European Journal of Cardiovascular Medicine

Introduction: Premedication in paediatric anaesthesia aims to reduce anxiety, facilitate parental separation, and achieve smooth induction. Dexmedetomidine, an α2‑adrenergic agonist, is used for its sedative and anxiolytic effects without significant respiratory depression. Intranasal administration is simple and well‑accepted in children. Objective: To evaluate the efficacy and safety of intranasal dexmedetomidine spray for premedication in paediatric patients undergoing elective surgeries. Methods: A prospective observational study was carried out with 30 children who received 2 mcg/kg dexmedetomidine intranasally as spray using a mucosal atomization device. Sedation was assessed at 5‑minute intervals up to 30 minutes using the University of Michigan Sedation Scale (UMSS). Hemodynamic parameters (heart rate and SpO₂) were recorded. Results: Onset of sedation was rapid with spray administration. By 25 minutes, 73.33 % achieved UMSS 4 (deep sedation). By 30 minutes, all achieved satisfactory sedation (UMSS ≥ 3), with 86.67 % at UMSS 4 and 13.33 % at UMSS 3. Heart rate showed a gradual, safe decline within physiological limits; oxygen saturation remained above 98 % throughout. No episodes of clinically significant bradycardia or desaturation were noted. Conclusion: Intranasal dexmedetomidine spray provides earlier and more consistent sedation while maintaining hemodynamic stability, making it a preferred premedication method in paediatric patients requiring timely procedural sedation.

Introduction: Emergency surgeries present heightened anesthetic risks due to limited preparation time, patient instability, and urgent decision-making. Despite technological and procedural advancements, critical incidents related to anesthesia in such settings remain inadequately characterized. Objective: To determine the incidence, nature, and contributing factors of anesthesia-related critical incidents during emergency surgeries in a tertiary care teaching hospital, and to propose strategies for improving patient safety. Methods: This prospective, descriptive study was conducted over a one-year period (June 2023–June 2024). All patients undergoing emergency surgical procedures were included. Critical incidents—defined as preventable events that could or did result in adverse outcomes—were reported voluntarily and anonymously by anesthesia providers using structured digital forms. Data were analyzed for demographic patterns, incident types, contributing factors, and patient outcomes. Results: Among 1,334 emergency surgery patients, 22 (1.64%) experienced critical incidents. The majority were young adults aged 19–30 years (63.6%) and female (72.7%), with obstetric and gynecological surgeries accounting for 54.5% of cases. Spinal anesthesia was the most commonly associated technique (50%), and most incidents (77.3%) occurred during anesthetic administration. Human factors were the predominant cause (81.8%), primarily due to lack of skill (54.5%). Cardiovascular (18.2%), airway (13.6%), drug-related (13.6%), and regional anesthesia-related complications were frequently observed. While 63.6% of affected patients experienced no serious complications, 18.2% had prolonged procedures and 18.2% experienced delayed or difficult recovery. Conclusion: Anesthesia-related critical incidents in emergency surgeries, although infrequent, are clinically significant and largely attributable to human factors—particularly lack of technical skill and vigilance. These findings underscore the need for enhanced training, simulation-based education, protocol-driven practices, and a non-punitive incident reporting culture to improve anesthetic safety in emergency settings.

Introduction: Whipple’s surgery (pancreaticoduodenectomy), although a standardized procedure is frequently associated with high postoperative morbidity, primarily due to infectious complications. Biliary contamination, especially in patients with preoperative biliary stenting, is a known risk factor. This study evaluates the microbiological profile of intraoperative bile cultures and their correlation with antibiotic usage and postoperative outcomes. Materials and Methods: This is a retrospective observational study, conducted at a tertiary care centre. It includes 65 patients who underwent Whipple’s surgery from 2022 to 2024. Data on demographics, biliary stenting, intraoperative bile cultures, antibiotic regimens, and 30-day postoperative complications was analyzed. A p-value < 0.05 was considered statistically significant. Results: Of 65 patients (35 males, 30 females; median age 55 ± 12.7 years), 26.1% had preoperative biliary stents. Bile culture positivity was significantly higher in stented patients (88.2%) than non-stented (54.1%) (p < 0.05). E. coli and Klebsiella were the predominant organisms. Cefoperazone-sulbactam was the most commonly used empirical antibiotic (83.1%). Postoperative complications occurred in 47.7% of patients, more frequently among those with positive bile cultures (53.7%) than those without (37.5%), though not statistically significant. Notably, complication rates were significantly lower with cefoperazone-sulbactam (38.9%) compared to piperacillin-tazobactam (90.9%) (p = 0.0024). Conclusion: Preoperative biliary stenting strongly correlates with bile colonization. Cefoperazone-sulbactam showed favorable empirical efficiency, with lower complication and escalation rates. These findings support its use as a cost-effective empirical agent in Indian settings, emphasizing the importance of tailoring antibiotic strategies to local microbiological patterns.

Background: Thyroid carcinoma represents the most common endocrine malignancy worldwide, with increasing incidence rates. Despite being relatively rare, accounting for approximately 1-2% of all malignancies, thyroid cancer poses significant diagnostic and therapeutic challenges. Objectives: To evaluate the clinical presentation, pathological distribution, diagnostic accuracy of fine needle aspiration cytology (FNAC), and surgical outcomes of thyroid carcinoma patients at a tertiary care center. Methods: A prospective observational study was conducted from September 2018 to June 2020, including 49 patients with confirmed thyroid carcinoma. Clinical presentation, FNAC results, histopathological findings, surgical procedures, and postoperative complications were analyzed. Statistical analysis included sensitivity, specificity, and predictive values of FNAC compared to histopathology. Results: The mean age was 42.3 years with female predominance (71.4%). Thyroid swelling was the predominant presentation (95.9%). Papillary carcinoma constituted 79.5% of cases, followed by follicular carcinoma (16.3%). FNAC demonstrated 73.5% sensitivity and 98.7% specificity. Total thyroidectomy was performed in 83.7% of patients. According to AMES criteria, 63.8% were classified as low-risk. Transient hypoparathyroidism occurred in 20.4% of cases. Stage I disease was most common (61.2%) per AJCC 2017 classification. Conclusions: Papillary carcinoma remains the predominant thyroid malignancy with excellent prognosis when diagnosed early. FNAC serves as a reliable initial diagnostic tool despite moderate sensitivity. Total thyroidectomy remains the preferred surgical approach with acceptable complication rates.

Background: Individual variations in response to antihypertensive therapy are partly influenced by genetic factors affecting drug metabolism. The CYP3A5 enzyme plays a key role in the biotransformation of amlodipine, a commonly prescribed calcium channel blocker. This study aimed to evaluate the effect of CYP3A5 genetic polymorphism on the antihypertensive response to amlodipine in patients with essential hypertension. Material and Methods: A prospective observational study was conducted among 120 newly diagnosed hypertensive patients aged 30–65 years. All participants received amlodipine (5–10 mg daily) for eight weeks. Genomic DNA was extracted and CYP3A5 (6986A>G) polymorphism was determined by PCR-RFLP. Participants were categorized as expressors (*1/*1 or *1/3) and non-expressors (*3/3). Blood pressure was recorded at baseline and after eight weeks. Data were analyzed using SPSS version 25, with p < 0.05 considered statistically significant. Results: Of the 120 subjects, 48 (40%) were expressors and 72 (60%) were non-expressors. Baseline characteristics were comparable between the two groups. The mean reduction in systolic and diastolic blood pressures was significantly greater in expressors (17.2 ± 6.3 mmHg and 13.2 ± 4.5 mmHg, respectively) than in non-expressors (13.9 ± 6.8 mmHg and 10.8 ± 4.9 mmHg; p = 0.02 and p = 0.01). Overall, 70.8% of patients were responders, with a higher response rate among expressors (81.3%) compared to non-expressors (63.9%; p = 0.04). Adverse effects, including pedal edema and headache, were mild and comparable between groups. Conclusion: CYP3A5 polymorphism significantly influences the antihypertensive efficacy of amlodipine. Expressor genotypes exhibit better blood pressure control, indicating the potential value of pharmacogenetic profiling in optimizing hypertension management

Background: Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a rare, benign, non-neoplastic vascular lesion characterized histologically by multiple angiomatoid nodules separated by sclerotic stroma. Owing to its nonspecific clinical and radiological features, preoperative diagnosis is challenging, and definitive identification requires histopathological evaluation. Case Presentation: We report the case of a 51-year-old female who presented with abdominal pain of eight days’ duration. Contrast-enhanced computed tomography (CECT) of the abdomen incidentally revealed a primary vascular lesion of the spleen. The patient underwent laparoscopic splenectomy, and the excised specimen was submitted for histopathological examination. Grossly, the spleen showed a well-circumscribed, solitary, gray-white solid mass with peripheral hemangioma-like nodular areas, distinctly demarcated from the surrounding normal splenic parenchyma. Microscopically, the lesion comprised variably sized angiomatoid nodules and concentric sclerotic areas separated by dense fibrosclerotic stroma with mixed inflammatory infiltrates. Conclusion: Due to the absence of pathognomonic clinical or imaging findings, SANT remains a diagnostic challenge. Histopathological assessment is essential for confirmation. Correlation with previously reported cases in the literature supported the final diagnosis of sclerosing angiomatoid nodular transformation of the spleen

Background: Pneumonia remains a leading cause of childhood morbidity and mortality worldwide, particularly in low- and middle-income countries where access to advanced diagnostics is limited. Chest radiography (CXR) is the traditional imaging standard but is limited by radiation exposure, interpretive variability, and low negative predictive value. Lung ultrasound (LUS) offers a radiation-free, portable, and reliable alternative. This study evaluates the diagnostic accuracy of LUS compared to CXR in detecting community-acquired pneumonia (CAP) and related complications in children. Methods: A hospital-based prospective observational study was conducted between January 2023 and December 2024 at PGIMER & Capital Hospital, Bhubaneswar. A total of 136 children (1 month–14 years) diagnosed with CAP using IMNCI/ICMR criteria underwent both CXR and LUS. LUS findings assessed included increased B-lines, shred sign, and anechoic collections. Diagnostic parameters—sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC)—were calculated using CXR as the reference standard. Results: LUS demonstrated a sensitivity of 79.3%, specificity of 80%, and PPV of 95.8% for detecting lung pathology. Increased B-lines alone showed high specificity (78.6%) and PPV (88.9%) but low sensitivity (44.4%). The shred sign was highly specific (92.9%) but less sensitive (22.2%). Using either shred sign or increased B-lines improved sensitivity to 81.5% with an AUC of 0.80 (p<0.05). For pleural effusion, LUS achieved 100% sensitivity, 93.2% specificity, and 100% NPV, outperforming CXR in detecting small effusions. Conclusion: LUS is a highly effective, radiation-free imaging modality for diagnosing pediatric CAP, particularly for detecting consolidation and pleural effusion. Combining LUS features improves diagnostic sensitivity without compromising specificity. Given its portability, safety, and diagnostic accuracy, LUS should be considered a first-line imaging tool for pediatric pneumonia, especially in resource-limited settings.

Introduction: Thyroid nodules are a common endocrine presentation requiring accurate differentiation between benign and malignant lesions. The Thyroid Imaging Reporting and Data System (TIRADS) provides a structured ultrasound-based malignancy risk assessment, whereas serum thyroglobulin (Tg) serves as a biochemical marker reflecting follicular activity. Correlating these modalities with cytology may enhance preoperative diagnostic reliability. Aim: To compare the TIRADS scoring system with serum thyroglobulin levels in the cytological diagnosis of thyroid lesions. Methods: A cross-sectional study was conducted among 50 patients presenting with thyroid nodules at Shri Atal Bihari Vajpayee Medical College and Research Institute, Bengaluru. All patients underwent ultrasound-based TIRADS classification, fine-needle aspiration cytology (FNAC) using the Bethesda system, and serum Tg estimation by chemiluminescent immunoassay (Beckman Coulter Access 2). Data were analyzed using SPSS v21; ANOVA, chi-square, and ROC analyses determined associations and diagnostic performance. Results: Mean age was 42.7 ± 13.4 years, with females comprising 66 %. Distribution across TIRADS categories was TR2 (12 %), TR3 (34 %), TR4 (26 %), and TR5 (28 %). Mean serum Tg rose significantly with higher TIRADS grades (24.7 → 142.6 ng/mL, p < 0.001; η² = 0.55). Cytological diagnosis correlated strongly with both TIRADS (χ² = 16.04, p = 0.001) and Tg (ANOVA F = 13.91, p < 0.001). Mean Tg levels differed markedly between benign (45.3 ± 27.1 ng/mL) and malignant (138.9 ± 70.8 ng/mL) lesions (p < 0.001; AUC = 0.84). Integration of TIRADS, cytology, and Tg improved diagnostic accuracy to AUC = 0.91, surpassing cytology alone (ΔAUC = +0.09; p = 0.028). Conclusion: Serum thyroglobulin levels exhibit a significant positive correlation with increasing TIRADS category and cytological suspicion. The combined use of TIRADS scoring, cytology, and Tg estimation provides superior diagnostic precision for thyroid lesion assessment, offering a reliable, cost-effective triad for preoperative evaluation

Background: Surgical site infections (SSIs) remain one of the most common healthcare-associated infections worldwide, contributing to increased morbidity, prolonged hospital stay, and healthcare costs. Continuous surveillance and root cause analysis are vital to identify modifiable risk factors and improve surgical outcomes. Aim: To study the incidence, microbial profile, and risk factors associated with surgical site infections in a tertiary care hospital over a one-year period. Materials and Methods: A prospective observational surveillance study was conducted from June 2024 to June 2025 among patients undergoing elective and emergency surgeries in Orthopaedics, Obstetrics & Gynaecology, and General Surgery departments. Data on demographic, clinical, procedural, and environmental factors were collected. Microbiological cultures were performed, and results analysed using descriptive statistics and chi-square tests. Results: A total of 17 SSI cases were recorded. The mean age of affected patients was 54.4 ± 22.5 years, with females comprising 70.6%. Diabetes mellitus (47.1%), delayed surgical antimicrobial prophylaxis (>2 hrs before incision), and lack of HEPA filtration were significant risk factors (p < 0.05). The most common organisms isolated were Staphylococcus aureus (including MRSA) and Escherichia coli. Implementation of corrective and preventive actions led to improved compliance with infection control measures. Conclusion: SSIs are preventable through strict adherence to aseptic protocols, timely antimicrobial prophylaxis, and maintenance of operating theatre sterility. Regular surveillance, staff sensitization, and infrastructural improvements such as HEPA filtration and proper CSSD practices can markedly reduce SSI incidence.

Peripartum cardiomyopathy (PPCM) is an uncommon but life-threatening condition that occurs in the peripartum period, affecting 1 in 1,000 to 1 in 4,000 live births worldwide, with regional variation [1]. Defined by the European Society of Cardiology (ESC) as an idiopathic cardiomyopathy with reduced left ventricular ejection fraction (LVEF <45%) developing toward the end of pregnancy or in the months following delivery, PPCM remains underdiagnosed due to its nonspecific symptoms [2].

Background: Blunt abdominal trauma (BAT) is a major cause of morbidity and mortality, requiring rapid and accurate diagnosis. Imaging plays a central role, with ultrasonography (US) widely available as a first-line tool and computed tomography (CT) regarded as the gold standard. Aim: To compare the diagnostic performance of plain radiography, ultrasonography, and computed tomography in the evaluation of blunt abdominal trauma. Materials and Methods: A prospective study of 31 hemodynamically stable patients with suspected BAT was conducted between June  2022 and June 2024 at Arundathi Institute of Medical Sciences in radiology department. All patients underwent plain X-ray, Ultrasound, and CT.  Organ injuries were staged according to the Organ Injury Scaling (OIS) system. Diagnostic accuracy of each modality was correlated with operative findings and clinical outcomes. Results: X-ray Detected free air/fluid in 2 cases; sensitivity 33%, specificity 100%, accuracy 60%.US: Detected hemoperitoneum in 26 cases; sensitivity 96%, specificity 100%, accuracy 96% overall. CT Positive in all patients; sensitivity, specificity, and accuracy 100%.CT provided additional findings in 48% of cases and was decisive in 12.9% for management planning. Of 31 patients, 20 (64.5%) underwent laparotomy, with a non-therapeutic rate of 8.3%. Eleven patients (35.4%) were managed conservatively, and there were no deaths. Conclusions: Plain X-ray has a limited role in BAT evaluation. US is a reliable initial modality, but CT remains indispensable for precise delineation of injury, excluding missed lesions, and guiding management. While hemoperitoneum grading reflects severity, the choice between surgical and conservative treatment is primarily determined by hemodynamic status

Background: Cutaneous adverse drug reactions (CADRs) are a frequent complication in patients undergoing anti-tubercular therapy (ATT) often leading to therapy interruption. This study investigates the prevalence, clinical patterns and associated risk factors for CADRs among hospitalized TB patients receiving ATT. Methods: This prospective observational study was conducted in the Department of Respiratory Medicine and the Department of Dermatology, Venereology and Leprosy (DVL) in Government Medical College and Hospital, Nizamabad. It included 50 hospitalized TB patients who developed CADRs during ATT course.  Data on demographics, clinical manifestations and implicated medications were collected and analyzed using descriptive statistics. Results: Among the 50 patients studied (23 males and 27 females; mean age-50 years), 60% had pulmonary TB and 40% had extra-pulmonary TB. The primary drugs implicated were ethambutol (46%), pyrazinamide (20%), and isoniazid (18%). The most common dermatological presentation was maculopapular rash (42%), followed by urticarial rash (18%) and lichenoid eruptions (12%). Severe reactions included DRESS syndrome (26%), exfoliative dermatitis (12%), and AGEP (8%). Systemic involvement included eosinophilia in 80% of cases, transient hepatitis in 38%, and renal dysfunction in 8%. Conclusion: CADRs are a notable concern in ATT regimens. Early detection, risk stratification and individualized therapy are essential to ensure treatment adherence and minimize complications. Older age and polypharmacy appear to elevate CADR risk.

Background: Hypertensive disorders of pregnancy, particularly pre-eclampsia, remain one of the leading causes of maternal and perinatal morbidity and mortality worldwide. Early identification of high-risk women allows timely interventions and improved pregnancy outcomes. Uterine artery Doppler ultrasonography, being a non-invasive technique, offers potential in predicting the development of pre-eclampsia by assessing uteroplacental circulation. Objectives: To determine the role of uterine artery Doppler in predicting pre-eclampsia in high-risk pregnant women and to evaluate its sensitivity, specificity, and predictive accuracy. Methods: A prospective observational study was conducted at the Department of Obstetrics and Gynaecology, Government Maternity Hospital, Tirupati, from January to December 2023. Eighty-seven antenatal women aged 18–38 years with high-risk factors such as advanced maternal age, obesity, diabetes, chronic hypertension, previous pre-eclampsia, or multifetal gestation were included after obtaining informed consent. Uterine artery Doppler studies were performed using a Toshiba Nemio 30 colour Doppler to assess resistance index (RI) and presence of diastolic notches. Women were followed throughout pregnancy for the development of pre-eclampsia, defined as blood pressure ≥140/90 mmHg with proteinuria after 20 weeks of gestation. Data were analyzed using SPSS v23.0, and statistical significance was considered at p < 0.05. Results: Out of 87 participants, 15 (17.2%) developed pre-eclampsia. Abnormal Doppler findings were noted in 16 women (18.39%), of whom 12 (75%) subsequently developed pre-eclampsia. Among Doppler abnormalities, unilateral RI >0.58 was most common (33.3%), followed by bilateral RI >0.58 (20%) and bilateral uterine artery notching (13.3%). The test demonstrated a sensitivity of 80%, specificity of 94.4%, positive predictive value of 75%, negative predictive value of 95.8%, and an overall diagnostic accuracy of 91.9%. Higher maternal age, obesity (BMI >30 kg/m²), previous history of pre-eclampsia, and comorbidities such as gestational diabetes mellitus were significantly associated with increased risk. Conclusion: Uterine artery Doppler ultrasonography is a reliable, non-invasive screening tool for predicting pre-eclampsia in high-risk pregnancies. An RI >0.58 and the presence of persistent diastolic notching are significant predictors of disease development. Incorporating uterine artery Doppler screening into routine antenatal assessment, especially for high-risk women, can facilitate early intervention, reduce maternal and perinatal complications, and improve pregnancy outcomes.

Background: Heart failure (HF) phenotyping by left ventricular ejection fraction (LVEF) guides management, yet data on the intermediate HFmrEF category (LVEF 41–49%) are limited in South Asia. Understanding HFmrEF prevalence, demographics, and etiology is critical for targeted therapy.  Objective: To determine the prevalence of HFmrEF among patients with acute decompensated heart failure at a tertiary care center in Southern IndiaMethods: In this hospital‐based cross-sectional study, 230 consecutive ADHF patients ≥18 years were enrolled at a tertiary care center from March 2021 to April 2022. HF was confirmed by Framingham criteria. Transthoracic echocardiography measured LVEF via Simpson’s biplane method, stratifying into HFrEF (<40%), HFmrEF (41–49%), and HFpEF (≥50%). Baseline demographics, symptoms, comorbidities, and risk factors were recorded. Descriptive statistics summarized results, and chi-square tests compared categorical variables with significance set at p<0.05. Results: HFrEF comprised 46.5% (n=107), HFmrEF 25.7% (n=59), and HFpEF 27.8% (n=64). HFmrEF patients had mean age 59 ± 14 years, 76.3% male, with dyspnea in 93.2% and NYHA class II in 78.0%. Ischemic heart disease was predominant in HFmrEF (74.6%), with AWMI in 39.0%. Hypertension and diabetes were present in 62.7% and 45.8%, respectively. HFmrEF exhibited significantly higher IHD than HFpEF (74.6% vs. 42.2%; p=0.01). Electrocardiographic LVH occurred in 18.7% (p=0.033), LAD wall motion abnormalities in 37.8% (p<0.001), and valvular disease in 12.5% (p=0.006). Conclusion: HFmrEF represents one-quarter of ADHF admissions, primarily in middle‐aged men with high ischemic burden, distinguishing it from HFpEF and aligning it more closely with HFrEF. These findings support ejection fraction–based phenotyping for tailored therapeutic strategies.

Background: Heart failure with mildly reduced ejection fraction (HFmrEF) occupies an intermediate position between HFrEF and HFpEF, yet longitudinal outcome data remain limited, particularly in South Asian populations. This study evaluated one-year mortality, rehospitalization, and left ventricular ejection fraction (LVEF) trajectory in HFmrEF patients. Objective: To evaluate one-year mortality and rehospitalization rates in patients with HFmrEF Methods: The present prospective observational study enrolled 59 patients with HFmrEF (LVEF 41-49%) presenting with acute decompensated heart failure at a tertiary care center. Patients underwent comprehensive baseline evaluation and standardized follow-up at 6 and 12 months. Primary endpoints included all-cause and cardiovascular mortality, rehospitalization rates, and major adverse cardiovascular events (MACE). Secondary endpoints assessed LVEF trajectory and transition patterns. Results: At one year, 8 patients (13.6%) died from any cause, including 6 (10.2%) cardiovascular deaths. Rehospitalization occurred in 31 patients (52.5%), with 18 (30.5%) readmitted for heart failure. Composite MACE affected 31 patients (52.5%), comprising ischemic events (11.9%), stroke (6.8%), and ventricular tachycardia (3.4%). Regarding LVEF trajectory, 18 patients (30.5%) deteriorated to HFrEF, 27 (45.8%) remained stable within HFmrEF range, and 14 (23.7%) improved to HFpEF. Cardiac mortality concentrated between 4-8 months, with ischemic events causing 50% of cardiovascular deaths. Conclusion: HFmrEF carries substantial one-year morbidity and mortality with high MACE rates and significant LVEF transitions. Early cardiac mortality clustering and predominant ischemic etiology emphasize the need for aggressive management, vigilant surveillance, and HFrEF-aligned therapeutic strategies to optimize outcomes in this intermediate phenotype

Introduction: Oral cavity squamous cell carcinoma (OCSCC) remains a prevalent and aggressive malignancy, particularly in South Asian populations. Tumor stage and cervical nodal involvement are key determinants of prognosis, yet the lymph node ratio (LNR)-the ratio of metastatic to total lymph nodes-has recently emerged as a more precise indicator of tumor burden. This study aimed to determine the association between tumor stage and LNR in oral cavity malignancies. Methods: A retrospective analytical study was conducted in the Department of Surgical Oncology, VTSM Peripheral Cancer Centre, Kalaburagi, from 2022 to 2024. A total of 200 histopathologically confirmed cases of oral cavity squamous cell carcinoma were analyzed. LNR was calculated as the ratio of positive lymph nodes to total nodes retrieved. Tumors were staged using the AJCC 8th edition criteria. Statistical analysis included Welch’s t-test, chi-square tests, and Spearman’s correlation. Results: Of 200 patients, 109 (54.5%) had early-stage (T1-T2) and 91 (45.5%) had advanced-stage (T3-T4) tumors. Mean LNR was significantly higher in advanced stages (0.186 ± 0.107) than in early stages (0.082 ± 0.058), with a mean difference of +0.104 (95% CI 0.079-0.129; p < 0.001). A high LNR (≥0.12) was observed in 54.9% of advanced-stage cases versus 30.3% of early-stage cases (RR 1.81; p < 0.001). A strong positive correlation existed between T stage and LNR (Spearman ρ = 0.47; p < 0.001). High LNR was significantly associated with extranodal extension (OR 2.93; p = 0.00085) and nodal positivity (RR 1.62; p < 0.001). Conclusion: Lymph node ratio increases significantly with advancing tumor stage and correlates with adverse pathological features. LNR serves as a valuable prognostic adjunct to conventional TNM staging, offering improved risk stratification for postoperative management in oral cavity carcinoma.

Background: With the rising burden of coronary artery disease (CAD) in India, percutaneous coronary intervention (PCI) using multiple stents has become increasingly common in complex cases. However, data on outcomes for patients receiving ≥3 stents remain limited. Objective: To evaluate the Clinico-demographic and angiographic profile and assess short-term procedural outcomes in patients undergoing PCI with three or more coronary stents. Methods: A mixed-design cohort study was conducted at a tertiary center including 134 patients undergoing PCI with ≥3 stents. Data on demographics, clinical presentation, lesion characteristics, and procedural outcomes were analyzed. Results: Of 134 patients, 74% were male. Most were between 41–70 years (77%). TVD (46%) was the most common angiographic pattern. Type B (43%) and Type A (37%) lesions predominated. In-hospital complications were negligible; at 3 months, mortality was 1.49%, and angina occurred in 8.96%. Conclusion: PCI with ≥3 stents is safe and effective with favourable short-term outcomes in complex CAD. Long-term follow-up is warranted for definitive conclusions.

Background: Subarachnoid block (SAB) with hyperbaric bupivacaine is routinely administered for abdominal surgeries. Intravenously administered dexmedetomidine has been shown to prolong the duration of sensory and motor blockade obtained with subarachnoid block. Aim of the study was to assess the efficacy of Intravenous Dexmedetomidine on Spinal anaesthesia. Materials and methods: Prospective Randomized Double-blind Placebo-Controlled Study in the department of Anaesthesia at  Khaja Banda Nawaz Teaching and General hospital Kalaburagi  for duration of 18 months ie from (Dec 2019 to  30 may 2021) among  patientsaged between 18-55 years, ASA grade I and II posted for elective lower abdominal surgeries under spinal anaesthesia The patients divided into 2 groups , Group D (study group) patients  received single bolus dose of 0.5mcg/kg of intravenous Dexmedetomidine Diluted upto 10ml with normal saline slowly over 10 minutes and Group C (control group) patients  received 10ml of normal saline Intravenously slowly over 10 minutes.   Results: Mean age of 34.23 ± 8.481 years in Group D and Group C constituting 38% with 33.51 ± 8.375 years. The number of subjects requiring rescue analgesia in Group D (n=22) at 4 hours was significantly lower than C group (n=40) (p=<0.05) and higher requirement seen in Group D at 6^th hour compared to NS group (n= 20, n=0 respectively) which was statistically significant (p<0.05) Conclusion: we conclude that with spinal anaesthesia intravenous dexmedetomidine was efficient in reducing postoperative pain, and prolonging the time to the requirement of first rescue analgesia.

Background: Hypertension is one of the most prevalent non-communicable diseases in India and a leading cause of cardiovascular morbidity and mortality. Despite the availability of effective antihypertensive agents, interindividual variability in treatment response remains a challenge. Genetic polymorphisms in drug-metabolizing enzymes and receptor targets influence the pharmacokinetics and pharmacodynamics of antihypertensive drugs. Genotype-guided therapy, which tailors treatment based on the patient’s genetic profile, represents a promising step toward personalized medicine in hypertension management. Objectives: To evaluate the effectiveness of genotype-guided antihypertensive therapy compared with standard guideline-based treatment in achieving optimal blood pressure control, reducing time to therapeutic target, and minimizing adverse drug reactions among patients with essential hypertension. Methods: This prospective, randomized, open-label, controlled clinical study was conducted in the Department of Cardiology of a tertiary care teaching hospital in India between March 2023 and April 2024. A total of 380 adults (aged 30–65 years) with essential hypertension were randomized equally into two groups:

• Genotype-guided therapy group (n = 190): Treatment tailored to polymorphisms in CYP2D6, ADRB1, and AGT genes.
• Standard therapy group (n = 190): Treatment per national hypertension guidelines without genetic input.

Genotyping was performed using validated TaqMan assays, and participants were followed up for six months. The primary outcome was the proportion achieving target blood pressure (<130/80 mmHg). Secondary outcomes included time to reach target blood pressure, change in mean systolic and diastolic pressures, and incidence of adverse drug reactions. Statistical analyses used t-tests, chi-square tests, and repeated-measures ANOVA, with significance set at p < 0.05. Results: At six months, 77.9% of participants in the genotype-guided group achieved target blood pressure compared with 61.3% in the standard therapy group (p < 0.001). The average time to achieve target systolic pressure was shorter in the genotype-guided group (8.2 ± 2.5 weeks vs. 12.4 ± 3.3 weeks; p < 0.001). Mean reduction in systolic and diastolic pressures was greater in the genotype-guided group (−18.5 ± 6.1 mmHg and −11.2 ± 4.8 mmHg, respectively) compared to standard care (−12.3 ± 5.9 mmHg and −7.4 ± 4.2 mmHg, respectively). Adverse reactions such as fatigue and orthostatic hypotension were less frequent in the genotype-guided group (5.3%) than in standard care (10.5%). Conclusion: Genotype-guided antihypertensive therapy significantly improved blood pressure control, accelerated therapeutic response, and reduced drug-related adverse effects compared with conventional treatment. Implementing pharmacogenomic profiling in routine hypertension management could enhance treatment precision, adherence, and patient outcomes in the Indian population.

Objective: To compare the diagnostic efficacy of multi-detector computed tomography (MDCT) virtual bronchoscopy (VB) with conventional fiberoptic bronchoscopy (FOB) in detecting, characterizing, and localizing airway lesions, and to assess their agreement in evaluating tracheobronchial abnormalities. Methods: This prospective observational study was conducted in the Departments of Radiodiagnosis and Pulmonary Medicine at a tertiary care center. A total of 50 adult patients clinically suspected of having tracheobronchial lesions underwent both contrast-enhanced MDCT and FOB. MDCT images were reconstructed into multiplanar reformatted (MPR), minimal-intensity projection (minIP), and virtual bronchoscopy (VB) views. FOB was performed within 72 hours by a blinded pulmonologist. Parameters assessed included lesion detection, degree and length of stenosis, segmental involvement, visualization of distal airways, and overall diagnostic confidence. Statistical analysis was performed using SPSS version 25. Results: MDCT-VB detected airway lesions in 45 out of 50 patients (90.0%), while FOB detected lesions in 47 patients (94.0%) (p = 0.456). The mean degree of stenosis on VB was 71.2 ± 10.4% vs. 73.5 ± 9.8% on FOB (p = 0.328). VB allowed visualization of distal airways in 86.0% of cases versus 70.0% for FOB (p = 0.027). The sensitivity, specificity, and diagnostic accuracy of VB were 95.7%, 60.0%, and 92.0%, respectively. Cohen’s Kappa coefficient showed substantial agreement (κ = 0.73). The area under the ROC curve for VB was 0.93. Conclusions: MDCT virtual bronchoscopy is a highly accurate, non-invasive imaging modality with diagnostic performance comparable to FOB, and serves as a valuable complementary tool in airway evaluation, especially in patients with obstructive lesions

Background: Sedation in ophthalmic day-care procedures such as cataract surgery enhances patient comfort and cooperation. Midazolam is commonly used, while dexmedetomidine may provide superior sedation with minimal respiratory depression. Objective: To compare sedation quality, hemodynamic stability, recovery profile, and patient satisfaction between dexmedetomidine and midazolam in ophthalmic day-care surgeries. Methods: A prospective randomized study was conducted on 100 adult patients (ASA I–II) undergoing elective ophthalmic day-care procedures, primarily cataract surgery. Patients were randomized to receive intravenous dexmedetomidine (1 µg/kg loading, 0.2–0.5 µg/kg/h infusion) or midazolam (0.03 mg/kg bolus, 0.01–0.02 mg/kg/h infusion). Ramsay Sedation Scale, hemodynamics, recovery time, patient and surgeon satisfaction, and adverse events were recorded. Results: Dexmedetomidine achieved higher sedation scores (RSS 3–4) than midazolam (RSS 2–3, p<0.001). Hemodynamics were more stable in the dexmedetomidine group, without clinically significant hypotension or bradycardia. Recovery times were comparable (23 ± 6 vs 21 ± 5 min, p=0.21). Patient satisfaction was higher in the dexmedetomidine group (4.7 ± 0.3 vs 3.9 ± 0.4, p<0.01). No respiratory depression or serious adverse events occurred. Conclusion: Dexmedetomidine provides superior sedation quality, patient comfort, and hemodynamic stability compared to midazolam, making it ideal for ophthalmic day-care procedures under local anesthesia

Background: Background: Left ventricular hypertrophy (LVH) is a common target organ manifestation of hypertension and is one of the major predictors of cardiovascular morbidity. Electrocardiogram (ECGs), a low-cost method for LVH identification, is still up for dispute, especially when it comes to resistant hypertension (RH), a subgroup of hypertensive patients with a higher risk of cardiovascular disease. Objective: To evaluate the correlation between LVH identified using the Romhilt-Estes¹ ECG scoring system and left ventricular mass (LVM) measured by echocardiography in patients with resistant hypertension. Methods: In this cross-sectional study, 95 adults diagnosed with resistant hypertension were enrolled at a tertiary care center in India. All patients underwent standard 12-lead ECG and two-dimensional transthoracic echocardiography. LVH on ECG was defined using the Romhilt-Estes point score. LVM was calculated via the Devereux formula and indexed to body surface area (LVMI)¹. Pearson correlation and inter-rate agreement were used to evaluate the relationship between echocardiographic LVM and ECG-detected LVH. Results: The cohort's mean age was 55.2±12.3 years, and 74.7% of the participants were male. While echocardiographic LVH was seen in 50.5% of patients (absolute values) and 82.1% of patients (indexed with BMI), 36.8% of patients had definitive LVH on their ECG. Echocardiography-based LVH detection and ECG had a weak correlation (kappa < 0.06). Using echocardiography as the reference, ECG's sensitivity, specificity, and diagnostic accuracy for LVH detection were 53.3%, 55.6%, and 53.7%, respectively. Conclusion: When it comes to identifying LVH in individuals with resistant hypertension, the Romhilt-Estes ECG criteria show poor agreement with echocardiographic findings. In this high-risk population, echocardiography is still the recommended modality for LVH evaluation

Background: Neuroendocrine tumors (NETs) are uncommon and biologically diverse neoplasms that often arise from small, clinically silent primary sites and typically demonstrate overexpression of somatostatin receptors (SSTRs). Imaging with ⁶⁸Ga-labeled somatostatin analogues using positron emission tomography/computed tomography (PET/CT) has been shown to outperform conventional techniques in the evaluation of NETs. The aim of this study was to evaluate the diagnostic utility of ⁶⁸Ga-DOTANOC PET/CT for visualizing somatostatin receptor (SSTR) expression and detecting previously unidentified lesions. Methods We conducted a prospective single-center study of 100 consecutive adults with suspected or known NETs over 12 months (May 2023–May 2024). ⁶⁸Ga-DOTANOC was administered intravenously, followed by whole-body PET/CT approximately 60 minutes post-injection. Images were interpreted visually, and focal uptake above background consistent with somatostatin receptor expression was considered positive. Indications included initial staging and restaging. Primary outcomes were identification of the index primary in suspected NET and detection of residual or recurrent disease in previously diagnosed cases. Proportions with 95% confidence intervals were calculated. Ethics approval and informed consent were obtained. Results Of 100 patients (69 males, 31 females; mean age 55 years, range 40–70 years), 68 underwent initial staging and 32 restaging. Primary lesions were detected in 61 of 68 suspected NET cases (89.7%). The most frequent sites were gastrointestinal tract (n=51), pancreas (n=11), and bronchus (n=7). In the restaging cohort, 18 of 32 patients (56.2%) demonstrated ⁶⁸Ga-DOTANOC–avid residual or recurrent disease, while 12 showed no active disease. All studies exhibited high target-to-background contrast. Conclusion ⁶⁸Ga-DOTANOC PET/CT demonstrated excellent lesion detection and proved valuable for identifying primary sites, metastases, and disease recurrence in NET patients. It serves as a robust molecular imaging tool for staging, restaging, and follow-up in oncology practice

Background: Dental caries and obesity are two major public health concerns worldwide. Recent studies have explored the relationship between body fat percentage and dental health, particularly the incidence of dental caries, with mixed results. While some studies show a positive association between higher body fat and poor oral health, others suggest that factors such as diet, oral hygiene, and socioeconomic status also play significant roles. This study aims to investigate the relationship between body fat percentage and dental health, specifically dental caries as measured by DMFT (Decayed, Missing, and Filled Teeth) scores. Method: This cross-sectional study included 100 patients aged 18-65 years, categorized into three groups based on body fat percentage: low, normal, and high. Body fat percentage was assessed using bioelectrical impedance or skinfold thickness measurements. The DMFT scores were obtained from dental examinations performed by trained professionals. Data analysis was conducted using descriptive statistics, and a Chi-square test was used to assess the correlation between body fat category and DMFT scores. Results: Patients in the high body fat group had significantly higher DMFT scores compared to those in the low and normal body fat categories. The high body fat group showed the highest mean DMFT score and a greater percentage of patients with DMFT scores greater than 5 (35%). Statistical analysis confirmed a significant relationship between body fat category and DMFT scores (p=0.0002). The low body fat group had the least dental decay, with no patients exhibiting severe dental issues. Conclusion: The study demonstrates a significant association between higher body fat percentage and poorer dental health, as indicated by higher DMFT scores. These findings suggest that body fat management should be incorporated into broader dental care strategies. Further research is needed to explore the underlying biological mechanisms of this association and to develop targeted interventions for populations at risk of both obesity and dental caries

Background: Type 2 diabetes mellitus (T2DM) is a main worldwide health challenge requiring long-term pharmacological management. Multiple antidiabetic drug classes are available, but direct comparative evidence on efficacy and safety remains limited. Methods: A Retrospective observational study was led in a Internal Medicine clinic Prime Specialist Medical Centre, including 100 patients with T2DM. Participants were randomized into five groups of 20 patients each, with one group assigned to each drug class. Over one year, effectiveness endpoints included HbA1c, plasma fasting glucose, or postprandial glucose changes. Safety outcomes included unfavourable events, hypoglycaemic events, weight fluctuations, and hospitalisation. The study utilised ANOVA for continuous variables and chi-square testing for categorical outcomes. Results: All drug classes significantly reduced HbA1c levels (p<0.05). GLP-1 receptor agonists (-1.6%) and SGLT2 inhibitors (-1.4%) showed the greatest HbA1c reductions, along with favourable weight loss and low hypoglycaemia risk. Metformin achieved solid efficacy (-1.2%) but was associated with gastrointestinal side effects. Sulfonylureas demonstrated strong glycaemic control (-1.3%) but had the highest hypoglycaemia incidence (25%). DPP-4 inhibitors were well tolerated but showed modest efficacy (-0.9%). Conclusion: GLP-1 receptor agonists and SGLT2 inhibitors offered the best balance of efficacy and safety. Metformin remains a robust first-line therapy, while sulfonylureas require cautious use due to hypoglycaemia risk. Larger multicentre trials are recommended to validate these findings and assess long-term outcomes

Background: Ischemic heart disease (IHD), also known as coronary artery disease (CAD), accounts for approximately 13% of all global deaths, according to the World Health Organization, and has remained the leading cause of mortality for the past two decades. A thorough understanding of coronary artery anatomy and its morphological variations is essential for accurate diagnosis, interventional cardiology, and surgical management of CAD. Materials and Methods: The present descriptive anatomical study was conducted on 53 formalin-fixed human hearts obtained from the Department of Anatomy over a period of two years. Each specimen was meticulously dissected to observe the branching pattern of the left coronary artery (LCA) and its major branches — the left anterior descending (LAD) and left circumflex (LCx) arteries. Results: Among the 53 specimens, the trifurcation pattern of the LCA was observed in 24 hearts (45.3%), the bifurcation pattern in 24 hearts (45.3%), the tetrafurcation pattern in 3 hearts (5.7%), and the pentafurcation pattern in 2 hearts (3.8%). Conclusion: Comprehensive anatomical knowledge of the morphological variations in the branching pattern of the left coronary artery is vital for cardiac surgeons, interventional radiologists, and cardiologists. Such understanding minimizes intraoperative complications and enhances the precision of coronary interventions, angiographic interpretation, and bypass graft planning

Background: South Asia is experiencing a rising burden of cardiovascular diseases (CVDs) and non-communicable diseases (NCDs), contributing to high morbidity, premature mortality, and socio-economic challenges. Understanding epidemiological shifts and effective preventive strategies is essential for public health planning. Methods: A systematic review was conducted following PRISMA guidelines. Databases including PubMed, Scopus, Web of Science, and Embase were searched for studies published between 2010 and 2025. Inclusion criteria comprised observational and cohort studies reporting prevalence, risk factors, or preventive interventions for CVDs and NCDs among adults in South Asia. Study quality was assessed using the Newcastle–Ottawa Scale. Data were extracted on country, study design, sample size, methods, results, and conclusions. Results: A total of 38 studies from India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, Maldives, and Afghanistan were included. Prevalence of hypertension ranged from 18–26%, diabetes 8–12%, and obesity 12–21% across countries. Tobacco use, unhealthy diet, physical inactivity, and metabolic risk factors were consistently reported. Urban populations showed higher prevalence of CVD risk factors compared with rural counterparts. Preventive interventions, including lifestyle modification, health education, community-based screening, and digital health programs, demonstrated potential in reducing risk factors but were inconsistently implemented. Study quality ranged from moderate to high. Conclusion: South Asia faces a significant and growing NCD burden, driven by modifiable lifestyle and metabolic risk factors. Coordinated, multi-sectoral, and culturally tailored preventive strategies, including lifestyle interventions, early screening, and health system strengthening, are urgently needed to mitigate the rising epidemic and achieve healthier populations

Background: Hip fractures represent a major cause of morbidity, functional decline, and mortality in the elderly population worldwide. Their incidence continues to rise in developing countries like India due to ageing demographics, osteoporosis, and fall-related injuries. Understanding local epidemiological trends and clinical outcomes helps improve preventive and management strategies. Aim of the study was to evaluate the demographic profile, fracture patterns, comorbidities, modes of injury, management practices, and early postoperative outcomes among elderly patients presenting with hip fractures at a tertiary-care teaching hospital in South India. Materials and Methods: This retrospective observational study was conducted in the Department of Orthopedics, Mamata Academy of Medical Sciences, Hyderabad, over one year (January–December 2024). A total of 30 patients aged ≥60 years with radiologically confirmed proximal femur fractures were included. Data were collected from hospital records regarding age, sex, comorbidities, mechanism of injury, fracture type, treatment modality, and postoperative course. Statistical analysis was performed using SPSS version 26.0. Continuous variables were expressed as mean ± standard deviation (SD) and categorical variables as frequency and percentage. Results: The mean age was 72.4 ± 7.6 years, and females constituted 60% of the study population. Slip and fall at home was the most common mechanism of injury (80%). Extracapsular fractures were more frequent (60%) than intracapsular (40%). The majority (86.7%) underwent surgical management—hemiarthroplasty (40%), DHS fixation (23.3%), and PFN fixation (23.3%)—while 13.3% were treated conservatively. Mean hospital stay was 8.6 ± 2.4 days; 30% required blood transfusion. Early postoperative complications occurred in 26.7%, and in-hospital mortality was 3.3%. Conclusion: Hip fractures predominantly affect elderly women following trivial domestic falls, with extracapsular patterns being most common. Early surgical intervention, effective perioperative care, and multidisciplinary rehabilitation can significantly improve short-term outcomes. Preventive measures focusing on fall prevention and bone health are essential to reduce fracture burden in the ageing Indian population

Introduction: Critical limb ischemia (CLI) represents the end stage of peripheral arterial disease and is frequently complicated by infection, tissue necrosis, and gangrene. When revascularization is not feasible, amputation becomes necessary. The optimal surgical strategy—one-stage versus staged amputation—remains debated, particularly in infected ischemic limbs. Aim: To compare the outcomes of one-stage and staged amputations in patients with lower-limb critical ischemia and infection. Materials and Methods: A prospective comparative study was conducted on 50 patients (30 with staged amputations, 20 with one-stage amputations) admitted between January and December 2017. Diagnosis of CLI was based on rest pain, gangrene, and absence of distal pulses, confirmed by arteriography. Patients with uncontrolled infection or non-demarcated necrosis underwent staged amputation (initial guillotine followed by definitive closure), whereas those with well-defined ischemia underwent one-stage amputation. Primary outcomes included stump healing (success), need for revision surgery, 30-day and 12-month mortality. Data were analyzed using appropriate statistical tests, with p < 0.05 considered significant. Results: Staged amputations were performed more often in patients with severe ischemia (Rutherford 5–6), diabetes, and infection, while one-stage amputations predominated among hypertensive and cerebrovascular disease cases. The mean hospital stay was 25.18 ± 18.18 days (SA) versus 16.3 ± 16 days (OSA) (p = 0.9999). Primary success was significantly higher in SAs (p< 0.05), particularly at the transtibial level (p = 0.0001). Survival analysis revealed longer overall survival in SA patients, while early mortality was higher in diabetics and smokers undergoing OSA. Logistic regression identified non-diabetic status, absence of coronary disease, and non-smoking as independent predictors of better survival. Conclusion: Staged amputations, despite being applied to more severe ischemic and infected limbs, achieved superior stump healing and survival compared to one-stage amputations. The staged approach effectively controls infection, enhances wound viability, and reduces peri-operative mortality.

Background: Ocular surface disease (OSD) represents a significant yet often underrecognized complication in glaucoma patients receiving chronic topical therapy. The preservatives and active ingredients in anti-glaucoma medications can compromise ocular surface integrity, leading to symptoms that affect quality of life and treatment adherence. This study aimed to comprehensively assess the prevalence and severity of OSD symptoms and signs in glaucoma patients using topical medications. Methods: A cross-sectional study was conducted involving 40 glaucoma patients on topical anti-glaucoma therapy for at least six months. Comprehensive evaluation included the Ocular Surface Disease Index (OSDI) questionnaire for symptom assessment, tear film break-up time (TBUT), Schirmer test, corneal fluorescein staining, and assessment of superficial punctate keratitis. Statistical analysis examined correlations between OSD severity and medication-related factors including preservative exposure, number of medications, and treatment duration. Results: Among 40 participants, 73% (29/40) demonstrated clinical evidence of OSD, with 35% showing mild, 27.5% moderate, and 10% severe disease. Mean OSDI score was 29.2±14.8, TBUT averaged 7.1±2.7 seconds, and Schirmer test showed 8.7±3.5 mm. Preserved medication users had significantly higher OSDI scores than preservative-free users (33.4±13.9 vs 19.8±11.2, p=0.006). Multiple medication use strongly correlated with OSD severity (r=0.71, p<0.001). Superficial punctate keratitis was present in 62.5% of patients. Conclusion: OSD demonstrates high prevalence in glaucoma patients on topical therapy, with severity correlating significantly with preservative exposure and medication burden. These findings emphasize the importance of routine ocular surface assessment and consideration of preservative-free alternatives in glaucoma management to optimize both treatment efficacy and quality of life.

Introduction: Malnutrition is one of the leading causes of secondary immunodeficiency in children, contributing to impaired cell-mediated immunity and increased risk of infections. The Mantoux test and absolute lymphocyte count (ALC) are widely used to assess delayed hypersensitivity and immune competence. Few Indian studies have comprehensively assessed the interplay of nutritional status, Mantoux reactivity, and ALC in pediatric populations. With increasing recognition of malnutrition’s role in immunosuppression, such studies are essential to form interventions. This study was designed to evaluate the influence of clinical and nutritional status on delayed hypersensitivity and ALC in children admitted to a tertiary care hospital, and to analyze Mantoux responses in relation to BCG vaccination. Material and Methods: This cross-sectional study included 503 children (1 month–18 years) admitted to the Pediatric Department of Tertiary Care Teaching Hospital over a period of 18 months. Demographic, clinical, and nutritional details were collected. Nutritional status was assessed by WHO growth charts. Mantoux testing was performed with 5 TU PPD RT23. ALC was calculated from complete blood counts. Tuberculin skin test was done with PPD-RT 23 with Tween 80 of strength 5TU according to standard technique (Ref of tuberculin test article) with 26–27-gauge needles over volar surface of arm. Indurations were measured twice with transparent scale and were noted in millimeters, once after 48 hours and again after 72 hours. Depending on size of induration Delayed Hypersensitivity Reaction (DTH) was determined using Mantoux test. Results: The mean age was 81 months; 53.5% were male, 97% were from rural areas, and most belonged to lower socioeconomic status. Malnutrition was prevalent: 19% severely underweight, 19% underweight, 14.6% severely wasted, and 13.3% wasted. Severely underweight: 19%, Underweight: 19%. Severely wasted: 14.6%, Wasted: 13.3%. Severely stunted: 12%, Stunted: 20.5%. Overweight/obese: 2.9%. Mantoux positivity was significantly lower in malnourished children (p<0.05). ALC was reduced in undernourished children compared to well-nourished peers. BCG vaccination correlated with Mantoux positivity, but the response diminished with age and nutritional deficits. Conclusion: Malnutrition significantly impairs cell-mediated immunity as reflected by reduced Mantoux responses and lower ALC. Early nutritional interventions are essential to improve immune competence in children

Introduction: Direct oral anticoagulants (DOACs) have emerged over the past decade as important alternatives to traditional anticoagulants such as vitamin K antagonists (VKAs).Among them, rivaroxaban, a direct factor Xa inhibitor, is widely prescribed for stroke prevention in atrial fibrillation, venous thromboembolism management, and prophylaxis following orthopedic surgeries. AIM: Study of postoperative bleeding risk for oral surgery under continued rivaroxaban anticoagulant therapy. Methodology: This prospective cross-sectional study was conducted at department of Dentistry, Govt. Medical college, Barmer, for 6 months, on 63 patients were included during the study periodConsecutive patients receiving rivaroxaban who required simple tooth extraction(s) were enrolled. Result: Among 63 patients on rivaroxaban undergoing oral procedures, the majority were older adults (50–60 years: 39.4%; >60 years: 28.6%) with a mild male predominance (57%). Atrial fibrillation was the most common indication (47.6%), followed by DVT (23.8%) and PE (15.9%). Postoperative bleeding was mostly mild and manageable, occurring in 60% of cases, with only 2% requiring hospital admission. Conclusion: Oral surgical procedures, including extractions, can be safely performed in patients on continued rivaroxaban therapy, with most bleeding being mild and manageable, however oral anticoagulant increase the risk of bleeding. Atrial fibrillation was the most common indication, and careful hemostatic measures minimize the risk of significant postoperative complications

Background: Accurate early risk stratification in ST-elevation myocardial infarction (STEMI) is critical for guiding management and improving outcomes. The Global Registry of Acute Coronary Events (GRACE) score assesses clinical severity, while the Synergy Between PCI with Taxus and Cardiac Surgery (SYNTAX) score quantifies coronary anatomical complexity. This study aimed to evaluate the correlation between GRACE and SYNTAX scores in STEMI patients and assess their comparative utility for in-hospital risk prediction. Methods: This prospective, observational study was conducted at Dr. Vithalrao Vikhe Patil Foundation’s Medical College and Hospital, Ahmednagar, Maharashtra, from March to November 2024. Forty-three STEMI patients aged ≥18 years were enrolled. GRACE scores were calculated using clinical and laboratory parameters, and SYNTAX scores were derived from coronary angiography. Correlation between the two scores was analyzed using Pearson’s correlation coefficient, and their association with hemodynamic and clinical variables was assessed. Results: The mean age of patients was 65.9 ± 11.4 years, with a male predominance (58.1%). The mean GRACE and SYNTAX scores were 138.9 ± 33.5 and 15.7 ± 4.0, respectively. A very strong positive correlation was observed between GRACE and SYNTAX scores (r = 0.988, p = 0.001). Higher SYNTAX scores (≥23) were significantly associated with lower systolic blood pressure (p = 0.002) and advanced Killip class (p = 0.001). Patients in Killip Class IV had the most complex coronary disease. Conclusion: There exists a strong and statistically significant correlation between GRACE and SYNTAX scores in STEMI patients, indicating that clinical severity closely reflects angiographic complexity. Combined use of both scores can enhance early risk stratification and guide treatment planning, especially in resource-limited settings lacking immediate access to coronary angiography. Further large-scale, multicentric studies are warranted to validate these findings and explore their prognostic implications.

Introduction: Total knee arthroplasty (TKA) offers durable relief for end-stage knee osteoarthritis, but wound-related complications such as delayed wound healing (DWH) and postoperative infection continue to impair recovery and increase revision risk. Identifying modifiable predictors is vital for prevention. Aim of the study was to determine predictive factors for delayed wound healing and postoperative infections following primary TKA. Materials and Methods: A prospective observational study was conducted in the Department of Orthopedics, Mamata Academy of Medical Sciences, Hyderabad, from [insert period]. Thirty consecutive patients undergoing primary TKA were evaluated. Preoperative variables included age, sex, body-mass index (BMI), diabetes, HbA1c, and serum albumin. Intraoperative parameters operative duration, blood loss, and drain use—were recorded. Patients were followed for 30 days for wound outcomes. DWH was defined as drainage > 72 h or incomplete epithelialisation > 14 days; infection was categorised as superficial surgical-site infection (SSI) or deep periprosthetic joint infection (PJI). Logistic regression identified independent predictors (p < 0.05). Results: Mean age was 66.2 ± 7.8 years and mean BMI 30.4 ± 4.6 kg/m². Diabetes was present in 36.7 %, and 20 % had hypoalbuminaemia (< 3.5 g/dL). Incidences were: DWH 13.3 % (n = 4), SSI 6.7 % (n = 2), no PJI. On multivariate analysis, albumin < 3.5 g/dL (AOR 4.86, 95 % CI 1.06–22.2; p = 0.041*) and HbA1c > 7 % (AOR 3.40, 95 % CI 1.01–11.8; p = 0.048*) predicted DWH. Albumin < 3.5 g/dL (AOR 4.21, 95 % CI 1.02–18.9; p = 0.047*) and operative time > 100 min (AOR 3.66, 95 % CI 1.00–14.0; p = 0.049*) predicted infection. Conclusion: Hypoalbuminaemia, poor glycaemic control, and prolonged operative time were independent predictors of postoperative wound complications after TKA. Preoperative nutritional and metabolic optimisation and operative efficiency are essential to reduce early wound morbidity.

Background: Understanding coronary artery variations is crucial for accurate diagnosis, surgical safety, and interventional precision. While imaging delineates coronary topography, cadaveric dissection remains the benchmark for anatomical correlation. To document the origin, number, and position of coronary ostia; analyze morphometric parameters; identify branching and variant patterns; and determine dominance relationships in human cadaveric hearts. Materials and Methods: A cross-sectional anatomical study was performed on 80 formalin-fixed adult cadaveric hearts with intact aortic roots. Each heart was dissected to trace the right and left coronary systems. Parameters included ostial origin and height relative to the sinutubular ridge, vessel lengths and diameters, branching configuration, variant features (ramus intermedius, high take-off RCA, duplicated LAD, myocardial bridging), and coronary dominance. Data were analyzed descriptively with appropriate statistical tests (p < 0.05). Results: The RCA originated uniformly from the anterior aortic sinus (100%), and the LCA from the left posterior sinus (97.5%), with ectopic origin in 2.5%. Multiple RCA ostia were noted in 27.5%, and most ostia were located below the sinutubular ridge (RCA 88.7%, LCA 83.7%). The RCA (10.2 ± 2.1 cm) was the longest artery, followed by LAD (8.6 ± 1.8 cm), while the left main trunk was short and variable (5.3 ± 2.7 mm). LCA bifurcation predominated (68.7%), trifurcation occurred in 23.8%, and quadrifurcation in 7.5%. Variants included high take-off RCA (6.3%), duplicated LAD (3.8%), and myocardial bridging (7.5%). Right dominance was seen in 88.8%, left dominance in 8.8%, and balanced circulation in 2.5%, with a strong correlation between posterior termination and dominance pattern (p < 0.01). Conclusion: Coronary anatomy in this series exhibited a consistent RCA origin, predominantly right-sided dominance, and a short, variable left main trunk. The frequent presence of multiple RCA ostia and occasional variants emphasizes the importance of anatomical awareness during coronary angiography, bypass grafting, and valve surgeries. These findings provide valuable morphometric and morphological reference data for the Indian population and reinforce the anatomical basis for interventional precisio

Introduction: Stroke is a common manifestation of cerebrovascular disease. The common risk factors for stroke include hypertension and diabetes mellitus. Retinal and cerebral vessels have common embryological and anatomical characteristics; thus, they show similar patterns of damage from diseases. Therefore, examination of the fundus could provide a noninvasive view of intracranial vascular pathology. Purpose: To examine the fundus of patients presenting with acute stroke to see prevalence of retinal findings and their correlation with stroke.  Material and Methods: This observational cross-sectional study was carried out among 50 patients over 6 months period with acute stroke presenting to medicine emergency of tertiary care teaching hospital in North India. Detailed medical history was taken and complete general physical examination was performed. Fundus was examined with the help of direct and indirect ophthalmoscopy. Data was analyzed with online software OpenEpi version 3. Chi square test was applied and p values <0.05 Conclusions: Therefore, routine retinal examination is important in patients with stroke. Presence of retinal findings act as marker for underlying diseases such as hypertension and diabetes, providing risk stratification among individual patients.

Background and Objective: Intraocular pressure (IOP) is maintained by the balance between aqueous humor secretion and drainage. Elevated IOP is a key modifiable risk factor for glaucoma, one of the leading causes of irreversible blindness. Hypertension has been proposed as a potential factor influencing IOP. Understanding the relationship between blood pressure (BP) and IOP is essential for early detection and prevention of glaucomatous changes. To investigate the correlation between intraocular pressure and blood pressure in patients attending the Ophthalmology outpatient department at GVPIHC & MT, Visakhapatnam. Methods: A hospital-based, prospective, cross-sectional study was conducted over three months including 300 participants aged above 18 years. Patients with systemic comorbidities, glaucoma, prior ocular surgery, trauma, or ocular pathologies affecting IOP measurement were excluded. Blood pressure was measured using an automatic digital monitor, and intraocular pressure was recorded with a Goldmann applanation tonometer between 9–11 a.m. to minimize diurnal variation. Data were analyzed using SPSS software with descriptive statistics and tests of significance; p < 0.05 was considered statistically significant. Results: Among the 300 subjects, 162 were males and 138 females, aged 21–80 years. Mean IOP in males was 14.77 ± 3.03 mmHg and in females 15.25 ± 2.59 mmHg. Mean systolic and diastolic blood pressures increased significantly with age in both genders (p < 0.05). Mean IOP increased progressively across BP categories — from 13.99 ± 3.07 mmHg in normotensives to 16.33 ± 3.86 mmHg in grade 3 hypertension. Pearson correlation revealed a positive relationship between both systolic and diastolic BP with IOP across all age groups, more significant in females and older individuals. Conclusion: Intraocular pressure shows a positive correlation with both systolic and diastolic blood pressure. Hypertension is a significant risk factor for elevated IOP, which may contribute to glaucomatous optic neuropathy. Regular IOP screening in hypertensive and elderly patients can facilitate early glaucoma detection and help reduce the burden of preventable blindness.

Background: - Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are major contributors to morbidity, hospitalizations, and mortality. Bacterial infections are responsible for a significant proportion of exacerbations, and rising antimicrobial resistance complicates management. Understanding the clinical profile, microbial etiology, and antibiotic sensitivity patterns is essential to guide effective therapy. Aim: -To evaluate the clinical profile, microbial etiology, antimicrobial sensitivity pattern, and treatment outcomes of patients presenting with AECOPD. Methods: -A prospective observational study was conducted on 60 patients with AECOPD at Konaseema institute of medical sciences Amalapuram. Demographic data, comorbidities, clinical presentation, and baseline spirometry were recorded. Sputum samples were collected before antibiotic therapy for culture and sensitivity testing, following CLSI 2023 guidelines. Patients received standard AECOPD management, and treatment outcomes were assessed as clinical improvement, treatment failure requiring ICU care, or in-hospital mortality. Data were analyzed using SPSS v25.0. Results: - The mean age was 62.5 ± 8.7 years, with 80% males. Common comorbidities included hypertension (50%) and diabetes mellitus (40%). Most patients presented with dyspnea (90%), cough (85%), and purulent sputum (80%). Sputum cultures were positive in 24 (40%) patients; predominant pathogens were Klebsiella pneumoniae (37.5%) and Pseudomonas aeruginosa (29.2%). K. pneumoniae was highly sensitive to piperacillin-tazobactam (90%) and meropenem (85%), whereas P. aeruginosa was sensitive to piperacillin-tazobactam (80%) and meropenem (75%). Clinical improvement was achieved in 75% of patients, 15% required ICU care, and in-hospital mortality was 10%. Patients infected with multidrug-resistant organisms had a higher treatment failure rate (37.5% vs. 10%, p < 0.05). Conclusion: - AECOPD predominantly affects older males with comorbidities. Gram-negative bacteria, particularly K. pneumoniae and P. aeruginosa, are common pathogens. Culture-guided antimicrobial therapy improves clinical outcomes, while multidrug resistance is associated with higher treatment failure. Regular surveillance of microbial patterns and antibiotic susceptibility is crucial for effective management of AECOPD

Introduction: Shivering is a common occurrence, reported in 40% to 70% of patients undergoing abdominal surgery with regional anesthesia. Incidence is even more common in geratric patients undergoing TURP under spinal anaesthesia. Both pharmacological and non-pharmacological methods are employed for the control of shivering. various studies have shown contradictory results on effectiveness of prophylactic low doses of tramadol and ketamine, to fill in the gap in showing better prophylactic agents concerning the effectiveness of prevention of post spinal anaesthesia shivering incidence, severity and occurrence of adverse effects the present study was conducted to compare the efficacy of intravenous Tramadol and intravenous ketamine for prevention shivering in patients undergoing TURP under spinal anaesthesia. Materials and methods: Ninety patients aged between 40 and 75years belonging to the American Society of Anesthesiologists-Physical Status I and II, undergoing TURP under spinal anaesthesia were included in the study. Group T patients (n=30) received 0.5 mg/kg Tramadol in 10ml normal saline IV infusion over 5 minutes. Group K patients (n=30) received 0.25 mg/kg Ketamine in 10ml normal saline IV infusion over 5 minutes. Whereas Group P patients (n=30) received plain 10ml normal saline IV infusion over 5 minutes. Results: Both Ketamine and Tramadol were found to be effective to prevent shivering as compared to placebo group. Tramadol group had a statistically lower incidence of shivering than ketamine. The incidence of nausea, and vomiting were significantly more in tramadol group as compared to placebo and ketamine group. (p-value =0.002) Conclusion: Both Tramadol and Ketamine are effective to prevent post-spinal shivering in patients undergoing TURP. Tramadol is superior agent as prophylaxis against postspinal shivering when compared with 0.25mg/Kg Ketamine without any psychomimetic side effects. However, IV tramadol is also associated with side effects like nausea and vomiting. Furthur studies are required to establish the findings of present study.

Introduction: Diabetic retinopathy (DR), the most common microvascular complication of type 2 diabetes mellitus (T2DM), has been increasingly linked to macrovascular disease, particularly coronary artery disease (CAD). The retina provides a non-invasive marker of systemic vascular injury, but evidence from Indian cohorts using standardized DR grading and angiography-confirmed CAD is limited. This study aimed to assess whether DR severity is independently associated with CAD in T2DM. Materials and Methods: A cross-sectional study was conducted on 150 T2DM patients at the Department of General Medicine, Mamata Medical College, Khammam. Demographic and clinical data, including age, sex, diabetes duration, hypertension, smoking, and alcohol use, were recorded. Biochemical evaluation included fasting plasma glucose, HbA1c, lipid profile, and renal function tests. DR was graded using the Early Treatment Diabetic Retinopathy Study (ETDRS) classification. Cardiovascular evaluation included ECG, echocardiography, treadmill test, and coronary angiography. CAD was defined as ≥50% stenosis in a major epicardial coronary artery. Logistic regression assessed the association between DR severity and CAD after adjusting for confounders. Results: The mean age was 56.2 ± 9.1 years, with 61.3% males. DR was present in 48%: mild NPDR (12%), moderate NPDR (11.3%), severe NPDR (7.3%), PDR (12%), and DME (5.3%). CAD was diagnosed in 64 patients (42.7%), with prevalence rising from 31.2% in those without DR to 72.2% in those with PDR. Multivariate analysis confirmed significant associations for moderate NPDR (OR 2.35), severe NPDR (OR 2.98), PDR (OR 4.12), and DME (OR 3.54). Conclusion: DR severity is strongly and independently associated with angiography-confirmed CAD in T2DM. Advanced DR should be considered a marker for comprehensive cardiovascular evaluation.

Background: Day care surgeries using spinal anaesthesia are on the rise as they offer many advantages. This study was carried out with an aim to evaluate the effectiveness of intrathecal 40 mg of 1% 2-chloroprocaine (2-CP) in unilateral tunica vaginalis hydrocele cases. Method: A prospective, observational study was conducted for a duration of one year at a tertiary care hospital in India. Adult male patients aged 18-60 years and American Society of Anaesthesiologists (ASA) physical status I-III were included. In the operation theatre, spinal anaesthesia was given in sitting position in L2-L3 or L3-L4 space with 25G spinal needle using 40 mg of 1% 2-CP. Hemodynamic parameters were monitored. Pinprick method and modified Bromage scale were used to assess sensory and motor block, respectively. The post anaesthesia discharge scoring system (PADSS) was used to assess discharge readiness.  Results: Data from 56 patients was analysed. Average time of onset of T10 sensory block was 7.55±1.81 mins and highest level attained was T8 in 57% patients. Mean time for regression to L1 level was 65.91±13.98 mins. Total duration of sensory and motor block ranged from 75-105 mins and 70-110 mins, respectively. All patients achieved onset of motor block within 3 mins and highest level was grade 3. 93% patients were discharge ready within 125 minutes of giving spinal anaesthesia. Conclusion: 2-CP is a fast-acting local anaesthetic providing quick onset and recovery of sensory and motor block with minimal side effects. Shorter time to discharge readiness makes it an attractive choice for day care surgeries.

Introduction: Endometrial hyperplasia ranges from benign to precancerous changes and requires accurate diagnosis to prevent progression to carcinoma. To evaluate the diagnostic utility of p53, Ki-67, and PTEN immunohistochemical markers in differentiating endometrial hyperplasia and carcinoma. Materials and Methods: Thirty endometrial biopsy cases were analyzed using H&E and immunohistochemistry. Marker expression was correlated with histopathological findings, age, menopausal status, parity, and endometrial thickness. Results: Initially, 76.67% were diagnosed as hyperplasia without atypia, 6.67% as atypical hyperplasia, and 16.67% as carcinoma. Post-IHC, 26.67% were upgraded to atypical hyperplasia. Most cases showed low p53 and Ki-67 expression, while PTEN loss was observed in 76.67%, especially in carcinoma and postmenopausal women.  Conclusion: IHC markers significantly improved diagnostic precision. p53, Ki-67, and PTEN are valuable tools in distinguishing between hyperplastic and malignant endometrial lesions

Introduction: Obstructive Sleep Apnea (OSA) is a common sleep disorder characterized by recurrent episodes of upper airway obstruction during sleep, leading to intermittent hypoxia and fragmented sleep. Aims and Objectives: To assess prevalence of Obstructive sleep apnea in asthma patients and to find out correlation between severity of asthma with Obstructive sleep apnea. To determine prevalence of Obstructive sleep apnea in asthma patients attending OPD of respiratory medicine department of tertiary care center. To access correlation between asthma severity and apnea hypopnea Index. To access correlation between asthma severity and STOP-BANG questionnaire. Materials and methods: The present study was an Observational Cross-Sectional Study. This Study was conducted from February 2024 to July 2024 at Kamla Nehru Chest Hospital, Dr S N Medical College, Department of Pulmonary Medicine, Jodhpur, Rajasthan.  Total 78 patients were included in this study. Result:  In this study of 78 participants, the majority (53.85%) were aged 41–60 years, with 56 males and 22 females. Most patients had non-severe asthma (69, 88.46%) and varying control levels, while 42 (53.85%) were diagnosed with obstructive sleep apnea, predominantly males (32). Risk assessment showed 29 (37.17%) at low risk, 22 (28.20%) intermediate, and 27 (34.61%) high risk. Sleep analysis revealed altered patterns, with stage 2 sleep being the longest (52.11 ± 8.02 minutes) and REM sleep averaging 11.17 ± 6.32 minutes, underscoring the need for comprehensive asthma-OSA management. Conclusion: In conclusion, the study demonstrates a considerable overlap between asthma and obstructive sleep apnea (OSA), with a higher prevalence observed in males. Patients exhibited a range of OSA severities.

Introduction: Persistent pulmonary hypertension of the newborn (PPHN) is a life-threatening condition characterized by the failure of normal postnatal fall in pulmonary vascular resistance, resulting in sustained elevation of pulmonary artery pressure, right-to-left extrapulmonary shunting through the ductus arteriosus and foramen ovale, and severe hypoxemia. Aims & Objectives: The aim of the study was to evaluate the predictors of outcome in newborns with persistent pulmonary hypertension (PPHN) admitted to a tertiary care NICU. The objectives included assessing the clinical profile and associated morbidity, analyzing echocardiography findings and their correlation with outcomes, evaluating the impact of different treatment modalities on survival and recovery, and identifying key factors that predict morbidity and mortality in neonates with PPHN. Materials & Methods: This was a prospective observational study conducted in the Neonatal Intensive Care Unit of the Department of Pediatrics, SSG Hospital, Baroda. The study was carried out over a period of 12 months as a time-bound investigation. Result: In this study of 80 neonates, the sex distribution was nearly equal, with no significant difference between males and females. A majority of the infants were full-term, and most had a birth weight above 2.5 kg, both showing highly significant differences. More than half of the neonates were small for gestational age, while none were large for gestational age, indicating a significant variation in growth patterns. Survival outcomes showed no statistically significant difference, suggesting that factors other than sex, gestational age, and birth weight may influence neonatal survival. Conclusion: The study found that sex did not significantly affect outcomes, while full-term status, birth weight, and gestational age–weight classification showed significant variations, particularly with a higher proportion of small-for-gestational-age infants. Survival was not significantly influenced by these factors, highlighting the need to monitor gestational maturity and growth parameters to identify at-risk neonates and guide care.

Background: Chronic obstructive pulmonary disease (COPD) is associated with significant cardiovascular morbidity due to chronic hypoxemia, pulmonary vascular remodeling, and right heart strain. Electrocardiography (ECG) and echocardiography provide valuable, non-invasive insights into cardiac involvement in COPD, yet such changes are often under-recognized in routine practice. Aim: - To evaluate electrocardiographic and echocardiographic changes in patients with COPD and to correlate these findings with disease severity. Methods: -A cross-sectional observational study was conducted on 60 COPD patients diagnosed by clinical and spirometric criteria. All patients underwent detailed ECG and transthoracic echocardiography. Cardiac abnormalities were documented and correlated with disease severity as per GOLD staging. Data were analyzed using descriptive statistics and Pearson’s correlation. Results: -The mean age of the study population was 58.4 ± 9.2 years, with a male predominance (M:F = 3.3:1). Most patients were smokers (78.3%). Based on GOLD criteria, 33.3% were stage II, 43.3% stage III, and 23.3% stage IV. Electrocardiographic abnormalities were observed in 70% of patients, the most common being P pulmonale (40%), right axis deviation (30%), and right ventricular hypertrophy (26.7%). Echocardiographic abnormalities were present in 60%, with pulmonary hypertension (46.7%, mean RVSP 47.5 ± 8.6 mmHg) being the most frequent, followed by right ventricular dilatation (33.3%) and right atrial enlargement (30%). Left ventricular diastolic dysfunction was seen in 20%, while systolic dysfunction was less frequent (10%). A significant negative correlation was found between FEV1 and pulmonary artery systolic pressure (r = –0.46, p < 0.01). Conclusion: - Cardiac involvement is common in COPD, increasing with disease severity. ECG and echocardiography reveal valuable information on right heart strain, pulmonary hypertension, and ventricular dysfunction. Incorporating routine cardiac evaluation into COPD management may aid in early detection of complications and improve long-term outcomes.

Background Labour pain is one of the most severe forms of pain experienced by women, caused by uterine contractions and cervical/perineal stretching. Conventional epidural analgesia (CEA) is the gold standard for labour analgesia but may be associated with slower onset, patchy block, or motor weakness. The dural puncture epidural (DPE) technique has emerged as a modification that enhances analgesic efficacy by improving drug spread in the subarachnoid–epidural interface. Aim To compare the quality of labour analgesia between conventional epidural block and dural puncture epidural block with respect to onset, uniformity, motor blockade, and maternal satisfaction. Methods A prospective randomized double-blind study was conducted on 46 parturients fulfilling inclusion criteria. Patients were randomly allocated into two groups: Group A (Conventional Epidural, n=23) and Group B (DPE, n=23). Analgesia was initiated with 10 ml of 0.125% bupivacaine + fentanyl 2 μg/ml, followed by intermittent boluses on maternal demand. Visual Analogue Scale (VAS), onset time, sacral spread, motor blockade (Bromage scale), and maternal satisfaction (Likert scale) were assessed. Statistical analysis included Fisher’s exact test and unpaired t-test, with p<0.05 considered significant. Results Mean onset of analgesia was significantly shorter in the DPE group (10±1.31 min) versus conventional epidural (16.26±1.68 min, p<0.001). Duration before first top-up was significantly longer in DPE (105.5±7.9 min) compared to conventional (82.5±10.0 min, p<0.001). VAS scores at 60 minutes showed superior analgesia in DPE (100% patients’ pain-free) versus conventional (47.8% pain-free, p<0.001). Motor blockade was minimal in both groups and not statistically different. Maternal satisfaction was higher in DPE (69.6% very satisfied) compared to conventional (60.9%). Conclusions Dural puncture epidural provides faster onset, longer duration of analgesia, and better maternal satisfaction compared to conventional epidural, without increasing motor blockade. DPE can be considered a superior alternative for labour analgesia.

Background: Although various studies demonstrate a positive relationship between vitamin- A supplementation and decreased mortality and morbidity rates from measles, diarrhea and respiratory diseases, there are very few data available on the relationship between urinary tract infections (UTI) and vitamin A status. Therefore this study was planned to evaluate the efficacy of co-administration of Vit-A in treating Urinary Tract Infections over the standard regular treatment in our tertiary care hospital. Research Question: What is the efficacy of co-administration of vitamin A in treating Urinary Tract Infections? Methods: A six months observational study was conducted at the Department of General Medicine, Mahatma Gandhi Medical College and Research Institute, Pondicherry, from January 2025 to June 2025. About hundred urinary tract infection patients attending the General Medicine OPD were included in the study divided into two groups “A” & “B” and group A treated with standard UTI treatment with Vit-A supplementation where as group B treated with only standard UTI treatment and the efficacy of the treatment was compared. Socio-demographic profiles like age & sex, weight, h/o Hypertension and Diabetes, distribution of clinical symptoms and duration of hospital stay etc; were studied. Results: Significant matching was observed between the two groups. And maximum number of study subjects was observed between 21-30 years of age group among both the groups (group A 42% & group B 38%). About maximum 72% of the study subjects were married among both the groups. It was observed that with regard to signs & symptoms cloudy urine and increased frequency was significantly (P<0.05) decreased among group A patients when compared to group B. With reference to other features there was significant (P<0.05) difference observed among group A patients regard to Duration of hospital stay and Average duration of negative urine culture etc.

Background:  CAD remains the number one cause of morbidity and death related deaths within the world and multivessel and left main coronary artery disease (LMCAD) are high risk subtypes of the anatomy. Angioplasty- coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI), are probably the highest points of treating severe coronary artery disease (CAD) though the best methodology remains a thorny subject in the current world of drug-eluting stents (DES). Objectives: The aim of the meta-analysis was to compare the long-term ( five years or more ) survival, major adverse cardiac events (MACE), myocardial infarction (MI) and repeat revascularisation and the secondary outcomes, namely stroke, quality of life (QoL), angina resolution and hospitalization in adults with CAD, using CABG and PCI. Methods:  Systematic searching of PubMed/MEDLINE, Embase, Cochrane Library, Web of Science and Scopus databases was performed (January 2000 to May 2024) and grey literature and hand-searching of references were sought. They added studies that were randomized controlled trials (RCTs) and high-quality cohort studies of adults with multivessel CAD or LMCAD with 5 years follow-up. An inverse-variance DerSimonianLaird Random-effects model was used to combine Hazard ratios (HR) or relative risks (RR) with 95 confidence interval (CI). The statistic I 2 and Cochran Q test were computed to find out the heterogeneity. Results:  Ten studies (six RCTs, four cohort; total n = 21,546) met inclusion criteria. CABG was associated with improved survival (HR = 0.88, 95% CI: 0.81–0.96), reduced MACE (RR = 0.80, 95% CI: 0.74–0.87), MI (RR = 0.84, 95% CI: 0.73–0.97), and repeat revascularization (RR = 0.43, 95% CI: 0.37–0.50). Stroke risk was slightly higher with CABG (RR = 1.18, 95% CI: 1.02–1.37). Heterogeneity was low to moderate (I² = 25–42%).Conclusion:  CABG has the best long-term outcomes in patients with complex multi-problem CAD and diabetics and results in the greater durable potential albeit a detrimental increment in perioperative stroke risk. PCI is still a possibility in cases of lower complexity and high risk surgeons. The findings support the significance of an individualized and multidisciplinary approach to “heart team” decision-making

Background: Postoperative pain management in cesarean deliveries presents unique challenges, with effective pain relief being essential for patient satisfaction and recovery. The use of Transverse Abdominis Plane (TAP) block has been increasingly favored as a part of multimodal analgesia strategies. This study aims to compare the analgesic efficacy of Bupivacaine alone versus Bupivacaine combined with Dexamethasone in TAP blocks, specifically focusing on the duration of analgesia, pain intensity, and the need for additional analgesic interventions.  Methodology This study was conducted as a randomized controlled trial involving 172 women undergoing elective cesarean sections under spinal anesthesia. Patients were randomly assigned to two groups: Group A Received Bupivacaine and Dexamethasone, while Group B received Bupivacaine in the TAP block. The primary outcome measures included the duration of effective postoperative analgesia, visual analog scale (VAS) pain scores at specified intervals, and the frequency of rescue analgesic requirements. Secondary outcomes included the incidence of postoperative complications and overall patient satisfaction. Results The addition of Dexamethasone to Bupivacaine significantly extended the duration of postoperative analgesia by approximately 7 hours compared to Bupivacaine alone. Group B patients reported lower VAS pain scores at all-time points postoperatively and required fewer rescue analgesics. The combination therapy was also associated with a reduced incidence of opioid-related side effects and enhanced patient comfort. Conclusion The combination of Bupivacaine and Dexamethasone in TAP blocks offers a superior analgesic profile for cesarean deliveries, providing prolonged pain relief and reducing the need for additional analgesics. This approach should be considered a standard component of enhanced recovery protocols in obstetric surgery.

Background: Vitamin D, beyond its classical role in bone and mineral metabolism, has been implicated in glucose homeostasis and insulin sensitivity. Deficiency of vitamin D is highly prevalent in India and may contribute to poor glycaemic control in type 2 diabetes mellitus (T2DM). This study aimed to evaluate the association between serum vitamin D levels and glycaemic as well as lipid parameters in patients with T2DM. Methods: A cross-sectional study was conducted at a tertiary care hospital in eastern India over three months. A total of 150 adult T2DM patients on metformin monotherapy were enrolled, comprising 75 cases with vitamin D deficiency (<20 ng/ml) and 75 controls with sufficient levels (≥20 ng/ml). Groups were matched for age, gender, BMI, and duration of diabetes. Primary outcome was glycated hemoglobin (HbA1c), while secondary outcomes included fasting blood sugar (FBS), postprandial blood sugar (PPBS), and lipid profile (total cholesterol, LDL, HDL, triglycerides). Data were analyzed using unpaired t-test and Fisher’s exact test, with p<0.05 considered significant. Results: Patients with vitamin D deficiency had significantly higher HbA1c (7.29% vs. 6.97%, p=0.0497), FBS (157.89 vs. 145.23 mg/dl, p=0.0048), and PPBS (203.54 vs. 181.49 mg/dl, p<0.0001) compared to controls. Only 36% of deficient patients achieved HbA1c <7.0%, versus 52% in controls. Lipid analysis revealed significantly higher total cholesterol (210.83 vs. 195.07 mg/dl, p=0.0221) and LDL (137.28 vs. 124.56 mg/dl, p=0.0380) in deficient patients, while HDL and triglycerides showed no significant difference. Conclusion: Vitamin D deficiency is significantly associated with poorer glycaemic control and adverse lipid parameters in T2DM patients. Routine screening and correction of vitamin D deficiency may represent a valuable adjunctive strategy in comprehensive diabetes management, particularly in populations with high prevalence of deficiency

Background: Polypharmacy is increasingly prevalent among elderly patients due to multimorbidity, but it carries a heightened risk of drug–drug interactions (DDIs). Age-related physiological changes, including altered pharmacokinetics and pharmacodynamics, further increase susceptibility to adverse outcomes. This study aimed to evaluate the prevalence, nature, and clinical impact of DDIs in hospitalized elderly patients on polypharmacy. Methods: A prospective observational study was conducted over six months in the Department of General Medicine at a tertiary care hospital in eastern India. Patients aged ≥65 years on polypharmacy (≥5 medications) were enrolled. DDIs were identified using Medscape® and Lexicomp® databases and classified as minor, moderate, or major. Clinical outcomes assessed included serious adverse events and duration of hospital stay.  Results: Among 262 patients, 68.32% had minor DDIs, 35.88% moderate DDIs, and 16.41% major DDIs. Major DDIs were significantly associated with older age (mean 74.23 vs. 70.87 years, p=0.0285), dyslipidaemia (60.47% vs. 38.81%, p=0.0111), and neuropsychiatric disorders (37.21% vs. 13.24%, p=0.0006). Patients with major DDIs had a longer mean hospital stay (9.57 vs. 7.03 hours, p<0.0001) and a higher incidence of serious adverse events (16.28% vs. 5.02%, p=0.0154). The risk of major DDIs increased with higher medication counts (>8 drugs). Conclusion: This study demonstrates a high prevalence of clinically significant DDIs among elderly inpatients on polypharmacy, with major DDIs contributing to prolonged hospitalization and increased adverse events. Systematic medication reconciliation, clinical pharmacologist review, and use of interaction screening tools are essential to mitigate risks and improve therapeutic outcomes in this vulnerable population

Background: While glycated hemoglobin (HbA1c) is the established standard for glycemic control, growing evidence suggests that glycemic variability (GV)—the amplitude, frequency, and duration of glucose fluctuations—may be an independent risk factor for diabetic complications. However, long-term data linking GV to the incidence and progression of microvascular complications are limited. Methods: We conducted a prospective cohort study of 352 T2DM patients recruited from a tertiary diabetes center. At baseline and annually for five years, participants underwent 14-day continuous glucose monitoring (CGM) to calculate GV metrics, primarily the Mean Amplitude of Glycemic Excursions (MAGE). Comprehensive assessments for retinopathy, nephropathy, and neuropathy were performed at baseline and at the end of the study. Patients were stratified into tertiles based on their 5-year average MAGE (Low, Moderate, High GV). Cox proportional hazards regression was used to analyze the association between GV tertiles and a composite microvascular outcome. Results: Over a median follow-up of 5.1 years, 102 patients (29.0%) developed the composite microvascular outcome. The incidence was significantly higher in the high GV tertile (45.3%) compared to the moderate (26.5%) and low GV (15.4%) tertiles (p<0.001). The mean 5-year HbA1c was similar across groups (7.4% ± 0.6% vs. 7.6% ± 0.7% vs. 7.7% ± 0.8% for low, moderate, and high GV, respectively; p=0.112). After adjusting for mean HbA1c, age, sex, diabetes duration, and other confounders, the high GV tertile was associated with a significantly increased risk of the composite outcome (Hazard Ratio [HR] 2.92, 95% CI 1.68–5.08, p<0.001) compared to the low GV tertile. Conclusion: Long-term high glycemic variability is a potent and independent predictor of the incidence and progression of microvascular complications in patients with T2DM. These findings suggest that targeting GV, in addition to achieving HbA1c goals, may be a crucial strategy for preventing long-term diabetic complications

Background: Anemia is a common comorbidity in hospitalized patients, associated with increased morbidity and mortality. The two most frequent types are anemia of chronic disease (ACD) and iron deficiency anemia (IDA). Distinguishing between them is crucial for appropriate management, yet their comparative prevalence and impact on clinical outcomes in a general inpatient population remain poorly characterized. Methods: We conducted a retrospective, cross-sectional analysis of adult patients admitted to a tertiary academic medical center. Patients with anemia (hemoglobin <13 g/dL for men, <12 g/dL for women) who had complete iron studies and C-reactive protein (CRP) levels were included. Patients were categorized into ACD (ferritin >100 ng/mL, transferrin saturation [TSAT] <20%, CRP >5 mg/L) or IDA (ferritin <30 ng/mL, or ferritin 30–100 ng/mL with TSAT <20%). Independent t-tests and chi-square tests were used for statistical comparisons. Results: Of 482 eligible anemic patients, 221 (45.8%) were classified as having ACD and 145 (30.1%) as having IDA. The remaining patients had mixed or other anemia types. Patients with ACD were significantly older (68.4 ± 12.1 vs. 55.2 ± 15.8 years, p<0.001) and had a higher mean Charlson Comorbidity Index (4.8 ± 1.9 vs. 2.5 ± 1.5, p<0.001). Compared to the IDA group, the ACD group experienced a significantly longer mean hospital LOS (8.2 ± 4.5 vs. 6.1 ± 3.3 days, p<0.001), a higher 30-day readmission rate (24.9% vs. 15.2%, p=0.028), and greater in-hospital mortality (8.1% vs. 3.4%, p=0.045). Conclusion: In this hospitalized cohort, ACD was more prevalent than IDA and was associated with significantly poorer clinical outcomes, including longer hospitalizations, higher readmission rates, and increased mortality. These findings suggest that ACD is not merely a benign laboratory finding but a marker of severe underlying disease, highlighting the importance of its accurate diagnosis and the management of the associated inflammatory condition

Introduction: Among female genital tract related malignancies, ovarian tumors are the leading cause of mortality. The present study was conducted to identify the various histopathological spectrums of ovarian neoplasm according to the World Health Organization (WHO) classification in a single center. Objective: To assess the histological patterns of ovarian neoplasm their clinical presentation and age distribution. Methods: It is a retrospective study conducted over a period (Nov 2022-Oct 2024) at Government General Hospital, Kakinada. A total of 200 cases were followed and ovarian specimens are obtained after excluding functional cyst. Data was analysed and tabulated. Results: Out of 200 cases of ovarian tumors, 88.5% cases were benign, 7% cases were borderline, 4.5% cases were malignant. Conclusion: Most of the ovarian tumors benign tumors followed by borderline and then malignant. In this study most common benign tumor is serous cystadenoma.  From this study by histopathology, we can differentiate benign from malignant

COVID-19 has shown significant variability in its clinical presentation and severity, often influenced by underlying comorbidities and metabolic derangements. This study investigates the relationship between COVID-19 severity, renal failure, and glycemic variations in hospitalized patients. Retrospective analysis of 150 COVID-19 patients revealed that the presence of DKA and renal failure was strongly associated with increased ICU admissions and mortality. Glycemic variations, particularly hyperglycemia during the acute phase, were significant predictors of worse outcomes. CKD patients demonstrated heightened vulnerability to severe disease, likely due to impaired immune responses and metabolic imbalances. These findings emphasize the importance of early recognition and management of these conditions in mitigating adverse outcomes in COVID-19 patients.

Chronic alcohol consumption is associated with significant alterations in hematological parameters, including red blood cell (RBC) indices, white blood cell (WBC) counts, platelet levels, and biochemical markers, which may serve as early indicators of systemic effects and aid in the diagnosis and management of alcohol-related disorders. This systematic review, conducted following PRISMA guidelines, analyzed studies published between 2019 and 2025 that investigated hematological changes in individuals with chronic alcohol use. Databases including PubMed, Scopus, and Web of Science were searched for observational, cross-sectional, or cohort studies reporting on RBC indices, WBC counts, platelet levels, or biochemical markers in alcohol users. A total of 22 studies met the inclusion criteria, consistently demonstrating that chronic alcohol intake leads to macrocytic anemia, evidenced by elevated mean corpuscular volume (MCV) and reduced hemoglobin and RBC counts. Leukopenia and thrombocytopenia were also prevalent, indicating compromised immune function and increased bleeding risk. Furthermore, biochemical markers such as MCV, gamma-glutamyl transferase (GGT), and carbohydrate-deficient transferrin (CDT) were elevated, reflecting liver dysfunction and excessive alcohol intake, while alcohol withdrawal syndrome was associated with fluctuations in hematological and inflammatory markers. These findings highlight that chronic alcohol use profoundly impacts hematological and biochemical profiles, underscoring the importance of routine hematological screening in individuals with alcohol use disorders to enable early detection and timely intervention.

Background: Post-stroke seizures are a notable complication of cerebrovascular events, particularly in elderly patients, with significant impact on prognosis and quality of life. This study aims to analyze the characteristics and patterns of post-stroke seizures, examining associations with demographic factors, lesion characteristics, stroke classification, and stroke severity. Aim: To assess the demographic and clinical characteristics of post-stroke seizures, examining associations with stroke subtypes, lesion location, seizure types, and stroke severity as per NIHSS and Oxfordshire classifications. Material and Methods: This prospective, cross-sectional study was conducted at the Neurology Department, St. Stephen’s Hospital, Delhi, over a period of 19 months. Sixty patients presenting with a first episode of post-stroke seizure were included. Inclusion criteria were based on clinical findings, neuroimaging (MRI or CT), and EEG. Data were analyzed using descriptive statistics, and correlations were assessed using Chi-square tests. Results: Among the study cohort, 62% were male, with a mean age of 65.8 years; 81% were over 50 years. Focal seizures were more common (56.6%) than generalized seizures (38.4%), with immediate onset seizures occurring in 55% of cases. Cortical lesions were more associated with seizures (65%) than subcortical lesions (11.6%), particularly in the left hemisphere (55%). PACI was the most common ischemic stroke type (64%) associated with seizures, while larger volume ICH presented greater risk in hemorrhagic stroke. Significant associations were found between NIHSS severity and stroke subtype (p = 0.0001), as well as with Oxfordshire classification (p = 0.00001). Conclusion: Post-stroke seizures exhibit distinct demographic and clinical patterns, with focal seizures predominating in cortical and left-sided lesions. PACI and cardio-embolic strokes were linked to higher seizure risk. Stroke severity as measured by NIHSS and Oxfordshire classification were significantly associated with seizure onset, underscoring the importance of targeted monitoring in high-risk groups.

Background: Lung cancer has emerged as the leading cause of cancer-related mortality globally. Various clinical, socioeconomic, and environmental factors have been implicated in its development. However, such comprehensive studies are limited in developing countries, hindering the formulation and execution of effective public health policies. Aim: To assess the clinic-epidemiological and pathological characteristics of lung cancer patients presenting to a tertiary care teaching hospital in South India. Methods: A total of 160 patients with histologically confirmed bronchogenic carcinoma were included in this study. Cases with other malignancies or isolated malignant pleural effusion without clear evidence of bronchogenic carcinoma were excluded. Results: The findings reveal a troubling pattern of delayed diagnosis, presentation at advanced stages, and poor survival rates among bronchogenic carcinoma cases. Conclusion: Implementing robust strategies for early detection and prompt intervention could significantly improve outcomes for lung cancer patients in this region. Enhancing awareness and streamlining referral pathways in primary care may play a vital role in improving survival rates in this population.

Background: Isolated lower limb monoparesis is a rare clinical presentation of stroke, often mistaken for peripheral or spinal pathology. Infarcts in the anterior cerebral artery (ACA) territory, particularly involving the paracentral lobule, can present with contralateral lower limb weakness. Non contrast CT scan of brain which is usually the first investigation for suspected acute strokes could detect the ACS infarct in only 25%. 20 % of patients present with only isolated lower limb weakness and a normal NCCT brain in these cases may lead to erroneous localization of pathology to a peripheral cause. [1] Case Summary: We report three cases of patients presenting with isolated lower limb monoparesis due to ACA territory infarcts.  Two patients underwent MRI brain with diffusion-weighted imaging (DWI) and one patient underwent urgent NCCT head, which was able to demonstrate the cerebral infarct. Lesions were localized to the medial frontal cortex, specifically the paracentral lobule. Timely imaging led to appropriate diagnosis and management with favorable outcomes. Conclusion: Central causes should be considered in patients presenting with lower limb monoparesis. ACA infarcts, though uncommon, are a critical differential diagnosis and can be accurately identified with neuroimaging.

We report the case of a 56-year-old female diabetic and hypertensive with ovarian carcinoma undergoing staging laparotomy. She presented with chemotherapy-induced neutropenia, complicated by rhino-orbital mucormycosis, cavernous sinus thrombosis and lower limb ischemia (Raynaud’s phenomenon). Perioperative considerations included management of vasospastic disorder and balancing the anticoagulant therapy and pain management. This case highlights the multidisciplinary challenges in anaesthetic management of complex, immunocompromised patients with invasive fungal infections and vascular comorbidities.

Introduction: Patients of Chronic Urticaria (CU) face significant issues due to bothersome itching and hives, and their condition often doesn’t respond well to treatments. Chronic idiopathic urticaria (CIU) can be triggered by various factors, with autoimmune issues being one of the most common causes. There’s a crucial need for therapies that not only extend remission periods but also target the key factors contributing to the disease’s development. Aim: To evaluate the effectiveness of histaglobulin, a combination of histamine and human immunoglobulin, in providing symptom relief for Chronic Urticaria (CU) patients, and to assess the differential impact in ASST-positive and ASST-negative groups. Materials And Methods: This was a single-center, open-label, non-randomized, prospective clinical study involving       CU patients. Participants received a weekly 1 mL subcutaneous injection of histaglobulin for eight weeks. They were also allowed to take cetirizine 10 mg tablets as needed, without exceeding the recommended dose. The drug's efficacy was evaluated using the Urticaria Activity Score (UAS 7), a simple, validated scoring system. Assessments were conducted at each weekly visit, with a final evaluation after 24 weeks. Results: Twenty-eight chronic urticaria patients completed an 8-week course of histaglobulin treatment. The average age was 38.2 years, with a male-to-female ratio of 1.3:1, and an average disease duration of 18.2 months. The baseline Urticaria Activity Score (UAS) significantly decreased from 19.6 to 3.9 following treatment (p < 0.0001) and remained low at 3.5 after 24 weeks, indicating sustained improvement. Most patients (89%) achieved complete remission by week 24, with the majority experiencing excellent or good responses to therapy. Conclusion: Histaglobulin significantly improves symptoms and achieves high remission rates in chronic urticaria patients. Its safety and tolerability make it an excellent adjunct treatment option.

Background: Acute dyspnea is a prevalent and challenging symptom in emergency settings, often stemming from either cardiac or pulmonary etiologies.Differentiating between these causes is crucial for appropriate management.Lung ultrasound (LUS), particularly the identification of B-lines, has emerged as a valuable tool in this diagnostic process. The differential diagnosis is broad, encompassing both cardiac and pulmonary etiologies.Timely and accurate differentiation is crucial, as it directly influences management strategies and patient outcomes.

Aims And Objectives:

1.To evaluate the diagnostic accuracy of B-lines in lung ultrasound for distinguishing between cardiac and pulmonary causes of acute dyspnea.

2.To assess the prognostic significance of B-line patterns in predicting patient outcomes, including mortality and readmission rates.

3.To compare the effectiveness of lung ultrasound in detecting B-lines with traditional imaging modalities like chest X-ray and computed tomography in the context of acute dyspnea.

4.To investigate the impact of B-line quantification on clinical decision-making and management strategies in emergency department settings.

5.To explore the feasibility and reliability of implementing B-line assessment in prehospital and point-of-care settings for rapid diagnosis.

Methods In this prospective observational study conducted in the Emergency Department on 20 adult patients between may and June 2025, we aimed to evaluate the diagnostic utility of B-line lung ultrasound (LUS) in differentiating cardiac from pulmonary causes of acute dyspnea.Adult patients presenting with acute dyspnea were assessed using a standardized 8-zone LUS protocol, focusing on identifying B-lines—vertical, hyperechoic artifacts originating from the pleural line. Diagnostic performance metrics, including sensitivity, specificity, and interobserver reliability, were calculated to assess the accuracy of B-line LUS in distinguishing between cardiac and pulmonary etiologies of acute dyspnea. Results: The cohort comprised 20 adults (mean age 68.5 ± 12.3 years; 55% male) presenting with acute dyspnea. Lung Ultrasound Findings:  B-profile (B-lines with lung sliding): Observed in 12 patients (60%), indicative of cardiogenic pulmonary edema. B'-profile (B-lines without lung sliding): Detected in 8 patients (40%), suggesting non-cardiogenic causes such as pneumonia or ARDS. Final Diagnoses:Cardiac Etiology: 12 patients (60%) diagnosed with acute decompensated heart failure. Pulmonary Etiology: 8 patients (40%) diagnosed with conditions like pneumonia or ARDS. Diagnostic Performance: Sensitivity: 90% ,Specificity: 85% ,Positive Predictive Value (PPV): 92% ,Negative Predictive Value (NPV): 80% . Conclusion: B-line lung ultrasound (LUS) is a rapid, non-invasive, and highly effective diagnostic tool for differentiating between cardiac and pulmonary causes of acute dyspnea in the emergency department.The presence of B-lines, particularly when observed with lung sliding (B-profile), is strongly indicative of cardiogenic pulmonary edema, whereas B-lines without lung sliding (B'-profile) suggest non-cardiogenic causes such as acute respiratory distress syndrome (ARDS) or pneumonia.LUS offers advantages over traditional imaging methods, including higher sensitivity and specificity, absence of ionizing radiation, and the ability to perform bedside assessments, facilitating timely and appropriate therapeutic interventions.Integrating B-line LUS into clinical practice can enhance diagnostic accuracy, optimize patient care, and improve outcomes for patients presenting with acute dyspnea.

Background: Soft tissue tumors of the extremities comprise a heterogeneous group of benign and malignant lesions with variable clinical behavior. Accurate preoperative diagnosis is critical for management. Fine-needle aspiration cytology (FNAC) offers a rapid, cost-effective, and minimally invasive diagnostic option, but its accuracy requires validation against histopathology. Objective: To assess the diagnostic accuracy of FNAC in soft tissue tumors of extremities and correlate cytological findings with histopathological diagnoses. Methods: A prospective study was conducted at Bombay Health Care, Ujjain, from May 2024 to April 2025. A total of 120 patients with clinically suspected soft tissue tumors of extremities underwent FNAC followed by histopathological examination. FNAC results were categorized as benign, malignant, or suspicious. Diagnostic indices including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated using histopathology as the gold standard. Results: Out of 120 cases, FNAC classified 72 (60%) as benign, 40 (33.3%) as malignant, and 8 (6.7%) as suspicious. Histopathology confirmed 70 benign and 50 malignant tumors. FNAC showed 45 true positives, 5 false negatives, 68 true negatives, and 2 false positives. The calculated sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 90%, 97.1%, 95.7%, 93.1%, and 94.2% respectively. Lipoma was the most common benign tumor (42.8%), while pleomorphic sarcoma was the most frequent malignant tumor (32%). Conclusion: FNAC is a simple, safe, and highly accurate technique for evaluating soft tissue tumors of extremities. It serves as an effective first-line investigation to guide management decisions. However, histopathology remains indispensable for definitive diagnosis, grading, and subtyping.

Background: Meditation and mindfulness-based interventions (MBIs) are increasingly recognized for their potential effects on physiological and psychological health, particularly in regulating cardiovascular parameters and stress responses. However, variations in study designs and outcomes necessitate a comprehensive synthesis to evaluate the overall impact of these interventions. Material and Methods: A systematic review was conducted following PRISMA 2020 guidelines. Databases and registers were searched to identify studies evaluating meditation or mindfulness-based interventions on cardiovascular and emotional outcomes. Records were screened for eligibility, with duplicates removed. Data were extracted regarding study design, intervention type, sample size, outcome measures, and results. Quality and risk of bias were assessed using standardized tools. Results: A total of 460 records were identified, with 410 screened after duplicates removal. Of these, 135 full-text articles were assessed for eligibility, and 23 studies were included in the qualitative synthesis and analyses. Findings indicate that slow-paced breathing, meditation, and MBIs are associated with significant reductions in heart rate, blood pressure, and perceived stress levels. Heterogeneity across studies was noted due to differences in intervention duration, participant characteristics, and outcome measures. Overall, evidence quality ranged from moderate to high, with most studies demonstrating consistent physiological and psychological benefits. Conclusion: Meditation and mindfulness-based interventions demonstrate beneficial effects on cardiovascular and emotional health. Despite some heterogeneity, current evidence supports their integration into stress management and cardiovascular wellness programs. Future research should focus on standardized protocols and long-term follow-up to strengthen evidence.