Background: Self-medication among medical students is common worldwide and may contribute to inappropriate drug use and antimicrobial resistance. MBBS students, due to their medical knowledge, may be more prone to self-prescription, making it important to assess their practices and influencing factors. Objectives: To determine the prevalence, pattern, reasons, and associated factors of self-medication among MBBS undergraduates. Methods: A cross-sectional questionnaire-based survey was conducted among 44 MBBS students. Information on demographic characteristics, self-medication practices in the preceding six months, indications, drug classes, sources of information, reasons, and safety behaviours was collected. Chi-square test was applied to identify factors associated with self-medication. Results: Participants’ mean age was 20.5 ± 1.4 years, with 54.5% females and 59.1% in clinical years. The prevalence of self-medication was 68.2%, with 60.0% reporting one episode and 40.0% reporting ≥2 episodes in the past six months (Table 2). Common indications included headache/musculoskeletal pain (66.7%), common cold/URI (53.3%), and allergic symptoms (33.3%) (Table 3). The most used drug classes were NSAIDs/analgesics (63.6%), antipyretics (61.4%), and antibiotics (27.3%) (Table 4). Primary information sources were previous prescriptions (56.7%) and pharmacists (50.0%) (Table 5). Common reasons were perceived minor illness (66.7%) and convenience (53.3%) (Table 6). Safety behaviours included checking expiry dates (90.0%) and reading labels (56.7%) (Table 7). Clinical-year students had higher self-medication rates than pre-clinical peers (76.9% vs 55.6%, p = 0.0837) (Table 8). Antibiotic self-medication was lower among those with prior antimicrobial stewardship training (20.0% vs 33.3%, p = 0.3009) (Table 9). Conclusion: Self-medication is highly prevalent among MBBS students, mainly for minor ailments, with NSAIDs and antibiotics frequently used. Educational strategies promoting rational drug use and discouraging inappropriate antibiotic practices are warranted.

Background: Fine Needle Aspiration Cytology (FNAC) is the gold standard for evaluating thyroid nodules, offering a minimally invasive, cost-effective, and reliable diagnostic approach. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) standardizes cytological interpretations, enhancing diagnostic clarity and inter-observer reproducibility. Objective: To categorize thyroid lesions using TBSRTC and assess inter-observer agreement among cytopathologists in a tertiary care setting. Methods: A retrospective and prospective observational study was conducted over two years (March 2023–February 2025) at SPV Government Medical College, Machilipatnam. FNAC smears of 120 patients with thyroid nodules were re-evaluated and classified into TBSRTC categories. Inter-observer reproducibility between two experienced pathologists was assessed using Cohen’s kappa statistics. Results: Out of 120 cases, the majority were classified as Benign (Category II) in 66.7%, followed by AUS/FLUS (Category III) in 8.3%, Follicular Neoplasm (Category IV) in 6.7%, Suspicious for Malignancy (Category V) in 5.8%, and Malignant (Category VI) in 8.3%. Non-diagnostic smears (Category I) accounted for 4.2%. Among malignant cases, Papillary Carcinoma was predominant (70%), followed by Medullary Carcinoma (20%). Inter-observer agreement was almost perfect for Categories I, II, and VI (kappa 0.85–0.92) and substantial for Categories III to V (kappa 0.75–0.80). The study cohort exhibited a female predominance (75%), with a mean age of 42 years. Conclusion: TBSRTC proves to be an effective and reproducible reporting system for thyroid cytopathology, enhancing diagnostic accuracy and clinical decision-making. The high inter-observer agreement underscores its utility in routine cytological practice.

Background: Pediatric obesity is a growing public health concern with long-term implications for cardio metabolic health and psychosocial development. Despite widespread use of dietary counseling, evidence on long-term outcomes of structured nutritional interventions in children remains limited. Methods: This prospective interventional study included 120 obese children aged 6–16 years, divided into three groups based on intervention intensity: Group A received standard counseling; Group B received dietitian-led plans; and Group C participated in a multidisciplinary program. BMI z-scores, metabolic parameters, and quality-of-life scores were evaluated over 12 months. Results: Group C showed the most significant reduction in BMI z-score (−1.2, p=0.004) and improved insulin sensitivity (HOMA-IR −1.1, p=0.002). HbA1c, LDL, ALT, and systolic blood pressure also improved significantly in Group C compared to Groups A and B. Resolution of pre-diabetes (60%) and pre-hypertension (65%) was highest in Group C. Parental involvement and adherence rates were significantly correlated with better outcomes. No adverse events or dropouts were reported. Conclusions: Multidisciplinary interventions with strong behavioral and parental components are superior to standard counseling in managing pediatric obesity. Early intervention targeting lifestyle, diet, and psychosocial support is critical for reversing metabolic risk and improving long-term outcomes.

Background: Rotator cuff tears are a frequent cause of shoulder morbidity, especially in middle-aged and elderly individuals. While MRI is considered the gold standard for diagnosis, ultrasound has gained popularity due to its availability and cost-effectiveness. This study compares the diagnostic performance of MRI and ultrasound in detecting rotator cuff tears. Materials and Methods: A cross-sectional study was conducted at a tertiary care center involving 234 patients with clinically suspected rotator cuff injuries. All patients underwent both MRI and ultrasound imaging. Demographic and clinical profiles were documented. MRI findings served as the reference standard for calculating the diagnostic efficacy of ultrasound.   Results: The mean age group affected was 46–60 years, with males comprising 58.55% of the sample. The most common clinical symptom was shoulder pain (93.59%). MRI identified full-thickness tears in 47.86% and partial-thickness tears in 32.48% of patients. Ultrasound detected full-thickness and partial-thickness tears in 43.16% and 29.49% of patients, respectively. When compared to MRI, ultrasound demonstrated a sensitivity of 90.64%, specificity of 71.43%, positive predictive value of 89.61%, and diagnostic accuracy of 85.47%. Conclusion: Ultrasound shows high sensitivity and diagnostic accuracy in the evaluation of rotator cuff tears and may be a useful first-line imaging modality, especially in resource-limited settings. However, MRI remains superior for comprehensive assessment and surgical planning.

Background: Physical activity during pregnancy is increasingly recognized as a modifiable factor influencing maternal and neonatal health. This study evaluates the impact of antenatal physical activity on maternal physiological parameters and pregnancy outcomes. Methods: A prospective clinical study was conducted on 200 pregnant women (≤20 weeks gestation) divided into two groups: Group A (physically active) and Group B (sedentary). Participants were followed through pregnancy, and data were collected on weight gain, hemoglobin, blood pressure, blood glucose levels, complications, delivery outcomes, and neonatal health. Statistical analysis was done using SPSS version 26. Results: Group A showed significantly lower gestational weight gain (10.2±2.1 vs 13.1±3.5 kg; p<0.001), better hemoglobin levels (11.6±1.0 vs 10.8±1.2 g/dL; p=0.002), and lower fasting blood glucose (83.2±8.6 vs 90.1±9.4 mg/dL; p<0.001). Complications like GDM, PIH, and anemia were less frequent in the active group. Birth weight and rate of vaginal delivery were significantly better in Group A. Conclusion: Regular antenatal physical activity is associated with improved maternal health indicators and better pregnancy outcomes. Integrating physical activity counseling into routine antenatal care may enhance both maternal and neonatal well-being.

Background: Appendectomy is one of the most commonly performed emergency surgical procedures worldwide. With the advent of minimally invasive surgery, laparoscopic appendectomy (LA) has increasingly replaced open appendectomy (OA). However, debates continue regarding their relative benefits, particularly in terms of post-operative recovery and complication rates. Objective: To compare post-operative recovery parameters and the incidence of complications between laparoscopic and open appendectomy in patients with acute uncomplicated appendicitis. Methods: This prospective, observational study was conducted in the Department of Surgery at MV ASMC Ghazipur in Uttar Pradesh over a 12-month period. A total of 120 patients with acute uncomplicated appendicitis were included, with 60 undergoing LA and 60 undergoing OA. Data on operative time, post-operative pain (VAS score), hospital stay, return to normal activity, and post-operative complications were collected and analyzed using SPSS version 25.0. Results: The mean operative time was significantly longer in the LA group (58.4 ± 11.3 minutes) compared to the OA group (52.1 ± 9.2 minutes; p = 0.02). However, LA patients experienced significantly less post-operative pain (mean VAS score at 24h: 3.1 vs. 5.6; p < 0.001), shorter hospital stays (2.4 ± 0.6 vs. 4.1 ± 1.2 days; p < 0.001), and faster return to normal activities (7.2 vs. 11.5 days; p < 0.001). The incidence of surgical site infections was significantly lower in the LA group (6.7%) compared to the OA group (21.7%; p = 0.01). Conclusion: Laparoscopic appendectomy offers superior post-operative outcomes compared to open appendectomy, with reduced pain, shorter hospitalization, quicker recovery, and fewer wound infections. LA should be preferred when feasible, especially in tertiary care settings with adequate laparoscopic infrastructure and trained personnel.

Background: Lymphangiomas are congenital heterogenous group of benign malformations of lymphatic system.  Surgical excision is the main stay of treatment. Total excision is not always possible due to its infiltration along the nerves and muscles. Intralesional sclerotherapy is now practiced in many pediatric surgical centres. The purpose of our study is to evaluate the efficiency of intralesional bleomycin in pediatric lymphangioma cases as a first line of management. Materials and methods: Retrospective evaluation was done on 40 patients who were treated with intralesional bleomycin for lymphangioma. Under I.V sedation and aseptic conditions, 0.5 IU/kg body weight of bleomycin is injected directly into the lesion. The response was graded as excellent, good and poor response. Results: Out of 40 cases 22 were males and 18 are females with mean age of 3.3 years. Out of 40 cases, 14 cases are located over neck, 8 cases on upper limb, 7 cases over chestwall, 6 cases on lower limb and 5 over face. Macro cystic type is seen in 27 cases, microcystic type in 4 cases and mixed variety in 19 cases. The response was excellent in 25 patients, good response was seen in 9 patients and poor response was seen in 6 cases.  Conclusion: Sclerotherapy with Bleomycin is very effective and the response rate is 85% in our study without any major complications. So this therapy can be practiced as first line management instead of surgery in selected group of lymphangioma cases.. 

Background: Fine needle aspiration cytology (FNAC) has become a widely accepted tool for the diagnosis of breast lesions as it is a safe and simple method with high diagnostic accuracy.3,4 It offers rapid, minimally invasive, and cost-effective means of diagnosis. However, definitive diagnosis often relies on histopathological examination. This study aims to correlate the cytological findings of breast lesions with histopathological results to assess diagnostic accuracy. A comprehensive clinicopathological correlation will facilitate a better understanding of FNAC's role and effectiveness in diagnosing various breast lesions, ultimately leading to more accurate diagnosis and improved patient care. Materials and Methods: A retrospective study was conducted at the Department of Pathology among 120 patients presenting with palpable breast lumps. FNAC was performed followed by excisional biopsy. FNAC was performed using a 22-23 gauge needle with a 10 mL disposable syringe under aseptic conditions. Multiple passes were made and aspirated material was smeared on glass slides. Air-dried smears were stained with May-Grünwald-Giemsa (MGG) and alcohol-fixed smears with Papanicolaou stain. Data were analyzed for concordance between FNAC and FFPE(formalin fixed paraffin embedded) histopathology slides. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.  Results: Out of 120 cases, 80 (66.7%) were benign, 36 (30%) were malignant, and 4 (3.3%) were suspicious on FNAC. Histopathology confirmed 82 benign and 38 malignant lesions. Suspicious cases on FNAC (n=4) were later resolved via histopathology. The overall diagnostic accuracy of FNAC was 93.3%, with sensitivity of 94.7% and specificity of 95.1%. Further interpretation of concordance data reveals that among 80 benign FNAC cases, 78 matched histopathology and 2 were discordant (false negatives). All 36 malignant FNAC cases were confirmed on histology (no false positives), reflecting FNAC’s strong diagnostic reliability in identifying malignancies. However, the 4 cases labeled suspicious on FNAC were all discordant, emphasizing the importance of further histopathological evaluation for indeterminate findings. Conclusion: FNAC is a reliable and effective preliminary diagnostic tool for breast lesions. However, suspicious and discordant cases should be further evaluated histologically for accurate diagnosis.

Background: Molar pregnancy is a gestational trophoblastic disorder with distinct epidemiological and clinical patterns, particularly prevalent in low-resource settings. Early identification and intervention are crucial to avoid complications. Objectives: To determine the incidence and assess the demographic, clinical, and obstetric risk factors associated with molar pregnancy among antenatal patients at Government General Hospital, Siddipet. Methods: This was a cross-sectional study conducted over 18 months, involving 20 confirmed cases of molar pregnancy. Data were collected on demographic parameters, clinical presentation, obstetric history, gestational age at diagnosis, and immediate complications. Descriptive statistics and inferential tests (Chi-square, Fisher’s exact, Mann–Whitney U) were used to analyze associations between risk factors and mole type. Results: The incidence of molar pregnancy was 2.42 per 1,000 antenatal admissions. Most patients were above 35 years (40%), from low socioeconomic backgrounds (70%), and presented with classical symptoms such as uterine enlargement (55%) and hyperemesis (50%). Although a high proportion had a history of abortion (70%), no statistically significant association was observed between this factor and mole type (Fisher’s exact p = 0.586). The mean gestational age at diagnosis was 10.83 weeks for complete moles and 9.92 weeks for partial moles (p = 0.564). Haemorrhage occurred in 25% of cases, with suction evacuation being the predominant treatment modality (80%). Conclusion: Molar pregnancy remains an important clinical condition in resource-limited settings, with higher incidence among women of low socioeconomic status and limited education. While classical symptoms remain common, a notable proportion of cases were asymptomatic. Early ultrasonography and targeted risk-based surveillance are essential to improving maternal outcomes.

Background: The prevalence of low back pain is estimated at 31%, with a lifetime prevalence ranging between 60% and 80%. In recent years, the application of ultrasonography (US) for administering injections in chronic pain management has expanded considerably, due to the numerous advantages that US offers over other imaging modalities, such as ease of use, the absence of ionizing radiation, portability, cost- effectiveness, enhanced visualization of soft tissues (including muscles, ligaments, and blood vessels), and real-time needle advancement visualization. Methods: The study has been conducted in the Department of Anesthesiology at Dr. R.P.G.M.C, Kangra at Tanda, Himachal Pradesh for a period of 12 months, starting from December 2022 after obtaining institutional ethical committee approval and registering at Clinical Trial Registry India vide no. CTRI/2023/03/051144.  This was a prospective interventional study. Results: The visibility of anatomical structures during ultrasound-guided procedures shows that 92.5% of cases had good visibility, with a mean score of 21 out of a possible range of 16 to 22. Only 7.5% of cases had average visibility, indicating that most procedures benefited from clear ultrasound imaging. Conclusion: This study concluded that ultrasound-guided lumbar transforaminal peri radicular nerve root injections are a highly accurate, safe, and effective technique for managing radicular pain, with a 98% overall accuracy and significant pain relief observed across all follow-up intervals. The consistently high ultrasound visibility, minimal radiation exposure, and absence of major complications further affirm the utility of ultrasound as a primary imaging modality in spinal interventions. These findings, consistent with and building upon previous research, support the integration of ultrasound guidance into routine clinical practice for spinal pain management, providing a viable, efficient, and patient-friendly alternative to traditional fluoroscopic methods.

Background: Dengue fever is a rapidly spreading mosquito-borne viral infection that poses a significant public health burden in India, particularly in rural areas where awareness and preventive practices are often inadequate. This study aimed to assess the knowledge, attitude, and practices (KAP) regarding dengue among adults in a rural settlement of Gautam Buddha Nagar district, Uttar Pradesh. Methodology: A community-based cross-sectional study was conducted over a 15-month period among 632 adults aged 18–60 years, selected through multistage random sampling across eight rural villages under the Rural Health and Training Centre (RHTC) of Sharda University. Data were collected using a pre-tested semi-structured interview schedule covering socio-demographics, knowledge, attitude, and practice domains. Descriptive and inferential statistical analyses were performed using SPSS v21.0, including chi-square tests and binary logistic regression to identify factors associated with poor KAP. Results: The study found substantial gaps in community awareness: only 53.3% of respondents agreed that dengue is a preventable disease, and 50.2% delayed seeking medical care for more than 24 hours after symptom onset. While 88.0% used mosquito nets, integrated and consistent preventive practices were less commonly followed. Illiteracy, low income, and lack of prior dengue-related information were significantly associated with poor knowledge, negative attitudes, and suboptimal practices (p < 0.001). Logistic regression analysis confirmed these as independent predictors. Conclusion: The findings highlight the need for structured health education strategies and community-level awareness campaigns to improve dengue-related knowledge and encourage timely and comprehensive preventive practices. Special attention should be given to vulnerable groups such as the illiterate and economically disadvantaged.

Background: Thyroid dysfunction has been increasingly recognized as a significant factor influencing women's reproductive and metabolic health. With a higher prevalence in women, conditions such as hypothyroidism, hyperthyroidism, and autoimmune thyroid diseases may adversely affect fertility, pregnancy outcomes, and metabolic regulation. Objective: This systematic review aimed to synthesize current evidence on the impact of thyroid disorders on female reproductive and metabolic outcomes, including menstrual irregularities, infertility, pregnancy complications, insulin resistance, dyslipidemia, obesity, and cardiovascular risk. Methods: Following PRISMA guidelines, a comprehensive literature search was conducted across PubMed, Embase, Scopus, Web of Science, and the Cochrane Library. Peer-reviewed observational studies, randomized controlled trials, systematic reviews, and clinical guidelines published in English were included. Data were independently screened, extracted, and assessed for quality using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. Results: Of 1,324 records screened, 54 studies met the inclusion criteria. Thyroid dysfunction was consistently associated with menstrual abnormalities, infertility, premature ovarian failure, miscarriage, and adverse pregnancy outcomes. Metabolically, hypothyroidism—both overt and subclinical—was linked to dyslipidemia, insulin resistance, metabolic syndrome, and increased cardiovascular risk. Study quality was moderate to high. Conclusion: Thyroid disorders significantly impact women’s reproductive and metabolic health. Routine thyroid screening should be considered for women with infertility, menstrual disturbances, or metabolic syndrome features. Early diagnosis and management may improve reproductive outcomes and reduce long-term cardiometabolic risks. Further research is needed to define optimal treatment strategies, particularly for subclinical hypothyroidism.

Background: Stroke is a leading cause of morbidity and mortality globally, with ischemic stroke being the most common subtype. Accurate and timely imaging is essential for diagnosis, classification, and management. Magnetic Resonance Imaging (MRI) offers superior sensitivity in identifying ischemic changes and vascular territories involved. Objective: To evaluate the role of MRI in assessing the territory of involved intracranial blood vessels in patients clinically suspected of stroke. Methods: This cross-sectional observational study included 30 patients with clinical signs of stroke who underwent MRI brain evaluation at the Department of Radiodiagnosis, Shree Giriraj Multi-Speciality Hospital, Rajkot, over a 12-month period. MRI scans were performed using a 1.5 Tesla system with standard stroke protocol sequences. Imaging findings were analyzed to determine stroke type and vascular territory involved. Results: The mean age of patients was 58.4 ± 13.2 years, with a male predominance (63.3%). Ischemic stroke was the most common type (70%), followed by intracerebral hemorrhage (20%) and cerebral venous thrombosis (10%). The middle cerebral artery (MCA) territory was the most frequently involved (50%), followed by posterior cerebral artery (20%), anterior cerebral artery (10%), and others. Diffusion-weighted imaging (DWI) and MR angiography (TOF-MRA) were instrumental in early lesion detection and vascular assessment. Conclusion: MRI is a non-invasive and radiation-free imaging modality that plays a critical role in the early and accurate diagnosis of stroke, particularly in localizing the vascular territory involved. Routine use of MRI in acute stroke cases can significantly enhance diagnostic accuracy and guide therapeutic decision-making..

Background: Androgenetic alopecia (AGA), also known as male-pattern hair loss (MPHL), is a genetically driven, progressive condition characterized by the gradual transformation of terminal hair into vellus hair. The most commonly prescribed treatments for AGA include topical minoxidil and oral finasteride. Dutasteride, administered at a daily dose of 0.5 mg, inhibits both type I and type II isoforms of the 5-alpha reductase (5-AR) enzyme. This study was conducted to evaluate this theoretical basis by comparing the effectiveness and side effect profiles of oral dutasteride and oral finasteride in the management of male AGA. Methods: This hospital-based, prospective interventional study included men aged 18 to 50 years diagnosed with androgenetic alopecia. Patients who fulfilled the inclusion criteria were recruited after taking an informed consent and were randomized into two groups of 25 sample size each, receiving either 0.5 mg Dutasteride tablet or 1 mg Finasteride tablet daily for a period of 24 weeks. The efficacy was assessed through changes in thick and thin hair counts, subjective evaluations, adverse effects, and overall patient satisfaction scores. Results: Fifty participants were enrolled, with 25 patients assigned to each treatment group. The mean age across the cohort was 32.52 ± 6.66 years, with 46% of participants falling within the 21–30 years age range. After six months of treatment, 32% of patients in the dutasteride group and 40% in the finasteride group were classified as grade 3 (Hamilton-Norwood scale) compared to baseline figures of 48% and 52%, respectively. The average increase in total hair count after 24 weeks was significantly higher in the dutasteride group (22.04/cm²) than in the finasteride group (5.88/cm²).   Conclusion: Dutasteride demonstrated superior efficacy compared to finasteride in the treatment of male-pattern hair loss.

Background: C-reactive protein (CRP), a marker of systemic inflammation, is increasingly recognized for its role in the pathophysiology of type 2 diabetes mellitus (T2DM) and its complications. This study evaluates the association of CRP with glycemic control, microvascular complications, and cardiometabolic risk factors in patients with T2DM. Methods: A cross-sectional study was conducted involving 100 adults—50 with T2DM and 50 age- and sex-matched non-diabetic controls. Anthropometric data, blood pressure, glycemic markers (HbA1c), lipid profile, CRP, and micro albuminuria were measured. Diabetic retinopathy was assessed by fundus examination. Correlation analysis and multivariate logistic regression were performed to determine independent associations with elevated CRP levels. Results: Diabetics exhibited significantly higher CRP levels than controls (5.05 ± 1.87 vs. 2.13 ± 0.76 mg/L; p < 0.001). Poor glycemic control (HbA1c >7%) was present in 62% of diabetics and was associated with higher CRP levels (5.64 ± 1.62 vs. 3.82 ± 1.61 mg/L; p < 0.001). Microalbuminuria was observed in 50% of diabetics, with elevated CRP in affected individuals (5.94 ± 1.55 vs. 3.59 ± 1.51 mg/L; p < 0.001). CRP showed strong positive correlations with HbA1c (r = 0.829, p < 0.0001), microalbuminuria (r = 0.461, p = 0.0007), and BMI (r = 0.29, p = 0.04). CRP levels were significantly higher among diabetics with retinopathy, hypertension, and dyslipidemia. Multivariate regression identified HbA1c (OR: 2.14, 95% CI: 1.41–3.26), microalbuminuria (OR: 3.78, 95% CI: 1.71–8.33), and LDL cholesterol (OR: 2.21, 95% CI: 1.05–4.64) as independent predictors of elevated CRP. Conclusion: Elevated CRP levels are significantly associated with poor glycemic control, microalbuminuria, and dyslipidemia in T2DM, suggesting a critical role of low-grade inflammation in the development of diabetic complications. CRP may serve as a valuable adjunct marker for identifying high-risk patients

Background and Objectives: Tuberculosis (TB) remains a significant public health challenge despite available treatments. The emergence of multidrug-resistant TB (MDR-TB) has further complicated disease control efforts. Early and accurate detection of MDR-TB is crucial for effective patient management and infection control. The nitrate reductase assay (NRA) has emerged as a promising rapid diagnostic method for drug susceptibility testing (DST). This study evaluates the utility of blood agar in detecting MDR-TB using NRA compared to the conventional proportion method (PM). Methods: A comparative-validation study was conducted at the Department of Microbiology, Maulana Azad Medical College, in collaboration with the Lok Nayak Hospital and the New Delhi Tuberculosis (NDTB) Centre. A total of 32 patients suspected of MDR-TB were enrolled based on predefined inclusion criteria. Sputum samples were collected, processed, and subjected to drug susceptibility testing using two methods: proportion method on LJ media and indirect NRA on blood agar. The sensitivity, specificity, positive predictive value, and negative predictive value of NRA were calculated against the proportion method as the gold standard. Statistical analysis was performed using SPSS version 16.0. Results: Out of the 32 samples, 31 were successfully tested. The indirect NRA on blood agar demonstrated a sensitivity of 88.9%, specificity of 92.3%, positive predictive value of 94.1%, and negative predictive value of 85.7% for isoniazid resistance detection. For rifampicin, the sensitivity and specificity were 89.5% and 100%, respectively. The overall percentage agreement between indirect NRA on blood agar and PM was 90.3% for isoniazid and 93.5% for rifampicin. Kappa values of 0.80 and 0.87 for isoniazid and rifampicin, respectively, indicated excellent agreement beyond chance. Conclusion: The results suggest that blood agar-based NRA is a reliable and cost-effective and rapid alternative for MDR-TB detection in resource-limited settings. The high sensitivity, specificity, and agreement with the proportion method highlight its potential for widespread implementation. Further studies with larger sample sizes are warranted to validate these findings.

Background: Hepatorenal syndrome (HRS) is a severe, often fatal complication of cirrhosis and ascites, driven by circulatory dysfunction and renal vasoconstriction. Early identification of incidence and prognostic factors is essential to improve patient outcomes in tertiary care settings. Methods: A prospective observational study enrolled 100 consecutive cirrhotic patients with ascites at a tertiary care center from March 2023 to March 2024. Inclusion criteria comprised evidence of cirrhosis and ascites without recent gastrointestinal hemorrhage, hepatic encephalopathy, or other causes of acute kidney injury. Demographics, etiology, clinical parameters, laboratory values, and complications were recorded. HRS was diagnosed per International Club of Ascites criteria, and liver disease severity was assessed with the Child-Pugh score. Statistical analysis was performed using SPSS v25, with p<0.05 deemed significant. Results: The cohort was predominantly male (82%) and middle-aged (31–45 years: 47%; 46–60 years: 41%). Alcohol-related cirrhosis accounted for 58% of cases, and 67% had Grade 2 esophageal varices. HRS developed in 17% of patients. Overall mortality was 17%, with 76.5% of deaths occurring in those with HRS; non-HRS patients had an 84.3% survival rate. At HRS onset, mean serum creatinine rose from 0.94±0.35 to 4.08±1.35 mg/dL (p<0.001), urine output declined from 1,313±174 to 359±154 mL/day (p<0.001), serum sodium dropped from 139.97±3.24 to 129.18±4.11 meq/dL (p<0.001), and mean arterial pressure decreased from 75.52±3.07 to 67.59±3.69 mmHg (p<0.001). Child-Pugh score worsened from 8.03±0.99 to 9.47±0.62 (p<0.001). Common precipitants of HRS were upper gastrointestinal bleeding (58.8%), spontaneous bacterial peritonitis (52.9%), and hepatic encephalopathy (35.3%). Conclusion: HRS affects nearly one-fifth of cirrhotic patients with ascites and carries a high mortality rate. Key prognostic markers include rising creatinine, hyponatremia, oliguria, and worsening Child-Pugh scores. Prompt recognition of precipitating events and close monitoring of renal and hemodynamic parameters are vital for early intervention and may improve survival.

Background: Malaria is very critical illness caused by parasites from the Plasmodium genus. Infection occurs through the bite of a female Anopheles mosquito carrying the parasite, making malaria a type of vector-borne disease. This study presents a comparison of Rapid antigen tests and Blood smears in the diagnosis of malarial protozoal parasites. Material and methods: A total of 147 febrile patients referred to the Parasitology section of the Department of Microbiology at TMU Hospital were included in a cross-sectional study conducted over a period of 12 months. Blood samples were collected and assessed for malarial parasites through microscopic examination and (MRDTs). Result: In our study, out of 147 participants, there were 82 males (55.78%) and 65 females (44.21%). An overall of 147 peripheral smears were investigated for malarial parasites, of which 113 were positive. Among these, 107 cases (94.69%) were diagnosed with Plasmodium vivax & 6 patients with Plasmodium falciparum. RDTs detected one zero seven findings: one zero one cases of Plasmodium vivax & 6 cases of Plasmodium falciparum. Conclusion: Based on the outcome of this study, the researchers found a significant proportion of cases presented with malaria infection, with detection rates of 72.78% by peripheral blood smear and 76.87% by rapid diagnostic tests. The PBS method is regarded as the gold standard. It is affordable and reliable.  RDTs are also specific but more expensive than PBS. There is a need for a perfect diagnostic test that is highly accurate, highly specific, highly sensitive and cost-effective.

Background: Tumor markers are routinely used for screening, diagnosis and follow-up of certain tumors. Renal failure causes decreased excretion of some but not all tumor markers. Tumor marker reference ranges need to be thoroughly explored in renal failure patients. Objective: To evaluate the prevalence of elevated tumor markers in maintenance hemodialysis patients without known malignancy and assess their clinical significance. Methods: This cross-sectional study analyzed 123 patients on maintenance hemodialysis at ESI-PGIMSR Maniktala, Kolkata, a tertiary care hospital in Eastern India. The study was approved by the Institutional Ethics Committee of ESI-PGIMSR Maniktala. Tumor markers CA19-9, PSA (Total & Free), CA125, AFP, CEA, and CA15-3 were measured by chemiluminescence immunoassay on Beckman Coulter Access 2. Patients had no known history or signs of malignancy. Statistical analysis was performed using R version 3.6.1. Results: The study population (n=123) had a mean age of 48.5 ± 12.5 years with median age 50 (39-58) years and M:F ratio 1.5:1. A significant proportion of patients had elevated tumor markers: CEA was elevated in 66.4% (77/116), CA125 in 22.5% (27/120), CA19-9 in 16.4% (18/110), CA15-3 in 6.7% (8/120), total PSA in 4.0% (4/99), and AFP in only 1.7% (2/116). Multiple marker elevations were common, with 42.3% having one elevated marker and 33.4% having two or more elevated markers. These elevations were independent of age, sex, or smoking status. Among 2 HCV-reactive patients (1.6%), tumor marker elevations were not exceptional compared to the general cohort. Free PSA was detectable in 80% of patients, with no high-risk free/total PSA ratios (<10%) observed. Conclusion: Two-thirds of hemodialysis patients have significantly elevated CEA levels, while AFP remains the most specific marker with only 2% elevation. The majority of traditional tumor markers are elevated in hemodialysis patients regardless of malignancy status, necessitating caution in interpretation and consideration of dialysis-specific reference ranges.

Introduction: A liver abscess is a pus-filled mass in the liver that typically results from liver injury or the spread of intra-abdominal infections via the portal vein. AIM: To study of clinical profile and various treatment modalities in patient of liver abscess at tertiary care center in Rajasthan. Methodology: This is an observational descriptive hospital-based study with a cross-sectional design conducted in the Department of General Medicine at Mahatma Gandhi Medical College & Hospital, Jaipur. Result: In this study, pigtail catheterization for single large abscesses showed the highest treatment success with significantly better clinical and biochemical outcomes compared to other modalities, especially in contrast to conservative management for multiple abscesses. Conclusion: Pigtail catheter drainage and percutaneous aspiration were significantly more effective than conservative management, especially in large and single abscesses, due to better symptom relief and reduction in inflammatory markers.

Background: Tibial shaft fractures are common orthopaedic injuries, particularly in low-income populations with limited access to imaging, physiotherapy, and long-term follow-up. This study evaluates the radiological and functional outcomes following intramedullary interlocking (IM) nailing in a resource-constrained environment. Methods: A prospective observational study was conducted on 30 patients with tibial shaft fractures treated with IM nailing. Patients were followed for 6 months postoperatively and assessed using the Radiographic Union Score for Tibia (RUST), Lysholm Knee Score (LKS), AOFAS Ankle-Hindfoot Score, and Visual Analog Scale (VAS) for pain. Surgical technique, fracture classification, complications, and time to union were documented. Results: Mean age was 39.1 years; 76.7% were male. Road traffic accidents accounted for 60% of injuries. Mean time to radiological union was 16.9 ± 2.8 weeks. Radiological union (RUST ≥10) was achieved in 90%. Lysholm and AOFAS scores improved significantly from 45.5 and 34.3 at 15 days to 87.1 and 87.3 at 6 months, respectively. VAS pain score declined from 5.1 to 1.3. Complications included anterior knee pain (10%), delayed union (6.7%), and nonunion (3.3%). Radiological union showed strong correlation with functional scores (LKS r=0.84, AOFAS r=0.85, p<0.001). Conclusion: Intramedullary nailing is a reliable and effective method for managing tibial shaft fractures even in resource-limited settings, with favorable union rates, minimal complications, and excellent functional recovery when standard techniques are adhered to.

Background: The erythrocyte sedimentation rate (ESR) is a straightforward and cost-effective laboratory parameter; however, its diagnostic utility is limited by low sensitivity and specificity, and its values may be influenced by a wide range of physiological and pathological variables. Importantly, there is no universally applicable reference threshold that is valid for all patient populations. Similarly, anemia represents a clinical condition that necessitates comprehensive evaluation, as it may indicate diverse underlying pathologies. The present study was undertaken to evaluate the correlation between hemoglobin concentration and elevated ESR (greater than 40 mm/h) in patients with concomitant anemia.  Materials And Methods: The medical records of 200 patients presenting with anemia and elevated erythrocyte sedimentation rate (ESR), who attended the Outpatient Department at laboratory, department of pathology, PDU medical college & hospital - Rajkot, between 5 May 2025 and 6 June 2025, were retrospectively reviewed and analyzed.   Conclusion: Lowering the threshold for the erythrocyte sedimentation rate (ESR) to 50 mm/h did not yield a statistically significant alteration in the diagnostic distribution of patients when compared with existing data in the literature. Furthermore, an inverse correlation was identified between hemoglobin concentration and ESR values, indicating that a decrease in hemoglobin is associated with a corresponding increase in ESR. In light of these observations, it is advisable to pursue comprehensive differential diagnostic workups in patients exhibiting markedly elevated ESR in the presence of anemia, to exclude underlying pathological conditions that may otherwise be overlooked. A total of 200 patients with an erythrocyte sedimentation rate (ESR) exceeding 40 mm/h accompanied by anemia were included in the study. Of these patients, 142 (71%) were female and 58 (29%) were male. The mean age was 46.42 ± 10.0 years for female patients and 44.74 ± 11.1 years for male patients. The mean ESR value was 58.13 ± 10.2 mm/h in women and 56.9 ± 10.5 mm/h in men. The mean hemoglobin concentration was 10.75 ± 1.60 g/dL in the female cohort and 10.6 ± 1.52 g/dL in the male cohort. Regarding the distribution of anemia types, normochromic normocytic anemia was the most prevalent, accounting for 53% of cases, followed by hypochromic microcytic anemia at 45.5%. Macrocytic anemia was the least common, observed in only 1.5% of the patients..

Background: Short interconceptional periods (ICPs) following a lower segment caesarean section (LSCS) have been linked to adverse neonatal outcomes. Understanding this association is crucial in guiding birth spacing and antenatal care practices in high-risk pregnancies. Methodology: A prospective analytical study was conducted over two years (January 2023–December 2024) at a tertiary care centre in Thane. A total of 150 women with a history of one LSCS and an ICP of less than 18 months were included. Data on maternal and neonatal outcomes were collected and analysed using standard statistical methods, with p<0.05 considered significant. Results: Most participants (63.33%) were aged 26–30 years. Low birth weight (<2.5 kg) was seen in 7 (4.7%) neonates with an ICP ≤6 months, compared to 1 (0.7%) in 6–12 months and none in 12–18 months (p<0.05). Respiratory distress occurred in 12 (8%) and neonatal jaundice in 10 (6.7%) neonates from the ≤6 months group, both significantly associated with shorter ICP (p<0.05). NICU admissions were highest in the ≤6 months group (16 cases, 10.7%), further reinforcing the risks linked to short birth spacing (p<0.05).Conclusion: Short interconceptional intervals after LSCS are significantly associated with increased neonatal complications. Adequate birth spacing is essential to improve neonatal outcomes.

Background: Chronic alcohol dependence is associated with a wide array of cutaneous manifestations due to its direct toxic effects, nutritional deficiencies, immune dysregulation, and poor hygiene. Despite being easily accessible for clinical inspection, the skin remains an underutilized tool in identifying alcohol misuse, especially in rural and primary care settings. Aim of the study was to determine the prevalence and spectrum of cutaneous manifestations in male patients with chronic alcohol dependence and to categorize these manifestations based on their pathophysiological associations with alcohol use. Material and Methods: A descriptive cross-sectional study was conducted over two years at a rural tertiary care hospital in Telangana, India. A total of 199 adult male patients diagnosed with Alcohol Dependence Syndrome (ADS) as per ICD-10 criteria were enrolled. Severity of alcohol dependence was assessed using the Severity of Alcohol Dependence Questionnaire (SADQ). Detailed dermatological examination was performed to identify and categorize cutaneous findings. Descriptive statistics and independent sample t-tests were used for analysis. Results: Out of 199 male participants, 174 (87.4%) had at least one significant cutaneous manifestation. The most prevalent conditions were xerosis (25.6%), oral pigmentation (52.2%), melanonychia (25.1%), seborrheic dermatitis (19%), and onychomycosis (23.4%). Infections accounted for a significant portion, with fungal (21.6%), bacterial (11.5%), and viral (4.5%) dermatoses. Nail changes and pigmentary disorders were also common. A statistically significant association was found between the quantity of alcohol consumed and the presence of skin disease (p = 0.05), while no significant association was observed with duration of alcohol intake or SADQ scores .Conclusion: Cutaneous manifestations are highly prevalent in chronic alcoholics and serve as valuable clinical indicators of underlying alcohol misuse. Early recognition of these signs can aid in timely diagnosis, referral, and intervention, particularly in resource-limited rural settings. Dermatological evaluation should be integrated into routine screening for alcohol dependence.

Background: A substantial body of empirical evidence underscores the profound influence of nutritional factors on respiratory well-being. Much of the scientific inquiry in the domain of nutrition has been centered on the consumption of botanical produce, encompassing fruits and vegetables, along with essential antioxidant micronutrients. This targeted focus is attributed to the intricate susceptibility of pulmonary tissues to an array of oxidative stressors, coupled with the pivotal role that antioxidant defense mechanisms assume in safeguarding pulmonary structures from injurious processes. Materials and Methods: The current investigation encompassed a cohort of 86 individuals diagnosed with Chronic Obstructive Pulmonary Disease (COPD). In the baseline clinical assessment, quantification of malondialdehyde (MDA) levels, red blood cell superoxide dismutase (SOD) activity, and erythrocyte glutathione peroxidase (GPx) concentrations was undertaken. Subsequent to this, the aforementioned parameters were subjected to reevaluation subsequent to a twelve-week regimen involving daily supplementation with 1000 mg of vitamin C. Results: Administration of vitamin C resulted in a noteworthy reduction in serum MDA levels, concomitant with a substantial elevation in erythrocyte SOD activity and the catalytic performance of erythrocyte GPx. However, discernible enhancements in Forced Expiratory Volume in 1 second (FEV1) and the FEV1 to Forced Vital Capacity (FVC) ratio were not apparent following the twelve- week vitamin C intervention. Conclusion: The study reveals that vitamin C supplementation over a twelve-week period mitigated plasma lipid peroxidation indicated by MDA levels in COPD patients. This intervention led to noticeable increases in pivotal antioxidants - GPx and SOD concentrations. Importantly, the administration of exogenous vitamin C did not yield statistically significant changes in spirometric indices (FEV1 and FEV1/FVC). Despite this, the observed MDA reduction implies potential attenuation of ongoing oxidative stress. In essence, the research offers insights into the multifaceted impacts of vitamin C supplementation on various aspects of COPD pathophysiology.

Background: Peripheral intravenous catheters (PIVCs) are commonly used in clinical settings for the administration of medications and fluids. However, their use is frequently associated with complications, the most prevalent being catheter-related thrombophlebitis. This condition leads to increased patient morbidity, prolonged hospitalization, and potential risk of bloodstream infection. The study aimed to assess the incidence and profile of PIVC-related thrombophlebitis in a tertiary care center. Materials and Methods: A cross-sectional observational study was conducted from May 2023 to December 2024 in the Department of General Medicine at a tertiary care hospital in Odisha, India. A total of 1340 hospitalized patients aged ≥14 years with PIVCs inserted for at least 24 hours were included. Patients were monitored daily for signs of phlebitis using the Visual Infusion Phlebitis (VIP) score. Catheter tips from clinically diagnosed cases (VIP score ≥2) were cultured to detect any bacterial pathogens. Data were analyzed using appropriate statistical tests to determine associations between risk factors and thrombophlebitis. Results: The overall incidence of PIVC-related thrombophlebitis was 22.0%. A statistically significant association was found between age and thrombophlebitis (p = 0.011), with the highest prevalence among patients aged 40–59 years. Female patients had a higher incidence compared to males. Most cases were mild (Grade 2) per VIP scoring. Smaller gauge catheters (20G and 22G) were most commonly used. Gloves were not used in over half of the cannulation procedures, indicating potential lapses in aseptic technique. Conclusion: PIVC-related thrombophlebitis is a frequent complication influenced by demographic, procedural, and infection control factors. Early detection and adherence to aseptic practices are essential to reduce its occurrence.

Background: Oral Submucous Fibrosis (OSMF) is a chronic, progressive, and premalignant condition predominantly affecting individuals of South Asian descent. Surgical intervention using nasolabial flaps remains a preferred treatment for advanced cases. The fishtail modification of the nasolabial flap has been proposed to improve postoperative mouth opening and aesthetic outcomes. Objective: This study aims to evaluate and compare the functional and aesthetic outcomes of the conventional nasolabial flap and nasolabial flap with fishtail modification in the surgical management of OSMF. Materials and Methods: A prospective randomized clinical study was conducted on 40 patients with grade III–IV OSMF. Twenty patients underwent reconstruction using conventional nasolabial flap (Group A), and 20 patients received the fishtail-modified flap (Group B). Parameters including interincisal mouth opening (IMO), patient-reported outcomes, and scar visibility were recorded over a 6-month follow-up. Statistical analysis was performed using paired t-tests and Chi-square tests. Results: At 6 months postoperatively, the mean IMO improved from 18.3 ± 2.7 mm to 33.6 ± 3.1 mm in Group A and from 17.9 ± 3.0 mm to 36.2 ± 2.9 mm in Group B (p = 0.03). Group B demonstrated better scar concealment and higher patient satisfaction scores (p < 0.05). No significant difference in flap viability was noted between groups. Conclusion: The nasolabial flap with fishtail modification provides superior functional improvement and aesthetic outcomes compared to the conventional flap, making it a valuable technique in the management of advanced OSMF.

Background: Thyroid dysfunction is a common endocrine comorbidity in diabetes mellitus (DM) that can adversely affect glycaemic control and increase the risk of complications. Its exact impact on metabolic parameters in type 1 (T1DM) and type 2 diabetes mellitus (T2DM) is not well established in diverse populations. Objectives:To determine the prevalence of thyroid dysfunction in T1DM and T2DM patients and to evaluate its effect on glycaemic control by comparing fasting blood glucose (FBG), postprandial blood glucose (PPBG), and glycated haemoglobin (HbA1c) between euthyroid and thyroid dysfunction groups. Materials and Methods: A cross-sectional study was conducted on 180 patients (60 T1DM, 120 T2DM) attending the Endocrinology OPD of a tertiary hospital. Thyroid function tests (TSH, free T4) identified euthyroid and thyroid dysfunction (subclinical/overt hypo- or hyperthyroidism) cases. FBG, PPBG, and HbA1c were compared between groups using appropriate statistics. Results: Thyroid dysfunction was found in 32% of T1DM and 28% of T2DM patients. T1DM patients with thyroid dysfunction had higher mean FBG (168.5 ± 23.4 mg/dL vs 145.2 ± 20.1 mg/dL, p < 0.001), PPBG (245.6 ± 32.8 mg/dL vs 218.3 ± 29.7 mg/dL, p = 0.002), and HbA1c (9.2 ± 1.1% vs 8.1 ± 0.9%, p < 0.001) than euthyroid patients. Similar trends were noted in T2DM: higher FBG (162.7 ± 21.5 mg/dL vs 139.8 ± 18.6 mg/dL), PPBG (238.9 ± 35.1 mg/dL vs 205.4 ± 27.8 mg/dL), and HbA1c (8.7 ± 0.8% vs 7.5 ± 0.7%); all p < 0.001.Conclusion: Thyroid dysfunction is prevalent and significantly worsens hyperglycaemia in both T1DM and T2DM. Regular screening and prompt management are essential to optimise glycaemic control and minimise complications.

Vertical jump (VJ) is not only a marker of lower limb muscular strength and power, but also an important determinant of athletic performance. There is limited data for gender difference and anthropometric correlates of VJ among Indian university players. Understanding these correlates could inform training protocols for Indian athletes. The study was done to evaluate the gender difference of VJ and to find the anthropometric and body composition correlates of VJ. The study was approved by IMS, BHU, Institutional Ethics Committee. VJ was assessed using a countermovement jump test in 32 male (22.61±1.5years old) and 14 female (22.64±0.93years old) university players. Height (HT), weight (WT), waist (WC) and hip (HC) circumference were measured, and BMI, waist-hip ratio (WHR) and waist-height ratio (WHtR) were calculated. Percentage body fat (%BF) and skeletal muscle mass (SKM) were evaluated using a bioelectric impedance analysis (BIA) based equipment. Females had significantly lower HT, WT, SKM and VJ; but had significantly higher WHtR and %BF. VJ normalized to SKM showed no significant gender difference. Gender's unique contribution to VJ variance, beyond SKM, was non-significant. This was true for %BF also. Among the females, VJ correlated positively with HT, HC and SKM. The regression equations for predicting VJ in females were: VJ=0.491HT-39.781 (r2=0.570, p=0.003, SEE=2.8897), VJ=0.885HC-46.254 (r2=0.510, p=0.006, SEE=3.087) and VJ=0.99SKM+2.489 (r2=0.501, p=0.007, SEE=3.116). Males jumped significantly higher than females, and this might be related with the gender difference in body composition parameters like SKM. Among the females, SKM, HT and HC were the important determinants for VJ, suggesting their potential role in players’ selection and monitoring. These findings may also guide gender-specific training programs.

Background: Serum albumin is a reliable indicator of protein-energy malnutrition, which may not always be clinically apparent but is significantly associated with an increased risk of postoperative morbidity and mortality. In this study, we aimed to assess the relationship between pre-operative serum albumin levels and post-operative morbidity in patients undergoing emergency abdominal surgery.  Methods: This hospital-based observational study was conducted at Mahatma Gandhi Medical College and Hospital and included 100 patients undergoing emergency abdominal surgery. Hypoalbuminemia was defined as a serum albumin level of less than 3.5 g/dL. The types of surgeries performed, the postoperative complications encountered, and the relationship between pre-operative albumin levels and post-operative morbidity were recorded and analyzed.  Results: Of the hundred patients included in the study, 44 were diagnosed with hypoalbuminemia (serum albumin < 3.5 g/dL), while 56 had normal albumin levels (≥ 3.5 g/dL). Postoperative complications were observed in 52 patients. Among those with hypoalbuminemia, 32 developed complications, indicating a complication rate of 72.7%. In comparison, 20 patients with normal serum albumin levels developed complications, reflecting a complication rate of 35.7%. Surgical site infections were noted in three patients from each group—those with albumin levels above and below 3.5 g/dL, respectively. Wound dehiscence occurred in four patients with serum albumin ≥ 3.5 g/dL, whereas ten patients with hypoalbuminemia developed this complication. Additionally, prolonged hospital stays were observed in 12 patients with low serum albumin levels, all of whom required an average of fifteen days of hospitalization. In contrast, only two patients with a normal albumin level experienced an extended hospital stay.  Conclusion: Pre-operative serum albumin serves as a valuable, low-cost prognostic marker for predicting postoperative outcomes. The findings of this study demonstrate that patients with hypoalbuminemia are more likely to experience postoperative complications and prolonged hospital stays following emergency abdominal surgery.

Background: Induction of labor (IOL) is a common obstetric intervention performed to initiate labor artificially for maternal or fetal indications. Oxytocin and misoprostol are widely used pharmacological agents for IOL, but their comparative effectiveness and safety profiles in nulliparous women remain under investigation. Aim: To compare the effectiveness of induction of labor with oxytocin versus misoprostol in nulliparous women.  Methods: A prospective comparative study was conducted at [Hospital Name], involving 200 nulliparous women indicated for labor induction. Participants were randomly assigned to receive either intravenous oxytocin or vaginal misoprostol. Primary outcomes included induction-to-delivery interval and rate of vaginal delivery within 24 hours. Secondary outcomes assessed maternal and fetal complications. Data were analyzed using t-tests and chi-square tests, with p < 0.05 considered significant. Results: The misoprostol group showed a significantly shorter induction-to-delivery interval (7.56 ± 2.98 hours) compared to the oxytocin group (9.87 ± 3.42 hours, p < 0.001). Vaginal delivery within 24 hours was higher in the misoprostol group (85.0%) than in the oxytocin group (72.0%, p = 0.024). Rates of uterine hyperstimulation, fetal distress, postpartum hemorrhage, and neonatal complications were similar between groups (p > 0.05). Conclusion: Misoprostol is more effective than oxytocin in inducing labor in nulliparous women, with comparable maternal and neonatal safety profiles. Misoprostol represents a viable option for labor induction, especially when timely delivery is needed..

Background: Preterm labor is a major cause of neonatal morbidity and mortality. Accurate prediction is essential for timely intervention. Cervical length measurement by transvaginal ultrasound (TVUS) is considered more objective than digital vaginal examination (DVE), but comparative evidence in clinical settings remains essential. Aim: To compare the effectiveness of cervical length measurement by TVUS versus DVE in predicting preterm labor. Methods: A prospective observational study was conducted on 120 pregnant women between 24 and 34 weeks gestation presenting with risk factors for preterm labor. Cervical length was assessed by both TVUS and DVE. Predictive accuracy, sensitivity, specificity, and correlations with pregnancy outcomes were analyzed using appropriate statistical tests. Results: Mean cervical length by TVUS (2.71 ± 0.61 cm) was significantly shorter than by DVE (3.08 ± 0.74 cm) (p < 0.001). TVUS demonstrated higher sensitivity (84.3%) and specificity (78.7%) than DVE (62.5% and 56.2%, respectively) in predicting preterm labor (p < 0.01). Cervical length by TVUS correlated strongly with gestational age at delivery (r = 0.63, p < 0.001) and neonatal birth weight (r = 0.48, p < 0.001). DVE showed weaker correlations. Conclusion: TVUS is a more accurate and reliable method than DVE for predicting preterm labor and associated adverse pregnancy outcomes. Its routine use is recommended for better clinical management of at-risk pregnancies.

Background: Pneumoconiosis, the venerable and insidious scourge of the labouring class, persisteth as an occupational malady of grievous magnitude within the industrious precincts of Eastern India. Born of protracted inhalation of mineral particulates—most notably crystalline silica, iron, and aluminium dusts—this affliction orchestrates a cascade of fibrotic degeneration and respiratory incapacitation. Yet, the precise epidemiological burden and therapeutic landscape of this malady remain lamentably enshrouded in scholarly obscurity .Materials and Methods: A meticulously orchestrated, cross-sectional epidemiological inquiry was executed over three consecutive calendrical years (2022–2024) within a premier tertiary care centre in Eastern India. A cohort of 624 industrial labourers, consorting daily with metalliferous effluvia, were subjected to rigorous socio-demographic assessment, occupational exposure appraisal, and an expansive battery of diagnostic investigations—including chest radiography, High-Resolution Computed Tomography (HRCT), spirometry, diffusion studies, serum biomarkers (KL-6, SP-D), and histopathological evaluation where mandated. Statistical exegesis encompassed multivariate logistic regression and correlational analyses.Results: Of the 624 labourers scrutinised, a lamentable 498 (79.8%) were adjudged to manifest radiological, serological, or histopathological hallmarks of pneumoconiosis. Silica exposure (AOR: 22.1; 95% CI: 12.7–38.5), tobacco use (AOR: 13.4; 95% CI: 7.2–24.9), inadequate ventilation (AOR: 10.3; 95% CI: 5.8–18.4), and occupational tenure exceeding a decade (AOR: 7.9; 95% CI: 3.8–16.5) emerged as formidable independent predictors. Biomarker elevation, spirometric impairment, and radiological severity correlated robustly with cumulative exposure. Conclusion: This elaborate scholarly exposition unveil eth with statistical magnificence the grievous burden of pneumoconiosis within Eastern India’s industrial bastions. The malady’s inexorable progression, delineated through advanced diagnostic pathology and emergent pharmacotherapeutics, demandeth immediate legislative, infrastructural, and multidisciplinary intervention, lest the vitality of those who tend the crucibles of industry be irretrievably sacrificed

Background: Pediatric fractures are among the most common injuries in children and exhibit significant variation based on geographic, environmental, and socioeconomic factors. Urban and rural populations in developing countries like India may present differing patterns in fracture incidence, type, and access to treatment. This study aimed to compare the incidence, prevalence, and types of fractures in pediatric populations from urban versus rural regions. Methods: A prospective, cross-sectional study was conducted among 410 children aged 1–16 years presenting with radiologically confirmed fractures at two tertiary care centers—one urban and one rural. Patient demographics, mechanism of injury, fracture type, and time to hospital presentation were recorded and analyzed using SPSS version 25.0. Results: The majority of fractures occurred in children aged 6–10 years, with a male predominance in both groups. Fall-related injuries were more common in rural children, while urban cases had a higher proportion of sports-related trauma. Distal radius and supracondylar fractures were the most frequent. Rural patients showed significantly delayed hospital presentation (p < 0.001), although surgical intervention rates were comparable. Conclusion: The study reveals notable differences in pediatric fracture patterns and healthcare access between urban and rural populations, underscoring the need for context-specific preventive and referral strategies

Background: Subclinical hypothyroidism (SCH) is a biochemical condition characterized by elevated thyroid-stimulating hormone (TSH) levels with normal free thyroxine (FT4) and free triiodothyronine (FT3) levels. Its association with type 2 diabetes mellitus (T2DM) and hypertension (HTN) remains an area of significant clinical interest. This study aimed to determine the prevalence of SCH in patients with T2DM and/or HTN and to explore its correlation with obesity and age. Methods: A cross-sectional study was conducted over 18 months in a tertiary care hospital in rural North India. A total of 460 participants were enrolled and categorized into four groups: T2DM (n=105), HTN (n=101), T2DM + HTN (n=104), and controls (n=150). Baseline characteristics, anthropometric measurements, thyroid function tests, glycemic markers, and cardiovascular parameters were assessed. Statistical analysis was performed using SPSS version 20, with a significance threshold of p<0.05 .Results: The prevalence of SCH was significantly higher in patients with T2DM (23.8%) and HTN (22.3%) as compared to controls (10.7%) (p<0.001). Among T2DM + HTN patients, SCH prevalence was 26.9%. Females exhibited a higher prevalence of SCH across all groups (p=0.002). Obesity (BMI ≥25 kg/m²) was strongly associated with SCH, particularly in T2DM + HTN patients (OR: 2.14, 95% CI: 1.48-3.08). No significant correlation was observed between SCH and HbA1c levels (p=0.07). Conclusion: The study highlights a significantly higher prevalence of SCH in patients with T2DM and HTN, especially among females and obese individuals. Routine screening for SCH in these high-risk populations may facilitate early intervention and prevent associated metabolic complications.

Background: A substantial proportion of airway obstruction—approximately 89%—is observed during the administration of general anesthesia, with nearly 70% of these cases implicating the upper respiratory tract. Therefore, selecting an appropriate sedative agent is critical for minimizing respiratory complications in the immediate postoperative phase. Objective of the study was to evaluate and compare the peak expiratory flow rate (PEFR) in patients who received either propofol or midazolam as anesthetic agents. Materials and Methods: This comparative observational study assessed PEFR in patients emerging from anesthesia induced with either propofol or midazolam. A total of 78 participants were included, with 39 individuals allocated to each sedative group. PEFR was measured using Mini-Wright Peak Flow Meter. Results: The average PEFR values recorded post-anesthesia were significantly different between the two groups, with a p-value of <0.01, indicating high statistical significance. In the propofol group, PEFR values differed significantly between males and females (p = <0.01). Similarly, in the midazolam group, a significant gender-based difference in PEFR was also noted (p = <0.01). Conclusion: Midazolam demonstrates a more pronounced depressive effect on respiratory function compared to propofol. Additionally, irrespective of the anesthetic agent used, female patients exhibited lower PEFR values than their male counterparts.

Introduction: Cholelithiasis (gallstone disease) is a prevalent gastrointestinal disorder influenced by cholesterol metabolism and biliary motility. Hypothyroidism, through mechanisms such as dyslipidemia, reduced bile flow, and altered sphincter of Oddi function, may contribute to gallstone formation. Despite previous studies, the association remains inconclusive. This study aims to evaluate the correlation between clinical and subclinical hypothyroidism and cholelithiasis in an Indian cohort. Materials and Methods: A prospective observational study was conducted at Victoria Hospital, BMCRI, from October 2023 to March 2024. Eighty adult patients with ultrasonographically confirmed gallstones were recruited. Exclusion criteria included choledocholithiasis and unwillingness to participate. All patients underwent thyroid function testing (TSH, T3, T4) and gallstone characterization. Statistical analysis included Chi-square tests for categorical data and ROC curve analysis for TSH as a predictive marker. Results: Among the 80 patients, 65% were female and 52.5% were aged 31–50 years. Thyroid dysfunction was present in 40% of patients—25% had subclinical and 15% had clinical hypothyroidism.  Female gender and age >40 was significantly associated with hypothyroidism. Hypothyroid patients more frequently had multiple stones and cholesterol- type stones. A significant association between hypothyroidism and cholelithiasis was observed (p = 0.032). ROC analysis of TSH showed moderate predictive value (AUC = 0.72; sensitivity = 68%, specificity = 75%). Conclusion: This study demonstrates a significant association between hypothyroidism—especially subclinical forms—and gallstone disease, particularly in women over 40. Routine thyroid screening should be considered in gallstone patients to aid early detection and potentially reduce disease progression or recurrence.

Background: Gut anastomosis is one of the most frequently performed surgeries in emergency setup. Commonly after gut anastomosis, patients are kept "NIL PER ORAL” till bowel sound is heard. Until this time the patient remains with nasogastric tube for decompression of stomach. Aims: Aim of the study is on early enteral feeding following emergency gastrointestinal surgery.   Methods: A prospective study was executed over a period of 18 months in General Surgery Department of Burdwan Medical College and Hospital. The study aims at determining if early enteral feeding (within 48 hrs) after GI surgeries is of any benefit to the patient.  Results: OF 54, 20 were female, 34 were male with a percentage of 37% and 63%. Every patient was given early enteral feeding 16 (29.6%) patients developed gastrointestinal disturbances and only 6(11.1%) developed paralytic ileus. Among 54, 6(11.1%) developed chest infection and 9 (16.7%) developed SSI. Among 29 who underwent anastomosis 3(10.3%) patients had anastomotic leak. Conclusion: We can conclude that early enteral feeding induces early return of postoperative gastrointestinal motility. Early enteral feeding reduces the rate of SSI. It is safe and beneficial for postoperative patients, even if there is no bowel sound. There is no significant correlation between early enteral feeding and development of complications (i.e. paralytic ileus and postoperative chest infections and anastomotic leak).

Background: Vitamin D is a fat-soluble vitamin that is involved in bone metabolism and calcium haemostasis.Vitamin D levels of the new-born are entirely dependent on maternal Vitamin D levels. Low Vitamin D intake in pregnancy has been linked with increased risk of low birth weight, respiratory tract infections, low immunity, asthma & diabetes later in offsprings’life.Our findings will help to identify socio-demographic, obstetric and personal health factors that combine to influence vitamin D levels in the new-born and will helpclinicians and policy makers empower pregnant women to optimize their vitamin D status .Aim:  To evaluate the prevalence of Vit-D deficiency&measure vitamin D levels in 1st or 2nd trimester to reassess levels of vit D in 3rd trimester after supplementation of vit D for 8 weeks evaluate its feto-maternal outcomes. Material & Methods: In this prospective longitudinal study, 80 booked antenatal patients were enrolled from OPD during their 1st or 2nd trimester for study, among these 28 patients lost to follow up, remaining 52 patients supplemented with 60000 IU of cholecalciferol and were compared with 50 antenatal patients who came during emergency for their foetal and maternal outcome. Results: Prevalence of vitamin D deficiency in our study population is 90.7%,while only 9.23% patients had optimal levels of vitamin D. Majority of vitamin D deficient women were 20 -30 years of age and were multigravida (50.8% were multigravida and 10.1% were grand multipara). Majority of vitamin D deficient women were of lower middle-class family. In our study no association was found between vitamin D deficiency and caesarean section (p=0.4). Our study shows that vitamin D supplementation has not significantly reduced the incidence of Gestational Diabetes Mellitus, this incidence was not statistically significant (p value=0.12). Cases of preeclampsia/ eclampsia, preterm (p=0.03) and low birth weight (p=0.04) were significantly low in study group, showing vitamin D deficiency as an individual risk factor of preeclampsia/eclampsia (p=0.01).Conclusion: Vitamin D deficiency is quite prevalent in pregnant women (>90%). Majority of women are 20-30 years of age, multigravida, and belong to lower middle-class strata. Timely supplementation can significantly reduce pre-eclampsia, preterm delivery and low birth weight babies. No association was found with rates of C-section, GDM, APGAR, NICU admission, delivery complications.

Background: The role of IV lidocaine in pain relief after trauma or surgery and decrease in the need for other opioids. The aim of study is- study the efficacy and analgesic benefit with intravenous lidocaine and intravenous nalbuphine upper extremity fractures patients. This is a prospective, observational study done in department of anaesthesiology in Shri Rawatpura Sarkar Institute of Medical Sciences and Research, Raipur in Patients coming to emergency with upper extremity fractures-Distal end of radius fractures hospital was selected from April 2024 to April 2025 in total 80 patients. Group A – Patients receiving i.v. lidocaine. Group B- Patients receiving i.v. nalbuphine. both the drugs provided good pain relief which was significant from 10min of administration of the drugs with VAS score <5 at 25 and 30 min. However, the VAS score in Lidocaine group was significantly lesser at both 25 and 30 min when compared to Nalbuphine. There were no medication side effects seen in patients receiving IV Lidocaine but mild sedation and nausea were observed in patients receiving IV Nalbuphine. Our study confirmed that both the drugs are hemodynamically stable and safe. And the important thing was that the chance of not managing pain in the lidocaine group vs the nalbuphine group was less than one, confirming its superior efficacy, although it is statistically non- significant. Inj. Lidocaine IV at a dose of 1.5mg/kg (bolus) followed by infusion at a dose of 0.5-2mg/kg could be considered as a reasonable alternative choice for acute pain management

Background: Hypothyroidism is a common presentation due to inadequate production of thyroid hormone. This often leads to the development of nonspecific symptoms such as fatigue and anemia. There may be coexisting iron deficiency in these patients. Serum ferritin is an indicator of iron storage which could act as a diagnostic marker for these patients. The current study aimed to evaluate the serum ferritin levels in hypothyroid patients and assess its clinical significance with respect to anemia, symptom severity, and thyroid hormone levels. Methods: A cross-sectional observational study was conducted on 100 subjects: 50 hypothyroid patients and 50 age- and sex-matched euthyroid controls were included. The lab investigations included thyroid function tests, serum ferritin, iron profile, and hemoglobin, and were compared between the groups. Results: Hypothyroid patients showed significantly lower serum ferritin compared to euthyroid patients (32.6±14.2 ng/mL vs. 68.9±22.5 ng/mL; p<0.001), hemoglobin, and serum iron. Ferritin levels negatively correlated with TSH (ρ = –0.72) and positively with hemoglobin (ρ = 0.68). Patients with low ferritin had more fatigue and pallor. Conclusion: Iron deficiency is common in hypothyroidism and contributes to clinical symptoms and anemia. Routine evaluation of serum ferritin can aid in optimizing diagnosis and management in hypothyroid patients.

Background: Urethral stricture is common complication of transurethral resection of prostate due to various reasons. Usual practice is to do OTIS urethrotomy before TURP with 26 Fr resectoscope to ovoid stricture formation. As external urethral meatus is narrowest portion of urethra only dilation of meatus will avoid injury to other parts of urethra and will also increase feasibility of 26 Fr resectoscope. In our study we have compared outcomes of OTIS urethrotomy and meatal dilatation before TURP to facilitate introduction of 26Fr resectoscope. 

Background: Skull pin placement during neurosurgical procedures elicits intense nociceptive and hemodynamic responses, potentially compromising cerebral perfusion and patient stability. Scalp blocks using ropivacaine are commonly employed to attenuate these responses. Dexmedetomidine, an α2-adrenergic agonist, is increasingly used as an adjuvant in regional anesthesia due to its analgesic and sympatholytic properties.  Materials and Methods: A prospective, randomized, comparative study was conducted on 60 ASA I–II patients aged 18–65 years undergoing elective craniotomies at a tertiary care center. Participants were divided into two groups: Group 1 received 0.25% ropivacaine with dexmedetomidine, and Group 2 received 0.25% ropivacaine alone for scalp block. Hemodynamic parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded at defined intervals up to 4 hours post-induction. Statistical analysis was done using the Mann–Whitney U test; p < 0.05 was considered significant. Results: Demographic variables and baseline vitals were comparable between groups. Group 1 demonstrated a significant reduction in SBP at 1 hour (110.5 vs 116 mmHg, p<0.01), 1.5 hours (110 vs 113 mmHg, p<0.01), and 3.5 hours (118 vs 110 mmHg, p<0.01) post-induction. DBP was significantly lower in Group 1 at 1 hour (71 vs 77 mmHg, p<0.01) and 1.5 hours (70 vs 72 mmHg, p<0.01). MAP values were significantly lower in Group 1 at 5 minutes (93.5 vs 99.15 mmHg, p<0.01), 1 hour (84 vs 89 mmHg, p<0.01), and 1.5 hours (83.17 vs 88.33 mmHg, p<0.01). Heart rate was significantly lower in Group 1 at multiple time points, with the lowest median at 4 hours (66.5 vs 74 bpm, p<0.01). Conclusion: The addition of dexmedetomidine to 0.25% ropivacaine for scalp block significantly attenuated the hemodynamic responses to skull pin placement in neurosurgical patients. This combination provided better intraoperative stability, particularly in the early postoperative period.

Background: Twin pregnancies are inherently high-risk, and mode of conception—spontaneous versus assisted reproductive techniques—may further influence maternal and neonatal outcomes. This study aimed to compare clinical profiles and perinatal outcomes between in vitro fertilization (IVF)-conceived and spontaneously conceived twin pregnancies. Methods: In this prospective observational study conducted at a tertiary care hospital over one year, 50 women with twin pregnancies were enrolled—25 following IVF and 25 conceived spontaneously. Demographic, antenatal, intrapartum, and neonatal variables were recorded and compared using appropriate statistical tests (Chi-square, t-tests, Mann-Whitney U). Composite morbidity was analyzed descriptively and visually. Findings: Women in the IVF group were older (mean age 32.5 vs 26.8 years) and predominantly nulliparous. Antenatal hospitalization (56% vs 28%, p=0.045) and corticosteroid use (72% vs 44%, p=0.041) were significantly higher in the IVF group. Elective caesarean was more frequent in IVF pregnancies (80% vs 48%, p=0.021). NICU admissions (36% vs 22%) and neonatal complications were more common, though not statistically significant. Composite postpartum and neonatal morbidity was higher in IVF-conceived pregnancies. Interpretation: IVF twin pregnancies carry a greater clinical burden compared to spontaneous twins, particularly in terms of intervention rates and neonatal support requirements. Anticipatory care and proactive obstetric strategies may mitigate associated risks. Funding: None.

Background: Adolescent gynaecological issues constitute a critical area of reproductive health, often underrepresented in mainstream clinical discourse. This study aims to evaluate the clinical profile, diagnostic spectrum, and management patterns among adolescent girls presenting with gynaecological complaints in a tertiary care outpatient setting. Methods: A prospective observational study was conducted over six months at GGH Siddipet, involving 100 adolescent girls aged 10–19 years. Data were collected on age, age at menarche, presenting complaints, clinical findings, diagnoses, investigations, and referrals. Descriptive statistics were supplemented with inferential analyses, including chi-square tests to evaluate associations between age groups and clinical variables. A p-value < 0.05 was considered statistically significant. Results: The majority of participants were aged 13–15 years (39%) and 16–19 years (32%). Menstrual irregularities (35%), dysmenorrhea (22%), and abdominal pain (28%) were the most common complaints. Statistically significant associations were observed between age and presenting complaints (χ² = 16.39, p = 0.037), and between age and menstrual disorder subtype (χ² = 12.87, p = 0.044). Clinical diagnoses such as dysmenorrhea (32%), oligomenorrhea (21%), and PCOS (12%) were significantly clustered (χ² = 28.15, p < 0.001). Physical examination findings and investigation/referral patterns also showed significant variability (p < 0.001). Conclusion: Menstrual and pelvic complaints form the cornerstone of adolescent gynaecological presentations. The statistically significant correlations observed emphasize the importance of structured evaluation protocols and age-sensitive reproductive healthcare services. Early intervention and targeted education may enhance clinical outcomes and adolescent well-being.

Background: Obstetric patients represent a vulnerable population in critical care, particularly in low-resource settings. Understanding the clinical profiles, interventions, and outcomes of obstetric ICU admissions is essential for improving maternal survival. Objective: To evaluate the causes, interventions, and outcomes of obstetric ICU admissions at Government General Hospital, Siddipet, and to assess the predictive value of the MEOWS score in this cohort. Methods: A retrospective observational study was conducted over 12 months in 2023. All obstetric patients (pregnant or within 6 weeks postpartum) admitted to the ICU were included. Clinical, demographic, and outcome data were extracted and analyzed using descriptive statistics, Chi-square/Fisher’s exact tests, Mann–Whitney U test, logistic regression, and ROC curve analysis. Results: Of 5,009 total obstetric admissions, 38 (7.6/1000) required ICU care. The mean age was 30.05 ± 6.95 years; 57.9% were antepartum, and 44.7% required mechanical ventilation. Hypertensive disorders (31.6%), obstetric haemorrhage (26.3%), and sepsis (18.4%) were the most common ICU diagnoses. The ICU mortality rate was 18.4%. No significant associations were found between mortality and diagnosis, MEOWS category, or intervention type (p > 0.05). The MEOWS score had poor predictive performance for mortality (ROC AUC = 0.45). Multivariate logistic regression revealed no independent predictors of mortality. Conclusion: Maternal ICU mortality remains high in low-resource settings, with hypertensive and haemorrhagic complications predominating. MEOWS scoring did not predict outcomes in this cohort, highlighting the need for improved, locally validated early warning systems and critical care protocols.

Background: Vancomycin-Resistant Enterococci (VRE) have become one of the most significant healthcare-associated, multidrug-resistant pathogens. Genotypic assessments have shown that vancomycin resistance is mediated by nine distinct genes named vanA to vanE, vanG, vanL to vanN. The present study was conducted in a tertiary care institute with an aim of characterizing the phenotypic and genotypic resistance to vancomycin isolates along with an analysis of the antibiogram to estimate the drug resistance to different antimicrobials at a tertiary care center from Northern Rajasthan.  Methods: The present study was an observational, cross-sectional study conducted at a tertiary care center from North India from June 2023 to May 2024 in which Enterococci isolates from different clinical specimen such as blood, pus, urine and other body fluids were included in the study. VRE genes were detected by a real time PCR based method.  Results: Out of 105 enterococci isolates, 78 (74.3%) were identified as Enterococcus faecalis while the rest 27 (25.7%) were Enterococcus faecium. Among these, 10 were resistant to vancomycin, indicating a prevalence of 9.5%. Vancomycin-resistance gene was detected in eight isolates by qPCR. Five of these strains carried vanA gene and three carried vanB gene.  Conclusions: The prevalent Enterococcus isolates in the present study demonstrated approximately 9.5% resistance to vancomycin. Majority of the isolates were found to be carrying the vanA gene that suggests a need for continuous monitoring of vancomycin resistant enterococci.

Background: Type 2 diabetes mellitus (T2DM) is associated with a range of ocular surface complications, notably dry eye disease (DED) and diminished corneal sensitivity. Despite their clinical significance, the prevalence and interrelationship of these conditions, particularly in the context of diabetic retinopathy, remain underexplored in the Rajasthan population. Methods: A hospital-based cross-sectional study was conducted from November 2022 to January 2024, enrolling patients aged over 40 years attending the ophthalmology outpatient department. Exclusion criteria included systemic or ocular conditions (other than diabetes) known to cause dry eye, contact lens use, prior ocular surgery, and medications affecting the ocular surface. Dry eye was diagnosed using symptom questionnaires and clinical tests (Schirmer’s, TBUT, fluorescein and rose Bengal staining), while corneal sensitivity was measured with a Cochet-Bonnet esthesiometer. Diabetic retinopathy was graded per ETDRS guidelines. Results: Of 100 participants (mean age 55.02 ± 9.33 years; 57 males, 43 females), 64% had T2DM. Dry eye prevalence was significantly higher in diabetics (45.3%) compared to non-diabetics (5.5%) (p < 0.0001). Among diabetics with dry eye, 44.9% had mild, 41.4% moderate, and 13.8% severe disease. Diminished corneal sensitivity was present in 23.4% of diabetics, all of whom also had dry eye. Severity of dry eye correlated with reduced corneal sensitivity (p < 0.0001), but neither parameter showed a significant association with diabetic retinopathy. Age and duration of diabetes were significantly associated with both dry eye and reduced corneal sensitivity. Conclusion: Dry eye and reduced corneal sensitivity are significantly more prevalent in patients with T2DM, and these conditions are closely interrelated. However, their severity does not correlate with the presence or stage of diabetic retinopathy. Routine assessment of tear film and corneal sensitivity should be integral to the ophthalmic evaluation of diabetic patients to enable early detection and management of these potentially sight-threatening complications.

Background: Perforation peritonitis occurs due to the leak of gastrointestinal contents into the peritoneal cavity it is a surgical emergency. It can lead to severe infection therefore, peritoneal lavage with antimicrobials is a commonly employed method to decrease the microbial load during surgery. Imipenem, a broad-spectrum carbapenem, offers wider antibacterial activity. Metronidazole is used for its anaerobic spectrum of action. This was aimed to compare the efficacy of Imipenem versus Metronidazole lavage in improving clinical outcomes, infection control, and recovery in patients undergoing surgery for perforation peritonitis. Methods:  This prospective comparative study was done on n=40 adult patients undergoing surgery for perforation peritonitis at our hospital. Patients were randomly divided into two equal groups: Group A (n=20) received intraoperative peritoneal lavage with Imipenem (500 mg in 1 liter NS), and Group B (n=20) received Metronidazole (500 mg in 1 liter NS). The standard surgical procedures and postoperative care were followed in all patients. Outcomes assessed included infection rates, recovery parameters, complications, and inflammatory markers.  Results: Out of 40 patients included in the study, 20 received imipenem lavage Group A, and 20 received metronidazole Group B. Both groups were comparable at baseline in terms of age, gender, BMI, ASA grade, and primary diagnosis. Group A showed lower rates of surgical site infections (15% vs. 20%), intra-abdominal abscesses (10% vs. 25%), and reoperation (5% vs. 15%) compared to Group B. Postoperative recovery was better in Group A, with a shorter hospital stay, faster return to oral intake, and lower fever duration. Inflammatory markers (WBC, CRP, febrile days) were significantly lower in the imipenem group. Conclusion: This study concludes that Imipenem offers clinically superior outcomes. Although the difference in primary infection-related outcomes such as surgical site infections, intra-abdominal abscesses, and reoperation rates did not reach statistical significance, a favorable trend was observed in the Imipenem group. Statistically significant improvements were noted in secondary outcomes, including shorter hospital stay, faster return to oral intake, reduced fever duration, and better inflammatory marker profiles (WBC, CRP, and febrile days) in the Imipenem group.

Background: Thyroid nodules (TNs) are frequently encountered clinical entities, and distinguishing benign from malignant nodules is essential for appropriate management. Ultrasonography (USG) and fine-needle aspiration cytology (FNAC) are commonly employed diagnostic modalities; however, their comparative diagnostic accuracy requires further assessment. Objective: To evaluate and compare the diagnostic accuracy of ultrasonography and FNAC in differentiating benign and malignant thyroid nodules.  Materials and methods: This retrospective study reviewed medical records of 80 patients with thyroid nodules who underwent both USG and FNAC evaluation at a tertiary care center in India. Nodules were classified according to the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) guidelines on USG and the Bethesda System for FNAC. Histopathological examination was used as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of USG and FNAC were calculated and compared. Results: Most nodules were firm in consistency (65%) and measured between 1 and 4 cm in size (55%). Ultrasonography demonstrated a sensitivity of 87.5%, specificity of 76.5%, PPV of 77.8%, NPV of 86.1%, and an overall accuracy of 81.3% for malignancy detection. A significant correlation between USG and FNAC findings was observed (χ² = 28.76, p < 0.001). Subgroup analysis indicated strong concordance in nodules sized 1–4 cm (p = 0.002) and >4 cm (p = 0.001). Conclusion: Ultrasonography is a reliable, non-invasive diagnostic modality with high sensitivity and moderate specificity for thyroid nodule evaluation, particularly for nodules larger than 1 cm. Its application may enhance FNAC decision-making and optimize patient management by minimizing unnecessary invasive procedures.

Background: The concept of combining ketamine with propofol, 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. The aim of this study- to evaluate the difference in haemodynamic variable post induction with propofol v/s ketofol at different time interval. Material and methods: this is a prospective, randomized, Interventional Comparative Study done in department of anaesthesis in general surgery operation theatre, DKS PGI hospital, Raipur, Chhattisgarh from January 2023 to January 2025 with permission from institutional ethics committee. Cases undergoing Elective Laparoscopic Cholecystectomy Surgeries under General Anaesthesia requiring endotracheal intubation. A sample of 36 cases in each group was calculated at 95% confidence and 80% power to predict the expected difference of 6.73(+-10.11) beats per minutes in both study groups at 1 min post induction as per seed article. The study was conducted in following two groups of patients. Each group was consisting of 36 patients. Our study was to assess and compare haemodynamic variables post induction period at different time interval (1,3,5,10,15 min) between the study groups. Results: 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. 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). 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: induction of general anaesthesia in patients 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: Congenital hypothyroidism (CH) is the most common preventable cause of intellectual disability and developmental delay in neonates worldwide. Early diagnosis through newborn screening is critical due to often subtle or absent clinical symptoms in affected infants. Various screening protocols exist, with primary TSH measurement complemented by free thyroxine (FT4) being the most sensitive and specific method. Indian infants carry a higher risk of CH due to factors such as ethnicity, iodine deficiency, and improved survival of low birth weight neonates. Despite this, nationwide neonatal screening programs remain limited in India. Objective: This multicentric study aimed to determine the prevalence of congenital hypothyroidism among neonates delivered in secondary level healthcare centers in Navi Mumbai.  Methods: A retrospective analysis was conducted over one year across four healthcare centers: Navi Mumbai Municipal Corporation’s General Hospitals of Vashi, Nerul and Airoli respectively and Mother & child hospital of Belapur. Neonates born during the study period were screened for CH using dried blood spot TSH measurement at 48-72 hours of life. TSH ≥ 20 mIU/mL indicated CH diagnosis, while those with TSH between 10-19 mIU/mL underwent repeat TSH and FT4 testing between days 10-14. Data on birth weight, gestational age, gender, and mode of delivery was collected. Statistical analysis included chi-square tests for association.  Results: Out of 4989 neonates screened, 6 (1.17 per 1000 live births) were diagnosed with CH. A significant association was observed between low birth weight and CH prevalence (p < 0.0001), whereas no significant association was found with gestational age, gender, or mode of delivery. Notably, CH correlated strongly with small for gestational age status rather than prematurity. Conclusion: Routine neonatal screening for congenital hypothyroidism is feasible and essential for early diagnosis and treatment. The prevalence of CH in Navi Mumbai is consistent with higher risk in low birth weight neonates, underscoring the need for targeted screening and follow-up in this population.l

Background: Meningitis is a clinical syndrome characterized by inflammation of meninges. The classic triad of meningitis consists of fever, headache and neck stiffness. This is a prospective observational, single center study done in Department of medicine and anaesthesia at DKS PGI hospital, Raipur, Chhattisgarh in 93 patients of acute meningoencephalitis cases:  1st March 2024 to 1st march 2025. The main aim of this study is ‘To study serum c-reactive protein levels in differentiating bacterial meningitis from viral meningitis’’ patients who presented with meningitis and meningoencephalitis who fulfilled the inclusion criteria. Proforma is used to collect data needed. Data are statistically analysed. Among the 93 patients with meningo-encephalitis in this study, the common initial presenting symptoms were fever (89%) and Vomiting (89%) >altered sensorium> headache and neck pain and stiffness>Focal neurological deficit> seizure. Fever was the most common initial presenting symptom. 86 patients (92.5%) had fever and headache (92.5%). 31 patient was found as bacterial meningitis which had s-crp value mostly ranging between >24 mg/l, out of them 19 patient had s-crp value >48 mg/l (61.29%). Most of them had poor prognosis and presented with altered sensorium and high-grade fever. Most of the case out of 37 had s-crp value between intermediate range (12-48) mg/l and 2 patients had range between >48 mg/l which had miliary tuberculosis. Tuberculous meningitis was the most common overall cause in our study. Both viral meningo-encephalitis and pyogenic meningitis constituted most of the cases of acute Meningo-encephalitis. Tuberculous meningitis was the most common cause in patient with subacute meningitis. All patients with chronic presentation had tuberculous meningitis. We came across atypical presentation of cryptococcal meningitis in a non-HIV patient. 47 patients recovered well without neurological deficits. Estimation of C-reactive protein in serum is the cheapest, sensitive and specific test to differentiate bacterial from viral infections. It is a simple qualitative as well as quantitative test and can be done as a bed side investigation. With serum C-reactive protein, a definite etiological diagnosis can be made rapidly at the time of admission itself.

Background: Microalbuminuria serves as a critical early biomarker of hypertensive complications, preceding overt target organ dysfunction. This study evaluated microalbuminuria in essential hypertensive patients and its correlation with target organ damage. Methods: A cross-sectional study was conducted on 160 patients with essential hypertension at Sri Aurobindo Medical College. Patients underwent comprehensive evaluation including fundoscopy, echocardiography, renal ultrasonography, and biochemical analysis. Microalbuminuria was assessed using urinary albumin-creatinine ratio (UACR). Statistical analysis included descriptive statistics, Chi-square test, Pearson correlation using R software, one way ANOVA and Kruskal-Wallis Test. Results: The study comprised 100 males (62.5%) and 60 females (37.5%) with mean age 51.66±15.28 years. Grade 1 systolic hypertension was present in 96.3% patients. Target organ damage included retinopathy in 53.7%, left ventricular hypertrophy in 51.2%, and diastolic dysfunction in 61.9%. Mean UACR was 1373.37±2784.01 mg/g. Significant correlation was found between UACR and creatinine levels (rho=0.305, p<0.0001). Proteinuria showed significant association with elevated creatinine (p=0.016). Conclusions: Microalbuminuria demonstrates strong correlation with renal dysfunction markers in essential hypertension, supporting its role as an early indicator of target organ damage. Regular UACR screening is recommended for hypertensive patients, particularly those over 40 years.

Background: Diabetic retinopathy (DR), a significant microvascular complication of Type 2 Diabetes Mellitus (T2DM), is a predominant cause of vision impairment. Emerging studies highlight a hypercoagulable state in diabetes that may exacerbate DR progression. Aim: To evaluate plasma levels of coagulation parameters—D-dimer, fibrinogen, prothrombin time (PT), and activated partial thromboplastin time (APTT)—in T2DM patients with and without diabetic retinopathy and correlate them with glycaemic control and disease duration. Methods: This cross-sectional study enrolled 120 T2DM patients divided into three groups: Group I (n=40) without retinopathy, Group II (n=40) with non-proliferative diabetic retinopathy (NPDR), and Group III (n=40) with proliferative diabetic retinopathy (PDR). Glycaemic markers (FBG, HbA1c) and coagulation parameters (D-dimer, fibrinogen, PT, APTT) were assessed using standard laboratory techniques. Results: Statistically significant increases in D-dimer (Group I: 311.62±136.92 ng/ml; Group II: 483.55±179.36 ng/ml; Group III: 511.55±167.15 ng/ml), fibrinogen (Group I: 246.15±35.47 mg/dL; Group II: 366.22±94.02 mg/dL; Group III: 369.40±87.44 mg/dL), PT (Group I: 12.95±1.26 sec; Group II: 15.41±2.64 sec; Group III: 16.07±2.84 sec), and APTT (Group I: 27.54±4.65 sec; Group II: 31.37±6.26 sec; Group III: 30.62±6.24 sec) were noted with progression of DR. Similarly, HbA1c and FBG levels were significantly elevated in DR groups (HbA1c Group I: 6.91±0.23%; Group III: 8.75±1.20%). Longer diabetes duration was also significantly associated with DR severity (p<0.01). Conclusion: Coagulation abnormalities reflected by elevated D-dimer and fibrinogen and prolonged PT and APTT are positively associated with DR severity in T2DM. These biomarkers may serve as early indicators for DR progression and aid in risk stratification and management.

Background: Obesity and physical inactivity are major public health concerns, associated with increased risk of cardiovascular disease and mortality. Autonomic nervous system (ANS) dysfunction, characterized by altered autonomic modulation, contributes to these conditions. Heart rate variability (HRV), a non-invasive measure of ANS activity, has been linked to body mass index (BMI) and exercise. Over the past two decades, a notable connection has been established between the autonomic nervous system and cardiovascular mortality, including the risk of sudden cardiac death1-4. which is equal to weight/ height in kg/m2. Central (primarily visceral) obesity (high ratio of the circumference of the waist to the circumference of the hips [waist-to-hip ratio], >0.9 in women and 1.0 in men) is independently associated with a higher risk for metabolic syndrome, diabetes mellitus, hyperandrogenism in women, and cardiovascular disease. Objectives: Study of Heart rate variability in normal adult v/s overweight/obese adult during pre and post exercise period. Material And Methods: A case control study was conducted from 2023-2024 on 170 subjects. Study was conducted in Department of Physiology to examine HRV by computerized Physiograph (Exercise physiology system -Ad company) & stationary bicycle Ergometer (Viva Fitness Company). Result And Conclusion: Elevated BMI is linked to increased sympathetic activity and reduced parasympathetic tone, both at rest and in response to physical stress. These autonomic alterations may contribute to the higher incidence of cardiovascular diseases observed in individuals with elevated BMI. Heart rate variability indices in group I (Normal BMI) before and after exercise: For SDNN, the correlation coefficients (Rho) are -0.164 at rest and -0.106 post-exercise, with p-values of 0.132 and 0.333, indicating no significant relationship. RMSSD shows a significant negative correlation with BMI at rest (Rho = -0.372, p<0.01*), but a non-significant positive correlation post-exercise (Rho = 0.028, p=0.802). pNN50% correlates negatively with BMI at rest (Rho = -0.133, p=0.255) and post-exercise (Rho = -0.187, p=0.087), though the later approaches significance. Heart rate variability indices in group II (elevated BMI) before and after exercise: At rest, SDNN has a strong positive correlation with BMI (Rho = 0.730, p<0.01*), indicating that higher BMI is associated with increased SDNN. RMSSD and pNN50% also show significant positive correlations with BMI at rest (Rho = 0.221, p=0.043* and Rho = 0.533, p<0.01* respectively). Conversely, post-exercise, these correlations diminish, with RMSSD (Rho = 0.127, p=0.248) and pNN50% (Rho = 0.169, p=0.122) showing non-significant relationships. LF shows a significant negative correlation with BMI at rest (Rho = -0.251, p=0.021*), while post-exercise, this correlation is more pronounced and negative (Rho = -0.548, p<0.01*). HF exhibits significant positive correlations with BMI both at rest (Rho = 0.347, p=0.001*) and post-exercise (Rho = 0.544, p<0.01*). The LF/HF ratio shows a significant negative correlation with BMI in both conditions (Rho = -0.246, p=0.023* at rest; Rho = -0.638, p<0.01* post-exercise).

Introduction: Prostate cancer is a significant health concern, particularly in rural areas with limited access to healthcare facilities. Transrectal ultrasound (TRUS)-guided prostate biopsy is a critical diagnostic tool for prostate cancer. This study aims to analyze the outcomes of TRUS-guided prostate biopsies conducted over the last five years at Narayan Medical College and Hospital, Jamuhar, Sasaram, Bihar. Materials and Methods A retrospective analysis was conducted on 168 patients who underwent TRUS-guided prostate biopsy at Narayan Medical College and Hospital from January 2019 to December 2023. Patient demographics, clinical presentations, biopsy indications, and histopathological findings were recorded. Data were analyzed to determine the diagnostic yield and complication rates associated with the procedure. Results Out of the 168 patients, 120 (71.4%) had positive biopsy results for prostate cancer. The mean age of the patients was 65 years (range: 50-80 years). The most common clinical indication for biopsy was elevated prostate-specific antigen (PSA) levels, accounting for 75% of cases. The Gleason scores of diagnosed cancers varied, with 40% of patients having a score of 7 or higher. The complication rate was low, with minor complications such as hematuria and rectal bleeding occurring in 15% of cases, and no major complications reported. Conclusion TRUS-guided prostate biopsy is an effective diagnostic tool for prostate cancer in rural tertiary healthcare settings. The high diagnostic yield and low complication rate underscore its importance in early cancer detection and management. Efforts should be made to improve awareness and access to this procedure in rural areas to facilitate early diagnosis and treatment of prostate cancer.

Background: Oral cancer is the most common cancer and constitutes a major health problem. Tobacco and alcohol remains the most important etiologic factors. Molecular level changes in the lesion occur before clinical and histopathological changes. The prognostic evaluation of this neoplasia is given by histological and immunohistochemical findings, including staging, histological grade, tumor size, lymph node involvement, immunohistochemical expression of p53 and Ki-67.In squamous cell carcinomas of oral cavity, p53 and Ki-67 are related to large tumors, metastasis to lymph nodes and very likely to a worse prognosis. Aim and objectives: To assess and compare the expression p53, Ki-67 and their combination markers in squamous cell carcinoma of oral cavity in relation to lymph node status, degree of histological differentiation and pathological staging. Materials and Methods: The prospective study was conducted in department of Pathology carried out with 108 cases of oral cavity squamous cell carcinoma with lymph node resection. The p53 and Ki-67 labelling indices were expressed as the percentage of Ki-67 and p53 immunolabelled tumor nuclei per 1000 tumor nuclei counted. Results: The maximum numbers of cases were found to be in the age group of 40-60 years (61.8%), mostly being men (85.1%). Female comprised of only 14.9% of the patients. All cases were subjected to immunohistochemical study for Ki- 67 and p53. Positive expression of Ki 67 detected was in 92 cases and p53 was detected in 72 cases. Both Ki -67 and p53 were positive in 58 cases. Ki -67 marker was tested in all 108 cases. Out of total 108 cases 92 (85.2%) were found to be positive for Ki -67 and only 16(14.8%) were found negative. In the histological grading 48 (44.4%) were low grade (well differentiated), and 30 (55.6%), were high grade (moderately and poorly differentiated). Out of 48 low grade cases 14(29.2%) cases and out of 60 high grade cases 44(73.3%) were positive for p53and Ki 67 which was statistically significant The relationship of p53 and Ki -67 expression was statistically significant when compared with lymph node status. Conclusion: Male to female ratio was 5.7:1 with age ranging from 40-60 years. The most common site of squamous cell carcinoma was buccal mucosa followed by tongue in oral cavity. Positive expression of Ki 67 was detected in 92 cases and p53 positive expression was detected in 72 cases.

Background: Diffuse Alveolar Damage (DAD) represents the prototypical histopathological correlate of acute respiratory distress syndrome (ARDS) and recurs ubiquitously across varied terminal events. Within forensic autopsy paradigms, delineating its morphological nuances provides critical insight into agonal pulmonary compromise, yet remains under-elucidated in medico-legal literature. Aims and Objectives: 1.To retrospectively analyse 150 forensic autopsies exhibiting histologically confirmed DAD. 2. To elucidate morphological stages—exudative, transitional, fibro proliferative—and correlate them with underlying etiological constructs. 3. To assess demographic distribution, phase-specific prevalence, and temporal pathogenesis. 4. To situate findings within contemporary forensic pathology discourse and propose histomorphological interpretive frameworks. Materials & Methods: A retrospective, descriptive–analytical study was conducted on 150 consecutive autopsy lung specimens (2019–2024) from the Department of Forensic Medicine & Toxicology. Inclusion required well-preserved formalin-fixed specimens and light-microscopy suitability. Histological sections (4 μm) were stained with H&E, Masson's trichrome, and periodic acid–Schiff. DAD was diagnosed per Katzenstein–Latticed criteria[1]. Demographic parameters (age, sex), postmortem interval (PMI), and cause-of-death were extracted from medico-legal records. Statistical analysis employed descriptive metrics: mean ± SD, ranges, and proportions. Chi-square test evaluated associations between DAD phase and etiology (p < 0.05 considered significant). Temporal phase distribution analysis utilised Kaplan–Meier survival curves to approximate agonal duration until histological transition. Result and Analysis: 1.Demographics: Mean age = 55.3 ± 14.7 years (range 19–87). Male: Female ratio = 1.6:1. 2. Etiological Distribution (n = 150): Pulmonary embolism: 32 (21.3%), Drowning: 27 (18.0%), ARDS (sepsis/pneumonia): 23 (15.3%) Congestive cardiac failure: 18 (12.0%), Hepatorenal syndrome: 10 (6.7%), Renal artery stenosis: 7 (4.7%), Chronic kidney disease: 8 (5.3%), Small-cell lung carcinoma: 11 (7.3%), Pulmonary contusions (trauma): 8 (5.3%), Myocardial infarction: 3 (2.0%), Pneumoconiosis: 2 (1.3%), Other restrictive lung diseases: 2 (1.3%), Advanced COPD: 9 (5.3%) 3. Phase Prevalence: Exudative: 63 cases (42%), Transitional: 57 cases (38%), Fibroproliferative: 30 cases (20%) Chi-square analysis revealed a significant correlation between etiology and histological phase (χ² = 27.42, df = 4, p < 0.001). Kaplan–Meier survival estimates suggested median interval to fibroproliferative changes ≈ 7.8 days post-insult. Conclusion: The heterogeneity of DAD in forensic series mirrors the multiplicity of terminal pulmonary insults. Histomorphological phase stratification—anchored in statistical association and temporal inference—yields refined forensic interpretive value. The study underscores the indispensability of integrating histopathology with contextual and clinical metadata to resolve terminal pulmonary pathology in equivocal medico-legal scenarios.

Background: Regional anesthesia (RA) offers several advantages compared to general anesthesia, encompassing the reduction of the surgical stress response, avoidance of airway instrumentation, provision of effective post-operative analgesia, and facilitation of early ambulation with a decreased risk of deep vein thrombosis. However, the utilization of RA is not without considerations. Aim of the study is- to study hemodynamics variable post-induction with propofol versus ketofol. This is a prospective observational study done in Department of and anaesthesia at Shri Rawatpura Sarkar Institute of Medical Sciences and Research, Raipur, Chhattisgarh:  1st May 2024 to 1st May 2025 in 72 patients.  This study will be approved by institutional ethical committee and written informed consent will be obtained from all participants before inclusion in the study. The study was conducted in following two groups of patients. Each group was consisting of 36 patients 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. 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). 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). 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: Peritonitis is a condition that is typically the consequence of a localized or systemic infection and is defined by inflammation of the peritoneum as well as peritoneal cavity. Primary peritonitis is the result of bacterial, fungal, chlamydial, or mycobacterial infections that do not result in gastrointestinal perforation. To study the prognosis of traumatic and non traumatic gastrointestinal perforation in a tertiary care hospital. Material And Methods: Data will be collected from records among patients admitted with diagnosed Gastrointestinal perforation(both Traumatic and Non-traumatic) in the department of surgery from October 2023 to October 2024.All the patients admitted to the Department of surgery with complete hospital record data will be used for the study. Study design: A Prospective Comparative Study. Study period: October 2023 to October 2024 Sample size:  60 cases (30 cases of Traumatic and 30 cases of Non traumatic Gastrointestinal Perforation). Results: Results will be formulated in the form of tables and Charts. The most common perforation among all the hollow viscera in the body according to Pal N et al. 26 (2020) is the ileum accounts for 37.01% of perforations, followed by the duodenum with a maximum of 28.36%. In 27.40% of 171 cases, cause of the perforation was acid peptic disease. Conclusions: Non- traumatic perforations happened without any visible harm, but traumatic perforations were more frequently linked to blunt and penetrating traumas. Patients with traumatic perforations needed different surgical procedures, including primary closure and resection, and their hospital stays were longer than those of patients having non-traumatic perforations.

Introduction: Fine Needle Aspiration Cytology (FNAC) is a basic, generally safest, fast, trustworthy strategy for the diagnosis of lung lesions, especially with the guide of Ultrasonography (USG) or Computed tomography (CT) scan. FNAC plays an integral part in recognizing benign and malignant lesions and aids in typing of lung cancers to start particular treatment like chemotherapy or surgery immediately. The aim of the study was to diagnose the cytopathological spectrum of lung lesions by USG/CT guided FNAC. Methods: This is a cross-sectional study which was carried out in the Department of Pathology, Government Medical College, Kota for a period of 18 months from December 2022 to May 2024. Patients of all age groups in whom FNAC of lung lesions has been advised were the study subjects. Total 113 patients were included in the study. Each case was subjected to a detailed history, thorough clinical examination, routine haemogram, prothrombin time and/or platelet count (where necessary), imaging (USG/CT) and guided FNAC. Results: The study included 113 patients. Majority of the patients were in the age group 61-80 years with 73 patients (64.60%). Male patients were 91 (80.53%) and female patients were 22 (19.47%). Adequate sampling material was obtained in 99 patients (87.61%) out of 113 patients. The most common lesion diagnosed on cytology was adenocarcinoma in 29 patients (29.29%) followed by squamous cell carcinoma in 27 patients (27.27%), small cell carcinoma in 12 patients (12.12%) and poorly differentiated carcinoma in 5 patients (5.05%). 6 patients (6.06%) were reported as suspicious for malignancy. 11 patients (11.11%) were diagnosed as nonspecific inflammatory pathology, 7 patients (7.07%) were diagnosed as tubercular pathology, 1 patient (1.01%) was diagnosed as benign cystic lesion and 1 patient (1.01%) was diagnosed as fungal pathology.  Conclusion: Conclusion of this study showed that USG/CT guided FNAC is a safe, quick and minimally invasive procedure for the evaluation of lung lesions. It provides early diagnosis and sub-classification of various lung lesions based on cytomorphological features. It helps to formulate immediate and proper management of lung lesions.

Background: Gallstone disease typically manifest as right upper quadrant pain, nausea, and vomiting, though it can occasionally stay asymptomatic. If left untreated, it can result in obstructive jaundice, acute or chronic cholecystitis, Mirizzi syndrome, gangrenous cholecystitis, empyema gall bladder and in rare cases, carcinoma GB. Aims: To assess and compare the surgical outcome of laparoscopic cholecystectomy with       and without abdominal drain. Materials & Methods: The present study was a Prospective comparative study. This Study was conducted from November 2023 to November 2024 at Department of General surgery, Jorhat Medical College and Hospital. Total 90 patients were included in this study. Result:In our study, a majority of patients (70 %) who underwent LC without a drain were pain-free after 24 hours, while only 20 % of those with a drain reported the same. Patients who underwent LC without a drain experienced a notably shorter hospital stay, with 30 % being discharged within a day and 50 % within two days. The mean subhepatic fluid collection was 24.80 ± 9.404 ml in the LC with drain group and 24.30 ± 11.500 ml in the non-drain group, with a non-significant mean difference of 0,50 ml . This indicates that drains are typically used in complicated calculous cholecystitis cases involving adhesions, bile spillage and intraoperative haemorrhage. Conclusion: Our study findings suggest that laparoscopic cholecystectomy without a drain is associated with less postoperative pain, fewer complications, shorter hospital stay, and faster recovery, making it a preferable approach in uncomplicated elective cases. While drain placement remains necessary in certain complicated cases, its routine use should be reconsidered to enhance patient comfort and outcomes.

Background: Infertility is a significant global health concern, with tubal factors and uterine anomalies contributing to a substantial proportion of cases. Hysterosalpingography (HSG) remains a key diagnostic tool in evaluating these causes due to its accessibility, cost-effectiveness, and ability to provide detailed imaging of the uterine cavity and fallopian tubes. HSG involves the injection of a radiopaque contrast medium through the cervix, followed by fluoroscopic imaging to assess tubal patency and uterine morphology. Objective: To determine the role of hysterosalpingogram in further evaluation of tubal factors and uterine anomalies as the cause of infertility. During the study period, 50 subjects were chosen for the study. Conclusion: HSG remains a first-line investigation for tubal and uterine factor infertility, offering both diagnostic and potential therapeutic benefits.

Background: Primary infertility affects approximately 10-15% of couples worldwide and is defined as the inability to conceive after one year of regular, unprotected sexual intercourse. In India, infertility rates are increasing due to changing lifestyle patterns, delayed marriages, and environmental factors, creating substantial burden on healthcare systems. Aims and Objectives: To study the demographic distribution, clinical presentation, menstrual patterns, gynecological history, and hysterosalpingographic findings in women diagnosed with primary infertility in a clinical setting. Materials and Methods: This observational study was conducted on 100 female patients diagnosed with primary infertility. Data on age, socio-demographic profile, literacy status, occupation, socio-economic status, menstrual history, gynecological history, and HSG findings were collected. Inclusion and exclusion criteria were applied, and findings were analyzed using descriptive statistics. Results: Most patients were aged 26-30 years (41%) and belonged to upper middle socio-economic class (40%). The majority were literate (89%) and housewives (65%). Regular menstrual history was observed in 54% of patients, while 46% had abnormal menstrual patterns. PCOS was the most common gynecological condition (13%), followed by fibroids (6%). HSG study revealed normal findings in 92% of patients, with tubal blockage in only 8%. Conclusion: Primary infertility predominantly affects women in their peak reproductive years (26-30 years) with relatively good socio-economic backgrounds. While most patients have normal tubal patency on HSG, menstrual irregularities and PCOS represent significant contributing factors. Early detection, comprehensive evaluation, and individualized management are essential for optimal patient outcomes.

Background: Hypothyroidism is one of the most common endocrine disorders, characterized by an underactive thyroid gland with insufficient production of thyroid hormones. Ferritin is an iron-binding protein and serum ferritin levels are negatively correlated with hypothyroidism. However, its clinical utility is not fully explored in hypothyroidism. Therefore, the aim of the present study was to assess serum ferritin and its clinical utility in hypothyroidism. Materials and methods: The present study was a hospital-based case-control study carried out between April 2022 and August 2022. A total of 55 hypothyroid subjects (cases; n=55) and an equal number of healthy, age-matched controls (n=55) were recruited. Serum free T3, free T4, TSH and ferritin levels were analyzed using chemiluminescent immunoassay (CLIA). Statistical analysis was performed using an unpaired student’s t-test. Results were expressed as mean ± SD. Results: The mean concentrations of free T3 and T4 were significantly lower among cases when compared with controls (p < 0.001). The mean levels of TSH were significantly higher among cases (p < 0.001), while the mean levels of ferritin were significantly lower among cases as compared to controls (p < 0.001). Conclusion: The present study found that the serum ferritin levels were substantially lower in hypothyroid subjects, indicating a significant association of serum ferritin with hypothyroidism. As serum ferritin levels deplete well before iron levels deplete in iron deficiency, estimation of serum ferritin levels could be useful in the evaluation and management of hypothyroidism.

Background: Vitamin D plays a crucial role in musculoskeletal and neuropsychological health. Emerging evidence suggests a link between vitamin D deficiency, depressive symptoms, and musculoskeletal pain. Aim: To assess the association between vitamin D deficiency, depression, and musculoskeletal pain among general medicine outpatients. Methods: A cross-sectional study was conducted on 200 adult outpatients at a tertiary care hospital. Serum 25-hydroxyvitamin D levels were measured using chemiluminescence immunoassay. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), and musculoskeletal pain severity was assessed using the Visual Analog Scale (VAS). Statistical analysis included t-tests, chi-square tests, and Pearson’s correlation coefficient. Results: Vitamin D deficiency (<20 ng/mL) was found in 123 patients (61.5%). A significant negative correlation was observed between vitamin D levels and PHQ-9 scores (r = -0.43, p < 0.001), as well as VAS scores (r = -0.39, p < 0.001). Limited sunlight exposure (<30 minutes/day) was significantly associated with vitamin D deficiency (OR = 1.67, p = 0.04). Conclusion: Vitamin D deficiency is prevalent among general medicine outpatients and is significantly associated with higher depression and musculoskeletal pain scores. Routine screening for vitamin D status may aid in the comprehensive management of patients with such complaints.

Background: Surgical Site Infections (SSIs) constitute a formidable subset of nosocomial morbidities, characterized by multifactorial pathogenesis orchestrated through host immunosenescence, procedural breaches, and microbial virulence. In the milieu of escalating antimicrobial resistance (AMR), the surveillance of SSIs assumes paramount significance in perioperative epidemiology and pharmacological stewardship. Materials and Methods: This prospective, monocentric, cross-sectional observational study enrolled 101 post-surgical individuals, selected via stratified systemic randomization from operative abdominal and herniorrhaphy cohorts. Specimens underwent rigorous microbiological processing and antimicrobial susceptibility testing in compliance with CLSI protocols. Data synthesis employed SPSS v26 with chi-square analysis for categorical differentials. Results: SSI prevalence was ascertained at 12.02%, with 65.3% culture-positivity and a polymicrobial index of 27.2%. Gram-negative bacilli—predominantly Escherichia coli (23.8%) and Klebsiella spp. (22.8%)—overshadowed Gram-positive cocci. Resistance profiling revealed critical levels of insusceptibility to β-lactams, aminoglycosides, fluoroquinolones, and carbapenems. Tigecycline and colistin displayed tenuous activity, heralding a therapeutic inflection point. Summary: The study elucidates a hyper-resistant microbial ecology within SSIs, marked by alarming multidrug resistance among dominant aerobic flora. The findings underscore the patho-therapeutic incongruity between current empirical regimens and prevailing resistance phenotypes. Conclusion: This investigation substantiates the exigency of recalibrating institutional antimicrobial protocols, instituting dynamic stewardship frameworks, and integrating molecular diagnostics to preempt the looming specter of pan-resistant post-surgical sepsis in resource-stressed surgical ecosystems.

Background: This study aimed to compare intracorporeal knotting with clip ligation for securing the cystic duct in laparoscopic cholecystectomy. The comparison was based on feasibility, operative time (from incision to closure), and post-surgical factors such as pain, complications, and associated risks, including gallbladder perforation, bile leakage, liver injury, wound infection, clip migration, and clip slippage. Methodology: Patients were randomly divided into two groups: Study group: Underwent extracorporeal knotting for cystic duct closure. Control group: Had the cystic duct secured using clips. The study was conducted from August 2023 to March 2025 Results: Among 60 patients, 11 in the control group experienced intraoperative complications, whereas no complications were observed in the study group. The average operative time for the study group (intracorporeal knotting) was 67.33 minutes, compared to 61.89 minutes for the control group (clip ligation). Conclusion: Intracorporeal knotting in laparoscopic cholecystectomy offers advantages like reduced complications, with minimal increase in surgical time. 

Background: Distal femur fractures, particularly comminuted and intra-articular types, pose significant challenges in orthopedic trauma care. Traditional conservative treatments are associated with high rates of complications such as malunion and joint stiffness. With advancements in surgical techniques, the Locking Compression Plate (LCP) has gained attention for its biomechanical and biological advantages. This study aims to assess the clinical, radiological, and functional outcomes of distal femur fractures treated with LCP using the Neer scoring system. Materials and Methods: This prospective study was conducted at the department of Orthopaedics, Government Medical College, Jayasankar Bhupalpally, Telangana, India, for a period from July 2024 to March 2025, involving 15 patients aged between 18 and 60 years who sustained distal femur fractures. All patients underwent Open Reduction and Internal Fixation (ORIF) with LCP. Follow-up evaluations were conducted at 3, 6, and 9 months postoperatively, including clinical examination, radiographic union assessment, and functional scoring using Neer’s scoring system. Results: Most patients were aged 41–50 years (33%) and male (74%). Road traffic accidents were the leading cause of injury (81%). Type C (intra-articular) fractures accounted for 54% of cases, and Type A (extra-articular) for 46%. By 9 months, 54% of fractures had achieved radiological union. Functional outcomes at final follow-up showed 73% of patients had good results, 20% excellent, and 7% fair according to Neer’s score. Knee stiffness was observed in 33% of patients, while 6% had malalignment (>5° varus). No cases of infection, delayed union, or implant failure were reported. Conclusion: Locking Compression Plates provide effective fixation for distal femur fractures, offering high union rates, low complication risk, and satisfactory functional outcomes, particularly in Type A fractures. This technique supports early mobilization and is a reliable option for managing complex distal femur injuries.

Background: Organophosphate poisoning represents a significant global health challenge, accounting for approximately 3 million poisoning cases annually and 300,000 deaths, predominantly in developing countries. While acetylcholinesterase levels remain the gold standard for diagnosis and severity assessment, their limited availability in resource-constrained settings necessitates exploration of alternative biomarkers. Methods: This prospective cohort study included 73 patients with organophosphate poisoning admitted to a tertiary care center. Clinical severity was assessed using the Peradeniya Organophosphorus Poisoning (POP) scale. Serum acetylcholinesterase, amylase, and CPK levels were measured on days 1, 3, and 5 of hospitalization. Statistical analysis was performed to determine correlations between biochemical parameters and clinical severity, as well as their associations with outcomes. Results: Among the 73 patients, 67.1% were young adults (21-40 years), with a nearly equal gender distribution. Based on the POP scale, 43.8% had mild poisoning, 39.7% moderate, and 16.4% severe. Elevated serum amylase levels (>110 units) were observed in 63% of patients on day 1, while elevated CPK levels (>200 units) were noted in 16.4%. Strong correlations were found between the POP score and both amylase (r=0.865, p<0.001) and CPK levels (r=0.817, p<0.001). Acetylcholinesterase levels on admission were significantly associated with mortality, with lower levels (<5320 units) corresponding to higher mortality rates (34.5% vs. 6.7%, p=0.034). Ventilatory support was required in 26% of patients, and the overall mortality rate was 15.1%. Conclusion: Serum amylase and CPK levels demonstrate strong correlations with clinical severity in organophosphate poisoning, with amylase exhibiting a slightly stronger correlation. These readily available biochemical markers can serve as valuable adjuncts to clinical assessment in determining severity and predicting outcomes, particularly in settings where acetylcholinesterase assays are not available.

Background: Road traffic accidents (RTAs) are a significant public health issue globally, often resulting in fatal head injuries. Computed Tomography (CT) remains the gold standard for evaluating intracranial pathology in trauma-related deaths. This study aims to systematically describe CT findings in fatal RTA victims at a tertiary care center, providing valuable insights for clinicians, radiologists, and forensic experts. The results can also support policymaking in trauma care and accident prevention. Material and Methods: A retrospective descriptive study was conducted at The study was carried out in the Department of Radiodiagnosis, Adichunchanagiri Hospital and Research Centre from January 2023 to February 2025. CT brain scans of 34 fatal RTA cases were retrospectively analyzed. Parameters like extradural hemorrhage (EDH), subdural hemorrhage (SDH), subarachnoid hemorrhage (SAH), contusion, intraventricular hemorrhage (IVH), diffuse axonal injury (DAI), midline shift, and skull fractures were documented. Findings were categorized as present or absent and analyzed using descriptive statistics. Results: The majority of fatal RTA victims were young to middle-aged adults, with the highest percentage (41.2%) in the 30–49 years group, followed by 35.3% in the 18–29 years group. Males accounted for a significantly higher proportion (73.5%) of deaths. SDH (79.4%) and SAH (79.4%) were the most common findings. EDH was observed in 35.2% of cases, and contusions in 44.1%. Midline shift was observed in 38.2% of cases and is an important indicator of raised intracranial pressure and brain displacement. Herniation and pneumocephalus were seen in 29.4% of cases each. Calvarial (skull) fractures were found in 82.4% of cases, indicating that a majority of fatal head injuries were associated with high-impact trauma causing cranial disruption. Facial bone fractures were present in 58.8%, often occurring with direct facial impact. Cervical fractures were rare (2.9%) but signify potentially fatal cervical spine trauma in isolated cases. Conclusion: Subdural and subarachnoid hemorrhages are the most frequent CT findings in fatal RTAs. EDH, contusions, skull fractures, and midline shifts also play a significant role in morbidity and mortality. Emphasis on early imaging, trauma triage, and prevention strategies is essential to mitigate fatalities.

Background: Sepsis, a leading cause of mortality in intensive care units globally, involves a dysregulated host response to infection. High-density lipoprotein (HDL) has emerged as a potential biomarker with anti-inflammatory and antioxidant roles. This study was conducted to evaluate the prognostic significance of serum HDL levels in patients with sepsis admitted to M.K.C.G Medical College, Berhampur, Odisha. Objectives: To investigate the association of serum HDL levels with outcomes in septic patients, specifically comparing survivors versus non-survivors and assessing the temporal change in HDL over the initial days of admission. Methods: A hospital-based observational study was conducted among 105 patients aged ≥18 years diagnosed with sepsis based on qSOFA criteria. Patients on statins, with chronic comorbidities or terminal illness, were excluded. Serum HDL levels were measured on day 1 and day 4 of admission. SOFA and qSOFA scores were recorded. Data were analyzed using SPSS v21.0, with significance set at p<0.05. Results: The mean HDL level on day 1 was significantly lower in non-survivors (12.0 ± 1.54 mg/dL) compared to survivors (20.63 ± 8.48 mg/dL, p<0.05). A significant difference was also observed in SOFA (6.01 ± 1.86 vs 8.76 ± 1.97) and qSOFA (1.93 ± 0.86 vs 2.62 ± 0.49) scores among survivors and non-survivors respectively (p<0.001). HDL levels tended to improve by day 4 among survivors (24.32 ± 8.35 mg/dL), whereas in non-survivors the change was negligible (11.33 ± 2.59 mg/dL). Conclusions: Lower serum HDL levels at admission and minimal increase over 4 days are significantly associated with mortality in sepsis. HDL can serve as a prognostic biomarker in sepsis management and may inform early risk stratification.

Background: Oral squamous cell carcinoma (OSCC) is characterized by aggressive invasion and high metastatic potential, particularly at the invasive tumour front. The epithelial-mesenchymal transition (EMT) plays a pivotal role in tumour progression, with E-cadherin and vimentin being critical immunohistochemical markers. Objectives: To assess EMT marker expression in the invasive front of OSCC using E-cadherin and vimentin and correlate findings with histological grade and lymph node metastasis. Methods: A cross-sectional, retrospective-prospective study was conducted on 57 OSCC samples. EMT marker expression was evaluated by immunohistochemistry and graded semi-quantitatively. Statistical comparisons were made between marker expression in the central tumour and invasive front and with lymph node involvement. Results: E-cadherin expression was significantly reduced, and vimentin significantly increased at the invasive front compared to central tumour areas. High vimentin and low E-cadherin expression were significantly associated with poorly differentiated tumours and lymph node metastasis (p < 0.05). Conclusion: EMT markers demonstrate distinct expression patterns at the OSCC invasive front, correlating with tumour grade and metastatic potential. These findings highlight the invasive front as a prognostically significant region and support the utility of EMT markers in OSCC evaluation.

Background: Epilepsy complicates approximately 0.3–0.5% of all pregnancies and presents unique challenges for both maternal and fetal health. Seizure control, antiepileptic drug (AED) management, and teratogenic risk stratification are critical to optimizing outcomes. This study aimed to evaluate the clinical profiles, management, and outcomes of pregnancies in women with epilepsy. Methods: A prospective observational cohort study was conducted over a 12-month period (January to December 2024) at the Government General Hospital, Siddipet. Fifty pregnant women with a diagnosis of epilepsy were enrolled. Data on seizure frequency, AED use, obstetric management, and maternal-fetal outcomes were collected and analyzed using descriptive and comparative statistics. Results: The mean age of participants was 28.3 years. Generalized epilepsy was more common (60%), and 70% were on monotherapy. Seizure occurrence during pregnancy was documented in 50% of participants. Poor compliance with AEDs and polytherapy regimens were associated with increased seizure activity. Caesarean delivery was performed in 40% of cases. Obstetric complications occurred in 30% of pregnancies, and 42% of neonates had low birth weight (<2.5 kg). NICU admission was required in 30% of cases, and congenital anomalies were observed in 10% of neonates. Postpartum seizures occurred in 15% of women. Conclusion: Pregnancies complicated by epilepsy require vigilant monitoring and individualized treatment. Seizure control, consistent antenatal follow-up, and AED compliance are key determinants of favourable maternal and neonatal outcomes. Multidisciplinary care is essential to minimize morbidity.

Introduction: Myeloperoxidase (MPO), an enzyme found in neutrophils, is a key player in the immune response and has been identified as a potential biomarker for oxidative stress. The objective of this study is to investigate the relationship between psychological stress, sleep quality, and serum myeloperoxidase levels in medical undergraduate students, comparing stressed and non-stressed individuals. Material and Methods: This 6-month case-control study at tertiary care hospital, explored the relationship between oxidative stress (serum MPO levels) and psychological stress in 100 medical students (50 stressed, 50 non-stressed). Participants completed digital questionnaires (PSQI and SSI) and underwent anthropometric measurements and blood sampling. Serum MPO levels were analyzed using ELISA. Result: Stressed group had significantly higher serum myeloperoxidase (MPO) levels (7.9 ng/mL) compared to the non-stressed group (6.0 ng/mL), indicating a potential link between stress and oxidative stress. Furthermore, there was a significant association between sleep quality and stress status, with stressed students more likely to experience poor sleep quality (69.2%) and non-stressed students tending to have better sleep quality (70.8%). Correlation analysis showed a moderate positive correlation between sleep quality and MPO levels in the stressed group. Conclusion: Psychological stress is associated with increased oxidative stress, as evidenced by significantly MPO levels in stressed students. The strong associations between MPO levels, poor sleep quality, and stress severity highlight the physiological burden of academic and interpersonal stress on students.

Background: Teenage pregnancy remains a pressing public health challenge, particularly in low-resource settings. It is frequently associated with increased maternal and neonatal morbidity, compounded by socio-demographic vulnerabilities such as low education, early marriage, and inadequate prenatal care. Methods: This was a prospective observational cohort study conducted over one year (January to December 2024) at the Government General Hospital, Siddipet. Fifty pregnant adolescents aged 13–19 years were enrolled. Data on socio-demographic variables, antenatal profiles, and fetomaternal outcomes were collected and analyzed using descriptive and comparative statistical methods. Results: The mean age of participants was 16.3 years, with 78% residing in rural areas and 70% from low socioeconomic backgrounds. Only 76% received antenatal care. Anaemia was present in 56% of cases and was associated with lower Apgar scores (p = 0.0528; Cohen’s d = –0.59) and longer hospital stays. Obstetric complications occurred in 30% of participants, and 42% of neonates had low birth weight. NICU admission was required in 24% of cases, though not significantly associated with anaemia (p = 0.9178). Conclusion: Teenage pregnancy in this population was associated with poor antenatal coverage, high anaemia prevalence, and increased rates of maternal and neonatal complications. These findings emphasize the need for focused public health interventions targeting adolescent reproductive health and nutrition.

Background: Eclampsia, a severe hypertensive disorder of pregnancy characterized by new-onset seizures, remains a significant contributor to maternal and fetal morbidity and mortality, especially in resource-limited settings. Despite advancements in obstetric care, outcomes remain poor in regions with inadequate antenatal services. Objective: This retrospective study aimed to evaluate the clinical profile and maternal and fetal outcomes associated with eclampsia in a tertiary care hospital in Telangana, India. Methods: A total of 30 eclamptic women admitted between November 2023 and April 2025 were studied. Data were collected retrospectively from hospital records, including demographic details, clinical features, management strategies, and maternal and neonatal outcomes. Descriptive statistics were applied using SPSS v21. Results: The institutional incidence of eclampsia was 1.36%. The mean maternal age was 25.93 ± 4.04 years, with 53.3% being primiparous. Antepartum eclampsia was the most common type (83.4%). Pulmonary edema (13.3%), HELLP syndrome (10%), and PRES (10%) were leading maternal complications, while 3.3% of patients died. Preterm birth occurred in 60%, low birth weight in 26.7%, and stillbirth in 16.7% of cases. NICU admission was required for 20% of neonates, and neonatal mortality was 3.3%. Conclusion: Eclampsia poses a serious risk to both maternal and neonatal health, with a high incidence of complications even in tertiary care. Strengthening antenatal care, early identification of preeclampsia, standardized emergency management, and improved referral systems are critical to improving outcomes.

Background: Meconium stained amniotic fluid (MSAF) is a common clinical finding during labor, often considered a sign of fetal distress. However, its correlation with maternal risk factors and the perinatal outcome is variable and sometimes controversial. This study aims to explore these associations in the population served by Government Medical College, Mahbubnagar. To evaluate the maternal antenatal and intrapartum risk factors associated with MSAF, determine the mode of delivery in MSAF cases, assess the neonatal outcomes including Apgar scores and NICU admissions, and compare these outcomes between thin and thick MSAF. Material and Methods: This observational study was conducted from May 2024 to April 2025 in the Department of Obstetrics and Gynaecology at Government Medical College, Mahbubnagar. A total of 100 term pregnant women (>37 weeks gestation) with singleton, cephalic presentations and MSAF at or during labor were included. Patients with malpresentations, multiple gestations, congenital anomalies, antepartum hemorrhage, or intrauterine death were excluded. MSAF was clinically graded as thin or thick. Fetal monitoring via cardiotocography (CTG), mode of delivery, and neonatal outcomes (Apgar scores, NICU admission, resuscitation) were recorded and analyzed. Results: Out of 100 women, 67 had thin and 33 had thick MSAF. The incidence of MSAF was higher in primigravidae (59%) and in women aged 20–30 years (86%). Post-dated pregnancies were more commonly associated with MSAF (62%). Common risk factors included anemia (21%), prolonged labor (10%), oligohydramnios (6%), and hypertensive disorders (4%). Non-reactive CTG was more frequent in thick MSAF (48.48%) than in thin (38.80%). Cesarean deliveries were more common in the thick MSAF group (30.30% vs 7.46%). APGAR scores <7 at 5 minutes were observed in 13% of newborns, with thick MSAF showing higher rates of low scores and NICU admissions. Birth asphyxia incidence was 10%, with 6% in the thin and 18.1% in the thick group (P=0.0278). Overall perinatal morbidity was 14%. Conclusion: The study demonstrates that MSAF is significantly associated with maternal risk factors such as postdatism, anemia, and prolonged labor. Thick MSAF is linked with adverse perinatal outcomes including lower Apgar scores, higher NICU admissions, and increased cesarean rates. Timely identification and multidisciplinary management are essential to minimize neonatal morbidity and mortality.

Background: Bacterial vaginosis is a polymicrobial condition resulting in alteration of normal vaginal flora and increase in vaginal pH >4.5. We aimed to study the effectiveness of a vaginal pH detection kit as a Point of Care (POC) test for bacterial vaginosis. Methods: In this prospective observational study, 96 women attending the outpatient department with complaints of vaginal discharge were included in the study, after obtaining informed consent. Vaginal swabs were collected for vaginal pH measurement by pH kit containing a matching color card & pH was noted to be >/= 4.5 & < 4.5 and were grouped accordingly. Another swab was sent to the microbiology laboratory for visualization of clue cells which was taken as confirmatory test for bacterial vaginosis. Data was expressed as percentages and statistically analyzed. Results: 93.7 % (90/96) belonged to the upper socio-economic class and majority belonged to the 26-to-35-year age group (46/96). 92 women (95.3%) had vaginal pH of more than 4.5 by pH kit and out of these, 66 women (68.75%) had clue cells on microscopic analysis of vaginal fluid. The vaginal pH kit showed a sensitivity of 97.06%, specificity of 7.14% (95% CI) with a Positive Predictive Value (PPV) 71.74% and Negative Predictive Value (NPV) 50.0%. Conclusion: Vaginal pH detection kit has good sensitivity, hence can be utilized as a POC screening test for Bacterial vaginosis which will enable the specific treatment rather than empirical treatment for women with vaginal discharge.

Background: Objective: To examine the frequency and intensity of suicidal tendencies, aggressive behaviors, and hostile attitudes in individuals diagnosed with alcohol dependence syndrome, and to analyze relationships between alcohol abuse duration and these psychological manifestations. Methods: A cross-sectional investigation was undertaken with 50 male inpatients meeting ICD-10 criteria for alcohol dependence syndrome. Participants underwent evaluation using CAGE screening tool, Michigan Alcohol Screening Test, Beck's Suicidal Intent Scale, Extrapunitive-Intropunitive Scale, and Historical Clinical Risk Management Scale-20. Data analysis utilized SPSS version 29.02 employing chi-square testing and receiver operating characteristic curve analysis. Results: Participants averaged 38.78±8.39 years of age. Suicidal tendencies were documented in 36% of cases, comprising 18% with mild, 14% with moderate, and 4% with severe intent. Intimate partner aggression occurred in 48% physically, 38% emotionally, and 28% sexually, while general violence affected 10%. Hostile orientation analysis showed 66% directed outward and 34% inward. Strong statistical correlation emerged between hostility direction and suicidal ideation (p<0.001). Violence risk prediction using HCR-20 achieved moderate accuracy (AUC=0.783), categorizing 48% as low-risk, 14% moderate-risk, and 6% high-risk. Conclusion: Alcohol dependence syndrome correlates with elevated rates of self-destructive thoughts, aggressive conduct, and hostile disposition. Inwardly-directed hostility demonstrates powerful association with suicidal intent, highlighting the importance of thorough psychological evaluation and targeted therapeutic approaches.

Background: Fungal infection has been increasing recently due to greatly enhanced international traffic and opportunistic infections due to the use of powerful cytotoxic drugs or immunosuppression. The disease invariably occurs in diabetics, usually with ketoacidosis, immune-compromised patients. Therefore, the current study aimed to evaluate the types of fungal infections in our cases and the standard method of management of fungal infections of the nose and paranasal sinuses. Methods: Clinical evaluation and examination were done for all patients the clinical evaluation included detailed history taking, comprehensive ENT examination, focusing on the nose and paranasal sinuses, and systemic examination (respiratory, cardiovascular, neurological, and abdominal systems) was performed when indicated. Patients presenting with symptoms suggestive of fungal rhinosinusitis, such as nasal obstruction, facial pain, nasal discharge, headache, or facial swelling. Radiological and endoscopic findings consistent with fungal sinusitis. All patients were evaluated with the following investigations as required. Nasal swab or biopsy for histopathological examination and fungal culture. Diagnostic nasal endoscopy Radiological imaging (CT/MRI of the paranasal sinuses). Results: In this clinical study of 30 patients with fungal infections of the nose and paranasal sinuses, a slight male predominance was observed, with most patients aged 31–40 years. The commonest symptoms included proptosis (33.3%), nasal obstruction with rhinorrhea (20%), and nasal swelling (16.7%). Aspergillosis was the predominant etiology (40%), followed by allergic fungal sinusitis and mucormycosis. Bone erosion (33.3%) and mucosal thickening (30%) were key radiological findings. Management included medical therapy (liposomal amphotericin B, steroids, dapsone) and surgical interventions, primarily maxillary antrostomy and FESS. Combined therapy was often necessary for optimal outcomes. Conclusion: In conclusion, we found fungal sinusitis is a heterogeneous disease and has variable clinical presentation. Early diagnosis using appropriate investigations and the use of antifungal therapy is needed. Timely surgical interventions are required in a few cases for optimal outcomes. Therefore, this study shows that multidisciplinary management of this condition using current guidelines will improve the outcomes in the cases. 

Background: Distal tibial fractures are prevalent in orthopedic clinics; they are difficult to deal with and sometimes require operative treatment. Fixation with a locking compression plate by minimally invasive percutaneous plate osteosynthesis technique is an alternative treatment option. The aim of the present study was to Determine the results of MIPO and its clinical outcomes. Methods: This prospective study was done in Rajiv Gandhi Institute of Medical Sciences [RIMS], Adilabad. A total of 20 patients were treated with minimally invasive Plate osteosynthesis [MIPO]. Patients were examined clinically and radiologically at a periodical interval of 4-6 weeks for a period ranging from 6 to 40 weeks. Inclusion criteria were closed and open fractures of the distal tibial bone in adults. Exclusion criteria included pathological fractures, polytrauma, and crush injuries.  Results: In this study of 20 patients treated with the MIPO technique for distal tibial fractures, the majority were males (70%), with the 31–45 years age group most commonly affected. Right-sided fractures predominated (60%), and road traffic accidents were the leading cause (60%). The mean operative time was 78.6 minutes, the incision length was 4.5 cm, and full weight-bearing was achieved by 8.1 weeks. Complications were minimal, with only 10% superficial infections and 5% each of delayed union and implant irritation. Functional outcomes were favorable, with 90% of patients achieving good to excellent AOFAS scores (mean: 91.4 ± 5.2). Conclusion: Minimally invasive plate osteosynthesis [MIPO] is a safe and effective technique for managing distal tibial fractures. It has advantages like early rehabilitation, mobilization, and reduced postoperative pain. It provides good stability with pre-contoured plates and improves the outcomes, particularly in elderly patients. It has overall lower incidences of complications and excellent clinical outcomes.

Introduction: Magnesium (Mg) has a critical role in the actions of important enzymes and is the fourth most abundant cation in the human body. Aim: to assess association of Hypomagnesemia with Diabetic Neuropathy. Methods: This Cross-sectional Observational study was carried out in The Department of General Medicine, MG Medical College and Research Centre, Jaipur. This study was conducted from June 2023 to Oct 2024. Results: Out of 150 cases 111 cases have normal magnesium level and 39 found to have hypomagnesemia. Out of 39 cases in hypomagnesemia group 32 cases have Neuropathy and out of 111 cases in normal magnesium level group only 21 cases have Neuropathy i.e. the prevalence of Neuropathy was statistically higher in hypomagnesemia group as compared to normal magnesium level group. Conclusion: Hypomagnesemia was found to be associated with poor glycemic control. Further studies with large sample size are required to prove a definite role of hypomagnesemia in diabetic complications.

Introduction: The pancreas functions as both an endocrine and exocrine organ. Its exocrine part releases digestive enzymes, while the endocrine portion secretes hormones into the bloodstream. The disease occurs when protective mechanisms fail, leading to premature trypsinogen activation. This triggers autodigestion of the pancreas and localized inflammation. AIM: Comparative evaluation of clinical and radiological scoring system in early prediction of severity in acute pancreatitis using BISAP score and MCTSI. Methodology: This hospital-based observational study was conducted in the Department of General Medicine at Mahatma Gandhi Medical College and Hospital, Jaipur. Following approval from the institutional research and ethical committee, the study was carried out over a period of 18 months—12 months dedicated to data collection and 6 months to data analysis. Result: The study found that BISAP had higher specificity (73.5%) than Modified CTSI (58.5%) in predicting mortality, indicating BISAP's superior accuracy. Both scores showed a statistically significant correlation with disease severity based on the Revised Atlanta Classification. CONCLUSION: BISAP is a simple, reliable, and accurate tool for early prediction of severity and mortality in acute pancreatitis, reducing the need for early CT imaging.

Background: Endotracheal intubation (ETI) in critically ill patients with chronic liver disease (CLD) carries a risk of hemodynamic instability. The optimal choice of induction agent in this population is unclear, with limited comparative data between etomidate and ketofol (ketamine and propofol). Objectives: To compare etomidate vs. ketofol for incidence of early post-intubation hypotension (within 6h, focusing on 15 min) in critically ill patients with liver disease. Evaluate the impact of etomidate versus ketofol in these patients on 7-day mortality, organ dysfunction (SOFA at 24h), renal injury (AKI at 24h), and vasopressor-free status at 24h. Material and Methods: This prospective, randomised, controlled, open-label trial included 100 adult CLD patients who required ETI in liver ICU. Patients were randomised (1:1) to receive induction of ketofol (1-2 mg/kg) or etomidate (0.1-0.2 mg/kg). Hemodynamics were monitored; the primary outcome was hypotension (defined criteria) within 6 hours. Results: The baseline characteristics were comparable. Ketofol (n=50) was associated with significantly less hypotension at 6 hours (26% vs. 62%, p<0.01) and at 15 minutes (18% vs. 48%, p<0.01) compared with etomidate (n=50). Ketofol required significantly lower doses of norepinephrine and vasopressin and resulted in a lower median 24 hour cardiovascular SOFA score ([1 (IQR 0, 4)] vs [2 (IQR 1, 4)], p=0.02) and a lower new onset of AKI (4% vs 20%, p=0.04). No significant differences found in mortality. Conclusion: Ketofol induction provides superior haemodynamic stability, reduces the need for vasopressor and reduces the risk of early AKI compared to etomidate during ETI in critically ill patients with CLD, indicating that it may be the preferred agent in this subset of population.

Background: Thyroid lesions are one of the common conditions encountered in clinical practice. It is difficult to clinical evaluation and reach to correct diagnosis. Hence it is essential that a correct diagnosis is made as early as possible. The Bethesda system of thyroid cytopathology is a well-established, standardized, category-based system of reporting thyroid FNA. Aims And Objective: To study various cytological features of thyroid lesion on FNAC to reach a diagnosis based on the Bethesda system and to decide spectrum of thyroid lesions in tertiary care hospital. To correlate FNAC diagnosis with histopathological diagnosis whenever histopathology examination is available. Materials And Methods: The present study was carried out in cytopathology and histopathology laboratory of department of pathology, PDU Medical College and Hospital, Rajkot during the 1 February to 31st July 2024. FNAC is a diagnostic tool in which cells are extracted from a palpable swelling using 22-24G needle with disposable syringes and smears are prepared and stained with H & E and MGG stain. Results: We have received 110 thyroid gland lesions for aspiration over a period of six months. The most affected age group was from 31 to 40 years.  As per the Bethesda category system, 17(15.45%) were category I, 77(70%) were category II, 04(3.64%) were category III, 08(7.27%) were category IV, 04(3.64%) were category V. Out of total 110 cases, 30 patients were correlated with histopathological findings.24(80%) had benign lesion and 06 cases (20%) were malignant.  Conclusion: Thyroid cytology proves to be a reliable, simple, and cost-effective first-line diagnostic procedure with high patient acceptance and with rare, usually easily treated and not life-threatening complications. The Bethesda system is very useful for a standardized and reproducible system of reporting thyroid FNAC. It satisfactorily correlates with the histopathological diagnosis.

Background: Extreme leukocytosis (EL), defined as an abnormally high white blood cell (WBC) count, is a critical clinical indicator associated with various underlying conditions, such as infections and malignancies. This study investigated the etiological factors and clinical profile of patients presenting with extreme leukocytosis at P.D.U Medical College and Hospital, Rajkot, Gujarat.   Objective: To analyse the etilogical factors and clinicopathological profile in patients with extreme leukocytosis. Materials and Methods: The present study was carried out in the Central Clinical Laboratory, Department of Pathology, P.D.U Medical College and Hospital, Rajkot, Gujarat over a period of 7 months between January 2024 to July 2024. Complete blood count, peripheral blood smear and cytochemistry study whenever required were used to diagnose. Results: A total of 74 patients with extreme leukocytosis (male predominance of 54.05%) were included in the study. Malignant conditions accounted for 48.64% of cases, with haematological malignancies, predominantly acute myeloid leukaemia (36.11%). Infections were the second most frequent cause (43.25%). Patients with malignancies had significantly higher median WBC counts and thrombocytopenia. Conclusion: Malignant etiologies, particularly haematological malignancies, are a leading cause of extreme leukocytosis in patients with WBC counts ≥50,000 cells/cumm. Clinicians should maintain a high suspicion of malignancies in such patients and conduct thorough diagnostic evaluations to ensure optimal management.

Background: Preoperative anxiety is known to influence the induction of anesthesia, affecting both the pharmacodynamics of anesthetic agents and patient outcomes. This study aims to assess the impact of different sedative protocols on managing preoperative anxiety and optimizing anesthesia induction. Methods: This randomized controlled trial involved 140 adult patients scheduled for elective surgery requiring general anesthesia. Participants were assigned to receive either benzodiazepines or dexmedetomidine as a preoperative sedative. Key parameters measured included heart rate, blood pressure, time to induction, patient anxiety scores, sedation levels, respiratory rate, and recovery times. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) was utilized to quantify preoperative anxiety. Results: Patients administered dexmedetomidine showed significantly lower anxiety scores (p=0.015) and more stable sedation levels (p=0.031) compared to those receiving benzodiazepines. Furthermore, dexmedetomidine was associated with better control of respiratory rates during induction (p=0.007). Overall, sedative choice based on preoperative anxiety levels significantly affected the induction times, with dexmedetomidine resulting in shorter times compared to benzodiazepines. Recovery times and patient satisfaction were also significantly improved in the dexmedetomidine group compared to the benzodiazepine group. Conclusion: The study demonstrates that dexmedetomidine is superior to benzodiazepines in managing preoperative anxiety with regards to faster induction times, stable respiratory rates, and higher patient satisfaction during the anesthesia induction phase. This suggests that tailoring sedative protocols based on individual anxiety levels can significantly enhance anesthesia management and patient outcomes in surgical settings.

Background: Intertrochanteric fractures of the femur are common in cases of road traffic accidents and elderly population because of osteoporosis. The incidence is increasing because of increased urbanization and the aging population. This study evaluated the function and radiological outcomes of patients with intertrochanteric fractures treated with Dynamic Hip Screw (DHS) and Proximal Femoral Nail (PFN). Methods: This prospective observational study was done on n=30 cases of intertrochanteric fractures reported to our hospital. They were equally distributed in two groups (15 DHS, 15 PFN). They underwent the implant placements as per the standard protocol. The functional outcomes were assessed using the Harris Hip Score (HHS), and the operative characteristics (Length of incision, Blood loss, operative time, and post-operative stay) including the rate of complications were noted and analyzed. Results: The important results of this study showed that the PFN group was significantly better than HHS at 3 months compared to DHS (57.60 ± 16.48 vs. 41.47 ± 20.03, p = 0.023). At 6 months (82.73 ± 12.83 vs. 65.33 ± 18.95, p = 0.006). PFN had a shorter incision length (4.27 cm vs. 15.35 cm, p < 0.001), and less blood loss (84.14 mL vs. 217.02 mL, p < 0.001). The mean operative time in PFN was significantly shorter than in the PFN group (P=<0.001). The duration of hospital stay in PFN was slightly less than DHS (7.47 days vs. 8.47 days). The radiation exposure was higher in the PFN group and the rate of complication was similar in both groups.   Conclusion: PFN offers superior functional outcomes, reduced operative time, blood loss, and hospital stay compared to DHS, despite higher radiation exposure. PFN may be preferred for intertrochanteric fractures, particularly in unstable cases.

Background: Abdominal trauma is a significant cause of morbidity and mortality, particularly among young adults. This study aimed to evaluate the clinical profile, intra-operative findings, follow-up status, and management outcomes of patients presenting with abdominal trauma at a tertiary care hospital. Methods: A total of 101 patients with abdominal trauma were enrolled. Data were collected on demographics, type of trauma (blunt vs. penetrating), clinical presentation, management approach (conservative or surgical), operative findings, postoperative course, and outcomes. Results: Blunt abdominal trauma (BAT) was observed in 54.45% of cases, while penetrating abdominal trauma (PAT) accounted for 45.54%. Males, especially in the 21–30 years age group, were most commonly affected. Pain was the predominant symptom in both trauma types. Vomiting, distension, hypotension, hematuria, and urinary retention were more frequent in BAT. Conservative management was more common in BAT (36/55 cases), while operative intervention was predominant in PAT (37/46 cases), with exploratory laparotomy being the most frequent procedure. Bowel injuries and hemoperitoneum were more common in PAT, whereas solid organ injuries were slightly more frequent in BAT. Most patients in both groups showed significant improvement by postoperative Day 7. ICU admissions and transfusion requirements were slightly higher in penetrating injuries. The majority of patients were discharged in stable condition, with blunt trauma cases having shorter hospital stays. Conclusion: Blunt abdominal trauma was slightly more common and often managed conservatively, whereas penetrating injuries required more frequent surgical intervention. Timely diagnosis and appropriate management are key to favourable outcomes in abdominal trauma.

Background: Chronic rhinosinusitis (CRS) is a common inflammatory condition affecting nose and paranasal mucosa. Anatomical variations of nose and paranasal sinuses have been implicated in the development of CRS. Objective: To investigate correlation between anatomical variations of nose and PNS with CRS. Methodology: A cross-sectional observational study was conducted on 80 participants diagnosed with CRS. Computed tomography scans were used to assess anatomical variations of nose and PNS. Results: Septal deviation was most common anatomical variation, present in 37.5% of participants. A significant association was found between anatomical variations of nose and PNS with CRS, with septal deviation and concha bullosa(31.3%) being most common variations associated with sinusitis. Conclusion: Study demonstrates a significant association between anatomical variations of nose and PNS with CRS, highlighting importance of considering these variations in diagnosis and treatment of CRS.

Background: Artificial intelligence (AI) has revolutionized various domains of healthcare, including orthodontics. One of its promising applications is in treatment planning, particularly in predicting tooth movement based on biomechanical inputs and historical datasets. Traditional methods of treatment planning often rely on manual cephalometric analysis and practitioner expertise, which may lead to variability in outcomes. AI models, particularly machine learning and deep learning algorithms, offer a data-driven, consistent, and precise approach to forecasting orthodontic outcomes. Material and Methods: A retrospective cohort study was conducted using de-identified digital records of 850 patients treated with clear aligners (Invisalign) between January 2025 and May 2025. Data was sourced from a university orthodontic clinic’s digital archive. Inclusion criteria targeted Class I malocclusion patients (ANB 0–4°, normal overjet/overbite) to minimize skeletal confounders.  Pre- and post-treatment intraoral scans (iTero Element 5D, Align Technology) were exported as high-resolution.  Result: The mean patient age was 24.3 years (±8.2), indicating a young adult population, likely typical of orthodontic treatment cohorts. 62% female and 38% male, suggesting a higher uptake of orthodontic treatment among females. AI prediction was most accurate for incisors (rotation MAE: 0.87°, translation MAE: 0.38 mm) and least accurate for molars (rotation MAE: 1.34°, translation MAE: 0.43 mm). Prediction accuracy was highest for incisors (92.3%), decreasing progressively for canines (89.7%), premolars (90.5%), and lowest for molars (88.1%). Conclusion The current findings affirm the clinical utility of AI in orthodontic prediction, especially in reducing human error, streamlining treatment, and enhancing precision. Future studies should focus on integrating patient-specific variables such as bone density, periodontal status, and three-dimensional root orientation to further optimize prediction accuracy.

Background: Unintentional injuries are one of the most important public health problems among children in developed and some developing countries. Objectives: Our purpose is to determine the clinic-epidemiological profile, its immediate outcome of child injuries in a tertiary care center. Materials and Methods: 104 children aged less than 18 years admitted in our hospital with history of intentional and unintentional accidents were analysed in this study. Demographic details, clinical parameters and outcome of the patient will be recorded at the time of discharge and all the data will be noted on excel sheet for statistical analysis. Results: In our study, 62.5% cases were aged 0-5 years; males were predominant (64.4%). Substance ingestion emerged as the leading cause of admission (25%), followed by burns and bites (25%). Majority of accidents (61.54%) occurred at home. Seventy four percent (74.04%) of cases sought medical attention within 24 hours of injury. Most cases (67.31%) presented with mild severity. The most common complication was respiratory failure (47.06%). Majority of cases (76.92%) were discharged from the hospital and 13.46% of cases resulted in death. The death rate was higher in rural areas (10.58%) compared to urban (2.88%) Conclusion: By understanding the epidemiological profiles and immediate outcomes, it becomes helpful to develop targeted prevention strategies, leading to a reduction in the incidence and severity of child injuries.

Background: Anemia in pregnancy is a major public health issue in developing countries and has been associated with adverse fetal outcomes, including low birth weight (LBW). The current study was undertaken to determine the prevalence of anemia among pregnant women delivering at GGH, Siddipet, and to evaluate its association with neonatal birth weight, thus providing localized insight into the real burden and management challenges. Objectives: 1. To determine the prevalence of anemia among pregnant women delivering at GGH Siddipet. 2. To assess the association between maternal hemoglobin levels and neonatal birth weight. Methodology: An observational study was conducted at GGH, Siddipet, for six months from October 2024 to March 2025. Those with preterm deliveries, multiple pregnancies, hypertension, diabetes were excluded. Prevalence of anemia among the participants was analysed. Haemoglobin levels were categorized as normal, mild, moderate, severe and very severe anemia. Neonatal birth weights were classified as normal or low. Statistical analysis was performed using the chi square test applied to determine the significance of association between haemoglobin levels and neonatal birth weight. Results: A total of 1745 pregnant women with term gestational age, who delivered at GGH, Siddipet were included in the study, after eliminating those with exclusion criteria. 347 (19.9%) women had anemia which is lower than the state (52.2%) and national (57%) averages. 327 had mild anemia, 16 had moderate anemia, 3 had severe anemia and 1 had very severe anemia. Among the normal Hb% group, 27.3% had LBW newborns. Prevalence of LBW is 12.3% in mild anemia group, 6.2% in moderate anemia group, 33.3% in severe anemia group and 100% in very severe anemia group. Statistically significant differences were observed between normal Hb and mild (p=0.012), moderate (p=0.00014), and very severe anemia groups (p= 3.89X 10-26). LBW rate is lower among mild and moderate anemia compared to normal Hb group and it increased with increase in severity of anemia. A chi-square test comparing birth weight distribution across all haemoglobin categories yielded a p-value of 2.99×10_52, indicating a highly significant association between maternal Hb% and neonatal birth weight. Conclusion: This study demonstrates a strong association between maternal haemoglobin levels and low birth weight, especially in cases of severe and very severe anemia. The overall prevalence of anemia in pregnancy at GGH, Siddipet (19.9%), is significantly less compared to the state (52.2%) and national figures, implying potential improvements in local antenatal care practices, nutritional supplementation, and health care access. This highlights the importance of early detection, effective management and targeted interventions. High prevalence of low birth weight even among pregnant women without anemia warrants further studies to know the cause of such low birth weight and measures to improve birth weight and fetal outcomes.

Background: Accurately predicting the success of induction of labour (IOL) is essential to minimize maternal and neonatal complications and reduce the rate of caesarean deliveries. While the Bishop score remains a widely used clinical tool, transvaginal ultrasound (TVUS) offers a more objective alternative for assessing cervical readiness. Methods: This prospective observational study enrolled 100 term pregnant women undergoing IOL at a tertiary care centre. Cervical readiness was assessed using both Bishop score and TVUS-measured cervical length prior to induction. The primary outcome was successful vaginal delivery within 24 hours. Receiver operating characteristic (ROC) curves were used to compare the predictive accuracy of both tools. Results: Women with successful inductions had significantly higher Bishop scores and shorter cervical lengths. The mean Bishop score in the successful group was 7.8 ± 1.3 versus 5.1 ± 1.4 in the unsuccessful group (p < 0.001). Cervical length was shorter in successful inductions (23.5 ± 3.2 mm vs. 28.1 ± 3.8 mm; p < 0.001). ROC analysis showed the Bishop score had an area under the curve (AUC) of 0.78, compared to 0.60 for cervical length. Conclusions: Both Bishop score and cervical length were significantly associated with induction success, but the Bishop score demonstrated superior predictive performance. Clinical assessment remains a valuable tool, especially in settings with limited access to ultrasound. 

Background: Aim: To study the clinicopathological profile of unilateral sinonasal masses in patients presenting to a tertiary care centre. Objective: To evaluate the demographic characteristics, clinical presentation, radiological findings, and histopathological diagnosis of unilateral sinonasal masses. Methodology: A hospital-based descriptive study was conducted in the Department of ENT, Government Medical College, Thiruvananthapuram, over a period of 18 months (January 2023 to June 2024). A total of 95 patients with unilateral sinonasal masses were included using a consecutive sampling method. Clinical examination, diagnostic nasal endoscopy, radiological imaging (CT/MRI), surgical intervention, and histopathological evaluation were performed. Data were analyzed using SPSS version 27, with results expressed as frequencies and percentages. Results: The most commonly affected age group was 30–39 years (21%), with a mean age of 44.7 years and a male-to-female ratio of 1.4:1. Nasal obstruction (89.5%) and nasal discharge (78.9%) were the predominant symptoms. CT imaging revealed bone erosion in 16% of cases and bone expansion in 8%. Lesions most commonly originated from the middle meatus (63%). Extension to adjacent structures was seen in 9% of cases—orbital (7.4%), intracranial (3.2%), and oral cavity (3.2%). Histopathologically, 81 cases (85%) were benign, 2 (2%) were premalignant, and 12 (13%) were malignant. Inflammatory polyps (32%) were the most common non-neoplastic lesion, followed by rhinosporidiosis (21%) and inverted papilloma (21%). Squamous cell carcinoma (5%) was the most common malignancy. Functional endoscopic sinus surgery (FESS) and excision with cauterization were the most frequently performed procedures (each 32%). Conclusion: Unilateral sinonasal masses present with varied clinical and pathological features. While many are benign, a significant proportion may be malignant. Hence, a systematic approach involving clinical, endoscopic, radiological, and intraoperative assessment—followed by histopathological confirmation—is essential. Histopathology remains the gold standard for definitive diagnosis and treatment planning.

Background: The use of topical anesthesia rather than peribulbar or retrobulbar anesthesia in cataract surgery is becoming increasingly popular. While there is akinesia of the eyelids and the eyeball during peribulbar block, the eyelids and eyeball are not static during topical anesthesia, so this difference alters the surgical manipulation and hence may affect the endothelial cell loss during surgery. Objective: To compare Endothelial cell loss between peribulbar anaesthesia and topical anaesthesia following uncomplicated phacoemulsification. Methods: The study was a hospital based prospective study where all Patients undergoing phacoemulsification with intraocular lens implantation were divided into two groups with 55 patients in each group. Group I patients underwent phacoemulsification under peribulbar anesthesia (2 percent lignocaine + adrenaline 2%) and group II under topical anesthesia (0.5 percent proparacaine or lidocaine 2 percent jelly. Results: Mean endothelial cell count and central corneal thickness was also comparable between both groups at all time period. The mean endothelial cell loss at 6 weeks postoperatively was 7.98±3.91% in group I and 11.94±3.75% in group II. Conclusion: Based on finding of our study it can be concluded that peribulbar anaesthesia was better as compared to topical anaesthesia when the endothelial cell loss was taken into consideration. 

Background: In the current era of refractive cataract surgery, accurate postoperative refractive outcomes are largely contingent upon precise preoperative ocular biometry.[4] Conventionally, A-scan ultrasonography utilizing either contact or immersion techniques has been employed for measuring axial length (AL), anterior chamber depth (ACD), and lens thickness (LT).[5,6,7] However, limitations such as corneal compression, inter-operator variability, and the risk of transmitting infections have led to an increased preference for non-contact optical biometry methods. Methods: Patients aged 40 to 70 years, diagnosed with age-related cataract, and scheduled to undergo uneventful phacoemulsification with posterior chamber intraocular lens (IOL) implantation were recruited for the study. Informed written consent was obtained from all participants, and the study protocol was approved by the Institutional Ethics Committee in accordance with the Declaration of Helsinki. A total of 100 eyes from 100 patients were included. Each participant underwent a comprehensive ophthalmic evaluation, including uncorrected and best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure measurement, and dilated fundus examination. Detailed medical history and relevant systemic investigations were also recorded. Results: indicated that optical biometry demonstrated superior precision and refractive accuracy. Nonetheless, A-scan ultrasonography remains indispensable in resource-constrained settings. The findings underscore the importance of selecting appropriate biometry techniques based on individual patient characteristics. Further multicentric studies are recommended to validate these results and optimize cataract surgery planning in diverse clinical environments. Conclusion: While the advantages of optical biometry are evident, especially in terms of precision and refractive accuracy, the role of immersion A-scan remains indispensable in resource-limited settings.

Background: Impaired cognition is an important complication of hemodialysis that remains largely unrecognized. Studies suggest that approximately one-third of hemodialysis patients may develop dementia, many of whom have previously suffered from mild cognitive impairment (MCI). Advancement from chronic kidney disease (CKD) to end-stage renal disease (ESRD), which requires hemodialysis, is associated with declining cognition, possibly due to the accumulation of uremic toxins, hemodynamic fluctuation, and inflammation. Aimed to assess the presence and extent of cognitive impairment in patients with CKD undergoing hemodialysis and to identify contributing factors. Material & Method: The cross-sectional study was performed at BLDE (DU), Shri B.M. Patil Medical College Hospital and Research Centre, Vijayapura, for a duration of 18 months (May 2023 – December 2024). 64 patients on maintenance hemodialysis were screened for cognitive impairment using the Montreal Cognitive Assessment (MoCA). Data was processed with SPSS software Version 20 and independent t-tests with Chi-square tests were used to determine significance (p<0.05). Results: The mean age of participants was 52.67±14.2 years, with 62.5% males and 37.5% females. Hypertension (50%) and diabetes (31.3%) were common comorbidities. Cognitive impairment was present in 40.6% of patients. Patients with cognitive impairment had significantly longer CKD duration (2.5 years vs. 1.6 years) and hemodialysis duration (8.6 months vs. 3.5 months) (p<0.05). Conclusion: Patients undergoing hemodialysis usually experience cognitive difficulties, which is linked with the length of time the patients have suffered from CKD or undergone dialysis. Proactively addressing these factors through prompt screening and intervention is necessary in order to lessen cognitive deterioration and enhance overall patient wellbeing.

Background: The lumbar spine is a complex structure providing support and flexibility, but its intricacy makes it prone to injury and pain. AIM: To study the efficacy of fluoroscopic guided caudal epidural steroid injection in management of low back pain.  Methodology: A hospital-based prospective study was conducted in the Department of Orthopaedics and Trauma Centre at Sardar Patel Medical College, Bikaner, over a one-year period from May 2023 to April 2024, starting from ethical clearance until the completion of the sample size. Result: Our study found that patients with a mean age of 45.38 ± 12.13 years, predominantly in the 41–60 age group, showed significant improvements in pain, functionality, and quality of life after caudal epidural block, with 94.55% cured and 80% achieving good outcomes, consistent with similar studies. Conclusion: Fluoroscopic-guided caudal epidural steroid injection is a simple, effective, and minimally invasive procedure that significantly alleviates chronic low back pain, improving patients' quality of life.

Background: A number of studies have revealed an inverse correlation between vitamin D levels and body mass index (BMI). Objective: To examine the concentration of 25-hydroxyvitamin D (25[OH]D) in apparently healthy females of age group 30-60 years and its association with BMI. Methodology: This was an observational cross sectional study. About 100 apparently healthy females were evaluated for BMI (height, weight) and their serum 25 hydroxyvitamin D (25[OH]D) levels were done. Appropriate statistical analysis was done to find the vitamin D and BMI status amongst study participants. Correlation analysis was done to find relationship of vitamin D with body mass index. Results: Our study demonstrated that 18% participants were found to be vitamin D sufficient, 70% were insufficient and 12 % were deficient. About 65 % were found to be obese. Vitamin D status comparison between obese and non-obese group by Chi square test showed a significant difference (p < 0.0001). 25(OH)D levels showed significant negative correlation with BMI (r = − 0.785). Conclusions: Vitamin D levels should be assessed in females with higher BMI. This may be helpful in treatment of obesity and prevention of further complications.

Background: Life expectancy of people who are infected with Human immune deficiency virus are most important in providing valuable information to patients regarding their prognosis in long term, in estimating the future costs associated with HIV related care, in predicting the probable future socioeconomic and demographic impact of HIV. The life anticipation gauges of HIV positive grown-ups in developing countries have been distributed, and numerous of these thinks about have appeared critical enhancements in life hope after the presentation of highly active antiretroviral treatment (cART). Materials And Methods: This is a Descriptive and Cross sectional study. Clinical epidemiological profile was collected from patient file available in ART centre as mentioned in annexure 1 was assessed by WHO questionnaire as mentioned in annexure 2. Study was initiated after approval was obtained from the institutional ethics committee. Study related procedures and enrolment of eligible subjects was done only after obtaining an informed consent from the patient. Confidentiality of patient’s details was maintained at all levels using appropriate coding. Subjects fulfilling inclusion & exclusion criteria were enrolled in to the study. 300 records were collected from ART centre KMC Attavar ID clinic ART centre who are on cART for A minimum of ten years. Results: In age distribution 18 to 20 years are 2%, 21 to 30 are 15%, 31 to 40 50.3%, 41 to 50 are 24.3%, 51 to 60 are 6.7%, 61 to 70 are 1.3% and 71 to 80 are 1%. This indicates main age group affected is between 31 to 40 years indicating young age group is mainly affected. 70% were male patients and 30% were female indicating more number of HIV cases in male population. 93.3% of HIV patients were heterosexual, 2 % were homosexual, 4.7% was mother to child transmission. 42% of HIV+ve patients had reactive or HIV +ve spouses and 29% had non-reactive spouses whereas it was not applicable for28.7 % (unmarried /widowed). 53.3% of HIV +ve cases did not have any opportunistic infections. i.e. approximately 47% had opportunistic infections.16.7% of HIV +ve cases had pulmonary Tuberculosis followed by extra pulmonary tuberculosis being 9.3% and pulmonary TB with candidiasis being 4.3 %.  Conclusion: In our study Major age group affected are between age 31-40 years. In our study we found increased incidence of HIV infection in males, in rural areas and in low education statuses peoples. Most common mode of transmission was sexual (heterosexual mode). CD4 count improved after initiating patient on cART. Incidence of Opportunistic infections has decreased in those who were on cART.

Background: Malignant phyllodes tumours (MPTs) are uncommon fibroepithelial breast neoplasms, comprising less than 1% of all breast tumours. While most are managed effectively with surgical excision, malignant variants may demonstrate aggressive behaviour, including local recurrence and distant metastasis. Lung is the most frequent metastatic site; however, lymphatic spread—particularly to axillary nodes—is rare. Chest wall and diaphragmatic invasion are even more uncommon and often indicate advanced disease. Case Presentation: We report a rare case of a 42-year-old female who presented with a progressively enlarging mass in the left breast. Imaging revealed a suspicious BI-RADS 4B lesion, and core biopsy suggested a phyllodes tumour. She underwent a left mastectomy with sentinel lymph node biopsy, which was initially negative. Histopathology confirmed malignant phyllodes tumour. The patient completed six cycles of adjuvant chemotherapy and was stable until January 2025, when she developed respiratory symptoms. Imaging revealed multiple spiculated lung nodules, chest wall invasion, diaphragmatic extension, and malignant pleural effusion. Cytological and histopathological analysis confirmed metastatic phyllodes tumour. Notably, axillary lymph node metastasis was also confirmed—an extremely rare finding in MPTs. Despite resumption of chemotherapy, the patient succumbed to the disease. Conclusion: This case illustrates an exceptionally aggressive presentation of MPT with synchronous pulmonary, pleural, diaphragmatic, chest wall, and axillary lymph node involvement. Comparison with existing literature underscores the rarity of such dissemination patterns. It highlights the need for clinicians to remain vigilant for atypical metastatic routes and advocates for further research into molecular markers and tailored therapeutic approaches.

Background: Perforation peritonitis, a life-threatening surgical emergency, results from the rupture of a hollow viscus and subsequent contamination of the peritoneal cavity. Accurate prediction of morbidity and mortality is essential for timely intervention and optimal patient management. Scoring systems such as the Mannheim Peritonitis Index (MPI) and the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) are widely employed to estimate patient outcomes. Objectives: This study aimed to compare the efficacy of the MPI and POSSUM scoring systems in predicting morbidity and mortality among patients with perforation peritonitis. A secondary objective was to identify postoperative complications commonly associated with different scoring categories. Methods: A prospective observational study was conducted over two years (2023–2025) at S.N. Medical College, Agra, involving 100 patients aged 18–60 years diagnosed with perforation peritonitis. Data on clinical parameters, intraoperative findings, and postoperative outcomes were collected. MPI and POSSUM scores were calculated and analyzed using ROC (Receiver Operating Characteristic) curves to determine their predictive accuracy. Results: The patient cohort had a nearly equal gender distribution (52% males, 48% females) and a mean age of 41 years. ROC analysis revealed an optimal MPI cut-off of 27, yielding 91.7% sensitivity and 88.9% specificity (AUC = 0.940), while POSSUM had a cut-off of 0.4750 with 91.7% sensitivity and 90.5% specificity (AUC = 0.944). POSSUM demonstrated slightly better predictive performance. Higher MPI scores were significantly associated with increased mortality and postoperative complications. Conclusion: Both MPI and POSSUM are effective in predicting morbidity and mortality in perforation peritonitis. POSSUM exhibits marginally superior accuracy, but MPI remains a simpler, condition-specific tool. Implementing these scoring systems can enhance risk stratification, surgical planning, and overall patient outcomes.

Background: Sedation is essential for patient comfort during various procedures. Dexmedetomidine and propofol are widely used sedatives with differing hemodynamic effects. This study aimed to compare their impact on heart rate, blood pressure, adverse events, recovery, and patient satisfaction. Methods: A prospective randomized study was conducted on 200 adult patients undergoing elective procedures, randomized equally to receive dexmedetomidine or propofol sedation. Hemodynamic parameters, adverse events, recovery times, and patient satisfaction were recorded and analyzed. Results: Baseline characteristics were comparable between groups. Dexmedetomidine caused a significantly greater maximum decrease in heart rate (18.3 ± 5.7 vs. 10.5 ± 6.1 bpm; p<0.001), while propofol caused a larger decrease in mean arterial pressure (28.9 ± 8.5 vs. 22.7 ± 7.3 mmHg; p<0.001). Hypotension and need for vasoactive drugs were more frequent with propofol (p=0.004 and p=0.01 respectively), whereas bradycardia was higher with dexmedetomidine (p=0.001). Recovery time was shorter with propofol (24.3 ± 6.2 vs. 32.8 ± 7.5 min; p<0.001). Patient satisfaction scores favored dexmedetomidine (p=0.003), with similar sedation quality. Postoperative nausea was less common in the dexmedetomidine group (p=0.02). Conclusion: Dexmedetomidine provides more stable hemodynamics and better respiratory safety but slower recovery compared to propofol. Sedative choice should consider patient risk factors and procedural needs.

Background: Button battery ingestion in children is a serious medical emergency due to the potential for severe esophageal injury, even in asymptomatic cases. Early diagnosis and prompt removal are crucial to prevent complications such as perforation, fistula formation, or stricture development. Case Presentation: We report the case of a 10-year-old girl who presented to the emergency department with a history of button battery ingestion from a watch toy six hours before presentation. The child informed her mother immediately after the incident. She remained asymptomatic except for mild abdominal discomfort, with no signs of respiratory distress, dysphagia, or systemic symptoms. A chest X-ray (posteroanterior and lateral views) confirmed the presence of a button battery in the esophagus. Given the high risk of mucosal injury, the patient was prepared for emergency endoscopy. The endoscopy revealed a button battery impacted in the lower esophagus, with deep ulceration and severe sloughing (Grade 3A injury). The foreign body was successfully removed using forceps, and the patient was admitted to the pediatric intensive care unit (PICU) for observation. A contrast- enhanced computed tomography (CECT) scan ruled out esophageal perforation, and the patient was discharged in stable condition on supportive management. Conclusion: This case highlights the importance of early endoscopic intervention in button battery ingestion cases, even when symptoms are minimal. The rapid onset of significant esophageal injury underscores the need for urgent diagnosis and removal to prevent severe complications.

Introduction: Pancreatic pseudocyst is a frequent complication of pancreatitis and pancreatic trauma, with significant morbidity if not managed appropriately. Understanding its etiopathogenesis, clinical presentation, and therapeutic options is crucial for timely intervention and improved patient outcomes. Despite advances in imaging and intervention techniques, the condition may still lead to severe complications or mortality if not properly addressed. Materials and Methodology: This prospective observational study was conducted on 40 patients diagnosed with pancreatic pseudocyst over a defined period. Patients were evaluated based on demographic data, clinical features, imaging findings, and treatment modalities. CECT abdomen was used as the primary diagnostic tool, supplemented by Endoscopic Ultrasound (EUS), ERCP, or CT angiogram as required. Management strategies were selected based on cyst size, wall maturity, symptom severity, and presence of complications. Outcomes and post-intervention complications were recorded and analyzed. Results: The majority of patients were males, predominantly aged 31–40 years. Alcohol consumption was the most common etiological factor, followed by biliary tract disease and abdominal trauma. Persistent abdominal pain was the leading symptom, with others including gastrointestinal obstruction and infection. Small, uncomplicated cysts (<6 cm) were successfully managed conservatively. Larger or symptomatic cysts required intervention—ultrasound-guided drainage in select cases, endoscopic drainage in stable patients, and surgical drainage in complicated or necrotic cases. Surgical drainage had the lowest recurrence but longer hospital stays. Post-intervention complications included bleeding, perforation, and pancreatic fistula. Conclusion: Early diagnosis, appropriate modality selection, and complication management are key in improving outcomes in pancreatic pseudocyst cases. Patient education and resource optimization remain essential.

Background: Midshaft tibial fractures are common injuries requiring surgical intervention for optimal healing and function. Plate fixation and intramedullary nailing are established methods, each with distinct advantages and drawbacks. Aim: To comparatively evaluate the clinical and radiological outcomes of plate fixation versus intramedullary nailing in midshaft tibial fractures. Methods: A prospective observational study was conducted involving 120 patients with midshaft tibial fractures, divided equally into plate fixation (n=60) and intramedullary nailing (n=60) groups. Demographic data, time to clinical and radiological union, functional outcomes, complications, and radiological alignment were assessed over a minimum follow-up of 12 months. Statistical analyses included t-tests and chi-square tests, with significance set at p<0.05. Results: The intramedullary nailing group showed significantly shorter time to clinical union (16.7 vs. 18.9 weeks, p=0.003) and radiological union (18.9 vs. 21.4 weeks, p=0.005). Functional outcomes measured by LEFS were better in the nailing group (78.1 vs. 73.8, p=0.003). Plate fixation demonstrated superior radiological alignment with less varus-valgus and anterior-posterior angulation (p=0.001 and p=0.010, respectively). Infection rates, implant failure, and nonunion were comparable between groups. Conclusion: Intramedullary nailing promotes faster fracture healing and improved functional recovery, while plate fixation provides better anatomical alignment. Treatment choice should be tailored considering patient and fracture-specific factors.

Background: Distal radius fractures are common in the elderly and can be managed surgically or conservatively. Optimal treatment remains controversial due to age-related factors and fracture complexity. Aim: To compare the clinical and functional outcomes of surgical versus conservative management in elderly patients with distal radius fractures. Methods: A prospective comparative study was conducted on 200 patients aged ≥60 years with distal radius fractures. Patients were divided into surgical (n=100) and conservative (n=100) treatment groups. Baseline demographics, functional outcomes (DASH, PRWE scores, grip strength, wrist range of motion), radiological parameters (volar tilt, radial inclination, ulnar variance), complications, and patient satisfaction were assessed over six months. Statistical analysis involved t-tests and Chi-square tests, with p<0.05 considered significant. Results: Both groups were comparable in baseline characteristics (p>0.05). The surgical group demonstrated significantly better functional outcomes with lower DASH (18.6 vs. 27.3; p<0.001) and PRWE scores (20.1 vs. 29.5; p<0.001), greater grip strength (78.2% vs. 66.5%; p<0.001), and improved wrist range of motion (72.9° vs. 62.7°; p<0.001). Radiological alignment was superior in the surgical group (p<0.001). Although infection rates were higher post-surgery (7% vs. 1%; p=0.02), overall patient satisfaction favored surgical management (4.2 vs. 3.4 on Likert scale; p<0.001). Conclusion: Surgical management provides better functional and anatomical outcomes than conservative treatment in elderly distal radius fractures, with acceptable complication rates. Treatment should be individualized considering patient factors.

Introduction: Sjögren’s syndrome (SS) is a systemic autoimmune disorder that classically presents with xerostomia and xerophthalmia. However, extraglandular manifestations such as distal renal tubular acidosis (RTA) and neurological complications may occur and precede typical symptoms. Recognizing such atypical presentations is critical to avoid misdiagnosis and irreversible complications. Case Presentation: We report a case series of three young female patients who presented to the emergency department with acute flaccid paralysis, weakness, or altered sensorium. Laboratory evaluation revealed non-anion gap metabolic acidosis with severe hypokalemia, consistent with distal RTA. None of the patients had prior autoimmune diagnoses, and two lacked classical sicca symptoms. Autoimmune workup showed positive antinuclear antibodies and strongly elevated anti-SSA and anti-SSB antibodies, confirming primary Sjögren’s syndrome (pSS). One patient also developed metabolic encephalopathy with MRI-confirmed osmotic demyelination. Another was pregnant, raising concerns about fetal complications due to transplacental passage of autoantibodies. Management and Outcome: All patients received intravenous potassium correction followed by oral bicarbonate and potassium citrate. Neurological improvement was seen in all three cases. One patient required mechanical ventilation and intensive care for encephalopathy but eventually stabilized. Conclusion: Distal RTA may be the first clinical manifestation of pSS, especially in young women presenting with hypokalemic paralysis. Neurological and obstetric implications underscore the systemic nature of the disease. Autoimmune screening, including ANA and anti-Ro/La antibodies, should be considered in patients with unexplained electrolyte abnormalities or neuromuscular symptoms.

Introduction: The JN.1 variant of SARS-CoV-2, a sublineage of the Omicron BA.2.86 strain, has emerged as a globally dominant COVID-19 variant since its first identification in August 2023. This variant demonstrates increased transmissibility, immune escape, and public health implications due to key spike protein mutations. Objective: To systematically review the virological, clinical, epidemiological, therapeutic, and preventive characteristics of the JN.1 variant, and assess its impact on global COVID-19 containment strategies. Methods: A systematic literature search was performed using PubMed, Scopus, MEDLINE, and Web of Science for studies published between January 2023 and April 2025. Studies focusing on the biology, transmission, clinical effects, vaccine response, and antiviral treatment related to the JN.1 variant were included. Quality assessment was done using NOS and Cochrane tools. Data synthesis was narrative due to heterogeneity. Results: Fifty studies met the inclusion criteria. JN.1 exhibited key spike mutations (L455S, S456L) associated with increased ACE2 affinity and immune evasion. It accounted for over 95% of sequences globally by early 2024. Hospitalization and ICU admissions increased significantly, although case fatality remained low (0.34%). Breakthrough infections were reported in 25% of triple-vaccinated individuals. Updated mRNA boosters and antivirals like Paxlovid remain effective, but monoclonal antibody therapies showed diminished efficacy. Conclusion: JN.1 represents a significant evolution in SARS-CoV-2 with increased global prevalence and partial vaccine resistance. Ongoing genomic surveillance, widespread use of updated vaccines, early antiviral interventions, and reinforcement of public health measures are essential to limit its impact.

Background: The study examines the impact of storage conditions on the stability of various serum biochemical analytes. Delayed serum separation and prolonged storage may alter the test results, potentially affecting clinical decision-making. AIM: To determine changes in analytes stored at –20°C over different periods. Materials And Methods: Around 6ml of blood samples were collected from 40 healthy individuals aged 25 to 40 years then centrifuged and separated into aliquots for analysis. The analytes were tested for serum glucose, total proteins, sodium, potassium, urea, creatinine, chloride, AST, ALT, and ALP. Samples were analyzed at different time points --0, 1, 3, 7, 14, 21, and 30 days—using standard biochemical methods. Statistical analysis was performed to evaluate changes in analyte levels over time, providing insights into their stability under storage conditions. Results: Significant changes were observed in Glucose, AST, ALT, Creatinine, and Potassium levels. No significant variations were noted in Sodium, Total Protein, Urea, Chloride, and ALP levels. Conclusion: Prolonged storage affects certain biochemical analytes, particularly Glucose, AST, ALT, Creatinine, and Potassium. Blood samples should be processed promptly to ensure accurate laboratory results and prevent misinterpretation. The findings can help to determine optimal assay timelines for stored samples.

Background: Lichtenstein mesh hernioplasty is a tension-free open surgical technique for inguinal hernia repair where a polypropylene mesh is used to support the inguinal muscular layer and repair the defect with fixation of mesh over the hernial defect. The original technique for fixation of mesh in Lichtenstein hernioplasty used non-absorbable sutures placed medially near the pubic periosteum and the upper corner of the mesh, and continuous sutures along the inguinal ligament. Chronic pain is the most common complication observed after hernia repair causing hinderance to patient’s day to day activities. Aims and objectives: This study presents a modification of Lichenstein Inguinal tension free repair by fixation of mesh with a single air knot over the conjoint tendon by a delayed absorbable suture material Materials and Methods: This prospective study was conducted over 200 patients with uncomplicated inguinal hernia. The hernia was repaired with the modification in Lichenstein technique of tension free hernioplasty and patient followed for 1 year for any complication like pain, recurrence, wound infection, paraesthesia and foreign body sensation. Results: The study clearly shows that the modification in technique for inguinal hernia leads to less or no post-operative pain, early return to home and no early recurrences after 1 year. Hence, mesh fixation with delayed absorbable suture with a single air knot is a good alternative for hernia repair.

Background: Landslides in mountainous regions are typically natural disasters that commonly cause blunt force injuries and burial-related trauma. However, deaths resulting from soil aspiration and mechanical asphyxia are rarely reported and insufficiently documented. This case series presents autopsy findings and explores the medico-legal aspects of fatalities caused by soil aspiration and asphyxia in recently reported incidents. Methods: We examined five fatal landslide cases resulting from three separate incidents in a hilly area of Uttarakhand, India, related to ongoing construction activities. Of the five victims, three were declared dead on arrival, while the remaining two succumbed within an hour of reaching the hospital. Detailed autopsies were performed on all individuals. Results: Both gross and microscopic examinations revealed the presence of soil particles in the airways and stomach. In each case, the cause of death was identified as mechanical asphyxia due to soil aspiration, with no significant traumatic injuries observed. None of the victims had any pre-existing medical conditions that contributed to their deaths. Conclusion: Fatalities resulting from landslide debris inhalation and traumatic asphyxia are infrequently documented in medical literature. To reduce such incidents, especially at under-construction sites, it is crucial to promote awareness campaigns focusing on safety measures and engineering precautions. Additionally, understanding these mechanisms is vital for accurate postmortem diagnosis and effective disaster response planning.

Background: WHO defines self-care as the ability of individuals, families and communities to promote their own health, prevent disease, maintain health, and to cope with illness with or without the support of a health or care worker. Despite the self-care practices having paramount importance and raising prevalence of diabetes, very few studies have been conducted, and research was initiated with an aim of assessing the Knowledge on diabetes and self-care practices and its determinants among diabetic population. Methodology: A community based Cross Sectional Survey was conducted among adult diabetic populations with 18 and above years in Balaji Nagar, a Urban field practice area of a Government medical College, Ongole   from October to November 2024. As per n= 4pq/l² sample size was 210and there are 7 secretariats under Balaji Nagar UHC and from each secretariat, a sample of 30 Diabetic patients was obtained residing in the area. An Ethical approval was obtained and Informed consent was secured from all the participants. The Diabetes Knowledge Questionnaire (DKQ) used to gather information about knowledge on diabetes and questions about self-care behaviors were taken from a related survey done in Andhra Pradesh. Data was analyzed using descriptive statistics, test of significance for associated factors, and chi square test to determine the association between various Sociodemographic determinants and self-care practices and knowledge. Results: Out of total 210 participants females (54.3%) slightly outnumbered males (45.7%). The majority (64.3%) were on a single-drug oral hypoglycemic agent (OHA). The mean knowledge score was 12.41 (SD: 4.89), with 60.5% of participants demonstrating good knowledge of diabetes. Only 47.9% engaged in any major physical activity apart from daily activities. A majority (58.1%) consumed green leafy vegetables 1-2 times per week, 55.1% checked for blood glucose levels as per doctor's advice. 62.9% reported taking medications regularly. 52% of the study population is found to be adhering to self-care. Participants with good diabetes demonstrated significantly better self-care practices (p<0.001). Conclusions: A significant proportion (28.1%) were unaware of diabetes monitoring tool HbA1C testing. This gap highlights the need for increased awareness and accessibility of diagnostic facilities.  Focused education programs will improve self-care among Diabetic patients.

Background: Neonatal seizures are critical indicators of underlying neurological dysfunction and are associated with high morbidity and mortality. Early identification of etiological factors is essential for timely management and better outcomes. Objectives: To study the clinico-etiological profile of neonatal seizures and evaluate their outcomes in neonates admitted to the neonatal intensive care unit (NICU). Methods: This prospective observational study was conducted in Department of Paediatrics, CAIMS, Karimnagar over 12 months in a tertiary care NICU and included 60 neonates presenting with seizures. Detailed clinical history, biochemical investigations, neuroimaging, and EEG (where available) were used to determine the etiology. Outcomes were assessed at discharge. Results: Of the 60 neonates, 60% were male and 46.7% had a birth weight <2.5 kg. Subtle seizures were the most common type (46.7%), followed by tonic (23.3%) and clonic seizures (16.7%). Hypoxic-ischemic encephalopathy (36.7%) was the leading cause, followed by metabolic (20%) and infectious (16.7%) etiologies. Biochemical abnormalities included hypoglycemia (30%) and hypocalcemia (16.7%). Ventilator and inotrope support were required in 30% and 23.3% of cases, respectively. At discharge, 53.3% had a favorable outcome, 16.7% had neurological sequelae, and 20% succumbed to illness. Conclusion: HIE and metabolic disturbances remain the predominant causes of neonatal seizures. Subtle seizures are the most frequent and often underdiagnosed, emphasizing the need for improved diagnostic vigilance. Early recognition and management can significantly improve outcomes.

Background: Bacteremia is a life-threatening condition requiring prompt diagnosis and treatment. Clinical signs of bacteremia often overlap with non-infectious inflammatory responses, leading to diagnostic uncertainty and potentially inappropriate empirical antibiotic use. Artificial intelligence (AI) offers a novel approach to enhance early detection of bacteremia and support clinical decision-making in ICU settings. Aim and Objectives: Aim: To evaluate the utility of an AI-based model in predicting bacteremia in critically ill patients. Objectives: To develop and externally validate an AI-based Bacteremia Prediction Model (AI-BPM). To compare AI predictions with blood culture reports to assess diagnostic accuracy. Methodology: A prospective observational study was conducted in the Medical ICU of GG Hospital from January 2024 to January 2025. A total of 566 patients with at least one blood culture sample were included. A Random Forest Classifier was developed using Python 3.7.3. The dataset was split into training (80%) and testing (20%) sets. Input variables included clinical signs, lab markers, comorbidities, APACHE IV score, and exposure history. Model predictions were compared against culture-confirmed bacteremia to assess performance. Results: The AI-BPM demonstrated excellent diagnostic performance: AUROC: 0.93, Sensitivity: 90, Specificity: 100%, Precision (PPV): 100%, F1 Score: 95% The model showed strong agreement with blood culture results and outperformed several previously published AI-based models in sensitivity and specificity. Conclusion: The AI-BPM is a reliable, data-driven tool for early identification of bacteremia in ICU patients. Its high accuracy and specificity can support timely, evidence-based decisions on antimicrobial use, contributing to better patient outcomes and antimicrobial stewardship. Wider validation and real-time integration into clinical practice are recommended.

Background: Neonatal sepsis is a serious infection occurring within the first 28 days of life. It is a significant cause of mortality and morbidity. Red cell distribution width (RDW) and Mean Platelet Volume (MPV)  is estimated within the standard CBC profile and considered a simple tool for the diagnosis of neonatal sepsis without any additional cost.  Aim of this study is to investigate the potential role of red cell distribution width (RDW) and MPV in the diagnosis of early-onset neonatal sepsis (EONS and prognosis of early-onset neonatal sepsis (EONS). Materials And Methods: This is a prospective observational study conducted at the Neonatology department at a tertiary care hospital in Telangana. A total of 200 newborn babies with suspected early onset sepsis were enrolled in our study. Of which 161 were preterm babies, 39 babies were term and 7 babies were very preterm .C-reactive protein, and blood culture of all the babies were compared with Red Cell Distribution width (RDW) and Mean Platelet Volume (MPV) and Evaluated the role of Red Cell Distribution width (RDW) and Mean Platelet Volume (MPV) as an early diagnostic marker of early-onset neonatal sepsis (EONS). Results: Considering CRP as gold standard for sepsis; at RDW cut value of ≥18- we found that Sensitivity 86%; Specificity 76%; Positive predictive value(PPV)-55%; Negative predictive value(NPV)-94%; and Accuracy-79%; Considering CRP as gold standard for sepsis; at MPV cut value of ≥8.5- we found that Sensitivity 92%; Specificity 68%; Positive predictive value( PPV)-49%; Negative predictive value (NPV)-96%; and Accuracy 74%. In Our study the mean RDW was significantly higher in CRP positive EONS cases (p<0.001). RDW combined with MPV has a potential role as early marker in diagnosing and  predicting prognosis in early onset neonatal sepsis Conclusions: This study revealed that RDW and MPV have a potential role in  the diagnosis and prognosis of early-onset neonatal sepsis. As they are simple, less expensive, easily available, and easily repeated, routinely done with Complete Blood count (CBC), RDW and MPV are good early diagnostic marker of Early neonatal sepsi and good indicator for prognosis of Early neonatal sepsis.

Background: Snakebite is a neglected tropical disease (NTD) responsible for immense suffering, disability, and premature death. In 2020 with 24,437 cases Maharashtra ranked first in India for snakebite envenomation.  Objective: To study the clinico-epidemiological profile and outcome of snake bite cases presenting to a tertiary care teaching hospital. Materials and Methods: A record based retrospective study was carried out in a tertiary care teaching hospital in western Maharashtra and all snake bite cases from 1st January 2023 to 31st December 2023 were included in the study. Data regarding demographic factors, history of snakebite, clinical features, complications, details of treatment received and outcomes of the snake bite victims were recorded.  Results: Total of 201 snake bites were noted in the year of 2023. Majority of the snake bites were in month of June (20.4%) and during night time (47.8%). Most of the snake bites were in males (76.1%). Non-venomous snake bite was seen in 59.2% cases and venomous in 40.8%. In majority of cases snake bites were in lower extremities (85.6%). ASV was received by 73.1% of snake bite cases. Most patients had complete recovery while few (9.5%) developed complications like gangrene, cellulitis, acute kidney injury and respiratory failure. Case fatality due to snake bite noted to be 2.5%.  Conclusion: Most of the snake bites occurred in the monsoon and post monsoon months, in young males. Creating awareness regarding snake bite and preventive measures with emphasis on personal protective measures must be done in communities frequently.

Background: Urolithiasis, particularly ureteric stone disease, poses a significant global health burden with increasing prevalence, driven by factors such as obesity, dietary habits, and geographic variations. Effective management of proximal ureteric stones remains challenging due to variability in stone characteristics and patient factors, necessitating comparative evaluation of treatment modalities like Percutaneous Nephrolithotomy (PCNL) and Ureteroscopic Lithotripsy (URSL), using holmium laser. Aim and Objectives: This prospective observational study aimed to compare the outcomes of PCNL and URSL in managing proximal ureteric stones up to 2 cm, focusing on stone-free rates, operative time, duration of hospitalization and intra- and postoperative complication rates.  Methods: The study was conducted at S.N. Medical College, Agra, from January 2023 to December 2024, which enrolled 80 patients (aged 18–60 years) with proximal ureteric stones, up to 2 cm in size, randomly assigned to miniPCNL (n=40) or URSL (n=40) groups. Patients with concomitant renal stones, prior ipsilateral endourological procedures, or uncontrolled comorbidities were excluded. Data on demographics, surgical duration, hospital stay, residual stones, and intraoperative and postoperative complications were collected and analyzed using chi-square tests. Results: The study population predominantly comprised of males (70%) and individuals aged 18–40 years (65%). mPCNL demonstrated a higher stone-free rate (95%) compared to URSL (75%) (p=0.012), with residual stones in 5% versus 25% of cases, respectively. Operative time was significantly longer for mPCNL (all ≥100 minutes) than URSL (82.5% cases of <100 minutes) (p<0.001). Hospital stay was notably extended in mPCNL (all ≥6 days) versus URSL (90% cases of <6 days) (p<0.001). Intraoperative (mPCNL: 7.5%, URSL: 12.5%) and postoperative complication rates (mPCNL: 7.5%, URSL: 12.5%) showed no significant difference (p=0.456). Conclusion: PCNL is more effective for achieving stone-free status in proximal ureteric stone management but entails longer surgery and hospitalization. URSL provides quicker recovery with acceptable outcomes for smaller stones. Treatment selection should be tailored to stone size, patient health, and resource availability to optimize outcomes.

Background: Stress urinary incontinence (SUI) is a prevalent condition among and women, significantly impairing quality of life. Surgical options like Trans-obturator Tape (TOT) and Tension-Free Vaginal Tape (TVT) are commonly employed. This study compares the surgical outcomes of TOT and TVT regarding quality-of-life improvement, complication rates, and recurrence. Materials and Methods: A prospective analytical study was conducted at SN Hospital, Agra, between January 2023 and December 2024. Forty female patients diagnosed with SUI were enrolled and randomized into two subgroups. Patients were treated with either TOT or TVT and followed up at 6 months, 1 year, and 2 years. Outcomes were assessed through Quality of Life (QoL) scores, continence rates, and complication analyses. Results: Quality of Life (QoL) scores improved significantly (p<0.001), with continence rates increasing from 55% at 6 months to 75% at 2 years. Complication rates declined consistently, and recurrence of incontinence significantly decreased (p=0.00021). Trans-obturator Tape (TOT) procedures had a shorter operative time compared to Tension-Free Vaginal Tape (TVT) (p<0.001), offering a potential advantage in surgical efficiency and patient recovery. Conclusion: TOT and TVT effectively improve continence and quality of life in women with SUI, with complications decreasing over time. TOT offers the added benefit of shorter surgery duration and faster recovery.

Background: Female bladder outlet obstruction (FBOO) is an uncommon but increasingly recognized cause of lower urinary tract symptoms (LUTS) in women. It often leads to impaired voiding and reduced quality of life. While medical therapy may offer relief, surgical intervention, such as bladder neck incision (BNI), is indicated when conservative measures fail. However, long-term outcomes and complication profiles of BNI in women remain inadequately studied. So this was aimed at studying the Bladder Neck Incision in Female Bladder Outlet Obstruction  Objectives: To evaluate the long-term outcomes of bladder neck incision (BNI) for bladder neck obstructions in women. To find out the incidence of various cases of female bladder outlet obstruction.  To identify the post-operative complications in different cases of female bladder outlet obstruction Methodology: A prospective observational study was conducted on 50 female patients diagnosed with bladder outlet obstruction and treated with BNI. Data collected included follow-up quality of life (QoL) scores at 6 months, 1 year, and 1.5 years, voiding function, residual urine volume, severity of obstruction, surgical approach, and postoperative complications. Statistical analysis involved repeated measures ANOVA, chi-square tests using SPSS v26. Results: Significant improvement in QoL scores was observed over time: 11.94 ± 2.68 at 6 months, 10.58 ± 2.34 at 1 year, and 9.56 ± 1.83 at 1.5 years (p < 0.001). Postoperative voiding difficulty was absent in 54% of patients, and mean residual urine volume was 25.02 ± 10.08 mL. At 1.5 years, 86% of patients were complication-free, with lower complication rates associated with transurethral and one-slit procedures. Conclusion: BNI is a safe and effective treatment for FBOO in women, providing sustained improvements in quality of life and voiding parameters. Complication rates decrease over time, with procedural approach and obstruction severity significantly influencing outcomes.

Background: Borderline Personality Disorder (BPD) is a severe and chronic psychiatric condition characterized by emotional dysregulation, impulsivity, interpersonal dysfunction, and a increased sensitivity to perceived abandonment. Individuals with BPD often experience comorbid mood disorders, self-injurious behaviors, and difficulties in maintaining stable relationships. When such individuals assume parenting roles, their psychopathology can significantly influence parenting behaviors and negatively impact child developmental outcomes. This systematic review aims to evaluate and synthesize current evidence regarding parenting practices in individuals with BPD and the emotional, behavioral, and psychological outcomes experienced by their children. Methods: A systematic literature search was conducted across multiple databases including PubMed, Scopus, MEDLINE, Cochrane Library, and Google Scholar for articles published between 2014 and 2025. Inclusion criteria encompassed English-language studies assessing parenting in clinically diagnosed BPD or BPD-trait populations and associated child outcomes. Eight studies met the eligibility criteria and were analyzed for this review. Results: Findings reveal that parents with BPD frequently demonstrate elevated parenting stress, low self-efficacy, emotional insensitivity, and inconsistent caregiving behaviors. Children of these parents are at increased risk for emotional and behavioral dysregulation, insecure attachment, and poor autonomy development. Additionally, adverse perinatal outcomes were more prevalent among mothers with BPD. Risk of bias analysis showed a moderate-to-high variability in study quality. Conclusion: The review underscores a consistent association between BPD-related psychopathology and maladaptive parenting, contributing to negative intergenerational outcomes. There is a critical need for trauma-informed, parent-focused interventions to support this vulnerable population and to promote healthier developmental trajectories for their children.

Background: Vitamin D deficiency is highly prevalent among patients with chronic liver disease (CLD) and may contribute to disease progression and adverse outcomes. This study aimed to assess the prevalence of vitamin D deficiency in CLD patients and explore its association with hepatic disease severity. Methods: A cross-sectional observational study was conducted on 100 adult CLD patients admitted to PGIMER and Capital Hospital, Bhubaneswar. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured and classified as deficient (<20 ng/mL), insufficient (20–30 ng/mL), or sufficient (>30 ng/mL). Disease severity was assessed using the Child-Pugh score. Statistical analysis examined the association between vitamin D status and liver disease severity. Results: The mean age of participants was 52.4 ± 11.7 years, with 68% males. Vitamin D deficiency was observed in 68% of patients, insufficiency in 20%, and sufficiency in only 12%. Deficiency rates increased significantly with worsening Child-Pugh class: 45% in Class A, 70% in Class B, and 85% in Class C (p < 0.01). Mean serum 25(OH)D levels declined from 24.1 ± 6.2 ng/mL in Class A to 14.5 ± 4.3 ng/mL in Class C. Conclusion: Vitamin D deficiency is common in CLD patients and correlates strongly with hepatic decompensation severity. Routine screening and management of vitamin D deficiency could serve as an important adjunct in comprehensive care for patients with chronic liver disease.

Background: The spleen plays a pivotal role in immune regulation. Conditions like asplenia or hyposplenism significantly increase susceptibility to life-threatening infections, particularly overwhelming post-splenectomy infections (OPSI). Despite established vaccination guidelines to prevent such infections, adherence among surgeons remains uncertain. Objectives: This study aims to assess the awareness and practices of surgeons regarding preventive vaccination in splenectomy cases, and to identify factors influencing adherence to vaccination protocols at MKCG Medical College and Hospital, Berhampur. Methods: A cross-sectional study was conducted from February to November 2024 at MKCG Medical College, Berhampur. Participants included postgraduates, senior residents, and faculty from General Surgery and GI Surgery. Data were collected via a pretested, semi-structured questionnaire and analyzed using MS Excel and Jamovi V2.6.13. Results: Out of 67 surgeons, 61.2% performed 0–5 splenectomies yearly; 38.8% did 6–10. Most cases were hematological. Pneumococcal vaccines were commonly advised (34.33%), followed by pneumococcal plus flu (25.37%), and flu (17.91%). Only 23% provided preoperative counselling; 77% did so near discharge. Conclusion: Adherence to vaccination post-splenectomy is essential. Future research should examine barriers limiting vaccine uptake. Understanding the gap between awareness and practice will help guide interventions to improve vaccination coverage and reduce OPSI risk among splenectomized patients