative tools such as the Scandinavian Stroke Scale (SSS). Objectives: To compare the diagnostic accuracy of the NIHSS and SSS in assessing early stroke severity among adult patients presenting to the emergency medicine department, using CT brain imaging as the reference standard. Methods: This cross-sectional analytical study was conducted at the Emergency Medicine Department of Bharati Hospital, Pune, over a one-year period (January 2024–January 2025). Adults (≥18 years) with suspected ischemic stroke were assessed using both NIHSS and SSS at presentation. Stroke severity was categorized into mild, moderate, and severe for each scale. CT imaging served as the reference standard. Sensitivity, specificity, and positive predictive value (PPV) were calculated for each scale. Results: A total of 306 patients were included. The NIHSS classified 39.5% as mild, 40.5% moderate, and 19.9% severe, while SSS categorized 38.2% as mild, 40.8% moderate, and 20.9% severe. Cohen’s Kappa between the two scales was 0.567, indicating moderate agreement. In patients with classifiable CT findings (n = 13), SSS showed higher sensitivity (62.5%) and PPV (83.3%) compared to NIHSS (sensitivity 37.5%, PPV 75.0%). Both tools had equal specificity (80.0%). Conclusions: While NIHSS and SSS are both effective in early stroke severity assessment, the SSS demonstrated greater sensitivity and predictive value when compared to CT imaging. These findings suggest that SSS may offer a more sensitive alternative for early stroke triage in emergency settings