Background: Ventilator-associated pneumonia (VAP) is a hospital-acquired infection that develops 48 hours or more after endotracheal intubation and mechanical ventilation. It remains a major contributor to ICU morbidity, prolonged ventilation, increased antibiotic use and mortality. Diagnosing VAP continues to be challenging due to overlapping clinical and radiological findings in critically ill patients, and the growing burden of multidrug-resistant pathogens further complicates management. Aim: The aim of this retrospective study was to determine the incidence, demographic characteristics, risk factors, microbiological profile, clinical complications and outcomes of ventilator-associated pneumonia among patients mechanically ventilated in the Intensive Care Unit of the Super-Speciality Hospital, Government Medical College Srinagar. Methods: A retrospective analysis was conducted for all adult patients who were mechanically ventilated for more than 48 hours between January 2023 and December 2023. Data extracted from ICU records included demographics, primary diagnosis, comorbidities, ventilation duration, laboratory and radiological findings, endotracheal aspirate culture results, antibiotic therapy, ICU complications, length of ICU stay and final clinical outcome. Five structured tables summarise demographic features, ventilator parameters, microbial pattern, complication profile and outcome distribution. Two bar graphs later illustrate VAP incidence in major risk-factor groups and comparative ICU stay between VAP and non-VAP patients. Statistical analysis included descriptive calculations, chi-square testing and multivariate logistic regression to identify predictors of VAP and mortality. Results: A total of 271 patients were mechanically ventilated for the required duration during the study period, of whom 36 (13.2%) developed VAP. The mean age of VAP patients was 57.3 ± 13.9 years, with males comprising 63.8%. Patients with VAP had significantly longer ventilation duration (mean 12.7 ± 4.9 days) compared with non-VAP patients (7.4 ± 3.1 days). Gram-negative organisms accounted for most isolates (72%), including Klebsiellapneumoniae (27%), Pseudomonas aeruginosa (23%) and Acinetobacterbaumannii (22%). Methicillin-resistant Staphylococcus aureus comprised 11% of isolates. VAP was associated with septic shock in 25%, acute respiratory distress syndrome in 17% and multi-organ dysfunction in 12% of cases. The mean ICU stay of VAP patients was 18.6 ± 7.1 days, markedly higher than the 10.9 ± 5.2 days in non-VAP patients. Mortality in the VAP group was 36.1%, compared with 19.7% in non-VAP patients. Logistic regression showed that ventilation longer than 9 days, re-intubation and prior broad-spectrum antibiotic exposure were independent predictors of VAP. Conclusion: Ventilator-associated pneumonia remains a significant challenge in critically ill patients in our setting. It was associated with prolonged ventilation, increased ICU stay, predominance of multidrug-resistant Gram-negative organisms and a substantially higher mortality rate. Strengthening VAP prevention bundles, improving antibiotic stewardship and identifying high-risk patients early are essential measures to reduce the burden of this complication. Further studies are warranted to refine diagnostic criteria and evaluate targeted preventive strategies specific to our region.

Background: Parents caring for children with intellectual disability (ID) experience substantial caregiving demands that can diminish their quality of life (QOL). This study examined caregiver burden and quality of life among primary caregivers of children with Intellectual Disability in a tertiary-care setting in Goa, India. Methods: Cross-sectional study of 50 primary caregivers of children/adolescents with Intellectual Disability (Internation Classification of Diseases ICD-10). Caregiver burden was assessed using the Zarit Burden Interview (ZBI) and quality of life using the World Health Organization Quality of Life- Brief version (WHOQOL-BREF). Descriptive and inferential statistics were computed; p < 0.05 was considered significant. Results: A majority of caregivers were mothers. Most caregivers rated overall QOL as “neither poor nor good” (70%), with 16% “good” and 12% “poor.” Domain means (WHOQOL-BREF) for ID caregivers were: social 72.24 ± 12.03, physical 52.90 ± 10.56, psychological 49.72 ± 12.21, and environmental 49.22 ± 8.24. Interpersonal and financial stressors were associated with significantly lower QOL in physical and psychological domains (p = 0.028; 0.036 and p = 0.010; 0.034 respectively). 78 % of caregivers were aware of government disability benefits, however only 44 % availed the benefits Burden categories showed 6% little or no burden, 74% mild to moderate, 20% moderate to severe, and 0% severe to profound. A significant association was seen between burden of care score and severity of intellectual disability with p-value of 0.005 and a significant negative correlation was observed between caregiver burden and all QOL domains. Conclusion: Caregivers of children/adolescents with ID exhibit meaningful burden and impairments in QOL, particularly in physical, psychological, and environmental domains. Structured psychoeducation, social support, and financial assistance may improve caregiver outcomes.

Background: Hepatitis C virus (HCV) is the common cause of post transfusion hepatitis in developing countries. Hepatitis C virus infection occurs worldwide. Every year, 3-4 million people are infected with HCV with more than 3.5 lakhs deaths. Higher prevalence rates have been documented from Africa (up to 10%), followed by South America & Asia. In India, the prevalence is about 1 %. Various modes of transmission of HCV are Parenteral, Vertical transmission and sexual transmission. However, Hepatitis C virus doesnt spread through breast milk, food or casual contacts including hugging or kissing. Incubation period is about 15-160 days (average 50 days). About 20% of people develop acute hepatitis characterized by symptoms similar to that of other Hepatitis viruses. About 75-80% directly develops chronic disease out of which 60-70% develops chronic Hepatitis, 5-20% develops cirrhosis and 1-5% develops Hepatocellular carcinoma. The present study was done to determine the common clinical features, serological and molecular parameters in the diagnosis of Hepatitis C Virus infection in clinically suspected patients. Materials & Methods: This study was carried out in the department of Microbiology and Molecular Diagnostics in association with the Department of Pathology at Krsnaa Diagnostics Ltd, Guwahati, Assam over a period of 3 months from May, 2024 till July, 2024. This study was conducted among 687 patients, who were clinically suspected for HCV infection and screened for Hepatitis C ICT (HCV TRIDOT Card) serological test as well as HCV real time PCR molecular test with viral count quantification. The collected data was entered into MS excel followed by the analysis using SPSS version 21 (licensed to KDL). Results: In our study, we noted that, out of a total of 687 HCV suspected patients, 627(91%) patients were in the age group of 13-35 years, followed by 56 (8%) patients were in the age group of 36-59years, followed by 04(1%) patients were in the age group of >60 years. Number of intravenous drug users was 179, which signifies that 26% of study subjects were Intravenous drug users. Conclusion: Out of 687 samples, 627 were males & 60 were females. Out of total 687 patients, 446 came out to be reactive by rapid ICT card test and 241 came out to be HCV non reactive. 464 Came out to be reactive by real time PCR and 223 came out to be non reactive. Samples which came out to be HCV reactive by PCR but not reactive by ICT rapid card test were 18. The PCR results average log value was 5.07548 & average CT value was 26.80.

Introduction: Children are among the most psychologically vulnerable during crises and traumatic events. The Pahalgam incident, a significant and distressing event, likely had emotional and cognitive implications for children exposed directly or indirectly. Understanding their perception and psychological response is essential for effective mental health intervention and support. Aims: To assess the level of awareness, emotional impact, perception of safety, and coping mechanisms among children (Classes 4–7) following the Pahalgam incident, and to evaluate the roles of family, school, and media in shaping their responses. Materials and Methods: A descriptive, cross-sectional study was conducted among 164 students aged 9–14 years from Classes 4 to 7. A pre-tested, semi-structured questionnaire assessed demographics, awareness of the incident, emotional responses, coping strategies, and communication with parents and teachers. Data were analyzed using descriptive statistics. Result: Among the 164 participants, 92.7% were aware of the Pahalgam incident, primarily through television (32.9%) and parents (28%). Emotional responses included anger (41.5%), sadness (38.4%), and fear (6.7%), while 45.7% reported mood or sleep disturbances. Only 7.3% of students reported that teachers discussed the event in school. While 68.9% had conversations with parents about the incident, only 36% felt emotionally reassured. Additionally, 54.3% had actively tried to find out more information about the incident. Conclusion: The Pahalgam incident had a considerable emotional impact on children, with significant levels of sadness, anger, and anxiety. Limited school engagement and insufficient explanation about safety drills added to confusion and fear. Strengthening child-focused crisis communication, parental guidance, and school-based mental health support is crucial to mitigating the psychological effects of such incidents.

Background: Enlarged nuchal translucency (NT) in the first trimester is a well-recognized marker for chromosomal and structural abnormalities. The contribution of maternal serum biomarkers: free β-hCG, PAPP-A, and alpha-fetoprotein (AFP) to risk assessment in pregnancies identified with NT ≥ 3 mm remains uncertain. This study aimed to evaluate the association between NT thickness and these serum biomarkers in a high-risk cohort. Methods: A prospective observational study was conducted over 18 months at the Department of Anatomy, Government Medical College, Srinagar. Out of 22,679 women screened between 11 and 14 weeks of gestation, 22 fetuses (0.1%) were identified with NT ≥ 3 mm and formed the study cohort. NT was measured using standardized transabdominal ultrasonography. Maternal serum free β-hCG (IU/L), PAPP-A (MoM), and AFP (ng/mL) were analyzed. Correlation coefficients between NT and each biomarker were calculated using Pearson’s correlation, with p < 0.05 considered statistically significant. Results: The mean NT thickness was 4.36 ± 0.61 mm (range: 3.40–5.40 mm). The mean maternal serum free β-hCG level was 123.87 ± 68.65 IU/L (range: 29.80–231.00 IU/L), the mean PAPP-A concentration was 57.25 ± 59.73 MoM (median: 44.70; range: 15.20–302.00 MoM), and the mean AFP level was 37.75 ± 17.38 ng/mL (median: 25.59; range: 20.12–68.91 ng/mL). Correlation analysis showed no significant association between NT and free β-hCG (r = 0.027, p = 0.904), a weak positive but non-significant association between NT and PAPP-A (r = 0.111, p = 0.622), and a weak non-significant association between NT and AFP (r = 0.156, p = 0.486). Conclusion: Within the subgroup of pregnancies with NT ≥ 3 mm, maternal serum free β-hCG, PAPP-A, and AFP levels did not demonstrate significant correlations with NT thickness. These findings suggest that, once NT is enlarged, it remains the principal predictor of early fetal risk, and serum biomarkers provide limited additional value.

Background: Anorectal malformations (ARM) constitute one of the most common congenital anomalies in children, with vestibular fistula being the predominant type among females. The advent of anterior sagittal anorectoplasty (ASARP) has simplified the approach to these anomalies, offering single-stage correction with favorable cosmetic and functional outcomes. Objective: To evaluate the functional outcomes and postoperative complications following primary ASARP in female children with vestibular fistula. Methods: A retrospective follow-up study was conducted on 34 female patients who underwent primary ASARP at the Department of Pediatric Surgery, Government Medical College, Thiruvananthapuram, from 2008 to 2017. Functional outcomes were assessed using the Kelly scoring system, along with parameters such as staining, soiling, anal sphincter tone, bowel movement frequency, and constipation. Postoperative and intraoperative complications were documented from hospital records and follow-up visits. Results: The mean age at surgery was 12.74 ± 12.05 months, and the mean current age was 17.12 ± 15.63 months. Rectovestibular fistula was the most common anomaly (55.9%). The mean Kelly score was 5.62 ± 0.65, with 91.2% achieving good continence (≥5). Soiling was absent in all, and 73.5% had no staining. Sphincter tone was strong in 88.2%, and constipation occurred in 20.6%. Postoperative complications were minimal (11.8%), comprising wound infection (5.9%), wound dehiscence (2.9%), and stenosis (2.9%). No mortality was reported. Conclusion: Primary ASARP provides excellent functional outcomes with minimal postoperative morbidity and should be considered a safe, single-stage definitive procedure for female vestibular-type ARM.

Background: Peritoneal inclusion cysts are reactive fluid-filled lesions. They are rare and only a few case reports have been found in literature. They have a low risk of malignant transformation but a high rate of recurrence. Higher incidence is noted in female population in reproductive age group with prior history of multiple abdominal surgeries. A 40-year old woman with history of multiple abdominal surgeries presented with complaints of lower abdominal pain ,distension and difficulty in micturition. MRI was done and peritoneal inclusion cyst was considered. She underwent exploratory laparotomy and surgical excision of the cyst along with the ovary. Cystic fluid was negative for malignant cells and histopathological examination of excised cyst wall along with the ovary was consistent with features of peritoneal inclusion cyst.

Background: Objective: To identify factors associated with delayed enteral nutrition (EN) and interruptions to enteral nutrition (EN) and to find avoidable reasons for interruptions to enteral nutrition (EN) in the paediatric intensive care unit. Design, Setting, and Measurements: Children admitted to the PICU of MGM Medical College and Hospital Aurangabad who were on enteral feed were enrolled and studied for over 3 months. Clinical characteristics, anthropometric measurements, and time to reach caloric goals were noted. Daily nutrient intake and time of starting EN after admission and the number and duration of interruptions to EN were recorded in patients. Results: Daily records of nutrient intake were obtained in 50 consecutive patients on EN. Fifty patients had a total of 381 EN days (median, 2 days). The median time to EN initiation was 32.5 hrs. However, EN was subsequently interrupted in all patients at an average of 2.36 times per patient, for a total of 118 episodes accounting for 2048 hrs of EN deprivation in this cohort. Of the 118 episodes of EN interruption, 82.23% were deemed avoidable. Patients with neurological and respiratory problems were at the highest risk of EN interruptions. Conclusions: Many causes of delayed EN and EN interruptions are avoidable in critically ill children. Knowledge of existing barriers to EN, such as those identified in this study, will allow appropriate interventions to optimize nutrition provision in the PICU.

Background: Ventilator-associated pneumonia (VAP) remains a significant cause of morbidity and mortality in pediatric and neonatal intensive care units. Identifying prevalent pathogens and their antimicrobial susceptibility patterns is essential for rational antibiotic use and improved outcomes. Aim: To determine the antimicrobial resistance patterns of bacterial isolates from endotracheal (ET) secretions of ventilated patients in the PICU. Methods: This retrospective observational study was conducted at a tertiary care hospital in Indore over two years (April 2020 – March 2022). Patients aged 0–15 years, ventilated for more than 48 hours, and with suspected VAP (CPIS >6) were included. ET secretions were collected under aseptic precautions for culture and sensitivity testing. Multidrug resistance (MDR) was defined as per CLSI 2011 guidelines. Results: Of 253 ventilated patients, 113 met the inclusion criteria. ET cultures were sent for 88 patients; 41 samples from 39 patients showed significant bacterial growth. Culture positivity rate was 46%. Nine patients (23%) developed VAP. Among 41 isolates, 31 (75.6%) were MDR. Gram-negative bacteria dominated, with high resistance to third-generation cephalosporins and aminoglycosides. Staphylococcus spp. isolates showed significant resistance, including methicillin resistance. Conclusions: A high prevalence of MDR organisms was found among ventilated pediatric patients, emphasizing the need for rational antibiotic protocols tailored to local microbial profiles. Regular surveillance, early microbiological diagnostics, and strict infection control practices are key to reducing VAP incidence and improving clinical outcomes.

Background: Neuro-tuberculosis continues to represent a major pediatric health challenge despite significant advancements in tuberculosis (TB) control globally. AIM: To study the efficacy of the geneXpert MTB/RIF assay in cerebrospinal fluid for diagnosis of neurotuberculosis. Methodology: The present hospital-based prospective observational study was conducted in the Department of Paediatrics at PBM Hospital, S.P. Medical College, Bikaner, over a duration of one year. Result: The study demonstrated that fever and excessive crying were universally presenting symptoms in pediatric neurotuberculosis, with most cases showing abnormal neurological features, stage II disease, and low BCG vaccination coverage. MRI abnormalities and Gene Xpert positivity were limited, yet gene-positive cases showed significantly higher CSF cell counts and sugar levels but lower protein levels, highlighting key diagnostic differences. Conclusion: The study concludes that while Xpert-MTB/RIF shows low positivity in pediatric TBM, it remains a promising supportive diagnostic tool, especially in severe cases. Further research is necessary to validate its role and improve early detection and management strategies.

Background: Retinopathy of prematurity (ROP) is an important cause of preventable childhood blindness, particularly in low- and middle-income countries. Regional variations in incidence and risk factors necessitate localized studies to guide screening strategies. Objective: To determine the incidence, pattern, and risk factors associated with ROP in preterm and low birth weight neonates admitted to a tertiary care hospital in Himachal Pradesh. Methods: A prospective observational study was conducted in the NICU of Shri Lal Bahadur Shastri Government Medical College, Mandi, over one year (2023–24). Two hundred neonates with gestational age <34 weeks, birth weight <2000 g, or unstable clinical course were screened for ROP using indirect ophthalmoscopy at four weeks of age. Disease staging followed the International Classification of ROP (ICROP). Maternal and neonatal variables were analyzed using chi-square and logistic regression. Results: The incidence of ROP was 27.5% (n=55/200). Zone 1 involvement was most common (67.3%). Stage 1 ROP accounted for 65.5% of cases, Stage 2 for 30.9%, and Stage 3 for 3.6%. Plus disease was present in 14.5% of neonates. Significant risk factors included gestational age <34 weeks (p<0.001), birth weight <1500 g (p<0.001), prolonged oxygen therapy >7 days (OR 5.5, p<0.001), respiratory distress syndrome (OR 3.5, p=0.005), and sepsis (OR 2.0, p=0.04). No infant progressed to Stage 4 or 5 disease. Conclusion: ROP incidence in this setting (27.5%) is comparable to other Indian studies. Prematurity, low birth weight, prolonged oxygen exposure, RDS, and sepsis were major contributors. Early screening and judicious oxygen use are crucial to prevent sight-threatening disease in resource-limited regions.

Background: Type 2 diabetes mellitus (T2DM) is closely linked to accelerated atherosclerosis through complex lipid abnormalities and insulin resistance. Dyslipidaemia, marked by elevated triglycerides, low HDL cholesterol, and predominance of small dense LDL particles, plays a central role in the development of ischaemic heart disease (IHD). The burden of this dual pathology continues to rise across Indian populations, where metabolic risk clustering occurs at an earlier age and with greater intensity. Aim: To describe the clinical and biochemical profile of dyslipidaemia among adults with T2DM and to determine the association between specific lipid abnormalities and the presence of IHD. Materials and Methods: A cross-sectional descriptive study was conducted among 100 T2DM patients attending the diabetic clinic and medical wards of Government Stanley Medical College and Hospital, Chennai, from April 2024 to March 2025. Clinical data included duration of diabetes, blood pressure, body mass index, waist–hip ratio, and smoking status. Biochemical variables included fasting and post-prandial glucose, HbA1c, total cholesterol, LDL-C, HDL-C, triglycerides, and VLDL. Resting ECG and echocardiography were used to identify IHD. Statistical tests included chi-square and Pearson’s correlation, with p < 0.05 considered significant. Results: The mean age was 56.3 ± 8.4 years (62% male). Dyslipidaemia was present in 82% of participants. The most common pattern was mixed dyslipidaemia (38%), followed by isolated hypertriglyceridaemia (25%) and low HDL cholesterol (19%). IHD was documented in 36% of cases. Those with IHD showed significantly higher mean triglycerides (212 ± 68 mg/dL) and lower HDL-C (38.6 ± 7.1 mg/dL, p < 0.01). Duration of diabetes ≥ 10 years was strongly associated with IHD (χ² = 12.4, p = 0.001). Multivariate analysis revealed serum triglycerides and HDL-C as independent predictors of IHD after adjusting for age and BMI. Conclusion: Dyslipidaemia is highly prevalent among T2DM patients, and mixed lipid abnormalities substantially increase the risk of ischaemic heart disease. Routine lipid profiling and aggressive management of triglycerides and HDL cholesterol should form an integral part of diabetes care to prevent cardiovascular events.

Background: Metabolic syndrome (MetS) represents a constellation of interrelated metabolic abnormalities, including abdominal obesity, insulin resistance, hypertension, and dyslipidemia, that collectively elevate cardiometabolic risk. Increasing evidence suggests that these metabolic disturbances can also impair lung function. Yet, in Indian adults, the extent of pulmonary compromise among MetS patients remains underexplored. Methods: A hospital-based cross-sectional study was conducted among 106 adults diagnosed with MetS according to NCEP-ATP III criteria in the Department of General Medicine, Government Stanley Medical College, Chennai. Anthropometric indices, fasting blood glucose, lipid profile, and blood pressure were assessed. Pulmonary function was evaluated by spirometry, measuring FEV₁, FVC, FEV₁/FVC, and FEF₂₅–₇₅. Data were analyzed using SPSS v25 with ANOVA and chi-square tests; p<0.05 was considered significant. Results: Mean participant age was 50.9 ± 9.9 years, with 55.7% males. Normal spirometric pattern was seen in 58.5%, while 17.9% showed restrictive, 10.4% obstructive, and 10.4% mixed defects; 2.8% had small airway disease. Impaired lung function correlated significantly with fasting blood sugar, waist circumference, triglycerides, and systolic blood pressure (p<0.05), but not with HDL cholesterol. Restrictive changes predominated among males and those with ≥4 MetS components. Conclusion: Metabolic syndrome is associated with measurable reductions in pulmonary function, particularly of a restrictive pattern, likely due to central adiposity and insulin-resistance–related inflammation. Early spirometry screening can identify subclinical respiratory compromise, allowing timely lifestyle and pharmacologic interventions to prevent progressive lung decline.

Background: Medicolegal cases (MLCs) are integral to medical practice, yet undergraduate medical students often have limited exposure. This study aimed to assess the knowledge, attitude, and practice (KAP) of MBBS students regarding MLCs in Madhya Pradesh. Methods: A cross-sectional survey was conducted among 200 MBBS students using a pre-validated KAP questionnaire. Data were analyzed to determine frequencies, percentages, and graphical distributions of responses. Results: Majority of participants were aged 21–23 years (56%) and academic interns (36.5%). Most students demonstrated adequate knowledge regarding MLC definitions (75.5%), scenarios requiring registration (82%), and responsible personnel (64.5%). Positive attitudes towards compulsory MLC training were noted (48.5% strongly agree). However, practical exposure was limited: only 43% observed MLC registration during postings and 49.5% never attended an autopsy. Conclusion: MBBS students in NSCB Medical College, Jabalpur Madhya Pradesh show good theoretical knowledge and favorable attitudes towards MLCs, but hands-on experience is lacking. Structured practical training should complement theoretical teaching to bridge this gap.

Background: objectives The complete syndrome of diabetes mellitus, related metabolic aberrations and diabetic complications is posing a major threat in the 21st century. Cognitive dysfunction is a well-known complication of diabetes which continues to be investigated. The objective of this study was to evaluate the cognitive functions using comprehensive neuropsychological and electrophysiological tests in diabetics and non diabetics and find out the usefulness of psychometric tests in assessing cognitive dysfunction. Methodology The study was conducted on 50 diabetics and 50 non diabetics aged between 40 and 59 years. Cognition was assessed using psychometric tests and electrophysiological tests. Psychometric tests included MMSE, FWSTMT and CDT. Electrophysiological test included P300 potential which was recorded using RMS EMG EP MARK II equipment in the auspices of Department of Physiology, S.S.Institute of Medical Sciences & Research Centre, Davangere. P300 data analysis was done using Student unpaired T test to compare the mean of two groups. Chi Square test was used to analyze MMSE and CDT. Fischer exact test was used to analyze FWSTMT. Differences were considered significant at P<0.001. Results The absolute peak latencies of P3 component of endogenous cognitive evoked potentials was significantly prolonged among diabetics (334.8 + 20.8) as compared to controls (285.7 + 14.9). We did not detect statistically significant difference between groups when analyzed for N2 in Cz and Fz. Psychometric tests did not reveal cognitive deficits in diabetics. Interpretation and conclusion This study identifies prevalence of cognitive dysfunction in diabetic patients when assessed using electrophysiological tests. Psychometric tests were not sensitive to detect subtle cognitive changes. Good cognitive function is critical to safely manage diabetes and draws attention to various challenges in their management. Clinicians should consider screening for cognitive function in diabetics using P300, as it is effective in detecting subtle changes much before their clinical manifestation.

Background: Fat grafts have commonly been used as “natural fillers” for depressed scar correction. However, peri-scar area deformity gets ignored, causing sub-optimal results. Our aim was to develop a 3-dimensional approach to address the scar area with peri-scar deformity, and correct it using subcision and fat grafting. Methodology: 10 patients with 11 depressed scars underwent subcision and fat grafting in scar and peri-scar area by Coleman's technique after meticulous pre-operative planning and measurement of volume of fat graft required for correcting it. The Patient and Observer Scar Assessment Scale Score (POSAS) and the Modified Vancouver Scar Scale Score were used for pre- and post-operative comparison. Additionally, we added other scoring parameters to assess results relevant to this study. Results: The Modified Vancouver Scar Scale Score and POSAS Scores showed significant reduction post-operatively. There was significant peri-scar area deformity correction noted on follow up. The estimated volume deficit at scar site at 6 months follow up also showed a significant reduction compared to pre-operative value. Conclusion: A 3-D approach to correct a depressed scar and peri-scar area deformity using subcision and fat grafting can lead to more satisfactory cosmetic outcomes.

Background: Adnexal torsion refers to the twisting of the ovary or ipsilateral fallopian tube or both, along the axis of their vascular pedicle. Present study was aimed to review role of laparoscopic surgery versus laparotomy in the management of ovarian torsion. Material and Methods: Present study was single-center, prospective, observational study, conducted in female patients with twisted ovary, diagnosed by clinical examination, ultrasonography and colour Doppler, confirmed intraoperatively. Results: In present study, 54 cases of ovarian torsion were studied. Majority were from 21-30 years age group (42.59 %), followed by < 20 years age group (20.37 %) & 11 (20.37 %) were postmenopausal. Common risk factors noted were presence of ovarian mass (94.44 %), parity > 2 (40.74 %), H/o tubal ligation (20.37 %) & PCOS (12.96 %). In present study common symptoms noted were acute abdomen (77.78 %), acute abdomen ± vomiting (64.81 %), chronic abdominal pain (>7 days) (20.37 %) & fever (12.96 %). USG diagnosis of torsion was given in 77.78 % cases. Ultrasonography imaging findings were simple/Hemorrhagic cyst (46.30 %), complex adnexal mass (42.59 %) & dermoid cyst (11.11 %). Mean diameter of the cysts was 7.8 ± 4.6 cm. USG Doppler was suggestive of absent blood flow (57.41 %) in majority of cases, low peripheral vascularity (20.37 %), & normal vascularity (22.22 %) was also noted. CT/MRI was done in 3 cases (5.56 %) to confirm diagnosis. Among them, 32 underwent laparotomy while 22 underwent laparoscopic surgery. Comparable distribution was noted for laterality & size of ovarian mass. Laparoscopy group had more conservative surgeries (p-<0.001), less radical surgeries (p-<0.001), less h Conclusion: Timely Laparoscopic approach remains the gold standard for the management of adnexal torsion and enables quick recovery, less hospital stay & complications.

Background: Diabetic macular edema (DME) is a leading cause of vision loss in diabetic retinopathy (DR) patients. Spectral domain optical coherence tomography (SD-OCT) enables precise morphological classification, critical for diagnosis and treatment planning. Objective: To establish a comprehensive SD-OCT-based classification system for DME and evaluate its clinical correlations with visual acuity, central foveal thickness, and risk factors. Methods: A prospective observational case-series (90 eyes/48 patients with DR, Dec 2013–Nov 2015, Gandhi Medical College, Bhopal) included complete ophthalmic workup and SD-OCT imaging, analyzing DME patterns, visual acuity, central foveal thickness, diabetes duration, HbA1c. Classification followed established morphologic criteria and correlated with clinical variables. Results: SD-OCT detected DME in 91.11% of eyes, compared to 77.7% by slit-lamp biomicroscopy (p=0.0224). Cystoid macular edema was most common (33.75%), followed by serous detachment (26.25%), vitreomacular traction (21.25%), spongy pattern (13.75%), and epiretinal membrane traction (5%). Significant correlation was found between central foveal thickness and visual acuity (r=0.46, p=0.002531). Serous detachment predicted the worst visual acuity (mean log MAR 0.84) and highest mean foveal thickness (618.61 μm). Longer diabetes duration (≥10 years) and deranged HbA1c significantly increased DME risk.[1][2][3][4] Conclusion: SD-OCT offers superior sensitivity for early DME detection. The six-type OCT-based classification correlates well with anatomical findings and functional vision, guiding management and prognosis.

Background: Clinical manifestations of haematological malignancies range from vague systemic signs to sudden multi-organ failure. The study was conducted to determine the prevalence and clinicopathological profile at a Tertiary Care Centre to better understand the nature of the disease and improve treatment outcomes. OBJECTIVES: The objectives of the research were to assess the clinical features and pathological profile and the distribution of various hematological malignancies. MATERIAL AND METHODS- This retrospective observational study included 158 cases with relevant clinical features and hematological findings in the Department of Medical Oncology of our tertiary care centre. This study period spanned two years, from January 2023 to December 2024. RESULTS- Most patients belong to the age group 51-60 years (22.8%). The average median age for diagnosis was 50 years. The number of males was more than females (53.8% vs 46.2%). The majority of them were unskilled workers, followed by semi-skilled workers. Fever (93%) was the most frequently reported symptom, while the pallor (95.4%) was the most common clinical sign. CONCLUSION- This retrospective study highlights the diverse clinicopathological spectrum of hematological malignancies encountered at a tertiary care centre. The findings underscore the presence of certain malignancies such as leukemia and lymphoma, with a noticeable variation in age distribution, gender prevalence, and clinical presentation. Early diagnosis based on hematological, histopathological, and immunophenotypic parameters is critical for timely and effective treatment planning. The study emphasizes the need for continuous surveillance, improved diagnostic infrastructure, and standardized treatment protocols to enhance patient outcomes. Further prospective studies with large sample size are required for better understanding of the evolving trends and to guide evidence-based clinical practice.

Background: Gallstone disease, common in India, can lead to carcinoma gallbladder due to chronic mucosal irritation. The rate of incidental carcinoma found after cholecystectomy differs by region, highlighting the importance of early detection for improved prognosis. Aims and Objectives: The present study aimed to determine the incidence of carcinoma gallbladder in patients undergoing simple cholecystectomy for gallstone disease and to analyze the demographic and clinicopathological profile of these cases. Methods: This prospective observational study was conducted at Calcutta National Medical College & Hospital from November 2017 to April 2019, including 200 patients with symptomatic, ultrasonography-confirmed gallstone disease undergoing elective cholecystectomy. Data on clinical, demographic, and histopathological parameters were analyzed to determine the incidence and associations of incidental gallbladder carcinoma. Results: In this study of 200 patients with gallstone disease, the majority (26.5%) were aged 26–35 years, and females accounted for 68.5% (p < 0.0001). Over half of the patients (57.5%) had symptoms lasting less than 6 months (p < 0.0001). Open cholecystectomy was performed in 51.5% and laparoscopic in 48.5% (p = 0.5485). Histopathology revealed chronic cholecystitis in 76%, acute on chronic cholecystitis in 8.5%, and cholesterosis in 7.5% (p < 0.0001). Incidental gallbladder carcinoma was found in 4 cases (2%), predominantly in females and those with disease duration >12 months (p = 0.015). Conclusion: Though rare, incidental carcinoma gallbladder in cholecystectomy specimens is clinically important. Routine histopathology, especially in elderly females with long-standing or large stones, enables early detection and better outcomes.

Background: Phacoemulsification is the preferred technique for cataract surgery, but sometimes it is challenging as in case of hard cataracts. In this review we will discuss various intraoperative complications of phacoemulsification while handling hard cataract and ways to manage them. Methods: An extensive literature writing search was done using search engines like PubMed and Google scholar using significant terms/ key words “Phacoemulsification, intra-operative complications, hard cataract”. Results: A total of 34 studies were included in the review. The various etiological factors were discussed in detail. The most common factors were noted. Conclusions: There are myriad factors involved in the occurrence of postoperative dry eye of which transection of corneal nerves during surgery and the use of post-operative topical medication with preservatives, rank as the two most important causes.

Background: Preeclampsia is a multisystem hypertensive disorder unique to pregnancy that arises from abnormal placentation, oxidative stress, and endothelial dysfunction. Serum uric acid (SUA) reflects these underlying pathophysiological processes and has been proposed as a prognostic biomarker for disease severity and adverse outcomes. This study aimed to evaluate the diagnostic performance of elevated SUA levels in identifying preeclampsia among antenatal women. Method: A hospital-based analytical cross-sectional study was conducted on 500 pregnant women, comprising 250 diagnosed cases of preeclampsia and 250 normotensive controls matched by gestational age. Serum uric acid was measured using the enzymatic uricase-peroxidase method, and a cut-off value of >6.2 mg/dL was used for analysis. Diagnostic performance was assessed using sensitivity, specificity, predictive values, diagnostic accuracy, and receiver operating characteristic (ROC) analysis. Results: SUA levels >6.2 mg/dL were observed in 72.4% of preeclampsia cases compared to 12.4% of normal pregnancies (p < 0.001). The test demonstrated sensitivity 72.4%, specificity 87.6%, positive predictive value 85.3%, negative predictive value 76%, and diagnostic accuracy 83.3%. Younger age groups (≤19 years) showed higher prevalence of elevated SUA (77.9%). The ROC analysis indicated an area under the curve >0.80, signifying good discriminatory ability of SUA for detecting preeclampsia. Conclusion: Serum uric acid levels above 6.2 mg/dL show significant association with preeclampsia and offer good diagnostic accuracy, highlighting their role as a useful rule-in marker. Although SUA should not replace standard diagnostic criteria, it can serve as a cost-effective adjunct for risk stratification and early identification of high-risk pregnancies, particularly in resource-limited settings.

Background: Hemorrhoidal disease is common in rural India, where treatment decisions must balance clinical outcomes with economic feasibility. Milligan-Morgan hemorrhoidectomy (MMH) and stapled hemorrhoidopexy (SH) are widely used surgical options, but their comparative cost-effectiveness and recurrence rates remain crucial considerations for rural populations. Objectives: To compare operative parameters, cost, postoperative outcomes, and six-month recurrence rates between MMH and SH in patients with Grade III and IV hemorrhoids. Methods: A prospective randomized comparative study was conducted on 66 patients (33 per group) in a rural tertiary care hospital from January 2023 to June 2024. Group A underwent MMH and Group B underwent SH. Primary outcome was recurrence; secondary outcomes included operative time, blood loss, postoperative pain (VAS), hospital stay, time to return to work, cost, and complications. Data were analyzed using t-tests and chi-square tests. Results: SH significantly reduced operative time (25 ± 4 vs 35 ± 5 min), blood loss, pain scores, and hospital stay, and allowed earlier return to work. Patient satisfaction was higher in SH group despite threefold higher costs. Recurrence was slightly higher in SH (6%) compared to MMH (3%) but was not statistically significant. Conclusion: SH offers superior short-term recovery benefits but is less cost-effective. MMH remains more practical for rural populations due to lower costs and comparable recurrence rates.

Background: Negative pressure wound therapy on closed incisions reduces surgical site infection and wound complications in high risk laparotomy and cesarean patients by improving perfusion, reducing edema/exudate, and protecting the incision environment. Methods: Prospective observational study (2017–2019) at a tertiary center including 100 adults (post laparotomy n=50; post cesarean n=50) receiving NPWT immediately post closure for 3–7 days; outcomes included infection categories, wound closure, infection reduction, re intervention, and complications, analyzed with descriptive statistics and group comparisons (p<0.05). Results: Mean age 32.6 ± 7.1 years (laparotomy 35.4 ± 7.6; cesarean 29.8 ± 6.2); obesity 21%, hypertension 15%, diabetes 10%; emergencies 50% in laparotomy vs 20% in cesarean. Infections: superficial 25%, deep 13%, infected seroma 8%; 54% had no infection; wound closure 94% (92% laparotomy; 96% cesarean); infection reduction 82.5% (80% vs 85%); re intervention 7.5% (10% vs 5%); complications were infrequent (pain 10%, skin irritation 8%, inadequate seal 6%, bleeding 5%) and consistent with published tolerability profiles. Conclusion: NPWT on closed laparotomy and cesarean incisions was associated with high closure rates, substantial infection reduction, low re interventions, and acceptable safety, supporting targeted use in risk enriched postoperative pathways with attention to local SSI baselines and implementation factors.

Background: Granulomatous lesions of skin include a broad category of infectious and non-infectious diseases of skin. They are often present with overlapping clinical and histopathological features. Therefore, the diagnosis requires attention to clinicopathological correlation by using special stains and other investigations. The current study was designed to evaluate the clinical profile, histopathological pattern, and etiological spectrum of granulomatous lesions of skin to assess the agreement with clinical and histopathological diagnosis. Methods: This cross-sectional study was conducted in 60 cases presenting with granulomatous skin lesions who were referred for diagnosis by histopathology. Evaluation of history and examination was recorded in a proforma. Skin biopsies were processed and examined histopathologically initially by using hematoxylin and eosin (H&E) staining. Special stains such as Ziehl–Neelsen, Fite–Faraco, Periodic Acid–Schiff (PAS), and Gomori Methenamine Silver (GMS) were used based on the requirement as indicated in the cases. Statistical analysis of histopathological correlation was done to determine agreement. Results: The mean age of the participants was 45.2 ± 16.8 years, slightly higher than that of the male cases, with 53.3%. Infectious granulomatous dermatosis was found to be present in 58.3% cases, and the rest were infectious in nature. The common infectious cases were leprosy in 33.3% of cases, followed by cutaneous tuberculosis in 16.7% of cases. Tuberculoid granulomas are the common histological pattern in 30% of cases, followed by sarcoidal (16.7%) and necrobiotic (13.3%) cases, respectively. The use of a special stain for confirmation of etiological agents was required in 65% of cases. The assessment of clinicopathological correlation was done in the study, and it was found that 63.3% of cases had good correlation. The use of Cohen's Kappa value was 0.65, indicating good agreement between clinical and histopathology outcomes. Conclusion: The most common etiologies of granulomatous dermatological lesions are infectious ones, and mostly leprosy and cutaneous tuberculosis are the two major causes. The cornerstone of proper diagnosis and proper treatment has remained histopathology enhanced with special stains and clinical correlation.

Background: To estimate the prevalence of obesity and hypertension in school children and to study the relationship of blood pressure with body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and triceps skinfold thickness (TSFT). Methods: A total of 854 children (410 rural, 444 urban; 431 females, 423 males) were studied. Anthropometric measurements and blood pressure were recorded. Obesity, overweight, thinness, and hypertension prevalence were analyzed, and correlations between body fat indices and blood pressure were evaluated using Pearson correlation and ROC analysis. Results: Among 854 children, 15 (1.76%) were obese, 53 (6.21%) were overweight, 129 (15.10%) were thin, and 53 (6.21%) were severely thin. Hypertension and prehypertension were observed in 19 (2.23%) and 23 (2.69%) children, respectively. Obese children had the highest prevalence of hypertension (46.67%) and prehypertension (33.33%). Positive correlations were observed between BMI and systolic BP (r = 0.544) and diastolic BP (r = 0.465), WC and systolic BP (r = 0.524) and diastolic BP (r = 0.456), and WHtR and systolic BP (r = 0.374) and diastolic BP (r = 0.382). ROC analysis showed that BMI (AUC: 0.78 for SBP, 0.68 for DBP), WC (AUC: 0.76 for SBP, 0.72 for DBP), and WHtR (AUC: 0.62 for SBP, 0.63 for DBP) had discriminatory ability to predict high blood pressure. These correlations were consistent across gender and urban/rural populations. Conclusion: The overall prevalence of obesity and hypertension among school children was 1.76% and 2.23%, respectively. Body fat indices, including BMI, WC, WHtR, and TSFT, are positively correlated with both systolic and diastolic blood pressure. Increases in these indices are associated with higher blood pressure, highlighting their utility in early identification of children at risk for hypertension.

Background: The diagnosis of Anaplastic Large Cell Lymphoma (ALCL) includes its histomorphology and the expression of Immunohistochemical markers. However, the studies available on the clinicopathological features, histomorphology, and the evaluation of ALK expression have not been done adequately in India. This study aimed to study the clinicopathological profile of ALCL along with categories of ALCL based on IHC staining. Methodology: This retrospective study was done for all patients of ALCL, where standard IHC was performed, and these patients were studied. Cases were excluded where IHC was unavailable/insufficient data/no blocks, or inadequate clinical information. Data were collected from the records/slides from the Department of Pathology, SJMC. Demographic/clinical details from the Medical Record Department (MRD), SJMCH. Results: N=39 ALCL cases were studied. Most cases were ≤10 years (20.5%) and 11–20 years (20.5%). Males (74.4%) were more affected. Fever was reported in 71.8%. Nodal and extranodal involvement occurred in 25.6%. Serum LDH >450 IU/L in 79.5%. "Common pattern" was the most frequent (82.1%). All showed "hallmark" cells (100%). ALK-positive cases were 82.1%. CD3 was positive in 69.2% and negative in 30.8%. Cytoplasmic and nuclear ALK staining was seen in 53.1%, only cytoplasmic in 37.5%, and only nuclear in 9.4%. Skin was the most common extranodal site (23%). One pc-ALCL case (2.56%) was identified. Conclusion: In this study, most patients diagnosed with Anaplastic Large Cell Lymphoma (ALCL) were younger than 20 years, with a male predominance. Fever and nodal involvement were the most frequent clinical presentations, while the skin was the most common extranodal site. Histologically, the common pattern was predominant, followed by the Hodgkin-like variant, with hallmark cells seen in all cases. Sinusoidal involvement and architectural effacement of the lymph nodes were seen in more than half of the lymph nodes involved.

Background: Fistula-in-ano is a common anorectal condition that significantly affects quality of life. Surgical management options include fistulotomy, fistulectomy, and seton placement. This study evaluates the outcomes of these surgeries in terms of recurrence, wound healing, and complications. Materials and Methods: A retrospective observational study was conducted at Melmaruvathur Adhiparasakthi Institute of Medical Sciences, Tamil Nadu. Sixty patients who underwent fistula-in-ano surgery between 2018 and 2023 were included. Outcomes like recurrence rate, wound healing, and postoperative pain were analyzed using descriptive and comparative statistics. Results: Fistulectomy had the lowest recurrence rate (5%), the fastest wound healing (5-6 weeks), and the least postoperative pain. Fistulotomy showed a 10% recurrence rate with an 8-week healing time, while seton placement had the highest recurrence (30%) and longest healing (10-12 weeks). No anal incontinence was reported. Conclusion: Fistulectomy was the most effective treatment for low anal fistulas, offering superior outcomes in recurrence and recovery compared to fistulotomy and seton placement. Further studies are needed to evaluate long-term results.

Anaemia remains a major global health issue, particularly in developing countries like India, where it significantly affects health and productivity. Although red blood cell (RBC) parameters are central to diagnosis, platelet parameters also reflect bone marrow function and may provide additional diagnostic insights as both arise from a common progenitor (Megakaryocyte/ Erythroid Progenitor). This study aimed to evaluate the correlation between RBC parameters and platelet parameters in patients with moderate and severe anaemia. Materials and Methods: A retrospective observational study was conducted on 400 patients aged ≥15 years with moderate (Hb- 8-10.9 g/dL) or severe anaemia (Hb- <8 g/dL) as per WHO; at Gian Sagar Medical College and Hospital, Rajpura. Patients with pregnancy, recent transfusion, hematologic disorders, or chronic systemic diseases were excluded. Hematological data were obtained using an automated analyzer (Nihon Kohden MEK-6420P, Japan). RBC parameters (Hb, RBC count, Hct, MCV, RDW) and platelet parameters (Plt count, PCT, MPV, PDW) were analyzed. Correlations were assessed using Pearson’s coefficient with p < 0.05 considered significant. Results: The mean hemoglobin concentration of the study cohort was 8.4 ± 1.2 g/dL, mean RBC count 3.1 ± 0.7 million/µL, MCV 78.2 ± 9.4 fL. The mean platelet count was 280 ± 85 ×10³/µL, with thrombocytopenia observed in 23% and thrombocytosis in 5% of patients. Comparison between moderate and severe anaemia groups revealed significant reductions in Hb, RBC, and Hct (p < 0.05), but platelet parameters showed no significant difference. Correlation analysis demonstrated a strong negative relationship between MCV and platelet count (r = –0.39, p < 0.0001) and between RBC and PDW (r = –0.36, p < 0.0001), while MCV exhibited a strong positive correlation with PDW (r = 0.61, p < 0.0001). These findings suggest that platelet distribution width dynamically reflects changes in red cell morphology and marrow activity. Conclusion: This study highlights a significant association between several RBC and Platelet parameters. The results support the concept of a coordinated marrow response, where alterations in red cell and platelet morphology occur concurrently. Routine inclusion of platelet indices in anaemia assessment can provide a more comprehensive understanding of marrow physiology, especially in iron-deficiency states.

Background: Grade III injuries of the medial collateral ligament (MCL) of the knee, characterized by complete ligament disruption, are often encountered in athletic and trauma populations and present a treatment dilemma between surgical repair and conservative management. While prior meta-analyses have focused on ligament stability and functional knee scores, return-to-sport (RTS) outcomes and range of motion (ROM) recovery, which are both crucial to patient-centered decision-making, have not been systematically evaluated. This meta-analysis aims to assess whether surgical intervention leads to a higher rate or faster return to pre-injury sport or activity levels, and greater ROM recovery, compared to non-surgical treatment in adults with acute Grade III MCL injuries. Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive literature search was performed across MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science from inception to July 2025. Eligible studies included randomized controlled trials (RCTs) involving adults (18 years and older) with acute, isolated or combined Grade III MCL injuries, comparing surgical repair or reconstruction with non-surgical management such as bracing or physiotherapy. The primary outcomes were the rate and timing of return to sport or pre-injury activity level, and range of motion recovery. Secondary outcomes included functional performance such as the one-leg hop test, and complication rates. Data extraction and risk of bias assessment were performed independently by two reviewers using the Cochrane Risk of Bias 2.0 tool. Pooled analyses were conducted using a DerSimonian and Laird random-effects model, with heterogeneity assessed via I² statistics. Results: Three randomized controlled trials comprising a total of 144 adult patients were included in the meta-analysis, with 73 patients undergoing surgical treatment and 71 receiving non-surgical (conservative) management. Follow-up periods ranged from 12 to 27 months. All studies reported on return-to-sport (RTS) and range of motion (ROM) outcomes. There was no statistically significant difference in RTS rates between the surgical and non-surgical groups (Risk Ratio [RR] 1.04, 95% Confidence Interval [CI] 0.92 to 1.17, p = 0.48, I² = 15.7%). Pooled analysis of patients achieving full ROM also showed no significant difference between treatment groups (RR 1.06, 95% CI 0.95 to 1.18, p = 0.26, I² = 22.4%). Secondary outcomes such as hop test performance and complication rates were reported inconsistently across studies and were not pooled. Discussion and Conclusion: The results of this meta-analysis indicate that, based on current randomized controlled trial data, there is no statistically significant difference between surgical and non-surgical management of Grade III MCL injuries with respect to return-to-sport rates or range of motion recovery. In practical terms, this suggests that neither treatment modality demonstrates clear superiority in promoting functional recovery. However, this absence of statistical significance does not confirm that the two approaches are clinically equivalent. Rather, it highlights limitations in the current evidence. The studies included in this analysis may have been underpowered to detect meaningful differences, with relatively small sample sizes and moderate variability in surgical technique, rehabilitation protocols, and outcome definitions. Additionally, wide confidence intervals and low event counts could have contributed to non-significant findings. These results underscore the need for further high-quality, adequately powered trials with standardized RTS and functional outcome metrics. Until then, treatment decisions for Grade III MCL injuries should continue to be individualized based on patient goals, comorbidities, injury complexity, and surgeon experience.

Background: Awareness of fertility cycles and access to contraceptive services play a decisive role in reducing unintended pregnancies, limiting unsafe abortions, and improving maternal outcomes. In Assam, where maternal mortality remains high and unmet contraceptive need is above 12%, understanding women’s knowledge and practices is essential for effective interventions. Aim: To examine fertility awareness and family planning practices among women attending the outpatient department of a tertiary hospital in Assam, and to explore barriers contributing to unmet contraceptive needs. Methods: This cross-sectional study involved 300 women aged 15–49 years who attended the Obstetrics and Gynaecology OPD of Assam Medical College between April 2018 and March 2019. Participants were chosen using systematic random sampling. Data were collected through structured interviews covering socio-demographic details, awareness of fertility, knowledge and attitudes toward contraception, and current practices. Ethical approval was obtained from the Institutional Ethics Committee (AMC/EC/PG/2018). Statistical analysis included descriptive measures and Chi-square/t-tests, with p < 0.05 considered significant. Results: Most participants had limited awareness of fertility periods and misconceptions about contraceptive methods. Educational attainment and parity showed significant associations with contraceptive use (p < 0.05). Barriers included fear of side effects, cultural norms, and partner opposition. Conclusion: Fertility awareness and contraceptive use remain suboptimal. Integrating culturally sensitive counselling into outpatient services could reduce unmet needs and strengthen maternal health outcomes.

Background: Emergency caesarean delivery often leaves little scope for physiological optimization before surgery. Here, every hour saved in recovery counts. The Enhanced Recovery After Surgery (ERAS) framework, once tailored for abdominal and orthopedic procedures, is now finding a place in obstetrics. Its philosophy, minimizing perioperative stress and restoring normal function early, has shown promise in elective caesareans, but its role in emergencies remains uncertain. This trial was designed to explore whether ERAS-based care could tangibly improve maternal outcomes following emergency caesarean section. Methods: A randomized controlled study was undertaken at Vels Medical College and Hospital, Tiruvallur, Tamil Nadu, over a period of six months (January 2024–October 2025). One hundred women who underwent emergency caesarean delivery were randomized equally into two arms. The ERAS group (n=50) received multimodal care, early feeding, mobilization within six hours, multimodal non-opioid analgesia, and early catheter removal, while the control group (n=50) followed standard postoperative routines. Recovery parameters, including pain (Visual Analogue Scale), time to ambulation, duration of hospital stay, return of bowel function, and satisfaction, were compared. Statistical analysis was performed using the chi-square and independent t-tests, with p<0.05 regarded as significant. Results: Women under the ERAS protocol walked nearly twice as early (7.8 ± 2.4 hours) as those in conventional care (16.2 ± 3.1 hours, p<0.001). Oral intake was reintroduced earlier (4.6 ± 1.7 vs. 10.5 ± 2.6 hours, p<0.001). Average hospital stay was shorter by about one full day (2.3 ± 0.8 vs. 3.4 ± 0.9 days, p=0.002). Pain levels were consistently lower in the ERAS group at both 6 and 24 hours post-surgery (VAS 3.2 ± 1.1 vs. 5.6 ± 1.4 and 2.4 ± 1.0 vs. 4.8 ± 1.3, p<0.001). Satisfaction scores were markedly higher (92% vs. 74%, p=0.01), while wound-related or readmission complications showed no statistical difference. Conclusion: Applying the ERAS pathway to emergency caesarean delivery clearly improved early recovery, reduced discomfort, and increased patient satisfaction without compromising safety. Such structured perioperative protocols, when integrated into tertiary obstetric practice in India, may redefine standards of maternal care and resource utilization.

Background: Adverse cutaneous drug reactions (ACDRs) remain an important cause of avoidable hospital morbidity. Their presentations range from mild, self-limiting rashes to life-threatening syndromes such as Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) [1,2]. Despite frequent encounters in Indian tertiary hospitals, local epidemiological evidence remains sparse. Objectives: To document the clinical spectrum, timing, and drug associations of ACDRs observed in a tertiary-care dermatology unit during the Department of Dermatology Venerology& Leprosy, KAP Vishwanadham Government Medical College & Hospital, Tiruchirappalli, Tamil Nadu, India, in the year 2023 Methods: A prospective observational approach was adopted. Seventy-five consecutive patients with clinically confirmed ACDRs were enrolled. Demographic characteristics, type of eruption, mucosal involvement, lag time between drug intake and symptom onset, and the suspected drugs were analyzed descriptively. Results: Participants had a mean age of 41.9 ± 15.9 years, and males comprised 58.7 % of cases. Fixed drug eruption was the most frequent presentation (22.7 %), followed by bullous FDE (17.3 %), exanthematous drug eruptions (10.7 %), urticaria (10.7 %), and SJS (9.3 %). Paracetamol (20 %), phenytoin (16 %), and anti-tuberculosis therapy (12 %) were the leading culprits. Most reactions occurred within the first 48 hours after drug exposure. Mucosal involvement was observed in 18.7 % of cases, most often on the lips. Conclusions: The findings highlight FDE and bullous variants as predominant forms of ACDR, with paracetamol and anticonvulsants as key triggers. Early-onset clustering underlines the importance of medication review within the first two days of therapy initiation.

Background: Effective obturation of the root canal system requires sealers that exhibit strong dentinal tubule penetration yet remain retrievable during retreatment. Newer bioceramic sealers offer enhanced bonding and bioactivity, but their retreatability remains under evaluation. Aim: To compare the dentinal tubule penetration and retreatability of AH Plus, MTA Fillapex, and BioRoot RCS using confocal laser scanning microscopy (CLSM) and field emission scanning electron microscopy (FESEM). Methods: Sixty extracted human single-rooted teeth were prepared and randomly divided into two groups (n=30 each): sealer penetration and retreatment, each subdivided by sealer type (n=10). Sealers were fluorescently labeled, placed using lateral condensation, and analyzed after 14 days using CLSM for penetration depth and residual sealer. Select samples underwent qualitative FESEM evaluation. Results: All sealers showed greater penetration and residual material in the coronal third compared to apical (p < 0.001). BioRoot RCS showed the greatest penetration in coronal (2235.06 ± 56.02 µm) and apical thirds (1364.03 ± 20.46 µm), while MTA Fillapex was highest in the middle third (1757.49 ± 12.59 µm). During retreatment, BioRoot RCS exhibited the most residual sealer in coronal and middle thirds, whereas AH Plus retained the most in the apical third. Conclusion: BioRoot RCS achieved the highest dentinal penetration and was least retrievable, followed by MTA Fillapex and AH Plus. Complete sealer removal was not achieved with any material, indicating that deeper penetration may compromise retreatability.

Background: Newborn supplementation, particularly with essential micronutrients such as Vitamin D, plays a crucial role in infant growth and development. Despite clinical recommendations, caregiver awareness, adherence, and cultural practices can significantly influence supplementation patterns. Understanding parental perceptions is essential for improving uptake and efficacy of such interventions. Aims: To assess and analyse parental perceptions, knowledge, and practices related to newborn supplementation, and to identify the factors influencing their decisions regarding the administration of supplements such as vitamin D, vitamin K, and other essential micronutrients. Materials and methods: The present study was a Descriptive Study. This Study was conducted from 1 Year at Department of Paediatrics, Mahatma Gandhi Mission Medical College, Plot No14, Sector 8, Nerul, Navi Mumbai, Maharashtra 400706. Study population 380 parents of newborns. Result: Out of 380 participants, 75.8% were aware of supplementation, and 58.9% were aware of Vitamin D supplementation. Healthcare providers were the most cited source of information (35.8%). Vitamin D was the most commonly administered supplement (58.9%), followed by calcium and gripe water. Cultural practices such as pre-lacteal feeding (48.9%) and Janam Ghutti use (24.2%) were prevalent. Positive effects of supplementation were perceived by 55.8% of parents. While 62.9% were aware of government-provided supplements, only 43.2% reported receiving them free of cost. Conclusion: Despite good awareness, gaps remain in understanding, accessibility, and cultural acceptance. Strengthening health education and culturally sensitive counseling is vital for improving supplementation practices.

Background: Epistaxis, or nasal bleeding, is a common otolaryngological emergency, accounting for up to 10% of all ENT presentations. The majority of cases originate from Kiesselbach’s plexus in the anterior nasal septum and are generally benign but can cause significant patient distress. Traditional management involves anterior nasal packing, which, while effective, is uncomfortable, carries a risk of mucosal trauma, infection, and rebleeding upon removal. In recent years, tranexamic acid (TXA), an antifibrinolytic agent, has emerged as a potential topical therapeutic alternative that promotes hemostasis by stabilizing the fibrin clot. Objectives: This study aimed to compare the efficacy, patient comfort, recurrence rates, and complications associated with the topical application of injection tranexamic acid versus conventional anterior nasal packing in the management of anterior epistaxis. Methods: A prospective comparative study was conducted on 120 patients presenting with anterior epistaxis at a tertiary care center over a period of 12 months. Participants were randomly allocated into two equal groups. Group A received topical application of injection tranexamic acid (500 mg in 5 mL) applied over the bleeding site using a soaked pledget, while Group B underwent conventional anterior nasal packing using lubricated ribbon gauze impregnated with antibiotic ointment. The time to bleeding control, patient discomfort (assessed on a visual analog scale), duration of hospital stay, recurrence within 48 hours, and complications were recorded. Data were statistically analyzed using SPSS version 26, and p-values < 0.05 were considered significant. Results: Hemostasis was achieved significantly faster in Group A (mean 4.6 ± 1.2 minutes) compared to Group B (mean 8.9 ± 2.7 minutes, p < 0.001). Patient discomfort scores were notably lower in the TXA group (mean 2.3 ± 1.1) than in the packing group (mean 6.8 ± 1.6, p < 0.001). Recurrence of bleeding within 48 hours was observed in 6.7% of Group A and 13.3% of Group B, though this difference was not statistically significant. The incidence of mucosal trauma, infection, and post-removal bleeding was higher in the nasal packing group. The mean duration of hospital stay was shorter in Group A (0.9 ± 0.4 days) compared to Group B (2.1 ± 0.7 days, p < 0.001). Conclusion: Topical application of injection tranexamic acid is an effective, safe, and patient-friendly alternative to conventional anterior nasal packing for anterior epistaxis. It provides faster hemostasis, significantly greater comfort, and fewer complications while maintaining comparable recurrence rates. The findings support the routine use of topical TXA as a first-line treatment option in suitable cases of anterior nasal bleeding.

Background: Faciomaxillary fractures constitute a significant disease burden to the society. They are clinically and aesthetically important owing to their close vicinity to vital structures and structures of cosmetic value respectively1and are clinically highly significant for number of reasons. Objectives- Our study aims at analysing the aetiology, distributions within sexes and various age groups, manifestations, anatomical distribution and management of faciomaxillary trauma presenting to ENT OPD, plastic surgery OPD and emergency department of K.R. Hospital, Mysore Methods- 95 patients with faciomaxillary trauma who came to casualty, outpatient department of Ear, Nose and Throat, department of Plastic Surgery, Krishna Rajendra Hospital, Mysore attached to Mysore Medical College and Research Institute, Mysore, from January 2020 to June 2021 were enrolled into the study. Aetiology, distributions within sexes and various age groups, manifestations, anatomical distribution and management of faciomaxillary trauma data has been collected after careful clinical and radiographic examinations. Data obtained was analysed using appropriate statistical test. Based on epidemiological data, clinical and imaging findings, treatment modalities and outcome of patients were also analysed. Results- A total of 95 patients presenting with 138 maxillofacial fractures were analysed. Most of them [34 (35.8%)] were young adults aged 18-25. Men [83 (87.37%)] were more affected than women. Road traffic accidents remain the main aetiology causing fractures in 57 (60%). Mandible was more frequently involved with 66 (42.03%) fractures, and condyle being the most common site. A total of 52 (54.7%) patients underwent open reduction with internal fixation under general anaesthesia. Conclusion- With increasing incidence of RTAs, there is a need to understand the pattern, review our management techniques and hence be able to provide appropriate and individualized management to those in need of it.

Background: Hearing impairment affects the ability of learning spoken language in children and hampers their social, psychological and emotional life. A cochlear implant is surgically implanted electronic device that helps in social rehabilitation of the patient with hearing loss. In this context the present study aims to evaluate various factors affecting outcome in cochlear implant surgery. A prospective study of 15 patients was carried out by means of information obtained from patients who underwent Cochlear Implant Surgery, being evaluated using 3 parameters- Revised CAP score (CAP), Meaningful Auditory Integration Scale (MAIS), speech intelligibility rating (SIR) at various intervals postoperatively and outcome was seen. The Mean Revised CAP Score was raised from 0.47±0.49 preoperatively to 3.90±0.61 at 6 months and 7.84±0.66 at 12 months respectively. The mean SIR score was raised from 1.0±0.0 preoperatively to 2.33±0.47 at 6 months and 2.46 ±0.49 at 12 months. Similarly, the mean MAIS score was raised from 2.0±2.01 preoperatively to 25.53±1.40 at 6 months and 32.20±0.77 at 12 months i.e., the patient start using his environmental sounds in more meaningful way when compared to start of speech therapy. Statistically, significant difference was found between the preoperative and postoperative revised CAP, SIR and MAIS Score which implies that Cochlear Implant surgery is a safe surgery with very less complications.

Background: Aim- To correlate the findings of diagnostic nasal endoscopy (DNE) and CT scan of nose and paranasal sinus in evaluation of chronic rhinosinusitis (CRS) Methodology: All the patients attending ENT OPD fullfiling the inclusion criteria and met no exclusion criteria were enrolled in the study during the period of January 2024 to August 2024. All patients underwent comprehensive otorhinolaryngological examination including DNE and non-contrast CT scan of nose and paranasal sinuses. Result: The highest congruence between DNE and CT scan was seen in findings like osteomeatal complex (OMC) occlusion (94.28%), paradoxically curved middle turbinate (92.85%), and septal deviation (92.14%), suggesting these are reliably detected by both methods. A lower congruence was observed in findings like accessory maxillary ostium (82.85%). High sensitivity observed for conditions like OMC occlusion (96.92%), septal deviation (96.43%), paradoxically curved middle turbinate (96.15%), and finding abnormal uncinate process (96.15%) as compared to CT scan. High specificity values indicate that DNE accurately rules out these conditions in most cases, notably OMC occlusion (92%), nasal polyp (90.91%) and paradoxically curved middle turbinate (90.91%) as compare to CT scan. Conclusion: Both DNE and CT scan are essential preoperative investigations before undergoing functional endoscopic sinus surgery (FESS). While DNE provides a real-time assessment of mucosal pathology, CT imaging serves as a ―road map for the surgeon, offering detailed visualization of sinus structures and guiding surgical planning to minimize complications.

Background: Percutaneous nephrolithotomy (PCNL) is the standard of care for renal calculi >2 cm and complex stones. This prospective study of 60 patients evaluates outcomes, complications, stone-free rate, hospital stay, and recovery following PCNL, with attention to renal function and clearance outcomes where available. Methods: Sixty consecutive patients undergoing PCNL between March 2021 and September 2022 were prospectively studied. Standardized technique included ureteral catheter placement, prone positioning, fluoroscopic calyceal puncture, tract dilation to 30F, and use of a 24-F nephroscope. Primary outcomes included stone-free rate (SFR) assessed by KUB/CT, intra- and post-operative complications, duration of surgery, hospital stay, and time to recovery. Data were analyzed descriptively; Fisher’s exact test was used where appropriate. Results: The cohort had a male: female ratio of 3:2 with mean age concentrated in 31–40 years. Stone-free rate after primary PCNL was 85% (51/60). Intra-operative complications occurred in 16.7% (10/60) — hemorrhage (13.3%) being most common. Post-operative complications occurred in 13.3% (8/60), with surgical site infection (5%) most frequent. Mean operative time was 69.0 ± 9.8 minutes. Mean hospital stay was 2.57 ± 0.99 days; 93.3% were discharged within 3 days. Patient satisfaction was high (81.7%). No mortalities were observed. Conclusion: In this single-center series, PCNL demonstrated an 85% stone-free rate with acceptable complication rates and short hospitalization. Findings support PCNL as a safe and effective modality when performed by experienced surgeons. Renal clearance data were not retrievable from the accessible thesis excerpts and are noted as a limitation; inclusion of specific renal clearance outcomes will be added if provided.

Background: Rapid sequence intubation (RSI) is a high-stakes intervention in emergency and prehospital care. Protocolised approaches, including checklists, equipment changes, and operator training, have been proposed to improve first-pass success (FPS) and reduce complications such as hypoxemia, but their aggregate effect across diverse settings remains unclear. Objectives: To systematically review and synthesise evidence on the impact of protocolised RSI interventions compared with usual care on FPS and peri-intubation hypoxemia. Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 (PROSPERO registration number 2025 CRD420251136118). The review was framed using the PICO format: adult patients undergoing emergency or prehospital RSI (Population); protocolised RSI interventions such as standard operating procedures, pre-intubation checklists, mandatory bougie use, or videolaryngoscopy protocols (Intervention); non-standardised or clinician-dependent practice (Comparator); with FPS as the primary outcome and peri-intubation hypoxemia as the secondary outcome (Outcomes). We searched PubMed, Embase, CENTRAL, and grey literature, supplemented by manual reference screening. Data extraction was performed in duplicate, effect sizes were calculated where possible, and risk of bias was assessed using Cochrane RoB 2.0 and ROBINS-I tools. Results: Ten studies met inclusion criteria, encompassing >7,300 RSI episodes across emergency departments, helicopter emergency medical services (HEMS), and ground EMS in eight countries. Interventions included protocol bundles (n=4), checklist implementation (n=3), routine bougie use (n=1), videolaryngoscopy with bougie (n=1), and a low-dose rocuronium strategy (n=1). Across six studies with complete pre–post data, mean FPS increased from 72.7% to 84.4% (absolute improvement +8.9%). The largest gains were observed in ED-based protocol bundles (+23.0%) and routine bougie use (+7.0%), with more modest improvements from checklist and operator-model changes (+2–3%). Pooled analysis of seven studies reporting hypoxemia demonstrated a significant reduction (RR 0.77, 95% CI 0.65–0.91), although baseline incidence and definitions varied. Risk of bias was moderate in most studies (n=6), low in three, and high in one, reflecting the predominance of before–after observational designs. Conclusions: Protocolised RSI interventions are associated with clinically meaningful improvements in FPS and modest reductions in hypoxemia in both ED and prehospital settings. Multifaceted interventions, particularly protocol bundles and mandatory bougie use, appear most effective. However, the overall certainty of evidence remains limited by study design, underscoring the need for future high-quality randomised or controlled studies.

Background: Uterine fibroids are the most common benign tumors of the reproductive tract and may complicate pregnancy depending on their size and location. Submucosal fibroids, though less frequent, can distort the uterine cavity and cause adverse obstetric outcomes. While atonic postpartum hemorrhage (PPH) is a recognized complication, persistent secondary PPH due to submucosal fibroids is exceedingly rare. Objective: To describe varied clinical presentations and management challenges of persistent secondary PPH in pregnancies complicated by submucosal fibroids. Methods: This case series includes three patients with submucosal fibroids complicating pregnancy, managed at Gandhi Hospital, Secunderabad, between August 2023 and August 2025. Clinical presentation, imaging findings, surgical management, and outcomes were analyzed. Results: All three cases demonstrated partial or complete placental implantation overlying the fibroid, leading to subinvolution of the placental bed and reopened vascular sinuses. Two patients were successfully managed with uterine artery embolization (UAE), while one required peripartum hysterectomy due to intractable hemorrhage. Imaging confirmed high vascularity of submucosal fibroids as the bleeding source. Conclusion: Submucosal fibroids can present as rare causes of persistent secondary PPH due to placental site subinvolution and abnormal vascular persistence. Antenatal recognition and multidisciplinary planning—including interventional radiology and adequate blood bank support—are essential. Pre-pregnancy hysteroscopic resection should be considered for large, cavity-distorting fibroids to prevent life-threatening hemorrhagic complications.

Background: Injury is a significant global health burden and can result in mortality if not attended to on time. Trauma system refers to a collection of services provided by various super-specialties. According to the WHO-World Bank Report, RTA will rise from ninth place to the third biggest cause of mortality. Aims: To analyze the patterns and severity of injuries among road traffic accident cases presenting to a secondary care rural health centre in India. Materials and Methods: This prospective, longitudinal, and observational study was conducted over a period of one year at Maa Vindhyawasini Autonomous State Medical College, Mirzapur, Uttar Pradesh. A total of 100 patients involved in road traffic accidents presenting to the emergency department of the secondary care rural health centre were enrolled as the study population. Data on injury patterns, severity, and associated factors were collected and analyzed to identify trends and outcomes. Results: Out of 100 road traffic accident cases analyzed, injury patterns varied significantly across age groups, with limb fractures and head injuries most common in patients under 18, while head injuries predominated in adults aged 18–40 and those over 40 (p = 0.032). Injury severity also differed by road user type, with pedestrians sustaining the most severe injuries (mean ISS 22.5), followed by two-wheeler riders and car occupants (p = 0.004). Gender differences were noted, as males experienced higher rates of head injuries (40%) and polytrauma compared to females (p = 0.021). Use of safety gear significantly reduced head injuries (16.7% vs. 64.3%, p < 0.001). Additionally, injury patterns varied by time of day, with more limb injuries during daytime and more head injuries at night (p = 0.048). Conclusion: This study highlights key injury patterns and severity in road traffic accidents, showing significant differences based on age, gender, type of road user, safety gear use, and time of day. Head injuries were most common and severe, especially among males, adults aged 18–40, and those not wearing helmets or seatbelts. Pedestrians faced the highest injury severity, while car occupants had less severe injuries. The protective effect of safety gear was clear, and night-time accidents resulted in more serious head trauma. These findings stress the importance of targeted safety measures and strict enforcement of protective gear to reduce RTA-related injuries.

Background: movements or abnormal postures. Treatment options remain limited, particularly for refractory or segmental forms. Here, we present a rare case of a 22-year-old female diagnosed with dystonia secondary to PINK1 gene mutation, suggestive of an autosomal recessive Parkinsonian syndrome. The patient presented with contractions of the fingers of the left hand and toes of the left foot for ten years, along with persistent pain and neck stiffness. Conventional pharmacotherapy yielded limited improvement. Repetitive Transcranial Magnetic Stimulation (rTMS) was initiated using both Deep TMS and figure-of-8 coil stimulation over a five-day period. Assessments using the Fahn-Marsden Dystonia Scale, Global Dystonia Severity Rating Scale, and PEG Scale demonstrated significant improvement post-intervention: movement scale score reduced from 22 to 2, disability score from 7 to 3, global severity from 31 to 7, and pain score from 27 to 8. The patient reported functional improvement and pain relief, confirmed by objective scale reductions. This case underscores the clinical potential of rTMS as an adjunctive neuromodulatory approach in dystonia management.

Background: Cleft palate patients are predisposed to otitis media with effusion and conductive hearing loss due to Eustachian tube dysfunction. During palatoplasty, pterygoid hamulotomy is often performed to relieve flap tension, though concerns persist regarding its potential effect on middle ear physiology. Aim: To evaluate whether hamulotomy performed during palatoplasty influences postoperative hearing and middle ear function. Materials and Methods: In this prospective, randomised clinical study, 100 non-syndromic cleft palate patients aged 10–24 months were allocated to two groups: Group A (hamulotomy) and Group B (control). Tympanometry and transient evoked otoacoustic emissions (OAE) were recorded pre-operatively and at 1 and 6 months post-surgery. Data were analysed using SPSS v27.0; p < 0.05 was considered significant. Results: Ninety-six children completed follow-up. Both groups showed significant improvement in tympanometric (Type A curves: 83.3 % vs 79.2 %) and OAE pass rates (87.5 % vs 83.3 %) at 6 months (p > 0.05). No significant inter-group differences were observed in hearing outcomes or postoperative complications. Conclusion: Hamulotomy facilitates tension-free palatal closure without adversely affecting hearing or middle ear ventilation. It can be safely employed during palatoplasty in non-syndromic cleft palate patients.

Background: Falls among older adults in rural India are a major public health concern, often causing fractures, head trauma, and soft tissue injuries. Both intrinsic factors (age, gender, and chronic illnesses, walking aids) and extrinsic factors (poor lighting, uneven surfaces) increase fall risk. Data on fall-related injuries in rural emergency settings remain limited. Aims: The aim of the study is to determine the prevalence and identify the associated risk factors of fall-related injuries among older adults presenting to emergency departments in rural India. Materials and Methods: The present study was a hospital-based cross-sectional observational study conducted over a period of 12 months, from 1 July 2024 to 30 June 2025, in the emergency departments of Maa Vindhyawasini Autonomous State Medical College Mirzapur Uttar Pradesh in India. The study population comprised older adults aged 60 years and above who presented with fall-related injuries, with a total sample size of 50 patients included for analysis. Results: In our study of 50 older adults from rural India, 36% experienced falls in the past year, mostly single incidents. Age, gender, and comorbidities were not significantly associated with falls, whereas uneven flooring was a significant risk factor (p = 0.02). The most common injuries were bruises (38.9%) and fractures (33.3%). Conclusion: In our study of 50 rural older adults, 36% experienced falls, mostly single incidents. Age, gender, and comorbidities were not significant, while uneven flooring was a key risk factor. Bruises and fractures were the most common injuries, underscoring the need for home modifications and fall prevention programs.

Background: The clavicle, a uniquely shaped long bone in the human skeleton, plays a critical role in shoulder girdle mechanics and is frequently fractured, particularly in the middle third. These fractures, while often managed conservatively, can lead to significant morbidity, non-union rates, and complications when displaced. Global research emphasizes the need for precise morphometric data to optimize fracture fixation strategies, such as plating and intramedullary nailing. Key anatomical variations include overall length, cross-sectional width, axial bending (most pronounced at the acromial end), and curvatures (medial and lateral), which influence the design of fixation devices. This study aimed to quantitatively assess clavicular dimensions. specifically total length, medial angle (formed by the medial curvature relative to the shaft), and lateral angle (formed by the lateral curvature relative to the shaft). Methods: A total of 320 dry adult clavicles (185 male and 135 female) were sourced from the osteology collections of first-year MBBS students across multiple medical colleges in South India. Measurements were performed using standardized manual techniques: length was determined with a digital caliper along the superior border from sternal to acromial end; medial and lateral angles were measured with a protractor aligned to the shaft's midline. Data were analyzed descriptively, calculating means, standard deviations, and ranges, with comparisons between sexes and sides using unpaired t-tests (p < 0.05 considered significant). Results: Male clavicles demonstrated significantly greater mean length (142.90 ± 10.59 mm) compared to females (132.30 ± 10.44 mm; p < 0.001), reflecting sexual dimorphism. Side-specific analysis revealed minimal asymmetry: right male clavicles averaged 142.10 ± 11.70 mm versus left 143.80 ± 9.55 mm; right female 131.12 ± 12.22 mm versus left 131.10 ± 9.02 mm (no significant side differences, p > 0.05). Medial angle ranges were 136°–163° (right) and 135°–166° (left), indicating greater variability on the left. Lateral angles ranged from 122°–162° (right) and 126°–168° (left), with left-sided angles showing broader dispersion. Overall, curvatures exhibited subtle bilateral differences, with left clavicles displaying slightly more pronounced lateral bending, potentially influencing plate adaptation during surgery. Conclusion: These morphometric findings underscore the importance of gender- and side-specific clavicular dimensions in enhancing the precision of orthopedic fixation devices, reducing intraoperative bending needs, and minimizing complications like non-union or implant failure. The data contribute to a normative database for South Indian populations, benefiting orthopedic surgeons in treatment planning, anatomists in educational models, and anthropologists/forensic experts in skeletal profiling. Future studies incorporating 3D modeling could further refine these parameters for personalized implants.

Background: Despite advancements in pedagogical strategies, traditional didactic lectures remain the cornerstone of medical education, often limiting student engagement and collaborative learning. The Jigsaw method, a cooperative learning technique, encourages active participation by dividing students into "expert" groups to master subtopics before teaching peers in "parent" groups. This study evaluates the effectiveness of the Jigsaw method as an adjunct to traditional teaching in enhancing histology comprehension and retention among first-year MBBS students. Aim: The present study was conducted to compare the academic performance of students taught via the Jigsaw method versus traditional lectures, to assess student perceptions of the Jigsaw method’s impact on collaborative learning and knowledge retention and to evaluate the reproducibility of outcomes through a crossover study design. Methods: A comparative interventional study conducted with 139 first-year MBBS students randomly allocated into Group 1 (control: traditional teaching) and Group 2 (intervention: Jigsaw method). Both groups received a histology lecture followed by a pre-test. Group 2 underwent the Jigsaw activity, where students formed expert groups to study subtopics and later taught their parent groups. Post-tests were administered to both groups. In Phase 2, the groups crossed over to validate results. Data were analysed using Wilcoxon signed-rank tests (within-group) and Mann-Whitney U tests (between-group). Student feedback was collected via a 5-point Likert scale survey. Results: • Phase 1: The Jigsaw group (Group 2) showed a significant improvement in post-test scores (mean ± SD: 22.06 ± 2.952) compared to pre-test scores (13.87 ± 3.459; p = 0.001) and outperformed the control group (15.91 ± 4.428; p = 0.001). • Phase 2 (Crossover): Results were replicated, with Group 1 (now Jigsaw) demonstrating higher post-test scores (13.10 ± 2.632 vs. pre-test: 8.60 ± 3.224; p = 0.001). • Student Feedback: Over 85% of participants agreed/strongly agreed that the Jigsaw method enhanced understanding (60.2%), teamwork (56.4%), and engagement (53.4%). A majority (55.6%) requested more such sessions. Conclusion: The Jigsaw method significantly improves histology learning outcomes and fosters collaborative skills compared to traditional lectures. Its integration into medical curricula is recommended to promote active learning and peer interaction.

Background: Oral cancer ranks among the most prevalent cancers globally. The expression of E-cadherin and p53 plays a crucial role in understanding tumor characteristics such as local invasiveness, metastatic potential, and cellular proliferation. Early detection of high-risk cases for distant metastasis is vital to improving patient prognosis. This study aims to systematically evaluate the immunohistochemical expression of E-cadherin and p53 in both normal and neoplastic oral epithelium, comparing their levels across various tumor grades to assess their potential as independent or combined predictors of the biological behavior of oral epithelial tumors. Methodology: A descriptive study was conducted at the Department of Pathology, Gandhi Hospital, from October 2019 to October 2021, including 60 cases of normal oral epithelium and OSCC diagnosed by H&E staining. Immuno-histochemical staining for E-Cadherin and p53 was performed, and data were analyzed using SPSS 22. Inclusion criteria covered all properly fixed tumor specimens; exclusions included other oral cancers and inadequate biopsies. Results: Among the 60 cases, males predominated (77%), with most patients aged 51–60 years. The tongue was the most common lesion site (40%). E-Cadherin was positive in 82.85% of cases but showed reduced expression in neoplastic tissue. p53 positivity was observed in 77% of cases. A statistically significant correlation was noted between tumor differentiation and marker expression: E-Cadherin positivity decreased from well-differentiated (57.14%) to poorly differentiated tumors (5.7%) (p=0.004), while p53 positivity also correlated significantly with differentiation (p<0.001). p53levels increased as pathological grade increased. Conclusion: Altered expression of E-Cadherin and p53 is significantly associated with tumor differentiation in OSCC, highlighting their potential as diagnostic and prognostic biomarkers in oral malignancies.

Background: Frozen shoulder (FS), also known as adhesive capsulitis (AC), is a painful disorder of the shoulder joint characterized by gradual onset and progressive restriction of both active and passive shoulder movements. AIM: To evaluate the efficacy, advantages, and disadvantages of intra-articular steroid injection in idiopathic frozen shoulder unresponsive to NSAIDs, using VAS, SPADI, and Oxford Shoulder Score for outcome assessment. Methodology: This prospective study was conducted on the Indian population using radiographic tools at the Orthopedic and Physiotherapy Departments of Medical College and Associated Group of Hospitals, Kota, from November 2022 to January 2024. Result: In this study of 45 patients with idiopathic frozen shoulder, most were middle-aged housewives with the dominant arm affected, presenting mainly with shoulder pain. Corticosteroid injection with physiotherapy produced significant, consistent improvement in pain, function, and range of motion over 12 weeks, confirming its short-term efficacy. Conclusion: Corticosteroid injections are effective for short-term pain relief and functional improvement in adhesive capsulitis, especially when combined with physiotherapy in the early disease stages.

Background: Rheumatoid arthritis (RA) is a persistent inflammatory condition linked to heightened cardiovascular morbidity and mortality. Cardiac autonomic dysfunction may elevate cardiovascular risk but is still inadequately investigated in RA patients. Methodology: This case-control study comprised 80 RA patients diagnosed by ACR/EULAR 2010 criteria and 80 age- and sex-matched healthy controls. The evaluation of cardiac autonomic function was conducted using 24-hour Holter monitoring and heart rate variability analysis. Time-domain parameters (SDNN, RMSSD, pNN50) and frequency-domain parameters (LF, HF, LF/HF ratio) were assessed. The DAS28-ESR score was utilized to evaluate disease activity. The statistical analysis comprised independent t-tests and Pearson correlation coefficients. Results: Patients with RA exhibited markedly reduced heart rate variability measures in comparison to the control group. In rheumatoid arthritis (RA) patients, SDNN measured 98.4 ± 24.6 ms, compared to 142.3 ± 28.4 ms in the control group (p < 0.001). RMSSD measured 24.8 ± 8.2 ms compared to 38.6 ± 10.4 ms (p < 0.001). The LF/HF ratio was markedly increased in RA patients (2.8 ± 0.9 compared to 1.6 ± 0.5, p < 0.001), signifying sympathetic dominance. Cardiac autonomic dysfunction exhibited a strong correlation with disease duration (r = -0.52, p < 0.001) and DAS28-ESR score (r = -0.48, p < 0.001). The prevalence of autonomic dysfunction was 62.5% in RA patients compared to 18.8% in the control group (p < 0.001). Conclusion: Patients with RA demonstrate considerable cardiac autonomic dysfunction, marked by diminished heart rate variability and sympathovagal imbalance. The activity and length of illness are critical factors influencing autonomic dysfunction, indicating the necessity for early cardiovascular risk evaluation in the management of RA.