Background: Thirty-day readmission remains a major challenge in patients hospitalized with heart failure with reduced ejection fraction (HFrEF). Despite advances in guideline-directed medical therapy, early readmission continues to reflect the combined influence of residual congestion, renal dysfunction, comorbidity burden, suboptimal treatment optimization, and transitional-care gaps. Objective: To identify contemporary clinical, laboratory, echocardiographic, and treatment-related predictors of 30-day readmission among patients hospitalized with HFrEF. Materials and Methods: This prospective observational study was conducted in the Department of Cardiology, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, from October 2024 to September 2025. A total of 250 consecutive adult patients hospitalized with HFrEF, defined as left ventricular ejection fraction (LVEF) ≤40%, were enrolled and followed for 30 days after discharge. Demographic characteristics, comorbidities, New York Heart Association (NYHA) functional class, laboratory parameters, natriuretic peptide levels, renal function, echocardiographic findings, congestion status, length of stay, previous heart-failure admissions, and discharge guideline-directed medical therapy (GDMT) were recorded. The primary outcome was unplanned all-cause readmission within 30 days. Multivariable logistic regression was used to identify independent predictors. Results: Of 250 patients, 71 (28.4%) were readmitted within 30 days. The mean age was 61.8 ± 12.4 years and 165 patients (66.0%) were male. Readmitted patients had higher discharge NT-proBNP levels, more frequent chronic kidney disease, lower LVEF, higher NYHA class, more persistent congestion, lower serum sodium, and a greater frequency of heart-failure hospitalization during the preceding year. Use of all four foundational HFrEF drug classes at discharge was lower among readmitted patients. On multivariable analysis, persistent congestion at discharge (adjusted odds ratio [aOR] 2.84, 95% CI 1.42-5.69), estimated glomerular filtration rate <60 mL/min/1.73 m² (aOR 2.19, 95% CI 1.14-4.22), NT-proBNP ≥5000 pg/mL at discharge (aOR 2.62, 95% CI 1.33-5.15), previous HF admission within 12 months (aOR 2.47, 95% CI 1.28-4.78), and absence of quadruple GDMT at discharge (aOR 1.96, 95% CI 1.01-3.81) independently predicted 30-day readmission. Conclusion: Early readmission after hospitalization for HFrEF was common and was associated with residual congestion, renal dysfunction, high natriuretic peptide levels, recent prior hospitalization, and incomplete implementation of foundational GDMT. These findings support systematic predischarge assessment of congestion, renal function, biomarkers, recent utilization, and treatment optimization to identify patients who may benefit from intensified transitional care

Background: Laparoscopic inguinal hernia repair (totally extraperitoneal [TEP] and transabdominal preperitoneal [TAPP]) has emerged as a gold standard approach due to reduced postoperative pain and accelerated return to normal physical activity. However, elevated Body Mass Index (BMI) presents unique anatomical and technical challenges, including thick preperitoneal fat, limited workspace, and distorted landmarks, which may influence surgical difficulty and recovery. Objective: To evaluate the impact of Body Mass Index on intraoperative difficulty parameters, operative duration, perioperative complications, and short-term postoperative recovery following laparoscopic inguinal hernia repair. Methods: A prospective observational cohort study was conducted over 18 months involving 120 consecutive adult patients undergoing elective laparoscopic inguinal hernia repair (TEP/TAPP) at a tertiary-care teaching hospital. Patients were stratified into three BMI categories: Normal weight (<23.0 kg/m², n = 42), Overweight (23.0–27.4 kg/m², n = 46), and Obese (≥27.5 kg/m², n = 32), categorized as per the revised Asian-Indian guidelines. Primary outcome measures included operative duration, subjective technical difficulty (10-point Visual Analogue Scale), rate of peritoneal tears/conversion, visual analog scale pain scores on postoperative days (POD) 1 and 7, length of hospital stay, and 30-day postoperative complications (seroma, hematoma, urinary retention, surgical site infection). Results: The mean operative time increased significantly with increasing BMI (52.4 ± 10.2 min in Normal weight vs 63.8 ± 12.6 min in Overweight vs 78.5 ± 15.4 min in Obese; p < 0.001). Subjective operative difficulty was markedly higher in obese patients (mean score 6.8 ± 1.5 vs 3.4 ± 1.1 in normal weight; p < 0.001). Peritoneal tear rates were significantly higher in obese patients undergoing TEP (31.3% vs 7.1%; p = 0.012). Obese patients demonstrated higher pain scores on POD 1 (4.2 ± 0.9 vs 2.8 ± 0.8; p < 0.001) and prolonged time to return to unassisted ambulation (21.4 ± 5.2 h vs 14.6 ± 3.8 h; p < 0.001). Furthermore, obese patients had a higher overall complication rate (31.3% vs 9.5%; p = 0.038), primarily driven by early seroma formation (21.9% vs 4.8%; p = 0.027) and transient urinary retention (12.5% vs 2.4%; p = 0.089). There was no significant difference in 30-day surgical site infection or mesh infection between groups. Conclusion: Elevated BMI is significantly associated with increased operative duration, heightened technical difficulty, and higher rates of early postoperative seroma following laparoscopic inguinal hernia repair. Nonetheless, laparoscopic repair remains safe and feasible in overweight and obese cohorts when meticulous preperitoneal dissection and anatomical identification are preserved.

Background: Cholecystectomy is one of the most common surgical operations in the abdomen in the world. Gallbladder removal leads to constant direct contact of the intestine with bile and may lead to changes in bile-acid composition in the intestine, the intestinal microbiota, the degree of intestinal inflammation, and the metabolism and signaling in the intestine. All these changes have raised concerns about a potential long-term link between cholecystectomy and colorectal cancer. Epidemiological studies, however, have had mixed results and the impact of tumour location, length of time since surgery and traditional risk factors of CRC is unclear. Objective To assess the long-term colorectal cancer incidence in patients with a prior history of cholecystectomy and determine clinical, demographic and lifestyle risk factors for colorectal cancer in a multi-centre hospital-based population. Methods Patients were identified by a multicenter observational cohort of hospital records of adults with and without a previous cholecystectomy. Excluded were patients with a prior history of colorectal malignancy, hereditary colorectal cancer syndromes or inflammatory bowel disease. Demographic data, comorbidities, family history, indication for cholecystectomy, interval from surgery, tumour location, histopathology, stage and clinical outcomes were noted. In a sub-group, a supplementary patient questionnaire was employed to learn about smoking, dietary pattern, physical activity, bowel-habit changes and colorectal screening. Multivariable regression was planned to determine factors Each independently related to colorectal malignancy. Results Twenty-four hundred and seventy-two participants (1,236 after cholecystectomy, 1,236 comparison) were evaluated. Thirty-four (2.8%) patients in the cholecystectomy group and 22 (1.8%) controls developed colorectal malignancy. The crude risk ratio was 1.55 (95% CI: 0.91–2.63). The association was reduced and was not statistically significant after adjustment for age, sex, obesity, diabetes, smoking, family history and screening history. Proximal/right-sided tumors were more common in patients with an affected post-cholecystectomy. The strongest associations with malignancy were older age, male sex, family history of colorectal cancer, diabetes, and length of time since cholecystectomy. Conclusion The results indicate that cholecystectomy is linked to unique colorectal cancer patterns, especially the occurrence of proximal colon cancer, but with limited conclusions due to the fact that the findings were overall associated. Larger prospective studies with longer follow-up and careful control for screening practices, lifestyle and metabolic factors, and gallstone disease are needed.

Background: Acute pancreatitis (AP) remains one of the most clinically challenging abdominal emergencies with a wide spectrum of severity. Contrast-enhanced computed tomography (CECT) is the imaging modality of choice for evaluating the extent and complications of AP. The CT Severity Index (CTSI) developed by Balthazar et al. integrates morphological grading with the extent of pancreatic necrosis to stratify disease severity and predict clinical outcome.Objective: To evaluate the role of CECT in assessing acute pancreatitis and to correlate the CT Severity Index with clinical outcome, including morbidity, complications, need for intervention, duration of hospitalization, and mortality.Methods: A prospective observational study was conducted at BRIMS Teaching Hospital, Bidar, over a six-month period. Fifty adult patients with acute pancreatitis who were not adequately evaluated by ultrasonography because of technical limitations underwent contrast-enhanced CT. The CT Severity Index (CTSI) was calculated using Balthazar morphological grading and the extent of pancreatic necrosis. Clinical outcomes, including complications, organ failure, ICU admission, need for intervention, duration of hospitalization, and mortality, were recorded and correlated with CTSI.Results: Of the 50 patients, 38 (76%) were male and 12 (24%) were female, with a mean age of 42.3 ± 12.8 years. Alcohol was the predominant etiology (50%). Based on CTSI, 18 patients (36%) had mild disease (CTSI 0-3), 20 (40%) had moderate disease (CTSI 4-6), and 12 (24%) had severe disease (CTSI 7-10). The complication rate increased significantly with CTSI severity: 11.1% in the mild group versus 92% in the severe group (p<0.001). Mean hospital stay was 8.2 ± 3.1 days for mild, 14.6 ± 4.2 days for moderate, and 22.4 ± 6.8 days for severe disease. Mortality was observed exclusively in the moderate (5%) and severe (16.7%) groups. The overall mortality rate was 6%.Conclusion: Higher CTSI scores were significantly associated with increased complications, organ failure, ICU admission, need for intervention, prolonged hospitalization, and mortality. CECT provides valuable morphological and prognostic information when clinically indicated in acute pancreatitis. Larger multicenter studies with standardized CT timing are required to confirm the prognostic performance of CTSI

Background: Loss of reduction (LOR) remains an important challenge after treatment of distal radius fractures and may adversely affect wrist function. This study evaluated radiological parameters associated with LOR and their relationship with 6-month functional outcomes.Methods: This observational study included 80 adults with distal radius fractures treated at a tertiary care hospital in Bihar, India, during 2026. Patients were followed radiologically for secondary displacement. Radial height, radial inclination, volar/dorsal tilt, articular step-off, Three-Point Index (TPI), Cast Index, and Padding Index (PAD index) were assessed. Independent predictors of LOR were evaluated using multivariable logistic regression. Six-month outcomes were assessed using VAS, QuickDASH, and Mayo Wrist Score.Results: LOR occurred in 17 (21.3%) patients. Compared with patients maintaining reduction, the LOR group had significantly lower radial height and inclination, greater articular step-off, and higher TPI, Cast Index, and PAD Index (all p≤0.0003). Articular step-off >2 mm (adjusted OR 4.14, p=0.018), radial shortening >3 mm (adjusted OR 4.53, p=0.013), TPI >1.0 (adjusted OR 5.81, p=0.005), Cast Index >0.84 (adjusted OR 6.62, p=0.003), and PAD Index >0.90 (adjusted OR 3.20, p=0.048) were independent predictors of LOR. At 6 months, the LOR group had higher VAS and QuickDASH scores and lower Mayo Wrist Scores (p≤0.0085).Conclusion: Specific post-reduction radiological parameters, particularly Cast Index, TPI, radial shortening, and articular step-off, were independently associated with LOR. LOR was also associated with poorer 6-month pain and functional outcomes

Background: Fixed-dose combinations (FDCs) of antibiotics are widely prescribed, but inappropriate combinations may contribute to antimicrobial resistance, unnecessary costs, and treatment-related risks. This study evaluated the prescribing patterns, rationality, regulatory status, and clinical outcomes of antibiotic FDCs in a tertiary-care hospital.Materials and Methods: A retrospective observational study was conducted using hospital records and prescription data from January 2024 to December 2025. A total of 274 eligible patients receiving at least one antibiotic FDC were included. Demographic characteristics, FDC type, indication, treatment outcomes, compliance, adverse drug reactions, hospital stay, readmission, and treatment cost were assessed. Rationality was evaluated against regulatory information and standard treatment recommendations. Results: β-lactam + β-lactamase inhibitor combinations were most frequently prescribed (35.0%), and respiratory tract infections were the leading indication (33.9%). Potentially irrational FDCs accounted for 79.9% of prescriptions. Rational FDCs showed higher treatment completion (90.9% vs. 78.5%; p=0.0357), shorter hospital stay (5.24±2.17 vs. 6.79±3.48 days; p=0.0018), lower treatment cost (₹4,860±1,940 vs. ₹6,420±3,180; p=0.0006), and shorter antibiotic duration (6.18±2.05 vs. 7.49±3.13 days; p=0.0035). Treatment success was higher with rational FDCs (87.3% vs. 76.3%), although not statistically significant (p=0.0978). Rational FDC use, good compliance, and targeted therapy were independent predictors of treatment success. Conclusion: Antibiotic FDC prescribing showed a high burden of potentially irrational use. Rational FDC prescribing was associated with improved treatment completion and more favorable healthcare utilization outcomes. Strengthening antimicrobial stewardship, prescription auditing, and adherence to evidence-based treatment guidelines is warranted.

Aim: To evaluate the effect of Kangaroo Mother Care (KMC) provided during gavage feeding in preterm infants.Objectives: To assess the effect of KMC during gavage feeding on weight gain, feeding intolerance, necrotizing enterocolitis (NEC), duration of hospital stay, and mortality among preterm infants.Methods: This randomized controlled trial was conducted in the NICU of a tertiary care centre in NORTHERN India. A total of 124 hemodynamically stable preterm infants were randomized into two groups: gavage feeding during KMC (GF-KMC) and conventional gavage feeding in the supine position (GF-S). Outcomes assessed included daily weight gain, episodes of feed regurgitation, incidence of NEC, duration of hospitalization, and other associated morbidities.Results: Infants in the GF-KMC group experienced significantly fewer episodes of regurgitation (p<0.002), achieved full enteral feeding earlier (p=0.003), and transitioned to oral feeding sooner (p=0.004). Abdominal distension was significantly less frequent in the GF-KMC group than in the GF-S group (16.0% vs. 38.7%; p=0.016). Daily weight gain (p<0.002), weight on day 21 (p=0.002), and weight at discharge (p=0.006) were significantly greater among infants receiving GF-KMC. The overall incidence of NEC was comparable between the two groups (12.9%; p>0.988). However, no cases of NEC were observed among infants who received KMC for 9–12 hours/day, compared with 19.3% among those receiving KMC for 5–8 hours/day (p=0.003).Conclusion: KMC administered during gavage feeding appears to be a safe and beneficial intervention in preterm LBW infants, with improved feeding tolerance, enhanced weight gain, and reduced feeding-related morbidity.

Background: Mental health disorders often remain underrecognized and inadequately addressed by patients, their families, and society. Epidemiological evidence from the past decade indicates that mental disorders are highly prevalent worldwide and are associated with substantial functional impairment, adversely affecting individuals' social, occupational, and overall quality of life. Aim and Objectives: To assess the prevalence and pattern of psychiatric disorders among patients attending a Tertiary care centre in Bagalkot, and to assess the distribution of psychiatric disorders according to selected sociodemographic characteristics such as age, sex, education, occupation, domicile, and socioeconomic status. To study the association between psychiatric morbidity and selected sociodemographic characteristics of the participants. Materials and Methods: A total of 600 consecutive patients were included in the study. Psychiatric disorders were diagnosed and classified according to the International Classification of Diseases, 10th Revision (ICD-10) diagnostic criteria. The collected data were entered into Microsoft Excel and subsequently analyzed using SPSS software. Descriptive statistics, including frequencies, percentages, and proportions, were used to summarize the categorical variables. Results: The study included 600 patients attending the Psychiatry Outpatient Department. Sociodemographic characteristics, including age, sex, and place of residence, were obtained from the available records. The mean age of the study population was 37.10 ± 14.60 years. Males constituted the majority of the participants (approximately 56%), while new cases accounted for approximately 36.1% of the study population. With regard to place of residence, most participants were from rural areas (approximately 59%). Anxiety and stress-related disorders were the most frequently observed psychiatric disorders, accounting for approximately 30.1% of the cases, followed by affective disorders, which constituted approximately 27.3% of the study population. Conclusion: The results of this survey showed that anxiety and stress-related disorders were the most common condition, followed by depression. To take the early and necessary steps for better care, accurate and relevant statistics of the pattern of psychiatric disorders are required. We anticipate that the findings of this study will be useful in developing a strategy for improving mental health services in tertiary care facilities

Background: Blood donor selection is a critical component of ensuring the safety of transfusion services and protecting both donors and recipients. While donor deferral is an essential safety measure, unnecessary or temporary deferrals may adversely affect the availability of eligible blood donors and contribute to a reduction in the donor pool. The pattern and frequency of donor deferral may vary considerably with demographic, socioeconomic, cultural, and regional factors. Therefore, analysis of local donor deferral patterns is important for identifying predominant causes of deferral and developing effective strategies for donor recruitment, counselling, retention, and follow-up. Previous studies from different regions of India have demonstrated considerable variation in overall donor deferral rates and in the relative contribution of causes such as anaemia, medical and medication history, alcohol intake, hypertension, and other health-related factors. Assessment of these patterns at the institutional level can help identify potentially preventable causes of deferral and guide targeted interventions to improve donor retention and ensure an adequate and safe blood supply. Objective: To evaluate and analyse the blood donor deferral pattern and its causes among blood donors in a tertiary care hospital blood Centre. Materials and Methods: This is a retrospective observational study conducted in the Blood Centre of Raichur Institute of Medical Sciences (RIMS), Raichur, a tertiary care hospital over a period of 2years fromOctober 2019to September 2021. Results: During the study period, a total of 9,184 blood donors were screened, of whom 8, 924 (97.2%) were accepted for donations, while 260 (2.8%) were deferred, resulting in an overall donor deferral rate of 2.8%. Among the deferred donors, 180 (69.2%) were temporarily deferred, whereas 80 (30.8%) were permanently deferred. Anaemia was the predominant cause of temporary deferral, while hypertension was the most common reason for permanent deferral. Conclusion: Analysis of blood donor deferral patterns provides valuable insights into the major causes of donor deferral and helps strengthen the donor screening and selection process. Appropriate pre-donation medical assessment, along with effective counselling and clear explanation of the reasons for deferral, can improve donor awareness and acceptance of the donation process.

Background: Prolonged intensive care unit (ICU) stay following cardiovascular and thoracic surgery is associated with increased morbidity, mortality, resource utilisation, and healthcare expenditure. Early identification of patients at increased risk may support perioperative optimisation and ICU resource planning. Objectives: To determine the perioperative predictors of prolonged ICU stay among adults admitted to a cardiovascular and thoracic surgical ICU and to assess its association with postoperative complications and in-hospital outcomes. Methods: This retrospective cohort study included 286 consecutive adults admitted to the cardiovascular and thoracic surgical ICU of a tertiary-care centre between 1 September 2022 and 31 December 2023. Prolonged ICU stay was defined as a cumulative ICU stay of five days or longer. Demographic, preoperative, intraoperative, and postoperative variables were extracted from hospital records. Factors associated with prolonged ICU stay were evaluated using univariable and multivariable logistic regression. Results: Prolonged ICU stay occurred in 58 patients (20.3%). Patients with prolonged stay were older and more frequently had chronic kidney disease, preoperative anaemia, left ventricular ejection fraction below 40%, emergency surgery, and complex procedures. Cardiopulmonary bypass duration, aortic cross-clamp duration, transfusion requirement, and mechanical ventilation duration were greater in the prolonged-stay group. After adjustment, emergency surgery (adjusted odds ratio [aOR] 3.06; 95% confidence interval [CI] 1.37–6.84), chronic kidney disease (aOR 2.48; 95% CI 1.13–5.44), preoperative haemoglobin below 10 g/dL (aOR 2.39; 95% CI 1.15–4.98), left ventricular ejection fraction below 40% (aOR 2.57; 95% CI 1.23–5.39), cardiopulmonary bypass duration exceeding 120 minutes (aOR 3.18; 95% CI 1.55–6.52), and transfusion of at least three units of packed red cells (aOR 2.74; 95% CI 1.31–5.75) independently predicted prolonged ICU stay. In-hospital mortality was higher among patients with prolonged ICU stay than among those with shorter stays (10.3% versus 0.9%; P<0.001). Conclusion: Prolonged ICU stay affected approximately one-fifth of adults admitted after cardiovascular and thoracic surgery. Renal dysfunction, anaemia, impaired ventricular function, emergency surgery, prolonged cardiopulmonary bypass, and greater transfusion requirement were independent predictors. Recognition of these factors may assist perioperative optimisation, risk counselling, and critical-care resource allocation.

Background: Parotid neoplasms are histologically heterogeneous and range from indolent benign lesions to aggressive salivary malignancies. Clinical decision-making integrates preoperative diagnosis, tumor location, facial nerve status, histopathology and oncological risk. This review synthesizes published evidence on the clinicopathological spectrum, diagnostic evaluation, surgical management and outcomes of parotid tumors. Methods: A systematic-review framework was developed in accordance with PRISMA 2020. The intended databases are PubMed/MEDLINE, Embase, Scopus, Web of Science and the Cochrane Library. The present manuscript development draft incorporates verifiable evidence from systematic reviews, meta-analyses, guidelines and representative clinicopathological cohorts identified in a focused literature search. [FINAL SUBMISSION: insert complete search dates, exact database-specific strategies, deduplicated record counts, dual-reviewer screening process, risk-of-bias tools and PRISMA flow counts.] Results: Published evidence consistently shows that benign tumors predominate in most parotid series, with pleomorphic adenoma the leading benign histology. In an Indian 59-patient prospective cohort, 77.97% of tumors were benign; superficial parotidectomy was performed in 69.49%, and transient facial palsy occurred in 22.03%. A 102-patient North Indian series reported pleomorphic adenoma in 76.5% and temporary facial weakness in 23.28%. A network meta-analysis of 44 studies (7,841 participants) reported recurrence rates of 14.3%, 3.6%, 3.7%, 2.8% and 1.4% after enucleation, extracapsular dissection, partial superficial parotidectomy, superficial parotidectomy and total parotidectomy, respectively. Deep-lobe tumors had a malignancy rate of 26.6% and higher temporary facial weakness than superficial lobe tumors (32.5% vs 11.7%) in a meta-analysis of eight studies. Conclusion: Parotid tumors require individualized management based on histology, anatomic extent and oncological risk. Contemporary evidence supports tissue-sparing surgery for appropriately selected benign superficial tumors, while malignant and deep-lobe tumors demand more extensive risk-adapted planning. Facial nerve morbidity remains a central outcome. High-quality prospective studies with standardized surgical definitions and long-term follow-up remain necessary

Background: Knee osteoarthritis is a common degenerative joint disorder associated with chronic pain and functional disability. Intra-articular platelet-rich plasma (PRP) and corticosteroid injections are frequently used nonsurgical interventions; however, their comparative efficacy remains an important clinical consideration.Aim: To compare the efficacy and safety of intra-articular PRP versus corticosteroid injections in patients with early knee osteoarthritis. Materials and Methods: This randomized controlled trial included 60 patients aged ≥45 years with Kellgren–Lawrence Grade I–II knee osteoarthritis, equally allocated into PRP (n=30) and corticosteroid (n=30) groups. Pain and functional outcomes were evaluated using Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores over six months. Data were analysed using appropriate statistical tests, with p<0.05 considered significant. Results: Baseline demographic and clinical characteristics were comparable between groups. At one week, corticosteroids provided significantly greater pain relief (VAS: 4.8 ± 0.9 vs. 5.6 ± 0.8; p=0.01). However, PRP demonstrated significantly lower VAS and WOMAC scores from eight weeks onwards. At six months, VAS scores were 2.6 ± 0.6 versus 5.5 ± 1.3, while WOMAC scores were 28.7 ± 5.8 versus 55.3 ± 11.5 in the PRP and steroid groups, respectively (p<0.001). PRP achieved greater percentage improvement in VAS (63.9% vs. 22.5%) and WOMAC (54.0% vs. 10.5%). No major adverse events were reported. Conclusion: PRP provided greater sustained pain relief and functional improvement than corticosteroids over six months, making it a promising nonsurgical option for early knee osteoarthritis

Background: Anesthesia technique can influence perioperative hemodynamics, analgesia, and recovery after lower-limb orthopedic surgery. Comparisons require consideration of procedure characteristics and patient selection. Objectives: To compare intraoperative events, postoperative pain, analgesic requirements, adverse events, and hospital stay between spinal and general anesthesia. Methods: This retrospective comparative study concerns lower-limb orthopedic surgery at RVM Institute of Medical Sciences and Research Center, Laxmakkapally, Mulugu, Siddipet, Telangana, India, during August 2025–July 2026. The study includes 50 patients, divided equally between spinal and general anesthesia. Demographic characteristics and perioperative outcomes are presented descriptively. Results: Mean age was 49.8 ± 13.6 years with spinal anesthesia and 51.2 ± 14.1 years with general anesthesia. Estimated blood loss was 182 ± 76 versus 224 ± 91 mL. Hypotension occurred in 28% versus 16%. Pain scores at two hours were 2.1 ± 1.0 versus 4.3 ± 1.4, while time to first rescue analgesia was 4.8 ± 1.6 versus 1.9 ± 0.8 hours. Rescue opioid administration occurred in 36% versus 68%, and postoperative nausea or vomiting in 12% versus 32%. Urinary retention occurred in 16% versus 4%. Hospital stay averaged 4.6 ± 1.3 versus 5.2 ± 1.6 days. Conclusion: The study indicates lower early pain scores and less opioid administration with spinal anesthesia, alongside more hypotension and urinary retention.

Background: Hip fracture surgery in elderly patients requires anaesthetic care that addresses physiological vulnerability, procedural difficulty, and postoperative recovery. Objectives: To describe perioperative outcomes and common challenges associated with spinal anaesthesia in elderly patients undergoing hip fracture surgery. Methods: The study describes an observational study framework for 50 patients aged 65 years or older at RVM Institute of Medical Sciences and Research Center, Laxmakkapally, Mulugu, Siddipet, Telangana, India, between March and August 2026. Baseline characteristics, block adequacy, intraoperative events, procedural challenges, and postoperative outcomes are summarised descriptively. Results: Mean age was 76.4 ± 7.2 years; 28 patients (56%) were women. ASA physical status III accounted for 31 patients (62%). Spinal anaesthesia was adequate without conversion in 48 patients (96%); two (4%) required general anaesthesia. Hypotension occurred in 18 patients (36%), vasopressor administration in 16 (32%), and bradycardia in six (12%). Positioning pain affected 21 patients (42%); landmark identification was difficult in 14 (28%). Postoperative delirium occurred in seven patients (14%), urinary retention in five (10%), and respiratory complications in four (8%). Thirty-five patients (70%) mobilised within 48 hours. Median hospital stay was 6 days (interquartile range, 5–8); in-hospital mortality was 2%. Conclusion: Positioning pain and haemodynamic instability emerge as prominent care priorities in the reported summaries.

Background: Objective: To assess the clinical & functional outcome of fractures of distal end of radius managed with conservative & surgical management. Methods: The present study is an analytical study of 30 Patients with distal end radius fractures. 15 were treated with conservative management, 15 with surgical management. Out of 15 cases treated surgically, 3 were managed by K-wire, 3 with External fixator & 9 with Plating from August 2025 to September 2026 in Department of Orthopaedics, Government General Hospital, Government Medical College, Paderu. Result: In our series of 30 patients, 17 were male & 13 female. Most of the patients were between 20-30 yrs. (minimum 20, maximum 80 & mean 40.35 years). Most commonly the mode of injury, wrist involvement & fracture type were self fall (50%), Left side (60%) & Frykmans III (63%) respectively. Excellent results were seen in 60% in surgical group & 40% in conservative group. Conclusion: Conservative management is better in managing minimally displaced fractures of the distal end radius whereas Surgical management is better in the treatment of minimal/highly comminuted, displaced fractures of distal end of radius with intra-articular extension.

Background: Social media has become an important source of health information for adults; however, it also facilitates the rapid spread of inaccurate and misleading health content. Exposure to health misinformation may influence treatment choices, self-medication, healthcare-seeking behavior, vaccination decisions, and use of unverified remedies. This study assessed the association between health misinformation on social media and healthcare decision-making among adults. Materials and Methods A community-based cross-sectional study was conducted over a period of three months in the urban field practice area of Katuri Medical College and Hospital. A total of 350 adults aged 18 years and above who used at least one social media platform were included. Data were collected using a structured interviewer-administered questionnaire assessing sociodemographic characteristics, social media use, exposure to health misinformation, verification practices, trust in information sources, and healthcare-related decisions. Associations were examined using appropriate statistical tests, and multivariable binary logistic regression was used to identify independent predictors of healthcare decision-making influenced by social media. A p-value <0.05 was considered statistically significant. Results Among 350 participants, 79.7% reported exposure to health misinformation on social media, while 48.3% reported that social media health information had influenced at least one healthcare-related decision. Moderate and high misinformation exposure were observed in 41.4% and 33.7% of participants, respectively. The proportion reporting influenced healthcare decisions increased from 25.3% among participants with low exposure to 47.6% with moderate exposure and 66.1% with high exposure (p<0.001). Conclusion Exposure to health misinformation on social media was common and was significantly associated with healthcare decision-making among adults. Greater misinformation exposure was associated with progressively higher likelihood of altered healthcare decisions

Background: Lymph node yield (LNY) and lymph node ratio (LNR) are increasingly recognized as potential prognostic factors in oral cavity squamous cell carcinoma (OCSCC). Their prognostic significance in clinically node-negative patients undergoing elective neck dissection remains incompletely defined. Aims and Objectives: To evaluate the association of LNY and LNR with overall survival (OS) in patients with clinically and radiologically node-negative OCSCC undergoing elective neck dissection. Methodology: This retrospective cohort study included 250 consecutive patients with cN0/rN0 OCSCC treated with curative-intent primary tumor resection and elective neck dissection between January 2022 and January 2026. LNY was defined as the total number of lymph nodes examined and categorized as <18 or ≥18 nodes. LNR was calculated as the number of metastatic lymph nodes divided by the total number examined. Survival was assessed using Kaplan-Meier analysis and the log-rank test. Cox regression was used to evaluate prognostic associations. Results: The median LNY was 20 nodes, with 104 (41.6%) patients having <18 and 146 (58.4%) having ≥18 nodes. Occult nodal metastases were identified in 78 (31.2%) patients, and ENE was present in 26 (10.4%). Five-year OS was 67.41% for LNY <18 versus 72.73% for ≥18 (p=0.234). In contrast, 5-year OS was 89.92% versus 55.67% according to LNR category (p=0.004). Conclusions: LNY ≥18 was not significantly associated with OS, whereas LNR demonstrated a significant association with survival. LNR may provide useful prognostic information in clinically node-negative OCSCC undergoing elective neck dissection.

Background: Ketoacidosis is a clinically important cause of high-anion-gap metabolic acidosis in the Emergency Department. Diabetic ketoacidosis (DKA) is common, whereas starvation ketoacidosis (SKA) is less frequently recognized and can present with substantial ketonaemia despite normal or near-normal glucose concentrations. Objectives: To compare the clinical presentation, precipitating factors, biochemical profile, and severity of acidosis in patients with DKA and SKA presenting to an Emergency Department. Methods: This prospective observational comparative study was conducted in the Emergency Department of Manipal Hospital, Varthur Road, Bengaluru, Karnataka, India, from February to June 2026. Adults with biochemically confirmed ketoacidosis were consecutively evaluated. Clinical features, precipitating factors, glucose, glycated haemoglobin, blood pH, bicarbonate, anion gap, β-hydroxybutyrate, electrolytes, renal indices, lactate, and calculated serum osmolality were recorded. Between-group comparisons were performed using appropriate parametric or categorical tests. Results: Of 108 patients assessed, 100 were analysed: 70 with DKA and 30 with SKA. Mean age was 42.6 ± 15.8 years and 56.0% were male. Polyuria/polydipsia was more frequent in DKA, whereas generalized weakness was more frequent in SKA. DKA showed higher glucose (392.6 ± 118.4 vs 87.9 ± 21.6 mg/dL), HbA1c (10.3 ± 2.1% vs 5.4 ± 0.5%), anion gap (24.8 ± 5.7 vs 20.5 ± 4.4 mmol/L), and β-hydroxybutyrate (5.7 ± 1.8 vs 4.3 ± 1.5 mmol/L), with lower pH and bicarbonate. Moderate-to-severe acidosis occurred in 72.9% of DKA and 40.0% of SKA patients. Conclusion: DKA and SKA share overlapping symptoms but demonstrate distinct glycaemic and acid-base profiles. Simultaneous assessment of glucose, β-hydroxybutyrate, pH, bicarbonate, anion gap, and dietary history can support early differentiation in emergency care.