European Journal of Cardiovascular Medicine

The study sampled five bottled water consumed in Kano which include Sona, Santana, Aquafina, Eva and Swan bottled water (popularly consumed in eateries, suya spots, garage among others in kano). Analysis was done using standard method and results obtained for the physicochemical and microbial assay was below the guidelines limit of WHO, indicating the suitability of the bottled water analyzed for the aforementioned parameters. Hence, the populist believed bottled water is safe for consumption; thorough monitoring survey is needed to enhance the quality and safety sustenance.

Introduction: Eclampsia has been recognized as a clinical entity since the time of Hippocrates; and has been a nightmare to healthcare providers ever since. It is defined as the occurrence of generalised convulsions associated with preeclampsia during pregnancy, labour or within 7 days of delivery and not caused by epilepsy or other convulsive disorders. The incidence of eclampsia has often been viewed as an index of civilization in a country. There is low utilization of both antenatal and intrapartum care services and the patients may present to the hospital only as a last resort. Materials And Methods: This is a Prospective Study was carried out at the Department of Obstetrics and Gynecology at Tertiary Care Teaching Hospital over a period 2 years. All patients presenting with eclampsia during the said period were recruited into the study. All patients presenting with eclampsia during the said period were recruited into the study. Eclamptics are usually admitted directly into the labour ward. Patients who were diagnosed with other causes of convulsions in pregnancy like cerebral malaria and epilepsy were excluded from the study. A total of 821 pregnant mothers with eclampsia admitted in the inpatient department of the tertiary care teaching hospital were recruited for the study, irrespective of their previous antenatal check up history. Results: Majority (66%) of the patients had between 2 to 5 episodes of convulsion. The MINIMUM number was 1 episode of convulsion , seen in 13 % of the patients. The MAXIMUM number of convulsions was 40. Of the 66 patients who had had more than 10 no. of convulsions , 30 had not received any treatment prior to referral, while there were no patients who had had more than 10 no. of convulsions after receiving the Loading Dose of MgSO4. For patients having less than 5 no. of convulsions , the number of patients having received only the IM Dose of MgSO4 was 1.5 times those having received the Loading Dose.(228/154 =1.48) In 29% of the patients, Hypertension was controlled by delivery alone. Those who failed to achieve a control of BP by Delivery alone were administered Calcigard (Nifedipine). Conclusion: Eclampsia was noted to be commoner among the young primigravida patients. The importance of this finding is that this group of patients deserve extra surveillance during antenatal care in terms of monitoring their blood pressure and screening their urine for proteinuria to detect pre-eclampsia. It is hoped that such interventions will have positive impact on maternal and child care. However, all this will go in vain unless health care providers at the grassroot levels are sensitised regarding the early diagnosis of Pre eclampsia and prompt and appropriate initiation of treatment

Background: Ambulatory assessment of the heart rate–corrected QT interval (QTc) within arrhythmia patients can be of diagnostic value where these patients are on QTc-prolonging medication. Repeating sequential 12-lead electrocardiograms (ECGs) to monitor the QTc is cumbersome, but Spandan Smartphone ECG devices can potentially solve this problem. Objective: Objective of this prospective and retrospective, cross-sectional, within patient diagnostic validation study was to validate the measurement of QTc interval in Spandan 12 lead ECG and to assess the accuracy of the 12 lead Spandan Smartphone ECG device in measuring the QTc intervals in the general cardiology outpatient population with normal ECG and arrhythmias. Materials and Methods: This single-center study was carried out at Shri Mahant Indresh Hospital (SMIH), Dehradun, Uttarakhand, India from August 2022 to October 2022. All patients (n=1168) visiting the electrocardiogram (ECG) room at the Department of Cardiology of the SMIH, Dehradun during the study period were enrolled in the study by taking their written consent and explaining the purpose of the study. Results: Mean (SD) age was 54.36±4.9 years. The male gender (n=783,67.03%) shows the maximum frequency than female gender. Primary Coronary Intervention was noted in 426 (36.4%) of the study population. All the four parameters showed positive Pearson correlation between 12 Lead Standard ECG and Spandan Smartphone ECG. The maximum mean difference between 12 Lead Standard ECG and Spandan Smartphone ECG was noted for QTc parameter in overall participants. Conclusion: 12-lead Spandan Smartphone ECG allows for QTc assessment with good accuracy and can be used safely in ambulatory QTc monitoring. This may improve patient satisfaction and reduce healthcare costs

Background: Programmed labour protocol was developed with principles asensuring adequate uterine contractions , providing optimum pain relief & close clinical monitoring of labor events. Present study was conducted to evaluate the safety and efficacy of Programmed Labour protocol in a study group as against Spontaneous progression of labour in primigravida patients. Material and Methods: The present study was a hospital based randomized prospective clinical study, conducted in primigravidae at term with cephalic presentation, adequate liquor and no high risk factors and in active phase of first stage of labour or Cervical dilatation ≥ 3cm, ≥ 80% effacement and intact membranes, Reactive stress Test. 200 primigravidas were alternately allocated into 2 groups. as study group (100 women received programmed labour protocol) & control Group (100 women were observed expectantly and underwent spontaneous labour). Results: Mean age of patients in the study group was 23.13 ± 2.46 years and 23.74 ± 2.58 years in the control group. Among patients of the study group; period of gestation was 38.87 ±1.00 weeks and 38.74 ± 1.12 weeks in the control group. We compared various labour related parameters such as duration of active phase of labour (hours), rate of cervical dilatation (cm/hr), duration of 2nd stage of labour (mins), duration of 3rdstage of labour (mins), total duration of labour (min) & average blood loss (ml) between study & control group. All above parameters were favourable in study group & difference was highly significant statistically (p<0.001). Perception in degree of pain relief among patients of the study and control group was found be highly significant statistically. (p<0.001) i.e. pain relief was significantly much higher among patients of the study group than pain relief in control group patients. The difference in degree of maternal satisfaction in the study and control group was found be statistically significant (p<0.001). Conclusion: Programmed labour is safe, effective providing labour analgesia; facilitating cervical dilation and shortening duration of labour with good maternal and fetal outcomes

Diabetes is a public health problem; prevalence of diabetes is progressively on the rise. International diabetes federation estimates a doubling prevalence of diabetes mellitus by 2035 from that of 541 million in 2022. Objectives: To find out the prevalence of peripheral neuropathy among known type 2 diabetics and to correlate peripheral neuropathy with select socio – demographic variables. Materials and Methods: A Descriptive cross -sectional community-based study was done among Known type 2 diabetes mellitus individuals of age group 30 years and above. The study was carried out for a period of 10 months after getting approval from the institutional ethical committee. Peripheral neuropathy was classified using the Toronto clinical scoring system of peripheral neuropathy. Data collected was entered in Microsoft 2010 excel spread sheet, compiled and analyzed using IBM SPSS Version 22 statistical package. Results: The prevalence of peripheral neuropathy was found to be 12.6% among the study subjects. Frequency of Peripheral neuropathy was increasing as the duration of diabetes increases. A significant association was found between duration of diabetes and peripheral neuropathy. A significant association was found between increased RBS value and peripheral neuropathy. Conclusion: Maintaining a proper blood-glucose control is the key to primary prevention of diabetes related complications. Regular monitoring of blood-glucose level must be done for the management of Diabetic peripheral neuropathy.

Introduction: Fetal movement tracking may be used to identify worsening in the fetus condition. It is described as any kick, flutter, swish, or roll perceived by the pregnant women and is considered evidence of the musculoskeletal and central nervous systems' integrity. Decreased fetal movement has been linked to poor pregnancy outcomes such as intrauterine growth restriction, fetal death and preterm deliveries. Clinical data on the association between decreased fetal movements and perinatal outcome is insufficient. Methodology: Ethical clearance was obtained from SRIMANTA SANKARDEVA UNIVERSITY of HEALTH SCIENCE for study of decreased fetal movements in Gauhati medical college and hospital. A doppler study was conducted using 3 dimensional ultrasound machines in ANOPD, departmental indoor USG room, and 2 dimensional ultrasound machine in observation room in the Department of Obstetrics & Gynaecology, Gauhati Medical College& Hospital. Patients were placed in supine position with left lateral tilt and umbilical artery Wave forms were recorded in the mid position from the free floating loops. Indices noted were S(systolic)/D(diastolic) ratio, resistance index (RI), plasticity index (PI), and reversal of blood flow in diastole. CTG monitoring was done in Departmental Observation Room using a CTG machine (labelled as FETAL MONITOR, SN-EATB8L1732, manufacturer-BPL, model no. FM 9854). Each selected patient was monitored for a period of 20minutes with a paper speed of 3cm/minutes during antepartum or intrapartum status. Noted following information were: base line FHR, beat to beat variability, FHR accelerations, presence of deceleration, and reactive. Results: A prospective observational study was conducted in Gauhati Medical College & Hospital, Guwahati, Assam during a time period of one year. 150 antenatal women at term gestation with decreased fetal movements without any other high risk conditions were monitored for fetal wellbeing by CTG and Doppler. Four groups were categorised into four groups: Group I-CTG reactive and Umbilical Artery Doppler normal, Group IIA, Group IIB, and Group III. The findings of each group were compared with different modes of delivery and different parameters of perinatal outcomes. Conclusion: Maternal perception of fetal movements is the most widely used technique to evaluate fetal wellbeing. Low-risk pregnancies with decreased fetal movements should be monitored for close antenatal fetal monitoring, appropriate and prompt interventions. Non-reactive CTG alone or with combination of abnormal Doppler results are better predictors of poor perinatal outcome and can indicate if neonatal resuscitation is required. These two tools can be used together for fetal monitoring and appropriate intervention at the correct time to improve the perinatal outcomes

Introduction: Diabetes mellitus is one of the most common diseases whose prevalence is on the rise. It is believed that within the next 30 years, the number of diabetic patients will double in comparison to the year 2000.Aims: To Study the effect of impaired blood glucose level on cognitive functions. Materials and Methods: The present study was a Prospective cross-sectional study. This Study was conducted from Dec 2019 to June 2021 at Department of Physiology in association with department of Medicine at tertiary care hospital  Result: In the present study, it was also seen that reduction in mean MMSE score in type2 DM subjects having duration above 5 years was significant when compared to those with duration less than 5 years. It shows that longer duration has an effect over cognitive function. Correlation coefficient between MMSE score and HbA1c was negative in this study, from which it is inferred that increase in HbA1c levels is associated with decrease in MMSE scores. Conclusion: We found that, Effective control needs proper diet, regular exercise, monitoring blood glucose by self and management of medications. A person’s cognitive skill to bring about the above mentioned needs is thus crucial for self-management of diabetes

The purpose of the current study is to evaluate the impact of low dose isotretinoin therapy on the changes of total cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol in acne vulgaris patients. Methodology: Fifty patients with moderate to severe acne who were attending the dermatology department and were between the ages of 15 and 45 were treated with 20 mg of isotretinoin every day for four months. Blood samples were taken on day 0, the second week, the first, second, third, and fourth months. Results: The measured baseline cholesterol levels in the continuous therapy group were 116.86 ± 23.55, and they grew above the baseline levels at each subsequent interval of 4 weeks, 8 weeks, 12 weeks, 16 weeks, and at the end of the treatment. The P-value is significant when compared to the baseline. At all time points, compared to baseline and above the normal limit, there was a statistically significant increase in cholesterol, triglycerides, and LDL. There was also a statistically significant decline in HDL levels. Conclusion: Increase in cholesterol, triglycerides, and LDL over the usual range was brought on by low dosage continuous isotretinoin therapy. HDL values fluctuate with grade 1 (increase and decrease). Mild, well-tolerated side effects did not need therapy discontinuation. So it's crucial to raise awareness of the implications. We tell our expert that using low dose isotretinoin for moderate to severe acne can be done with little worry, although close monitoring is crucial

Introduction: Pancreatitis is one of most complex and clinically challenging of all abdominal disorders. USG and abdominal CT are the most commonly used diagnostic imaging modalities for the evaluation of pancreas. Computed Tomography (CT) is highly accurate and sensitive than USG in both diagnosing as well as demonstrating the extent. Early assessment of the cause and severity of acute pancreatitis is of utmost importance for prompt treatment and close monitoring of patient with severe disease. CT is the imaging method of choice for assessing the extent of acute pancreatitis and for evaluating complications. Materials and methods: This is a prospective study was conducted in the Department of Radiology at Dr. VRK Women's Medical College, Teaching Hospital and Research Centre Hyderabad, among 70 cases of acute pancreatitis. All the cases of acute pancreatitis referred under department of radiology in a tertiary healthcare institute, and fulfil the set inclusion criteria, who consented to participate in the study were included in the present study. It was carried out among 46 indoor cases of acute pancreatitis referred under department of radiology for further diagnostic evaluation, in a tertiary healthcare teaching institute in Maharashtra during study period. Ethical Approval was taken from the college ethics committee. Result: In our study, a total 70 patients were studied using CT scan, who was suspected to have acute pancreatitis. Among them, 50 (71.5%) were males and 20 (28.5) were females. Necrosis of the pancreatic gland parenchyma was seen in 17 (24.3%) patients. 12 patients (17.1%) showed <30% necrosis. 8 patients (11.4%) showed 30-50% necrosis, and 10 patients (14.3%) showed more than 50% necrosis. Conclusion: In conclusion CECT was found to be an excellent imaging modality for diagnosis, establishing the extent of disease process and in grading its severity. The Modified CT Severity Index is a simpler scoring tool and more accurate than the Balthazar CT Severity Index. In this study, it had a stronger statistical correlation with the clinical outcome, be it the length of hospital stay, development of infection, occurrence of organ failure and overall mortality. It could also predict the need for interventional procedures

Background: Prostate cancer (PCa) is a major cause of morbidity and mortality among men in the United States and globally. However, many men with prostate cancer have slow growing tumor and experience an indolent course even without curative therapy. The increasing incidence may be due to increased PSA-measurements and other diagnostic efforts. However, this review does not handle the associated differential diagnosis. Also, the biological heterogeneity that characterizes this disease causes decision issues unique to prostate cancer. Low-grade cancer diagnosed late in life may have no impact on the quality or length of life.  Materials and methods: A cross-sectional study was conducted to test the hypothesis of an association of IFN-γ, IL-6 and PSA with obesity parameters for the severity of prostate cancer. Total 90 participants included in study and Anthropometric examination and hormonal test were also performed simultaneously. Among 90 participants; Total 45 participants were grouped in Benign Prostatic Hyperplasia (BPH) and 45 in PCa groups respectively. Serum samples of men with suspicion of prostate cancer based on high prostate specific antigen (PSA) and/or abnormal DRE were withdrawn before biopsy between 8 a.m.  and 11 a.m. Serum PSA, IFN-gamma and IL-6 levels were estimated using ELISA on the same day. The serum was separated, aliquoted and kept frozen at -80ºC for analysis. Result: Waist hip ratio was significantly (p<0.0001) higher in the patients of PCa (2.9 ± 1.43) as compared to BPH (1.92 ± 1.20). Level of IFN-γ was significantly (p<0.0001) higher in PCa (144.6 ± 49.9) patients as compared to BPH patients (61.8 ± 11.9). Similarly, the Interleukin-6 level was significantly (p<0.0001) higher in PCa patients (36.95±11.37) as compared to BPH patients (13.7±9.47). The age of the patients was almost similar in both Lower (68.59±12.15) and Higher (67.70±12.70) grades.  The level of BMI was significantly (p=0.008) higher in the patients of Higher grade (28.35±7.99) as compared to Lower (26.85±5.89) grade.  The higher-grade patients had more risk of being overweight than the lower grade patients (Unadjusted OR=1.14, 95%CI=1.03-1.16). Similarly, the waist-hip ratio was also significantly (p=0.03) higher in the patients of Higher grade (2.33±1.53) as compared to Lower grade (2.09±1.38). Conclusion: The introduction of total PSA in clinical practice has resulted in early detection and reduced mortality from PCa. However, PCa screening remains controversial, because of the risk of over diagnosis reduced mortality and overtreatment and the inability to detect a significant proportion of dangerous tumors. A large concerted effort has been made to improve and/or monitoring the activity of PCa and to guide molecular targeted therapy and/or assess therapeutic response. An integrated approach with blood-based measurement of different molecular forms of PSA in combination with genetic and urine biomarkers hold the promise of improving screening for and diagnosis of PCa. Analysis of panels of blood-based biomarkers will be a significant step towards fingerprinting of the tumors biologic behavior.

Biomedical Waste Disposal has become a subject of great concern in the modern health care system. It is vital in maintaining public health and preventing transmission of certain infectious diseases. Knowledge and attitudes towards safe disposal of biomedical waste is key to the successful implementation of the program particularly in the health care facilities. 200 health care professionals interviewed to understand the ground realities of their knowledge and attitudes. While all of them agreed to the fact that knowledge about Biomedical Waste disposal is essential, only 55% have the knowledge of color coding. 74% have knowledge of segregation and 86% use protective gear while segregating. 99% have favorable attitude score. Knowledge among the medical personnel is high whereas the same among the house keeping staff is low. The need for providing continuous education and monitoring its implementation and strict law enforcement are some of the suggestions made to achieve a complete and meaningful Biomedical Waste Management. 

Introduction: Hospital waste is “Any waste which is generated in the diagnosis, treatment or immunization of human beings or animals or in research” in a hospital. “Hospital waste is a special type of waste produced in small quantities carrying a high potential of infection and injury and high potential to transmit infection to others. There are serious health effects from public health standpoint if hospital waste is not handled properly. Usually, the terms medical waste, hospital waste, infectious, and regulated medical wastes are often used interchangeably with medical wastes since there is no universally accepted definition for these terms.  Material and Methods: This is a Facility based cross-sectional study conducted at Health care facilities at various levels in Ganjam district.  In each health care facility, the medical officer, the pharmacist, the staff nurse and attendant comprised our study population. Those health care providers who gave consent to participate in the study. Using the observation checklist, the facilities were observed for infrastructure, logistics and practice of the stake holders. Then, the respondents were interviewed using the structured questionnaire for knowledge. A value of 1 and 0 was assigned for correct and incorrect practices respectively. For knowledge a value of 1 and 0 was assigned for correct and incorrect responses respectively. The total knowledge and practice score for each facility was calculated and then mean score was calculated. They were asked for their valuable feedback. Finally, they were thanked for their valuable support. Results: Only 12 (46.1%) of the doctors agreed that their facilities generate biomedical wastes, 15 (57.7%) of the doctors had opined that biomedical wastes associate with health hazard, 17 (65.4%) of the doctors were concerned regarding needle stick injury, 15 (57.7%) doctors believed wearing PPE reduces infection.  Color coding of the waste segregation could be answered by 17 (65.4%) doctors, 13 (50%) of the doctors agreed that the BMW containers need to be labelled and 16 (61.5%) doctors agreed that the wastes need to be segregated at point of generation. Regarding color coded bins, 19 (73.1%) doctors practiced putting wastes in color coded bins. 20 (76.9%) doctors had the practice of displaying segregation instructions at their work place.  16 (61.5%) doctors were properly segregating wastes and aided in its proper transport. 18 (69.2%) doctors were not in practice of getting dustbins filled more than 3/4th. Conclusion: Findings from our study reveal that though the participants in our study have a fair knowledge regarding biomedical waste management still there is a lot of scope in not only improving the knowledge but also in changing the attitude and inculcating more rational practices towards the same. Majority of attendants had poor knowledge and practice regarding BMWM. Thus, there has to be a regular training programmes on biomedical waste management and its hazards for all the healthcare workers including group D workers. Along with educational intervention, strict implementation of biomedical waste management guidelines with its monitoring at all levels is also very much essential.

Background: Birth asphyxia is defined by the occurrence of hypoxia, hypercapnia, and acidosis, resulting in systemic disruptions, potentially including electrolyte imbalances, in newborn infants. The acquisition of knowledge pertaining to electrolyte disturbances is of significant worth, as it serves as a crucial determinant impacting perinatal morbidity, mortality, and the subsequent course of treatment. Material and Methods: The study described herein is a one-year prospective case-control investigation that took place within the Department of Pediatrics located in central India. A total of 80 newborns, consisting of 40 in the study group and 40 in the control group, were included in the study.The diagnosis of birth asphyxia was determined through the utilization of the APGAR score, while the diagnosis of hypoxic ischemic encephalopathy was established by employing the SARNAT staging system.The renal parameters, including serum creatinine, blood urea nitrogen (BUN), serum electrolytes from blood samples, and urine sodium and urine potassium from urine samples, were assessed in all the newborns. Results: Total 80 newborns out of which 40 were included in study group and 40 were included in control group. Out of 40 asphyxiated newborn 25(62.5%) were males and 15(37.5%) female. So there was higher incidence seen in the male babies. The BUN levels were 28+8.98 in the asphyxiated newborns as compared to controls who had BUN level was 20.3+2.65 and it was statistically significant. BUN level was higher among cases as compared to control and it was statistically significant.The mean serum creatinine levels were 1.7+0.29 in case group and 1.12+0.4 in control and it was statistically significant difference between both the groups. Conclusion: Perinatal asphyxia is an important cause of neonatal renal failure. Monitoring of blood levels of urea, serum creatinine, serum calcium and urine output helps in the early diagnosis and management of renal failure in birth asphyxia. Serum electrolytes levels and renal parameters had a linear correlation with severity of birth asphyxia.

Introduction: Gestational diabetes affects a significant proportion of pregnant women and can have adverse health effects for both the mother and the baby. Monitoring blood glucose levels and lipid profiles is crucial in managing this condition. This comparative study examines how glycosylated hemoglobin (HbA1c) and lipid profile parameters change in women with gestational diabetes compared to normoglycemic pregnant women, with the goal of improving diagnostic and management strategies for this condition. The aim of this study was to determine that HbA1c is an independent marker of dyslipidaemia among GDM cases and emphasize the link between the aforementioned parameters among pregnant women in Bihar. Materials and Methods: In this comparative study, we included fifty patients who were diagnosed with gestational diabetes during pregnancy. All of the antenatal women were in their third trimester. We also included another fifty pregnant women as controls, who did not have gestational diabetes or any other pregnancy complications in their third trimester. Both the cases and controls were randomly selected from the age group of 20 to 45 years. In this study, we measured the serum lipid profile parameters, oral glucose tolerance test blood glucose levels, and glycosylated haemoglobin levels in patients with gestational diabetes, and compared them with those of healthy pregnant women. Results: In this study, 50 pregnant women with GDM had a mean age of 31.2 years, while 50 pregnant women in the healthy control group had a mean age of 29.3 years. In the present study, serum triglycerides were observed at 193.12±10.12 mg/dL in GDM cases and 150.76±8.54 mg/dL in the control group, while serum total cholesterol was observed at 211.43±14.34 mg/dL in GDM cases and 168.83±18.19 mg/dL in the control group. The levels of serum triglycerides and serum cholesterol in GDM cases were statistically significantly higher as compared to the controls. The serum HDL cholesterol was observed at 57.98±5.78 mg/dL in GDM cases and 55.12±6.67 mg/dL in the control group, while serum LDL cholesterol was observed at 92.13±13.45 mg/dL in GDM cases and 82.03±10.16 mg/dL in the control group. There was no statistically significant difference in their HDL and LDL Cholesterol in the cases and control group. The fasting blood glucose was recorded at 116±9.65 mg/dL in GDM cases and 89±5.89 mg/dL in the control group, the blood glucose level after 1 hour of 75grams oral glucose administration in oral glucose tolerance test was observed at 198.13±12.74 mg/dL in GDM cases and 158.33±9.34 mg/dL in the control group while blood glucose level after 2 hours was observed at 174.38±11.48 mg/dL in GDM cases and 140.11±7.87 mg/dL in the control group. The differences between cases and controls were statistically significant. The mean value of the HbA1c of cases and control groups was 8.15±1.12 mg/dL and 6.02±0.18 mg/dL respectively. This difference between healthy pregnant women and women with GDM was statistically significant. Conclusion: The study's findings have conclusively demonstrated that triglyceride, high-density lipoprotein, glycated haemoglobin, and glucose levels in the blood all play a significant role in the development of dyslipidemia in gestational diabetes mellitus (GDM). Although it is well known that lipid parameters increase during a healthy pregnancy, the way they increase in GDM is different.

Background: Dengue fever is a significant global health concern, particularly affecting children in tropical regions. This study aimed to comprehensively analyze the laboratory profiles of serologically proven dengue cases in children and their associations with clinical outcomes. Materials and Methods: A prospective observational study was conducted on 300 pediatric patients with suspected dengue fever. Demographic data, clinical symptoms, serological markers (IgM and IgG antibodies, NS1 ELISA), and laboratory parameters were analyzed. Associations with disease severity and clinical outcomes were explored. Results: High prevalence of dengue-specific IgM antibodies (91.7%) and IgG antibodies (63.3%) was observed, with 50% of cases indicating secondary infections. NS 1 antigen ELISA was positive in 40% of cases. Clinical symptoms included fever (91.7%), headache (80%), myalgia (60%), and bleeding manifestations (16.7%). Severe forms of dengue (DHF/DSS) accounted for 30% of cases. Hemoglobin levels were lower in DHF/DSS cases (10.5 g/dL) than in non-severe cases (9.8 g/dL). Platelet counts were significantly lower in DHF/DSS cases (110 × 10^3/µL) compared to ICU admissions (85 × 10^3/µL). Serum creatinine levels were slightly elevated in ICU admission cases (1.1 mg/dL) compared to DHF/DSS cases (0.9 mg/dL). Conclusion: This study highlights the importance of serological markers and laboratory parameters in diagnosing dengue and assessing disease severity in pediatric cases. Early diagnosis and monitoring of these markers are crucial for timely clinical intervention. Further research is needed to validate these findings and enhance our understanding of pediatric dengue pathophysiology.

Introduction: OPCAB was designed to reduce complications resulting from cardiopulmonary bypass like stroke, renal complications and myocardial ischemia and to reduce hospital stay, reduce morbidity and mortality. It includes various anatomical distortions of heart using stabilizers and suspensions which needs extensive monitoring techniques. To improve its efficiency neurological monitoring like NIRS and PA cannulation could play a significant role in further reducing such complications. Mixed venous oxygen saturation (SvO2) remains the accepted standard during anesthesia to evaluate the balance of oxygen delivery and consumption, especially during cardiac surgery. Monitoring the ScvO2-SvO2 with conventional PAC gives indirect evidence of myocardial ischemia, after excluding other causes of ischemia in lower body. Materials and Methods:  In this single centred prospective interventional study, 60 patients undergoing elective off pump CABG between March 2018 to March 2020 were taken. Institutional ethical and scientific committee approval was taken (UNMICRC/ANESTH/2017/09) and written informed consent from patients was obtained. Results:  Total 360 patients were enrolled in the study for comparative analysis of regional cerebral oxygen saturation (rScO2), central venous oxygen saturation (ScvO2) and mixed venous oxygen saturation (SvO2) in off pump CABG. Table 1 shows general characteristics of patients. Mean ejection fraction was 45.92 ± 9.23%. Fifty patients had triple vessel disease and 10 had double vessel disease for which 60, 53 and 49 patients had undergone Left anterior descending (LAD), Obtuse marginal (OM) or Diagonal (DG) and Posterior descending artery (PDA) or Right coronary artery (RCA) grafting respectively. Conclusion:  Positioning of the heart for distal anastomoses at lateral and posterior wall was associated with more hemodynamic alteration and increased in inotropic and vasopressor requirement and significant decreased in rScO2, ScvO2 and SvO2. There was significant positive correlation on measured gradient between ScvO2 & SvO2 and rScO2 & SvO2 and rScO2 & ScvO2. ΔrScO2 was found to be highest as compared to ΔSvO2 followed by ΔScvO2.

Introduction: Adverse drug reactions (ADR) are an important aspect of drug therapy and can be a major setback in clinical practice. An ADR is defined by the World Health Organization (WHO) as ‘a response to a medicine which is noxious and unintended, and which occurs at doses normally used in man. The safety of drugs used in patients of an adult age group cannot be extrapolated to a pediatric age group. The pharmacokinetics and pharmacodynamics of many commonly used drugs vary significantly between these two age groups of patients2.  Adverse drug reactions (ADRs) in children can have a relatively more severe effect when compared to adults. Thus, the ADRs can lead to significant morbidity among children.3 An increase in the number of drugs and self-medication with various medications have enhanced the occurrence of adverse drug reactions in recent times, especially in pediatric population. Material & Methods: This was a prospective, observation based, non-interventional study was Conducted in Dept. of Pediatrics, SCB Medical college and SVPPGIP, Cuttack which are two institutions under one department. This Department is a tertiary care center for pediatric patients in our state. Our institution is an approved ADR Monitoring Center (AMC) under Pharmacovigilance programme of India (Pvpi). ADRs were confirmed by the clinicians based on temporal relationship between start of drug and reaction, withdrawal of drug leading to decrease severity or abolition of reaction (dechallenge), exclusion of other causes etc. Sensitization of doctors in various seminar were done for spontaneous ADR reporting in Suspected Adverse Drug Reaction Reporting Forms by health care professionals. Results: Out of total 350 cases, dermatological system was most commonly involved i.e. 207 cases (59. 14%).This is followed by involvement of central nervous system 46 number of cases (13.14%). The GI system was involved in 34 cases i.e. (9.71%). Most of the ADRs were due to Antibiotics, these drugs are involved in 198 (56.57%) cases. Commonest antibiotics causing ADRs were Ofloxacin involving 26 cases (13.13%) of antibiotics followed by Ceftriaxone and cefixime comprising 22 cases (11.11%) and 14 cases (7.07%) respectively of total antibiotics used. A single drug as a possible causative agent of ADR,177 such cases were reported which constituted 50.57% of the total ADRs. Sometimes these agents were used with other drugs but Dechallenge test ruled out the probability of other drugs involvement. Out of 177, 110 drugs caused ADRs when used alone i.e. 31.4 % drug reactions were caused by monotherapy. Conclusion: Our study showed varied range of ADRs with higher reports in male children compared to females and maximum reports of ADRs obtained in age group 5-10 Years. Dermatological ADRs have highest incidence out of all the ADRs and FDE is most frequent among dermatological ADRs. Antibiotics were the commonest suspected agent in the reported ADRs. This study also exposed high occurrence of over-the-counter prescription to the pediatric age group causing ADRs (20.87%) of total ADRs and 12% of total serious ADRs. Incidence of serious ADRSs were more where multiple drugs were the suspected causative agents of ADRs. Various atypical ADRs were also observed due to active monitoring. Hence this study further emphasizes the need of proactive Pharmacovigilance, restriction of over-the-counter medications and increasing awareness among health care professionals, patients and public, for rational use of antibiotics, avoiding multidrug therapy and FDCs to reduce the incidence of ADRs especially in pediatric age groups.

Background: This study was conducted to evaluate the serum vitamin D levels in patients with type 2 diabetes mellitus with and without nephropathy. Methods: This was a hospital-based cross-sectional case control study conducted among 100 patients who attended OPD and IPD at the Department of Medicine, Dr. B.R. Ambedkar Medical College and Hospital, Bangalore, over a period of 18 months from December 2020 to May 2022, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: In comparison between diabetic nephropathy and non-diabetic nephropathy between both groups, a statistically significant difference (p<0.001) was noted between them with regard to serum creatinine, eGFR, UACR and vitamin D levels, suggesting that the diabetic nephropathic group has increased creatinine levels, highly reduced eGFR, highly elevated UACR and significantly decreased vitamin D levels, which are not present in the non-diabetic nephropathy patients. The eGFR and vitamin D levels were compared among the diabetic nephropathic subjects. The eGFR was split into three groups and by the ANOVA test measure, a significant association was obtained between them suggesting decreased eGFR also decreases vitamin D levels. On correlating vitamin D levels with serum creatinine and UACR a statistically significant (p<0.001) strong negative correlation was obtained (0.85 and 0.91) respectively. Conclusion: The study found that individuals with diabetic nephropathy had a higher prevalence of vitamin D insufficiency. However, at more advanced stages of diabetic kidney disease, their severity is more prevalent. Patients with CKD (Chronic Kidney Disease) should get information from health care providers on vitamin D monitoring and its dietary sources.

Background: Scorpion envenomation is a potentially fatal public health risk in tropical and subtropical places around the world. [1] However, morbidity and mortality from venomous animal bites or stings have received little attention in poor nations, including India. This is evident in the absence of a system for reporting venomous bites or stings. Objectives: 1. To study the clinical presentation, course, complications and outcome of scorpion sting envenomation. 2. To study the epidemiology and circumstances leading to scorpion sting in the community. Material & Methods: Study Design:  Hospital based prospective cross-sectional study. Study area: The study was conducted in the Department of Paediatrics. Study Period: 1 year. Study population: All the children admitted for scorpion sting into hospital.  Sample size: Study consisted a total of 54 subjects. Sampling Technique:  Simple Random technique.Study tools and Data collection procedure: On admission, a detailed clinical history, including the time of sting, symptomatology, details of treatment received before admission was taken. Further a description of the scorpion and details about the circumstances leading up to the sting were obtained. All the patients were subjected to a detailed clinical examination at admission and at frequent intervals thereafter, as was necessary in each case. Hourly monitoring of heart rate, respiratory rate, blood pressure, urine output, cardiovascular and respiratory status was done. Results: Commonest complications were, peripheral circulatory failure, pulmonary edema, Myocarditis and Congestive cardiac failure (15% of cases). One child developed popliteal artery thrombosis 76 hours after admission to hospital. Three patients presented with Encephalopathy, two of whom had massive pulmonary edema and succumbed within 5 hour of admission. One child had left sided hemiparesis and encephalopathy, secondary to Left MCA territory infarct with mild pulmonary edema. Conclusion: In India, cardiovascular complications are most common and life threatening. However, anticipation and close monitoring for other uncommon complications is critical for effective management. Prazosin has revolutionized the management of scorpion sting envenomation. Administration of prazosin, as early as possible, is probably the single most effective intervention for preventing complications following scorpion sting.

Introduction: COVID-19 is an acute viral illness caused by severe acute respiratory syndrome corona virus 2(SARS-CoV-2). Since the onset of the SARS-CoV-2 pandemic, multiple new variants of concern have emerged which are associated with enhanced transmissibility and increased virulence. It also highlights the role of the clinical inter professional teams, public health agencies, and community participation in improving patient care. Aim: An analysis of genomic sequencing variants of SARS-CoV-2 in symptomatic patients during 2nd and 3rd wave of pandemic by next-generation sequencing (NGS). Materials And Methods: A total of 200 symptomatic patients, throat/nasopharyngeal swab were collected for real-time reverse transcription-polymerase chain reactions (RT-PCR) at tertiary care hospital, Guntur. The specimens were transported under cold chain according to guidelines to Centre for Cellular & Molecular biology (CCMB), Hyderabad, for genome sequence analysis by next generation sequencing (NGS). Study period – 2ndwave i.e., MARCH 2021 –NOVEMBER 2021 & 3rdwave i.e., DECEMBER 2021 –MARCH 2022 according to WHO.  Result – Out of 200 samples analysed, 132 samples of 2nd wave & 68 samples in 3rd wave. Out of 132 samples, 57 Delta (B.1.617.2), 75 Delta sub-lineages. Out of 68 samples 41 Omicron (B.1.1.529), 11 Omicron lineages (BA.1), 16 Omicron (BA.2). Conclusion: During the 2ndwave the symptomatic patients were detected with more delta and delta sub lineages showing high mortality rate. During 3rdwave omicron and omicron sub lineages were detected more than delta showing very high transmissibility and less mortality. Continuous monitoring and analysis of the sequence variants to understand the genetic heterogenicity.

Background: This study examines the clinical outcomes and efficacy of management strategies for patients in the ICU of Government General Hospital, Nizamabad. It focuses on evaluating the impact of therapeutic interventions like oxygen therapy and CPAP adjustments in a critical care setting, particularly during the challenging period of the COVID-19 pandemic. Methods: A retrospective observational study was conducted involving 50 patients admitted to the ICU. The evaluation criteria included monitoring changes in oxygen saturation levels, the usage and adjustment of CPAP, and the presence of comorbid conditions. The study aimed to categorize patient outcomes into three groups: improvement, stability, and deterioration during their ICU stay. Results: Among the patients studied, 60% (30 patients) demonstrated clinical improvement, marked by increased oxygen saturation, reduced respiratory distress, and stabilized vital signs. 20% (10 patients) maintained a stable condition with no significant change in their health status. In contrast, another 20% (10 patients) experienced a deterioration in their condition, necessitating enhanced respiratory support. The study also found a high prevalence of comorbidities; 40% (20 patients) had hypertension, and 30% (15 patients) had diabetes mellitus. Conclusion: This study offers a comprehensive analysis of the clinical outcomes and management strategies in an ICU setting during a critical period. The findings highlight the effectiveness of personalized treatment approaches, the impact of comorbidities on patient outcomes, and the challenges posed by the COVID-19 pandemic. These insights are crucial for enhancing patient care in critical settings and for guiding future research in the field of critical care medicine.

Introduction: Mortality rates for COVID-19-related mucormycosis vary greatly in reported studies. A systematic evaluation of 101 cases revealed a fatality rate of 30.7 percent. However, research on the determinants of death in COVID-19 associated mucormycosis is insufficient. The purpose of this study was to find out what factors contributed to in-hospital mortality in patients with COVID-19-related mucormycosis. Objectives: To study the the Clinical profile , Haematological ,Biochemical and Radiological changes associated with mortality in patients with covid-19 associated mucormycosis. Methodology: In this single-center, observational study, 130 patients diagnosed with COVID-19 associated mucormycosis were recruited from a tertiary level intensive care unit from Bowring and Lady Curzon hospital, Bangalore, India. Results: Proportion of HTN, IHD, CKD and HIV was significantly more in non survivors compared to survivors. ICU admission and Oxygen requirement was scientifically higher in Non Survivors and had significant association with the outcome. . There was no significant difference in the levels of Hb, Neutrophils, Lymphocytes, Monocytes, Eosinophils, and Platelets as p>0.05. Total count (17191 7764), ESR (57.6± 12.4), CRP levels (199.0 69.5), and S.Ferritin (624.6 268.0) were significantly higher among the Non survivors. S.LDH (355.7 108.9), S.Free Iron (51.7 13.3), HBA1C (11.4 2.4), and S.Urea (36.9 35.3) were also found to be significantly higher among the non survivors. Conclusion: The current study highlights that a multidisciplinary approach in COVID-19 associated mucormycosis patients that includes timely and effective surgical debridement coupled with appropriate antifungal therapy and diligent sugar monitoring with intrahospital glycemic control may help to lower mortality. Key Words:

Introduction: Ocular structural and functional markers are important for early detection and monitoring of pre-diabetes and diabetes mellitus. Diabetes is a persistent metabolic condition marked by high levels of glucose in the blood, which can lead to complications affecting different organs, such as the eyes. Aims and Objectives: The primary objective of this research is to identify ocular structural and functional markers associated with pre-diabetes and diabetes mellitus. Methodology: Adults aged 25-45 underwent comprehensive eye and health assessments at a tertiary care centre, utilizing advanced tools like the Omron Body Fat device and A1C Now+ test. Ocular evaluations employed sophisticated methods, including the Cochet Bonnet esthesiometer and Zeiss OCT. The investigation included 59 participants. Result: The study's findings reveal a distinct connection between diabetes, HbA1c levels, and different ocular parameters. Individuals with diabetes show elevated average HbA1c levels, advanced age, decreased Amplitude of Accommodation, and heightened Presbyopic Addition. Significant variations are noted in Cerebrospinal Fluid values, Pain Sensitivity Reaction Time, and different ocular surface measures in individuals with diabetes or prediabetes, suggesting possible effects on both systemic and ocular health. Conclusion: Functional markers such as contrast sensitivity function and photo stress recovery test were notably reduced in prediabetes cases, suggesting their value as visual indicators. Additional investigation into the contrast sensitivity function is advised because of its negative relationship with blood sugar levels. Photo stress recovery test delays indicate early macular changes prior to diabetes diagnosis, highlighting the significance of proactive screening. 

Background: Fracture of the femur is a common reason for hospital admission among the elderly population, with increasing frequency due to factors such as longer life expectancy, osteoporosis, and sedentary lifestyles. Conservative treatment approaches often lead to complications and are not suitable for many patients. Hemiarthroplasty, particularly using bipolar endoprostheses, has emerged as an effective surgical intervention for displaced femoral neck fractures in elderly individuals, offering pain relief and improved mobility. Method: This prospective study evaluated 36 patients over the age of 50 with intra-capsular femoral neck fractures treated with hemiarthroplasty using bipolar endoprostheses. The study aimed to assess functional outcomes and quality of life using the Harris Hip Score. Patients underwent preoperative planning, medical evaluations, and surgical management with cemented bipolar hemiarthroplasty. Postoperative monitoring was conducted at regular intervals for up to six months, with clinical, functional, and radiological evaluations performed during follow-up appointments. Result: Among the study participants, 44.4% were aged 50-65, while 55.6% were over 65, with a mean age of 64.2 years. Females comprised 55.6% of the cohort. Evaluation of Harris Hip Scores showed that 50.0% of patients achieved excellent outcomes, 38.9% had good outcomes, and smaller proportions fell into fair and poor categories. Most participants reported no pain and exhibited favorable outcomes in terms of limping, support required, distance walked, range of motion, leg length discrepancy, and post-operative complications. Radiological assessments indicated satisfactory stem positions in the majority of cases. Conclusion: Bipolar hemiarthroplasty with cement fixation proves to be a beneficial treatment option for elderly patients with fractured neck of femur, offering good to satisfactory functional outcomes and low complication rates. This procedure facilitates early mobilization and restores pre-injury functional status in most patients, highlighting its effectiveness in addressing femoral neck fractures in the elderly population.

Background: Thyroid dysfunction during pregnancy is associated with adverse outcomes for both mother and child. This study aimed to investigate the prevalence of thyroid dysfunction among pregnant women and its correlation with obstetric outcomes and risk factors.Methods: A prospective observational study was conducted on 500 pregnant women. Thyroid function tests were performed at enrollment and during each trimester. Data on obstetric outcomes and compliance with treatment were collected. Results: The prevalence of thyroid dysfunction was 5.0%, with hypothyroidism (2.0%), hyperthyroidism (1.0%), subclinical hypothyroidism (1.6%), and subclinical hyperthyroidism (0.4%). No significant association was found between thyroid dysfunction and adverse obstetric outcomes such as preterm birth (20% vs. 9%, OR 2.5, p=0.08) and low birth weight (16% vs. 8%, OR 2.1, p=0.18). Age over 30 years (OR 2.0, p=0.02) and a family history of thyroid disease (OR 3.5, p=0.001) were significant risk factors. Followup results showed a progressive worsening of thyroid function during pregnancy. High compliance with levothyroxine treatment was observed (80%). Conclusion: While the prevalence of thyroid dysfunction in this cohort is in line with global rates, the study highlights the critical need for routine monitoring and management of thyroid function in pregnancy. The findings also emphasize the role of specific risk factors in identifying women at higher risk for thyroid dysfunction.

Background : In this study, we wanted to compare the haemodynamic responses to endotracheal intubation using Intubating Laryngeal mask airway (ILMA Fastrach ^TM) and  direct laryngoscopy in adult patients with normal airway. Methods: This was a hospital-based study conducted among 60 ASA grade I and II patients undergoing elective lumbar spine surgeries under general anaesthesia. They were grouped into two groups, group I -Laryngoscopy group and group II – ILMA Fastrach ^TM ( group II). Circulatory response to intubation was recorded in both groups  by invasive arterial Blood Pressure(BP) monitoring device placed before induction of anaesthesia. The values were recorded at pre induction, at induction, every minute post induction for 3minutes and at ILMA / laryngoscopy , every 10 second post intubation for 2 minutes followed by every minute for next 3 minutes. The maximum values and maximum increase in BP and HR were recorded in both groups. Results:Intubation through I LMA- Fastrach™ was associated with significantly lower cardiovascular responses compared to direct laryngoscopy and intubation. There was a significant increase in blood pressure and heart rate from baseline in both the groups. The maximum increase was above or equal to preinduction values with laryngoscopy and intubation. The maximum values in I LMA (Fastrach™ ) group were never beyond preinduction values with respect to changes in blood pressure. The maximum increase in blood pressure and heart rate from respective base line values were similar between the two groups. This occurred in spite of longer time required for intubation in I LMA(Fastrach™ )  group in comparison with laryngoscopy group. Conclusion:The intubation done through ILMA(Fastrach™) was associated with lesser haemodynamic response associated with intubation in adult normotensive patients with normal airway. 

Background: The escalating rates of cesarean sections (CS) globally necessitate evidence-based strategies to mitigate unnecessary surgeries. Robson's ten-group classification system offers a standardized approach to assess CS rates across diverse healthcare settings. Understanding the factors contributing to CS rates is crucial for effective obstetric management. Methods: This study analyzed 346 cases of CS using Robson's classification scheme, incorporating data on demographics, gestational age, parity, onset of labor, and indications for CS. The sample size was determined based on previous research, and data were collected from case records using a proforma. The primary objective was to identify the group exerting the most significant influence on CS rates and evaluate rates within each category. Results: Group 5, comprising women with a history of previous CS, contributed notably to overall CS rates. Fetal distress emerged as a predominant indication for primary CS, followed by malpresentation of the fetus and failed induction. Groups 1 and 3, involving spontaneous labor, exhibited moderate contributions to CS rates. Conversely, Groups 6, 7, and 10 represented smaller proportions, indicating lesser impact on CS rates. Conclusion: The study underscores the significance of Robson's classification in assessing CS rates and identifying key contributors. Women with prior CS represent a substantial proportion of CS cases, highlighting the importance of offering trial of labor after cesarean section (TOLAC) where feasible. Efforts to enhance obstetric care should include improved training in fetal monitoring interpretation and reinstating skills in assisted vaginal breech birth and external cephalic version. By addressing these factors, healthcare facilities can strive towards optimizing CS rates while ensuring safe maternal and neonatal outcomes.

The COVID-19 pandemic highlights the complex interplay between viral infections and cardiovascular disease (CVD), with dietary factors emerging as a critical modifiable risk factor. Examining the intricate relationship between COVID-19 and circulatory risk factors, this review highlights the growing role cardiologists play in managing chronic heart problems that arise after immunization and assessing the prognosis of myocardial injury. Overshadowing myocarditis, acute myocardial damage is a prominent consequence of COVID-19 and is often linked with sickness severity and viral load. There is worry about possible long-term cardiac effects made worse by SARS-CoV-2 Post-Acute Sequelae (PASC). Acute disease severity influences the frequency of PASC. Several heart-related symptoms are emphasized, such as myocarditis, ischemic heart disease, and arrhythmias. Several heart problems, including myocardial ischemia, thrombosis, and inflammation, have been related to several mRNA COVID-19 vaccinations. There are differences in treatment approaches, therefore in order to lower cardiovascular mortality, early detection and care are required. Chronic symptom management is recommended to use a multidisciplinary strategy that includes ambulatory monitoring and stress testing. After the pandemic, eating will play a critical role in reducing the risk of disease as it has an impact on lifestyle, mental health, and access to healthcare. With a particular emphasis on nutrition as a significant modifiable risk factor, this review investigates the connections between COVID-19 infection and cardiovascular health

Introduction: Renal function is evidently modified in both hypothyroidism and hyperthyroidism. However, there is a scarcity of clinical data on the relationship between thyroid disease and renal function. The objective of this study was to evaluate alterations in biochemical indicators of renal function in individuals with thyroid dysfunction and to correlate these measurements with the patient's thyroid hormones. Material and Methods: A total of 25 patients with primary hyperthyroidism and 294 patients with primary hypothyroidism were included as cases. A group of 100 persons who were in good health were selected as controls. Immunoassay was used to evaluate thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3). The serum levels of urea, creatinine, and uric acid were measured using an EM-360 autoanalyzer. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) algorithm. Renal function tests were evaluated in all cases. Results: The results of our study showed a significant increase in the average levels of serum urea (36.26±3.69) and uric acid (6.55± 0.34) in patients with hypothyroidism. This increase was statistically significant (p value < 0.001). Similarly, we observed a significant increase (p value < 0.001) in serum urea (29.98±2.17) and uric acid (6.59± 0.34) levels in patients with hyperthyroidism. Nevertheless, hyperthyroid patients exhibited a decrease in serum creatinine levels (0.70± 0.04) compared to the control group, resulting in an increase in estimated glomerular filtration rate (eGFR) (121.55± 5.79). Conversely, the hypothyroid group showed a significant increase in creatinine levels (1.04± 0.05) (p value < 0.001), leading to a decrease in eGFR (102.05± 5.38) compared to the control group. Conclusion: Thyroid dysfunction is linked to abnormal renal function. The clinician should recognize the association between thyroid problems and abnormal kidney function to consider performing a thyroid function test for patients with slightly raised biochemical indicators of renal function during treatment. Monitoring creatinine levels is necessary for people with thyroid disease.

Objective: Determine correlation between perfusion index in index finger and right toe regarding hypotension during spinal anesthesia in parturients undergoing LSCS. Methods: A cohort of 75 parturients (aged 18 to 35 years), scheduled for elective LSCS and classified as ASA-II, underwent intraoperative vital sign monitoring including heart rate, NIBP, respiratory rate, SpO2, and perfusion index measurements from both finger and toe sites. Readings were taken at two-minute intervals until the 15th minute, followed by five-minute intervals until surgery completion. Data were analyzed using SPSS 20.0. Results: Mean age was 25.91 years (±3.82), heart rate 95.55 bpm (±14.9), Finger PI 5.64 (±3.49), Toe PI 3.38 (±3.36), and MAP 98.28 mmHg (±8.70). ROC analysis identified baseline cutoffs for predicting hypotension: Finger PI 3.55 and Toe PI 1.85. Spearman’s rank correlation analysis revealed significant correlations between baseline finger perfusion index (>3.5) and hypotension episodes (rs = 0.400, P < 0.000), and baseline toe perfusion index (>1.85) and hypotension episodes (rs = 0.549, P < 0.000), suggesting moderate agreement. Conclusion: Perfusion Index (PI) is a valuable predictor of hypotension in healthy parturients undergoing elective LSCS under subarachnoid block. Continuous toe PI monitoring during spinal anesthesia induction may aid in predicting post-spinal hypotension and assessing aortocaval compression by the gravid uterus.

Objective: To determine the sensitivity and specificity of perfusion index in the right toe and index finger as a predictor of post-spinal hypotension in parturient undergoing Lower Segment caesarean Section (LSCS). Methods: 75 Parturient aged 18 to 35 years who were undergoing LSCS elective procedures, of ASA-II were included in the study. Intraoperative assessment of vital parameters including heart rate, NIBP, Respiratory rate, Sp02 and perfusion index at both finger and toe were recorded every 2 minutes till the 15th minute and then every 5 minutes till the end of the surgery. The data for the study was calculated using the SPSS 20.0 package program. Results: In this study, the mean age was 25.91 years (±3.82), heart rate 95.55 bpm (±14.9), Finger PI 5.64 (±3.49), Toe PI 3.38 (±3.36), and MAP 98.28 mmHg (±8.70). Using ROC analysis, baseline cutoffs for predicting hypotension were identified, Finger PI 3.55 (83.3% sensitivity, 51.1% specificity) and Toe PI 1.85 (80% sensitivity, 56% specificity). Conclusion: The Perfusion Index (PI) can be used as an effective tool for predicting hypotension in healthy parturients posted for elective caesarean section under subarachnoid block. Continuous monitoring of toe PIs during induction of spinal anaesthesia might help to predict the development of post-spinal hypotension and reflect the aorto-caval compression by the gravid uterus.

Conclusion: This observational study provides evidence supporting the effectiveness and safety of rosuvastatin in reducing LDL cholesterol levels among individuals with dyslipidemia. Rosuvastatin therapy was well-tolerated and associated with improvements in lipid profiles. These findings highlight the potential of rosuvastatin as a therapeutic option for managing dyslipidemia and reducing cardiovascular risk

Background: Cardiac disease in pregnancy is considered to be an important cause of maternal morbidity and mortality. Cardiac disease complicates 1-3% of all pregnancies and considered as leading cause of indirect maternal deaths. Cardiac disease in pregnancy is considered to be high risk and management of it in pregnancy is challenging. Aim: To evaluate fetomaternal outcome in cardiac disease complicating pregnancy. Objectives: To evaluate fetal and maternal outcome in pregnancy with cardiac disease. To measure the prevalence of cardiac disease in pregnancy. Materials & Methods: A retrospective observational study of all women who delivered at a tertiary care centre from 2011 to 2018 with heart disease complicating pregnancy were included in the study. Their details were collected from the case record and registers, using data collection proforma. The outcomes were studied. Results: The prevalence of cardiac disease was found to be 0.66%. Most common heart disease in pregnancy was found to Rhematic heart disease (72%). Among them the most common heart disease was found to be mitral stenosis (35%). Conclusion: Cardiac disease is a high risk pregnancy and has major effect on fetal and maternal outcome morbidity and mortality in pregnancy. Hence proper antenatal monitoring, involvement of multidisciplinary team and delivery in a tertiary care setup with ICU and Cardiac care facilities will definitely improve the fetal and maternal outcomes in cardiac disease complicating pregnancy.

Conclusion: The present study stated that, vaginal mode of delivery is not always a completely safe option but may be considered as a safe mode for babies in breech as long as the selection criteria is fulfilled and delivery is done by a skilled and trained   obstetrician with continuous fetal monitoring. Therefore, it is concluded that a balanced decision to be taken about the mode of delivery on a case by case basis as it differs from case to case and gestational age as well as training of assisted breech delivery will go on a long term basis to optimise the outcome of breech presentation.

Background:   In modern era of medical science, patients’ post-anaesthesia recovery has improved mainly because of better monitoring, measures taken intra-operatively to avoid post-operative complications, and better immediate post-anaesthesia care. The present study aimed to know the incidence of postoperative nausea and vomiting, hypothermia and worst pain score in post-surgical patients in recovery room. Materials and Methods: This study was carried out after approval from institutional review board. This is a prospective observational study, conducted on the post-operative patients in the post anaesthesia recovery room in Tata Memorial Hospital, Mumbai for a period of two months. Data was collected from 1,007 patients out of 1,191 elective surgical procedures carried out. Incidence of postoperative nausea and vomiting (PONV), postoperative pain and hypothermia were assessed in the post-operative recovery room. Result: With the cut off value of 35°C, the incidence of hypothermia at ICU admission was 31.4%. There was significant correlation between duration of anaesthesia and hypothermia (p=0.04). Incidence of hypothermia in surface surgeries i.e. breast, head and neck, bone and soft tissue services was 26.3% (162/617) and in cavity surgeries i.e. gastrointestinal, genitourinary, gynaecology and thoracic surgeries was 39.5% (154/390) and in children <12 years was 35.5% (11/31). 6.6% of patients (66/1007) had nausea and 2% (20/1007) had vomiting on ICU admission. There is also no correlation between severe nausea and vomiting with the use of intraoperative antiemetic, duration of anaesthesia. 9.8 % (99/1007) had moderate to severe pain on admission to ICU, 12.1 % (122/1007) after one hour of admission and 2% had severe pain during ICU stay. There was no significant correlation between intra- operative analgesia and post-operative pain score. The study didn’t find any correlation with hypothermia, PONV and worst pain increasing the duration of ICU or hospital stay or affecting the outcome as the p value was >0.05. Conclusion: Incidence of hypothermia in ours study is similar as compared to previous studies. The incidence of severe pain is similar in cancer patients but lower than the patients undergoing general surgical procedures. Rate of re-admission and PONV in a post-surgical patient is very low in our ICU compared to other studies. We need to take further steps in improving the temperature monitoring, to control severe postoperative pain and PONV. Despite of pharmacological advances and known risk factors the incidences of postoperative complications is still higher.

Background: Dengue fever, a mosquito-borne viral infection caused by the dengue virus, presents a significant public health challenge, particularly in tropical and subtropical regions. While primarily known for its febrile and hemorrhagic manifestations, dengue fever can also lead to severe cardiac complications. This study aims to systematically investigate the incidence, clinical profile, and outcomes of cardiac complications in patients with dengue fever, providing critical insights into their management and prognostication. Materials and Methods: This prospective observational study was conducted at Patna Medical College and Hospital, Patna, from January to November 2023. It included 78 patients with a confirmed diagnosis of dengue fever, excluding those with pre-existing cardiac conditions. Detailed clinical assessments, electrocardiographic (ECG) monitoring, and echocardiographic evaluations were performed to identify cardiac complications. Routine laboratory investigations included cardiac biomarkers such as troponin I and creatine kinase-MB (CK-MB). Data were analyzed using SPSS software version 25, with logistic regression analyses to identify potential risk factors. Statistical significance was set at p<0.05. Results: The study included 78 patients with an average age of 35.4 ± 15.2 years; 66.7% were male. Cardiac complications were observed in 19.2% of patients, including myocarditis (7.7%), arrhythmias (5.1%), pericarditis (3.8%), and heart failure (2.6%). Patients with cardiac complications were more likely to have hemorrhagic manifestations (53.3% vs. 19%, p=0.018) and shock (33.3% vs. 7.9%, p=0.011). ECG abnormalities, such as arrhythmias and conduction defects, and echocardiographic findings, including reduced left ventricular ejection fraction and pericardial effusion, were prevalent. Elevated troponin I and CK-MB levels were noted in 66.7% and 53.3% of patients with cardiac complications, respectively. These patients had longer hospital stays (12.5 ± 4.2 days vs. 8.3 ± 2.1 days, p<0.001), higher intensive care needs (66.7% vs. 12.7%, p<0.001), and increased in-hospital mortality (13.3% vs. 1.6%, p=0.032). Conclusion: Cardiac complications in dengue fever are associated with significant morbidity and mortality. Hemorrhagic manifestations and shock are strong predictors of cardiac involvement. Routine cardiac monitoring using ECG and echocardiography, alongside the measurement of cardiac biomarkers, is essential for early detection and management. Addressing these complications promptly can improve patient outcomes and reduce the disease burden.

Background:  To explore the association of carotid intima medial thickness (CIMT) with TSH and other biochemical parameters among young adults with thyroid dysfunction. Material methods: Our study included 50 young subjects , 13-39 years, attending endocrinology clinic of our centre for thyroid dysfunction with no associated co-morbidities. BMI, thyroid and biochemical profile was assessed for all. All subjects underwent measurement of right and left CIMT using sonography (linear transducer 7mHz frequency). Statistical methods were then used to analyse the data. Results: CIMT values in our 50 subjects [hypothyroid:n=37 and hyperthyroid:n=13; age: 27.6±7.1 years ] fell in the normal range (Rt=0.53±0.10 mm ; Lt=0.52±0.11 mm).  Hypothyroids had a significantly higher HbA1C (p value;0.038) and Serum cholesterol (p value;0.028) levels as compared to hyperthyroid subjects. When the values for the entire group were studied, CIMT values did not correlate either with TSH or BMI [24.66±4.14 kg/m. sq.]; though it positively correlated with age and HbA1c (particularly right CIMT, correlation coefficient,0.50).  Hyperthyroid subjects had a significant positive correlation of TSH with Rt CIMT(0.750) and S.creatinine (0.780) and a negative correlation with cholesterol (-0.700). On the other hand, in hypothyroids, TSH levels did not significantly correlate with any parameters other than age (-0.38). Conclusion: Higher HbA1c (even in non diabetic range) are associated with higher CIMT among young patients of thyroid dysfunction, making it a useful tool for monitoring cardiovascular risk in conjunction with CIMT, especially in those with hypothyroidism.  

Background: This study was conducted to compare the efficacy of ketamine and ondansetron, two of the commonly used drugs, on blood pressure among patients undergoing laparoscopic cholecystectomy under general anesthesia. Methods: This was a prospective randomized double-blind study conducted among 56 patients coming for elective laparoscopic cholecystectomy under general anesthesia at UPUMS Saifai, Etawah, from November 2018 to April 2020 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Study assessed preoperative patient conditions and randomly allocated 56 patients into two groups for comparative anesthesia techniques. Group A (n = 28) received Inj. Ketamine10 mg diluted upto 5 ml in normal saline, while Group B received Inj. Ondansetron 4 mg diluted upto 5 ml in normal saline before induction. All patients were premedicated and induced with standard drugs. Vital signs were recorded just after giving the study drug, at the time of induction, immediately after intubation and every minute after intubation upto 10 minutes.  Monitored closely, and any deviations from baseline were noted,and hypotension managed through fluid resuscitation and rescue drugs if necessary. Heart rate changes were also recorded. The study aimed to evaluate the effects of Ketamine versus Ondansetron on hemodynamic stability during anesthesia induction, employing rigorous monitoring and treatment protocols for any adverse events. Results: In comparison of SBP (Systolic Blood Pressure) at baseline and different follow-up intervals between two study groups, just after giving away the trial drug, mean systolic blood pressure was 135.82±12.14 mmHg in group A (ketamine) as compared to 122.82±11.16 mmHg in group B (ondansetron), thus showing a statistically significant difference between two groups (p<0.001). Immediately after intubation, mean systolic blood pressure was 132.86±14.78 mmHg in group A (ketamine) as compared to 125.75±10.78 mmHg in group B (ondansetron). Statistically, the difference between the two groups was significant (p = 0.045). At all the follow-up intervals, mean values were higher in group A (ketamine) as compared to group B (ondansetron) and the difference was also significant statistically at 3 min and 10 min post-intubation intervals (p<0.05). Conclusion: Post-induction anesthesia hypotension incidence was higher in ondansetron as compared to that in ketamine group; however, the difference was not significant statistically. It seemed that pressor responses following intubation superseded the hypotensive effect of induction anesthesia

Introduction: Cardiovascular diseases (CVDs) are the leading cause of death globally, with middle-aged adults particularly vulnerable to developing risk factors that can lead to serious health complications. Understanding the dynamics of these risk factors is crucial for effective intervention and prevention. Objective: This study aims to assess the progression of cardiovascular risk factors in middle-aged adults through a longitudinal observational approach, providing insights into the prevalence, trends, and potential early indicators for reducing CVD incidence. Method: A longitudinal observational design of 522 middle-aged adults was selected through stratified random sampling from the Department of Cardiology, Hi-Tech Medical College & Hospital, Bhubaneswar, India. Baseline data collection, beginning in June 2019, included comprehensive health assessments, biochemical analyses, and lifestyle questionnaires. Follow-up assessments were conducted annually until June 2024. Key variables measured were blood pressure, lipid profiles, fasting glucose levels, body mass index (BMI), smoking status, and physical activity levels. Statistical analysis was performed using paired t-tests to compare baseline and follow-up data, with a p-value of <0.05 considered statistically significant. Results: Preliminary results indicate a high prevalence of hypertension (55%, p<0.01), dyslipidemia (47%, p<0.01), obesity (40%, p<0.01), and diabetes (30%, p<0.01) among participants. Over the five years, the incidence of hypertension increased to 60% (p<0.01), dyslipidemia to 52% (p<0.01), and obesity to 45% (p<0.01). Diabetes prevalence rose to 35% (p<0.01). Smoking rates slightly decreased from 25% to 22% (p=0.04), while physical inactivity remained high at 60% (p=0.03). Among urban populations, the increase in risk factors was more pronounced, with hypertension rising from 50% to 65% (p<0.01) and obesity from 35% to 50% (p<0.01). The interrelationship between obesity, hypertension, and diabetes was significant, suggesting a compounded risk for cardiovascular events. Conclusions: The study highlights the escalating prevalence of cardiovascular risk factors in middle-aged adults, emphasizing the need for early and targeted intervention strategies. Public health initiatives must focus on lifestyle modifications and continuous monitoring to mitigate these risks and reduce the burden of CVDs

Non-invasive blood pressure monitoring (NIBP) is a commonly used standard ASA monitor in Operation Theater. Beside of non-invasive, it can lead to various complications like petechial rash, ecchymosis, venous stasis, thrombophlebitis, infection, hematoma formation in patient on blood thinners, compartment syndrome, neuropathy due to compression and skin necrosis. These kinds of complications are not suspected by the anesthesiologist routinely. Most of these are seen invariably in diabetic, on anticoagulation therapy and old debilitating patients due to frequent monitoring. We are reporting a case of mechanical trauma caused due to NIBP monitoring in a patient posted for excision of bladder cyst. Intraoperatively, patient presented with carpopedal spasm distal to the BP cuff due to repeated cycling. We ruled out other causes of carpopedal spasm. Patient was managed for pain and for spasm calcium gluconate was given. Patient recovered and shifted to PACU. Through knowledge of complications and vigilance during perioperative period can helps the anesthesiologist to avoid them in their future course of perioperative care.

Osteoarthritis (OA) is a leading cause of disability, with its incidence rising in tandem with obesity rates. Traditional imaging methods, such as radiography, are limited in their ability to detect early cartilage changes, necessitating the exploration of advanced imaging techniques. MRI offers a non-invasive method to visualize joint structures, with various sequences providing different insights into cartilage morphology and composition. Methods: We conducted a comparative study involving 100 OA patients, utilizing multiple MRI sequences to assess joint cartilage. Each patient underwent imaging with the following sequences: T2 mapping, T2* mapping, T1 rho, dGEMRIC, gagCEST, sodium imaging, and DWI. Image quality, cartilage visualization, and sensitivity to cartilage degeneration were evaluated for each sequence. Quantitative measurements were taken to assess cartilage thickness, composition, and structural integrity. Results: •T2 Mapping: Effective in assessing cartilage hydration and collagen network integrity. Provided clear images of cartilage structure but was less sensitive to early biochemical changes. •T2 Mapping: * Similar to T2 mapping but offered improved sensitivity to iron and other paramagnetic substances within the cartilage. •T1 Rho: Excellent for detecting early biochemical changes in cartilage, particularly proteoglycan content. •dGEMRIC: Provided detailed information on glycosaminoglycan (GAG) concentration, a key marker of cartilage health. •gagCEST: Offered high specificity for GAG concentration, though image acquisition times were longer. •Sodium Imaging: Directly measured sodium content, correlating with GAG concentration. However, required specialized equipment and longer scan times. •DWI: Sensitive to changes in the microstructure of cartilage, offering insights into early degeneration processes. Conclusion: Advanced compositional MRI techniques, particularly T1 rho and dGEMRIC, hold significant promise for the early detection and monitoring of OA. While traditional morphological sequences like T2 mapping remain valuable for structural assessment, integrating these advanced techniques can enhance the diagnostic accuracy and treatment planning for OA patients. Further research is needed to streamline these techniques for widespread clinical adoption.

Introduction: The present study evaluated the cardiovascular responses of moderate physical activity in a population, which is underreported from all over world literature and can provide unique insights for Indian population. The aim of this research was to assess the cardiovascular response to moderate physical exercise in a healthy Indian population, providing distinctive perspectives. Methods: Participants undertook a standardized submaximal exercise protocol and cardiac output was evaluated continuously using non-invasive methods like cardiography throughout the procedure in a hospital setting. Rather, these approaches were designed to capture the cardiovascular adjustments during moderate exercise and not put subjects under substantial stress. The sample size was n=100 in the resting stage group and n=100 for the exercise group and total n=200. The age group of the participants was in the range of 19-50 years.  Results: The results indicated that there was a significant rise in cardiac output following exercise, and the non-linear data aligned within which the work bout took place. This study showed that cardiovascular adjustment to physical stress is particularly efficacious in Indian population. Heart function was found to be generally healthy in this group. Moreover, there were no significant differences in the gender in the present study indicating that among this people group both sexes have similar cardiovascular response suggestions. There was a significant effect on cardiac vascular activity amongst the people engaged in exercise in comparison to the control group. Conclusion: In conclusion, the studies provide useful data regarding cardiovascular fitness of Indian youth people and strength in carrying out frequent cardiovascular testing if engaged into physical activity. The results indicate that this type of monitoring may become a valuable tool in identifying the cardiac risk populations better, and eventually they will lead to greater health effects over an available period of time.

Background: Intrapartum hypoxia causes fetal suffocation, acidosis, newborn brain damage, long-term morbidity, and mortality.1 As a result, intrapartum fetal monitoring is performed to detect early indicators of fetal hypoxia and to take appropriate action as soon as possible to avoid fetal hypoxia complications. Objectives: 1. To study the correlation between fetal Doppler ultrasound and umbilical cord blood gas analysis in detecting fetal academia.  2.To identify the maternal and obstetric determinants associated with fetal acidemia. MATERIAL & METHODS:  Study Design: Hospital-based prospective observational study. Study area: The study was conducted in the Department of Obstetrics and Gynaecology.  Study Period:  1 year. Sample size:  Using a sample size calculator, expecting a correlation coefficient of r=0.300, the required sample size was calculated to be 85. Study population: During the study period, a total of 92 pregnant women with abnormal fetal Doppler ultrasound findings, meeting the below-mentioned inclusion and exclusion criteria were eventually recruited into this study. Sampling Technique: Simple Random technique. Study tools and Data collection procedure: The institutional ethical committee clearance was obtained. The design and nature of the clinical study were explained to the patients and significant relatives of the patients. Informed consent was obtained from patients. The socio-demographic data was collected and recorded in the specially designed proforma. The socioeconomic class was assessed using the Socio-Economic Status Schedule. The obstetric history data was gathered and recorded in the proforma. All the patients in the sample group (n=92) were subjected to thorough clinical examination which included general physical, systemic examination and pelvic examination. Maternal blood samples for routine laboratory investigations (including tests for acidosis) were sent. Results: There was a significant correlation between gestational age and fetal acidemia (p value=0.0096). A gestational age of 41 weeks or more has a lesser incidence of fetal acidemia. Middle cerebral artery pulsatility index (MCAPI) was significantly associated with fetal academia (p-value of <0.0001). The umbilical artery pulsatility index (UAPI) had a highly significant correlation (p <0.0001) with the umbilical cord blood gas analysis. Conclusion: Based on the statistical analysis of the data, it is safe to assume that fetal Doppler ultrasound can predict the development of fetal acidemia. Two indicators, the Middle cerebral artery pulsatility index and the Umbilical artery pulsatility index, are strong predictors of fetal acidemia. Similarly, determinants like obstetric score, medical comorbidity, general physical examination and status of labour per vaginal examination were also not found to be significantly associated with fetal acidemia.

Background: Liver cirrhosis significantly affects health outcomes, with rising cases linked to nonalcoholic steatohepatitis (NASH) in addition to chronic alcohol abuse. "Cirrhotic cardiomyopathy" is defined by systolic and diastolic dysfunction along with electrophysiological abnormalities, absent other cardiac disease. Patients are at risk of heart failure under stress, diagnosed through electrocardiography, 2D echocardiography, and biomarkers such as BNP. Key diagnostic indicators include a resting ejection fraction < 55%, diminished cardiac output under stress, and an E/A ratio < 1.0, while additional supportive features like electrophysiological changes and elevated biomarkers may be helpful but are not required. Methods: This cross-sectional study at Dr. PSIMS & RF Hospital included 50 cirrhosis patients, assessed using Child-Pugh and MELD scores. Evaluations included QTc interval assessment, 2D echocardiography, and cirrhotic cardiomyopathy criteria from the 2005 World Congress of Gastroenterology, Montreal. Inclusion criteria were hospitalized patients with cirrhosis, while those under 18 years of age, with COPD, or with co-existing heart disease were excluded. Statistical analysis used SPSS version 21, with significance set at p < 0.05. Results: Patients with QTc intervals ≤ 440 ms generally exhibited better liver function, with 65.5% in Child-Pugh Class A and 37.9% with MELD scores ≤ 9. Conversely, those with QTc intervals > 440 ms often had more severe liver impairment, with 71.4% in Child-Pugh Class C and 42.9% with MELD scores ≥ 30, showing significant differences (p < 0.05). Ejection fractions > 55% were associated with better liver function, while ejection fractions ≤ 55% indicated more severe impairment, with significant differences (p < 0.05). Cardiac parameters, including right atrial size, left atrial size, and ejection fraction, differed significantly across Child-Pugh classes, with Class C patients having larger right and left atrial sizes and lower ejection fractions compared to Classes A and B (p < 0.05). Conclusion: In conclusion, the study reveals that in liver cirrhosis patients, prolonged QTc intervals are strongly correlated with Child-Pugh and MELD scores, while an ejection fraction ≤ 55% indicates more severe impairment, highlighting the critical need for continuous cardiac monitoring.

Introduction: This case series study evaluates the optimization of anesthesia protocols for concurrent carotid endarterectomy (CEA) and off-pump coronary artery bypass (OPCAB). The study aims to create awareness about the significance of optimizing anesthesia for these combined high-risk procedures. The case series included fifteen patients, aged 54 to 72 years, with body mass indices (BMI) ranging from 24.2 to 28.7. Hospital stays ranged from 7 to 10 days, with minimal anesthesia-related complications observed. Key findings highlight the importance of individualized anesthesia management and meticulous postoperative monitoring to ensure favourable outcomes in patients undergoing concurrent CEA and OPCAB. The results contribute to the existing body of knowledge by demonstrating that a multidisciplinary approach and tailored anaesthetic protocols can enhance patient safety and surgical success. Future research should focus on larger, prospective studies to validate these findings and further refine anesthesia protocols. These insights underscore the critical role of optimized anesthesia in managing complex cardiovascular and cerebrovascular pathologies, ultimately improving patient care and outcomes in this high-risk population.

Background: Chronotherapy in hypertension control is considered to better control nocturnal blood pressure patterns. This study aimed at studying relation between diurnal blood pressure patterns and timing of antihypertensive medication. Method: Hypertensive patients of age group 19 years to 65 years who were on antihypertensives for a minimum period of one month and were free of any cardiovascular complication or chronic kidney disease were included in the study. After doing routine workup, they were subjected to 24-hour ambulatory blood pressure monitoring. Results: In this study of 105 patients (mean age 44±10.9), morning administration of antihypertensive medication resulted in significantly higher blood pressure surges and less nighttime BP decrease compared to nighttime administration, with a p-value of 0.001. No significant difference was found across medication classes for nocturnal dipping. Conclusion: Taking antihypertensive drugs in night appears to results in better control of hypertension.

Introduction: Cardiac disease is a leading cause of maternal morbidity and mortality during pregnancy. Effective management strategies are crucial for improving outcomes in this high-risk population. Aim: This study aimed to evaluate the outcomes of pregnant women with cardiac disease managed at the Rajendra Institute of Medical Sciences (RIMS), Ranchi, to refine treatment protocols. Methods: A prospective cohort study was conducted over one year, enrolling 35 pregnant women with either congenital or acquired heart diseases. Participants underwent regular monitoring with echocardiography, and data were collected on maternal and perinatal outcomes, including delivery methods and postpartum complications. Results: The study highlights significant maternal and perinatal complications in pregnant women with cardiac disease, with anemia (31.4%) and preterm birth (25.7%) as prevalent issues. The findings underscore the need for careful monitoring and management tailored to the severity of cardiac dysfunction to improve outcomes for both mothers and newborns. Conclusion: Effective cardiac and obstetric management in a tertiary care setting allowed for predominantly vaginal deliveries and highlighted the importance of echocardiography in monitoring. Recommendation: Tailored antibiotic prophylaxis and comprehensive postpartum contraceptive counseling should be integrated into care protocols for pregnant women with cardiac disease

Background: In India, poisoning is one of the common modalities for attempting suicide especially farmers. There is varied presentation among these patients. One such uncommon presentation is Methemoglobinemia. Methemoglobinemia is a rare but potentially life-threatening condition characterized by the oxidation of hemoglobin to methemoglobin (MetHb), rendering it incapable of effectively transporting oxygen, resulting in tissue hypoxia. This condition can be congenital or acquired, often due to exposure to certain chemicals, drugs, or toxins. Acquired methemoglobinemia is frequently seen in cases of poisoning, as highlighted in this case series of three patients admitted to a tertiary care hospital in central India following suicidal ingestion of toxic substances Material and Methods: This study was conducted in a tertiary care teaching hospital of central India where patients of Toxin induced Methemoglobinemia were recruited. It was an observational study of 6 months duration. Informed consent was obtained and duly signed by the patient or next of kin. History, Physical examination, Routine investigations, ABG, Co-Oximetry studies were done. Patients were managed as per established protocol with no additional out of protocol investigation or treatment was done pertaining to this study. Patient's confidentiality was maintained throughout this study.  Results: This case series involved three patients who developed toxic methemoglobinemia following ingestion of different toxic substances. - Effectiveness of Methylene Blue: In cases with moderate to severe methemoglobinemia (MetHb 33.5% to 41.4%), methylene blue proved effective in reducing MetHb levels and improving clinical outcomes. The initial treatment significantly improved MetHb levels and patient symptoms, with favorable outcomes observed in two of the three cases. - Severe Outcomes: The third case, with an exceptionally high MetHb level of 74%, demonstrated the limits of methylene blue treatment. Despite multiple doses, the patient’s condition deteriorated, indicating that extremely high MetHb levels and delayed treatment can lead to poor outcomes.Complications and Mortality: The case with the highest MetHb level resulted in mortality, underscoring the critical importance of early diagnosis and intervention. The other two cases, despite initial severe symptoms, responded well to timely methylene blue treatment and supportive care. Conclusion: This case series illustrates the clinical variability and challenges in managing toxin-induced methemoglobinemia. The condition should be suspected in cases of poisoning, particularly when there is a mismatch between oxygen saturation and arterial blood gas measurements. Early intervention with methylene blue, guided by co-oximetry, is essential for improving outcomes. Severe cases, especially those with MetHb levels exceeding 70%, carry a poor prognosis despite aggressive treatment, highlighting the need for early recognition, monitoring, and advanced supportive care

Introduction: Dyspnoea, coughing, and increased production and purulence of sputum are symptoms of chronic obstructive pulmonary disease (COPD), which can sometimes deteriorate rapidly. Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) describes this extreme worsening of symptoms all at once. Aims: To study the level of serum electrolytes in patients with acute exacerbation of COPD. Assessment of acute exacerbation of COPD based on severity of dyspnea using modified medical research council dyspnoea scale, clinical examinations and pulmonary function tests. Materials and Methods: The present study was a prospective hospital-based study. This Study was conducted from July 2022 to December 2023, spanning 18 months at Katihar Medical College and Hospital in Bihar, India. Result: In our study, 63 (63%) of the patients had fever, 100 (100%) had cough, 73 (73%) had crepitations, and 90 (90%) had wheeze. In our study, 77 (77%) patients had SPO2 levels between 94-85, 22 (22%) had SPO2 levels between 84-75, and 1 (1%) had SPO2 levels below 75. In our study, 25 (25%) patients had one mMRC Scale, 35 (35%) had two mMRC Scales, 25 (25%) had three mMRC Scales, and 15 (15%) had four mMRC Scales. In our study, 44 (44%) patients had <135 (hyponatremia), while 56 (56%) had 135-145 (normal). In our study, 49 individuals (49.0%) had <3.5 (hypokalemia), while 51 (51.0%) had 3.5-5.0 (normal). Conclusion: The findings suggest that serum electrolyte imbalances are common in acute exacerbations of COPD and may exacerbate respiratory symptoms. Monitoring and managing electrolyte levels could be essential in improving patient outcomes during acute exacerbations. Further studies are recommended to explore the therapeutic implications of these findings.

Background- Shivering is distressing for the patient’s undergoing surgery under both regional and after general anaesthesia. Shivering increases expenditure of cardiac and systemic energy, resulting in increased oxygen consumption and carbon dioxide production, lactic acidosis and raises the intraocular and intracranial pressure. It also interferes with haemodynamic monitoring intra operatively Aims- To evaluate the effectiveness of prophylactic use of intravenous ketamine, clonidine and tramadol in control of shivering in patient undergoing elective surgeries under spinal anaesthesia. Materials and methods- A Prospective, Randomized, Double Blind Comparative Study, done in Tertiary Care Superspeciality Hospital with in a span of 1 year. Adult patients posted for various elective surgeries under Spinal Anaesthesia. Patients scheduled for elective surgeries under spinal anaesthesia, Age group of 18-60 years of both sexes and ASA grades I or II included in study. The subjects were randomized in to 4 groups by using computer generated SPSS 16 software in to random numbers to receive ketamine, tramadol or clonidine. The patients were randomized into four groups of 42 patients each. Results- The age range was 18-60 years for all the groups.  There was no significant difference between the groups for age and sex distribution (p>0.05). There was no significant difference observed in the duration of surgery (p=0.46). There was no significant difference observed in the median level of spinal anaesthesia in the four groups (p=0.052). There was significant difference observed in the distribution of grade of shivering in normal saline group compared to tramadol, ketamine and clonidine group (p=0.0499). There was no significant surface temperature difference between the groups (p=0.67). There was statistically significant difference observed in ketamine group with respect to heart rate compared to tramadol, clonidine and normal saline groups till 40min after spinal anaesthesia with p-value of <0.001 except the baseline values (p=0.93). After 40 min, there was no statistically significant difference observed among the groups. There was statistically significant difference observed in ketamine group with respect to mean blood pressure compared to tramadol, clonidine and normal saline groups till 50 min after spinal anaesthesia with p-value of <0.001 except for baseline value (p=0.870) and value at 5 mins (p=0.0012).  After 50 min, there was no statistically significant difference observed in four groups. Conclusion- We conclude that giving either ketamine 0.5 mg/ kg, clonidine 75 mcg or tramadol 0.5 mg/kg i.v. prophylactically just before neuraxial blockade significantly decreases the incidence of shivering without causing any major side-effects. Using ketamine may be more beneficial as it improves the hemodynamic profile by its sympathomimetic effects and it sedates the patient effectively, which increases patient comfort during surgery, maintains cardiorespiratory stability and prevents recall of unpleasant events during the surgery.

Venous thrombosis is uncommon cause of stroke as compared to arterial occlusions, but it is an important consideration because of its potential morbidity and increasing incidence especially in current covid era. Historically comparatively low incidence of cerebral venous thrombosis {CVT} is approximately at 0.2 to 0.5 per 100000 per year while the mortality of CVT probably varied between 20%-50%. Standard medical management for CVT is hydration and systemic anticoagulation with heparin at therapeutic dosage, even in patients with an intracranial hemorrhage (ICH) i.e., Venous hemorrhagic infarct at baseline along with watchful monitoring for seizures & raised Intracranial Tension (ICT) and fundoscopy to monitor Papilledema. There are few cases that do not respond to standard of care with medical management & with progressive CVT leading to poor outcomes with resultant ischemic and hemorrhagic stroke, cerebral edema, mass effect and death.  Endovascular options has been in vogue in recent decade, including intra-venous application of thrombolytic agents and/or mechanical thrombectomy for patients with Major venous sinus thrombosis without large hematoma & significant  midline shift that necessitates emergency decompressive craniotomy  and those with Altered Sensorium (Glasgow Coma scale < 10)/ Refractory to anticoagulation with progressive disease or neurologic deterioration (deterioration on Glasgow Coma Scale ) refractory to anti- coagulation therapy or with new deterioration of symptoms or worsening of ICH or Haemorrage despite standard medical management. We present our unique experience of venous stroke patients in covid era that underwent endovascular salvage for major cortical venous sinus thrombosis & technical note on direct jugular vein accesses intervention utilizing peripheral hardware.

Introduction: Implantation of cardiac implantable electrophysiological devices (CIEDs), including permanent pacemakers and implantable cardioverter-defibrillators has been on the rise over the past years, largely due to the expanded indications for CIED implantation for primary prevention. Infection associated with implantable devices is a serious complication with high morbidity leading to mortality. The importance of appropriate empirical antibiotic coverage is illustrated by studies that document the association between inappropriate selection and increased mortality in patients with permanent pacemaker implantation. Increasing multi drug resistance problem could be due to mutations, over use of broad-spectrum antibiotics, across the counter availability of antibiotics and lack of infection control policy in the hospital settings. Methodology: A prospective observational study conducted at the major tertiary care centre of the State of Himachal Pradesh, for duration of one year. Patients who had undergone interventional cardiology procedure and developing any sign or symptom of general or systemic infection were included. Results: On direct Gram staining of clinical samples, microorganisms were seen in 12 (70.58%) samples and in 5 (29.41%) samples no microorganism seen. Out of 12 positive samples, Gram positive cocci were isolated from ten samples accounting for 83.33% of total isolates, while Gram negative bacilli were isolated from one sample (8.33%) and both Gram positive cocci and Gram-negative bacilli were isolated from single sample accounting for 8.33% of total isolates. Majority of the isolates were S.aureus (46%), followed by S.epidermidis (38%). Pseudomonas aeruginosa and Achromobacter spp. were 8% each. Out of 11 Staphylococcus isolates, 6 (54.54%) were identified as Staphylococcus aureus (S.aureus) and 5 (45.45%) were Staphylococcus epidermidis (S.epidermidis). There was 100% sensitivity to Vancomycin, Daptomycin and Linezolid. Almost 64% samples were resistant to Oxacillin, Cefoxitin, Cefazolin and Erythromycin; 45% were resistant to Co-trimoxazole and Clindamycin; 18% were resistant to Gentamicin and 9% were resistant to teicoplanin and Rifampicin. All the isolates were resistant to Ampicillin and Penicillin G. Out of 6 isolates of S.aureus, 3 (50%) were MRSA. Out of 5 isolates of S.epidermidis 4 (80%) were Methicillin resistant. All the MRSA isolates were sensitive to daptomycin, teicoplanin, vancomycin, linezolid and rifampicin but they were resistant to erythromycin, ampicillin and penicillin G. 67% isolates were sensitive to gentamicin, co-trimoxazole and clindamycin. All Methicillin resistant S.epidermidis were sensitive to daptomycin, vancomycin and linezolid. 75% were sensitive to gentamicin, teicoplanin and rifampicin and only 25% were sensitive to co-trimoxazole. However, all were resistant to erythromycin and clindamycin. In single isolate of Achromobacter spp resistance was observed for gentamicin, imipenem, meropenem, ciprofloxacin, levofloxacin and tetracycline. The isolate was sensitive to ceftazidime, piperacillin-tazobactam and co-trimoxazole. Single isolate of Pseudomonas aeruginosa was sensitive to amikacin, gentamicin, imipenem, meropenem, ceftazidime, cefepime, aztreonam, ciprofloxacin, levofloxacin and piperacillin-tazobactam. Conclusion: The present study indicated an infection rate of 8.1% following permanent pacemaker implantation. 84% of the causative organisms were Staphylococcus species and out of which 64% were methicillin resistant. Staphylococcus has been reported as a major cause of community and hospital acquired infections. Infections caused by Staphylococcus used to respond to β-lactam and related group of antibiotics. Vancomycin has been used as the drug of choice for treating MRSA infections. Further, the regular surveillance of hospital associated infections including monitoring antibiotic sensitivity pattern of MRSA and formulation of definite antibiotic policy may be useful for reducing the incidence of MRSA infection.

Background: Prone positioning during general anesthesia for spine surgery can induce significant hemodynamic changes. This study aimed to quantify these changes and their time course. Methods: Fifty-four patients undergoing elective spine surgery were included. Hemodynamic parameters were measured in supine position and at three time points after prone positioning: immediately, 5 minutes, and 10 minutes. Results: Significant decreases were observed in systolic blood pressure (mean difference 12.926 mmHg, p<0.001), diastolic blood pressure (mean difference 3.778 mmHg, p<0.001), and mean arterial pressure (mean difference 6.574 mmHg, p<0.001) immediately after prone positioning. Peak airway pressure increased significantly (mean difference 1.630 cmH2O, p<0.001). These changes persisted at 5 and 10 minutes, though some recovery was noted. Heart rate, end-tidal CO2, and oxygen saturation showed minimal changes. Conclusions: Prone positioning under general anesthesia leads to significant reductions in blood pressure and increases in airway pressure, with partial recovery over 10 minutes. These findings highlight the need for careful monitoring and management during prone positioning.

Background: Electrocardiographic (ECG) changes are reported frequently after acute strokes. It seems that cardiovascular effects of strokes are modulated by concomitant or pre-existent cardiac diseases, and are also related to the type of cerebrovascular disease and its localization. We aimed to determine the pattern of ECG changes associated with pathophysiologic categories of acute stroke among patients with/ without cardiovascular disease and to determine if specific ECG changes are related to the location of the lesion. Every year, more than half a million people in the world suffer from acute cerebrovascular events, including ischemic stroke, intracerebral and subarachnoid hemorrhage.  Materials and methods: This is a Prospective and observational study conducted in the Department of Medicine, Tertiary Care Teaching Hospital over a period of 1.5 years. Selection of study subjects - After admission, based on clinical history and Physical Examination, a presumptive diagnosis is made and later the patient will be subjected to Serial ECGs after informed consent. Patients admitted in the NICU and various medical wards within 24 hours after the onset of neurological deficit. Patients who developed stroke during their stay in hospital. Result: We have recruited 90 stroke patients, most of them were males. Major type was ischemic stroke. In total 62 (68.89%) stroke patients had some form of ECG change. Majority i.e. 35 (38.89%) patients had QTc prolongation followed by 32 (35.56%) patients had T wave changes. QTc prolongation and Atrial fibrillation were significantly more among hemorrhagic stroke patients (p<0.05) and T wave changes and ST changes (elevation or depression) were significantly more among ischemic stroke patients (p<0.05). Conclusion: PWDis and PTFV1 are independent predictors of PAF in patients with acute ischemic stroke. These simple and easily accessible predictors that can be detected via surface ECG may be used as a guide to identify patients who require longer rhythm monitoring to better detect occult PAF, thereby preventing recurrent strokes.

Introduction: Intestinal obstruction in paediatric age group differs from that in adults in presentation, etiology and management. Management of intestinal obstruction in children differs from that in adults in terms of fluid requirement, electrolytes and drugs dosage, mode of anesthesia, surgical technique & post-operative monitoring as well as complications. Present study was aimed to study of various causes, symptomatology & management of intestinal obstruction in paediatric age group at a tertiary hospital. Material and Methods: Present study was single-center, prospective, observational study, conducted patients of both the genders and age less than 16 years of age, presented with intestinal obstruction & underwent surgical intervention. Results: During study period, 100 patients satisfied study criteria. Male cases were 75 (75.0%) and female were 25 (25.0%). Maximum number of cases were from the age groups of 1-12 months and 1years -5 years (27.0% each) followed by age group of < 1 month (26.0%) & age group 5-10 years (20 %). Common clinical features observed were distention (83 %), vomiting (66 %), constipation (44 %), pain abdomen and bleeding PR (24 % each). Intussusception (25 %) was most common diagnosis followed by imperforate anus (21 %), volvulus (10 %), CHPS (10 %), Hirschsprung's disease (8 %), Meckle’s band (6 %) & post operative adhesive (6 %). Study reveals that, there was statistically very highly significant difference of distribution of mortality of patients among outcome of complicated and uncomplicated surgeries (P < 0.001) & all deaths were occurred in complicated surgeries 11 (100.0%) Common post operative complications observed were septicemia (9 %), fever (8 %), wound infection (6 %) & respiratory distress (4 %). Conclusion: The most important conclusion drawn out of this study is that with early diagnosis and intervention, the outcome and the mortality rates of these children can be reduced accountable.

Since posterior lumbosacral spine fixation surgeries are nowadays common spine procedures performed for various reasons and usually accompanied by moderate to severe postoperative pain, it is necessary to find effective postoperative analgesia in these patients. This study was aimed at monitoring the analgesic effect of dexmedetomidine in combination with bupivacaine versus bupivacaine alone on ESPB erector spinae plane blockade for postoperative pain relief in posterior lumbosacral spine fixation surgeries. Methodology: A study involving 75 patients who were randomly divided into 3 groups (25 patients each): Dexmedetomidine in combination with bupivacaine (group DB), bupivacaine (group B) and saline (control) (group S). Primary clinical outcomes were active (during mobilization) and passive (at rest) visual analog scale (VAS) pain scores in the first 24 hours measured every 2 hours, opioid consumption (number of PCA presses), and need for rescue analgesia. Other clinical outcomes included active and passive VAS pain scores at 24 hours, measured every 4 hours, opioid consumption, need for rescue analgesia, postoperative side effects of opioids, and intraoperative side effects of dexmedetomidine such as bradycardia and hypotension. Observation And Results: In our study we observed that Active and passive VAS pain scores, postoperative opioid consumption, need for rescue analgesia, and postoperative opioid side effects were significantly lower in DB group when compared to other groups (B and S groups). There were no additional intraoperative dexmedetomidine side effects as bradycardia and hypotension.

Background: Status epilepticus (SE) occurs when a child has repeated, prolonged seizures and doesn't regain consciousness. Due to high morbidity and mortality, prompt diagnosis and treatment are crucial. Paediatric SE has few risk factors and prognostic indicators, so its outcome depends on its etiology, treatment response, and prompt medical intervention. This study examined pediatric SE risk factors and prognostic indicators. Objective: The purpose of this study is to identify the risk factors, prognostic indicators, and outcomes in pediatric status epilepticus and explore the relationship between clinical and diagnostic findings and recovery. Methods: Kolkata's Vivekananda Institute of Medical Sciences pediatrics department conducted a descriptive study. The study included 50 SE-admitted children aged 2–12. The patient's medical history and physical status were assessed, along with EEG, blood, and brain CT and MRI scans. Data included neurological recovery, mortality, complications, risk factors, and prognostic indicators. Results: A majority of the 50 children studied were boys. The most common risk factors were infections (42%) and metabolic disturbances (30%). Most children had generalized tonic-clonic seizures (70%) and seizures lasting over 5 minutes (80%). Time to seizure control, treatment response, and abnormal EEG or brain imaging were associated with worse outcomes. 80% of children recovered neurologically, 4% died, and 10% had long-term developmental sequelae. Conclusion: This study emphasizes the importance of early diagnosis and intervention for pediatric status epilepticus. Early seizure control and normal EEG/brain imaging were prognostic indicators, but infections and metabolic disturbances were the biggest risk factors. Starting treatment early and monitoring SE children reduces the risk of neurological impairment and death.

Background – Misoprostol is a promising agent for cervical ripening and induction of labour. Though the route of administration and doses are not standardized. Aims and objective – The objective of our study is to compare efficacy and safety of oral route and intravaginal route of misoprostol for induction of labour. Materials and method - This was a prospective comparative study carried out at the department of obstetrics and gynecology, Gandhi medical college and Sultania zanana hospital, Bhopal on 200 pregnant women for a period of one year. Result – In our study no significant difference was observed between oral misoprostol and intravaginal misoprostol with respect to amount of drug required, induction- delivery interval, mode of delivery and neonatal outcome.Regarding maternal side effects and complications, nausea, vomiting and diarrhea were noted more with oral misoprostol while cervical tears, vaginal tears and lacerations were more with intravaginal route of administration. Conclusion – Both oral misoprostol and intravaginal misoprostol in a dose of 50 micrograms every four hours to a maximum of four doses are safe and efficacious in induction of labour in closely supervised hospital settings with adequate monitoring.

Spinal Anaesthesia is a procedure that is currently being used a lot because of its benefit to relieve temporary pain sensation in patients without affecting patients’ consciousness. However, this action can cause several complications. The present study was a descriptive observational study, conducted on 200 patients aged 12-65 in post operative unit undergone spinal anesthesia to find out the prevalence of complications on the bases of self-created questioner, in which included back pain, headache, urine retention, hypotension etc. Related to spinal complications recorded by medical record in the department of anesthesia and critical care of individual after the spinal anesthesia and performed statistical analysis on collected data. The results showed that the most prevalent complications in the recovery unit include shivering followed by hypotension, nausea, back pain, delirium, vomiting etc. The high prevalence of complications in the post-anesthetic care unit can be considered an alarm and also highlights the importance for skilled personnel and monitoring equipment in critical care unit.

Introduction: Due to the fast growth of cities and economies, health risks at work have become a significant public health issue. Several segments of society face an increased likelihood of experiencing negative outcomes due to their work conditions. One such group is petrol pump workers, who are consistently exposed to harmful chemical compounds found in gasoline as a result of their vocation. Hence, this cross-sectional research was conducted to examine the influence of workplace exposure to petrol vapours, diesel, and automobile emission on tests for pulmonary function. Methods: The study group consisted of thirty male petrol pump personnel, while the control group consisted of thirty healthy males who were matched to the study group. The assessment of pulmonary functions was conducted using a handheld spirometer. The mean ± standard deviation (SD) values for each parameter were calculated for both the study as well as the control groups. These values were subsequently compared utilizing an unpaired 't' test. Results: The study group (Petrol pump operators) exhibited a noteworthy decrease (p <0.05) in Forced Vital Capacity (FVC) and Forced Expiratory Flow between 25-75% (FEF 25-75%) compared to the control group. Conclusions: This study determines that petrol pump workers face an increased risk of developing pulmonary impairment, specifically a restrictive pattern of lung disease, over time. It also highlights the importance of medical monitoring and the enforcement of occupational safety measures to prevent work-related illnesses.

Obesity is a growing global health crisis that significantly contributes to chronic diseases such as type 2 diabetes, cardiovascular disorders, hypertension, and certain cancers. It is recognized as a multifactorial condition influenced by genetic, environmental, behavioral, and psychological factors. Traditional obesity management approaches, which predominantly focus on dietary modifications and increased physical activity, often fail to produce sustainable long-term results. As a result, there is an increasing emphasis on multidisciplinary approaches that integrate dietary interventions, physical activity, behavioral therapy, pharmacological treatments, and bariatric surgery to address obesity more comprehensively.

Obesity Management in a Multidisciplinary Approach Multifaceted in nature, the management of obesity requires teamwork that involves different health professionals from diverse fields, such as dietitians, exercise physiologists, psychologists, endocrinologists, and bariatric surgeons. They work best at offering individualized and global approaches to overcome the lifestyle challenges and the psychosocial issues that impact weight loss success. This approach emphasizes behavioural and psychological strategies, including evidence-based methods such as cognitive-behavioural therapy (CBT), mindfulness-based stress reduction for managing stress and other triggers that lead to emotional eating, and achieving sustainable lifestyle changes.

Pharmacological interventions are a critical component in obesity management, especially in those patients who do not respond to lifestyle changes alone. GLP-1 receptor agonists and orlistat are two examples of medications shown to help with weight loss. Bariatric surgery is the most effective intervention for patients with severe obesity, resulting in durable and clinically meaningful weight loss, improved metabolic control, and resolution of obesity-related comorbidities. Nevertheless, surgical solutions demand complete support pre-operatively and post-operatively to be successful in the long run.

This systematic review synthesized evidence from 30 studies to assess the effectiveness of multidisciplinary approaches for managing obesity. The results show that combining different modalities yields superior and longer-lasting weight loss to those delivered by a single modality. Moreover, multidisciplinary care enhances patients' psychological well-being, quality of life, and metabolic health. While the results are encouraging, adherence, access, and long-term feasibility are challenges for widespread implementation.

It also discusses future directions in obesity management, including the potential for mobile health applications, telemedicine, and wearable technology to promote patient engagement and monitoring. Such multidisciplinary approaches can transform obesity care by tackling the underlying causes of the disease and delivering personalized, patient-centred interventions. These results highlight the need for multidisciplinary approaches that focus on preventive care and holistic treatment models as healthcare systems move to help alleviate the global burden of obesity and improve long-term health outcomes.

Background: Nosocomial infections are a significant global concern, with an increasing prevalence of antibiotic-resistant strains, such as methicillin-resistant Staphylococcus aureus (MRSA), reported worldwide. Both MRSA and methicillin-resistant coagulase-negative staphylococci (MRCoNS) play crucial roles in healthcare-associated infections. The objective of this study was to determine and compare the prevalence and antibiotic susceptibility patterns of MRSA and MRCoNS.  Materials and Methods: In this cross-sectional, hospital-based study, clinical samples submitted to the bacteriology laboratory of the Microbiology Department at Burdwan Medical College over a nine-month period were screened for Staphylococcus species. The isolates were identified as Staphylococcus aureus and coagulase-negative staphylococci (CoNS) using standard microbiological techniques. Methicillin resistance in all isolates was tested with a 30 μg Cefoxitin disc and further confirmed through an automated system by measuring the Minimum Inhibitory Concentration (MIC). Antibiotic susceptibility patterns were determined using the modified Kirby-Bauer disc diffusion method following the guidelines of the Clinical and Laboratory Standards Institute (CLSI). The collected data were recorded and analyzed using Microsoft Excel (version 2010). Results: A total of 830 Staphylococcus strains were isolated from various clinical samples, including 694(84%) Staphylococcus aureus and 136(16%) coagulase-negative Staphylococcus (CoNS). Among the Staphylococcus aureus isolates, 285 (41.1%) were methicillin-resistant, while 54(39.7%) of the CoNS isolates showed methicillin resistance. Among methicillin-resistant Staphylococcus aureus (MRSA) strains, the highest resistance was observed against ceftriaxone(96.1%), and the lowest was against linezolid(1.05%) and teicoplanin(0%). In methicillin-resistant coagulase-negative staphylococci (MRCoNS) strains, the highest resistance was observed against ceftriaxone(90.7%), and lowest was noted for vancomycin (1.8%), linezolid (0%), and teicoplanin (0%). Conclusions: Continuous monitoring of the antimicrobial susceptibility patterns of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRCoNS) is essential for selecting appropriate therapies, developing antibiotic policies, and minimizing the use of reserved antibiotics.

Background: Dengue fever, caused by arthropod-borne viruses, presents as a mild illness with fever, muscle pain, rash, and swollen lymph nodes, while its severe form, dengue hemorrhagic fever, can be fatal due to capillary permeability and hemostasis issues. Infants aged 4-9 months face higher risks of severe dengue, with symptoms like convulsions and liver dysfunction being more common and fatal. Aim & Objectives: A Study on the Relationship Between Organomegaly, Dengue Severity, and Dengue Seropositivity in a Rural Tertiary Care Hospital in Western Maharashtra. Methodology: This descriptive longitudinal study was conducted over a period of two years, from June 2022 to May 2024, in the Department of Paediatrics at Dr. Balasaheb Vikhe Patil Rural Medical College, Loni. The inclusion criteria consisted of all male and female patients under one year of age with a laboratory-confirmed diagnosis of Dengue Fever, provided their parents gave written informed consent. The exclusion criteria included infants presenting with other viral exanthematous fevers or dengue-like illnesses with a negative laboratory test. Result: The study examined 79 infants admitted with dengue between June 2022 and May 2024, accounting for 12% of all infantile dengue cases. The average age of the infants was 7.5 months. Dengue fever without warning signs constituted 55.7% of the cases, while 26.6% had dengue with warning signs, and 17.7% were diagnosed with severe dengue. Severe outcomes were linked to hepatomegaly and splenomegaly. Conclusion: Infants with dengue frequently exhibit non-specific symptoms, making diagnosis challenging. While IgM positivity was commonly observed, NS1 positivity was associated with increased severity and mortality. Early detection of NS1 was vital for effective management. Hepatosplenomegaly were found to be linked to greater severity and higher mortality rates. Timely diagnosis, close monitoring, and proper supportive care are crucial for improving outcomes in the management of infantile dengue.

Objective: To evaluate the effectiveness of transthoracic echocardiography as a hemodynamic monitoring tool during induction of anesthesia and endotracheal intubation Design:  Prospective, single center, observational study Setting: Medical college teaching hospital Participants: Sixteen patients undergoing elective coronary artery bypass surgery Interventions: Patients were monitored with Transthoracic echocardiography and pulmonary artery catheter  Measurements and Main results: Baseline pre induction Transthoracic echocardiography was done to calculate fractional Shortening, fractional Area Change. Cardiac output and systemic vascular resistance were calculated by left ventricular outflow and mitral inflow Doppler. At the same time baseline pulmonary artery catheter measurements, cardiac output and calculated systemic vascular resistance were recorded. Measurements of Transthoracic echocardiography and pulmonary artery catheter were repeated during post induction and one minute after endotracheal intubation. Percent difference between baseline and post induction (Group A data) and percent difference between post induction and post intubation (Group B data) of all parameters were calculated. From group A and group B data estimated percent change in cardiac output and systemic vascular resistance correlated between two techniques. It also predicts the change in contractility during induction and endotracheal intubation. The change in cardiac output as estimated by the mitral inflow doppler and the left ventricular outflow doppler correlated well. Conclusion: Transthoracic echocardiography can be used as a replacement for pulmonary artery catheter to predict change in blood pressure, afterload and cardiac output during induction of anaesthesia in a non-invasive manner

Background: High-risk patients, including those with cardiovascular conditions and geriatric individuals, present significant challenges in anesthetic management due to their increased susceptibility to perioperative complications. Cardiovascular diseases (CVDs) are a leading cause of perioperative morbidity, while the aging population experiences unique physiological changes that complicate surgical outcomes. Objective: This study aims to evaluate the outcomes and effectiveness of tailored anesthetic strategies for high-risk cardiovascular and geriatric patients undergoing surgical procedures. Methods: A prospective observational study was conducted involving 500 high-risk patients, comprising 250 cardiovascular and 250 geriatric individuals. Data on perioperative challenges, anesthetic techniques, intraoperative monitoring, and postoperative outcomes were collected and analyzed. Results: Cardiovascular patients demonstrated increased risks of hemodynamic instability, arrhythmias (12%), and myocardial ischemia (8%). Effective management included preoperative cardiac optimization and advanced intraoperative monitoring. Geriatric patients exhibited heightened incidences of postoperative cognitive dysfunction (14%) and delayed recovery (10%), with age-specific protocols such as regional anesthesia and multimodal analgesia showing positive outcomes. Conclusion: Tailored anesthetic approaches are crucial for high-risk patients to mitigate complications and improve surgical outcomes. Multidisciplinary collaboration and the integration of advanced monitoring technologies play pivotal roles in enhancing patient safety. This study provides evidence supporting the need for personalized anesthetic strategies to address the unique challenges faced by cardiovascular and geriatric patients

Type 2 Diabetes Mellitus (T2DM) is a multifactorial metabolic disorder characterized by insulin resistance, impaired glucose regulation, and progressive beta-cell dysfunction. The global prevalence of T2DM has been rising at an alarming rate, influenced by genetic, lifestyle, environmental, and socio-economic factors. This systematic review examines the key risk factors associated with the development of T2DM, including obesity, physical inactivity, unhealthy diet, genetic predisposition, psychosocial stress, environmental toxins, and socioeconomic determinants. The review synthesizes evidence from epidemiological studies, clinical trials, and meta-analyses to provide a comprehensive understanding of the complex interplay of risk factors that contribute to T2DM onset. Identifying and addressing these risk factors through preventive strategies is crucial for reducing the burden of diabetes globally. Moreover, this review highlights the importance of personalized lifestyle interventions and early screening methods to mitigate risk and improve long-term health outcomes. Addressing disparities in healthcare access and developing targeted public health strategies are essential in reducing diabetes prevalence and improving patient quality of life. Future research should focus on innovative prevention programs, technological advancements in monitoring glucose levels, and community-based interventions that promote sustainable lifestyle changes

Background: Caesarean deliveries are one of the most commonly performed surgeries in this world. However, the past decades have witnessed a gradual rise in the caesarean section rate in India as well as worldwide. The objective of this present study is to analyse the rate and indications of caesarean delivery over a five year period in 7 Air Force Hospital, Kanpur, Uttar Pradesh. Methods: This is a retrospective study that analysed the rate and indications of caesarean delivery that took place over five years from 01 Jan 2019 to 31 dec 2023. Data of the patients was obtained from the hospital records and statistical analysis was done. Results:  There was an overall rise in the rate of caesarean delivery from 21.3% in 2019 to 32.2% in 2023. Previous caesarean status was the most common indication. There was an increase in primary caesarean section as well from 10% in 2019 to 24% in 2023. At the same time, there was a reduction in the incidence of neonatal birth asphyxia from 1.28% in 2019 to 0.5% in 2023. Conclusion: Efforts should be made to ensure that every caesarean delivery is medically justified and that every patient who needs a caesarean delivery receives it on time, instead of trying to achieve a specific rate of caesarean delivery. At the same time, patient education, better intrapartum care, improved monitoring of labour and regular audits can help us minimize the rate of caesarean delivery over time.

Background: Pulmonary tuberculosis (PTB) remains a significant public health concern, with drug-resistant tuberculosis (DR-TB) complicating treatment and prognosis. Radiological imaging plays a crucial role in the early detection and differentiation of drug-sensitive tuberculosis (DS-TB) and DR-TB. Objective: This study aims to evaluate the radiological features of DS-TB and DR-TB and identify distinguishing characteristics to facilitate early diagnosis and improved clinical decision-making. Methods: A prospective observational study was conducted from December 2023 to November 2024 at the Department of Respiratory Medicine, RKDF Medical College, Bhopal, and Maharshi Devraha Baba Autonomous State Medical College, Deoria. Patients aged ≥18 years with microbiologically confirmed DS-TB or DR-TB were included. Extrapulmonary TB cases and those with comorbid pulmonary conditions affecting imaging interpretation were excluded. Chest X-rays (CXR) and high-resolution computed tomography (HRCT) scans were analyzed for imaging patterns such as cavitation, consolidation, nodular opacities, fibrosis, pleural effusion, and bronchiectasis. Statistical analysis included descriptive statistics, chi-square tests, and logistic regression to determine significant differences. Results: DR-TB cases demonstrated a higher prevalence of cavitation (75.0% vs. 29.2%, p<0.001), bronchiectasis (50.0% vs. 12.5%, p<0.001), fibrosis (68.8% vs. 25.0%, p<0.001), and pleural effusion (31.3% vs. 16.7%, p=0.021) compared to DS-TB. Additional findings such as tree-in-bud appearance (81.3% vs. 33.3%, p<0.001) and lymphadenopathy (62.5% vs. 20.8%, p<0.001) were more frequent in DR-TB. Conclusion: Imaging serves as a critical tool in differentiating DS-TB from DR-TB. The distinct radiological patterns observed in this study can aid clinicians in early diagnosis, treatment planning, and monitoring of TB cases, thereby improving patient outcomes..

Background: Rheumatic mitral stenosis remains an important clinical problem, especially in developing regions where rheumatic heart disease prevails. While the severe lesions present a strong indication of urgent intervention, the non-severe lesions that involve mildly symptomatic or asymptomatic subjects warrant closer long-term follow-up for understanding their clinical course and guiding management strategies. Methods: This was a longitudinal cohort study of 140 adult patients with non-severe rheumatic mitral stenosis and a mitral valve area ≥1.0 but <2.0 cm² at Heritage Hospitals Lanka. The baseline characteristics, symptom progression, echocardiographic parameters, and quality of life were assessed in this three-year follow-up study. The primary outcome measure was progression of mitral stenosis, defined as a reduction in the mitral valve area to less than 1.0 cm². The secondary outcomes were incident atrial fibrillation and changes in the quality of life as measured with the Kansas City Cardiomyopathy Questionnaire. Results: During the median follow-up period of 20 months, mitral stenosis had progressed in 35.7% of patients. The median time to progression was 18 months. The risk of progression was significantly greater in patients with NYHA Class III at baseline, p < 0.01. Also, 25% of the patients developed atrial fibrillation, mostly in those with a mitral valve area <1.5 cm² (p < 0.001). Quality-of-life scores showed a significant improvement from baseline in all patients with p < 0.001, reflecting effective symptom management despite disease progression in some patients. Conclusion: The study lays much emphasis on long-term follow-up in patients with nonsevere rheumatic mitral stenosis, whereby the identification of such patients will be at a higher risk for disease progression and complications like atrial fibrillation. Individualized care strategy and regular monitoring improve outcome and enhance quality of life in these patients.

Background: Diabetes is a major cause of vision loss worldwide, with cataracts being a common complication. Cataract surgery in diabetic patients accounts for about 20% of total procedures and helps improve visual acuity while facilitating retinal examination. However, there is a potential risk of worsening diabetic retinopathy. This study aims to evaluate and compare visual outcomes and postoperative complications in diabetic and non-diabetic patients undergoing cataract surgery. Materials and Methods: This prospective observational study included 50 diabetic and 50 non-diabetic patients undergoing phacoemulsification or SICS with PCIOL implantation. Preoperative assessments included HbA1c levels, visual acuity, intraocular pressure, cataract grading, and fundus evaluation. Postoperative evaluations were conducted on days 1, 2, and 6 weeks, assessing BCVA, intraocular pressure, and fundus changes. Central foveal thickness (CFT) was measured using OCT preoperatively and six weeks postoperatively. Statistical analysis was performed using GraphPad version 8.4.3, with P-values < 0.05 considered significant. Results: This study compared visual outcomes, intraocular pressure, and retinal changes in diabetic and non-diabetic patients undergoing cataract surgery. Diabetic patients had a higher prevalence of cortical cataracts, while nuclear cataracts were slightly more common in non-diabetics. Preoperative glycaemic control, measured by HbA1c levels, significantly influenced postoperative visual recovery, with better-controlled diabetics (HbA1c <7%) achieving superior vision. Both groups showed significant improvement in visual acuity post-surgery, with no major differences between them. Postoperative complications, including iritis and Descemet’s membrane folds, were more frequent in diabetics but not statistically significant. A significant increase in central foveal thickness was observed in both groups, with a greater rise in diabetics, indicating a higher risk of subclinical macular edema. These findings highlight the importance of glycaemic control and close retinal monitoring in diabetic patients undergoing cataract surgery. Conclusion: Cataract surgery improves vision in diabetic patients, though outcomes are slightly better in non-diabetics. Complications like iritis and Descemet's membrane folds were more common in diabetics but not statistically significant. Poor glycaemic control and diabetic retinopathy affected recovery, with a greater increase in central foveal thickness post-surgery. Preoperative diabetic retinopathy remains a key factor in visual outcomes.

Background: Therapeutic Plasma Exchange (TPE) is a life-saving procedure used to treat various autoimmune, hematological, and neurological disorders. While effective, TPE is associated with a range of complications that can affect patient safety and treatment outcomes, especially in tertiary care settings managing critically ill patients. Objective: This study aimed to analyze the types, frequencies, severities, and timing of complications associated with TPE in a tertiary care hospital in Central India. Methods: A cross-sectional observational study was conducted at MGM Medical College and M.Y. Hospitals, Indore, from December 2020 to December 2024. Data were collected from 400 TPE sessions involving 160 patients. Complications were categorized as mild, moderate, or severe and recorded during the procedure and within 24 hours post-treatment. Statistical analyses, including chi-square tests, were used to assess associations between complications and patient or procedural characteristics. Results: Complications were observed in 37.75% of TPE sessions. Mild complications, such as hypotension, fever, and pruritus, accounted for the majority (69.5%) of the total complications and were primarily transient. Moderate complications included hypocalcemic symptoms (7.3%) and catheter-related issues (5.3%), while severe complications, such as deep vein thrombosis (3.3%) and sepsis, were rare but critical. Most complications occurred during the procedure (61.59%), followed by within one hour post-TPE (28.48%), and least after one hour (9.93%). A significant association was noted between the timing and severity of complications (p = 0.004).Conclusion: TPE is generally safe when performed with proper monitoring, but complications remain a concern, emphasizing the importance of individualized care and vigilance. Advanced technology, aseptic techniques, and adherence to evidence-based protocols are essential to minimizing risks. This study provides valuable insights into optimizing TPE protocols in tertiary care settings and improving patient outcomes

Background: Drug utilization studies (DUS) are an important resource for stakeholders in drug and health policies. DUS is the marketing, distribution, prescription and use of certain drugs in the society concerned, and the resulting medical, social and economic consequences therefore it covers prescribing, dispensing, administration or intake of medicine and related events. DUS is mainly aimed at analyzing drug therapy problem and monitoring its consequences in drug utilization, attempting to improve drug therapy quality.Drug utilization research promotes rational drug use by encouraging prescribers the correct drug, dose, and affordable price, Assessing whether drugs are prescribed and used appropriately, providing feedback to doctors on prescription rationality, evaluating the effectiveness of interventions aimed at improving rational drug use. Objective: To evaluate the drug utilization study in outpatient department (OPD) patients at a tertiary care teaching hospital in North India. Methods: An observational, prospective study was conducted in the OPD of a tertiary care hospital. The Patients' demographic data and prescription details were recorded.Results: A total of 650 patients were included in the study. The findings revealed that 89% drugs were prescribed by brand name, while 11% were by generic name, Antibiotics were prescribed in 6.50% of cases, Injections were prescribed in 6.30% of cases, Polypharmacy was observed in 20.6% of patients.Conclusion: This study highlights the need for rational use of drugs in OPD patients. The findings of this study can inform policy design, education, and awareness programs to motivate physicians to use drugs rationally.

Background: The most common laryngo-tracheal complaints following general anesthesia with tracheal intubation in the postoperative period are sore throat and hoarseness, with an incidence ranging from 24% to 90%, which may hamper the quality of recovery postoperatively. This study was designed to assess whether intraoperative monitoring of endotracheal tube cuff pressure can help reduce the incidence of sore throat and hoarseness. Aims & Objective: Main aim of our study is to compare the quality of recovery in post operative patients and hemodynamic stability, smooth extubation, less post operative airway related complication and better patient satisfaction in whom endotracheal cuff pressure is been measured and monitored intra operatively  v/s not measured. Materials & Methods: 60 patients scheduled for elective procedures under general anesthesia with orotracheal intubation were recruited through simple random sampling and divided into two groups of 30 each: Group A and Group B. All patients received general anesthesia following a standard protocol. In Group A, cuff pressure monitoring was performed, whereas Group B served as the control group with no such monitoring. The incidence and severity of sore throat and hoarseness were recorded for both groups. Result:  100 patients were analyzed for the outcomes without any dropouts. The basic parameters like age, sex, BMI, and duration of surgery were found to be statistically insignificant among the two groups. The incidence of sore throat and its severity along with that of hoarseness of voice were found to be statistically insignificant, but with an evident better outcome in Group A. Conclusion:  We conclude that intraoperative monitoring of cuff pressure using a cuff pressure monitor significantly reduced the incidence as well as the severity of sore throat and incidence of hoarseness of voice in patients undergoing orotracheal intubation, but came out to be statistically not significant with evident improvement in quality of recovery post operatively.

Background: Tuberculosis (TB) is a significant global health challenge, with India accounting for 27% of global cases. Despite improved treatment success rates, the long-term impact of post-pulmonary TB sequelae remains inadequately studied, particularly in high-burden countries. This study aimed to evaluate the pulmonary function abnormalities in post-pulmonary tuberculosis cases. Methods: A hospital-based observational study was conducted on 300 post-pulmonary TBpatients at a tertiary care center from September 2022 to March 2024. Thestudy utilized comprehensiveassessment methods including clinical evaluation and pulmonary function testing using computerized spirometry. Risk factors weresystematically evaluated, and statistical analysis was performed with significance set at p≤0.05. Results: Thestudypopulation (n=242)(meanage59.33±12.18years) showed male predominance(76.03%) and primarily rural residence (79.8%). History of smoking in 52.1% and biomass fuel exposure in 19.8% cases. Common clinical manifestations included shortness of breath (87.6%), cough (77.7%), and expectoration (59.5%). Spirometry wassuccessfully performed in 242 cases out of 300 cases. Spirometry revealed pulmonary function abnormalities in 89.26% of cases: restrictive pattern in 90 cases (37.19%), mixed pattern in 64 cases (26.45%), and obstructive pattern in 62 cases (26.62%). 98 cases (40.5%) had severe to very severe pulmonary function abnormalities. Conclusion: PostTB pulmonary function abnormalities are prevalent and associated with significant pulmonary function abnormalities, underscoring the need for comprehensive post-TB care. Strategies should include pulmonary rehabilitation, regular lung function monitoring, and interventions targeting modifiable risk factors like smoking and incomplete treatment adherence to improve long-term outcomes.

Background: Regular puncture for dialysis, treatment with anticoagulation and abnormal hemodynamics make infections, hematoma, thrombosis, limb oedema, cellulitis of limb, bleeding, pseudoaneurysms and true aneurysms a relatively common complication in patients with arteriovenous fistula (AVF) for hemodialysis. Aims: We aim to describe the presentations, treatment modalities and probable causative factors of true and pseudo aneurysms in CKD patients with arteriovenous access.Materials and Methodology: It was a retrospective observational study in the Department of Cardiothoracic and Vascular Surgery at IPGMER And SSKM Hospital, Kolkata, during the period July 2022 to July 2024. Results: In our study, 34.03% patients were in the age group 51-60 and 23.15% were in the age group 41-50. Of those studied, 61.4 % were male, the rest were female. All the patients had Stage V CKD. 68.77% patients had aneurysms of the brachiocephalic fistula while the rest had aneurysms of the radiocephalic fistula. Among comorbidities, 67.01% patients had Type 2 diabetes mellitus (T2DM), 86.31% patients were hypertensive, 64.21% patients had peripheral arterial disease, 36.14% patients had heart failure, 82.80% patients had dyslipidemia.In our study, 108 (37.80%) patients had Type Ia aneurysm, 142 (49.82%) had Type Ib aneurysm, 21 (7.36%) had Type IIa aneurysm, 14 (4.91%) had Type IIb aneurysm. 44.91% patients who presented were asymptomatic, while 40% presented as bleeding fistula and 15.09% presented as hematoma. Among treatment modalities undertaken, ligation of fistula was done for a significant 77.55% of cases, excision of aneurysm and repair for 16.84% and endovascular repair was done for 5.61 % of patients. Conclusions: Frequent monitoring of the arteriovenous access, avoiding repeated punctures in same site for dialysis, regular dressing and antibiotics to prevent infection may help identify and prevent aneurysms early and provide prompt treatment to avoid potentially fatal consequences like rupture, hemorrhage, thrombosis and stenosis. To determine the ideal treatment strategy and the appropriate time for intervention, studies outlining the etiology, natural history and development of aneurysms are necessary.

Background: According to studies, VAP is a serious C thus it’s O can vary depending on patient health, type & severity of pneumonia ans effectiveness of the treatment. Therefore the goal of our study was to evaluate its PD, C & O. Material and Method: 144 patients were randonly selected and evaluated for various PD parameters , C & O after undering routine investigation by questionnaire format. Result: We found that, C were significantly higher for late than early VAP, those who were present with VAP showed MTR in majority and early PD were significantly higher. Conclusion: We conclude that, VAP that starts early may respond well to more targeted therapies, but VAP that starts late needs continuous monitoring and care due to the increased risk of significant complications.

Background: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of morbidity and mortality globally. Serum lipid profiles play a crucial role in ASCVD risk assessment, but the predictive value of traditional and non-traditional lipid markers requires further investigation. Objectives: This study aims to determine the relationship between serum lipid profiles (total cholesterol, LDL-C, HDL-C, triglycerides) and ASCVD risk. Secondary objectives include analyzing lipid ratios (TC/HDL-C, LDL-C/HDL-C) as predictors, evaluating the role of non-traditional lipid markers, and identifying demographic and lifestyle factors influencing lipid profiles and ASCVD risk. Methods: This observational study included 100 adults (30–70 years) without pre-existing ASCVD, recruited from a single-center healthcare facility. Baseline demographic, lifestyle, and biochemical parameters were recorded. Lipid profiles, lipoprotein(a), apolipoproteins, fasting glucose, and HbA1c were assessed. Participants were followed for six weeks to monitor incident ASCVD events. Data were analyzed using SPSS and R software, with logistic regression applied for risk assessment. Results: The mean ASCVD risk score was 10.3 ± 4.7%. Elevated LDL-C (132.5 ± 21.6 mg/dL) and unfavorable lipid ratios correlated with higher ASCVD risk. Incident ASCVD events occurred in 15% of participants, including myocardial infarction (7%), stroke (4%), and peripheral arterial disease (4%). Lipoprotein(a) and apolipoproteins showed potential value in risk stratification. Conclusion: Dyslipidemia and unfavorable lipid ratios significantly predict ASCVD risk. Non-traditional lipid markers may enhance risk assessment. Routine lipid monitoring and targeted interventions are essential for early prevention.

Background: Ambulatory blood pressure monitoring (ABPM) is increasingly recognized for its ability to capture circadian variations in blood pressure, which are pivotal for managing patients with acute heart failure (AHF). This observational study investigates the utility of ABPM in a clinical setting to correlate blood pressure patterns with clinical outcomes in patients admitted with AHF. Methodology: This prospective observational cohort study was conducted at a tertiary care center, encompassing a sample of 100 patients diagnosed with AHF. ABPM was employed 24 hours prior to discharge post initial stabilization to monitor blood pressure fluctuations over a 24-hour period. Data were analyzed to correlate these fluctuations with clinical parameters including heart failure severity and cardiac structural changes, as evidenced by echocardiographic data. Results: The study findings highlighted that NYHA Class III or IV at admission was significantly higher in HFmrEF risers (96.2%) compared to non-risers (88.9%) (p = 0.02).  ABPM measurements showed that HFpEF patients had the highest average 24-hour SBP (124.9 ± 17.8 mmHg), followed by HFmrEF (112.4 ± 15.2 mmHg) and HFrEF (102.8 ± 13.9 mmHg). HFpEF patients had the highest prevalence of nocturnal hypertension (52.7%), followed by HFmrEF (34.1%) and HFrEF (27.4%). The differences were significant (p=0.01). The differences in LVEF between the AHF groups were statistically significant, with HFpEF showing the best heart function and HFrEF showing the worst. Conclusion: ABPM provides valuable insights into the prognostic implications of blood pressure variability in patients with AHF. The data suggests that ABPM should be considered as part of the routine assessment in AHF patients to better tailor therapeutic interventions and potentially improve clinical outcomes.

Background: A Complete Blood Count (CBC) and Peripheral Blood Picture (PBP) are essential diagnostic tools in assessing the severity and outcomes of dengue infection. Dengue, a mosquito-borne viral illness caused by the dengue virus (DENV), can range from mild dengue fever (DF) to severe forms such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). The CBC and PBP provide critical information about hematological changes that correlate with disease progression and severity. The objective is to observe the trends of recovery of white blood cells (WBCs) and platelets in dengue fever  Materials and Methods: This is a prospective and cross-sectional study conducted in the Department of Pathology at Uma Nath Singh Autonomous State Medical College, Jaunpur, Uttar Pradesh over period of 1 year. Patients diagnosed with dengue fever, dengue hemorrhagic fever (DHF), or dengue shock syndrome (DSS) based on WHO criteria were included. Cases confirmed by serological tests (NS1 antigen, IgM/IgG ELISA) or RT-PCR. Patients with recorded laboratory parameters, including hemoglobin, hematocrit, white blood cell count, platelet count, and peripheral blood smear findings were included. Results : A total of 560 patient data were analyzed in this study, comprising 280 males and 280 females. The mean age of the study population was 34.2 years, with a standard deviation of 13.7, and the age range was between 16 and 84 years. Among these patients, 245 did not develop DHF during hospitalization, while 315 progressed to DHF in the ward. During the acute febrile phase (Days 2–3) of the illness, leucopenia (WBC < 5000 cells/mm³) was observed in 72.4% of the patients. The average WBC counts for DF and DHF patients were 4.22 and 4.57, respectively. Neutrophil counts showed mean values of 2.85 in DF patients and 3.21 in DHF patients. Lymphocyte counts were lower in DHF patients, with a mean of 0.92 compared to 1.07 in DF patients.Conclusion: In conclusion, DF is an increasing, global problem with a growing footprint on millions of lives. At this time, monitoring decreases in hemoglobin and increases in WBC counts, particularly neutrophils, through routine CBC testing in hospitalized patients with suspected DF may identify those young children at higher risk of severe

Background: Acute Myocardial Infarction (AMI) is a leading cause of morbidity and mortality globally, with arrhythmias representing a frequent and significant complication. These arrhythmias, which can range from benign to life-threatening, are closely associated with the severity of myocardial injury and contribute to poor short- and long-term outcomes. This prospective observational study aimed to investigate the incidence, types, and outcomes of arrhythmias in patients with AMI admitted to the intensive coronary care unit at SVRRGGH, Tirupati. A cohort of 100 patients was assessed based on clinical features, ECG evidence, blood biomarkers, and imaging. The study found that the majority of patients were aged 41-70 years, with a significant male predominance (83%). Lifestyle factors such as smoking and alcohol use were common, and hypertension and diabetes were prevalent comorbidities. The most common type of myocardial infarction was Inferior Wall Myocardial Infarction (INFWMI). Arrhythmias, particularly ventricular premature contractions (VPCs), were observed in a significant number of patients, with spontaneous resolution noted in some cases. The study highlighted the relationship between the location of the myocardial infarction and the occurrence of specific arrhythmias, with no significant correlation found between MI type and mortality. Additionally, factors such as age, gender, and comorbidities influenced arrhythmic patterns and outcomes. These findings suggest that arrhythmias in AMI patients can often resolve spontaneously but require careful monitoring and timely intervention. The study underscores the importance of personalized treatment strategies and further research to refine management techniques and improve patient outcomes, particularly for those with high-risk factors such as comorbidities and lifestyle behaviors.

Background: Postoperative acute kidney injury (AKI) remains a significant complication in high-risk surgical patients, contributing to increased morbidity, prolonged hospital stays, and higher mortality rates. Fluid management during the perioperative period plays a critical role in maintaining renal perfusion and preventing ischemic kidney injury. Goal-Directed Fluid Therapy (GDFT), an individualized approach using hemodynamic monitoring to optimize fluid administration, has been proposed as a strategy to improve renal perfusion and organ function in surgical patients. However, its impact on postoperative renal function, particularly in high-risk populations, remains a subject of ongoing investigation. This study aims to evaluate the effectiveness of perioperative GDFT in preserving renal function and reducing the incidence of postoperative AKI in high-risk surgical patients. Objective: To assess the impact of perioperative Goal-Directed Fluid Therapy (GDFT) on postoperative renal function, determine its role in reducing AKI incidence, and compare it with standard fluid management protocols in high-risk surgical patients. Methods: This prospective observational study was conducted over six months in the surgical and critical care units of a tertiary care hospital, enrolling 50 high-risk surgical patients undergoing major non-cardiac surgery. Patients were divided into two groups based on intraoperative fluid management strategy: •GDFT Group: Patients managed using non-invasive hemodynamic monitoring (stroke volume variation, cardiac output, dynamic fluid responsiveness) to guide fluid administration. •Standard Fluid Therapy (SFT) Group: Patients managed using a fixed, weight-based fluid administration approach. Preoperative renal function was assessed using serum creatinine, estimated glomerular filtration rate (eGFR), and urine output. Postoperative renal function was evaluated using Acute Kidney Injury Network (AKIN) criteria, comparing serum creatinine changes, urine output, and AKI incidence between the two groups at 24 hours and 72 hours postoperatively. Secondary outcomes included length of hospital stay, need for renal replacement therapy (RRT), and overall morbidity and mortality rates. Results: The incidence of postoperative AKI was significantly lower in the GDFT group (12%) compared to the SFT group (32%) (p < 0.05). Patients in the GDFT group maintained better renal function, as indicated by lower serum creatinine elevation (mean increase of 0.2 ± 0.1 mg/dL vs. 0.5 ± 0.2 mg/dL in SFT, p < 0.05) and higher urine output (mean 1.2 ± 0.4 mL/kg/hr vs. 0.7 ± 0.3 mL/kg/hr, p < 0.05). The requirement for renal replacement therapy (RRT) was lower in the GDFT group (4%) compared to the SFT group (12%), although this difference was not statistically significant. Additionally, the length of ICU stay, and total hospital stay were significantly shorter in the GDFT group, suggesting an overall improved recovery trajectory. Conclusion: The findings of this study suggest that perioperative Goal-Directed Fluid Therapy (GDFT) is associated with improved renal function, reduced incidence of postoperative AKI, and shorter hospital stays in high-risk surgical patients. The use of dynamic hemodynamic monitoring for individualized fluid administration appears to be superior to standard fixed-volume resuscitation strategies, potentially leading to better renal perfusion and organ protection. These results support the implementation of GDFT protocols in high-risk surgical populations to improve postoperative outcomes. Further multi-center trials with larger patient cohorts are needed to establish standardized GDFT guidelines for optimizing perioperative renal protection strategies.

Background and objective: Thyroid function abnormalities are a recognized comorbid condition associated with tuberculosis. Research has been conducted on how second-line anti-tuberculosis drugs affect thyroid function. However, there is very limited research on baseline thyroid dysfunction in newly diagnosed MDR/RR TB patients. Method: Baseline thyroid function report of 51 microbiologically confirmed newly diagnosed MDR/RR TB patients including both pulmonary and extra pulmonary cases from September 2022 to June 2024 who reported to MY hospital, Indore, were documented from DRTB register. All the cases were more than 18 years old. Result: 17.64 % of our study population showed hypothyroidism. 13.72 % of patients had subclinical hypothyroidism and 3.91 % of patients had clinical hypothyroidism. Conclusion: Incidence of hypothyroidism was significantly more in MDR/RR TB patients in comparison to general population. Subclinical hypothyroidism was also more commonly associated in MDR/RR TB patients. So, hypothyroidism especially subclinical hypothyroidism is a serious concern associated with MDR/RR TB patients and this can also get deteriorated with 2nd line anti tubercular therapy. So proper monitoring of such issue and management is very important.

Background: Diabetes mellitus (DM) is a chronic metabolic disorder with a rapidly increasing global prevalence, contributing significantly to morbidity and mortality. Poor glycemic control is a key factor leading to severe complications, particularly cardiovascular diseases (CVD). This study assesses demographic distribution, glycemic control, diabetes duration, management strategies, and cardiovascular risk factors among diabetic patients. Aim: To evaluate glycemic control, management strategies, and the prevalence of cardiovascular risk factors among diabetic patients attending a tertiary care hospital. Methods: A cross-sectional study was conducted among 100 diabetic patients. Data on demographic characteristics, mean HbA1c levels, duration of diabetes, management approaches, and cardiovascular risk factors were collected and analyzed using SPSS software. Results: Of the study population, 63% were male and 57% were aged 41–60 years. The mean HbA1c was 8.2, indicating poor glycemic control. Most patients (61%) had diabetes for over five years, and 56% required both oral hypoglycemic agents (OHA) and insulin. The most prevalent cardiovascular risk factors were dyslipidemia (63%), hypertension (41%), and a high-risk CVD category (37%). Tobacco use and alcohol consumption were observed in 19% and 29% of the patients, respectively. Conclusion: The study highlights poor glycemic control and a high prevalence of cardiovascular risk factors among diabetic patients, emphasizing the urgent need for targeted interventions. Multidisciplinary diabetes management, including early lifestyle modifications, optimal pharmacological strategies, and regular monitoring, is crucial in reducing diabetes-related complications. Future research should explore individualized intervention strategies and their long-term impacts on glycemic control and cardiovascular risk reduction.

Introduction: Chronic kidney disease is classified into five stages based on the estimated glomerular filtration rate (eGFR), with stage 1 being the mildest and stage 5 representing end-stage renal disease (ESRD). Microalbuminuria is typically detected in the early stages of CKD and is defined as a urinary albumin-to-creatinine ratio (ACR) between 30 and 300 mg/g. It is indicative of glomerular injury and endothelial dysfunction, reflecting increased permeability of the glomerular filtration barrier. The pathophysiology of microalbuminuria in CKD involves multiple factors, including glomerular hypertension, podocyte injury, and inflammation. Persistent microalbuminuria is associated with a decline in renal function and an increased risk of cardiovascular events, making it an important marker for risk stratification and therapeutic monitoring in CKD patients.  Material and Methods:  This  is an Observational or cross-sectional study was conducted among CKD patients from outpatient clinics or hospitals, Index Medical College. Patients diagnosed with CKD stages 1–5, based on the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Demographic and Clinical Data: Collect information on age, gender, duration of CKD, comorbidities, medications, and lifestyle factors. Quantify urinary albumin excretion using spot urine samples or 24-hour urine collections. Normalize results to urinary creatinine concentration. Spot urine samples or 24-hour urine collections will be used to quantify urinary albumin excretion. Urinary albumin concentration will be measured using an immunoturbidimetric assay. Results Mean Urinary Albumin (mg/g creatinine) is 145.6 mg/g creatinine, SD: 85.3 and 24-hour Urinary Albumin (mg/day) is 320.4 mg/day, SD: 150.2. Both Urinary Albumin Measures Increase with CKD Progression: Urinary albumin (mg/g creatinine) rises from 45.2 mg/g (Stage 1) to 380.5 mg/g (Stage 5). 24-hour urinary albumin excretion shows a similar increase from 85.3 mg/day (Stage 1) to 600.5 mg/day (Stage 5). The rate of albumin increase is mild in Stages 1 & 2 but becomes steep in Stages 3-5. Urinary Albumin (mg/g creatinine) has a correlation of r=0.65r = 0.65r=0.65 (p < 0.001). 24-hour Urinary Albumin (mg/day) has an even stronger correlation of r=0.70r = 0.70r=0.70 (p < 0.001).  Conclusion This study demonstrates a significant negative correlation between antioxidant status and microalbuminuria in CKD patients, consistent with previous research. The findings highlight the role of oxidative stress in CKD progression and suggest that interventions targeting oxidative stress may help reduce microalbuminuria and slow disease progression

Introduction: Tuberculosis can significantly affect the hematopoietic system, leading to various hematological abnormalities like anemia, leukocytosis, and changes in platelet counts, which can be valuable in diagnosis and monitoring treatment response. Method: This prospective study conducted in PDU medical college and hospital, Rajkot, Gujarat from April 2021 to March 2022. Blood sample sent to clinical laboratory, Department of pathology, where peripheral smear was prepared from EDTA sample and data evaluated. Total 850 patient’s samples were studied in this study. Data collected includes patients diagnosed with Pulmonary tuberculosis, Extra pulmonary tuberculosis and MDR tuberculosis. hematological parameters like hemoglobin (HB), RBC count, RDW, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin  concentration (MCHC), total leucocyte count (TLC), differential leukocyte count (DLC), platelet count with the help of automated hematology analyzer. Result: Maximum numbers of cases found in 3^rd decade followed by 5^th decade and 4 th decade. Anemia was frequently encountered in patients with tuberculosis (70.24%).Among anemic patients most patients (51.09%) have moderate degree of anemia with Hemoglobin level between 7 - 10 gm/dl and (38.02%) have mild degree of anemia with hemoglobin level between 10.1 - 12.9 for male and 10.1 - 11.9 for female. Only few patients (10.89%) have severe degree    of    anemia with hemoglobin level between <7 gm/dl. Normocytic Normochromic anemia was the most common type of anemia (52.60%). Followed by hypochromic microcytic anemia (42.04%).Increased ESR is the commonest finding associated with tuberculosis (92.35%) Leucocytosis occurred in (43.18%) cases, among them (72.20%) cases show Neutrophilia while (24.79%) cases show Lymphocytosis. Most cases have normal platelet count but thrombocytosis was seen in (32.47%) cases. Conclusion: These types of hematological abnormalities are quite common in patients with tuberculosis and physicians must maintain a high index of suspicion for diagnosis of tuberculosis in patients with these abnormalities

Background: Thalassemia minor is a common hereditary hemoglobinopathy that may impact pregnancy outcomes despite being traditionally considered a benign carrier state. This study evaluates the maternal and neonatal complications associated with thalassemia carrier pregnancies in a tertiary care setting. Methods: A prospective observational study was conducted at a tertiary care hospital, comparing 100 pregnant women with thalassemia minor to 100 non-carrier controls. Maternal outcomes, including anaemia, gestational diabetes mellitus (GDM), hypertensive disorders, postpartum haemorrhage (PPH), and mode of delivery, were assessed. Neonatal outcomes such as low birth weight (LBW), intrauterine growth restriction (IUGR), preterm birth, NICU admissions, and perinatal mortality were evaluated. Logistic regression analysis adjusted for maternal BMI, gestational age, and anaemia severity.

Results:

• Anaemia was significantly more prevalent in thalassemia carriers (78% vs. 18%, p < 0.001), with a fourfold increased risk of severe anaemia (OR = 4.52, p < 0.001).
• Caesarean section rates were significantly higher in carriers (42% vs. 30%, p = 0.040).
• IUGR risk was significantly elevated in thalassemia carriers (24% vs. 10%, OR = 2.88, p = 0.010), and LBW was more frequent (38% vs. 22%, p = 0.020).
• NICU admissions were higher among carrier neonates (15% vs. 8%), though not statistically significant (p = 0.080).

Conclusion: Thalassemia minor is associated with a higher risk of anaemia, IUGR, LBW, and caesarean section, emphasizing the need for enhanced prenatal screening, haematological monitoring, and individualized obstetric care. Early detection and multidisciplinary management can mitigate adverse pregnancy outcomes in this population.

Background: Chronic kidney disease (CKD) is associated with significant electrolyte imbalances and cardiac complications. Hemodialysis plays a crucial role in correcting these abnormalities; however, rapid shifts in serum electrolytes can lead to ECG changes, increasing the risk of arrhythmias. This study aims to evaluate the frequency of different ECG abnormalities in CKD patients and analyze electrolyte changes after dialysis. Methods: A cross-sectional study was conducted at a tertiary care medical center on 200 patients with end-stage renal disease (ESRD) undergoing hemodialysis. Patients above 12 years of age meeting the inclusion criteria were enrolled. Exclusion criteria included ischemic heart disease, atrial fibrillation, left ventricular hypertrophy, left bundle branch block (LBBB), and antiarrhythmic medication use. Pre- and post-dialysis blood samples were analyzed for serum levels of potassium, calcium, magnesium, sodium, bicarbonate, urea, and creatinine. A 12-lead ECG was recorded before and after dialysis to assess changes in P wave amplitude, QRS complex, T wave, PR interval, QT interval, ST depression, and QT dispersion. Results: The majority of patients were males (66%), hypertensive (65%), and aged 51-60 years (22%). Hemodialysis led to significant changes in serum sodium (p<0.001), calcium (p<0.05), potassium (p<0.001), magnesium (p<0.05), bicarbonate (p<0.001), urea (p<0.001), and creatinine (p<0.05). Significant ECG changes included reductions in QT interval (p<0.001) and QT dispersion (p<0.001), and increased QRS amplitude (p<0.001).

Conclusion: Hemodialysis significantly alters electrolyte levels and induces ECG changes, highlighting the need for continuous cardiac monitoring in CKD patients undergoing dialysis.

Background: Ischemic stroke is a major cause of morbidity and mortality worldwide, with a strong association with atherosclerosis and dyslipidemia. Carotid artery plaque formation is a critical factor in stroke pathophysiology, and its evaluation through Doppler ultrasound provides valuable insights into disease progression. This study aims to assess the relationship between ischemic stroke, lipid profile, and carotid artery plaque characteristics. Materials and Methods: A total of 100 ischemic stroke patients, aged 45–75 years, were included in this hospital-based cross-sectional study. Patients underwent lipid profile analysis, including total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides (TG). Carotid Doppler ultrasound was performed to assess plaque presence, morphology, and degree of stenosis. Statistical analysis was conducted to determine correlations between lipid parameters and carotid plaque severity. Results: Among the patients, 70% had hyperlipidemia, with a mean LDL level of 150 ± 20 mg/dL and HDL of 38 ± 5 mg/dL. Carotid artery plaques were detected in 65% of cases, with 40% exhibiting significant stenosis (>50%). A strong positive correlation (r = 0.72, p < 0.01) was observed between LDL levels and plaque severity. Patients with TC > 200 mg/dL had a 3.5-fold increased risk of severe carotid plaque formation. Conclusion: The study highlights a significant association between dyslipidemia and carotid artery plaque formation in ischemic stroke patients. Routine lipid monitoring and carotid Doppler evaluation can aid in early detection and risk stratification, potentially reducing stroke recurrence through targeted lipid-lowering therapies.

Introduction: Iron deficiency anemia (IDA) is a significant concern among blood donors due to the potential impact on donor health and blood supply quality. This study assesses the prevalence of IDA in a cohort of blood donors, with a focus on gender differences and the efficacy of current screening practices. Methods: This cross-sectional study was conducted at a tertiary care center, including 74 blood donors (56 females and 18 males). Participants underwent screening for iron deficiency using standard hematological parameters, including hemoglobin and serum ferritin levels. Results: The prevalence of iron deficiency among female donors was 39.29% (95% CI: 26.79% - 51.79%), significantly higher than the 33.33% (95% CI: 11.11% - 55.56%) observed in male donors. The overall effectiveness of pre-donation screening in identifying iron deficiency was high, with a detection rate of 99.56% (95% CI: 90.91% - 100.00%) among those screened. Conclusions: Iron deficiency remains a prevalent issue among blood donors, particularly in females. The high rate of detection through pre-donation screening suggests that current methods are effective, but continuous monitoring and tailored interventions, such as iron supplementation and adjusted donation intervals, are recommended to manage iron levels in blood donors effectively. Further research is needed to refine screening techniques and develop gender-specific strategies to address this issue.

Background: Neonatal surgery is often performed to correct life-threatening conditions in newborns. However, little is known about its long-term impact on developmental and psychiatric outcomes in early childhood. This cohort study aimed to examine the association between neonatal surgery and the occurrence of developmental delays and psychiatric disorders in children. Methods: A cohort of children who underwent neonatal surgery was compared with a control group. Data on demographic characteristics, developmental delays at age 3, and psychiatric disorders at age 5 were collected. Statistical analyses included chi-square tests and multivariate regression models. Results: There were no significant differences between the two groups in terms of gender, gestational age, or birth weight. At age 3, 30% of children in the neonatal surgery group exhibited developmental delays, compared to 12% in the control group (p = 0.02). Specifically, motor delays were more prevalent in the neonatal surgery group (20% vs. 8%, p = 0.04). At age 5, 20% of children in the neonatal surgery group had psychiatric disorders, compared to 8% in the control group (p = 0.03). Anxiety disorders were more common in the surgery group (12% vs. 4%, p = 0.09). Multivariate analysis revealed that neonatal surgery was significantly associated with both developmental delays (OR = 2.8, p = 0.02) and psychiatric disorders (OR = 2.5, p = 0.03). Conclusion: Neonatal surgery is associated with a higher risk of developmental delays and psychiatric disorders in early childhood. These findings highlight the importance of early monitoring and intervention for children who undergo neonatal surgery

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

Background: Antipsychotic medications are essential in managing schizophrenia but are frequently associated with metabolic side effects. These adverse effects increase the risk of cardiovascular disease, diabetes, and mortality in affected patients. Objective: To evaluate the prevalence and progression of metabolic side effects in schizophrenia patients undergoing antipsychotic treatment over a six-month period. Methods:A retrospective observational study was conducted on 100 schizophrenia patients receiving antipsychotic therapy at a tertiary care hospital. Demographic details, medication history, and metabolic parameters were collected from patient records at baseline and after 6 months of treatment. Parameters assessed included body mass index (BMI), fasting blood glucose, lipid profile, and blood pressure. The presence of metabolic syndrome was determined using NCEP-ATP III criteria. Statistical significance was assessed using paired comparisons and chi-square tests. Results: Among 100 patients (mean age: 36.2 ± 9.4 years; 57 males, 43 females), 74% were on atypical antipsychotics. Olanzapine (32%) and Risperidone (24%) were the most frequently prescribed. Significant increases were observed in weight gain (14% to 38%), BMI >25 (22% to 49%), fasting glucose >100 mg/dL (18% to 41%), and triglycerides >150 mg/dL (27% to 46%) (p < 0.01). Atypical antipsychotics were associated with a higher incidence of metabolic abnormalities. The prevalence of metabolic syndrome rose from 8% to 28% over the treatment period (p < 0.001). Conclusion: Antipsychotic therapy, particularly with atypical agents, is strongly associated with metabolic side effects in schizophrenia patients. Routine monitoring and early intervention are essential to mitigate long-term health risks.

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

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

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

Background: Benign Prostatic Hyperplasia (BPH) is a common condition in aging men, characterized by the non-malignant enlargement of the prostate gland, which leads to lower urinary tract symptoms (LUTS) such as frequency, urgency, and nocturiaObjective: This study aimed to evaluate the impact of Diabetes Mellitus (DM) on the development and progression of Benign Prostatic Hyperplasia (BPH) in male patients. Methods: An observational cohort study was conducted with 100 male participants, 50 with DM and 50 without, aged 50-80 years. Participants were monitored over a 12-month period. Prostate volume and International Prostate Symptom Score (IPSS) were measured at baseline and after 12 months. Multivariate logistic regression and hazard ratio analysis were used to evaluate the relationship between DM and BPH development and progression. Results: The prevalence of BPH was significantly higher in the Diabetic group (72%) compared to the Non-Diabetic group (52%, p = 0.04). Diabetes was associated with a faster progression of prostate volume increase (1.4 ± 0.8 cm³ vs 0.9 ± 0.6 cm³, p = 0.02) and a greater increase in IPSS (5.2 points vs 3.1 points, p = 0.03). Multivariate analysis revealed diabetes mellitus (OR = 2.7, 95% CI 1.4–5.3, p = 0.01) and age (OR = 1.5, 95% CI 1.1–2.0, p = 0.03) as independent factors contributing to BPH risk. The Diabetic group also experienced more medical interventions and had a higher incidence of acute urinary retention (14% vs 6%, p = 0.08). Conclusion: Diabetes Mellitus significantly increases the likelihood of developing and accelerating the progression of BPH in men. Early monitoring and proactive management of BPH may be essential for diabetic patients.

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

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

Background: Post-COVID sequelae in young adults have garnered significant attention, particularly regarding cardiopulmonary recovery. This study aims to evaluate the impact of COVID-19 on resting oxygen saturation and exercise tolerance in young adults. Methods: An observational study was conducted between March 2020 and June 2020 involving 100 young adults (aged 18–35 years) who had recovered from mild to moderate COVID-19. Baseline demographic data, resting oxygen saturation (SpO₂), and 6-minute walk test (6MWT) performance were recorded. Post-exercise desaturation (≥4% drop in SpO₂), fatigue scores, and heart rate changes were analyzed. Symptomatology was assessed via self-reported outcomes. Results: The mean age was 26.8 ± 4.9 years with 58% males. Mean BMI was 24.6 ± 3.2 kg/m². Average resting SpO₂ was 96.4% ± 1.8; 12 participants (12%) had SpO₂ < 95%. The mean 6MWT distance was 465.3 ± 54.7 meters. A ≥4% SpO₂ drop was observed in 28% of participants. These individuals exhibited lower resting SpO₂, reduced walk distance (430.6 ± 48.1 meters vs. 478.2 ± 50.3 meters, p < 0.01), and higher fatigue scores (6.3 ± 1.7 vs. 4.5 ± 1.5, p < 0.01). Persistent fatigue and exertional dyspnea were reported in 37% and 29% respectively. Conclusion: A significant proportion of young adults exhibit post-COVID impairments in oxygen saturation and exercise tolerance, even after mild to moderate infection. These findings highlight the need for post-recovery monitoring and rehabilitation strategies in this population.

Introduction and Background: The collapse of the lungs and difficulty breathing are symptoms of spontaneous pneumothorax, which happens when air gets into the pleural cavity. But nothing is known about the effects of tube thoracostomy on clinical variables and ABG readings. This study compares the pre- and post-tube thoracostomy vital signs, respiratory status, and arterial blood gas characteristics in SP patients. Materials and Methods: At a tertiary care hospital, 50 patients who needed tube thoracostomy due to spontaneous pneumothorax were the subjects of a prospective observational study from January 2018 to December 2018 at Department of Pulmonary Medicine, Viswabharathi Medical College, Penchikalapadu, Kurnool, Andhra Pradesh, India. Patients who were at least 18 years old, had radiologically verified SP, and had a tube thoracostomy reason met the inclusion criteria. Patients with significant cardiopulmonary disorders or a history of traumatic or tension pneumothorax were not included. The following baseline clinical parameters were obtained before and 6–12 hours after the procedure: blood pressure, oxygen saturation, heart rate, respiratory rate, and ABG values. With SPSS Version 22, statistical analysis was carried out using Wilcoxon signed-rank tests or paired t-tests as needed. Results: There were 50 patients in all, with a mean age of 35.6 ± 10.2 years and a M:F ratio of 4:1. Chest discomfort (75%) and dyspnea (90%) were the most frequent initial symptoms. The mean respiration rate before the procedure was 28.4 ± 4.5 breaths per minute; after the thoracostomy, it considerably improved to 18.2 ± 3.1 breaths per minute (p < 0.001). Heart rate decreased from 110.3 ± 12.7 bpm to 89.6 ± 10.5 bpm (p = 0.002), and oxygen saturation rose from a pre-procedure mean of 86.5 ± 5.4% to 97.2 ± 2.3% (p < 0.001). PaO2 significantly improved (62.4 ± 9.1 mmHg to 85.7 ± 8.3 mmHg, p < 0.001) and PaCO2 significantly decreased (52.1 ± 7.5 mmHg to 41.8 ± 6.2 mmHg, p = 0.005), according to ABG analysis, suggesting improved ventilation and oxygenation.  Conclusion: When patients have spontaneous pneumothorax, tube thoracostomy greatly enhances their respiratory function as well as arterial blood gas values. Symptoms are alleviated as a result of the procedure's success in improving oxygenation and ventilation. The key to the best possible patient outcomes is the regular monitoring of ABG readings and the early diagnosis of problems. Research after an intervention should look at how patients' bodies change over time and how often symptoms return.

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

Background: Dengue fever, caused by the dengue virus (DENV) and transmitted by Aedes aegypti mosquitoes, is a rapidly growing public health concern, particularly in tropical regions like India. The disease exhibits a wide clinical spectrum from mild febrile illness to severe forms such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Early identification of hematological abnormalities is crucial for effective diagnosis, risk stratification, and timely intervention. This study aimed to evaluate the clinical and haematological profiles of patients with acute dengue infection and examine the correlation between laboratory parameters and disease severity. Materials and Methods: This hospital-based observational study was conducted at Anugrah Narayan Magadh Medical College, Gaya from July 2018 to March 2020. A total of 280 patients with serologically confirmed dengue (NS1 antigen and/or IgM antibody positive) were included. Demographic, clinical, and haematological data were recorded. Complete blood counts were analyzed using an automated hematology analyzer, and serial monitoring was performed in severe cases. Dengue severity was categorized as Dengue Fever (DF), DHF, or DSS based on WHO criteria. Statistical analysis was conducted using standard software, with p<0.05 considered significant. Results: The mean age of patients was 33.8 ± 14.5 years, with a predominance of young adults (18–40 years, 50%) and males (60%). Urban residents accounted for 70% of cases. Common clinical features included fever (100%), myalgia (80%), and headache (70%), with bleeding manifestations present in 30% of patients. Thrombocytopenia (<150,000/µL) and leukopenia (<4,000/µL) were observed in 82% and 58% of patients, respectively. Elevated hematocrit (>40%) was seen in 46%. Significant trends were noted across severity groups, with DSS patients showing the lowest platelet counts (mean 32,000/µL) and highest hematocrit (mean 46.0%; p<0.001). Serial monitoring showed platelet recovery by Day 7 in most severe cases. Patients with bleeding had significantly lower platelet counts and higher hematocrit compared to those without bleeding (p<0.001). Conclusion: Thrombocytopenia, hemoconcentration, and leukopenia are prominent haematological markers in dengue and are strongly associated with disease severity and bleeding risk. Routine monitoring of these parameters can guide early diagnosis, clinical management, and risk stratification. This study emphasizes the importance of localized data in shaping regional dengue control strategies and reinforces the value of simple haematological tests in the effective management of dengue, especially in resource-limited settings.

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

Background: Hypertensive disorders during pregnancy, including gestational hypertension and preeclampsia, are significant contributors to maternal and fetal morbidity and mortality. Emerging evidence suggests that alterations in serum magnesium and lipid profiles may play a role in the pathophysiology of these conditions. Objective: To evaluate and compare serum magnesium levels and lipid profiles among normotensive pregnant women and those with hypertensive disorders of pregnancy (HDP). Methods: A prospective case-control study was conducted involving 100 pregnant women beyond 32 weeks of gestation. Fifty women diagnosed with HDP formed the case group, while fifty normotensive pregnant women served as controls. Fasting blood samples were analyzed for serum magnesium, total cholesterol, triglycerides, HDL-C, LDL-C, and VLDL-C. Statistical analysis was performed using SPSS version 25. Results: Women with HDP exhibited significantly lower serum magnesium levels and higher levels of total cholesterol, triglycerides, LDL-C, and VLDL-C compared to controls. HDL-C levels were notably lower in the HDP group. These findings suggest a correlation between dysregulated mineral and lipid metabolism and the development of hypertensive disorders during pregnancy. Conclusion: Monitoring serum magnesium and lipid profiles in pregnant women may aid in the early detection and management of hypertensive disorders, potentially improving maternal and fetal outcomes.

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

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

Background: Elderly patients are particularly vulnerable to adverse drug reactions (ADRs) due to age-related physiological changes and polypharmacy. This study aimed to assess the incidence, pattern, severity, causality, and preventability of ADRs among elderly patients receiving polypharmacy in a tertiary care hospital. Methods: A prospective observational study was conducted over six months among 100 elderly patients (aged ≥60 years) on ≥5 medications. Patients were followed throughout their hospital stay for the development of ADRs. Data were recorded using standardized formats, and causality was assessed using WHO-UMC criteria, severity using the Modified Hartwig and Siegel Scale, and preventability using Schumock and Thornton criteria. Results: Out of 100 patients, 42% experienced at least one ADR, with a total of 58 ADRs recorded. Gastrointestinal (31.0%) and central nervous system (22.4%) manifestations were most common. The major drug classes implicated included antihypertensives (24.1%), NSAIDs (19.0%), and antidiabetics (17.2%). Most ADRs were moderate (50.0%) in severity, and causality assessment classified them as probable (46.6%), possible (43.1%), or certain (10.3%). Preventability analysis indicated that 19.0% of ADRs were definitely preventable and 36.2% were probably preventable. Patients on ≥10 medications (28%) had a higher incidence of ADRs, with an average of 7.8 ± 2.1 drugs per patient. Conclusion: ADRs are common among elderly patients receiving polypharmacy, with a significant proportion being preventable. Regular medication reviews, deprescribing, and vigilant monitoring are essential strategies to enhance drug safety in this population.

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

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

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

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

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

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

Background: Haemorrhoids, or piles, are a common condition affecting many adults, characterized by swollen vascular structures in the anal canal, leading to discomfort and bleeding. Treatment options range from conservative management to surgical interventions, with haemorrhoidectomy being a definitive surgical option for advanced cases. This study compares two surgical techniques: conventional haemorrhoidectomy and stapled haemorrhoidectomy. Objective: The objective of this study is to conduct a prospective comparative analysis of conventional and stapled haemorrhoidectomy, focusing on their effectiveness, patient acceptance, postoperative outcomes, complications, and cost-benefit analysis. Methods: This prospective observational study was conducted over 18 months at Maharaja Agrasen Hospital, New Delhi, involving 60 patients with symptomatic Grade II/III haemorrhoids. Patients were randomly assigned to either stapled or conventional haemorrhoidectomy. Data were collected through clinical examinations, interviews, and standardized assessments, with postoperative outcomes evaluated using the Visual Analogue Scale (VAS) for pain and monitoring for complications. Result: The study found that stapled haemorrhoidectomy had significantly shorter operative times (22.27 vs. 25.00 minutes), less blood loss (30.47 vs. 78.30 mL), shorter hospital stays (1.53 vs. 2.77 days), and quicker return to work (5.2 vs. 15.4 days). Pain scores were significantly lower in the stapled group at all measured intervals. Late complications, such as delayed wound healing, were also less frequent in the stapled group. Conclusion: Stapled haemorrhoidectomy is shown to be a superior option for managing advanced haemorrhoids, offering benefits such as reduced operative time, lower blood loss, faster recovery, and fewer complications. While further long-term studies are needed to assess recurrence rates, the findings support the adoption of stapled haemorrhoidectomy in clinical practice for its efficiency and patient-centered outcomes.

Background: To prospectively evaluate the impact of laparoscopic ovarian drilling  on ovarian reserve, hormonal changes, ovulation, and menstrual regularity in women with polycystic ovarian syndrome (PCOS) resistant to clomiphene citrate therapy. Methods: This prospective study included 48 women diagnosed with PCOS according to the Rotterdam criteria, who previously failed treatment with clomiphene citrate. Participants underwent laparoscopic ovarian drilling using electrocautery to create multiple ovarian punctures. Hormonal profiles (Anti-Mullerian Hormone [AMH], luteinizing hormone [LH], follicle-stimulating hormone [FSH], and testosterone) were assessed at baseline and at 3 and 6 months after surgery. Ovulation was confirmed through serum progesterone levels and ultrasound follicular monitoring, while menstrual regularity was tracked over 6 months. Statistical analysis was performed using paired t-tests or Wilcoxon signed-rank tests, with p-values <0.05 considered statistically significant. Results: Post ovarian drilling, significant reductions were observed in AMH levels (16% at 3 months, 25% at 6 months), LH levels (28% at 3 months, 35% at 6 months), and testosterone levels (30% at 3 months, 33% at 6 months). FSH levels remained relatively stable throughout the follow-up. Ovulation was restored in 78% of patients, and menstrual regularity returned in 72% of participants within 6 months post ovarian drilling. Conclusion: Laparoscopic ovarian drilling significantly improves hormonal balance, ovulatory function, and menstrual regularity in clomiphene resistant PCOS patients. However, the procedure is associated with a considerable reduction in ovarian reserve markers, particularly AMH, indicating a trade-off between immediate reproductive benefits and potential long-term fertility implications. Therefore, patient counseling regarding potential impacts on ovarian reserve is crucial when considering laparoscopic ovarian drilling  as a treatment option.

Background: Assisted Reproductive Technology (ART) has revolutionized infertility treatment, leading to an increasing number of ART-conceived births worldwide. However, concerns have emerged regarding the potential risks associated with ART, particularly the increased incidence of congenital anomalies, including congenital heart disease (CHD). CHD is one of the most common birth defects and a leading cause of neonatal morbidity and mortality. While several studies have suggested a potential link between ART and CHD, findings remain inconsistent, necessitating further investigation. Aim This study aimed to evaluate the correlation between ART and the risk of CHD in neonates by comparing the incidence and types of CHD among ART-conceived infants and naturally conceived infants. Methods One hundred neonates—50 ART-conceived and 50 naturally conceived—were included in a retrospective cohort analysis. Information about maternal factors, neonatal outcomes, and echocardiographic results were taken from hospital records. SPSS version 23.0 was used for the statistical analysis, and independent t-tests and chi-square tests were used to analyze continuous and categorical data, respectively. Confounding variables such birth weight, gestational age, and mother age were taken into account using multivariate logistic regression. P-values less than 0.05 were regarded as statistically significant. Results The incidence of CHD was significantly higher in ART-conceived infants (54%) compared to naturally conceived infants (24%) (p = 0.001). Atrial septal defects (16% vs. 8%), ventricular septal defects (20% vs. 10%), and patent ductus arteriosus (12% vs. 4%) were more frequent in the ART group. According to logistic regression analysis, low birth weight (OR = 0.67, p = 0.015), advanced maternal age (OR = 1.12, p = 0.003), and ART were all independent risk factors for CHD (OR = 3.45, p = 0.001). Conclusion This study showed a strong correlation between ART and a higher risk of congenital heart disease. Regardless of the mother's age or birth weight, the frequency of CHD was greater in infants conceived via ART. The necessity of focused prenatal and postnatal cardiac assessment in ART pregnancies is highlighted by these findings. Recommendations Regular fetal echocardiographic monitoring should be considered for ART-conceived pregnancies. Understanding the underlying mechanisms and possible long-term cardiovascular hazards related with ART will require more extensive, longitudinal research

Background: Hypertension is a major risk factor for cardiovascular diseases and can lead to significant changes in the heart's anatomy. This study aims to compare the anatomical variations of the heart between hypertensive and normotensive individuals and evaluate the correlation between hypertension duration and severity with cardiac structural changes. Objectives: To assess cardiac anatomical parameters, such as left ventricular wall thickness, left ventricular mass, and chamber dimensions in hypertensive individuals. To compare these anatomical parameters between hypertensive and normotensive individuals. To evaluate the correlation between hypertension duration and severity with observed cardiac anatomical variations. Methods: A total of 200 participants, including 100 hypertensive individuals and 100 normotensive controls, were included in this comparative study. The study employed echocardiographic measurements to assess left ventricular wall thickness, left ventricular mass, and chamber dimensions. The data were analyzed using independent t-tests, chi-square tests, and Pearson correlation to evaluate the significance of differences and associations. Results: Hypertensive individuals showed significantly higher left ventricular wall thickness, left ventricular mass, and chamber dimensions compared to normotensive controls (p<0.001 for all parameters). A significant positive correlation was observed between hypertension duration and severity with increased left ventricular wall thickness (r=0.58–0.64), left ventricular mass (r=0.62–0.67), and chamber dimension (r=0.47–0.52), indicating that longer duration and greater severity of hypertension are associated with more pronounced cardiac structural changes. Conclusion: This study confirms that hypertension leads to significant anatomical alterations in the heart, including increased left ventricular wall thickness, mass, and chamber dimensions. The findings highlight the importance of early intervention and regular monitoring to prevent further cardiac remodeling and adverse outcomes in hypertensive patients.

Background: With cesarean section (CS) rates rising globally, concerns about complications like uterine scar dehiscence (USD) have also increased. USD, where a previous cesarean scar weakens or separates, can pose serious risks to both mother and baby. This study explores how intraoperative scar conditions relate to maternal and fetal outcomes in women with a previous lower-segment cesarean section (LSCS) and scar tenderness. Aims & Objectives: To assess intraoperative uterine scar conditions (intact, thinned out, dehiscence, or rupture) in women with previous LSCS presenting with scar tenderness and to analyze the associated maternal and fetal outcomes to improve clinical management strategies. Methodology: This prospective observational study included 46 women with a history of LSCS and clinically assessed scar tenderness over 12 months. Scar tenderness was evaluated by gently palpating the suprapubic area. During surgery, scars were categorized as intact, thinned-out, dehiscent, or ruptured, and these findings were linked to maternal and fetal outcomes. Results: Most women (65.2%) were between 26 and 35 years old, and 76.08% delivered at term. Scar thinning (17.9%) and dehiscence (5.6%) were more common in those with multiple prior LSCS, though no cases of rupture occurred. Women with two prior LSCS had a higher rate of complications, including urinary issues (38.9%) and wound infections (27.8%). Among newborns, 19.5% had meconium-stained fluid, 6.5% had an APGAR score below 7, and 30.4% required immediate NICU admission. These findings suggest that repeat LSCS increases risks for both mother and baby, especially after multiple surgeries. Conclusion: Scar tenderness can serve as an important warning sign for complications in women with a history of LSCS. Most had intact scars, suggesting a trial of labor could be an option when there is no strong reason for another cesarean. However, thinned-out scars were linked to higher maternal and newborn risks, highlighting the need for close monitoring and timely decisions. Larger studies are needed to strengthen these findings and improve care for mothers and babies.

Background: PPROM, occurring in 2–4.5% of pregnancies, is a major contributor to preterm births and perinatal mortality, with microbial invasion increasing maternal and neonatal risks. CRP, an inflammatory biomarker, may help predict adverse outcomes in PPROM cases. Methodology: A prospective observational study of 78 PPROM cases analyzed CRP levels and their association with maternal and neonatal outcomes, categorizing participants into CRP-positive and CRP-negative groups. Results: Elevated CRP levels correlated with higher maternal complications (sepsis, UTI, atonic PPH), increased neonatal morbidity (lower APGAR scores, perinatal depression), and longer NICU stays, with more C-sections and labor inductions in the CRP-positive group. Conclusion: While CRP is a useful inflammatory marker, its predictive value for chorioamnionitis remains uncertain, and routine serial monitoring may not significantly alter clinical management. Further research is required to refine its role in PPROM care.

Background: Hypoglycemia is the most common metabolic abnormality in infancy and childhood. When prolonged or recurrent it is a potent cause of irreversible brain damage leading to cognitive impairment, recurrent seizure activity, cerebral palsy autonomic dysregulation. Late preterms are at higher risks for a number of problems including poor feeding ,hypoglycemia, hypocalcemia, Jaundice, infections, respiratory distress, failure to thrive and hospital readmission. So this study tried to evaluate the incidence of hypoglycemia in late preterm appropriate for gestational age babies who were on breast feeding. Material and methods: This is a Hospital Based Observational study was conducted in the Department of Pediatrics, Subbaiah Institute of Medical Sciences, Shimoga, Karnataka. A total of 120 consecutive late preterm babies appropriate weight for gestational age were monitored for glucose levels for this study. The babies which were not fitting into the inclusion and exclusion criteria are not considered for the study. When the hypoglycemia was noted ,the level of glucose was assessed and managed according to the standard AIMS NICU protocols. The hypoglycemia was confirmed with the laboratory diagnosis. Results: A total of 120 late preterm babies were assessed. Of which, 61 were female and 59 were male babies. In our study, overall incidence of hypoglycemia was 15.83%. Majority of the hypoglycemia occurred on the first day (84.21%) and 2nd day(15.78%) with no episodes on third day of life. Out of 19 hypoglycemic babies, 8(42.1%) were symptomatic, and 11(57.89%) were asymptomatic .In our study, hypoglycemia was slightly more in male babies. Out of babies born to 82 multiparous mothers, hypoglycemia occured in 9 and out of babies born to 38 primiparous mothers 10 developed hypoglycemia. Considering the mode of delivery, out of 53 babies born by normal vaginal route, 8 had hypoglycemia and in 67 caesarian born babies,11 had hypoglycemia.  Conclusions:  The incidence of asymptomatic hypoglycemia is much higher than symptomatic hypoglycemia. The highest incidence (84.2%) of hypoglycemia was noted in the first twenty four hours of life and 15.8% in next twenty four hours. Hence there is a need for monitoring blood glucose regularly in postnatal wards even in healthy late pre terms during the first 2 days of life.

Background: Chronic Otitis Media (COM) is a persistent inflammatory condition of the middle ear and mastoid cavity that significantly impacts patients quality of life. While clinical attention is often focused on the affected ear, the contralateral ear (CLE), defined as the asymptomatic or less affected ear, also plays a crucial role. The objective of this study was to assess and correlate the findings of status of the CLE in cases of COM and evaluate its clinical implications. Methodology: This cross-sectional observational study was conducted after obtaining approval from the institutional ethical committee. A total of 120 individuals diagnosed with unilateral COM were included. Patients with an intact tympanic membrane (TM) in the CLE from all age groups were enrolled. Exclusion criteria included prior ear surgery, head/ear trauma, or refusal to participate. Results: Among the 120 patients, 69 (57.50%) were male, and 51 (42.50%) were female. The primary symptoms were ear discharge and hearing impairment. The mean age of patients 37.48±12.13.   Otoscopic examination revealed large central perforation (LCP) in 34.2% of cases and medium central perforation  (MCP) in 25%. Posterior Superior Quadrant (PSQ) with Attic Retraction was observed in 6.70% of cases. The CLE showed Grade 1 TM retraction in 25% of cases and tympanosclerotic patches in 15.00%, followed by Grade 2 TM retraction in 12.5%. The pure tone audiometry (PTA) findings revealed 117 patients (97.5%) had conductive hearing loss in the diseased ear, with an average hearing loss of 43.65 ± 14.16 dB. In CLE showed, 84 patients (70%) had normal hearing while, 28.3% had mild hearing loss. Conclusion: This study highlight the significant impact of chronic otitis media (COM) on both the diseased and contralateral ears and evaluation  of both ears is essential for accurate diagnosis, disease monitoring, and timely therapeutic intervention. Regular assessments help determine the progression and potential impact of COM on the contralateral ear, allowing for early management and better patient outcomes. Proper patient education and continuous monitoring are crucial for effective treatment planning and prevention of further deterioration.

Background: Urinary tract infections (UTIs) are among the most common bacterial infections in Pediatric patients. The emergence of antibiotic-resistant uropathogens has complicated empirical treatment strategies, necessitating continuous surveillance of resistance patterns.  Objectives: To evaluate the distribution of uropathogens and their antibiotic resistance profiles in pediatric UTIs over a 12-month period. Methods: A longitudinal observational study was conducted over one year in a tertiary care hospital. A total of 100 pediatric patients (aged 1 month to 12 years) clinically diagnosed with UTI were enrolled. Midstream urine samples were collected and processed for culture and sensitivity. The isolated organisms were identified, and antibiotic susceptibility testing was performed using the Kirby-Bauer disk diffusion method according to CLSI guidelines. Multidrug resistance (MDR) was defined as resistance to three or more antibiotic classes. Results: Escherichia coli was the most common isolate (66%), followed by Klebsiella pneumoniae (14%), Proteus mirabilis (8%), Enterococcus faecalis (6%), and Pseudomonas aeruginosa (4%). High resistance rates were observed for ampicillin (84.8% in E. coli, 92.9% in Klebsiella), cotrimoxazole, and ciprofloxacin. Nitrofurantoin and imipenem retained better sensitivity. Overall, 38% of isolates exhibited multidrug resistance. A rising trend in resistance to ampicillin and cotrimoxazole was noted over the study period.  Conclusion: This study highlights the alarming prevalence of antimicrobial resistance in pediatric UTIs, particularly among Gram-negative organisms. Regular monitoring of resistance patterns is essential to guide empirical therapy and limit the spread of MDR pathogens.

Background: Sepsis is a major cause of morbidity and death in the neonatal period. The diagnosis and management of shock in the new-born presents many challenges to neonatologists. Functional echocardiography is rational, noninvasive, readily available, performed at the bedside, and provides information in real time, making it an ideal tool to evaluate hemodynamics and to acquire physiological and anatomical information in critically-ill patients. This study was conducted with the aim to assess correlation of functional echocardiography with clinical parameters in neonates with septic shock.  Material and Methods: This was a Single centric Prospective cross-sectional type of study conducted among 140 neonates. It was conducted in the Department of Neonatology (NICU), GMC Aurangabad. Study population included all the newborns in NICU, GMCH, Aurangabad who developed septic shock as diagnosed by signs and symptoms of sepsis and confirmed by clinical and lab parameters. Neonates with diagnosed or suspected congenital and/ or cardiac mal-formation, those diagnosed with shock of etiology other than septic shock and those already on inotropic support were excluded from the study. Results: The gestational age of the neonates ranged from 27 to 41 weeks, with a mean of 33.08 ± 3.17 weeks. The most frequent blood culture finding was K. pneumoniae (24.29%). Total Leukocyte Count was lower than normal in 70% neonates. Pearson’s correlation test was used to assess the correlation of the hemodynamic parameters with cardiac function at the time of diagnosis, after resuscitation with inotropes at 2 hours, and after stabilization.  Conclusion: Functional echocardiography aids in the clinical evaluation of neonatal shock and aids in monitoring the effectiveness of treatment.

Background: The anaesthesiologists and obstetricians encounter specific challenges while managing pregnant patients with congenital complete heart block (CCHB) who require cesarean delivery due to pregnancy-induced physiological changes which requires precise planning to ensure maternal and fetal hemodynamic stability and better outcome. The case involves a 20-year-old primigravida patient weighing 52 kg and measuring 141 cm in height who was pregnant at 38 weeks and 2 days while maintaining a stable fixed heart rate between 48 and 53 bpm due to congenital complete heart block. The patient underwent pacemaker implantation as a past medical procedure before experiencing an infection, which led to the device removal. An emergency LSCS under spinal anaesthesia required the patient to undergo surgery, while the anaesthesiologists anticipated and effectively treated complications of bradycardia and hypotension by using close monitoring and pre-emptive transcutaneous pacing support, targeted fluid therapy and vasopressor use. A 2.6 kg healthy female baby received good Apgar scores during delivery. The patient demonstratedfew sustained episodes of bradycardia during the perioperative period, which were successfully managed because of effective preoperative planning between multiple disciplines, as well as constant monitoring during surgery and after delivery to ensure the wellbeing of patients with congenital cardiac conduction disorders.

Background: The dual burden of type 2 diabetes mellitus (T2DM) and hypertension is a major contributor to cardiovascular morbidity and mortality. Integrated care models are essential for effective management. With the growing adoption of digital health technologies, telehealth has emerged as a potential alternative to conventional care. This study aimed to evaluate the clinical effectiveness of telehealth versus in-person care in the co-management of T2DM and hypertension. Materials and Methods: A total of 120 patients diagnosed with both T2DM and hypertension were randomly assigned into two groups: the Telehealth Group (n=60) and the In-Person Care Group (n=60). Inclusion criteria included age between 30–65 years, HbA1c ≥ 7%, and systolic BP ≥ 140 mmHg at baseline. The telehealth group received virtual consultations via a dedicated platform every 2 weeks, with remote monitoring of blood glucose and BP. The in-person group attended physical consultations at similar intervals. Primary outcomes were change in HbA1c and systolic blood pressure at 6 months. Secondary outcomes included medication adherence, patient satisfaction, and frequency of emergency visits. Results: At the end of 6 months, the telehealth group showed a mean reduction in HbA1c from 8.5% ± 1.1 to 7.2% ± 0.9 (p < 0.001), while the in-person group improved from 8.4% ± 1.0 to 7.5% ± 0.8 (p < 0.01). The reduction in systolic BP was also significant in both groups: from 148.2 ± 7.5 mmHg to 132.6 ± 6.3 mmHg in the telehealth group (p < 0.001), and from 147.9 ± 8.1 mmHg to 135.4 ± 7.1 mmHg in the in-person group (p < 0.01). Medication adherence was slightly higher in the telehealth group (92% vs. 87%, p = 0.04), and patient satisfaction scores were also greater (mean 4.5 vs. 3.9 on a 5-point Likert scale). No significant difference was observed in the number of emergency visits between the groups. Conclusion: Telehealth is a feasible and effective modality for the co-management of diabetes and hypertension, showing comparable or slightly superior outcomes in glycemic and blood pressure control compared to traditional in-person care. Improved adherence and satisfaction highlight the potential of remote monitoring in chronic disease management, particularly in resource-limited or rural settings.

Background: Wearable cardiovascular monitoring devices have emerged as promising tools for real-time arrhythmia detection and patient-managed care. Their diagnostic value, usability, and impact on clinical outcomes remain areas of active investigation. Objective: To systematically evaluate the diagnostic accuracy, clinical utility, and user acceptability of wearable devices in detecting arrhythmias, particularly atrial fibrillation (AF). Data Sources: A systematic search was conducted in PubMed (2018–2025) using terms related to “wearables,” “arrhythmia,” and “cardiac monitoring.” Filters applied included free full-text availability and original human studies. Study Selection: Studies were included if they assessed wearable, non-invasive devices (e.g., smartwatches, ECG patches) for arrhythmia detection and reported diagnostic performance or clinical outcomes. Data Extraction and Synthesis: Twelve studies were included. Data on study design, population, device type, diagnostic accuracy, intervention changes, and usability were extracted and narratively synthesized. Main Outcomes and Measures: Primary outcomes were AF detection rate, sensitivity, specificity, and clinical intervention changes. Results: Wearables demonstrated sensitivity ranging from 84% to 95% and specificity up to 93%. Intervention changes occurred in up to 35% of cases. High patient satisfaction and adherence were reported. Conclusions and Relevance: Wearable cardiac monitors provide accurate, patient-friendly arrhythmia detection and support timely clinical intervention, reinforcing their role in modern cardiovascular care.

Background: Pre-pregnancy body mass index (BMI) is a crucial determinant of maternal and neonatal health, significantly influencing the mode of delivery, maternal complications, and neonatal outcomes. With the increasing prevalence of maternal obesity and undernutrition, obstetricians face challenges in managing pregnancy-related risks. Obesity has been linked to gestational diabetes mellitus (GDM)1, hypertensive disorders, macrosomia, prolonged labor4, and an increased likelihood of cesarean delivery, while underweight mothers are more prone to intrauterine growth restriction (IUGR)6, low birth weight (LBW), and neonatal intensive care unit (NICU) admissions8. Understanding the relationship between BMI and delivery outcomes is essential for improving antenatal care, risk stratification, and maternal-fetal health management. Materials And Methods: This study was conducted as a prospective observational study at the Department of Obstetrics and Gynecology, Kempegowda Institute of Medical Sciences, Bangalore, from August 1, 2024, to October 31, 2024. A total of 40 term pregnant women were categorized into four BMI groups based on the WHO classification: underweight (<18.5 kg/m²), normal (18.5–24.9 kg/m²), overweight (25–29.9 kg/m²), and obese (≥30 kg/m²). Data collection included patient demographics, obstetric history, mode of delivery, maternal complications, and neonatal outcomes. Statistical analysis was performed using SPSS v23, with chi-square tests, logistic regression, and Pearson’s correlation coefficient applied to evaluate associations between BMI and pregnancy outcomes. A p-value <0.05 was considered statistically significant. Results: The results revealed that cesarean section rates increased with maternal BMI, with 100% of obese women undergoing cesarean delivery, compared to 62.5% in overweight women, 25% in normal BMI women, and 16.7% in underweight women. Vaginal delivery was most frequent in normal BMI (75%) and underweight (83.3%) women, whereas obese women had the highest incidence of labor complications, including prolonged labor (50%) and gestational diabetes (50%). Hypertensive disorders were significantly higher in overweight (37.5%) and obese (50%) women, indicating an increased risk of metabolic and vascular dysfunction in these groups. Neonatal outcomes were also significantly affected by maternal BMI. Low birth weight (50%) was most common in underweight mothers, suggesting nutritional insufficiency and placental insufficiency99. Conversely, macrosomia (25%) was prevalent in obese women, aligning with higher rates of gestational diabetes and excessive fetal growth1010. NICU admissions were highest in underweight (3.3%) and obese (50%) neonates, emphasizing the importance of BMI regulation before pregnancy to minimize neonatal morbidity. Statistical analysis confirmed that BMI was positively correlated with cesarean section rates (p < 0.001, OR = 4.2), while underweight mothers had a significantly higher risk of delivering low birth weight neonates (p < 0.001). Additionally, gestational diabetes was strongly associated with obesity (p < 0.001), reinforcing the need for early glucose screening in overweight pregnancies. Conclusion: In conclusion, this study demonstrates that both underweight and obese women face increased pregnancy-related risks, emphasizing the importance of achieving an optimal BMI before conception. Obese women are at a significantly higher risk of cesarean delivery, gestational diabetes, and hypertensive disorders, while underweight women are more likely to deliver low birth weight infants and experience increased NICU admissions. These findings highlight the need for preconception weight management programs, targeted antenatal monitoring, and early interventions for high-risk pregnancies. Future research should explore larger-scale studies to evaluate long-term neonatal outcomes and assess the effectiveness of maternal weight optimization programs in reducing pregnancy-related complications.

Background: The COVID-19 pandemic, caused by SARS-CoV-2, has been associated with a wide range of clinical presentations, ranging from asymptomatic cases to severe respiratory failure. Inflammatory biomarkers such as C-reactive protein (CRP), D-dimer, and Ferritin have been recognized as important indicators of disease severity and prognosis. This study is aimed to evaluate the levels of these biomarkers in COVID-19-positive patients and correlate them with demographic parameters and clinical outcomes. Methods: A Retrospective Observational Study was conducted in the Department of Pathology, Central Laboratory, RGSSH, OPEC, RIMS, Raichur, from June 2021 to May  2022. A total of 400 COVID-19-positive patients were included. Data on CRP, D-Dimer, and Ferritin levels were collected and analyzed concerning gender, age group, and clinical outcome (ICU vs. ward admission). Results: Of the 400 patients, 58.3% were male and 41.7% were female. The majority belonged to the age group of 41–60 years. Statistically significantly higher levels of CRP (p = 0.02) and D-dimer (p < 0.001) were observed in ICU patients compared to ward patients, while the difference in ferritin levels was not statistically significant (p=0.142). There was no significant association of biomarker levels with gender. However, D-dimer levels showed a significant correlation with age (p = 0.004), with the highest levels in patients above 80 years. Conclusion: Elevated CRP and D-dimer levels are significantly associated with severe COVID-19 infection and ICU admission. These biomarkers may serve as valuable tools for the early identification of high-risk patients, aiding in timely clinical decision-making. Regular monitoring of these markers is recommended to improve patient outcomes.

Introduction: The prevalence of chronic kidney disease is rising globally because of numerous contributing variables, such as lower urinary tract blockage, urinary stones, co-morbidities, and sepsis. Monitoring is required for several indicators, including blood pressure, blood sugar, renal function tests, etc. The high mortality rate of urosepsis in CKD necessitates the early identification of the sepsis-causing organisms and the determination of antibiotic sensitivity to identify resistant species. Taking this into consideration, the study was conducted accordingly. Aim and Objectives: To study the microbiological spectrum, antimicrobial-resistant pattern, and treatment involved in urosepsis of CKD patients. Materials and methods: A total of 100 CKD patients were included in the study; detailed history was obtained, and clinical examination was done. Blood and urine samples were collected and sent to the microbiology laboratory for further processing. After culture sensitivity, empirical treatment was accordingly changed, and results were observed. Results: The most often isolated organism in blood and urine cultures was E. coli. The most frequent organism that caused death was Candida. The common drugs to which the patients responded were cefeperozone-sulbactum and meropenem. Conclusion: In conclusion, microbiological tests such as blood and urine cultures are crucial for the early detection of urosepsis in patients with chronic kidney disease (CKD) and the precise delivery of antibiotics.

Background: Ocular physiology plays a central role in the detection and progression of many eye diseases. Physiological parameters such as intraocular pressure (IOP), tear film break-up time (TBUT), central corneal thickness (CCT), ocular blood flow (OBF), and pupillary reflex responses offer objective metrics essential for accurate diagnosis and patient monitoring. This study aims to assess the clinical utility of these parameters in diagnosing glaucoma, dry eye syndrome, and optic neuritis. Materials and Methods: A hospital-based, cross-sectional study was conducted on 200 subjects categorized into four groups: glaucoma, dry eye syndrome, optic neuritis, and healthy controls (n=50 each). Each participant underwent detailed ophthalmic evaluation, including IOP measurement, TBUT testing, pachymetry, ocular blood flow assessment via color Doppler imaging, and pupillary reflex testing. Statistical analysis was performed using SPSS v26.0 with ANOVA and Pearson’s correlation tests. Results: Significant intergroup differences were observed. Glaucoma patients exhibited the highest mean IOP (23.32 mmHg) and lowest OBF (9.06 cm/s). Dry eye patients showed markedly reduced TBUT (5.98 seconds). Central corneal thickness was thinnest in glaucoma (519.03 µm), while optic neuritis patients had the most prolonged pupillary reflex times (351.52 ms). Control subjects had normal physiological ranges across all parameters. Conclusion: Physiological parameters are vital tools in diagnosing and managing ocular disorders. Integrating these objective measures into routine clinical assessments can enhance early detection, guide treatment, and improve patient outcomes.

Background: Cirrhosis is a chronic liver condition characterized by hepatic fibrosis, anatomical distortion, and compromised liver function. Autonomic dysfunction (AD) is a significant concern due to its impact on cardiovascular stability, hemodynamic modulation, and patient prognosis. AD is characterized by irregularities in heart rate variability, impaired blood pressure management, and abnormal reflex reactions, which can increase the risk of cardiac events. Cirrhotic cardiomyopathy, characterized by compromised ventricular contractility and electromechanical dysfunction, is linked to autonomic abnormalities. ECG and ECHO are vital tools for assessing heart function in cirrhosis patients, revealing anatomical and functional heart alterations. Objective: This study aims to evaluate autonomic dysfunction in individuals with liver cirrhosis, its impact on ECG abnormalities, heart rate variability, blood pressure regulation, and cardiovascular reflexes, and its influence on various Child-Pugh and MELD score groups. It also seeks to identify potential predictors of autonomic dysfunction in cirrhosis, which could aid in early risk assessment and therapeutic management. Methods: A retrospective analysis was performed on clinical data from 100 patients admitted with cirrhosis over an 18-month period, from May 2023 to December 2024, at Shri B M Patil Medical College and Research Center, Vijayapura, where the data was collected. The information gathered included the patient's demographics, clinical conditions at admission, ECG results (QTc interval), echocardiographic results, and signs of autonomic dysfunction. Results: The study examined the age distribution and physiology of patients with heart conditions, focusing on 20-60-year-olds. Pulse rates were categorized into three ranges: 81-100 bpm, 60-80 bpm, and 101-130 bpm. The Valsalva maneuver showed a similar distribution, with 52% falling in the 81-100 bpm range and 36% in the 60-80 bpm range. Blood pressure was measured using a blood pressure cuff, with higher pressure indicating a higher risk of heart failure. The study also examined blood pressure readings under three conditions: Supine BP (lying down), Standing BP, and Hand Grip BP. The Child-Pugh classification assessed the severity of chronic liver disease, with the mean age group mostly middle-aged. The study found a strong link between autonomic dysfunction, cardiovascular abnormalities, and liver disease progression. Conclusion: The study reveals a significant gender disparity in the population, with 95% being males. Cardiovascular assessments show normal physiological responses, but some individuals show signs of autonomic dysfunction. ECG analysis reveals abnormalities in sinus rhythms, highlighting the need for continuous monitoring. Liver function assessments reveal a high prevalence of severe liver disease, necessitating urgent medical interventions. Early detection and management of these health issues are crucial for improving health outcomes. Future research should focus on lifestyle modifications, targeted treatments, and long-term monitoring.

Background: Primary hyperparathyroidism (PHPT) is an endocrine disorder characterized by autonomous production of parathyroid hormone (PTH). We planned the present study to evaluate the level of PTH intraoperatively and postoperatively and determine the outcome of the surgery.  Materials & Methods: A total of 36 patients scheduled to undergo parathyroidectomy for hyperparathyroidism were involved in the present study. Complete physical examination of all the subjects was carried out. Pre-surgical assessment of all the subjects was done. Minimally invasive parathyroidectomy (MIP) was done in all the patients. A 50% reduction in PTH level from baseline was used as an indication that the exploration was successful. If a parathyroid adenoma was not found or if the PTH did not drop sufficiently after the removal of the gland, the incision was extended and bilateral neck exploration was done. Results: MIP was carried out in 33 patients, while bilateral neck exploration was required in 3 patients. A significant decline in the mean PTH concentration was seen during surgery and postoperatively. Also, we observed a significant fall in the postoperative calcium levels in comparison to the preoperative calcium levels. Conclusion: Intraoperative PTH monitoring plays a significant and crucial role in assessing the surgical treatment of primary hyperparathyroidism. 

Background: Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality globally, particularly in low-resource settings. The Non-Pneumatic Anti-Shock Garment (NASG) is a first-aid compression device endorsed by WHO and FIGO to stabilize women in hypovolemic shock while awaiting definitive care. Despite its potential, utilization remains suboptimal in many countries. Objectives: To systematically assess the role of NASG in managing hemorrhagic shock in PPH cases, with a focus on utilization rates, associated factors, and outcomes in low-resource settings. Methods: This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD42023412128). Electronic databases including PubMed, Embase, AJOL, and Google Scholar were searched up to May 2023. Observational and interventional studies reporting NASG utilization and associated outcomes were included. Data extraction and quality assessment were independently performed. Meta-analysis was conducted using a random-effects model. Results: Eight studies involving 2,690 healthcare providers were included. The pooled utilization rate of NASG was 43.2% (95% CI: 35.88–50.52; I² = 93.5%). Utilization was significantly associated with three factors: training (OR = 5.43), availability (OR = 7.78), and provider knowledge (OR = 4.61). Sensitivity analysis confirmed the robustness of the pooled estimate. Conclusion: Despite proven efficacy, NASG utilization remains limited in real-world settings. Structured training, consistent availability, and improved provider awareness are essential to scale up usage and reduce PPH-related mortality. Strengthening policy integration and monitoring systems will further enhance implementation outcomes.

Background: Type-2 Diabetes Mellitus (T2DM) is a chronic condition that has reached epidemic proportions worldwide, affecting millions of individuals and representing a significant public health burden. The ratio of serum uric acid to creatinine (SUA/Cr ratio) has been proposed as a novel marker for assessing the risk of kidney damage and other metabolic disturbances, including in diabetic patients. Elevated SUA/Cr ratios have been linked to the early stages of diabetic nephropathy, including proteinuria, and may help identify individuals at risk before significant kidney dysfunction develops. Objectives: To estimate the correlation between serum uric acid to creatinine ratio and proteinuria in Diabetes Mellitus patients Methods: It’s a cross-sectional study conducted on 60 Diabetic patients visiting to K R Hospital, Mysuru from April 2023 to October 2024. Serum uricacid and creatinine ratio, proteinuria will be measured and then correlating these values with diabetic patients. Results

The analysis revealed a positive correlation (r = 0.42) between the serum uric acid to creatinine ratio and proteinuria in patients with type 2 diabetes mellitus, with a statistically significant p-value of 0.05. This suggests that as the serum uric acid to creatinine ratio increases, the level of proteinuria also tends to rise, indicating a potential link between this biochemical ratio and renal involvement in diabetic individuals. Conclusion: This study highlights the importance of early detection and monitoring of kidney disfunction in individuals with Type-2 DM particularly by using SUA/Cr ratio and proteinuria as a potential marker and demonstrates clear relationship between SUA/Cr ratio and proteinuria.

Introduction: Surgical site infections (SSIs) are common postoperative complications that increase morbidity and healthcare costs. The role of preoperative antibiotic prophylaxis in clean surgical procedures remains controversial. Aim: To evaluate the efficacy of preoperative antibiotic prophylaxis versus no prophylaxis in reducing SSIs in clean surgeries. Methods: A cross-sectional comparative study was conducted involving 120 patients undergoing clean surgeries at a tertiary care center. Patients were divided equally into two groups: one receiving a single dose of preoperative intravenous ceftriaxone and the other receiving no prophylaxis. Outcomes measured included incidence of SSI, postoperative complications, hospital stay, and antibiotic-related side effects. Data were analyzed using appropriate statistical tests with significance set at p < 0.05. Results: SSI incidence was significantly lower in the antibiotic group (6.7%) compared to the no prophylaxis group (25.0%) (p = 0.004). Postoperative fever and wound discharge were also significantly reduced (p = 0.04). The antibiotic group experienced shorter hospital stays (mean 4.1 vs. 5.3 days, p < 0.001) and lower pain scores (p = 0.006). However, antibiotic-related side effects occurred in 11.7% of patients receiving prophylaxis. Conclusion: Preoperative antibiotic prophylaxis significantly reduces surgical site infections and improves postoperative outcomes in clean surgeries, supporting its routine use with cautious monitoring for adverse effects.

Background: Connective tissue disorders (CTDs) are systemic autoimmune diseases that frequently involve the lungs, leading to interstitial lung disease (ILD), which is a major cause of morbidity and mortality. High-resolution computed tomography (HRCT) has emerged as a critical tool for the non-invasive assessment of ILD patterns and severity. This study aims to evaluate the HRCT imaging spectrum of CTD-associated ILD and correlate imaging findings with pulmonary function test (PFT) results.Objectives: To determine the predominant HRCT patterns in ILD associated with CTDs, quantify fibrosis severity using a scoring system, and correlate these scores with spirometric parameters. Methods: A prospective observational study was conducted at the Departments of Respiratory Medicine and Radiodiagnosis at Government Medical College and Hospital, Nizamabad and Nirmal. A total of 40 patients diagnosed with CTDs and suspected ILD underwent HRCT imaging. Fibrosis severity was scored based on zonal involvement (upper, middle, lower zones). PFTs were performed, and parameters such as FVC, FEV₁, and FEV₁/FVC ratio were recorded. Pearson’s correlation was used to assess relationships between HRCT scores and PFT values. Results: Among the 40 participants, systemic sclerosis (42.5%) and rheumatoid arthritis (37.5%) were the most common CTDs. NSIP was the predominant HRCT pattern, seen in 80% of cases. Quantitative fibrosis scores averaged 26.5 in systemic sclerosis and 28.8 in rheumatoid arthritis. A weak to moderate positive correlation was observed between fibrosis scores and FEV₁/FVC ratio (r = 0.43), suggesting that HRCT grading reflects pulmonary functional impairment. Conclusion: HRCT is a reliable tool for detecting and classifying ILD in CTD patients, with NSIP being the most common radiological pattern. The fibrosis scoring system offers a semi-quantitative method to estimate disease burden and demonstrates correlation with functional parameters. These findings support HRCT’s role in disease monitoring and prognosis in CTD-associated ILD.

Objective: To know the effect of antiepileptic drugs on liver enzymes.  Study Design: Cross sectional study. Materials & Methods: The study was conducted on 108 patients at Santosh Medical College & Hospital, Ghaziabad between Sep 14 to Oct 14. Patients divided into 3 groups, consisting of 36 patients in each group of phenytoin, carbamazepine and valproate. Results: Total No. of Patients was 108, out of which 36 patients were there is each group of Phenytoin, Carbamazepine and valproate. Most of the patients 36 (33.33%) and 32 (29.62%) belongs to age group of >40 – 50 years and >50 year respectively. Regarding raised SGPT, it was seen in 5 (13.89), 3 (8.33) and 3 (8.33) in phenytoin, carbamazepine and sodium valproate group respectively. SGOT were raised in sodium valproate group respectively. Alkaline phosphatase was raised in 10 (27.78), 20 (55.56) and 22 (61.11) in phenytoin group, carbamazepine group, and sodium valproate group respectively.  Conclusion: From the present study we can conclude that sodium valproate is more hepatotoxic than carbamazepine which is more toxic than phenytoin. It is recommended that base line Liver Function Test (LFT) is essential before starting of AEDs and regular monitoring of LFT is also done between the course of treatment.

Introduction: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that predispose individuals to increased cardiovascular risk. Dyslipidemia is a core component of MetS and plays a crucial role in its pathogenesis. This study aimed to compare lipid profile abnormalities between metabolic syndrome patients and healthy controls. Methods: A comparative cross-sectional study was conducted involving 200 participants (100 MetS patients and 100 healthy controls). Anthropometric measurements, blood pressure, fasting blood glucose, and lipid profiles—including total cholesterol, triglycerides, LDL cholesterol, and HDL cholesterol—were assessed. Statistical analysis was performed to compare lipid parameters between groups. Results: Metabolic syndrome patients demonstrated significantly higher mean total cholesterol (220.6 ± 38.5 mg/dL vs. 182.4 ± 29.7 mg/dL, p < 0.001), triglycerides (186.9 ± 54.3 mg/dL vs. 111.3 ± 41.5 mg/dL, p < 0.001), and LDL cholesterol (140.4 ± 31.2 mg/dL vs. 108.7 ± 26.1 mg/dL, p < 0.001) compared to controls. HDL cholesterol was significantly lower in MetS patients (38.7 ± 8.9 mg/dL) than controls (52.3 ± 9.6 mg/dL, p < 0.001). Dyslipidemia prevalence was high among MetS patients, with 91% showing at least one abnormal lipid parameter. Conclusion: Significant dyslipidemia is prevalent in metabolic syndrome patients compared to healthy controls, underscoring the importance of lipid monitoring and management in this high-risk group to reduce cardiovascular complications.

Background: Diabetes mellitus is one of the most common chronic diseases has been related to various liver illnesses such as liver enzyme derangements, non-alcoholic fatty liver disease, hepatocellular carcinoma, and cirrhosis. There has been increased interest on the contribution of liver enzymes to prediction of diabetes and glycemic control.  Aims and Objectives: The aim is study was to correlate liver enzymes with type 2 diabetes mellitus (T2DM) and non-diabetic individuals.  Materials and Methods: Diabetic patients seen on Outpatient Department basis or admitted as inpatients are included in this study. Information is collected and detailed history is taken using pre-formed proforma at the time of admission. Liver function tests are measured to all participants, and HbA1C value is measured. Liver enzymes are correlated with HbA1C values. Results: Majority of the participants were males (64% in cases & 60% in control). The mean age among cases was 53.5 ± 9.3 and among control was 49.8 ± 5.6 years. The mean duration of diabetes is 7.86±5.38, mean HbA1c is 8.48±3.25. Mean fasting blood sugar and post-prandial blood sugar were 169.5±91.3 and 242.3±133.6, respectively. Liver enzymes like Aspartate transferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) were statistically significantly raised in diabetes mellitus cases (p<0.05) as compared to non-diabetic cases Conclusion: We have found significant association among AST, ALT, ALP and GGT with type 2 diabetes mellitus; all were negatively correlated with HbA1C level, Hence the monitoring the liver function tests in uncontrolled T2DM patients was essential.

Background: Diabetic ketoacidosis (DKA) is a serious complication of diabetes, occasionally triggered by acute pancreatitis due to hypertriglyceridemia. We report a rare case of a young male with undiagnosed T1DM presenting with DKA, hypertriglyceridemia-induced pancreatitis, AKI, and ARDS. Case Presentation: A 23-year-old male presented with abdominal pain, respiratory distress, and altered consciousness. He was hypotensive, hyperglycemic (CBG 428 mg/dL), with a GCS of E2V1M3. Investigations revealed high anion gap metabolic acidosis, triglycerides of 730 mg/dL, elevated lipase, positive urinary ketones, and renal impairment. Imaging confirmed pancreatitis with renal parenchymal disease. He was intubated and treated in ICU with insulin infusion, fluids, vasopressors, antibiotics, and dialysis. He later developed ARDS, which was managed appropriately. The patient recovered fully and was discharged with counselling on lifelong insulin therapy, glucose monitoring, and dietary adherence. Conclusion: Early multidisciplinary management in severe DKA cases with organ dysfunction can result in full recovery.

Background: Pilonidal sinus is treated with wide local excision and primary closure, which carries high recurrence, post-operative morbidity and cosmetic implications. In order to overcome that limberg transposition flap is done. Post-operative flap survival is crucial for proper healing. Hence there is a need for a tool to predict flap survival as earliest. Flap capillary blood glucose monitoring is such a tool which is, done as a clinical basic procedure, with no harm to patient or the flap. Methods:  To prospectively validate flap capillary blood glucose monitoring serially, as an indicator to predict flap survival in limberg flap in pilonidal sinus surgery patients at Government medical college & ESI hospital-general surgery department. Conducted as a prospective cohort study among 30 patients who underwent wide local excision and limberg flap for pilonidal sinus in the Department of General Surgery, Government Medical College & ESI Hospital between June- 2022 to November- 2022. Estimated capillary blood glucose at the edge of flap 3mm away from incision site, using glucometer at 0, 6, 24- hours following surgery. Results: Of the 30 patients who underwent limberg flap surgery, 1 patient developed postoperative flap necrosis due to venous thrombosis. 1 patient developed flap infection which was treated with appropriate antibiotics after culture and sensitivity and the flap survived. Rest of the 28 patients had healthy flaps and uneventful postoperative period. Of the 30 patients who underwent limberg flap for pilonidal sinus 29 patients in whom the flap survived had flap glucose level more than 62mg/dl, in the first 24 hours. Conclusion: Monitoring flap capillary blood glucose serially in postoperative period in order to identify the flaps in risk, to start early goal directed therapy to improve flap survival and the patients can benefit. This simple and cheap technique can be used for routine monitoring of Limberg flaps along with the routine clinical evaluation.

Background: Anemia in chronic kidney disease (CKD) arises from insufficient erythropoietin production and functional iron deficiency, significantly impairing quality of life and disease prognosis. Recombinant human erythropoietin (rh-EPO) remains the cornerstone of therapy, though associated with parenteral administration burdens and resistance. Desidustat, an oral hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), offers a novel mechanism by stimulating endogenous erythropoiesis and enhancing iron metabolism. Aims and Objectives: To evaluate and compare the efficacy and safety of oral Desidustat monotherapy against injectable rh-EPOs in CKD-associated anemia in terms of hematological indices, iron profile, renal function (eGFR), and cardiovascular risks, within a multidisciplinary framework. Materials and Methods: A prospective interventional cohort study was conducted on 150 CKD stage 3b–5 patients (October–December 2024) already on rh-EPO, who were switched to Desidustat. Regular monitoring of hemoglobin, reticulocyte parameters (ARC, ARI), ferritin, transferrin saturation (TSAT), eGFR, serum erythropoietin, and HEART score (MACE prediction) was done. Statistical analysis involved paired sample t-tests using SPSS v17, with p<0.05 considered significant. Results: Desidustat significantly improved hemoglobin (mean increase: 0.609 g/dL, p<0.05), eGFR (mean increase: 1.828 mL/min/1.73m², p<0.05), ARC (mean increase: 20.9×10⁹/L, p<0.05), ARI (mean increase: 0.16%, p<0.05), ferritin (mean increase: 7.86 ng/mL, p<0.05), and TSAT (mean increase: 4.91%, p<0.05). Peripheral smear confirmed effective erythropoiesis. No significant increase in MACE risk was observed. Compared to rh-EPOs, Desidustat demonstrated superior tolerability, oral convenience, and reduced need for adjunctive iron therapy. Conclusion: Desidustat presents a compelling oral alternative to rh-EPO injectables in managing CKD-associated anemia. Beyond hematological improvements, it shows promise in renal function stabilization and iron metabolism enhancement, with a favorable safety and compliance profile. This study reinforces the therapeutic potential of HIF-PHIs in nephrology and warrants further multicenter validation.

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is a common liver condition associated with Type 2 Diabetes Mellitus (T2DM). The high prevalence of NAFLD in diabetic patients is a growing concern due to its potential to progress to more severe liver conditions, such as non-alcoholic steatohepatitis (NASH), fibrosis, and cirrhosis. This study aimed to assess the prevalence and risk factors associated with NAFLD in T2DM patients in Central India. Methods: A cross-sectional observational study was conducted over 12 months at a tertiary care hospital in Central India. A total of 100 adult T2DM patients aged 40-70 years were included. Data were collected through structured questionnaires, physical examinations, and biochemical tests. Liver ultrasound was used to diagnose NAFLD and assess its severity. The risk factors for NAFLD, including age, gender, obesity, hypertension, dyslipidemia, family history of NAFLD, and duration of diabetes, were analyzed. Results: The prevalence of NAFLD in T2DM patients was found to be 65%. Significant risk factors for NAFLD included obesity (69.2%), hypertension (76.9%), dyslipidemia (73.8%), a family history of NAFLD (61.5%), and longer duration of diabetes (mean 8.5 years). Liver ultrasound showed that 46.2% of patients had mild NAFLD, 30.8% had moderate NAFLD, and 23.1% had severe NAFLD. Biochemical markers, including elevated ALT and AST levels, and higher fasting blood glucose, were significantly associated with NAFLD. Lifestyle modifications, weight loss, and regular monitoring of liver function were the primary management approaches. Conclusion: This study highlights the high prevalence of NAFLD in T2DM patients and identifies key risk factors such as obesity, hypertension, and dyslipidemia. Early detection and management through lifestyle interventions, regular monitoring of liver function, and appropriate pharmacotherapy are crucial for mitigating the adverse effects of NAFLD and improving long-term outcomes in diabetic patients.

Background: With the advent of antiretroviral therapy (ART) and improved follow-up strategies through ICTC services, the incidence of opportunistic infections in people living with HIV (PLHIV) has declined. However, there has been a concurrent rise in non-communicable diseases, particularly cardiovascular disorders. Electrocardiography (ECG) is a non-invasive tool for detecting early cardiac abnormalities, while serum C-reactive protein (CRP), an inflammatory biomarker, has been increasingly recognized for its prognostic role in cardiovascular risk among PLHIV. Materials and Methods: This prospective observational study was conducted at a tertiary care hospital from December 2020 to October 2022. A total of 50 HIV-positive patients aged above 18 years attending the ART center were enrolled after obtaining informed consent. Patients with known cardiovascular diseases, hypertension, or chronic alcoholism were excluded. All participants underwent 12-lead ECG and serum CRP testing to identify potential associations between ECG abnormalities and inflammatory status. Results: Out of the 50 participants, ECG abnormalities were noted in 48 (96%) patients. T wave inversions were the most prevalent, observed in 29 patients (58%), followed by ST-segment elevations in 12 (24%). Other findings included sinus tachycardia (4%), irregular rhythm (4%), left ventricular hypertrophy (4%), and electrical alternans (2%). Only 2 patients (4%) had normal ECGs. Elevated serum CRP levels were observed in 93% of patients with T wave inversions and in all cases with ST-segment elevations, where 60% had CRP levels exceeding 100 mg/L. Among patients with ST-T changes, 95% demonstrated elevated CRP levels, indicating a strong correlation (p < 0.001). In contrast, all patients with normal ECGs had normal CRP levels, suggesting lower cardiovascular risk. Conclusion: Cardiovascular abnormalities are emerging complications among PLHIV in the ART era. ECG serves as an effective preliminary tool for assessing these complications. Elevated serum CRP levels show a significant association with electrocardiographic abnormalities and can be used as a predictive marker for cardiovascular morbidity and mortality in this population. Regular ECG and CRP monitoring may enhance early detection and management of cardiovascular risks in PLHIV.

Background: The most frequent hospital-acquired illness (HAI) is still catheter-associated urinary tract infections (CAUTI). This highlights the necessity of putting in place and keeping an eye on efficient infection management measures in order to lower the risk of CAUTI. Aims: The current study's objectives were to compute CAUTI rat and identify the etiology with drug susceptibility. Materials & Methods: Catheter-associated urinary tract infections (CAUTIs) are a common healthcare-associated infection caused by prolonged catheter use. Effective prevention methods include maintaining sterile insertion techniques, ensuring proper catheter care, minimizing catheter use, and prompt removal when no longer needed. The antibiotic sensitivity pattern of uropathogens causing CAUTIs highlights the importance of monitoring local resistance trends to guide treatment. Common uropathogens include Escherichia coli, Klebsiella spp., and Pseudomonas aeruginosa, which often exhibit resistance to multiple antibiotics. Empirical therapy should be tailored based on antibiograms to avoid resistance development and ensure effective treatment. Result: Antimicrobial resistance (AMR) among uropathogens is a significant global challenge, with varying resistance profiles across pathogens. E. coli demonstrated moderate susceptibility to ampicillin and piperacillin-tazobactam but showed high resistance to amoxicillin-clavulanate and ceftriaxone. K. pneumoniae exhibited extensive resistance, including 100% resistance to several antibiotics, though partial susceptibility to some aminoglycosides and ceftazidime was observed. P. aeruginosa displayed multidrug resistance, with susceptibility limited to carbapenems like imipenem and meropenem. Acinetobacter species showed pan-resistance to all tested antibiotics, highlighting a severe clinical threat. These findings stress the urgent need for antimicrobial stewardship, novel therapies, and robust resistance surveillance systems. Conclusion:  We concluded that CAUTI continued to pose a serious threat to patient safety and to the infection control team. A major factor in lowering CAUTI rates, which in turn lowers patient morbidity and hospital stays, is the implementation of appropriate care bundles and ongoing training for healthcare professionals. Multidrug-resistant uropathogens such as E. coli and Klebsiella spp.

Background: CA125 (Cancer Antigen 125) is a tumor marker associated with ovarian cancer. It is gradually becoming apparent that it is also elevated in various conditions associated with inflammation or fluid overload. Similar to heart failure patients (Núñez et al., 2016),1 in chronic kidney disease patients on hemodialysis, who experience both fluid overload and inflammation, CA125 may potentially serve as a prognostic marker. Experimental evidence demonstrates that mechanical stretch directly upregulates expression of “MUC16” , the gene for CA125, secreted from mesothelial cells (Huang et al., 2013),2 providing a mechanistic basis for CA125 elevation in volume overload states. Objective: To investigate the correlation between CA125 levels and routine biochemical parameters (albumin and sodium) in maintenance hemodialysis patients, explore its potential as an early warning biomarker for patients at risk of developing hypoalbuminemia, and to explore gender-based differences in these relationships. Methods: This cross-sectional study analyzed 122 maintenance hemodialysis patients at a tertiary care government hospital in Eastern India. Complete data for CA125, albumin, and sodium was available for 87 patients. Serum albumin and sodium were measured using Beckman Coulter AU480, while CA125 was measured by chemiluminescent immunoassay. Statistical analysis included correlation analysis and ANOVA using R software version 3.6.1. To assess the diagnostic value of CA125 in identifying hypoalbuminemia, an analysis using receiver operating characteristic (ROC) curves was conducted (4.0 g/dL based on KDOQI). Multiple regression examined factors independently associated with log(CA125).A Results: The study population had a mean age of 47.9 ± 12.8 years with balanced sex distribution (M:F ratio 1.1:1). CA125 showed a log-normal distribution (p<10⁻¹⁶) with median 12.45 U/ml. Albumin demonstrated significant negative correlation with log CA125 (r=-0.47, p=0.000006). Among patients with elevated CA125 (>35 U/ml), 22.2% (4/18) had hypoalbuminemia (<3.5 g/dl) compared to only 1.4% (1/69) in those with normal CA125 (p<0.05). The albumin-sodium correlation was positive overall (r=0.20, p<0.00001) but showed progressive strengthening across CA125 tertiles, with only the high CA125 group showing significant correlation. Patients with hypoalbuminemia or hyponatremia had 5-fold higher mean CA125 (129.8 vs 26.1 U/ml). Gender analysis revealed stronger albumin-sodium correlation in females (r=0.35) compared to males (r=0.12). ROC analysis revealed that CA125 had excellent diagnostic accuracy for predicting hypoalbuminemia (<4.0 g/dL), with an AUC of 0.861 (95% CI: 0.791-0.932, p<0.001). The optimal cutoff value of 12.25 U/ml yielded a sensitivity of 77.1% and specificity of 80.7%. In multiple analysis, albumin remained significantly associated with log(CA125) after adjusting for confounders. Conclusion: High CA125 levels in hemodialysis patients correlate with dysregulation of albumin and sodium homeostasis, suggesting its potential as an early warning biomarker rather than a diagnostic replacement for albumin. CA125 reflects underlying pathophysiological processes (mesothelial stress, inflammation, volume overload) that precede overt hypoalbuminemia, making it valuable for risk stratification and targeted intervention. The stronger correlations observed in females warrant further investigation into gender-specific applications of CA125 monitoring in dialysis patients.

Background: Emerging evidence highlights the critical role of the maternal microbiome in modulating immune, metabolic, and hormonal functions during pregnancy. Alterations in microbial communities may contribute to adverse pregnancy outcomes such as preeclampsia, preterm birth, gestational diabetes mellitus (GDM), and intrauterine growth restriction (IUGR). This longitudinal study investigates the association between maternal microbiome composition and pregnancy outcomes across the three trimesters. Materials and Methods: A prospective cohort of 120 pregnant women aged 20–35 years was recruited at <12 weeks gestation and followed through delivery. Vaginal, oral, and fecal microbiome samples were collected at each trimester. 16S rRNA gene sequencing was used for microbial profiling. Pregnancy outcomes assessed included gestational age at delivery, incidence of GDM, hypertensive disorders, and neonatal birth weight. Alpha and beta diversity indices were calculated, and associations with outcomes were analyzed using multivariate regression models. Results: Out of 120 participants, 112 completed the study. Women who developed preeclampsia (n=14) showed significantly lower vaginal microbial diversity in the second trimester (Shannon index mean: 2.1±0.4) compared to normotensive women (3.5±0.6; p<0.001). Higher relative abundance of Prevotella and Gardnerella in the vaginal microbiome was significantly associated with preterm birth (n=11; OR=2.8, 95% CI: 1.4–5.6). Gut microbial dysbiosis characterized by a lower Firmicutes/Bacteroidetes ratio was observed in GDM cases (n=16) during the third trimester (p=0.02). No significant changes were observed in oral microbiome patterns across groups. Conclusion: This study underscores the dynamic nature of the maternal microbiome and its potential predictive value for pregnancy complications. Specific microbial shifts, particularly in the vaginal and gut environments, are associated with adverse outcomes such as preeclampsia, preterm birth, and GDM. Monitoring maternal microbiome profiles may serve as a non-invasive tool for early identification of at-risk pregnancies and inform targeted interventions.

Background: Sickle cell disease (SCD) is a chronic hemoglobinopathy with diverse clinical manifestations and regional variation in India. Understanding its clinicodemographic distribution and crisis-related risk factors is crucial for effective management. This study aimed to assess the demographic profile and clinical presentation of adult SCD patients and examine factors associated with vaso-occlusive crises (VOC). Materials and Methods: A hospital-based cross-sectional study was conducted among 157 adult SCD patients at a tertiary care center in Eastern India from May 2023 to December 2024. Data on demographics, geographic origin, clinical features, and treatment history were collected. Clinical manifestations including VOC, hemolytic crisis, cholelithiasis, and acute chest syndrome were documented. Associations between VOC and demographic or clinical factors were analyzed using appropriate statistical tests. Results: Most participants were aged 21–30 years (49%), with a slight female predominance (52.9%). A significant proportion hailed from Nayagarh, Angul, and Khordha districts. VOC was the most common complication (61.8%), followed by hemolytic crisis (25.5%). VOC was significantly associated with younger age (p < 0.001), presence of splenomegaly (p = 0.001), and history of blood transfusions (p < 0.001). No significant association was observed with gender or hydroxyurea therapy. Other acute complications were infrequent. Conclusion: VOC is the most prevalent clinical manifestation among adult SCD patients in Eastern India, particularly affecting younger individuals with splenomegaly and a transfusion history. Geographical clustering suggests the need for targeted regional interventions. Identification of VOC-associated factors can guide individualized patient monitoring and resource allocation.

Background: Muscle oxygen saturation (SmO₂) reflects local oxygen utilization during exercise and is a vital indicator of muscular and cardiovascular efficiency. Near-infrared spectroscopy (NIRS) offers a non-invasive method to monitor real-time changes in SmO₂. This study aimed to compare SmO₂ dynamics during graded exercise in trained and untrained individuals to evaluate the impact of physical conditioning on oxygen kinetics. Materials and Methods: A total of 30 participants (15 trained athletes and 15 untrained healthy individuals) aged 18–30 years were recruited. All participants underwent a standardized incremental cycling protocol on an ergometer. Muscle oxygen saturation was continuously measured using portable NIRS devices placed on the vastus lateralis muscle. Heart rate, perceived exertion (RPE), and SmO₂ were recorded at baseline, each workload stage, and immediately post-exercise. Data were analyzed using repeated-measures ANOVA with significance set at p<0.05. Results: At rest, the mean SmO₂ was significantly higher in trained individuals (78.4% ± 3.2) compared to untrained individuals (72.1% ± 4.5). During peak exercise, SmO₂ decreased to 42.5% ± 5.3 in the trained group and 35.2% ± 6.1 in the untrained group (p=0.01). Trained participants demonstrated faster recovery in SmO₂ values post-exercise (return to baseline in 90 ± 12 seconds) compared to untrained individuals (130 ± 18 seconds). Heart rate and RPE were also significantly lower in the trained group at comparable workloads. Conclusion: Trained individuals exhibit higher baseline muscle oxygen saturation, reduced desaturation during exercise, and faster post-exercise recovery, indicating more efficient oxygen utilization. NIRS can serve as a reliable tool for assessing training status and monitoring exercise performance

Background: Chronic Kidney Disease (CKD) is a significant public health concern, and early detection is crucial for preventing disease progression. Ultrasound is an ideal imaging modality for CKD due to its non-invasive nature and accessibility. This study aimed to evaluate the correlation between renal cortical thickness, renal echogenicity, and renal size with eGFR in CKD patients. Research Question: Is there a correlation between renal cortical thickness, renal echogenicity, and renal size with eGFR in CKD patients? Methods: A one-year observational study was conducted at the Department of General Medicine, Mahatma Gandhi Medical College and Research Institute, Pondicherry, from January 2024 to December 2024. Ninety-one CKD stage 1-5 patients attending the General Medicine OPD were included in the study. Socio-demographic profiles, hemoparameters (eGFR, hemoglobin, serum sodium, serum potassium, serum calcium, serum phosphorus, serum creatinine, and blood urea), and ultrasound parameters (renal cortical thickness, renal echogenicity, and renal size) were studied. Results: The study population had a mean age of 55 years, with a higher burden of disease between 41-60 years (66%). Males (77%) had higher morbidity compared to females (23%). The mean values of hemoparameters were: hemoglobin (8.87 ± 1.94 g/dl), serum calcium (7.75 ± 1.04 mg/dl), serum phosphorus (3.89 ± 1.04 mg/dl), serum sodium (134.3 ± 3.14 mmol/L), serum potassium (6.17 ± 13.04 mmol/L), serum creatinine (3.57 ± 2.33 mg/dl), and blood urea (59.57 ± 23.16 mg/dl). The mean eGFR value was 24.92 ± 13.77 ml/min/1.73m². Significant abnormal values of hemoparameters were observed in relation to decreased eGFR and grading of renal echogenicity. There was a significant (P<0.01) reduction in mean values of eGFR, renal size, and renal cortical thickness with increasing renal echogenicity grade. A significant correlation was observed between renal cortical thickness, renal echogenicity, and renal size with eGFR. Conclusion: This study demonstrates a significant correlation between renal cortical thickness, renal echogenicity, and renal size with eGFR in CKD patients. These ultrasound parameters can be useful in monitoring disease progression and predicting renal function decline.

Background: Major open abdominal surgeries are associated with significant postoperative morbidity. Serum albumin, traditionally considered a nutritional marker, is also a dynamic indicator of surgical stress and systemic inflammation. While preoperative hypoalbuminemia is a known predictor of poor outcomes, the prognostic value of a postoperative drop in serum albumin remains underexplored. This study aimed to correlate postoperative serum albumin decline with the development of postoperative complications. Materials and Methods: A prospective observational study was conducted in the Department of General Surgery, KIMS, Bhubaneswar, from February 2023 to January 2025. Eighty-four adult patients undergoing elective major open abdominal surgeries (>2 hours duration) were included. Serum albumin levels were recorded preoperatively and at 6 hours, postoperative day (POD) 1, and POD 3. A drop ≥1 g/dL in serum albumin on POD1 was considered significant. Postoperative complications such as wound infections, sepsis, and anastomotic leaks were recorded. Statistical analyses included chi-square, t-test, ANOVA, and diagnostic accuracy metrics. Results: Postoperative complications were observed in 45 patients (53.6%). Significant associations were found between complications and age >60 years (p=0.018), male gender (p<0.001), BMI >25 (p=0.027), presence of comorbidities (p<0.001), surgery duration >3 hours (p<0.001), and blood loss >200 mL (p<0.001). A ≥1 g/dL drop in serum albumin on POD1 occurred in 71.1% of patients with complications, versus only 2.6% in those without (p<0.001). This drop showed strong predictive power: sensitivity 71.1%, specificity 97.4%, positive predictive value (PPV) 97%, negative predictive value (NPV) 74.5%, and diagnostic accuracy 83.3%. Moreover, a high correlation was observed between decreased albumin and elevated MPASS scores (p<0.001), reinforcing its role as a surgical stress marker. Conclusion: A postoperative serum albumin declines of ≥1 g/dL within 24 hours is a strong, early, and cost-effective predictor of postoperative complications in major open abdominal surgeries. Routine monitoring of serum albumin levels can significantly aid in identifying high-risk patients and guide timely interventions to improve clinical outcomes

Background: Bronchial asthma is one of the most prevalent chronic respiratory disorders affecting children globally. Effective pharmacotherapy is crucial in minimizing symptoms, improving quality of life, and preventing exacerbations. Through systematic monitoring of prescribed medications and vigilant documentation of any adverse events, this study intends to provide insights into drug safety, optimize therapeutic regimens, and enhance overall asthma care in pediatric populations.  However, adverse drug reactions (ADRs) associated with asthma medications, especially in the pediatric population, pose a significant clinical challenge. Materials and Methods: This prospective observational study was conducted over a period of 12 months in the pediatric Department and Pharmacology of a tertiary care hospital. Children aged 1–14 years diagnosed with bronchial asthma and receiving pharmacological treatment were included. Patients were followed throughout their hospital stay or during monthly outpatient visits for up to three months. During each visit, adherence, drug tolerance, and the emergence of new ADRs were assessed. Specific emphasis was placed on detecting ADRs related to long-term corticosteroid use (e.g., oral candidiasis, growth suppression) and β2-agonists (e.g., tachycardia, tremors). Results: Out of 150 pediatric patients enrolled, the majority were male (63.3%). A total of 47 ADRs were reported, with salbutamol being the most common offending agent. The majority of pediatric asthma cases were in the 7–10 years age group (30%). There was a male predominance (63.3%) in asthma incidence. SABA (especially salbutamol) was the most frequently prescribed agent (93.3%), followed by inhaled corticosteroids. Most ADRs were mild to moderate (93.6%), indicating manageable side effects. Most ADRs were classified as "Probable" (42.5%) or "Possible" (38.3%), indicating a moderate level of evidence linking the ADR to the drug. Only 10.6% were confirmed as “Certain,” emphasizing the diagnostic challenges in pediatric ADR surveillance. Conclusion: Pharmacotherapy in pediatric asthma is effective but not without risks. Active monitoring for ADRs, especially in long-term corticosteroid and β2-agonist use, is imperative. Patient and caregiver education, proper inhalation technique, and routine follow-ups are vital components of asthma management in children.

Background: Psoriasis is a chronic inflammatory skin disorder associated with systemic metabolic changes. Serum electrolytes and uric acid levels have been implicated in the pathophysiology of psoriasis. This study aims to evaluate and compare the serum electrolyte levels (sodium, potassium) and uric acid levels in psoriasis patients and healthy controls and to correlate serum electrolytes with uric acid in psoriasis patients. Materials and Methods: A case-control study was conducted at ACSR Government Medical College, Nellore, including 30 psoriasis patients and 30 age- and sex-matched healthy controls with exclusion criteria (Chronic alcoholics and smokers, people with hypertension, diabetes, personal or family history of metabolic disease, patients who were on oral contraceptives and any other medication, pregnant women, and postmenopausal women) . Serum sodium, potassium levels were analysed on ISE electrolyte analyser and uric acid levels were measured on semi auto analyser. Results: The mean and SD values of Serum Sodium (146.8 ± 4.5) were higher in cases compared to mean and SD (138.6 ± 3.8) of controls and mean and SD of Serum potassium (5.2 ± 0.5) were higher in cases compared to mean and SD (4.1 ± 0.4) of controls. The mean and SD of Serum Uric acid (6.8 ± 1.4) levels were higher in psoriasis patients compared to mean and SD (5.2 ± 1.1) of controls where the p value is <0.0001 and is considered highly significant and serum electrolytes shows positive correlation with uric acid where the p value is <0.0001 and is considered highly significant. Conclusion: Increased Serum sodium and potassium levels may reflect systemic inflammation, increased epidermal turnover and metabolic disturbances (hyperuricemia) in psoriasis patients. These findings emphasize the need for regular biochemical monitoring and to identify potential complications early.

Background: Idiopathic left fascicular ventricular tachycardia (ILFVT) is an uncommon, verapamil-sensitive arrhythmia that typically occurs in structurally normal hearts. Its presentation during pregnancy is rare, and management becomes more complex when accompanied by underlying congenital valvular abnormalities such as bicuspid aortic valve (BAV), aortic regurgitation (AR), and mitral valve prolapse (MVP). Prompt recognition and individualized multidisciplinary care are critical to ensure optimal maternal and fetal outcomes. Case Summary: We present the case of a 26-year-old primigravida at 32 weeks gestation who presented with palpitations and dizziness. Electrocardiogram revealed regular monomorphic ventricular tachycardia with right bundle branch block morphology and right axis deviation, consistent with ILFVT. Echocardiography incidentally revealed a bicuspid aortic valve with moderate aortic regurgitation and mitral valve prolapse. Initial pharmacological therapy with verapamil, amiodarone, and beta-blockers was ineffective; however, transcutaneous pacing successfully terminated the arrhythmia, followed by a positive response to oral verapamil. The patient was managed medically throughout pregnancy, with continuous fetal monitoring and serial echocardiography. At 38 weeks, she underwent elective cesarean section. Postpartum electrophysiological study confirmed reentrant ILFVT localized to the left posterior fascicle. Successful radiofrequency ablation was performed using CARTO 3D mapping with irrigated-tip catheter technology. She remained arrhythmia-free during a subsequent pregnancy and at three-year follow-up. Conclusion: This case highlights the rare occurrence of ILFVT in pregnancy complicated by valvular abnormalities. Transcutaneous pacing and verapamil can be effective in acute management. Definitive ablation postpartum offers excellent long-term outcomes. Early recognition, multidisciplinary coordination, and timing of intervention are key to successful management in such complex scenarios.

Background: Electrolyte imbalance is a common and critical complication in patients with end-stage renal disease (ESRD), particularly concerning sodium and potassium levels. Hemodialysis serves to correct these imbalances and improve clinical outcomes. Aim and Objective: To assess the pre- and post-hemodialysis levels of sodium and potassium among ESRD patients and analyze additional biochemical parameters including urea, creatinine, calcium, and phosphorus in a tertiary care setting. Material and Methods: This was a Cross-sectional study carried out in the Department of Biochemistry for a period of 24 months.  A total of 101 ESRD patients undergoing routine hemodialysis were enrolled. Pre- and post-dialysis sodium and potassium levels were recorded. Associated parameters such as urea, creatinine, calcium, and phosphorus were analyzed. Statistical analysis was done using SPSS version 26.0, employing t-tests and chi-square tests. Results: In the present study it was observed that significant decrease in potassium levels post-dialysis was observed (mean pre: 5.58±0.66 vs. post: 4.23±0.63, p < 0.001), while sodium levels showed a non-significant change (mean pre: 145.67±7.68 vs. post: 144.98±6.48, p = 0.140). Significant alterations were also found in serum urea, creatinine, calcium, and phosphorus. Conclusion: Hemodialysis significantly reduces hyperkalemia in ESRD patients but does not produce a statistically significant change in sodium levels. Continued biochemical monitoring is essential to mitigate complications and optimize treatment.

Background: Beta-thalassemia major (B-TM) is a hereditary hemoglobinopathy requiring lifelong transfusions, predisposing patients to iron overload and metabolic disturbances. Emerging evidence links B-TM to early vascular dysfunction and atherosclerosis, traditionally considered age-related. Altered lipid profiles and atherogenic indices may serve as early cardiovascular risk markers, yet comprehensive studies in pediatric populations remain limited. This study aims to assess lipid abnormalities and cardiovascular risk markers in transfusion-dependent B-TM children, enabling early intervention to mitigate long-term atherosclerotic complications and improve risk stratification in this vulnerable group. Methods: This prospective observational study was conducted at Hassan Institute of Medical Sciences (HIMS), Hassan, over five months (May–September 2023), involving 70 pediatric participants (35 beta-thalassemia major, 35 healthy controls). Eligibility criteria included children aged 2–18 years with transfusion-dependent beta-thalassemia receiving at least eight transfusions annually. Demographic, clinical, and biochemical parameters (CBC, lipid profile, serum ferritin, CRP, liver enzymes, blood glucose) were assessed. Results: Children with transfusion-dependent beta-thalassemia presented with significant hematological abnormalities, including lower hemoglobin (8.06 g/dL vs. 11.37 g/dL, p < 0.001) and severe iron overload (serum ferritin: 2080.70 ng/mL vs. 128.03 ng/mL, p < 0.001). They also show altered lipid metabolism, with higher total cholesterol, LDL, triglycerides, and VLDL, and lower HDL, contributing to increased cardiovascular risk. Atherogenic indices (TG/HDL ratio, Castelli’s Risk Index, AIP) were significantly elevated, indicating a greater propensity for premature cardiovascular complications. Liver dysfunction markers were also raised. These findings underscore the need for regular monitoring, early interventions, and optimized management strategies to mitigate long-term complications in beta-thalassemia patients. Conclusion: Children with transfusion-dependent B-TM major exhibit significant lipid profile abnormalities with higher LDL, triglycerides, and atherogenic indices, and lower HDL, increasing cardiovascular risk. These findings justify the need for regular lipid monitoring and early interventions to mitigate long-term cardiovascular complications in affected children.

Background: Heart failure is often complicated by renal dysfunction and lipid abnormalities, conditions that frequently share underlying risk factors such as hypertension, diabetes, and obesity. Heart failure and renal dysfunction are closely interlinked due to their common underlying risk factors like hypertension, diabetes mellitus and age. Dyslipidemia characterized by abnormal levels of cholesterol and triglycerides are prevalent in patients with heart failure due to shared risk factors like obesity, diabetes mellitus, and metabolic syndrome. Objective:  This study aimed to assess the relationship between serum lipid profiles and renal dysfunction in individuals newly diagnosed with heart failure at a tertiary care hospital in Gujarat. Methods:  A total of 168 patients diagnosed with heart failure were enrolled in a cross-sectional study conducted at GMERS Medical College and Hospital, Gotri, Vadodara. Renal function was evaluated using the Cockcroft-Gault equation, while lipid abnormalities were identified based on established clinical criteria. Data analysis was performed using SPSS software, with a p-value of less than 0.05 considered statistically significant. Results:  Among the participants, 47.02% were found to have renal dysfunction, and 51.79% had dyslipidemia. Notably, 72.15% of those with renal impairment also exhibited lipid abnormalities. A statistically significant association was observed between renal dysfunction and dyslipidemia (χ² = 24.77; p < 0.00001). Common comorbid conditions included hypertension and diabetes, and most patients were classified as overweight or obese. Conclusion:  The study findings suggest a strong association between renal dysfunction and dyslipidemia in heart failure patients. Monitoring lipid profiles may play a critical role in identifying patients at greater risk for renal complications, potentially guiding more targeted interventions.

Introduction: Respiratory allergies such as allergic rhinitis and bronchial asthma are major global health burdens, with rising prevalence, particularly in developing countries. Eosinophils play a pivotal role in the pathophysiology of allergic diseases, and Absolute Eosinophil Count (AEC) is considered a potential biomarker reflecting disease activity and severity. Objectives: To evaluate the correlation between Absolute Eosinophil Count and the clinical severity of respiratory allergic conditions. Materials and Methods: This cross-sectional observational study was conducted over 1.5 years at RKDF Medical College and Maharishi Devraha Baba Autonomous State Medical College. A total of 200 patients clinically diagnosed with respiratory allergies (allergic rhinitis and bronchial asthma) were included. AEC was measured and compared across mild, moderate, and severe grades of disease severity. Statistical analyses including correlation coefficients were applied. Results: The mean AEC values were significantly higher in patients with severe allergic symptoms (mean AEC 650 ± 82 cells/µL) compared to those with moderate (410 ± 65 cells/µL) and mild (270 ± 49 cells/µL) symptoms (p < 0.001). A strong positive correlation (r = 0.81) was observed between AEC and clinical severity score. Additionally, asthmatic patients demonstrated higher AEC values than those with isolated allergic rhinitis. Conclusion: AEC is significantly correlated with the clinical severity of respiratory allergy, particularly bronchial asthma. It serves as a simple, cost-effective, and readily available marker that may aid in disease monitoring and stratification of patients for appropriate therapeutic intervention

Introduction: Intrahepatic cholestasis of pregnancy is most common pregnancy related liver disorder and unique to pregnancy. It is characterised by pruritus with onset in the 2nd or 3rd trimester of pregnancy without skin rash, elevated serum amino transferases and bile acid levels and spontaneous relief of signs and symptoms within 2-3 weeks after delivery. Aims: To find out the adverse effects of intrahepatic cholestasis of pregnancy on feto- maternal outcomes. Materials & Methods: The present study was a prospective observational study. This Study was conducted from 1 ½ years (March 2018 to July 2019) at department of obstetrics and gynaecology in Chittaranjan Seva Sadan College of Obstetrics & Gynecology and Child Health. Total 100 patients were included in this study. Result: At 1 minute, 20% of new-borns had an APGAR score <6, while 80% had scores ≥6, indicating good initial adaptation. The occurrence of low APGAR scores was relatively limited but clinically significant. The result was statistically significant with a P value < 0.0001, suggesting a non-random distribution. At 5 minutes, 8.5% of new-borns had an APGAR score <6, while 91.5% showed improved scores ≥6, indicating better postnatal recovery. Though fewer new-borns had low scores at this stage, it remains clinically relevant. The distribution was statistically significant with a P value < 0.0001. Conclusion: Intrahepatic cholestasis of pregnancy (ICP) significantly impacts feto-maternal outcomes, predominantly affecting women in their prime reproductive age. This study highlights that ICP is associated with increased risks of adverse fetal events, including low birth weight, low APGAR scores, and a higher rate of NICU admissions, emphasizing the need for vigilant fetal monitoring.

Purpose: This study was conducted to explore the etiogical and clin profile of GI perforation in a tertiary care center located in a tribal region of Central India. Methods: A prospective observational study was conducted at the Department of Surgery in a tertiary hospital in Central India between January, 2024 to December, 2024 on patients who presented with GI perforation. Patients underwent detailed clinical evaluation, relevant investigations, surgical intervention, and postoperative monitoring. Data were analyzed using chi-square, Fisher’s exact test, and Student’s t-test to determine statistical significance. Results: A total of 105 patients were included in the study. The most affected age group was 21–30 years, and 76.2% of patients were male. Common etiologies included peptic ulcer (60%) and appendicitis (32.4%). The most frequent sites of perforation were prepyloric and appendicular regions. Conclusion: GI perforations remain a major surgical challenge in tribal populations, with peptic ulcers and appendicitis as leading causes

Background: Caesarean section has classically been defined as an operative procedure performed for the delivery of the fetus through a surgical incision made on the abdominal wall and an intact uterine wall after the period of viability. Aims: Analysis of leading groups contributing to the high caesarean section rates in a tertiary care hospital of West Bengal near Sundarbans area based on Modified Robson Ten Group Classification System (MRTGCS) Materials & Methods: The present study was conducted at Diamond Harbour Government Medical College and Hospital, West Bengal, over a period of 18 months, comprising 12 months of data collection followed by 6 months dedicated to data analysis. It was designed as an observational descriptive cross-sectional study, aiming to capture a snapshot of relevant clinical and demographic parameters within the study population at a single point in time. This design facilitated the assessment of prevalence and distribution patterns without manipulating study variables, thereby ensuring a comprehensive and unbiased representation of the existing scenario. Result: In our study, 8 (0.12%) patients had all abnormal lies (including previous Caesarean section but excluding breech), in Spontaneous labour 3 (0.04%) patients had all abnormal lies (including previous Caesarean section but excluding breech) in Induced labour, 14 (0.22%) patients had Caesarean section before labour, who had all abnormal lies (including previous Caesarean section but excluding breech). Association of All abnormal lies (including previous Caesarean section but excluding breech) with Group was statistically significant (p<0.0001). Conclusion: Enhanced antenatal counseling, standardized labor management, and adherence to clinical guidelines can help optimize caesarean delivery rates. This classification system proves to be a valuable tool in monitoring, auditing, and guiding clinical practices to improve maternal and neonatal outcomes

Background: Postoperative complications such as surgical site infections, deep vein thrombosis (DVT), and respiratory distress remain a major source of morbidity, prolonged hospitalization, and unplanned ICU admissions. Standard ward monitoring, performed intermittently, may miss early signs of deterioration. Advances in wearable sensor technology enable continuous, multiparameter monitoring, potentially allowing earlier recognition and intervention. Objective: To evaluate the efficacy of continuous wearable health-monitoring devices compared with standard intermittent monitoring in detecting early postoperative complications, and to assess their impact on clinical outcomes. Methods: This single-center, prospective, randomized controlled trial enrolled 200 adult postoperative patients undergoing major surgery. Participants were randomized 1:1 to wearable continuous monitoring (heart rate, respiratory rate, SpO₂, skin temperature, activity) or standard intermittent monitoring every 4–6 hours. The primary outcome was early complication detection rate. Secondary outcomes included time from physiological change to recognition, length of stay, ICU transfers, and 30-day readmissions. Results: Wearable monitoring nearly doubled overall early complication detection compared to standard care (30% vs 13%, p=0.01), with significant increases for surgical site infection (14% vs 7%, p=0.04), DVT (8% vs 3%, p=0.05), and respiratory distress (12% vs 5%, p=0.03). Mean detection was 7–11 hours earlier across complications (p<0.001). Wearable devices detected abnormal heart rate (+14 bpm), respiratory rate (+5 bpm), SpO₂ (-4%), and skin temperature (+1.2°C) several hours before clinical recognition. The wearable group had shorter hospital stays (5.6 ± 1.8 vs 7.4 ± 2.1 days, p=0.002), fewer ICU transfers (6% vs 14%, p=0.04), and fewer readmissions (8% vs 16%, p=0.03). Mortality differences were not statistically significant. Conclusions: Continuous wearable monitoring significantly improves early detection of postoperative complications, provides a substantial lead time for intervention, and is associated with reduced ICU transfers, readmissions, and hospital stay

Background: Pancreaticoduodenectomy (PD) is a complex procedure with significant morbidity, particularly in newly established Hepato-Pancreato-Biliary and Liver Transplant (HPB & LT) units. Methods: A retrospective cohort study analyzed 59 patients undergoing PD at a new HPB & LT department. Variables included demographics, diagnosis, intraoperative blood loss, hospital stay, and complications (Clavien-Dindo classification, ISGPS-defined postoperative pancreatic fistula [POPF] and delayed gastric emptying [DGE], post-pancreatectomy hemorrhage [PPH], surgical site infection [SSI] per Southampton Wound Scoring System, intra-abdominal abscess, bile leak, chyle leak). Statistical analyses used non-parametric tests, correlations, and Fisher’s Exact Test (p < 0.05). Results: Mean age was 51.8 ± 14.0 years; 57.6% were male. Periampullary carcinoma predominated (55.9%). PPH occurred in 1 patient (1.7%), POPF in 4 (6.8%), DGE in 22 (37.3%), SSI in 71.2%, intra-abdominal abscess, bile leak, and chyle leak in 3.4% each. Mean hospital stay was 8.1 ± 3.8 days. PPH was associated with a 25-day hospital stay vs. 7.8 ± 3.3 days for no PPH (p = 0.017). DGE (p = 0.001) and POPF (p = 0.045) prolonged hospital stays (9.8 ± 4.7 and 11.8 ± 6.7 vs. 7.8 ± 3.4 and 7.8 ± 3.4 days, respectively). SSI presence (p = 0.002) and severity (ρ = 0.60, p < 0.001) correlated with longer stays. Head of pancreas mass and IPMN trended toward higher complication severity (p = 0.08). Conclusion: SSI and DGE are primary morbidity drivers in PD, with POPF and PPH contributing significantly despite lower incidence. Enhanced infection control and complication monitoring are critical in new HPB units

Introduction: Sickle cell anaemia (SCA) is a hereditary haemoglobin disorder characterized by abnormal haemoglobin S (HbS), leading to chronic haemolysis, Vaso-occlusion, and a variety of systemic complications. The urinary albumin-to-creatinine ratio (ACR) is a sensitive marker for detecting microalbuminuria, a precursor to overt kidney disease. In this study we have determined urinary ACR in adults with both sickle cell disease (SCD) and trait (SCT) and compare the values between these two groups. Materials And Methods: In this cross-sectional study total 40 spot urine samples (20 trait and 20 disease) of patients attending outpatient department (OPD) /In patient department (IPD) of medicine in Assam Medical College and Hospital were collected over a period of 6 months. Spot urine micro albumin, urine creatinine analysis done on Vitros 5600 Autoanalyzer. Results: Mean ± SD of urinary ACR (61.04±42.79) in patients with SCD is significantly (p value is 0.0023) higher than that of patients with SCT (26.33±20.74). Additionally, the urinary ACR is higher in patients aged 31–40 (71.66±50.96) than in those aged 21–30 (41.74±6.83), or in those aged ≤20 (19.00±6.73) for all the study participants. Conclusion: Urinary ACR serves as a valuable marker for assessing renal dysfunction in adults with sickle cell disease and trait. Since ACR increases with age, it could be a useful monitoring tool in adults with sickle cell related hemoglobinopathies. Monitoring Urinary ACR in such patients may improve the overall management of patients affected by sickle cell-related renal complications.

Background: Sepsis is a life-threatening condition with significant cardiovascular implications, including sepsis-induced myocardial dysfunction, arrhythmias, and circulatory collapse. Although blood culture is the gold standard for etiological diagnosis, delayed results limit early targeted intervention. Biomarkers such as procalcitonin (PCT) and C-reactive protein (CRP) have gained prominence for early sepsis diagnosis, but their relationship with both microbiological confirmation and cardiac involvement in septic patients warrants further exploration. Objectives: To evaluate the correlation between serum PCT and CRP levels with blood culture positivity in suspected sepsis patients and to examine their association with cardiovascular dysfunction as assessed by clinical and echocardiographic parameters. Materials and Methods: A prospective observational study was conducted over 12 months in the Departments of Microbiology, Biochemistry, and Cardiology at a tertiary care hospital. Adults (≥18 years) fulfilling Sepsis-3 criteria were enrolled. Blood samples were collected prior to antibiotic administration for culture and measurement of serum PCT (chemiluminescent immunoassay) and CRP (immunoturbidimetry). Cardiac function was assessed using echocardiography and hemodynamic monitoring. Statistical analyses included ROC curve evaluation, correlation coefficients, and multivariate logistic regression. Results: Of the 210 patients, 92 (43.8%) had positive blood cultures. Gram-negative bacilli (56.5%) predominated. Median PCT and CRP levels were significantly higher in culture-positive patients (p < 0.001 and p < 0.01, respectively). Cardiovascular dysfunction, defined as ejection fraction <50% and/or elevated NT-proBNP, was present in 48.9% of cases and showed a strong positive correlation with elevated PCT (r = 0.68) and CRP (r = 0.54) levels. Combined biomarker assessment improved diagnostic accuracy for predicting both culture positivity and cardiac involvement. Conclusion: PCT demonstrated superior predictive value over CRP for culture-confirmed sepsis and cardiovascular dysfunction. Incorporating these biomarkers into early sepsis workup, alongside echocardiographic evaluation, can guide timely antimicrobial and hemodynamic interventions.

Introduction: Early detection of inflammatory progression in hospitalized patients is vital for timely intervention. Serum ferritin and C-reactive protein (CRP) are key acute-phase reactants, but the prognostic value of their serial measurements is underexplored. To assess the utility of serial ferritin and CRP measurements in predicting inflammatory progression during hospitalization. Methods: A prospective observational study was conducted among 73 adult inpatients with inflammatory conditions. Patients were classified into progression (n = 25) and no-progression (n = 48) groups based on clinical outcomes. Serum ferritin and CRP levels were measured on Days 1, 3, and 5. Intergroup comparisons, temporal trends, and independent predictors were analyzed using repeated measures statistics and logistic regression. Results: Baseline ferritin and CRP levels were significantly higher in the progression group (median [IQR]: 418.0 [184.8–549.5] ng/mL and 88.2 [62.2–103.3] mg/L) than in the no-progression group (128.6 [71.8–226.9] ng/mL and 23.1 [16.4–27.9] mg/L; p < 0.001 for both). CRP percent change from Day 1 to Day 5 showed excellent discrimination for progression (AUC 0.996; sensitivity 96%; specificity 100%; cut-off +33.6%). Logistic regression identified baseline CRP (OR 14.45, 95% CI 3.00–69.61, p = 0.001) and ferritin (OR 4.17, 95% CI 1.28–13.58, p = 0.018) as independent predictors. Conclusion: Serial monitoring of ferritin and CRP enhances early detection of inflammatory progression. A >33.6% CRP increase over five days is a strong predictor, warranting closer surveillance and potential intervention.

Background: Chemotherapy for tuberculosis (TB), though highly effective, is often associated with adverse drug reactions (ADRs) that may impact treatment adherence and outcomes. Pharmacovigilance studies are essential to identify and characterize these reactions in clinical practice. Objectives: To assess the incidence, pattern, causality, severity, and outcomes of chemotherapy-induced ADRs in patients with TB. Methods: This prospective observational study included 100 adult TB patients receiving anti-tubercular chemotherapy. Baseline demographics, clinical characteristics, and regimen details were recorded. ADRs were identified through active monitoring and evaluated for organ system involvement, causality (WHO–UMC criteria), and severity (Modified Hartwig scale). Outcomes were documented at follow-up. Data were analyzed descriptively. Results: The mean age was 42.6 ± 13.2 years, with a male predominance (62%). Pulmonary TB accounted for 72% of cases, and 84% received the standard HRZE regimen. ADRs occurred in 68% of patients, totaling 92 events, with a median onset of 14 days (IQR: 9–21). Multiple ADRs were noted in 19% of patients. Gastrointestinal (26.1%), hepatobiliary (21.7%), cutaneous (15.2%), and neurological (13.0%) systems were most frequently affected. Causality was probable in 47.8%, possible in 40.2%, and certain in 12.0% of cases. Severity grading showed 45.6% mild, 42.4% moderate, and 12.0% severe ADRs. Recovery occurred in 91.3%, residual effects in 6.5%, and mortality in 1.1%. Conclusions: ADRs to TB chemotherapy are common, predominantly gastrointestinal and hepatobiliary, and require early detection and management to optimize adherence and outcomes. Strengthened pharmacovigilance systems are vital in TB control programs

Background: Echocardiography (Echo.), through transthoracic (TTE) and transoesophageal (TEE) approaches, is a pivotal bedside tool in the intensive care unit (ICU) for rapid diagnosis and monitoring of cardiovascular emergencies. Its ability to provide real-time anatomical and functional assessment supports early recognition of life-threatening conditions and timely therapeutic interventions. Methods: A qualitative secondary data analysis was conducted using peer-reviewed literature, clinical guidelines, and retrospective case reports on ICU or high-dependency patients (≥18 years) evaluated with Echo. for suspected myocardial infarction. Data on echocardiographic findings, clinical presentation, and management outcomes were synthesised to assess diagnostic yield, therapeutic impact, and detection of post-MI complications.  Results: Echo. identified key pathologies including LV systolic dysfunction, segmental wall motion abnormalities, acute valvular lesions, pulmonary embolism, and pericardial tamponade. ACS evaluation frequently revealed LAD territory hypokinesia, prompting urgent interventions. Clinical management changed in 51.2% of studies, with immediate changes in 41.5%. Interventions included fluid therapy adjustment, vasoactive drug titration, urgent cardiac procedures, and pericardiocentesis. No procedure-related complications occurred.  Conclusion: Echo. enables early diagnosis of MI in ICU patients by detecting SWMAs and mechanical complications before clinical or biochemical confirmation. Its real-time integration into decision-making significantly influences treatment strategies, improving timeliness and precision of care

Background: The ketogenic diet (KD), characterized by high-fat, moderate-protein, and very low-carbohydrate intake, has garnered widespread attention for its therapeutic potential in various clinical conditions. Traditionally used in the management of refractory epilepsy, KD has evolved to demonstrate beneficial effects in metabolic disorders such as obesity, type 2 diabetes, and even neurological conditions like Alzheimer's disease. The core mechanism of KD involves shifting the body's primary energy source from glucose to ketone bodies, resulting in altered metabolic and physiological processes.  Materials and Methods This is a Case-control study was conducted in the Department of Physiology at Index Medical College. Data was collected from consenting participants attending the outpatient departments (OPD) of General Medicine and Physiology at Index Medical College and hospital from January 2023 to December 2024. Participants were recruited after meeting inclusion criteria and providing informed consent. Participants will follow a monitored KD consisting of <10% carbs, ~70% fats, and ~20% proteins. Participants will continue a balanced Indian diet based on standard dietary recommendations. Results The KD group demonstrated substantial reductions in CRP (−0.8 mg/L), IL-6 (−0.9 pg/mL), TNF-α (−1.3 pg/mL), and fecal calprotectin (~15% decline). These improvements are in agreement with several clinical and preclinical studies.  Conclusion While the anti-inflammatory and motility effects may hold clinical promise, caution is warranted regarding microbiota diversity and distal transit changes. Personalization and careful monitoring should guide KD implementation for gastrointestinal and immunological health optimization.

Introduction: Human Immunodeficiency Virus (HIV) infection in children is associated with a broad spectrum of mucocutaneous manifestations, which are often the first clinical indicators of underlying immunodeficiency. These manifestations range from common infections to neoplastic and inflammatory conditions and significantly affect quality of life, morbidity, and sometimes mortality in pediatric patients. Early recognition of these skin and mucous membrane lesions is crucial for timely diagnosis, initiation of antiretroviral therapy (ART), and prevention of further complications. Methods: This prospective study was conducted over a period of one year at the Calcutta School of Tropical Medicine. A total of 60 patients with confirmed Human Immunodeficiency Virus (HIV) infection presenting with mucocutaneous manifestations were included. Relevant demographic and clinical data, including age, gender, and body mass index (BMI), were recorded. Detailed evaluation of associated endocrine disorders, including thyroid, adrenal, pituitary disorders, and polycystic ovarian syndrome (PCOS), was performed. Comprehensive dermatological examination was carried out to document the type of skin manifestations and specific skin features. All data were systematically collected, compiled, and analyzed to assess the pattern and association of mucocutaneous lesions with clinical and laboratory parameters. Results: In this study of 60 HIV-infected children, most were aged 6–10 years, with no significant age or gender differences. Seventy percent were on ART, and shorter ART duration was significantly associated with higher lesion prevalence. Oral candidiasis was the most common mucocutaneous manifestation, followed by seborrheic dermatitis, bacterial infections, molluscum contagiosum, and herpes zoster. Lower CD4 counts and shorter ART duration were significantly linked to higher rates of oral candidiasis and other lesions. Conclusion: Mucocutaneous manifestations are highly prevalent in children with HIV infection and often reflect the degree of immunosuppression. Recognizing these lesions can aid in early diagnosis, monitoring disease progression, and guiding timely initiation of antiretroviral therapy. Pediatricians and dermatologists should maintain a high index of suspicion for HIV in children presenting with recurrent or atypical mucocutaneous lesions.

Background: Late preterm infants (34⁰–36⁶ weeks) are at increased risk of respiratory morbidity and other complications compared to term neonates. Antenatal corticosteroids have proven efficacy in improving neonatal outcomes in early preterm births, but their role in late preterm deliveries remains an area of active investigation. Objective: To evaluate the impact of antenatal corticosteroid administration on neonatal and maternal outcomes in women at risk of late preterm delivery. Methods: This prospective observational study included 120 women with late preterm pregnancies, divided into two groups: those who received a complete course of dexamethasone (n = 60) and those who did not (n = 60). Maternal and neonatal characteristics were recorded, and outcomes were compared using appropriate statistical tests. Results: Neonates exposed to corticosteroids required significantly less respiratory support (11.7% vs. 18.3%, p = 0.0022) and had fewer NICU admissions (11.7% vs. 20.0%, p = 0.018) compared with the non-steroid group. However, the incidence of neonatal hypoglycemia was higher in the corticosteroid group (23.3% vs. 15.0%, p = 0.0048). No significant differences were observed in neonatal resuscitation, surfactant use, APGAR scores, sepsis, or maternal complications such as chorioamnionitis. Mode of delivery was unaffected by corticosteroid use. Conclusion: Antenatal corticosteroid administration in late preterm pregnancies significantly reduces neonatal respiratory morbidity and NICU admissions but increases the risk of hypoglycemia. The therapy appears safe for mothers and should be considered in clinical practice, with appropriate neonatal glucose monitoring

Background - Chronic burn wounds are a worldwide challenge leading to morbidity and mortality in patients thus adding a great amount of socio-economic burden. Conventional dressing in chronic burn wounds intends to reduce the exudation of fluids and electrolyte loss but lack of cell therapy-based support function. In such scenario, freshly collected human amniotic membrane (HAM) possessing progenitor cells, cytokines, and growth factors support may enhance regenerative capacity. Objective - To focus on markers and mediators of wound healing thus evaluating the sequential histological, biochemical, and cytokine changes in chronic burn wounds treated with freshly collected HAM, and to correlate these findings with phases of wound healing. Method - In this study, placentas are collected from sero-negative mothers after proper consent. Freshly collected amniotic membrane was applied on 10 non – diabetic patients (Sample group) after having institutional ethical permission and proper informed consent and 10 patients were placed under the Control group who received conventional burn wound dressing. Investigations including biochemical and inflammatory markers studies, cytokines profiling and histology were being conducted to study the healing outcomes. Pain and wond closure assessment, wound infection if any, wound size measeurement and  duration of epithelialization were routinely monitored. Result - Dressing with freshly collected amniotic membrane showed a decrease in wound size, rapid epithelialization, lowering of pain score, and rare graft rejection. Histology demonstrated a clear transition from inflammation-rich granulation tissue without epidermal covering, to early/mid proliferation with active angiogenesis and fibroblast activity, late proliferation with organized collagen synthesis, and finally early remodeling with complete epithelialization. Serum albumin increased from 36→43.5 g/L and wound fluid albumin from 16→26 g/L; total protein rose in serum from 66.5→79.8 g/L and in wound fluid from 30→47 g/L. Wound fluid LDH (Lactate Dehydrogenase) decreased from 3820→2650 U/L, indicating reduced local tissue injury. TGF-β1 (Transforming Growth Factor – beta – 1) peaked mid-phase, supporting fibroblast proliferation, while IL-1β (Interleukin beta – 1) declined markedly by three months, reflecting inflammation resolution. Overall freshly collected amniotic membrane considered to be hypo-antigenic contains great potential to improve chronic burn wounds by regeneration with minimal scarring.  Conclusion - Sequential histology, combined with biochemical and cytokine markers, provided objective evidence of progressive healing in chronic burn wounds treated with HAM. The observed modulation of inflammatory and regenerative pathways supports HAM’s role as an effective, low-cost, and biologically active dressing, particularly beneficial in resource-limited settings. This integrated assessment approach may serve as a valuable model for monitoring chronic wound healing

Background: High-risk surgical patients frequently experience intraoperative haemodynamic fluctuations, which increase perioperative morbidity and mortality. Closed-loop anaesthesia delivery systems (CLADS), which automatically titrate anaesthetic drugs based on real-time feedback, are increasingly studied as tools to improve haemodynamic stability compared to conventional manual administration. However, evidence in high-risk populations remains limited. Materials and Methods: This prospective, randomized controlled trial included 120 high-risk surgical patients (ASA III–IV) undergoing major abdominal and thoracic procedures. Patients were divided into two groups: Group A (n=60) managed with CLADS, and Group B (n=60) managed with manual anaesthesia delivery. Haemodynamic parameters (mean arterial pressure [MAP], heart rate [HR]), intraoperative hypotensive episodes, total vasopressor requirement, anaesthetic drug consumption, and recovery times were recorded. Data were analyzed using Student’s t-test and chi-square test, with p<0.05 considered statistically significant. Results: Patients in Group A had significantly fewer episodes of hypotension (2.1 ± 1.4 vs. 5.7 ± 2.3 per case; p<0.001) and reduced vasopressor use (12.6 ± 4.3 mg vs. 24.2 ± 6.5 mg; p<0.01) compared to Group B. Mean MAP deviations from baseline were smaller in Group A (8.5 ± 3.2 mmHg) versus Group B (15.4 ± 5.8 mmHg; p<0.001). Anaesthetic drug consumption was lower in CLADS patients (propofol: 540 ± 110 mg vs. 670 ± 150 mg; p=0.02). Recovery times were shorter in Group A (12.4 ± 4.1 min vs. 18.7 ± 6.3 min; p=0.03). No major adverse events were noted. Conclusion: Closed-loop anaesthesia delivery systems significantly improved intraoperative haemodynamic stability, reduced vasopressor requirements, and shortened recovery time in high-risk surgical patients compared to conventional manual techniques. These findings support wider clinical adoption of CLADS to optimize outcomes in vulnerable patient populations

Introduction: Dengue fever, a mosquito-borne viral illness, varies from dengue fever (DF) to dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). This prospective study examines 80 dengue cases to explore associations between demographic factors, laboratory parameters, clinical severity, and outcomes. Materials and Methods: Prospectively 80 patients with confirmed dengue (NS1 and/or IgM positive) at a hospital. Data included age, gender, ABO blood group, fever duration, platelet count, haematocrit, severity, bleeding, hospital stay, and outcome. Severity was classified per WHO guidelines. Comparative analysis evaluated links between severity, bleeding, platelet count, haematocrit, and blood group. Trends in laboratory markers were assessed across severity groups. Results: 80 patients (53.75% male, 46.25% female, mean age 34.4 years), 47 had DF, 23 had DHF, and 10 had DSS. DSS cases had the lowest platelet counts (mean 28.8x10³/µL) and highest haematocrit (mean 51.4%). Bleeding occurred in all DHF and DSS cases but none in DF. DSS required the longest hospital stays (mean 11.9 days). Blood group distribution showed O (37.5%), A (28.8%), B (22.5%), and AB (11.2%), with more severity in O blood group and association (DSS 40% O, 30% A, 20% B, 10% AB). 1 DSS patient (age 85, female) died due to coronary heart disease; others recovered. Conclusion: Low platelet counts, high haematocrit, and bleeding strongly predicted dengue severity. Blood group O showed more severity. Prospective monitoring of key markers can guide early interventions, reducing severe outcomes, including mortality tied to comorbidities like coronary heart disease.

Background: Adjuvant agents are usually added to the local anesthetic agents during the use of subarachnoid block for prolongation of subarachnoid block for prolongation of both analgesic and anesthesia duration.  Aim: The present study was aimed to comparatively assess the efficacy of two different doses of 30 µg and 50 µg intrathecal clonidine as an adjuvant to the hyperbaric ropivacaine in subjects undergoing lower limb surgeries.  Methods: The present study assessed 180 subjects that were randomly divided into two groups of 90 subjects each where Group I subjects were given 3ml of 0.75% hyperbaric ropivacaine along with 30µg clonidine which was diluted with normal saline for total of 3.5mL volume. Group II subjects were given 50 µg clonidine with 3ml of 0.75% hyperbaric ropivacaine diluted with normal saline for total of 3.5mL volume. The study compared hemodynamic changes, complications, side-effects, sensory and motor blockade, and analgesia duration. Results: The study results showed that 30µg clonidine took longer time to reach highest spinal level with 12.4±1.24 minutes compared to 50µg clonidine that took 11.6±1.4 minutes with p=0.003. For two segment regression, time was significantly longer with 50µg clonidine compared to 30µg clonidine with p<0.001. Durations for motor and sensory block was also higher with 50µg clonidine compared to 30µg clonidine with p<0.001. Analgesia duration was significantly longer in 50µg clonidine group with p<0.001. Higher incidence of hypotension and bradycardia was seen with 50µg clonidine that were managed using standard interventions. Conclusion: The present study concludes that 50µg of intrathecal clonidine provides higher analgesic effects in comparison to 30µg clonidine. However, it is linked with a higher risk of hypotension and bradycardia. Timely interventions and careful watch and monitoring are vital when clonidine is used in higher dose compared to a low dose.

Introduction: Venous thromboembolism (VTE), encompassing both deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant postoperative complication in patients undergoing major oncologic surgeries, particularly those involving microvascular free flap reconstruction. Head and neck cancer patients are considered at elevated risk due to prolonged operative times, malignancy-associated hypercoagulability, and perioperative immobilization. However, the incidence of VTE in this specific surgical subset within the Indian population remains underreported. Objective: To evaluate the incidence of VTE in patients undergoing free flap reconstruction for head and neck cancer in a tertiary care institution in Eastern India, and to identify potential risk factors associated with its occurrence Methods: This retrospective observational study was conducted over a period of one year, from January 2024 to January 2025, at the Department of Head & Neck Surgery, IPGMER and SSKM Hospital, Kolkata, West Bengal, India. A total of 50 patients who underwent oral oncologic surgery with simultaneous reconstruction were included in the study. Clinical, surgical, and postoperative data were collected and analyzed to evaluate the incidence and associated risk factors for venous thromboembolism (VTE) in this high-risk surgical population. Results: The comparative analysis between VTE-positive (Group 1) and VTE-negative (Group 2) patients revealed no statistically significant differences in demographic, oncologic, or surgical variables. Although Group 1 showed slightly higher mean age, BMI, and rates of comorbidities, smoking, alcohol use, and prior VTE, none of these reached statistical significance. Tumor site, TNM stage, histological type and grade, as well as prior chemotherapy or radiotherapy, were also comparable between the groups. Surgical factors—including type of free flap used, duration of surgery, intraoperative blood loss, transfusion requirement, and number of vascular anastomoses—did not differ significantly between the two groups. However, certain postoperative factors showed significant associations with VTE occurrence. The use of DVT prophylaxis was significantly lower in Group 1 (p = 0.002), and postoperative mobility was also reduced (p = 0.035). Additionally, ICU stay was significantly longer in VTE-positive patients (p = 0.029). Although postoperative complications were more frequent in Group 1 and hospital stay was longer, these differences were not statistically significant. The mean time to VTE diagnosis was 6.1 ± 3.2 days postoperatively, underscoring the importance of early monitoring. Conclusion: This institution-based study highlights a notable incidence of VTE (5.9%) in patients undergoing free flap reconstruction for head and neck cancer. The findings underscore the need for vigilant perioperative thromboprophylaxis, early mobilization, and high clinical suspicion for early detection and management of VTE in this high-risk surgical cohort. Tailoring VTE prevention protocols based on individualized risk assessment may further reduce associated morbidity.

Background: Individuals with diabetes mellitus (DM) face a two- to four-fold higher risk of cardiovascular disease (CVD) compared to the general population, making cardiac health awareness and preventive practices critical. India, home to over 77 million diabetics, is experiencing a surge in diabetes-related cardiovascular morbidity and mortality. However, data on awareness, preventive behaviors, and emergency preparedness in this group remain limited. Materials and Methods: A descriptive, cross-sectional study was conducted using a structured, validated questionnaire distributed via Google Forms. The survey assessed socio-demographic characteristics, medical history, knowledge of cardiac risks and emergency measures (20-item questionnaire), and adoption of preventive practices. Participants (n = 400) were adults with self-reported diabetes residing in India. Knowledge scores were categorized as Excellent (16–20), Good (12–15), Fair (8–11), and Poor (0–7). Statistical analysis employed chi-square tests and multivariate logistic regression to identify determinants of good knowledge (SPSS v 25; p < 0.05 considered significant). Results: The majority of respondents were aged 45–54 years (34.5%), male (55%), and urban residents (61%). Type 2 diabetes predominated (90.5%), with 67% reporting hypertension and 48.5% dyslipidemia. While 77% recognized diabetes as a major cardiovascular risk factor and 71.5% understood the role of hypertension, only 38.5% knew optimal BP targets and 43% knew HbA1c goals. Awareness of CPR and aspirin use during emergencies was poor (46.5% and 42%, respectively). Preventive behaviors were inconsistent: blood glucose monitoring (93.5%) and medication adherence (84%) were high, but only 42% underwent regular cardiac check-ups and 46% engaged in daily physical activity. Overall, 17% achieved excellent knowledge, while 34.5% scored fair and 18% poor. Education (p < 0.001), urban residence (p = 0.002), and occupation (p = 0.008) were significantly associated with higher knowledge levels. Multivariate analysis confirmed education and prior CPR awareness as strong predictors. Conclusion: Cardiac health awareness among Indian diabetics remains suboptimal, with critical gaps in practical knowledge and emergency preparedness. Despite good adherence to basic diabetes management, comprehensive cardiovascular risk reduction strategies are inadequately practiced. Targeted interventions—emphasizing lifestyle modification, structured education, and community-based CPR training—are essential to mitigate the rising burden of diabetes-related cardiovascular complications in India

Background: Type 2 diabetes mellitus (T2DM) requires effective glycemic control to prevent complications. Combining agents with complementary mechanisms may improve outcomes. Objective: To evaluate the safety and efficacy of the repaglinide plus voglibose combination in T2DM patients over one year. Methods: A prospective study was conducted involving 180 T2DM patients receiving repaglinide plus voglibose. Glycemic parameters, including fasting blood glucose (FBG), postprandial blood glucose (PPBG), and HbA1c, were measured at baseline and after 12 months. Safety was assessed by monitoring adverse events and hypoglycemic episodes. Results: Significant reductions were observed in mean FBG (156.8 ± 28.5 to 120.5 ± 22.3 mg/dL), PPBG (240.3 ± 35.7 to 170.7 ± 28.1 mg/dL), and HbA1c (8.2 ± 0.7 to 6.9 ± 0.6%) after 12 months (p < 0.001 for all). The combination was well tolerated, with mild hypoglycemia reported in 6.7% of patients and mild gastrointestinal side effects. Conclusion: Repaglinide plus voglibose combination therapy is effective and safe for improving glycemic control in T2DM patients, offering a viable option for optimizing diabetes management.

Introduction: Meconium-stained amniotic fluid (MSAF) is a common obstetric complication associated with increased risk of adverse perinatal outcomes, including meconium aspiration syndrome (MAS), low Apgar scores, neonatal intensive care unit (NICU) admissions, and perinatal morbidity and mortality. The incidence of MSAF increases with gestational age, but it may also occur in preterm pregnancies. Understanding its impact across term, preterm, and postterm pregnancies is essential for timely obstetric interventions. Aims: To evaluate the perinatal outcomes of MSAF in term, preterm, and postterm pregnancies and to determine the association of MSAF with mode of delivery, MAS, Apgar scores, and neonatal morbidity. Materials and Methods: This was a prospective, comparative study conducted over one year, from 1st December 2019 to 30th November 2020, in the Department of Obstetrics and Gynecology at MR Bangur Hospital, Tollygunge, and Kolkata, which serves both rural and urban populations of South 24 Parganas district. The study included 108 booked antenatal cases attending the hospital’s antenatal clinic, enrolled according to predefined inclusion and exclusion criteria. Results: In our study, there was no statistically significant difference between cases and controls in terms of maternal age and gravidity (p = 0.546 and p = 0.841, respectively). However, birth weight and fetal heart rate showed significant differences between the two groups. A higher proportion of cases had birth weight <2 kg compared to controls (20.4% vs. 3.7%, p = 0.015). Similarly, fetal heart rate distribution differed significantly, with more cases having heart rate >120/min and fewer cases with heart rate <100/min compared to controls (p = 0.023). Conclusion: MSAF is associated with adverse perinatal outcomes, particularly in postterm pregnancies. Close fetal monitoring, timely obstetric intervention, and preparedness for neonatal resuscitation are crucial to improve neonatal outcomes. Early recognition and management of MSAF can reduce the risk of MAS and other complications

Background: Artificial intelligence (AI) has become more relevant in healthcare, especially in the management of chronic diseases, where precise diagnosis, long-term monitoring, and individualized interventions are paramount. Its potential aside, there are questions about how it would be integrated in clinical practice, within ethical considerations, and with equal access. Objective: This review sought to integrate current evidence concerning AI-supported diagnostic trends in chronic disease management, emphasizing technological developments, human aspects, and clinical implications. Methods: A narrative review approach was adopted, with literature sourced from PubMed, Scopus, and Web of Science. Studies published in the past decade were included if they evaluated AI applications in chronic illness diagnosis, decision support, or patient engagement. Data were thematically synthesized into domains of diagnostic accuracy, human–technology interaction, and access to care. Results: Evidence shows that AI models improve diagnostic accuracy across conditions including diabetes, hypertension, and cardiovascular disease, frequently outperforming traditional techniques. Clinical decision support systems enhanced workflow productivity and treatment customization. Conversational agents and remote monitoring devices improved patient engagement, especially in rural and under-resourced environments. Yet provider trust, transparency in systems, and ethical governance remain essential drivers of adoption. Comparative analysis with previous studies across oncology, osteoporosis, and pandemic response further affirmed AI’s cross-domain utility, while underscoring the importance of regulatory and methodological rigor. Conclusion: AI holds substantial promise in transforming chronic illness management, but its effectiveness will depend on transparent design, ethical integration, and alignment with human-centered care values.

Leptospirosis and scrub typhus, while significant causes of acute febrile illness in endemic regions, rarely lead to cardiac complications in children. This case report presents a unique instance of a 13-year-old previously healthy female who developed hypotension and sinus bradycardia during an episode of leptospirosis, which was successfully treated with doxycycline. However, the weeks following this initial episode saw the persistence of bradycardia, syncope, and left-sided chest pain, leading to a cardiology evaluation. Despite the absence of conduction block in serial ECGs and Holter monitoring, her symptoms continued until a second febrile episode—scrub typhus—again triggered symptomatic bradycardia. The patient responded well to doxycycline and a short course of corticosteroids, with complete resolution of symptoms and normalization of heart rate. This case highlights the potential of sequential tropical infections to precipitate functional sinus node disturbances in children and underscores the importance of including reversible infectious causes in the differential diagnosis of pediatric bradyarrhythmias.

Background: Dengue fever is a common mosquito-borne infection that may present with systemic and organ-specific complications. Cardiac manifestations, particularly electrocardiographic (ECG) changes, are increasingly recognized in patients with dengue. Correlation of these cardiac abnormalities with established warning signs may provide critical prognostic information. Aim: To study cardiac manifestations in patients presenting with dengue infection and to observe electrocardiographic changes, with special emphasis on correlation with warning signs of dengue. Material and Methods: This observational study included 120 patients with laboratory-confirmed dengue infection. Baseline clinical data, warning signs, and 12-lead ECGs were obtained and analyzed. ECG abnormalities were correlated with clinical warning signs using appropriate statistical tests. Results: The most frequent ECG abnormality was sinus bradycardia, followed by sinus tachycardia and conduction disturbances. ECG abnormalities showed significant correlations with abdominal pain, mucosal bleeding, fluid accumulation, shock, respiratory distress, and ARDS, whereas persistent vomiting, lethargy, and hepatomegaly did not show significant associations. Conclusion: ECG monitoring should be considered an essential part of the evaluation of dengue patients, especially those presenting with warning signs, as it can facilitate early identification of cardiac involvement and improve management outcomes.

Background: Perinatal asphyxia is a major cause of neonatal morbidity and mortality, often associated with hypoxic-ischemic encephalopathy (HIE) and multi-organ dysfunction. Among affected organs, the kidneys are particularly vulnerable, leading to acute kidney injury (AKI). Aim: To evaluate renal function among term neonates with perinatal asphyxia and assess its correlation with the degree of HIE. Material and Methods: A prospective case–control study was conducted including 120 term neonates, of which 60 had perinatal asphyxia (cases) and 60 were healthy controls. Renal function was assessed using serum creatinine, creatinine clearance, urine output, and urinary indices. Data were analyzed to compare renal function parameters between groups and correlated with the severity of HIE. Results: Asphyxiated neonates demonstrated significantly reduced creatinine clearance and urine output compared to controls. Urinary indices including FeNa, renal failure index, and osmolality were markedly altered. Severity of renal dysfunction was positively correlated with the stage of HIE. Conclusion: Perinatal asphyxia significantly impairs renal function in term neonates, with dysfunction correlating with HIE severity. Early recognition and monitoring are crucial to reduce morbidity and prevent long-term renal complications.

Background: Non-healing ulcers are chronic wounds that fail to progress through normal healing due to factors like poor circulation, infection, or underlying conditions. Freshly collected human amniotic membrane (HAM) has emerged as an effective biological dressing due to its anti-inflammatory, anti-microbial, and regenerative properties. Rich in growth factors and extracellular matrix components, HAM promotes tissue repair, reduces scarring, and accelerates healing, making it a promising treatment for managing non-healing ulcers Objective: The objective is to assess the role of freshly collected human amniotic membrane as a biological dressing in chronic non-healing ulcers by evaluating its impact on pro-angiogenic growth factor expression, endothelial and vascular markers, histopathological tissue regeneration, and modulation of cytokine levels. Method: Fresh human amniotic membrane was aseptically collected from consenting mothers undergoing elective cesarean section after screening for infections. The membrane was washed in sterile saline, trimmed, and immediately applied to chronic non-healing ulcers in 15 patients (study group). The control group (15 patients) received conventional dressing. All procedures followed ethical guidelines with informed consent from both donors and recipients, ensuring sterility and prompt application to preserve bioactivity. Healing outcomes were assessed through biochemical analysis, growth factor and cytokine profiling, and histological examination. Regular monitoring included pain score, wound size measurement, infection status, and duration of epithelialization. Results: After applying HAM as a biological dressing on chronic non-healing ulcers in 15 patients, significant improvements were observed compared to 15 control patients treated with conventional dressings. Clinically, the HAM group showed a greater wound size reduction (60% vs.30 %, p<0.01), enhanced granulation tissue formation, decreased pain scores, and reduced exudate levels.Histopathological analysis revealed increased neovascularization, demonstrated by higher microvessel density along with thicker epithelialization and reduced inflammatory infiltrate in the HAM group.VEGF levels in wound tissue and exudate were significantly elevated (4.2-fold increase, p<0.01) in the HAM group, alongside increased basic fibroblast growth factor (bFGF) and platelet-derived growth factor (PDGF), supporting enhanced angiogenesis and tissue regeneration.Blood parameters showed reduced systemic inflammation markers, including lower CRP and normalized white blood cell counts in the HAM group. These findings collectively indicate that fresh HAM promotes accelerated vascular regeneration and healing compared to conventional dressings. Conclusion: Fresh human amniotic membrane significantly improved healing outcomes in non-healing ulcer patients compared to conventional dressings. It accelerated wound closure, enhanced granulation tissue formation, and reduced pain and exudate. Improved histopathology and increased angiogenic growth factors like VEGF supported better vascular regeneration. Reduced inflammatory markers and normalized blood parameters further confirmed its effectiveness as a superior biological dressing.

Background: Gestational hypertension is a common complication of pregnancy, often requiring antihypertensive medication. Labetalol, a combined alpha- and beta-blocker, is frequently used. However, its use has been associated with potential neonatal complications, including hypoglycemia and bradycardia, due to its ability to cross the placenta. This study aims to investigate the prevalence and characteristics of neonatal hypoglycemia and bradycardia in newborns born to gestational hypertensive mothers treated with labetalol at Trichy SRM Medical College. Methods: This was an prospective observational study conducted at Trichy SRM Medical College by collecting data from newborns born to gestational hypertensive mothers. The study population included all newborns of mothers diagnosed with gestational hypertension, with a specific focus on those exposed to maternal labetalol therapy. Data on maternal demographics, gestational hypertension characteristics, labetalol usage (dose, duration), and neonatal outcomes (birth weight, APGAR scores, presence of hypoglycemia and bradycardia, levels, NICU admission, duration of stay) were collected and analyzed. Detailed descriptive statistics, including frequencies, percentages, means, and standard deviations, were calculated. Graphical representations were used to visualize key findings. Results: The study included 50 newborns born to gestational hypertensive mothers. Of these, 22 (44%) were exposed to maternal labetalol therapy1. Neonatal hypoglycemia was observed in 30 (60%) of the total newborns 2, with an average blood glucose of 37.84 mg/dL3. Neonatal bradycardia was present in 20 (40%) of the total newborns 4, with an average heart rate of 94.74 bpm5. In the labetalol-exposed group, 14 (63.6%) experienced hypoglycemia and 12 (54.5%) experienced bradycardias. Further detailed statistics are presented in the results section. Conclusion: The findings suggest a notable prevalence of neonatal hypoglycemia and bradycardia in newborns of gestational hypertensive mothers, including those exposed to maternal labetalol. While this observational study cannot establish causality, the observed trends warrant further investigation into the precise relationship between maternal labetalol use and these neonatal adverse events. Close monitoring of blood glucose and heart rate is recommended for newborns of mothers receiving labetalol for gestational hypertension.

Introduction: Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease and end-stage renal failure. Early detection of renal hemodynamic changes is crucial as functional impairment often precedes overt biochemical derangements. Doppler ultrasound provides a non-invasive means of assessing intrarenal vascular resistance indices, particularly the resistive index (RI) and pulsatility index (PI). However, limited consensus exists on their diagnostic value in DKD when compared with conventional biochemical markers. Material and Methods: This cross-sectional study was conducted in the Department of Radiology, including 100 patients with type 2 diabetes mellitus and evidence of DKD. All participants underwent renal ultrasound and Doppler evaluation using a high-resolution machine with a 3.5–5 MHz curvilinear probe. RI and PI were measured in the main, segmental, and interlobar arteries. Biochemical investigations included fasting blood glucose, glycated hemoglobin (HbA1c), serum creatinine, blood urea, estimated glomerular filtration rate (eGFR, CKD-EPI), and urinary albumin excretion. Correlations between Doppler and biochemical parameters were analyzed using Pearson’s correlation. Results: The mean RI was 0.73 ± 0.06, and the mean PI was 1.35 ± 0.18. RI correlated positively with serum creatinine (r = 0.46, p < 0.001) and urinary albumin excretion (r = 0.42, p < 0.01), and negatively with eGFR (r = –0.41, p < 0.001). HbA1c showed a mild but significant correlation with RI (r = 0.32, p < 0.05). Violin and box plots demonstrated progressive increases in RI across albuminuria categories (normo-, micro-, macroalbuminuria) and CKD stages (G1–G5). Bland–Altman analysis confirmed good repeatability of RI measurement. Conclusion: Renal Doppler indices, especially RI, are strongly associated with key biochemical markers of renal function and disease severity in DKD. Doppler ultrasound offers a reliable, non-invasive adjunct to biochemical assessment and may facilitate earlier detection and monitoring of DKD progression. Larger longitudinal studies are warranted to establish prognostic thresholds and validate the role of RI/PI in risk stratification.

Background: Intraoperative awareness under general anaesthesia, though rare, can lead to severe psychological consequences. This study compares the efficacy of propofol and dexmedetomidine in preventing intraoperative awareness in patients undergoing open cholecystectomy. Objectives: To evaluate and compare the incidence of intraoperative awareness and explicit recall using propofol versus dexmedetomidine infusions during open cholecystectomy surgeries under general anaesthesia, and to assess their effects on intraoperative hemodynamic parameters. Methods: A prospective, randomized, single-blind study was conducted on 60 ASA I & II patients aged 18–65 years undergoing open cholecystectomy in a resource-limited setting. Patients were randomized into two groups (n=30): Group P received propofol (2 mg/kg induction, 0.25 mg/kg/hr infusion), and Group D received dexmedetomidine (1 mcg/kg bolus over 10 minutes, followed by 0.5 mcg/kg/hr infusion). Hemodynamic parameters and intraoperative awareness were assessed using the Brice Questionnaire 24 hours post-extubation. Results: Intraoperative awareness was reported in three patients (two definite, one possible) in the propofol group and none in the dexmedetomidine group. Hemodynamic parameters (MAP, HR) were more stable in the dexmedetomidine group at key surgical milestones. Mild bradycardia occurred in three patients in Group D. Statistical analysis showed a significant difference in awareness incidence (p = 0.04) and MAP changes during intubation and incision (p < 0.005). Conclusion: Both dexmedetomidine and propofol reduce intraoperative awareness, but dexmedetomidine demonstrated superior effectiveness and hemodynamic stability. In resource-limited settings where BIS monitors are not available, tools like the Brice Questionnaire offer a viable and accessible method for assessing awareness.

Introduction: Feto-maternal haemorrhage (FMH) is the transplacental passage of fetal blood into the maternal circulation, which can lead to significant clinical consequences such as fetal anemia, alloimmunization, and even fetal demise. This study aims to evaluate the incidence, volume, and clinical implications of FMH during the third trimester of pregnancy and the immediate postpartum period in a sample size of 90 women. Materials and Methods: A prospective observational study was conducted on 90 pregnant women in their third trimester and immediate postpartum period. Inclusion criteria included singleton pregnancies with no known placental abnormalities, while exclusion criteria included multiple pregnancies, placental abruption, and preeclampsia. FMH was detected using the Kleihauer-Betke (KB) test and flow cytometry. Results: The incidence of FMH was 11.1% (10/90) during the third trimester and 16.7% (15/90) in the immediate postpartum period. The mean volume of FMH was 4.2 mL in the third trimester and 14.8 mL postpartum. Significant associations were found between FMH and maternal age, parity, and mode of delivery. Five tables summarize the findings, including demographic data, FMH incidence, volume, and clinical outcomes. Conclusion: FMH is a significant clinical event with a higher incidence in the immediate postpartum period. Early detection and monitoring are crucial to prevent adverse fetal outcomes. Further research is needed to establish standardized protocols for FMH screening and management

Introduction: Pulmonary hypertension (PH) is a serious complication of interstitial lung disease (ILD) that worsens functional status and survival. While right heart catheterization is the diagnostic gold standard, echocardiography provides a practical non-invasive screening tool. This study aimed to determine the prevalence of PH among ILD patients using echocardiography and to evaluate associated clinical and echocardiographic correlates. Methods: A cross-sectional observational study was conducted on 140 patients with ILD at a tertiary care hospital. Patients underwent detailed clinical assessment, high-resolution computed tomography, and echocardiographic evaluation. PH was defined as an estimated systolic pulmonary artery pressure (sPAP) >35 mmHg. Echocardiographic parameters, demographic data, and functional indices were compared between patients with and without PH. Statistical analyses included t-tests, chi-square tests, and logistic regression where appropriate. Results: Of 140 ILD patients, 48 (34.3%; 95% CI: 26.9-42.5) had echocardiographic evidence of PH. Prevalence was highest in idiopathic pulmonary fibrosis (51.3%) and lowest in sarcoidosis (16.7%). Patients with PH had significantly higher mean sPAP (52.7 ± 8.1 vs. 28.9 ± 4.6 mmHg, p<0.0001), larger RV basal diameter, reduced TAPSE, and higher frequency of right atrial enlargement and RV dysfunction. Clinically, PH patients were older, had longer ILD duration, poorer 6-minute walk distance, lower resting oxygen saturation, reduced DLCO, and greater need for long-term oxygen therapy. Conclusion: PH is prevalent in one-third of ILD patients, with higher frequency in fibrotic subtypes. Echocardiography remains a valuable tool for early detection and risk stratification. Recognition of PH in ILD should prompt closer monitoring, supportive interventions, and consideration of advanced therapies.

Artificial intelligence (AI) is becoming an important part of modern healthcare, and anesthesiology is one of the fields where it can make a big difference. AI uses computer methods such as machine learning (ML), deep learning (DL), natural language processing (NLP), and computer vision to support doctors in their work. In anesthesia, these tools can improve patient safety, make drug delivery more accurate, reduce errors, and improve the efficiency of the operating room. AI can help before surgery by predicting risks, during surgery by monitoring depth of anesthesia, blood pressure, and breathing, and after surgery by predicting complications like nausea, delirium, or death. Closed-loop drug delivery systems, robotic airway management, and AI-based monitoring are new areas where progress is happening fast. Clinical decision support systems (CDSS) and AI-based intensive care monitoring also show promise. Despite many advantages, there are challenges. Data privacy, algorithm bias, medico-legal issues, high cost, and lack of training remain big concerns. For AI to be widely used, it must be safe, fair, cost-effective, and well-integrated into hospital systems. In the future, AI may allow fully personalized anesthesia, autonomous systems that can deliver anesthesia on their own, and the use of virtual and augmented reality for better guidance and training. Federated learning and continuous learning systems will also make AI safer and more reliable. With responsible use and teamwork between doctors, engineers, AI can make anesthesia safer, more effective, and more patient-centered.

Background: The Correlation between total serum calcium, ionic calcium, and the severity of birth asphyxia is an important area of research in neonatal care.  Birth asphyxia remains a significant contributor to neonatal morbidity and mortality. Among the various biochemical disturbances associated with hypoxic-ischemic events, calcium imbalance—especially hypocalcemia—plays a crucial role in worsening clinical outcomes. Aim: This study evaluates the correlation between total serum calcium, ionic calcium levels, in severity of birth asphyxia. Material and Methods: This prospective observational study was conducted over one year in the Department of Paediatrics at a tertiary care teaching hospital. A total of 80 term neonates were enrolled and divided into two groups: Group A (n=40) included neonates with birth asphyxia, and Group B (n=40) included healthy term neonates. Total serum calcium was measured using the Arsenazo III method, and ionized calcium was assessed using an ion-selective electrode technique. Blood samples were collected within six hours of life. Data were analyzed using SPSS version 25, with p<0.05 considered statistically significant. Results: The mean total serum calcium in the asphyxiated group was 7.12 ± 0.65 mg/dL, significantly lower than 8.42 ± 0.52 mg/dL in controls (p<0.001). Hypocalcemia (<7 mg/dL) was observed in 45% of Group A versus 5% in Group B. The mean ionized calcium level in Group A was 0.92 ± 0.14 mmol/L, significantly lower than 1.15 ± 0.12 mmol/L in Group B (p<0.001), with 60% of Group A showing ionized hypocalcemia compared to 10% in controls. A significant positive correlation was found between Apgar scores at 5 minutes and both total calcium (r=0.48, p=0.002) and ionized calcium (r=0.52, p<0.001). Conclusion:  Neonates with birth asphyxia exhibit significantly lower levels of both total and ionized calcium compared to healthy neonates. The high prevalence of hypocalcemia and its association with lower Apgar scores highlight the need for routine calcium monitoring and timely correction to improve neonatal outcomes.

Background: Accurate and timely arrhythmia detection in acute coronary syndrome (ACS) is critical for improving outcomes. Artificial intelligence (AI)–enabled ECG interpretation may offer advantages over conventional physician reporting. Objective: To compare the diagnostic performance of AI-assisted versus conventional ECG interpretation in predicting arrhythmias among ACS patients. Methods: In this prospective diagnostic accuracy study, 1,000 ACS patients underwent ECG evaluation using both an AI-based system and physician interpretation. Confirmed arrhythmic events from continuous cardiac monitoring served as the reference standard. Diagnostic metrics (sensitivity, specificity, AUC), agreement (Cohen’s κ), and time to diagnosis were assessed. Results: AI interpretation achieved higher sensitivity (97.5% vs. 86.7%), specificity (91.8% vs. 81.7%), and diagnostic accuracy (93.4% vs. 83.1%) compared to physician reporting (p < 0.001). The AUC was significantly greater for AI (0.991; 95% CI: 0.987–0.995) than for conventional methods (0.919; 95% CI: 0.899–0.937). AI also reduced time to diagnosis (1.8 ± 0.6 min vs. 6.5 ± 1.2 min; p < 0.001). Agreement with the reference standard was higher for AI (κ = 0.85) than for physicians (κ = 0.67). Conclusion: AI-assisted ECG interpretation demonstrated superior diagnostic accuracy and efficiency in detecting arrhythmias in ACS patients. Its integration into acute cardiac care may enhance early triage and treatment, though further validation is warranted.

Background: Influenza A (H1N1) continues to cause significant morbidity and mortality worldwide, with variable clinical presentations and outcomes. Periodic evaluation of its clinical profile, associated comorbidities, radiological features, and outcomes is essential to improve case management and identify high-risk groups.Objective:To study the clinical profile, comorbidities, radiological findings, and outcomes of RT-PCR–confirmed H1N1 patients admitted to a tertiary care hospital. Methods This prospective cross-sectional analytical study was conducted in the Department of Internal Medicine, Max Super Specialty Hospital, Saket, New Delhi, from May 2019 to April 2020. A total of 207 adult patients with RT-PCR–confirmed H1N1 infection were included. Data regarding demographics, clinical features, comorbidities, laboratory investigations, chest radiographs, ICU admission, ventilatory support, and outcomes were recorded. Statistical analysis was performed using SPSS version 21.0, with chi-square applied; p < 0.05 was considered statistically significant. Results Males constituted 64% of cases, and the majority were in the 51–60 years age group (32%). Fever (88%) and dry cough (80%) were the most common symptoms. Breathlessness, myalgia, sore throat, coryza, and diarrhea showed significant associations with mortality (p < 0.001). Hypertension (37%) and diabetes mellitus (33%) were the leading comorbidities, with all comorbidities significantly associated with death. Laboratory abnormalities including anemia, leukocytosis, thrombocytopenia, and deranged liver and kidney function were significantly higher among non-survivors. Abnormal chest radiographs were present in 61% of patients and were significantly associated with mortality (p = 0.011). Overall mortality was 6%. Conclusion H1N1 infection most commonly affected middle-aged adults, with comorbidities, abnormal laboratory parameters, and radiological findings strongly predicting adverse outcomes. Early identification and close monitoring of high-risk patients are crucial to improve survival

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

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

Background: Postoperative complications remain a leading cause of morbidity and mortality in general surgery patients. Early prediction could guide timely interventions. Objective: To evaluate the predictive utility of selected serum biomarkers for postoperative complications in patients undergoing elective and emergency general surgery. Methods: A prospective observational study was conducted on 300 patients undergoing general surgery procedures between January 2023 and June 2024. Preoperative and postoperative biomarkers including C-reactive protein (CRP), procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR), and interleukin-6 (IL-6) were measured and correlated with 30-day postoperative complications. Receiver operating characteristic (ROC) curves assessed predictive performance. Results: Postoperative complications occurred in 92 patients (30.6%), most commonly surgical site infection (14.6%) and sepsis (7.3%). Elevated postoperative PCT (>2 ng/mL) and CRP (>150 mg/L on day 3) showed strong predictive value for infectious complications (AUC: 0.86 and 0.79, respectively). NLR >5 was independently associated with cardiopulmonary complications (p <0.05). IL-6 demonstrated early elevation within 24 hours, correlating with systemic inflammatory response. Conclusion: Biomarkers such as PCT, CRP, NLR, and IL-6 show strong potential for early prediction of postoperative complications in general surgery patients. Integration of biomarker monitoring into perioperative protocols may improve patient outcomes.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a significant global concern, particularly in healthcare settings. This study aimed to screen asymptomatically colonized patients and healthcare workers for MRSA and assess the susceptibility of those MRSA isolates to mupirocin and vancomycin. Methods: In this cross-sectional study, nasal swabs were collected from 100 inpatients, 50 outpatients, and 50 healthcare workers. MRSA isolates were identified using standard microbiological techniques and confirmed using the cefoxitin disk diffusion method. High-level mupirocin resistance was detected using 200 μg mupirocin disks and vancomycin susceptibility was assessed using the E-test. Demographic and clinical data were collected and analyzed. Results: The prevalence of MRSA carriage was 33.0% among inpatients, 24.0% among outpatients, and 28.0% among healthcare workers, with no statistically significant differences between the groups. High-level mupirocin resistance was highest among healthcare workers (42.9%), followed by inpatients (27.3%) and outpatients (25.0%). Vancomycin-intermediate Staphylococcus aureus (VISA) was detected in one inpatient and one healthcare worker isolate, whereas no vancomycin-resistant Staphylococcus aureus (VRSA) was observed. Conclusions: This study revealed substantial MRSA colonization among patients and healthcare workers, with notably high-level mupirocin resistance in healthcare workers. These findings underscore the importance of routine MRSA surveillance, targeted decolonization, and judicious antibiotic use in informing infection control strategies in tertiary care settings. Regular monitoring of resistance trends and further molecular epidemiological studies are recommended to elucidate the transmission dynamics and guide interventions

Introduction: Oral squamous cell carcinoma (OSCC) is one of the most common malignancies of the oral cavity, representing approximately 3% of all cancers worldwide and more than 90% of all oral cancers. It remains a major public health challenge due to its high incidence, morbidity, and mortality. Aim: To assess the Salivary biomarkers in oral squamous cell carcinoma Methodology: This was a case–control study conducted in the Department of dentistry, Govt medical college, Dungarpur, between Dec 2022 to Nov 2023. A total of 58 participants were enrolled, consisting of 29 histopathologically confirmed cases of oral squamous cell carcinoma (OSCC) and 29 age- and sex-matched healthy controls. Result: In this study, most OSCC cases were middle-aged males with a high prevalence of smoking and alcohol use.More than half presented with lymph node metastasis and advanced-stage tumors (T III–IV). Salivary biomarkers (IL-8, IL-6, TNF-α, MMP-9, CYFRA 21-1, LDH) were significantly elevated in cases, while AZGP1 was reduced compared to controls. Conclusion: Salivary biomarkers such as IL-8, IL-6, TNF-α, MMP-9, CYFRA 21-1, and LDH were significantly elevated in OSCC, while AZGP1 was reduced. These findings suggest that salivary biomarkers can serve as reliable, non-invasive tools for early detection and monitoring of OSCC.

Background: Early and accurate assessment of small joint arthritis is critical for diagnosis, monitoring, and management of inflammatory and degenerative arthropathies. Ultrasonography (USG) and plain radiography are widely employed imaging modalities, yet their relative diagnostic utility in small joint evaluation remains underexplored. Aim: To compare ultrasonographic and radiographic findings in patients presenting with arthritis of the small joints of the hands and wrists and to correlate imaging parameters with inflammatory biomarkers. Methods: A prospective observational study was conducted on 100 patients presenting with clinical evidence of small joint arthritis. Each patient underwent ultrasonography and plain radiography. Parameters including joint effusion, synovial hypertrophy, hyperemia, osteophytes, erosions, and joint space narrowing were evaluated. Laboratory investigations (ESR, CRP, and rheumatoid factor) were correlated with imaging findings. Statistical analysis was performed using Chi-square and correlation tests, with p < 0.05 considered significant. Results: Rheumatoid arthritis was the predominant diagnosis (48%), followed by osteoarthritis (26%), psoriatic arthritis (16%), and gouty arthritis (10%). Ultrasonography detected more abnormalities than X-ray across all parameters, particularly for synovial hypertrophy (60 vs. 48) and joint effusion (65 vs. 52), showing strong modality agreement (p < 0.001). ESR and CRP were significantly associated with ultrasonographic findings of hyperemia and synovial thickening. Grade III changes in hypertrophy and hyperemia were the most frequent, indicating active inflammation. Conclusion: Ultrasonography proved superior in detecting early inflammatory changes compared to plain radiography, while radiographs remained indispensable for evaluating structural joint damage.

Background: Fluid resuscitation is a cornerstone of sepsis management, yet the optimal strategy regarding the volume and rate of fluid administration remains debated. Objective: To assess the clinical outcomes, including mortality, length of ICU stay, duration of mechanical ventilation, and incidence of complications, associated with restrictive versus liberal fluid strategies in septic patients. Methods: A prospective observational cohort study was conducted at Dept of Anaesthesia, Gulbarga Institute of Medical Sciences, Kalaburagi.  A total of 235 patients diagnosed with sepsis were enrolled. Patients were divided into two groups: the restrictive fluid group (n=117) and the liberal fluid group (n=118). Fluid resuscitation strategies were guided by either a restrictive protocol using dynamic monitoring tools or a liberal protocol following the Surviving Sepsis Campaign guidelines. Results: The 28-day mortality rate was significantly lower in the restrictive fluid group (18.8%) compared to the liberal fluid group (27.1%) (p = 0.03). The restrictive group also had a shorter ICU stay (8.2 ± 3.5 days vs. 10.4 ± 4.1 days, p = 0.02) and a shorter duration of mechanical ventilation (5.7 ± 2.8 days vs. 7.3 ± 3.2 days, p = 0.01). Additionally, the restrictive fluid strategy resulted in fewer cases of acute kidney injury (15.4% vs. 23.7%, p = 0.04) and pulmonary edema (9.4% vs. 16.9%, p = 0.05). The incidence of fluid overload was also lower in the restrictive group (26.5% vs. 42.4%, p = 0.03). Conclusion: The restrictive fluid strategy in sepsis management was associated with lower mortality, fewer complications, and improved recovery outcomes compared to the liberal fluid strategy

Introduction: Electrolytes such as potassium, magnesium, calcium, and phosphate play an important role in cell membrane potential regulation. Dsyelectrolemia in the setting of cardiac diseases and subsequent on pump cardiac surgery may be life threatening  AIM: To evaluate the incidence of electrolyte depletion in cardiac surgery patients, its correction and implications in intraoperative and intensive care unit management. Methods: We measured serially serum levels of magnesium, phosphate, potassium, calcium and sodium in 100 consecutive patients. 50 who were undergoing cardiac surgical interventions (group 1) and the rest 50 underwent lung/peripheral vascular surgery.  Results: Group 1 (cardiac surgery patients) had levels of potassium, magnesium, phosphate and calcium that were significantly lower than group 2 (control individuals). Potassium levels were 10.4 ± 4.6 mmol/ hour for group 1 versus only 1.6 ± 1.4 mmol/hour for group 2 (P < 0.001). A similar observation was observed for magnesium, with 38 patients in group 1 receiving an average amount of 2.1 g due to arrhythmias as opposed to only one patient in group 2 (P < 0.001). 8 patients in the cardiac surgery group received calcium as a treatment or preventive measure compared to one in the control group (P < 0.001). Group 1 had 23 patients (46%) whose magnesium levels were below 0.70 mmol/l, compared to 8 patients (16%) in group 2 (P < 0.001). In group 1, 42 patients (84%) had phosphate levels lower than 0.60 mmol, compared to 6 patients (12%) in group 2 (P < 0.001). Conclusion: In patients undergoing cardiopulmonary bypass cardiac surgery, electrolyte depletion is a high risk. This study partly explains the elevated risk of tachyarrhythmia in cardiac surgery. Hence, we recommend frequent measurement of electrolytes mainly magnesium, potassium, phosphorus and calcium levels in perioperative period. Careful and frequent monitoring with meticulous correction even preemptive of electrolytes shall be beneficial to prevent postoperative tachyarrhythmia. This will result in better outcomes in patients undergoing cardiac surgery. Prophylactic administration of potassium, magnesium and phosphate should be taken into account intraoperatively and postoperatively in all cardiac patients. 

Background: Dengue causes characteristic hematological and biochemical abnormalities during acute infection. The presence of diabetes mellitus may modify these laboratory patterns through underlying metabolic and endothelial dysfunction. Objectives: To compare hematological and biochemical parameters between dengue patients with and without diabetes mellitus and assess whether diabetes is associated with distinct laboratory abnormalities during acute dengue infection. Methods: This cross-sectional analytical study was conducted in the Department of General Medicine at K. B. Bhabha Municipal General Hospital, Mumbai, over one year (June 2023–June 2024). A total of 100 confirmed dengue patients (25 diabetics and 75 non-diabetics) were included. Hematological indices (hemoglobin, hematocrit, leukocyte count, and platelet count) and biochemical parameters (liver function tests, renal markers, and electrolytes) were measured at presentation. Diabetes mellitus was defined by previous diagnosis or HbA1c ≥ 6.5%. Statistical comparisons were made using the t-test and Chi-square test, with p < 0.05 considered significant. Results: Both groups exhibited comparable hemoglobin levels, leukocyte counts, and overall platelet reduction. Severe thrombocytopenia was marginally more frequent among people with diabetes, though not statistically significant. Biochemical profiles showed more pronounced elevation of AST and ALT levels in diabetic patients (p < 0.05), along with a mild trend toward higher serum urea and creatinine and lower sodium levels. These differences indicate greater hepatic and metabolic stress in the diabetic subgroup. Conclusion: While hematological abnormalities were similar in dengue patients irrespective of diabetes status, biochemical derangements—particularly liver enzyme elevation—were more prominent among people with diabetes. This suggests that diabetes may potentiate hepatic vulnerability during dengue infection, warranting closer biochemical monitoring in this comorbid population

Background: Hand hygiene (HH) is a critical infection prevention strategy in intensive care units (ICUs); however, compliance remains suboptimal in resource-limited settings. This prospective observational study aimed to evaluate HH practices among healthcare workers (HCWs) in the ICU of a government medical college hospital in West Bengal, India. Methods: Using the WHO Hand Hygiene Observation Tool, trained observers directly observed the ICU healthcare workers a total of 380 HH opportunities (HHOs) and actions across the WHO's "Five Moments" framework. HH compliance was calculated by dividing the number of times hand hygiene was performed by the total number of hand hygiene opportunities.Results: A total of 380 HHOs were observed over two months, with an overall adherence rate of 27.1% (103/380). Compliance declined slightly from January (28.7%) to February (26.0%), despite ongoing surveillance. Profession-specific analysis revealed the highest adherence among nurses (40.6%), followed by housekeeping staff (30.2%) and physiotherapists (25.9%), while doctors showed lower compliance (9.1%–20.8%). Logistic regression confirmed significantly lower adherence odds among resident medical officers (OR=0.23, 95%CI: 0.11–0.46) and interns (OR=0.38, 95%CI: 0.20–0.75) than among nurses. Moment-specific adherence was highest before aseptic procedures (42.9%) and after body fluid exposure (42.6%) but lower before (26.6%) and after patient contact (18.6%) or contact with patient surroundings (17.3%). Conclusions: The findings highlight behavioral​ and contextual barriers to consistent HH adherence, emphasizing the need for targeted education, leadership engagement, and continuous monitoring to strengthen infection prevention practices in governmental healthcare settings. Future research should evaluate multimodal interventions and electronic monitoring to support evidence-based policies that optimize patient safety in resource-limited ICUs.

Background Community-acquired pneumonia is one of the leading reasons for morbidity and mortality worldwide, particularly in less developed countries. Early identification of the causative organisms, and their antimicrobial susceptibility, can guide effective management and minimize complications. In many parts of the world, antibiotic resistance is on the rise, and it is necessary to maintain continuous, local -level surveillance to develop a case management strategy. Objectives To identify the bacteriological profile and assess the antibiotic sensitivity pattern among patients diagnosed with community-acquired pneumonia in a tertiary care hospital in India. Methods This was a prospective cross-sectional observational study conducted over one year from January 2024 to December 2024. A total of 130 patients with clinical and radiological diagnosis of community-acquired pneumonia were included. Sputum samples, blood cultures, and other respiratory specimens were collected before initiation of antibiotics when possible. Organism identification and antibiotic susceptibility testing were performed using standard microbiological methods. Relevant demographic and clinical data were recorded. Results A positive bacterial culture was obtained in 74.6 percent of patients. Streptococcus pneumoniae was the most common pathogen, followed by Haemophilus influenzae, Staphylococcus aureus, and Klebsiella pneumoniae. Most isolates showed high sensitivity to amoxicillin-clavulanate, ceftriaxone, and azithromycin. Resistance to fluoroquinolones and third-generation cephalosporins was more common in Gram-negative organisms, particularly Klebsiella species. Methicillin-resistant Staphylococcus aureus was identified in a small but relevant proportion of cases. Conclusion Streptococcus pneumoniae continues to be the leading bacterial cause of pneumonia acquired in the community, but increasing resistance among Gram-negative organisms emphasizes the importance of judicious choice of antibiotics. Monitoring local bacterial patterns and susceptibility shifts can guide rational antimicrobial choice and enhance patient outcomes

Background: Effective anticoagulation after mechanical heart valve replacement is essential to mitigate thromboembolic and hemorrhagic complications. The combination of warfarin and low-dose aspirin provides enhanced protection; however, the optimal dosage of aspirin is still a subject of debate. This study analyzed the clinical outcomes of warfarin in comparison to 75 mg and 150 mg aspirin following mechanical valve replacement. Method: A prospective observational study was performed at Pt. B. D. Sharma PGIMS, Rohtak, involving 60 patients who underwent mechanical valve replacement. Patients were assigned randomly to two groups: Group A received warfarin in combination with 75 mg of aspirin, while Group B received warfarin with 150 mg of aspirin. The quality of anticoagulation was evaluated through Time in Therapeutic Range (TTR) utilizing the Rosendaal method. Thromboembolic and bleeding events, the necessity for fluoroscopy, and mortality were assessed over a six-month period. Results: The majority of patients demonstrated moderate INR control, with TTR values of 64.1% for Group A and 73.4% for Group B (p = 0.53). Prosthetic valve thrombosis was observed in 3 patients (10%) in Group A, while none were reported in Group B (p = 0.05). All cases were associated with TTR < 50%. Bleeding complications were similar (8.3% overall; p = 0.53), and no significant hemorrhage was observed. Fluoroscopy was necessary for 5% of patients, all of whom were in Group A. The mortality rate was 1.7%, confined to patients experiencing valve thrombosis. Conclusion: the combination of warfarin and 150 mg aspirin offers enhanced thromboembolic protection and improved time in therapeutic range (TTR) without elevating the risk of bleeding. It is crucial to maintain a TTR greater than 60% to avert valve thrombosis. Individualized anticoagulation, accompanied by consistent INR monitoring and patient education, is essential for achieving optimal postoperative outcomes

Background: Few studies in literature have reported that MHR and HRR high predictive value in post-PCI and heart failure patients. Concerning PCI, HRR can be predictive low HRR signifying increased cardiovascular events and mortality in subjects with CAD. HRR monitoring can help in identification of subjects at higher complication risk for better management and follow-up. Aim: The present study was aimed to compare the novel predictive markers monocyte to high density lipoprotein ratio (MHR) and haemoglobin to red –cell distribution width ratio (HRR) in coronary heart disease post – PCI. Methods: The study assessed 138 subjects with CAD. The outcomes assessed in the study subjects were Major adverse cardiovascular event (MACE) Manifestation of mild signs and symptoms like anxiety, fatigue, chest pain – not amounting to hospital visit, mortality, and restenosis. Demographic data and clinical data of patient was obtained from case files and was recorded on a separate sheet. Findings of laboratory investigations done were also recorded on the same sheet. Patients were followed till discharge or final outcome Results: HRR level was evaluated for prediction of post-PCI mortality at a cut-off with a lower value indicating positive result. Area under curve for HRR was 0.838 (indicating a projected accuracy of 83.8%). A cut off of HRR ≤0.8116 was found to be 75% Sensitive and 85.1% Specific. MHR level was evaluated for prediction of post-PCI mortality at a cut-off with a higher value indicating positive result. Area under curve for MHR was 0.863 (indicating a projected accuracy of approximately 86.3%). A cut off of MHR ≥0.1017 was found to be 100% Sensitive and 88.9% Specific. Conclusion: The findings of the study showed the scope for utilization of MHR and HHR for prognostic purposes in post-PCI coronary heart disease patients. In the present study, despite the limitation of a short-term follow-up and limited sample size they depicted some predictive value. Further studies on a larger sample size and longer duration of follow-up are recommended to validate and substantiate the findings of the present study.

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: 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: 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

Introduction: Supraglottic airway device has replaced endotracheal intubation for elective surgeries requiring GA. Insertion of SADs requires adequate depth of anaesthesia in spontaneously breathing patient and Propofol with adjuvants was commonly used to facilitate its insertion. With this background, this study was conducted to compare ease of insertion by addition of either dexmedetomidine or butorphanol added to propofol for insertion of newer generation SAD - Baska mask in short elective surgeries done under general anaesthesia. Aim & Objectives: To compare Butorphanol and Dexmedetomidine as adjuvants to Propofol on the insertion conditions of Baska Mask for short surgical procedures. To assess the ease of insertion & the incidence of complications such as cough, laryngospasm during insertion. Material and Methods: Around 88 adult patients belonged to ASA I or II of either sex, scheduled for elective surgery under general anaesthesia were allocated randomly either to receive dexmedetomidine 0.5µ/kg IV (Group A) or butorphanol 20µ/kg IV (Group B). All patients were uniformly pre-medicated, induced and Baska mask was inserted as per standard protocol. Ease of insertion score was determined by Modified scheme of Lund & Stovner grading & time taken for insertion was noted. Intra operative monitoring of HR, systemic arterial pressures, SpO2 & EtCO2 were recorded at baseline, after induction, 1,3,5,10 and 15 mins after insertion of Baska mask. Results: There were no statistically significant differences in the demographic characteristics and duration of insertion of Baska mask (P > 0.05). The efficacy of successful insertion was statistically significant with respect to various ease of insertion characteristics & number of attempts required to insert Baska mask in Butorphanol group as compared to Dexmedetomidine Group (P < 0.05). Conclusion: The Study conclude that addition of Butorphanol to Propofol as adjuvant compared to Dexmedetomidine reduces the dose of propofol required and provides superior insertion conditions and good jaw relaxation for ease of insertion of Baska mask. The first pass success rate was greater in Butorphanol group than Dexmedetomidine group. We recommend Butorphanol at 20µ/kg as an adjuvant to propofol for Bask mask insertion without hemodynamic compromise when compared to Dexmedetomidine at 0.5µ/kg.

Background: Anemia is a common and clinically significant complication of chronic kidney disease (CKD), particularly in stages 3-5, where progressive renal impairment leads to reduced erythropoietin production, iron dysregulation, and chronic inflammation. Understanding anemia patterns and iron profile alterations is essential for effective management. Aim: To evaluate anemia patterns and iron indices among patients with CKD stages 3-5. Methods: A hospital-based cross-sectional study was conducted among 120 adults diagnosed with CKD stages 3-5. Detailed demographic, clinical, and laboratory data were collected. Hemoglobin levels, anemia prevalence, anemia morphologic types, and iron indices (serum iron, ferritin, TSAT, TIBC) were assessed. Statistical analyses included chi-square tests, t-tests, ANOVA, and correlation coefficients, with p < 0.05 considered significant. Results: The mean age of the study population was 56.7 ± 11.3 years, with 59.2% males. Anemia prevalence was 78.3%, increasing significantly with CKD stage (68.4% in stage 3, 80.5% in stage 4, 85.4% in stage 5; p = 0.041). Normocytic normochromic anemia was the most common type (55.3%), followed by microcytic hypochromic (22.3%) and mixed-pattern anemia (12.8%). Anemic patients had significantly lower serum iron (42.8 ± 15.7 µg/dL) and TSAT (18.7 ± 7.3%) than non-anemic patients (p < 0.001). Ferritin was lower in anemic individuals but remained elevated overall, suggesting combined absolute and functional iron deficiency. Hemoglobin showed a significant positive correlation with eGFR (r = +0.41, p < 0.001) and TSAT (r = +0.36, p < 0.001). Age ≥60 years was associated with significantly lower hemoglobin levels (p = 0.023). Conclusion: Anemia is highly prevalent in CKD stages 3-5 and becomes more severe as renal function declines. Normocytic normochromic anemia predominates, but a substantial proportion of patients exhibit iron-deficiency patterns. The significant alterations in iron indices highlight the importance of early detection, regular monitoring, and individualized management of anemia in CKD patients

Background: Thiazides are used commonly to manage hypertension and can also increase the risk of falls and syncope in its users. However, this issue remains under studied and mentioned. Aim: The present study was aimed to assess the relationship between thiazide use and syncope or fall in hypertensive Indian subjects admitted to the tertiary care hospital Methods: The present study assessed 472 subjects that presented with hypertension to the Institute within the defined study period and were on thiazides and 472 control subjects that were not on thiazides. The data from all the subjects were gathered and assessed from the previous records of the Institute including demographic characteristics, clinical data, laboratory findings, and outcomes. The main outcome assessed was syncope or fall episode occurrence. Also, association in syncope/fall risk and various factors was assessed.  Results: The study results showed higher prevalence of chronic kidney disease, acute kidney injury, metabolic alkalosis, hypercalcemia, hypokalaemia, and hyponatremia in subjects with thiazides compared to control subjects with p-value of <0.05. Also, a significantly higher prevalence of syncope and fall was seen in subjects on thiazides compared to controls with p=0.002. Also, increased risk of syncope/ fall was seen in subjects with decreased eGFR, acute kidney injury, metabolic alkalosis, hypokalaemia, hyponatremia, longer thiazide duration, congestive heart failure, and age. Conclusion: The use of thiazide diuretics in subjects with hypertension is associated with the syncope which is mainly mediated with renal impairment and electrolyte disturbances. These results focus on vital role of individualized treatment and careful monitoring approaches for prescription of thiazide diuretics in subjects having hypertension

Background:  Post-dated pregnancy, defined as gestation extending beyond 42 completed weeks (294 days), poses significant risks to both maternal and fetal health. Despite advances in obstetric care, post-term pregnancies continue to be associated with increased perinatal morbidity and mortality. This study aimed to evaluate the effects of post-dated pregnancy on maternal and fetal outcomes in a tertiary care setting. Methods A prospective observational study was conducted from June 2023 to July 2024 at the Department of Obstetrics and Gynaecology, Tezpur Medical College and Hospital. A total of 106 pregnant women with gestational age beyond 40 weeks were included. Detailed maternal and fetal assessments were performed, including biophysical profile, non-stress test, and Doppler studies. Maternal outcomes assessed included mode of delivery, induction of labour, and maternal complications. Fetal outcomes evaluated were birth weight, Apgar scores, meconium-stained liquor, neonatal intensive care unit (NICU) admissions, and perinatal mortality. Results The mean gestational age at delivery was 41.2 ± 0.8 weeks. The caesarean section rate was 48.1%, with fetal distress being the most common indication (35.3%). Labour induction was required in 67.9% of cases. Meconium-stained amniotic fluid was observed in 42.5% of deliveries. Macrosomia (birth weight >4000g) occurred in 16.0% of neonates. Low Apgar scores (<7 at 5 minutes) were documented in 13.2% of newborns. NICU admission rate was 28.3%, significantly higher compared to term pregnancies. Maternal complications included postpartum haemorrhage (11.3%), perineal trauma (23.6%), and operative delivery morbidity. Conclusion Post-dated pregnancy is associated with increased maternal and fetal complications. Higher rates of operative delivery, meconium aspiration, macrosomia, and neonatal morbidity were observed. Active management with timely induction of labour and continuous intrapartum monitoring are essential to improve perinatal outcomes in post-term pregnancies

Background:  Primary cardiac lymphoma (PCL) is a rare extranodal lymphoma comprising <2% of all cardiac tumors. Clinical manifestations are nonspecific and often mimic pulmonary embolism (PE) or intracardiac thrombus. We report a rare case of right atrial (RA) diffuse large B-cell lymphoma (DLBCL) initially suspected as a large intracardiac thrombus/clot-in-transit with clinical features resembling PE. Materials and Methods A 69-year-old male presented with progressive dyspnea, presyncope, and tachycardia. Emergency evaluation with ECG, 2D echocardiography, CT pulmonary angiography, venous Doppler, Holter monitoring, and laboratory investigations was performed. The patient underwent right atrial mass excision through midline sternotomy. Postoperative recovery, complications, atrial fibrillation episodes, anticoagulation management, and oncologic referral were documented. All data were prospectively collected from hospital records (Feb–Mar 2025). Results Echocardiography showed a 4×3×5 cm RA mass protruding into the right ventricle (RV) causing tricuspid inflow obstruction with a mean gradient of 9 mmHg. CT angiography revealed a lobular RA lesion suspicious for clot-in-transit vs neoplasm, without pulmonary artery thrombosis. Surgical excision achieved complete removal of the mass. Histopathology confirmed DLBCL (CD20+, BCL6+, Ki-67 ~70%). Postoperatively, the patient developed transient atrial fibrillation managed medically and was discharged in stable condition on antiplatelet and anticoagulation therapy. Conclusion This case highlights that primary cardiac lymphoma may masquerade as pulmonary embolism. Early multimodal imaging, high clinical suspicion, and urgent surgical exploration in obstructive cases are lifesaving. Combined cardiology–cardiac surgery–oncology management is essential for optimal outcomes

Background:  High-risk pregnancies contribute significantly to perinatal morbidity and mortality. Cardiotocography (CTG) remains a vital tool for intrapartum fetal monitoring, enabling early detection of distress and timely obstetric intervention. However, its predictive accuracy and effect on perinatal outcomes require further evaluation. Methods A prospective cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Tezpur Medical College and Hospital, from September 2023 to August 2024. A total of 180 antenatal women with ≥37 weeks of gestation and one or more high-risk factors were included. Admission CTG was performed for 20 minutes and categorized as reactive, non-reactive, or pathological. Maternal outcomes (mode of delivery) and neonatal outcomes (Apgar score, NICU admission, perinatal mortality) were recorded. Statistical analysis was done using SPSS v20.0, with p < 0.05 considered significant. Results Reactive CTG was observed in 70.55% of cases, non-reactive in 19.44%, and pathological in 10%. A significant association existed between CTG findings and mode of delivery (p < 0.0001), with 90.5% of reactive CTG cases delivering vaginally, while 97.47% of pathological CTG required caesarean section. Pathological CTG correlated with low Apgar scores (<7) and increased NICU admissions. CTG showed 80% sensitivity and 80.74% specificity, with a high negative predictive value (99.09%). Conclusion Abnormal CTG patterns are strongly linked to adverse perinatal outcomes, especially in conditions like PIH and IUGR. Although CTG is a sensitive tool for detecting fetal distress, its low positive predictive value necessitates adjunctive methods for accurate fetal assessment and minimizing unnecessary interventions

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder associated with persistent hyperglycemia, chronic low-grade inflammation, and an increased risk of cardiovascular and microvascular complications. Glycated hemoglobin (HbA1c) remains the gold standard for assessing long-term glycemic control but does not fully capture the inflammatory state that contributes to disease progression.  Methodology: A hospital-based cross-sectional observational study was conducted in the Department of Medicine at MKCG Medical College and Hospital, Berhampur, Odisha, India. A total of 180 adults aged 18–70 years with T2DM, diagnosed according to ADA criteria, were enrolled using a simple random sampling method. Patients with inflammatory, hepatic, renal, or hematological disorders were excluded. Clinical data, hematological parameters, HbA1c, NLR, and MLR were recorded.  Results: The mean age of participants was 54.1 ± 8.3 years. Most patients in both groups were aged 50–59 years, and no significant association was found between gender and glycemic control. Elevated NLR (>2) was present in 62.99% of uncontrolled patients compared to 42.31% of controlled patients (p < 0.05). Similarly, elevated MLR (>2) was observed in 63.64% of uncontrolled patients versus 34.62% of controlled patients (p < 0.05). Both NLR and MLR showed significant positive correlations with HbA1c, indicating their potential as markers of poor glycemic control. Discussion: The findings highlight that subclinical inflammation, as reflected by elevated NLR and MLR, is closely associated with poor glycemic control in T2DM. These results support previous studies demonstrating that inflammatory pathways play a pivotal role in diabetes progression and complications.  Conclusion: This study demonstrates a significant positive association between elevated NLR and MLR and poor glycemic control in patients with T2DM. Incorporating these inflammatory markers into clinical practice alongside HbA1c could enhance patient monitoring, risk stratification, and early detection of complications

Background: Oral submucous fibrosis (OSMF) a chronic and an insidious disease of buccal mucosa has a strong predisposition to malignant transformation. In OSMF, the disturbance in equilibrium between matrix metalloproteinases (MMPs) and tissue inhibitor matrix metalloproteinases (TIMP) results in elevated deposition of extracellular matrix (ECM). MMPs play a crucial role in fibrosis of the oral cavity. The present study was conducted with an aim to evaluate MMP-3 as a possible biomarker for OSMF. Methods: The study included a total of 118 clinically diagnosed OSMF patients. Additionally, total of 118 healthy individuals was recruited as controls. MMP-3 was estimated using the TIMP ELISA method involves quantifying MMP-3 levels in serum samples. Results: Poor oral hygiene, chronic alcoholism and consumption of spicy food were common confounders other than tobacco chewing and arecanut consumption found to be associated with OSMF. The mean serum levels of MMP-3 were higher in OSMF patients as compared to individuals belonging to control group and the difference was highly statistically significant. The mean MMP-3 of OSMF patients increased with severity of the disease. Conclusion: From this study, it can be concluded that it was noted that elevated serum MMP- 3 levels can be used as screening tool in the early detection of OSMF. Additionally, it can be ideal tool for monitoring the prognosis of the patients

Background: Serum albumin is a well-recognized biomarker reflecting nutritional and inflammatory status, and its prognostic relevance in critically ill patients continues to be explored. This study evaluated the association between baseline and serial serum albumin levels with survival and morbidity indicators in patients admitted to intensive care. Material and Methods: A prospective, hospital-based observational study was conducted over two years in the MICU and ICCU of a tertiary care center. One hundred critically ill adult patients meeting the inclusion criteria were enrolled using purposive sampling. Detailed clinical assessment and routine laboratory investigations were performed at admission. Serum albumin levels were measured on Day 0, 1, 3, 5, 7, and 10. Patients were categorized as survivors or non-survivors, and comparisons were made with respect to mortality, need for mechanical ventilation, and duration of hospitalization. Statistical analyses were conducted using SPSS version 22, with significance set at p < 0.05. Results: Demographic factors such as age distribution and sex did not differ significantly between survivors and non-survivors. Admission serum albumin levels showed a significant association with mortality, with lower values more frequent among non-survivors. Serial follow-up measurements demonstrated consistently reduced albumin levels in the non-survivor group at all time points, with highly significant differences throughout the observation period. Lower albumin levels at presentation were also associated with an increased likelihood of requiring mechanical ventilation. Conclusion: Both baseline and early serial serum albumin measurements serve as meaningful prognostic indicators in critically ill patients. Persistently reduced albumin levels are linked to higher mortality and increased need for ventilatory support, highlighting the utility of albumin monitoring in risk assessment and clinical management.

Background: Air pollution is a leading environmental risk factor for global morbidity and mortality, and the Air Quality Index (AQI) serves as a critical measure of exposure severity. This systematic review evaluates the short-term and long-term effects of high AQI on human health by synthesizing findings from epidemiological and clinical studies published between 2000 and 2024. Major databases including PubMed, Scopus, and Web of Science were searched for studies linking elevated AQI levels to health outcomes across respiratory, cardiovascular, neurological, and reproductive systems. A total of 78 studies met the inclusion criteria, encompassing over 40 million individuals across diverse geographic regions. The evidence consistently indicates that short-term exposure (hours to days) to elevated AQI primarily induces respiratory distress, asthma exacerbations, acute cardiovascular events, and hospital admissions, particularly in children and the elderly. Long-term exposure (months to years) is associated with chronic obstructive pulmonary disease (COPD), ischemic heart disease, stroke, metabolic dysfunction, neuroinflammation, cognitive decline, and increased all-cause mortality. The findings reveal a dose–response relationship, with sustained exposure above AQI 150 posing significant cumulative health risks. This review underscores the urgent need for stricter air quality regulations, continuous monitoring, and public health interventions aimed at reducing exposure and improving urban air management.

Background: Fetal femur length (FL) is one of the most reliable skeletal indicators for estimating gestational age (GA) in clinical, anatomical, and forensic contexts. Direct anatomical measurement provides higher accuracy than ultrasound, especially because cartilaginous epiphyses are not fully visualized in imaging. Aim: To evaluate the longitudinal growth of femur length measured laterally (FL1) and medially (FL2) in South Indian fetuses and to determine the strength of correlation between these measurements and gestational age. Materials and Methods: Thirty spontaneously delivered normal fetal specimens ranging from 11 to 30 weeks of gestation were included. Following standardized dissection, both FL1 (greater trochanter to lateral condyle) and FL2 (fovea capitis to medial condyle) were measured using a high-precision digital Vernier caliper. Fetuses were categorized into four gestational groups. Mean values, standard deviations, and weekly growth rates were calculated. Correlation analysis and ANOVA were performed. Results: Mean FL1 increased from 2.4 cm (Group A: 11–15 weeks) to 6.73 cm (Group D: 26–30 weeks). FL2 increased from 2.06 cm to 6.91 cm in the same groups. Weekly growth rates were 2.16 mm/week for FL1 and 2.42 mm/week for FL2. FL2 consistently exceeded FL1 due to inclusion of the femoral head and neck. A strong linear correlation was observed between both measurements and gestational age. Conclusion: Femur length shows a robust, predictable increase with gestational age. FL2, due to its anatomical breadth, serves as a stronger growth indicator. The study provides population-specific reference data for Indian fetuses, valuable for anatomical research, intrauterine growth monitoring, forensic identification, and medicolegal evaluation.

Background: Renal artery stenosis is a frequently under-recognized comorbidity in patients presenting with acute coronary syndromes undergoing primary percutaneous transluminal coronary angioplasty. Objective: This study aimed to determine the incidence of significant renal artery stenosis in patients undergoing primary PTCA. Methodology: This cross-sectional observational study was conducted at, Dept of Cardiology, Adichunchanagari Medical College, Bellur, Karnataka,  India and it included 200 consecutive adult patients undergoing primary PTCA for ST-elevation myocardial infarction or high-risk non-ST elevation myocardial infarction. Following coronary intervention, selective renal angiography was performed during the same procedural session. Results: Out of 200 patients, 32 (16 percent) had significant renal artery stenosis. Among these, 24 (75 percent) had unilateral stenosis, while 8 (25 percent) had bilateral involvement. Patients with stenosis were older (63.1 ± 9.3 years) compared with those without stenosis (56.3 ± 10.9 years). Hypertension was more prevalent in the stenosis group (87.5 percent vs. 64.3 percent), and median serum creatinine was higher (1.24 mg/dL vs. 1.05 mg/dL). Differences in age and hypertension were statistically significant (p = 0.01 and p = 0.03, respectively). No procedural complications related to renal angiography were observed. Conclusion: Significant renal artery stenosis is present in a substantial proportion of patients undergoing primary PTCA, particularly among older and hypertensive individuals. Early detection during coronary angiography may support better contrast management, guide blood pressure control, and improve renal monitoring strategies.

Introduction: Amiodarone, a class III antiarrhythmic agent, is widely employed in the management of supraventricular and ventricular tachyarrhythmias. While hepatotoxicity related to chronic oral administration is a well-recognized complication, acute hepatic injury following intravenous (IV) amiodarone is exceedingly rare and potentially fatal. The mechanism is multifactorial, often attributed to the solvent polysorbate 80, which may induce mitochondrial dysfunction and hepatic ischemia. We present a case of acute, reversible hepatocellular injury following IV amiodarone infusion, successfully managed with early discontinuation of the drug and administration of intravenous N-acetylcysteine (NAC). Case Presentation: A 74-year-old male with a history of hypertension and dyslipidemia presented with acute abdominal pain and was diagnosed with a perforated duodenal ulcer. Following emergency laparotomy and primary repair, the patient developed postoperative respiratory failure requiring ICU care and mechanical ventilation. During his ICU stay, he developed new-onset atrial fibrillation with rapid ventricular response, for which IV amiodarone was initiated (150 mg loading followed by continuous infusion). Within 24 hours, the patient reverted to sinus rhythm but exhibited a sharp rise in hepatic transaminases   AST 5024 U/L, ALT 1393 U/L   with mild hyperbilirubinemia (1.6 mg/dL) and normal alkaline phosphatase levels. No hypotension, hypoxia, or exposure to other hepatotoxic drugs was noted. Viral and autoimmune hepatitis panels were negative, and abdominal ultrasound revealed normal hepatic architecture. The diagnosis of IV amiodarone-induced acute hepatocellular injury was made based on clinical chronology and exclusion of alternative causes. Amiodarone was discontinued, and IV N-acetylcysteine was initiated using a standard 5-day infusion protocol (150 mg/kg loading dose followed by 50 mg/kg and 100 mg/kg maintenance doses). Remarkable biochemical improvement occurred within 48 hours, with normalization of liver enzymes by day five. The patient recovered completely and was discharged in stable condition, maintaining sinus rhythm on oral beta-blocker therapy. Discussion: Acute hepatocellular injury following IV amiodarone infusion is rare but potentially severe, with an onset typically within hours of drug administration. The hepatotoxic component is likely related to polysorbate 80, an emulsifying agent in the IV formulation, which induces mitochondrial damage, circulatory collapse, and hepatic ischemia. The biochemical pattern of massive aminotransferase elevation with mild bilirubin rise mimics ischemic hepatitis but in the absence of hypotension. N-acetylcysteine, originally developed for acetaminophen toxicity, has demonstrated efficacy in non-acetaminophen acute liver failure by replenishing glutathione stores, scavenging reactive oxygen species, and improving hepatic microcirculation. In this case, early NAC administration led to rapid enzyme normalization and clinical recovery, supporting its hepatoprotective role in IV amiodarone-induced hepatic injury. Conclusion: This case highlights that intravenous amiodarone can cause acute, severe but reversible hepatocellular injury even in patients with normal baseline liver function. Early recognition, immediate discontinuation of the drug, and timely administration of N-acetylcysteine can result in complete hepatic recovery and prevent progression to acute liver failure. Vigilant monitoring of liver function tests within the first 24 hours of infusion is crucial to ensure patient safety.

Background: Stroke is one of the leading causes of mortality and disability worldwide, with diabetes mellitus recognized as a major modifiable risk factor. Glycated hemoglobin (HbA1c) reflects long-term glycemic control and has been proposed as a potential marker for predicting stroke risk even in non-diabetic individuals. This study aimed to evaluate the relationship between HbA1c levels and ischemic stroke in diabetic and non-diabetic patients admitted to a tertiary care hospital in eastern India. Materials and Methods: A hospital-based, descriptive, case–control study was conducted in the Department of General Medicine, PGIMER & Capital Hospital, Bhubaneswar, Odisha, over six months (October 2024–March 2025). A total of 240 inpatients with acute ischemic stroke were included—120 diabetics and 120 non-diabetics—aged ≥18 years. Detailed history, clinical examination, and investigations including HbA1c, fasting and random blood glucose, lipid profile, and blood pressure were recorded. Data were analyzed using R software (version 4.3.2), with p < 0.05 considered statistically significant. Results: The majority of stroke cases (58%) occurred in patients aged 51–70 years. Based on glycemic status, 50% were known diabetics, 5.4% were newly diagnosed, 12.9% had stress hyperglycemia, and 31.7% were euglycemic. The mean HbA1c level was significantly higher among diabetic patients (7.85 ± 2.30%) compared to non-diabetics (6.25 ± 2.10%, p < 0.01). Although diabetics also had higher mean values of fasting blood sugar, lipid parameters, and blood pressure, these differences were not statistically significant. Discussion: The study demonstrates that elevated HbA1c levels are strongly associated with ischemic stroke, independent of other risk factors. These findings are consistent with previous studies that identified HbA1c as a reliable predictor of vascular risk and subclinical atherosclerosis. Routine HbA1c assessment in acute stroke cases can identify undiagnosed diabetes or prediabetes and guide early preventive interventions. Conclusion: Higher HbA1c levels are significantly correlated with the occurrence of ischemic stroke. Poor long-term glycemic control may contribute to increased cerebrovascular vulnerability in diabetics and may also signal higher risk among non-diabetics. Monitoring and management of hyperglycemia should therefore form an integral part of acute and long-term stroke care.

: Background: Spinal anesthesia (SAB) is a common technique for infraumbilical surgeries, but it frequently causes hypotension and bradycardia. Hypertensive patients are thought to be more vulnerable to these hemodynamic perturbations due to altered vascular autoregulation. This study aimed to compare the hemodynamic changes and incidence of hypotension following SAB between hypertensive and normotensive patients. Methods: In this prospective, observational study, 100 patients (ASA I & II) aged 40-65 years scheduled for elective surgery below the umbilicus under SAB were enrolled. They were allocated into two groups: Group H (n=50, hypertensive on medication) and Group N (n=50, normotensive). All patients received preloading with 10 ml/kg isotonic saline. Spinal block was performed with 3.5 ml of 0.5% hyperbaric bupivacaine. Systolic (SBP), diastolic (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at baseline, after fluid loading, and at 1, 3, 5, 10, 20, 30-, 40-, 50-, and 60-minutes post-SAB. Hypotension was defined as a >25% decrease from baseline SBP. Results: The incidence of hypotension was significantly higher in Group H (36%) compared to Group N (14%) (p = 0.012). The mean maximum decrease in SBP, DBP, and MAP was also significantly greater in Group H at multiple time intervals (p < 0.05). There was no statistically significant difference in the incidence of bradycardia between the groups (Group H: 10%, Group N: 6%; p = 0.717). Conclusion: Hypertensive patients experience a significantly greater incidence and magnitude of hypotension following spinal anesthesia compared to normotensive patients, underscoring the need for intensified hemodynamic monitoring and proactive management in this population.

Background:  Iron deficiency anemia (IDA) , utmost  established  nutritional deficiency disorder and primary causative factor  of anemia specifically in developing countries . As far as with high prevalence, there is no standard definition of anemia but as per the WHO determines  hemoglobin <11  g/dL is considered as Anemia .  Among this 50% of anemia is only  due to the iron deficit .But the  Prevalence of  IDA among females after puberty because of menstrual bleeding  and further after marriage, predominantly they suffer with severe iron deficiency during  period of pregnancy . IDA in men might be  considered as red flag for the possible presence of serious  inflammatory disease, and  considerable proportion of asymptomatic gastric issues , colorectal diseases and precancerous lesions . So  in the present  study we focused on especially oxidative stress parameters and their imbalance in Iron deficiency anemia. Objectives: The present study focused to estimate Malondialdehyde   , total antioxidant capacity levels in IDA patients compared with healthy volunteers, and to find out their association with hemoglobin levels.   Materials and methods: Fifty IDA patients with  all the age groups of  men and women  were selected and 50 healthy age matched subjects were selected as controls. Serum Total antioxidant capacity & MDA were estimated by spectrophotometric methods and Hb and other complete blood picture analysis carried out by Hematology Analyzer. Results:  MDA  levels were significantly increased in IDA patients compared with healthy controls .  TAC and Hemoglobin  values are significantly decreased in IDA patients. Hemoglobin levels positively correlated with TAC, and negatively  correlated with MDA .  Conclusion:  Total antioxidant capacity  , lipid peroxidation  vital risk factor responsible for increased oxidative stress in IDA patients.  Regular monitoring and supplementation of iron and other multivitamins are beneficial for reduction of oxidative stress and to reduce  iron deficiency  anemia complications.

INTRODUCTION;Hypertensive crisis (HC) is a life-threatening emergency characterized by severely elevated blood pressure, which can lead to organ damage, stroke, heart failure, and acute renal failure. These patients often require ICU admission for intensive monitoring and immediate intervention.  Aims and objectives: This study aims to evaluate the clinical profile of hypertensive crisis patients admitted to the ICU, including demographic factors, clinical presentations, and management strategies. Materials and Methods: A cross-sectional, descriptive study was conducted in the Intensive Care Unit of St. Stephens Hospital, Delhi, from February 2023 to July 2024. The study included 81 patients admitted with hypertensive crisis. Key variables examined included age, systolic and diastolic blood pressure, and diagnoses such as acute coronary syndrome (ACS), acute kidney injury (AKI), acute decompensated heart failure (ADHF), hypertensive retinopathy, and acute ischaemic stroke. Results: The majority of patients were middle-aged to elderly, with 28% in the 51–60 age group and 27% in the 61–70 age group. Blood pressure improved significantly, with systolic blood pressure decreasing from 198.29 mm Hg at 0 hours to 131.25 mm Hg at discharge. Ventilation needs varied, with 32 patients requiring non-invasive ventilation (NIV) and 17 requiring intravenous (IV) support. Conclusion: Hypertensive crisis is a severe condition requiring ICU care. Elderly patients with comorbidities like chronic hypertension and renal disease are at higher risk. Early recognition and aggressive management with intravenous antihypertensive therapy are critical for improving outcomes and preventing complications. Future research should focus on optimizing treatment protocols and targeting high-risk patients.

Background: Mechanical prosthetic valve thrombosis (PVT) is a serious condition with high morbidity and mortality. While emergency surgery has long been the standard treatment, thrombolytic therapy (TT) using agents like streptokinase has become a valuable alternative—particularly for patients with high surgical risk or in resource-limited settings, showing variable success across different populations. Objective: To evaluate the effectiveness and safety of thrombolytic therapy in patients with mechanical prosthetic valve thrombosis at a tertiary care center. Methods: This retrospective study included 27 mechanical PVT patients diagnosed via clinical assessment, echocardiography, and fluoroscopy. All received intravenous streptokinase. Demographics, clinical features, causes, and outcomes were documented. Thrombolysis success was defined by clinical improvement and imaging resolution. Complications such as embolism, bleeding, and mortality were assessed. Results Among the 27 patients (mean age 48.1 ± 14.1 years; 77.8% female), the mitral prosthesis was most commonly affected. The leading cause of PVT was non-compliance with oral anticoagulation and subtherapeutic INR levels. Thrombolysis was successful in 85.2% of patients, with restoration of valve function and clinical recovery. Complications included minor bleeding and embolic events and mortality in 7.4% (2 patients). Prognostic analysis indicated worse outcomes in older patients and in those presenting with severe NYHA functional class. Conclusion: Thrombolytic therapy with streptokinase is a safe and effective treatment for mechanical prosthetic valve thrombosis, especially in settings where surgical intervention is not immediately available. Strict anticoagulation monitoring and patient compliance are critical to prevention.

Background: Diabetic retinopathy (DR) is a long-term complication of diabetes characterized by progressive damage to the small blood vessels of the retina, which can ultimately threaten vision. Glycated hemoglobin (HbA1c) is widely recognized as a reliable marker for monitoring long-term glycemic control and may serve as an early indicator for identifying individuals at higher risk of developing DR. Aim: To evaluate the correlation between HbA1c level and grade of diabetic retinopathy, to study the awareness of diabetic retinopathy in diabetic patients and to identify the systemic risk factors associated with diabetic retinopathy. Materials and methods: This study was designed as a cross-sectional, hospital-based study. A total of 206 individuals attending the non-communicable disease (NCD) clinic at a tertiary care hospital in Kalaburagi. Data collection was carried out over a 12-month period, from November 2023 to November 2024.  Results: In our study, Out of the 206 participants, diabetic retinopathy was detected in 133 patients, giving a prevalence of 64.5%. The condition was observed more frequently in males, with the highest proportion of cases falling in the 50–60 year age group. Distribution by severity revealed that 53 patients (25.75%) had mild non-proliferative DR (NPDR), 32 (16.47%) had moderate NPDR, 4 (1.94%) showed severe NPDR, and 6 (2.91%) had very severe NPDR. Proliferative DR (PDR) was present in 8 patients (3.88%), another 8 (3.88%) showed advanced diabetic eye disease, and 22 (10.7%) exhibited clinically significant macular edema (CSME). A progressive increase in HbA1c levels was noted with higher grades of retinopathy, and correlation analysis confirmed a significant positive relationship (r = 0.523, 0.687, 0.872; p < 0.05). Awareness about DR was generally poor, with nearly two-thirds of patients (67.48%).  Conclusion: This study demonstrates a clear positive association between elevated HbA1c levels and the severity of diabetic retinopathy. Limited awareness about the condition among patients appears to contribute to delayed detection, resulting in advanced retinal changes and substantial visual impairment. These findings highlight the importance of regular eye screening, better patient education, and effective control of both blood glucose and blood pressure in reducing the burden of diabetic retinopathy.

Background: Hypoglycaemia remains a major limitation in insulin-treated diabetes despite advances in continuous glucose monitoring (CGM). AI-predictive CGM systems aim to reduce hypoglycaemia by forecasting impending low glucose events and enabling earlier preventive interventions. The overall effectiveness of these technologies has not been comprehensively synthesized. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials comparing AI-predictive CGM with standard CGM or usual care. Electronic databases were searched from inception to the final search date. Primary outcomes included hypoglycaemia burden (time below range), with secondary outcomes comprising severe hypoglycaemia, time in range, HbA1c, mean glucose, and CGM wear duration. Random-effects meta-analyses using REML were performed. Risk of bias was assessed using RoB 2.0, and certainty of evidence was evaluated using GRADE. The review was prospectively registered in PROSPERO (CRD420251270444). Results: Eleven randomized trials involving 1,164 participants were included. AI-predictive CGM significantly reduced hypoglycaemia burden and severe hypoglycaemia events compared with comparators. Improvements were also observed in time in range, HbA1c, and mean glucose levels, without a consistent effect on CGM wear duration. Substantial heterogeneity was noted across outcomes, but the direction of effect consistently favored AI-predictive CGM. Conclusions: AI-predictive CGM is associated with clinically meaningful reductions in hypoglycaemia and improved overall glycaemic control. These findings highlight the added value of predictive intelligence beyond conventional CGM and support its role in contemporary diabetes management.

Objective: Subclinical hypothyroidism (ScH), has been increasingly explored for its potential lipometabolic and vascular implications. Evidence remains inconsistent, with some studies suggesting adverse effects on lipid metabolism and vascular function, while others show no significant associations.. With regional variation in thyroid disorder prevalence and metabolic patterns across India, this study evaluated lipometabolic and related clinical markers in individuals with ScH in Kashmir. Methodology: A cross-sectional study was conducted on fifty patients with ScH and fifty age- and gender-matched euthyroid controls attending a tertiary care centre in Srinagar. Standardized procedures were used for anthropometry, blood pressure measurement, and biochemical analysis, including thyroid profile, lipid parameters, and fasting glucose. Statistical analysis employed independent t-tests, chi-square tests, and Pearson’s correlations, with p < 0.05 considered significant.

Results: Baseline demographics were similar between groups. Mean systolic and diastolic blood pressures in the ScH group were not significantly different from controls(p>0.05). Lipid and glycaemic parameters—including fasting glucose, triglycerides, HDL, and LDL—also showed no significant differences.(p > 0.05)  Wide variability in BMI, triglyceride and LDL levels suggested notable inter-individual differences. Findings indicate that ScH did not produce measurable alterations in the lipometabolic profile within this cohort. Conclusion: ScH was not associated with significant changes in blood pressure, lipid parameters, or BMI in this Kashmiri sample. Although these results support studies reporting minimal metabolic impact, conflicting evidence elsewhere highlights the importance of ongoing monitoring. Larger longitudinal studies are needed to clarify whether progression of ScH contributes to future lipometabolic risk. 

Background: Epilepsy is one of the most common chronic neurological disorders in children requiring long-term anti-epileptic drug (AED) therapy. Enzyme-inducing AEDs (EIAEDs) can accelerate vitamin D metabolism, leading to hypovitaminosis D and bone health concerns. This study compares serum vitamin D levels in children with first-episode unprovoked seizures and those on AED therapy for over 12 months. Methods: A cross-sectional comparative study was conducted in the Department of Paediatrics, Hassan Institute of Medical Sciences, Karnataka. One hundred children aged 2–18 years were enrolled: Group A (first-episode unprovoked seizures, n=50) and Group B (on AED therapy >12 months, n=50). Serum vitamin D, calcium, phosphorus, and alkaline phosphatase (ALP) levels were measured and analyzed using independent t-test and chi-square test, with p<0.05 considered significant. Results: Mean serum vitamin D levels were 30.28 ± 5.94 ng/mL in Group A and 31.00 ± 6.15 ng/mL in Group B (p=0.55). Serum calcium, phosphorus, and ALP levels showed no significant difference. Levetiracetam was the most common drug in Group A, while phenytoin predominated in Group B. No significant differences were found in demographic or vital parameters. Total leukocyte count was significantly higher in Group A (p=0.001), indicating postictal stress response. Conclusion: Long-term AED use did not significantly affect serum vitamin D or bone metabolism markers. Routine monitoring of vitamin D levels is advisable in children on chronic AED therapy, though current regimens appear metabolically safe and well-tolerated.

Background: Blood pressure (BP) derangements after non-cardiac surgery are common and have been linked to myocardial injury and early mortality in perioperative cohorts. Whether early postoperative BP variability itself predicts major adverse cardiac events (MACE) is less clear. Objectives: To assess BP variability during the first 48 postoperative hours and its association with in-hospital MACE. Methods: A retrospective cohort study was conducted on eighty adults undergoing non-cardiac surgery under general or regional anesthesia were included. Postoperative BP readings over 48 hours were extracted from records. Variability was summarized by standard deviation (SD) and coefficient of variation (CV). High systolic BP variability was defined as SD ≥12 mmHg (median). MACE included myocardial injury, new-onset arrhythmia, acute heart failure, and cardiac death. Results: Mean age was 57.4 ± 10.2 years and 65.0% were men. High systolic BP variability was present in 42 (52.5%). Eighteen patients (22.5%) had ≥1 MACE; myocardial injury was most frequent (12.5%). MACE occurred in 33.3% of the high-variability group versus 10.5% of the low-variability group (unadjusted odds ratio 4.25, 95% CI 1.26–14.38). After adjustment for age, hypertension, diabetes, and surgical risk, high variability remained an independent predictor (adjusted odds ratio ≈ 3.1). Conclusion: High early postoperative BP variability was common and independently associated with higher in-hospital MACE after non-cardiac surgery

Background: Laryngoscopy and tracheal intubation trigger a sympathetic surge that produces short-lived tachycardia and hypertension, which can precipitate myocardial ischemia in patients with hypertension and coronary artery disease (CAD). Objectives: To quantify peri-intubation hemodynamic changes and describe electrocardiographic (ECG) alterations in adults with hypertension and/or CAD undergoing elective surgery under general anesthesia. Methods: This prospective observational study enrolled eighty adult patients classified as ASA physical status II–III, all of whom had established hypertension and/or coronary artery disease (CAD). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and ECG (lead II and V5) were recorded at baseline, during laryngoscopy, immediately after intubation, and at 3 and 5 minutes after intubation. Maximum percentage change from baseline was calculated and the proportion with >20% rise was documented. Results: Mean age was 56.8 ± 9.4 years; 65% were male; 47.5% had hypertension alone and 30% had both hypertension and CAD. HR increased from 76.4 ± 8.9 to 98.8 ± 11.6 beats/min immediately after intubation; SBP rose from 138.6 ± 12.8 to 170.8 ± 18.2 mmHg, with gradual decline by 5 minutes. More than half had >20% rise in HR (57.5%) and SBP (52.5%). Transient ECG changes occurred in 22.5%; ST-segment depression was seen in 7.5% and no patient developed sustained arrhythmia or required intervention. Conclusion: Adults with hypertension and/or CAD demonstrated a pronounced but transient pressor response to laryngoscopy and intubation, with infrequent, self-limited ECG changes. Close monitoring and proactive attenuation strategies during airway instrumentation are essential in high-risk patients

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: 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: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: 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: Laryngoscopy, tracheal intubation, and pneumoperitoneum during laparoscopic surgery provoke significant sympathetic stimulation, resulting in tachycardia and hypertension. Pharmacological attenuation of this hemodynamic stress response is essential to improve perioperative stability. This study compared dexmedetomidine and fentanyl for their effectiveness in controlling hemodynamic responses during these critical periods. Material and methods: This prospective, randomized, double-blind study included 100 adult patients of ASA physical status I and II undergoing elective laparoscopic surgery under general anaesthesia. Patients were randomly allocated into two groups (n = 50 each). Group D received dexmedetomidine (1 µg/kg loading dose followed by 0.2 µg/kg/h infusion), while Group F received fentanyl in an equivalent dosing regimen. Heart rate, systolic, diastolic, and mean arterial blood pressure, and oxygen saturation were recorded at baseline, during airway manipulation, throughout pneumoperitoneum, at extubation, and during the postoperative period up to 6 hours. Demographic variables were also compared. Results: Baseline demographic characteristics and initial hemodynamic parameters were comparable between the two groups. Dexmedetomidine produced a significantly greater attenuation of heart rate and blood pressure responses following the loading dose, during laryngoscopy and intubation, throughout pneumoperitoneum, and at extubation compared with fentanyl. The differences were most pronounced during periods of maximal surgical stress. Hemodynamic parameters gradually returned toward baseline values in both groups during late postoperative monitoring, with no significant intergroup differences at 3 and 6 hours. Oxygen saturation remained stable and comparable between the groups at all time points. Conclusion: Dexmedetomidine provides superior control of hemodynamic stress responses compared with fentanyl during laparoscopic surgery, without compromising oxygenation. Its use contributes to improved perioperative hemodynamic stability during airway manipulation and pneumoperitoneum

Background: Beta-thalassemia major is a common hereditary hemoglobin disorder requiring lifelong blood transfusions. Advances in transfusion therapy and iron chelation have improved survival; however, chronic complications involving various organ systems continue to emerge. Pulmonary dysfunction in thalassemia major is often subclinical and remains under-recognized, with conflicting evidence regarding its pattern and association with iron overload. Objectives: To evaluate pulmonary function abnormalities in children with β-thalassemia major and to assess their association with age and serum ferritin levels. Methods: A hospital-based cross-sectional study was conducted among 70 children aged 5–15 years with confirmed β-thalassemia major admitted for periodic blood transfusion. Children with pre-existing pulmonary disease or congenital/rheumatic heart disease were excluded. Clinical details, transfusion history, and chelation status were recorded. Pre-transfusion hemoglobin and serum ferritin levels were measured. Pulmonary function tests were performed using spirometry within 24 hours of transfusion. Pulmonary patterns were classified as normal, restrictive, obstructive, or combined. Statistical analysis included descriptive statistics and correlation analysis, with p < 0.05 considered significant. Results: Pulmonary function abnormalities were observed in 54 (77.1%) children. The restrictive pattern was the most common abnormality (88.9%), followed by obstructive and combined patterns. Reduced FVC and FEV₁ were frequently noted, while the FEV₁/FVC ratio remained normal in most children. A significant negative correlation was observed between age and FVC%, FEV₁%, and PEFR, indicating progressive pulmonary involvement with advancing age. Although spirometric values were lower in children with higher serum ferritin levels, no statistically significant association was found between serum ferritin and pulmonary dysfunction. Discussion: The predominance of restrictive lung disease suggests impaired lung growth or chronic parenchymal involvement in thalassemia major. Progressive decline in pulmonary function with age highlights the cumulative impact of disease duration and chronic transfusion therapy. The lack of a strong association with serum ferritin indicates that pulmonary dysfunction is likely multifactorial rather than solely related to iron overload. Conclusion: Pulmonary dysfunction is highly prevalent in children with β-thalassemia major, predominantly presenting as restrictive ventilatory impairment. Routine pulmonary function monitoring should be incorporated into the standard care of thalassemic children to enable early detection and timely intervention, even in the absence of respiratory symptoms.

INTRODUCTION:HIV is a virus that attacks the immune system, especially CD4 cells. It leads to progressive immunodeficiency and can result in AIDS if untreated. HIV spreads through blood, sexual fluids, and from mother to child. HIV infection often causes skin, hair, nail, and mouth problems early on. Mucocutaneous manifestations may indicate HIV infection and disease severity. Opportunistic infections like bacterial, viral, and fungal infections are common in HIV. Non-infectious skin conditions, drug reactions, and malignancies are also seen.This study focuses on identifying mucocutaneous lesions in HIV patients in relation to CD4 lymphocyte count as a marker of immune status. AIM: The study aims to correlate the CD4 counts with occurrence of mucocutaneous manifestations in HIV patients.MATERIALS AND METHODS: This is a cross-sectional study which includes 140 HIV-positive patients visiting OPD of Department of Dermatology a nd Venereology at Government General Hospital, Ananthapuramu from April 2023 to Oct 2024.  RESULTS: Among 140 HIV patients with mucocutaneous manifestations, there were 44 males and 56 females, most commonly aged 31–40 years. Heterosexual transmission was the predominant route (94%), and the mean CD4 count was 462.9 cells/µl, with 46% in WHO stage 2 and 8% severely immunosuppressed (CD4 <200). Non-infectious dermatoses were slightly more prevalent, with Pruritic Papular Eruption (PPE) being the most common (n=19, mean CD4 379), followed by Xanthelasma palpebrarum and vitiligo. Infectious manifestations included oral candidiasis (n=17), tinea corporis, tinea versicolor, vulval candidiasis, HPV warts, molluscum contagiosum, leprosy, and furunculosis. Nail changes (longitudinal melanonychia), hair changes (chronic telogen effluvium), and drug reactions (FDE, lichenoid eruptions) were also observed. Infectious skin conditions like tinea and scabies occurred in patients with moderate to preserved immunity (CD4 >490), whereas severe infections such as oral candidiasis and genital herpes were associated with advanced immunosuppression (CD4 <200), highlighting their role as clinical markers of immune status. These findings underscore the importance of regular dermatological assessment in HIV care, particularly in resource-limited settings, as mucocutaneous manifestations can aid early diagnosis, monitoring, and evaluation of HAART effectiveness. CONCLUSION: Cutaneous and mucosal lesions are key clinical indicators of HIV infection. These manifestations can occur at any stage and correlate with immunological status. Certain dermatoses are associated with profound immunosuppression, suggesting advanced HIV disease. Common dermatological conditions may present with atypical morphology or increased severity in HIV-positive patients.Unusual or recalcitrant presentations can complicate diagnosis, particularly in undiagnosed individuals.

Introduction: Diabetes mellitus markedly increases cardiovascular morbidity and mortality due to the combined effects of hyperglycemia, insulin resistance, hypertension, obesity, and dyslipidemia, which accelerate atherosclerosis and vascular dysfunction. Diabetic patients often develop silent myocardial ischemia, leading to late presentation with severe cardiac events. Chronic subclinical elevation of cardiac biomarkers such as CK total, CK-MB, and LDH in diabetes suggests ongoing myocardial injury. This study evaluates the association of these biomarkers with cardiovascular risk factors in type 2 diabetes compared with non-diabetic individuals. Material and methods: This cross-sectional study was conducted at a tertiary care hospital in Surat, India. Serum creatine kinase total (CK total), CK-MB, and lactate dehydrogenase (LDH) were analyzed in 149 diabetic and 149 non-diabetic individuals using an Erba XL-640 fully automated chemistry analyzer. Height and weight were recorded to calculate body mass index (BMI). Statistical analysis was performed using SPSS version 16. Result and discussion: We had observed significantly (p<0.001) higher level of CK total (158 ± 75.10 U/l) in diabetic and non-diabetic (127.5 ± 73.9 U/l) individuals. We had observed significantly (p<0.001) higher level of CK-MB (41.18 ± 14.6 U/l) in diabetic and non-diabetic (29.19 ± 19.1 U/l) individuals. We had observed significantly (p<0.001) higher level of LDH (687 ± 180 U/l) in diabetic and non-diabetic (428 ± 197 U/l) individuals. We had also observed significant higher level of CK total, CK-MB and LDH in all age and BMI groups in diabetic subjects compared to non-diabetic individuals.  Conclusion: This study demonstrates that, Serum CK total, CK-MB, and LDH are significantly elevated in type 2 diabetes mellitus, reflecting early, subclinical myocardial injury driven by chronic hyperglycemia, oxidative stress, and metabolic inflammation. Despite the availability of high-sensitivity troponins, CK-MB and LDH remain reliable, cost-effective markers of cardiac stress and respond to metabolic control and antioxidant therapy. Routine monitoring of these enzymes, alongside glycemic and lipid parameters, can facilitate early cardiovascular risk detection and guide preventive strategies to reduce future cardiac events in diabetic patients.

Aim: The study aimed at assessing serum sodium levels as a prognostic factor in “decompensated liver disease” (DCLD). Methods: The study was conducted in the General Medicine Department of SGT Hospital, utilizing the inpatient (IPD) settings over a period of 18 months. Patients presenting with clinical symptoms of decompensated cirrhosis, such as ascites, hepatic encephalopathy, and gastrointestinal bleeding, were screened and enrolled in the study. A total of 60 patients diagnosed with decompensated liver disease were included in the study.  Results: The mean age of participants was 46.3 ± 6.8 years, with an age range spanning from 18 to 55 years, reflecting the inclusion criteria. A significant proportion of patients, approximately 55%, were aged 41 to 55 years, while 40% were within the 30 to 40 years category. Gender distribution revealed a marked male predominance, with 78.3% (47/60) of the patients being male, while 21.7% (13/60) were female. A significant proportion (20%) belonged to the lower class group, while 45% were from the lower middle class group. A significant proportion (20%) belonged to the lower class group, while 45% were from the lower middle class group. Only 15% of the patients belonged to the middle class category, with 3% in upper middle and 1.6% in upper class category. In this study, alcohol consumption emerged as the most prominent risk factor, with 70% (42/60) of patients having a documented history of chronic alcohol use.  Conclusion: In conclusion, this study provides compelling evidence that serum sodium is an independent and reliable predictor of disease severity, complications, and mortality in decompensated liver disease. The strong associations observed between hyponatremia and adverse outcomes reinforce the need for early detection, continuous monitoring, and targeted therapeutic interventions. The integration of serum sodium assessment into routine liver disease management and transplantation evaluation has the potential to enhance risk stratification, guide therapeutic decision-making, and ultimately improve patient outcomes.

Background: Recurrent urinary tract infection (rUTI) is common in adult women, and recurrent inflammation can influence renal homeostasis and blood pressure regulation. Objectives: To compare renal function parameters and blood pressure profiles between adult women with rUTI and age-matched controls, and to examine associations between rUTI burden, albuminuria, and blood pressure indices. Methods: A hospital-based comparative study was conducted on one hundred adult women were enrolled (50 rUTI; 50 controls). Serum creatinine, blood urea, estimated glomerular filtration rate (eGFR), and urine albumin–creatinine ratio (UACR) were assessed. Blood pressure was measured using a standardized protocol. Group comparisons, correlation analysis, and multivariable regression were performed. Results: Women with rUTI had higher serum creatinine (0.92 ± 0.18 vs 0.81 ± 0.14 mg/dL) and blood urea (28.6 ± 7.9 vs 24.9 ± 6.8 mg/dL), with lower eGFR (89.4 ± 16.8 vs 98.8 ± 14.9 mL/min/1.73 m²). UACR was higher in the rUTI group (median 24 vs 10 mg/g), and microalbuminuria was more frequent (32.0% vs 8.0%). Systolic/diastolic blood pressure was higher in the rUTI group (128.6 ± 12.9/82.1 ± 8.7 vs 121.4 ± 11.2/77.6 ± 7.9 mmHg). rUTI status remained independently associated with lower eGFR, higher systolic blood pressure, and microalbuminuria after adjustment. Conclusion: Adult women with rUTI demonstrated subtle deterioration in renal functional markers and higher blood pressure levels, supporting periodic renal and blood pressure monitoring in this population

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by hyperglycemia due to insulin resistance and/or impaired insulin secretion. This study aimed to evaluate the association between various biochemical markers and glycemic control in T2DM patients. A cross-sectional analysis was conducted on 200 patients recruited from a tertiary care hospital. Data collection included demographic information, anthropometric measurements, and laboratory tests for fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), lipid profile, adipokines (adiponectin, leptin), inflammatory markers (CRP, IL-6), and oxidative stress markers (MDA, TAC). Results indicated significant correlations between several biochemical markers and HbA1c levels. FPG, total cholesterol, LDL-C, CRP, IL-6, and MDA were positively correlated with HbA1c, indicating poorer glycemic control. Conversely, adiponectin and TAC showed negative correlations with HbA1c, suggesting a protective role. Multiple linear regression analysis identified FPG, CRP, and adiponectin as significant independent predictors of HbA1c levels. The findings underscore the critical role of a comprehensive panel of biochemical markers in the management of T2DM. Incorporating inflammatory and oxidative stress markers into routine monitoring could enhance the precision of glycemic control strategies and improve patient outcomes. Future research should focus on longitudinal studies and intervention trials to further elucidate these associations and develop targeted therapeutic intervention

Background: Electrolyte disturbances are common in hospitalized adults and are linked to adverse clinical outcomes. Objectives: To estimate the prevalence and pattern of electrolyte imbalances among adult inpatients and to describe key clinical determinants. Methods: This hospital-based observational study enrolled 100 consecutive adults admitted to the Department of General Medicine, Prathima Institute of Medical Sciences, Karimnagar, Telangana, India, from January 2022 to June 2022. Admission serum sodium, potassium, and calcium were reviewed along with comorbidities and selected clinical exposures. Electrolyte imbalance was defined as any sodium, potassium, or calcium value outside the institutional reference range. Results: Electrolyte imbalance was present in 64% of admissions. Hyponatremia was the most frequent abnormality, followed by hypokalemia. Imbalance occurred more often among patients receiving diuretics and among those with chronic kidney disease, gastrointestinal fluid loss, diabetes mellitus, and sepsis or severe infection. Conclusion: Electrolyte disturbances affected nearly two-thirds of medical inpatients. Early identification and risk-based monitoring of vulnerable groups are essential to improve inpatient safety.

Background: Intraoperative fluid management plays a critical role in gastrointestinal (GI) surgery, as both fluid overload and hypovolemia can contribute to postoperative complications. Goal-directed fluid therapy (GDFT) has been proposed to optimize tissue perfusion and reduce morbidity. Aim: To evaluate the impact of intraoperative fluid management strategies on postoperative outcomes in patients undergoing major gastrointestinal surgery. Methods: This prospective observational study included 160 adult patients undergoing elective gastrointestinal surgery. Patients were divided into two groups: GDFT (n=80), managed with individualized fluid therapy guided by dynamic hemodynamic monitoring, and Liberal Fluid (LF) group (n=80), managed with conventional fluid protocols. Demographic data, intraoperative fluid volume, and postoperative outcomes—including surgical site infection, anastomotic leak, postoperative ileus, acute kidney injury, and length of hospital stay—were recorded. Statistical analysis was performed using SPSS 26, with p<0.05 considered significant. Results:

Baseline demographics were comparable between groups. Total intraoperative fluid administered was significantly lower in the GDFT group (2,350 ± 450 mL vs. 3,200 ± 500 mL, p<0.001). The incidence of surgical site infection (5% vs. 15%, p=0.03) and postoperative ileus (8% vs. 18%, p=0.04) was significantly reduced in the GDFT group. Patients in the GDFT group experienced faster gastrointestinal recovery, with earlier time to first flatus (2.1 ± 0.6 vs. 3.0 ± 0.8 days, p<0.001) and shorter hospital stay (6.2 ± 1.5 vs. 8.1 ± 2.0 days, p<0.001). No significant differences were observed in anastomotic leaks or pulmonary complications. Conclusion: Goal-directed intraoperative fluid therapy reduces postoperative complications, accelerates gastrointestinal recovery, and shortens hospital stay compared to standard liberal fluid administration in patients undergoing gastrointestinal surgery. Incorporating GDFT into routine perioperative care may improve surgical outcomes and enhance recovery pathways.

Background: Intraoperative fluid management plays a critical role in gastrointestinal (GI) surgery, as both fluid overload and hypovolemia can contribute to postoperative complications. Goal-directed fluid therapy (GDFT) has been proposed to optimize tissue perfusion and reduce morbidity. Aim: To evaluate the impact of intraoperative fluid management strategies on postoperative outcomes in patients undergoing major gastrointestinal surgery. Methods: This prospective observational study included 160 adult patients undergoing elective gastrointestinal surgery. Patients were divided into two groups: GDFT (n=80), managed with individualized fluid therapy guided by dynamic hemodynamic monitoring, and Liberal Fluid (LF) group (n=80), managed with conventional fluid protocols. Demographic data, intraoperative fluid volume, and postoperative outcomes—including surgical site infection, anastomotic leak, postoperative ileus, acute kidney injury, and length of hospital stay—were recorded. Statistical analysis was performed using SPSS 26, with p<0.05 considered significant. Results:

Baseline demographics were comparable between groups. Total intraoperative fluid administered was significantly lower in the GDFT group (2,350 ± 450 mL vs. 3,200 ± 500 mL, p<0.001). The incidence of surgical site infection (5% vs. 15%, p=0.03) and postoperative ileus (8% vs. 18%, p=0.04) was significantly reduced in the GDFT group. Patients in the GDFT group experienced faster gastrointestinal recovery, with earlier time to first flatus (2.1 ± 0.6 vs. 3.0 ± 0.8 days, p<0.001) and shorter hospital stay (6.2 ± 1.5 vs. 8.1 ± 2.0 days, p<0.001). No significant differences were observed in anastomotic leaks or pulmonary complications. Conclusion: Goal-directed intraoperative fluid therapy reduces postoperative complications, accelerates gastrointestinal recovery, and shortens hospital stay compared to standard liberal fluid administration in patients undergoing gastrointestinal surgery. Incorporating GDFT into routine perioperative care may improve surgical outcomes and enhance recovery pathways.

Background: The optimal treatment strategy for in‑stent restenosis (ISR) still remains under debate. There have been scarce data on Indian patients relating to ISR treatment. Hence the present study was undertaken to study the clinical profile and angiographic patterns of patients admitted with ISR and they were followed for 6 months for outcomes associated with different treatment modalities.  Method: A total of 200 patients were enrolled in study during a period from January 2022 to March 2023. All patients underwent a general and cardiac evaluation. We evaluated the types of clinical presentation, and angiographic characteristics of ISR, laboratory parameters, treatment modalities used for stenting ISR lesions and the outcomes that occurred within a minimum period of 6 months from the date of the clinical presentation. Results: Unstable angina (39.5%) and NSTEMI (36%) were the common clinical presentations noted for ISR cases. Single vessel disease (46%) with LAD involvement (60%) was common amongst ISR cases, with uncontrolled DM (90%) being a commonly noted factor. Non-focal ISR (65%) with involvement of previous DES and BMS stent usage was seen amongst patients. Most patients with previous BMS stent had neo-atherosclerosis (56.25%) while for previous DES cases, the commonest IVUS finding was under expansion (53.84%). Commonest treatment modality adopted for ISR cases was PTCA (64%), which led to significant increase in both, stent length and stent diameter after management. The overall outcomes of ISR management were promising, with 97.5% cases discharged from hospital after management and maintaining well at 6-month follow up as well.  Conclusion: This study highlights the effectiveness of current ISR management strategies and underscores the need for ongoing monitoring and tailored treatment approaches in the Indian population.

Background: Adverse drug reactions (ADRs) represent a significant burden on healthcare systems globally, contributing to increased morbidity, prolonged hospitalisation, and substantial economic costs. Systematic pharmacovigilance in tertiary care settings provides essential safety data for clinical decision-making. Objective: To prospectively identify, assess, and characterise ADRs in patients admitted to a tertiary care teaching hospital over a 12-month period, with a focus on causality, severity, preventability, and drug class involvement. Methods: A prospective, observational study was conducted over 12 months (January–December 2020) across medicine, surgery, and allied departments. ADRs were collected via spontaneous reporting, active ward monitoring, and prescription review. Causality was assessed using the Naranjo Algorithm and WHO-UMC criteria. Severity was graded by the Modified Hartwig and Siegel scale, and preventability was evaluated using the Schumock and Thornton criteria. Results: Of 3,842 patients monitored, 312 ADRs were identified (incidence: 8.12%). Female patients were more frequently affected (58.3%). The most common drug classes implicated were antimicrobials (27.6%), NSAIDs (18.3%), and cardiovascular drugs (15.7%). The gastrointestinal system was the most frequently affected organ (32.4%). Causality assessment revealed 41.0% probable, 38.5% possible, and 18.3% definite ADRs. Overall, 72.4% were mild-to-moderate, and 34.9% were considered preventable. Conclusion: The high proportion of preventable ADRs underscores the urgent need for structured pharmacovigilance programmes, therapeutic drug monitoring, and multidisciplinary medication safety teams in tertiary hospitals.