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.