Background: Ureteric calculi are a common cause of obstructive uropathy. Minimally invasive approaches such as pneumatic and holmium laser lithotripsy are routinely used for stone fragmentation. This study aims to compare the efficacy and safety of pneumatic versus holmium laser lithotripsy in the management of upper ureteric calculi. Methods: A prospective comparative study was conducted on 100 patients diagnosed with upper ureteric stones at a tertiary care center. Patients were randomly assigned into two equal groups: Group A (Pneumatic lithotripsy, n = 50) and Group B (Holmium laser lithotripsy, n = 50). Parameters analyzed included operative time, stone-free rate, stone migration, complication rates, and postoperative hospital stay. Follow-up was conducted at 4 weeks to assess residual fragments and need for ancillary procedures. Results: Both groups were comparable in terms of age, gender, and stone size. Mean operative time was significantly shorter in the holmium laser group (31.2 ± 4.9 minutes) compared to the pneumatic group (36.4 ± 5.2 minutes, p < 0.001). Stone-free rate after a single session was higher in the laser group (96%) than the pneumatic group (84%, p = 0.04). Stone migration was significantly lower with laser lithotripsy (2% vs 12%, p = 0.03). Postoperative hospital stay was also reduced in the laser group. Complication rates were comparable. At 4-week follow-up, fewer residual fragments and re-interventions were noted in the laser group. Conclusion: Holmium laser lithotripsy is more effective and offers better clinical outcomes compared to pneumatic lithotripsy for upper ureteric stones.

Background: Pneumonia remains a leading cause of morbidity and mortality in India, particularly in resource-constrained settings. This study evaluates the management strategies for pneumonia patients in a tertiary care hospital in Andhra Pradesh, India, between September 2021 and April 2022, using retrospective data from prior studies to inform the framework. Objective: To assess the clinical outcomes, treatment protocols, and factors influencing the management of pneumonia patients, focusing on antibiotic efficacy, hospitalization duration, and mortality rates. Methods: A retrospective cohort study was conducted, analyzing medical records of 350 pneumonia patients admitted between September 2021 and April 2022. Data on demographics, clinical presentation, treatment regimens, and outcomes were collected. Statistical analyses included chi-square tests and logistic regression to identify predictors of recovery. Results: Of the 350 patients, 60% were male, with a mean age of 45 years. Community-acquired pneumonia (CAP) accounted for 85% of cases. Antibiotic therapy, primarily ceftriaxone, was effective in 78% of patients, with a mean hospital stay of 7.2 days. Mortality was 8%, linked to comorbidities like diabetes and chronic obstructive pulmonary disease (COPD). Conclusion: Effective pneumonia management requires timely diagnosis and tailored antibiotic therapy. Strengthening outpatient care and addressing comorbidities could improve outcomes in tertiary settings.

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: Renal masses encompass a wide spectrum of benign and malignant lesions, necessitating accurate imaging for early detection and appropriate clinical management. Ultrasound (USG) is the initial imaging modality for renal mass detection due to its accessibility and cost-effectiveness, while computed tomography (CT) is widely used for further characterization and staging. This study aims to compare the diagnostic accuracy of ultrasound and CT in differentiating benign and malignant renal masses in a tertiary care setting. Methods: This prospective, hospital-based study was conducted over a period of one year, from January to December 2021, at a tertiary care hospital in south India. A total of 150 patients with clinically suspected or incidentally detected renal masses underwent detailed ultrasound evaluation, followed by contrast-enhanced CT (CECT) for further characterization. Imaging findings were compared based on lesion size, echotexture, enhancement characteristics, and vascular involvement. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ultrasound were calculated using CT as the reference standard. Results: Among the 150 renal masses, 96 cases (64%) were malignant, while 54 cases (36%) were benign. The most common malignant lesion was renal cell carcinoma (RCC) in 78.1% of malignant cases, followed by urothelial carcinoma (12.5%) and Wilms tumor (9.4%). Among benign lesions, simple renal cysts (51.8%) and angiomyolipomas (31.4%) were the most frequently observed. Ultrasound demonstrated an overall sensitivity of 85.4% and specificity of 89.1% in differentiating benign from malignant renal masses. The sensitivity was highest for detecting simple cysts and solid exophytic tumors but was lower for complex cystic masses, where CT provided better delineation of septations, calcifications, and contrast enhancement patterns. CT was particularly useful in identifying vascular invasion and extracapsular extension, which were often inconclusive on ultrasound. The correlation between ultrasound and CT findings was statistically significant (p < 0.001). Conclusion: Ultrasound is an effective first-line imaging tool for detecting renal masses, with high sensitivity and specificity in differentiating solid from cystic lesions. However, CT remains the gold standard for detailed characterization, staging, and vascular assessment. The findings support a stepwise imaging approach, where ultrasound serves as an initial screening tool, with CT reserved for further evaluation of indeterminate or complex renal masses.

Introduction Primary cataract removal is suggested if the lens is fragmentized, swollen causing a pupillary block or to examine the posterior segment otherwise blocked by lens opacity. Secondary cataract removal is more beneficial because of improved visibility, proper intraocular lens calculation, and less chances of postoperative inflammation.  Ocular trauma can occur via many mechanisms, affecting the crystalline lens in various ways, including perforating or blunt trauma, electric shock, ultraviolet and ionizing radiation, and chemical injuries. In penetrating trauma, where an object with a sharp edge, such as glass, wood, or metal, pierces the eye, a traumatic cataract may develop immediately if the object reaches the lens after passing through the cornea Materials and Methods Patients of both genders and all age groups with unilateral traumatic cataract were included in the study. Patient's data including demographic details, causative agents, initial visual acuity, intraocular pressure, slit lamp examination findings, B-scan findings, treatment / surgery, early and late complications and final outcome were obtained from patient's chart in the hospital record. Removal of cataract was performed as a second and separate procedure in patients of perforating ocular injury, intraocular lens (IOL) implantation was performed only in patients with adequate capsular support. Patients without any capsular support were kept aphakic. Anterior vitrectomy was performed in patients with posterior capsular tear and vitreous prolapse Results In the current study, the majority of cases were seen in the 5–15-year age group, with a male preponderance. Age Group: The majority of cases (40%) were seen in the 5–14 years age group, with a significant male preponderance (71%). Type of Trauma 54% of cases involved penetrating trauma 46% of cases were caused by blunt trauma. The most common associated injuries were Corneal and iris tissue injuries. 6/6–6/18: Achieved in 43% of patients. 6/24–3/60: Achieved in 31% of patients.Less than 3/60: Observed in 26% of patients Conclusions Primary posterior capsulectomy with anterior vitrectomy may improve the final visual outcome in cases of traumatic cataract. These findings should be confirmed in a study of a larger population that includes multiple centers. In our study males were predominantly affected by traumatic cataract because of their nature of work and outdoor occupation. The age group of 5-15 years formed the core group of people to get traumatic cataract. The final visual outcome showed good result however the final visual outcome depends upon the extent of associated ocular injuries. Effective Intervention and management are the key points in preventing monocular blindness due to traumatic cataract.

Introduction Herein, concurrent true bacteremia with S. epidermidis andB. pseudomallei was managed appropriately in a healthy woman. Case report A thirty-two-year-old previously well farmer presented with a 2-day history of fever and malaise. Having low blood pressure (90/60 mmHg) with a high pulse rate (104 beats/minute) she was admitted to the intensive care unit suspecting sepsis. Two blood cultures from 2 different venipuncture sites were collected and empiric intravenous (i.v.) ceftriaxone was commenced. On day 2, C-reactive protein (CRP) was 320 mg/dL and procalcitonin (PCT) was 128 ng/dL and both cultures yielded methicillin resistant S. epidermidis (MESE), subsequently, vancomycin was added. On day 5, she developed breakthrough fever despite adequate therapy. The CRP level decreased to 110 mg/dL, however, PCT rose to 148 ng/dL. Subsequently, meropenem was added replacing ceftriaxone. Two sets of repeated blood cultures yielded MRSE and MRSE with B. pseudomallei, respectively. B. pseudomallei-IgM antibody titer was 1:5600 (cut off 1:320). Oral cotrimoxazole was added. On day 7, CRP and PCT decreased to 140 mg/dL and 67 ng/dL, and by day 9 only B. pseudomallei was isolated. Vancomycin was continued for a total of 10 days. Following 21 days of meropenem, the patient was discharged with oral cotrimoxazole for 90 days. Conclusions Concurrent bloodstream infection with S. epidermidis and B. pseudomallei is rare and not documented in the literature. Clinical vigilance has provided an opportunity to detect the pathogens in advance and proceed to a complete cure.

IntroductionCoffee is one of the most consumed beverages in the world because of its energizing effects. Medical students are often under great stress and in need of energy, which is why they frequently consume coffee. Methods We conducted a prospective study using an online questionnaire among medical students to assess the reasons, frequency and amount of coffee consumption and adverse events experienced. Results A total of 119 students responded to the questionnaire. The majority consumed coffee (84.9%, n=101), but also caffeinated drinks (68.1%, n=81). The main reasons for drinking coffee were the need to improve productivity (75.2%, n=76) and the need to combat sleep deprivation (64.4%, n=65). A total of 84.2% (n=85) experienced at least one adverse event, including agitation (78.8%, n=67/85), tachycardia (72.9%, n=62/85) and tremor (63.5%, n=54/85). Smoking was encountered in only 21.8% (n=26) of students. Conclusions Although the beneficial effects of balanced coffee consumption are well known, a large proportion of medical students use it to combat fatigue, sleepiness and to increase productivity.

Introduction Psychogenic nonepileptic seizures (PNES) is a non-epileptic event which needs to be differentiated from epileptic seizures and poses a diagnostic challenge. It has psychological etiology without any associated abnormal electrical discharges in the brain. We have tried to explain in detail the semiology and socioeconomic factors of patients presenting with the diagnosis of PNES to our hospital so that it will help in early diagnosis and prevent unnecessary antiepileptics use. Methods This is a retrospective study. We have included all patients admitted to the Neurology Department of Kalinga Institute of Medical Sciences (KIMS) during 2020-2021 and discharged with a diagnosis of PNES. Those having associated epileptic events were excluded from the study. All events were categorized as hypermotor, hypomotor and sensory symptoms as per the patient’s presentation as there is no universal classification system for PNES. Results A total of 50 patients were included in the study. Of them 70% had PNES of hypermotor and 30% of hypomotor type. The mean number of events in the hypomotor group was significantly higher than that in the hypermotor group. The hypomotor variety was found predominantly in females and hypermotor in males. Overall, 10% of the patients had a history of epilepsy in one of the family members. A total of 74% patients had associated anxiety, depression or post-traumatic stress disorder. Conclusions Hypermotor events were more common than hypomotor events. Hypomotor events were found mostly in females. Most of the patients had pre-existing anxiety, depression, or post-traumatic stress disorder as underlying risk factors.

Introduction This study’s purpose was to investigate the relationship between laboratory blood parameters and ocular findings in patients hospitalized with moderate or severe COVID-19. Methods Ophthalmologic examination of 215 patients who were hospitalized with the diagnosis of COVID-19 was performed in their hospital beds and their ocular findings were noted. Blood parameters were compared in patients with and without conjunctivitis-like symptoms. Results Conjunctivitis-like inflammatory findings were detected in 15 (7.44%) of 215 moderate or severe COVID-19 patients. There was no difference between the patients with and without ocular findings in terms of laboratory findings such as white blood cells count, neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, procalcitonin, D-dimer, C-reactive protein, and ferritin. Conclusions There was a significant relationship between COVID-19 and an acute conjunctival inflammatory response. Blood parameters that determined progression in patients with COVID-19 were not significant in terms of ocular findings.

"I want to break free” - the famous lyric from Queen`s song seems appropriate for today’s times, when everyone wants to escape the restrictions that were enforced with the COVID-19 pandemic. Looking back, the alarming spread of SARS-CoV-2 infection has induced fear and panic among people. The fear of getting sick with the "unknown virus” made us self-isolate at home, and be very careful about hand hygiene and interactions with others. Since March 2020, face masks have become an essential part of our lives, together with hand hygiene products. The initial months of the pandemic have been marked by a significant disruption of the availability of these products on the market, which, in turn, exponentially increased people’s fears. But as the months passed and SARS-CoV-2 became better known, opponents of the restrictions began to emerge, and the mask became a means of "suppressing people’s freedom”. In a personal study (unpublished data), Romanian adults’ fear of contracting COVID-19 has dropped in one year since the start of the pandemic from 79.4% to 24.9%. Why these paradigm shifts – from desperately seeking to procure masks to wanting to get rid of them, or from fear of the disease to underestimating SARS-CoV-2 infection?