Background: Low-energy fractures are important clinical indicators of impaired bone strength and may be associated with vitamin D deficiency, reduced BMD and an increased probability of subsequent fractures. Combined evaluation of these factors may facilitate early identification and management of patients at high risk of recurrent fractures. Aim: To assess the relationship between serum vitamin D status, BMD and estimated fracture risk among patients presenting with low-energy fractures. Materials and Methods: This hospital-based, observational, analytical cross-sectional study included 200 adult patients with radiologically confirmed low-energy fractures. Demographic characteristics, fracture details and clinical risk factors were recorded using a structured proforma. Serum 25-hydroxyvitamin D [25(OH)D], calcium, phosphorus and alkaline phosphatase were measured. Vitamin D status was classified as deficient at <20 ng/mL, insufficient at 20–<30 ng/mL and sufficient at ≥30 ng/mL. BMD was assessed by DXA at the lumbar spine, femoral neck and total hip. Patients were classified as having normal BMD, osteopenia or osteoporosis according to the lowest valid T-score. The 10-year probabilities of major osteoporotic and hip fractures were estimated using FRAX. Associations were analysed using the chi-square test, ANOVA, Pearson’s correlation and univariable linear regression. A p value <0.05 was considered statistically significant. Results: The mean serum 25(OH)D concentration was 18.74±8.63 ng/mL. Vitamin D deficiency was present in 111 (55.5%) patients, insufficiency in 58 (29.0%) and sufficiency in 31 (15.5%). Overall, 169 (84.5%) patients had vitamin D concentrations below 30 ng/mL. The lowest vitamin D concentration was observed among patients with hip or proximal-femur fractures (15.62±7.44 ng/mL; F=6.46, p=0.002). The mean lowest BMD T-score was -2.36±0.91. Normal BMD was observed in 39 (19.5%) patients, osteopenia in 94 (47.0%) and osteoporosis in 67 (33.5%). The femoral neck had the lowest site-specific mean T-score at -2.48±1.11. The mean 10-year probabilities of major osteoporotic and hip fractures were 18.21±9.47% and 8.03±6.12%, respectively. Serum 25(OH)D was positively correlated with the lowest BMD T-score (r=0.42, p<0.001) and inversely correlated with major osteoporotic-fracture probability (r=-0.36, p<0.001) and hip-fracture probability (r=-0.39, p<0.001). The lowest BMD T-score was inversely correlated with major osteoporotic-fracture probability (r=-0.57, p<0.001) and hip-fracture probability (r=-0.62, p<0.001). Patients with vitamin D deficiency and osteoporosis had the highest estimated fracture probabilities. Conclusion: Vitamin D inadequacy and low BMD were highly prevalent among patients with low-energy fractures. Lower serum vitamin D and poorer BMD were significantly associated with greater estimated fracture probability, with femoral-neck BMD showing the strongest association with hip-fracture risk. Assessment of vitamin D, DXA-derived BMD and clinical fracture probability should form part of comprehensive secondary-fracture prevention following a low-energy fracture

Background: Interstitial lung disease (ILD) comprises a diverse group of parenchymal lung disorders characterized by varying degrees of inflammation and irreversible pulmonary fibrosis. Regional epidemiological, radiological, and microbiological insights remain limited in Southern Odisha. Objective: To characterize the clinical spectrum, risk factors, radiological patterns, and microbiological profiles in patients presenting with ILD, particularly during acute exacerbations. Methods: A cross-sectional observational study was conducted on 88 adults diagnosed with ILD at M.K.C.G. Medical College and Hospital. Patient evaluation included clinical history, physical examination, spirometry, 6-minute walk testing (6MWT), high-resolution computed tomography (HRCT), autoimmune serology, and bronchoalveolar lavage (BAL) fluid analysis during acute exacerbation episodes. Statistical analyses employed odds ratios (OR), Chi-square tests, and Student's t-tests (considered statistically significant). Results: Female patients predominated (), with the highest overall concentration in the 31–50 age bracket (). The primary presenting symptoms were exertional dyspnea () and dry cough (). Fine end-inspiratory crackles were present in of patients. Restrictive ventilatory defects were observed in . Usual Interstitial Pneumonia (UIP) was the most common HRCT pattern (). Idiopathic Pulmonary Fibrosis (IPF) was the primary subtype (), followed by Connective Tissue Disease-Associated ILD (CTD-ILD, ), with Systemic Sclerosis accounting for of CTD cases. Smoking (OR = 5.7, ) and Gastroesophageal Reflux Disease (GERD) (OR = 7.1, ) showed statistically significant associations with IPF. BAL culture yielded bacterial growth in of acute exacerbation cases, led by Klebsiella pneumoniae () and Pseudomonas species (). Conclusion: IPF and CTD-ILD represent the predominant ILD burden in Southern Odisha. HRCT classification integrated with clinical history, serology, and targeted BAL analysis is pivotal for accurate diagnosis and timely therapeutic intervention

Background: Classical Hodgkin lymphoma (cHL) is a mature B-cell neoplasm with high cure rates using contemporary chemotherapy, risk-adapted imaging, and autologous stem cell transplantation (ASCT) in relapsed disease. However, persistent immune cytopenias after successful treatment may indicate underlying immune dysregulation. Monogenic defects affecting T-cell costimulatory pathways are increasingly recognized as contributors to lymphoproliferative disease and immune-mediated complications. Case Presentation: A 25-year-old woman presented with fever, weight loss, and cytopenias. Initial evaluation suggested granulomatous lymphadenitis. Subsequent fluorodeoxyglucose positron emission tomography–computed tomography revealed metabolically active lymphadenopathy, and excisional biopsy confirmed classical Hodgkin lymphoma, mixed cellularity subtype. She achieved complete metabolic remission after frontline chemotherapy but relapsed within six months. Following salvage chemotherapy, she underwent autologous stem cell transplantation with BEAM conditioning and achieved sustained complete metabolic response. Despite durable oncologic remission, she developed persistent thrombocytopenia (40,000–75,000/µL). Bone marrow examination showed trilineage hematopoiesis with adequate megakaryocytes and no evidence of relapse. Immune thrombocytopenia was treated with corticosteroids and thrombopoietin receptor agonists. Owing to refractory cytopenia, next-generation sequencing was performed and revealed a homozygous pathogenic mutation in TNFRSF9, consistent with immunodeficiency 109 with lymphoproliferation. At last follow-up, she remained in complete oncologic remission with platelet recovery to 136,000/µL under eltrombopag therapy. Conclusion: This case highlights the intersection of cHL, post-ASCT immune thrombocytopenia, and TNFRSF9-associated immunodeficiency. Persistent cytopenias after transplantation in the absence of relapse should prompt evaluation for immune-mediated mechanisms and possible underlying genetic predisposition. Recognition of monogenic immune defects may refine diagnostic pathways and support personalized long-term management.

Background: Perioperative fluid and electrolyte management sits at the very heart of safe surgical care. How we handle fluids directly dictates whether a patient bounces back quickly or runs into a maze of complications. When a patient undergoes surgery, their body undergoes a massive biochemical upheaval triggered by the trauma of the knife and the effects of anaesthesia. Understanding these microscopic shifts is vital to keeping them safe.Objectives: This study set out to closely monitor the biochemical changes in fluid balance and electrolyte levels among surgical patients at our institution, and to see how tailoring our fluid therapy in real-time impacts their overall recovery.Methods: We carried out a prospective observational study involving 122 adult patients who underwent major elective and emergency surgeries at PMP Medical College and Hospital, Talcher, between April 2025 and June 2026. We tracked key biochemical markers—such as serum sodium, potassium, chloride, kidney function metrics, and blood gas values—right before surgery, during the operation, and at specific milestones after the procedure.Results: Postoperative electrolyte slips were surprisingly common, affecting about 41.8% of our patients. Sodium and potassium dips were the most frequent culprits, largely tied to the stress hormone responses that trap water in the body. When we used goal-directed fluid strategies driven by these lab values, we saw a noticeable drop in acute kidney injuries and shorter hospital stays.Conclusion: Treating fluid therapy as a dynamic, biochemical balancing act rather than a blind routine helps dodge common postoperative potholes and gets patients back on their feet much faster

Background: Birth asphyxia remains an important cause of neonatal intensive care unit (NICU) admission, morbidity, and mortality, particularly in resource-limited settings. Objective: To determine the burden of birth asphyxia among neonates admitted to the NICU and to describe associated neonatal characteristics, mortality patterns, duration of hospitalization, and short-term outcomes.Methods: This hospital-based cross-sectional study was conducted in the Neonatal Intensive Care Unit of Koppal Institute of Medical Sciences (KIMS), Koppal, Karnataka, India, from 1 January 2026 to 31 January 2026. A total of 270 neonatal treatment outcomes were evaluated, while detailed admission-profile data were available for 244 neonates. Demographic characteristics, admission source, gestational age, admission weight, indications for NICU admission, duration of stay, mortality, and treatment outcomes were recorded. Results: Among 270 neonates in the admission-profile analysis, 139 (56.97%) were male, 151 (61.9%) were inborn, 90 (36.9%) were preterm, and 107 (43.9%) weighed 1500–2499 g. Perinatal asphyxia was documented in 44 (18.0%) neonates and was one of the leading indications for NICU admission. Overall, among 270 treatment outcomes, 237 (87.8%) neonates were discharged, 26 (9.6%) expired, 4 (1.5%) were referred, and 3 (1.1%) left against medical advice. The mean NICU stay was 5.97 days. Mortality was higher among preterm than term neonates (20.0% vs 5.5%) and among facility-referred outborn than inborn neonates (16.3% vs 7.3%). Mortality was particularly high among neonates born at <28 weeks (80.0%) and 28 to <32 weeks (55.6%). Hypoxic-ischemic encephalopathy/moderate-to-severe birth asphyxia accounted for 6 of 26 deaths (23.1%). Conclusion: Birth asphyxia constituted a substantial proportion of NICU admissions and contributed importantly to neonatal mortality. Prematurity, lower gestational age, low birth weight, and outborn status were associated with poorer outcomes.

Background: Low-flow anesthesia reduces fresh gas and volatile anesthetic consumption and may offer economic and environmental advantages. However, concerns remain regarding its effects on intraoperative hemodynamic stability and postoperative recovery. This study compared low-flow anesthesia with conventional-flow anesthesia in patients undergoing elective surgery under general anesthesia. Methods: This prospective randomized comparative study was conducted in the Department of Anaesthesiology, Government Medical College, Datia, Madhya Pradesh, over a period of three months in 2025. A total of 60 ASA physical status I–II patients aged 18–60 years were allocated into two equal groups. Group LF received low-flow anesthesia with a maintenance fresh gas flow of 1 L/min, while Group CF received conventional-flow anesthesia with a fresh gas flow of 3 L/min. Recovery outcomes included time to eye opening, response to verbal commands, extubation, achievement of a Modified Aldrete Score ≥9, and PACU duration. Perioperative adverse events were also documented. Results: Baseline demographic and perioperative characteristics were comparable between the two groups. Serial heart rate and mean arterial pressure showed expected peri-induction variations but remained clinically stable, with no significant group effect or group-by-time interaction. SpO₂ remained approximately 99% in both groups, while EtCO₂ remained within the target range of 35–45 mmHg. Conclusion: Low-flow sevoflurane anesthesia at a fresh gas flow of 1 L/min provided intraoperative hemodynamic and respiratory stability comparable to conventional-flow anesthesia without delaying postoperative recovery or increasing perioperative adverse events

Purpose: To compare corneal endothelial cell density (ECD) loss over six months after manual small-incision cataract surgery (MSICS) and phacoemulsification, both with rigid polymethyl methacrylate intraocular lens implantation. Methods: Prospective comparative study at a tertiary teaching hospital in southern India, August 2022 to January 2024. Sixty eyes of 60 consecutively enrolled patients aged 40 years or older with nuclear sclerosis of Lens Opacities Classification System III grade 3 or below underwent MSICS (n = 30) or phacoemulsification (n = 30) by one surgeon. Non-contact specular microscopy measured ECD preoperatively and on day 1, at 1 week and at 6 months. The primary outcome was change in ECD at 6 months. Results: Groups were comparable at baseline for age, sex, cataract morphology and ECD (2555.23 ± 200.58 vs 2536.03 ± 310.87 cells/mm², P = 0.777). At 6 months ECD was 2512.70 ± 239.95 cells/mm² after MSICS and 2425.06 ± 313.13 cells/mm² after phacoemulsification, a difference of 87.64 cells/mm² (P = 0.232), representing losses of 1.66% and 4.38% from baseline. The groups differed only on day 1 (2505.14 ± 216.44 vs 2282.76 ± 409.83 cells/mm², P = 0.017). Within each arm the reduction from baseline was no longer significant at 6 months (P = 0.081 and P = 0.064). Conclusion: Endothelial cell loss at six months did not differ significantly between MSICS and phacoemulsification when both delivered a rigid lens through a comparable sclerocorneal incision. The early advantage of MSICS resolved, and MSICS remains endothelially safe where phacoemulsification is unavailable

Background: Ocular morbidity in childhood is a leading contributor to avoidable visual impairment and can impair learning, school adjustment, and development. Population- and school-based data from India are relatively abundant, but the pattern of paediatric ocular disease presenting to tertiary care in southern India is less well described. We characterised the pattern of ocular morbidity among children attending a tertiary care ophthalmology outpatient department. Methods: We conducted a hospital-based cross-sectional study in the Department of Ophthalmology, Vijayanagara Institute of Medical Sciences/Ballari Medical College and Research Centre, Ballari, Karnataka, from July 2022 to December 2023. Consecutive patients younger than 15 years presenting with any ocular disorder underwent visual acuity testing, torchlight and slit-lamp anterior segment examination, colour vision testing, and cycloplegic refraction and dilated fundus examination where indicated. Morbidities were classified and analysed by age group (0-5, 5-10, and 10-15 years) and sex, and are reported as counts and percentages. Results: A total of 350 children were evaluated; 202 (57.7%) were male, giving a male-to-female ratio of 1.36:1. Most presented in the 5-10-year group (133/350, 38.0%), followed by the 10-15-year (122/350, 34.9%) and 0-5-year (95/350, 27.1%) groups. Refractive error was the commonest morbidity (123/350, 35.1%), followed by vernal keratoconjunctivitis (82/350, 23.4%), conjunctival disorders (47/350, 13.4%), lacrimal drainage disorders (25/350, 7.1%), squint (19/350, 5.4%), developmental cataract (17/350, 4.9%), lid disorders (15/350, 4.3%), and ocular trauma (14/350, 4.0%). Refractive error predominated in every age band and was proportionally highest in the 5-10-year group.Conclusion: Refractive error and vernal keratoconjunctivitis together accounted for more than half of paediatric ocular morbidity at this tertiary centre, and most affected children were of school-going age. Because these conditions are largely treatable, the findings support strengthening school vision screening and community eye-health education in this region

Background: COVID-19-associated mucormycosis emerged as an important opportunistic fungal infection, particularly among patients with diabetes mellitus and corticosteroid exposure. Histopathological examination confirms tissue invasion and may also provide valuable information regarding disease severity and prognosis. Aim: To evaluate the histopathological spectrum and associated clinicopathological characteristics of mucormycosis in post-COVID-19 patients. Materials and Methods: This retrospective, hospital-based clinicopathological study included 200 post-COVID-19 patients with histopathologically confirmed mucormycosis. Demographic characteristics, clinical manifestations, anatomical distribution, predisposing factors, microbiological findings, treatment and outcomes were retrieved from hospital records. Tissue sections stained with haematoxylin and eosin, periodic acid-Schiff and Grocott-Gomori methenamine silver were reviewed for fungal morphology, fungal load, necrosis, inflammatory response, angioinvasion, thrombosis, perineural invasion, bone invasion and mixed infection. Categorical variables were compared using the chi-square or Fisher’s exact test, and associations were expressed as odds ratios with 95% confidence intervals. A p value <0.05 was considered statistically significant. Results: The mean age was 51.84±12.73 years, and 137 (68.5%) patients were male. The mean interval between COVID-19 and mucormycosis was 24.68±11.42 days. Diabetes mellitus was present in 144 (72.0%) patients, while 129 (64.5%) had received systemic corticosteroids. Isolated sinonasal, rhino-orbital and rhino-orbito-cerebral disease accounted for 33.5%, 29.0% and 21.5% of cases, respectively. Broad, irregular, pauci-septate fungal hyphae were identified in 176 (88.0%) specimens. Extensive necrosis and angioinvasion were each present in 107 (53.5%), vascular thrombosis in 96 (48.0%), bone invasion in 79 (39.5%) and perineural invasion in 59 (29.5%). Angioinvasion, extensive necrosis and bone invasion were significantly associated with advanced clinical disease, with odds ratios of 5.41, 5.48 and 5.53, respectively (all p<0.001). An adverse outcome occurred in 48 (24.0%) patients. Extensive necrosis showed the strongest association with adverse outcome (OR=9.37; 95% CI: 3.76-23.36), followed by angioinvasion (OR=5.35), bone invasion (OR=4.47), perineural invasion (OR=3.34) and mixed fungal infection (OR=3.16). Conclusion: Post-COVID-19 mucormycosis predominantly affected middle-aged diabetic men with previous corticosteroid exposure and most commonly involved the sinonasal-orbital-cerebral region. Extensive necrosis, angioinvasion, perineural invasion and bone invasion were important indicators of advanced disease and adverse outcome. Histopathological examination is therefore essential for diagnosis, assessment of severity and clinicopathological risk stratification

Background: Iron deficiency anemia is a common cause of microcytic anemia, but the pattern of complete blood count changes may differ depending on the severity of the iron deficiency and the inflammatory status. Methods: This was a cross-sectional study conducted in a hospital setting with 180 adult patients, 120 of whom had iron deficiency anemia confirmed by biochemistry and 60 of whom were age matched and did not have iron deficiency anemia. Complete blood count parameters, reticulocyte indices, serum ferritin, serum iron, total iron-binding capacity and transferrin saturation were analyzed. Results: The iron deficiency anemia group had significantly lower hemoglobin (8.9 ± 1.4 g/dL vs. 13.2 ± 1.0 g/dL), mean corpuscular volume (68.7 ± 8.1 fL vs. 86.5 ± 5.7 fL), mean corpuscular hemoglobin (20.9 ± 3.8 pg vs. 29.1 ± 2.1 pg) and ferritin (10.8 ± 6.4 ng/mL vs. 62.3 ± 28.5 ng/mL) than controls (all p<0.001). Red cell distribution width was higher in cases (18.9 ± 2.6% vs. 13.2 ± 1.1%, p<0.001), and reactive thrombocytosis was observed in 31.7% of cases. There was a moderate inverse correlation between platelet count and hemoglobin (r=-0.46, p<0.001), and a positive correlation between ferritin and MCV (r=0.58, p<0.001). Conclusion: The characteristic combination of microcytosis, hypochromia, anisocytosis and decreased iron stores, combined with increased reactive platelets, confirmed the potential of routine haematological parameters as a readily available severity-screening tool for iron deficiency anemia.

Background: Thrombocytopenia is a frequent hematological abnormality in dengue fever and the role of platelet count as a marker of severity is still controversial. Methods: Prospective observational study on 160 serologically confirmed dengue patients aged 15 years and older. Dengue without warning signs, dengue with warning signs and severe dengue were defined based on standard clinical criteria. The following parameters were recorded: serial platelet count, hematocrit, leukocyte count, liver enzymes, bleeding manifestations and outcomes. Results: There was significant difference in mean platelet count between dengue without warning signs (102.4 ± 44.6 ×10^3/µL), dengue with warning signs (68.1 ± 31.2 ×10^3/µL) and severe dengue (33.7 ± 16.8 ×10^3/µL) (p<0.001). There was a strong inverse correlation between platelet count and severity grade (r=-0.64, p<0.001) and a moderate inverse correlation between platelet count and rise in hematocrit (r=-0.41, p<0.001). Bleeding occurred in 8.3%, 21.3% and 51.9% of the three groups respectively (p<0.001). A platelet count of ≤50 ×10^3/µL was found to have a sensitivity of 81.5%, specificity of 74.4% and an area under the ROC curve of 0.82 for predicting severe dengue. Conclusion: Warning signs, hemoconcentration, bleeding and severe dengue were significantly associated with lower platelet count, but clinical assessment is important as platelet count alone is not sufficient to predict complications.

Background: Neonates admitted to the Neonatal Intensive Care Unit (NICU) often require multiple medicines for conditions such as respiratory distress, infections, and prematurity-related complications. Because drug absorption, metabolism, and excretion differ markedly in neonates compared with older children and adults, and because evidence on dosing and safety in this population remains limited, hospital-specific drug-utilization studies are important for understanding local prescribing practices.Objective: To assess the drug utilization pattern among neonates admitted to the NICU of a tertiary-care hospital using the WHO Anatomical Therapeutic Chemical (ATC) classification system and selected WHO core prescribing indicators.Methods: A retrospective, observational, cross-sectional study was conducted among 850 neonates admitted to the NICU of Koppal Institute of Medical Sciences, Koppal, who received at least one therapeutic medicine during their hospital stay. Data on demographics, diagnoses, and prescribed drugs were collected from medical records using a structured proforma, classified according to the WHO-ATC system, and analyzed using SPSS 25.Results: Males comprised 52.0% of the cohort, and 68.0% of neonates were born at ≥37 weeks of gestation. Respiratory distress syndrome (58.0%), neonatal jaundice (45.0%), and neonatal sepsis (30.0%) were the most common morbidities. A total of 2,125 medicines were prescribed (mean 2.5 drugs/neonate). Respiratory-system medicines were the most frequently prescribed ATC category (42.0%), followed by anti-infectives (28.0%); surfactant, aminophylline, ampicillin, and gentamicin were the leading individual agents. Antibiotics were prescribed in 45.0% of cases, injectable medicines in 60.0%, and 90.0% of prescribed drugs were from the essential medicines list.Conclusion: Prescribing in this NICU was largely driven by respiratory morbidity, with a comparatively lower antibiotic and injectable burden than reported in several other Indian and international neonatal cohorts, likely reflecting a lower proportion of extremely preterm and very-low-birth-weight admissions. High adherence to the essential medicines list suggests broadly rational prescribing, though periodic audits are recommended to further strengthen neonatal pharmacotherapy

Aim: To compare the efficacy of BISAP score and Modified CT Severity Index (MCTSI) in early prediction of severity and mortality in patients with acute pancreatitis.Materials and Methods: A hospital-based observational study was conducted in the Department of General Medicine at ESIC Medical College and Hospital, Alwar, Rajasthan, among 100 patients diagnosed with acute pancreatitis. Patients aged 18–65 years fulfilling inclusion criteria were enrolled after informed consent. BISAP score was calculated within the first 24 hours of admission and MCTSI was assessed using contrast-enhanced computed tomography within 48 hours. Patients were classified according to the Revised Atlanta Classification. Statistical analysis was performed using SPSS version 22.0 and p value <0.05 was considered statistically significant.Results: Among 100 patients, 76% were males and the highest incidence was observed in the 31–40 years age group (48%). Gallstones (47%) were the commonest etiology followed by alcoholism (22%). According to Revised Atlanta Classification, 22% had mild AP, 61% had moderate AP, and 17% had severe AP. MCTSI categorized 27% as mild, 49% as moderate, and 24% as severe pancreatitis. BISAP score was ≥3 in 39% patients. Significant association was observed between disease severity and both MCTSI (p=0.008) and BISAP score (p=0.005). Mortality was observed in 7% patients. BISAP demonstrated sensitivity of 100% and specificity of 73.5% in predicting mortality, whereas MCTSI showed sensitivity of 100% and specificity of 58.5%.Conclusion: Both BISAP and MCTSI are effective tools in predicting severity of acute pancreatitis. However, BISAP score is simpler, clinically convenient, and demonstrated better specificity in predicting mortality compared to MCTSI. BISAP can therefore be considered a reliable bedside prognostic tool for early risk stratification in acute pancreatitis

Background: Internal derangement of the knee (IDK) commonly results from injuries to the menisci and cruciate ligaments following trauma or sports-related activities. Accurate diagnosis is essential for appropriate treatment and prevention of long-term functional impairment. Clinical examination, magnetic resonance imaging (MRI), and arthroscopy are routinely used for diagnosis; however, the relative diagnostic performance of clinical examination and MRI remains controversial. This study compared the diagnostic performance of clinical examination and MRI using arthroscopy as the reference standard.Methods: A prospective hospital-based diagnostic accuracy study was conducted in the Department of Orthopaedics. Thirty-five patients aged 17–60 years with clinically suspected internal derangement of the knee underwent comprehensive clinical examination, MRI evaluation, and diagnostic arthroscopy. Arthroscopic findings were considered the reference standard. The diagnostic performance of clinical examination and MRI was evaluated by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, and Cohen's kappa coefficient.Results: The mean age of the participants was 29.9 ± 9.9 years, and 65.7% were males. Arthroscopy confirmed anterior cruciate ligament (ACL) tears in 77.1%, medial meniscal tears in 68.6%, lateral meniscal tears in 22.9%, and posterior cruciate ligament (PCL) tears in 2.9% of patients. Clinical examination demonstrated higher diagnostic accuracy than MRI for ACL injuries (98.15% vs. 81.94%) and medial meniscal injuries (85.42% vs. 63.07%). For lateral meniscal injuries, the diagnostic accuracy of clinical examination and MRI was 94.29% and 73.84%, respectively. Both modalities correctly identified the single PCL injury. MRI showed comparatively lower sensitivity and specificity for meniscal injuries than clinical examination.Conclusion: Clinical examination demonstrated higher diagnostic performance than MRI for detecting ACL and meniscal injuries and should remain the first-line diagnostic approach in patients with suspected internal derangement of the knee. MRI serves as a valuable non-invasive adjunct, particularly in patients with equivocal clinical findings or suspected complex injuries. Arthroscopy remains the reference standard for confirming intra-articular pathology and provides the additional advantage of simultaneous therapeutic intervention.

To evaluate admission serum ferritin as a predictor of mortality among children with sepsis, a hospital-based cross-sectional analytical study was conducted involving 70 children aged >1 month to 18 years admitted with sepsis to the pediatric intensive care unit (PICU) of a tertiary care hospital over a one-year period. Venous blood was collected at admission to quantify serum ferritin alongside C-reactive protein (CRP) and procalcitonin. Participants were followed until discharge or death to determine the primary outcome of PICU mortality. Among the 70 participants (median age 6 years; 54.29% boys), overall PICU mortality was 31.43% (n=22). Mean admission serum ferritin levels were significantly higher in non-survivors (3317.73 ± 1025.74 ng/mL) compared to survivors (578.85 ± 409.63 ng/mL; p<0.001). Elevated ferritin concentrations correlated with rural residence, inotrope requirement, acute respiratory distress syndrome, and significantly prolonged mechanical ventilation and PICU stays (p<0.05). Secondary inflammatory markers, CRP (206.73 ± 54.6 vs. 47.99 ± 37.69 mg/L) and procalcitonin (28.31 ± 21.0 vs. 5.29 ± 5.52 ng/mL), were also significantly higher among non-survivors (p<0.001). Receiver operating characteristic curve analysis for ferritin demonstrated an area under the curve of 0.998. An optimal discriminatory cut-off of 1542 ng/mL predicted mortality with 100% sensitivity and 97.92% specificity. Markedly elevated admission serum ferritin is an excellent early prognostic biomarker that predicts multiorgan failure and mortality in critically ill children with severe sepsis.

Background: Female cancers are a major public health concern, with breast, cervical, and ovarian cancers accounting for a substantial proportion of cancer-related morbidity and mortality. Evaluation of histopathological trends is essential for improving early detection, screening strategies, and treatment outcomes. Aim: To evaluate the recent histopathological trends of female malignancies and assess their demographic distribution, clinicopathological characteristics, and treatment outcomes. Methods: A retrospective observational study was conducted at a tertiary care centre in Raipur between 2025 and 2026. A total of 90 female patients with histopathologically confirmed malignancies were included. Demographic, clinical, histopathological, staging, treatment, and outcome data were retrieved from medical records. Statistical analysis was performed using IBM SPSS Statistics version 29.0. Descriptive statistics were used to summarize the data, while inferential statistics were applied to determine associations, with p < 0.05 considered statistically significant. Results: The mean age of the patients was 50.75 years, with the highest proportion (55.6%) belonging to the 41–60-year age group. Breast cancer was the most common malignancy (34.4%), followed by cervical cancer (20.0%) and ovarian cancer (15.5%). Most patients were diagnosed at stage II (38.9%), followed by stage III (28.9%). Surgical intervention was the primary treatment modality (47.8%). The overall survival rate was 70%, with significantly better survival among patients diagnosed at early stages compared to advanced stages (p < 0.01). A significant association was also observed between cancer type and age group. Conclusion: Breast cancer was the predominant female malignancy in this cohort, followed by cervical and ovarian cancers. Early-stage diagnosis was associated with significantly improved survival, emphasizing the importance of strengthening cancer awareness, screening programs, and timely intervention to improve outcomes among women in Chhattisgarh.

Background: Sepsis is a life-threatening condition associated with high morbidity and mortality. Early prediction of disease severity using routine hematological and biochemical markers may improve patient outcomes. Methods: This prospective observational study included 80 patients with clinically suspected sepsis admitted to the Department of Pathology, Shri Balaji Institute of Medical Science, Raipur. Hematological parameters (WBC, RBC, platelet count, ANC, and immature granulocyte percentage) and biochemical markers (CRP and procalcitonin) were evaluated and compared between non-severe and severe sepsis groups. ROC curve analysis was performed to determine the predictive accuracy of the biomarkers. Results: Of the 80 patients, 48 (60%) had non-severe sepsis and 32 (40%) had severe sepsis. Patients with severe sepsis had significantly higher WBC count, ANC, immature granulocyte percentage, CRP, and procalcitonin levels, while platelet count and RBC count were significantly lower (p < 0.05). Procalcitonin showed the highest diagnostic accuracy (AUC = 0.91), followed by immature granulocyte percentage (AUC = 0.89) and CRP (AUC = 0.87). Conclusion: Routine hematological and biochemical markers, particularly procalcitonin, CRP, immature granulocyte percentage, and platelet count, are useful predictors of sepsis severity and can assist in early risk stratification and clinical decision-making

Background: Acute STEMI remains a major cause of cardiovascular mortality, with substantial burden in India. Hyponatremia (<135 mmol/L), reflecting neurohormonal activation and physiological stress, may indicate greater disease severity and poorer outcomes. Therefore, this study evaluated the occurrence, timing, and severity of hyponatremia and its association with 30-day all-cause mortality, along with relevant demographic and clinical predictors, among patients with acute STEMI.Materials and Methods: This prospective observational study included 100 consecutive patients with acute STEMI. Clinical characteristics and LVEF were recorded. Serum sodium was measured at admission and at 24, 48, and 72 hours, with hyponatremia defined as <135 mmol/L. Patients were categorized according to sodium status and followed for 30-day all-cause mortality. Group comparisons used ANOVA, chi-square/Fisher’s exact tests, and unadjusted odds ratios, with p<0.05 considered significant.Results: Hyponatremia occurred in 29% of acute STEMI patients, including 11% at admission and 18% within 72 hours. Overall 30-day mortality was 8%, increasing from 2.8% with normal sodium to 27.3% with admission hyponatremia (OR 12.9; p=0.016) and 16.7% with hyponatremia developing within 72 hours. All patients with sodium <130 mmol/L died (100%; p=0.005). Non-survivors were older (65.5 vs 57.7 years) and more frequently had diabetes, hypertension, and Killip class II, supporting hyponatremia as an important prognostic marker following acute STEMI.Conclusion: Hyponatremia occurred in 29% of acute STEMI patients and was associated with higher 30-day mortality, particularly when present at admission or severe. Mortality increased markedly with decreasing sodium levels, supporting hyponatremia as a clinically relevant prognostic marker for 30-day mortality following acute STEMI

Background: Cirrhosis is defined by the liver developing fibrosis and nodules as a result of a persistent damage that changes the liver's typical lobular arrangement.Aim:To evaluate the renal artery Doppler findings and renal resistive index (RRI) in patients with decompensated liver disease.Methodology: This cross-sectional observational study was conducted on 50 patients with decompensated liver disease with ascites and 50 cirrhotic patients without ascites admitted in JLN Medical College and hospital, Ajmer.Result:Patients with decompensated liver disease and ascites showed significantly worse liver function, higher RRI, hyponatremia, elevated serum creatinine, and a markedly higher incidence of Hepatorenal Syndrome compared with compensated cirrhosis (p < 0.0001). ConclusionRenal artery Doppler-derived Renal Resistive Index (RRI) is a valuable non-invasive marker for early detection of renal hemodynamic impairment in patients with decompensated liver disease. Increased RRI is strongly associated with advanced liver dysfunction and predicts the development of Hepatorenal Syndrome.

Background: Melasma is characterized by symmetrical hyperpigmented macules, which may be blotchy, irregular, arcuate, or polycyclic and rarely have a linear or a starburst distribution. Centrofacial pattern is the most common and consist of lesions on the forehead, cheeks, nose, upper lip or chin. Malar pattern describes lesions located primarily on the cheeks and nose. Mandibular pattern consists of lesions on ramus of the mandible. All female patients, who presented with the primary symptoms, suggestive of facial dermatoses, attending the OPD were subjected to detailed history and clinical examination. During the study period, a total of 300 cases were selected randomly after taking their consent. Ethical clearance was obtained before commencing the study. Most common type of melasma was malar (72.72%) followed by centrofacial (27.27%). On Wood‘s lamp examination, 63.63% had epidermal type, 10.6% had dermal type and 25.75% had mixed type of melasma.

Background: Hypermelanoses are a group of disorders characterized by abnormally darker skin that results from increased melanin production from a normal number of melanocytes. Hypermelanoses may result from increased melanin in the epidermis (epidermal hypermelanoses), the dermis (dermal hypermelanoses) or both (mixed hypermelanoses). All female patients, who presented with the primary symptoms, suggestive of facial dermatoses, attending the OPD were subjected to detailed history and clinical examination. During the study period, a total of 300 cases were selected randomly after taking their consent. Ethical clearance was obtained before commencing the study. Among pigmentary disorders, the most common age group was 26-35 years (50%). Predisposing factors of pigmentary disorders were sun exposure (35.29%), cosmetics (16.66%), pregnancy(11.76%), family history (7.8%), stress (3.92%), hypothyroidism (3.92%), anemia (3.92%), drug intake (3.92%), refractive errors (2.9%). 95% had localized pattern of pigmentation and 5% had diffuse pattern of pigmentation.

Background: Sickle cell disease (SCD) is a debilitating heritable hemoglobinopathy caused by a structural mutation where glutamic acid is replaced by valine at the sixth position of the β-globin chain, producing abnormal hemoglobin HbS. Because patients with SCD are vulnerable to ischemic episodes, evaluating metabolic factors like plasma homocysteine—known to promote endothelial dysfunction and thrombosis—is of high clinical interest. Objectives: To evaluate serum homocysteine levels in patients with sickle cell anaemia, compare levels between steady-state and vaso-occlusive crisis (VOC) groups, and correlate findings with disease severity and folic acid therapy. Methods: This cross-sectional analytical study was conducted at VIMSAR, Burla, from November 2018 to October 2020, involving matched SCD cases and healthy controls. Fasting blood samples were analyzed for serum homocysteine. Results: Serum homocysteine levels were significantly higher (p<0.0001) in SCD patients compared to controls. A positive correlation was observed between elevated homocysteine and the annual rate of VOC. Furthermore, patients not receiving folic acid therapy demonstrated higher homocysteine concentrations than those on supplementation. Conclusion: Serum homocysteine is elevated in SCD patients and strongly associates with a higher rate of VOC, highlighting its utility as a biomarker for disease monitoring and management

Background: Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease characterized by persistent synovial inflammation and progressive joint damage. Melatonin is a circadian hormone with complex immunomodulatory, antioxidant, and inflammatory effects, but its relationship with RA activity remains incompletely understood. Objective: To evaluate serum melatonin levels in patients with rheumatoid arthritis and determine their associations with disease activity, inflammatory markers, and serological status. Methods: A hospital-based case-control study was conducted at Kirkuk Teaching Hospital, Kirkuk, Iraq, from February 11 to August 1, 2026. The study included 100 participants: 50 patients with established RA and 50 apparently healthy controls. Serum melatonin was measured using a competitive enzyme-linked immunosorbent assay (ELISA). Clinical and laboratory assessments included DAS28, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), tender joint count, and swollen joint count. Results: Serum melatonin was significantly higher in RA patients than controls (44.86 ± 15.72 vs. 28.34 ± 9.65 pg/mL; P < 0.001). Melatonin increased progressively across disease-activity categories, from 31.45 ± 7.62 pg/mL in remission to 54.72 ± 14.16 pg/mL in patients with high disease activity (P < 0.001). Significant positive correlations were observed between melatonin and DAS28 (r = 0.568), CRP (r = 0.476), ESR (r = 0.421), tender joint count (r = 0.389), and swollen joint count (r = 0.354), whereas correlations with age and disease duration were not significant. Melatonin concentrations were also significantly higher among RF-positive and anti-CCP-positive patients. Elevated melatonin (>35 pg/mL) was independently associated with RA after adjustment for age, sex, and BMI (adjusted OR = 6.84; 95% CI: 2.67–17.52; P < 0.001). Conclusion: Serum melatonin concentrations are significantly elevated in patients with rheumatoid arthritis and are positively associated with clinical disease activity, systemic inflammation, and seropositivity. These findings suggest that altered melatonin physiology may be involved in the circadian and immunoinflammatory processes of RA and may have potential value as an adjunctive biomarker of disease activity. Further longitudinal studies incorporating serial circadian measurements are required to clarify its biological and clinical significance.

Background: Distal radius fractures are highly prevalent upper extremity injuries frequently managed in emergency settings. While manual manipulation under a hematoma block (HB) serves as a common, simple alternative to procedural sedation and analgesia (PSA), standard single-agent lidocaine protocols often provide short-lived or suboptimal analgesia. To optimize patient comfort without escalating the risk of systemic local anesthetic toxicity, alternative dosing combinations must be explored. This study evaluated the clinical rationale for a novel, low-dose combination of lidocaine and bupivacaine to improve post-reduction pain relief.objectives: The aim of this study is to evaluate Clinico-Radiological Efficacy of a Combined Local Anesthetic Hematoma Block for Distal Radius Fracture Reduction. Methods:This prospective, randomized, single-blind, controlled clinical trial evaluated 50 patients with clinically and radiologically confirmed extra-articular distal radius fractures. Following informed consent, the cohort was randomized and equally assigned into two groups of 25 patients each. The intervention groups received a hematoma block utilizing either standard local anesthetic lidocaine or a lidocaine-bupivacaine combination, followed by manual manipulation, fracture reduction, and immobilization in a plaster of Paris (POP) cast. Pain severity was sequentially monitored using the Visual Analogue Scale (VAS) before, during, and after the reduction process. Post-reduction alignment and anatomical adequacy were radiologically assessed according to the Modified Sarmiento Criteria, and any procedure-related complications were recorded. conclusion: A hematoma block using a local anesthetic is a safe and effective technique for providing adequate analgesia during the manipulation and reduction of distal radius fractures, eliminating the need for the prolonged monitoring required by other anesthetic techniques. This makes the hematoma block a highly acceptable anesthetic option for patients with systemic diseases or comorbidities.Our study demonstrated that immediate post-reduction pain management is superior when the hematoma block utilizes a combination of lidocaine and bupivacaine at minimal therapeutic doses, without any increase in procedure or drug-related adverse effects. Consequently, using a minimal volume and concentration of this combination provides a highly effective alternative to the traditional dosage of lidocaine alone (typically 2 mg/kg of body weight in a 10 mL volume) for blocking distal radius fractures.

Background: Globally, antimicrobial resistance (AMR) presents a significant threat to human health driven largely by irrational antimicrobial usage, which often leads to prolonged hospital stay, increased morbidity and mortality. Antimicrobial stewardship (AMS) emphasizes appropriate antibiotic use through strict implementation of antimicrobial policy guidelines. Hence, this study aims to correlate Defined Daily Dose (DDD), Days of Therapy (DOT) and Antimicrobial Resistance in Intensive Care Unit (ICU) patients with bacteremia.Materials and Methods:A prospective cross-sectional study was conducted over three months in the SRM Medical College Hospital and Research Centre, including patients over 18 years old receiving antimicrobials with positive blood cultures. Antimicrobial usage was assessed using WHO-recommended metrics such as DDD per 100 patient bed days and DOT per 1000 patient bed days. Resistance data were obtained from microbiology surveillance records.Results:Among 50 culture-positive ICU patients, 36% were aged 51-70 years and 34% were 31-50 years, with 56% of males. Among the pathogens isolated, Klebsiella pneumoniae (28%), Escherichia coli (22%), and Acinetobacter baumannii (22%) were the predominant organisms, followed by Pseudomonas, Enterococcus and Staphylococcus species. Stewardship interventions resulted in de-escalation in 54% of cases, escalation in 20%, and no change in 26%. Mean empirical DDD and DOT were 4.95 and 3.7 days, respectively, while the mean definitive DDD and DOT were 4.05 and 4.3 days. Wide variation reflects individuals' therapy adjustments. Higher mortality was observed in patients infected with multidrug-resistant (MDR) and extensively drug-resistant (XDR) organisms than in drug-sensitive cases. Conclusion:In conclusion, structured stewardship prescribing practices decrease unnecessary antimicrobial use and result in better clinical outcomes, highlighting the value of continuous AMS monitoring and feedback in combating AMR. Clinical significance:This study is clinically significant for the optimization of antibiotic usage and improve patients outcomes by formulation targerted antimicrobial stewardship strategies

und: Distal femur fractures are uncommon but challenging injuries that require anatomical reduction, stable fixation, and early mobilization to achieve satisfactory functional outcomes. Although both the lateral parapatellar and swashbuckler approaches are commonly employed for dual plate fixation, comparative evidence regarding their clinical effectiveness remains limited. This study compared the functional and radiological outcomes of dual plate fixation using these two surgical approaches. Methods: A prospective observational comparative study was conducted in the Department of Orthopaedics, Sri Aurobindo Medical College and Post Graduate Institute, Indore, from November 2024 to December 2025. Twenty adult patients with distal femur fractures underwent open reduction and internal fixation with dual locking compression plates through either the lateral parapatellar approach (n=10) or the swashbuckler approach (n=10). Operative duration, intraoperative blood loss, fracture union, time to weight-bearing, knee range of motion, extensor lag, Knee Society Score (KSS), Lysholm Knee Score, Neer's Rating System, and postoperative complications were evaluated and compared. Results: Baseline demographic and fracture characteristics were comparable between the two groups. The lateral parapatellar approach was associated with significantly shorter operative time (108.4±12.1 vs. 126.8±13.9 minutes; p=0.006), lower intraoperative blood loss (278±46 vs. 352±58 mL; p=0.004), earlier radiological union (16.2±1.8 vs. 18.4±2.3 weeks; p=0.028), and earlier progression to weight-bearing (p<0.05). Patients in the lateral group also achieved significantly greater knee flexion, lower extensor lag, higher Knee Society, Lysholm, and Neer's scores, and a lower incidence of postoperative complications. Excellent functional outcomes were observed in 70% of patients in the lateral group compared with 40% in the swashbuckler group. Conclusion: Both approaches achieved successful fracture union; however, the lateral parapatellar approach demonstrated superior operative efficiency, earlier rehabilitation, better functional recovery, and fewer complications. It appears to be a safe and effective approach for dual plate fixation of distal femur fractures, although larger multicenter studies are required to validate these findings.

Background: Intertrochanteric femur fractures are a major cause of morbidity, particularly among the aging population. The Trochanteric Femoral Nail (TFN) offers biomechanical advantages, but continuous evaluation of postoperative fixation stability and clinical outcomes remains essential for optimizing patient care. Methods: An ambispective cross-sectional study was conducted on 30 patients with intertrochanteric femur fractures at a tertiary care center over a period of 18 months. Patients were treated with a TFN and evaluated radiographically and clinically at 3, 6, 12, and 24 weeks. A customized Fixation Stability Score (FSS) was utilized to quantify radiographic alignment and fixation stability. Results: The mean age of the cohort was 60.60 ± 16.06 years, with a male predominance (60%). The majority of fractures were Evans Type 1B (53.3%). Bone union was successfully achieved in all cases, with a mean union time of 2.90 ± 0.61 months. The mean FSS demonstrated statistically significant, progressive improvement from 5.36 ± 0.61 at 3 weeks to 6.89 ± 0.31 at 6 months (p < 0.05). Complications were rare, limited to one case of implant failure (3.3%) and one superficial infection (3.3%). Conclusion: TFN is a highly reliable implant for intertrochanteric fractures, facilitating early mobilization, low complication rates, and progressively stable fixation leading to predictable bone union.

Introduction: Viral keratitis is an important cause of preventable corneal blindness. Clinical characteristics, symptoms, laterality, lesion morphology, and corneal layer involvement are essential for diagnosis and management. Owing to limited region-specific evidence, this study evaluated the demographic and clinical spectrum of viral keratitis among patients attending a tertiary care centre.Material and Methods: A prospective observational study was conducted over one year at a tertiary care centre, enrolling 72 clinically diagnosed viral keratitis patients using convenience sampling. After informed consent, participants underwent detailed history, comprehensive ophthalmic examination, fluorescein staining, Giemsa staining of corneal/conjunctival scrapings, and routine laboratory investigations. Corneal lesions and involved layers were classified, and data were analyzed using descriptive statistics in SPSS.Results: Among 72 patients with viral keratitis, the mean age was 37.63 ± 13.20 years; 34.7% were aged 10–20 years, 54.2% were males, and 87.5% were urban residents. Unilateral disease occurred in 62.5%. Redness (68.1%) and diminished vision (50.0%) were the main symptoms. Superficial punctate keratitis was most common (50.0%), followed by stromal keratitis (27.8%). Epithelial involvement predominated (72.2%) over stromal involvement (27.8%).Conclusion: The study fulfilled its objectives by characterizing viral keratitis as predominantly unilateral and epithelial, commonly affecting younger individuals, males, and urban residents. Redness and reduced vision were the main symptoms, while superficial punctate keratitis was the most frequent lesion pattern

Background: Stroke is a leading cause of morbidity, disability, and mortality in India. Non-contrast CT (NCCT) brain and MRI are the primary neuroimaging modalities for evaluating acute ischemic stroke. This study characterises the clinico-radiological profile of ischemic stroke in a South Indian tertiary care centre.Objectives: To study the clinical presentation, radiological findings, and risk factor profile of patients with acute ischemic stroke.Methods: A cross-sectional study of 60 patients with confirmed acute ischemic stroke was conducted over 18 months (March 2021–August 2022) at Basaveshwara Medical College and Hospital, Chitradurga. All patients underwent detailed clinical assessment, routine blood investigations, ECG, 2D echocardiography, carotid Doppler, and brain neuroimaging (NCCT/MRI). Data were analysed with IBM SPSS v25.Results: Mean age was 59.75 ± 13.69 years; males predominated (M:F = 2.3:1). Hypertension (75%) and diabetes mellitus (68.3%) were the leading risk factors. Motor weakness was present in 76.7%, speech disturbance in 60%, and altered sensorium in 56.7%. MCA territory was the most commonly affected (81.7%). Increased carotid intimal thickness was found in 80% of cases. Dyslipidaemia on fasting lipid profile was noted in 71.7%.Conclusion: Hypertension and diabetes are the dominant modifiable risk factors. MCA territory ischemic strokes are most prevalent. NCCT brain with MRI DWI is essential for early diagnosis and management.

Background and Aims: Elderly patients suffering from proximal femur fractures frequently experience intense pain, particularly during the positioning maneuvers required for spinal anaesthesia. This investigation explored a newer regional anaesthesia method known as the Pericapsular Nerve Group (PENG) block, which is designed to preserve motor function while providing pain relief. Our primary objective was to evaluate how effectively landmark-guided PENG block could facilitate proper patient positioning during spinal anaesthesia in proximal femur fracture patients. Material and Methods: We designed a prospective, randomized controlled trial that enrolled 60 patients (aged 18-80 years) with ASA physical status I-III who required surgery under spinal anaesthesia for proximal femur fractures. The patients were divided equally: Group P received landmark-guided PENG block using 20 ml of 0.25% bupivacaine administered 30 minutes prior to positioning for spinal anaesthesia, whereas Group C underwent standard care without regional block. We measured pain intensity during positioning using the Numeric Rating Scale (NRS) as our primary outcome, along with several secondary measures including positioning quality, satisfaction levels, hemodynamic responses, and any adverse events. Results: Patients receiving the PENG block demonstrated substantially lower pain scores during positioning (NRS: 2.4 ± 0.8 versus 7.2 ± 1.1, p<0.001). Notably, the positioning quality was notably superior in the PENG group, with 86.7% of patients achieving optimal positioning compared to only 33.3% in the control group (p<0.001). Both patient ratings and anesthesiologist satisfaction levels were considerably higher in the PENG block group. Importantly, hemodynamic parameters remained stable throughout the procedure in both groups, and we observed no serious adverse events in either group. Conclusion: Our findings demonstrate that landmark-guided PENG block represents a highly efficacious, safe, and straightforward approach for managing pain during positioning prior to spinal anaesthesia in patients with proximal femur fractures. The technique successfully reduces pain perception, enhances positioning quality, and increases patient comfort without inducing muscle weakness. This method should be considered for routine use in clinical practice

Background: Postoperative sore throat (POST) is one of the most common airway-related complications following endotracheal intubation under general anaesthesia. Although usually self-limiting, it adversely affects patient comfort and quality of recovery. Topical lubricants and corticosteroids have been investigated for reducing POST; however, evidence comparing anti-inflammatory and lubricating agents’ remains limited. Methods: A prospective randomized comparative study was conducted in 123 ASA physical status I–II adult patients undergoing elective surgery requiring oral endotracheal intubation. Patients were randomly allocated into three equal groups (n = 41 each) to receive lubrication of the endotracheal tube with 0.05% betamethasone gel (Group BG), 2% lignocaine jelly (Group LG), or plain water-based jelly (Group PG). Anaesthetic management was standardized. The primary outcome was the incidence and severity of POST assessed using a four-point grading scale at 1, 6, 12, and 24 hours following extubation. Results: Baseline demographic characteristics and perioperative variables were comparable among the groups. Betamethasone gel significantly reduced the incidence of POST during the early postoperative period. At 1 hour, POST occurred in 80.5% of patients in Group BG compared with 97.6% in Group LG and 95.1% in Group PG (p = 0.014). At 6 hours, the incidence further decreased to 41.5% in Group BG compared with 75.6% and 87.8% in Groups LG and PG, respectively (p < 0.001). Although fewer patients in the betamethasone group experienced POST at 12 hours, the difference was not statistically significant (22.0% vs. 34.1% vs. 34.1%; p = 0.380). By 24 hours, only mild symptoms persisted with comparable incidence among all groups (p = 0.758

Background: Spinal anaesthesia is the preferred anaesthetic technique for caesarean section because it provides rapid onset of anaesthesia, dense sensory and motor blockade, minimal fetal drug exposure, and avoids the risks associated with general anaesthesia. However, spinal-induced hypotension remains the most common complication following neuraxial anaesthesia during caesarean delivery and is associated with maternal discomfort, increased vasopressor requirement, and potential reduction in uteroplacental perfusion. Hyperbaric bupivacaine is the standard intrathecal local anaesthetic used for caesarean section but is frequently associated with significant haemodynamic instability. Hyperbaric levobupivacaine, the pure S(-)-enantiomer of bupivacaine, has been proposed as a safer alternative because of its lower cardiotoxicity and potentially improved haemodynamic profile. This study compared maternal haemodynamic stability following intrathecal administration of hyperbaric levobupivacaine and hyperbaric bupivacaine during caesarean section. Methods: In this prospective randomized comparative study, 200 parturients undergoing elective or emergency lower segment caesarean section under spinal anaesthesia were randomly allocated into two equal groups. Group LH received 10 mg (2 mL) of 0.5% hyperbaric levobupivacaine, whereas Group BH received 10 mg (2 mL) of 0.5% hyperbaric bupivacaine intrathecally. Maternal systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and peripheral oxygen saturation were recorded serially from baseline until completion of surgery. The incidences of hypotension, bradycardia, vasopressor requirement, glycopyrrolate administration, intravenous fluid bolus requirement, and severity of hypotension were compared between the two groups. Results: Baseline demographic, obstetric, and haemodynamic characteristics were comparable between the study groups. Hyperbaric levobupivacaine demonstrated significantly better preservation of systolic, diastolic, and mean arterial pressures during the early intraoperative period. Maternal hypotension occurred significantly less frequently in the levobupivacaine group than in the bupivacaine group (28% vs. 61%; P < 0.001). Bradycardia (12% vs. 29%; P = 0.003), vasopressor requirement (24% vs. 55%; P < 0.001), glycopyrrolate administration (10% vs. 24%; P = 0.008), and intravenous fluid bolus requirement (31% vs. 58%; P < 0.001) were also significantly lower in the levobupivacaine group. Heart rate remained comparable between the groups except for a transient difference at four minutes after spinal anaesthesia. Conclusion: Intrathecal hyperbaric levobupivacaine provided superior maternal haemodynamic stability compared with hyperbaric bupivacaine during caesarean section. It was associated with a lower incidence and severity of hypotension, reduced vasopressor requirement, and fewer haemodynamic interventions while maintaining satisfactory surgical anaesthesia. Hyperbaric levobupivacaine may therefore be considered a suitable alternative to hyperbaric bupivacaine in obstetric patients where preservation of maternal cardiovascular stability is a clinical priority.

Background: Effective postoperative pain control following hip surgery is essential for early mobilization, improved functional recovery, and reduced postoperative morbidity. Lumbar plexus block (LPB) is an established regional analgesic technique, but the optimal approach remains controversial. This study compared the analgesic efficacy and safety of Capdevila's posterior approach and Winnie's anterior approach for LPB in patients undergoing hip surgeries. Objectives: To compare Capdevila's posterior approach and Winnie's anterior approach of lumbar plexus block with respect to: • Postoperative pain scores (VAS) • Onset of block • Duration of analgesia • Time to first rescue analgesia • Total 24-hour rescue analgesic consumption • Complications. Methods: This prospective comparative study was conducted at a tertiary care hospital over 18 months after Institutional Ethics Committee approval. Seventy-eight ASA I–II adult patients undergoing elective hip surgeries under spinal anaesthesia were enrolled and allocated into two equal groups (n = 39 each). Group C received a nerve stimulator-guided lumbar plexus block using Capdevila's posterior approach, while Group W received Winnie's anterior approach. Both groups received an identical 40 mL local anaesthetic mixture. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 0, 2, 4, 6, 8, and 12 hours. Secondary outcomes included onset of block, duration of analgesia, time to first rescue analgesia, 24-hour rescue analgesic consumption, hemodynamic parameters, and complications. Statistical analysis was performed using SPSS version 28, with p <0.05 considered statistically significant. Results: Baseline demographic characteristics, ASA status, duration, and type of surgery were comparable between the groups (p >0.05). Group C demonstrated significantly lower postoperative VAS scores from 2 to 12 hours (p <0.001). The onset of block was significantly faster in Group C than Group W (12.85 ± 1.79 vs. 15.19 ± 1.61 minutes; p <0.001). Duration of analgesia was significantly longer in Group C (760.38 ± 64.59 vs. 585.44 ± 64.55 minutes; p <0.001), with delayed first rescue analgesia (722.79 ± 57.84 vs. 574.38 ± 63.12 minutes; p <0.001). Twenty-four-hour rescue analgesic consumption was significantly lower in Group C (115.38 ± 37.88 vs. 176.92 ± 36.45 mg; p <0.001). Hemodynamic parameters remained stable, and both techniques demonstrated a low incidence of complications without any serious adverse events. Conclusion: Capdevila’s approach provided better postoperative pain relief when compared to Winnie’s anterior approach. Patients in the Capdevila group experienced a significantly lower postoperative VAS scores, longer duration of analgesia, delayed requirement of first rescue analgesic and reduced total analgesic consumption during the first 24 hours after surgery.

Background: Hyperbaric Ropivacaine and hyperbaric Levobupivacaine are increasingly used as safer alternatives to hyperbaric Bupivacaine for spinal anaesthesia in Lower Segment Caesarean Section (LSCS). However, direct comparative evidence evaluating the spinal block characteristics of hyperbaric 0.75% Ropivacaine and hyperbaric 0.5% Levobupivacaine in parturients undergoing LSCS remains limited. This study aimed to compare the onset and duration of sensory and motor blockade following intrathecal administration of these two agents in patients undergoing LSCS. Method: This prospective, randomized comparative study included 136 ASA physical status II parturients aged 18–40 years with singleton term pregnancies undergoing LSCS under spinal anaesthesia. Participants were randomly allocated to receive either 2 mL of intrathecal hyperbaric 0.75% Ropivacaine (Group R, n=68) or 2 mL of intrathecal hyperbaric 0.5% Levobupivacaine (Group L, n=68). The primary outcome measures were the onset and duration of sensory blockade and the onset and duration of motor blockade. Results: Levobupivacaine produced a significantly faster onset of sensory blockade than Ropivacaine (4.16 ± 1.29 vs. 5.33 ± 1.52 min; P<0.001) and a significantly longer duration of sensory blockade (133.96 ± 17.68 vs. 109.99 ± 15.08 min; P<0.001). Similarly, the onset of motor blockade was faster (5.78 ± 1.31 vs. 6.76 ± 1.48 min; P<0.001), and the duration of motor blockade was significantly longer (113.49 ± 14.42 vs. 96.76 ± 15.03 min; P<0.001) in the Levobupivacaine group. Conclusion: Intrathecal hyperbaric 0.5% Levobupivacaine demonstrated superior spinal block characteristics compared with hyperbaric 0.75% Ropivacaine by providing a faster onset and longer duration of both sensory and motor blockade. Ropivacaine, with its shorter duration of motor blockade, may be advantageous when early postoperative mobilization is desired.

Background: Thyroid cancer is most common endocrine malignancy and there is high incidence of thyroid nodule detection in ultrasonography in general population. Hence there is a need to categorise thyroid nodules based on their risk of malignancy which would help in better patient management. High-resolution ultrasonography is the primary imaging modality for evaluating thyroid nodules, and standardized reporting systems such as the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) and Korean Thyroid Imaging Reporting and Data System (K-TIRADS) have been developed to improve diagnostic consistency and guide management. Objective:To compare the diagnostic performance of ACR TI-RADS and Korean TI-RADS in the risk stratification of thyroid nodules using cytopathology and histopathology as the reference standards. Materials and Methods :It was prospective observational study conducted in the Department of Radiodiagnosis. Patients presenting with thyroid nodules underwent high-resolution ultrasonography, and each nodule was categorized according to both ACR TI-RADS and Korean TI-RADS criteria. Ultrasound findings including composition, echogenicity, shape, margins, and echogenic foci were recorded. Fine-needle aspiration cytology (FNAC) and histopathological examination, wherever available, served as the reference standard. Diagnostic indices including sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy were calculated for both classification systems.Results:Both ACR TI-RADS and Korean TI-RADS demonstrated good diagnostic performance in differentiating benign from malignant thyroid nodules. Increasing TI-RADS categories showed a progressive increase in the probability of malignancy. Comparative analysis demonstrated differences in sensitivity and specificity between the two systems, with each showing distinct strengths in risk stratification and biopsy recommendations.Conclusion:Both ACR TI-RADS and Korean TI-RADS are reliable ultrasound-based risk stratification systems for thyroid nodules. Their systematic application improves communication between radiologists and clinicians and assists in selecting nodules for FNAC. Comparative evaluation may help determine the most appropriate classification system for routine clinical practice.

SUMMARY: Acute intermittent porphyria (AIP) is a rare metabolic disorder that presents with nonspecific neurovisceral manifestations, often leading to delayed diagnosis. We report a 14-year-old female presenting with recurrent seizure-like episodes, severe abdominal pain, persistent hypertension, and hyponatremia. Initial evaluation for structural, infectious, and autoimmune causes was unremarkable.Further metabolic workup revealed elevated urinary delta-aminolevulinic acid and positive urinary porphobilinogen, confirming the diagnosis of AIP. The patient was managed with seizure control, antihypertensive therapy, correction of electrolyte imbalance, and high-carbohydrate therapy, with subsequent clinical improvement.This case underscores the importance of considering AIP in adolescents presenting with unexplained seizures and abdominal pain, particularly when associated with hyponatremia and autonomic instability. Early diagnosis and appropriate management are critical to preventing complications and avoiding the use of contraindicated medications.

Background: Bag-mask ventilation (BMV) is a fundamental airway management skill used during induction of general anaesthesia and emergency airway management. Effective one-hand BMV depends on achieving an adequate mask seal and maintaining airway patency. Although the EC grip is the conventional technique, the Thenar Eminence (TE) and Hook grip techniques have been proposed as alternatives to improve ventilation efficiency. However, evidence comparing these techniques in clinical practice remains limited. Objectives: To compare the effectiveness of three one-hand bag-mask ventilation techniques—EC, Thenar Eminence (TE), and Hook grip—in adult patients undergoing general anaesthesia, and to determine the technique providing optimal ventilation with minimal complications. Methods: This prospective comparative study included 111 adult patients (ASA I–II) scheduled for elective surgery under general anaesthesia. Patients were equally allocated into three groups according to the BMV technique used: EC, TE, and Hook (n=37 each). Ventilation quality was assessed during the first three minutes of one-hand BMV using tidal volume, end-tidal carbon dioxide (EtCO₂), adequacy of chest rise, oxygen saturation, gastric distension, heart rate, and blood pressure. Statistical analysis was performed using ANOVA and Chi-square tests, with p<0.05 considered statistically significant. Results: Baseline demographic and airway characteristics were comparable among the groups. The Hook technique produced significantly higher tidal volumes and EtCO₂ values throughout the study (p<0.001). Adequate chest rise at 3 minutes was observed in 97.3% of patients in the Hook group compared with 91.9% in the EC group and 48.6% in the TE group. Gastric distension was least frequent with the Hook technique (2.7%), compared with EC (27.0%) and TE (70.3%). Oxygen saturation and haemodynamic parameters remained stable in all three groups. Conclusion: The Hook grip demonstrated superior one-hand bag-mask ventilation compared with the EC and Thenar Eminence techniques by providing better ventilation efficiency, improved airway

Background: Music therapy is a non-pharmacological intervention that has been shown to reduce anxiety, improve hemodynamic stability, and enhance recovery in surgical patients. This study evaluates the impact of intraoperative music therapy on postoperative awakening, hemodynamic stability, and pain perception in patients undergoing elective surgical procedures under general anesthesia. Methods: This prospective, non-randomized controlled trial was conducted at a tertiary care hospital in Maharashtra over four months. Seventy adult patients (aged 18–50 years, ASA Grade I/II) undergoing elective surgeries were allocated into two groups: the music therapy group (Group M, n=35) and the control group (Group C, n=35). Patients in Group M listened to instrumental, slow-tempo music through noise-cancelling headphones during surgery, while Group C received standard care. The primary outcome was the quality of awakening, assessed using the Riker Sedation-Agitation Scale (RSAS). Secondary outcomes included hemodynamic stability, postoperative pain (Visual Analog Scale), and analgesic requirements. Statistical analysis was performed using IBM SPSS Statistics version 28.0. Results: Patients in the music therapy group demonstrated significantly lower postoperative pain scores at all time points (p<0.05) and required less opioid analgesia over 24 hours (p=0.01). They also exhibited better hemodynamic stability intraoperatively and had a significantly higher proportion of calm and cooperative awakenings (RSAS score 4, p=0.02). No significant differences were observed in intraoperative awareness. Conclusion: Intraoperative music therapy significantly improves postoperative awakening, reduces pain, and stabilizes hemodynamic parameters in patients undergoing elective surgery under general anaesthesia. Its integration into perioperative care may enhance patient outcomes.

Background: Pregnancy-induced hypertension (PIH), pre-eclampsia, and eclampsia are major contributors to maternal morbidity and mortality, often associated with raised intracranial pressure (ICP) secondary to cerebral edema. Optic nerve sheath diameter (ONSD) measurement using ultrasonography provides a non-invasive method to estimate ICP. This study aimed to evaluate ONSD in parturients with PIH, pre-eclampsia, and eclampsia, and to correlate these findings with disease severity and anaesthetic decision-making. Methods: A prospective observational study was conducted at a tertiary care centre in Nashik, Maharashtra, from May 2024 to April 2025. Sixty parturients aged 18–40 years with gestational age ≥28 weeks were enrolled and divided into four groups: normotensive controls (n=10), PIH (n=20), pre-eclampsia (n=20), and eclampsia (n=10). ONSD was measured 3 mm behind the globe using a 7.5–13 MHz linear probe in transverse and sagittal planes. A mean ONSD >5.8 mm was considered raised ICP. Data were analyzed using ANOVA and correlation tests. Results: The mean bilateral ONSD increased progressively from 4.83 ± 0.31 mm in controls to 6.18 ± 0.62 mm in eclampsia (p<0.001). Raised ONSD (>5.8 mm) was observed in 0%, 10%, 60%, and 80% of the respective groups. ONSD correlated strongly with mean arterial pressure (r=0.71, p<0.001) and neurological symptoms such as headache (r=0.63) and seizures (r=0.66). Among parturients with raised ONSD, 68.2% underwent general anaesthesia, while 92.1% with normal ONSD received neuraxial anaesthesia safely. Conclusion: Ultrasonography-guided ONSD measurement is a simple, non-invasive, and reliable bedside tool to detect raised ICP in hypertensive disorders of pregnancy. Its incorporation into pre-anaesthetic assessment can enhance safety and guide anaesthetic management in high-risk obstetric patients

Background: Elderly patients with fragility fractures are particularly susceptible to hyponatremia because of their impaired physiology, multiple co-morbidities,polypharmacy,hospitalization, perioperative fluid restrictions, and homeostatic stress from the fracture itself and the subsequent surgery.These patients are also at a higher risk of the complications of hyponatremia such as brain injury, the main result of acute symptomatic hyponatremia and associated with significant morbidity and mortalityObjective: To investigate the proportion of hyponatremia in elderly patients with hip fractures, focusing on the differences between female and male patients with extracapsular or intracapsular proximal femoral fracturesMethodology: All records containing clinical and laboratory information about patients admitted to orthopaedic department of S. Nijalingappa Medical College and HSK Hospital and Research Centre, Bagalkot from November 2022 to November 2023 were retrieved from the hospital database.A total of 100 patients were determined from the hospital database.They were divided into 4 groups based on sex and type of fracture (extracapsular or intracapsular). A total of 62 patients with extracapsular proximal femoral fractures and 38 patients with intracapsular proximal femoral fractures were obtainedResults : Of the 100 patients, there were more males ( n = 54, 54%) than females ( n = 46, 46%), with a ratio of 1.2: 1. In both male and female patients, there were more extracapsular proximal femoral fractures, 30/54 (55%) and 32/46 (69%), respectively than intracapsular proximal femoral fractures, 24/54 (44%) and 14/46 (30%),respectively. Overall, the proportion of hyponatremia in the total population was 22% (22/100).Conclusion: There was high prevalence (22%) of hyponatremia in elderly patients with hip fractures. Serum sodium concentrations should be routinely assessed in elderly patients with hip fractures to prevent occurrence of Hyponatremia

Background: Sickle Cell Disease (SCD) is highly prevalent in the tribal populations of Koraput, Odisha. Avascular necrosis (AVN) of the femoral head is a frequent, debilitating complication for these patients, often requiring Total Hip Replacement (THR) to restore mobility. Anesthetizing SCD patients is a high-stakes challenge; physiological stressors like hypoxia, hypothermia, acidosis, and sudden hypotension can easily trigger a life-threatening vaso-occlusive crisis. This study compares the hemodynamic stability, block characteristics, and postoperative outcomes of spinal versus epidural anaesthesia in this vulnerable demographic.Methods: In this prospective, randomized study at SLN MCH, 60 adult SCD patients scheduled for elective THR were divided into two equal groups of 30. Group S received spinal anaesthesia (hyperbaric bupivacaine) and Group E received epidural anaesthesia (isobaric bupivacaine with catheter placement). We monitored Haemodynamics (Mean Arterial Pressure, Heart Rate), block characteristics, postoperative pain via Visual Analog Scale (VAS), and complication rates.Results: Spinal anaesthesia provided a much faster block onset (p<0.001). However, epidural anaesthesia offered far superior hemodynamic stability. Intraoperative hypotension occurred in 36.6% of the spinal group compared to only 10.0% of the epidural group (p=0.015). Furthermore, postoperative pain control was significantly better and longer-lasting in the epidural group due to catheter top-ups.Conclusion: While both regional techniques avoid the risks of general anaesthesia, epidural anaesthesia proves to be the safer choice for SCD patients undergoing THR. It ensures gradual hemodynamic shifts and provides excellent continuous postoperative pain relief, fundamentally reducing the triggers for sickle cell crises

Background: Plantar fasciitis (PF) is the most common cause of inferior heel pain. While often diagnosed clinically, imaging modalities like Ultrasonography (USG) and Magnetic Resonance Imaging (MRI) are crucial for confirming the diagnosis, quantifying disease severity, and ruling out other pathologies.Objective: To evaluate and correlate the thickness of the plantar fascia using high-resolution USG and MRI in patients with clinically suspected plantar fasciitis, and to assess the statistical significance of their correlation.Materials and Methods: This prospective cross-sectional study included 50 patients (60 symptomatic heels) presenting with clinical signs of PF. All patients underwent both high-resolution USG and MRI of the affected foot. Plantar fascia thickness was measured at its calcaneal insertion.Results: The mean age of the patients was 45.2 ± 10.4 years. The mean plantar fascia thickness measured by USG was 5.42 ± 1.18 mm, while MRI measured 5.56 ± 1.25 mm. A very strong positive correlation was found between USG and MRI measurements (Pearson’s r = 0.892). This correlation was highly statistically significant (p < 0.001).Conclusion: High-resolution USG is a highly reliable, cost-effective primary imaging modality that correlates strongly and significantly with the gold-standard MRI in measuring plantar fascia thickness in PF.

Abstract Introduction: Acne vulgaris can adversely affect psychological well-being, self-perception, and social functioning among young adults. This study was conducted to assess the impact of acne vulgaris on self-esteem, body image, and social anxiety among young adults attending a tertiary care hospital and to determine their association with acne severity.Methods: A hospital-based cross-sectional study was conducted among 110 young adults aged 18–25 years with clinically diagnosed acne vulgaris attending the Dermatology Outpatient Department of a tertiary care hospital. Acne severity was assessed using the Global Acne Grading System (GAGS). Self-esteem, body image, and social anxiety were evaluated using the Rosenberg Self-Esteem Scale, a validated Body Image Scale, and the Liebowitz Social Anxiety Scale, respectively. Data were analyzed using descriptive statistics, Chi-square test, and ANOVA. Results: Among the participants, 43.6% had low self-esteem, 46.4% reported disturbed body image, and 40.0% experienced social anxiety. Moderate acne was the most common severity category (41.8%), followed by severe acne (25.5%). The prevalence of low self-esteem increased from 23.1% in mild acne to 80.0% in very severe acne. Similar trends were observed for disturbed body image and social anxiety. Mean self-esteem scores decreased significantly with increasing acne severity, whereas body image disturbance and social anxiety scores increased significantly (p<0.05).Conclusions: Acne vulgaris exerts a substantial psychosocial impact on young adults. Increasing acne severity is significantly associated with lower self-esteem, poorer body image, and higher social anxiety, highlighting the need for integrated psychological assessment and management in acne care

Background: Anaemia is one of the most prevalent nutritional disorders among adolescent girls and remains a major public health concern in India. It adversely affects physical growth, cognitive development, educational performance, immunity, and future reproductive health. Despite the implementation of national programmes such as Anemia Mukt Bharat and Weekly Iron and Folic Acid Supplementation (WIFS), the burden of anaemia among adolescents continues to be high. Understanding its prevalence and determinants at the community level is essential for planning targeted interventions. Aim: To determine the prevalence of anaemia and identify its determinants among adolescent girls in the RHTC field practice area of GMERS Medical College, Dharpur–Patan, using a mixed-method approach. Materials and Methods: A community-based mixed-method study was conducted among 90 adolescent girls aged 10–19 years residing in the field practice area of tertiary care hospital medical College, over a period of one month. Participants were selected using simple random sampling. Quantitative data were collected using a pretested semi-structured questionnaire covering socio-demographic characteristics, dietary habits, menstrual history, iron-folic acid supplementation, deworming status, and knowledge regarding anaemia. Haemoglobin estimation was performed using a portable digital haemoglobinometer, and anaemia was classified according to WHO criteria. Qualitative data were obtained through focus group discussions and key informant interviews to explore perceptions and barriers related to anaemia prevention. Data were analysed using SPSS version 26.0. Descriptive statistics, Chi-square test, and multivariable logistic regression were applied, with a p-value <0.05 considered statistically significant. Results: The mean age of participants was 15.3 ± 2.1 years. The overall prevalence of anaemia was 60.0%, with mild anaemia (51.9%) being the most common, followed by moderate (40.7%) and severe anaemia (7.4%). The mean haemoglobin concentration was 11.2 ± 1.4 g/dL. Significant determinants of anaemia included inadequate dietary diversity (χ²=12.81, p<0.001), irregular iron-folic acid tablet consumption (χ²=13.54, p<0.001), heavy menstrual bleeding (χ²=5.89, p=0.015), underweight nutritional status (χ²=4.78, p=0.029), maternal illiteracy (χ²=5.36, p=0.021), and lack of deworming (χ²=4.96, p=0.026). Qualitative findings revealed inadequate awareness regarding anaemia, poor dietary practices, fear of side effects of iron-folic acid tablets, and insufficient nutrition counselling as major barriers to prevention and treatment. Conclusion: Anaemia was highly prevalent among adolescent girls in the study area and was significantly associated with nutritional, behavioural, and socioeconomic determinants. Strengthening nutrition education, improving dietary diversity, ensuring regular iron-folic acid supplementation and deworming, and enhancing community awareness through school- and community-based interventions are essential to reduce the burden of anaemia among adolescent girls

Background: Diabetes is an increasingly important disease globally. The breakdown of foods high in protein intochemicals known as purines is responsible for the production of uric acid in the body. Objectives of the study: To study the levels of serum uric acid in cases of type 2 Diabetes Melitus (DM ) and to compare with healthy controls and to correlate .Materials and methods: This was an observational case control study conducted in department of Medicine CMCRI , Chitradurga for a duration of 12 months from June 2025 to June 2026. A total of 90 subjects were prospectively included in the study (45 cases of DM and 45 matched controls). The concentration of serum uric acid were measured in all subjects and correlated. Results: The levels of serum uric acid were found to be significantly increased in cases of DM compared to healthy controls.(p<0.01)Conclusion: There was significant statistical association between uric acid levels and serum creatinine levels (p value < 0.001). Uric acid levels had statistically significant relationship with fasting blood sugar and PPBS (P value <0.05).

Background: Pulmonary hypertension (PH) complicating chronic kidney disease (CKD) is associated with substantial excess mortality, yet the mechanisms driving it remain incompletely defined. Anaemia, disordered mineral metabolism, the haemodynamic burden of an arteriovenous fistula and the volume shifts of maintenance haemodialysis have all been proposed as contributors. Establishing which of these track most closely with PH is important because each is, in principle, modifiable. Objectives: To compare the biochemical profile of CKD patients with and without pulmonary hypertension, and to examine the association of pulmonary hypertension with the presence of an arteriovenous fistula and with maintenance haemodialysis. Materials and Methods: A prospective descriptive study was conducted in the Departments of Nephrology and General Medicine, Ballari Medical College and Research Centre (formerly Vijayanagar Institute of Medical Sciences), Ballari, Karnataka, over 18 months. Sixty-four patients with CKD of any aetiology and an estimated glomerular filtration rate below 60 mL/min/1.73 m² were enrolled after institutional ethics approval and written informed consent. Patients with chronic obstructive pulmonary disease, parenchymal lung or chest wall disease, prior pulmonary hypertension or pulmonary embolism, more than five pack-years of smoking, collagen vascular disease, left ventricular ejection fraction below 50%, or significant mitral or aortic valve disease were excluded. Biochemical values were taken as the mean of the last six readings for each patient. All participants underwent electrocardiography, chest radiography and transthoracic echocardiography. Group comparisons used the unpaired t-test and the chi-square or Fisher's exact test in SPSS v24.0, with p<0.05 taken as significant and p<0.001 as highly significant. Results: Pulmonary hypertension was present in 17 of 64 patients (26.6%). Patients with PH had significantly lower haemoglobin (8.38 ± 1.27 versus 9.84 ± 1.92 g/dL; t = 2.888, p = 0.005), significantly lower serum calcium (7.88 ± 0.77 versus 9.25 ± 0.73 mg/dL; t = 6.504, p = 0.0001) and significantly higher serum phosphorus (3.49 ± 0.45 versus 2.87 ± 0.41 mg/dL; t = −5.242, p = 0.0001). Serum creatinine (6.84 ± 3.83 versus 5.40 ± 3.15 mg/dL, p = 0.133), blood urea (115.12 ± 40.08 versus 103.76 ± 60.66 mg/dL, p = 0.477) and serum albumin (2.66 ± 0.35 versus 2.88 ± 0.39 g/dL, p = 0.053) did not differ significantly. Pulmonary hypertension was significantly commoner in patients with an arteriovenous fistula (11 of 24, 45.8%) than without one (6 of 40, 15.0%; p = 0.01), and showed a non-significant trend towards higher prevalence among patients on maintenance haemodialysis (14 of 41, 34.1%) compared with those managed conservatively (3 of 23, 13.0%; p = 0.07). Conclusion: Pulmonary hypertension in CKD was associated with a distinct biochemical signature of anaemia, hypocalcaemia and hyperphosphataemia, and with the presence of an arteriovenous fistula, but not with the conventional markers of azotaemia. These findings implicate anaemia-driven high cardiac output, vascular calcification from disordered mineral metabolism, and fistula-related shunt flow — rather than the degree of uraemia itself — in its pathogenesis.

Background: Hepatic encephalopathy (HE) is a reversible neuropsychiatric syndrome complicating cirrhosis, arising from the accumulation of gut-derived neurotoxins — principally ammonia — that the failing liver can no longer detoxify. The great majority of episodes in cirrhotic patients are triggered by an identifiable precipitating event rather than by spontaneous hepatic decompensation alone. Because these triggers are largely preventable and correctable, their timely recognition is the single most important determinant of recovery. The relative frequency of individual precipitants varies substantially between geographical regions and healthcare settings, and region-specific data from South India remain limited. Objectives: To ascertain the most common precipitating factors and their frequency in patients presenting with hepatic encephalopathy among diagnosed cases of cirrhosis of the liver of any aetiology, and to describe the demographic profile, underlying aetiology of cirrhosis and distribution of encephalopathy grades in this population. Materials and Methods: A prospective, descriptive, hospital-based observational study was carried out in the Department of General Medicine, Ballari Medical College and Research Centre (formerly Vijayanagar Institute of Medical Sciences), Ballari, Karnataka. Eighty-five consecutive patients above 12 years of age with established cirrhosis of the liver who presented with hepatic encephalopathy, including minimal hepatic encephalopathy, were enrolled after Institutional Ethics Committee clearance and written informed consent. Patients with psychiatric illness, altered sensorium attributable to metabolic disease or head injury, acute alcohol intoxication and alcohol withdrawal states were excluded. Sample size was estimated using nMaster v2.0. All patients underwent detailed history taking, clinical examination, complete blood count, liver and renal function tests, serum electrolytes, coagulation profile, ascitic fluid analysis and abdominal ultrasonography. Encephalopathy was graded clinically from grade 1 to 4. Data were analysed with IBM SPSS Statistics v23.0 using frequency and percentage analysis, with the chi-square or Fisher's exact test applied to categorical associations at a 5% significance level. Results: Of 85 patients, 78 (91.8%) were male and 7 (8.2%) female. The disease clustered in the fourth and fifth decades, with 31 patients (36.5%) aged 31–40 years and 27 (31.8%) aged 41–50 years. Alcoholic cirrhosis was overwhelmingly predominant, accounting for 70 cases (82.4%), followed by hepatitis B in 8 (9.4%), cryptogenic cirrhosis in 4 (4.7%) and hepatitis C in 3 (3.5%). Gastrointestinal bleeding was the leading precipitant, present in 33 patients (38.8%), followed by constipation in 19 (22.4%), infection in 18 (21.2% — spontaneous bacterial peritonitis 10, pneumonia 5, urinary tract infection 3), electrolyte imbalance in 9 (10.6%) and iatrogenic or procedure-related causes in 6 (7.1%). Conclusion: Gastrointestinal bleeding, constipation and infection together accounted for over four-fifths of all episodes of hepatic encephalopathy in this cohort, and alcohol was the dominant aetiology of the underlying cirrhosis. Systematic variceal surveillance, routine bowel regulation with lactulose, early detection of spontaneous bacterial peritonitis and community-level alcohol reduction represent the interventions with the greatest potential to reduce the burden of hepatic encephalopathy in this population.

Background: Anti-snake venom is the only specific antidote available for snakebite envenoming, yet the optimal dose remains contested, with published Indian series reporting mean requirements ranging from under 12 to over 21 vials. Complications — cellulitis, acute kidney injury, respiratory paralysis and disseminated intravascular coagulation — determine much of the morbidity, while reported case fatality varies more than tenfold between centres. The single breath count has been proposed as a simple bedside predictor of impending respiratory failure in neuroparalytic envenoming. Objectives: To determine the anti-snake venom requirement in relation to the type of envenomation syndrome, to describe the vital and laboratory derangements observed, to assess the utility of the single breath count in identifying patients needing ventilatory support, and to document complications and in-hospital outcome. Materials and Methods: A hospital-based prospective observational study was conducted in the Department of General Medicine, Koppal Institute of Medical Sciences, Koppal, Karnataka, from 1 August 2022 to 30 May 2024. One hundred consecutive patients with snake bite and one or more manifestations of envenomation were enrolled after institutional ethics committee clearance and written informed consent. Patients with bites other than snake bite and non-poisonous bites were excluded. Polyvalent anti-snake venom was given as 10 vials in 500 mL normal saline over one hour, with repeat clinical assessment, prothrombin time with international normalised ratio and 20-minute whole blood clotting test determining further doses to a maximum of 30 vials. Single breath count, need for ventilation, dialysis and blood product transfusion were recorded. Analysis used SPSS version 21. Results: Envenomation was local in 52 patients (52%), haemotoxic in 30 (30%), neurotoxic in 16 (16%) and combined in 2 (2%). Overall mean anti-snake venom requirement was 17.0 vials; 47 patients (47%) received 10 vials, 36 (36%) received 20 and 17 (17%) received 30. Requirement tracked the envenomation syndrome closely: mean vials were 12.7 for local, 21.0 for haemotoxic, 22.5 for neurotoxic and 25.0 for combined envenoming; no patient with neurotoxic envenoming was managed on 10 vials alone. Mean admission systolic and diastolic pressures were 119.9 ± 16.9 and 75.87 ± 10.12 mmHg, pulse 100.3 ± 10.3/min and oxygen saturation 96.51 ± 2.71%. Mean haemoglobin was 12.91 ± 1.77 g/dL, total leucocyte count 10,769 ± 4,766/mm³, platelets 257.98 ± 78.03 × 10³/mm³, international normalised ratio 1.84 ± 1.27 and creatinine 0.981 ± 0.428 mg/dL; 11 patients (11%) had creatinine between 1.8 and 3.0 mg/dL but none required dialysis. Six patients (6%) required ventilatory support, all drawn from the 26 with a single breath count of 30 or below. Cellulitis was the commonest complication (52%), followed by respiratory failure (6%), acute kidney injury (5%) and disseminated intravascular coagulation (2%); 35 patients (35%) had no complication. Ninety-nine patients (99%) survived, the single death resulting from neuroparalysis with respiratory failure. Conclusion: Antivenom requirement rose in clear proportion to the severity of systemic envenoming, with neurotoxic and combined syndromes needing roughly twice the dose of local envenomation. A single breath count of 30 or below identified every patient who subsequently required ventilation. Survival of 99% is among the highest reported from Indian centres and is attributable to early presentation and tertiary-level supportive care.

Background: Nausea and vomiting are important defence mechanism of body against the Ingestion of toxins but exact mechanism of Nausea and vomiting are not known though the problem exists for more than 150 years. This is a multifactorial and so very complex process. Objective: to determine the efficacy of prophylactic Ondansetron and Ramosetron in preventing the incidence of postoperative nausea and vomiting after carboprost in LSCS under spinal anesthesia and assess the requirement of other rescue antiemetic in the postoperative period and assess any adverse effects associated with their use. Methods: This Prospective, Comparative study was conducted among Patients scheduled for LSCS with use of carboprost IM under spinal anaesthesia in Bapuji Hospital, Chigateri General Hospital, Women and Child Health Hospital attached to JJM Medical College, Davangere. Duration of study was Two years, the study was covered over a period from October 2019- September 2021. Result: There was no statistically significant difference between Ondansetron and Ramosetron with incidence of nausea, retching, vomiting, need for rescue antiemetic at intervals of 0-3 hours, 6-12 hours and 12-24 hours. Both Ondansetron and Ramosetron were well tolerated, with minimum adverse effects. There was no significant difference between the two groups with respect to adverse effects. Overall incidence of complete response in Ramosetron group (76%) is higher than Ondansetron group (56%) and is statistically suggestive of significance p value (< 0.023). Based on the results of our study, Ramosetron at an intravenous dose of 0.3 mg is safe and well-tolerated and more effective than 4 mg intravenous Ondansetron for antiemetic prophylaxis in LSCS under spinal anaesthesia after carboprost. Conclusion: Ramosetron at an intravenous dose of 0.3mg is more effective than intravenous inj ondansetron 4mg to prevent postoperative nausea and vomiting with carboprost in LSCS patients.