European Journal of Cardiovascular Medicine

Background: Proximal tibia extra-articular fractures are challenging injuries due to their complex anatomy and risk of complications. Surgical management primarily includes intramedullary nailing (IMN) and locking compression plate (LCP) fixation. Comparative evaluation of these methods in terms of functional outcomes, fracture healing, and complications is essential to guide optimal treatment. Aim: To compare the clinical and functional outcomes of intramedullary nailing versus locking compression plate in the management of proximal tibia extra-articular fractures. Methods: A prospective study was conducted over a period of 9 months at Government Medical College, Kathua. Forty patients with proximal tibia extra-articular fractures were enrolled and divided into two groups of 20 each. Group A underwent intramedullary nailing, while Group B underwent locking compression plate fixation. Patients were evaluated for operative time, intraoperative blood loss, time to radiological union, functional outcome using the Lysholm knee scoring system, and complications. Data were analyzed using standard statistical methods. Results: The mean age of patients was 38.5 ± 11.2 years, with a male predominance (70%). The mean operative time was 65 ± 12 minutes in the IMN group and 95 ± 15 minutes in the LCP group. Mean intraoperative blood loss was significantly lower in the IMN group (120 ± 25 mL) compared to the LCP group (250 ± 30 mL). Radiological union was achieved at a mean of 16 ± 3 weeks in the IMN group and 18 ± 4 weeks in the LCP group. Functional outcome as per Lysholm score at 6 months was superior in the IMN group (mean score 88 ± 6) compared to the LCP group (mean score 82 ± 7). Complications included superficial infection in 2 patients in the LCP group and delayed union in 1 patient in the IMN group. Conclusion: Both intramedullary nailing and locking compression plate are effective modalities for proximal tibia extra-articular fractures. IMN offers advantages of shorter operative time, less blood loss, earlier union, and slightly better functional outcomes. LCP remains a reliable alternative in cases with complex fracture patterns or where IMN is technically challenging

Background: Homocysteine metabolism is closely linked to Vitamin B12 and folate status, and disturbances in this pathway are recognized contributors to vascular pathology. Elevated homocysteine levels have been increasingly associated with ischemic stroke, particularly in individuals presenting for the first time. Understanding these biochemical patterns at initial presentation may aid in targeted prevention and secondary risk reduction. Aim: To assess serum homocysteine, Vitamin B12, and folate levels in patients with first-episode ischemic stroke and determine the prevalence of metabolic derangements. Materials and Methods: This observational study included 50 adult patients diagnosed with first-episode ischemic stroke based on clinical assessment and neuroimaging. Demographic details and clinical risk factors were recorded. Fasting blood samples were analyzed for serum homocysteine, Vitamin B12, and folate levels. Standard laboratory cut-off values were used to categorize abnormalities. Data were summarized using descriptive statistics. Results: The mean age of the participants was 58.4 ± 9.6 years, with males constituting 62%. Hypertension (56%) and Type 2 diabetes mellitus (42%) were commonly observed clinical risk factors. The mean serum homocysteine level was 19.8 ± 6.7 µmol/L, and elevated homocysteine (>15 µmol/L) was detected in 64% of subjects. Vitamin B12 deficiency was present in 56% of patients, while low folate levels were found in 36%. A noticeable proportion of patients with hyperhomocysteinemia also had concomitant Vitamin B12 or folate deficiency. Conclusion: A significant number of patients with first-episode ischemic stroke exhibited elevated homocysteine levels alongside reduced Vitamin B12 and folate status. These findings highlight the importance of routinely evaluating and correcting these metabolic parameters in acute stroke care as part of comprehensive vascular risk management

Glucose serves as fuel for metabolism and is central to producing energy for all organisms, even the most simplistic, and for humans. Its rapid conversion to ATP allows glucose to be the primary energy source for the brain, the renal medulla, the retina, and red blood cells, which are all tissues that depend on glucose. In adults, the obligatory glucose requirement is around 130–150 grams daily. For those whose work requires significant physical or mental exertion, this requirement increases to 200–250 grams. In the case of insulin-deficiency state carbohydrate restriction could be dangerous. Stabilizing carb intake helps avoid diabetes ketoacidosis or DKA, which can happen as a result of enhanced lipolysis and lack of control over ketone body formation. Carbohydrate restriction is a faulty strategy that poses risks, not benefits. Metabolic control and protection against DKA are optimal with physiologically balanced meals, ensuring adequate hydrative intake and personalized insulin. Glucose is necessary, not as a biochemical fuel, but as a central part of safe and effective diabetes control.

Background: Right ventricular dysfunction (RVD) is an under-recognized determinant of outcomes in acute ST-elevation myocardial infarction (STEMI). While left ventricular ejection fraction (LVEF) remains the standard prognostic marker, accumulating evidence highlights the independent clinical significance of right ventricular (RV) impairment. This study evaluated RV function across anterior wall MI (AWMI), inferior wall MI (IWMI), and inferior wall MI with RV involvement (IWMI+RVMI) using echocardiographic indices, and correlated these with in-hospital outcomes. Methods: This prospective observational study enrolled 120 consecutive patients with first-episode STEMI admitted to the Department of Cardiology, S.C.B. Medical College & Hospital, Cuttack, between October 2022 and September 2023. Echocardiographic assessment within 48 hours included tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), myocardial performance index (MPI), and tricuspid annular systolic velocity (S′). Patients were followed for 7 days for complications including arrhythmias, heart failure (HF), cardiogenic shock, and conduction disturbances. Results: Of 120 patients, 62 had AWMI (51.7%), 38 had IWMI (31.7%), and 20 had IWMI+RVMI (16.6%). Mean age was 59.6 ± 11.8 years, with male predominance (71.7%). At least one abnormal RV parameter was observed in 55% of AWMI, 50% of IWMI, and all (100%) IWMI+RVMI cases. Multiparametric dysfunction (all four indices abnormal) was most frequent in IWMI+RVMI (30%). TAPSE (mm) progressively declined from AWMI (20.9) to IWMI (18.9) to IWMI+RVMI (15.8) (p<0.001). FAC (%) followed a similar trend (40.1, 34.8, 24.5; p<0.001). LVEF was lowest in AWMI (41.3%) compared to IWMI (55.2%) and IWMI+RVMI (53.6%) (p<0.001). In-hospital complications included HF (10%), arrhythmias (8%), cardiogenic shock (4%), and mechanical complications (2%). Patients with abnormal RV indices had significantly higher complication rates (p<0.05). Conclusion: RV dysfunction is frequent in STEMI, extending beyond classical RV infarction. TAPSE and FAC were the most sensitive parameters for detecting RV impairment, while AWMI patients demonstrated predominant LV dysfunction. Abnormal RV indices strongly correlated with adverse in-hospital outcomes, underscoring the need for routine RV functional assessment in STEMI management protocols.

Background: Inflammation and thrombosis underlie acute coronary syndromes (ACS). Hematological indices derived from routine complete blood counts (CBC)—including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR)—may offer low-cost prognostic value, particularly in resource-limited settings. Objectives: To evaluate whether admission NLR, PLR, platelet indices (MPV, PDW, PCT), and coagulation markers (PT, aPTT) predict in-hospital mortality and morbidity among patients with ACS. Methods: We performed a hospital-based longitudinal study at S.C.B. Medical College & Hospital, Cuttack, India (1 September 2022–31 August 2023). Consecutive adults with ACS (STEMI, NSTEMI, or unstable angina) were enrolled (N=516). Exclusions included immediate pre-hospital/ED cardiac arrest and chronic inflammatory, malignant, renal, hepatic disease, or pregnancy. Admission CBC-derived indices (NLR, PLR, MPV, PDW, PCT) and PT/aPTT were measured. Outcomes were in-hospital mortality and major adverse events: ventricular tachyarrhythmia, cardiogenic shock, left ventricular failure (LVF), and prolonged hospitalization (>5 days). Associations were tested using t-tests/χ², univariate and multivariable logistic regression, and ROC analysis. Results: Cohort mean age was 60.6±12.3 years; 64.1% were male; STEMI comprised 53.3%. Mortality was 5.8% (30/516). Morbidity included cardiogenic shock 20.9%, LVF 10.9%, ventricular tachyarrhythmia 3.5%, and prolonged hospitalization 10.9%. On multivariable analysis, NLR independently predicted all outcomes—mortality (adjusted OR 1.130 per unit; 95% CI 1.044–1.223), ventricular tachyarrhythmia (1.221; 1.097–1.359), cardiogenic shock (1.150; 1.071–1.234), LVF (1.104; 1.032–1.181), and prolonged hospitalization (1.224; 1.140–1.314). PLR independently predicted mortality (1.003; 1.001–1.006), cardiogenic shock (1.006; 1.003–1.009), and LVF (1.003; 1.001–1.006). MPV, PDW, and PCT were not independent predictors. PT prolongation was strongly associated with mortality. Discrimination was highest for NLR: AUC 0.909 for mortality (cut-off 9.38; sensitivity 87.5%, specificity 88.8%), with robust AUCs for other morbidities (≥0.774). PLR showed good but consistently lower performance (mortality AUC 0.862 at cut-off 201). Conclusions: Admission NLR—and to a lesser degree PLR—provides powerful, inexpensive prognostic information for in-hospital mortality and complications in ACS, outperforming platelet volume indices. PT adds complementary risk signal for mortality. Incorporating NLR/PLR into routine assessment and existing risk models may enhance early stratification, especially where advanced biomarkers are inaccessible

Background: Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal morbidity and mortality. Alterations in lipid metabolism have been implicated in their pathogenesis through endothelial dysfunction and oxidative stress. This study evaluated and compared serum lipid profiles in hypertensive and normotensive pregnant women and correlated them with maternal and fetal outcomes. Objectives: To evaluate serum lipid profiles in hypertensive and normotensive pregnant women. To compare lipid parameters between both groups. To correlate abnormal lipid levels with maternal and fetal outcomes. Methods: A comparative prospective study was conducted among 100 pregnant women (50 hypertensive and 50 normotensive) attending the Department of Obstetrics and Gynaecology at a tertiary care hospital. Fasting venous blood samples were analyzed for total cholesterol, triglycerides, HDL-C, LDL-C, VLDL-C, and non-HDL-C using enzymatic methods. Maternal and neonatal outcomes were recorded. Statistical analysis included Welch’s t-test, chi-square test, relative risk, and 95% confidence intervals, with p < 0.05 considered significant. Results: Hypertensive women showed significantly higher mean values of total cholesterol (224.7 ± 32.9 mg/dL), triglycerides (204.3 ± 41.8 mg/dL), LDL-C (139.8 ± 27.6 mg/dL), and non-HDL-C (183.0 ± 31.8 mg/dL) and lower HDL-C (41.7 ± 6.9 mg/dL) compared with normotensive women (p < 0.001). Adverse neonatal outcomes such as preterm birth, low birth weight, and IUGR were more frequent among those with abnormal lipid levels. Elevated TC/HDL ratio (≥4.5) conferred the highest risk (RR = 3.02; p = 0.0007). Conclusion: Dyslipidemia is significantly associated with hypertensive disorders of pregnancy and adverse perinatal outcomes. Early lipid screening and targeted management may aid in reducing maternal and neonatal complications.

Background: Post-dated pregnancy, defined as gestation extending beyond 40 weeks, is associated with an increased risk of maternal and perinatal morbidity. The optimal management of such pregnancies—whether to await spontaneous onset or to induce labour—remains a critical obstetric consideration. Aim: To compare the maternal and fetal outcomes between spontaneous and induced labour among post-dated pregnancies. Methods: This prospective interventional study included 100 women with post-dated singleton pregnancies admitted to the Department of Obstetrics and Gynaecology at a tertiary care centre. Participants were divided into two groups: Group I (spontaneous onset of labour, n=50) and Group II (induced labour, n=50). Induction was performed using prostaglandin E₂ gel followed by oxytocin as needed. Maternal outcomes such as mode and duration of delivery, perineal injuries, and postpartum haemorrhage were compared. Fetal outcomes assessed included Apgar scores, meconium aspiration, NICU admissions, and perinatal mortality. Statistical analysis was performed using SPSS version 20.0, with p<0.05 considered significant. Results: Cesarean section rates were significantly higher in the induced group (50%) than in the spontaneous group (16%) (p<0.001). Vaginal delivery was more common in spontaneous labour (70% vs 42%; p=0.003). The mean duration of labour was longer in induced cases (10.48 ± 3.50 h vs 8.72 ± 3.81 h; p=0.018). Maternal complications and neonatal outcomes, including Apgar <7 at 5 minutes (12% vs 10%), meconium aspiration (10% each), and NICU admission (12% vs 10%), did not differ significantly between groups. Conclusion: Induction of labour in post-dated pregnancies is associated with an increased cesarean delivery rate and prolonged labour duration but does not adversely impact maternal or fetal outcomes when managed appropriately. Vigilant monitoring and individualized decision-making are essential for optimizing perinatal results

Background: It is vital to assess, report, record, and document the rate of stillbirths in India for accurate estimation of the concern. Also, for decrease in preventable stillbirths, it is needed to determine its etiology. However, existing literature data is scarce in Indian context. Aim: The present study was aimed to identify the risk factors and causes of stillbirths utilizing the histopathology of placenta in females delivering at Indian healthcare centers and to classify the cause of fetal death using Causes of Death and Associated Conditions (CODAC) simplified classification. Methods: The study assessed the cases of stillbirths at the Institute within the defined study period. In all the cases, clinical data were gathered for mothers and stillbirths were recorded on preformed structured proforma. At birth, heart blood or cord blood along with wedge of placenta were taken and assessed for bacterial culture. Remnant placenta was assessed histopathologically. Reports and data were collected and assessed to determine the cause of death and classified using CODAC simplified classification. Results: The study results showed that the rate of stillbirth in the present study was 26.2 per 1000 total birth. The most common cause of stillbirths in the study subjects was placental factors seen in 51.7% (n=88) mothers followed by maternal factors as recorded in 28.2% (n=48) mothers. Among placental factors, common causes were placental insufficiency, placental abruptions, and placental infarction in 5.9% (n=10), 17.6% (n=30), and 28.2% (n=48) subjects. The most common maternal cause of stillbirths was hypertensive disorders as seen in 22.4% (n=38) subjects.   Conclusion: The present study concludes that classification of stillbirths using CODAC classification depicts vital role of placenta in stillbirths directly as reason for stillbirth or was related indirectly to placental causes as hypertension. Histopathology of placenta identified placenta factors as reason for death in subjects when no other apparent clinical reasons can be assigned and can be classified as unknown when not present.

Background: The oral mucosa often reflects a person overall health. The oral cavity often exhibits notable signs of systemic disease, highlighting the crucial role of oral examination in diagnosing and managing dermatological conditions." Aims and Objectives: To examine the epidemiological and clinical profiles of oral mucosal lesions in patients with diseases attending the DVL outpatient department Materials and Methods: This hospital-based observational study enrolled patients who met specific inclusion and exclusion criteria. Comprehensive data collection involved detailed histories, thorough clinical examinations, and photographic documentation, followed by data analysis, tabulation, and interpretation of results. Results: Out of 160 cases, Age group of 18-80 years were included and most common age group were 31-50 years. Males were more common than in Females in Gender distribution. Erosions and Pigmentation were the most common clinical presentations of oral dermatoses. Oral Lichen Planus was the most common oral dermatological condition observed in this study

Dementia imposes profound cognitive, emotional, and physical burdens on affected individuals and their caregivers, particularly as global and Indian populations age. Informal caregivers in urban India often lack access to formal training, increasing the risk of inadequate patient support and high caregiver stress. This study was designed to evaluate the effectiveness of a photobook intervention aimed at enhancing dementia caregiving skills and knowledge among caregivers in Gurugram.A quasi-experimental, non-randomized study was conducted with 60 informal dementia caregivers, divided equally into experimental (photobook intervention) and control (no intervention) groups. Socio-demographic data were collected, and caregiver knowledge was measured using a structured questionnaire before and after a two-week intervention period. Statistical analysis included paired t-tests and chi-square tests to determine changes in knowledge and any demographic associations. The experimental group demonstrated a significant improvement in post-intervention knowledge scores compared to the control group (p<0.001). Prior to the intervention, the majority of caregivers exhibited inadequate knowledge regardless of group. After using the photobook, experimental participants showed a pronounced shift towards moderate and adequate knowledge categories, as illustrated by graphical analysis. No significant knowledge improvement was observed in the control group, and demographic variables such as age and gender were not significantly associated with score changes.Photobook interventions proved highly effective in broadening caregivers’ understanding and capability in key dementia care activities. These findings support previous research on the value of visual and structured educational resources for both professional and informal caregivers. The study highlights the importance of integrating accessible educational tools into community-based caregiver programs but notes limitations related to sample size and geographic focus

Background:  Anaemia is a frequent hematological abnormality observed in patients with hypothyroidism, attributed to reduced thyroid hormone–mediated erythropoietin production, impaired iron metabolism, and bone marrow suppression. This study aimed to assess the prevalence, types, and clinical correlation of anaemia among hypothyroid patients and to evaluate the relationship between thyroid hormone levels and hematological indices. Methods: A cross-sectional study was conducted on 100 clinically and biochemically confirmed hypothyroid patients attending a tertiary care hospital. Detailed clinical history, thyroid profile (TSH, FT4, FT3), and complete blood count (Hb, RBC indices) were analyzed. Anaemia was classified based on WHO criteria and red-cell indices. Statistical analysis included t-test, ANOVA, Chi-square, and Pearson’s correlation using SPSS version 25.0, with p < 0.05 considered significant. Results: Out of 100 patients, 78% were female and 62% had overt hypothyroidism. Anaemia was present in 58% of cases, with normocytic normochromic anaemia being the most common (44.8%), followed by microcytic (34.5%) and macrocytic (20.7%) types. Anaemic patients had significantly higher TSH (18.94 ± 7.12 µIU/mL) and lower FT4 (0.68 ± 0.21 ng/dL) and FT3 (2.31 ± 0.51 pg/mL) compared to non-anaemic patients (p < 0.001). TSH showed a negative correlation with haemoglobin (r = –0.412), while FT4 and FT3 showed positive correlations (r = +0.438 and +0.406, respectively). Conclusion: Anaemia is highly prevalent in hypothyroidism, especially in overt disease, with normocytic normochromic anaemia being most frequent. The severity of anaemia correlates inversely with thyroid hormone levels, emphasizing the need for routine hematological assessment in hypothyroid patients for early detection and management

Background: Head and neck positioning is critical for optimizing laryngeal exposure and facilitating safe, efficient endotracheal intubation. The sniffing position (SP) has been the conventional standard, yet recent investigations highlight that modest modifications to head elevation may significantly influence glottic visualization. This study evaluates three head elevations—0 cm (no pillow), 3 cm, and 6 cm—assessing their effects on Cormack–Lehane (CL) grade, Percentage of Glottic Opening (POGO), and Intubation Difficulty Scale (IDS). Methods: In this prospective randomized analytical study conducted between May 2023 and November 2024, 159 adult patients (ASA I–II) undergoing elective surgery were evaluated. Each patient underwent laryngoscopic assessment in all three positions; the best glottic view was chosen for intubation. CL grade and POGO scores were recorded for each position (n=159 per position). IDS and intubation-related outcomes were analyzed in patient groups where a given pillow height provided the best view and was used for intubation (n=21 for 0 cm, n=110 for 3 cm, n=28 for 6 cm). Statistical significance was set at p<0.05. Results: The 3 cm pillow position provided superior glottic visualization—CL grades 1–2 were observed in 94.3% of 3 cm assessments compared to 56.6% (0 cm) and 48.4% (6 cm) (p<0.001). POGO distribution favored 3 cm: high POGO (100%) observed in 47.2% vs. 12.6% (0 cm) and 11.9% (6 cm) (p<0.001). IDS outcomes in intubation groups showed easier intubation at 3 cm (67.3% classified as 'easy') compared to 0 cm (57.1%) and 6 cm (57.1%) (p<0.001). Mucosal trauma and postoperative complications were also lowest in the 3 cm intubation cohort. Conclusion: Moderate head elevation (3 cm) optimizes airway alignment, enhances laryngeal exposure, reduces intubation difficulty, and lowers mucosal injury—supporting its routine consideration as a refined modification of the sniffing position in elective cases

Background: With changing lifestyle patterns, obesity is increasingly being seen even among young adults who are otherwise presumed to be healthy. Medical students, despite their health literacy, often experience irregular routines and stress-related habits that quietly affect their cardiovascular system. This study set out to explore how excess body weight might be linked to early changes in heart rate regulation and blood pressure among first-year MBBS students in South India. Objective: To examine the association between obesity and resting cardiovascular parameters, specifically heart rate, blood pressure, and short-term heart rate variability (RMSSD), as indicators of autonomic modulation in young adults. Methods: Over eight months (September 2024 to April 2025), 100 undergraduate medical students were recruited at Dhanalakshmi Srinivasan Medical College, Perambalur. Participants were grouped using Asia-Pacific BMI guidelines into normal weight (18.5–22.9 kg/m², n = 50) and obese (≥25 kg/m², n = 50) categories. Resting heart rate and blood pressure readings were obtained under standardized morning conditions. Autonomic function was assessed noninvasively through RMSSD derived from lead II ECG. Statistical comparisons between groups were made using unpaired t-tests, and associations were explored through Pearson correlation. Findings: Students in the obese category showed a consistently higher mean heart rate (83.87 ± 4.67 bpm), elevated systolic (129.69 ± 8.12 mmHg) and diastolic blood pressure (85.91 ± 6.55 mmHg), and reduced parasympathetic tone (RMSSD: 25.16 ± 3.87 ms) when compared to their normal-BMI counterparts (heart rate: 72.09 ± 4.37 bpm; SBP: 118.59 ± 6.26 mmHg; DBP: 74.89 ± 5.40 mmHg; RMSSD: 41.09 ± 5.91 ms). All differences were statistically significant (p < 0.001). Conclusion: The findings highlight an early pattern of autonomic imbalance in obese young adults, suggesting increased cardiovascular strain even in the absence of clinical disease. These subtle shifts, detectable through noninvasive screening, underscore the need for proactive monitoring and health counseling tailored to medical students’ unique academic pressures.

Background: Incidental adrenal masses are a common clinical finding, present in 4-6% of abdominal imaging studies. While most are benign adenomas, differentiation from malignant or hyper-functioning lesions is critical for patient management. Computed Tomography (CT) is the primary imaging modality, but lipid-poor adenomas can mimic aggressive pathologies, necessitating advanced quantitative techniques like contrast washout analysis. This study aimed to validate the diagnostic performance of a dedicated tri-phasic CT protocol in a clinically diverse patient population.  Materials and Methods: An observational, hospital-based study was conducted on 42 consecutive patients with adrenal masses. All patients underwent a tri-phasic adrenal CT protocol (unenhanced, 65 to 70-second portal venous, and 15-minute delayed phases). Quantitative analysis included unenhanced attenuation in Hounsfield Units (HU) and calculation of Absolute and Relative Percentage Washout (APW and RPW, respectively). Radiological diagnoses were correlated with the histopathological gold standard in 34 cases.  Results: The study cohort (N=42) had a mean age of 48.2 years and a slight female predominance (52.4%). A significant portion of lesions were large (42.9% >4 cm), indicating a high-risk population. The CT protocol demonstrated a sensitivity of 94.0%, specificity of 100.0%, a positive predictive value (PPV) of 100.0%, and an overall accuracy of 94.12% in differentiating benign from malignant or other non-adenoma lesions (p<0.01). Histopathology confirmed a complex case mix, with pheochromocytoma (21.4%) and adrenocortical carcinoma (7.1%) being prominent diagnoses alongside adrenal cortical adenomas (26.2%).  Conclusion: A strictly implemented tri-phasic quantitative CT protocol demonstrates exceptionally high specificity and positive predictive value, establishing it as a robust and reliable tool for the non-invasive characterization of adrenal masses. Its stellar performance, particularly in a high-risk cohort, validates its role as a critical gatekeeper in the clinical algorithm. This high-fidelity imaging serves as an indispensable bridge, confidently triaging patients toward appropriate surveillance, further investigation, or immediate, specialized management pathways, including definitive guidance for complex interventional radiology procedures.

Background: Residual neuromuscular blockade can delay the recovery in paediatric patients and lead to postoperative complications. Both neostigmine & sugammadex are commonly used for reversing the neuromuscular blockade; however, onset, mechanism of action and recovery profile is significantly different. It is important to compare their efficacy in paediatric tonsillectomy to facilitate faster and safer recovery with minimal postoperative complications. Aims And Objective:  To evaluate the effectiveness of sugammadex versus neostigmine in paediatric adenotonsillectomy by comparing extubation time and postoperative complications such as hypotension, hypertension, bradycardia, anaphylactic reaction, vomiting & nausea in order to evaluate overall recovery and haemodynamic stability between the two groups. Methods:  This prospective, randomized study enrolled 128 paediatric patients (ASA grade I–II, aged 3–17 years) scheduled for adenotonsillectomy. Participants were randomly allotted into two different groups: Group S received sugammadex 2 mg/kg, while Group N received neostigmine 0.05–0.09 mg/kg combined with glycopyrrolate 0.008–0.15 mg/kg. General anaesthesia was standardized using propofol, fentanyl, and vecuronium. Recovery indices, extubation time, and postoperative clinical parameters were carefully recorded and compared.  Results:  A total of 128 paediatric patients were included in the study, with no significant differences in demographic characteristics between the two groups (p > 0.05). The mean extubation time was significantly shorter in the sugammadex group (2.6 ± 0.7 min) compared to the neostigmine group (7.0 ± 1.8 min; p < 0.001) Hemodynamic parameters remained stable in both groups; however, postoperative stability was better in the sugammadex group (p < 0.05).  Postoperative nausea and vomiting were reported only in the neostigmine group (40.6% and 12.5%; p < 0.001, p = 0.003). Overall, sugammadex achieved faster recovery and a lower incidence of adverse effects than neostigmine. Conclusion:  Compared to neostigmine, sugammadex is more effective in reversing vecuronium induced neuro muscular blockade. Sugammadex provides shorter extubation time with higher safety profile and less post operative complications. The incidence of PONV is very less with sugammadex as compared to neostigmine.

Background: Veno-lymphatic malformations in head and neck region pose significant clinical challenges, due to high morbidity and recurrences associated with traditional surgical management. Bleomycin sclerotherapy has emerged as a first-line treatment modality for such lesions. Methods: This retrospective observational study was conducted in the division of interventional radiology at a tertiary care hospital where twenty patients with slow-flow vascular and lymphatic malformations in the head and neck region who underwent bleomycin sclerotherapy were included. Primary outcome measures included lesion size reduction and treatment response rates. Secondary outcomes encompassed patient satisfaction, complication rates and safety profile.  Results: The study cohort comprised 20 patients with a mean age of 18.5 years, with 65% being female. The facial region was most commonly affected (35%), followed by periorbital region (20%), oral cavity (15%), scalp (15%) and salivary glands (15%). Patients received a mean of 2.9 treatment cycles. Overall response (≥25% reduction) was achieved in 95% of patients, with substantial response (≥50% reduction) in 50%. Three treatment cycles demonstrated optimal efficacy with 100% achieving ≥50% reduction, while two cycles showed 100% patient satisfaction. Complications occurred in 40% of patients, all classified as minor, like swelling (20%) and hyperpigmentation (10%). Statistical analysis revealed highly significant associations between cycle number and size reduction (p<0.001) and patient satisfaction (p=0.034).Conclusions: Bleomycin sclerotherapy is a highly effective and safe first-line treatment for head and neck veno-lymphatic malformations. The study identifies 2-3 treatment cycles as optimal for balancing efficacy, safety, and patient satisfaction, providing valuable guidance for clinical practice and treatment protocols.

Background: Head and neck positioning is critical for optimizing laryngeal exposure and facilitating safe, efficient endotracheal intubation. The sniffing position (SP) has been the conventional standard, yet recent investigations highlight that modest modifications to head elevation may significantly influence glottic visualization. This study evaluates three head elevations—0 cm (no pillow), 3 cm, and 6 cm—assessing their effects on Cormack–Lehane (CL) grade, Percentage of Glottic Opening (POGO), and Intubation Difficulty Scale (IDS). Methods: In this prospective randomized analytical study conducted between May 2023 and November 2024, 159 adult patients (ASA I–II) undergoing elective surgery were evaluated. Each patient underwent laryngoscopic assessment in all three positions; the best glottic view was chosen for intubation. CL grade and POGO scores were recorded for each position (n=159 per position). IDS and intubation-related outcomes were analyzed in patient groups where a given pillow height provided the best view and was used for intubation (n=21 for 0 cm, n=110 for 3 cm, n=28 for 6 cm). Statistical significance was set at p<0.05. Results: The 3 cm pillow position provided superior glottic visualization—CL grades 1–2 were observed in 94.3% of 3 cm assessments compared to 56.6% (0 cm) and 48.4% (6 cm) (p<0.001). POGO distribution favored 3 cm: high POGO (100%) observed in 47.2% vs. 12.6% (0 cm) and 11.9% (6 cm) (p<0.001). IDS outcomes in intubation groups showed easier intubation at 3 cm (67.3% classified as 'easy') compared to 0 cm (57.1%) and 6 cm (57.1%) (p<0.001). Mucosal trauma and postoperative complications were also lowest in the 3 cm intubation cohort. Conclusion: Moderate head elevation (3 cm) optimizes airway alignment, enhances laryngeal exposure, reduces intubation difficulty, and lowers mucosal injury—supporting its routine consideration as a refined modification of the sniffing position in elective cases

Background: Coronary artery bypass grafting (CABG) remains one of the most frequently performed cardiac surgeries worldwide. Accurate pre-operative risk stratification helps predict mortality and optimize peri-operative care. The Society of Thoracic Surgeons (STS) score, developed from large North American datasets, is increasingly used in India despite limited regional validation. This study evaluated the predictive accuracy of the STS score for postoperative mortality among CABG patients in a South Indian tertiary cardiac center. Methods: A retrospective analysis was conducted among adult patients who underwent isolated CABG over a 12-month period. Data on demographics, comorbidities, peri-operative variables, and postoperative outcomes were retrieved from hospital records. STS mortality scores were calculated using the official online calculator. Observed mortality was compared with predicted mortality, and calibration was assessed using Hosmer-Lemeshow goodness-of-fit. Discrimination was tested with the area under the receiver operating characteristic (ROC) curve (AUC). Statistical significance was defined at p < 0.05. Results: A total of 409 patients (mean age 60 ± 8 years; 89.5 % male) were included. The overall observed mortality was 2.2 % (n = 9), while the mean predicted mortality by the STS model was 1.65 ± 0.74 %. Mortality correlated significantly with increasing STS risk category (p = 0.006). ROC analysis demonstrated an AUC = 0.83 (95 % CI 0.76–0.89), indicating good discrimination. The model showed adequate calibration between predicted and observed events (Hosmer–Lemeshow χ² = 6.1; p = 0.41). Conclusion: The STS risk model demonstrated good discrimination and acceptable calibration for predicting mortality after CABG in the South-Indian cohort. It can be reliably used for preoperative counselling, benchmarking, and quality assurance in resource-limited cardiac surgical programs

Purpose: To study clinicodemographic profile of patients undergoing MRI with Focal Liver Lesions.. Methods: Sixty-four consecutive patients with liver lesions underwent DWI using standardized MRI protocols. Lesions were characterized by both qualitative signal intensity and quantitative ADC measurement. Final diagnosis, based on histopathology or imaging follow-up, was used as reference. Statistical analysis included sensitivity, specificity, and ROC curve assessment. Results: 64 patients with ages 27-80 with a mean age of 51.42 years with sex ratio M/F of 29/35 underwent MRI in which 24 lesions were found to be benign and 40 were found to be malignant. The average lesion size was 4.6. Conclusion: DWI with ADC quantification provides robust, non-invasive discrimination between benign and malignant FLLs, facilitating clinical management and reducing reliance on invasive biopsy.

Background: Purpose: To quantitatively assess the diagnostic value of DWI and ADC mapping in distinguishing liver metastases from primary hepatic malignancies (hepatocellular carcinoma and cholangiocarcinoma). Methods: DW-MRI data from patients with biopsy-proven malignant liver lesions were retrospectively analyzed. ADC values of metastatic lesions were compared to those of HCC and cholangiocarcinoma using t-tests and ROC analysis. Results: Mean ADC of metastases (0.81±0.19×10−3 mm2/s0.81±0.19×10−3mm2/s) was significantly lower than that of HCC (1.03±0.23×10−3 mm2/s1.03±0.23×10−3mm2/s), p=0.01. ROC analysis produced an AUC of 0.83 and an optimal cutoff of 0.90×10−3 mm2/s0.90×10−3mm2/s for identifying metastases Conclusion: DW-MRI ADC quantification is a practical adjunct for differentiating metastatic lesions from primary hepatic cancers, supporting more precise patient management

Background Palpable breast swelling, whether benign or malignant, results from hormonal influences. Most cases are benign. Triple assessment-clinical, histological, and radiological-enables accurate detection and evaluation, guiding effective interventions. The research aimed to compare the patterns of breast swelling in premenopausal and postmenopausal women and identify the most common breast lumps in each group. Methods One hundred female patients with palpable breast lumps were evenly divided into premenopausal (50 patients) and postmenopausal groups (50 patients). Each patient underwent clinical examination, fine-needle aspiration cytology (FNAC), and core needle biopsy if necessary. Ultrasonography (USG) of the breast was conducted for all patients, and mammograms were performed for selected cases. All postoperative specimens underwent histopathological examination. Results Among the total 100 patients, 60 were diagnosed with benign breast disease, and 40 had malignant breast disease. In premenopausal women, 82% were diagnosed with benign disease, while in postmenopausal women, 38% had a benign diagnosis. Conversely, premenopausal women showed an 18% incidence of malignant breast disease, while postmenopausal women exhibited a 62% incidence. Among malignant breast diseases, 60% were invasive ductal carcinoma, 32.5% were invasive lobular carcinoma, 5% were invasive medullary carcinoma, and 2.5% were inflammatory carcinoma. Conclusion The study finds a higher prevalence of malignant breast disease in postmenopausal women, while premenopausal women commonly experience benign breast disease, notably fibrocystic cystic disease. Premenopausal women exhibit a higher percentage of invasive lobular carcinoma than the general population, while postmenopausal women predominantly face invasive ductal carcinoma breast NST/NOS with increased invasive lobular carcinoma.

Background Twin pregnancies are associated with increased maternal and perinatal risks compared to singleton gestations. They contribute significantly to maternal morbidity, obstetric complications, and adverse neonatal outcomes. This study aimed to evaluate the maternal and perinatal outcomes of twin pregnancies at a tertiary care hospital in Tezpur, Assam. Objectives To determine the incidence of twin pregnancies and analyse maternal complications, maternal morbidity and mortality, as well as neonatal morbidity and mortality. Methods This study was conducted over one year at Tezpur Medical College and Hospital. A total of 100 women with twin pregnancies beyond 28 weeks of gestation were included, fulfilling inclusion and exclusion criteria. Data were collected through structured proformas, clinical examinations, ultrasonography, and perinatal monitoring. Maternal and neonatal outcomes were analysed using descriptive statistics. Results The incidence of twin pregnancy was 0.7% among 13,737 deliveries. Most women were aged 20–29 years (73%), with nearly equal distribution between primigravida (49%) and multigravida (51%). Preterm delivery occurred in 84% of cases, and anemia (72%) was the most common maternal risk factor. Premature labour (76%) was the leading complication, with maternal mortality recorded in 2%. Caesarean delivery was slightly more common (54%) than vaginal birth (46%). Perinatal outcomes were marked by low birth weights (s (<2.5 kg in 80–90% of twins), intrauterine deaths (3–5%), and a high NICU admission rate (52–56%). Conclusion Twin pregnancies are high-risk with significant maternal and perinatal complications. Strengthening antenatal care, early risk identification, and skilled intrapartum management are essential to improve outcomes.

Background Type 2 diabetes mellitus (T2DM) has been increasingly linked to cognitive dysfunction through mechanisms involving chronic hyperglycemia, microvascular disease, and neurodegeneration. Magnetic Resonance Imaging (MRI) provides an objective method to assess these brain changes.  Aim: To compare MRI brain changes in Type 2 diabetic patients with and without cognitive impairment. Materials and Methods: A hospital-based cross-sectional comparative study was conducted on 120 Type 2 diabetic patients divided into two groups: 60 with cognitive impairment (CI+) and 60 without (CI-). Cognitive assessment was performed using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE). MRI scans were analyzed for white matter hyperintensities (Fazekas score), hippocampal volume, cortical thickness, lacunes, microbleeds, and diffusion tensor imaging parameters (FA and ADC). Data were statistically analyzed using Student’s t-test, Chi-square test, and correlation analyses, with p < 0.05 considered significant. Results: Patients with cognitive impairment were older (64.1 ± 7.8 vs 60.3 ± 7.5 years; p = 0.007), had longer diabetes duration (12.3 ± 4.6 vs 9.7 ± 4.1 years; p = 0.0015), and higher HbA1c (8.7 ± 1.1 vs 7.9 ± 1.0; p < 0.001). MRI revealed higher Fazekas WMH scores (2.4 ± 0.8 vs 1.6 ± 0.7; p < 0.001), lower hippocampal volume (6.2 ± 0.7 vs 6.8 ± 0.6 cm³; p < 0.001), and thinner cortex (2.38 ± 0.12 vs 2.46 ± 0.11 mm; p < 0.001) in CI+ patients. WMH and hippocampal volume correlated significantly with MoCA scores (r = -0.56 and +0.49, respectively; p < 0.001). Logistic regression identified diabetes duration, HbA1c, hypertension, and LDL as independent predictors of MRI changes. Conclusion: T2DM patients with cognitive impairment exhibit distinct MRI abnormalities indicating both vascular and neurodegenerative pathology. Poor glycemic control and longer disease duration significantly contribute to these brain changes. Early neuroimaging screening in diabetic individuals may aid in detecting subclinical brain injury and preventing cognitive decline.

Purpose: To compare corneal biomechanical parameters in eyes with keratoconus and post-refractive surgery ectasia using Scheimpflug-based imaging and to evaluate whether distinct biomechanical signatures can aid in differentiating the two entities. Methods: This observational cross-sectional study included 80 eyes of 60 subjects — 40 with keratoconus (Group A) and 40 with post-refractive surgery ectasia (Group B). All participants underwent corneal assessment with Pentacam HR and Corvis ST. Parameters such as stiffness parameter (SP-A1), deformation amplitude (DA ratio), integrated radius, and Ambrosio Relational Thickness (ARTmax) were compared between groups. Data were analyzed using independent t-test, with p < 0.05 considered statistically significant. Results: Mean SP-A1 was significantly lower in post-refractive ectasia (67.8 ± 12.5) compared to keratoconus (75.6 ± 14.2, p = 0.01), indicating greater biomechanical weakness post-surgery. DA ratio and integrated radius were both higher in ectasia (1.12 ± 0.04 and 8.23 ± 0.6 respectively) than in keratoconus (1.05 ± 0.03 and 7.68 ± 0.5; p < 0.01). ARTmax was significantly reduced in both groups but lowest in post-refractive ectasia (230.4 ± 35.2 µm vs 258.7 ± 32.5 µm). Conclusion: Scheimpflug-based biomechanical assessment demonstrates quantifiable differences between keratoconus and post-refractive ectasia. Post-refractive ectasia shows greater structural destabilization and lower corneal stiffness, suggesting different pathophysiological mechanisms despite overlapping topographic features.

Introduction: Vaginal discharge is one of the most common reasons for gynecologic visits. Infectious etiologies—bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), Trichomonas vaginalis (TV), and less frequently Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG)—predominate, yet local etiologic profiles and resistance patterns vary, necessitating setting-specific data for empirical therapy. Materials and Methods: This is a Cross-sectional study conducted was conducted in the Department of Gynecology and Microbiology at tertiary-care teaching hospital over 12 months. Non-pregnant women (18–49 years) attending a tertiary-care gynecology OPD over 12 months. Standardized clinical proforma, pH/whiff tests, saline/KOH microscopy, Gram stain with Nugent scoring, wet-mount and Giemsa staining for TV, culture/identification for yeasts and aerobic vaginitis (AV) bacteria, and staining and culture for NG and serological tests for CT were performed. Antimicrobial susceptibility of aerobic isolates followed CLSI guidelines; antifungal susceptibility used broth microdilution for fluconazole, itraconazole, voriconazole, and amphotericin B. Primary outcomes were etiologic prevalence and susceptibility profiles. Results: Among 300 women (mean age 31.2 ± 7.1 y), BV (33.0%), VVC (29.7%), TV (7.7%), AV (13.7%), CT (4.3%), and NG (2.3%) were identified; 14.0% had mixed infections. Candida albicans comprised 58% of yeasts; non-albicans Candida (NAC) included C. glabrata (22%), C. tropicalis (12%), and others (8%). Among AV isolates, E. coli (34%), Enterococcus faecalis (23%), and S. aureus (16%) predominated. High nitrofurantoin (92%) and fosfomycin (88%) susceptibility were observed in Enterobacterales; fluoroquinolone resistance was frequent. NAC showed reduced fluconazole susceptibility (28%) versus C. albicans (86%). Conclusion: BV and VVC accounted for most symptomatic discharge, with meaningful burdens of AV and TV. Given high fluoroquinolone resistance among aerobic isolates and reduced azole activity against NAC, empiric choices should align with guideline-concordant regimens for BV/TV and reserve targeted agents for culture-proven AV or recurrent VVC. Routine microscopy plus targeted culture and serological tests improve accuracy and stewardship

Fetal aortic stenosis (AS) is a congenital cardiac defect characterized by narrowing of the aortic valve, impairing blood flow from the left ventricle to the aorta. The condition varies from mild to severe and can progress to hypoplastic left heart syndrome (HLHS), a critical, often lethal state where left heart structures are underdeveloped. Early diagnosis and multidisciplinary management are vital for optimizing outcomes. We report a case of a 33-year-old primigravida diagnosed antenatally with gestational hypothyroidism and fetal aortic stenosis, which was successfully managed

Background: The saphenofemoral junction (SFJ) is a crucial anatomical landmark for high ligation and stripping procedures in varicose vein surgery. Unrecognized anatomical variations may result in incomplete ligation, intraoperative injuries and recurrence. This study aimed to compare the anatomy of the SFJ, its relationship with the superficial external pudendal artery (SEPA), and tributary patterns between normal cadavers and patients with chronic venous insufficiency (CVI). Methods: An ambispective comparative study was conducted involving 46 cadaveric lower limbs (Group C) and 40 patients undergoing high ligation and stripping (Group S) from January 2023 to March 2024. The relation of SEPA to SFJ and pattern of venous tributaries were studied, along with demographics. Statistical analysis was performed using Independent t-test, Chi-square test, and Pearson correlation. p≤0.05 was considered significant. Results: The position of SFJ was found to be below junction of medial one-third and lateral two-third of inguinal ligament, occurring lower down in cadaveric population vs surgical population (3.1cm vs 2.8cm, p=0.006). The distance between SFJ location and inguinal ligament showed a positive correlation with the femur length (r=0.58, p=0.00002 for Group C, r=0.6, p=0.0003 for Group S).  The venous anatomy was found similar in the cadaveric groups with normal limbs and surgical group with CVI in terms of SEPA position and tributary pattern. In relation to SFJ, SEPA was found to posterior in 58.7% vs 60%, anterior in 19.6% vs 20%, absent in 15.2% vs 15% and duplicated, occurring anteriorly and posteriorly in 7% vs 5% when comparing Group C and Group S respectively (p>0.05). Major tributaries at SFJ in Group C and Group S were identified as the superficial pudendal vein (84.8% vs 87.5%), superficial epigastric vein (76.1% vs 80%), superficial circumflex iliac vein (76% vs75%), anterior accessory vein (54.4% vs 45%) posteromedial thigh vein (37% vs 35%) and additional veins (26.1% vs 47.5%)(p>0.05). Conclusion: Location of SFJ varies as per stature of person. The SFJ shows consistent anatomical relationships across cadaveric and surgical groups. SEPA is found posterior to insertion of great saphenous vein at SFJ in approximately 65% of population. Superficial pudendal vein is the tributary most consistently found at SFJ in North Indian population.

Background: The no-reflow phenomenon and suboptimal TIMI (Thrombolysis in Myocardial Infarction) flow following percutaneous coronary intervention (PCI) are critical predictors of adverse outcomes in ST-elevation myocardial infarction (STEMI). While pharmacoinvasive strategies offer an effective alternative in resource-limited settings, the timing of PCI post-thrombolysis may influence both pre-procedural thrombus burden and post-procedural microvascular reperfusion. Objective: To evaluate the impact of timing of pharmacoinvasive PCI on pre- and post-procedural TIMI flow grades and the incidence of the no-reflow phenomenon in patients presenting with anterior wall STEMI. Methods: This prospective observational study enrolled 480 patients with anterior STEMI who received thrombolysis followed by planned PCI within 24 hours. Patients were divided into three groups based on time from thrombolysis to PCI: Group A (3–10 hours), Group B (10.1–17 hours), and Group C (17.1–24 hours). Pre- and post-procedural TIMI flow grades were assessed angiographically. TIMI flow <3 post-PCI was considered indicative of no-reflow. Comparative analyses across groups were performed using chi-square and ANOVA tests with significance at p<0.05. Results: Baseline pre-PCI TIMI 0/I flow was observed in >65% across all groups, with no significant intergroup difference (p=0.998), indicating similar initial thrombotic burden. However, post-procedural TIMI III flow was highest in Group A (96.0%) compared to Group B (91.7%) and Group C (90.7%), though the difference was not statistically significant (p=0.135). The incidence of no-reflow (post-PCI TIMI <3) was numerically lower in Group A (4.0%) versus Group B (8.3%) and Group C (9.3%). Conclusion: Early pharmacoinvasive PCI (within 3–10 hours) is associated with a higher rate of achieving optimal post-procedural TIMI III flow and a lower, albeit not statistically significant, incidence of no-reflow. These findings support the clinical utility of early PCI in improving myocardial perfusion and limiting microvascular damage in anterior STEMI managed via a pharmacoinvasive strategy.

Meditation and breathing-based mind–body practices have been increasingly investigated for their potential to improve cardiovascular and respiratory health through autonomic and mechanical mechanisms. This systematic review aimed to synthesize evidence from randomized controlled trials, controlled physiological studies, and systematic reviews examining the effects of meditation, mindfulness, pranayama, and integrated yoga interventions on cardio-respiratory parameters. Literature searches were conducted in PubMed, Scopus, and Web of Science for English-language studies published. Nineteen studies meeting predefined eligibility criteria were included and grouped thematically into mindfulness and meditation-based programs, breathing and pranayama-focused interventions, and integrated yoga approaches. Across studies, meditation and mindfulness training resulted in significant reductions in systolic and diastolic blood pressure, improved heart rate variability, and enhanced emotional regulation among both healthy and hypertensive participants. Breathing and pranayama techniques, including slow breathing, Bhrāmarī, and OM chanting, consistently improved forced vital capacity, forced expiratory volume in one second, and peak expiratory flow rate, while increasing baroreflex sensitivity and parasympathetic activity. Integrated yoga interventions combining postures, breathing, and meditation demonstrated synergistic benefits across cardiovascular and pulmonary domains, reflected by lower resting heart rate, reduced blood pressure, and improved ventilatory efficiency. Collectively, these findings support that meditation and related mind–body techniques can beneficially modulate autonomic and respiratory physiology, offering safe and accessible adjuncts for prevention and rehabilitation in cardiometabolic and pulmonary disorders. However, heterogeneity in study design, small sample sizes, and limited long-term follow-up underscore the need for larger, standardized trials to establish dose–response relationships and sustainability of benefits