Background: Precision nutrition—tailoring dietary interventions based on microbiome and clinical profiling—is gaining relevance in the management of pediatric inflammatory bowel disease (IBD). This study investigates the efficacy and feasibility of a microbiota-targeted nutritional intervention in children with Crohn’s disease and ulcerative colitis. Methods: A prospective observational study was conducted on 50 pediatric IBD patients (6–17 years). Participants received a two-phase dietary protocol: (1) six weeks of microbiota-directed exclusive enteral nutrition and (2) six weeks of a structured maintenance diet based on Crohn’s Disease Exclusion Diet principles. Primary outcome was clinical remission (PCDAI or PUCAI <10). Secondary outcomes included changes in inflammatory markers (CRP, fecal calprotectin), BMI z-score, and adherence rates. Microbiota profiles were analyzed at baseline and week 12 using 16S rRNA sequencing. Results:Clinical remission was achieved in 68% of patients at week 6 and sustained in 62% at week 12. Significant reductions in PCDAI/PUCAI scores, CRP (−12.1 mg/L), and fecal calprotectin (−341 µg/g) were observed (p < 0.01). Nutritional status improved with a mean BMI z-score increase of +0.5. Adherence rate was 82%, and tolerance to the intervention was high. Only mild gastrointestinal adverse events were reported. Conclusions: Precision nutrition is a promising, safe, and effective adjunctive therapy for pediatric IBD. Personalized dietary strategies can induce remission and reduce systemic inflammation, with high tolerability and adherence. Integration into clinical pathways may reduce reliance on pharmacotherapy and improve long-term outcomes.

Background:  Dengue Virus (DENV) is the most common arbovirus found in India. Around the world, it primarily affects tropical and subtropical areas. It is predominantly endemic in urban and semi-urban regions. There are four dengue virus serotypes (DENV1 through DENV4) that are known to infect people.  Aims and Objectives: To diagnose Dengue infection by serology ELISA and confirmed by RTPCR testing along with serotyping of Dengue virus.  Material and Method:  Acute phase serum samples were collected from five hundred individuals, and were tested for processed through Dengue NS1Ag by ELISA, Dengue viral RNA by RT PCR kit for Dengue virus genes. PCR positive Dengue samples were tested for serotyping to identify the of Dengue virus into 4 Dengue serotypes (DENV1, DENV2, DENV3 and DENV4) by Multiplex RT-PCR kit (CDC DENV 1-4 Real-Time RT-PCR Assay for Detection and Serotype Identification of Dengue Virus).  Result:  Of the 500 samples tested for Dengue during the peak positivity months of Dengue, September 2021 to November 2021, 289 (%) samples were positive for Dengue NSI Ag by ELISA, 140/ 289(% ). One hundred forty samples out of total positive dengue NS1 samples were positive for Dengue virual RNA s gene. Out of 140 Dengue RT PCR positive samples 90 ( % )  were DENV2, 26 ( % ) were DENV1, 4 ( % ) were DENV3 and none (%) were DENV4. Twenty (% )  samples were Dengue RNA positive but no serotype was detected.  Conclusion:  Positivity for Dengue was high – and DEN-2 was the most prevalent serotype in our area. It is important to keep an eye on prevalent Dengue serotypes out by surveillance involving every area for the to rapidly detect emergence of newer serotypes of Dengue viruses in hitherto unknown territory. Only a Rrapid diagnosis can help in benefit with patient management in a timely manner due to the lack of an effective therapy and vaccine.

Background: Regional anesthesia plays a crucial role in lower limb surgeries, with ongoing efforts to optimize pain management and patient outcomes. The Sciatic-Obturator-Femoral Technique (SOFT) block emerges as a potential alternative to traditional spinal anesthesia, offering potential advantages in pain control and hemodynamic stability. Methods: A prospective comparative study was conducted on 82 patients aged 18-60 years undergoing tibial fracture surgeries at A.C.S Medical College and Hospital, Chennai. Patients were divided into two groups: Group S1 (SOFT block, n=41) and Group S2 (Spinal anesthesia, n=41). The SOFT block group received ultrasound-guided sequential blocking of sciatic, obturator, and femoral nerves using 0.25% bupivacaine. The spinal anesthesia group received 15 mg hyperbaric bupivacaine 0.5% at L3-L4 intervertebral space. Onset of sensory and motor blockade, duration of analgesia, hemodynamic parameters, pain scores, and analgesic requirements were monitored. Results: The SOFT block demonstrated significantly different characteristics compared to spinal anesthesia. The sensory blockade was slower in the SOFT block group (14.7 ± 3.8 min vs. 4.2 ± 1.6 min). Analgesia duration was markedly longer in the SOFT block group (9.8 ± 2.1 hours vs. 3.2 ± 1.4 hours). Hemodynamic stability was superior in the SOFT block group, with lower incidences of hypotension (7.3% vs. 46.3%), bradycardia (2.4% vs. 34.1%), and vasopressor requirements (2.4% vs. 19.5%). Postoperative pain scores at 6 hours were significantly lower in the SOFT block group (1.1 ± 1.0 vs. 4.2 ± 1.6), with reduced rescue analgesia requirements (63.4 ± 38.2 mg vs. 176.8 ± 31.5 mg). Conclusion: The SOFT block technique demonstrates superior postoperative analgesia, extended pain relief, and improved hemodynamic stability compared to spinal anesthesia in tibial fracture surgeries across adult patients aged 18-60 years. This approach offers a promising alternative for patients requiring comprehensive pain management with minimal cardiovascular complications.

Background: Percutaneous nephrolithotomy (PCNL) is a standard surgical approach for managing large renal calculi. While effective, standard PCNL (S-PCNL) is associated with notable perioperative blood loss. Miniaturized PCNL (M-PCNL) has emerged as a less invasive alternative with potential benefits in reducing surgical morbidity. This study compares perioperative blood loss between S-PCNL and M-PCNL techniques. Methods: A prospective observational study was conducted among 100 patients undergoing PCNL for renal stones, with 50 patients each assigned to S-PCNL and M-PCNL groups. Baseline characteristics were recorded. Perioperative hemoglobin drops, estimated blood loss, transfusion requirements, operative time, and complications were compared. Statistical analysis was performed using independent t-tests and chi-square tests, with p < 0.05 considered significant. Results: Baseline demographic and clinical characteristics were comparable between groups. The mean hemoglobin drop was significantly greater in the S-PCNL group (2.1 ± 0.6 g/dL) compared to the M-PCNL group (1.2 ± 0.5 g/dL; p < 0.001). Estimated blood loss was also higher in S-PCNL (189.5 ± 41.3 mL vs. 112.8 ± 36.7 mL; p < 0.001). Blood transfusion was required in 16% of S-PCNL cases versus 4% in M-PCNL (p = 0.045). Operative time was marginally longer in M-PCNL (p = 0.028), with no significant difference in complication rates. Conclusion: Mini-PCNL is associated with significantly reduced perioperative blood loss and lower transfusion requirements compared to Standard PCNL, with similar safety profiles. These findings support the adoption of M-PCNL, particularly in patients with increased bleeding risk.

Photodynamic therapy (PDT), also known as photo-radiation therapy, phototherapy, or photochemotherapy, is a minimally invasive treatment modality initially developed for oncology applications. In recent years, PDT has gained increasing interest in clinical dentistry due to its wide range of potential therapeutic applications. Currently, it is used for treating oral malignancies, infectious bacterial and fungal diseases, and photodynamic diagnosis (PDD) of potentially malignant oral cavity disorders. In summary, promising clinical outcomes have been reported in cases of oral leukoplakia, oral lichen planus, and head and neck cancers. In addition to its oncological applications, PDT is a potential method to disrupt oral biofilms, which are largely responsible for the pathogenesis of plaque-related diseases. By selectively acting on pathogenic microorganisms and preserving commensal flora, PDT helps restore homeostasis of the microbial flora in the oral cavity, which reduces the risk of secondary infections. Additional researchers are working to develop new photosensitizers with greater specificity and efficacy against particular oral pathogens. Amidst the constant evolution in the dental field, PDT is being appreciated as a potentially important complement to traditional dental treatment modalities. It provides the advantages of selective reactivity, reduced side effects, and overall clinical improvement.

Diabetic Neuropathy is one of the most important complications of Type 2 Diabetes Mellitus. But whether the glycaemic variability is related with the diabetic neuropathy is not proven with sufficient data yet. So, this study is aimed at determining the association between the glycaemic variability with the diabetic neuropathy. Fifty patients [32 males and 18 females; aged (yr) 58.32 ± 9.629 (mean±SD)] were investigated for this study. Glycaemic variability is estimated by HbA1c measurement and neuropathy is quantitatively evaluated by nerve conduction velocity (NCV) of median nerve for sensory and motor component. HbA1c had a significant association with the NCV. In patients in whom HbA1c value improves both right and left sided motor and sensory NCV increased which is statistically significant (P˂0.05). In patients in whom HbA1c value deteriorates both sided median nerve motor and sensory NCV decreased, but the left sided reduction in NCV is statistically significant (P˂0.05) but in right side reduction in motor and sensory NCV is statistically insignificant (P˃0.05). So, we may conclude that glycaemic variability could be a risk factor. This study addresses one of the key issues related to the evaluation of diabetic neuropathy.

Background: Chronic obstructive pulmonary disease (COPD) and periodontal disorders appear to be linked through common inflammatory pathways. Both conditions are mediated by the activation of neutrophils and pro-inflammatory cytokines, which contribute to progressive tissue damage and chronic degeneration. This investigation aimed to evaluate and contrast the periodontal condition of individuals diagnosed with COPD against that of matched healthy controls, considering both age and gender. Materials and Methods: Individuals older than 30 years who received a physician-confirmed diagnosis of COPD were enrolled as the case group. Control participants were healthy individuals matched for age and sex. Information regarding demographic characteristics, socioeconomic background using the Kuppuswamy classification, tobacco and other harmful oral practices, and oral hygiene habits was collected. The Simplified Oral Hygiene Index (OHI-S) and the World Health Organization's 1997 basic oral health survey format were utilized to assess oral hygiene and periodontal parameters.   Results: A majority of the COPD group exhibited moderate disease severity. Mean scores for OHI-S, Community Periodontal Index (CPI), and Loss of Attachment (LOA) were notably higher in the COPD group compared to the control group. An upward trend in these indicators was observed with increasing COPD severity. Although factors such as sex, tobacco habits, and alcohol intake affected periodontal health in both groups, statistically significant risk associations were evident primarily among COPD patients. Moreover, individuals with COPD demonstrated increased likelihood of presenting with poor oral hygiene, advanced periodontal pocketing, and attachment loss. Conclusion: The findings underscore a notable correlation between periodontal disease and COPD. The deterioration of oral and periodontal health was more pronounced with escalating COPD severity.

Background: Chronic cancer pain is a widespread public health issue. Studies of cancer patients' pain control consistently reveal that up to half of patients receive inadequate analgesia. Aim: The primary aim of this study was the reduction in numerical rating scale (NRS) score for pain in gastric and pancreatic malignant patients who have undergone USG guided anterior approach coeliac plexus ethanol neurolysis.(CPN) Methods: This is a retrospective cohort study. Secondary outcome measure was a reduction in consumption of oral analgesics and morphine.This procedure was done in an ICU as a bedside procedure. Trial coeliac  plexus block was done after identification of celiac trunk using ultrasound, 15 cc of 1% xylocard was given after negative aspiration of blood and under direct visualization. After 30 minutes pain relief was assessed with Numerical rating scale for pain (NRS). Patient was then given 20ml of 60% ethanol after negative aspiration of blood and under direct visualization. Pain relief was documented using NRS immediately and  at 24hours, 72 hours,1 week and 3 months. Results 90% of the patients had a pain relief which is significant and did not require any oral analgesics and oral morphine. The remaining 10% of the patients required oral analgesics and oral morphine but the total consumption was reduced. Our study shows highly statistically significant difference between pre-NRS and post immediate-NRS (mean 8.26 ±0.52 and 3.40 ±0.47)(P value <0.0001) and significant decrease in NRS  seen after 24 hours,72 hours,1 week,and 3 months. Pre and post procedure morphine consumption shows significant difference in p-value (0.007). Hypotension is most common complication recorded Conclusion USG guided anterior approach coeliac plexus ethanol neurolysis is effective in treating pain associated with gastric and pancreatic malignancy

Background Aim and Objective: Therefore, this study aims to directly compare the block characteristics, performance times, and complications of ultrasound-guided supraclavicular and infraclavicular brachial plexus blocks in patients undergoing forearm and hand surgeries. Methods: A prospective observational study was conducted on 166 patients undergoing forearm or hand surgery, comparing ultrasound-guided supraclavicular and infraclavicular brachial plexus blocks. Patients were randomized into two groups (n=83 each), receiving a standardized local anesthetic mixture. Sensory and motor blocks were assessed in specific nerve territories at 30 minutes post-procedure. Data were analyzed using the Mann–Whitney U test and Chi-square test, with significance set at P<0.05. Results: The supraclavicular block showed a faster onset of both sensory and motor blockade (mean onset: 8.5 ± 2.1 min) compared to the infraclavicular block (mean onset: 10.4 ± 2.5 min, p < 0.01). Procedure duration was shorter in the supraclavicular group (6.2 ± 1.4 min vs. 7.1 ± 1.6 min, p < 0.05). Success rates were comparable in both groups (96% vs. 94%, p = 0.62). However, the infraclavicular approach had a slightly lower incidence of complications, including vascular puncture and Horner’s syndrome. Conclusion: Both supraclavicular and infraclavicular approaches are effective for brachial plexus blockade in upper limb surgeries. The supraclavicular block offers a faster onset and shorter procedural time, whereas the infraclavicular block may have a marginally better safety profile. The choice of technique should be tailored to patient anatomy, clinician expertise, and surgical requirements.

Background: Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality worldwide. Early detection significantly improves outcomes, highlighting the importance of effective screening methods. Colonoscopy is considered the gold standard for CRC detection, offering high sensitivity and specificity. However, its invasiveness and cost limit widespread use. The fecal immunochemical test (FIT), a non-invasive alternative, is widely used for population screening. This study compares the sensitivity and specificity of FIT versus colonoscopy to evaluate their diagnostic performance for CRC detection. Methods: This prospective observational study compared the diagnostic accuracy of FIT and colonoscopy in 100 participants with comparable baseline characteristics. Participants (n=50) were instructed to collect a stool sample at home using a commercially available quantitative FIT kit which detects hemoglobin in stool using antibodies specific to human hemoglobin. Colonoscopy (n=50) examinations occurred within two weeks of performing FIT sampling for all participants. Experienced gastroenterologists who were unaware of the FIT outcomes conducted the colonoscopies. The procedure for bowel preparation utilized a standard polyethylene glycol solution. Gastroenterologists evaluated the entire colon segment extending from the cecum and collected biopsies or performed surgical removal of observed polyps and suspicious lesions which underwent histological analysis.  Results: FIT showed high sensitivity (90%) and specificity (88%) versus colonoscopy's perfect metrics. FIT performance was strongest in Stage II–III cancers but less effective in early and advanced stages. False positives were linked to benign bleeding conditions, while right-sided and small lesions caused false negatives. Despite lower accuracy, FIT had higher patient compliance (100% vs. 92%) and satisfaction. These findings support FIT as a reliable, patient-friendly screening tool, especially valuable in large-scale settings where colonoscopy access may be limited. Conclusion: In conclusion, while colonoscopy remains the definitive diagnostic and therapeutic tool for colorectal cancer screening, FIT offers a practical, accurate, and patient-preferred alternative. Its performance is especially notable in detecting Stage II and III cancers. However, its limitations particularly in detecting right-sided and early-stage tumors highlight the need for integrated strategies that combine FIT with targeted colonoscopy follow-up in high-risk cases.

Background: To assess patient’s expectation in a hospital setting. Study Design: Hospital based, cross sectional study.  Result: A total of 451 patients, of more than 18 years, were included in this study. Majority of patients were female 52.55% and maximum number of patients were from age group 31-45 years (n=145). Majority of patient desired for proper diagnosis (n=143) and affordable treatment cost (n=134). Whereas medical knowledge and experience of doctor (n=165) was primarily the influencing factor for the patient in outpatients but inpatients voted for way of communication (n=52). Patients were unwilling to pay more for premium services (n=389) and were not ready to get evaluated by junior doctor, prior to specialist consultation (n=276). Almost 35 % of patient claimed that they were not informed about possible side effects of medicine. However, most of patient claimed that they were satisfied (n=322) and would recommend this hospital to others (n=423).  Conclusion: Most of patients expressed satisfaction with their physician but this study revealed that patients were unwilling to be seen by junior doctor or Artificial intelligence (AI) Chabot/ online consultation and desired time for consultation to be 5 to 15 min. A significant number patients were satisfied with hospital/ doctors but an improvement is required in communicating side effects of medicine was found.

Background: Chronic Pharyngitis (ICD 10 J31.2) is a chronic inflammatory condition of the pharynx. Pathologically, it is characterized by hypertrophy of mucosa, seromucinous glands, sub epithelial lymphoid follicles and even the muscular coat of the pharynx .Pharyngeal pain without an obvious explanation is chronic nonspecific pharyngitis. Aims: To determine the treatment efficacy between appropriate anti-biotics and anti-reflux medication in the management of Chronic Pharyngitis and to determine the etiopathological role of infection vs. LPR in Chronic Pharyngitis. Materials and method: The present study was a single centered, hospital based longitudinal analytical study. This study was conducted from April 2021 March 2022 at ENT OPD, Midnapore medical college and hospital. 200 patients were included in this study. Result: In Group-A, the mean Reflux Symptom Index Post – treatment (mean± s.d.) of patients was 22.7344±2.6055. In Group-B, the mean Reflux Symptom Index Post – treatment (mean± s.d.) of patients was 28.5032±2.8087. Distribution of mean Reflux Symptom Index Post - treatment with Group was statistically significant (p<0.0001). Conclusion: We concluded that Chronic Pharyngitis is more often due to long standing irritation at the laryngopharynx due to acidic and non-acid reflux from the esophagus. It has been found that chronic and recurrent cases of pharyngitis often develop resistance to antibiotics and that antibiotics have limited role, especially in culture negative pharyngitis and Non-specific Chronic Pharyngitis. Thus it is expected that anti-reflux pharmacotherapy will be more effective than anti-biotics.

Introduction: Diabetic Peripheral Neuropathy (DPN) is a common yet often underdiagnosed complication of diabetes, leading to significant morbidity, including pain, sensory loss, and an increased risk of foot ulcers. This study aims to assess the prevalence of DPN and identify its key risk factors, aiding in early detection and effective management strategies. Material and Methods: This single-center, cross-sectional study at MGM Medical College, Navi Mumbai, assessed 160 Type 2 Diabetes Mellitus patients for Diabetic Peripheral Neuropathy (DPN) prevalence and risk factors. Ethical approval and informed consent were obtained. Evaluation included the Michigan Neuropathy Scale, Vibration Perception Threshold (VPT) assessment, and blood tests for HbA1c, glucose levels, lipid profile, and renal function. Data analysis was conducted, with a p-value <0.05 considered statistically significant. Results: Hypertension was present in 35% of subjects, and 85% were overweight (p<0.05). Smoking and alcohol consumption were observed in 10.6% and 3.8% of participants, respectively. The overall prevalence of Diabetic Peripheral Neuropathy (DPN) was 30.6% (MNSI) and 36.9% (VPT), with higher rates among overweight individuals, smokers (76.5%, p<0.01), hypertensive patients (39.3%, p<0.01), and those with prolonged diabetes (p<0.01). Elevated HbA1c, cholesterol, uric acid, and liver enzymes were significantly associated with DPN (p<0.01). The sensitivity and specificity of MNSI were 88.12% and 62.71%, with an accuracy of 78.75%. Conclusion: Diabetic Peripheral Neuropathy (DPN) is prevalent among Type 2 Diabetes Mellitus patients, with significant associations observed with hypertension, obesity, smoking, prolonged diabetes duration, and elevated metabolic markers

Background: Hepatitis C virus (HCV) exhibits substantial genotypic variability, which impacts clinical manifestations and associated conditions. This study evaluates the relationship between HCV genotypes and the prevalence of jaundice, ascites, and HIV status in chronically infected patients. Materials and Methods: A prospective analytical study was conducted on 70 patients with chronic HCV infection at a tertiary care hospital. HCV genotyping (for 1a, 1b, 2, and 3), blood tests for LFT & HIV status, and clinical parameters were recorded, and statistical analyses were performed to evaluate associations. Results: showed that Genotype 3 was the most prevalent (64.3%), followed by Genotype 1a (25.7%), Genotype 2 (5.7%), and Genotype 1b (4.3%). Jaundice was observed in 81.4% of patients, with the highest prevalence in Genotype 3 (86.7%), though this association was not statistically significant (p=0.4998). Ascites was noted in 14.3% of patients, occurring most frequently in Genotype 1b (33.3%), but without statistical significance (p=0.4150). A significant association was found between HIV status and genotype, with 33.3% of Genotype 1b patients exhibiting reactive HIV status (p=0.0075). Conclusion: These findings highlight the importance of understanding genotype-specific variability in the clinical presentation of HCV, which may inform more effective management strategies. Further research is needed to explore host and viral factors influencing disease severity and progression.

Background: Hepatitis C virus (HCV) is characterized by extensive genotypic variability, which significantly impacts the effectiveness of treatment regimens. Direct-acting antiviral agents (DAA) have transformed HCV management, offering high cure rates, but the response to therapy can vary across different genotypes and viral load levels. Understanding this variability is crucial for optimizing treatment outcomes. The viral load is directly related to the infectivity in patients. Aims and objective: HCV viral load was measured prior to the initiation of therapy to establish a baseline for each patient. Following completion of the Direct-Acting Antiviral (DAA) therapy, sequential measurements of HCV viral load were conducted at 6 weeks, 12 weeks, 6 months, and 9 months to assess the virological response and monitor treatment efficacy over time. Materials and Methods: This prospective analytical study was conducted at Medical College and Hospital, Kolkata, from February 2020 to January 2021. A total of 70 chronic Hepatitis C Virus (HCV) infected patients attending the Department of Gastroenterology were enrolled after determination of their HCV viral load and genotype. Patients were administered Sofosbuvir-based combination therapy by the Department of Gastroenterology. The virological response to therapy was monitored by sequential measurement of HCV viral load at 6 weeks, 12 weeks, 6 months, and 9 months post-treatment, conducted by the Department of Microbiology. Results: Among the 70 HCV patients studied, genotype 3 was most prevalent (64.3%), and Sofosbuvir + Ledipasvir was the most commonly used treatment across all genotypes. Sofosbuvir + Velpatasvir was mainly used in genotype 3, while Sofosbuvir + Daclatasvir was used in a smaller subset. A significant association was found between genotype and treatment regimen (P = 0.0112). Post-DAA therapy, significant reductions were observed in serum bilirubin, AST, ALT, and ALP levels across all genotypes, indicating consistent and statistically significant (p < 0.0001) biochemical improvement and effective liver function restoration following treatment. Conclusion: HCV genotypic variability and viral load are critical factors influencing the efficacy of DAAs. While DAAs offer high rates of SVR, personalized treatment based on genotype and viral load remains essential for optimal outcomes. Further research into resistance-associated substitutions and the role of host factors is needed to enhance treatment strategies.

Background: In newborn care, neonatal mortality is still a major concern, especially for outborn neonates in tertiary intensive care units.  The purpose of this study is to assess how well the SNAP-PE 2 score predicts infant mortality in relation to clinical variables including temperature, oxygen saturation, perfusion, and blood sugar (TOPS).  The results of this study, which was carried out at GMERS Gotri, will improve knowledge of the risk factors for death in this susceptible group. Aims: To study TOPS (Temperature, Oxygen Saturation, Perfusion, Sugar) & SNAP PE II (Score for Neonatal Acute Physiology II with Perinatal Extension) score to measure neonatal mortality among outborn neonates in tertiary level NICU in GMERS GOTRI Materials and Methods: This is an institution-based observational study with a prospective design. The study was conducted in the inpatient ward and the NICU of the Department of Pediatrics of the GMERS Medical College, Gotri, Vadodara, Gujarat and study duration was The study was conducted for 12 months, from November 2023 to December of 2024. The sample size of this study is 120. Result: It was seen that at a cut-off of 5.5, post-transport TOPS score had a sensitivity of 76.1% and specificity of 94.3% in the prediction of death in the participants (AUC 0.918, p-value <0.001). Conclusion: With an emphasis on temperature, oxygen saturation, perfusion, and sugar levels (TOPS) as well as the SNAP-PE 2 score (Score for Neonatal Acute Physiology-Perinatal Extension), this study attempts to evaluate neonatal mortality among outborn neonates in the tertiary-level NICU at GMERS Gotri.  Mortality results will be assessed through data analysis

Background: Fluid biomarker detection at a stage of disease growth is essential to implement preventive treatment so patients can experience enhanced results. The non-invasive biofluid saliva contains multiple biomarkers which reflect systemic health conditions. The development of artificial intelligence (AI) has brought forward substantial interest in using salivary biomarkers for predictive diagnostics tests. A research objective established the creation and validation of artificial intelligence-driven diagnostic software built from salivary biomarkers to identify systemic conditions starting from diabetes mellitus, cardiovascular disease and ending with chronic kidney disease. Materials and Methods: Three hundred participants received equal distribution based on systemic disease diagnosis and healthy participants in this cross-sectional study. The study collected unstimulated saliva samples which were sent to ELISA kits for biomarker analysis of glucose, cortisol, CRP, creatinine, and IL-6. A data preprocessing step followed by normalization processes enabled the transfer of data to Random Forest and Support Vector Machine and Artificial Neural Network machine learning models. The evaluation of models used accuracy, precision, recall and AUC-ROC metrics to determine their performance. Results: The Artificial Neural Network achieved best results from the tested models which produced a 91.3% diagnostic accuracy alongside 89.8% precision and 92.5% recall and 0.95 AUC-ROC. The RF model reached 88.7% diagnostic accuracy coupled with 0.91 AUC-ROC value yet the SVM model only attained 85.4% accuracy. The connection between systemic inflammation-linked conditions and salivary IL-6 and CRP functioned as strong indicators and salivary glucose mirrored diabetic disease with a robust correlation value of 0.78 at p<0.001. Conclusion: The diagnostic model built with artificial intelligence relies on saliva samples to identify systemic diseases before symptoms appear through non-harmful testing methods. The incorporation of these tools into standard clinical work environments has the potential to strongly boost preventive healthcare services. Additional extended research focusing on different population groups should follow to verify these discovery results.

Background: The internet has become an indispensable part of daily life, particularly for medical students, providing access to academic resources and medical literature. However, its excessive use has led to the emergence of Internet Addiction (IA), a behavioral disorder with potential adverse effects on physical, psychological, and academic performance. Objectives: To assess the prevalence and spectrum of Internet Addiction among undergraduate medical students and to identify socio-demographic and usage-related determinants influencing addiction levels. Methods: A cross-sectional study was conducted over six months (April–September 2023) at Government Medical College, Anantnag, involving 400 MBBS students. Data were collected using a semi-structured proforma and Young's Internet Addiction Test (IAT). Socio-demographic characteristics and internet usage patterns were recorded. Ethical clearance was obtained from the Institutional Ethics Committee. Results: The mean age of participants was 21±4 years with nearly equal gender distribution. Most participants were hostel residents (88.8%) and from nuclear families (76.3%). The prevalence of Internet Addiction was 87%, with 61% exhibiting moderate addiction, 25% mild, and 1% severe addiction. Significant associations were observed between internet addiction and variables such as age >20 years (OR=2.6, p=0.001), MBBS year (highest in 4th year students, p=0.001), and reported negative impact on academic performance (OR=3.0, p=0.001). No significant association was found with gender, residence, or years of internet use. Conclusions: A high prevalence of Internet Addiction was observed among medical students, predominantly at a moderate level. Age, academic year, and perceived academic impact were significant predictors of IA. These findings underscore the need for awareness and interventions to promote responsible internet usage among medical students to safeguard their academic and mental well-being.

Background: Psychological morbidity, particularly depression and anxiety, is common among cancer patients and significantly impacts their quality of life (QoL). Early detection and management of these conditions are essential for holistic cancer care. To assess the prevalence of depression and anxiety among cancer patients undergoing treatment and to evaluate their association with socio-demographic variables and quality of life using validated screening tools. Materials and Methods: A cross-sectional study was conducted on 100 cancer patients at MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad. Participants were assessed using the Hospital Anxiety and Depression Scale (HADS) and WHOQOL-BREF scale. Socio-demographic data were collected using a structured intake proforma. Statistical analyses included descriptive statistics, t-tests, ANOVA, and correlation coefficients to evaluate associations. Results: The mean age of participants was 43.34 years. Equal gender distribution was observed. HADS revealed that 38% had abnormal depression scores and 30% had abnormal anxiety scores. Depression was significantly associated with younger age, unmarried status, nuclear family type, and higher education (p < 0.05). Anxiety was also significantly associated with age and education (p < 0.05). No significant associations were found for gender, occupation, or domicile in relation to depression or anxiety. Depression and anxiety showed a moderate positive correlation (R = 0.47, p < 0.0001). Depression was strongly negatively correlated with all WHOQOL-BREF domains: physical (R = -0.66), psychological (R = -0.51), social (R = -0.50), and environmental (R = -0.67). Anxiety showed a weaker but significant negative correlation with QoL domains, except for social relationships. Conclusion: Depression and anxiety are prevalent among cancer patients and are significantly associated with impaired quality of life. Routine psycho-oncological screening using standardized tools like HADS and WHOQOL-BREF can help in early identification and management of psychological distress, thereby improving treatment outcomes and overall well-being.

Background: Accurate measurement of haemoglobin (Hb) is essential in the management of critically ill patients, particularly for diagnosing anaemia and guiding transfusion therapy. Arterial blood gas (ABG) analysers offer rapid, point-of-care Hb estimation; however, their agreement with conventional laboratory methods remains uncertain. Methods: We conducted a retrospective, cross-sectional observational study in the Surgical Intensive Care Unit (ICU) at AIIMS Nagpur. Haemoglobin values from paired arterial and venous blood samples were analyzed in 40 adult patients. Arterial Hb was measured using an ABG analyser, while venous Hb was assessed using a standard laboratory haematology analyser. Statistical analysis included paired t-test, Pearson correlation, simple linear regression, and Bland-Altman analysis to assess the relationship and agreement between the two methods.

Results: The mean arterial Hb was 9.54 ± 2.16 g/dL, and the mean venous Hb was 10.00 ± 2.57 g/dL. The mean difference was -0.46 ± 2.09 g/dL (95% CI: -1.16 to 0.23; p = 0.187), indicating no statistically significant difference. A moderate positive correlation was found between ABG and laboratory Hb values (r = 0.623, p < 0.001). Linear regression revealed that arterial Hb moderately predicted venous Hb (R² = 0.388). Bland-Altman analysis showed a mean bias of -0.46 g/dL, with wide limits of agreement ranging from -4.55 to +3.63 g/dL. Conclusions: Haemoglobin measurements obtained from ABG analysers demonstrate moderate correlation but considerable variability when compared to venous laboratory results. While ABG-derived Hb values may serve as a rapid screening tool in critical care, laboratory confirmation remains essential for accurate clinical decision-making when precision is required.

Background: There has been an increase in the incidence and prevalence of cataract in younger patients. This study has been conducted to identify the probable risk factors for early opacification of lens and the different morphological varieties of presenile cataract Materials and Methods: Patients in the age group of 18–50 years attending the Out-Patient Clinic of the Ophthalmology Department who were found to have presenile cataract were included in this study. They were given a preformed questionnaire enumerating various risk factors and comprehensive ocular examination was done. The type of cataract was also noted. Results: In total, 75 males and 75 females that fulfilled the inclusion criteria were included. There was no sex predilection. The mean age of presentation in males was 45 years and the mean age of presentation in females was 46 years. Most of the patients had no risk factor. The most common risk factor was sunlight exposure followed by diabetes and alcohol consumption. The most common type of cataract was Posterior subcapsular type. Conclusion: Presenile cataract is on the rise due to lifestyle choices, addictions, eating habits, sunlight exposure. Modifiable risk factors of presenile cataract identified in this study were sunlight exposure, alcohol, consumption and diabetes mellitus. High risk groups such as people working outdoors for longer hours such as labourers, farmers, vendors; diabetic patients, patients with addictions have to be identified, screened and counseled for regular eye checkups for early identification and treatment.

Background: Prediabetes, a precursor to type 2 diabetes mellitus (T2DM), is increasingly recognized as a state associated with early microvascular complications, including microalbuminuria and retinopathy. This study aims to evaluate the prevalence of these complications in prediabetic individuals and explore their potential association. Methods: A cross-sectional study was conducted at ASRAM Hospital, Eluru, involving 100 prediabetic patients (FBS 100-125 mg/dL or HbA1c 5.7-6.4%) selected based on strict inclusion and exclusion criteria. Participants underwent comprehensive assessments, including spot albumin-to-creatinine ratio (ACR) for microalbuminuria and fundoscopy for retinopathy. Statistical analyses, including prevalence estimation and p-value calculations, were performed to assess associations. Results: Microalbuminuria was identified in 10% of participants, with a slightly higher prevalence in females (12%) compared to males (8.7%, p>0.05). Retinopathy was present in 7%, with no significant gender disparity (7% in males vs. 7% in females, p=0.045). Both conditions showed increased prevalence with advancing age and higher HbA1c/FBS levels. A statistically significant association was observed between microalbuminuria and retinopathy (p=0.0017), particularly in patients with mild non-proliferative diabetic retinopathy (NPDR). Conclusion: This study highlights the emergence of microvascular complications in prediabetes, with a notable correlation between microalbuminuria and retinopathy. These findings underscore the urgency of early screening and personalized management strategies to mitigate the progression to T2DM and its complications. Further research with larger cohorts is recommended to validate these observations.

Background: Bipolar I Affective Disorder (BPAD-1) is associated with persistent neurocognitive impairments even during euthymic phases. These impairments are believed to be influenced by various clinical factors such as age of onset, illness duration, episode frequency, and substance use. Objective: This study aimed to examine the association between neurocognitive functioning and clinical variables including age of onset, duration of illness, number of episodes, and substance use in euthymic patients with BPAD-1. Methods: In a cross-sectional design, 30 euthymic BPAD-1 patients attending the Psychiatry Outpatient Department and 30 healthy controls were assessed using standardized neuropsychological tests covering domains such as processing speed, sustained attention, verbal and visuospatial working memory, verbal fluency, and executive function. Statistical analysis was performed using SPSS v14.0 with Pearson's correlation, Student’s t-test, and ANOVA. Results: A younger age of onset correlated significantly with poorer verbal working memory, particularly delayed recall in Rey’s Auditory Verbal Learning Test (r = -0.48, p = 0.007). Longer illness duration was associated with impairments in processing speed and sustained attention, as evidenced by Trail Making Test-A (TMT-A), Digit Symbol Substitution Test (DSST), and Digit Vigilance Test (DVT) (p < 0.01). Higher episode frequency similarly correlated with worsening processing speed and attention (p < 0.01). No significant relationship was observed between substance use and cognitive performance, likely due to the small number of substance users in the sample. Conclusion: Neurocognitive deficits in BPAD-1 persist during remission and are significantly influenced by clinical variables such as earlier age of onset, longer illness duration, and higher number of mood episodes. These findings highlight the importance of early intervention and cognitive monitoring to mitigate long-term cognitive deterioration in BPAD-1 patients.

Background: Hearing loss in neonates is a critical condition that can significantly affect a child's language development, communication skills, and overall cognitive growth. Early detection and intervention are essential to mitigate these effects. Therefore, the present study was conducted to screen for hearing loss among neonates and identify the factors affecting hearing in neonates. Methods: A Prospective Observational study was conducted at the Department of Pediatrics and District Early Intervention Center (DEIC), Government Medical College, Nalgonda, among 1000 neonates born over a period of 12 months. Neonates with congenital anomalies of the external ear, active ear infections, or hearing loss due to middle and external ear conditions were excluded from the study. The hearing screening was performed using otoacoustic emission (OAE) and brainstem-evoked response audiometry (BERA). Data on neonatal medical history, birth condition, and family history of hearing loss were also collected and analyzed. Results: Out of 1,000 newborns screened, 7.1% failed the initial OAE test. After repeat OAE testing, 22 newborns underwent diagnostic BERA, confirming hearing loss in 6 (0.6%). Risk factors significantly associated with hearing loss included preterm birth, low birth weight, birth asphyxia, hyperbilirubinemia, family history of deafness, congenital infections, and ototoxic drug exposure (p < 0.001). Family history of deafness and congenital infections were strong independent predictors. The OAE screening showed 100% sensitivity and 98.3% specificity. The overall prevalence of confirmed hearing loss was 6 per 1,000 newborns. Early identification highlights the importance of universal newborn hearing screening programs. Conclusion: This study highlights the need for routine neonatal hearing screening programs to ensure early detection and intervention, which are crucial for the optimal development of affected children.

Background: Encountering an unanticipated difficult laryngoscopy is a challenge that nearly every clinician has faced at some point, even when pre-procedural airway assessments suggest otherwise. Various airway ultrasound parameters have been identified as significant predictors of difficult laryngoscopy. The purpose of this observational study is to evaluate the use of USG measured distance from skin to epiglottis (DSE) in correlation with Cormack Lehane (CL) grading for the prediction of difficult laryngoscopy. Methodology: In this study we have included 400 patients of age ≥ 18 years scheduled for elective surgeries under general anaesthesia requiring endotracheal intubation. A comprehensive pre-anaesthetic evaluation was done one day prior to surgery and then ultrasonographic measurements of DSE were taken before intubation on day of surgery.CL grades were recorded while doing direct laryngoscopy and correlated with DSE measurements. A Receiver Operating Characteristics (ROC) curve analysis was used to assess the diagnostic accuracy of DSE in predicting difficult laryngoscopy. Results: The incidence of difficult laryngoscopy was 10.2%. And at a cut off value of 2 cm, DSE had a sensitivity of 68.3% in predicting difficult laryngoscopy with an area under the curve (AUC) of 0.961 and a p-value < 0.05, indicating strong statistical significance. Conclusion: Our study concluded that DSE is a reliable parameter and can be used effectively in preoperative period for predicting difficult laryngoscopy.

Background: Behavioral disorders among school-going children pose significant challenges to mental health and social adaptation. This study examines the prevalence of behavioral disorders and their associated risk factors in Bikaner city, Northwest Rajasthan. Methods: Using a hospital-based cross-sectional survey approach, data were collected from 500 school children aged 6–14 years. Findings indicate a high prevalence of behavioral disorders, with major contributing factors including socio-economic conditions, parental influence, and academic stress. Results: Aggressive behavior (11.2%) and somatic complaints (10.8%) were the most prevalent. Gender, age, BMI, and academic performance significantly influenced behavioral outcomes. The study underscores the importance of early identification and intervention programs to mitigate behavioral issues and promote psychological well-being among children. Conclusion: A significant number of children require support to cope with emotional and behavioral issues. Schools should implement mental health services, including counseling and awareness programs

Background: Pleural effusion is an excess fluid that accumulates between two pleural layers.There are two types of effusions including Transudative and Exudative effusion.Common causes of exudative effusion include tuberculosis, parapneumonic effusion, viral infections, and malignancy. Pleural fluid analysis and cytology are the mainstays for diagnosing various pulmonary diseases.  Aim of the study: A clinicopathological study of pleural effusion in a tertiary care hospital. Material and Methods: Prospective study was conducted in the department of General medicine at TRR medical college for duration of 1 year i.e. from March 2021 to Feb 2022. Results: In the present study Tuberculosis was commonly reported accounting 38.4%(25/65) , Pneumonia 30.7% (20/65), Empyema, Pancreatitis, Liver cirrhosis and Malignancy 7.6%(5/65). Purulent 76.8%(50/65), Hemorrhagic 15.3%(10/65) and Straw colored 7.6% (5/65) . Conclusion: Aetiological evaluation of pleural effusion is very important for management of the disease. This is important because management is different for different cases. Pleural fluid analysis can be considered as gold standard in evaluation of pleural effusion

Background: Thrombocytopenia is a frequent hematological disease affecting neonates hospitalized to neonatal intensive care unit (NICU). Several maternal and neonatal factors contribute to thrombocytopenia development. Objectives: To determine etiology, various comorbid conditions, onset, clinical features, immediate outcome, and a short term follow up of the neonates.  Methods: Ethical clearance was obtained from institutional ethics committee. A prospective observational study was done on 100 neonates with thrombocytopenia in the Department of Pathology for over a period of two years i.e August 2022 to July 2024 at Tagore Medical College and Hospital. Results: In our study, sepsis was commonest etiological factor contributing 42 %. Next common was prematurity accounting for 28 %. Respiratory distress in 10% cases, intra uterine growth retardation in 8% cases, meconium aspiration syndrome 3%, birth asphyxia 5%, jaundice 4%. 55% showed late onset thrombocytopenia (>72 hours) and 45% with early onset thrombocytopenia (< 72hours). Mild, moderate and severe thrombocytopenia is noted in 15%, 60% and 25% cases respectively. Conclusion: Neonatal thrombocytopenia is a treatable and reversible condition. Hence, it is important to identify neonates at risk and initiate transfusion therapy to prevent severe bleeding and potentially significant morbidity.

Introduction: In present study an attempt has been made to analyze various trends and factors associated with the violent asphyxial deaths in UP region so that further insight into the existing knowledge related to the subject can be gained with the view to assist the process of crime investigation and proper utilization of resources. Materials and Methods: The structured questions include symptoms, duration, tobacco and alcohol use and treatment sought. The open narrative section related to illness and circumstances preceding death and was completed with the aid of systematic prompting by the MPHW.  Result: Proportion of violent asphyxia deaths was 12.3% (401 cases) of total 3234 autopsies in the present study. Conclusion: Prevention strategies for drowning should be comprehensive and include multiple aspects like removal of hazard by using modern engineering technologies, tough laws to enforce prevention and increase awareness among individuals to understand risk.

Introduction: Pulmonary arterial hypertension (PAH) is a serious long-term complication in patients treated for pulmonary tuberculosis (PTB). This study investigates the prevalence of PAH, associated clinical and radiological findings, pulmonary function abnormalities, and the role of smoking as a contributing factor in treated PTB patients. Methodology: Conducted over 12 months in the Department of Respiratory Medicine at Geetanjali Medical College and Hospital, the study included 75 treated PTB patients after excluding those with positive sputum AFB smears. Patients underwent detailed evaluations, including clinical assessments, chest X-rays, pulmonary function tests (PFTs), and transthoracic echocardiography. Data analysis was performed using SPSS, focusing on correlations between PAH, radiological findings, smoking history, and spirometric patterns. Results: PAH was observed in 50% of patients. Fibrosis (24%) was the most common radiological finding, followed by calcified lesions (22.67%) and fibrocavitary changes (18.67%). A significant association was found between smoking history and radiological abnormalities (p-value = 0.002), as well as smoking and PAH (p-value = 0.04). Obstructive ventilatory defects were the predominant spirometric abnormality (84%), strongly correlated with PAH (p-value = 0.001). Fibrosis and fibrocavitary lesions were the most frequent radiological findings associated with PAH, consistent with existing literature. Discussion: The study highlights the multifactorial nature of PAH in treated PTB patients. Chronic inflammation, vascular remodelling, restricted pulmonary vasculature, and smoking contribute significantly to its pathogenesis. Radiological findings, particularly fibrosis, and obstructive spirometric patterns were strongly linked to PAH. These results align with studies by Bhattacharyya P et al. and Ahmed AE et al. Conclusion: Treated PTB patients are at high risk of developing PAH, especially those with obstructive patterns or a smoking history. Routine screening using spirometry and echocardiography is recommended for early detection and management to mitigate morbidity and improve outcomes.

Background: Pre-labour rupture of membranes (PROM) is a common obstetric condition that can significantly influence maternal and neonatal outcomes. Accurate prediction of spontaneous labor onset following PROM remains a clinical challenge. Lactate, a byproduct of anaerobic metabolism, is found in increased concentrations in vaginal fluid during labor. Its levels may reflect biochemical changes preceding uterine contractions. Assessing vaginal fluid lactate could serve as a non-invasive, rapid tool to predict imminent labor, guiding timely interventions in suspected PROM cases. Methods: The study cohort consisted of 98 pregnant women presenting with singleton pregnancies beyond 34 completed weeks of gestation and clinical suspicion of prelabour rupture of membranes (PROM). Variables and Grouping Participants were divided into two groups based on findings of sterile speculum examination: Group 1 (Visible): Women with visible pooling of amniotic fluid in the posterior vaginal fornix (n = 40). Group 2 (Non-visible): Women with no visible fluid seen on speculum examination (n = 48). The main outcome was the timing of the spontaneous onset of labor, defined as the occurrence of regular uterine contractions associated with progressive cervical dilation within 24 hours of presentation. Results: In this study of 88 women with suspected PROM, vaginal fluid lactate levels were significantly higher in those with visible amniotic fluid pooling (mean 10.2 ± 2.4 mmol/L) compared to those without (mean 6.3 ± 1.9 mmol/L; p < 0.001). Labor onset within 24 hours occurred in 85% of women with visible pooling versus 45.8% without (p < 0.001). Lactate ≥8.5 mmol/L demonstrated high sensitivity (82.1%) and specificity (84.4%) with an AUC of 0.89. Logistic regression confirmed lactate ≥8.5 mmol/L (OR 5.2) and visible pooling (OR 3.8) as independent predictors of spontaneous labor onset. Conclusion: The current study found that elevated vaginal fluid lactate levels above 8.5 mmol/L, are strongly associated with the onset of spontaneous labor within 24 hours in women with suspected pre-labor rupture of membranes. The visible pooling of amniotic fluid also appears to be significantly correlated with early onset of labor. Therefore, these clinical and biochemical parameters offer valuable predictive utility and could aid clinicians in timely decision-making to optimize maternal and neonatal outcomes.

Background: Fungal infection of the external ear (otomycosis) is a common condition encountered by the otorhinolaryngologist in routine ENT clinic. Otomycosis associated with symptoms of itching, pain, aural fullness, aural discharge, hearing impairment and tinnitus. we have undertaken this study with the aim to describe the spectrum of fungi, clinic-pathology of patients with otomycosis. Methods: Present study was prospective in nature conducted among 100 otomycosis patients. All patients fulfilling inclusion criteria and exclusion criteria were taken up for the study. Study was carried out over a period of 1.5 years. Results: Majority of the patients was in the age group of 16-30 years and most of them were male. Most common presenting complaint was itching (83%) followed by otalgia (54%), ear block (34%), hearing loss (31%) and ear discharge (20%). Most common fungal spp. Isolate was Aspergillus Niger. Conclusion: Aspergillus Niger was the commonest fungal species in otomycosis with 75% sensitivity to usually started clotrimazole and fluconazole being least efficacious antifungal.

Background and Aim: Avulsion fractures of the cruciate ligaments are uncommon but significant injuries that compromise knee stability and function. Early diagnosis and appropriate surgical fixation are essential to prevent long-term complications.  Material and Methods: This prospective study evaluated 30 adult patients with ACL or PCL avulsion fractures who underwent surgical fixation using various techniques. Clinical outcomes were assessed using the Lysholm scoring system, range of motion, and knee stability tests over a minimum follow-up of 6 months.  Results: Most injuries involved ACL avulsion (Grade 3A being the most common). Arthroscopic suture disc fixation was the most frequently used technique. Excellent to good outcomes were observed in the majority, with minimal complications and satisfactory functional recovery. Conclusion: Timely surgical fixation of cruciate ligament avulsion fractures yields favorable clinical and functional results in adults. Both open and arthroscopic techniques are effective when applied judiciously.

Background: Proximal tibial fractures, especially high-energy Schatzker Type IV, V, and VI fractures, pose significant challenges due to their complex anatomy and associated soft tissue involvement. Traditional external fixation methods carry risks such as infection and joint stiffness, whereas dual plating with modern internal fixation offers improved stability and outcomes. This study evaluates the functional and radiological outcomes of dual plating in the management of complex intra-articular proximal tibial fractures. Methods: A prospective observational study was conducted on 30 adult patients with Schatzker Type IV–VI fractures at PG Institute and Aurobindo Institute of Medical Sciences. Patients underwent dual plating fixation, and outcomes were assessed through clinical, radiological, and functional evaluation using the Oxford Knee Score over a minimum 3-month and maximum 8-month follow-up. Results: Among the 30 participants (17 males, 13 females), the most common fracture type was Schatzker Type V. The average time to surgery was 9.2 days, with an average hospital stay of 8 days and surgical time of 90.67 ± 4.18 minutes. Bone grafting was performed in 6 cases. Fracture healing was observed at an average of 11 weeks, and full weight-bearing was achieved by 18.5 weeks. The mean Oxford Knee Score was 45.72 ± 1.5. Functional outcomes were exceptional in 50% of patients, good in 40%, acceptable in 6.67%, and poor in 3.33%. Complications included superficial infections (4), deep infections (2), and one case of flexion deformity; no non-unions or implant failures were reported. Conclusion: Dual plating provides robust stabilization in high-energy proximal tibial fractures, leading to favorable functional and radiological outcomes. Early mobilization, anatomical reduction, and posteromedial support play a key role in minimizing complications such as varus collapse and improving recovery.

Background: Intestinal obstruction (IO) is a common surgical emergency with variable presentations and outcomes. There is a critical need for an objective, validated scoring system to guide clinicians in determining which patients require surgical intervention. Objective: To develop and validate a multimodal predictive scoring system for timely surgical decision-making in patients with intestinal obstruction. Methods: A prospective observational study was conducted involving 385 patients diagnosed with IO. Thirteen clinical, biochemical, pathological, and radiological parameters were analyzed and assigned binary values (0 or 1) based on retrospective associations with operative outcomes. A cumulative score was calculated, and its predictive performance assessed using sensitivity, specificity, and ROC analysis. Results: A cumulative 13-point score was developed including age, BMI, symptom duration, leukocyte count, renal and pancreatic function tests, liver enzymes, and ultrasonographic wall thickness. Patients with higher scores were significantly more likely to require surgery. The score demonstrated high predictive accuracy for operative management, offering a simple, reproducible, and efficient decision-support tool. Conclusion: The proposed scoring system provides an effective method for stratifying patients with intestinal obstruction based on their need for surgery. Its bedside applicability and reliance on commonly available data support its use in both urban and rural healthcare settings for timely surgical triage

Background: Tympanoplasty is a surgical intervention aimed at the reconstruction of the tympanic membrane (eardrum) and the ossicles in cases of chronic otitis media (COM) and tympanic membrane perforations. The procedure, specifically Type 1 tympanoplasty, focuses solely on the repair of the tympanic membrane without ossicular reconstruction. Aim: To evaluate and compare the surgical outcomes of sliced tragal cartilage grafts versus temporalis fascia grafts in patients with large or subtotal tympanic membrane perforations (involving two or more quadrants) undergoing Type 1 tympanoplasty in a tertiary care hospital setting. Materials And Methods: 70 patients, with 35 receiving sliced tragal cartilage grafts (Group A) and 35 receiving temporalis fascia grafts (Group B). Patients aged 15-60 years, MERI score less than 3, with chronic otitis media mucosal inactive are included and Patients under 15 or over 60 years, active ear discharge, revision tympanoplasty, and those not consenting to the study. Included pre-operative assessment, detailed history, ENT examination, and classification based on the Middle Ear Risk Index (MERI) data collected. Data measured in Graft uptake rates, audiological improvements at 3 and 6 months, post-operative complications, and patient satisfaction. Results: In a study of 70 patients, divided equally between Group A (cartilage) and Group B (fascia), the mean age was 35.9 years with a standard deviation of 12.7. Group A had a mean age of 35.6 ± 12.4 years, while Group B had a mean age of 36.2 ± 13.1 years. Gender distribution was similar across both groups, with 37 males and 33 females in total. The overall mean MERI score was 1.7 ± 0.7, with Group A having a mean of 1.6 ± 0.7 and Group B a mean of 1.8± 0.6. Audiological improvement showed similar mean improvements of 15.3 ± 5.1 dB in Group A and 14.6 ± 5.4 dB in Group B, with a non-significant p-value of 0.67. The graft uptake rates were 88.6% for Group A and 82.9% for Group B, also not significantly different (p = 0.52). However, post-operative complications differed slightly, with 8.6% in Group A and 17.1% in Group B, yielding a p-value of 0.31, indicating no significant difference between the groups in this aspect as well. Conclusion: In conclusion, our study demonstrates that both sliced tragal cartilage and temporalis fascia grafts are effective in type 1 tympanoplasty for patients with large or subtotal perforations. The findings suggest that tragal cartilage may be preferable for achieving more consistent long-term outcomes, although the choice of graft should consider individual patient factors and surgical contexts.

Background: The concept of combining ketamine with propofol, often referred as 'Ketofol,' has been suggested as a potential strategy to mitigate the hemodynamic adverse effects associated with each drug individually. This combination aims to achieve a stable hemodynamic profile during the induction of anesthesia, offering an additional advantage of reducing the incidence of postoperative nausea and vomiting (PONV) as well as postoperative shivering Aims: To evaluate the difference in haemodynamic variable (Mean Heart Rate, Mean Systolic Blood Pressure, Mean Diastolic Blood Pressure, Mean Arterial Pressure, Mean SpO2, Mean Rate Pressure Product) post induction with propofol v/s ketofol at different time interval Material And Methods: A prospective randomised interventional study was conducted in general surgery OT, Department of Anaesthesiology, S.M.S. Medical College, Jaipur in the following two groups of patients. GROUP A - Patients received 1 mg/kg propofol plus 1 mg/kg ketamine (10 mg/ml dilution) diluted to 20 ml in a syringe as an induction agent. GROUP B – Patients received 2 mg/kg propofol diluted to 20 ml with normal saline in a syringe as an induction agent. The study was conducted on 72 patients with both the groups consisting of 36 patients each. Both the groups consisted of male and female patients of age group between 18 and 55 years, ASA grades I and II undergoing Laparoscopic Cholecystectomy under General Anaesthesia. Primary Objective of our study was to assess and compare haemodynamic variables (Mean HR, MAP, Mean SBP, Mean DBP, Mean SpO2, Mean RPP) post induction period at different time interval (1,3,5,10,15 min) between the study groups. Results: In Group A, the mean age of patients was 37.38±9.56years and in Group B was 36.94±8.08 years. The gender distribution in our study was in Group A and Group B male: female patients are 20:16 and 22:14 respectively. In Group A mean weight of the patients was 56.16±8.86 kg whereas in Group B the mean weight of the patients was 55.41±9.36 kg.  The baseline parameters mean HR, mean SBP, mean DBP, MAP, mean SpO2 and mean RPP of both the groups were comparable and no significant difference was observed. In Group B, heart rate was significantly decreased in comparison to Group A just after induction, but after intubation heart rate increased and the difference between Group A (ketofol) & Group B (propofol) was significant. In Group A heart rate showed a comparatively stable pattern from intubation to just before the creation of pneumoperitoneum. After induction, systolic blood pressure was less in group B as compared to Group A. This difference was statistically significant. The MAP was significantly lower in group B than group A at various time intervals. Thus, it shows that group A was better at maintaining hemodynamic stability as compared to group B. The difference of Mean SpO2 between both the groups was statistically not significant at various time intervals (P >0.05). In group A 2 patients experienced the pain on injection out of 36 patients while in group B 10 patients experienced the pain on injection out of 36 patients. In our study, 8 patients had shivering in group A and 20 patients in group B had shivering in the postoperative period. The incidence of shivering was significantly less in group A than group B.(P <0.05). 2 patients had hypotension in group A and 10 patients had hypotension in group B in the postoperative period which was statistically significant. (P <0.05). Conclusion: Our study concluded that induction of general anaesthesia in patients undergoing laparoscopic cholecystectomy with Ketofol is associated with a more stable haemodynamic stability without apparent side effects as compared to Propofol. Hence, the combination of ketamine and propofol proved to be significantly better than propofol alone.

Background: ABPM is superior to clinic BP measurements in diagnosing white-coat hypertension, masked hypertension and helpful in detecting nocturnal BP changes, which predict cardiovascular mortality in CRF.Objectives: To detect masked hypertension in CKD patients and investigate whether home BP measurements provide a feasible and reliable alternative to ABPM and repeated clinic BP measurements in differentiating true from white-coat hypertension. Materials and Methods: This cross-sectional study was carried out among 75 confirmed cases of CKD. HTN was defined as per JNC-7 and British Hypertension Society as CBP ≥140/90mmHg, mean HBP >135/85 mmHg, mean ABPM daytime >135/85 mmHg, mean ABPM night-tie >120/70 mmHg. Results: Around 69.3%, 61.3%, and 40% were hypertensive when detected by ABPM, HBP and CBP, respectively. Among hypertensive, 38.7% were masked HTN, 9.3% were observed with white coat HTN, 30.7% were sustained HTN, and 21.3% were normotensive. Similarly, ABPM and HBP showed concordance in 88.5% hypertensive. HBP achieved a specificity of 100% and a sensitivity of 88.5% for detecting hypertension when using ABPM as the gold standard. Conclusion: ABPM was the gold standard for detecting hypertension. HBP was no longer far behind ABPM in detecting white coat and masked HTN.

Background: Levobupivacaine appears to be a reasonable alternative for racemic Bupivacaine in light of lesser cardiotoxicity. Levobupivacaine and racemic Bupivacaine in epidural and infiltration anaesthesia show that both are equally effective. Levobupivacaine is a regional anaesthetic that is clinically well tolerated in a variety of regional anaesthesia procedures, both after bolus administration and continuous postoperative infusion. Levobupivacaine toxicity reports are rare, and when they do occur, such symptoms are frequently treatable with minimal morbidity and mortality Aim: To compare the clinical effects of spinal anesthesia with 0.5% hyperbaric levobupivacaine and 0.5% hyperbaric bupivacaine in patients undergoing elective surgeries in tertiary care hospital. Materials and methods: This was a double-blind randomized clinical study carried out at a tertiary care center after the ethical committee approval and taking valid written informed consent from the patients (study subjects) among 110 ASA I / II patients undergoing elective surgeries under spinal anaesthesia in a stipulated time of 2 years duration. Patients were divided into two groups based on the drug given. Group L received intrathecal hyperbaric 0.5% Levobupivacaine [total 3.5ml]. Group B received intrathecal 15mg hyperbaric hyperbaric 0.5% Bupivacaine with 0.5 ml of normal saline [total 3.5 ml]. Results: Males were slightly more as compared to females, The mean age in groups L and B was 41.77±12.87 and 44.63±13.76 years in L and B groups. Subjects belonged to ASA grade II was reported more as compared to grade I. The mean duration of surgery was 87.48±10.87 and 84.52±11.69 min in the L and B groups respectively. Mean SBP increases in both the groups after the spinal block and then it decreases till 20 minutes. After 20 minutes, SBP increases and is maintainable in an appropriate range. Mean DBP increases in both the groups after the spinal block and then it decreases till 14 minutes. After 14 minutes, DBP increases and is maintainable in an appropriate range. Mean MAP increases in both the groups after the spinal block and then it decreases till 30 minutes. After 30 minutes, MAP increases and is maintainable in an appropriate range. Mean heart rate increases in both the groups after the spinal block and then it decreases till 14 minutes. After 14 minutes, the heart rate increases and is maintainable in an appropriate range. In both the study groups, the maximum sensory level was achieved at T6 (58.18% and 49.09% in L and B groups respectively) followed by T4 (20% and 16.36% in L and B groups respectively). When the sensory level achieved was compared between groups L and B using the chi-square test; an insignificant difference was found as p>0.05.Onset of sensory and motor block was earlier in group B (4.46 min and 3.74 min respectively) as compared to group L (9.1 min and 6.82 min respectively). Duration of sensory and motor block was prolonged in group B (223.41 min and 218.2 min respectively) as compared to group L (210.17 min and 183.5 min respectively). Conclusion: In comparison to 0.5% hyperbaric bupivacaine, our research showed that 0.5% hyperbaric levobupivacaine has intermediate anesthetic qualities. Compared to hyperbaric bupivacaine, the onset of sensory and motor blockage occurs more slowly. When compared to hyperbaric bupivacaine, the length of sensory and motor blockade was shorter, allowing for early movement and making it a viable option for daycare procedures.

Background: TAP block is now a "must-know" approach for postoperative pain management for these surgeries due to recent improvements in ultrasonography technology. The majority of abdominopelvic procedures are frequently performed under spinal anaesthesia, and postoperative pain is seldom given enough attention. Aim: To compare duration of analgesia of levobupivacaine and levobupivacaine plus Dexmedetomidine in USG guided Transvers abdominis plane block in patients undergoing abdominal and pelvic surgeries. Materials and methods: The tertiary care centre approved this prospective randomised double blind case control research by the Hospital Ethical Committee and all patients gave their informed consent. This study included 80 patients who had procedures on their abdomens and pelvises. Two groups of forty people each were formed out of them. Bilateral ultrasound-guided TAP block was administered to both groups. The proper needle position and the distribution of the local anaesthetic solution in the neuro-fascial plane between the transversus abdominis and internal oblique muscles were determined using ultrasonography. Group L received 18 ml of levobupivacaine 0.25% +2ml normal saline and Group LD received 18 ml of levobupivacaine 0.25% + 1 μg/kg Dexmedetomidine diluted up to 2ml of normal saline Following the block, the haemodynamic parameters include blood pressure, pulse rate, respiratory rate, oxygen saturation, and blood pressure. Using the VAS score, the effectiveness of the analgesic was tracked. From the moment the TAP block was performed until a VAS score of 4 was obtained, the length of analgesia was determined. Obtaining a VAS score of ≥4 was the main goal of the study. Results: In the present study in Group L 42.30 years mean age where in Group LD 39.18 years mean age was observed. Statistically no significant difference was observed in age between both groups. (p=0.26). In Group L 55% were male cases and 45% were female cases whereas in Group LD 47.5% were male cases and 52.5% were female cases. In Group L 40% cases were seen with ASA Grade I and 60% cases with ASA Grade II whereas in Group LD 45% cases were seen with ASA Grade I and 55% cases with ASA Grade II. In the present study in Group L 6.63 mean time for analgesia was observed where in Group LD 12.85 mean time for first analgesia was observed. Statistically significant difference was observed in time for first analgesia between both groups. Group L 45% cases were observed with nausea, 25% cases with vomiting and 20% cases were observed with headache whereas in Group LD 5% each case were observed with nausea and vomiting side effects respectively. Statistically significant association was observed between the adverse side effects between both groups. There is no statistically significance found in heart rate, mean arterial pressure and SPO2 in various time duration. Conclusion: Ultrasound guided Transversus Abdominis Plane (TAP) block is a very successful method of postoperative analgesia in patients undergoing abdominal and pelvic surgeries. When compared to ordinary levobupivacaine, the addition of dexmeditomedine to levobupivacaine in TAP block prolonged the duration of analgesia with negligible side effects and caused no appreciable alterations in haemodynamic parameters or problems. Analgesia with ultrasound guided TAP block is dependable and efficient, and it was simpler to execute.

Background: Estimating the time since death is a crucial aspect of forensic investigations. Among various postmortem biochemical changes, potassium concentration in the vitreous humor of the eye has emerged as a reliable indicator due to its predictable linear rise after death. The vitreous humor is relatively isolated and resistant to decomposition, making it ideal for analysis. This study explores the correlation between vitreous potassium levels and postmortem interval (PMI), aiming to enhance accuracy in estimating time since death through biochemical profiling. Methods: The study was done on 100 cases of PME which included a Control Group (n = 50): Cases with a reliably known time of death. Study Group (n = 50): Cases with an unknown time of death. Demographic and circumstantial data such as name, age, sex, presumed time of death, cause of death, and environmental conditions were obtained. At the time of sample collection, ambient temperature (°C) and relative humidity (%) were recorded to account for environmental influences on postmortem changes. From each deceased individual, two samples were collected one from each eye just before the commencement of the postmortem examination. These were labeled as Sample 1 (right eye) and Sample 2 (left eye) and treated as matched pairs for internal comparison. Results: The study demonstrated a strong positive correlation between vitreous potassium levels and time since death. In the control group with known death times, potassium concentration rose steadily: from a mean of 6.2 mmol/L at 0–6 hours to 18.4 mmol/L at 24–48 hours. A regression equation estimated Time Since Death (hours) = (2.1 × K⁺) – 3.5 showed high accuracy (R² = 0.89, p < 0.001). Model validation yielded a mean absolute error of 1.2 hours. When applied to the study group, estimated death times aligned closely with investigative estimates, confirming the model’s reliability in real-world forensic scenarios. Conclusion: Our study confirms the utility of vitreous humor potassium concentration as a reliable biochemical marker for estimating the time since death (PMI). We found a strong linear correlation between these two parameters. This enables the derivation of a predictive formula with a high accuracy and minimal error. The predictive formula accurately estimated unknown death times by matching the model results with independent investigator estimates.

Background: Rhino-orbital mucormycosis, a rare but aggressive fungal infection, saw a surge during the COVID-19 pandemic, particularly in individuals with diabetes and those treated with corticosteroids. This study aims to investigate the pattern of ophthalmic involvement in patients who developed mucormycosis in the context of COVID-19. Understanding the specific ways this infection manifests in the eye is crucial for early diagnosis, appropriate management, and potentially improving outcomes for this vulnerable patient population. Methods: A total of 443 patients diagnosed with mucormycosis in the post-COVID-19 setting were included in the study. All patients had microbiologically or radiologically confirmed mucormycosis and a history of recent COVID-19 infection (confirmed by RT-PCR or rapid antigen test. All patients underwent a comprehensive evaluation by a multidisciplinary team consisting of Ophthalmologists, ENT Surgeons, Neurologists, and Infectious Disease Specialists. Data was collected regarding the age, gender, history of COVID-19, severity, duration of hospitalization, use of steroids and oxygen therapy. The history of Pre-existing diabetes, insulin dependence, and newly diagnosed (de novo) diabetes post-COVID. Results: In this study of 443 COVID-19-associated mucormycosis cases, 68% were male and the majority (65.9%) were aged between 41–60 years. Diabetes was present in 57.7% and 29.6% had newly diagnosed diabetes post-COVID. Most patients (87.1%) were unvaccinated, and mucormycosis onset occurred 31–70 days post-COVID in 68% of cases. Ophthalmic involvement was predominantly rhino-orbital (79%), with vision loss observed in 35.8% of orbital cases. Common ocular findings included CRAO (12.5%) and diabetic retinopathy (17.2%). These findings highlight the aggressive ophthalmic presentation and emphasize the need for early screening and intervention in high-risk, post-COVID-19 individuals. Conclusion: In the present study we found that there is a significant ophthalmic burden of mucormycosis in post-COVID-19 patients, particularly among diabetic, unvaccinated, and middle-aged male populations. Most of the cases in this study were with rhino-orbital involvement, and a substantial number had irreversible vision loss due to CRAO, optic atrophy, or extensive orbital spread. These findings show the importance of early ophthalmic evaluation in patients with COVID-19-associated mucormycosis.

Background: Electrolyte imbalances are commonly encountered in critically ill children admitted to the Pediatric Intensive Care Unit (PICU) and can significantly affect clinical outcomes if not promptly managed. Objectives: The study aimed to determine the frequency of dyselectrolytemia in children admitted to the PICU, assess its association with the primary illness (based on system-wise classification), and evaluate its relationship with morbidity and mortality.  Methods: This observational study included 300 children admitted to the PICU of the Department of Pediatrics at Niloufer Hospital, a tertiary care teaching hospital affiliated with Osmania Medical College, Hyderabad, India. Serum sodium, potassium, and calcium levels were analyzed at the time of admission. Patients were categorized based on age groups, primary illness system involvement, and outcomes (improved vs. non-survivors). The duration of PICU stay was recorded to assess morbidity. Statistical analysis using chi-square tests was performed to determine the significance of electrolyte abnormalities across different variables. Results: Hyponatremia (27.67%), hypokalemia (16%), and hypocalcemia (18%) were the most common electrolyte imbalances. Potassium disturbances showed a statistically significant association with mortality (p < 0.0001), with both hypokalemia and hyperkalemia more common among non-survivors. No significant association was found between sodium, and calcium levels and clinical outcomes. Electrolyte abnormalities were variably distributed across primary illness systems, with potassium imbalances more frequent in patients with neurological and renal conditions. Morbidity, measured by prolonged PICU stay, was more common in patients with significant potassium disturbances. The prevalence of electrolyte imbalances was relatively consistent across age groups (p > 0.05), indicating uniform susceptibility. Conclusion: Electrolyte disturbances, particularly potassium imbalances, are common and clinically significant in the PICU. They are associated with increased mortality and longer PICU stays. Early detection and prompt correction of these imbalances—especially potassium-related—are essential to improving outcomes in critically ill pediatric patients.

Background: Introduction: Proximal humerus fracture accounts for approximately 5% of all fractures. More than 70% of patients with these fractures are older than 60 years of age. In displaced three- and four- part proximal humerus fractures surgical treatment is recommended. However the optimal surgical management remains controversial. Materials and method: This is a single center, randomized comparative study between PHILOS and Shoulder Hemiarthroplasty conducted over a period of 1 year (July 2023 to June 2024). In total 24 patients are randomized between the two surgical procedures. Patients older than 60 years of age with displaced three- and four-part proximal humerus fractures as diagnosed by X-rays and CT scan within 14 days of injury are included in the study .Patients are followed up at 2 weeks, 4 weeks, 2 months, 6 months and 9 months postoperatively. The outcomes of the surgical procedures in pain relief, shoulder function, quality of life, radiological evaluation and complications are assessed. VAS, Constant-Murley Score and Disability of Arm Shoulder and Hand (DASH) are being used. Results: In the PHILOS group the functional outcome is better but has complications which require revision surgery, whereas the hemiarthroplasty group shows better pain relief with limited functional outcome. Conclusion: Proximal Humeral Internal Locking System (PHILOS) yields a more functional shoulder with proper care if taken for anatomical reduction and fixation of tuberosities intraoperatively. Shoulder Hemiarthroplasty can serve as a salvage procedure in failure of PHILOS or in cases with severely osteoporotic bone. It gives a shoulder with optimal functional outcome, sufficient enough for this elderly population.

Introduction: - Preeclampsia affects 5-10% of pregnancies and is associated with a fivefold increase in infant mortality in cases of severe pregnancy-induced hypertension compared to normotensive pregnancies. Placental location plays a crucial role in determining the blood flow dynamics, which in turn affects the oxygen and nutrient supply to the developing fetus. Uterine artery Doppler ultrasonography provides a non-invasive method to assess blood flow in the uterine arteries, offering insight into placental perfusion and the risk of complications such as preeclampsia Timely prediction of preeclampsia remains challenging due to limited resources, especially in settings where Doppler imaging is unavailable. This study aims to assess whether uterine placental localization, a simpler and cost-effective method, can serve as a predictor of preeclampsia. By utilizing this method, it is hoped that early identification and intervention may improve outcomes in low-resource environment. Aims & Objectives: - This study aims to explore the relationship between placental position, uterine artery Doppler indices, and their impact on development of pre eclampsia shedding light on their clinical significance in obstetric care. Method: - The study included 372 patients admitted over a period of 12 months. Various data such as clinical history, examination and other necessary parameters of the patients included in the study were analysed using simple statistical methods. Results: The distribution of placental positions was as follows: anterior (33.9%), posterior (25.5%), fundal (15.3%), and lateral (15.9%)Lateral placental locations (right and left) are significantly associated with higher rates of preeclampsia, with 32.2% of cases occurring in these positions. In contrast, preeclampsia was observed in 6.4% of cases with central placental locations. Altered uteroplacental circulation in lateral positions, indicated by higher Doppler indices, contributes to increased vascular resistance, heightening the risk of preeclampsia. Conclusion: Placental location and abnormal uterine artery Doppler indices are crucial factors in predicting maternal and fetal outcomes. In pregnancies with lateral placental locations, the risk of pre-eclampsia is elevated due to compromised blood flow, as indicated by abnormal Doppler indices. Proactive measures such as low-dose aspirin therapy in the early second trimester can help mitigate these risks, improving maternal and fetal outcomes in high-risk cases

Background: Liver abscess remains a common clinical problem, particularly in developing countries. It is often associated with significant morbidity and mortality if not diagnosed early. This study evaluates the risk factors, clinic etiological profile, and biochemical markers of liver abscess patients admitted to a tertiary care centre in Central India Methods: A prospective study was conducted over 16 months at SS Medical College, Rewa, India. Total 300 patients suspected with liver abscess admitted in department of surgery were enrolled. Detailed clinical history, biochemical profiles, and imaging findings were analyzed using statistical methods to identify significant associations. Results: Amoebic liver abscess was the most common (71.3%) type. The abscesses were predominantly in right lobe (83.4%) and solitary (78%). Alcohol intake (49.3%) and diabetes mellitus (20%) were the common risk factors. Abdominal pain (100%) and fever (52%) were the common clinical presentation.  Klebsiella pneumoniae (41.86%) was common isolate in pyogenic liver abscess Elevated TLC (77.33%), anemia (56.66%), elevated alkaline phosphatase (42.33%), elevated SGOT (47.66%) and SGPT (43.66%) was found. Pigtail catheter insertion (49.6%) and percutaneous needle aspiration 28.6% were most effective treatment modality. Conclusions: Right lobe solitary amoebic liver abscess was most common. Alcoholic and diabetes mellitus was the main risk factors of liver abscess. Abdominal pain and fever were common clinical manifestation. Appropriate management, including drainage and antibiotic therapy, can significantly improve outcomes.

Background: Pregnant women who suffer from anemia face a serious public health concern. Particularly in areas with high maternal mortality, risk factors and morphological patterns of anemia during pregnancy are thought to be crucial for patient classification, diagnosis, and treatment. Objectives: This study evaluated morphological patterns of anaemia among pregnant women and morphological differences across characteristics of participants Methods: In this cross-sectional study all first trimester pregnant women aged 18-40 years were enrolled. Demographic characteristics, risk factors, and Peripheral blood smears were performed for various morphological patterns of anemia were measured and recorded Results: In the present study prevalence of anemia was found to be 61.5%. Majority of them (57%) had mild anemia. Rural residence, illiteracy, vegetarian diet, low birth interval, lack of awareness of anemia and ANC were significantly associated with the anemia among pregnant women. The most frequent morphological pattern of anaemia was Microcytic hypochromic. Conclusions: Microcytic hypochromic blood picture is predominant. Morphological patterns of anaemia reflect the underlying aetiology, the study of which would ensure benefits in the early detection and appropriate treatment.

Background: Diabetes mellitus is associated with altered immune function, potentially reflected in changes to the neutrophil-to-lymphocyte ratio (NLR). This study aimed to investigate the NLR among diabetic patients compared to non-diabetic controls. Methods: A total of 60 subjects (30case & 30 controls) were taken for the study which was conducted at Government medical college, Kadapa. The case group comprised patients diagnosed with diabetes mellitus, while the control group consisted of individuals without diabetes. Peripheral blood samples were collected from both groups to determine neutrophil and lymphocyte counts, Fasting Blood sugar. The NLR was calculated for each participant. Statistical analysis was performed to compare the NLR between the two groups. Results: The Mean and SD of NLR were higher when compared to the control group   (p < 0.0001) and there was a positive correlation between NLR and FBS among Diabetics. Conclusion: This study shows that diabetic patients, have an elevated NLR, suggesting a potential link between diabetes and systemic inflammation. The NLR may serve as a simple and accessible marker for assessing inflammatory status in diabetic patients.

Background: Wound healing remains a significant challenge following open abdominal surgeries, with complications such as delayed healing and infections contributing to extended hospital stays. Platelet-rich plasma (PRP), a concentrate of autologous platelets, is known for its potential to accelerate tissue regeneration and reduce inflammation. This study aims to evaluate the efficacy of topically applied PRP on postoperative wound healing in patients undergoing open abdominal procedures. Materials and Methods: A prospective comparative study was conducted at a tertiary care hospital over a period of 12 months. A total of 60 patients undergoing open abdominal surgeries were randomly divided into two groups: Group A (n=30) received standard wound care, while Group B (n=30) received topical autologous PRP application along with standard care. PRP was prepared intraoperatively using a two-step centrifugation method. Wound healing was assessed using the Southampton wound grading system on postoperative days 3, 7, and 14. Incidence of surgical site infection (SSI), time to epithelialization, and overall patient satisfaction were also recorded. Results: On postoperative day 14, complete wound healing was observed in 86.7% of patients in the PRP group compared to 63.3% in the control group. The mean healing time in Group B was significantly shorter (9.1 ± 1.3 days) compared to Group A (12.5 ± 2.2 days) (p < 0.05). The rate of SSI was lower in the PRP group (6.7%) than in the control group (20%). Patient satisfaction scores were also higher in Group B (mean score: 4.6/5) versus Group A (3.9/5). Conclusion: Topical application of autologous PRP in open abdominal surgeries appears to enhance wound healing, reduce infection rates, and improve overall patient satisfaction. PRP is a promising, cost-effective adjunct to conventional wound management in abdominal surgeries.

Background: Preoperative anaesthesia assessments (PAA) play a pivotal role in identifying perioperative risks, optimizing patient status, and planning anaesthetic management. While PAAs are standard for elective procedures, their utility in emergency surgeries is often compromised by time constraints. This study aims to evaluate the impact of structured PAA on postoperative outcomes and complication rates in emergency versus elective surgeries. Materials and Methods: A prospective observational study was conducted over 12 months in the departments of surgery and anaesthesiology at a tertiary care hospital. A total of 200 patients undergoing surgery were included and divided into two groups: Group A (n=100) underwent elective surgeries with complete PAA, while Group B (n=100) comprised emergency surgeries with limited or expedited assessment. Surgical outcomes, including intraoperative events, postoperative complications, ICU admissions, and 30-day mortality, were documented and compared using SPSS v25.0. Statistical significance was set at p<0.05. Results: Group A (elective surgeries) demonstrated significantly lower rates of intraoperative complications (6%) compared to Group B (18%) (p=0.002). Postoperative infection rates were 4% in Group A and 12% in Group B. ICU admissions were required in 10% of emergency cases versus 3% of elective cases. The 30-day mortality was higher in Group B (7%) compared to Group A (2%) (p=0.045). A well-conducted PAA was strongly associated with better outcomes, particularly in high-risk patients (ASA III and IV). Conclusion: Comprehensive preoperative anaesthesia assessments significantly enhance surgical outcomes and reduce complications, especially in elective procedures. Emergency surgeries, due to time-limited evaluations, carry higher perioperative risks. Strengthening rapid PAA protocols in emergency settings may help mitigate these adverse outcomes.

Background: Acute diarrhoea is a significant public health concern, particularly in developing countries, and remains a leading cause of morbidity and mortality among children under five years of age. Contributing factors include dehydration, malnutrition, and secondary infections such as pneumonia. This study aimed to assess the clinical profile and associated risk factors of acute diarrhoea in children under five years admitted to a tertiary care hospital in Odisha. Methods: A descriptive, hospital-based study was conducted in the Department of Paediatrics at a tertiary care hospital in Berhampur, Odisha. A total of 190 children aged 6 months to 5 years admitted with diarrhoea were enrolled after obtaining informed consent from their caregivers. Children with congenital anorectal malformations, metabolic disorders, or prior antibiotic use within 48 hours of admission were excluded. Data were recorded in a structured format and analysed using R software. Results: The highest prevalence of diarrhoea was observed in the 1–3 years age group (39.5%), followed by children aged 6 months to 1 year (36.8%). Males constituted 61.1% of cases. Among the study participants, 37.4% had some form of malnutrition, with 32.1% classified as Grade 1 Protein-Energy Malnutrition (PEM). Dehydration was noted in 22.6% of cases, with severe dehydration in 6.3%. Vomiting (49.5%) was the most common associated symptom, followed by fever (8.4%) and abdominal pain (2.6%). Stool analysis showed the presence of pus cells in 8.4% and blood and mucus in 4.2% of cases. A significant association was found between malnutrition and dehydration (p < 0.001), with children experiencing severe malnutrition at a higher risk of dehydration. Conclusion: This study highlights the substantial burden of acute diarrhoea among young children, particularly those under three years of age. Malnutrition and dehydration were identified as major risk factors, emphasizing the need for early nutritional interventions and appropriate fluid management. Public health initiatives should focus on improving hygiene, breastfeeding practices, and caregiver education to reduce the incidence and severity of diarrheal illnesses in this vulnerable population.

Scope And Objective: Pain is an emotional experience and discomfort the patient feels due to organ or tissue damage. Treatment of acute postoperative pain, before it turns into chronic postoperative pain. It is necessary for improved outcomes. Multimodal analgesia helps to achieve an effective analgesic action by limiting the dosage and minimizing side effects. In our study, we adapted multimodal analgesia in the combination of opioid and non-opioid analgesics (tramadol with paracetamol and aceclofenac with paracetamol), to compare the safety and efficacy of the combination of analgesics among patients who are in postoperative period. Objective is to compare the safety and efficacy of aceclofenac with paracetamol versus tramadol with paracetamol in terms of pain score. Methods: The current study was done at Govt. Medical College, Ongole. 87 patients posted for various surgeries were included. The study was done after getting institutional ethical committee approval. Patients were randomized into groups A and B by computer-generated software. Group A patients were given Aceclofenac with paracetamol and group B patients were given Tramadol with Paracetamol. Results: There is no significant difference in demographic parameters and hemodynamic parameters between two groups. 70% of patients were male. The umbilical hernia was the most common surgery done. 6.9% of patients had retroviral infection. There is no significant difference in mean pain scores, as assessed by the visual analogue scale (VAS) between groups from 6th to 24th hour of post operative period.  Conclusion: Aceclofenac + Paracetamol (100/325mg) orally and Tramadol + Paracetamol (37.5/325mg) orally are equally effective in treating post-operative pain. Postoperative pain should be managed effectively and quickly to reduce the patient’s discomfort by providing early recovery and quality postoperative period by avoiding complications.

Background: The success of labor induction relies on several determinants, including cervical status, maternal factors, and the procedure of induction. This research determines the predictive worth of transvaginal cervical length (TVCL) and Bishop score as predictors of labor induction success by prostaglandin E₂ (PGE₂) gel. Methods: A prospective observational study was performed in 250 pregnant women with singleton cephalic pregnancies between 37–42 weeks of gestation who were induced with intracervical PGE₂ gel. TVCL was assessed prior to induction by transvaginal ultrasonography, and Bishop scores were evaluated. Success of induction was considered as the attainment of active labor within 72 hours, and delivery outcomes were noted. Data were analyzed with receiver operating characteristic (ROC) curve analysis and statistical tests. Results: Mean TVCL was 2.71 cm (±0.38 SD), and a cutoff value of 2.65 cm predicted successful vaginal delivery with 97.8% specificity. Women with a shorter TVCL had greater vaginal delivery rates (p <0.0001), and women with longer cervix underwent cesarean section (LSCS). Multiparity and lower BMI were also shown to have greater vaginal delivery rates. The mean induction-to-delivery interval was 20.1 hours, and neonatal outcome was still good with 81.6% of neonates having Apgar scores ≥8/10. Conclusion: TVCL is a significant predictor of induction success, and it supports clinical decision-making. Adding cervical ultrasound examination to Bishop score could enhance labor management and maximize maternal and neonatal outcomes.

Introduction: Allergic bronchopulmonary mycoses are complex pulmonary disorders caused by immune reactions mounted against fungi, most often Aspergillus fumigatus (Allergic Bronchopulmonary Aspergillosis), which colonize the airways of patients with chronic lung disease, most commonly asthma, cystic fibrosis (CF), bronchiectasis and chronic obstructive pulmonary disease [1eur journal]. Although rare, other aspergillus spp.., such as A.flavus, A.niger, A.oryzae can also cause ABPA [2]. ABPA affects approximately 2% of patients with asthma. CASE: ABPA HAM AND ASPERGILLUS NIGER. A 32-year-old female presented with generalized weakness and fatigue for 6 months and dry cough for 3 months. She had multiple episodes of cough and shortness of breath in past 1 year, diagnosed as asthma and treated with short course inhaled corticosteroids and oral antibiotics.

Background: Oral Submucous Fibrosis (OSMF) is a chronic, progressive, and potentially malignant disorder that significantly affects airway management due to fibrosis-induced restricted mouth opening. This study evaluates the difficulties in tracheal intubation among OSMF patients and determines the predictive value of airway assessment parameters in facilitating safe and effective intubation. Methods: A prospective observational study was conducted at PDU Government Medical College and Hospital, enrolling 50 adult OSMF patients (age 15–65 years) scheduled for elective surgery under general anaesthesia. Preoperative airway assessments included Modified Mallampati Grading (MPG), inter-incisor distance (IID), thyromental distance (TMD), and sternomental distance (SMD). Intubation difficulty was categorized based on Cormack-Lehane scores (CL II = easy, CL III & IV = difficult), which was used to determine the predictive value of airway parameters. Results: Among the study population, Patients with MPG III had a 50% chance of successful direct laryngoscopy, while all MPG IV patients required advanced airway techniques. Difficult intubation was significantly correlated with reduced TMD (<6 cm) and SMD (<12.5 cm) (p < 0.05). 42% were found to have Cormack-Lehane (CL) Grade II, indicating easy intubation, while 54% had CL Grade III and 4% had CL Grade IV, signifying difficult intubation. 90% of patients were successfully intubated on the first attempt, with 10% requiring a second attempt using external laryngeal maneuvers, stylet, bougie, TruView video laryngoscopy or fiberoptic intubation. Postoperative complications were minimal (8% had transient sore throat). Conclusion: Direct laryngoscopy remains a feasible option in OSMF patients with IID ≥3 cm, provided adjuncts like external laryngeal maneuvers, stylet, or TruView laryngoscopy are available. However, fiberoptic intubation is preferred in IID <3 cm. Preoperative airway assessment remains crucial in anticipating intubation challenges and optimizing airway management strategies.

Background: Influenza A (H1N1, H3N2) and Influenza B are major contributors to respiratory illness in India, yet region-specific data on their distribution and impact in West India (Maharashtra, Gujarat, Dadra & Nagar Haveli) are limited. This study aimed to characterize the epidemiology, clinical outcomes, and molecular features of these strains from 2020 to 2024. Methods: A prospective, multi-centre surveillance study was conducted, testing 45,320 patients with influenza-like illness (ILI) or severe acute respiratory illness (SARI) across 12 sentinel sites. Nasopharyngeal/oropharyngeal swabs were analysed using real-time RT-PCR for Influenza A (H1N1, H3N2) and Influenza B (Victoria, Yamagata lineages). Clinical, demographic, and climatic data were collected, and 500 isolates underwent sequencing for HA gene mutations. Statistical analyses included chi-square tests, logistic regression, and time-series modelling. Results: Of 7,892 influenza-positive cases (17.4%), H1N1 was predominant (49.5%), followed by Influenza B (25.1%) and H3N2 (25.4%). H1N1 dominated annually except in 2022, when H3N2 surged (38.1%). Influenza B showed Victoria lineage dominance (70%). Monsoon peaks (July–September, 54.2%) correlated with rainfall (r = 0.72). H1N1 affected adults (20–40 years), H3N2 the elderly (≥60 years, hospitalization OR = 1.9), and Influenza B children (<15 years). H3N2 had higher hospitalization (32.0%) and mortality (2.1%) rates. Mutations included H1N1’s S179N/I312V, H3N2’s N158 glycosylation (2022), and Influenza B Yamagata’s T121N. Vaccination coverage was low (12.0%), with protective effects (OR = 0.6). Conclusion: H1N1’s dominance, H3N2’s severity in the elderly, and Influenza B’s paediatric burden highlight strain-specific challenges in West India. Monsoon-driven transmission and low vaccination coverage underscore the need for pre-monsoon vaccination, genomic surveillance, and enhanced rural healthcare access to reduce influenza burden.

Background: The early diagnosis of multidrug-resistant tuberculosis (MDR-TB) is crucial for effective treatment. GeneXpert, a molecular diagnostic test, is commonly used to detect Mycobacterium tuberculosis and rifampicin resistance. However, some GeneXpert results are indeterminate, posing a challenge in clinical decision-making. This study aims to investigate the phenomenon of heteroresistance in rifampicin-indeterminate results from GeneXpert assays and explore its clinical significance. Methods: A one-year prospective study was conducted in three tertiary care hospitals in Central India. We included patients with clinically suspected tuberculosis who received GeneXpert testing. Patients with rifampicin-indeterminate results were further evaluated by culture-based methods and Line Probe Assay (LIPA) to detect heteroresistance. The outcomes were compared to rifampicin-sensitive and rifampicin-resistant cases. Results: A total of 350 patients with indeterminate GeneXpert results were included in the study. Of these, 12% showed heteroresistance to rifampicin when further tested. The sensitivity and specificity of GeneXpert for detecting rifampicin resistance were analyzed, along with the clinical and demographic factors contributing to indeterminate results. Conclusion: Heteroresistance in rifampicin-indeterminate GeneXpert results is a significant challenge in the diagnosis and management of tuberculosis. The study highlights the need for further diagnostic refinement and alternative strategies to confirm rifampicin resistance, especially in high-burden settings.

Background: Neonatal septicaemia is a critical cause of morbidity and mortality in newborns. Blood culture remains the diagnostic gold standard, yet its low sensitivity and long turnaround time necessitate adjunctive tools. This study aimed to evaluate the diagnostic performance of C-reactive protein (CRP) compared with blood culture in neonates with suspected sepsis. Methods: This retrospective study included 118 neonates admitted with clinically suspected sepsis. Both CRP and blood cultures were obtained at admission. CRP ≥6 mg/L was considered positive. Diagnostic accuracy measures including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using blood culture as the reference standard. Subgroup and discordance analyses were also performed. Results: Among the 118 neonates, 59.3% were CRP positive, while 26.3% were blood culture positive. CRP showed a sensitivity of 87.1%, specificity of 50.6%, PPV of 38.6%, and NPV of 91.7%. Discordant results were observed in 47 neonates (36.4% CRP-positive/culture-negative; 3.4% CRP-negative/culture-positive). CRP positivity and culture positivity rates were comparable across birth weight and gestational age subgroups. Conclusion: CRP is a sensitive and readily available screening tool for neonatal septicaemia, offering rapid assessment to guide early intervention. However, it should be used in conjunction with clinical evaluation and blood culture for definitive diagnosis due to its modest specificity.

Background: Lactate dehydrogenase (LDH) is an intracellular enzyme released when tissue damage and/or inflammation occurs. Elevated LDH levels in serum and CSF in Meningitis indicate cellular injury and heightened metabolic activity of infection. Distinguishing bacterial from viral meningitis is important for appropriate management but clinical and diagnostic features frequently overlap. As a readily available inexpensive marker, serum LDH can be a supportive diagnostic marker. Assessing its diagnostic performance could improve early differentiation and potentially inform timely therapeutic decisions. Methods: This prospective study was carried out in the Department of Biochemistry from Aug 2023 to July 2024 (1 year). Children aged ≥1 year with clinical and CSF features consistent with meningitis were eligible. Patients with traumatic taps, pre-existing liver dehydrogenase-elevating conditions, or previous antibiotics were excluded. We enrolled 50 cases of each of bacterial and viral meningitis. Serum LDH and CRP levels were quantified by photometric and immunoturbidimetric methods, respectively. Meningitis was classified based on CSF findings and PCR. Results: There were 50 cases each of bacterial and viral meningitis in the study. Meningitis due to bacteria had a significantly higher level of CSF WBC and protein and a lower level of glucose (p<0.05). Serum LDH was markedly increased in cases of bacterial meningitis versus viral meningitis and controls (384 IU/L vs. 210 IU/L vs. 134 IU/L respectively). Specificity and sensitivity for bacterial meningitis at LDH ≥350 IU/L were 84.6% and 80.2%, respectively. LDH ≥460 IU/L associated with admission to ICU and low GCS scores. Therefore, the serum LDH may help to differentiate the types of meningitis and poor outcomes prediction. Conclusion: The current study demonstrated, within the limits of the study design, that serum LDH is a reliable, easy to obtain biomarker to differentiate bacterial versus viral meningitis and predict severe outcomes. although CSF analysis is the classic and established gold standard to diagnose meningitis and its type, serum LDH levels may be adding additional valuable and possible diagnostic information, especially when CSF analysis is delayed or difficult. Our suggested cutoffs (≥350 IU/L for diagnostic purposes; ≥460 IU/L for prognostic purposes) provide clinicians, especially in resource-constrained settings, with actionable thresholds based on the relevant literature.

Background: Celphos is very common toxicity in India; Very lethal; Most of the patients die with traditional medication, so recent advance in medication is required to save many lives. A very few research have been done to save life of celphos toxicity patients. And no antidote is available till now, so some new research is required. Introductions: Celphos is pesticide. Compound name is aluminum phosphide. It reacts with hydrochloric acid of stomach and generates phosphine gas, which circulate in blood and paralyses electron transport system of mitochondria. Thus, I concentrate my study in two parts decrease absorption and fast expulsion.

Alu-Phosphide + Water  Aluminum Hydroxide + Phosphine

Alu-Phosphide + Hydrochloric Acid  Aluminum Chloride + Phosphine

To decrease absorption I use coconut oil and sodium bicarbonate solution for stomach wash with sodium bicarbonate solution neutralize hydrochloric acid. And coconut oil forms layer in stomach and also does not react with celphos, so very minimal phosphine gas is release. In 2nd Part, we recommend early ventilation with high respiratory rate and sedation for fast expulsion of phosphine and also to less utilization of energy system. Aim/Objectives: To study validness of new medication for old medication for celphos toxicity. Material and Method:  Setting and Design: 25 patient admitted in our hospital after taking celphos toxicity were evaluated for recent advance in medication as compare to traditional medication. Every patient admitted in our hospital for medication of celphos toxic tying. We followed old medication protocol from earlier till November 2012 and after that in new era of medication, We started giving stomach wash with soda bicab and coconut oil as a first step. In 2nd step, sedative given to patient to reduce energy consumption and at last 3rd step, patient put on ventilator to facilitate fast expulsion of gas. Result: As compare to previous medication, new era of medication is statically very significant. Recent advance in medication shows encouraging results. Conclusion: Ordinary medication should be replaced by new era of medication.

Background: Maternal Near Miss (MNM) cases reflect severe maternal morbidity where a woman nearly dies but survives a life-threatening complication during pregnancy, childbirth, or within 42 days of termination. Haemorrhage is a leading cause of MNM and maternal mortality, particularly in tertiary care settings receiving high-risk referrals. Objective: To assess the incidence, etiologies, and associated risk factors of maternal near miss cases due to haemorrhagic complications in a tertiary care hospital. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Mahatma Gandhi Memorial Medical College & Maharaja Yashwant Rao Hospital, Indore, from March 2023 to March 2024. A total of 130 women who fulfilled the National Health Mission (NHM) MNM criteria were included. Data collection involved clinical history, examination, investigations, and management outcomes. Statistical analysis was performed using Chi-square test, Student’s t-test, and ANOVA. Results: Out of the 130 MNM cases, 71 (54.6%) were due to haemorrhagic causes. Postpartum haemorrhage (PPH) was most common (39 cases), followed by antepartum haemorrhage (APH) (17 cases), ectopic pregnancy (15 cases), and one case of abortion. Most patients required multiple blood transfusions, and some needed ventilatory and ionotropic support. Hypertensive disorders were the second most common cause (35 cases), with eclampsia being predominant (25 cases), followed by severe preeclampsia (6) and HELLP syndrome (4). Sepsis, cardiac dysfunction, hepatic dysfunction, and ARDS were less common but serious contributors to MNM. The maternal near miss to mortality ratio was 5.2:1. Conclusion: Haemorrhagic complications, especially PPH, are the leading cause of maternal near miss in tertiary care. Early recognition, timely referral, and standardized, protocol-based emergency obstetric care are vital to improving maternal outcomes.

Background: Intrauterine growth restriction (IUGR) and pregnancy-induced hypertension (PIH) are significant contributors to adverse perinatal outcomes. Early detection and management are crucial to improving neonatal health. Non-stress tests (NST) and Doppler velocimetry are widely used for fetal surveillance, but their comparative effectiveness in predicting perinatal outcomes remains a subject of debate. This study aims to assess the diagnostic performance of NST and Doppler ultrasound in forecasting adverse perinatal outcomes in high-risk pregnancies. Method: This prospective observational study was conducted at the Department of Obstetrics and Gynecology, R.D. Gardi Medical College, Ujjain, from January 2023 to December 2024. A total of 142 pregnant women diagnosed with PIH and/or IUGR were included. Umbilical artery and middle cerebral artery Doppler studies were performed, along with NST monitoring. Perinatal outcomes such as birth weight, Apgar score, NICU admission, and neonatal mortality were recorded. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both tests. Statistical analysis was performed using chi-square and Fisher's exact tests, with a significance level of p < 0.05. Results: Doppler ultrasound demonstrated higher sensitivity (75.4%) and diagnostic accuracy (79.29%) compared to NST (50% sensitivity, 70.71% accuracy). Abnormal Doppler findings were significantly associated with adverse perinatal outcomes (75.8%), whereas NST showed a higher false negative rate (50.8%). Doppler also had superior predictive value for neonatal mortality and morbidity. However, NST maintained higher specificity (87.3% vs. 82.2% for Doppler). Conclusion: Doppler velocimetry is more reliable than NST in predicting adverse perinatal outcomes due to its higher sensitivity and diagnostic accuracy. While NST remains a valuable screening tool with high specificity, Doppler studies should be prioritized for high-risk pregnancies to enable timely interventions. Combining both modalities may enhance predictive accuracy and optimize perinatal care.

Background: Effective pain management during root canal treatment is essential for patient comfort and treatment success. This study compares the efficacy of Lidocaine, Articaine, and Bupivacaine in controlling intraoperative and postoperative pain. Aim: To evaluate and compare intraoperative and postoperative pain levels using three different local anesthetic agents in patients undergoing root canal therapy. Materials and Methods: A randomized, single-blind clinical study was conducted on 90 patients diagnosed with symptomatic irreversible pulpitis in mandibular first molars. Patients were divided into three groups (n = 30): Group A (2% Lidocaine), Group B (4% Articaine), and Group C (0.5% Bupivacaine). Pain was recorded using the Heft-Parker Visual Analog Scale (HP-VAS) during access preparation and at 6 and 12 hours postoperatively. Statistical analysis was performed using ANOVA and post hoc Tukey’s test. Results: Articaine demonstrated significantly lower intraoperative pain scores (p < 0.001), while Bupivacaine showed superior postoperative pain control at both 6 and 12 hours (p = 0.002 and p = 0.001, respectively). Lidocaine showed the least analgesic efficacy overall. Conclusion: Articaine is preferable for effective intraoperative anesthesia, while Bupivacaine offers extended postoperative pain relief. Selection of anesthetic agents should be tailored based on procedural and patient needs.

Background: The current gold standard in assessing anterior chamber angles in PACG patients is the gonioscopy which is subjective. More objective techniques like the Anterior Segment Optical Coherence Tomography (AS-OCT), pentacam, ultrasound biomicroscopy are being assessed for their reliability. Present study was aimed to compare gonioscopy versus anterior segment OCT for detecting angle closure in patients of angle closure glaucoma at a tertiary care center. Material and Methods: Present study was single-center, comparative study, conducted patients > 30 years of age, Known case of PACG, PAC or PACS, either gender. Results: In present study, total number of 60 Glaucoma patients were examined by Gonioscopy and AS OCT. Out of 60 patients of Glaucoma ratio of POAG: PACG was 1.94: 1. Male to female ratio was 1.14: 1. The majority of patients were in the age group of 51 to 60 years (58.33 %). Mean age of the study participants was 54.5 ± 7.92 years. Total 480 Angles were examined. Total number of Angles closed on Gonioscopy were 164 (34.17 %). Total number of Angles closed on AS OCT were 231 (48.13 %). The Anterior segment OCT turned out to be better than Gonioscopy & difference was statistically significant. The kappa statistic for the gonioscopy & AS-OCT was 0.734 showing ‘Moderate to Good’ agreement between Gonioscopy and AS OCT in diagnosing closed angle in all 4 quadrant angles. Conclusion: Anterior segment OCT is more efficient for detecting angle closure in patients of angle closure glaucoma as compared to gonioscopy.

Background: Cholecystectomy is a common treatment in gastrointestinal surgery, and the laparoscopic method has become the gold standard for symptomatic cholecystolithiasis and chronic and acute cholecystitis. Apart from the advantages of a much faster recovery time and better cosmetic outcome, the laparoscopic approach carries a greater risk of iatrogenic bile duct injury (IBDI) and hepatic (right) artery injury. Bile duct injury (BDI) is one of the most frightening sequelae of cholecystectomy, associated with significant perioperative morbidity and mortality, decreased long-term survival and quality of life, and a high rate of subsequent lawsuits. Aims: various presentations and management of bile duct injury after cholecystectomy in tertiary health care centre. Methods and materials: this prospective study was done in a tertiary healthcare center in our hospital with the help of a hepatobiliary surgeon, from January 2022 to January 2025 in 118 patients. Preoperative details of all patients with hospital records for post-cholecystectomy bile duct injury were entered in our database. Patients who sustained injuries while being operated in our hospital and also who were operated elsewhere and referred to our center after the injury was detected or suspected, were included in our study. There are three categories of patients according to time of presentation-Group-A injury was detected on a table during cholecystectomy, Group- B patients who presented in the early postoperative period, i.e. within 2 weeks of cholecystectomy, Group- C patients who presented 2 weeks after cholecystectomy. After receiving all the details of the patients, we classified them according to the Strasberg Classification of bile duct injury. Results: There is total 118 patients, 52 males and 66 females, mean age 50 years [range 20-62 years]. 48 patients operated for acute cholecystitis and 70 patients for chronic cholecystitis. The injury occurred open cholecystectomy in 44 patients and laparoscopic cholecystectomy in 74 patients. In group A, two patients with complete transection of the right hepatic duct (type C) and partial injury to left hepatic duct (LHD) underwent right hepaticojejunostomy and repair of the LHD over stent. 4 patients with type D and 6 patients with type E 2 injury underwent repair over T-tube and hepaticojejunostomy, respectively. In group B, all except 2 of the 36 patients with type A injury underwent endoscopic papillotomy and stenting. The bile leak subsided at a mean interval of 8 days in all, except 2 patient who died of fulminant sepsis. Of the 30 patients with type E injury, 10 underwent hepaticojejunostomy after a minimum gap of 3 months. Early repair was considered in 20 patients. 40 patients in group C underwent hepaticojejunostomy. In a mean follow-up of 40 months. The latter patient with a type E3 injury developed recurrent stricture and cholangitis necessitating percutaneous transhepatic dilatation.  Conclusion: The high success rate of bile duct repair in the present study can be attributed to the appropriate timing, meticulous technique and the tertiary care experience.

Background: In the tropical world, amebic liver abscess (ALA) is a common hepatic infection caused by the intestinal protozoan Entamoeba histolytica. While most cases of ALA have an uncomplicated clinical course, 4 to 40% of cases develop complications; the most frequent one is rupture into the thoracic or intraabdominal cavity. A complicated ALA usually require percutaneous catheter drainage in addition to antimicrobial therapy. There are a few rare complications as well, about which there is still a dearth of information. Because of its close proximity, ALA can rarely complicate into the thrombosis of adjacent blood vessels the blood vessels or perforation into a hollow viscus. Here, we present three intriguing cases of ALA with unusual complications: the first involved ALA rupture into the gastric lumen, which resulted in the formation of a hepatogastric fistula; the second involved ALA complicated by inferior vena cava thrombosis; and the third involved the incidental detection of a small hepatic pseudoaneurysm inside the abscess cavity. Our case series demonstrates that these complications may resolve on their own with the care of ALA alone, without the need for further intervention.

Background: Immunisation remains a cornerstone of preventive child healthcare, significantly reducing morbidity and mortality from vaccine-preventable diseases. However, disparities in immunization coverage persist due to variations in sociodemographic and health system factors across urban and rural areas. This study aims to compare beneficiary characteristics and immunization patterns between an Urban Health Centre and a Rural Primary Health Centre, highlighting factors influencing immunization uptake. Understanding these differences is essential for designing targeted interventions to improve vaccine coverage and equity in diverse healthcare settings. Methods: Participants were recruited prospectively through convenient sampling. Children accompanied by mothers or caregivers attending the immunization clinics at the selected centers were enrolled according to predefined inclusion criteria. Data collection was conducted using the validated semi-structured interview schedule. Participants were also counseled on the benefits, cost-effectiveness, and necessity of complete immunization. Results: 500 children were studied 250 each from the Rural PHC (Dharmasagar) and Urban Health Centre (MGM Hospital, Warangal). Age and gender distributions were comparable, but birth order differed significantly, with more first-borns in urban areas. Socioeconomic differences were evident, including higher SC/ST representation in rural and more Muslims in urban areas. Both centers achieved over 90% basic vaccine coverage, though rural areas had slightly higher completion rates. Booster dose coverage was suboptimal in both settings. Maternal illiteracy and religion (Muslim) were significant predictors of incomplete immunization, indicating the need for targeted, setting-specific interventions. Conclusion: This study highlights that while immunization coverage for basic vaccines is high in both urban and rural health settings, there are important gaps persist in timely vaccination, booster coverage, and equitable access. Rural areas benefit from better initial vaccine outreach, while urban centers perform better in defaulter tracking. Socioeconomic and religious differences influence immunization outcomes, with maternal education emerging as a critical factor across both settings.

Background: In India, the prevalence is 47-50% for all ages while as per NFHS-4, the prevalence of anaemia among men 15-49 year age (<13gm/dl) is 18.5% for urban & 25.3% for rural areas. Most of the programs are directed at the Reproductive & Adolescent age group & mainly for females & children. The above data shows 1 in 4 men suffers from anaemia & may face complications & consequences. Objective: Thus the present study is aimed to assess the Clinical & Haematological profiles of Male anaemic patients admitted to Medical wards. Methodology: 100 Male patients admitted to the medical ward for anaemia at tertiary care hospital affiliated with the medical college, during the study period, who met inclusion criteria and who were willing to participate in this study were subjected to further evaluation. Along with clinical data, demographic information was also obtained. Results: Severe Anaemia was present in 70% of males. Moderate anaemia was seen in 30% of males with a Mean age of 43 years. Hence in male patients, anaemia should be screened vigilantly so that we can treat it and avoid complications. Nutritional deficiency is the most common aetiology found. All patients had pallor. The most common symptom observed were weakness (85%) followed by easy fatigability (82%) and breathlessness on exertion (47%). In peripheral smear examination, 50% of males were having microcytic hypochromic anaemia. Conclusion: The most common type of anaemia was Iron deficiency anaemia observed in 50% of patients. In male anaemic patients, a thorough evaluation of the type of anaemia will make etiology-specific treatment more effective.

Background: Abnormal Uterine Bleeding (AUB) is a prevalent gynecological complaint characterized by deviations in menstrual volume, frequency or duration, as defined by the International Federation of Gynecology and Obstetrics (FIGO). It may arise from both structural and non-structural causes, with endometrial biopsies and histopathological evaluation serving as the diagnostic cornerstone. Objectives: To evaluate the histopathological spectrum of endometrial changes in patients presenting with abnormal uterine bleeding (AUB). And to correlate these histopathological findings with various age groups. Materials and Methods: A retrospective observational study was conducted on 90 archived endometrial biopsies received between January 2018 and December 2022 for histopathological evaluation of AUB. Cases with uterine fibroids, cervical/vaginal pathology, systemic disorders, or incomplete records were excluded. Data were categorized into reproductive (18–40 years), perimenopausal (41–50 years), and postmenopausal (>50 years) groups. Histopathological patterns were reviewed and analyzed using descriptive statistics. Results: In this study of 90 cases with AUB, it was found that most patients were in the reproductive age group with 48.9% followed by 31.1%. in perimenopausal age range. Histopathological findings, the most frequently observed was proliferative endometrium at 36.7%, followed by endometrial hyperplasia without atypia at 25.6%, and endometrial polyps at 8.9%. Endometrial carcinoma was noted in 5.6% of the cases, mostly among postmenopausal women.  Conclusion: The histopathological evaluation of endometrial biopsies is crucial for understanding the causes of abnormal uterine bleeding in women of all ages. This study reveals that younger and perimenopausal women tend to show more benign endometrial changes, whereas hyperplastic and neoplastic lesions are more common in postmenopausal women. This underscores the age-dependent nature of AUB etiologies. Therefore, endometrial biopsy and histopathological analysis are vital for tailored diagnosis and management of AUB at all life stages.

Background: Dengue fever, a global health challenge, frequently results in thrombocytopenia, with severe cases (platelet count <50,000/µL) increasing the risk of life-threatening haemorrhage. Early prediction of severe thrombocytopenia remains challenging due to reliance on late-emerging clinical signs. Machine learning (ML) offers potential to enhance risk stratification using routine clinical parameters.

Objective: To develop and validate ML algorithms for early prediction of severe thrombocytopenia in dengue patients using accessible clinical data. Methods: A retrospective cohort of 2,000 dengue-confirmed adults (2018–2023) from a tertiary hospital in Mumbai, India, was analysed. Routine parameters, including initial platelet count, haematocrit, fever duration, white blood cell count, aspartate aminotransferase, and serum albumin, were extracted within 48 hours of admission. Severe thrombocytopenia was defined per World Health Organization criteria. Four ML models—Logistic Regression (LR), Random Forest (RF), Support Vector Machine (SVM), and Gradient Boosting (GB)—were trained and tested (70:30 split) after preprocessing with k-nearest neighbours’ imputation and Adaptive Synthetic Sampling. Performance was evaluated using area under the receiver operating characteristic curve (AUC-ROC), accuracy, precision, recall, and F1-score. Results: Of 2,000 patients, 460 (23.0%) developed severe thrombocytopenia. RF achieved the highest AUC-ROC (0.93, 95% CI: 0.90–0.96), followed by GB (0.91), SVM (0.88), and LR (0.84). RF’s recall (0.84) minimized false negatives, critical for clinical utility. Initial platelet count (importance: 0.26) and haematocrit (0.20) were top predictors, reflecting dengue pathophysiology.  Conclusion: ML models, particularly RF, enable accurate early prediction of severe thrombocytopenia using routine parameters, offering a scalable tool for risk stratification in dengue-endemic regions. Prospective validation and integration into clinical workflows are warranted to reduce morbidity.

Background: Cervical cancer is one of the most extensively studied human cancers linked to a viral infection, with a well-established causal relationship to human papillomavirus (HPV), a preventable risk factor. Globally, data on HPV prevalence remain limited, with significant variations across different populations. This study was done to determine the prevalence of HPV in sexually active females reporting to our tertiary care hospital. Methods: 150 sexually active females aged [18–45 years] were included in the study. Participants were recruited from the gynecology outpatient department, and eligibility was based on the following inclusion and exclusion criteria. Sample Collection and Pap Smear Analysis: Cervical samples were collected using a sterile Ayre’s spatula and endocervical brush. The collected samples were immediately spread onto glass slides, fixed with 95% ethanol, and stained using the Papanicolaou (Pap) staining technique. Cytological evaluation was performed using the Bethesda System (TBS) to classify findings. Results: The prevalence of HPV in our study was 20% in 22.7% of cases classified as HSIL, indicating a high risk of cervical cancer. The majority of participants were aged 18–30 years, and 71.3% reported having only one sexual partner, a protective factor against HPV. Lower educational levels were linked to higher HPV risk, with 49.3% having only a high school education or less. Relative risk estimation showed age >30 years, multiple sexual partners, and a history of STIs have a higher chance of HPVs.

Conclusion: The prevalence of HPV in sexually active females was 20%. Most of the burden of HPV infection and its associated risk factors were lower educational levels, multiple sexual partners, and a history of sexually transmitted diseases. Of the cases in this study, 12.7% were suspected to be malignant. Therefore, these findings underscore the need for specific public health interventions, including vaccination, health education, and accessible screening programs. 

Background: Meckel’s diverticulum is a prevalent congenital anomaly of the gastrointestinal tract, resulting from the incomplete closure of the vitelline duct during the fifth week of gestation. Although often asymptomatic, it can lead to severe complications such as perforation, intestinal obstruction, hemorrhage, and acute diverticulitis. Understanding its anatomy and pathophysiology is crucial. The study aims to highlight the presentation of this disease and raise awareness among clinicians to ensure early intervention, ultimately reducing associated morbidity and mortality. Methods: In this study, 24 patients were assessed at our institution over one year from July 2023 to June 2024. Out of these, 16 presented with symptoms, while eight were incidental findings. The cases manifested as intestinal obstruction, perforation, and incidental Meckel’s diverticulum. This study describes five cases of Meckel’s diverticulum with various presentations. Results: Out of the 24 patients assessed, 16 presented with symptoms, and eight were incidental findings. Males were affected almost twice as often as females, with 17 cases compared to seven females. Conclusion: Symptomatic Meckel’s diverticulum is typically treated with surgical resection, which may involve wedge or partial ileum resection with end-to-end anastomosis. The outcomes are generally favorable. Because of diagnostic challenges, surgeons often recommend prophylactic diverticulectomy when incidentally found, as it has lower morbidity rates than resecting pathological diverticula. Timely intervention is crucial for preventing hospital mortality and morbidity.

Background: Febrile seizures are the most common type of convulsions in children aged 6–60 months and are often associated with fever without underlying neurological conditions. Iron is crucial in brain development, neurotransmitter function, and myelination. Iron deficiency anemia (IDA), prevalent in young children, may influence seizure threshold and severity. Understanding the association between IDA and febrile seizures is essential for early identification and intervention. This study explores the prevalence and clinical correlation of IDA in children with febrile seizures. Methods: After selecting the case based on the inclusion and exclusion criteria. A complete detailed history was taken and a general physical examination was done for all patients. Data was collected using a Predesigned, semi-structured questionnaire which includes age, sex, presenting complaint type and duration of seizures, socioeconomic classes, and comorbid illness (RTI, GIT infection, UTI, skin infections, others). After history taking and clinical examination, blood samples were collected from the patients for Hb, MCV, MCH, and serum ferritin. Based on lab investigations like complete blood picture, serum ferritin levels, and peripheral blood smear diagnosis of iron deficiency anemia was confirmed. Results: In this study of 50 children with febrile seizures, the majority (44%) were aged 13–24 months, with a mean age of 23.5 ± 13.4 months; 62% were male. Febrile seizures occurred most commonly on the first day of fever (54%). Simple febrile seizures were predominant (94%), with LRTI being the most common cause (45.7%). Iron deficiency anemia (IDA) was present in 54% of cases, with 42% showing hemoglobin <11 g/dl. A significant association was observed between IDA and a history of febrile seizures (p=0.010), while age and gender showed no statistically significant correlation with IDA. Conclusion: This study found a high prevalence (54%) of iron deficiency anemia among children with febrile seizures. This suggests that a potential association between the two may exist. While no significant relationship was observed with age, gender, or seizure type, iron deficiency was significantly associated with longer seizure duration and a history of previous febrile seizures.

Background: Infant and young child feeding (IYCF) practices play a crucial role in determining a child’s nutritional status, growth, and overall development. The first two years of life are critical for establishing optimal feeding practices to prevent malnutrition and promote health. Despite various national guidelines and programs, inappropriate feeding practices remain common, particularly in low-resource settings. Assessing maternal knowledge, attitude, and practices (KAP) regarding IYCF and their correlation with the nutritional status of children is essential for guiding effective interventions. Methods: A pretested questionnaire will be used to collect the information on nutrition knowledge of 200 mothers. The nutrition knowledge of mothers will be assessed regarding various aspects such as feeding practices and the child's diet and essential nutrients using a questionnaire. The mother's literacy status and attitude also will be assessed. A total of 20 questions are formed. For evaluating the knowledge test, one score will be awarded for each correct and zero for each wrong answer. The data on the length and weight (6 months - 24 months) of the children of those mothers will be obtained using standard methods. Results: Out of the total participants, a significant proportion of mothers demonstrated moderate knowledge and a positive attitude towards IYCF, yet only a fraction practiced optimal feeding methods. Exclusive breastfeeding for six months was reported by 60%, while timely initiation of complementary feeding was seen in 55% of cases. Malnutrition, particularly underweight and stunting, was more prevalent among children whose mothers had poor IYCF practices. A statistically significant correlation was observed between maternal KAP scores and the nutritional status of children, highlighting the impact of maternal education and awareness on child health outcomes. Conclusion: The study highlights that while breastfeeding practices are relatively well followed, complementary feeding and maternal knowledge remain suboptimal. A positive correlation between maternal KAP scores and child nutritional status underscores the importance of education and awareness. Targeted interventions focusing on improving maternal knowledge, promoting dietary diversity, and addressing cultural and socioeconomic barriers are essential.

Background: Intraoperative hypotension is a common and clinically significant event during major trauma surgery. Phenylephrine and norepinephrine are both used for blood pressure support; however, their comparative efficacy and safety remain under-investigated in trauma-specific populations. This study aimed to evaluate hemodynamic performance, cumulative vasopressor requirements, and adverse event profiles between these two agents. Methods: In this randomized trial, 100 adult patients undergoing trauma surgery under general anaesthesia were allocated to receive either norepinephrine (n=50) or phenylephrine (n=50) for intraoperative hypotension. Hemodynamic parameters, recovery time, cumulative dose, renal function, and adverse events were recorded and analyzed. Statistical comparisons included independent t-tests and chi-square analysis, with significance set at p<0.05. Results: The norepinephrine group demonstrated significantly higher mean arterial pressure (72.5 ± 3.7 mmHg vs. 65.6 ± 4.8 mmHg, p<0.0001), faster recovery to target MAP (13.6 ± 3.7 vs. 18.9 ± 4.7 minutes, p<0.0001), and lower cumulative vasopressor dose (680 ± 210 mcg vs. 1806 ± 437 mcg, p<0.0001). Bradycardia was more frequent in the phenylephrine group (26.0% vs. 4.0%), while arrhythmias were comparable. Renal function was better preserved in the norepinephrine group, with lower mean serum creatinine change (0.10 ± 0.06 vs. 0.16 ± 0.08 mg/dL, p=0.0001). Conclusion: Norepinephrine demonstrated superior hemodynamic stability, lower drug requirement, and fewer adverse events than phenylephrine for managing intraoperative hypotension during trauma surgery. These findings support its preferential use in high-risk surgical patients.

Background: Thrombocytopenic febrile illnesses, such as dengue, malaria, and certain bacterial infections pose significant clinical challenges due to their potential to cause severe complications including bleeding disorders and organ failure. Platelet indices such as Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), and Plateletcrit (PCT), have emerged as valuable diagnostic and prognostic tools in these conditions. This study explores the utility of platelet indices in the management, analyzing their role in early diagnosis, monitoring disease progression, and predicting outcomes. Materials And Methods: A total of 500 individuals, comprising both males and females aged 3-88 years, with thrombocytopenia due to acute febrile illness, were examined. Blood samples were collected in EDTA vacutainers and analyzed for thrombocytopenia. Mean platelet volume (MPV) Platelet distribution width, (PDW) plateletcrit (PCT) and platelet large cell ratio (P-LCR) were measured using automated cell analyzers. MPV and PDW parameters were monitored for 85 individuals from day 1 to day 3. Peripheral smear examinations were conducted in all 500 cases to exclude pseudo-thrombocytopenia. Results: Among the 500 cases of thrombocytopenia MPV, PDW, P-LCR and PLT values were assessed. 85 cases were selected and analysis was done using ANOVA test which revealed MPV and PDW showed significant statistical correlation.  Conclusion: The study demonstrates the effectiveness of MPV and PDW in detecting mechanism of thrombocytopenia (hyperdestructive or hypoproductive) through continuous assessment of patient’s blood samples. Moreover, estimating these indices proves to be cost-effective and helps in avoiding invasive diagnostic procedures.

Background: Breast cancer is the most common cancer in women, and its molecular subtypes influence prognosis and treatment response. PET/CT imaging with 18F-FDG is widely used to evaluate metabolic activity in breast tumors and may serve as a prognostic indicator. Objective: This study aimed to assess the correlation between SUVmax on 18F-FDG PET/CT scans and breast cancer molecular subtypes, as well as its prognostic value regarding treatment response. Methods: A total of 107 patients with breast cancer (median age 51 years) were included. The SUVmax values were measured and compared across four molecular subtypes: Luminal A, Luminal B, HER2-enriched, and TNBC. Statistical tests (Mann-Whitney U test and Kruskal–Wallis H test) were used to assess differences in SUVmax across subtypes and responses to therapy. Results: The mean SUVmax for the entire cohort was 7.94 (range 4.3 - 14.39). Significant differences in SUVmax were observed across subtypes: Luminal A (3.1%) showed the lowest SUVmax, whereas luminal B (36%), HER2-enriched (11.2%), and TNBC (14.9%) exhibited higher SUVmax values. Higher SUVmax values were directly correlated with better pathological complete response (pCR). Conclusion: The SUVmax on 18F-FDG PET/CT is a valuable predictor of metabolic activity and tumor aggressiveness in patients with breast cancer. Higher SUVmax values correlated with a better response to treatment, suggesting that SUVmax may serve as a potential biomarker for personalized treatment strategies.

Background: Shivering is a common complication during surgery, affecting 6% to 65% of patients. Various drugs, including midazolam and ketamine, are used for management but may cause side effects such as sedation and nausea. This study compares the efficacy of low-dose and optimum-dose midazolam and ketamine in preventing shivering during spinal anaesthesia. Methodology: A prospective observational study was conducted at Government Medical College, Thiruvananthapuram, with 186 patients undergoing elective lower limb surgeries. Participants were divided into three groups: Group A received midazolam (0.02 mg/kg) and ketamine (0.25 mg/kg), and Group B received midazolam (0.04 mg/kg) and ketamine (0.25 mg/kg). In contrast, Group C (control) received normal saline. Preheated IV fluids were administered, and MAP, HR, SpO2, and core body temperature were recorded at intervals post-spinal anaesthesia. Data analysis was performed using SPSS version 27. Results: Most participants were under 45 years old. All groups had significant Core body temperature changes (p < 0.001), but intergroup differences were minimal. Nystagmus was significantly higher in Groups A and B (p < 0.05). One patient each in Groups A and B experienced hallucinations. In Group C, 11.3% had grade 3 and 9.7% had grade 4 shivering. Group B showed the best prevention, with 91.9% remaining shiver-free post-30 minutes. Conclusion: Both midazolam and ketamine combinations were effective in preventing shivering. Hemodynamic parameters remained stable across all groups.

Background: Acute appendicitis is a common surgical emergency caused by the inflammation of the vermiform appendix. It is characterized by right lower abdominal pain, fever, and leukocytosis. The condition requires timely surgical intervention to prevent complications such as perforation, abscess formation, or peritonitis. Objective: To evaluate and compare the clinical outcomes and post-operative complications between open and laparoscopic appendicectomy in patients with acute appendicitis. Methods: A total of 100 patients diagnosed with acute appendicitis were included in the study. Of these, 58% underwent open appendicectomy, while 42% underwent laparoscopic appendicectomy. Patient demographics, pathological findings, and post-operative complications were recorded and analyzed. Results: The majority of patients (62%) were in the 21–30 years age group, with a slight male predominance (52%). Inflammation was the most common pathology (70%), followed by faecolith (23%), abscess (4%), and perforation (3%). Post-operative complications were observed in 13% of cases, with a higher incidence in open appendicectomy patients. Laparoscopic appendicectomy demonstrated lower complication rates and faster recovery compared to open surgery. Conclusion: Laparoscopic appendicectomy is associated with fewer post-operative complications, making it the preferred approach for uncomplicated appendicitis. However, open appendicectomy remains relevant in cases of complicated appendicitis or when laparoscopic expertise is unavailable. Early diagnosis and appropriate surgical intervention are essential to prevent complications and improve patient outcomes

Background: With improved screening and treatment modalities, the survival rate of breast cancer patients has significantly increased. However, survivorship brings its own challenges, including physical, psychological, and social sequelae that affect the quality of life (QoL) and functional status of survivors. Aim: To assess the quality of life and functional status in breast cancer survivors. Methods: A cross-sectional study was conducted among breast cancer survivors attending the oncology outpatient department of a tertiary cancer care center. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and its breast cancer-specific module (QLQ-BR23) were administered to evaluate QoL and functional outcomes. Sociodemographic and clinical data were also collected. Descriptive statistics and inferential analyses (chi-square, t-test) were used to determine significant associations. Results: Among the survivors (N = XX), the mean global health status/QoL score was XX. Functional domains such as emotional and physical functioning were notably compromised. Symptoms such as fatigue, pain, and arm swelling were prevalent. Lower QoL scores were significantly associated with advanced stage at diagnosis, comorbidities, and recent completion of treatment (p < 0.05). Conclusion: Breast cancer survivors face ongoing challenges that impair their quality of life and functional capacity. Integration of routine QoL assessments into follow-up care and provision of psychosocial support services are essential for holistic survivorship care.

Background: Epidural anesthesia is widely employed for below-umbilical surgeries due to its superior analgesic efficacy and reduced systemic side effects. Adding α2-adrenergic agonists like dexmedetomidine and clonidine enhances the quality and duration of epidural block. Dexmedetomidine, with higher receptor selectivity, offers prolonged analgesia and stable hemodynamics. Clonidine, though less selective, also improves block characteristics. This study aims to compare the efficacy of these agents as adjuvants in epidural anesthesia for optimized perioperative outcomes. Methods: This prospective, randomized, double-blinded comparative study was conducted in the Department of Anaesthesiology, Kakatiya Medical College, Warangal, over 24 months (September 2022–August 2024). Sixty patients undergoing elective lower abdominal, lower limb, urological, and gynecological surgeries were enrolled and randomized into two groups (n=30 each) based on the adjuvant used with epidural bupivacaine:   Group D: 15 mL of 0.5% bupivacaine + 1 µg/kg dexmedetomidine   Group C: 15 mL of 0.5% bupivacaine + 1 µg/kg clonidine. Demographic and Baseline Characteristics Results: The demographic, anthropometric, and ASA status were comparable between groups (p > 0.05). Dexmedetomidine (Group D) showed a significantly faster onset of sensory (4.38 ± 1.05 min) and motor blockade (8.19 ± 1.42 min) compared to clonidine (Group C) (p = 0.01). Duration of sensory and motor block was longer in Group D (p = 0.01). Group D had lower VRS scores and delayed time to first rescue analgesia (p ≤ 0.05). Sedation scores were higher in Group D (p = 0.005), but side effects were similar across groups (p = 0.0652). Hemodynamic and oxygenation parameters remained stable in both groups. Conclusion: Dexmedetomidine and clonidine added to bupivacaine in epidural anesthesia for below-umbilical surgeries found no significant differences in age, sex, height, weight, ASA category distribution, heart rate, blood pressure, and SpO2 levels. However, the dexmedetomidine group exhibited faster onset and longer duration of sensory and motor blocks than the clonidine plus bupivacaine group. Additionally, dexmedetomidine required rescue analgesics after clonidine was added to bupivacaine.

Background: The impact of anaesthetic techniques on cancer recurrence and long-term outcomes has gained substantial attention in recent years. With oncologic surgery being a critical point in the management of solid tumours, the perioperative period provides an opportunity to influence tumour biology and patient prognosis. This systematic review evaluates the role of intravenous (particularly propofol), volatile, and regional anaesthesia in modulating immune response, tumour microenvironment, inflammation, and metastatic potential. Findings from 36 clinical studies, including randomized controlled trials and observational cohorts, indicate that propofol-based total intravenous anaesthesia (TIVA) and regional techniques may support immune surveillance and reduce inflammatory cytokines, correlating with improved disease-free and overall survival. Conversely, volatile anaesthetics have been linked with immune suppression and increased risk of recurrence. Although these associations are biologically plausible and clinically relevant, inconsistencies in study designs, endpoints, and cancer types highlight the need for large-scale, stratified clinical trials. As the field of oncologic anaesthesia continues to evolve, anesthesiologists must be aware of their potential influence on long-term cancer outcomes and collaborate within multidisciplinary teams to optimize perioperative strategies for cancer patients.

Background: Cholera is an acute diarrheal illness caused by Vibrio cholerae O1 or O139, often resulting in outbreaks in India, especially in regions with poor sanitation and hygiene. The present study reports a cholera outbreak in Nerli village, Nanded, Maharashtra. Methodology: A total of 115 patients with acute watery diarrhea during the outbreak were line-listed. Samples included stool, rectal swabs, and vomitus, which were processed using standard microbiological methods, including enrichment culture, biochemical tests, serotyping, and antimicrobial susceptibility testing. Statistical analysis was performed using Microsoft Excel and Epi Info. Results: Out of 115 patients, 63% were male and 45% were children under 12 years. Vibrio cholerae was isolated from 24 samples—14 stool and 10 rectal swabs. All isolates were identified as Vibrio cholerae O1 Ogawa, El Tor variant, confirmed by biochemical and serological tests. The strains were sensitive to Ampicillin, Norfloxacin, Tetracycline, Azithromycin, and resistant to Cotrimoxazole. No deaths were reported in the outbreak. Conclusion: The outbreak was effectively managed with no mortality. Identification of the El Tor variant and its antimicrobial sensitivity profile can guide future outbreak preparedness and antibiotic stewardship.

Background And Objectives: India is recognised as the global hub for diabetes, with Gestational Diabetes Mellitus (GDM) constituting a substantial percentage of patients. GDM is a prevalent condition during pregnancy and can result in considerable complications. Thus, it was posited that a biomarker for forecasting carbohydrate intolerance in pregnancy could enable early intervention and avert related consequences. Thus, the role of HbA1c was evaluated as a predictive marker for GDM. This study aimed to evaluate the predictive capacity of the HbA1c test in identifying GDM, using the 75-gram OGTT (IADPSG GUIDELINES) as the reference standard. Methodology: This research was conducted as a prospective observational study inside the Obstetrics and Gynaecology Department of a tertiary care facility in Kerala. Among pregnant women throughout a duration of 1.5 years from December 2019 to June 2021. This aimed to investigate the correlation between HbA1c and GDM. This study evaluated 141 antenatal cases. All prenatal patients attending the clinic for the first time before 12 weeks of gestation were selected and subsequently had HbA1c testing followed by an OGTT between 24 to 28 weeks. The findings were examined to identify a correlation between the two variables. Results: In this study, of the 141 women tested, 69 were diagnosed with GDM. Our investigation identified a statistically significant connection between first-trimester HbA1c levels and GDM. The study indicated that the highest frequency of cases, specifically 33 out of 69 diagnosed with GDM, had HbA1c values between 5.1 and 5.5. This link was statistically significant with a p-value of 0.001. The receiver operating characteristic (ROC) curve is a graphical representation that demonstrates the diagnostic efficacy of a binary classification system. The ROC curve study demonstrated an AUC (area under the curve) of 0.687, indicating a significant predictive capability of HbA1c for GDM. The current study indicates that at a cutoff value of 5.15%, the sensitivity and specificity of HbA1c for predicting gestational diabetes are 72.5% and 58.3%, respectively. Further correlation derived from this study was a significant association between GDM and other factors like pre-pregnancy BMI, socioeconomic status, PCOD, and infertility. Among the group, 66.7% of overweight women developed GDM, and 95% of obese women also had GDM. Conclusion: Based on the aforementioned data, it was determined that HbA1c may function as a predictive biomarker for GDM. Future research with an expanded sample size may further confirm and validate the association between HbA1c levels and positive GDM screening tests. An effective predictor will facilitate the early detection and management of GDM, consequently diminishing the frequency of problems related to the condition during pregnancy.

Background: Retinal microvasculature shares anatomical and physiological characteristics with cerebral microvessels, making it a potential biomarker for cognitive decline. As the aging population grows, identifying early indicators of cognitive deterioration is crucial for timely intervention. This study aimed to evaluate the association between retinal microvascular alterations and cognitive function in older adults. Materials and Methods: A cross-sectional observational study was conducted on 120 participants aged 65 years and above. Retinal imaging was performed using fundus photography and Optical Coherence Tomography Angiography (OCTA) to assess vessel caliber, arteriolar-to-venular ratio (AVR), and capillary density. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Statistical analyses included Pearson’s correlation and multivariate regression to explore associations between retinal parameters and cognitive scores. Results: A significant positive correlation was found between AVR and MMSE scores (r = 0.42, p < 0.01), and between retinal capillary density and MoCA scores (r = 0.38, p < 0.01). Participants with narrower arterioles and wider venules showed lower cognitive performance. After adjusting for age, gender, hypertension, and diabetes, retinal vessel alterations remained independently associated with cognitive decline (β = 0.31, p = 0.002). Conclusion: Retinal microvascular changes, particularly reduced AVR and capillary density, are significantly associated with cognitive decline in older adults. Retinal imaging may serve as a non-invasive, cost-effective tool for early identification of individuals at risk for neurodegenerative conditions.

Background: Effective postoperative pain management is crucial for optimal recovery and patient comfort. Intrathecal administration of morphine with hyperbaric bupivacaine has gained attention for its ability to provide prolonged analgesia with a single dose. However, the ideal morphine dose that balances efficacy and side effects remains under investigation. This study compares three different doses of intrathecal morphine added to hyperbaric bupivacaine to evaluate their effects on analgesic duration, hemodynamic stability, and incidence of opioid-related adverse effects in spinal anesthesia. Methods: 90 patients were included in this double-blinded randomized controlled study. Patients were divided into 3 groups of thirty patients each. Patients in group M1 received 3ml of 0.5% hyperbaric bupivacaine plus 50µg preservative-free morphine 0.2ml. Patients in group M2 received 3ml of 0.5% hyperbaric bupivacaine plus 100µg preservative-free morphine 0.2ml. Patients in group M3 received 3ml of 0.5% hyperbaric bupivacaine plus 200µg preservative-free morphine 0.2ml. Results: The three groups were comparable in terms of age, height, weight, and type of surgical procedures. The onset of sensory and motor block, as well as two-segment regression and motor block duration, showed no significant difference among groups. A statistically significant decrease in intraoperative and postoperative heart rates was observed with higher morphine doses, while mean arterial pressures remained similar. Duration of analgesia significantly increased with higher morphine doses (7 h in M1, 18 h in M2, 24 h in M3). Side effects such as nausea, pruritus, and urinary retention were more frequent in higher dose groups, particularly M3. Conclusion: This study found that intrathecal morphine in doses up to 200 µg provides effective and prolonged postoperative analgesia with minimal and manageable side effects. Its incorporation into spinal anesthesia enhances patient comfort and reduces systemic opioid requirements.

Background: To evaluate the association between serum homocysteine levels and the Diabetic retinopathy (DR). Materials and Methods: A cross-sectional study was conducted on 120 T2DM patients attending a tertiary hospital. Fundus examination was used to classify patients into no DR, non-proliferative DR (NPDR), and proliferative DR (PDR). Serum homocysteine levels were measured, and other clinical parameters including HbA1c and duration of diabetes were recorded. Statistical correlations were assessed using ANOVA and Pearson’s coefficient. Results: Among 120 patients, 41.7% had no DR, 37.5% had NPDR, and 20.8% had PDR. Homocysteine levels were significantly higher in patients with NPDR and PDR. A strong positive correlation was found between homocysteine levels and DR severity (r = 0.52, p < 0.001). Conclusion: Elevated serum homocysteine levels are significantly associated with the presence and severity of diabetic retinopathy. Homocysteine may serve as a valuable biomarker for early detection and risk stratification in T2DM patients.

Background: Obstructive Sleep Apnea (OSA) is a common condition characterized by intermittent hypoxia and disrupted sleep, which predispose individuals to systemic inflammation and cardiovascular complications. This study evaluates the association between OSA and various clinical and inflammatory parameters in COVID-19 patients, including disease severity, C-reactive protein (CRP), D-dimer levels, ICU stay, and patient outcomes. A retrospective analysis of 120 COVID-19 patients revealed that individuals with pre-existing OSA had significantly higher levels of inflammatory markers, prolonged ICU stays, and elevated D-dimer levels compared to non-OSA patients. The findings suggest that OSA exacerbates the hyperinflammatory response and coagulopathy associated with severe COVID-19, emphasizing the need for targeted management in this population.

Background: First-trimester prenatal screening, incorporating nuchal translucency (NT) measurement and maternal serum double marker tests (β-hCG and PAPP-A), is primarily utilized for detecting chromosomal anomalies such as Trisomy 21, 18, and 13. However, their role in predicting broader adverse perinatal outcomes remains uncertain. Objective: To evaluate the association between first-trimester NT and double marker screening results and adverse perinatal outcomes in pregnant women. Methods: A diagnostic cross-sectional study was conducted over two years (June 2021–May 2023) at NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur. A total of 63 pregnant women with singleton pregnancies between 11 and 13 weeks of gestation, who underwent both NT measurement and double marker testing, were enrolled. Maternal and neonatal outcomes were tracked until delivery. Data were analyzed using t-tests and Chi-square tests with a significance threshold of p < 0.05. Results: Among the 64 women analyzed, NT and double marker values were significantly higher in those who experienced adverse perinatal outcomes. The mean NT in the adverse outcome group was 1.89 mm versus 1.22 mm in those without, while the mean MoM for the double marker was 1.90 versus 1.22 (p < 0.001 for both). Other maternal characteristics showed no statistically significant associations. Although trends toward higher NICU admissions and complications were observed in the marker-positive group, they were not statistically significant. Conclusion: Elevated NT and abnormal double marker values in the first trimester are significantly associated with adverse perinatal outcomes, highlighting their potential in early risk stratification and targeted antenatal care.

Background: The lack of standardized Platelet-Rich Plasma (PRP) protocols for Knee Osteoarthritis (KOA), combined with significant patient variability, leads to inconsistent PRP effectiveness across studies. This study aims to assess the influence of PRP injection frequencies on KOA treatment and explore the role of patient characteristics and PRP properties in the treatment’s effectiveness. Methods: A retrospective cohort study was conducted with KOA patients who received three PRP injections (4-week intervals) at a hospital in Faridabad. The Wilcoxon signed-rank test was used to analyze differences in self-reported recovery rates across different treatment time points, with Bonferroni correction applied for significance level adjustment (α). The Mann-Whitney U test, Kruskal–Wallis H test, Spearman correlation analysis, and restricted cubic spline models were used to assess the associations between sex, baseline Kellgren–Lawrence grade, age, PRP red blood cell (RBC) concentration, PRP white blood cell (WBC) concentration, PRP platelet concentration, the multiple of PRP platelet concentration relative to the baseline autologous level (Enrichment-PLT), and self-reported recovery rates. Results: The study included 28 KOA patients. Significant improvement in self-reported recovery rate was observed 4 weeks after the first treatment (median: 30.0%, P < 0.008) and after the second treatment (median: 45.0%, P < 0.008). However, no significant change was noted 4 weeks after the third treatment (median: 55.0%, P = 0.058), and recovery rates at 8, 12, and 24 weeks post-third treatment showed no significant differences compared to 4 weeks (all P > 0.008). Additionally, no correlations were found between sex, baseline Kellgren–Lawrence grade, age, PRP RBC concentration, PRP WBC concentration, PRP platelet concentration, or Enrichment-PLT and self-reported recovery rates. Conclusion: At least two PRP injections are recommended, with effects lasting for at least 24 weeks. Factors such as sex, age, baseline Kellgren–Lawrence grade, and PRP properties (prepared by apheresis) do not significantly affect treatment outcomes.

Background: Stroke is a serious neurological condition that can cause disability and death. The pathophysiology of stroke is related to inflammatory/oxidative damage, apoptosis, and angiogenesis. High-sensitivity C-reactive protein (hs-CRP) is associated with atherosclerosis and can predict the severity of stroke. The objective of this study was to determine the pattern of hs CRP in acute ischemic stroke cases reported to our hospital. Methods: This prospective observational study was conducted at the Department of General Medicine, Govt Medical College and Hospital, Wanaparthy, Telangana. Diagnosed with acute ischemic stroke (confirmed by MRI/CT within 24–48 hours of symptom onset). Baseline Data Collection was done on admission demographic details, and risk factors (hypertension, diabetes, smoking, dyslipidemia) were noted. A detailed history was obtained and a clinical examination was done. The severity of the stroke was assessed using the National Institutes of Health Stroke Scale (NIHSS) at admission.  Results: In this study of 80 acute ischemic stroke patients, participants were divided based on HsCRP levels: low (<1 mg/L, n=33) and high (>3 mg/L, n=47). High HsCRP was significantly associated with male gender, hypertension, diabetes, and smoking. Poor outcomes (mRS 3–6), mortality at discharge, and poor outcomes at 3 months were significantly higher in the high HsCRP group. Multivariate analysis confirmed high HsCRP, NIHSS at admission, diabetes, and hypertension as independent predictors of poor outcomes. ROC analysis showed good predictive accuracy (AUC 0.81, sensitivity 82.5%, specificity 75.9%) for HsCRP >3 mg/L in identifying patients at risk of poor functional outcomes. Conclusion: This study reinforces the prognostic value of HsCRP levels in AIS. HsCRP >3 mg/L was independently associated with worse functional outcomes, higher mortality, and increased likelihood of recurrent vascular events. Since HsCRP is a low-cost diagnostic marker, it could be a valuable adjunct in stroke prognostication and risk stratification.

Background: Acute intestinal obstruction (AIO) is a common surgical emergency encountered across all age groups. It is associated with considerable morbidity and mortality, especially when diagnosis and treatment are delayed. Objective: To evaluate the incidence and etiology of AIO in patients across all age groups in a tertiary care hospital. Methods: A prospective observational study was conducted on 110 patients with clinical and radiological features of AIO requiring surgical intervention. Data on demographics and etiological factors were collected. Statistical analysis was performed using MS Excel and Minitab version 13. Chi-square test was used and p-values <0.05 were considered statistically significant. Results: The highest incidence of AIO was observed in the 0–20 year age group (36.36%), with a male predominance (61.82%). The most common cause was adhesions (27.27%), followed by neoplasms (17.27%) and volvulus (12.73%). Intussusception, abdominal tuberculosis, and strangulated bowel were also notable causes. Less common etiologies included atresia, strictures, necrotizing enterocolitis, Hirschsprung’s disease, gangrenous bowel, and meconium aspiration. Conclusion: AIO demonstrates a diverse etiological profile and is more frequently observed in younger individuals. Adhesions remain the leading cause across all age groups. Early identification of etiology is essential for timely surgical intervention and improved outcomes.

Background: Metabolic syndrome (MetS) is increasingly recognized as a potential risk factor for pulmonary dysfunction, though the nature and mechanisms of this association remain incompletely understood. This study aimed to characterize the impact of MetS on pulmonary function parameters and identify key metabolic predictors of respiratory impairment. Methods: In this cross-sectional study, we compared 75 adults with MetS (diagnosed by NCEP ATP III criteria) with 75 age- and sex-matched healthy controls (aged 30-60 years). All participants underwent standardized spirometry following ATS/ERS guidelines. We assessed forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), FEV₁/FVC ratio, and peak expiratory flow rate (PEFR). Statistical analyses included t-tests and multivariate regression to adjust for confounders. Results: The MetS group demonstrated significantly reduced pulmonary function compared to controls: FVC (85.3±9.2% vs 95.6±8.4%, p<0.001), FEV₁ (82.7±8.8% vs 94.1±7.9%, p<0.001), and PEFR (6.8±1.5 vs 8.2±1.3 L/min, p<0.001). The FEV₁/FVC ratio was also lower in MetS participants (78.5±5.6% vs 81.2±4.9%, p=0.002). Regression analysis identified waist circumference (β=-0.32, p=0.001) and fasting glucose (β=-0.25, p=0.008) as independent predictors of reduced FVC. Conclusion: MetS is associated with clinically significant restrictive pulmonary impairment and mild airway obstruction, with central obesity and hyperglycemia emerging as key metabolic drivers. These findings suggest pulmonary function assessment should be considered in MetS management, and highlight the potential for metabolic interventions to preserve respiratory health.

Background: Aim: The aim of the present study was to assess the various types of congenital CNS malformations in 0 to 12 years of age group of patients relation to their neuroimaging findings. Methods: This was a single centre, observational, cross sectional, descriptive study conducted in Department of pediatrics of a tertiary care hospital. The study was conducted for a period of 24 month from 1st January 2019 to 31st December 2020. All patients in the age group of 0 to 12 years, presented to our hospital with CNS malformation. The sample size calculated was 100.  Results: The average age of enrolled patients in our study was 84.64 ± 336.07 days (̴3months). Majority of patients diagnosed at an age of < 7 days (76%).  Gender wise distribution showed relative prevalence of female patient (55%) in the study. The average birth weight among our study participants were 3.64 ± 3.42 kg. 50 % of children had birth weight ≤ 2.8 kg. Majority of patients enrolled had vaginal delivery. 26% patients underwent LSCS. Full term delivery was seen in majority of patients (93%) enrolled in study. 2% patients were born extremely preterm. Large head was the most common (75%) presentation seen in our patients. 29% patients presented with large head and mass at the back. The other common presentation seen were seizure and mass at the nape of neck. Majority of patients presented with no seizure (75%). GTCS was the most common type of seizure among those who presented with seizure. Conclusion: Hydrocephalous as the most common type of CNS malformation among patients enrolled in our study followed by those presenting with meningomyelocele and Arnold Chiari malformation. The other common malformations were Dandy walker syndrome, Spina bifida occulata and Occipital encephalocele. CTEV was the most common associated anomaly followed by presence of tetralogy of fallot and PDA. Majority of patients diagnosed at an age of < 7 days. Majority of patients enrolled had vaginal delivery. Full term delivery was seen in majority of patients.

Background: Asthma severity assessment remains challenging, with ongoing debate regarding optimal biomarkers. This study evaluated the comparative utility of sputum eosinophils, blood eosinophil count (AEC), and serum IgE in stratifying asthma severity. Methods: In this cross-sectional study, 120 adults with asthma (GINA 2023 severity steps 1-5) underwent sputum induction, complete blood count, and serum IgE testing. Sputum eosinophils were quantified microscopically after processing with dithiothreitol. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis. Results: Sputum eosinophils showed the strongest correlation with asthma severity (ρ=0.62, p<0.001), followed by AEC (ρ=0.51) and IgE (ρ=0.38). For severe asthma detection (GINA steps 4-5), sputum eosinophils ≥6.5% demonstrated 89% sensitivity and 92% specificity (AUC 0.88), outperforming AEC ≥450 cells/μL (AUC 0.72) and IgE ≥250 IU/mL (AUC 0.65). In multivariate analysis, sputum eosinophils remained the strongest independent predictor (OR 8.2, 95% CI 3.5-19.1). Conclusion: Sputum eosinophil measurement provides superior severity discrimination in asthma, supporting its role in precision management. When sputum analysis is unavailable, AEC offers a reasonable alternative, albeit with lower accuracy. These findings advocate for airway-specific inflammation assessment in severe asthma evaluation.

Background: Labor is a clinical diagnosis, classically defined by the triad of regular painful uterine contractions, progressive cervical effacement and dilatation, and show (bloody discharge). The present study was focused on utilizing transperineal ultrasound to measure the fetal head to perineum distance, aiming to evaluate a novel and potentially superior predictor for successful normal delivery in induced labors. Material and Methods: Present study was single-center, prospective, observational study, conducted in pregnant women with term singleton pregnancy with gestational age (>37) weeks, living fetus with vertex presentation, with poor bishop score ≤ 6, with reactive CTG, with intact amniotic membranes, underwent indication for medical induction of labor. Results: The majority of participants (n=87, 43.5%) fell within the 18-25 age range. Primiparous individuals (n=118, 59.0%) outnumbered multiparous individuals (n=82, 41.0%). Participants had varying gestational ages, with 41 weeks being the most common (n=54, 27.0%). Postdatism (n=65, 32.5%) and IHCP (n=55, 27.5%) were the most common indications for induction. Vaginal delivery was more common (n=142, 71.0%) than caesarean delivery (n=58, 29.0%). Vaginal delivery was associated with a smaller head to perineum distance, and ROC analysis indicated its significance (AUC – 0.777, p value <0.001). Cervical length significantly differed between delivery modes, with a predictive accuracy for caesarean delivery (Sensitivity – 84.48%, Specificity – 51.41% and accuracy – 61%). Significant association (p < 0.001) with a higher head to perineum distance on ultrasound showing an increased percentage of Caesarean deliveries, indicating as the distance increases, the likelihood of a Caesarean delivery significantly increases. Conclusion: The study underscored the significant relationship between the mode of delivery and key metrics and highlighting the pre-induction head-to-perineum distance, thereby illuminating their predictive value.

Background: MRKH syndrome is caused by the congenital lack or partial development of both mullerian ducts (class-1), which results in the absence of the uterus, bilateral fallopian tubes, cervix, and upper part of the vagina. Ten percent of newborns have some genitourinary system abnormalities, and problems in one system often correspond to abnormalities in other system. Globally, 1 in 4500 live female births is affected by MRKH. For these patients, the primary goal of treatment is to create a neovagina, either conservatively or surgically. Numerous surgical techniques, such as split thickness skin grafting, amnion grafting using an artificial mold (McIndoe), and peritoneal pulls with laparoscopic assistance using a modified Davydov's approach can be done on addition to neovaginal surgery. Materials and Methods: Three patients who presented with MRKH syndrome over a 1.5-year period in 2023–2024 were the subjects of this investigation. Every patient was brought to the Nootan General Hospital, which is linked to the NMCRC Medical College in Visnagar, Gujarat. All patients underwent the McIndoe technique, a surgical procedure in which the amniotic membrane lined the neovagina.   Results: All of the patients in our study underwent evaluation weekly for the first month following surgery and monthly for the next five months. During follow-up observations involve screening for genital or urinary complaints, stricture presence, and graft failure. None of the patients had any complications. All had outstanding outcomes following surgery. Conclusion: For patients with MRKH Syndrome, vaginoplasty using amnion as a graft is an incredibly safe and effective procedure that has no post-operative challenges when performed by a skilled gynecologist.

Background: The first visit to the hospital for majority of the women in India is during pregnancy, hence, pregnancy makes a good opportunity for the screening of premalignant and malignant cervical disease. Present study was aimed to study diagnosis of cervical cancer via pap smears and colonoscopy during pregnancy. Material and Methods: Present study was single-center, prospective, comparative, parallel-group, observational study, conducted in antenatal Women aged between 21 to 40 years, with 12-32 weeks of Gestational age Screening was done by conventional PAP smear method followed by colposcopy. Results: Among 200 pregnant women, majority were aged between 21 and 25 years, with a mean age of 31.3 years. Gestational age distribution showed that most participants were in the first trimester, with 56% having a gestational age of 12 weeks. Multigravida accounted for 70% of the participants. Per speculum examination revealed that 90% of participants had a healthy cervix, while 10% exhibited cervical erosion. The prevalence of abnormal PAP smears was 21%, with 1.5% of participants showing Atypical Squamous Cells of Undetermined Significance (ASCUS). Unsatisfactory PAP smear results were observed in 5% of cases. Unsatisfactory PAP smear results were observed in 5% of cases. Additionally, 11% tested positive for Candida, 2.5% for bacterial vaginosis, and 1% for Trichomonas vaginalis. Only 1.5% of participants underwent colposcopy, with 0.5% displaying low-grade lesions based on the Modified Sweden Colposcopy Index (MSCI). Multigravida status, abnormal per speculum, as well as higher BMI, emerged as risk factors associated with abnormal PAP smear findings. Conclusion: The identification of risk factors such as multigravida status, abnormal per speculum and per vaginum examinations, and higher BMI underscores the need for tailored interventions to address these factors and improve maternal health outcomes.

Background: Aim: This study aims to evaluate the efficacy of serum procalcitonin (PCT) as an early biomarker for detecting sepsis in patients with diabetic ketoacidosis (DKA). By assessing PCT levels, the study seeks to identify its potential role in differentiating bacterial sepsis from other inflammatory responses in DKA patients, ultimately aiding in timely diagnosis and treatment. Materials and Methods: A hospital-based observational study was conducted at FH Medical College, Agra, over 18 months. Fifty patients with DKA were enrolled. The sample size was calculated based on a 95% confidence interval and 5% margin of error. Blood samples were collected within six hours of admission for PCT, white blood cell count (WBC), and lactate levels, among other tests. PCT was measured using a double-antibody sandwich immunoassay, while other parameters were analyzed to evaluate their role in diagnosing sepsis. Results: The study found that elevated PCT levels (median: 6.39 ng/mL) were strongly associated with severe sepsis and septic shock, particularly in patients with respiratory tract infections. Other inflammatory markers like WBC and neutrophil count showed less sensitivity compared to PCT. The study also identified a high prevalence of comorbidities, including hypertension and diabetic retinopathy. A significant proportion of patients received antibiotic treatment, and the mortality rate was low at 4%. Conclusion: Serum PCT proved to be an effective early marker for sepsis detection in DKA patients, significantly improving diagnostic accuracy and facilitating timely intervention. Further large-scale studies are needed to establish standardized PCT thresholds for clinical use.

Background: Aim: The present study aimed to investigate the clinico-hematological issues in patients with acute and chronic liver diseases and explore their clinical correlations. Specifically, the study sought to analyze the distribution of red blood cell (RBC) types and the relationship between the severity of liver dysfunction, as indicated by the MELD score, and the severity of anemia in liver disease patients. Materials and Methods: This was a cross-sectional observational study conducted at the Postgraduate Department of Medicine, FH Medical College, Agra, over a period of 18 months. A total of 138 patients diagnosed with acute or chronic liver disease were included. Inclusion criteria included male patients aged 18-75 years with confirmed liver disease, while patients with liver toxicity from anti-tubercular drugs or unwilling to participate were excluded. Hematological parameters such as hemoglobin levels, total leukocyte count (TLC), red blood cell morphology, platelet count, and MELD score were evaluated. Results: The study population had a mean age of 48.26 ± 6.87 years, with a predominance of patients in the 51-60 years age group. A significant proportion of patients exhibited severe anemia (43.48%), with normocytic anemia being most common (56.52%). The MELD score distribution indicated that 64.49% of patients had scores greater than 12, indicating advanced liver dysfunction. A strong correlation was observed between higher MELD scores and increased severity of anemia, with patients in the MELD >12 group showing significantly higher rates of severe anemia. Conclusion: The study highlights the complex hematological abnormalities in liver disease, particularly anemia, thrombocytopenia, and leukocytosis. The findings emphasize the need for comprehensive clinical and hematological assessment for early detection, prognosis, and management of liver diseases. The MELD score was found to be a significant predictor of anemia severity in liver dysfunction.

Background: The neutrophil-to-lymphocyte ratio (NLR) has become a powerful predictor of death in patients with cardiovascular disease or peripheral arterial occlusive disease. Present study was aimed to study relationship of neutrophil to lymphocytes ratio in patients with acute ischemic stroke. Material and Methods: Present study was single-center, prospective, observational study, conducted in patients more than 18 years of age presenting first time with symptoms and signs consistent with acute ischemic stroke and /or CT findings suggestive of acute infarct. Results: The study included 120 patients with a mean age of 58.97 ± 14.97 years, with a predominance of males (67.50%) and individuals in the 61-80 years age group (45.83%). The most common infarct territories were the left and right middle cerebral arteries (34.17% and 33.33%, respectively), with the majority of strokes (82.50%) classified as moderate severity. Comorbidities were prevalent, with systemic hypertension (70.00%), alcoholism (47.50%), and diabetes mellitus (41.67%) being the most common. The study found that patients who died had a higher mean NLR (12.54 ± 9.16) compared to those discharged (9.40 ± 7.84), although this difference was not statistically significant (p = 0.171). A weak positive correlation was observed between NLR and stroke severity as measured by the NIHSS score (r = 0.029, p = 0.751). Notably, diabetes mellitus emerged as a significant predictor of mortality (p = 0.027), and multivariate analysis confirmed its importance (OR: 0.185, p = 0.048). The study also revealed a significant gender disparity in outcomes, with females showing a higher mortality rate (20.5%) compared to males (7.4%), p = 0.036. Conclusion: While patients who died had a higher mean NLR compared to those discharged, this difference was not statistically significant. A weak positive correlation was observed between NLR and stroke severity (NIHSS score), but this too lacked statistical significance.

Background: We operated 42 elderly osteoporotic patients with mean age of 64.5 years who had Comminuted Inter-trochanteric femur fracture treated with Cemented Bipolar hemiarthroplasty and Tension band wiring for Greater trochanter and we followed up the patients for 12 months. During our study we came across various serious complications like, dislocation, shortening, surgical site infection but no mortality was reported and two of our patients underwent repeat surgery under GA (closed reduction). Functional results include Harris hip score, postoperative mortality rate, operation time, post-operative stay in hospital and the amount of blood loss.

Background: Renal and ureteral stones constitute a significant urological challenge with multiple treatment modalities available. This study compares the efficacy and safety of Shockwave Lithotripsy (SWL) and Ureteroscopy (URS), two predominant treatments for renal and ureteral stones. Methods: A retrospective study was conducted with a total sample size of 140 patients, equally divided between those undergoing SWL and URS at a tertiary care hospital. Efficacy was primarily assessed through stone-free rates post-treatment at one and three months, while safety was evaluated by comparing complication rates. Patient-reported outcomes were measured to assess satisfaction and quality of life improvements. Results: URS demonstrated significantly higher stone-free rates at one month (92.9% vs. 64.3%, P < 0.001) and three months (97.1% vs. 71.4%, P < 0.001) compared to SWL. Although URS showed a lower complication rate (12.9% vs. 18.6%), this difference was not statistically significant (P = 0.231). Patient-reported outcomes favored URS, with higher satisfaction (97.1% vs. 78.6%, P = 0.001) and better quality of life scores (92.9% vs. 64.3%, P < 0.001). Conclusion: Ureteroscopy is superior to Shockwave Lithotripsy in achieving stone-free status in patients with renal and ureteral stones, with better patient satisfaction and quality of life outcomes. Despite its invasive nature, URS does not increase the risk of complications compared to SWL. These findings support the preferential use of URS for treating renal and ureteral stones, especially in cases requiring prompt and complete stone removal.

Background: Failure to thrive (FTT) in infants is a multifaceted clinical condition requiring detailed evaluation. This case report highlights a rare presentation of FTT with pneumonia, anemia, and mercury poisoning in a 2-month-old male infant. Case Presentation: A term male infant, born small for gestational age (SGA), presented with inadequate weight gain, respiratory symptoms, and anemia. Radiological imaging revealed bilateral infiltrates and radiopaque artifacts, leading to the diagnosis of mercury inhalation-induced chemical pneumonitis. Serum mercury levels were elevated (33.6 µg/L). Management included nutritional optimization, chelation therapy with British Anti-Lewisite (BAL), bronchoscopy, and blood transfusion. The baby showed clinical improvement with weight gain and resolution of respiratory symptoms. Conclusion: This case underscores the importance of considering environmental toxin exposure in infants presenting with FTT and unusual radiological findings. Early diagnosis and multidisciplinary management are crucial for favorable outcomes.

practice, particularly in emergency situations where efficiency, effectiveness, and patient outcomes are important. An understanding of the anatomical intricacies of the abdominal wall is imperative for surgeons tasked with selecting the most appropriate closure technique. Aims: To compare between the continuous and interrupted suture techniques of midline wound closures in patients who will be operated through midline incision laparotomy for any cause in emergency conducted at a tertiary care centre. Methods and materials: A Prospective Comparative Study conducted on patients admitted to the Department of General Surgery who required emergency midline laparotomy procedures from October 2022 to September 2024. All adult patients undergoing laparotomy by midline incision in a tertiary care centre are included. Patients not undergoing laparotomy through midline incision, those with previously treated or untreated incisional hernias and Those who underwent surgery by Grid-iron, subcostal, paramedian incisions, second laparotomy, or re-laparotomy were excluded. The study commenced in October 2022 after obtaining approval from the Institutional Ethics Committee (IEC).Results: Group A underwent continuous sutures, while Group B received interrupted sutures. The duration of surgery was slightly longer in Group B, with a mean time of 82.3 ± 17.8 minutes, compared to 78.5 ± 15.2 minutes in Group A. In Group A, wound gaping occurred in 20% of patients, while in Group B, it was noted in 12.5% of cases. Similarly, suture site infections were higher in Group A at 12.5% compared to 7.5% in Group B. Wound dehiscence was a less frequent complication, affecting 5% of patients in Group A and 2.5% in Group B. Overall, Group A showed a slightly higher incidence of post-operative complications compared to Group B. The mean hospital stay for Group A was 6.9 days, while for Group B it was slightly shorter at 6.4 days. Conclusion: there were slightly higher incidences of post-operative complications such as wound gaping, suture site infection and wound dehiscence in the continuous sutures group (Group A) compared to the interrupted sutures group (Group B), these differences were not statistically significant. The mean operative time was marginally longer in Group B. The suture material required was comparatively less in Group A. Therefore, both suturing techniques appear to be equally effective in terms of clinical outcomes, suggesting that the choice between continuous and interrupted suturing can be made based on surgeon's preference and specific patient’s considerations, as the differences in complication rates, cost effectiveness operative times are minimal and not clinically significant.

Background: Diabetic nephropathy is the main cause of morbidity and mortality in patients with diabetes mellitus. The results of many clinical studies shows variation in the correlation of HbA1c and microalbuminuria in diabetes mellitus. In the present study we tried to correlate the HbA1c levels and microalbuminuria with respect to duration in diabetes mellitus cases and also studied microalbuminuria as a marker of nephropathy in type diabetes mellitus. Materials and Methods: The study was conducted in the Department of Biochemistry at B.J Govt. medical college, Pune. 100 subjects were recruited based on the inclusion and exclusion criteria; 50 were healthy controls, and 50 were type 2 DM patients. FBS, PPBS, blood urea, serum creatinine, HbA1c, and urinary microalbumin were analysed. Statistical analysis was done by using student‘t’ test and Chi square test. Results: A statistically significant difference was observed in values of FBS, PPBS, blood urea, serum creatinine, HbA1c and urinary microalbuminuria levels in cases compared to controls. Conclusion: The present study concluded that estimating glycosylated hemoglobin as an indicator of glycemic control and microalbuminuria in random urine samples for renal involvement in diabetic subjects provides a convenient method for early diagnosis and intervention. Thus, the study suggests microalbuminuria as a nephropathic marker in type 2 diabetes mellitus. The possibility of delaying or reversing the progression of diabetic nephropathy can be achieved only by perfect long-term metabolic control.

Background: Intermittent fasting (IF) has gained popularity not only for weight management but also for its potential health benefits, including improved cardiovascular function. The autonomic nervous system (ANS) plays a vital role in regulating heart rate and blood pressure. However, limited data exist on how IF influences cardiovascular autonomic regulation in healthy individuals. Materials and Methods: A total of 60 healthy adult participants aged 20–40 years were enrolled in this 8-week prospective study. Subjects were divided into two groups: IF group (n=30) following a 16:8 fasting protocol (16 hours fasting, 8 hours feeding) and a control group (n=30) maintaining their regular diet. Heart rate variability (HRV), resting heart rate (RHR), and blood pressure (BP) were measured at baseline and post-intervention. HRV parameters such as SDNN (standard deviation of NN intervals) and RMSSD (root mean square of successive differences) were used to assess autonomic modulation. Results: After 8 weeks, the IF group showed a significant increase in SDNN (from 48.5 ± 10.2 ms to 61.3 ± 9.8 ms; p < 0.01) and RMSSD (from 35.2 ± 7.5 ms to 44.6 ± 6.9 ms; p < 0.05), indicating improved parasympathetic activity. Resting heart rate decreased significantly in the IF group (from 74.8 ± 6.3 bpm to 68.2 ± 5.7 bpm; p < 0.01). Systolic and diastolic BP showed modest reductions in the IF group compared to the control group, though not statistically significant. Conclusion: Intermittent fasting over eight weeks significantly improved cardiovascular autonomic regulation in healthy adults, as reflected by enhanced HRV and reduced resting heart rate. These findings suggest that IF may have a favourable impact on autonomic balance and cardiac health in normotensive individuals.

Introduction: Routine abdominal drainage after laparoscopic cholecystectomy is an issue of considerable debate. One of the reasons for drain placement is to allow CO2 insuflated during laparoscopy to escape via drain site thereby decreasing shoulder tip pain and post-operative nausea and vomiting. But some studies show no difference in post-operative nausea/vomiting/pain between drain and no drain group. Methodology: All patients admitted for laparoscopic cholecystectomy and fulfilling the inclusion and exclusion criteria will be included in the study. The patients will be randomised into two groups (cases and control) by simple random sampling. Patients will undergo laparoscopic cholecystectomy. At the end of the procedure in the cases group an intraperitoneal drain will be affixed, whereas in the control no drain will be inserted. All patients will be given routine post-operative. Results: A total of 244 patients who underwent laparoscopic cholecystectomy were enrolled in this study. Of these, 4 patients were excluded as they converted to laparotomy. 240 complete sets of data were available for analysis, 120 in the placebo group and 120 in the drain group Conclusion: Ours was a prospective cohort study designed to investigate the association between intraperitoneal drain use and Post Laparoscopy Shoulder Pain to explain the effect of residual intraperitoneal gas in patients undergoing Laparoscopic Cholecystectomy. Our results show that surgical drain use reduces the frequency and intensity of PLSP in the first 24 h after LC. This suggests that techniques to evacuate residual gas completely at the end of laparoscopic procedures can reduce PLSP.

Background: Hand and forearm injuries are common in occupational settings and also occur due to road traffic accidents, or industrial accidents. These injuries can range from minor lacerations to complex fractures, and tendon, nerve, and vascular damage, significantly impacting hand function. Effective management requires prompt diagnosis, appropriate surgical or conservative treatment, and rehabilitation. This study analyzes the clinical profile, treatment modalities, and outcomes of hand and forearm injuries to identify factors influencing recovery and functional restoration. Methods: After we obtained institutional ethics and scientific committee approval, and consented to the study a total of 91 patients met inclusion criteria and compliant with follow-up at 3 months and 6 months were included in this study. Tendon Repair Surgeries were performed under brachial block, general, or combined anesthesia with tourniquet control. Debridement and wash precede tendon retrieval, freshening, and proper positioning. Repair uses modified Kessler or mattress suturing with a polypropylene core and epitenon sutures. After hemostasis, a drain is placed, wounds are closed, and splints are applied. Results: In this study, 91 patients with hand and forearm injuries were analyzed. Males (86.8%) were more affected, with the 21-30 years age group (34.06%) being the most common. Road traffic accidents (65.93%) were the leading cause. Extensor tendon injuries (42%) were most frequent. The majority (74.8%) had dominant hand injuries. Suturing (64.8%) was the primary treatment, followed by skin grafts and flaps. Median nerve injuries were the most common. Complications occurred in 22 patients. Quick DASH scores indicated better outcomes for proximal and dorsal injuries.  Conclusion: Open wounds were the most common clinical presentation, predominantly involving the dominant hand. Extensor tendon injuries were the most frequent, with the ulnar artery and median nerve being the most commonly injured structures. Road traffic accidents were the leading cause of hand and forearm injuries. Early repairs and mild injuries resulted in better outcomes as assessed by the Quick DASH-9 score, while early mobilization and adherence to strict rehabilitation protocols significantly improved functional recovery.

Introduction: Impulsivity is considered a risk factor for the development and maintenance of substance use disorder. However, limited research has directly compared impulsivity levels between individual dependence to different substances. Objective: This study aimed to investigate the differences in impulsivity between individuals of alcohol and cannabis dependence syndrome Methodology: Thirty-two male participants of alcohol dependence syndrome (mean age = 29.5 years, SD = 5.2; mean addiction duration = 3.1 years, SD = 1.4) and 32 male participants of cannabis dependence syndrome (mean age = 27.8 years, SD = 4.6; mean addiction duration = 2.8 years, SD = 1.3) were recruited. Impulsivity was measured using the Barratt Impulsiveness Scale (BIS-11). An independent samples t-test was conducted to compare mean impulsivity scores between the two groups. Results: The mean impulsivity score was significantly higher in patient with alcohol dependence syndrome (64.9, SD = 9.3) compared to the cannabis dependence syndrome (59.25, SD = 8.7), t(62) = 2.61, p = 0.0087. The BIS-11 score ranged from 42 to 84 among alcohol dependence syndrome in comparison to 45 to 77 among cannabis dependence syndrome. No significant differences were found between groups in terms of age or duration of dependence’ Conclusion: The findings suggest that alcohol dependence syndrome may be associated with higher levels of impulsivity compared to cannabis dependence syndrome in this sample of male participants, independent of age or duration of dependence. The treatment of substance use disorder must take into account various psychosocial morbidities including impulsivity to improve the treatment outcome among patients with substance use disorder especially alcohol.

Background: The pervasive use of social media among young adults has raised concerns about its potential impact on mental health. Excessive social media use can lead to addictive behaviours, characterized by preoccupation, and mood changes. This addiction may be linked to psychological distress, including low self-esteem and depressive symptoms. Objective: This study aimed to examine the relationship between social media addiction, self-esteem, and depression in a sample of young adults. Methodology: A cross-sectional survey was conducted with 100 young adults (aged 18-25). Participants completed the Bergen Social Media Addiction Scale to assess social media addiction, the Rosenberg Self-Esteem Scale to measure self-esteem, and the Beck Depression Inventory-II to assess depression symptoms. Correlation analyses and multiple regressions were used to analyze the data. Results: Out of 100, a total of 34 participants scored more than 24 on BSMAS, 54 participants’ score between 15-23 and remaining 12 participants scored less than 15. We observed a significant positive correlation between social media addiction and depression (r = .42, p < .001), indicating that higher levels of social media addiction were associated with depressive symptoms. Additionally, a significant negative correlation was found between social media addiction and self-esteem (r = -.35, p < .01), suggesting that individuals with greater social media addiction tend to have lower self-esteem.  Discussion: These findings underscore importance of raising awareness about the potential negative mental health consequences of excessive social media use and implementing interventions to promote healthier online behaviours. Further research is needed to explore the causal mechanisms and potential long-term effects of social media addiction on mental well-being.

Background: Severe acute respiratory infection (SARI) is now defined as an acute respiratory illness with a history of fever or measured fever of ≥38°C and cough, with onset within the past 10 days and requiring hospitalization. Present study was aimed to study clinical and laboratory profile of SARI (Severe Acute Respiratory Infection) patients admitted at a tertiary care centre. Material and Methods: Present study was single-center, prospective, observational study, conducted in patients > 18 years age, admitted in SARI ward, had regular patient follows up to our OPD. Results: Majority patients were older adults, with significant representation over 61 years old, male participants, had normal BMI. Hospital stays were evenly distributed between less than one week and 1-2 weeks (43% each), with a notable 14% staying beyond two weeks. Fever was overwhelmingly the most prevalent symptom (99.2%), followed by common respiratory and systemic symptoms like headache, cough, and nausea/vomiting. Most participants (80%) had normal SpO2 levels (>95%), with a small proportion showing mild to moderate hypoxia. Bronchitis was the most frequently observed clinical sign (47.2%), followed by bronchiolitis and asthma, The study population was nearly evenly divided between Severe Acute Respiratory Illness (SARI) and non-SARI cases (55% vs. 45%). Most participants (88%) tested negative for COVID-19, suggesting a low incidence within the study group. Significant differences in WBC counts were observed between SARI and non-SARI patients, reflecting varying degrees of systemic inflammation and infection severity. Significant differences were found in haematocrit levels between SARI and non-SARI patients, indicating potential differences in fluid status and disease severity. Conclusion: Elevated CRP levels were significantly more common in SARI patients compared to non-SARI patients, reflecting higher levels of systemic inflammation. D-Dimer levels were significantly elevated in SARI patients compared to non-SARI patients, suggesting increased risk of thrombotic complications in severe cases.

Background: With the introduction of Antiretroviral Therapy (ART) there is remarkable reduction in HIV-related mortality and morbidity. Adherence to ART is the predictor to the successful treatment and survival of patients. Aims: To study the socio-demographic profile and baseline characteristics of HIV positive children at the time of ART initiation and to see their Adherence to ART drugs and its outcome. Methods and Material: This is a one-year follow-up study conducted from November 2012 to December 2013. Total of 189 children between 18 months to 15 years living with HIV, on ART attending the two ART Centers of Delhi were enrolled in the study. The level of adherence was calculated using pill count. Statistical analysis used: Collected data was transformed into variables, coded, entered and analyzed into SPSS. All observations were in terms of mean, median, standard deviations, percentages and proportions. Tests of significance like chi square, McNemar test, ANOVA were applied for comparisons wherever required. P value less than 0.05 was considered statistically significant at 95% confidence level. Results: Most of the study subjects (86% - 89%) had optimal adherence (≥ 95%) throughout the whole year. There was a statistical significant association in improvement in WHO clinical stage since ART started, also statistical significant association was found between adherence and improvement in immunological profile (p<0.01). Conclusion: Adherence is important determinant of successful treatment outcome and is strongly linked to the availability of treatment support, so expansion of services along with counseling and support to the children and their family is recommended. Key Message: It is critical to focus on maximizing paediatric ART adherence to ensure the effectiveness of ARV regimens. Besides counseling we may also need another strategy to address the level of adherence. Monitoring and evaluation of adherence strategies are important components of any ART program and should be strengthened for identifying the key factors that influence adherence.

Aims: There are many clinical and microbiological variants of dermatophytic infections and its epidemiological correlation. In our study we aimes to show the clinical and mycological findings in various dermatophytic infections and its epidemiological corelations. Subjects and Methods: It is a prospective observcational study conducted on 100 clinically diagnosed cases of dermatophytosis at mr medical college and basaveshwara teaching and general hospital, kalaburagi during a period of oct 2017 to April 2019. Clinically diagnosed cases were included. Results: out of 100 clinically diagnosed cases of dermatophytosis 60 % were adult males, majority being labourers. The most common complaint was itching with discoloration which was present in 93 % patients, followed by scaling at the affected area in 92 %. Presence of annular plaque with papule was the most common skin lesion seen being present in 74 % of patients. Tinea corporis was the most common clinical diagnosis 55 %. On direct microscopy dermatophyte hyphae were found in 73 % patients. On culture microbiological confirmation of the infection could be obtained only in 38 % patients. Of the 38 patients 23 patients grew trichophyton mentagrophytes making it the most common isolate (60.5%). Conclusion: 60% were adult males majority being labourers having ring lesions with itching and discoloration as most common complaint (93%), followed by scaling. 35 % of the patients had past history of dermatophytosis and 30% had positive family history. 76% patients had a history of sharing fomites including towels, footwear and bedding and 23 % had very poor personal hygiene. On examination annular plaques with papules was the most common presentation (74%). Tinea corporis was the most common clinical diagnosis (55%) followed by tinea cruris (10%) and tinea unguium (10%). 73% of patients showed elongated branched hyphae on direct microscopic examination after treating with koh. Microbiological cultures were positive in only 38% of the patients. T. Mentagrophyte (60.5%) was the most common species isolated followed by trichophyton rubrum (28.9%) followed by epidcrmophyton floccosum (2.6%) and trichophyton tonsurans (7.9%)

Background: Elevated intracranial pressure (ICP) is a critical medical condition requiring prompt intervention to prevent neurological deterioration. Mannitol, an osmotic diuretic, is commonly used to manage ICP. Methods: This study evaluates the efficacy of mannitol in patients with elevated ICP, analyzing clinical outcomes and safety. Results:  A total of 50 patients were included in the study, and their responses to mannitol administration were assessed using invasive intracranial monitoring and clinical evaluation methods. The results indicate a significant reduction in ICP, with notable improvements in clinical symptoms, particularly in patients with traumatic brain injury. However, side effects such as electrolyte imbalance and transient hypotension were observed in some cases. Conclusion:  This study supports the use of mannitol as an effective therapeutic option for managing elevated ICP while emphasizing the need for close monitoring and individualized treatment plans (Adams et al., 2020; Andrews et al., 2017).

Background: Plantar fasciitis is a prevalent cause of heel pain in adults, often attributed to biomechanical stress and inflammation. Conservative treatments, including nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy, and corticosteroid injections, are commonly used. However, limited studies have directly compared the efficacy of steroid injections versus NSAIDs combined with physiotherapy. This study aims to evaluate the effectiveness of these two treatment modalities in managing plantar fasciitis. Methods: A randomized controlled trial was conducted involving 200 patients diagnosed with plantar fasciitis. Participants were randomly assigned into two groups: Group A (n=100) received a single local injection of 40 mg methylprednisolone acetate, while Group B (n=100) underwent treatment with NSAIDs alongside a structured physiotherapy regimen, including stretching and strengthening exercises administered thrice weekly for six weeks. Pain reduction was assessed using the Visual Analog Scale (VAS), and functional improvement was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score at baseline, 1 month, 3 months, and 6 months. Data analysis was performed using repeated measures ANOVA, with statistical significance set at p < 0.05. Results Both groups demonstrated significant improvements in pain and function over time. At one month, Group A exhibited a more rapid reduction in VAS scores (3.2 ± 1.0) compared to Group B (5.5 ± 1.1). However, at six months, pain levels were comparable between the groups (3.0 ± 0.9 in Group A vs. 2.8 ± 1.0 in Group B). Functional outcomes measured by the AOFAS score improved in both groups, with Group B showing slightly superior scores at six months (89.4 ± 3.8 vs. 86.1 ± 4.5 in Group A). The proportion of patients achieving significant pain relief (>50% VAS reduction) at six months was 48.6% in Group A and 51.4% in Group B. No adverse events were reported in either group. Conclusion While corticosteroid injections provide more immediate pain relief, NSAIDs combined with physiotherapy result in superior long-term functional recovery. These findings support a stratified treatment approach based on patient-specific factors and disease chronicity

Background: Hypertensive disorders of pregnancy, particularly pregnancy-induced hypertension (PIH), are a major cause of maternal and perinatal morbidity and mortality. PIH affects 3–5% of pregnancies globally and 8–10% in India, with a higher incidence in primigravidae. Dyslipidemia during the early second trimester (12–24 weeks) has been identified as a potential non-invasive predictor of PIH, with abnormal lipid profiles contributing to the pathogenesis of the condition. Objectives: This study aimed to evaluate the predictive value of serum lipid profiles in the early second trimester for the development of PIH and assess maternal and neonatal outcomes associated with dyslipidemia. Materials and Methods: A prospective cohort study was conducted on 400 antenatal women aged 18–30 years with singleton pregnancies and normal blood pressure in the first trimester. Serum lipid profiles, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL), were assessed between 12–24 weeks of gestation. Women were followed until delivery and postpartum for 7 days. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., Armonk, NY, USA), and a p-value of <0.05 was considered statistically significant. Results: The frequency of PIH was found to be 20%. Women with PIH had significantly higher levels of TC, TG, LDL, and VLDL, along with increased TC/HDL and LDL/HDL ratios, compared to normotensive women (p < 0.05). Maternal and fetal complications were more common in the PIH group, with 11.25% of women experiencing maternal complications and 30% of cases showing adverse fetal outcomes. Conclusion: Dyslipidemia in the early second trimester is a strong predictor of PIH. Early identification of at-risk women through lipid profile screening can help in timely intervention, reducing maternal and perinatal complications.

Background: Reproductive health is vital for a safe sex life, reproduction, and reproductive choice. Despite its importance and the necessity of accessible reproductive health services, there is a global gap in contraceptive needs, particularly in rural areas. In India, while men are key in family decision-making, contraception studies focus mainly on women, neglecting men's potential role. Methods: This community-based cross-sectional study targeted first expectant fathers in rural India, attending a tertiary care hospital's antenatal outpatient department. Data were collected on demographics, contraceptive knowledge and awareness, attitudes, and practices.  Results: Among 300 participants, predominantly aged 26-30 and from lower socioeconomic backgrounds, there was limited contraceptive knowledge, with condoms being the most known method. A majority reported unplanned pregnancies, with condoms as the preferred contraceptive. Post-education, interest in male contraception methods increased, yet female sterilization was more favored than male. Conclusion: The study underscores a significant gap in contraceptive knowledge and practices among rural Indian expectant fathers. It highlights the need for inclusive reproductive health strategies that involve men, particularly in family planning and contraception education.

Background: Objective: This study aimed to evaluate the safety and efficacy of the Shockwave Peripheral Intravascular Lithotripsy (IVL) System for the treatment of calcified peripheral arterial disease (PAD) in below-the-knee (BTK) arteries. Methods: A single-center, observational, retrospective study was conducted, enrolling 25 patients with moderate to heavily calcified lesions involving BTK arteries. All patients had stenosis >50%, a lesion length <200 mm, and Rutherford category 1-6 ischemia. IVL was performed using the Shockwave Peripheral IVL System, followed by drug-coated balloon angioplasty. Procedural success, safety outcomes, and patency rates were evaluated at discharge and follow-up. Results: IVL catheter delivery was successful in all cases (100%). Post-procedure, the mean lumen diameter was 5.06 ± 1.66 mm, with a residual stenosis of 0.36%. No major adverse events (MAEs), including dissection, perforation, thrombus formation, or distal embolization, were observed. Freedom from target lesion revascularization (TLR) was 100% at both discharge and follow-up. Ulcer healing was achieved in all cases. The primary patency was rated as poor, but reported to be good at follow-up. Conclusion: The Shockwave Peripheral IVL System demonstrated high procedural success and a favorable safety profile in the treatment of calcified BTK lesions. When combined with drug-coated balloon therapy, IVL showed promising early outcomes with minimal complications. Further studies with larger cohorts and extended follow-up are required to confirm long-term benefits.

Background: Asthma is aglobal health problem which affects the physical quality and health of the individuals. In India, around 30 million people were suffering with asthma. Yoga is an age old tradition which promotes strength, endurance, flexibility and facilitates compassion and greater self-control, while cultivating a sense of calmness and well-being. Yoga being the innovative measure in the newer era for improving the quality of life of individuals, is used as a preventive and health promotive tool in many diseases. This study aims to know the affect of intervention with yoga among asthmatic patients on the pulmonary function. Materials and methods: A prospective interventional study was conducted among the asthmatic patients attending the outpatient department of a tertiary care teaching hospital. The patients were divided into intervention and control group by lottery method. Total 60 patients were included in the study with 30 patients in each group. Asthma control questionnaire and spirometry were used to measure FEV1, FVC, FEV1/FVC and PEFR. The data obtained was entered in Microsoft Excel sheet and analysis was done using Statistical Package for the Social Sciences (SPSS) V20. Results: The age of study subjects ranges from 21 to 45 years, with mean of 31 (± 6.1) yrs. In this study, 56.7% were male and 90% had asthma for more than 10 years. Asthma control questionnaire showed improvement in the intervention group after 4 weeks. There was statistically highly significant increase in FEV1/FVC and PEFR in the intervention group. There was statistically significant improvement in the pulmonary function in the intervention group when compared to the control group. Conclusion: In this study, it was observed that the pulmonary function and the symptoms due to asthma were improved among the intervention group who were intervened with various respiratory yoga exercises for 4 weeks than in the control group.