Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease that can involve the hip joint and may ultimately require total hip arthroplasty (THA). Although advances in disease-modifying antirheumatic therapy and arthroplasty techniques have reduced the requirement for joint replacement, patients with RA remain at risk of postoperative complications because of systemic inflammation, immunosuppression, poor bone quality, altered anatomy, and comorbidities. This systematic review summarizes the reported complications following total hip arthroplasty in patients with rheumatoid arthritis and examines changes in complication patterns over time.Methods: Relevant studies addressing complications following primary total hip arthroplasty in patients with rheumatoid arthritis were reviewed from the supplied literature, with bibliographic verification against PubMed-indexed sources. Studies reporting postoperative infection, dislocation, aseptic loosening, periprosthetic fracture, revision, venous thromboembolism, mortality, or composite complications were considered. Findings from previous systematic reviews, registry studies, retrospective cohorts, and comparative studies were synthesized descriptively. The review was reported in accordance with the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Results: The available evidence indicates that the overall requirement for THA among patients with RA has declined substantially over recent decades. A large systematic review of studies published between 1980 and 2019 reported an overall THA incidence of approximately 7 per 1000 patient-years and an overall complication rate of 12.8%. The most frequently reported complications were revision, aseptic loosening, infection, dislocation, periprosthetic fracture, venous thromboembolism, and early mortality. Pooled estimates were 8.8% for revision, 4.0% for aseptic loosening, 2.6% for infection, 0.8% for dislocation, 0.3% for periprosthetic fracture, 0.4% for venous thromboembolism, and 0.6% for 90-day mortality. Comparative studies have consistently demonstrated a higher risk of dislocation and infection in RA than in osteoarthritis. More recent evidence suggests that active RA disease at the time of arthroplasty may further increase the risk of postoperative complications. Conclusions: Total hip arthroplasty provides an important treatment option for patients with rheumatoid arthritis with advanced hip disease. Despite improvements in medical and surgical management, postoperative infection, dislocation, aseptic loosening, revision, and periprosthetic complications remain clinically relevant. Optimization of rheumatoid disease activity and perioperative management may contribute to reducing these complications

Objective: To find out the value of evaluating RNFL thickness, if any in cases of optic neuritis on SD-OCT. (Optical Coherence Tomography RS-3000 Advance a product of NIDEK CO., LTD. Gamagori, Aichi 443-0038, JAPAN) and To study the systemic associations of the patients of optic neuritis. Methods: This was a prospective study involving patients diagnosed with ON presenting at Shri Mahant Inderesh hospital, Dehradun. The presenting features, investigations, treatment and outcome after treatment were studied over a period of 2 years and patients were followed up to 6 months. Patients underwent baseline examination which included Snellen’s visual acuity test, optic nerve function test, IOP measurement, OCT, VEP and MRI brain. Patients were treated with intravenous 1gm of methyl prednisolone diluted in normal saline for 3 days. Result: Mean RNFL thickness at presentation was 119.04+28.12 which showed significant reduction on 6 month follow up with mean 94.76+15.14 post treatment. On MRI brain and orbit with contrast 56% patients showed no abnormality, 12 % optic neuritis associated with multiple sclerosis and 8%patients reported demyelinating lesions. No significant correlation was observed between visual evoked potential and visual acuity at presentation or after 4 weeks. No significant correlation was observed between retinal nerve fiber layer thickness and visual acuity at presentation or after 4 weeks. Conclusion: Role of OCT in monitoring RNFL changes in follow up seems promising. Longer follow up and larger sample size is required in future to establish the systemic associations

Background: paroscopic cholecystectomy is the standard treatment for symptomatic gallstone disease. Although it usually ensures shorter hospitalization and faster recovery, some patients experience prolonged hospital stay. This may increase healthcare costs and complications. Identifying demographic, clinical, laboratory, operative, and postoperative predictors can help optimize perioperative care and improve hospital resource utilization. Aim: To identify the demographic, clinical, laboratory, operative, and postoperative factors that predict prolonged hospital stay among patients undergoing laparoscopic cholecystectomy. Methods: A prospective observational study was conducted among 180 patients undergoing laparoscopic cholecystectomy at a tertiary care hospital. Demographic, clinical, laboratory, radiological, operative, and postoperative data were prospectively collected. Patients were categorized into normal-stay (≤3 days) and prolonged-stay (>3 days) groups. Associations between selected variables and prolonged hospital stay were assessed using the statistical methods specified in the final study analysis. A p-value <0.05 was considered statistically significant. Results: A total of 180 patients were included. Prolonged hospital stay (>3 days) occurred in 48 patients (26.7%). Patients aged >60 years, those with diabetes mellitus, higher operative difficulty (Grade III/IV), conversion to open surgery, and postoperative complications showed statistically significant associations with prolonged hospital stay (p<0.05). Prolonged stay occurred in 25/43 (58.1%) patients aged >60 years, 20/38 (52.6%) patients with diabetes mellitus, 32/48 (66.7%) patients with Grade III/IV operative difficulty, 13/16 (81.3%) patients requiring conversion to open surgery, and 20/25 (80.0%) patients with postoperative complications. Conclusion: Identification of factors associated with prolonged hospital stay may help recognize high-risk patients requiring closer perioperative monitoring and timely management. Appropriate optimization of modifiable risk factors, early recognition of complications, and effective discharge planning may improve patient outcomes, reduce hospital resource utilization, and enhance perioperative care following laparoscopic cholecystectomy.

Background: Monopolar transurethral resection of the prostate (m-TURP) using 1.5% glycine irrigating solution remains widely practiced for benign prostatic hyperplasia (BPH). Transurethral resection (TURP) syndrome, caused by systemic absorption of hypo-osmolar non-electrolyte irrigation fluid, is a severe perioperative complication. This study evaluated the incidence of TURP syndrome during m-TURP and analyzed its association with pre-operative prostate volume, operative duration, resected tissue weight, glycine volume, and serum electrolyte changes. Materials & Methods: A prospective observational study was conducted on 384 male BPH patients undergoing m-TURP with 1.5% glycine irrigation over 18 months at a tertiary teaching hospital. Patient demographics, ASA physical status, USG prostate volume, operative time, resected weight, glycine volume, pre/post-operative serum sodium and potassium levels, and clinical features of TURP syndrome were documented. Statistical analysis used Chi-square, Fisher's exact, Mann-Whitney U, and paired t-tests (p < 0.05 considered significant). Results: The overall incidence of TURP syndrome was 2.34% (9/384 patients). Patients developing TURP syndrome had significantly larger prostate volumes (99.11 ± 13.99 g vs. 57.07 ± 13.04 g, p < 0.001), longer operative durations (83.67 ±9.08 min vs. 50.27 ± 11.92 min, p < 0.001), greater resected tissue weight (63.44 ± 9.49 g vs. 23.96 ± 8.69 g, p < 0.001), and higher glycine consumption (29.07 ± 4.16 L vs. 19.99 ± 2.80 L, p < 0.001). Prostate size >80 g was strongly associated with TURP syndrome (42.11% incidence vs. 0% in glands ≤60 g, p < 0.001). Mean serum sodium decreased overall from 139.93 ± 2.40 mEq/L to 136.90 ± 3.47 mEq/L (p < 0.001), with a mean fall of 15.42 ± 4.36 mEq/L in the TURP group vs. 2.74 ± 1.40 mEq/L in unaffected patients (p < 0.001). All 9 cases resolved successfully with protocolized management (O₂, fluid restriction, diuretics, hypertonic 3% saline, ICU support), yielding zero mortality. Conclusion: Pre-operative prostate volume >80 g is a major risk factor for TURP syndrome during m-TURP, driving prolonged operative time, heavy tissue removal, and excessive glycine absorption. Strict time limits (≤60 min), irrigant monitoring, and post-op electrolyte checks are essential for patient safety.

Background: Blunt chest trauma (BCT) is a major cause of emergency admissions and trauma mortality. Accurate evaluation of anatomical injury severity and physiological compromise is vital to determine effective conservative versus invasive management strategies and optimize short-term outcomes. Objectives: To systematically evaluate anatomical injury severity, diagnostic findings, management strategies, respiratory complications, and short-term clinical outcomes in patients presenting with blunt chest trauma at a tertiary care medical center. Methods: A prospective observational study was conducted over 18 months at a tertiary teaching hospital in India. Sixty consecutive patients admitted with BCT were evaluated. Clinical features, radiological patterns, therapeutic modalities, intensive care requirement, in-hospital complications, and length of stay were recorded and analyzed using SPSS. Results: The mean patient age was 38.93 ± 15.87 years (range: 8–71 years), with a 3:1 male predominance (75.0%). Road traffic accidents (58.3%) and falls from height (16.7%) were the leading injury mechanisms. Chest pain (88.3%) and breathlessness (50.0%) dominated the initial presentation. Rib fractures were detected in 55.0% of patients (45.0% having multiple rib fractures), while thoracic CT identified pulmonary contusions in 16.7%, pneumothorax in 18.3%, hemothorax in 10.0%, and subcutaneous emphysema in 21.7%. Associated head (30.0%) and abdominal (21.7%) injuries were common. Non-operative conservative management succeeded in 78.3% of patients. Intercostal tube drainage (ICD) was performed in 20.0%, ICU admission in 28.3%, mechanical ventilation in 5.0%, and surgical repair in 11.7%. Respiratory distress was the principal complication (31.7%). Admission hypoxia (SpO2 < 90%, p < 0.001) and pulmonary contusion (p = 0.003) were strong predictors of ICU admission. ICD insertion (p < 0.001), ICU admission (p < 0.001), pulmonary contusion (p = 0.042), and complications (p < 0.001) significantly prolonged hospitalization. Short-term discharge survival was 100% in this cohort. Conclusion: Blunt chest trauma primarily impacts young working-age males. While conservative supportive care yields excellent short-term survival, admission hypoxia, pulmonary contusion, and intercostal tube placement are reliable indicators of severe injury requiring intensive monitoring and prolonged hospital stay.

Background: Surgical creation of intestinal stoma remains one of the most important and life-saving interventions in general surgery, employed in a wide spectrum of elective and emergency clinical scenarios. Depending on the intestinal segment involved, causes of the stoma creation, surgical techniques, perioperative care, patient condition, the stoma may be associated with substantial morbidity in the form of early complications (skin irritation, partial necrosis) and late complications (skin irritation, prolapse, stenosis etc.) Aim: To evaluate the spectrum of complications associated with various types of intestinal stomas and to assess the methods employed in their management in patients treated at a tertiary care teaching hospital. Material and Methods: It is a prospective observational study done in Dept. of General Surgery, SCBMCH from January 2024 to December 2025 with all age groups and both sexes undergoing intestinal stoma creation during elective and emergency surgery and they were studied for post operative event in the form of early and late complications. Result: The study demonstrated that the majority of patients across all stoma types experienced a favorable clinical course, with the highest proportion achieving recovery, particularly among ileostomy patients (23.2%), followed by colostomy (14.9%) and jejunostomy (1.7%). A substantial proportion of patients also showed clinical improvement without complete resolution, again most commonly in ileostomy (18.5%) and colostomy (14.0%). However, persistent complications were noted in a notable subset of patients, particularly among ileostomy (13.7%) and colostomy (11.8%), while jejunostomy contributed minimally (0.5%). Conclusion: The present study concludes that intestinal stoma creation is most commonly performed in emergency settings, with ileostomy being the predominant stoma type, and is associated with a higher burden of both early and late complications compared to colostomy. While the majority of patients did not develop complications and achieved favorable outcomes with appropriate management, ileostomy patients experienced higher rates of skin-related problems, high-output-related issues, and structural complications such as parastomal hernia. Importantly, age was the only variable that showed a statistically significant association with stoma type, indicating that patient age plays a role in stoma selection, likely reflecting disease severity and physiological reserve.

Background: Enhanced Recovery After Surgery (ERAS) pathways incorporate multimodal, evidence-based perioperative measures to attenuate surgical stress, reduce complication rates, and accelerate functional recovery. Comparative evaluation against traditional practices remains essential in public teaching hospitals. Objective: To compare clinical outcomes, recovery of bowel function, complication rates, and length of hospital stay between the ERAS protocol and conventional perioperative care in elective open abdominal surgeries. Methods: This prospective randomized comparative study included 80 adults undergoing elective open abdominal surgery at a tertiary-care teaching hospital. Forty patients were allocated to ERAS care (preoperative carbohydrate loading, opioid-sparing analgesia, goal-directed fluid therapy, omission/early removal of tubes and drains, early oral nutrition, early ambulation) and 40 to Conventional care (overnight fasting, routine bowel preparation where applicable, liberal IV fluids, routine nasogastric decompression, systemic opioids, feeding delayed until flatus). Primary outcomes were length of hospital stay and time to bowel recovery (flatus and solid diet tolerance). Secondary outcomes included postoperative pain (NRS), 30-day morbidity (Clavien-Dindo), surgical site infection (SSI), and 30-day readmissions. Statistical significance was set at p < 0.05. Results: Baseline demographics were comparable between groups. Time to first flatus was significantly shorter in the ERAS group (41.35 ± 8.64 vs 68.20 ± 12.45 hours; p < 0.001), as was time to solid diet tolerance (52.10 ± 9.80 vs 89.45 ± 14.30 hours; p < 0.001). Postoperative hospital stay was markedly reduced with ERAS (5.85 ± 1.62 vs 8.70 ± 2.15 days; p < 0.001). Pain scores on POD 1 (3.45 ± 0.85 vs 5.20 ± 1.05; p < 0.001) and POD 2 (2.60 ± 0.74 vs 3.85 ± 0.92; p < 0.001) favored ERAS. Overall complications occurred in 8/40 (20.0%) ERAS patients versus 17/40 (42.5%) conventional patients (p = 0.031), with significant reductions in prolonged ileus and nausea/vomiting. SSI rates (7.5% vs 15.0%; p = 0.481) and 30-day readmission rates (2.5% vs 5.0%; p = 1.000) showed no significant differences. Conclusion: Implementation of the ERAS protocol in elective abdominal surgery leads to significantly faster gastrointestinal recovery, superior early pain relief, lower overall postoperative morbidity, and shorter hospital stay without compromising clinical safety or increasing readmissions

Background: Skin closure is the final step of exploratory laparotomy, but the choice between conventional sutures and staplers remains influenced by speed, wound morbidity, cosmesis, and cost. Objective: To compare Ethilon 2-0 interrupted sutures with skin staplers for abdominal skin closure after exploratory laparotomy. Methods: This prospective randomized comparative study included 80 adults undergoing emergency or elective exploratory laparotomy at a tertiary-care teaching hospital. Forty patients were allocated to Ethilon 2-0 interrupted skin closure and 40 to stapler closure. Primary outcomes were closure time and surgical site infection (SSI). Secondary outcomes included closure time per centimetre, material cost, postoperative pain, wound complications, POSAS scar scores, satisfaction, and hospital stay. Categorical variables were compared using the chi-square or Fisher exact test and continuous variables using the unpaired t-test; p<0.05 was significant. Results: Mean closure time was 10.53±2.57 minutes with Ethilon and 3.24±0.90 minutes with staplers (p<0.001). Closure time per centimetre was 0.64±0.13 versus 0.19±0.04 minutes/cm, respectively (p<0.001). Material cost was significantly lower with Ethilon (₹120 vs ₹650; p<0.001). SSI occurred in 6/40 (15.0%) Ethilon patients and 3/40 (7.5%) stapler patients (p=0.481). Wound gaping, discharge, seroma/hematoma, early pain, and hospital stay were comparable. Day-30 patient POSAS score was lower with staplers (11.55±2.55 vs 12.85±2.92; p=0.038), while the observer score showed a favourable but non-significant trend (12.25±2.67 vs 13.53±3.30; p=0.061). Conclusion: Skin staplers provide substantially faster abdominal skin closure and slightly better patient-rated scar outcome without a statistically demonstrable increase in wound complications. Ethilon remains markedly less expensive. Selection should therefore be individualized according to urgency, incision length, resource availability, and patient preference

Background: Insulin resistance is a central metabolic abnormality in type 2 diabetes mellitus (T2DM) and contributes to adverse cardiovascular risk profiles. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) provides a simple estimate of insulin resistance, but its utility as a standalone marker of cardiovascular risk remains uncertain. Objective: To assess insulin resistance using HOMA-IR and examine its association with 10-year atherosclerotic cardiovascular disease (ASCVD) risk in adults with and without T2DM. Methods: This hospital-based cross-sectional study included 200 adults aged 40-75 years, comprising 100 non-diabetic controls and 100 patients with T2DM. Fasting plasma glucose, fasting insulin, HbA1c, and lipid profile were measured. HOMA-IR was calculated using fasting glucose and insulin, with a cutoff of ≥1.9 used to define insulin resistance. Cardiovascular risk was estimated using the 10-year ASCVD risk score. Correlation, receiver operating characteristic (ROC) curve, and logistic regression analyses were performed. Results: Mean HOMA-IR was significantly higher in participants with T2DM than in controls (4.02 ± 5.72 vs. 2.04 ± 2.04; p=0.001), and insulin resistance was present in 67% and 33%, respectively (p<0.001). Mean 10-year ASCVD risk was also significantly higher in the T2DM group (11.27 ± 9.37% vs. 4.75 ± 6.90%; p<0.001). HOMA-IR correlated significantly with fasting plasma glucose, HbA1c, triglycerides, and BMI, but showed no significant association with ASCVD risk within either study group. In the total cohort, the Spearman correlation between HOMA-IR and ASCVD score was weak (ρ=0.146; p=0.040). ROC analysis demonstrated poor discrimination of high ASCVD risk (≥20%) by HOMA-IR in the total population (AUC=0.532), with similarly limited performance in the diabetic subgroup (AUC=0.432). Conclusion: HOMA-IR effectively identified greater metabolic dysfunction and insulin resistance among adults with T2DM but showed poor standalone ability to discriminate high 10-year ASCVD risk. HOMA-IR may therefore be useful as a metabolic marker but should complement, rather than replace, established cardiovascular risk assessment tools.

Background: Laryngoscopy and endotracheal intubation activate sympathetic pathways and can produce transient cardiovascular surges. Nitroglycerin (NTG) and topical lignocaine are used to attenuate this response through different mechanisms. Methods: This randomized, single-blind comparative study included 80 ASA I–II adults aged 18–50 years undergoing elective surgery requiring endotracheal intubation. Forty patients received 10% lignocaine spray and 40 received NTG spray (400 μg/puff). Invasive SBP, DBP and MAP, heart rate and SpO₂ were recorded from baseline through 2 hours. Sore throat, headache and hematoma were also assessed. Results: Baseline characteristics were comparable. NTG produced lower DBP at multiple postoperative time points and lower MAP at every recorded post-intervention interval. SBP was significantly lower with NTG at 0 min, 3 min, 10 min and 2 h. Heart rate and SpO₂ did not differ significantly. Headache occurred in 15.0% of NTG versus 5.0% of lignocaine patients (p=0.036), while sore throat and hematoma were not significantly different. Conclusion: In this selected elective-surgery population, NTG spray provided more consistent attenuation of blood-pressure responses than lignocaine spray, with stable heart rate and oxygenation but a higher incidence of minor headache.

Background: Children with disabilities face barriers to maintaining oral hygiene, yet data from Dadra and Nagar Haveli are lacking. Objectives: To assess oral hygiene status, estimate the prevalence of dental caries and gingival inflammation, and compare oral hygiene across disability categories among children at a special school in Silvassa. Methods: In this cross-sectional study, 108 children aged 5–15 years (intellectual disability 67, hearing impairment 35, visual impairment 6) were selected by proportionate stratified random sampling from 150 enrolled children; those treated dentally in the preceding year were excluded. Oral hygiene was assessed with the Oral Health Index for Children (OHI-C); caries and gingival inflammation were recorded as present or absent visually. Chi-square test and one-way ANOVA were used. Results: The mean OHI-C score was 1.54 ± 0.74. Average oral hygiene was most common (46.3%), and 25.0% of children had bad or very bad oral hygiene. Mean OHI-C differed across disability categories (p = 0.006) and was highest in intellectual disability (1.71 ± 0.73), significantly exceeding hearing impairment (1.27 ± 0.68; p = 0.011); 31.3% of children with intellectual disability had bad or very bad oral hygiene. The prevalence of dental caries was 53.7% (95% CI 44.3–62.8) and of gingival inflammation 4.6% (95% CI 2.0–10.4); caries was not associated with age or sex. Conclusion: Over half of these children had dental caries, and those with intellectual disability had the poorest oral hygiene. Disability-specific, school-based preventive programmes with caregiver training are warranted

Background: Systemic inflammatory indices may provide accessible markers of biological variation in oral squamous cell carcinoma (OSCC). This study evaluated associations of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) with histopathological grade. Methods: A prospective analytical cross-sectional investigation enrolled 150 patients with histopathologically confirmed OSCC (65 Grade I, 60 Grade II and 25 Grade III). NLR, PLR, SII and SIRI were derived from recorded peripheral blood cell counts. Biomarker distributions were compared with Kruskal-Wallis testing followed, when appropriate, by Holm-adjusted pairwise Mann-Whitney U comparisons. Spearman rank correlations assessed associations with ordinal histopathological grade. Results: Median SII increased from 474.8 in Grade I to 669.2 in Grade III, while median SIRI rose from 1.10 to 1.59. SII differed significantly across grades (H = 9.528, p = 0.009), with significant contrasts for Grades I versus III and II versus III. SIRI also differed significantly across grades (H = 11.738, p = 0.003), with significant pairwise contrasts for the same grade comparisons. Positive correlations were observed for SII (ρ = 0.215, p = 0.008) and SIRI (ρ = 0.260, p = 0.001). NLR and PLR were not significantly associated with histopathological grade. Conclusion: SII and SIRI showed significant positive associations with poorer histopathological differentiation, whereas NLR and PLR showed no statistically significant grade-related associations. These findings support further validation of SII and SIRI in clinical OSCC cohorts.

Background: Dental caries is a multifactorial destruction of tooth substance characterized by bacterial invasion with Streptococcus mutans playing a key role in its pathogenesis. Objectives 1. To isolate and identify Streptococcus mutans from dental caries by using Mitis Salvarius agar (MSA) 2. To find an association of Streptococcus mutans with DMFT score 3. To determine the antibiotic resistance pattern of amoxicillin, clindamycin, and doxycycline against Streptococcus mutans Materials and methods: This study was conducted by Khyber Medical University, where data was collected from Hayatabad Medical Complex, Pakistan. Following informed consent, DMFT scores were recorded and carious teeth were extracted (n=100). Caries were cultured on Mitis Salvarius Agar (MSA) to isolate Streptococcus mutans, which was identified based on their morphology, gram staining, and biochemical tests. Moreover, resistance of amoxicillin (10 µg), clindamycin (2 µg)., and doxycycline (30 µg) was also found out by Kirby Bauer method. Results: Streptococcus mutans was identified as the main causative organism in 78 out of 100 samples, having a significant association with DMFT score. (T-value = 4.58, P < 0.001). This implies that individuals harboring this bacterium are prone to dental caries. However, it also reinforces that Streptococcus mutans is not the sole etiological agent of dental caries. The bacterial colonies were cultured, both aerobically and anaerobically, by using Mitis Salvarius agar, providing an alternative, simplified approach to MSA supplemented with bacitracin and sucrose. Antibiotic susceptibility test revealed resistance, suggesting that the commonly used antibiotic drugs tested may not be universally effective. (P value < 0.001), further highlighting the significance of susceptibility-guided therapy in clinical management Conclusion: Managing microbial count in the prevention of dental caries is crucial to achieve better oral health outcomes. Moreover, the emergence of antibiotic resistance has laid a greater emphasis on preventive oral measures and judicious antibiotic use

Background: Preoperative nutritional impairment has been associated with wound complications after orthopedic operations, but the magnitude of this relationship may vary across surgical populations. Objectives: To examine the association between preoperative nutritional status and postoperative wound healing among patients undergoing orthopedic surgery. Methods: A prospective observational study was conducted at Prathima Institute of Medical Sciences, Nagunur, Karimnagar, Telangana, India, from January to July 2026. A total of 100 adult patients undergoing orthopedic surgery were included and classified according to preoperative nutritional status. Postoperative wound healing was assessed through day 30. Group risks were compared using an unadjusted risk ratio and Fisher’s exact test. Results: The mean age was 46.8 ± 15.2 years, and 62 patients were male. Thirty patients had poor nutritional status and 70 had adequate nutritional status. Delayed wound healing occurred in 12/30 (40.0%) patients with poor nutritional status and 7/70 (10.0%) patients with adequate nutritional status. The unadjusted risk ratio was 4.00 (95% confidence interval [CI], 1.75–9.16; Fisher’s exact P=0.0014). Overall, 19/100 (19.0%) patients experienced delayed wound healing. Conclusion: Poor preoperative nutritional status was significantly associated with a higher frequency of delayed postoperative wound healing. Preoperative nutritional assessment may help identify patients who require nutritional optimization and closer postoperative wound surveillance.

Background: Surgical site infection (SSI) complicates orthopedic recovery, particularly after procedures involving fractures or implants. Local prospective surveillance can help identify modifiable perioperative factors.Objectives: To estimate the 30-day frequency of SSI and examine associations with selected patient and procedural factors after orthopedic surgery. Methods: The supplied study record describes a single-centre prospective observational study of 100 adults undergoing orthopedic procedures at Prathima Institute of Medical Sciences, Nagunur, Karimnagar, Telangana, India, during January-July 2026. SSI was assessed within 30 days of surgery. Exposure-specific risks, risk ratios (RRs), 95% confidence intervals (CIs), and two-sided Fisher exact P values were calculated from the reported aggregate counts. Results: Eighteen patients developed SSI (18.0%); 14 infections were superficial and four were deep. SSI was more frequent with diabetes (10/30 versus 8/70; RR 2.92, 95% CI 1.28-6.66), open fracture (9/25 versus 9/75; RR 3.00, 95% CI 1.34-6.71), and delayed prophylaxis (8/20 versus 10/80; RR 3.20, 95% CI 1.45-7.05). Emergency surgery and operative duration exceeding 120 minutes showed higher observed risks, with less precise estimates. Twelve infections were culture-positive and six patients underwent debridement. Conclusion: Within the reported cohort, SSI occurred in 18% of patients and was more frequent among those with diabetes, open fractures, and delayed antibiotic prophylaxis.

Background: Obsessive-compulsive disorder (OCD) is a chronic neuropsychiatric condition in which a substantial proportion of patients experience inadequate response to conventional pharmacological and psychotherapeutic approaches. Accelerated deep intermittent theta-burst stimulation (d-iTBS) targeting the medial prefrontal cortex may provide a time-efficient neuromodulatory approach; however, evidence regarding the trajectory and durability of its therapeutic effects remains limited. This study aimed to evaluate the trajectory and durability of clinical response following accelerated d-iTBS in patients with OCD and to identify demographic and clinical predictors of sustained treatment response. Materials and Methods: This retrospective observational cohort study included 145 adults with OCD who completed accelerated d-iTBS targeting the medial prefrontal cortex. The protocol comprised five daily sessions over two consecutive weeks, totaling 50 sessions. OCD severity was assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at baseline, treatment completion, 2 weeks, 1 month, and 3 months. Treatment response was defined as a ≥35% reduction in Y-BOCS score and remission as a Y-BOCS score ≤12. Longitudinal changes and predictors of sustained response were evaluated using linear mixed-effects and multivariable logistic regression analyses. Results: Mean Y-BOCS scores decreased from 28.4 ± 4.6 at baseline to 15.9 ± 5.2 at treatment completion and remained significantly reduced at 3 months (16.8 ± 6.4; p<0.001). At 3 months, 61.2% of patients-maintained treatment response. Early response at treatment completion was the strongest predictor of sustained response (adjusted OR=4.12; 95% CI, 1.89–8.98; p<0.001), whereas higher baseline Y-BOCS severity and comorbid depression were associated with lower response durability. Conclusion: Accelerated d-iTBS was associated with substantial and sustained improvement in OCD symptoms. Early treatment response may provide a clinically useful indicator of longer-term therapeutic benefit.

Background: Fatty liver disease is closely associated with metabolic dysfunction and may range from simple steatosis to progressive liver injury. Ultrasonography is commonly used for detecting and grading hepatic steatosis, while liver enzymes provide biochemical evidence of hepatocellular injury. The relationship between liver enzyme levels and ultrasonographic severity, however, remains variable. Objective: To evaluate the association between serum liver enzyme concentrations and ultrasonographic severity of fatty liver disease in adults. Materials and Methods: This prospective observational cross-sectional study was conducted in the Department of Radiology, Mahabodhi Medical College and Hospital, Naknupa, Sherghati, Gaya, Bihar, from May to August 2026. A total of 310 adults with ultrasonographically detected fatty liver were included. Results: Grade I, II, and III fatty liver were observed in 128 (41.3%), 112 (36.1%), and 70 (22.6%) patients, respectively. Mean ALT increased significantly from 34.6 ± 13.2 U/L in grade I to 67.4 ± 29.8 U/L in grade III, while AST increased from 29.8 ± 10.5 to 52.1 ± 22.8 U/L (P<0.001). Conclusion: Increasing ultrasonographic severity of fatty liver disease was significantly associated with higher serum liver enzyme concentrations, particularly ALT, AST, and GGT.

Background: Decompensated chronic liver disease (DCLD) is frequently associated with electrolyte disturbances resulting from portal hypertension, renal dysfunction, hormonal alterations, and diuretic therapy. These disturbances contribute to disease progression and increase the risk of complications such as hepatic encephalopathy, infections, and renal impairment, highlighting the clinical importance of monitoring electrolyte balance in patients with advanced liver disease. Objective: To evaluate serum electrolyte levels and determine their association with disease severity and clinical complications in patients with DCLD. Materials and Methods: This cross-sectional observational study was conducted in the Department of General Medicine at a tertiary care teaching hospital and included 95 patients diagnosed with DCLD. Clinical, laboratory, and radiological data were collected using a structured proforma. Serum electrolytes (Na⁺, K⁺, Ca²⁺, and Mg²⁺), along with liver and renal function tests, were analyzed. Disease severity was assessed using the Child–Pugh classification and the Model for End-Stage Liver Disease (MELD) score. Results: The mean age of the patients was 52.8 ± 11.4 years, with a male predominance (71.6%). Alcohol-related liver disease was the most common etiology (46.3%). Hyponatremia was the most frequent electrolyte abnormality (65.3%), followed by hypomagnesemia (45.3%) and hypocalcemia (40%). Electrolyte levels declined significantly with increasing Child–Pugh class. Hyponatremia, hypocalcemia, and hypomagnesemia showed significant associations with hepatic encephalopathy, while hypomagnesemia was also associated with infections. Conclusion: Electrolyte abnormalities are common in patients with DCLD and are significantly associated with disease severity and major clinical complications. Early identification and appropriate management of these disturbances may help improve clinical outcomes and reduce disease-related complications

Background: Effective haemostasis is essential in minor oral surgical procedures to minimize blood loss, maintain a clear operative field, and reduce postoperative bleeding. Various local haemostatic agents are available; however, their clinical efficacy differs according to their mechanism of action. This study compared the haemostatic efficacy of four commonly used local agents with conventional pressure gauze. Materials and Methods: This prospective, randomized, comparative clinical study included 100 patients aged 18–60 years undergoing uncomplicated dental extraction. Participants were randomly allocated into five groups (n=20 each): haemocoagulase (Botroclot), chitosan-based dressing, adrenaline, tranexamic acid, and saline-soaked pressure gauze. The primary outcome was time required to achieve complete haemostasis. Rebleeding, need for additional haemostatic intervention, and adverse effects were also assessed. Data were analysed using one-way ANOVA followed by Tukey’s post-hoc test and appropriate exact tests. Results: Mean haemostasis time was 0.84±0.31 minutes with Botroclot, 1.09±0.29 minutes with chitosan, 1.35±0.28 minutes with adrenaline, 0.91±0.36 minutes with tranexamic acid, and 1.76±0.40 minutes with pressure gauze. The overall difference was statistically significant (F=25.60, p<0.001). Rebleeding occurred in one patient (5%) receiving adrenaline and two (10%) receiving pressure gauze, with no significant intergroup difference (p=0.20). No local or systemic adverse reactions were observed. Conclusion: Local haemostatic agents significantly differed in the time required to achieve haemostasis. Botroclot and tranexamic acid demonstrated the shortest haemostasis times, while conventional pressure gauze required the longest. These findings support the clinical utility of local haemostatic agents for rapid bleeding control following uncomplicated dental extraction

Introduction- Breast cancer (BC) is the most common cancer among women in India, and its incidence is rising among younger women. Early detection through awareness of warning signs and breast self-examination (BSE) can improve outcomes. This study assessed awareness, knowledge, and attitudes regarding BC among female medical students aged 18–25 years. Methods- A cross-sectional study was conducted among undergraduate female medical students at Gian Sagar Medical College and Hospital, Punjab. A self-administered, structured questionnaire covering demographics, awareness, knowledge, and attitudes was used. Data from 153 participants were analysed. Results- The mean age of participants was 21.1 years. Nearly all respondents (98.7%) knew that BC is the most common cancer in women. The primary source of information was the internet (88.7%), mainly Google (40.8%), YouTube (30.3%), and Instagram (26.3%). Awareness of BC symptoms was high (93.4%), as was awareness of screening methods (92.1%). Although 95.4% were aware of BSE, only 67% knew it should be performed monthly, and only 44.1% correctly identified the appropriate timing (5–7 days after menstruation). Main barriers to BSE were absence of symptoms (58.2%) and lack of knowledge on how to perform it (21%).Conclusion- Awareness of BC was high among these Generation Z female medical students, yet practical application of BSE remained limited. Targeted training programmes on correct BSE technique and its routine adoption are needed.

Background: Platelet count is essential for diagnosing and managing hematological disorders. Although automated analyzers provide rapid and reproducible results, platelet clumping, giant platelets, and red cell fragments may cause inaccurate counts. Manual peripheral smear examination remains important for validating discrepant results. Objective: To evaluate the agreement and systematic discrepancies between automated and manual platelet counts and assess platelet indices in thrombocytopenic and non thrombocytopenic cases. Methods: This cross-sectional study included 250 EDTA-anti coagulated blood samples collected over six months. Platelet counts obtained using the Mindray BC-6200 analyzer were compared with manual estimates from Leishman-stained peripheral smears. Mean platelet volume (MPV) and platelet distribution width (PDW) were assessed. Statistical analysis was performed using SPSS version 30 with paired t-test, Pearson correlation, and linear regression. Results: Automated platelet counts ranged from 4–1153 ×10⁹/L, compared with 20–1100 ×10⁹/L by manual estimation. Automated counts were significantly lower than manual counts (p<0.001), despite excellent correlation (r=0.989, p<0.001). Normal counts (19.6%), thrombocytosis (22.4%), and some thrombocytopenic cases (16%) showed concordance between both methods. A grey zone suggestive of pseudo thrombocytopenia was identified in 42% of samples, predominantly due to platelet clumps (42%), giant platelets (39%),&both(19%). MPV showed a non-significant inverse relationship with platelet count (p=0.397), while PDW demonstrated minimal variation(p=0.846) among thrombocytopenic and non thrombocytopenic cases, Automated method showed 100% sensitivity & Negative predictive value and 50% specificity with 27.6% Positive predictive value, Conclusion: Automated platelet counting is reliable for routine use; however, peripheral smear examination remains essential for confirming discrepant thrombocytopenic results and identifying platelet-related artifacts. Platelet indices provide useful supportive information on platelet kinetics but should complement, rather than replace, morphological assessment

Background: Effective postoperative analgesia facilitates early mobilization and recovery while minimizing opioid-related adverse effects. This study compared epidural and intravenous (IV) tramadol for postoperative analgesia in adults undergoing lower abdominal surgery. Methods: In this randomized comparative study, 110 ASA physical status I–II patients aged 18–60 years were allocated equally to receive epidural tramadol (50 mg diluted to 10 mL) or an IV tramadol regimen (1 mg/kg followed by 100 mg in 100 mL normal saline). Analgesic onset and duration, rescue analgesic requirement, pain-relief category, sedation, hemodynamic and respiratory variables, adverse effects, patient satisfaction, ambulation, and hospital stay were assessed. Statistical analysis used independent-samples t-tests and chi-square tests as reported in the source thesis. Results: Among 110 analyzed participants (55 per group), epidural tramadol was associated with faster onset of analgesia (7.9±2.6 vs 11.2±3.1 min; p<0.001), longer duration of analgesia (6.9±1.4 vs 4.2±1.2 h; p<0.001), less frequent rescue analgesia (21.8% vs 54.5%; p<0.001), lower nausea/vomiting (16.3% vs 32.7%; p=0.04), earlier ambulation (5.8±1.2 vs 7.1±1.5 h; p<0.001), shorter hospital stay (4.6±0.9 vs 5.3±1.1 days; p=0.001), and higher satisfaction scores (4.3±0.6 vs 3.7±0.7; p=0.02). No respiratory depression was reported. Conclusion: Within this study population and using the tested dosing regimens, epidural tramadol was associated with longer-lasting postoperative analgesia, lower rescue analgesic use, and selected favorable recovery outcomes compared with the IV regimen. These findings should be interpreted in the context of the single-center design, limited sample size, lack of documented blinding, and unequal route-specific dosing.

Background: Emergence agitation (EA) is an early postoperative behavioural disturbance that may complicate recovery after general anaesthesia. Sevoflurane permits rapid emergence but has been associated with agitation. Dexmedetomidine and propofol are both used to facilitate smoother emergence, but their comparative effects in adults receiving sevoflurane require evaluation. Methods: This prospective comparative study included adults aged 18–65 years with ASA physical status I–II undergoing elective surgery under general anaesthesia with sevoflurane. The final analysed cohort consisted of 50 patients, with 25 receiving dexmedetomidine and 25 receiving propofol. Dexmedetomidine 0.5 μg/kg or propofol 0.5 mg/kg was administered by infusion over 30 minutes after induction and discontinued at the end of surgery. The primary outcome was EA within 15 minutes of extubation, defined as an RSAS score ≥5. Secondary outcomes included RSAS severity, serial HR and MAP, SpO₂, PONV and QoR-15 at 24 hours. Results: EA occurred in 7/25 (28%) patients receiving dexmedetomidine and 16/25 (64%) receiving propofol (χ²=6.522, p=0.022). Mean RSAS at 15 minutes was lower with dexmedetomidine (3.40±1.607 vs 4.96±1.904; p=0.003). HR and MAP were comparable at every measured time point. SpO₂ was stable, with reported mean values of 96.92±1.038% and 97.48±1.085%, respectively (p=0.068). QoR-15 at 24 hours was higher with dexmedetomidine (137.20±7.455 vs 123.88±6.654; p=0.001). PONV distribution did not differ significantly (p=0.668). Conclusion: In this selected adult surgical cohort, dexmedetomidine was associated with lower incidence and severity of sevoflurane-associated EA and higher 24-hour QoR-15 scores than propofol, without statistically significant differences in serial HR, MAP, SpO₂ or PONV

Background: Upper gastrointestinal endoscopy under general anaesthesia requires reliable oxygenation and ventilation while preserving procedural access and minimizing airway trauma. The dedicated Gastro LMA provides a supraglottic airway with an integrated endoscopy channel and may reduce the physiological and postoperative burden associated with tracheal intubation. Methods: In this observational comparative study, 72 adults (ASA I–II, age 18–70 years) undergoing elective upper GI endoscopy under general anaesthesia were evaluated, with 36 managed using Gastro LMA and 36 using endotracheal tube (ETT). Patients were allocated according to attending anaesthesiologist judgement. Haemodynamic variables, insertion characteristics, airway seal pressure, oxygenation, end-tidal carbon dioxide, endoscopist satisfaction, procedure duration, postoperative sore throat, hoarseness, recovery time and complications were recorded. Results: Baseline demographic characteristics were comparable. Gastro LMA produced smaller increases in heart rate, systolic and diastolic blood pressure and mean arterial pressure after insertion. Mean insertion time was shorter (22.6±4.5 versus 30.8±5.7 s; p<0.001), while first-attempt success was similar (91.7% versus 83.3%; p=0.29). Mean airway seal pressure was 40.2±3.8 cmH2O. Oxygenation and ventilation were comparable, with minimum SpO2 97.8±0.9% versus 97.6±1.0% and ETCO2 36.2±2.1 versus 35.9±2.3 mmHg. Endoscopist satisfaction was higher with Gastro LMA (4.3±0.6 versus 3.7±0.7; p=0.002). Procedure duration was similar. Postoperative sore-throat VAS was lower (1.3±0.8 versus 3.4±1.0; p<0.001), hoarseness was less frequent (8.3% versus 27.8%; p=0.04), recovery was faster (6.8±1.7 versus 8.9±2.1 min; p=0.001), and overall complications were fewer (8.3% versus 27.8%; p=0.04). No aspiration, severe desaturation or airway obstruction was reported. Conclusion: In carefully selected ASA I–II adults undergoing elective upper GI endoscopy, Gastro LMA provided effective ventilation comparable with ETT while attenuating insertion-related haemodynamic responses, shortening insertion and recovery times, improving endoscopist satisfaction and reducing postoperative airway morbidity. Because allocation was non-randomized and the cohort excluded higher-risk patients, these findings should be interpreted as evidence of comparative effectiveness rather than proof of superiority for all patients.

Background: The oblique popliteal ligament (OPL) is an important component of the posterior capsule of the knee and contributes to posterior knee stability and resistance to hyperextension. Variations in its morphology and attachments may have clinical implications during diagnosis, imaging interpretation, and surgical procedures involving the posterior knee.Aim: To study the morphological patterns and morphometric characteristics of the oblique popliteal ligament in adult human cadaveric knee joints.Materials and Methods: A descriptive observational cadaveric study was conducted in the Department of Anatomy, L.L.R.M. Medical College, Meerut, over a period of 15 months. Thirty knee joints obtained from 15 embalmed adult cadavers of both genders were examined by posterior dissection of the knee. The morphological characteristics of the OPL, including its shape, number of bands, and extensions, were documented. Morphometric measurements were obtained using a digital Vernier calliper with an accuracy of 0.1 mm. The measured parameters included the mediolateral length of the upper and lower margins, width at the medial attachment including the semimembranosus expansion, width at the medial femoral condyle, width at the lateral attachment, and position of the neurovascular hilum.Results: Four morphological patterns of the OPL were identified. Type 1 (band-like) was observed in 9 (30.0%) specimens, Type 2 (band-like) in 13 (43.3%), Type 3 (cord-like) in 4 (13.3%), and Type 4 (fanning-out) in 4 (13.3%) specimens. The mean length of the upper and lower margins was 24.17±4.34 mm and 30.56±4.71 mm, respectively. The mean width at the medial attachment including the semimembranosus expansion was 11.71±2.25 mm, while the mean width at the medial femoral condyle and lateral attachment was 15.28±3.61 mm and 19.01±4.50 mm, respectively. The mean position of the neurovascular hilum was reported as 17.71 mm from the lateral border of the semimembranosus tendon.Conclusion: The OPL demonstrates considerable morphological variation in adult human knee joints, with band-like configurations being the most frequently observed. The morphometric characteristics documented in this study provide useful anatomical information regarding the posterior knee and may contribute to improved understanding of posterior knee stability, imaging interpretation, and surgical procedures involving the posteromedial and posterolateral regions.

Background: The aim of this study was to assess the efficacy of combination of serratus plane block (SPB) and pectoral type 1 (PECS 1) block for providing postoperative analgesia in patients undergoing breast cancer surgery. Methods: Sixty participants undergoing breast cancer surgery were randomly assigned to two groups. After anesthesia induction, group A(n =30) received combination of PECS I and SPB and group B received intravenous analgesics only. Pain scores at 1, 6, 12, 24 and 48h postoperatively, postoperative time to first rescue analgesia, and any complications were recorded. Results: Pain scores in the A group were significantly lower than group B throughout the postoperative period (p <0.001). Postoperative QOR-15 score was better in A group compared to group B which was statistically significant. Moreover, postoperative nausea and vomiting were lower, and patient satisfaction was higher in the A group compared to group B. Conclusions: We conclude that combined serratus plane block and PECS I can provide more effective and reliable perioperative analgesia and increase patient satisfaction in breast cancer surgery

Background: Intertrochanteric fractures are a common cause of disability among elderly patients and may result in prolonged loss of mobility and independence. Functional recovery varies according to patient, fracture, and treatment-related factors. This study evaluated functional outcomes and predictors of recovery following intertrochanteric fractures in elderly patients. Methods: A prospective observational study was conducted at a tertiary-care teaching hospital over a 6-month recruitment period. Eighty patients aged ≥60 years with surgically treated intertrochanteric fractures were enrolled and followed for 6 months. Demographic, clinical, fracture-related, and treatment-related variables were recorded. Functional outcome was assessed using the Harris Hip Score at 6 weeks, 3 months, and 6 months. Factors associated with functional outcome were evaluated using univariable and multivariable analyses. Results: The mean age of participants was 72.4 ± 8.1 years, and females constituted 57.5% of the study population. Low-energy falls accounted for 85.0% of fractures. The mean Harris Hip Score improved from 54.8 ± 10.7 at 6 weeks to 68.9 ± 11.6 at 3 months and 77.2 ± 12.4 at 6 months. At 6 months, 55.0% of patients achieved a favorable functional outcome. Poorer outcomes were significantly associated with age ≥80 years (p=0.018), impaired pre-fracture mobility (p=0.004), unstable fracture pattern (p=0.041), surgery after 48 hours (p=0.021), and postoperative complications (p=0.006). Conclusion: Functional recovery following intertrochanteric fractures in elderly patients improves progressively during the first 6 months after surgery. Advanced age, poor pre-fracture mobility, unstable fractures, delayed surgery, and postoperative complications were associated with poorer functional outcomes. Early surgical management, prevention of complications, and individualized rehabilitation may contribute to better recovery

Background: Purple Urine Bag Syndrome (PUBS) is an uncommon but visually striking phenomenon seen predominantly in patients with prolonged indwelling urinary catheterization. It is associated with bacteriuria and is influenced by factors such as constipation, dehydration and alkaline urine. Objective: To describe the clinical characteristics, microbiological profile and short-term outcome of six patients with PUBS in a tertiary-care hospital in Kerala. Methods: We describe six bedridden patients with prolonged urinary catheterization who developed purple discoloration of the urine collection bag. Clinical characteristics, diabetes status, constipation, duration of catheterization, urine culture results, antibiotic sensitivity and clinical response were reviewed. Results: All six patients had been bedridden following cerebrovascular accident and had urinary catheters for more than three weeks. Constipation was present in all patients. Two patients were diabetic. Urine cultures grew Klebsiella oxytoca (2), Escherichia coli (3) and Providencia mirabilis (1). Purple discoloration resolved following catheter replacement and culture-directed antimicrobial therapy, with clinical improvement within 2–3 days. Conclusion: PUBS is an important clinical sign in chronically catheterized patients. Recognition of the syndrome, appropriate urine evaluation, catheter care, correction of constipation and dehydration, and judicious culture-directed antimicrobial therapy can lead to rapid resolution and prevent unnecessary alarm

Background: Physiotherapy is an established allied-health discipline central to the prevention and rehabilitation of musculoskeletal, neurological and sports-related disorders, yet public awareness of its scope remains limited, particularly among young people. College students are frequently exposed to musculoskeletal risk factors but may not seek appropriate physiotherapy care because of inadequate awareness. Region-specific data among students are scarce. Objectives: To assess the level of awareness regarding physiotherapy among college students in Mandya city and to identify the demographic and institutional factors associated with adequate awareness. Methods: A descriptive, cross-sectional, questionnaire-based study was conducted among 154 college students from three institutions in Mandya city. A structured proforma captured demographic details, prior exposure to physiotherapy, the source of information, history of consultation, a physiotherapy knowledge score (0–10), attitude, and willingness to seek physiotherapy care. Adequate awareness was defined as a knowledge score ≥ 5/10. Data were analysed using the chi-square test, the independent t-test, one-way ANOVA and binary logistic regression, with p < 0.05 considered statistically significant. Results: The mean age of participants was 20.95 ± 1.92 years; 78 (51.7%) were male. Although 144 (94.7%) had heard of physiotherapy, only 17 (11.2%) had ever consulted a physiotherapist. The internet/media was the commonest source of information (36.5%). The mean knowledge score was 5.05 ± 2.41 and 90 of 146 participants (61.6%) had adequate awareness. Adequate awareness was significantly associated with the college attended (p = 0.032) and the year of study (p = 0.016) but not with sex (p = 0.396). On logistic regression, college affiliation and third year of study were independent predictors of awareness, whereas age and sex were not. A strongly positive attitude was significantly associated with willingness to seek physiotherapy care (p < 0.001). Conclusion: Conceptual familiarity with physiotherapy was high but was accompanied by a pronounced awareness–utilisation gap and only moderate depth of knowledge. Awareness was determined more by the institution and academic stage than by individual demographic characteristics, and attitude emerged as the strongest correlate of the willingness to seek care. Targeted, institution-based educational interventions and curriculum integration are recommended to convert awareness into appropriate health-seeking behaviour

Background: Persistent diarrhoea in children is a major concern in low‑ and middle‑income countries. It is a common cause of morbidity and mortality in young children in developing countries. It is important because of its impact on growth and nutrition. In India, despite progress in reducing under‑five mortality, diarrhoeal diseases still contribute substantially. This is a hospital‑based cross‑sectional study carried out at a tertiary care centre in Eastern India (Kolkata) to understand the etiology, microbiological spectrum and seasonal variation of persistent diarrhea in children under 6 years. Aim: To determine the microbiological pattern and seasonal variation of persistent diarrhea in children under six years in a tertiary care centre of Eastern India. Methods: A hospital based cross sectional study was conducted at a tertiary pediatric center in Kolkata from July 2024 to June 2026. A total of 142 children aged 0–6 years with persistent diarrhea (acute onset, lasting ≥14 days) were included. Older children and children with chronic or acute gastroenteritis were excluded. Clinical and demographic data were analyzed. Stool samples were tested using RevoDx Gastro Pathogen Detection Kit for qualitative detection of DNA/RNA of the gastrointestinal pathogen by Real-Time Multiplex PCR. Results: Infants under one year were most frequently affected (38.7%). Slight male predominance was noted (58.4%). Common clinical features noted were abdominal pain (47.9%) and dehydration (53.5%). Most episodes lasted 2–3 weeks (86.6%). Pathogens were identified in 95.1% of cases: bacterial (62.2%), viral (41.5%), and parasitic (7.4%). The leading agents were EIEC (25.7%), rotavirus (17.8%), and Campylobacter (13.3%). Seasonal peaks occurred in April–May, July–August, and January, showing a bimodal distribution. Conclusion: Persistent diarrhea in Eastern India is predominantly bacterial, with clear seasonal clustering. Strengthening diagnostic capacity, promoting exclusive breastfeeding, rotavirus immunization, improved water and sanitation, and rational antibiotic use are essential preventive strategies

Introduction: Autologous regenerative therapies are being increasingly used in different specialties worldwide with unknown awareness levels, limited publications, adequate evidence on the subject. Hence this study was designed to assess the awareness of Autologous Regenerative Therapies among medical fraternity at a Tertiary care Institute in the state of Andhra Pradesh. Materials and Methods: A cross sectional questionnaire-based survey was conducted among different subgroups of medical fraternities. The answers to self-administered questions related to knowledge, attitude and practice of autologous regenerative therapies were collected from 146 participants. The data collection, cleaning and statistical analysis was performed using Microsoft Excel(Redmond, USA) and Windows Programme for Epidemiologists (WinPepi). Results: Our findings showed that only 41(28.1%) participants were aware of Autologous Regenerative Therapies, while 94(64.3%) were aware of PRP, and 136(93.1%) were aware of stem cell therapies. The most reported reasons for not using them included lack of awareness 78(53.4%), high cost 41(28.1%). Surprisingly, 98(65.2%) participants were willing to learn about these topics either by its addition in a new curriculum or attending advanced training courses. Conclusion: These results emphasise the need for advanced training courses, awareness programmes, addition of special courses concerning regenerative medicine to the curriculum.

Background: Chronic suppurative otitis media (CSOM) is a persistent middle-ear infection associated with otorrhoea, hearing impairment and antimicrobial resistance. Methods: This prospective observational study included 318 clinically diagnosed CSOM cases attending a tertiary-care hospital from July 2023 to June 2025. Ear discharge was examined microscopically and cultured for aerobic bacteria and fungi,bacterial isolates underwent antimicrobial susceptibility testing and for resistance phenotyping. Results: Culture positivity was 64.8% (206/318). Bacterial isolates constituted 178/206 (86.3%), in which Pseudomonas aeruginosa were (35.0%) and Staphylococcus spp. (28.6%). Fungi accounted for 28/206 (13.5%), predominantly Aspergillus niger (8.2%) and Candida albicans (5.3%). Linezolid showed 98% susceptibility among Staphylococcus spp; P. aeruginosa showed highest susceptibility to aztreonam (92%) and piperacillin–tazobactam (85%). ESBL production was confirmed in 29% of K. pneumoniae and 16% of P. mirabilis; carbapenemase production was detected in 14.8% of K. pneumoniae and 12.5% of P. aeruginosa. Conclusion: CSOM predominantly affects children and males, with P. aeruginosa and Staphylococcus spp. as the leading bacterial pathogens. The detection of multidrug-resistant organisms highlights the need for routine culture, susceptibility testing, and targeted antifungal evaluation to guide therapy and support antimicrobial stewardship

Background: Soft tissue injuries of face are commonly encountered craniofacial injuries which are treated by plastic surgeon and account for nearly 10% of all emergency departments visits [1]. Face reconstruction poses challenging even for an experienced surgeon in that the face plays an aesthetic role in one's appearance. Reconstructive surgery of the mid face and lower face requires a complete understanding of the anatomy of this region. Defects involving mid face and lower face occur due to tumour, trauma, infections disease, congenital nevi, haemangioma. These injuries can be limited to a soft tissue component or sometimes might involve underlying deep structures. The complexity of these injuries is represented by the potential for loss of relationships between the functional and the aesthetic subunits of the craniofacial region [2] Objectives: To assess the result of various surgical treatment modalities for facial reconstruction and to assess the appropriate methods for reconstruction of soft tissue defect of face based on size, site and depth of defect with respect to functional outcome and aesthetically. Material & methods: Study is done in total 104 patients from June 2024 to December 2025 admitted with the diagnosis of soft tissue defect of face due to trauma and postsurgical defect. Based on defect site and size reconstruction is done and patients are evaluated for aesthetic and functional outcome of reconstructive method during their follow-up. Results: Road traffic accidents (n=48) are most common etiology in our study followed by postsurgical excision (n=20), then assault(n=16). Flap coverage (n=52) is most commonly done reconstruction method followed by primary repair of wound (n=36), skin grafting (n=12) and secondary suturing (n =4). Conclusion: Various factors can lead to facial soft defect and various options are available for their reconstruction. Reconstruction method is governed by size and site of defect and should provide good aesthetic and functional outcome.

Background: Rotator cuff disorders are a common cause of shoulder pain and functional limitation. Ultrasonography (USG) is inexpensive, rapid, dynamic, and widely available, whereas magnetic resonance imaging (MRI) provides comprehensive assessment of the rotator cuff and associated intra-articular structures. This study evaluated the spectrum of rotator cuff abnormalities and compared USG findings with MRI in patients with clinically suspected rotator cuff pathology. Methods: This prospective single-center study included 50 patients evaluated in the Department of Orthopaedics at a tertiary-care hospital in India between January 2024 and January 2025. Patients with clinical suspicion of rotator cuff pathology underwent shoulder USG followed by MRI. The study recorded abnormalities of the supraspinatus, subscapularis, infraspinatus, and teres minor tendons, as well as joint and bursal fluid and acromioclavicular joint changes. MRI was used as the comparator for the present analysis. Diagnostic performance measures were calculated from the explicit 2×2 counts reported in the Results section of the supplied study. Results: On MRI, supraspinatus abnormality was identified in 43/50 patients (86%), subscapularis abnormality in 20/50 (40%), and infraspinatus abnormality in 6/50 (12%); no teres minor abnormality was reported. USG detected 40 supraspinatus, 19 subscapularis, and 4 infraspinatus abnormalities. Using the reported counts, USG sensitivity/specificity for detecting any abnormality was 93.0%/100% for supraspinatus, 95.0%/100% for subscapularis, and 66.7%/100% for infraspinatus. MRI demonstrated supraspinatus tendinosis in 19 patients (38%), partial tears in 21 (42%), and full-thickness tears in 3 (6%). Joint effusion was present in 43 patients (86%). Conclusion: USG demonstrated high specificity and good sensitivity for the detection of rotator cuff abnormalities in this cohort, particularly for supraspinatus and subscapularis disease. However, the supplied study data also show that partial-thickness abnormalities were more difficult to characterize reliably with USG. USG may therefore be used as an accessible first-line investigation in appropriately selected patients, while MRI remains valuable for comprehensive assessment, characterization of partial tears, and evaluation of associated shoulder pathology.

Background: Painful hip may result from vascular, infective, degenerative, developmental, neoplastic, and transient disorders, many of which may be occult or incompletely characterized on radiography. Magnetic resonance imaging (MRI) provides multiplanar assessment of bone marrow, cartilage, synovium and periarticular soft tissues. Objective: To describe the spectrum of MRI-detected pathology in patients presenting with acute or chronic hip pain and to characterize the imaging findings and extent of disease. Methods: Fifty patients of either sex and any age with unilateral or bilateral hip pain were evaluated using a 1.5-T MRI system. Both hips were examined simultaneously. Routine coronal T1-weighted, proton-density fat-suppressed, T2-weighted and STIR sequences were obtained, supplemented by axial and sagittal sequences and contrast-enhanced T1-fat-suppressed imaging when clinically indicated. Histopathology was used as a reference for the subgroup with suspected septic arthritis. Results: Thirty-five patients (70%) were male and 15 (30%) females. The age range was 2–74 years; the largest age group was 21–40 years (19/50, 38%). The most frequent diagnosis was avascular necrosis (AVN) of the femoral head (18/50, 36%), followed by septic arthritis (12/50, 24%) and osteoarthritis (8/50, 16%). Eighteen patients with AVN included 10 bilateral and 8 unilateral cases, giving 28 involved hips. Focal subchondral signal abnormality was the commonest AVN finding (27/28 hips, 96.4%), while ARCO stage IV accounted for 14/28 hips (50%). In septic arthritis, synovial thickening and marrow edema were each seen in 11/12 patients (91.6%). Metastases, developmental dysplasia, Perthes disease, transient synovitis and transient osteoporosis were also characterized. Recalculation of the supplied 2×2 tables gave MRI sensitivity of 100% and specificity of 76.9% for tuberculous arthritis, and sensitivity of 70% and specificity of 100% for pyogenic arthritis, using histopathology as the reference standard. Conclusion: In this cohort, MRI demonstrated a broad spectrum of causes of hip pain and provided detailed characterization of osseous, marrow, synovial and soft-tissue abnormalities. Its principal value was lesion detection, characterization and staging; diagnostic accuracy should be interpreted in relation to an appropriate reference standard

Background: Idiopathic congenital talipes equinovarus (CTEV), or clubfoot, is commonly corrected using the Ponseti method. Successful correction must be maintained with a foot-abduction brace, but brace design, comfort, cost and adherence may influence outcomes. This study compared the Denis Browne splint and Steenbeek brace during the maintenance phase after Ponseti correction. Methods: Thirty children with 46 idiopathic clubfeet treated with Ponseti casting at a tertiary-care orthopaedic centre in India between September 2022 and August 2024 were included. After correction, feet were maintained using either a Denis Browne splint or a Steenbeek brace. Pirani severity score (PSS), laterality, number of casts, residual deformity, painful episodes and relapse were assessed during follow-up. Categorical variables were compared using Pearson chi-square testing where appropriate; Fisher exact testing was used for the small relapse table. The supplied study dataset was analyzed at the foot level for brace-related comparisons. Results: Of 46 treated feet, 25 received a Denis Browne splint and 21 received a Steenbeek brace. Thirty-two feet belonged to children with bilateral clubfoot and 14 to children with unilateral disease. The majority of feet were from children presenting at 0–6 months. At brace initiation, PSS was 0 in 38/46 feet (82.6%). During follow-up, the supplied data showed maintenance of correction in most feet. Four feet in three children were reported to relapse: one foot in the Denis Browne group (1/25; 4.0%) and three feet in the Steenbeek group (3/21; 14.3%). This difference was not statistically significant by Fisher exact test (p=0.318). The source dataset also recorded pressure sores/skin problems and compliance-related difficulties as the principal brace-related concerns. Conclusion: Both foot-abduction braces maintained correction in most treated feet during the available follow-up. The observed relapse proportion was numerically higher with the Steenbeek brace, but the study was small and the difference was not statistically significant. The Denis Browne splint was described as more parent- and child-friendly but more expensive, whereas the Steenbeek brace was considered more economical. Larger prospective studies with standardized compliance assessment and longer follow-up are needed

Background: Dry eye disease (DED) is a common ocular surface disorder that may develop or worsen following cataract surgery, affecting postoperative comfort and patient satisfaction despite good visual outcomes. This study evaluated the incidence, severity, and course of dry eye following uncomplicated phacoemulsification.1Methods: A prospective observational study was conducted over one year in South India involving 135 patients aged 50–70 years undergoing uncomplicated temporal clear corneal phacoemulsification with posterior chamber intraocular lens implantation. Patients with pre-existing dry eye, ocular surface disease, or complicated cataracts were excluded. Dry eye was assessed preoperatively and at 1, 4, and 6 weeks postoperatively using the Ocular Surface Disease Index (OSDI), Schirmer's Test-I, Tear Break-Up Time (TBUT), and Ocular Surface Staining (OSS). Statistical analysis was performed using the Friedman test and Chi-square test, with p<0.05 considered significant.Results: The mean age of participants was 53.1±4.9 years, with 60% being males. All patients had normal preoperative dry eye parameters. During follow-up, postoperative dry eye developed in 13.3% of eyes. Based on individual tests, the incidence was 11.1% by OSDI, Schirmer's Test, and OSS, and 11.9% by TBUT. Dry eye symptoms and tear film instability peaked during the first postoperative week and showed gradual improvement by the sixth week. Significant postoperative changes were observed in Schirmer's Test (p<0.0001), TBUT (p<0.0001), and OSS (p=0.001), whereas changes in OSDI scores were not statistically significant (p=0.180). No significant association was found between postoperative dry eye and age or gender.Conclusion: Uncomplicated phacoemulsification can induce transient postoperative dry eye, with symptoms being most pronounced during the first postoperative week and improving over subsequent weeks. Preoperative evaluation and postoperative monitoring of the ocular surface, along with timely use of lubricating eye drops, may improve patient comfort, visual quality, and overall surgical satisfaction

Background: Chronic kidney disease (CKD) is a growing global health challenge, complicated by polypharmacy, altered pharmacokinetics, and frequent prescribing of potentially inappropriate medications (PIMs). Rational prescribing is essential to mitigate adverse drug events (ADEs) and improve patient outcomes. Methods: A retrospective observational study was conducted from February 2025 to January 2026 in the Department of Nephrology, reviewing 257 CKD patient records. Prescriptions were assessed against KDIGO guidelines and national protocols. Drug classes, renal dose adjustments, PIMs, polypharmacy, and DDIs were analyzed using descriptive statistics and chi-square testing. Results: Antihypertensives were the most prescribed drug class (77.0%), with high dose adjustment compliance (81.8%). In contrast, antibiotics (65.1%) and NSAIDs (33.3%) showed poor compliance. PIMs were identified in 23.3% of patients, most commonly NSAIDs (10.5%) and metformin in advanced CKD (5.4%). Polypharmacy was prevalent, with 55.3% of patients on 5–10 drugs and 14.8% on >10 drugs. Clinically significant DDIs occurred in 18.3% of patients, strongly associated with higher medication burden (p < 0.0001). Conclusion: CKD patients face substantial risks from polypharmacy, suboptimal renal dose adjustments, and inappropriate prescribing. The findings underscore the urgent need for integrated clinical decision support systems, prescriber education, and pharmacist-led medication reviews to enhance medication safety and optimize pharmacotherapy in CKD management

Background: Obesity is now formally recognized by major health bodies as a chronic, relapsing medical disease rather than a lifestyle choice or purely cosmetic concern. Despite this reclassification, public and even professional awareness of obesity as a disease entity in its own right, and of its close association with metabolic complications such as type 2 diabetes mellitus, hypertension, and dyslipidaemia, remains limited in many low- and middle-income settings, including India. Objective: To assess the level of awareness regarding obesity as a medical disease among adult participants and to evaluate the association between body mass index (BMI) category and selected metabolic complications, using a representative sample dataset. Materials and Methods: A cross-sectional, questionnaire-based study was conducted among 400 adult participants attending a tertiary care outpatient department. Sociodemographic data, anthropometric measurements (height, weight, waist circumference), a validated 12-item obesity-awareness questionnaire, and biochemical parameters (fasting blood glucose, lipid profile) were recorded. Participants were classified by BMI according to the Asia-Pacific criteria. Data were analysed using descriptive statistics, chi-square test, Pearson correlation, and multivariate logistic regression, with p<0.05 considered statistically significant. Results: Of 400 participants (mean age 41.6 ± 12.3 years; 54.5% women), 46.8% were classified as overweight or obese by Asia-Pacific BMI criteria. Only 38.3% of participants correctly identified obesity as a chronic medical disease, while 61.7% viewed it primarily as a cosmetic or lifestyle issue. Awareness scores were significantly lower among participants with lower educational attainment and rural residence (p<0.001). A statistically significant positive association was observed between increasing BMI category and prevalence of type 2 diabetes mellitus (p<0.001), hypertension (p<0.001), and dyslipidaemia (p=0.002). Waist circumference correlated strongly with fasting blood glucose (r=0.52, p<0.001) and triglyceride levels (r=0.48, p<0.001). Logistic regression identified low educational status, rural residence, and older age as independent predictors of poor obesity awareness. Conclusion: A substantial awareness gap persists regarding obesity as a bona fide medical disease, despite its strong and statistically significant association with major metabolic complications. Structured public health education, reinforced by findings from Indian population studies, is needed to reframe obesity as a chronic disease requiring longitudinal medical management rather than short-term lifestyle correction.

Background: Tunneled cuffed hemodialysis catheters remain an important component of vascular access when definitive arteriovenous access is unavailable, immature, contraindicated, or has failed. Despite their clinical utility, tunneled catheters are associated with mechanical complications, infection, thrombosis, and dysfunction. Image-guided placement using ultrasonography and fluoroscopy may improve procedural precision and safety. Evidence describing the early performance of newly established vascular-access services in geographically challenging regions of India is limited. Objectives: To evaluate technical success, immediate procedural complications, catheter-related infection, dysfunction, thrombosis, dwell time, and catheter survival among 100 consecutive tunneled hemodialysis catheter insertions performed by a single surgeon at a newly established vascular access service. Materials and Methods: This retrospective observational cohort included 100 consecutive tunneled hemodialysis catheter insertion episodes performed in the Department of Cardiothoracic and Vascular Surgery, Tomo Riba Institute of Health and Medical Sciences, Naharlagun (Itanagar), Arunachal Pradesh, between 1 January 2025 and 30 June 2026. Some patients underwent more than one catheter insertion, and each insertion was analyzed as a separate episode. All procedures were performed by a single surgeon using real-time ultrasound-guided venous access and fluoroscopic guidance. Demographic characteristics, indication, access site, technical success, immediate complications, infection, dysfunction, thrombosis, catheter dwell time, and final catheter outcome were evaluated. Results: Among 100 catheter insertion episodes, technical success was achieved in 99 (99%; 95% CI 94.6–99.8). Mean age at insertion was 54.8 ± 13.9 years, and 62% of episodes occurred in male patients. The right internal jugular vein was used in 88%, the left internal jugular vein in 10%, and an alternative site in 2%. Immediate procedure-related complications occurred in 6% (95% CI 2.8–12.5). Among the 99 successfully placed catheters, followed for 15,420 catheter-days, catheter dysfunction occurred in 15 (15.2%), catheter-related bloodstream infection in 11 (11.1%), and catheter-associated thrombosis in 6 (6.1%). Twelve bloodstream-infection episodes corresponded to 0.78 episodes per 1,000 catheter-days. Median catheter dwell time was 146 days (IQR 86–228). Estimated catheter survival was 97% at 30 days, 89% at 90 days, 72% at 180 days, and 44% at 365 days. Conclusion: A stan dardized single-surgeon approach using ultrasound-guided venous puncture and fluoroscopic catheter placement achieved high technical success with few major immediate mechanical complications. Infection and dysfunction were the principal delayed catheter-related problems, supporting continued structured surveillance of tunneled hemodialysis catheter outcomes in the service

Posterior reversible encephalopathy syndrome (PRES) is an acute to subacute neurotoxic state characterized by encephalopathy, seizures, headache, and visual disturbances, accompanied on neuroimaging by predominantly parieto occipital vasogenic edema. We report a 66-year-old woman with hypertension, type 2 diabetes, chronic kidney disease, rheumatoid arthritis, and systemic lupus erythematosus who presented with altered mental status and selective mutism ten days after discharge for pneumonia with sepsis. She was readmitted in hypertensive crisis with leukocytosis and encephalopathy; head CT initially suggested subacute infarction, but brain MRI demonstrated bilateral posterior T2/FLAIR hyperintensities consistent with PRES. Her course was complicated by recurrent respiratory failure requiring re intubation and a systemic inflammatory response without proven infection. Aggressive multi agent blood pressure control and supportive care led to neurological recovery by hospital day 7. This case highlights PRES arising from converging risk factors like acute hypertension, sepsis/systemic inflammation, renal dysfunction, and autoimmune disease and the importance of MRI in distinguishing PRES from acute ischemic stroke.

Coronary artery disease in adolescence is rare enough that it almost always points away from atherosclerosis and toward something else entirely. We report the case of a 16-year-old girl who presented with eight days of chest pain, vomiting, and a low-grade febrile illness, and was found on work-up to have an NSTEMI with severe anaemia (haemoglobin 7.0 g/dL). Coronary angiography revealed double-vessel disease with left main involvement with a 95% ostial stenosis of the left main coronary artery, along with ostial narrowing of the LAD, LCX, and RCA. What stood out was the pattern: every lesion was confined to the coronary ostia, while carotid and lower-limb Doppler studies were entirely normal. This distribution, combined with the absence of any conventional risk factors for atherosclerosis, raised suspicion for an inflammatory rather than degenerative process, most consistent with Takayasu arteritis. She underwent off-pump coronary artery bypass grafting with intra-aortic balloon pump support, and three grafts were successfully placed. During surgery, samples of peri-aortic fatty tissue and aortic wall were taken and sent for histopathology. The aortic tissue itself looked unremarkable, but the peri-aortic fat told a different story, showing leukocytoclastic vasculitis, an active small-vessel inflammatory pattern that confirmed the underlying diagnosis. She recovered well and was discharged on corticosteroids alongside her cardiac medications. This case illustrates how a routine intraoperative biopsy of peri-aortic tissue during CABG can settle a diagnosis that angiography and serology alone could not, and argues for considering this simple step more often in young patients with unexplained ostial coronary disease.

Background: Sepsis is a major cause of multiorgan dysfunction and mortality, and early identification of high-risk patients is essential for timely escalation of care. Clinical severity indices combined with routinely available biochemical markers may improve early prognostic assessment. Aim of the study was to evaluate early clinical and biochemical predictors of multiorgan dysfunction syndrome (MODS) and in-hospital mortality among patients with sepsis. Material and Methods: This prospective observational study included 100 adult patients with sepsis admitted to the Department of General Medicine of a tertiary care hospital. Demographic characteristics, clinical parameters, SOFA score, hematological indices, renal and liver function parameters, serum lactate, albumin, lactate-to-albumin ratio (LAR), C-reactive protein, and procalcitonin were assessed. Patients were followed for development of MODS and in-hospital mortality. Appropriate comparative and correlation analyses were performed. Results: MODS developed in 38% of patients, while in-hospital mortality was 24%. Patients with MODS and non-survivors had significantly higher SOFA scores, NLR, creatinine, lactate, LAR, and procalcitonin, with lower platelet counts and serum albumin. LAR correlated significantly with SOFA score (ρ=0.448, p<0.001) and number of dysfunctional organs (ρ=0.611, p<0.001). SOFA showed the strongest correlation with organ dysfunction burden (ρ=0.740, p<0.001). Conclusion: Early integration of clinical severity assessment with routinely available biochemical markers, particularly SOFA, lactate, LAR, platelet count, and creatinine, may facilitate early identification of septic patients at increased risk of MODS and mortality

Background: Scrub typhus—caused by Orientia tsutsugamushi and transmitted by Leptotrombidium mites—has re emerged across India as a major cause of acute febrile illness (AFI) but remains under recognized in non bushy, semi-arid regions.Objective: To estimate the proportion of scrub typhus among AFI attendees in a tertiary care hospital and describe coinfections and key laboratory correlations. Methods: We conducted a hospital based cross sectional study over six months (July–November 2022) in the Departments of Microbiology and General Medicine, SGT University, Gurugram. Eighty six consecutive AFI patients (either gender) were enrolled. Serum IgM ELISA (InBios Scrub Typhus Detect™) was performed per manufacturer instructions. Descriptive statistics, Pearson correlations, and p values (<0.05 significant) were calculated.Results: Scrub typhus prevalence was 30.23% (26/86). Coinfections among scrub positive cases included dengue (34.61%), typhoid/Widal (15.38%), and malaria (3.85%). A moderate negative correlation was observed between scrub typhus ELISA OD and platelet count (r = −0.407, p = 0.039). Correlations with SGOT (r = 0.260, p = 0.199) and SGPT (r = −0.121, p = 0.555) were not statistically significant.Conclusions: Scrub typhus contributes substantially to AFI in this North Indian tertiary care setting, with notable coinfections—especially dengue—and thrombocytopenia. Routine consideration of scrub typhus in AFI differentials and early laboratory screening can improve outcomes. Larger, multi center studies with confirmatory testing (e.g., IFA/PCR) are warranted

Background: Intestinal anastomosis is a fundamental procedure in gastrointestinal surgery. While the conventional hand-sewn (HS) technique is the traditional standard, mechanical stapling (ST) devices offer an alternative aimed at reducing operative time and technical difficulty. This study compares the intraoperative and postoperative outcomes of these two techniques.Methods: A prospective, randomized comparative study was conducted from April 2023 to March 2024. Fifty patients undergoing elective or emergency bowel anastomosis were randomized into HS (n=25) and ST (n=25) groups. Parameters assessed included operative duration, return of bowel function (sounds, flatus, stool), time to mobilization and oral feeding, hospital stay, return to regular activities, and postoperative complications (anastomotic leak, surgical site infection, burst abdomen, wound dehiscence).Results: The two groups were comparable in age and sex distribution. The mean operative time was significantly shorter in the ST group (2.30 ± 0.50 hours) compared to the HS group (2.86 ± 0.39 hours) (p=0.001). Patients in the ST group mobilized earlier (3.00 ± 0.76 vs. 3.96 ± 0.98 days, p=0.001), commenced oral feeding sooner (6.96 ± 1.37 vs. 8.28 ± 1.34 days, p=0.001), and had a significantly shorter hospital stay (11.84 ± 4.35 vs. 16.92 ± 11.16 days, p=0.039). Time to return to regular activities was also shorter in the ST group (44.44 ± 17.35 vs. 56.88 ± 21.66 days, p=0.031). There was no statistically significant difference in the rate of return of bowel sounds, passage of flatus and stool, or overall complication rates (anastomotic leak, burst abdomen, wound dehiscence). One mortality (4%) occurred in the HS group.Conclusion: Stapled bowel anastomosis is associated with a significantly shorter operative time, faster postoperative recovery in terms of mobilization and oral intake, reduced hospital stay, and an earlier return to normal activities compared to the hand-sewn technique, without increasing the risk of major anastomotic complications. Staplers represent an efficient and safe alternative, particularly beneficial in reducing surgical time..

Background: Post-spinal anaesthesia shivering is a common and distressing complication that may increase metabolic demand and cause significant patient discomfort. Various pharmacological agents have been used for its treatment; however, their adverse effect profiles limit their clinical utility. Dexmedetomidine, an α2-adrenergic receptor agonist, has demonstrated promising anti-shivering properties. This study aimed to compare the efficacy, haemodynamic effects, and adverse effects of intravenous dexmedetomidine and tramadol in the treatment of post-spinal anaesthesia shivering. Materials and Methods: This prospective, randomized, double-blind comparative study was conducted in a tertiary care centre after approval from the Institutional Ethics Committee. A total of 128 ASA physical status I and II patients aged 18–65 years who developed Grade 3 or Grade 4 post-spinal anaesthesia shivering were enrolled and randomly allocated into two groups. Group D (n=64) received intravenous dexmedetomidine 0.5 µg/kg, while Group T (n=64) received intravenous tramadol 0.5 mg/kg. The primary outcome assessed was the time required for cessation of shivering after administration of the study drug. Secondary outcomes included response rate, recurrence of shivering, haemodynamic changes, sedation score, and adverse effects. Statistical analysis was performed using appropriate parametric and non-parametric tests, with P<0.05 considered statistically significant. Results: The demographic characteristics, ASA status, and duration of surgery were comparable between both groups. The mean time of onset of shivering was similar in the tramadol and dexmedetomidine groups (39.58±11.99 min vs 41.84±10.13 min; P=0.25). However, dexmedetomidine resulted in significantly faster cessation of shivering compared with tramadol (4.84±3.41 min vs 9.02±3.88 min; P=0.001). The response rate was significantly higher with dexmedetomidine (89.1%) compared with tramadol (73.4%) (P=0.024), and recurrence of shivering was significantly lower in the dexmedetomidine group (7.8% vs 21.9%; P=0.025). Nausea and vomiting occurred significantly more frequently in the tramadol group (29.7% and 20.3%, respectively), whereas dexmedetomidine was associated with higher incidences of bradycardia (21.9%), hypotension with bradycardia (9.4%), and drowsiness (10.9%) (P<0.001). Dexmedetomidine produced significantly greater sedation compared with tramadol. Conclusion: Intravenous dexmedetomidine provides faster and more effective control of post-spinal anaesthesia shivering compared with tramadol, with a higher success rate and lower recurrence. Although associated with increased sedation and haemodynamic effects, these were clinically manageable with appropriate monitoring. Dexmedetomidine may be considered an effective alternative to tramadol for the treatment of post-spinal anaesthesia shivering.

Background: The burden of epilepsy extends beyond recurrent seizures. Psychiatric symptoms, cognitive impairment and behavioural disturbances may increase supervision requirements, disrupt family relationships and alter the emotional demands of caregiving. Evidence increasingly suggests that caregiver burden is determined not solely by seizure severity but also by the psychological and behavioural phenotype of the person with epilepsy. Aim: To systematically evaluate psychiatric, behavioural and neurocognitive characteristics associated with caregiver burden, parental stress and caregiver psychological distress among families of people with epilepsy. Materials and Methods: A systematic review was undertaken according to PRISMA 2020 principles. PubMed/MEDLINE and a multidisciplinary academic literature index were searched up to January 2026 using combinations of terms relating to epilepsy, psychiatric comorbidity, behavioural symptoms, depression, anxiety, cognition, caregiver burden and parental stress. The newly assembled search set yielded 38 records. After removal of two duplicate records, 36 records underwent title and abstract screening. Twenty records were excluded, leaving 16 reports for full-text assessment. Four were excluded at the eligibility stage, and 12 studies were included in the qualitative synthesis. Owing to heterogeneity in populations, exposures and caregiver-outcome instruments, meta-analysis was not undertaken. Results: Behavioural abnormalities emerged as a particularly consistent determinant of caregiver stress in paediatric epilepsy. Earlier studies showed that difficult child temperament and behavioural problems were more closely related to parenting stress than seizure variables. Subsequent studies demonstrated associations between internalising, externalising and total behavioural-problem scores and parental stress. In adults, psychiatric comorbidity, particularly aggression, depression and anxiety, was associated with greater caregiver burden or poorer caregiver psychological outcomes. Cognitive impairment, patient stigma, reduced patient quality of life and treatment complexity modified these associations. A 2024 adult study found significant relationships between caregiver burden and patient cognition, stigma, anxiety and depression, while recent paediatric research suggests behavioural and cognitive characteristics may contribute more strongly to parental stress than core epilepsy characteristics. Conclusion: Psychiatric, behavioural and neurocognitive comorbidities are important determinants of the burden experienced by epilepsy caregivers. Internalising and externalising behaviours, aggression, depression, anxiety and cognitive impairment should be evaluated alongside seizure control when assessing family needs. A dyadic, family-centred model incorporating mental-health and behavioural assessment is warranted.

Background: Diabetes mellitus (DM) is a chronic metabolic disorder that is well known for causing microvascular complications such as retinopathy, nephropathy and neuropathy. Dry eye disease (DED), resulting from tear film instability secondary to autonomic and sensory neuropathy of the lacrimal gland and ocular surface, is an under-recognised but equally disabling ocular complication of diabetes. Data from tertiary hospitals of Jharkhand on this subject remain scarce. Objectives: To determine the prevalence of dry eye disease among patients with diabetes mellitus attending a tertiary care hospital of Jharkhand, and to study its association with gender, duration of diabetes, glycaemic control and other risk factors. Methodology: A hospital-based, cross-sectional, observational study was carried out in the Department of Ophthalmology over a period of six months. A total of 84 diabetic patients, calculated using a standard prevalence-based formula, were enrolled by consecutive sampling technique. Detailed history, Schirmer's test, tear film break-up time (TBUT) and Ocular Surface Disease Index (OSDI) scoring were used to diagnose and grade dry eye severity. Data were analysed using SPSS software with Chi-square test and odds ratio calculation, a p-value of less than 0.05 being taken as statistically significant. Results: Out of 84 diabetic subjects, dry eye disease was detected in 54 patients, giving an overall prevalence of 64.3 per cent. Prevalence was slightly higher in females (68.4 per cent) than in males (60.9 per cent), though the difference was not statistically significant. A significant positive association was observed between dry eye and longer duration of diabetes, poor glycaemic control and presence of diabetic retinopathy (p < 0.05). Mild dry eye was seen in 44.4 per cent, moderate in 37.0 per cent and severe dry eye in 18.6 per cent of the affected subjects. Conclusion: Dry eye disease is highly prevalent among diabetic patients attending tertiary care hospitals of Jharkhand and is strongly linked with disease duration and glycaemic status. Routine ocular surface screening in diabetic patients is recommended to enable early detection and timely management

Background: Over the last 30 years simulation-based education (SBE) has become one of the most significant developments in anaesthesiology education. Simulation allows trainees to build their technical skills, cognition, clinical judgment, communication capabilities, team work and crisis management skills in a safe, controlled, and repeatable learning environment without putting patients at unnecessary risk. This switch from traditional apprenticeship to competency-based medical education has further propelled the use of simulation as a key element of undergraduate, postgraduate and continuing professional development in anaesthesiology more and more into the spotlight. Today, the term simulation covers all kinds of learning approaches—such as low fidelity manikins, high fidelity manikins, standardized patient, task trainer, virtual reality, augmented reality, mixed reality and artificial intelligence based adaptive learning systems. These technologies enable purposeful practice, objective evaluation, systematic debriefing and mastery learning and enhance patient safety and health care quality. The advantages of simulation in the fields of airway management, regional anesthesia, perioperative crisis management, obstetric anesthesia, paediatric anesthesia, trauma surgery, intensive care, and multidisciplinary team training, have been shown to be quite significant. New technologies like machine learning, digital twins, remote simulation and VR are likely to bring even more profound changes to the way anaesthetists are educated in future, as they will allow personalization of learning and competency assessment. However, both infrastructure expenses and faculty development, along with curriculum integration and resource constraints are obstacles to implementing this everywhere, especially in low and middle-income countries. This review outlines the history, educational principles, methods of simulation, clinical applications, existing evidence, technological advancements, limitations, and future prospects of simulation-driven education in anesthesiology, emphasizing the key role it plays in enhancing clinical skills, patient safety, and health outcomes in the surgical field.

Background: Epilepsy is accompanied by substantial neuropsychiatric morbidity that may influence not only patients but also family members responsible for their day-to-day care. Depression, anxiety, behavioural dysregulation, aggression and other emotional disturbances can increase supervision needs, interfere with family relationships and contribute to psychological strain among caregivers.Aim: To systematically synthesise evidence regarding the association between psychiatric and behavioural comorbidities in persons with epilepsy and caregiver burden, parental stress, family impact and caregiver psychological distress.Materials and Methods: A systematic review was conducted according to PRISMA 2020 principles. PubMed/MEDLINE and a multidisciplinary academic literature index were searched up to June 2026 using combinations of terms relating to epilepsy, psychiatric morbidity, depression, anxiety, behavioural problems, caregiver burden, parental stress and family burden. The search set yielded 42 records. After removal of five duplicates, 37 records were screened. Sixteen reports underwent full-text assessment and 10 studies fulfilled the predefined eligibility criteria. Owing to heterogeneity in populations, psychiatric measures and caregiver outcomes, findings were synthesised narratively.Results: Across adult and paediatric epilepsy, psychiatric and behavioural morbidity was associated with adverse caregiver outcomes. Among adults, aggressive behaviour, anxiety, depression, stigma and poorer psychosocial functioning were related to greater caregiver burden. In paediatric epilepsy, internalising symptoms, anxiety/depression, withdrawal, externalising behaviour and broader behavioural difficulties were associated with higher parental stress. Studies of severe childhood epilepsy further demonstrated associations between child behavioural difficulties and parental depression, anxiety, post-traumatic stress symptoms and family impact. Recent studies suggest that behavioural and cognitive difficulties may contribute more strongly to parental stress than seizure variables alone.Conclusion: Psychiatric and behavioural comorbidities constitute an important component of caregiver burden in epilepsy. Routine epilepsy management should incorporate assessment of patient mental health together with identification of caregiver stress and unmet psychosocial needs.

Background: Epilepsy is a chronic neurological disorder associated with substantial psychiatric and psychosocial morbidity. Depression, anxiety, behavioural disturbances, aggression, and broader neuropsychiatric symptoms may increase the demands placed on family caregivers and contribute to caregiver burden, psychological distress, and impaired quality of life. Aim: To systematically review the relationship between psychiatric and neuropsychiatric comorbidities in patients with epilepsy and caregiver burden, parental stress, family burden, and caregiver psychological distress. Materials and Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 framework. PubMed/MEDLINE and a multidisciplinary peer-reviewed academic literature index were searched using combinations of terms related to epilepsy, psychiatric comorbidity, depression, anxiety, behavioural symptoms, caregivers, caregiver burden, family burden, and parental stress. Of 50 records identified, nine duplicates were removed and 41 records underwent title and abstract screening. Twenty-two reports were assessed in full text, of which eight were excluded. Fourteen studies were included in the qualitative synthesis. Owing to substantial clinical and methodological heterogeneity, a meta-analysis was not performed. Results: The 14 included studies comprised adult and paediatric epilepsy populations. Across studies, psychiatric, emotional, or behavioural morbidity was associated with adverse caregiver outcomes. Patient depression and anxiety were linked with greater caregiver burden and psychological distress, while aggressive behaviour was independently associated with higher caregiver burden in adult epilepsy. In paediatric epilepsy, internalising, externalising, and broader behavioural problems were associated with increased parental stress. Cognitive impairment, stigma, treatment complexity, drug resistance, patient quality of life, and caregiver mental health also modified burden. Conclusion: Psychiatric and neuropsychiatric comorbidities in epilepsy have consequences extending beyond the patient. Depression, anxiety, aggression, internalising symptoms, behavioural disturbances, and associated cognitive and psychosocial impairment are linked with greater burden and psychological distress among caregivers. Integrated epilepsy care should incorporate psychiatric screening of patients together with assessment of caregiver well-being and family needs.

Background: Understanding public awareness and knowledge of glaucoma was important for identifying gaps in patient education concerning early detection and prevention of visual impairment. Objective: To assess glaucoma awareness and knowledge among adults attending an ophthalmology outpatient department and examine the association between awareness and selected sociodemographic characteristics. Materials and Methods: A hospital-based cross-sectional study framework was used for an dataset comprising 500 adult ophthalmology outpatients. Awareness was defined as having heard of glaucoma. Questions concerning disease knowledge, information sources and previous eye examinations were assessed among the 150 participants who reported awareness. Categorical variables were summarised using frequencies and percentages. Pearson’s chi-square test was used to examine associations between awareness and age, sex and educational attainment, with p<0.05 considered statistically significant. Results: Of the 500 participants, 150 (30.0%) were aware of glaucoma. Among these 150 participants, 42 (28.0%) recognised its asymptomatic nature, 60 (40.0%) recognised its familial association, 105 (70.0%) understood that glaucomatous visual loss was irreversible, and 125 (83.3%) recognised that treatment was available. Family or friends were reported as information sources by 85 (56.7%), healthcare personnel by 55 (36.7%), and media by 40 (26.7%); multiple responses were permitted. Previous eye examination was reported by 60 (40.0%) of the aware participants. Awareness was associated with age (χ²=10.714; p=0.005) and education (χ²=79.365; p<0.001), but not with sex (χ²=0.618; p=0.432). Conclusion: The dataset illustrated gaps in glaucoma awareness and understanding, particularly concerning asymptomatic disease and familial risk

Background: Tuberculous meningitis was associated with diverse neurological manifestations and intracranial complications. MRI enabled assessment of meningeal involvement, hydrocephalus, cerebral infarction and tuberculomas. Evaluation of these abnormalities alongside clinical findings provided a framework for understanding disease severity. Aim: To evaluate MRI patterns of tuberculous meningitis and their association with clinical manifestations and disease severity. Materials and Methods: An analysis was performed using simulated aggregate data representing 50 adults within a proposed hospital-based prospective observational study. Clinical manifestations and modified British Medical Research Council grades were compared with MRI abnormalities. Frequencies and percentages summarised categorical variables. Fisher’s exact test and the Fisher–Freeman–Halton exact test assessed clinicoradiological associations. Two-sided, unadjusted p-values below 0.05 were considered statistically significant. Results: Males constituted 58.0% of the simulated sample, and 54.0% were younger than 40 years. Meningeal enhancement occurred in 86.0%, tuberculomas in 50.0%, hydrocephalus in 44.0% and cerebral infarction in 36.0%. BMRC Grades I, II and III accounted for 24.0%, 50.0% and 26.0%, respectively. Cerebral infarction was associated with focal neurological deficits (p < 0.001), hydrocephalus with altered sensorium (p = 0.004), and cranial nerve enhancement with cranial nerve palsies (p < 0.001). Meningeal enhancement (p = 0.044), hydrocephalus (p = 0.009) and cerebral infarction (p < 0.001) were associated with clinical severity. Tuberculomas were not significantly associated with seizures (p = 0.114) or BMRC grade (p = 0.211). Conclusion: The analysis illustrated associations between selected MRI abnormalities and neurological manifestations or clinical severity. In the dataset, meningeal enhancement was the most frequent MRI abnormality, followed by tuberculomas, hydrocephalus and cerebral infarction. Cerebral infarction was associated with focal neurological deficits, hydrocephalus with altered sensorium, and cranial nerve enhancement with clinical cranial nerve palsies.

Background: Cataract surgery aims to restore functional vision, and intraocular lens (IOL) selection can influence postoperative visual outcomes. Monofocal IOLs provide a single focal point, whereas multifocal IOLs are designed to improve vision at more than one distance. This study compared the postoperative visual performance of monofocal and multifocal IOLs. Methods: This prospective interventional study included 60 patients (60 eyes) undergoing phacoemulsification at a tertiary eye care hospital. Based on the patients’ IOL choice, 30 eyes received monofocal IOLs and 30 received multifocal IOLs. Distance visual acuity, near visual acuity, and contrast sensitivity were assessed preoperatively and at postoperative day 1, week 1, and week 8. Between-group comparisons were performed using appropriate parametric and non-parametric tests, with statistical significance set at p < 0.05. Results: At eight weeks, 100% of eyes in the monofocal group and 93.3% in the multifocal group achieved uncorrected distance visual acuity of 6/9 or better. The difference in distance visual acuity was not statistically significant (p = 0.469). Near vision was significantly better in the multifocal group: 56.7% achieved N6 and 43.3% achieved N8, whereas 76.7% of the monofocal group achieved N18 and 23.3% achieved N12 (p < 0.0001). Contrast sensitivity was also significantly different between groups at eight weeks (p = 0.002); all monofocal eyes had a reported contrast sensitivity of 2.1, compared with 73.3% of multifocal eyes, while 26.7% of multifocal eyes had a value of 1.96. Conclusion: Both IOL groups demonstrated favourable postoperative distance visual acuity. Multifocal IOLs were associated with significantly better unaided near vision, while the study findings also indicated lower contrast sensitivity in the multifocal group. These outcomes may be considered during individualized IOL selection after discussion of patients’ visual needs and expectations

Background: Iatrogenic urinary tract injuries are uncommon but important complications of gynecologic and obstetric surgery. Early intraoperative recognition and timely urological management are essential to minimize postoperative morbidity and preserve urinary tract function.Objectives: To describe the pattern, intraoperative management, and early postoperative outcomes of urological injuries encountered during gynecologic and obstetric procedures at a tertiary care centre.Methods: This retrospective observational study included all patients requiring intraoperative urological consultation from the Department of Gynecology and Obstetrics to the Department of Urology at Kurnool Medical College and Government General Hospital, Kurnool, between October 2021 and February 2024. Patient age, index procedure, type and site of injury, operative management, duration of catheter or stent placement, and early postoperative complications were analyzed descriptively. Results: Ten patients were included, with a mean age of 32.8 years (range, 20–50 years). Emergency cesarean section accounted for 6 cases, hysterectomy for 2, and assisted vaginal delivery for 2. Isolated inadvertent cystotomy occurred in 6 patients, suspected isolated ureteral injury in 1, combined bladder and ureteral injury in 1, and urethral injury in 2. Bladder injuries mainly involved the dome and posterior wall, while the trigone was spared. Bladder rents were repaired in two layers using polyglactic acid sutures, followed by suprapubic and per-urethral drainage for 10–14 days. Ureteral injuries were managed by ureteroneocystostomy over a stent, with removal after 6 weeks. One urethral injury underwent primary repair, while another required suprapubic cystostomy. Wound infection occurred in 2 patients; no other major early postoperative complications were observed. Conclusion: Bladder injury was the predominant urological complication, with emergency cesarean section being the most frequent associated procedure. Prompt recognition, appropriate repair, and timely urological involvement were followed by favorable early postoperative outcomes in most patients.

Background: Maintaining a clear surgical field is essential during Functional Endoscopic Sinus Surgery (FESS), as even limited bleeding can impair visualization and increase operative difficulty. Various hemostatic strategies are used to reduce intraoperative bleeding, including tranexamic acid, dexmedetomidine, and warm saline irrigation. Aim of the study was to compare the effect of intravenous tranexamic acid, intravenous dexmedetomidine, and intraoperative warm saline irrigation on surgical field quality during FESS. Materials and Methods: This observational study included 60 patients undergoing FESS in the Department of ENT, Sri Krishna Multispecialty Hospital, Khammam and Midas ENT and Head and Neck Hospital, Hyderabad. Patients were assessed according to the hemostatic strategy used. Surgical field quality was evaluated using the Boezaart score. Intraoperative blood loss, operative duration, hemodynamic parameters, rescue hemostatic measures, and adverse events were also compared. Results: The mean overall Boezaart score was lowest with tranexamic acid (1.89 ± 0.52), followed by dexmedetomidine (2.09 ± 0.54) and warm saline (2.26 ± 0.59; p=0.039). Mean blood loss was also significantly lower with tranexamic acid (142.5 ± 61.8 mL; p=0.003). Dexmedetomidine produced the greatest reduction in heart rate and mean arterial pressure but was associated with more bradycardia. Boezaart score correlated strongly with blood loss (ρ=0.68, p<0.001). Conclusion: Intravenous tranexamic acid provided the best overall surgical field quality and lowest blood loss during FESS.

Background: Effective emergency medical care training is essential for improving timely responses to life-threatening emergencies. This study compared different instructional methods for emergency medical care skills training and assessed changes in participants knowledge. Materials and Methods: Of 247 enrolled students, 214 participated and were randomly allocated to four instructional groups: direct lecture, PowerPoint-based teaching, audio-visual (AV) teaching, and skill-based training. One-hour sessions covered adult, child, and infant basic life support (BLS), automated external defibrillator use, and choking management. Knowledge was assessed using pre- and post-tests. Data were analysed using mixed-effects models with Tukeys multiple-comparisons test and BrownForsythe and Welchs ANOVA. Results: Mean scores increased from 3.8 ± 2.3 to 7.0 ± 2.0 in Group 1, 3.8 ± 2.2 to 9.6 ± 1.9 in Group 2, 3.8 ± 2.4 to 6.7 ± 1.9 in Group 3, and 3.7 ± 2.1 to 6.6 ± 1.9 in Group 4. Improvements were significant in all groups (p < 0.0001). Overall differences were significant by BrownForsythe and Welchs ANOVA; however, post-training differences among instructional modalities were not significant. Conclusion: All four instructional approaches significantly improved emergency-care knowledge, supporting structured and practically oriented training for healthcare students.

Background: Non-seminomatous germ cell tumors (NSGCT) of the testis are highly chemosensitive[1] but 10-20% of patients develop chemotherapy-resistant disease[2]. A critical clinical gap exists in early identification of chemotherapy resistance, currently requiring 5-7 weeks for radiographic response assessment. Objective: To develop and validate a machine learning model for early chemotherapy response prediction in NSGCT using baseline serum tumor markers (β-HCG and α-fetoprotein) and IGCCCG risk stratification[6]. Methods: Retrospective cohort study of 29 patients with histologically confirmed NSGCT (TNM stage IIC-IIIC[1]. Logistic regression and random forest models were developed using stratified 70/30 train/test splits (training N=19, test N=9). Primary endpoint: AUC-ROC ≥0.75.[6]) receiving platinum-based chemotherapy Results: NSGCT demonstrated dramatic baseline marker elevation with 480-fold β-HCG gradient across IGCCCG risk classes (median 3.1 to 11,304 mIU/mL) and 150-fold AFP gradient (median 47 to 3,865 ng/mL). Dual-marker elevation occurred in 59.3% of patients. Logistic regression achieved excellent discrimination (test AUC 0.891, 95% CI 0.82-0.95). Log-AFP emerged as the sole statistically significant independent predictor (OR 0.499, 95% CI 0.27-0.93; p=0.028). Post-cycle 1 marker kinetics showed statistically significant differences across IGCCCG risk classes. Conclusions: A machine learning model incorporating dual tumor markers predicts chemotherapy response in NSGCT with excellent accuracy (AUC 0.891). AFP is the dominant independent predictor. The model enables early quantitative risk stratification within 1-2 weeks of treatment initiation. Prospective multicenter validation is required before clinical implementation.

Background: The under-reporting of adverse drug reactions (ADRs) is a significant problem in pharmacovigilance and nurses are an important group in the recognition and reporting of adverse drug reactions. Methods: The study design was a single group pre-test–post-test quasi-experimental study involving the nursing staff of a tertiary-care hospital. The baseline knowledge, attitude and practice (KAP) of pharmacovigilance was evaluated in 87 participants and paired pre- and post-training data was available for 56 participants. A pre- and post-structured 20-item questionnaire was used before and after hands-on pharmacovigilance training. Results: The attitude scores were the highest and practice scores were the lowest at baseline. In paired analysis, overall KAP improved from 13.25±2.55 to 17.39±1.42, with a mean increase of 4.14 points (95% CI 3.40–4.88; p<0.001; Cohen’s dz=1.50). There was a significant improvement in knowledge, attitude and practice. There was a significant increase in awareness of the ADR Monitoring Centre, its telephone numbers, PvPI and ADR reporting forms. Conclusion: Hands-on pharmacovigilance training led to significant short-term improvement in KAP among nursing staff and can facilitate hands-on training in pharmacovigilance in the context of continuing nursing education in the institution.

Background: Articular cartilage thickness varies across the patellar, femoral and tibial surfaces of the knee. Sex-related differences in skeletal dimensions, mechanical loading and hormonal factors may influence cartilage morphology. Establishing sex-specific measurements may improve the interpretation of quantitative knee MRI and help distinguish normal anatomical variation from pathological cartilage thinning. Aim: To compare patellar, femoral and tibial articular cartilage thickness between adult males and females using magnetic resonance imaging. Materials and Methods: This prospective comparative cross-sectional study included 52 adults comprising 30 males and 22 females. MRI of the right knee was performed using a 1.5-T scanner with a dedicated phased-array knee coil. Cartilage thickness was measured at the central, medial and lateral patellar sites; medial and lateral femoral condyles; femoral trochlea; and medial and lateral tibial plateaus. Three measurements were obtained at each site, and their mean was used for analysis. Thickness measurements were compared between males and females using Welch’s independent-samples t-test. Multiple linear regression was performed to determine whether sex remained associated with average knee cartilage thickness after adjustment for age. A p value below 0.05 was considered statistically significant. Results: The mean age was 40.17±17.12 years among males and 44.82±15.24 years among females (p=0.309). Males had significantly greater average patellar (5.12±1.00 versus 4.39±1.14 mm; p=0.021), femoral (4.88±1.25 versus 3.81±1.17 mm; p=0.003) and tibial cartilage thickness (4.52±0.56 versus 3.52±1.11 mm; p<0.001). The overall average knee cartilage thickness was 4.84±0.85 mm among males and 3.91±1.07 mm among females, with a mean difference of 0.93 mm (95% CI: 0.38-1.48; p=0.002). Significant sex differences were observed at all evaluated sites except the medial patellar facet (p=0.804). The largest difference was recorded at the medial femoral condyle (1.13 mm; 95% CI: 0.41-1.85; p=0.003). After adjustment for age, male sex remained independently associated with a 0.62-mm greater average cartilage thickness (95% CI: 0.29-0.95; p<0.001). Increasing age was independently associated with reduced cartilage thickness (β=-0.058 mm/year; p<0.001). The regression model explained 68% of the variability in average knee cartilage thickness. Conclusion: Males had significantly thicker patellar, femoral and tibial articular cartilage than females. However, the magnitude of the difference varied according to anatomical site, and no significant sex difference was observed at the medial patellar facet. Age and sex were independent determinants of average knee cartilage thickness. Sex-specific, age-adjusted and site-specific reference values should therefore be considered when interpreting quantitative knee MRI

Background: Articular cartilage thickness varies according to anatomical location, mechanical loading and individual characteristics. Magnetic resonance imaging permits direct, non-invasive and multiplanar assessment of knee cartilage. Establishing site-specific measurements may help distinguish normal anatomical variation from early degenerative thinning. Aim: To assess articular cartilage thickness at different anatomical sites of the adult knee joint using magnetic resonance imaging. Materials and Methods: This prospective cross-sectional observational study included 52 adults aged 20 years or older. MRI examination of the right knee was performed using a 1.5-T scanner with a dedicated phased-array knee coil. Cartilage thickness was measured at the medial and lateral femoral condyles, femoral trochlea, medial and lateral tibial plateaus, and central, medial and lateral patellar sites. Three readings were obtained at each site, and their mean was used for analysis. Cartilage thickness was compared across anatomical regions, age groups and sexes using repeated-measures analysis of variance, paired t-test, independent-samples t-test and one-way analysis of variance. Multiple linear regression was used to identify the independent associations of age and sex with average cartilage thickness. A p value below 0.05 was considered statistically significant. Results: The mean age of the participants was 42.13±16.36 years; 30 (57.7%) were males and 22 (42.3%) were females. The overall average knee cartilage thickness was 4.45±1.05 mm (95% CI: 4.16-4.74 mm). Average cartilage thickness was greatest in the patella (4.81±1.11 mm), followed by the femur (4.43±1.32 mm) and tibia (4.10±0.96 mm), with a significant regional difference (F=18.74, p<0.001). Central patellar cartilage was the thickest individual site at 5.81±1.48 mm, followed by femoral trochlear cartilage at 5.39±1.35 mm. Lateral tibial cartilage was significantly thicker than medial tibial cartilage (4.29±1.09 mm versus 3.92±0.98 mm; p=0.003). Average knee cartilage thickness progressively decreased from 5.23±0.34 mm in the 20-34-year group to 2.89±0.49 mm in the 65-79-year group (F=42.17, p<0.001). Males had significantly thicker cartilage than females (4.84±0.85 mm versus 3.91±1.07 mm; p=0.002). Increasing age was independently associated with reduced cartilage thickness (β=−0.058 mm per year, p<0.001), while male sex was associated with greater thickness (β=0.62 mm, p<0.001). Conclusion: Knee articular cartilage thickness differed significantly according to anatomical site, age and sex. The central patellar and femoral trochlear regions demonstrated the greatest thickness. Cartilage thickness progressively decreased with increasing age and was greater among males. MRI-based assessment should therefore be interpreted using site-, age- and sex-specific reference values

Background: Vascular calcification is a common and clinically significant complication among patients with end-stage kidney disease undergoing maintenance haemodialysis. It increases cardiovascular morbidity and mortality. Dialysis vintage may affect the progression of vascular calcification by prolonged exposure to mineral and bone disorders, inflammation, and metabolic abnormalities. Aim: To assess the relationship between dialysis vintage and radiographic vascular calcification burden Materials and Methods: This hospital-based cross-sectional analytical study was done on 100 adult patients with end-stage kidney disease. Demographic, clinical, and biochemical parameters were recorded. Vascular calcification burden was assessed using radiographic scoring methods, including plain radiographs of peripheral vessels and abdominal radiographs. Patients were categorized according to the severity of calcification. Results: Radiographic vascular calcification was present in 58% of patients. Mild, moderate, and severe calcification were seen in 38%, 12%, and 8% of patients. Increasing age showed a significant association with more vascular calcification burden. Longer dialysis vintage was associated with increased severity of calcification. Diabetes mellitus, hyperphosphataemia, and elevated intact parathyroid hormone (iPTH) levels were associated with greater vascular calcification burden Advanced age, prolonged dialysis duration, diabetes mellitus, hyperphosphataemia, and increased iPTH levels were found to be predictors of increased vascular calcification. Conclusion: Radiographic vascular calcification is more prevalent among maintenance haemodialysis patients. Longer dialysis vintage, increasing age, diabetes mellitus, and CKD-mineral bone disorder abnormalities contributed to calcification burden. Radiographic vascular calcification scoring is a simple and practical tool for cardiovascular risk assessment and may help identify high-risk haemodialysis patients requiring targeted preventive strategies

Background: Pneumonia may result from bacterial, viral, fungal, or mixed infections, and clinical and radiological findings alone may not reliably establish the underlying etiology. Respiratory microbiological investigations can provide etiological information and support appropriate antimicrobial management. This study evaluated the diagnostic contribution of individual and integrated respiratory microbiological investigations in differentiating bacterial from non-bacterial pulmonary infections. Methods: A prospective observational study was conducted among 180 adults presenting with clinical and radiological features suggestive of pulmonary infection at a tertiary-care teaching hospital in India. Respiratory specimens were evaluated using Gram staining, bacterial culture with antimicrobial susceptibility testing, respiratory viral polymerase chain reaction (PCR), targeted fungal investigations, and selected molecular assays according to clinical indication. Patients were classified as having bacterial pneumonia, viral pneumonia, fungal pulmonary infection, mixed bacterial-viral infection, or undetermined etiology. The diagnostic yield of individual and integrated microbiological approaches was assessed, along with their effect on antimicrobial therapy. Results: Among 180 patients, 86 (47.8%) had bacterial pneumonia, 49 (27.2%) had viral pneumonia, 18 (10.0%) had fungal pulmonary infection, 11 (6.1%) had mixed bacterial-viral infection, and 16 (8.9%) remained microbiologically undetermined. Bacterial culture identified a clinically relevant bacterial pathogen in 79/86 (91.9%) patients with bacterial pneumonia, while Gram staining demonstrated findings suggestive of bacterial infection in 69/86 (80.2%). Respiratory viral PCR detected a relevant viral pathogen in 56/60 (93.3%) patients with viral or mixed infection, and targeted fungal investigations provided positive or supportive findings in 16/18 (88.9%) patients with fungal pulmonary infection. The integrated microbiological approach established a specific etiological diagnosis in 164/180 (91.1%) patients. Previous antibiotic exposure was associated with lower bacterial culture positivity (73.8% versus 89.5%). Microbiological results led to modification of antimicrobial therapy in 72 (40.0%) patients. Conclusions: Respiratory microbiological investigations provide complementary information for differentiating bacterial and non-bacterial pulmonary infections. Bacterial culture remains important for bacterial identification and antimicrobial susceptibility testing, while viral PCR and targeted fungal investigations contribute to recognition of non-bacterial etiologies. An integrated, clinically guided microbiological approach may improve etiological diagnosis and support antimicrobial stewardship.

Background: Recurrent acute otitis media (RAOM) is a common reason for repeated antibiotic exposure and otolaryngology referral in early childhood. Host susceptibility and modifiable household or caregiving exposures often coexist, but their relative contribution varies across populations. The study is designed to identify demographic, environmental, feeding-related, and upper-airway factors associated with RAOM among children attending a tertiary care hospital. Materials and Methods: A hospital-based unmatched analytical case-control study was designed. Children aged 6 months to 6 years presenting with acute otitis media were classified as RAOM cases (n=90) when they had ≥3 separate episodes in 6 months or ≥4 in 12 months with ≥1 episode in the preceding 6 months. Controls (n=180) had acute otitis media without meeting recurrence criteria. Exposures were obtained from caregiver interview and clinical records. Chi-square tests, crude odds ratios (ORs), and multivariable logistic regression were used. Results: Cases were younger than controls (26.1±14.5 vs 33.8±17.4 months, p<0.001). On multivariable analysis, frequent upper respiratory tract infections (adjusted OR [aOR] 4.95, 95% CI 2.47–9.94), passive tobacco smoke (aOR 3.65, 1.81–7.33), pacifier use beyond 6 months (aOR 3.62, 1.68–7.80), age ≤24 months (aOR 3.38, 1.72–6.65), exclusive breastfeeding for <6 months (aOR 2.84, 1.46–5.54), adenoid hypertrophy (aOR 2.70, 1.34–5.48), day-care attendance (aOR 2.58, 1.30–5.11), ≥2 siblings (aOR 2.35, 1.19–4.65), and family history of recurrent otitis media (aOR 2.25, 1.00–5.03) remained associated with RAOM. Conclusion: RAOM clustered in younger children with frequent respiratory infections and repeated exposure to respiratory pathogens, while several modifiable factors, particularly household smoke, prolonged pacifier use, and shorter exclusive breastfeeding, were independently associated with recurrence. Risk-factor counselling can therefore complement appropriate clinical management

Background: Acute kidney injury (AKI) is a frequent complication following cardiac surgery and is associated with increased morbidity, prolonged hospitalisation, and mortality. This study evaluated the incidence, risk factors, and clinical outcomes of postoperative AKI in patients undergoing elective cardiac surgery. Materials and Methods: This retrospective observational study included 100 consecutive adult patients undergoing elective cardiac surgery. Postoperative AKI was defined and staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Demographic, preoperative, intraoperative, and postoperative variables were compared between patients with and without AKI. Multivariable logistic regression analysis was performed to identify factors independently associated with postoperative AKI. Results: Postoperative AKI developed in 28% of patients; 60.7%, 25.0%, and 14.3% of AKI cases were KDIGO stages 1, 2, and 3, respectively. Patients developing AKI were older and had lower preoperative haemoglobin, higher serum creatinine, lower estimated glomerular filtration rate, and lower left ventricular ejection fraction. AKI was also associated with longer cardiopulmonary bypass and aortic cross-clamp times, blood product transfusion, and postoperative inotropic/vasopressor support. Multivariable analysis identified age, lower haemoglobin, higher preoperative creatinine, prolonged cardiopulmonary bypass and cross-clamp durations, blood transfusion, and inotropic/vasopressor support as independently associated with postoperative AKI. AKI was associated with significantly longer intensive care and hospital stays and higher in-hospital mortality. Conclusion: Postoperative AKI occurred in more than one-quarter of patients undergoing cardiac surgery and was associated with adverse clinical outcomes. Recognition of preoperative renal and haematological abnormalities and optimisation of modifiable perioperative factors may facilitate risk stratification and reduce postoperative renal complications

Background: Pyogenic infections are one of the most common out patient’s encountered health problems. Pyogenic infections can be cause by either Gram positive or Gram negative or aerobic or facultative aerobes. Microbiological surveillance by appropriate sample culture and sensitivity will definitely aid in the earliest accurate antibiotic therapy. This study is aim to evaluate the prevalence of bacterial pathogens in pyogenic infections and to identify the antibiotic susceptibility profile of pyogenic isolates in our community.MATERIALS AND METHODS: In this retrospective study all the 460 participants during the study period irrespective of age and sex were included. Participants with suspicious of bacterial wound infections such as venous ulcers, diabetic ulcers, abscesses and traumatic injuries were included. Standard procedures as per microbiological guidelines were followed for processing of the culture specimens under aseptic precautions. All the results were tabulated and analyzed as number and percentages. RESULTS: Escherichia coli (23.8%) as the predominant pathogen followed by Klebsiella species (21.7%) and Staphylococcus aureus (20.3%), CONS (14.7%), Pseudomonas aeruginosa (11.5%), Enterococcus species (4.56%), and Proteus species (3.15%). Antibiotic susceptibility testing method of Gram negative bacilli showed higher susceptibility to tetracycline, levofloxacin, meropenem, minocycline, gentamicin, cotrimoxazole, piperacillin+tazobactum, cefaperazone+sulbactum, ceftazidime +avibactum. All the gram positive isolates were 100% susceptible to linezolid, teicoplanin, vancomycin. MRSA and MRCONS were noted as 55.2% and 40.5% respectively. 69.2% of Ampicillin sensitive Enterococcal isolates was observed. CONCLUSION: The percentage resistance of different isolates against different antibiotics varies; most of the isolates were sensitive to broad spectrum antibiotics, aminoglycosides and beta lactam and beta lactam inhibitor antibiotics. MDR pathogens can be treated by penems, fluoroquinolones along with aminoglycosides to add synergistic effect

Seizures occur when a large group of neurons undergo excessive synchronized depolarization. Depolarization can result from excessive excitatory amino acid release (eg, glutamate) or deficient inhibitory neurotransmitter (eg, gamma amino butyric acid [GABA]). Another potential cause is disruption of ATP-dependent resting membrane potentials, which causes a flow of sodium into the neuron and potassium out of the neuron. Hypoxic-ischemic encephalopathy disrupts the ATP- dependent sodium-potassium pump and appears to cause excessive depolarization. It as an important cause of neonatal seizures. The biochemical effects of neonatal seizures included derangements of energy metabolisın. The vitals of the baby (Heart Rate, Respiratory Rate, Peripheral pulses, Blood pressure, temperature, Capillary filling time) were recorded. General physical examination of neonate was done according to the proforma and any disparity in Head size and Shape, Skin lesions were noted. Anthropometry of the neonate was recorded & gestational age was assessed according to New Ballard scoring. CNS examination was done as per the proforma and HIE was staged according to modified Sarnat staging in to stage I, II and Ill. Other systems were also examined. Mortality in our study was 6 cases (5.45%) and birth asphyxia was the commonest cause seen in 4 cases (66.66%).

Background: To evaluate the effectiveness of concept mapping as a teaching–learning method, in terms of knowledge gain and retention, among 2nd and 3rd year MBBS students posted in Community Medicine, and to assess students' perception of the method. Methods: A quasi-experimental, single-group pre-test/post-test study was conducted among 300 undergraduate medical students across 10 Community Medicine posting batches (five each from 2nd and 3rd year MBBS; 30 students/batch). Students completed a pre-test, an immediate post-test following a structured concept-mapping session, and a delayed retention test at 4–6 weeks. Concept maps were scored using a four-domain rubric (propositions, hierarchy, cross-links, examples). Perception was assessed using a 5-point Likert questionnaire. Paired t-tests compared time-point scores; Pearson's correlation assessed the rubric–performance relationship. Results: Mean knowledge scores rose from 4.8 ± 1.4 (pre-test) to 7.9 ± 1.1 (immediate post-test), a gain of 3.1 points (95% CI 2.9–3.3; p<0.001). At 4–6 weeks, the retention score was 7.1 ± 1.3, a decline of 0.8 points from post-test (95% CI −1.1 to −0.5; p=0.002) but well above baseline. The mean rubric score was 20.0 ± 3.9/28 (71.4%), with cross-links scoring lowest (56.7%). Rubric score correlated moderately with post-test performance (r=0.52, R²=0.27; p<0.001). Perception was favourable, with 86.0% wanting more such sessions and 68.0% finding the maps easy to construct. Conclusion: Structured concept mapping produced significant immediate knowledge gains with substantial retention at 4–6 weeks. Higher-quality concept maps were associated with better post-test performance, and student perception was predominantly favourable, supporting concept mapping as a feasible active-learning strategy for undergraduate Community Medicine postings.

Background: Acute headache is a common presentation in emergency departments and may represent either a primary headache disorder or an underlying intracranial pathology. Computed tomography (CT) of the brain is frequently used for rapid evaluation, particularly when clinical features suggest a secondary cause. This study aimed to describe the spectrum of CT brain findings among patients presenting with acute headache and to identify clinical factors associated with abnormal CT findings. Methods: This retrospective observational study included 300 adult patients presenting with acute headache who underwent CT brain examination at a tertiary-care hospital. Demographic characteristics, clinical presentation, neurological findings, presence of headache red flags, and CT findings were retrieved from medical records. CT examinations were categorized as normal, showing acute clinically significant pathology, or showing incidental/non-acute abnormalities. Associations between clinical variables and abnormal CT findings were evaluated using the chi-square test. A p-value <0.05 was considered statistically significant. Results: The study included 300 patients with a mean age of 43.8 ± 19.1 years; 164 (54.7%) were women and 136 (45.3%) were men. CT brain was normal in 198 (66.0%) patients, while 102 (34.0%) demonstrated an abnormality. Acute ischemic infarction was the most frequent acute intracranial abnormality (25, 8.3%), followed by intracranial hemorrhage (20, 6.7%), subdural hematoma (12, 4.0%), subarachnoid hemorrhage (10, 3.3%), intracranial mass lesions (9, 3.0%), sinusitis (14, 4.7%), hydrocephalus (5, 1.7%), cerebral edema (4, 1.3%), and other findings (3, 1.0%). Patients aged ≥50 years were more likely to have abnormal CT findings than those aged <50 years (45.7% vs. 23.8%, p<0.001). Abnormal CT findings were also significantly associated with focal neurological deficits (66.7% vs. 23.7%, p<0.001) and the presence of at least one headache red flag (55.0% vs. 20.0%, p<0.001). Conclusions: Most patients presenting with acute headache had no acute intracranial abnormality on CT. However, a substantial proportion demonstrated clinically relevant pathology, particularly ischemic stroke and intracranial hemorrhage. Older age, focal neurological deficit, and headache red flags were significantly associated with abnormal CT findings. These findings support careful clinical risk stratification when selecting patients for neuroimaging.

Background: Benign ovarian tumors may be accompanied by alterations in the hormonal environment, but the pattern of circulating reproductive hormones in these lesions is not well defined. Evaluating endocrine variations may provide additional insight into ovarian physiology in benign disease. Objective: To compare serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), progesterone (P4), and prolactin (PRL) levels between women with benign ovarian tumors and age-matched healthy controls, and to assess their correlations and discriminatory performance. Methods: This case-control study included 100 women at a tertiary care center in Western Maharashtra, comprising 50 women with benign ovarian tumors and 50 age-matched healthy controls. Serum LH, FSH, P4, and PRL were assessed using standard immunoassay techniques. Between-group comparisons were performed using the Mann–Whitney U test. Spearman’s rank correlation was used to evaluate associations, and receiver operating characteristic (ROC) analysis assessed discriminatory performance. Results: P4 was significantly higher in women with benign ovarian tumors than in healthy controls (median 4.80 vs. 1.15 ng/mL; p=0.045), whereas LH, FSH, and PRL showed no significant differences. Age correlated positively with LH (ρ=0.634, p<0.001) and FSH (ρ=0.713, p<0.001) and negatively with P4 (ρ=−0.470, p=0.001). LH and FSH were strongly positively correlated (ρ=0.750, p<0.001). P4 showed the highest ROC performance (AUC=0.616), with 74% sensitivity and 50% specificity, indicating limited discriminatory value. Conclusion: Benign ovarian tumors were associated with selective endocrine variation, particularly higher P4 levels, rather than generalized hormonal disturbance. Age-related endocrine changes remained prominent, while the evaluated hormones showed limited value as standalone diagnostic indicators

Background:Serous effusions involving the pleural, peritoneal, and pericardial cavities are common manifestations of benign and malignant disease. Cytological examination provides a minimally invasive method for detecting malignancy, establishing metastatic disease, guiding staging, and sometimes identifying the probable primary site. Diagnostic sensitivity, however, varies according to tumour type, specimen cellularity, preparation technique, and availability of ancillary investigations.Objective: To systematically evaluate the diagnostic utility of serous effusion cytology for detecting malignancy, with emphasis on diagnostic accuracy, risk of malignancy across the International System for Reporting Serous Fluid Cytopathology (TIS) categories, causes of false-negative and indeterminate results, and the incremental value of cell-block preparation and immunocytochemistry. Methods: A systematic review was structured according to PRISMA 2020. MEDLINE/PubMed, Embase, Scopus, Web of Science, and Google Scholar were searched for studies published from January 2020 to June 2026. Eligible primary studies evaluated pleural, peritoneal/ascitic, or pericardial fluid cytology for malignancy and reported cytohistological/clinical correlation, TIS category-specific risk of malignancy, or diagnostic performance. Risk of bias was assessed using QUADAS-2. Because of heterogeneity in reference standards, tumour spectra, and diagnostic thresholds, a narrative synthesis was performed and interpreted alongside contemporary meta-analyses. Results: The search identified 1,946 records. After removal of 512 duplicates, 1,434 titles and abstracts were screened. Of 156 full-text reports assessed, 142 were excluded, leaving 14 primary studies in the final qualitative synthesis. Contemporary TIS studies ranged from 150 to 3,790 specimens. A 2024 diagnostic meta-analysis of 16 studies and 19,128 cases reported sensitivity/specificity of 77%/95% when AUS and higher categories were considered positive, 57%/100% when SFM and MAL were positive, and 70%/99% when only MAL was positive. A separate TIS meta-analysis reported pooled risks of malignancy of 27%, 11%, 49%, 90%, and 100% for ND, NFM, AUS, SFM, and MAL, respectively. Pleural-fluid cytology showed tumour-dependent sensitivity, ranging from 83.6% for lung adenocarcinoma and 85.2% for ovarian carcinoma to 24.2% for pulmonary squamous-cell carcinoma and 28.9% for mesothelioma. Cell-block preparation and immunocytochemistry improved diagnostic yield in difficult cases. Most included studies had moderate risk of bias, chiefly from retrospective design and incomplete reference-standard verification. Conclusion: Effusion cytology is a highly specific and clinically valuable method for detecting malignant serous effusions, but its sensitivity is incomplete and varies substantially by tumour type. TIS improves standardization and risk stratification. Cell blocks, immunocytochemistry, repeat sampling, and tissue biopsy should be used selectively when cytology is negative or indeterminate despite persistent clinical suspicion

Background: Fine-needle aspiration cytology (FNAC) is the principal minimally invasive investigation used to stratify thyroid nodules. Its diagnostic performance, however, varies with sampling technique, lesion type, cytological reporting system, and the way indeterminate categories are handled. Objective: To systematically evaluate the diagnostic accuracy of FNAC in thyroid nodules using histopathology as the reference standard and to identify important causes of cytology-histology discordance. Methods: This systematic review was structured according to PRISMA 2020. PubMed/MEDLINE, Scopus and Web of Science were searched for diagnostic-accuracy studies correlating thyroid FNAC with histopathology. Ten primary cytohistological studies were included in the focused synthesis. The index test was FNAC, principally classified using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), and surgical histopathology was the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, risk of malignancy and discordance were extracted. Risk of bias was evaluated using QUADAS-2. Results: The search yielded 728 records. After removal of 186 duplicates, 542 records were screened; 471 were excluded at title/abstract stage and 71 full-text reports were assessed. Sixty-one full-text reports were excluded, leaving 10 studies in the qualitative synthesis. Across included studies, reported sensitivity ranged from 71.4% to 100%, specificity from 41.9% to 100%, and overall accuracy from 54.8% to 97.7%, reflecting substantial differences in patient selection and analytical thresholds. A major 2022 meta-analysis of 16,597 patients from 36 studies reported pooled sensitivity of 85.6% (95% CI 79.9-89.5), specificity of 71.4% (95% CI 61.1-79.8), and an area under the summary ROC curve of 86.1%. Indeterminate Bethesda categories, follicular-patterned lesions, sampling error, papillary microcarcinoma, cystic change and thyroiditis were important sources of discordance. QUADAS-2 assessment identified patient-selection and flow/timing bias, particularly selective surgical verification, as the dominant methodological concerns. Conclusion: FNAC is a reliable first-line diagnostic test for thyroid nodules, with particularly strong clinical utility at the benign and malignant ends of the Bethesda spectrum. Histopathology remains essential for definitive diagnosis, especially in follicular-patterned lesions. Diagnostic performance can be improved through ultrasound-guided sampling, adequacy assessment, standardized Bethesda reporting and appropriate management of indeterminate cytology.

Background: Safe intramuscular (IM) drug administration requires integration of pharmacological knowledge, applied anatomy, appropriate site selection, needle characteristics, and correct injection technique. Inadequate knowledge may result in ineffective drug delivery and preventable complications. Aim of the study was to assess the knowledge of pharmacological and anatomical principles of safe intramuscular drug administration among medical students and healthcare professionals. Materials and Methods A descriptive cross-sectional study was conducted by the Department of Pharmacology in collaboration with the Department of Anatomy among 175 participants, including 105 medical students and 70 healthcare professionals. Knowledge was assessed using a structured questionnaire covering pharmacology, anatomy, injection technique, and complication prevention. Data were analysed using descriptive statistics, independent-samples t-test, and Pearson/Spearman correlation tests. A p-value <0.05 was considered statistically significant.Results The mean overall knowledge score was 17.78 ± 4.57 out of 29. Healthcare professionals demonstrated significantly higher overall knowledge than medical students (19.96 ± 3.80 vs. 16.32 ± 4.47; p<0.001). Significant differences were also observed in pharmacological, anatomical, technique, and complication-prevention scores. Pharmacological and anatomical knowledge were positively correlated (r=0.445, p<0.001). Age, clinical experience, and frequency of IM administration showed positive associations with overall knowledge. Conclusion Knowledge regarding safe IM drug administration was moderate, with notable deficiencies in anatomical landmarking, gluteal-site selection, aspiration, and patient-specific needle selection. Structured, integrated pharmacology-anatomy teaching and periodic skill-based training may improve safe IM administration

Background: In the cases of severe mental disorders like schizophrenia and bipolar affective disorder, the caregivers experience a considerable amount of burden which, in turn, affects their quality of life. Aim: To compare the quality of life (QoL) among the caregivers of patients with schizophrenia and bipolar affective disorder. Methodology: It was a cross-sectional study, conducted at a tertiary care hospital, and involved 30 caregivers each of patients with schizophrenia and bipolar disorder. WHO-QoL-Bref was used for assessing the QoL experienced by the caregivers, along with a specially designed proforma was used to gather socio-demographic information about the patients and their caregivers. Result: Most subjects were males, were spouses in case of bipolar affective disorder patient (43.30%) and parents (46.70%) among schizophrenia patients. In terms of socio-demographic profile, no significant difference was found between the groups. The mean total score of bipolar disorder group was 85.03 ± 12.87 and schizophrenia group was 76.57 ± 13.95, the difference between two groups was statistically significant (P value 0.018). Further, the difference was statistically significant in the psychological as well as environmental domains, and insignificant in physical health and social domains. Conclusion: Persistent experience of poor quality of life poses risk of overt as well as substantial sub-syndromal psychiatric morbidity among the caregivers of patients with chronic psychiatric morbidities. Support programme should be planned in accordance with the uniqueness of each care-giving scenario to provide maximum assistance to the caregivers.

Background: Orthopaedic implant-associated infection is a major complication following fracture fixation and joint arthroplasty. Early diagnosis remains challenging because clinical features may be subtle and microbiological confirmation requires time. Serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are widely used inflammatory markers, whereas procalcitonin (PCT) has been proposed as a more infection-specific biomarker. The relative diagnostic performance of these markers in patients with suspected orthopaedic implant infection remains incompletely defined. Objective: To compare the diagnostic accuracy of serum CRP, ESR, and procalcitonin for the early detection of orthopaedic implant-associated infection. Methods: A prospective diagnostic-accuracy study was conducted in the Department of Orthopaedics at Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, from April 2025 to March 2026. A total of 120 consecutive adult patients with an orthopaedic implant in situ who underwent evaluation for suspected infection or revision/removal surgery were included. Serum CRP, ESR, and PCT were measured at initial evaluation before definitive microbiological diagnosis. Final infection status was determined using a composite reference standard incorporating clinical findings, intraoperative findings, multiple deep-tissue cultures, and histopathology in accordance with accepted periprosthetic joint infection and fracture-related infection definitions. The index biomarkers were not incorporated into the final adjudicated infection definition to minimize incorporation bias. Diagnostic accuracy was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios, and receiver operating characteristic (ROC) curve analysis. Results: Of the 120 patients, 42 (35.0%) fulfilled the reference standard for orthopaedic implant infection, while 78 (65.0%) were classified as aseptic implant failure or non-infected cases. Median CRP, ESR, and PCT values were all significantly higher in infected patients. At a CRP threshold of ≥10 mg/L, sensitivity was 85.7% and specificity was 76.9%, with an area under the ROC curve (AUC) of 0.86. ESR ≥30 mm/hour demonstrated sensitivity of 78.6%, specificity of 69.2%, and AUC of 0.79. PCT ≥0.25 ng/mL demonstrated lower sensitivity of 45.2% but the highest specificity at 94.9%, with an AUC of 0.74. CRP demonstrated the most favorable overall balance between sensitivity and specificity, whereas PCT was more useful as a rule-in than a screening marker. Conclusion: CRP demonstrated the best overall diagnostic performance for early identification of orthopaedic implant-associated infection. ESR provided moderate diagnostic value but was less discriminative than CRP. Procalcitonin showed excellent specificity but inadequate sensitivity when used alone, limiting its value as a screening test. PCT may nevertheless provide additional support when markedly elevated in patients with suspected infection. No single serum biomarker should replace clinical assessment, microbiological sampling, and accepted diagnostic criteria.

Background: Competency-based medical education (CBME) requires medical graduates to demonstrate not only biomedical knowledge and clinical skills but also effective communication, ethically defensible decision-making, empathy, accountability and professional behavior. The Attitude, Ethics and Communication (AETCOM) framework was incorporated into the Indian undergraduate medical curriculum to provide structured longitudinal training in these affective and behavioral competencies. Since its implementation, AETCOM has been delivered using diverse educational approaches, including role-play, simulation, reflective writing, patient encounters, portfolios, visual humanities, video-based learning and more recently digitally supported and artificial-intelligence-assisted assessment. Objective: To systematically evaluate the educational effects of AETCOM interventions on communication competence, ethical reasoning, professionalism, empathy, reflective ability and associated learner outcomes among undergraduate medical students and interns. Methods: A systematic review was conducted and reported according to PRISMA 2020. Literature published from January 2019 through July 31, 2026 was considered. PubMed/MEDLINE, PubMed Central, journal and publisher databases, and citation tracking were searched using combinations of “AETCOM,” “Attitude Ethics Communication,” “medical student,” “communication,” “ethics,” “professionalism,” “empathy,” “role play,” “simulation,” and “reflective writing.” Original studies involving undergraduate medical students or interns with explicit AETCOM exposure and measurable learner outcomes were eligible. Reviews, editorials, faculty-only investigations, non-AETCOM CBME studies and studies without learner outcomes were excluded. Methodological quality was evaluated using principles of the Mixed Methods Appraisal Tool. Because of marked heterogeneity in interventions and outcome measures, narrative synthesis rather than meta-analysis was undertaken. Results: A working search set of 96 records was identified. After removal of 27 duplicate records, 69 records underwent title and abstract screening; 26 were excluded. Of 43 reports sought for retrieval, 2 could not be retrieved, leaving 41 full-text reports assessed for eligibility. Twelve full-text reports were excluded: absence of an AETCOM-specific learner intervention/outcome (n=4), general CBME studies without separately analyzable AETCOM outcomes (n=3), faculty-only studies (n=2), reviews/editorials (n=2), and overlapping or duplicate cohort reporting (n=1). Consequently, 29 studies were included in the qualitative synthesis.Communication was the most consistently and objectively improved outcome. Structured AETCOM interventions using Kalamazoo-based assessment, role-play, video review, simulated patients and standardized checklists repeatedly demonstrated favorable post-training performance. A 230-student quasi-experimental study demonstrated significant improvement in communication domains after video-assisted and role-play-based AETCOM training. A multicentre communication intervention reported improvement in mean total scores from approximately 55 before training to 94 after training. In 2026, video-recorded peer role-play involving 250 first-year students showed that 98% of valid submissions met or exceeded expected performance. Professionalism-oriented case-based role-play significantly increased knowledge scores, while ethics-focused modules improved understanding of autonomy, confidentiality, error disclosure and fiduciary responsibility. Reflective writing, visual humanities, cadaver-based professionalism and caregiver-focused activities promoted empathy and self-reflection. A 2026 artificial-intelligence-augmented standardized-patient pilot suggested the feasibility of scalable technology-assisted AETCOM assessment. Most studies, however, were single-centre, uncontrolled and dependent on short-term or perception-based outcomes. Conclusion: AETCOM interventions have a positive educational effect across communication, ethical understanding, professionalism, empathy and reflective practice, with the strongest evidence supporting communication training delivered through active experiential methods. Simulated encounters, standardized assessment tools, role-play, feedback, reflection and longitudinal reinforcement appear more effective than passive instruction. Evidence that these educational gains persist into independent clinical behavior remains limited. Future research should prioritize multicentre longitudinal studies, workplace-based assessment, validated instruments, patient-reported outcomes and measurement of sustained professional behavior

Background: Modern medical education increasingly recognizes that clinical competence extends beyond biomedical knowledge and procedural expertise. Effective communication, ethical reasoning, empathy, accountability and professional conduct are fundamental attributes of a competent physician. In India, the Attitude, Ethics and Communication (AETCOM) curriculum was introduced within competency-based medical education to develop these attributes longitudinally throughout undergraduate medical training. Although multiple studies have evaluated individual AETCOM interventions, the consistency and durability of their educational effects remain uncertain. Objective: To systematically synthesize available evidence regarding the impact of AETCOM-based medical education on communication skills, professionalism, ethical competence, empathy, reflective capacity and related educational outcomes among undergraduate medical students and interns. Methods: A systematic literature review was undertaken following the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020). PubMed/MEDLINE and PubMed Central were searched together with supplementary searches of journal and publisher platforms and backward citation screening. Studies published or available online up to 30 June 2026 were considered. Primary studies involving undergraduate medical students or interns exposed to structured AETCOM teaching, implementation or assessment were eligible. Outcomes were classified into communication competence, professionalism, ethical competence, empathy/reflection and implementation/acceptability. Owing to substantial heterogeneity in interventions, participants and assessment instruments, meta-analysis was considered inappropriate and narrative synthesis was performed. Results: Twenty-six primary studies fulfilled the eligibility framework. Communication skills demonstrated the most consistent objective improvement. A multicentre study involving 240 third-year students from six medical colleges reported an increase in mean communication scores from 54.89 ± 11.55 before intervention to 94.4 ± 19.3 following AETCOM training. Structured role-play, simulated encounters, video-recorded communication exercises, standardized checklists and feedback were repeatedly associated with favorable outcomes. A 2026 study involving 250 first-year students reported that 98% of valid video-recorded role-play submissions met or exceeded expected communication performance, while 87% considered peer role-play effective. Professionalism and ethical competence generally improved after case-based, reflective and experiential interventions; however, most studies assessed knowledge, perception or short-term attitudes rather than sustained clinical behavior. Empathy-oriented, visual humanities, cadaver-respect and reflective-writing interventions were well received. Recent process-assessment evidence demonstrated student satisfaction approaching 88–90% during ethics-focused AETCOM sessions. Among interns, structured AETCOM training significantly improved knowledge, attitude and communication-practice scores. Major methodological limitations included single-centre designs, absence of control groups, convenience sampling, self-reported outcomes and limited longitudinal follow-up. Conclusion: AETCOM-based medical education appears effective in improving communication competence and contributes positively to professionalism, ethical awareness, empathy and reflective learning among medical students. Evidence is strongest when competency development involves active participation, repeated practice, structured observation and feedback. Nevertheless, evidence demonstrating sustained behavioral change in real clinical environments remains limited. Future AETCOM research should prioritize multicentre longitudinal designs, validated competency measures, workplace-based assessments and patient-centred outcomes.

Background: Temporomandibular disorders are common musculoskeletal conditions that cause pain, restricted mandibular movement and difficulty with everyday jaw activities. Oxidative stress, inflammation and tissue degradation may contribute to these disorders. Saliva offers a simple method for assessing biomarkers linked to these processes. Objective: This study compared selected salivary biomarkers and mandibular function between adults with temporomandibular disorders and controls without TMD. It also examined whether biomarker levels were associated with pain and functional impairment. Methods: This case-control study included 70 adults with temporomandibular disorders and 70 controls. Salivary malondialdehyde, total antioxidant capacity, interleukin 1 beta, interleukin 6 and matrix metalloproteinase 3 were measured. Mandibular movements, pain intensity and Jaw Functional Limitation Scale scores were assessed. Groups were compared using appropriate parametric or nonparametric tests. Spearman correlations and adjusted linear regression models were used to examine biomarker associations with mandibular dysfunction. Results: Median salivary malondialdehyde was 30.9 nmol/mL in cases and 25.1 nmol/mL in controls (P < 0.001). Cases had lower mouth opening, lateral excursion and protrusion. They also reported greater pain and functional limitation. Higher malondialdehyde was associated with lower maximum unassisted opening, greater pain and higher functional limitation scores. After adjustment, malondialdehyde remained associated with maximum unassisted opening (standardised β = -0.453, P < 0.001) and JFLS-20 score (standardised β = 0.649, P < 0.001). TAC, IL-1β, IL-6 and MMP-3 did not show significant group differences or independent associations. Conclusion: Salivary malondialdehyde was associated with temporomandibular disorders and greater mandibular dysfunction. Longitudinal studies with repeated biomarker measurements are needed to assess causality and clinical value.

Background: Non-Specific Neck Pain is most often caused by continuous forward head carrying posture leading to sub-occipital muscle tightness, decreased cervical mobility and obliterated cervical spine curvature. Management of Non-Specific Neck Pain due to Sub occipital Muscle tightness includes active chin tucking exercises, ultrasound therapy, stretching, and mobilization of upper cervical muscles. The aim of this study was to find out the effect of Active chin Tuck Exercise and Myofacial Release (MFR) to reduce pain and improvement of Neck Function among the Computer Professionals. Materials and Methods: The present comparative study was done on subjects were diagnosed with Neck pain of computer professionals in OPD of Vidyasagar Institute of Health, Rangamati, Paschim Midnapore,West Bengal and TRA General Hospital, Kolkata. A total no of thirty(30) subjects of this study were recruited for this study. The study period was 6 months (August 2017 to January 2018). The statistical data were analyzed using SPSS V.23.0 and Microsoft Excel. Results: Subjects treated with Myofascial Release showed better improved Pain and also significant change in Neck function, as per CNFDS (P<.0001). There was also a significant difference as per VAS scores between the 2 Groups (p‹.0001) and Myofascial Release given Group was showed better improvement than Active Chin Tuck Exercise given Group. Conclusion: Myofascial Release and Active Chin Tuck Exercise along with Ultra sound therapy were found to be effective in treatment of Non Specific Neck Pain. But Myofascial Release can be thought of as a choice of technique for reducing pain, and improvement in neck function in non-specific Neck Pain.

Background: Attitude, Ethics and Communication (AETCOM) was introduced into Indian competency-based undergraduate medical education to make communication, professionalism, empathy, ethical reasoning and reflective practice explicit longitudinal competencies rather than leaving them primarily to the hidden curriculum. Evidence regarding its educational impact has expanded rapidly, but the magnitude, durability and methodological quality of reported effects remain uncertain. Objective: To systematically evaluate the impact of AETCOM-based education on communication competence, professionalism, ethical competence, empathy, reflection and related learner outcomes among undergraduate medical students and interns. Methods: This systematic review was structured according to PRISMA 2020. The evidence window included reports published or available online up to January 31, 2026. PubMed/MEDLINE, scholarly web searches of publisher and journal platforms, and backward citation searching were used. Primary studies of undergraduate MBBS students or interns explicitly exposed to AETCOM teaching, implementation or assessment were eligible. Outcomes were grouped into communication competence, professionalism, ethical competence, empathy/reflection, and acceptability/engagement. The selection framework comprised 162 identified records, 41 duplicates removed, 121 records screened, 70 records excluded at title/abstract stage, 51 reports sought, 2 not retrieved, 49 full texts assessed, 27 full texts excluded, and 22 primary studies retained. Because educational interventions, assessment instruments and study designs were markedly heterogeneous, meta-analysis was not undertaken and results were synthesized narratively. Study quality was appraised with design-specific principles from the Mixed Methods Appraisal Tool (MMAT), and certainty was summarized using GRADE-informed judgments. Results: Twenty-two primary studies were included. Communication was the most consistently supported outcome. A six-college interventional study of 240 third-year students reported improvement in mean Kalamazoo-adapted communication scores from 54.89 ± 11.55 before training to 94.4 ± 19.3 after AETCOM training. Case-based role-play for professionalism improved mean knowledge scores from 11.56 ± 2.81 to 16.76 ± 3.00 (p<0.0001). An autonomy-empathy-equanimity module increased mean assessment scores from 4.86 ± 1.43 to 9.05 ± 0.99 (p=0.001). Studies of empathy, cadaveric respect, reflective learning, portfolios and ethics generally reported favorable learner responses, but many relied on self-report and short follow-up. Longitudinal evidence suggested that favorable communication and professionalism attitudes were not necessarily sustained throughout medical training. Risk of bias was mainly driven by uncontrolled pre-post designs, convenience sampling, single-center recruitment, self-reported outcomes and limited long-term assessment. Certainty was judged low for communication and very low to low for professionalism, ethical competence and empathy. Conclusion: AETCOM-based education is associated with short-term improvement in communication performance and supports learning related to professionalism, ethical reasoning, empathy and reflection, particularly when experiential strategies such as role-play, structured observation, simulation, portfolio work and feedback are used. Evidence that these improvements translate into durable professional behavior or authentic patient-care outcomes remains limited. Multicenter longitudinal studies with objective workplace-based assessment are required

Background: Clinician are frequently reluctant to administer adequate parenteral analgesia to these patients, for fear of worsening intercurrent disease or of precipitating unwanted side effects in patients who are often already frail. Systemic analgesia including both opioids and NSAIDS can have significant adverse effects especially in the elderly population due to age related changes in pharmacokinetics and pharmacodynamics. The subjects were informed about the study on the morning of the scheduled surgery, risks and benefits were explained, and informed consent was obtained from those who volunteered. These patients were divided in two groups on the basis by using computerized randomization with MS excel programme. GROUP F: Patients receiving femoral block. GROUP I: Patients receiving facia iliac block. Fascia iliaca block has faster onset of action. It requires less time, simpler to perform and more cost effective when compare to FNB . Move rover it is independent in terms of any gadget requirement. Hence it could be preferred block of choice over FNB.

Background: Infrazygomatic crest (IZC) screws are widely used for maxillary arch distalization; however, the optimal screw length and insertion site remain unclear. This study evaluated stress distribution and displacement patterns associated with IZC screws of varying lengths and positions using finite element analysis. Methods: A 3D finite element model was developed from computed tomography data of an adult with skeletal Class II malocclusion. IZC screws of 8 mm, 12 mm, and 14 mm were analyzed at 2 insertion sites (IZC 6 and IZC 7). A bilateral force of 350 g was applied to simulate en-masse distalization. Von Mises stress and displacement were assessed in cortical bone, cancellous bone, teeth, and the periodontal ligament. Results: Maximum stress concentration occurred at the screw–bone interface and point of force application in all models, with higher stress values observed in the 8-mm screws. Cortical bone exhibited greater stress than cancellous bone. Displacement patterns were similar across all configurations, with maximum displacement localized at the screw region. The IZC 7 site demonstrated slightly greater displacement (≈0.19 mm) than IZC 6 (≈0.175 mm). Distal tooth movement was consistent (≈0.24 mm) irrespective of screw length or site. Intrusion was observed in anterior and posterior teeth, with reduced anterior intrusion and slightly increased posterior intrusion in IZC 7 models. Periodontal ligament responses were comparable across all groups. Conclusion: IZC screws provide effective anchorage for maxillary distalization with physiologic stress levels. Longer screws (12–14 mm) and placement in the IZC 7 region demonstrate more favorable biomechanical characteristics.

Background: Multidrug-resistant pulmonary tuberculosis (MDR-PTB) is characterized not only by resistance to key first-line drugs but also by considerable variation in mycobacterial burden, molecular diagnostic characteristics, and structural lung involvement. Although molecular assays establish resistance rapidly, sputum bacillary burden and thoracic imaging provide complementary information regarding disease activity, transmissibility, and anatomical severity. This systematic review synthesized evidence linking molecular resistance detection with microbiological burden and radiological manifestations of MDR pulmonary tuberculosis. Methods: A systematic-review framework consistent with PRISMA 2020 was used. Literature addressing pulmonary MDR/RR-TB, rapid molecular drug-resistance testing, sputum bacterial burden, smear microscopy, culture indices, Xpert cycle-threshold measurements, chest radiography, and computed tomography was considered. Eligible primary studies investigated at least one of three domains: molecular resistance detection, microbiological/bacillary burden, or comparative radiological disease severity, with preference given to studies that linked two or more domains. For the present manuscript framework, 703 records were identified, 162 duplicates were removed, and 541 records underwent title and abstract screening. After exclusion of 421 records, 120 reports were sought for retrieval. Five were unavailable, leaving 115 full-text articles for eligibility assessment. Ninety-one were excluded and 24 primary studies were retained for qualitative synthesis. Because of substantial heterogeneity in diagnostic platforms, resistance definitions, bacterial-load measurements, and imaging scoring systems, statistical pooling was not undertaken. Results: Molecular studies consistently demonstrated rapid and high-specificity detection of rifampicin resistance using Xpert MTB/RIF, Xpert MTB/RIF Ultra, and line-probe assays. Xpert Ultra improved detection in paucibacillary and smear-negative disease, whereas direct line-probe testing performed most reliably in specimens with higher bacillary concentrations. Molecular cycle-threshold values were inversely related to sputum bacterial burden: lower Ct values were associated with higher smear grades and shorter culture time-to-positivity. Radiological studies demonstrated that MDR pulmonary TB more frequently exhibited multiple cavities, bilateral parenchymal involvement, thick-walled cavitation, bronchiectasis, extensive consolidation, tree-in-bud abnormalities, and greater overall lung involvement than drug-sensitive disease. A smear grade of 3+ and cavitary disease were independently associated with MDR-TB in several observational datasets. Studies directly linking imaging and microbiology showed that increasing radiographic severity and cavitation correlated with higher bacillary burden. Conclusion: MDR pulmonary tuberculosis is best characterized through complementary molecular, microbiological, and radiological assessment. Molecular assays define resistance, microbiological measurements estimate organism burden, and imaging depicts anatomical disease severity. High bacillary burden combined with multiple or bilateral cavities represents an advanced disease phenotype but cannot independently establish multidrug resistance. Integrated interpretation may improve early risk recognition, infection-control prioritization, and clinical monitoring.

Background: Anterior segment ocular trauma is a preventable cause of visual morbidity among working-age populations. This study described the demographic profile, occupational distribution, mechanisms, clinical spectrum, management and visual outcomes of anterior segment eye injuries in Northeast India. Subjects/Methods: This prospective hospital-based observational study was conducted at Assam Medical College and Hospital, Dibrugarh, from 1 December 2024 to 30 November 2025. Patients aged >10 years with recent trauma involving the conjunctiva, cornea, sclera, anterior chamber, iris, ciliary body or crystalline lens were included. Patient-level variables were analysed among 104 patients, while eye-level findings, interventions and visual acuity outcomes were analysed among 113 injured eyes. Visual acuity was recorded at presentation, day 3, day 7 and 1 month. Results: Of 104 patients, 74 (71.2%) were male. The commonest age group was 20–29 years (24.0%). Industrial/manual workers formed the largest occupational group (26.9%), followed by agricultural/tea-garden workers (18.3%). Unilateral injury occurred in 95 patients (91.3%). The commonest mechanism was mechanical/industrial injury (34.5%), followed by road traffic accident (19.5%) and sports equipment-related injury (15.9%). The commonest principal diagnosis was conjunctival laceration with subconjunctival haemorrhage (17.7%), followed by hyphema (15.0%). Medical management alone was used in 34.5% of eyes; corneal repair was the commonest surgical intervention (18.6%). Eyes with visual acuity ≥6/36 increased from 30.1% to 51.3% at 1 month. Conclusions: Anterior segment injuries predominantly affected young males in manual or outdoor occupations. Short-term visual improvement occurred after treatment, but persistent poor vision highlights the need for early referral and preventive eye protection measures

Background: Multidrug-resistant tuberculosis (MDR-TB) remains a major obstacle to global tuberculosis control. Rapid molecular assays have substantially shortened the time required to detect Mycobacterium tuberculosis and drug resistance; however, the relationship between molecular detection, sputum bacillary burden, and radiographic severity remains incompletely integrated into routine clinical interpretation. This systematic review evaluated molecular methods for detecting drug-resistant pulmonary tuberculosis and examined their relationship with sputum bacillary load and chest radiographic findings. Methods: A systematic literature search was undertaken for studies evaluating pulmonary tuberculosis using molecular resistance assays together with sputum bacillary-load indicators and/or chest radiographic characteristics. PubMed/MEDLINE-indexed literature, World Health Organization publications, and reference lists of relevant studies were searched using combinations of terms relating to M. tuberculosis, multidrug resistance, rifampicin resistance, Xpert MTB/RIF, Xpert MTB/RIF Ultra, line-probe assay, nucleic acid amplification testing, sputum smear grade, cycle-threshold value, bacillary load, chest radiography, cavitation, and disease extent. Diagnostic-accuracy studies were interpreted according to QUADAS-2 domains, whereas observational radiographic studies were evaluated for selection, measurement, and confounding biases. Owing to substantial heterogeneity, findings were synthesized qualitatively rather than statistically pooled. Results: The search identified 444 records, comprising 426 records from database searching and 18 records from citation/reference searching. After removal of 108 duplicates, 336 records were screened and 80 full-text reports were assessed for eligibility; 18 primary studies were included in the qualitative synthesis. Xpert MTB/RIF showed very high sensitivity among smear-positive pulmonary TB specimens but lower sensitivity in paucibacillary and smear-negative disease. Line-probe assays demonstrated high accuracy for rifampicin and isoniazid resistance in specimens with adequate bacillary burden. Lower molecular cycle-threshold values consistently corresponded to higher smear grades and greater culture-based bacterial burden. MDR-TB was repeatedly associated with extensive, bilateral, and cavitary pulmonary disease, particularly multiple or large cavities. Conclusion: Rapid molecular testing is central to early recognition of drug-resistant pulmonary tuberculosis, but diagnostic performance and assay interpretability are influenced by sputum bacillary burden. High bacillary load is reflected by lower molecular cycle-threshold values and higher smear grades and is frequently accompanied by more extensive or cavitary pulmonary disease. Multiple, bilateral, or large cavities increase suspicion for MDR-TB but cannot determine resistance independently. Integration of molecular drug-resistance testing, quantitative or semiquantitative sputum bacterial burden, and standardized radiographic assessment may improve early risk stratification, infection-control decisions, and clinical management

Aim: To evaluate the correlation between MRI and arthroscopic findings of meniscal tears using the ISAKOS classification. Methods: A prospective observational study was planned in the Department of Orthopaedics, Hind Institute of Medical Sciences, Mau, Ataria, Sitapur, Uttar Pradesh. Sixty adult patients with clinically suspected meniscal injury, MRI evidence of a meniscal tear and subsequent knee arthroscopy were included. MRI findings were documented according to the ISAKOS classification with respect to tear pattern, depth, rim width, radial location, tissue quality and tear length. Arthroscopy was considered the reference standard. Agreement between MRI and arthroscopy was evaluated using Cohen's kappa coefficient for categorical variables and intraclass correlation coefficient (ICC) for tear length. Results: Among 60 patients, the mean age was 34.6 ± 11.7 years and 42 (70.0%) were male. The right knee was involved in 32 (53.3%) patients. A total of 64 meniscal tears were identified, including 37 (57.8%) medial and 27 (42.2%) lateral meniscal tears. Longitudinal tears were the commonest pattern on arthroscopy (23.4%), followed by complex (21.9%) and radial tears (18.8%). MRI and arthroscopy showed good agreement for tear pattern (κ=0.74) and tear depth (κ=0.72). Agreement was moderate for rim-width classification (κ=0.57) and tissue quality (κ=0.52), while radial location demonstrated good agreement (κ=0.79). Mean tear length was 21.6 ± 9.8 mm on MRI and 20.1 ± 9.1 mm on arthroscopy, with an ICC of 0.86. MRI showed a statistically significant tendency to measure slightly longer tears (p=0.012). Conclusion: MRI showed good correlation with arthroscopy for most clinically relevant characteristics of meniscal tears when the ISAKOS classification was applied. The classification may improve standardized communication and preoperative planning. Nevertheless, tissue quality and exact peripheral/rim involvement remain relatively less reliable on MRI and may require arthroscopic confirmation.

Background: Propofol is commonly used for sedation during gastrointestinal endoscopy. Although it does not have significant analgesic properties, its combination with different adjunctive agents is used. The commonly used adjunctive agents are fentanyl and midazolam. The present study aimed to compare midazolam m-propofol and fentanyl-propofol combinations for gastrointestinal endoscopic sedation Methods: This prospective comparative study included n=80 adult patients undergoing upper GI endoscopy in our tertiary care hospital. They were sequentially allocated into two groups. Group M (n = 40) received midazolam with propofol, while Group F (n = 40) received fentanyl with propofol. The outcome characteristics noted were time to achieve sedation, total propofol requirement, recovery time, BIS and OAAS scores, procedure duration, haemodynamic and respiratory parameters, adverse events, and patient and endoscopist satisfaction. Results: Overall results showed that the time to achieve sedation was significantly shorter in Group F than Group M (2.1 ± 0.4 vs. 3.7 ± 0.6 minutes), with significant p-values. The recovery time was less in Group F (28.9 ± 5.1 minutes) compared to (43.6 ± 7.4 minutes) in Group M. The lowest BIS score was lower in Group F (68.1 ± 3.8 vs. 72.4 ± 4.5) and p = 0.002, indicating deeper sedation. OAAS scores were also lower in Group F (1.9 ± 0.3 vs. 2.1 ± 0.4) and p = 0.041. Oxygen desaturation and hypotension were numerically more frequent with fentanyl-propofol, but these differences were not statistically significant. Patient satisfaction was comparable, whereas endoscopist satisfaction was significantly higher with fentanyl-propofol (9.3 ± 0.6 vs. 8.2 ± 1.3) and p = 0.004. Conclusion: Fentanyl-propofol combination appears to provide faster sedation, lower propofol requirements, shorter recovery, and greater endoscopist satisfaction than midazolam-propofol. Although it produced deeper sedation and a greater tendency toward transient cardiorespiratory changes, both regimens had an acceptable safety profile in ASA I–II patients when appropriately monitored. Fentanyl-propofol may therefore be a useful option for efficient sedation during gastrointestinal endoscopy.

Background: Caesarean section rates are increasing worldwide and in India. Elective and repeat caesarean sections may increase neonatal respiratory morbidity and NICU admission. This study compared neonatal outcomes following elective LSCS, repeat elective LSCS and VBAC. Objective: To compare neonatal outcomes among babies delivered by elective LSCS, repeat elective LSCS and VBAC. Methods: This observational study included 90 term neonates, with 30 each in the E-LSCS, R-LSCS and VBAC groups. Apgar score, birth weight, NICU admission, respiratory morbidity, sepsis, phototherapy requirement and duration of NICU stay were assessed. Results: NICU admission occurred in 36.6% of neonates in both E-LSCS and R-LSCS groups and 30% in the VBAC group (p=0.821). Respiratory distress was the commonest indication for NICU admission in the caesarean groups. Mean birth weight and Apgar scores were comparable among the groups. Sepsis and phototherapy requirements also showed no significant differences. No neonatal mortality was observed. Conclusion: Neonatal outcomes were broadly comparable among E-LSCS, R-LSCS and VBAC. Respiratory distress was more frequently associated with NICU admission following caesarean delivery. VBAC may be considered in appropriately selected women with suitable obstetric and neonatal care facilities.

Background: Febrile seizures are the most common neurological disorder in young children. Iron deficiency anemia (IDA), a common nutritional deficiency, may alter neurotransmitter metabolism and reduce the seizure threshold. However, the association between IDA and first febrile seizure remains controversial. Objective: To evaluate the association between iron deficiency anemia and first febrile seizure in children aged 6 months to 6 years. Methods: A hospital-based case-control study was conducted among 100 children, including 50 children with first febrile seizure (cases) and 50 age- and sex-matched children with febrile illness without seizures (controls). Clinical details and laboratory investigations including hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), serum iron, serum ferritin, total iron-binding capacity (TIBC), and serum transferrin were compared between the two groups. Results: Iron deficiency anemia was significantly more common in children with first febrile seizure than in controls (58% vs. 18%, P<0.003). Cases had significantly lower hemoglobin, MCV, MCH, serum ferritin, and serum iron levels, while TIBC was significantly higher than controls. Conclusion: Iron deficiency anemia is significantly associated with first febrile seizure and may represent a modifiable risk factor. Early identification and treatment of iron deficiency could help reduce the occurrence of febrile seizures.

Background: Anaesthesia forms an integral yet often poorly understood component of surgical care. First-time surgical patients, lacking any prior personal experience, frequently harbour misconceptions and gaps in knowledge regarding anaesthesia, which may heighten preoperative anxiety and adversely affect patient satisfaction and cooperation. Objectives: To assess the level of preoperative awareness regarding anaesthesia among first-time surgical patients and to determine its association with socio-demographic variables. Materials and Methods: A hospital-based, cross-sectional study was conducted among 250 first-time surgical patients admitted for elective and emergency surgery in the Department of Anaesthesiology of a tertiary care teaching hospital over a period of six months, using a pre-validated, semi-structured questionnaire administered through face-to-face interview during the preanaesthetic check-up. Awareness was assessed across eight domains, including type of anaesthesia, preoperative fasting, potential complications, and the role of the anaesthesiologist. Data were analysed using descriptive statistics and the Chi-square test, with p<0.05 considered statistically significant.Results: The mean awareness score was 4.2 ± 1.8 out of a maximum of 8. Only 20% of participants demonstrated good awareness, whereas 38.4% had poor awareness. Awareness of preoperative fasting was highest (78.4%), while awareness of the types of anaesthesia (48.8%) and possible complications (41.6%) was comparatively low. Education status (p<0.001), residence (p=0.007), and prior family hospitalisation experience (p<0.001) were significantly associated with the level of awareness, while age showed no significant association (p=0.408).Doctors/anaesthesiologists were the most common source of information (56.8%), and fear of pain during surgery (41.6%) was the most frequently reported concern. Conclusion: A significant proportion of first-time surgical patients have inadequate awareness about anaesthesia. Structured preoperative education and effective anaesthesiologist–patient communication during the preanaesthetic check-up are essential to bridge this knowledge gap and alleviate perioperative anxiety

Background: Inguinal hernia is one of the most common surgical conditions seen in clinical practice. Although most cases present as an uncomplicated groin swelling, an irreducible and painful hernia may conceal severe bowel pathology. Obstruction, strangulation, ischemia and perforation are recognized complications, but perforation of the caecum within an obstructed indirect inguinal hernia is an uncommon presentation. We report a case of a 40-year-old male smoker who presented with a painful, irreducible right groin swelling of 10 days' duration. Contrast-enhanced computed tomography (CECT) showed a right inguinoscrotal hernia containing the ascending colon, part of the right transverse colon, caecum, terminal ileum and omentum. 10 × 5 cm right indirect hernial sac contained an overdistended caecum along with the terminal ileum and ascending colon. One constriction ring at the neck of the hernia produced a closed-loop obstruction. Two approximately 1 × 1 cm perforations were identified in the caecum, with pneumoperitoneum on CECT and fecal peritonitis noted intraoperatively. The patient underwent exploratory laparotomy with resection of the caecum, ascending colon and terminal ileum, followed by end ileostomy and right inguinal hernia repair. The case shows the importance of looking beyond the visible groin swelling and recognizing the serious pathology concealed within the hernial sac. Comparison with previously reported cases demonstrates that caecal perforation within an inguinal hernia may result from different mechanisms, including closed-loop obstruction, strangulation, caecal diverticular disease, appendiceal pathology and malignancy. CECT proved valuable in defining the hernial contents, identifying the constriction ring, showing closed-loop obstruction and detecting pneumoperitoneum. Early recognition and urgent surgical intervention are essential to reduce the morbidity associated with complicated inguinal hernias. This case highlights the importance of recognising significant bowel pathology within an irreducible inguinoscrotal hernia and the value of CECT in defining the hernial contents and complications

Background: Cardiovascular diseases (CVDs) are a major cause of morbidity and mortality worldwide, with a substantial proportion of cardiovascular events attributable to modifiable risk factors such as hypertension, diabetes mellitus, dyslipidaemia, tobacco use, physical inactivity, unhealthy diet and obesity. Primary health-care facilities provide an important opportunity for early identification and management of individuals at increased cardiovascular risk. Risk prediction tools such as the 10-year atherosclerotic cardiovascular disease (ASCVD) risk score can help identify individuals who may benefit from intensified preventive interventions. Objectives: To assess the prevalence of cardiovascular risk factors among adults attending an urban primary health-care facility and to estimate their 10-year ASCVD risk and determine factors associated with increased cardiovascular risk. Methods: A facility-based cross-sectional study was conducted among adults aged ≥40 years attending an urban primary health-care facility during the study period. Participants with a documented history of established cardiovascular disease were excluded from ASCVD risk estimation. Sociodemographic characteristics, behavioural risk factors, anthropometric measurements, blood pressure, diabetes status and lipid profile were assessed. Ten-year ASCVD risk was estimated using the ACC/AHA Pooled Cohort Equation among eligible participants. Participants were categorised into low (<5%), borderline (5–<7.5%), intermediate (7.5–<20%) and high (≥20%) 10-year ASCVD risk groups. Statistical analysis was performed using descriptive statistics and appropriate tests of association. Results: A total of 300 adults were included. The mean age was 54.2 ± 9.8 years and 56.0% were females. Hypertension was present in 44.7%, diabetes mellitus in 27.3%, overweight/obesity in 61.0%, tobacco use in 18.0% and physical inactivity in 46.7%. Dyslipidaemia was identified in 42.3% of participants. Among 270 participants eligible for ASCVD risk estimation, 44.1% had low risk, 19.3% borderline risk, 25.2% intermediate risk and 11.5% high risk. Increasing age, male sex, hypertension, diabetes, tobacco use and higher total cholesterol were significantly associated with higher ASCVD risk. Conclusion: A considerable proportion of adults attending the urban primary health-care facility had multiple modifiable cardiovascular risk factors, with approximately one-third demonstrating intermediate or high estimated 10-year ASCVD risk. Routine cardiovascular risk assessment integrated into primary health-care services may facilitate early identification and targeted prevention of cardiovascular disease

Background: Periprosthetic joint infection (PJI) is one of the most serious complications following total joint arthroplasty (TJA), frequently requiring prolonged antimicrobial treatment, repeated revision surgery, and substantial healthcare utilization. Although the absolute incidence is relatively low, the increasing number of total hip arthroplasties (THAs) and total knee arthroplasties (TKAs) makes prevention an important clinical priority. Objective: To systematically evaluate patient-related, disease-related, infectious, nutritional, and perioperative factors associated with PJI following primary hip or knee arthroplasty and to identify factors amenable to preoperative optimization. Methods: A systematic literature search was designed for PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library from database inception through 31 January 2026. Observational cohort studies, case-control studies, registry analyses, systematic reviews, and meta-analyses evaluating PJI risk after primary THA or TKA were considered. Risk factors were grouped as demographic, metabolic, nutritional, immunological, infectious, behavioral, and procedure-related factors. Because substantial overlap existed between published meta-analyses and because this review was intended as a qualitative evidence synthesis rather than a new statistical pooling exercise, previously published adjusted and pooled effect estimates were summarized without deriving a single overall risk estimate. Results: The most consistently supported patient-related risk factors were obesity, diabetes mellitus, male sex, tobacco exposure, rheumatoid or systemic inflammatory disease, immunosuppressive or corticosteroid therapy, malnutrition/hypoalbuminemia, preoperative anemia, and greater medical comorbidity. Obesity demonstrated a dose-dependent relationship with infection risk; prior meta-analysis reported a relative risk (RR) of 1.60 for BMI >=30 kg/m2 and 3.68 for BMI >=40 kg/m2. Tobacco use was associated with approximately twice the odds of PJI. Malnutrition was associated with more than three-fold higher odds in pooled analyses. Infectious risk factors included symptomatic urinary tract infection, asymptomatic bacteriuria in some pooled analyses, methicillin-resistant Staphylococcus aureus (MRSA) colonization, previous joint infection, and recent cellulitis. Procedure-related factors included prolonged operative time, blood transfusion, prior surgery, wound complications, and high ASA physical-status class. Operative times exceeding 90 and 120 minutes were associated with pooled odds ratios of approximately 1.50 and 1.56, respectively. Evidence regarding vitamin D deficiency, asymptomatic bacteriuria treatment, cement type, drains, and several cardiovascular comorbidities was less consistent. Conclusion: PJI risk following TJA results from the cumulative interaction of host, infectious, and procedural factors rather than a single determinant. The strongest opportunities for prevention involve optimization of obesity, diabetes, nutritional deficiency, anemia, smoking, active infections, immunosuppression, operative efficiency, and perioperative blood management. Standardized risk assessment and individualized optimization should be incorporated into elective arthroplasty pathways

Objectives: To evaluate the functional and radiological outcomes of posterior column tibial plateau fractures treated with open reduction and internal fixation (ORIF) using a column-specific fixation strategy, and to assess postoperative recovery, complications, range of motion, and early post-traumatic osteoarthritic changes. Materials and Methods: This ambispective observational study included 42 skeletally mature patients (18–65 years) with AO/OTA 41-B or 41-C posterior column tibial plateau fractures treated with ORIF at a tertiary care center. Demographic, clinical, radiological, and perioperative data were collected through retrospective record review and prospective follow-up. Functional outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) for pain, activities of daily living, sports/recreation, and quality of life. Radiological evaluation included assessment of reduction quality and Kellgren–Lawrence (K–L) osteoarthritis grading. Patients were followed postoperatively at 3, 6, and 12 months. Statistical analysis was performed using chi-square, independent samples Student's t-test, and paired samples Student's t-test, with p<0.05 considered statistically significant.Results: Among 42 patients, 76.2% were male, and the most common age group was 31–40 years (28.6%). Injury mechanism, implant type, time to surgery, operative time, blood loss, and hospital stay were comparable between AO 41-B and AO 41-C fractures (p>0.05). Implant choice showed complete correspondence with the surgical approach (p<0.001). Radiological reduction was satisfactory, with no significant difference in acceptable articular step-off between fracture groups (p=0.779). Early complications were uncommon, with superficial surgical site infection in 4.8%, deep infection in 0%, deep vein thrombosis/pulmonary embolism in 2.4%, and wound dehiscence in 2.4%. Late complications included symptomatic hardware (14.3%), arthrofibrosis (9.5%), implant failure (2.4%), and reoperation (2.4%). KOOS pain, activities of daily living, sports/recreation, and quality of life scores improved significantly from the immediate postoperative period to 3, 6, and 12 months (all p<0.001). At 12 months, mean knee flexion was 120.78±9.22°, 89.5% achieved full extension, and most patients demonstrated absent or mild osteoarthritic changes (K–L Grade 0–1, 84.2%). Mean KOOS quality of life score was 68.3±7.66, with 81.6% of patients having quality of life scores <75.Conclusion: Column-specific ORIF for posterior column tibial plateau fractures provides excellent radiological restoration, low complication rates, and significant improvement in patient-reported functional outcomes during the first postoperative year. Comparable outcomes between AO 41-B and AO 41-C fractures suggest that fracture morphology and column-specific fixation are more important than AO classification alone. Despite favorable clinical and radiological recovery, knee-related quality of life remained suboptimal in many patients at one year, emphasizing the need for continued rehabilitation, patient counseling, and longer-term follow-up

Background: Glutathione peroxidase 1 (GPX1) is a selenium-dependent antioxidant enzyme that limits peroxide-mediated cellular injury. The functional GPX1 Pro198Leu polymorphism (rs1050450, C>T) has been associated with inter-individual variation in GPx activity, but its relationship with antioxidant capacity in sickle cell anaemia (SCA) and iron deficiency anaemia (IDA) remains inadequately characterized. Objectives: To compare GPX1 rs1050450 genotype and allele frequencies among patients with SCA, patients with IDA, and healthy controls; to determine its association with disease status; and to evaluate the relationship between genotype and erythrocyte GPx activity. Methods: This hospital-based analytical case-control study included 180 adults aged 18-50 years at Siddhartha Medical College, Vijayawada, Andhra Pradesh, from December 2023 to November 2025. Sixty participants each were enrolled in the SCA, IDA, and healthy-control groups. GPX1 rs1050450 was genotyped using polymerase chain reaction-restriction fragment length polymorphism with ApaI. Erythrocyte GPx activity was measured using a coupled enzymatic assay. Genotype and allele distributions were compared using chi-square tests; odds ratios (ORs) with 95% confidence intervals (CIs) were estimated; and multivariable linear regression assessed independent predictors of GPx activity. Results: GPX1 genotype distribution differed significantly across groups (p=0.043). The TT genotype occurred in 13.3% of SCA, 8.3% of IDA, and 3.3% of controls. T-allele frequencies were 36.7%, 28.3%, and 18.3%, respectively (p=0.006). Compared with controls, carriage of CT+TT genotypes was associated with SCA (OR 3.00, 95% CI 1.42-6.32; p=0.006), while the T allele was associated with SCA on an allele-count basis (OR 2.58, 95% CI 1.43-4.67; p=0.002). Mean GPx activity decreased stepwise from CC to CT to TT in SCA (32.72, 28.65, and 23.58 U/g Hb), IDA (39.51, 36.10, and 24.60 U/g Hb), and controls (50.92, 46.37, and 40.29 U/g Hb). After adjustment, CT and TT genotypes remained independently associated with lower GPx activity than CC. Conclusion: The GPX1 rs1050450 T allele was more frequent in SCA and was associated with lower erythrocyte GPx activity. These findings support a potential role of GPX1 Pro198Leu as a functional modifier of antioxidant capacity, particularly in SCA, while requiring confirmation in larger, ethnically characterized cohorts

Background: Early enteral feeding after gastrointestinal (GIT) anastomosis is increasingly recognized as a safe and physiologically beneficial approach. This study compared early versus late enteral feeding with respect to postoperative pain, return of bowel function, complications, hospital stay, and mortality. Materials and Methods: A retrospective and prospective comparative study was conducted in the Department of Surgery, Sheth L.G. Hospital, Ahmedabad, from March 2022 to June 2024. Seventy patients undergoing gastric, hepatobiliary, small- or large-bowel surgery with anastomosis or primary repair were included and divided equally into an early-feeding group (n=35), receiving enteral feeding within 2–3 postoperative days, and a late-feeding group (n=35), receiving feeding after the fourth postoperative day. Postoperative pain, bowel function, complications, Ryle's tube requirement, duration of hospital stay, and outcome were assessed. Results: The mean age was 40.5 ± 17.6 years in the early-feeding group and 43.3 ± 19.3 years in the late-feeding group, with male predominance (68.6%). Mean VAS pain scores were significantly lower in the early-feeding group throughout postoperative days 1–7 (p<0.001). Return of peristalsis (2.7 vs. 4.3 days), passage of flatus (3.7 vs. 4.9 days), and stool (4.4 vs. 6.5 days) occurred significantly earlier with early feeding (p<0.001). Hospital stay was significantly shorter in the early-feeding group (7.5 vs. 10.6 days). Postoperative complications, particularly wound infection, intra-abdominal collection, paralytic ileus, and anastomotic dehiscence, were more frequent in the late-feeding group. Mortality was 0% versus 8.6%, respectively, but the difference was not statistically significant (p=0.23). Conclusion: Early enteral feeding following gastrointestinal anastomosis is safe, feasible, and well tolerated, and is associated with reduced postoperative pain, earlier bowel recovery, fewer complications, and shorter hospital stay

Background: Major abdominal surgery may be associated with perioperative factors that can affect ocular function. Although severe postoperative visual loss is rare, patients may develop transient visual complaints that can remain unrecognized in the immediate postoperative period. Preoperative ocular assessment provides a baseline against which postoperative changes can be identified. Objective: To assess the preoperative ocular status and determine the frequency and pattern of postoperative visual complaints among patients undergoing major abdominal surgery. Methods: A prospective observational study was conducted in the Department of General Surgery, Venkateshwara Institute of Medical Sciences (VIMS), Gajraula, Uttar Pradesh, India, in collaboration with the Department of Ophthalmology. The study included 155 adult patients undergoing major abdominal surgery. Demographic, clinical and perioperative characteristics were recorded. All patients underwent preoperative ocular assessment, including visual acuity and ophthalmological examination. Following surgery, patients were evaluated for new visual complaints, and those with significant or persistent symptoms underwent repeat ophthalmological assessment. The association between postoperative visual complaints and selected demographic and perioperative factors was analysed using appropriate statistical tests. A p-value <0.05 was considered statistically significant. Results: Pre-existing ocular abnormalities were detected in 52 (33.5%) patients, with refractive error (17.4%) being the most common finding, followed by cataract (9.7%). Postoperative visual complaints occurred in 29 (18.7%) patients. Blurred vision was the most frequent complaint (10.3%), followed by difficulty focusing (5.2%) and ocular dryness or burning (4.5%). Postoperative visual complaints were significantly more frequent among patients undergoing surgery for more than 3 hours (28.0% vs. 14.3%; p=0.041) and among those who experienced intraoperative hypotension (31.3% vs. 15.4%; p=0.048). Most visual complaints were transient, and no patient developed permanent severe visual loss. Conclusion: Pre-existing ocular abnormalities were common among patients undergoing major abdominal surgery, and nearly one-fifth experienced postoperative visual complaints. Prolonged surgery and intraoperative hypotension were significantly associated with postoperative visual symptoms. Routine documentation of preoperative ocular status and appropriate perioperative eye care may facilitate early recognition and management of postoperative ocular problems

Background: Preeclampsia remains a leading cause of maternal and perinatal morbidity and mortality worldwide. Early identification of highrisk women allows targeted prophylaxis and surveillance, yet effective firsttrimester screening strategies in lowresource Indian settings are not fully established. Objective: To evaluate the predictive performance of firsttrimester uterine artery Doppler indices and maternal serum pregnancyassociated plasma proteinA (PAPPA) for the development of preeclampsia in a tertiary care centre in Pune, India. Methods: In this prospective observational study, 24 women with singleton pregnancies attending the firsttrimester combined screening clinic between 11 and 13⁺⁶ weeks were enrolled. Transabdominal uterine artery Doppler was performed and mean pulsatility index (PI), resistance index (RI), and presence of diastolic notching were recorded. Serum PAPPA was measured and expressed as multiples of the median (MoM). Participants were followed until delivery, and preeclampsia was defined according to ISSHP criteria. Receiver operating characteristic (ROC) curves were constructed, and sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results: Of 24 women, 8 (33.3%) developed preeclampsia, including 3 earlyonset and 5 lateonset cases. Mean uterine artery PI was significantly higher in the preeclampsia group (2.18 ± 0.42 vs. 1.47 ± 0.31, p<0.001). Bilateral notching was present in 50% of women who later developed preeclampsia compared with 6.3% in the unaffected group (p=0.016). Median PAPPA MoM was lower in the preeclampsia group (0.62 [IQR 0.48–0.81] vs. 1.12 [0.89–1.34], p=0.002). The combination of uterine artery PI >95th percentile and PAPPA <0.5 MoM yielded a sensitivity of 87.5%, specificity 81.3%, PPV 70.0% and NPV 92.9%, with an area under the ROC curve of 0.84 (95% CI 0.68–1.00). Conclusion: Firsttrimester uterine artery Doppler and PAPPA are promising predictors of preeclampsia in this Indian cohort. The combined model demonstrated good discriminatory ability and could be integrated into existing aneuploidy screening programs to identify women who may benefit from aspirin prophylaxis

Background: Obstetric Doppler ultrasonography is a non-invasive tool that evaluates uteroplacental and fetoplacental circulation, identifying pregnancies at risk of adverse outcomes. In India, rural women often face health disparities that may increase the burden of placental insufficiency; however, comparative Doppler data between rural and urban antenatal populations are scarce. Methods: This cross-sectional study enrolled 36 singleton pregnant women at 28–34 weeks of gestation attending a tertiary care hospital in Pune, India, from July 2025 to March 2026. Participants were categorized into rural (n=18) and urban (n=18) groups based on residence. Doppler indices of uterine, umbilical, and middle cerebral arteries were measured. Abnormal Doppler was defined as mean uterine artery pulsatility index >95th percentile/bilateral notching, umbilical artery PI >95th percentile, or middle cerebral artery PI <5th percentile. Prevalence was compared using Fisher’s exact test. Results: The overall prevalence of any abnormal Doppler finding was 36.1% (13/36). Rural women showed a higher prevalence (44.4%) compared to urban women (27.8%), though the difference was not statistically significant (p=0.305). Uterine artery abnormalities were the most common (rural 33.3% vs. urban 16.7%). No absent or reversed end-diastolic flow was observed. Conclusion: A trend towards higher abnormal Doppler indices was noted in the rural group, suggesting a possibly greater burden of subclinical placental dysfunction. Larger studies are warranted to confirm these findings and to explore the utility of Doppler screening in resource-limited rural settings

Background: Rheumatoid factor (RF) is an autoantibody frequently linked to rheumatoid arthritis, however it is also present in numerous other inflammatory and systemic disorders. Recent data indicates a potential association between increased RF levels and cardiovascular disorders, especially ischemic heart disease (IHD). Aim: The present study was undertaken to investigate the correlation between rheumatoid factor and ischemic heart disease in patients. Materials and Methods: This observational study was carried out during an 8-month duration at the General Medicine Inpatient Department in a tertiary care hospital. A total of 80 patients were enrolled using predetermined inclusion and exclusion criteria. Patients over 18 years old admitted with a clinical suspicion of IHD were included. A comprehensive history, clinical assessment, and requisite tests, including electrocardiography (ECG), echocardiography, cardiac enzymes, and pertinent biochemical markers, were conducted. Serum RF concentrations were assessed with the latex agglutination technique. Patients were subsequently categorized according to the presence or absence of IHD, as verified by clinical and diagnostic assessments. Chi-square tests and correlation coefficients were used in the statistical analysis; a p-value of less than 0.05 was considered significant. Results: Among the 80 patients examined, 46 (57.5%) were diagnosed with IHD, whereas 34 (42.5%) exhibited no signs of IHD. RF levels were elevated in 28 individuals (35%). Of the individuals with elevated RF, 20 (71.4%) had IHD, whereas 8 (28.6%) had no signs of IHD. Conversely, among individuals with normal RF levels, only 26 (50%) exhibited IHD. Statistical analysis demonstrated a significant association between RF and IHD (p < 0.05). Conclusion: The study revealed a notable association between increased RF and IHD, indicating that RF could function as an additional risk marker for identifying patients at risk for coronary artery disease. Integrating RF testing in high-risk populations may facilitate early detection and preventative healthcare

Background: Children with special healthcare needs are at increased risk of oral diseases due to physical, cognitive, and behavioral limitations that hinder effective oral hygiene practices. As special educators spend considerable time with these children, their knowledge, attitudes, and practices (KAP) toward oral health are crucial for promoting healthy behaviors within the school environment. Aim: To assess the oral health knowledge, attitudes, and practices among educators working in special education schools and to identify factors associated with their oral health knowledge. Materials and Methods: A descriptive cross-sectional questionnaire-based study was conducted among 92 special educators from selected special schools in a southern Indian district. Data were collected using a validated bilingual self-administered KAP questionnaire comprising socio-demographic details, oral health knowledge, attitudes, and practices. Responses were analyzed using IBM SPSS Statistics version 26.0. Descriptive statistics were expressed as frequencies and percentages, while Chi-square tests were used to determine associations between socio-demographic variables and KAP scores. Statistical significance was set at p < 0.05. Results: Most participants demonstrated satisfactory oral health knowledge and highly positive attitudes toward school-based oral health promotion. However, professional oral health practices, particularly the use of adapted teaching methods and routine monitoring of students' oral hygiene, were comparatively less satisfactory. Previous oral health training and higher educational qualifications were significantly associated with better knowledge scores (p < 0.05). Lack of professional training and inadequate educational resources were the most frequently reported barriers to oral health promotion. Conclusion: Although special educators exhibited encouraging knowledge and attitudes, strengthening their practical competencies through structured training and resource development is essential to improve oral health promotion among children with special healthcare needs.

Background: Upper gastrointestinal (UGI) endoscopy is the gold standard for diagnosing structural lesions in the stomach. In regions with predominantly rural and tribal populations, patients often present late with severe symptoms. This study aims to evaluate the spectrum of gastric lesions using UGI endoscopy and correlate these findings with histopathology in a tertiary care setting. Methods: This cross-sectional observational study was conducted at Saheed Laxman Nayak Medical College and Hospital (SLN MCH), Koraput, from February 2025 to January 2026. A total of 102 patients presenting with dyspepsia, abdominal pain, and other upper GI symptoms underwent endoscopy. Biopsies were taken when clinically indicated. Results: Out of 102 patients, the majority were males (60.8%) and most commonly belonged to the 41–60 years age group (43.1%). Epigastric pain was the most frequent presenting symptom (44.1%). Endoscopy revealed normal mucosa in 16.7% of patients, while gastritis (45.1%) and gastric ulcers (21.6%) were the most common abnormalities. There was a statistically significant correlation between endoscopic diagnosis and histopathological confirmation of malignancy (p < 0.01). Furthermore, Helicobacter pylori infection was significantly associated with ulcerative and inflammatory lesions (p = 0.003). Conclusion: UGI endoscopy is a highly reliable and indispensable tool for the early detection and management of gastric lesions, especially in resource-limited settings where distinguishing between benign and malignant lesions is critical.