European Journal of Cardiovascular Medicine

Background: Caffeine is widely consumed, yet its acute effects on cardiac autonomic regulation remain incompletely understood. Heart rate variability (HRV) provides a sensitive, non-invasive method to assess autonomic balance and detect subtle neural cardiovascular effects. Objectives: To evaluate the short-term effects of moderate caffeine intake on cardiac autonomic function in healthy young adults using time-domain and frequency-domain HRV analysis, with assessment of sex-related differences and effect sizes. Methods: In this cross-sectional interventional study, 100 healthy young adults underwent baseline HRV and hemodynamic assessment under resting conditions. HRV was recorded for 5 minutes before and 60 minutes after oral caffeine administration (3 mg/kg body weight). Time-domain and frequency-domain HRV parameters were analysed according to standard guidelines. Sex-based comparisons and effect sizes were calculated. Results: Caffeine intake resulted in a significant increase in parasympathetic HRV indices, including NN50 and high-frequency (HF) power, along with a significant reduction in the LF/HF ratio, indicating a shift toward parasympathetic predominance. These changes were associated with small-to-moderate effect sizes. Hemodynamic parameters, including heart rate and blood pressure, remained clinically stable. Sex-specific analysis revealed a greater increase in NN50 among females, while other autonomic responses were comparable between sexes. Conclusion: Moderate acute caffeine intake enhances cardiac parasympathetic modulation without adverse hemodynamic effects in healthy young adults.

Background: Acute coronary syndrome (ACS) remains a leading cause of cardiovascular mortality globally, particularly in developing nations like India. Risk stratification at presentation is crucial for optimizing treatment strategies and resource allocation. While established scores like GRACE require laboratory values and complex calculations, the PADMA (PADjadjaran Mortality in Acute Coronary Syndrome) score offers a simpler alternative using only clinical examination findings. Objectives: To assess the predictive capability of the PADMA score for in-hospital mortality in ACS patients and compare its performance with other established risk scores including GRACE, C-ACS, and ProACS. Methods: This prospective observational study included 84 consecutive ACS patients (STEMI and NSTEMI) admitted to a tertiary care center. PADMA, GRACE, C-ACS, and ProACS scores were calculated at admission for each patient. The primary outcome was in-hospital mortality. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminatory power of each score, with Youden's index employed to determine optimal cutoff values. Results: The study population had a mean age of 63.63 ± 12.944 years with 63.1% males. Overall in-hospital mortality rate was 14.3% (12/84). The PADMA score demonstrated strong discriminatory ability with an AUC of 0.825 (95% CI: 0.73-0.92), sensitivity of 91.7%, and specificity of 66.7% at a cutoff of 8.5. PADMA scores were significantly higher in non-survivors (11.67 ± 3.80 vs. 6.57 ± 3.90, p<0.001). Comparative analysis showed GRACE score AUC of 0.837, C-ACS AUC of 0.751, and ProACS AUC of 0.694. Mortality was significantly associated with female gender (OR 4.26, p=0.021), Killip class III-IV (p=0.001), and elevated shock index (1.06 vs 0.76, p<0.001). No significant mortality difference was observed between STEMI and NSTEMI (p=0.788). Conclusion: The PADMA score demonstrated excellent efficacy in predicting in-hospital mortality in ACS patients with discriminatory ability comparable to the more complex GRACE score. Its high sensitivity (91.7%) makes it particularly valuable for identifying high-risk patients requiring urgent intensive care. The simplicity of the PADMA score—requiring only clinical assessment parameters—offers substantial practical advantages in resource-constrained settings where laboratory data may be delayed or unavailable

Chronic cutaneous ulcers represent a persistent clinical problem due to impaired healing and frequent recurrence despite standard wound care practices. This prospective comparative study assessed the effectiveness of autologous platelet-rich plasma (PRP) in the treatment of chronic non-healing cutaneous ulcers. Ninety patients were randomly allocated into a PRP group (n = 45), which received local autologous PRP injections, and a control group (n = 45), managed with conventional 10% povidone-iodine dressings. Patients were followed until complete epithelialization or the requirement for surgical intervention. Wound culture findings were comparable between the two groups, with Staphylococcus aureus being the most commonly isolated organism and no statistically significant difference observed (p = 0.5737). Despite similar microbial profiles, PRP-treated patients demonstrated faster and more complete wound healing than those receiving conventional treatment. These findings indicate that autologous PRP is a safe, cost-effective, and effective adjunct in the management of chronic non-healing cutaneous ulcers.

Background: Infants of diabetic mothers (IDM) are at increased risk of neonatal hypoglycemia, contributing to interventions and NICU admissions.Objectives: To estimate the incidence of hypoglycemia in IDM, identify predictors, and describe timing and short-term outcomes.Methods: Prospective observational study (18 months) at SSPM Medical College and Lifetime Hospital, Padve, Maharashtra. Consecutive IDM (n=220) underwent scheduled glucose screening (2, 6, 12, 24, 48, 72 hours and if symptomatic). Hypoglycemia was defined using Indian guideline–based operational thresholds. Predictors were assessed using bivariate analysis and multivariable logistic regression.Results: Hypoglycemia occurred in 69/220 (31.4%) (95% CI 25.6–37.8). First episodes were most frequent at 6 hours (43.5%) and 12 hours (27.5%). Among affected neonates, 36.2% were symptomatic, 20.3% had severe hypoglycemia (<25 mg/dL), and 7.2% had recurrent episodes. IV dextrose was required in 37.7% and NICU admission was higher with hypoglycemia (40.6% vs 23.2%, p=0.009). On multivariable analysis, HbA1c (aOR 1.67, p=0.062) and LGA status (aOR 2.13, p=0.063) showed borderline association with hypoglycemia.Conclusion: Nearly one-third of IDM developed hypoglycemia, predominantly within the first 12 hours, with increased need for IV therapy and NICU admission. Early feeding and protocol-based monitoring are essential.

Background: Vitamin D deficiency is common in children and may adversely affect linear growth, yet regional data from coastal western India are limited.Objectives: To estimate the prevalence of vitamin D deficiency and examine its association with growth parameters among children aged 1–10 years in Sindhudurg, Maharashtra.Methods: A hospital-based cross-sectional study was conducted over 6 months at SSPM Medical College and Lifetime Hospital, Padve. In 400 children (1–10 years), serum 25-hydroxyvitamin D [25(OH)D] was measured and categorized as deficient (<20 ng/mL), insufficient (20–29 ng/mL), or sufficient (≥30 ng/mL). Anthropometry was used to derive HAZ, WAZ, and BAZ; determinants and growth associations were assessed using multivariable regression.Results: Vitamin D deficiency was present in 40.3% (161/400), insufficiency in 25.3%, and sufficiency in 34.5%. Deficient children had lower mean HAZ than sufficient children (−1.06 ± 1.07 vs −0.73 ± 1.17; p=0.028). In adjusted linear models, deficiency remained associated with lower HAZ (β −0.37, 95% CI −0.64 to −0.10; p=0.008) and WAZ (β −0.29, 95% CI −0.55 to −0.04; p=0.024), with no association with BAZ. Higher sun exposure was independently protective against deficiency (aOR 0.77 per hour/day, 95% CI 0.60–0.99; p=0.042). Conclusion: Nearly two-thirds of children had suboptimal vitamin D status, and deficiency was independently associated with lower linear growth indices. Improving effective sun exposure and appropriate supplementation may reduce deficiency burden and support child growth.

Background: Complete dentures significantly improve oral function and quality of life for edentulous patients. However, first-time denture wearers often face challenges during the adaptation period, including discomfort and functional difficulties. This study aims to assess adaptation time, comfort levels, and overall satisfaction among first-time complete denture wearers in the Bangladeshi population. Methods: This observational study was conducted at the Department of Prosthodontics, Bangabandhu Sheikh Mujib Medical University (BSMMU) and beau-dent, Dhaka, Bangladesh, over one year from January 2010 to December 2010. A total of 50 first-time complete denture wearers were evaluated. Data were collected on demographic characteristics, primary complaints, adaptation time, comfort progression, and satisfaction levels over six months. Statistical analysis was performed using SPSS version 12. Results: In our study pain/discomfort (44%) was the most common complaint, followed by difficulty in chewing (36%) and speech problems (20%). The majority (70%) adapted within a month, with 36% adjusting in 1-2 weeks. Comfort levels improved from 10% in the first week to 84% at six months. After six months, 74% of participants were satisfied or very satisfied with their dentures, while 12% reported dissatisfaction. Conclusion: First-time denture wearers experience significant adaptation challenges, particularly in the early weeks. However, comfort and satisfaction levels improve over time. Regular follow-ups, patient education, and psychological support play crucial roles in ensuring a successful adaptation process.

Background:Hypertension is highly prevalent in patients with chronic kidney disease (CKD) and is a major contributor to cardiovascular morbidity and progression of renal dysfunction. Accurate assessment of blood pressure (BP) in CKD patients is challenging due to altered circadian BP patterns and poor reliability of office blood pressure measurements. Ambulatory blood pressure monitoring (ABPM) provides comprehensive evaluation of BP variability, nocturnal BP behavior, and overall BP burden, which may have important clinical implications in CKD.Objectives:To study various blood pressure parameters obtained by ambulatory blood pressure monitoring in patients with chronic kidney disease, to compare office blood pressure monitoring with ambulatory blood pressure monitoring, to determine the prevalence of resistant, masked, and white-coat hypertension, and to evaluate altered circadian BP patterns and their association with CKD stages and target organ damage.Methods:This hospital-based observational cross-sectional study was conducted among 88 hospitalized CKD patients aged more than 12 years admitted to the general medicine wards of Government Medical College, Kozhikode, between January 2022 and December 2022. Office BP was measured using a mercury sphygmomanometer, and all participants underwent 24-hour ABPM using a validated device. Ambulatory parameters including daytime and nighttime systolic and diastolic BP, nocturnal dipping status, hyperbaric index, percent time elevation, and BP phenotypes were analyzed. Data were expressed as mean ± standard deviation and percentages.Results:Hypertension was detected in 80.7% of patients by ABPM compared to 76.1% by office BP measurement. Resistant hypertension was observed in 34.1% of the study population and in 44.7% of hypertensive patients, with prevalence increasing with advancing CKD stage. A high prevalence of nocturnal non-dipping pattern was noted (73.9%), and all patients with resistant hypertension were non-dippers. Nighttime hyperbaric index and percent time elevation were significantly higher than daytime values, particularly in advanced CKD stages. Target organ damage was common, with left ventricular hypertrophy present in 44.5% and hypertensive retinopathy in 37.5% of patients, while resistant hypertension patients showed markedly higher prevalence of these complications.Conclusion:Ambulatory blood pressure monitoring provides superior diagnostic and prognostic information compared to office BP measurement in hospitalized CKD patients. ABPM enables accurate identification of resistant and masked hypertension, detects abnormal nocturnal BP patterns, and reveals increased nighttime BP burden associated with target organ damage. Routine use of ABPM in CKD patients may improve blood pressure management, risk stratification, and prevention of cardiovascular complications.

Background: Myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide. Arrhythmias are common complications following acute MI, particularly after thrombolytic therapy, and significantly influence clinical outcomes. Objectives: To evaluate the demographic and clinical profile of patients with acute MI, assess the incidence and pattern of arrhythmias following thrombolytic therapy, and analyze their association with infarct location, comorbidities, and in-hospital mortality. Methods: This prospective observational study included 160 patients with acute MI admitted to a tertiary care center. Demographic variables, comorbid conditions, type and site of MI, occurrence and type of arrhythmias after thrombolysis, and clinical outcomes were recorded and analyzed. Results: The majority of patients were aged 46–60 years, with a mean age of 54.54 ± 11.09 years, and males constituted 65% of the study population. Hypertension and diabetes mellitus were the most common comorbidities. Anterior wall MI was the predominant infarct type. Arrhythmias occurred in 63.13% of patients, with ventricular premature complexes (22.77%), sinus tachycardia (19.80%), and idioventricular rhythm (14.85%) being the most frequent. Ventricular arrhythmias were associated with higher mortality. The overall in-hospital mortality rate was 13%, predominantly observed in patients with anterior and anteroinferior wall infarctions. Conclusion: Arrhythmias are common following thrombolytic therapy in acute MI, particularly in patients with anterior wall involvement and associated comorbidities. Early detection, continuous cardiac monitoring, and timely management of arrhythmias, along with effective control of cardiovascular risk factors, are essential to improve patient outcomes and reduce mortality.

Background: Effective postoperative pain management is critical for enhancing recovery and minimizing complications after surgical procedures. Percutaneous nephrolithotomy (PCNL), though minimally invasive, often results in significant postoperative pain due to renal and muscular trauma. Regional anaesthesia techniques, such as paravertebral block (PVB) and peri-tubal infiltration (PTI), are increasingly used to improve analgesia while reducing systemic opioid use. Objective: To compare the efficacy of PVB and PTI in controlling postoperative pain in patients undergoing PCNL, with a focus on pain scores, opioid consumption. Methods: In this prospective, randomized clinical study, adult patients scheduled for PCNL were divided into three groups: Group B received a thoracic paravertebral block with 15ml of 0.25% Levobupivacaine, Group I received peri-tubal infiltration with 20 mL of 0.25% Levobupivacaine and Group C received IV paracetamol 1 gm and inj. diclofenac 75 mg IM intraoperatively. Pain was assessed using the Numerical Rating Scale Scale (NRS) at 0, 2, 4, 8, 12, and 24 hours after completion of surgery. Mean time of first rescue analgesia were recorded and analyzed. Results:  Postoperative pain scores were initially comparable across all groups. However, from 2 hours post-surgery onward, Group C (Control) reported significantly higher VAS scores than both Group B (Paravertebral Block) and Group I (Peritubal Infiltration) (p < 0.0001). At 24 hours, Group C had the highest pain score (5.0 ± 0.79), followed by Group I (4.25 ± 0.68) and Group B (3.46 ± 0.86). The mean time to first rescue analgesia was significantly longer in Group B (8.20 ± 2.21 hours) compared to Group I (4.00 ± 1.17 hours), with p < 0.001, indicating more prolonged analgesia with the paravertebral block. Conclusion: Paravertebral block provides superior early postoperative pain relief compared to peri-tubal infiltration in patients undergoing PCNL. Its use is associated with reduced opioid requirements and improved patient comfort, supporting its role in enhanced recovery protocols

Background: Recurrent pregnancy loss (RPL), defined as two or more failed pregnancies, affects 10–15% of women. Endocrine factors contribute to approximately 8–12% of cases, with growing evidence implicating subclinical hypothyroidism (SCH) and thyroid autoimmunity (TAI) in adverse pregnancy outcomes. However, data on their role in early pregnancy loss remain limited. Objectives: To analyse the association between subclinical hypothyroidism and anti-thyroid peroxidase (anti-TPO) antibodies in women with recurrent pregnancy loss, and to estimate the prevalence of SCH and anti-TPO positivity in this population. Methods: This prospective, descriptive observational study was conducted from July 2023 to December 2024 at a tertiary care centre in Kolkata. A total of 166 multigravida women with ≥2 pregnancy losses were enrolled after excluding anatomical and chromosomal causes. Clinical data, biochemical parameters, and thyroid profiles (TSH, free T4, anti-TPO antibodies) were analysed using SPSS version 25. Associations were assessed using Fisher’s exact test. Results: The mean age was 28.09 ± 5.62 years. Of the study population, 44.0% had subclinical hypothyroidism and 54.8% were euthyroid. Anti-TPO antibody positivity (≥35 IU/ml) was observed in 59.6% of women. A statistically significant association was found between subclinical hypothyroidism and anti-TPO antibody positivity (p = 0.0028), as well as between overt hypothyroidism and anti-TPO positivity (p = 0.0018). Most miscarriages (89.1%) occurred during the first trimester. Conclusion: Subclinical hypothyroidism in the presence of thyroid autoimmunity is significantly associated with recurrent pregnancy loss. Routine screening for thyroid dysfunction and anti-TPO antibodies may facilitate early intervention and improve reproductive outcomes.

Background: Invasive fungal infections (IFIs) are associated with high morbidity and mortality, particularly among immunocompromised and critically ill patients. Timely and accurate diagnosis is essential for improving outcomes. Histopathology and microbiological methods, including culture and molecular diagnostics, remain the principal modalities for diagnosing IFIs; however, their relative diagnostic yield and concordance vary across studies. Objective: To systematically compare the diagnostic yield of histopathology versus microbiological methods in invasive fungal infections and to evaluate their complementary roles in establishing proven infection. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed/Medline, Embase, Scopus, and PubMed Central were searched from inception to January 2025 for studies reporting paired histopathology and microbiological findings on tissue or sterile site specimens from patients with suspected IFIs. Data on diagnostic yield, concordance, and the contribution of molecular techniques were extracted. Due to heterogeneity in study design, specimen types, and reporting of diagnostic accuracy measures, results were synthesized narratively, with quantitative tabulation where feasible. Results: Forty-two studies met the inclusion criteria. Histopathology consistently demonstrated a higher diagnostic yield for detecting fungal elements and tissue invasion compared with fungal culture alone, particularly in patients with prior antifungal exposure and in infections caused by fastidious organisms. Microbiological culture showed variable sensitivity but remained essential for species identification and antifungal susceptibility testing. Molecular diagnostic methods significantly enhanced detection rates and improved concordance with histopathology, especially in culture-negative cases. Considerable variability in concordance between histopathology and microbiology was observed across studies. Conclusion: Histopathology remains indispensable for establishing invasive fungal infection through demonstration of tissue invasion, while microbiological and molecular methods are critical for etiological identification and therapeutic guidance. An integrated diagnostic approach combining histopathology, culture, and molecular techniques provides the highest diagnostic yield and should be considered the standard strategy for the diagnosis of invasive fungal infections.

Background: Coronary arterial dominance describes which coronary artery gives rise to the posterior descending artery (PDA) and largely perfuses the inferior interventricular septum and adjacent diaphragmatic myocardium. Objectives: To document the dominance pattern and related morphological features of the PDA and crux cordis in adult human hearts. Methods: A descriptive cross-sectional study was conducted on 80 adult human hearts examined in the Department of Anatomy, Government Medical College, Karimnagar, Telangana, India (February–November 2025). The right coronary artery (RCA) and left circumflex artery (LCx) were traced to identify the origin of the PDA, the vessel reaching/crossing the crux cordis, and the predominant inferior ventricular supply. Dominance was categorized as right, left, or co-dominant. Results: Right dominance was observed in 70% of hearts, left dominance in 20%, and co-dominance in 10%. The PDA arose from the RCA in 70% and from the LCx in 20%, while dual contribution was seen in 10%. At the crux cordis, the RCA crossed the crux in 70% and the LCx reached the crux in 20%; both vessels reached the crux in 10%. Inferior wall supply was predominantly by the RCA in 70%, by the left coronary system in 20%, and balanced in 10%. Conclusion: Right coronary dominance predominated, with consistent correspondence between dominance category, PDA origin, crux reach, and inferior ventricular supply. These baseline data support safer interpretation of coronary imaging and procedural planning in the regional context

CIN  is the impairment of renal function gauged as either a 25% rise in serum creatinine from baseline or an increase of 0.5 mg/dL (44 µmol/L) in absolute serum creatinine value within 48-72 hours following intravenous contrast administration.The renal impairment that is linked with the administration of contrast is acute, usually occurring within 2-3 days. However, it has been recommended that renal impairment developing up to seven days post-contrast administration should be considered CIN if it is not attributable to any other possible cause of kidney failure.The incidence of contrast-induced nephropathy is calculated to be more than 2% in the general population. However, in high-risk groups with risk factors for kidney disease, the incidence is as high as 20% to 30%. It is reported that there is a lower risk of contrast-induced nephropathy when low osmolar contrast media is used.Additionally, it decreases water reabsorption, causing an increase in interstitial pressure.The study aimed to predict the CIN after PCI in comparision with Meharan score. METHODS A cross-sectional study was conducted in the Department of Cardiology at a multispecialty teaching hospital. A total of 300 patients were taken undergoing PCI including  elective and emergency PCI , were creatinine was done at admission and at 48hrs after PCI.survivors of a first episode of AMI who returned for follow-up one month after discharge were included. .  Data were analyzed using SPSS version 26. Descriptive statistics, z-test, Chi-square test, Spearman’s correlation, and binary logistic regression were applied. A p-value < 0.05 was considered statistically significant. RESULTS A total of 300 study participants based on inclusion and exclusion criteria were included in the study. Majority of the study participants were between the age group of 51-70 constituting to 61.3% (n=184), followed by 20.3% (n=61) in 31-50 years, 18% (n=54) in 71-90 years and 0.3% (n=1) in 18-30 years group. Among the study participants, 70.3% (n=211) were male and 29.7% (n=89) were female.The Very High modified score group shows a spread: ~57% remain Low, ~31% shift to Moderate, and ~12% distribute into High/Very High by the original score.This indicates that the Modified Mehran Score reclassifies higher-risk patients more aggressively, while the original Mehran Score tends to under-classify risk.Almost all patients with High or Very High original scores are classified as Very High by the modified score.Patients with Low original scores are spread across Moderate, High, and Very High modified categories, highlighting some reclassification. CONCLUSIONS  Our study showed a significant positive results with modified mehran score for better prediction of CIN and its complications.Most patients classified as Moderate or High by the modified score fall almost entirely into the Low risk category of the original Mehran score.The Very High modified score group shows a spread: ~57% remain Low, ~31% shift to Moderate, and ~12% distribute into High/Very High by the original score

Background: Type 2 diabetes mellitus (T2DM) is frequently associated with metabolic syndrome (MS), a constellation of metabolic abnormalities that significantly increases cardiovascular morbidity and mortality. Gamma-glutamyl transferase (GGT), traditionally regarded as a hepatic enzyme, has emerged as a potential biomarker of oxidative stress and metabolic risk. Elevated GGT levels have been linked to individual components of MS and cardiovascular disease, even in the absence of overt liver pathology. Aim & Objective: To evaluate serum Gamma-glutamyl transferase levels in patients with Type 2 diabetes mellitus with metabolic syndrome and to assess its association with metabolic syndrome in comparison with T2DM patients without metabolic syndrome and healthy controls. Materials & Methods: This cross-sectional analytical study was conducted at a tertiary care hospital in Tamil Nadu from April to July 2024. A total of 105 participants aged 30–60 years were enrolled and divided into three groups: healthy controls (n=35), T2DM patients without metabolic syndrome (n=35), and T2DM patients with metabolic syndrome (n=35), diagnosed using NCEP-ATP III criteria. Anthropometric measurements, blood pressure, fasting and postprandial glucose, lipid profile, and serum GGT levels were assessed. Statistical analysis was performed using SPSS version 16.0, with ANOVA and Bonferroni post-hoc tests applied. A p-value <0.05 was considered statistically significant. Results: Serum GGT levels were significantly higher in T2DM patients with metabolic syndrome (52.58 ± 48.10 U/L) compared to T2DM patients without metabolic syndrome (24.97 ± 14.62 U/L) and healthy controls (20.16 ± 8.37 U/L) (p < 0.001). Waist circumference, systolic and diastolic blood pressure, total cholesterol, and triglyceride levels were also significantly elevated in the metabolic syndrome group. No statistically significant difference in GGT levels was observed between T2DM patients without metabolic syndrome and healthy controls. Conclusion: Serum Gamma-glutamyl transferase levels are significantly elevated in T2DM patients with metabolic syndrome. Incorporating GGT estimation into routine evaluation of patients with Type 2 diabetes mellitus may facilitate early identification of metabolic syndrome and help reduce future cardiovascular morbidity and mortality.

Background: The foramen magnum (FM) is a key osteological landmark at the craniovertebral junction. Its dimensions and contour influence surgical corridors and inform radiologic and forensic interpretation. Objectives: To describe FM morphometry and shape patterns in adult skulls from Telangana, and to evaluate sex-related differences in FM dimensions. Methods: This cross-sectional observational study examined 80 adult dry human skulls (42 male, 38 female) from the Department of Anatomy, GMC Karimnagar, Telangana, India (February 2025–November 2025). Anteroposterior diameter (basion–opisthion) and transverse diameter (maximum width) were measured using a digital vernier caliper. FM index was calculated as (transverse/anteroposterior)×100, and FM area was estimated using an ellipse-based formula. FM shape was categorized as oval, round, tetragonal, pentagonal, or irregular. Results: Mean anteroposterior and transverse diameters were 34.8±2.6 mm and 29.6±2.4 mm, respectively; mean FM index was 85.1±6.9 and mean area was 810.5±98.7 mm². Oval shape was most frequent (45.0%), followed by round (27.5%). Males had larger diameters and area than females, with statistically significant differences. Conclusion: FM morphometry in this sample showed clear sexual dimorphism, with oval and round shapes predominating. These regional baseline data support skull-base surgical planning and provide context for imaging and forensic applications

Background: Chronic serous otitis media associated with Eustachian tube dysfunction (ETD) is commonly managed with long-term ventilation tube (grommet) insertion. Balloon Eustachian tuboplasty (BET) has emerged as a novel therapeutic option aimed at improving Eustachian tube function. This study compares the outcomes of BET alone versus BET combined with grommet insertion in patients with chronic serous otitis media and ETD. Aim and Objectives: To evaluate and compare the effectiveness of Balloon Eustachian Tuboplasty (BET) alone and BET combined with grommet insertion in patients with chronic serous otitis media associated with Eustachian tube dysfunction (OME-ETD). Methods: This prospective comparative study included 72 patients with OME-ETD treated between October 2024 and November 2025. Patients were divided into two groups: BET group (n = 36) and BET + Grommet group (n = 36). Postoperative outcomes assessed at 6 and 12 months included air-bone gap (ABG), Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), Eustachian tube inflammation scale, Chronic Otitis Media Outcome Test-15 (COMOT-15), Valsalva maneuver results, and patient satisfaction. Results: Postoperative ABG improvement was significantly greater in the BET + Grommet group compared to the BET group at both 6 and 12 months. The ETDQ-7, Eustachian tube inflammation scale, and COMOT-15 scores showed a significant reduction in the BET + Grommet group at follow-up intervals. The proportion of patients able to perform a positive Valsalva maneuver was significantly higher in the BET + Grommet group at both 6 and 12 months. Overall patient satisfaction was also superior in the combination therapy group. Conclusion: Balloon Eustachian Tuboplasty combined with grommet insertion demonstrates superior efficacy compared to BET alone in patients with OME-ETD. The combined approach results in better hearing outcomes, improved Eustachian tube function, reduced inflammation, and enhanced quality of life

Background: Diabetes mellitus is a major chronic health condition associated with significant morbidity, mortality, and healthcare burden worldwide. Achieving optimal glycaemic control is critical to preventing complications, and adherence to prescribed antidiabetic medications plays a pivotal role in this process. Despite the availability of effective therapies, poor adherence remains a leading cause of uncontrolled diabetes and adverse outcomes. Objective: This study examines the interaction between controlling blood sugar levels and taking diabetes medicines as prescribed in Type 2 Diabetes Mellitus patients from India, attending the Medicine Department, Central Hospital, Kalla. Methods: From June 2024 to June 2025, EMR records from 100 adults with diabetes were used in a retrospective observational study. For type 2 diabetes, six months of diabetes medicine and HbA1c statistics were required. Patients' adherence was rated as high, average, or low by the Medication Possession Ratio (MPR). HbA1c numbers (<7%, ≥7%) show the way glucose levels are controlled. For statistical research, we used SPSS and Pearson's coefficient (p < 0.05) to find correlations. Results: Patient adherence was 46% strong, 32% moderate, and 22% poor. Lower HbA1c levels were associated with higher adherence, decreasing the connection between poor glycaemic management (p < 0.05). Conclusion: Higher blood sugar results with better medicine adherence. Patient education, follow-ups, and adherence-monitoring technology are needed to improve diabetic management in India.

Macro Creatine Kinase (CK) is a rare cause of elevated serum CK levels that can mimic myocardial injury. We present a case of a 56-year-old male with persistently elevated CK-MB by immunoinhibition method, initially raising concerns for silent myocardial ischemia. Extensive cardiac evaluation revealed normal coronary anatomy and cardiac function. Further testing ultimately identified Macro CK Type 1 as the etiology, highlighting the importance of considering macroenzymes in the differential diagnosis of elevated CK-MB levels without clinical correlation.

Background: The cardiovascular diseases are the primary cause of morbidity and death globally. A significant increase in obesity rates has been linked to the accelerating increase in cardiovascular disease around the world. Excessive body fat accumulation is the hallmark of obesity, a metabolic illness that is closely linked to cardiovascular disease.  Material & Methods: The study was conducted in a sample of 113 healthy medical students age between 18 and 24 years. Evaluation of body composition (weight, BMI and body fat percentage—BFP) was done by using Omron HBF 375 body composition analyser. Two measurements were taken for each subject, and mean BFP was calculated. A twelve-lead ECG monitor was used for recording of ECG ventricular parameters (HR, QT, QTc, TQ, TQc, RR, TQ/QT, RR/ TQ, TQc/QTc and RRc/TQc). Correlation analysis was done between the body composition parameters and ECG parameters. Linear Regression Analysis was done for the variables with relevant associative relationships.  Results and Discussion: The results of the study revealed that the regression models for BFP (independent variable) and the dependent variables weight, QTc, TQc and TQc/QTc, were statistically significant (p < 0.01). The regression models for BFP (independent variable) significantly predicted each dependent variable: QTc, TQc, TQc/QTc. QTc interval has positive association with BFP whereas TQc and TQc/QTc showed negative association with BFP. Conclusion:  Ventricular electrical activity in young adults is influenced by the body composition, which implies the risk for ventricular impairment in medical students with high body composition and suggests for an early intervention.

Background: Seizures are common neurological emergencies in children, with febrile seizures (FS) being the most frequent, particularly in those aged below five years. While generally benign, FS may recur and contribute to later epilepsy in some children. Zinc, an essential trace element, plays a crucial role in neuronal excitability and GABA synthesis. Reduced zinc levels have been implicated in lowering seizure thresholds; however, the evidence remains inconsistent. This study aimed to evaluate serum zinc levels in children with seizures compared to febrile controls without seizures. Methods: A hospital-based case-control study was conducted in the Department of Paediatrics in a tertiary care Centre. A total of 80 children aged 5 months to 12 years were enrolled, including 40 cases with seizures (simple febrile, atypical febrile, and other types) and 40 age- and sex-matched febrile controls without seizures. Three millilitres of venous blood were collected, and serum zinc levels were estimated using the colorimetric method. Data were analyzed using SPSS software, and p < 0.05 was considered statistically significant. Results: Most participants were between 1–5 years of age, with a male predominance (60%). Simple febrile seizures were the most common (57.5%), followed by atypical febrile seizures (27.5%). The mean serum zinc level in seizure cases was 59.6 µg/dl compared to 101.4 µg/dl in controls (p < 0.0001). Zinc deficiency was observed in 52.5% of cases versus 10% of controls. Both simple and atypical febrile seizure groups showed significantly lower zinc levels compared with controls, whereas other seizure types did not demonstrate significant differences. Conclusion: Serum zinc levels are significantly reduced in children with febrile seizures compared to febrile controls, suggesting zinc deficiency may play a role in seizure pathogenesis. Larger multicentric studies are recommended, and zinc supplementation could serve as a cost-effective preventive measure in susceptible pediatric populations.

Background: Background: Varicose veins are increasingly recognized as an occupational health issue, particularly among professionals with prolonged standing hours. Medical residents, due to long working hours and extended duty shifts, may be at heightened risk. Aim: To assess the incidence and contributing factors of varicose veins among newly joined residents in clinical branches at a tertiary care institute. Materials and Methods: This retrospective study analyzed data collected from 50 newly joined residents (January 2023–June 2025) at Vilasrao Deshmukh Government Medical College, Latur, using a structured questionnaire assessing demographics, work hours, lifestyle, preventive awareness, and symptoms of varicosities. Results: Out of 50 residents, 6 (12%) showed symptoms suggestive of varicose veins. The majority reported prolonged standing (>8 hours/day) and extended working shifts. Three affected residents were from the Pediatrics discipline. Awareness of varicose vein prevention was noted in 70% of participants; however, only 20% practiced preventive measures such as limb elevation or compression stocking use. Conclusion: The incidence of varicose veins among newly joined residents was 12%, with prolonged standing hours and inadequate preventive practices identified as key contributing factors. Occupational modifications, awareness programs, and preventive strategies should be implemented to safeguard the vascular health of residents.

Background: Early and accurate diagnosis of Acute Coronary Syndrome (ACS) remains crucial for optimal outcomes. While cardiac Troponin I (cTnI) is the gold standard biomarker, its delayed rise limits early diagnosis. Heart-type Fatty Acid-Binding Protein (H-FABP) is a promising early marker, with potential diagnostic and prognostic utility. Aim: To evaluate the diagnostic and prognostic significance of H-FABP in ACS and compare its performance with cTnI and NT-proBNP across ACS subtypes and severities. Methods: This prospective observational study included 130 patients with ACS. H-FABP and cTnI were measured at 0 and 6 hours post-admission; NT-proBNP was analyzed once. Echocardiography assessed left ventricular ejection fraction (LVEF), and coronary angiography quantified disease extent using SYNTAX score. Statistical analyses included ROC curves, logistic regression, and correlation tests. Results: H-FABP positivity (>9 ng/mL) was observed in 100% of STEMI and NSTEMI and 6.9% of unstable angina cases (p < 0.001). H-FABP (0h and 6h) showed excellent diagnostic accuracy for left ventricular dysfunction (AUC = 0.937 and 0.949), outperforming Troponin I (AUC = 0.768 and 0.756). HFABP correlated significantly with SYNTAX score (r = 0.320, p < 0.001). NT-proBNP also showed strong predictive performance (AUC = 0.948). Conclusion: H-FABP demonstrates superior early diagnostic accuracy and prognostic significance in ACS compared to Troponin I and performs comparably to NT-proBNP. Its integration with conventional biomarkers may enhance early risk stratification and management in ACS.

Background: Many Local anaesthetics have been tried and tested to enhance the safety and efficacy in subarachinoid block. From previous studies, bupivacaine is widely used because of its excellent motor blockade but because of its side effects of cardiotoxicity and neurotoxicity, there is a search for a better alternative which provides similar effects with significantly reduced cardiotoxicity and neurotoxicity. Objectives: To study and compare the effects of equal volume of 0.75% Hyperbaric Ropivacaine with 0.5% Hyperbaric Bupivacaine for lower abdominal surgeries. Materials & Methods: A Prospective randomized double-blind study. Control study done on 60 patients in the Department of Anaesthesiology, Khaja Banda Nawaz Teaching and General Hospital, Kalaburagi.  Patients were randomly divided into 2 groups of 30 each. Group A: Hyperbaric Ropivacaine 0.75% 3ml, Group B: Hyperbaric Bupivacaine 0.5% 3ml.  Results: Ropivacaine significantly produced slower onset but shorter time to peak effect (4.01 ± 0.83, 13.43 ± 0.77) than bupivacaine (3.06 ± 0.69, 14.36 ± 0.99); however, level of sensory block achieved was similar and duration of sensory block was significantly lesser with ropivacaine (154.93 ± 6.45 min).The onset of pinprick analgesia at T10 was more rapid in bupivacaine Group B than in ropivacaine Group A. (P <0.001) However, the time to (peak) maximum extent of cephalad spread and the level achieved were similar in both groups. The mean duration of sensory block was shorter in Group A (154.93 ± 6.45) than in Group B (190.00 ± 7.20). (P<0.001) The time to maximum motor blockade was statistically similar Conclusion: Ropivacaine is comparable to the hyperbaric 0.5% bupivacaine in terms of quality of block, but with a shorter recovery profile, it is a useful agent for Spinal Anaesthesia for intermediate duration of surgeries.

Background: Early recognition of sepsis remains a major clinical challenge. Conventional clinical scoring systems such as qSOFA, SOFA, SIRS, and NEWS have limited sensitivity for early detection. Machine learning (ML)–based early warning systems have been increasingly developed to leverage electronic health record data for earlier and more accurate sepsis . Objectives: To systematically evaluate and quantitatively synthesize the diagnostic performance of ML-based early warning systems for early sepsis prediction in hospitalized adult patients. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Scopus, Web of Science, and related databases were searched for studies published between 2015 and 2025 that evaluated ML-based models for early sepsis prediction in adult populations. Pooled estimates of sensitivity, specificity, area under the receiver operating characteristic curve (AUC), accuracy, precision, and F1 score were calculated using random-effects models. Risk of bias was assessed using the ROBINS-I tool. Results: Thirty studies encompassing approximately 5.5–6.0 million adult patient encounters were included. ML-based early warning systems demonstrated high pooled sensitivity (0.89), specificity (0.87), and overall accuracy (0.88). Discriminative performance was excellent, with a pooled AUC of 0.93. Precision and F1 score indicated balanced diagnostic performance but showed substantial heterogeneity across studies, largely driven by differences in sepsis prevalence, clinical settings, and model thresholds. Most studies exhibited a moderate risk of bias, primarily related to retrospective design. Conclusions: ML-based early warning systems demonstrate robust and superior diagnostic performance for early sepsis prediction compared with conventional clinical scoring tools. While heterogeneity across studies remains substantial, the consistency of pooled estimates supports the potential clinical value of ML-driven approaches. Prospective validation and context-specific calibration are essential for successful real-world implementation.

Background: Postoperative pain remains a significant clinical challenge that affects recovery, mobility, and overall patient outcomes. Although opioids have historically served as the primary analgesic agents, their adverse effects including respiratory depression, nausea, ileus, and potential for dependency have prompted a shift toward multimodal analgesia (MMA). Incorporating anesthetic interventions such as peripheral nerve blocks and neuraxial (epidural or spinal) anesthesia into MMA regimens offers an opportunity to improve analgesic efficacy while reducing opioid consumption. Methods: This systematic review was conducted following PRISMA 2020 guidelines. A comprehensive search of PubMed, the Cochrane Library, and ScienceDirect databases identified studies published between 2015 and 2025 that evaluated multimodal analgesia protocols including anesthetic techniques for postoperative pain control. Eligible studies included randomized controlled trials, cohort studies, and meta-analyses assessing pain intensity, opioid use, and functional recovery. Data were synthesized narratively due to heterogeneity in protocols and outcome measures. Results: Eight key studies were included, comprising randomized trials, cohort analyses, and systematic reviews across orthopedic, abdominal, and spinal surgeries. Consistently, MMA protocols that integrated anesthetic methods such as adductor canal, transversus abdominis plane, erector spinae, and epidural blocks resulted in significantly lower pain scores and reduced opioid consumption. For instance, epidural local anesthetics provided superior analgesia and faster gastrointestinal recovery compared to systemic opioids, while adductor canal block preserved mobility with comparable analgesic efficacy. In ERAS-based cohorts, structured MMA bundles reduced median opioid use by up to 70%. Additionally, improved patient satisfaction, earlier ambulation, and shorter hospital stays were observed. Discussion: Regional and neuraxial anesthesia enhances multimodal analgesia by blocking nociceptive transmission and reducing central sensitization. When combined with non-opioid agents—such as acetaminophen, NSAIDs, gabapentinoids, ketamine, and dexamethasone these techniques provide synergistic pain relief while minimizing opioid-related complications. Despite consistent benefits, variability in study design and dosing regimens highlights the need for procedure-specific standardization and further trials on long-term outcomes such as chronic postsurgical pain and sustained opioid abstinence. Conclusion: Evidence strongly supports the integration of anesthetic techniques into multimodal analgesia for effective postoperative pain control. These strategies reduce opioid requirements, enhance functional recovery, and align with ERAS principles of patient-centered and opioid-sparing care. Future research should focus on optimizing multimodal combinations, evaluating continuous versus single-shot techniques, and developing individualized analgesic pathways to maximize efficacy and safety across diverse surgical populations.

Background: Intraabdominal infections remain one of the most serious postoperative complications following gastrointestinal surgery, contributing significantly to morbidity, prolonged hospital stay, and mortality. Early diagnosis is often challenging as clinical signs may be nonspecific in the immediate postoperative period. Biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) have been increasingly studied for their role in the early detection of infective complications. Aim: To evaluate the role of serum C-reactive protein and procalcitonin levels in the early diagnosis of intraabdominal infections in patients undergoing gastrointestinal surgery. Materials and Methods: This prospective observational study was conducted at Government Medical College, Kadapa, over a period of one year. Adult patients undergoing elective or emergency gastrointestinal surgery and requiring postoperative intensive care monitoring were included. Serum CRP and PCT levels were measured at 1^st, 24^th, 48^th, and 72^nd postoperative hours. Patients were monitored clinically and radiologically for the development of intraabdominal infections such as anastomotic leaks and intraabdominal abscesses. Diagnostic accuracy of CRP and PCT was assessed using sensitivity, specificity, and receiver operating characteristic (ROC) curve analysis. Results: A significant proportion of patients developed postoperative intraabdominal infections. Both CRP and PCT levels were significantly higher in infected patients compared to non-infected patients, particularly at 48 and 72 hours postoperatively. Procalcitonin demonstrated higher sensitivity and specificity than CRP at these time points, indicating superior predictive value for early diagnosis of intraabdominal infections. Conclusion: Serial measurement of serum procalcitonin and C-reactive protein is valuable in the early detection of postoperative intraabdominal infections. Procalcitonin, especially at 48 and 72 hours, is a more reliable biomarker than CRP and can aid clinicians in early diagnosis and timely intervention.

Background: Sleep disturbances are increasingly recognized as an important factor influencing glucose metabolism and metabolic control in patients with Type 2 Diabetes Mellitus (T2DM). While HbA1c reflects average glycemic control, glycemic variability provides additional insight into short-term glucose fluctuations that contribute to diabetic complications. Objectives: To evaluate the association between sleep quality and glycemic variability in patients with Type 2 Diabetes Mellitus. Methods: This prospective observational study was conducted over one year at PDU Medical College and attached group of Hospital (Dedraj Bhartiya Hospital -Churu). A total of 100 patients with T2DM were enrolled. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and patients were categorized into good and poor sleep quality groups. Glycemic variability was evaluated using fasting blood glucose, standard deviation of glucose values, coefficient of variation, and mean amplitude of glycemic excursions. HbA1c was measured to assess overall glycemic control. Statistical analysis was performed to determine the association between sleep quality and glycemic variability. Results: Poor sleep quality was observed in 54% of the study participants. Patients with poor sleep quality demonstrated significantly higher fasting blood glucose levels, greater glycemic variability, and higher HbA1c compared to those with good sleep quality. Increased glycemic variability was present in a substantially higher proportion of patients with poor sleep quality, indicating a strong association between impaired sleep and glucose instability. Conclusion: Poor sleep quality is common among patients with Type 2 Diabetes Mellitus and is significantly associated with increased glycemic variability and suboptimal glycemic control. Routine assessment of sleep quality may serve as an important component of comprehensive diabetes management and may help identify patients at higher risk for glycemic instability and related complications.

Background: Type 2 Diabetes Mellitus (T2DM) is a major public health problem and is frequently associated with microvascular and macrovascular complications that significantly increase morbidity and mortality. Magnesium plays an essential role in glucose metabolism, insulin action, and vascular function. Hypomagnesemia is commonly observed in patients with T2DM and has been implicated in the development of diabetic complications. Objectives: To evaluate serum magnesium levels in patients with Type 2 Diabetes Mellitus and to assess their role in predicting the presence of diabetic complications. Methods: levels were This prospective observational study was conducted over a period of one year at PDU Medical College and attached group of Hospital (Dedraj Bhartiya Hospital -Churu). A total of 100 patients with Type 2 Diabetes Mellitus were enrolled. Serum magnesium measured at baseline, and patients were assessed for the presence of diabetic microvascular and macrovascular complications using standard clinical and laboratory criteria. Data were analyzed to determine the association between serum magnesium levels and diabetic complications using appropriate statistical tests, with a p-value of <0.05 considered statistically significant. Results: Hypomagnesemia was observed in 37% of the study participants. Diabetic complications were present in 54% of patients and were significantly more common among those with low serum magnesium levels. The prevalence of hypomagnesemia was markedly higher in patients with complications compared to those without complications. Mean serum magnesium levels were significantly lower in patients with complications than in those without. A significant association was also observed between longer duration of diabetes and the presence of complications, while gender showed no significant association. Conclusion: Hypomagnesemia is common in patients with Type 2 Diabetes Mellitus and is significantly associated with diabetic complications. Serum magnesium estimation may serve as a simple and cost-effective tool for early identification of patients at higher risk for complications, supporting its inclusion in routine diabetic evaluation and management.

Background: In obstetric critical illness, distinguishing hypoperfusion from venous congestion is challenging. VExUS-based POCUS and endothelial biomarkers may support individualized hemodynamic decisions, but feasibility data are limited. Objectives: To assess feasibility of integrating VExUS POCUS with endothelial biomarkers in critically ill obstetric patients and explore early management and organ-outcome signals. Methods: Prospective 1-year feasibility study (N=50) at Mahabodhi Medical College & Hospital, Bihar. Within 6 hours of ICU/HDU admission, participants underwent IVC, hepatic, portal, and intrarenal venous Doppler to assign VExUS grade (0–3) and biomarker sampling (syndecan-1; sFlt-1/PlGF where available). Feasibility endpoints were completion rate, scan time, biomarker acquisition, and documented management changes attributable to findings. Exploratory outcomes included KDIGO-AKI and fluid balance. Results: POCUS protocol completion was 47/50 (94%) with median scan time 15 min (IQR 12–17); biomarkers were obtained in 46/50 (92%). Management change attributed to POCUS/biomarkers occurred in 29/50 (58%), most often diuretics (13/29, 44.8%) or fluid restriction (11/29, 37.9%). VExUS 2–3 occurred in 24/50 (48%). AKI occurred in 16/50 (32%), higher in VExUS 2–3 vs 0–1 (45.8% vs 19.2%; OR 3.55). Fluid balance differed at 24 h (+0.81 L vs −0.81 L) and 48 h (+0.74 L vs −1.15 L). Syndecan-1 correlated with VExUS grade (ρ=0.48, p=0.0008). Conclusions: Combined VExUS POCUS and endothelial biomarker integration was feasible and frequently influenced hemodynamic decisions. Higher congestion aligned with greater AKI and distinct fluid balance patterns, supporting larger validation studies.

Introduction: Hypothyroidism is one of the most common endocrine disorders in India, with varying clinical and biochemical presentations. It remains underdiagnosed, especially in peripheral regions such as Jammu & Kashmir.

Objectives: To evaluate the clinical profile and biochemical patterns of hypothyroidism and to assess the association of anaemia, obesity, and menstrual irregularities with disease severity. Methods: A descriptive cross-sectional study was conducted among 500 newly diagnosed hypothyroid patients attending the Medicine Department of a district hospital in Jammu and Kashmir from January 2023 to December 2024. Detailed history, clinical examination, and laboratory evaluation including serum TSH, T4, and haemoglobin levels were performed. Patients were classified as subclinical or overt hypothyroidism based on biochemical criteria. Statistical analysis was done using SPSS v26.0, with p < 0.05 considered significant. Results: Of 500 patients, 370 (74%) were females and 130 (26%) males, with a mean age of 38.9 ± 11.6 years. Subclinical hypothyroidism constituted 64.4% and overt 35.6%. Common symptoms were fatigue (78.4%), weight gain (71%), and dry skin (62.4%). Anaemia was found in 27.4% and obesity in 22.2%, both significantly associated with overt disease (p=0.002 and p=0.03, respectively). Menstrual irregularities occurred in 40% of females (p=0.001). Conclusion: Hypothyroidism predominantly affects middle-aged females. Early screening, especially in women with menstrual or metabolic symptoms, is essential for timely diagnosis and treatment.

Background: The clinical profile and outcomes of severe COVID-19 vary across regions and health-care settings. We evaluated the clinico-demographic characteristics and in-hospital outcomes of patients with severe COVID-19 pneumonia admitted to a tertiary hospital in North India. Methods: We performed a prospective observational study of RT-PCR–confirmed COVID-19 patients meeting severity criteria (respiratory rate >24/min, SpO₂ <94% on room air, or organ dysfunction) over seven months. Demographics, symptoms, comorbidities, laboratory tests, and HRCT findings were recorded. Outcomes included in-hospital mortality. Results: Of 179 severe cases, 95 were men (53.1%) and 100 were from rural areas (55.9%). Fever was the most common symptom, followed by cough and breathlessness; universal hypoxaemia was documented on admission. Tachycardia occurred in 89.4%, tachypnoea in 50.3%, bradycardia in 7.3%, and hypotension in 1.7%. Hypertension (48.0%) and diabetes (9.5%) were the leading co-morbidities; one-third had none. Lymphopenia was seen in 19.0% and leukocytosis in 11.2%; HRCT showed a CT severity index >6 in all patients. Overall mortality was 13.4% (24/179) and was higher in males (62.5% of deaths), in those ≥60 years (58.3%), with comorbidities (66.7%), and from rural areas (75%). Conclusion: Severe COVID-19 pneumonia at our centre was characterised by fever with hypoxaemia, frequent hypertension and lymphopenia, and a moderate fatality rate. Male sex, older age, rural residence, co-morbidities, lower SpO₂, and higher CT severity were associated with death, underscoring the need for early risk stratification and intensified management in these subgroups.

Background: The fibular incisura of the distal tibia is essential for ankle stability and proper syndesmotic function. Variations in its morphology can affect ankle biomechanics and the management of ankle fractures. As morphometric data from the Eastern Indian population are limited, this study aimed to evaluate the dimensions of the fibular incisura in adult tibiae and to assess sex-wise and side-wise differences for clinical relevance. Materials And Methods: A cross-sectional observational study was carried out on 60 adult human dry tibiae of known gender. The sample comprised equal numbers of male and female tibiae, with both right- and left-sided specimens included, but not paired. Only well-preserved tibiae with intact distal ends and without any deformity or pathological changes were selected. Morphometric parameters of the fibular incisura, including width, depth, height, and the lengths of the anterior and posterior tubercles, were measured using a digital vernier calliper with an accuracy of 0.01 mm. All measurements were recorded in millimetres following standard anatomical landmarks. The data were analysed using SPSS software, and sex-wise and side-wise comparisons were performed using the unpaired Student’s t-test. A p-value of less than 0.05 was considered statistically significant. Results: Among the 60 adult tibiae studied, males showed significantly larger dimensions of the fibular incisura than females. The mean width was 23.6 mm in males and 21.0 mm in females, while the mean depth was 3.30 mm and 3.05 mm, respectively. The height of the fibular incisura was also greater in males (31.9 mm) compared to females (29.5 mm). The anterior tubercle length showed a significant gender difference, whereas the posterior tubercle did not show statistical significance. No significant differences were observed between right and left sides for any parameter, indicating bilateral symmetry of the fibular incisura. Conclusion: The present study demonstrates significant sexual dimorphism in most morphometric parameters of the fibular incisura, with male tibiae showing greater dimensions than female tibiae. In contrast, no significant side-wise differences were observed, indicating bilateral symmetry. These findings provide useful baseline anatomical data that may assist in the interpretation of imaging, surgical planning, and management of ankle and syndesmotic injuries.