Current Issue

Background: Lymphadenopathy has varied causes, from reactive to malignant. Fine-Needle Aspiration Cytology (FNAC) is a rapid, minimally invasive, cost-effective diagnostic tool. The Sydney System (2019) standardises lymph node cytology, enhancing consistency. This study assesses its applicability, accuracy, and diagnostic performance in a tertiary center. Materials and Methods: A prospective observational study was carried out in the Pathology Department at a tertiary care rural hospital in Maharashtra from May 2024 to April 2025. All lymph node FNAC cases received during this period were included. Clinical details were systematically recorded, and smears were categorized using the Sydney System for Lymph Node Cytology. Based on available follow-up, histopathological correlation and Risk of Malignancy (ROM) were determined. Data were compiled in Microsoft Excel and analyzed descriptively. Results: Patient ages ranged from 6-months to 94-years (mean 32.6-years), with a slight female predominance (M:F = 0.98). Among 208 cases, 53% involved cervical nodes, and 85.1% were classified as L2 (Benign). L5 (Malignant) and L4 (Suspicious) accounted for 5.3% and 4.8%, respectively, while L1 and L3 each comprised 2.4%. Histopathological follow-up (24 cases) showed ROM values of L2 7.7%, L3 50%, L4 100%, and L5 100%. Using expanded criteria, FNAC sensitivity, specificity, PPV, NPV, and accuracy were 91%, 92%, 91%, 92%, and 91.7%. With strict criteria, sensitivity was 83%, specificity 100%, PPV 100%, NPV 92%, and accuracy 94.4%. Conclusion: The study validates Sydney System’s utility for lymph node cytology, showing predominantly benign cases, common cervical involvement, and high diagnostic accuracy with sensitivity (>80%) and specificity (>90%). Keywords: Fine Needle Aspiration Cytology (FNAC), Lymphadenopathy, Sydney System, Lymph Node Cytology, Risk of Malignancy (ROM).

Atypical pneumonia refers to forms of pneumonia not caused by typical pathogens like Streptococcus pneumoniae, and may present with non-classical symptoms. Haemolytic anaemia, a rare but serious complication, involves immune-mediated red blood cell destruction. We retrospectively reviewed five female patients admitted between December 2024 and February 2025 with confirmed atypical pneumonia and immune haemolytic anaemia. All patients presented with respiratory symptoms, anemia, and positive Direct Coombs Test (DCT), and were confirmed positive for Mycoplasma pneumoniae via lgM or urine antigen. Management included macrolides or fluoroquinolones, steroids, and blood transfusions where necessary. All patients showed clinical and radiological resolution. This series underscores the importance of early diagnosis and intervention in such complex clinical scenarios. Keywords: Hemolytic anemia, Atypical Pneumonia.

Background: Chronic obstructive pulmonary disease (COPD) is one of the top three causes of death worldwide. Since COPD is a chronic and progressive disease it produces health related problems as well as economic and social burden to patients and families. In these patients, exercise capacity, health- related quality of life and participation in daily activities are often impaired out of proportion to lung function impairment. Pulmonary rehabilitation is not frequently included in the integrated care of patients and is often inaccessible to patients. Aim: To assess the impact of pulmonary rehabilitation on exercise capacity (6 Minute Walk Test), lung function (FEV1) and quality of life in COPD. Materials and Methods: Sixty patients in the age group 40-80 years who were diagnosed with COPD as per GOLD guidelines were included in this study. Detailed evaluation was done. Pulmonary rehabilitation offered patient education, breathing exercises, chest physiotherapy, and exercise training. A 6MWT, Spirometry (FEV1), SGRQ, BORG dyspnoea scale was assessed initially and after 12 weeks of the programme. Results: Pulmonary rehabilitation program for 3 months was associated with statistically significant and clinically relevant improvement in physical performance. The mean improvement in 6MWT was 57 meters. Quality of life which was measured by the SGRQ score improved by more than 10 points while the BORG scale dropped significantly from 5.05 to 3.35. The mean FEV1 which was 62.43 at baseline, improved to 62.88 after pulmonary rehabilitation, but the result failed to achieve the desired level. Conclusion: This study clearly demonstrates that, pulmonary rehabilitation plays a definite role in the management of COPD patients. Outpatient based pulmonary rehabilitation resulted in significant improvement in exercise tolerance, dyspnea scale (BORG) and quality of life; although there was no significant improvement in lung function. Keywords: 6MWT, COPD, Pulmonary Rehabilitation, Quality of Life.

Background: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in the paediatric population. Owing to age-specific anatomical and physiological differences, children exhibit unique clinical presentations, injury patterns, and outcomes compared to adults. The objective is to study the clinical spectrum, radiological findings, and outcomes of traumatic brain injury in children. Materials and Methods: This hospital-based observational study was conducted in the Department of Paediatrics at a tertiary care teaching hospital. Children presenting with traumatic brain injury were evaluated for demographic profile, mechanism of injury, clinical features, Glasgow Coma Scale (GCS) at admission, radiological findings on CT scan, management, and outcome. Outcome was assessed using the Glasgow Outcome Scale at discharge. Results: A male predominance was observed. Falls were the most common mode of injury, particularly in younger children, while road traffic accidents were more common in older age groups. Vomiting, altered sensorium, and seizures were frequent presenting symptoms. On CT imaging, extradural hematoma, subdural hematoma, subarachnoid hemorrhage, cerebral edema, and skull fractures were commonly identified. Most patients were managed conservatively, while a minority required surgical intervention. Favorable outcomes were seen in the majority of cases. Poor outcomes were significantly associated with severe GCS scores and diffuse cerebral edema. Conclusion: Paediatric TBI demonstrates a wide clinical and radiological spectrum. Early diagnosis, prompt neuroimaging, and appropriate management result in good outcomes in most children. Preventive strategies focusing on fall prevention and road safety are essential to reduce the burden of paediatric TBI. Keywords: Traumatic brain injury, Paediatric head injury, Computed tomography, Glasgow Coma Scale, Outcome.

Background: Dry Eye Disease (DED) is a prevalent ocular surface disorder characterized by tear film instability, hyperosmolarity, neurosensory dysfunction and inflammatory changes, significantly affecting visual performance and quality of life. Its burden is increasing globally, driven by aging demographics, digital screen exposure, lifestyle factors, environmental pollution and systemic comorbidities. The aim is to determine the prevalence, severity, associated risk factors and treatment response of dry eye disease in a tertiary care hospital using TFOS DEWS II diagnostic criteria. Materials and Methods: A prospective observational study was conducted on 100 patients aged ≥18 years presenting with symptoms suggestive of DED. Clinical evaluation included Schirmer’s test, Fluorescein Tear Break-Up Time (TBUT), Rose Bengal staining, Lissamine green staining and tear meniscus height assessment. Environmental exposure, systemic disease history and lifestyle factors were recorded. Patients diagnosed with DED received lubricating eye drops and were re-evaluated after four weeks. Statistical analysis included Chi-square test, paired t-test and logistic regression; p<0.05 was considered significant. Results: The prevalence of DED was 23.68%, with higher occurrence among individuals >60 years and those reporting prolonged screen exposure, outdoor occupation, smoking, and use of air-conditioning. Diabetes mellitus showed a notable association with DED. TBUT <10 seconds was observed in 72.2% of affected individuals, indicating evaporative dry eye as the predominant subtype, whereas Schirmer’s test <10 mm was present in 38.9%, suggesting mixed pathology. Post-treatment follow-up demonstrated statistically significant improvement across all diagnostic parameters (p<0.001), including tear film stability and ocular surface staining scores. Conclusion: Dry eye disease is a common clinical entity with multifactorial etiology influenced by demographic, environmental, systemic, and lifestyle-related factors. The predominance of evaporative dry eye underscores the increasing role of digital screen exposure and environmental stressors. Early identification and targeted management significantly improve clinical outcomes. Keywords: Dry Eye Disease; TFOS DEWS II; Tear Film Instability; Meibomian Gland Dysfunction; Epidemiology; Digital Screen Exposure; Schirmer’s Test; Tear Break-Up Time; Ocular Surface Disease; Risk Factors.

Background: Spatial transcriptomics (ST) is a molecular technique that helps in gene expression mapping within intact tissue. Among the various approaches, Multiplexed Error-Robust Fluorescence in Situ Hybridization (MERFISH) is built on the power of single molecule RNA Fluorescent in situ hybridization which detect individual RNA molecules with high accuracy and sort out thousands of genes at once. Although the technique has been widely adopted across neuroscience, oncology, and developmental biology, its role in spatial transcriptomics is still limited. Objectives: This meta-analysis aims to evaluate its applications, accuracy, reproducibility and its comparison with other spatial transcriptomics. We also illustrated how MERFISH integrates with other multi- omics platforms and its role in biomedical research. Material and Methods: Systematic searches carried out across PubMed, Scopus, Web of Science and EMBASE (2014–2025). Data reporting of MERFISH based spatial transcriptomics carried out with either quantitative or qualitative outcomes. For data extraction PRISMA guidelines are followed. Quantitative analysis was performed on reproducibility measures, gene detection efficiency and spatial resolution while for qualitative synthesis we examined functional and clinical insights from the included studies. Results: Thirty-four studies (N = 34) met the inclusion criteria covering neuroscience, oncology, developmental biology, and pathology. Across these studies, MERFISH achieved >95% molecular detection accuracy and subcellular spatial precision. On comparing with other techniques like seqFISH+ and Slide-seqV2, MERFISH showed superior spatial resolution (50–100 nm) and maintained a strong multiplexing capacity (>10,000 genes). MERFISH integration with single-cell RNA-seq enhanced tissue-level transcriptome reconstruction and cell-type classification. Conclusions: MERFISH emerges as a highly reliable, high-throughput and advanced spatial transcriptomics platform with significant translational potential. Integrating MERFISH with computational modelling and multimodal imaging is expected to expand diagnostics, developmental biology and disease mapping applications. Keywords: MERFISH, spatial transcriptomics, single-cell analysis, multiplexed imaging, gene expression, tissue mapping.

Background: The significance of encouraging the adoption of less expensive generic substitutes for name-brand medications is highly contested. Although generic medications have been shown to be just as effective at treating ailments as brand name medications, there has been much discussion about their bioavailability, or the amount of the medication that reaches its site of action. As assumed in this analysis, many specialists still think that brand-name and generic medications are equally feasible and bioequivalent options for successful pharmacological therapy. Material and Methods: The costs of several branded and generic medications were contrasted. Forty widely used medications from several classifications that are available in both branded and generic variants with the same concentration, dosage form, and combination. Results: Out of the 40 medications chosen, the average cost of 37 branded medications was more than that of their generic counterparts. Three generic medications were more expensive on average than branded ones. The mean cost difference between branded and generic medications ranged from less than 10% to more than 72%. Conclusion: The majority of branded medications were much more expensive than generic ones, and prescribing branded medications was linked to patients not completing their therapy as directed by their physician. Keywords: Branded drugs, Cost-analysis, Generic drugs, Mean costs and Pharmacoeconomics.

Background: Sepsis remains one of the leading causes of mortality in the intensive care units (ICUS) worldwide, despite advances in antimicrobial therapy and critical care management. The wide range of clinical manifestations and prognosis emphasizes the need to identify helpful and affordable prognostic biomarkers. Beyond transport into lipid, the high-density lipoprotein cholesterol (HDL-C) possesses anti-inflammatory, anti-oxidant and endotoxin-inactivating qualities, which can lead to evident interest in foretelling sepsis. The objective was to determine the association between serum HDL cholesterol levels and the disease severity, organ dysfunction, and the clinical outcomes in patients with sepsis Materials and Methods: This was a prospective observational study done for 12 months in the wards and intensive care units of General Medicine of a tertiary care teaching hospital in Central Kerala. The participants were adults (>18 years) and satisfying the Sepsis-3 criteria (SOFA score>2). The serum HDL-C levels were measured on Day 1 (24 hrs of admission) and Day 5. The clinical outcomes like mortality rate in the hospitals, mechanical ventilation, inotropic support, renal replacement therapy (RRT), and days of stay in the ICUs were recorded. Statistical analysis included student t -test, Chi-square test, Pearson correlation and receiver operating characteristic (ROC) curve. Results:194 patients with sepsis were included with mean age 58.6 ±11.6 years. The result showed significant difference between non-survivors and survivors at the time of admission in the mean value of HDL-C level (27.52 ± 3.53 mg/dL versus 41.47±7.65mg/dl respectively; p < 0.001). On Day 5, HDL-C levels in non-survivors decreased to 16.27±5.26mg/dL whilst the level increased in survivors 47.92± 6.13mg/dL. The HDL-C and SOFA scores at the admission (r = -0.67) and at Day 5 (r = -0.76) had a significant negative correlation between them. An HDL-C cut off value of 29.5mg/dL was identified to relate survival with sensitivity of 95.5% and specificity of 80% (AUC =0.965). Conclusion: Lower serum HDL-C has a strong relationship with critical sepsis, organ support, prolonged ICU stay and in-hospital mortality. The HDL-C is a free and readily available clinical useful prognostic biomarker of sepsis. Keywords: Sepsis; HDL cholesterol; Prognostic biomarker; SOFA score; Critical care.

Background: Proximal tibial articular fractures can be caused by auto accidents and injuries from bumper collisions. The fracture patterns are very complex and may involve medial, lateral, or both the tibial plateaus. Complications include joint stiffness, compartment syndrome, malunion, skin loss, osteomyelitis, and possible amputation. The Ilizarov external fixator helps in minimizing these complications by allowing early mobilization and weight bearing, minimal soft tissue injury and blood loss along with a stable fixation. The aim of this study to assess the outcome of Schatzker type 5 and type 6 tibial plateau fractures treated with Ilizarov external fixator in terms of functional and radiological outcome. Materials and Methods: This is a hospital based prospective study done on 25 patients who were diagnosed with Schatzker type V or VI tibial plateau fractures, aged 18 to 75 years, of both sexes in orthopaedic department in JLN Medical College, Ajmer, Rajasthan, India during one-year period. They were counselled for circular Ilizarov ring fixator method of treatment after explaining the benefits and limitations of the procedure. Radiological assessment criteria were done using Rasmussen radiological scoring system and functional outcome assessment was done using the Rasmussen clinical score and Lysholm knee score. Results: Out of the 25 patients, 22 were male and 3 were female. Mean age of incidence was 42.3 years with a range of 18 to 75 years. All patients had high velocity injury in form of road traffic accidents or fall from height. Duration of hospital stay was from 1 to 27 days with an average of 8.3 days. Of the 25 cases 22 were close injuries, 3 were open. 16 patients had Schatzker type V injury and 9 patients were having type VI injury. Average duration of frame application was 118 days with a range of 75 days to 160 days. Based on clinical rasmussen scores and functional score more than 80 % of patients had that were excellent or good results. 60% patients had early weight bearing permitted due to circular fixator stability followed by 20% patients had permitted partial weight bearing within 1–2 weeks. Conclusion: We concluded primary external fixation by Ilizariov ring fixator in Schatzker type V and VI fractures of proximal tibia is a safe and effective method. It can be done in same surgical sitting thus avoiding staged procedures as in other methods. Keywords: Knee Joint, Schatzker Type 5 And Type 6, Tibial Plateau Fractures, Ilizarov External Fixator, Functional Outcome, Radiological Outcome.

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by persistent hyperglycemia, insulin resistance, and progressive metabolic derangements. Increasing evidence suggests that oxidative stress plays a pivotal role in the pathogenesis of insulin resistance and the development of diabetic complications. Glucose-6-phosphate dehydrogenase (G6PD), a key enzyme of the pentose phosphate pathway, is essential for maintaining cellular redox balance through the generation of NADPH. Reduced G6PD activity may impair antioxidant defenses and exacerbate oxidative stress, thereby contributing to worsening insulin resistance and poor glycemic control in patients with T2DM. the aim is to analyse and correlate Oxidative Stress and Insulin Resistance with G6PD Activity in Type 2 Diabetics. Materials and Methods: This hospital-based analytical cross-sectional study included 96 adult patients with confirmed T2DM. Detailed clinical evaluation and anthropometric measurements were performed. Fasting venous blood samples were collected for estimation of fasting plasma glucose, HbA1c, lipid profile, serum insulin, oxidative stress markers [malondialdehyde (MDA), superoxide dismutase (SOD), and reduced glutathione (GSH)], and erythrocyte G6PD activity. Insulin resistance was assessed using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Patients were categorized based on G6PD activity status. Results: The mean age of participants was 54.72 ± 8.91 years, with a male predominance (60.42%). Low G6PD activity was observed in 32.29% of patients. Individuals with low G6PD activity had significantly higher MDA levels and lower SOD and GSH levels, indicating increased oxidative stress. Fasting insulin levels, HOMA-IR, and HbA1c were also significantly higher in the low G6PD group compared to those with normal activity. G6PD activity showed a significant negative correlation with MDA, fasting insulin, HOMA-IR, and HbA1c, and a positive correlation with antioxidant markers. Conclusion: Reduced erythrocyte G6PD activity in T2DM patients is associated with enhanced oxidative stress, increased insulin resistance, and poorer glycemic control. These findings underscore the importance of redox imbalance in the metabolic dysregulation of T2DM and suggest that G6PD activity may serve as a useful biomarker for identifying high-risk patients. Keywords: Type 2 Diabetes Mellitus; Oxidative Stress; Insulin Resistance; Glucose-6-Phosphate Dehydrogenase; HOMA-IR.

Background: Student’s absenteeism is becoming a continuous and major problem in medical education despite mandatory attendance policies introduced by universities. Medical education truelydemands high attendance for good understanding and grasps over the subject. Anatomy teaching in medical education traditionally relies on didactic lectures supplemented by practical sessions, particularly cadaveric dissection. In recent years, declining class attendance and increased reliance on online learning resources, especially after the COVID-19 pandemic have raised concerns about their impact on academic performance. Evidence relating attendance to learning outcomes in preclinical subjects from eastern India remains limited. Objectives: (1) To determine the association between attendance in theoretical and practical anatomy classes and student assessment outcomes, and (2) to evaluate whether attendance in dissection practical classes is associated with better overall assessment performance. Material and Methods: A retrospective, cross-sectional observational study was conducted in the Department of Anatomy, RG Kar Medical College and Hospital, among first-year MBBS students of the 2023–24 batch (n = 250). Attendance records for theory and practical classes and marks obtained in three departmental examinations were collected. Pearson correlation analysis was used to assess the relationship between attendance and examination performance. Results: Mean theory attendance was 58.48% (±10.21), while mean practical attendance was 85.18% (±22.94). Theory attendance showed a significant positive correlation with theory examination scores (r = 0.471, p < .001). Practical attendance demonstrated a stronger correlation with practical examination scores (r = 0.634, p < .001) and was also significantly correlated with total examination performance (theory + practical) across all three semesters (r = 0.467–0.552, p < .001). Discussion: Regular class attendance, particularly in practical anatomy sessions, is strongly associated with improved academic performance among first-year medical students. Emphasizing consistent participation in both theory and practical classes may be an effective strategy to enhance learning outcomes in anatomy. Perhaps medical schools should offer as many unique quality resources as budgets allow, inform students of their availability and let students decide which learning methods work best for them individually, thus facilitating self-directed learning. Conclusion: Emphasizing consistent student participation may therefore be a simple yet effective strategy for enhancing academic success in anatomy among first-year medical students. Keywords: anatomy; medical education, class attendance, assessment, performance.

Background: Management of complex general surgical wounds remains a significant clinical challenge due to delayed healing and high complication rates. Negative-pressure wound therapy (NPWT) has emerged as an advanced wound care modality, but its comparative effectiveness against conventional drainage methods requires further evaluation. Aim: To compare the effectiveness of conventional drainage versus negative-pressure wound therapy in the management of complex general surgical wounds. Materials and Methods: This prospective comparative study included 120 patients with complex general surgical wounds admitted to a tertiary care hospital. Patients were divided into two equal groups: conventional drainage (n = 60) and NPWT (n = 60). Baseline demographic and wound characteristics were recorded. Outcomes assessed included time to healthy granulation tissue formation, wound size reduction, rate of complete wound closure, duration of hospital stay, wound-related complications, and requirement for secondary surgical interventions. Statistical analysis was performed using appropriate parametric and non-parametric tests, with a p-value <0.05 considered statistically significant. Results: Baseline characteristics were comparable between the two groups. NPWT resulted in significantly faster granulation tissue formation, greater reduction in wound size, and higher rates of complete wound closure compared to conventional drainage (p <0.05). Patients treated with NPWT had a significantly shorter hospital stay and lower incidence of wound infection, persistent discharge, and prolonged antibiotic use. The need for secondary surgical interventions was significantly reduced in the NPWT group, with a higher proportion of patients requiring no further procedures. Conclusion: Negative-pressure wound therapy is superior to conventional drainage in the management of complex general surgical wounds, leading to improved healing outcomes, reduced complications, shorter hospital stay, and fewer secondary surgical interventions. Keywords: Negative-pressure wound therapy; Conventional drainage; Complex surgical wounds.

Background: The Lichen planus is a chronic inflammatory and immune mediated disease. It generally affects skin, nails, hair, mucous membrane and appendages. It has many morphological presentations. It is usually affects the flexor surfaces of extremities. The aim is to study the clinicopathological study of Lichen Planus in tertiary care centre. Materials and Methods: This was a hospital based cross sectional study, conducted at the Department of Dermatology, Venereology and Leprosy in Dhanalakshmi Srinivasan Medical College and Hospital, Siruvachur, Perambalur, Tamil Nadu. The study was conducted from 1st May 2023 to 30th April 2024. Based on the inclusion and exclusion criteria the study participants were included and the final sample size was 40. Baseline characteristics like name, age were documented. Skin biopsy were taken. The data were entered in SPSS 23. P value <0.05 is considered statistically significant. Results: 21-30 years of the study participants 13 (32.5%) were most common. Male preponderance was observed 21(52.5%).The most common site involved is Lower Limb 22(55%). Classical LP 27(67.5%) was the most common variant found. Baseline characteristics were found to be not significant. Whereas Common sites of presentation and histopathology was were found to be statistically significant with age group. Conclusion: We may conclude that lower limb is the common site of LP. Classical LP is the most common variant. The most common histological finding is Hypergranulosis and Hyperkeratosis. Keywords: Lichen planus, hyperkeratosis, hypergranulosis, Chronic inflammatory, immune mediated.

Background: Alcoholic liver disease (ALD) is a major cause of morbidity and mortality, especially in chronic alcohol users. The study aimed to evaluate the clinical, biochemical, ultrasonographic, and histopathological features of ALD in patients admitted to a tertiary care hospital over one year. Materials and Methods: The study included 50 patients with alcoholic liver disease admitted between June 1997 and May 1998. A detailed history and clinical examination were supplemented with laboratory investigations, liver biopsy, ultrasonography, and oesophagogastroduodenoscopy (OGD) when necessary. Blood tests included liver function tests, serum bilirubin, and enzyme levels, while ultrasonography and histopathology were used to confirm the diagnosis of ALD. Results: The highest incidence of ALD was observed in the 31-40 years age group, with a male preponderance. Fatty liver was the most common lesion (38%), followed by cirrhosis (32%). The most frequent symptoms included loss of appetite, abdominal pain, and distension. Physical signs such as pallor and icterus were prevalent, and elevated serum bilirubin, SGOT, and SGPT were noted in the majority of patients. Histopathology confirmed fatty liver and cirrhosis in a significant number of cases, with ultrasonography being less reliable for definitive diagnosis. A considerable proportion of patients experienced complications such as ascites, hepatic encephalopathy, and variceal bleeding. Conclusion: This study highlights the high prevalence of alcoholic liver disease in chronic alcohol users, particularly those with prolonged alcohol consumption. Histopathology remains the gold standard for diagnosis, while clinical and biochemical tests play a crucial role in patient management. Early intervention is essential to prevent complications and improve prognosis. Keywords: Alcoholic Liver Disease, Fatty Liver, Cirrhosis, Histopathology, Ultrasonography

Background: Lipids play a crucial role in energy storage, cell membrane composition, and signaling. Key components of the serum lipid profile, such as total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and very low-density lipoprotein cholesterol (VLDL-C), are used to assess the risk of cardiovascular and metabolic diseases. Typically, lipid profiles are measured in fasting states, but non-fasting testing has emerged as an alternative for simplicity, especially for components other than triglycerides. This study aims to compare lipid levels in fasting versus non-fasting states and assess any significant differences. Materials and Methods: A cross-sectional observational study was conducted on 250 patients who visited the Dr. Babasaheb Ambedkar Memorial Central Railway Hospital in Mumbai, India, from October 2020 to May 2022. The study analyzed total cholesterol, triglycerides, HDL-C, LDL-C, and VLDL-C levels in both fasting and non-fasting samples. Results: The study showed that there were no significant differences in total cholesterol, HDL-C, LDL-C, or non-HDL-C levels between fasting and non-fasting samples. However, triglyceride levels were significantly higher in non-fasting samples (p<0.0001). The age group 41-50 years was the most prevalent, with a male-to-female ratio of 1.71:1. Conclusion: The findings suggest that non-fasting lipid profiles, except for triglycerides, can be used for assessing cardiovascular risk. This supports the current guidelines that recommend non-fasting lipid screening, except in cases of inherited hypertriglyceridemia. Keywords: Lipid Profile, Fasting, Non-Fasting, Cardiovascular Risk, Triglycerides

Background: Diabetic retinopathy (DR) is one of the most common microvascular complications of type 2 diabetes mellitus (T2DM) and continues to be a leading cause of preventable visual impairment worldwide. As retinal damage may develop before clinical recognition of diabetes, early screening at the time of diagnosis is essential for timely intervention. The aim is to determine the prevalence and severity of diabetic retinopathy among newly diagnosed patients with T2DM and to identify clinical predictors associated with its presence. Materials and Methods: A cross-sectional observational study was conducted among 120 newly diagnosed T2DM patients attending a tertiary care hospital. All participants underwent comprehensive ophthalmological examination including dilated fundus evaluation. Glycated haemoglobin (HbA1c) was recorded. DR was classified using the Early Treatment Diabetic Retinopathy Study (ETDRS) criteria. Statistical analysis included chi-square test, correlation analysis, and binary logistic regression. Results: The prevalence of DR in the study population was 12%. Mild NPDR constituted the largest subgroup (42.9%), followed by moderate NPDR (35.7%), severe NPDR (14.3%), and proliferative DR (7.1%). Mean HbA1c was significantly higher among patients with DR (8.54 ± 2.21) compared with those without retinopathy (7.12 ± 1.31) (p < 0.01). Increasing HbA1c levels and older age were significantly associated with presence and severity of DR. Logistic regression confirmed HbA1c (OR 2.37) and age (OR 1.09) as independent predictors. Conclusion: A notable proportion of individuals present with diabetic retinopathy at the time of first diagnosis of T2DM. Poor glycemic control and increasing age were major determinants. These findings highlight the importance of routine retinal screening at diagnosis and aggressive glycemic optimization to prevent early retinal microvascular complications. Keywords: Diabetic retinopathy; Type 2 diabetes mellitus; HbA1c; Non-proliferative diabetic retinopathy; Proliferative diabetic retinopathy; ETDRS classification; Screening; Risk factors.

Background: Nuclear medicine represents a critical medical specialty that exposes practitioners and medical students to significant radiation doses. This study aimed to assess the level of knowledge regarding appropriate use of nuclear medicine modalities and awareness of radiation protection among MBBS third professional part-II students and interns at a tertiary care teaching institute. Materials and Methods: A total of 401 participants, 196 third professional part-II students and 205 interns—were enrolled using convenience sampling in this cross-sectional study. The questionnaire assessed demographic characteristics, knowledge about nuclear medicine procedures, radiation protection awareness, and satisfaction with institutional radiation protection measures. Statistical analysis was performed using descriptive statistics and chi-square tests to examine associations between demographic variables and knowledge levels. Results: The overall prevalence of inadequate knowledge was 24.9% (n=100), moderate knowledge 29.2% (n=117), and adequate knowledge 45.9% (n=184). Interns demonstrated significantly higher awareness than third professional students (χ² = 148.586, p<0.001). Notably, 81.5% (n=327) of participants were unaware of how to use personal monitoring devices, and 70.7% (n=284) lacked knowledge about the types of personal monitoring devices. Regarding satisfaction with radiation protection measures, 40.1% (n=161) of participants expressed satisfaction, while 37.9% (n=152) reported dissatisfaction. Conclusion: This study reveals substantial gaps in knowledge regarding appropriate use of nuclear medicine modalities and radiation protection awareness among medical students and interns. Critical deficiencies exist particularly concerning personal monitoring devices, dose limits, and shielding materials. Keywords: Nuclear medicine; Radiation safety; Radiation protection; Medical education.

Background: Spontaneous reporting of adverse drug reactions (ADRs) constitutes the cornerstone of the pharmacovigilance program. However, underreporting by healthcare professionals remains a significant challenge. The objective is to evaluate the knowledge, attitude, and practice of pharmacovigilance among undergraduate medical students in relation to adverse drug reaction reporting and to compare findings across different academic years. Materials and Methods: A cross-sectional study was conducted at a tertiary care teaching institute in Haryana. A total of 772 undergraduate MBBS students participated, comprising 210 students from 1st Professional, 194 from 2nd Professional, 196 from 3rd Professional (Part-I), and 172 from 3rd Professional (Part-II). A validated questionnaire containing 21 questions was administered. Results: The mean knowledge score across all years ranged from 4.60 to 5.71 out of a maximum of 10. Mean attitude scores ranged from 4.37 to 5.19 out of 7. Mean practice scores ranged from 1.43 to 1.71 out of 4, with statistically significant differences observed (P=0.0319). Students demonstrated significantly better attitude scores compared to knowledge and practice. Second and 3rd Professional (Part-II) students showed superior knowledge scores regarding pharmacovigilance definition and mandatory reporting. Conclusion: Undergraduate medical students exhibited average knowledge and positive attitude toward pharmacovigilance but demonstrated poor practice regarding adverse drug reaction reporting. The findings underscore the critical need for integration of comprehensive pharmacovigilance training and ADR reporting skills into the undergraduate medical curriculum to enhance future physician participation in drug safety monitoring. Keywords: Pharmacovigilance, Adverse drug reactions, Undergraduate medical students, Drug safety.

Background: Subarachnoid block is a widely practiced regional anaesthesia technique for infraumbilical surgeries. Opioid adjuvants such as buprenorphine are commonly added to hyperbaric bupivacaine to enhance block quality and duration. However, premixing opioids with hyperbaric local anaesthetics may alter solution density and influence intrathecal drug spread. Objectives: To compare the efficacy and haemodynamic effects of premixed versus sequential intrathecal administration of buprenorphine as an adjuvant to hyperbaric bupivacaine, with respect to block characteristics and adverse effects. Materials and Methods: This prospective, randomized, double-blinded study included 105 ASA I–II patients aged 18–65 years undergoing infraumbilical surgeries under spinal anaesthesia. Patients were randomized into three groups (n=35 each): Group A received premixed hyperbaric bupivacaine with buprenorphine; Group B received buprenorphine followed by hyperbaric bupivacaine; Group C received hyperbaric bupivacaine followed by buprenorphine. Primary outcomes included onset of sensory and motor block, two-segment sensory regression time, and duration of motor block. Secondary outcomes were haemodynamic parameters and incidence of adverse effects. Statistical analysis was performed using one-way ANOVA and Chi-square test. Results: Sequential administration significantly hastened the onset of sensory and motor blockade, with Group C showing the fastest onset (p<0.001). Two-segment sensory regression time and duration of motor block were significantly prolonged in sequential groups compared to the premixed group (p<0.001). Haemodynamic parameters remained comparable among groups. The incidence of hypotension and bradycardia was significantly higher in the premixed group (p<0.05). Conclusion: Sequential intrathecal administration of buprenorphine and hyperbaric bupivacaine offers superior block characteristics with better haemodynamic stability and fewer adverse effects compared to premixed administration in infraumbilical surgeries. Keywords: Subarachnoid block; Intrathecal buprenorphine; Hyperbaric bupivacaine; Sequential administration; Premixed spinal anaesthesia; Infraumbilical surgery; Opioid adjuvant.

Background: Anaemia remains a major public health problem among adolescents worldwide, particularly in low and middle-income countries. Dietary habits, micronutrient intake, and meal patterns significantly influence anaemia risk. This study examines the correlation between anaemia and dietary habits among school-going adolescents in Kolar, Karnataka. The objective is to determine the prevalence of anaemia and assess its association with dietary behaviours among adolescents. Materials and Methods: A cross-sectional study was conducted among 300 adolescents selected using Simple random sampling. Haemoglobin estimation was done with Haemcue. Dietary habits were assessed using Food frequency questionnaire. Statistical analysis was done in SPSS Ver 22. Results: Anaemia prevalence was 36.3%. Low dietary diversity (OR 2.54), inadequate green leafy vegetable intake (OR 1.92), breakfast skipping (OR 2.08), and junk food consumption ≥3 times/week (OR 1.76) were significantly associated with anaemia. Logistic regression identified dietary diversity and GLV intake as independent predictors. Conclusion: Anaemia among adolescents in Kolar is significantly associated with modifiable dietary behaviours. School-based nutrition education and iron supplementation programs are essential to reduce prevalence and improve adolescent health outcomes. Keywords: Anaemia, Adolescents, Dietary habits, Nutrition, Public health.

Background: Coronavirus disease 2019 (COVID-19) has emerged as a major global health crisis and has been associated with a rise in secondary fungal infections, particularly in patients with uncontrolled diabetes and steroid exposure. These infections are difficult to diagnose and manage, often leading to increased morbidity and mortality. Early identification of disease patterns, laboratory abnormalities, and outcome predictors is essential to improve patient management. Objectives: To evaluate the demographic profile, clinical characteristics, histopathological and microbiological findings, management strategies, and outcomes of patients with fungal infections secondary to COVID-19, and to assess associations between diagnostic findings and clinical outcomes. Materials and Methods: This observational study included 413 patients presenting with fungal infections secondary to COVID-19 at a tertiary care centre between January 2021 and December 2022. Clinical details, laboratory investigations, histopathology, and KOH/culture results were analysed. Patients were classified as early or late fungal infections. Management modalities and outcomes were recorded. Statistical analysis was performed using IBM SPSS version 25, with p < 0.05 considered statistically significant. Results: The mean age was 49.8 ± 12.4 years, with a male predominance (72.4%). Late fungal infections constituted 97.8% of cases. Histopathological positivity was observed in 49.9%, while KOH/culture positivity was seen in 37.5%. Laboratory findings indicated systemic inflammation and poor glycaemic control. Combined medical and surgical management was required in 63.7% of patients. Overall survival was 94.7%. Histopathological positivity was significantly associated with mortality (p < 0.001), and KOH positivity was significantly associated with the need for combined management (p < 0.001). Conclusion: Fungal infections secondary to COVID-19 are associated with significant systemic inflammation and metabolic derangements. Histopathological and microbiological findings are important predictors of disease severity, management requirements, and outcomes. Early diagnosis and aggressive multidisciplinary management are crucial to reduce morbidity and mortality. Keywords: COVID-19; Secondary fungal infections; Mucormycosis; Histopathology; KOH mount; Diabetes mellitus; Systemic inflammation; Medical and surgical management; Patient outcomes.

Background: Nonalcoholic fatty liver disease (NAFLD) spans from simple steatosis to cirrhosis and hepatocellular carcinoma. While obesity is a major determinant, lean NAFLD is increasingly recognized in Asia, highlighting the need to reappraise BMI thresholds for early detection. Aims and Objectives: To compare correlations between non-invasive fibrosis indices and FibroScan-derived stiffness across lean and non-lean groups using World Health Organization (WHO) and Asia-Pacific (APAC) BMI criteria, determining the most appropriate framework for South Asian populations. Materials and Methods: A retrospective cross-sectional analysis of 493 patients at Jagannath Gupta Institute of Medical Sciences, Kolkata, was performed. Participants were classified by WHO (≤25 vs >25 kg/m²) and APAC (<23 vs ≥23 kg/m²) criteria. Biochemical variables included liver enzymes, lipids, HbA1c, and fibrosis indices (AST/ALT ratio, BARD, FIB-4, FIB-5, TyG). FibroScan quantified stiffness (F0–F4), analyzed by correlation and AUROC statistics. Results: FIB-4 showed the strongest correlation with stiffness (r = 0.34, p < 0.001; AUC ≈ 0.72 for APAC <23). BARD and FIB-5 showed moderate or inverse trends, while lipid indices and TyG had poor discrimination (AUC ≤ 0.55). Correlations strengthened with higher BMI. APAC criteria improved sensitivity for early fibrosis, WHO for specificity. Conclusion: FIB-4 is the most reliable non-invasive marker of ≥F2 fibrosis. Asia-Pacific BMI cut-offs (≥23 kg/m²) enhance early detection sensitivity, while WHO cut-offs favor specificity. A dual approach optimizes NAFLD risk stratification in Indian populations. Keywords: NAFLD, APAC, WHO.

Background: Chronic hyperglycaemia in diabetes mellitus leads to biochemical and structural alterations in red blood cells (RBCs), potentially influencing routine hematological indices. Understanding how RBC parameters reflect glycaemic control may provide additional, cost-effective tools for patient monitoring. The aim is to evaluate red blood cell parameters and their correlation with glycaemic indices in patients with diabetes mellitus. Materials and Methods: A comparative cross-sectional study was conducted among 200 diabetic patients, categorized into two groups: Group A (n=100) with good glycaemic control and Group B (n=100) with poor glycaemic control. Socio-demographic variables, anthropometric indices, and clinical parameters including HbA1c, fasting blood sugar (FBS), and postprandial blood sugar (PPBS) were recorded. RBC indices such as RBC count, hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and red cell distribution width (RDW) were compared between groups and correlated with glycaemic markers. Results: Patients with poor glycaemic control demonstrated significantly higher BMI (27.4 ± 3.6 kg/m²) and WHR (0.96 ± 0.05) compared to Group A. HbA1c, FBS, and PPBS were markedly elevated in Group B (all p<0.001). RBC parameters also differed significantly: Group B exhibited lower RBC count (4.38 ± 0.39 million/µL), Hb (12.6 ± 1.4 g/dL), and HCT (38.2 ± 4.3%), along with higher MCV (92.3 ± 6.0 fL), MCH (30.8 ± 2.1 pg), and RDW (15.4 ± 1.6%) (all p<0.001). Correlation analysis revealed strong associations between glycaemic indices and RBC parameters, particularly RDW and HbA1c. Conclusion: Poor glycaemic control is associated with significant alterations in red blood cell indices. Routine hematological parameters, especially RDW, may serve as valuable supplementary markers for assessing metabolic control and monitoring disease progression in diabetic patients. Keywords: Glycaemic index, correlation, RBC parameters, diabetes mellitus, tertiary care, comparative study.

Background: Infertility is a significant reproductive health concern that affects women not only physically but also emotionally and socially. Women undergoing infertility treatment often experience psychological stress due to prolonged treatment duration, uncertainty of outcomes, social expectations, and repeated treatment failures. Emotional well-being is an important yet frequently overlooked component of infertility care, particularly in tertiary care settings where treatment intensity and complexity are high. Understanding the emotional well-being of women undergoing infertility treatment and identifying associated factors is essential for providing comprehensive, patient-centered care. Aim: To assess the emotional well-being of women undergoing infertility treatment in a tertiary care hospital and to examine its association with selected socio-demographic and infertility-related factors. Materials and Methods: This hospital-based descriptive cross-sectional study was conducted among 102 women undergoing infertility evaluation or treatment at a tertiary care hospital. Participants were recruited using a consecutive sampling technique after obtaining informed consent. Data were collected using a structured proforma to record socio-demographic and clinical characteristics and the World Health Organization–Five Well-Being Index (WHO-5) to assess emotional well-being. WHO-5 scores were converted to percentage scores, with scores ≤50 indicating poor emotional well-being. Data were entered and analyzed using SPSS version 26.0. Descriptive statistics were used to summarize variables, and associations between emotional well-being and independent variables were analyzed using appropriate inferential tests. Results: The majority of participants were aged 26–30 years (35.29%) and had primary infertility (66.67%). Poor emotional well-being was observed in 59.80% of women, with a mean WHO-5 score of 48.62 ± 14.37. Poor emotional well-being was significantly more common among women aged above 30 years, those with lower educational status, homemakers, women with primary infertility, infertility duration exceeding five years, and those with a history of previous treatment failure (p < 0.05). These findings indicate that both socio-demographic and clinical factors contribute to reduced emotional well-being during infertility treatment. Conclusion: A high proportion of women undergoing infertility treatment experience poor emotional well-being. Routine screening for emotional well-being and integration of psychosocial support into infertility services are essential to improve holistic care and treatment experiences. Keywords: Infertility, Emotional well-being, WHO-5 Well-Being Index, Women’s mental health.

Background: Contact lenses are widely used for refractive correction and cosmetic purposes; however, improper handling and inadequate hygiene practices can lead to microbial contamination of contact lenses and their storage cases. Such contamination increases the risk of contact lens–related ocular infections, including microbial keratitis, which may result in serious visual morbidity. Hygiene education is a key preventive strategy, yet its measurable impact on bacterial growth among contact lens users in routine clinical settings requires further evaluation. Aim: To assess bacterial growth in contact lens users before and after hygiene education and to evaluate the effectiveness of structured hygiene education in reducing microbial contamination. Materials and Methods: This prospective observational study was conducted at a tertiary care hospital and included 110 contact lens users attending the ophthalmology outpatient department. Demographic data, contact lens usage patterns, and hygiene practices were recorded using a structured proforma. Samples were collected from contact lenses and lens storage cases under aseptic conditions and cultured on appropriate media for bacterial isolation and identification using standard microbiological techniques. Following baseline sample collection, all participants received structured hygiene education focusing on hand hygiene, lens cleaning and disinfection, proper storage case maintenance, and safe lens-wearing practices. Post-education samples were collected and processed using identical methods. Data were analyzed using SPSS version 26.0, and statistical significance was determined with a p-value <0.05. Results: Before hygiene education, bacterial growth was detected in 66 participants (60.00%), while 44 (40.00%) showed no growth. After hygiene education, bacterial growth significantly decreased to 28 participants (25.45%), with 82 (74.55%) showing no growth (p <0.001). Staphylococcus aureus was the most common isolate before education (25.45%), followed by coagulase-negative Staphylococci (16.36%) and Pseudomonas aeruginosa (10.91%). Significant reductions were observed in these isolates after education (p <0.05). Inadequate cleaning and improper storage case hygiene were strongly associated with bacterial growth prior to education (p <0.001). Conclusion: The study demonstrates that inadequate contact lens hygiene is associated with high rates of bacterial contamination. Structured hygiene education significantly reduces bacterial growth and pathogenic isolates among contact lens users. Incorporating regular hygiene counseling into routine ophthalmic practice may help prevent contact lens–related ocular infections. Keywords: Contact lens hygiene; Bacterial contamination; Hygiene education; Contact lens users; Microbial growth.

Background: Sepsis and septic shock remain leading causes of morbidity and mortality worldwide. The Sepsis-3 definitions emphasize organ dysfunction assessed by the Sequential Organ Failure Assessment (SOFA) score; however, its routine application is limited in resource-constrained settings. Serum lactate, a readily available biomarker, has been recognized as an independent predictor of adverse outcomes in sepsis, but its diagnostic and prognostic utility relative to established scoring systems remains uncertain. The objective is to evaluate the diagnostic and prognostic value of serum lactate levels in patients with sepsis and septic shock, compare its performance with SOFA, qSOFA, and SIRS criteria, and assess whether the addition of serum lactate to qSOFA improves clinical utility. Materials and Methods: This prospective observational study was conducted at a tertiary care hospital over 16 months and included 100 adult patients admitted with suspected sepsis or septic shock. Serum lactate levels were measured at admission, day 3, and day 7. SOFA, qSOFA, and SIRS scores were calculated concurrently. Patients were followed for 28-day outcomes. Diagnostic performance was assessed using sensitivity and specificity, prognostic accuracy using receiver operating characteristic curves, and survival using Kaplan–Meier analysis. Multivariable Cox regression was performed to identify independent predictors of mortality. Results: Elevated serum lactate levels (≥2 mmol/L) demonstrated moderate diagnostic performance for sepsis and high sensitivity for septic shock but were inferior to SOFA criteria. SOFA score showed superior prognostic accuracy for 28-day mortality and prolonged ICU stay. Elevated serum lactate at admission was independently associated with increased 28-day mortality (adjusted hazard ratio 2.01; p = 0.037). The modified qSOFA score showed improved diagnostic sensitivity compared with lactate alone but did not outperform SOFA. Conclusion: Serum lactate is a valuable prognostic marker in sepsis and septic shock but does not replace SOFA for diagnosis or risk stratification. Lactate measurement remains a useful adjunct, particularly in resource-limited settings. Keywords: Sepsis; Septic shock; Serum lactate; SOFA score; qSOFA; Prognosis.

Background: Femoroacetabular impingement (FAI) is a clinical syndrome characterized by abnormal contact between the femur and acetabulum, leading to force loading across the hip joint during extreme ranges of motion. FAI is a recognized pathogenic factor in the development of hip osteoarthritis. The impingement is secondary to anatomic abnormalities at the femoral head-neck junction or the acetabulum The alpha angle is a key radiological measurement used to quantify the concavity (head-neck offset) of the femoral head-neck junction extent of cam-type deformity. The present study aims to determine the prevalence of CAM type of Femoroacetabular impingement (FAI) in the South Indian population by measuring the alpha angle using MRI. Materials and Methods: A cross-sectional, observational study will be conducted on individuals undergoing MRI of the hip for non-traumatic indications. scans which were available in the Department of Radio-diagnosis, S. Nijalingappa Medical College and Hospital and Research Centre, Bagalkot. Parameters assessed are Alpha Angle in the CHECK (Cohort Hip and Cohort Knee), followed by angle determination using statistical shape modeling (SSM)software. Circle of best fit was defined by use of validated MATLAB (The MathWorks)-based software. Results: The Alpha angle measured in total of 50 individuals showed 44 individuals with normal morphology of Alpha angle less than 550 and 6 patients showed alpha angle more than 550 with CAM lesion of FAI. Conclusion: The alpha angle in measured individuals (50 cases) showed 88% with normal morphology and 12% showed CAM lesions of FAI. These findings highlight that while the prevalence of CAM lesions in this regional population is relatively low, population-specific data remains essential for early intervention to prevent progressive cartilage damage and early osteoarthritis. Keywords: Anthropometric analysis, CAM Lesion, Alpha angle, MRI scan.

Background: Cytologic examination of serous fluids is a minimally invasive and inexpensive procedure for diagnosing, staging and prognosis of malignancy. Further, evaluation of serous fluid specimens can determine the primary site of origin. The newly proposed International System for Reporting Serous Fluid Cytopathology (ISRSFC) aims to standardize reporting. The aim is to determine the prevalence of malignant changes in serous effusions and to classify the serous fluids cytologically into five categories using international system for reporting serous fluid cytology. Materials and Methods: This is a hospital based cross sectional study done over a period of 17 months between Aug 2022 and Dec 2023 in the department of pathology, in a tertiary care hospital, Chitradurga. The patients presenting with pleural, peritoneal and pericardial effusions were aspirated and samples were sent for cytological evaluation. The samples were stained wit H and E stain and were classified based on The International System for Reporting Serous Fluid Cytopathology (TIS)into 5 categories. Results: Total of 310 patients were included in the study, out of which 148 were females. Of all the samples 176(56.8%) were ascitic fluid and 134(43.2%) were pleural fluid samples. On cytological evaluation of all samples, 223(71.95%) were negative for malignancy, 32(10.3%) were AUS, 18(5.8%) were SFM and 37(11.95%) were malignant. Malignancy was dected more in ascitic fluid (13.6%) as compared to pleural fluid (9.7%). Malignancy was detected more in males than females. Conclusion: The proportion of malignant serous effusion is detected majority in male specially in ascitic fluid with prevalence being 11.95%. The International system for reporting serous fluid cytology will increase standardization and reproducibility in reporting. Keywords: Serous effusion; Malignancy; The International System for Reporting Serous Fluid Cytopathology; Atypia of Undetermined Significance; Suspicious for Malignancy.

Background: Women’s empowerment is increasingly recognized as a critical social determinant of maternal and child health, particularly in low- and middle-income countries. In India, community-based empowerment initiatives—often implemented through non-governmental organizations and Corporate Social Responsibility (CSR) programs—aim to enhance women’s autonomy, economic security, and health-seeking behavior. However, robust empirical evidence linking such interventions to measurable maternal and child health outcomes remains limited, especially across urban–rural contexts. Materials and Methods: A community-based mixed-methods study was conducted in selected urban and rural areas of Tamil Nadu where structured women’s empowerment programs had been operational for at least two years. Quantitative data were collected through a cross-sectional survey of 400 women aged 15–49 years with at least one child under five years of age. Maternal healthcare utilization, child immunization status, and child nutritional indicators were assessed. Multivariable logistic regression was used to examine associations between program participation and health outcomes. Qualitative data were obtained through in-depth interviews and thematically analysed to explore pathways linking empowerment and health behaviours. Results: Women participating in empowerment initiatives demonstrated significantly higher odds of completing recommended antenatal care visits (adjusted OR: 2.3; 95% CI: 1.6–3.4) and ensuring full immunization of their children (adjusted OR: 1.9; 95% CI: 1.2–3.0) compared to non-participants. Qualitative findings revealed enhanced decision-making autonomy, increased confidence in navigating health systems, and improved household-level prioritization of maternal and child health. Conclusion: Community-based women’s empowerment initiatives are positively associated with improved maternal and child health outcomes in both urban and rural settings. Integrating empowerment strategies within existing health systems and scaling them in underserved regions may accelerate progress toward health equity and Sustainable Development Goals related to gender equality and maternal and child health. Keywords: Women’s empowerment; Maternal health; Child health; Community-based interventions; Tamil Nadu; Health equity.

Background: Non-communicable diseases such as hypertension and type 2 diabetes mellitus are major contributors to morbidity and mortality in India. Although the burden of non-communicable diseases (NCDs) is well established in urban populations, there is a paucity of community-level evidence from rural populations. The objective is to assess the burden of hypertension and type 2 diabetes mellitus among adults in rural Bareilly district, Uttar Pradesh. Materials and Methods: A community-based cross-sectional epidemiological study was conducted among adults aged 18 years and above residing in villages adopted under the Family Adoption Programme. Blood pressure and random blood sugar were measured using standard protocols. Results: Of 2,826 adults screened, 567 (20.1%) had raised blood pressure and 395 (14.0%) had deranged random blood sugar levels. A high prevalence of adverse anthropometric indicators was also observed. Conclusion: The study highlights a substantial burden of hypertension and diabetes in rural Bareilly, underscoring the need for strengthened community-based screening and preventive strategies. Keywords: Hypertension, Type 2 Diabetes Mellitus.

Background: Radio frequency ablation in the therapy of choice for superficial and perforator venous reflux in the current era (RFA).Both RFA and venous stripping cause obliteration of the superficial venous system in the near term. Both groups show similar clinical improvement as indicated by CEAP and venous severity score. RFA on other hand is less painful than surgery. Patients who have undergone RFA are able to return to work sooner than those who have had surgery. The aim of the study was to compare the efficacy between conventional open surgery and RFA for varicose vein. Materials and Methods: The study was conducted in the Department of General Surgery, Government Coimbatore Medical College and Hospital, Coimbatore. It is a comparative study conducted during the year 2020-2021.Preoperative and postoperative details will be collected from the patients admitted for open surgeries and radio frequency ablation The collected data will be entered in the MS excel sheet Windows 10. The analysis was done using SPSS 23. Results: Most common age group in our study was 41-50 years22(37%).Male were predominant in our study 42(70%).Right side was commonly observed 32(53.33%).The post hospital infection , post hospital stay, intraoperative bleeding was found more in surgery group compared to RFA group and was found to be statistically significant. Postop ambulation was less than one day in RFA group study participants. Conclusion: In the modern period, endovenous radio frequency ablation has become the preferred alternative treatment for superficial and perforator venous reflux illness. In terms of morbidity and outcome the RFA not only outperforms standard vein stripping and perforator interruption but it also lowers the creation of neovascularization which is commonly blamed for higher recurrence rates after venous stripping. Keywords: Sapheno femoral junction, long saphenous vein, Radio frequency ablation, Sapheno popliteal vein,Chronic venous insufficiency.

Background: Concerns have been raised regarding possible effects of COVID-19 vaccination on menstrual health. This study aimed to evaluate menstrual cycle characteristics, symptom patterns, and systemic effects following vaccination in women of reproductive age. Materials and Methods: A cross-sectional observational study was conducted among 300 women aged 18–45 years who received at least one dose of a COVID-19 vaccine. Data on menstrual cycle regularity, cycle duration, duration of bleeding, perceived menstrual flow, dysmenorrhea, analgesic use, and interference with daily activities were collected and compared with self-reported pre-vaccination menstrual patterns. Descriptive and comparative analyses were performed. Results: Following vaccination, menstrual irregularity increased from 8.9% pre-vaccination to 16.2% post-vaccination. A shift toward longer cycle durations was observed, particularly cycles of 32–35 days and >35 days. Duration of menstrual bleeding and perceived menstrual blood flow showed minimal variation after vaccination. Increased menstrual pain was reported by 16.9% of participants, 13.6% required analgesics, and 14.2% reported interference with daily activities. The majority of women (86.8%) did not report systemic post-vaccination symptoms; among those who did, fever, headache, and fatigue were the most common. Conclusion: COVID-19 vaccination was associated with temporary alterations in menstrual regularity and cycle length, increased dysmenorrhea, higher analgesic use, and greater functional interference in a subset of women. Most systemic symptoms were mild and self-limiting. These findings support counseling women regarding possible transient menstrual changes following vaccination. Keywords: COVID-19; Vaccination; Menstrual cycle; Dysmenorrhea.

Background: Segmental variations in the width and thickness of knee menisci influence load distribution and are clinically significant in meniscal injury, repair, and reconstruction. The objective is to evaluate and compare the segmental width and thickness of the medial and lateral menisci at the anterior, middle, and posterior thirds in adult human cadavers. Materials and Methods: A cadaveric observational study was performed on 35 embalmed adult human cadavers, yielding 70 knee joints. Medial and lateral menisci were dissected and divided into anterior, middle, and posterior thirds. Segmental width and thickness were measured using a vernier caliper. Measurements were recorded separately for the right and left sides. Data were expressed as mean ± standard deviation, and side-wise comparisons were analysed using Welch’s unpaired t-test, with p < 0.05 considered statistically significant. Results: The medial meniscus showed progressive widening from anterior to posterior segments, with significantly greater posterior width on the left side (14.95 ± 4.66 mm) compared to the right (11.32 ± 3.87 mm; p < 0.01). Thickness of the medial meniscus was greater at the middle and posterior thirds, with a significant side-wise difference observed only at the anterior third (p = 0.03). The lateral meniscus demonstrated maximal thickness at the middle third bilaterally, while posterior thickness was significantly greater on the right side (5.98 ± 2.02 mm vs 4.66 ± 1.73 mm; p < 0.01). Segmental width of the lateral meniscus remained relatively uniform, with no statistically significant side-wise differences. Conclusion: Distinct segmental morphometric patterns were observed between medial and lateral menisci, reflecting their functional adaptations. These data provide clinically relevant anatomical benchmarks for imaging interpretation and meniscal surgical procedures. Keywords: Knee joint; Menisci; Morphometry; Cadaveric study; Width and thickness.

Background: Hypoxic-ischemic encephalopathy (HIE) in neonates is a major contributor to adverse outcomes, including death and long-term neurological impairment. Recent focus has shifted toward identifying biochemical markers that could aid in early severity assessment. This study evaluates whether serum uric acid (SUA), an oxidative stress-related metabolite, correlates with the clinical staging of HIE in term neonates. Materials and Methods: In this prospective study, 72 term neonates diagnosed with HIE were categorized into mild (n=22), moderate (n=29), and severe (n=21) stages based on the Sarnat classification. Blood samples were collected within 24 hours of birth to measure SUA concentrations. Statistical tools including ANOVA and Pearson correlation were used to assess group differences and relationships. Results: Mean SUA levels increased with disease severity: 4.2 ± 0.6 mg/dL in Stage I, 5.3 ± 0.7 mg/dL in Stage II, and 6.1 ± 0.8 mg/dL in Stage III (p<0.001). A strong positive correlation was found between SUA and HIE stage (r = 0.72, p<0.001). The receiver operating characteristic (ROC) curve analysis demonstrated robust predictive ability, with an AUC of 0.87 (95% CI: 0.78–0.95) for detecting severe HIE. Conclusion: Serum uric acid levels rise proportionately with HIE severity and may serve as a cost-effective, early marker for clinical assessment and triaging in term neonates presenting with encephalopathy. Keywords: Neonatal HIE, oxidative stress, serum uric acid, biomarker, neurological outcomes, ROC analysis.

Background: In parallel to the dawn of modern neonatal intensive care, the survival of the Neonate has greatly improved. Cranial ultrasound is the most available and easily repeatable imaging technique for the neonatal brain showing brain development and the most frequently occurring forms of cerebral injury in the preterms and terms. Modern machines, probes, a variety of acoustic windows and sequential scanning at optimal times giving high-quality images has increased with the recognition of more subtle patterns of injury and features suggestive of developmental, metabolic and infectious disorders. Objectives: To assess the importance of cranial ultrasound as an investigatory modality for neonates and to find out the morphology of various cerebral lesions and correlate clinically. Materials and Methods: An observational prospective clinical study conducted on 100 neonates at NICU, Department of Paediatrics, Siddhartha Medical College, Vijayawada. During February 2024 to February 2025. After obtaining Informed consent from the parents/guardian details were recorded in a pre-designed pretested, structured proforma. Detailed clinical examination and Cranial ultrasound was performed on 1st,3rd and on 7th post-natal day. If cranial ultrasonography revealed various findings, repeat neurosonogram were done to follow up sequelae if any. Results: On cranial ultrasound, 67% of neonates had abnormal findings. 18% of these had evidence of intracranial bleed, 6% hyperechogenic thalami, 2% definite HIE, 4% had cerebral edema. One preterm neonate on regular follow up developed findings suggestive of cystic periventricular leukomalacia. Two neonates on regular follow up CUS had developed cystic encephalomalacia with hydrocephalus. Interpretation and Conclusion: Cranial ultrasonography (CUS) is the best point of care neuroimaging method available for neonates. It is critical as an investigatory modality in NICU and effectively documents morphology of cerebral damage. Keywords: Cranial ultrasound; NICU; Thalamic hyperechogenecity; Intraventricular hemorrhage; HIE.

Background: Clinical examination has long served as an accessible means of initial anemia screening. Among these, pallor examination—especially of the conjunctiva, tongue, nail beds, and palm—remains widely practiced. However, inter-observer variability and subjective interpretation often reduce the reliability of these physical signs when used alone. The World Health Organization acknowledges palmar pallor as a reasonable screening feature but emphasizes its limited sensitivity and specificity when used as an isolated marker. The objective is to evaluate the accuracy of the Clinician’s Palmar Comparison Method as a rapid bedside screening tool for anemia, using laboratory-measured hemoglobin levels as the reference standard. Materials and Methods: Prospective, cross-sectional diagnostic accuracy study conducted in the Department of Paediatrics at KIMS, Narketpally, Nalgonda district of Telangana. The index test is the Clinician’s Palmar Comparison Method (palmar pallor grading by the clinician); the reference standard is haemoglobin measured on an automated haematology analyser blinded to the clinical assessment. Results: The largest proportion of participants (42%) belongs to the >15 years age group, indicating that older adolescents or adults form the major share of the study population. The mean Hb level measured clinically was 10.78 ± 1.97 g/dL, while the mean Hb level measured in the laboratory was 10.81 ± 1.88 g/dL (p>0.05). Conclusion: The findings of the present study demonstrate that the Clinician’s Palmar Comparison Method is a simple, rapid, and reliable bedside tool for the initial screening of anemia in paediatric patients. Keywords: Clinician’s Palmar Comparison Method, bedside screening tool, anemia, laboratory-measured hemoglobin.

Background: The COVID-19 pandemic forced a rapid transition to work-from-home (WFH) arrangements, significantly affecting employees in the IT sector. The objective is to assess the impact of WFH on well-being and work performance among IT professionals in Bangalore. Materials and Methods: A cross-sectional study was conducted among 115 IT professionals working in various software companies in Bangalore during the COVID-19 pandemic. Data were collected using a structured questionnaire assessing sociodemographic characteristics, physical and mental well-being, job stress, productivity, job satisfaction, and work–life balance. Descriptive statistics and chi-square tests were applied. Results: Among 115 participants, 68 (59.1%) were males and 47 (40.9%) females; mean age was 30.8 ± 4.9 years. Around 72% reported increased screen time, 56% reported new-onset musculoskeletal issues, and 64% experienced moderate–high stress levels. Productivity improved for 41%, remained unchanged for 33%, and decreased for 26%. Better work–life balance was associated with significantly higher productivity (p < 0.05). Mental well-being was negatively affected in 48% of respondents. Conclusion: WFH during COVID-19 had mixed effects: while productivity improved for some, many faced compromised well-being due to stress, ergonomic issues, and work–life imbalance. Supportive organizational policies and ergonomic interventions are recommended. Keywords: Work from home, IT professionals, COVID-19, well-being, productivity, Bangalore.

Background: Laparoscopic inguinal hernia repair using mesh has become a standard approach owing to reduced postoperative pain and faster recovery compared with open techniques. However, the necessity of routine mesh fixation during laparo-endoscopic repair remains controversial, as fixation may increase operative time, cost, and risk of chronic groin pain without clearly reducing recurrence. This study was designed to compare clinical outcomes of laparoscopic inguinal hernia repair performed with mesh fixation versus without mesh fixation at a tertiary care centre. Materials and Methods: A total of 108 patients with unilateral primary inguinal hernia were randomized into two groups: Group A (n=54) underwent laparoscopic repair with mesh fixation, and Group B (n=54) underwent repair without mesh fixation. All patients underwent standardized transabdominal preperitoneal (TAPP) repair using a polypropylene mesh. Patients were followed for 12 months. Primary outcomes included chronic postoperative groin pain and hernia recurrence. Secondary outcomes included operative time, postoperative pain scores, complications, length of hospital stay, and time to return to normal activities. Results: Baseline demographic and clinical characteristics were comparable between groups. Operative time and early postoperative pain scores were significantly higher in the mesh fixation group (p<0.05). The non-fixation group demonstrated shorter hospital stay and earlier return to normal activities. Chronic groin pain at 12 months was more frequent in Group A, while hernia recurrence rates were low and comparable between both groups, with no statistically significant difference. Conclusion: Laparoscopic inguinal hernia repair without mesh fixation is a safe and effective alternative to routine fixation in selected patients, offering comparable recurrence rates with reduced postoperative pain and faster recovery. Keywords: Laparoscopic inguinal hernia repair, Mesh fixation, non-fixation technique, Chronic groin pain, Hernia recurrence.

Background: Incisional hernia repair is associated with significant postoperative morbidity, prolonged recovery, and extended hospital stay. Enhanced Recovery After Surgery (ERAS) protocols aim to attenuate surgical stress and accelerate recovery through evidence-based, multimodal perioperative care. However, data evaluating ERAS in major incisional hernia repair remain limited, particularly from real-world clinical settings. This study was designed to assess the impact of an ERAS protocol on postoperative recovery, complications, and length of hospital stay in patients undergoing major incisional hernia repair. Materials and Methods: This ambidirectional observational study included 64 adult patients undergoing elective major incisional hernia repair at a tertiary care center. Thirty-two patients managed with conventional perioperative care formed the retrospective cohort, while 32 patients managed under a standardized ERAS protocol constituted the prospective cohort. Demographic variables, operative details, postoperative recovery parameters, complication rates, readmission, and early recurrence were analysed. Statistical comparisons were performed using appropriate parametric and non-parametric tests, with a p-value <0.05 considered significant. Results: Baseline demographic and clinical characteristics were comparable between the two groups. The ERAS group demonstrated significantly earlier oral intake (11.8±3.2 vs 28.6±6.4 hours), earlier ambulation (18.9±4.6 vs 36.4±8.1 hours), and lower postoperative pain scores at 24 hours (VAS 3.4±1.0 vs 5.6±1.2) compared to the conventional care group (p<0.001). The mean length of hospital stay was significantly reduced in the ERAS group (4.1±1.2 vs 7.2±1.8 days; p<0.001). Postoperative complication rates, readmission, and early recurrence were lower in the ERAS group but did not differ significantly. Conclusion: Implementation of an ERAS protocol in major incisional hernia repair significantly improves postoperative recovery and reduces hospital stay without increasing complications, supporting its safe and effective adoption in abdominal wall surgery. Keywords: Enhanced Recovery After Surgery, Incisional hernia, Abdominal wall reconstruction, Postoperative recovery, Duration of hospital stay.

Background: Post-operative delirium (POD) is a prevalent and significant neuropsychiatric consequence marked by disruptions in attention, cognition, and consciousness. New research shows that POD is caused by a complicated mix of neuroinflammation, oxidative stress, cholinergic dysfunction, and neurotransmitter imbalance. Anaesthetic techniques and agents may affect these pathways and modify the risk of postoperative delirium (POD). The current study sought to assess the incidence of postoperative delirium (POD), elucidate the underlying neuropsychiatric mechanisms, and compare its prevalence between patients undergoing inhalational versus intravenous anesthesia. Materials and Methods: A prospective observational research was performed involving 50 adult patients (ASA I–III) undergoing elective surgical operations under general anaesthesia. Patients were categorized according to anesthetic technique: Group I (inhalational agents) and Group II (complete intravenous anesthesia). The Mini-Mental State Examination (MMSE) was used to check the patient's cognitive condition before surgery. After the surgery, patients were tested for delirium using the Confusion Assessment Method (CAM) at 6, 24, and 48 hours. To investigate the underlying mechanisms, serum indicators of neuroinflammation (IL-6, TNF-α) and oxidative stress (MDA, SOD) were assessed both pre- and post-operatively. Statistical analysis of the data was conducted using chi-square and paired t-tests, with a significance level set at p < 0.05. Results: Out of fifty patients, ten (20%) experienced post-operative delirium. The inhalational group had a greater incidence (28% vs. 12% in the TIVA group). A significant rise in post-operative IL-6 and MDA levels and a decrease in SOD activity (p < 0.05) were observed in patients who developed POD, suggesting a role for neuroinflammation and oxidative stress. Decreased attention scores on CAM assessment were the result of cholinergic dysfunction. Delirium was more likely in patients who were older than 65 years old, whose surgeries lasted more than three hours, and who had inhalational anesthesia. After 48 hours, individuals who tested positive for delirium showed a little drop in MMSE scores, indicating that their cognitive impairment was temporary. Conclusion: Triggers for post-operative delirium include imbalances in neurotransmitters, oxidative stress, and activation of neuroinflammatory pathways. One factor is the method of anesthesia chosen; TIVA has a lower rate of POD than inhalational anesthesia. It is possible to decrease the occurrence of POD through early monitoring, optimization of the peri-operative neuroinflammatory response, and cautious selection of anaesthetics. Keywords: Post-operative delirium, neuroinflammation, oxidative stress, anaesthetic choice, TIVA, inhalational anaesthesia, cognitive dysfunction.

Background: Pediatric pneumonia is a common cause of morbidity, and chest X-ray remains the conventional imaging modality despite concerns regarding radiation exposure. Lung ultrasound has emerged as a promising alternative. The aim is to compare the diagnostic ability of lung ultrasound with chest X-ray in pediatric pneumonia and evaluate its potential as a radiation-free imaging modality. Materials and Methods: This prospective observational study included 90 pediatric patients with clinically suspected pneumonia. All patients underwent lung ultrasound and chest X-ray, and diagnostic performance parameters were analyzed. Results: Lung ultrasound demonstrated high sensitivity, specificity, and diagnostic accuracy for both lobar pneumonia and bronchopneumonia, comparable to chest X-ray findings. Conclusion: Lung ultrasound is a reliable and effective alternative to chest X-ray in pediatric pneumonia and can reduce unnecessary radiation exposure in children. Keywords: Pediatric pneumonia; Lung ultrasound; Chest X-ray; Radiation-free imaging.

Background: Drug utilization studies assess prescribing patterns and rational drug use for common pediatric infections, informing stewardship and quality‑improvement efforts. The aim is to prospectively evaluate prescribing patterns for upper and lower respiratory tract infections (URTI, LRTI) among pediatric inpatients and assess rationality of drug use. Materials and Methods: Prospective, 3‑month study at a tertiary care hospital. Seventy‑five patients were approached; 50 provided consent and were enrolled. Demographic and clinical data and prescription details were extracted from medical records. Descriptive analysis was performed; results are reported as percentages and means. Results: Of 50 enrolled children, 52% were male and 48% female; 54% were aged <1 year. URTI was the most frequent diagnosis. The modal prescription counts were 7 and 8 drugs (26% of prescriptions); mean total medications per patient was 7.56. Azithromycin was the most frequently prescribed antibiotic (76%). Nebulizer therapy was the most common supportive treatment (92%). For LRTI, ceftriaxone was prescribed in 39.13% of cases; for URTI, amoxicillin–clavulanic acid was used in 85.71% of cases. Other commonly used supportive agents included antacids and ondansetron. Conclusion: In this tertiary‑care pediatric cohort, antibiotic use and overall drug counts were substantial but judged rational within the institutional context. Continued stewardship, guideline adherence, and periodic prescription audits are recommended to sustain appropriate prescribing. Keywords: Prescribing pattern, antibiotic, supportive treatment, in- patient, paediatric.

Background: Cervical cancer is still one of the leading causes of health problems in India. It mostly affects women from rural areas and those who are socioeconomically disadvantaged. So, figuring out the risk factors that can be changed is a must if we want to be able to prevent the disease better and also detect it early. The objective is to identify socio-demographic, reproductive, behavioral, and hygienic risk factors associated with cervical cancer among women attending a tertiary care hospital in Shivamogga, Karnataka. Materials and Methods: A hospital, based casecontrol study was carried out among 150 women, of which 50 were histopathologically confirmed cervical cancer cases, and 100 were age, matched controls. Data were collected through face, to, face interviews using a semi, structured questionnaire that included socio, demographic details, reproductive history, personal habits, and hygienic practices. Statistical analysis was performed using SPSS version 24. Associations were assessed by Chi, square test, and independent risk factors were determined by logistic regression analysis. Statistical significance was considered at p < 0.05. Results: Most of the cases were aged from 41 to 50 years (57.3%). Lack of formal education, unemployment, tobacco, and alcohol consumption, higher parity (>3), and poor menstrual hygiene practices were significantly associated with cervical cancer (p < 0.05) as per the univariate analysis. Among the cases, 58% had no formal education, and 84% were unemployed. More than three children were born to 34% of the cases as against 16% of the controls and this was significantly associated with cervical cancer (OR = 2.70; 95% CI: 1.225.97). On multivariate logistic regression analysis, unemployment (AOR: 5.38; 95% CI: 1.5818.32), consumption of a mixed (predominantly non, vegetarian) diet (AOR: 13.37; 95% CI: 4.2242.33), and poor menstrual hygiene practices such as the use of cloth and improper drying methods (AOR: 4.69; 95% CI: 1.4415.24) were the factors that remained independently associated with cervical cancer. Conclusion: The research findings indicate that cervical cancer is largely affected by factors such as socioeconomic disadvantage, unhealthy lifestyle behaviors, as well as poor menstrual hygiene practices. To effectively alleviate the incidence of cervical cancer, the deployment of targeted health education, the promotion of hygienic menstrual practices, improvement of womens socioeconomic status, and the strengthening of screening programs are absolutely necessary, especially in the case of rural populations. Keywords: Cervical cancer, Risk factors, Socioeconomic status, Menstrual hygiene practices, Parity, Case–control study.

Background: Most upper respiratory tract infections (URTIs) in children are viral, yet antibiotics are often prescribed unnecessarily, contributing to rising antimicrobial resistance worldwide. Parental expectations, anxiety, and self-medication practices play a key role in inappropriate antibiotic use, while physician prescribing is often influenced by parental pressure. Materials and Methods: A cross-sectional study was conducted in four Primary Health Centres (PHCs) between January–May 2025, covering rural, semi-urban, and urban areas through geographic clustering. The study targeted parents aged 18–50 years with children attending PHCs. Using Raosoft calculator with 50% response distribution, 5% margin of error, and 95% CI, the required sample size was 377, increased to 400 to account for non-response. Convenience sampling was adopted for feasibility. Data were collected using a structured, self-administered questionnaire adapted from validated studies. Content validity was ensured by experts in paediatrics, infectious diseases, pharmacy, and biostatistics, and a pilot study (n=30) tested clarity. The final questionnaire included four sections: demographics, knowledge, attitudes, and practices regarding antibiotic use. Items assessed parental awareness, expectations, perceptions of antibiotic effectiveness, symptoms prompting consultation, and physician–parent communication regarding antibiotic prescriptions. Results: A total of 400 parents participated (response rate 100%), with a mean age of 34.6 ± 7.8 years; mothers comprised 62.5%. Participants were from rural (42%), semi-urban (33%), and urban (25%) areas. Education levels showed 28% with primary, 40% with secondary, and 32% with university or higher education; 46% reported low income, 38% moderate, and 16% high income. Health insurance was present in 72% of families, and 14% reported a child with chronic illness, mainly asthma. Knowledge levels were limited: 47% correctly identified ≥4 antibiotics, 62% knew they act on bacteria, but 58% wrongly thought they help viral infections; 69% were aware of side effects. Physicians (54%) were the main information source, followed by pharmacists (26%) and internet/social media (20%). Attitudes were suboptimal: 45% expected antibiotics for URTIs, 64% believed they hasten recovery, and 30% preferred supportive care. Practices included self-medication (28%), mostly due to urgency (41%) or financial/time constraints (32%). Overall, 42% had poor knowledge, 55% displayed inappropriate attitudes, and 30% reported inappropriate practices such as self-medication, pressuring doctors, or incomplete courses. Conclusion: This study demonstrates inadequate knowledge, inappropriate attitudes, and concerning practices regarding antibiotic use among parents. Strengthening parental education, enforcing prescription regulations, and enhancing physician–parent communication are critical steps toward promoting rational antibiotic use and reducing antimicrobial resistance. Keywords: Antibiotic misuse, Parental knowledge, Antimicrobial resistance.

Background: Breast cancer prognosis is shaped by hormone receptor expression and HER2/neu status, yet their survival impact is time-dependent and may be underestimated in cohorts with short follow-up and low event rates. This retrospective cohort of 350 patients from a tertiary centre characterized ER, PR, and HER2/neu distributions alongside demographics, tumour biology, treatments, and survival, and assessed associations with long-term survival status (>5 years) using standardized reporting elements for structured abstracts to ensure clarity, completeness, and stand-alone interpretability. Hormone receptor (ER/PR) and HER2/neu profiles guide systemic therapy and risk stratification, with ER/PR generally conferring late benefits via endocrine therapy and HER2-positive disease transformed by targeted agents; however, early-phase analyses can miss these effects without sufficient duration and events, underscoring the need for structured, outcome-focused abstracts. The objective is to evaluate the distribution of ER, PR, and HER2/neu status and their relationship with long-term survival (>5 years) while identifying clinical predictors of mortality during early follow-up using standardized abstract components to enhance interpretability and indexing. Materials and Methods: A retrospective cohort included breast cancer patients with documented ER/PR/HER2 and survival data; cases lacking definitive biomarker or survival information were excluded. Survival was categorized (>5 vs ≤5 years) and summarized with time-to-event metrics. Descriptive statistics profiled age, sex, laterality, stage, histology, grade, surgery, radiotherapy, distant metastases, contralateral disease, and mortality. Survival differences were tested using log-rank, and independent predictors were assessed with Cox regression, presented within a structured abstract format recommended for clinical oncology journals. Results: Among 350 patients, 47.1% were <45 years, 40.3% were 46–60, and 12.6% were >60; 98.9% were female. Disease was predominantly stage II–III, with 9.2% stage IV. Invasive ductal carcinoma comprised 92%, with Grade 3 tumours in 65.7%. ER was positive in 49.4% (171/346), PR in 42.2% (146/346), and HER2 in 26.0% (87/335), with 8.4% HER2 equivocal. Modified radical mastectomy was performed in 72%, and radiotherapy in 94%. Distant metastases occurred in 23.7%; contralateral involvement in 2%. Mortality was 3.4% (12/350) over a mean observed survival of 26.8 months (SE 0.34). Survival differed by age (log-rank χ²=6.52, p=0.038); hazard was higher for <45 versus 46–60 years (HR 4.2, 95% CI 1.2–14.1). ER, PR, and HER2 showed no significant early survival separation (log-rank p=0.58, 0.52, 0.91). Distant metastases strongly worsened outcomes (mean 17.3 vs 27.2 months; log-rank χ²=9.4, p=0.002; HR 4.96, 95% CI 1.08–21.9). In multivariable Cox analysis, independent predictors were age (older vs younger HR 0.16, 95% CI 0.03–0.72, p=0.017) and distant metastases (HR 5.72, 95% CI 1.84–17.85, p=0.003), while ER/PR/HER2 were not significant—findings consistent with guidance that structured abstracts emphasize primary results and major conclusions within word limits.

Background: The aim is to evaluate and compare the diagnostic accuracy, sensitivity, specificity, and clinical utility of different colposcopic scoring systems, in detecting cervical intraepithelial neoplasia and predicting lesion severity. Materials and Methods: A comprehensive systematic review and comparative analysis of colposcopic scoring systems was conducted. Data were extracted from prospective observational studies and clinical trials evaluating colposcopic scoring systems published between 2020 and 2025. The performance characteristics of Reid Index, Swedescore, Modified Reid Index, and Modified Swede Colposcopic Index were analyzed. Diagnostic accuracy parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC) were compared. Histopathological findings confirmed by cervical biopsies served as the gold standard. Results: The review found that litigation under the CPA is more frequent in private healthcare settings, with a high prevalence in surgical and obstetric specialties. Key causes of legal action include lack of informed consent, inadequate documentation, and poor communication. The CPA 2019 amendment introduced new challenges by increasing the scope of jurisdiction and expediting complaint procedures. Defensive medical practices, increased insurance claims, and institutional legal preparedness were also found to be evolving trends in response to rising litigation. Conclusion: Both Reid Index and Swedescore represent validated scoring systems with complementary strengths. Reid Index demonstrates superior specificity for high-grade lesions, while Swedescore provides better standardization and improved trainability. Integrated scoring systems combining morphological parameters, vascular patterns, and chemical staining characteristics offer superior diagnostic accuracy. Implementation of structured scoring systems reduces inter-observer variability and improves diagnostic consistency in colposcopy practice. Further prospective studies are warranted to establish standardized protocols for optimal lesion characterization and management strategies. Keywords: Colposcopy, Reid Index, Swedescore, Cervical intraepithelial neoplasia, Diagnostic accuracy, Scoring systems, HPV screening

Background: Multilevel lumbar degenerative disc disease is a frequent cause of chronic low back pain and disability, often requiring surgical fusion when conservative treatment fails. Transforaminal lumbar interbody fusion (TLIF) is a widely used posterior approach, while oblique lumbar interbody fusion (OLIF) has emerged as a minimally invasive alternative that may offer perioperative and radiological advantages. The objective is to compare the clinical and radiological outcomes of OLIF and TLIF in patients with multilevel lumbar degenerative disc disease. Materials and Methods: This prospective comparative study included 30 patients with multilevel lumbar degenerative disc disease, divided into OLIF (n = 15) and TLIF (n = 15) groups. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Radiological parameters included lumbar lordosis, sagittal vertical axis, anterior disc height, and posterior disc height. Operative variables such as blood loss, postoperative drainage, operative time, and hospital stay were analyzed. Results: Baseline characteristics were comparable between groups. OLIF demonstrated significantly lower intraoperative blood loss, reduced postoperative drainage, and shorter hospital stay compared to TLIF (p < 0.01), with comparable operative time. Both groups showed significant improvement in VAS and ODI scores, with no significant intergroup difference. OLIF achieved significantly greater improvement in lumbar lordosis and disc height parameters (p < 0.05), while sagittal vertical axis was similar between groups. Conclusion: Both OLIF and TLIF are effective for multilevel lumbar degenerative disc disease. OLIF offers superior perioperative recovery and radiological correction with comparable clinical outcomes. Keywords: Oblique lumbar interbody fusion; Transforaminal lumbar interbody fusion; Multilevel lumbar degenerative disc disease; Lumbar lordosis; Minimally invasive spine surgery.

Background: Donor human milk is a critical life-saving intervention for preterm and sick neonates when a mother’s own milk is unavailable or insufficient. Despite the establishment of human milk banks, breast milk donation remains underutilized, largely due to gaps in maternal knowledge, attitude, and practices. Objectives: To assess the knowledge, attitude, and practices (KAP) regarding breast milk donation among mothers of neonates admitted to the Special Newborn Care Unit (SNCU) and to identify factors associated with willingness to donate breast milk. Materials and Methods: A hospital-based cross-sectional study was conducted among mothers whose babies were admitted to the SNCU of a district hospital in Tonk, Rajasthan. Data were collected using a pre-tested, structured questionnaire covering socio-demographic variables and KAP domains related to breast milk donation. Data were analyzed using descriptive statistics and inferential tests. A p-value of <0.05 was considered statistically significant. Results: A total of 150 mothers participated in the study. Awareness that donated breast milk could be used for sick or preterm neonates was observed in 52% of mothers, while only 28% were aware of the existence of human milk banks. A positive attitude toward breast milk donation was noted in 64% of participants; however, actual donation practices were low, with only 12% having donated breast milk previously. Willingness to donate breast milk was significantly associated with higher educational status, multiparity, and prior counseling by healthcare workers (p<0.05). Conclusion: Although most mothers demonstrated a favorable attitude toward breast milk donation, significant gaps persist in knowledge and actual donation practices. Structured counseling and integration of milk donation education into routine SNCU care may enhance donor milk availability and utilization. Keywords: Breast milk donation; Human milk bank; Knowledge, attitude, practice; SNCU; Neonatal care.

Background: Hepatic encephalopathy is a serious complication of chronic liver disease and is defined as alteration in mental status and cognitive function occurring in the presence of liver failure. Impairment in body water homeostasis is a common feature of advanced cirrhosis. The inability to excrete an adequate amount of solute‐free water in the urine is due increased vasopressin release. High ferritin levels might be related to poor prognosis of the chronic inflammatory disease as well as liver cirrhosis since its secretion can also depend on certain cytokines that have several roles during inflammatory surges. Materials and Methods: A cross sectional study of 49 patients with HE admitted in during the period of study of 5 months, who meets diagnostic criteria will be included in the study conducted at Department of General Medicine at the teaching hospital of Sri Chamundeshwari Medical College and Research institute. Results: Amongst 49 patients, 26.5%(13) patients had serum sodium levels below 135 meq/l out of which 54.5%(6) patients were in Child B and 18.4%(7) patients in Child C. 73.5%(36) patients had serum sodium levels between 135-145 meq/l out of which 45.5%(5) patients belonged to Child B and 81.6%(31) belonged to Child C. p value was statistically significant between Child pugh score and serum sodium levels. Conclusion: In this study, it was found that there was a correlation between sodium levels and severity of hepatic encephalopathy whereas there was no correlation with serum ferritin levels and severity. In conclusion, serum sodium levels can be used to assess severity in patients with hepatic encephalopathy. Keywords: Hepatic encephalopathy, serum ferritin, serum sodium.

Background: Breastfeeding is a cornerstone of infant nutrition, offering numerous health benefits for both mothers and newborns. However, despite global recommendations, breastfeeding initiation and continuation rates remain suboptimal in many regions. Healthcare providers play a crucial role in influencing mothers’ decisions regarding breastfeeding. This study aims to assess the impact of healthcare professionals on breastfeeding initiation and continuation within the first three months postpartum. Materials and Methods: A prospective observational study was conducted from January 15, 2024, to June 15, 2024, in a Rural field practice area of Saraswati Medical College, Unnao. A total of 180 postpartum mothers were enrolled and categorized into two groups: those who received active breastfeeding counseling (intervention group, n=90) and those who received standard care (control group, n=90). Data were collected using structured questionnaires assessing breastfeeding knowledge, initiation rates within the first hour of birth, and continuation rates at three months. Statistical analysis was performed using SPSS software, with chi-square and t-tests applied for significance testing. Results: The breastfeeding initiation rate within the first hour was significantly higher in the intervention group (85%) compared to the control group (62%) (p<0.05). At the three-month follow-up, exclusive breastfeeding rates were 72% in the intervention group and 48% in the control group (p<0.01). Mothers who received counseling from healthcare providers reported higher confidence in breastfeeding and better problem-solving strategies for common lactation issues. Conclusion: Healthcare providers play a pivotal role in promoting and sustaining breastfeeding through targeted counseling and support. Early and consistent professional guidance significantly improves breastfeeding initiation and continuation rates. Implementing structured breastfeeding education programs in healthcare settings can enhance maternal confidence and breastfeeding outcomes. Keywords: Breastfeeding initiation, healthcare providers, exclusive breastfeeding, maternal counseling, infant nutrition, lactation support

Background: Occupational contact dermatitis is one of the most common work-related skin disorders, particularly among construction workers who are frequently exposed to chemical and physical irritants. Despite rapid infrastructural growth in India, region-specific data on occupational dermatitis among construction workers remain limited. The objective is to assess the prevalence of occupational dermatitis and identify associated occupational and behavioral risk factors among building construction workers in Kalaburagi, Karnataka. Materials and Methods: A cross-sectional study was conducted among 100 construction workers employed at various building and civil construction sites in Kalaburagi from May to July 2025. Data were collected using a structured questionnaire covering demographic details, occupational exposure, hygiene practices, PPE usage, and skin-related symptoms. Data were analyzed using Microsoft Excel and IBM SPSS version 22.0. Categorical variables were expressed as frequencies and percentages, and associations were assessed using the Chi-square test with a significance level of p<0.05. Results: The prevalence of occupational dermatitis was 34%. Higher prevalence was observed among painters (53.85%), welders (44.44%), and supervisors (41.67%). Younger workers (18–30 years), those with longer work experience, and males showed higher prevalence. Inconsistent use of PPE, inadequate hand hygiene practices, and prolonged exposure to irritants were significantly associated with dermatitis. Common symptoms included redness, itching, pain, blistering, and cracking, with hands and legs being the most commonly affected sites. Conclusion: Occupational dermatitis is a significant yet preventable occupational health problem among construction workers in Kalaburagi. Strengthening PPE compliance, improving hygiene facilities, and implementing regular occupational health surveillance are essential to reduce disease burden. Keywords: Occupational dermatitis; Construction workers; Contact dermatitis; Personal protective equipment; Occupational health; Kalaburagi.

Background: Sepsis and septic shock are the leading causes of death worldwide. Many studies were done to determine the prognostic utility of blood lactate and lactate clearance in predicting mortality. The significance of lactate clearance from 6 hours of resuscitation is already proven and has been used for treatment protocol. However, literature does not provide much information on the usefulness of lactate clearance beyond 6-hour period in predicting mortality and lactate clearance-guided therapy. Materials and Methods: This is a hospital-based, prospective observational study. The patient data of 125 patients with septic shock in the medical ICU were analysed. The hemogram (CBC), lactate (these levels were repeated every six hours), and routine examinations were done. The statistical software for the social science system, version SPSS 17.0, was used for statistical testing. Results: Out of 125 patients, there were 78 males and 47 females. 125 patients ranged from 18 to 80 years with a mean age of 60.49 years. Among patients with septic shock, 71 did not survive for 28 days, whereas only 54 patients survived. The association between % Lactate Clearance at 6 hours, 12hours, 18hours, 24hours, and 28-day mortality was found to be significant with P-value = <0.0001. Conclusion: The current study revealed that lactate clearance at 24 hours is helpful in predicting mortality in septic shock. The median lactate clearance value is used to identify clearers and non-clearers. Further studies are required to determine optimal cut-off values to guide the therapy. Keywords: Lactate clearance, Septic shock, Mortality rate.

Background: Objective: To evaluate the frequency and pattern of electrocardiographic (ECG) abnormalities in patients with different types of stroke and assess their association with stroke subtype. Materials and Methods: A cross-sectional observational study was conducted among 78 patients diagnosed with acute stroke at a tertiary care hospital from August 2024 to January 2025. Stroke was classified as ischaemic, haemorrhagic or transient ischaemic attack (TIA) based on neuroimaging. Standard 12-lead ECGs were analysed for abnormalities including left ventricular hypertrophy (LVH), ST-segment elevation, T-wave changes, QT prolongation and rhythm disturbances. Data were analysed using Microsoft Excel and GraphPad Prism. Comparisons across stroke subtypes were performed using Chi-square and Fisher’s exact tests, with p < 0.05 considered statistically significant. Results: Among the 78 patients, 70.5% had ischaemic stroke, 23.1% haemorrhagic stroke and 6.4% TIA. ECG abnormalities were present in 82% of cases, the most frequent being left atrial enlargement (26.9%), ST-segment elevation (25.6%) and left ventricular hypertrophy (24.4%). LVH demonstrated a statistically significant association with stroke subtype (p = 0.0008), with higher prevalence in haemorrhagic and TIA cases. Other ECG findings did not differ significantly between stroke groups. Conclusion: ECG abnormalities are highly prevalent among patients with acute stroke, reflecting neurogenic myocardial injury and autonomic dysfunction. Routine ECG evaluation should be incorporated into acute stroke assessment to identify patients at increased risk of cardiac complications. Keywords: Stroke; Electrocardiography; Ischemic Stroke; Hemorrhagic Stroke; Autonomic Nervous System Diseases.

Background: Intra-abdominal collections are a common cause of morbidity and sepsis in surgical practice. While open surgical drainage has traditionally been the standard of care, advances in imaging have made ultrasound-guided percutaneous drainage (USG-PD) an attractive minimally invasive alternative. This study aimed to evaluate the clinical outcomes of USG-PD and compare them with open surgical drainage in the management of intra-abdominal collections. Materials and Methods: This prospective comparative observational study included 104 adult patients with radiologically confirmed intra-abdominal collections managed at a tertiary care hospital. Patients were allocated to either ultrasound-guided percutaneous drainage (USG-PD; n = 53) or open surgical drainage (SD; n = 51) based on clinical and radiological criteria. Baseline demographic and clinical characteristics, etiology and location of collections, procedural details, clinical outcomes, complications, and hospital course were analyzed and compared between the two groups. Results: Baseline characteristics were comparable between the groups. Technical success of USG-PD was achieved in 96.2% of patients. Clinical success rates were similar in the USG-PD and SD groups (84.9% vs 84.3%; p = 0.932). The USG-PD group had significantly shorter procedure duration (28.4 ± 9.6 vs 78.6 ± 18.3 minutes; p < 0.001), shorter hospital stay (7.6 ± 3.1 vs 12.4 ± 4.8 days; p < 0.001), and faster defervescence (2.8 ± 1.3 vs 4.6 ± 2.1 days; p < 0.001). Overall complication rates were significantly lower in the USG-PD group (13.2% vs 31.4%; p = 0.024), with no surgical site infections observed following USG-PD. Conclusion: Ultrasound-guided percutaneous drainage is a safe and effective first-line treatment for intra-abdominal collections, offering clinical outcomes comparable to open surgical drainage with the added benefits of reduced procedural time, shorter hospitalization, and fewer complications. Open surgical drainage should be reserved for selected cases with complex or inaccessible collections or failure of percutaneous management. Keywords: Intra-abdominal abscess; Ultrasound-guided percutaneous drainage; Surgical drainage; Minimally invasive procedures; Clinical outcomes.

Background: Pre-analytical errors, particularly sample rejection and resampling, remain a major challenge in clinical biochemistry laboratories, adversely affecting turnaround time, patient comfort, and clinical decision-making. Hemolysis is a leading cause of sample rejection, especially in inpatient settings. The aim is to audit the frequency, causes, patterns, and operational factors associated with sample rejection and resampling in a clinical biochemistry laboratory and to evaluate corrective measures. Materials and Methods: A retrospective and prospective audit was conducted in the Clinical Biochemistry Laboratory of PSG Institute of Medical Sciences and Research over four months (July, August, September, and November 2016). Consecutive sampling was used. Data were retrieved from the sample rejection register, Laboratory Information System (LIS), archived request forms, and environmental monitoring records. Quantitative analysis was performed using Microsoft Excel and IBM SPSS 17. Focused Group Discussions (FGDs) were conducted with nursing staff from selected wards and with OPD phlebotomists to qualitatively explore causes and operational challenges. Results: Out of 297,616 samples processed, 856 samples were rejected, yielding an overall rejection rate of 0.28%. Hemolysis accounted for 80% of rejections. Inpatient samples constituted 93.6% of rejected specimens, with a rejection rate 13.6 times higher than outpatient samples. Rejections were more frequent during early morning hours (05:00–07:00), on Sundays in proportionate terms, and with heparinized samples. Operational delays in sample transport, receipt, centrifugation, and communication of rejection were identified as major contributory factors. FGDs highlighted procedural lapses in phlebotomy, delayed processing, pneumatic tube handling issues, and inconsistent instructions as key drivers of hemolysis. Conclusion: Sample rejection in the studied laboratory was low overall but predominantly driven by hemolysis in inpatient samples. Operational inefficiencies and pre-analytical practices significantly contributed to resampling. Targeted corrective measures focusing on standardized phlebotomy practices, improved staffing patterns, optimized sample transport, and LIS-based automation are essential to reduce resampling and improve patient care. Keywords: Sample rejection; Resampling; Hemolysis; Pre-analytical errors; Clinical biochemistry laboratory; Turnaround time; Laboratory Information System; Quality indicators; Phlebotomy; Patient safety.

Primary hyperparathyroidism (PHPT) is an endocrine disorder characterized by excessive secretion of parathyroid hormone (PTH), resulting in hypercalcemia and multi-system involvement. Parathyroid adenoma remains the most frequent etiology. We present a rare case of parathyroid adenoma in a 55-year-old woman presenting with recurrent abdominal pain, vomiting, and laboratory evidence of hypercalcemia and pancreatitis. Biochemical evaluation confirmed elevated PTH levels, and localization was achieved using 18F-Choline PET-CT, a novel and highly sensitive imaging modality rarely employed in routine practice. This case highlights the significance of advanced imaging in atypical presentations of PHPT and the importance of multidisciplinary management. Keywords: Parathyroid adenoma, Hyperparathyroidism, 18F‑Choline PET‑CT, Hypercalcemia, Pancreatitis, Nephrolithiasis.

Background: Vitamin D deficiency is highly prevalent in India and has been associated with increased risk of cardiovascular diseases including stroke. This study aimed to evaluate the relationship between serum vitamin D levels in cerebral stroke patients and assess its association with stroke severity, lipid profiles, and inflammatory markers. Materials and Methods: A cross-sectional study was conducted on 118 stroke patients (both ischemic and hemorrhagic) at Jawaharlal Nehru Institute of Medical Sciences, Imphal, over a two-year period. Serum 25-hydroxyvitamin D levels were measured using chemiluminescence immunoassay. Lipid profiles (HDL, LDL, total cholesterol, triglycerides) and high-sensitivity C-reactive protein (hs-CRP) were evaluated. Stroke severity was assessed using the NIHSS scoring system. Results: Only 24% of stroke patients had normal vitamin D levels (>30 ng/ml), while 39% had vitamin D insufficiency (21-29 ng/ml), 34% had deficiency (10-20 ng/ml), and 3% had severe deficiency (<10 ng/ml). The most common type of stroke was ischemic stroke involving the MCA territory (56.4%). Vitamin D deficiency was associated with higher BMI (mean 25 kg/m²), with severe deficiency observed at mean BMI of 26 kg/m². Patients with vitamin D deficiency showed trends toward higher mean LDL levels, lower HDL levels, higher triglyceride levels, and elevated hs-CRP levels (21-22 mg/L), though these correlations were not statistically significant (p>0.05). Discussion: Our findings suggest that vitamin D status may influence stroke risk through both direct effects on endovascular function and inflammatory regulation, and indirect effects through modulation of established risk factors including hypertension, dyslipidemia, and insulin sensitivity. The high prevalence of vitamin D deficiency among stroke patients warrants consideration of vitamin D assessment in stroke prevention strategies. Study limitations include the small sample size, which likely contributed to the lack of statistical significance in observed correlations. Larger prospective studies are needed to further elucidate the complex relationship between vitamin D status, lipid profiles, inflammation, and stroke outcomes. Keywords: Vitamin D deficiency, stroke, lipid profile, hs-CRP, NIHSS

Background: Laparoscopic cholecystectomy under general anaesthesia is associated with perioperative stress responses and postoperative pain, which may influence recovery quality. Dexmedetomidine, a selective α2-adrenergic agonist, has been increasingly used as an anesthetic adjuvant due to its sedative, analgesic, and opioid-sparing properties. The aim is to evaluate the effects of dexmedetomidine infusion on postoperative recovery scores and analgesic requirement in patients undergoing laparoscopic cholecystectomy maintained on sevoflurane under general anaesthesia. Materials and Methods: This hospital-based, prospective, double-blind randomized controlled trial included 80 patients (ASA I–II) undergoing elective laparoscopic cholecystectomy. Patients were randomly allocated into two groups: Group D (dexmedetomidine, n=40) received a loading dose of dexmedetomidine followed by intraoperative infusion, while Group C (control, n=40) received normal saline. Anaesthesia was maintained with sevoflurane. Postoperative recovery was assessed using emergence times, Ramsay Sedation Score, Modified Aldrete Score, pain intensity using Visual Analogue Scale (VAS), time to first analgesic request, and total postoperative rescue analgesic consumption over 24 hours. Results: Dexmedetomidine significantly prolonged early recovery parameters such as emergence, response to commands, and orientation (p<0.001) and resulted in higher early postoperative sedation scores. However, Modified Aldrete Scores and PACU discharge times were comparable between groups. Postoperative pain scores were significantly lower in the dexmedetomidine group at most time intervals, with a markedly prolonged time to first analgesic requirement and a significant reduction in total tramadol consumption over 24 hours (p<0.001). Conclusion: Intraoperative dexmedetomidine infusion provides superior postoperative analgesia and significant opioid-sparing effects with acceptable and transient sedation, without delaying discharge readiness. Dexmedetomidine is an effective anesthetic adjuvant for laparoscopic cholecystectomy under sevoflurane-based general anaesthesia. Keywords: Dexmedetomidine. Postoperative recovery. Laparoscopic cholecystectomy.

Background: Urinary tract infection is infection in any part of the urinary system, including the kidneys, ureter, urethra, and bladder. It is growth of significant number of microorganisms within the urinary tract. In general, the lower urinary tract is more affected than the upper urinary tract. The objective is to estimate the overall prevalence and clinical profile of urinary tract infection in children suspected to have urinary tract infection aged from 5 years to 15 years in a tertiary care hospital. Materials and Methods: This Prospective Observational Study was conducted among Febrile children with symptoms of UTI aged between 5 to 15 years admitted to the Department Of Pediatrics, PESIMSR Hospital, Kuppam. Duration of study was 18 months (Jan 2019 – Jun 2020). Results: In our study UTI is most common in girls (57%) when compared to boys (43%). UTI is more common in low socio economic status. Among 100 cases in the study, most common clinical features in the presence of fever were abdominal pain (61%) followed by vomiting (59%) and burning micturition (43%). Most common clinical sign which was elicited was supra pubic tenderness (31%) followed by renal angle tenderness. Risk factors were present in 43% of study subjects; voiding difficulty is most common, followed by tight clothing and history of previous urinary tract infection. Those patients with risk factors were counseled to maintain genital hygiene, avoidance of tight clothing and constipation. Conclusion: Among 100 cases in the study, most common clinical features in the presence of fever were abdominal pain (61%) followed by vomiting (59%) and burning micturition (43%). Risk factors were present in 43% of study subjects; voiding difficulty is most common, followed by tight clothing and history of previous urinary tract infection. Those patients with risk factors were counseled to maintain genital hygiene, avoidance of tight clothing and constipation. Keywords: Prevalence, Clinical features, febrile children, aged 5-15 years, urinary tract infection.

Background: Anterior cruciate ligament (ACL) rupture represents one of the most prevalent knee injuries affecting athletes and active individuals. The selection of an appropriate graft material remains a critical determinant of successful ACL reconstruction outcomes. While hamstring tendon (HT) autografts have traditionally been utilized, peroneus longus tendon (PLT) grafts have emerged as a promising alternative with potentially favorable characteristics. Materials and Methods: This retrospective comparative study evaluated 78 patients who underwent arthroscopic ACL reconstruction at R.L. Jalappa Hospital, Kolar, between January 2021 and December 2024. Patients were divided into two groups: Group A (n=40) received PLT grafts, while Group B (n=38) received HT grafts. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score, Lysholm knee score, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score at preoperative, 2-week, 1-month, 3-month, and 6-month postoperative intervals. Results: Both groups demonstrated significant improvements in functional outcomes following surgery. The mean IKDC scores at 6 months were 87.42 ± 5.63 for Group A and 85.89 ± 6.21 for Group B (p=0.248). Lysholm scores reached 89.15 ± 4.82 and 87.63 ± 5.44 respectively (p=0.186). The AOFAS ankle-hindfoot score in Group A remained satisfactory at 94.28 ± 3.92 at final follow-up, indicating minimal donor-site morbidity. No significant differences were observed in knee stability assessments between groups. Conclusion: Peroneus longus tendon graft demonstrates comparable clinical outcomes to hamstring tendon graft in ACL reconstruction, with acceptable donor-site morbidity. PLT graft represents a viable alternative, particularly when hamstring tendons are unavailable or inadequate. Keywords: Anterior cruciate ligament reconstruction, peroneus longus tendon, hamstring tendon, autograft, knee stability, functional outcomes.

Background: Pemphigus vulgaris (PV) is a chronic autoimmune blistering disorder characterized by autoantibodies against desmoglein 3 and desmoglein 1, leading to suprabasal acantholysis and mucocutaneous erosions. Infections, particularly viral, are recognized contributors to disease exacerbation, and Herpes simplex virus (HSV) has been implicated as both a trigger and complicating factor in PV. This study aimed to evaluate the relationship between PV severity and PCR-confirmed HSV infection in an Indian tertiary-care cohort. Materials and Methods: A cross-sectional study was conducted on 82 patients diagnosed with PV. Demographic and clinical data, including disease duration, comorbidities, and mucosal involvement, were collected. Disease severity was assessed using the Pemphigus Disease Area Index (PDAI). Oral and/or genital swabs were collected for HSV detection using polymerase chain reaction (PCR) and subtype identification. Associations between HSV positivity and disease severity, mucosal involvement, and immunosuppressive therapy were analyzed using Chi-square, Fisher’s exact, t-test, and Pearson correlation as appropriate. Results: The mean age of patients was 47.1 ± 11.0 years, with a female predominance (61%). Mucosal involvement was present in 81.7% of patients, predominantly oral (76.8%). HSV was detected in 31.7% of patients, with HSV-1 predominating (24.4%). HSV positivity increased with disease severity: 12.5% in mild, 25% in moderate, and 63.6% in severe PV (p = 0.001). HSV-positive patients had higher mean PDAI scores compared to HSV-negative patients (49.2 ± 16.8 vs 33.1 ± 15.2, p = 0.0002), and PDAI scores correlated positively with HSV positivity (r = 0.41, p < 0.001). HSV detection was higher in patients receiving combined corticosteroid and immunosuppressive therapy (38%) than in those on steroids alone (19.2%), though not statistically significant (p = 0.060). Conclusion: HSV infection is common in PV patients and is significantly associated with higher disease severity. Severe PV and immunosuppressive therapy may predispose to viral reactivation, while HSV infection may exacerbate clinical severity. Early PCR-based detection of HSV in PV patients can guide timely antiviral therapy, potentially reducing morbidity and improving outcomes. Keywords: Pemphigus vulgaris, Herpes simplex virus, Disease severity, Mucosal involvement, Immunosuppression.

Background: Diabetes damages small vessels in retina and kidney together. Many patients come late for eye check. Simple renal tests like eGFR and ACR may help to pick higher-risk cases early. Objectives was to study whether eGFR and ACR reflect DR severity and presence of DME in adults with diabetes. Materials and Methods: Hospital based cross-sectional study in a tertiary care hospital, South India (6 months). 630 diabetics (18–80 years, Type 1/Type 2) were enrolled by convenient sampling. Fundus exam with photos was done and DR graded by modified ETDRS (No DR, mild/moderate/severe NPDR, PDR). DME was marked present/absent clinically, OCT when possible. Renal markers were serum creatinine based eGFR and spot urine ACR categories. Associations were analysed using standard tests. Results: DR distribution: No DR 223 (35.4%), Mild NPDR 217 (34.4%), Moderate NPDR 154 (24.4%), Severe NPDR 16 (2.5%), PDR 20 (3.2%). Mean eGFR fell with DR severity from 104 ± 14 (No DR) to 54.8 ± 12.0 mL/min/1.73 m² (PDR). Mean ACR rose from 12.5 ± 5.5 to 76.4 ± 29.7 mg/g. DME increased with DR grade: 2.2%, 9.2%, 27.3%, 81.3%, 90% (No DR → PDR). DME also increased with worse eGFR stage, maximum in Stage 5 (72%). In DR cases (n=407), ACR stages did not differ significantly by diabetes type. Conclusion: Falling eGFR and rising ACR track worse DR and higher DME. These routine tests can be used as simple triggers for early retinal and macular screening in OPD. Keywords: diabetic retinopathy; eGFR; albumin–creatinine ratio; albuminuria; diabetic macular edema; diabetes mellitus.

Background: Reconstruction of posterior elbow defects with exposed olecranon requires durable, gliding, and sensate coverage. This study evaluates the clinical outcomes of a sensate bilobed fasciocutaneous flap from the medial arm, innervated by the medial brachial cutaneous nerve (MBCN), in a consecutive case series. Materials and Methods: A retrospective review of 20 patients who underwent reconstruction of posterior elbow defects using the sensate bilobed flap between March 2022 and December 2023 at Heritage Institute of Medical Sciences, Varanasi, was conducted. Data collected included demographics, etiology, defect size, surgical details, complications, and sensory recovery measured by two-point discrimination (2PD) and Semmes-Weinstein monofilament testing. Results: The mean age was 38.2 years (range: 21–65). Etiologies included electrical burns (n=8), traumatic soft tissue loss (n=6), pressure ulcers (n=3), and post-infection defects (n=3). The mean defect size was 37.5 cm² (range: 15–64 cm²). All flaps survived completely. One patient (5%) developed a distal tip epidermolysis that healed with conservative management. The mean postoperative 2PD at 3 months was 18.7 mm (range: 12–25 mm), compared to 7.2 mm on the contralateral arm. Protective sensation (≤4.31 monofilament) was achieved in 18 patients (90%) by 6 months. All donor sites were closed primarily without need for grafting. Patient satisfaction, assessed via a visual analogue scale (VAS), averaged 8.9/10. Conclusion: The sensate medial arm bilobed flap is a reliable, single-stage reconstructive option for small-to-moderate posterior elbow defects. It consistently provides sensate coverage, avoids donor site grafting, and yields high patient satisfaction with minimal morbidity. Keywords: Bilobed flap, Sensate flap, Elbow reconstruction, Olecranon, Medial brachial cutaneous nerve, Case series, Fasciocutaneous flap.

Background: Refractive errors are among the leading causes of visual impairment globally and significantly affect adolescents learning performance. Early detection and correction can prevent vision loss. The objective is to determine the prevalence and determinants of refractive errors among school-going adolescents in government and private schools in Bareilly, Uttar Pradesh. Materials and Methods: A cross-sectional study was conducted among 300 adolescents aged 10–19 years, selected through stratified random sampling from government and private schools. Vision was assessed using Snellen’s chart, and a structured questionnaire recorded sociodemographic, behavioural, and familial factors. Data were analyzed using Jamovi. Chi-square and logistic regression analyses were used to identify the predictors of refractive errors (p<0.05). Results: Overall prevalence was 20% (60/300). Refractive errors were more prevalent in private schools (24%) than in government schools (16%). Significant predictors included screen time >2 hours/day (AOR=2.46, 95% CI: 1.30–4.65, p=0.005), positive family history (AOR=3.75, 95% CI: 1.98–7.09, p<0.001), and outdoor activity <1 hour/day (AOR=1.96, 95% CI: 1.03–3.74, p=0.038). Conclusion: Refractive errors are common among adolescents and are strongly associated with modifiable risk factors, such as prolonged screen exposure and less outdoor activity. School-based eye screening and awareness programs are crucial for early prevention of amblyopia. Keywords: Adolescents, Myopia, Refractive errors, Risk factors, Vision screening.

Background: Smokeless tobacco (SLT) is widely used in rural India and predisposes to oral precancerous lesions. Socio-demographic factors strongly influence its consumption. The objective is to determine the socio-demographic correlates of tobacco-chewing habits and their association with oral precancerous lesions among adults in rural Bareilly, Uttar Pradesh. Materials and Methods: A community-based cross-sectional study was conducted from May to August 2025 among 435 adults (≥18 years) selected by simple random sampling from the field-practice area of Rajshree Medical Research Institute, Bareilly. A pre-tested semi-structured questionnaire captured socio-demographic details and tobacco habits. Oral examination followed WHO (2013) guidelines. Data were analysed in Jamovi using descriptive statistics, Chi-square tests and logistic regression; p < 0.05 was significant. Results: Prevalence of current tobacco chewing was 28.5 %. Gutkha (36.3 %) and khaini (29.0 %) were most common. Oral precancerous lesions were detected in 10.3 %, mainly leukoplakia (5.1 %) and oral submucous fibrosis (3.7 %). Lesions were more frequent among participants ≥ 45 years (p < 0.001). In multivariate analysis, age ≥ 45 years (AOR 2.31; 95 % CI 1.24–4.32; p=0.008) and illiteracy (AOR 1.78; 95 % CI 1.02–3.11; p=0.042) were independent predictors. Conclusion: One-third of rural adults chew tobacco; one in ten already have oral precancerous lesions. Older age and low literacy markedly increase risk. Strengthened oral-screening and health-education programmes are required. Keywords: Smokeless tobacco; Gutkha; Khaini; Oral precancerous lesions; Rural health; Socio-demographic factors.

Background: Acute abdomen in pregnancy poses diagnostic challenges in resource-limited settings due to physiological changes, overlapping obstetric/surgical etiologies, limited imaging, and health system constraints. Objective: To systematically review diagnostic and management challenges of acute abdomen in pregnancy in low-resource settings and propose context-specific recommendations. Materials and Methods: Following PRISMA 2020 guidelines (including PRISMA-A), we searched PubMed, Scopus, and Google Scholar (Jan 2000–Oct 2025) for English-language peer-reviewed articles using terms like "acute abdomen”, “pregnancy”, "low-resource”, "surgical/obstetric emergencies”. Inclusion: observational studies, case series/reports, reviews from LMICs (low- and middle-income countries) addressing diagnosis/management of acute abdominal conditions in pregnancy. Exclusion: high-income settings only, opinion pieces. Data extracted on etiology, diagnostics, barriers, outcomes; quality assessed via Newcastle-Ottawa Scale (observational) and JBI checklists (case reports). Thematic synthesis conducted (no meta-analysis due to heterogeneity). Results: From 352 records (plus 10 from references), 278 unique records were screened; 48 full-texts assessed; 18 studies included (mostly case reports/series from Africa/Asia). Key challenges: (1) pregnancy-altered anatomy/physiology masking signs, (2) nonspecific symptoms overlapping obstetric emergencies, (3) limited ultrasound accuracy/operator training, (4) unavailable CT/MRI, (5) referral delays, (6) surgical/anesthesia capacity gaps, (7) high morbidity from appendicitis/obstruction/rupture. Risk of bias: moderate-high (observational designs). Underutilized solutions: POCUS (Point-of-Care Ultrasound) training, referral protocols. Limitations: Heterogeneity, publication bias toward successful cases, few prospective LMIC studies. Conclusion: Enhanced POCUS training, standardized protocols, and surgical capacity building are essential to improve outcomes in resource-limited settings. Keywords: Acute abdomen, pregnancy, low-resource settings, obstetric emergencies, surgical emergencies, diagnostic challenges.

Background: The Whipple’s Procedure, also known as pancreaticoduodenectomy, is performed to treat tumors of the ampulla of Vater, cancer of head of pancreas, cancer of the distal part of the bile duct, duodenal cancer, chronic Pancreatitis, etc. Pathological assessment of surgical specimens from Whipple’s surgery needs special attention in order to accurately evaluate many factors that are prognostically important such as tumor size, location, extension, histological type and grade, surgical margin status, vascular & perineural invasion and lymph node status. Aim: To analyse and compare the incidence and different histological parameters of various tumors encountered in Whipple’s resection specimens. Materials and Methods: This is a retrospective histopathological study of total 45 Whipple’s resection specimens that were received during January 2012 to October 2018 in a tertiary care hospital in Ahmedabad, India. All the cases were retrieved from the records. Results: Out of 45 Whipple’s specimens, 41 were malignant, 3 were benign and 1 was non-neoplastic. Mean age was 51.42 years with 2:1 male predominance. Peri-ampullary region was the most common site of tumor location(62.3%). We found that for grossing of pancreaticoduodenectomy specimens, Axial slicing method is more beneficial than Bi-valving except for cystic pancreatic tumors. 35 cases(85.3%) were of Adenocarcinoma and Moderately differentiated Adenocarcinoma(58.7%) was the most common histological type. The incidence of lymphnode involvement(37.1%) and perineural invasion(48.5%) was higher in cases of adenocarcinoma, associated with poor prognosis. Conclusion: Whipple’s resection specimens require meticulous histopathological evaluation and pathologists should be aware of possibility of a benign diagnosis. Keywords: Acinar cell carcinoma, Ampullary carcinoma, Pancreaticoduodenectomy, Paraduodenal pancreatiis, Periampullary carcinoma, Whipple’s resection specimen.

Background: Hemiarthroplasty is the treatment for displaced femoral neck fractures in elderly patients. When compared with osteosynthesis, hemiarthroplasty results in less pain, better mobility, and improved health related quality of life and has been shown to be more effective. Objective: to assess the functional outcome following uncemented hemiarthroplasty using a tapered wedge shaped hydroxyapatite or titanium coated femoral component in displaced fracture neck of femur in elderly patients. Materials and Methods: This Prospective Interventional case series was conducted in Department of Orthopaedics, Southern Railways Headquarter Hospital, Chennai. Our study included displaced fracture neck of femur patients above 60 years of age of both sex treated by uncemented bipolar hemiarthroplasty in our hospital. Duration of study was December 2017 to December 2018. Result: Out of 22 patients 12 were females (55%) and 10 were males (45%). The mean age of the patients was 73 years with a range of 60 to 86 years. All the patients had a trivial fall and sustained the fracture. The left side hip was commonly affected in our patients. Most of our patients belonged to the ASA II and III class. 17(77%) patients in our study had multiple co-morbid conditions. Most of the patients had hypertension as the predominant co-morbidity. The mean duration of the surgery was 78 minutes with a range of 67 to 90 minute and the mean blood loss in was 174 milliliters with a range of 120 milliliters to 320 milliliters. We had one case of intra operative periprosthetic fracture which was managed with wiring. The other complications were one superficial infection and one deep infection both were managed with debridement and antibiotics. We had one case of bed sore which was managed with in bed mobilization, air mattress and dressings. The final Harris hip score at six months follow up was 81 with a range of 58 to 94. There were 5 patients with excellent outcome, 10 patients with good outcome, 6 patients with fair outcome and one patient with poor outcome due to acetabular erosion. Conclusion: In our study the Harris hip score improved with increasing periods of follow up. The final functional outcome in our study at 6 months is comparable with various studies. The complications are also lower in our study. This suggests that modern uncemented bipolar hemiarthroplasty prosthesis can provide a satisfactory result and can be used for treatment of displaced neck of femur patients. Keywords: Functional Outcome, Uncemented Bipolar Hemiarthroplasty, Neck of Femur Fractures.

Background: Undernutrition and social vulnerability significantly influence tuberculosis (TB) treatment outcomes, often leading to delayed sputum smear conversion among disadvantaged populations. While micronutrient supplementation has shown overall benefit, evidence on its equity-enhancing effects—particularly whether it reduces outcome disparities across socio-demographic groups—remains limited in routine programmatic settings. The objective is to assess whether adjunct micronutrient supplementation narrows socio-demographic inequities in early treatment response, measured by two-month sputum smear conversion, among pulmonary TB patients treated under the National Tuberculosis Elimination Programme. Materials and Methods: A programmatic cohort study was conducted among 200 newly diagnosed smear-positive pulmonary TB patients receiving micronutrient supplementation during the intensive phase of treatment in a high-burden district of Karnataka, India. Sputum smear status was assessed at baseline and after two months. Equity-relevant variables included age, gender, residence (urban/rural), employment status, and baseline bacillary load. Stratified analyses compared conversion rates across vulnerable and non-vulnerable subgroups. Interaction terms were used to examine whether supplementation modified outcome disparities. Absolute risk differences and relative measures were calculated to assess equity effects. Results: Overall two-month sputum smear conversion was high among supplemented patients. Conversion rates were consistently lower among older patients (≥45 years), rural residents, unemployed individuals, and those with high baseline bacillary load (3+). However, the absolute differences in conversion between vulnerable and non-vulnerable groups were smaller than those reported in comparable non-supplemented programmatic cohorts. The greatest equity gains were observed among unemployed patients and those with high bacillary load, indicating a disproportionate benefit of supplementation in these groups. Interaction analyses suggested attenuation of socio-demographic gradients in early treatment response. Conclusion: Micronutrient supplementation delivered within routine TB services demonstrated equity-enhancing effects, partially mitigating socio-demographic disparities in early bacteriological response. Beyond improving average outcomes, nutritional support may serve as a pragmatic strategy to advance equity-oriented tuberculosis care. Integrating targeted nutritional interventions within national TB programs could accelerate progress toward equitable treatment outcomes in high-burden settings. Keywords: Tuberculosis, Micronutrient supplementation, Equity, Sputum smear conversion, Social determinants, Programmatic research.

Background: Abdominal tuberculosis (TB) poses significant diagnostic challenges due to its nonspecific clinical manifestations and overlapping imaging features with other intra-abdominal pathologies. Emerging imaging biomarkers have shown potential for early, non-invasive and more accurate detection. Materials and Methods: A systematic review of imaging literature published between January 2015 and May 2025 was conducted, focusing on both morphological and functional imaging modalities in the evaluation of abdominal TB. Results: CT and MRI remain the cornerstone imaging modalities for morphological assessment, identifying features such as bowel wall thickening, necrotic lymphadenopathy, and ascites. However, advanced techniques such as diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) mapping, PET-CT, and radiomics are increasingly recognized for their ability to offer functional insights. These biomarkers enhance diagnostic precision, particularly in distinguishing TB from malignancies and other mimicking conditions. Conclusion: Imaging biomarkers—particularly functional and AI-enhanced tools—are redefining the diagnostic paradigm of abdominal TB. Their successful translation into routine clinical practice will require standardized imaging protocols, unified biomarker thresholds, and validation through large-scale multicentric studies. Keywords: Abdominal tuberculosis; imaging biomarkers; CT; MRI; PET-CT; diffusion-weighted imaging; ADC; radiomics; functional imaging.

Background: Bacterial conjunctivitis is one of the most common ocular infections encountered in clinical practice and accounts for a significant proportion of outpatient ophthalmology visits. Although the condition is often self-limiting, topical antibiotics are frequently prescribed to hasten symptom resolution, reduce transmissibility, and improve patient comfort. Variability in clinical presentation, empiric antibiotic selection, and patient response highlights the importance of systematically evaluating treatment outcomes under routine care conditions. Prospective monitoring of antibiotic response provides valuable insight into real-world effectiveness and supports rational antimicrobial use in tertiary care settings. The aim of this study was to prospectively monitor the clinical response to antibiotic therapy in patients diagnosed with bacterial conjunctivitis at a tertiary care hospital. Materials and Methods: This prospective observational study included 94 patients clinically diagnosed with bacterial conjunctivitis. Patients of either gender presenting with signs suggestive of bacterial conjunctivitis and initiated on topical antibiotic therapy were enrolled. Diagnosis was based on ophthalmological evaluation, including conjunctival hyperemia, purulent or mucopurulent discharge, eyelid sticking, foreign body sensation, and ocular irritation. Patients with viral or allergic conjunctivitis, ocular trauma, chronic ocular surface disease, or prior antibiotic use were excluded. Antibiotic therapy was prescribed according to institutional practice and clinician discretion. Patients were followed prospectively to assess treatment response. Primary outcomes included improvement or resolution of clinical signs and symptoms, categorized as complete, partial, or no response. Secondary outcomes included need for change in therapy and occurrence of adverse drug reactions. Data were analyzed using SPSS version 26.0. Results: Among the 94 patients, males constituted 55.32% and females 44.68%. The most affected age group was 21–40 years (38.30%). Conjunctival hyperemia was present in all patients, while purulent or mucopurulent discharge was observed in 93.62%. Fluoroquinolones were the most commonly prescribed antibiotics (46.81%), followed by aminoglycosides (27.66%). A complete clinical response was achieved in 70.21% of patients, partial response in 21.28%, and no response in 8.51%. No statistically significant association was observed between gender and treatment outcome (p = 0.512). Conclusion: The study demonstrates a high overall clinical response to topical antibiotic therapy in bacterial conjunctivitis. Prospective monitoring facilitates early identification of non-responders and supports effective and rational antibiotic use in tertiary care ophthalmic practice. Keywords: Bacterial conjunctivitis; Antibiotic therapy; Prospective study; Clinical response.

Background: Acute appendicitis is a frequent cause of abdominal pain requiring urgent surgical intervention in children. Timely and accurate diagnosis is essential to prevent complications such as perforation and peritonitis. Ultrasound has emerged as the preferred first line imaging modality due to its accessibility, absence of ionizing radiation, and ability to support clinical decision-making when combined with established scoring systems. This study was designed to evaluate the diagnostic performance of ultrasound in suspected pediatric appendicitis and correlate with clinical assessment and operative outcomes. Materials and Methods: A total of 72 children aged 2-18 years presenting with clinical features suggestive of acute appendicitis. All patients underwent structured clinical evaluation with Alvarado scoring followed by graded-compression ultrasound performed by experienced radiologists. Sonographic parameters were recorded. Final diagnosis was confirmed by intraoperative findings and histopathology in surgically managed cases, and by clinical follow-up in conservatively treated patients. Diagnostic metrics were calculated using standard statistical methods, and ROC analysis assessed overall discriminatory ability. Results: Ultrasound visualized the appendix in 88.9% of cases and was suggestive of appendicitis in 50 patients. Non-compressible appendix and diameter ≥6 mm were the most frequent indicators. Compared with final diagnosis, ultrasound demonstrated a sensitivity of 90%, specificity of 77.3%, positive predictive value of 90%, negative predictive value of 77.3%, and an overall diagnostic accuracy of 86.1%. ROC analysis yielded an area under the curve of 0.83, indicating good discriminatory performance. Conclusion: Ultrasound provides high diagnostic accuracy in pediatric appendicitis and remains a reliable first-line imaging tool. When interpreted alongside clinical scoring systems, it enhances diagnostic confidence, reduces radiation exposure, and supports timely surgical decision-making. Keywords: Pediatric appendicitis, Ultrasound, Acute abdomen, Alvarado score, Diagnostic accuracy, ROC curve.

Background: Clavicle fractures are among the most common skeletal injuries, frequently affecting young, active adults. While conservative management has been the traditional approach, recent advances in fixation techniques have renewed interest in surgical management. The objective is to evaluate and compare radiological union, functional outcomes, pain levels, and complications in adult patients with midshaft clavicle fractures managed either operatively or conservatively. Materials and Methods: A prospective comparative study was conducted on 60 adult patients with midshaft clavicle fractures in a tertiary care teaching hospital. Thirty patients underwent open reduction and internal fixation with plates and screws, while thirty were managed conservatively with an arm sling and figure-of-eight bandage. Patients were followed up for six months. Radiological union time, Constant-Murley score, DASH score, and Visual Analogue Scale (VAS) for pain were assessed and statistically analysed. Results: The mean time to union was significantly shorter in the operative group (9.8 weeks) compared to the conservative group (14.2 weeks) (p < 0.001). Operative patients demonstrated higher mean Constant-Murley scores (90.6 vs. 82.3) and lower DASH scores (9.4 vs. 18.2). Pain reduction occurred earlier, and cosmetic satisfaction was greater in the surgical group. Non-union and malunion were more frequent in the conservative group, while minor implant-related irritation occurred in some operative cases. Conclusion: Operative management of displaced midshaft clavicle fractures provides faster union, improved early function, and better cosmetic outcomes compared to conservative treatment. Non-operative care remains suitable for undisplaced fractures. Keywords: Operative Management, Conservative Management, Clavicle Fractures, Adults.

Background: Acute leukemias are aggressive hematological malignancies characterized by rapid proliferation of immature hematopoietic cells, leading to increased cellular turnover and metabolic disturbances. In resource-limited settings, simple and readily available biochemical markers such as serum lactate dehydrogenase (LDH) and uric acid may serve as useful adjuncts in disease evaluation and risk stratification. The objective is to assess the clinical utility of serum LDH and uric acid levels in adult patients with acute leukemia and to evaluate their relationship with total leukocyte count (TLC) and leukemia subtype. Materials and Methods: A cross-sectional study was conducted on 60 newly diagnosed adult patients with acute leukemia. Serum LDH, uric acid, and TLC were measured at diagnosis. Patients were classified as acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL). Statistical comparisons and Pearson’s correlation analysis were performed. Results: The mean age was 38.6 ± 14.2 years with male predominance (1.7:1). AML accounted for 56.7% and ALL for 43.3% of cases. Markedly elevated LDH levels were observed in 60% of patients, while 23.3% had significant hyperuricemia. Mean serum LDH and uric acid levels were significantly higher in AML compared to ALL (p = 0.041 and p = 0.048, respectively). Serum LDH showed a strong positive correlation with TLC (r = 0.62, p < 0.001), and uric acid showed a moderate correlation (r = 0.51, p < 0.001). Conclusion: Serum LDH and uric acid levels are frequently elevated in newly diagnosed acute leukemia patients, particularly in AML, and correlate significantly with total leukocyte count. These findings support the role of LDH and uric acid as simple, cost-effective biomarkers reflecting tumor burden and disease activity, with potential utility in the initial evaluation and risk assessment of acute leukemia. Keywords: Acute leukemia, Lactate dehydrogenase, Uric acid, Total leukocyte count, Acute myeloid leukemia, Acute lymphoblastic leukemia.

Background: The Rh system, most immunogenic after ABO, contributes significantly to alloimmunization when red cells with incompatible antigens are transfused. Determining regional Rh antigen and phenotype frequencies is essential for improving antigen-matched transfusion and reducing alloimmunization risk. The present study was undertaken to observe the frequency distribution and prevalence of Rh antigens and phenotypes in the local blood donor population and to compare the difference between proportions between various groups. Materials and Methods: This cross-sectional study was conducted at the blood centre of a medical institute in Western Uttar Pradesh. Donor records from April 2017 to March 2022 were retrieved and analysed for the distribution and prevalence of Rh antigens and phenotypes across gender and ABO groups. Results: Among 54,986 donors (97.64% males, 2.36% females), 97.97% were Rh-D positive. Blood group B was most common (35.67%), followed by O (29.60%), A (24.62%) and AB (10.11%). The e antigen was most prevalent (98.92%), followed by D (97.97%), C (90.62%), c (52.80%), and E (19.60%). Antigen E showed higher prevalence in females (p = 0.004). Rh antigen distribution varied significantly across ABO groups (p < 0.00001). Rh-D negative donors showed higher c and e frequencies (p = 0.02). Fourteen Rh phenotypes were identified, with CCDee being the most common (44.40%), and phenotype CCDEe showed a significant gender difference (p = 0.032). Conclusion: A varied distribution of Rh antigens and phenotypes among donors highlights the need for rational transfusion practices. Antigen-matched transfusions can reduce alloimmunization risks in transfused and pregnant individuals. Keywords: Rh antigens, Rh phenotypes, Rh-antigen frequency, antigen-matched transfusions, blood donor.

Background: Vitamin D deficiency and obesity are major global public health challenges. Evidence suggests a significant association between the two, but data from South Indian adults are scarce. This study aimed to assess the association between vitamin D deficiency and obesity in a tertiary care setting in Tamil Nadu. Materials and Methods: A hospital-based matched case-control study was conducted from August to December 2024 at MAPIMS Hospital. We enrolled 166 participants: 83 obese cases (BMI ≥25 kg/m²) and 83 age and sex matched normal-BMI controls (BMI 18.5-22.9 kg/m²). Serum 25-hydroxyvitamin D [25(OH)D] levels were measured. Data on demographics, lifestyle, diet, and comorbidities were collected via a validated questionnaire. Vitamin D deficiency was defined as serum 25(OH)D <20 ng/mL. Statistical analyses included Chi-square tests, t-tests, ANOVA, and multivariable logistic regression. Results: Vitamin D deficiency was significantly more prevalent in the obese group (77.4%) than in controls (22.6%) (p<0.001). Obese individuals had nine-fold higher degrees of deficiency (OR: 9.0, 95% CI: 4.43-18.32). Mean serum 25(OH)D was significantly lower in obese participants (24.44 ± 25.12 ng/mL) versus controls (49.92 ± 26.89 ng/mL) (p<0.001). Obese subjects also had significantly less daily outdoor exposure and lower fish intake (p<0.001). In multivariable analysis, obesity, reduced outdoor exposure, higher systolic blood pressure, and an adverse lipid profile were independent predictors of vitamin D deficiency. Conclusion: This study demonstrates a strong association between obesity and vitamin D deficiency among adults in Tamil Nadu. The findings highlight the need for routine vitamin D assessment and management in obese populations, with emphasis on lifestyle modifications. Keywords: Vitamin D, Obesity, India, Case-control, 25-hydroxyvitamin D, Adults.

Background: Team-based Learning (TBL) is an innovative active learning strategy that fosters teamwork, critical thinking, and problem-solving, gaining traction in medical education. Traditional lecture-based methods in Community Medicine often lack student engagement and fail to promote higher-order thinking skills necessary for addressing complex public health issues. The study aims to evaluate the effectiveness of TBL in Community Medicine and assess its perception among third-year MBBS students, promoting peer-assisted learning through interaction and cooperation. The objective is to assess the effectiveness of TBL in Community Medicine. To evaluate students' perceptions of TBL. Materials and Methods: An interventional control study was conducted with 100 third-year medical undergraduates at Mahadevappa Rampure Medical College, Kalaburagi, over 5 months (August 2024 to December 2024). Inclusion criteria included Phase III Part I MBBS students who consented to participate. Data collection involved pre-validated MCQ questionnaires for both the study and control groups, along with a perception questionnaire for the TBL group. Results: Students in the TBL group showed a statistically significant improvement in post-test scores compared to the control group (p < 0.05). Engagement was high, with 87% of students finding TBL more engaging than lectures, 82% noting improvements in problem-solving and critical thinking skills, and 90% appreciating the collaborative nature of TBL. Challenges included time constraints for pre-class preparation (32%) and balancing TBL with other academic responsibilities. Conclusion: The study demonstrates TBL's effectiveness as a student-centered method in medical education, significantly enhancing academic performance among third-year MBBS students in Community Medicine. Keywords: Team-Based Learning (TBL), Perception, Teaching Tool, Medical Education.

Background: Obesity is increasingly prevalent among women of reproductive age and is linked to adverse pregnancy outcomes such as gestational diabetes mellitus, hypertensive disorders, and fetal macrosomia. Early pregnancy body mass index (BMI) is considered an important predictor of metabolic risk, while glycated hemoglobin (HbA1c) provides an estimate of average glycemic levels over the preceding 2–3 months. Understanding the relationship between BMI and HbA1c in early pregnancy may assist in identifying women at risk of hyperglycemia and improving maternal–fetal outcomes. The aim is to evaluate the correlation between maternal BMI and HbA1c levels during the first trimester of pregnancy. Materials and Methods: This observational cross-sectional study was conducted among pregnant women attending the antenatal clinic at Yenepoya Medical College Hospital, Deralakatte, Mangalore. A total of 162 eligible women aged 18–40 years with singleton pregnancies in their first trimester were recruited using consecutive sampling. Women with pre-existing diabetes, medical conditions or medications affecting glucose metabolism, and hemoglobinopathies were excluded. Data were collected using a structured form, including demographic and obstetric details. BMI was calculated from measured height and weight, and venous blood samples were obtained for HbA1c estimation. Descriptive statistics were used to summarize data, and correlation analysis was performed to assess the relationship between BMI and HbA1c, with significance set at p < 0.05. Results: The study evaluated BMI and HbA1c levels in early pregnancy and analyzed their relationship. Preliminary findings indicated variation in HbA1c values across BMI categories. Comparison between the two groups using the Mann–Whitney U test demonstrated a statistically significant difference in HbA1c levels (U = 506.00, p = 0.0001). This finding suggests that obesity is significantly associated with higher HbA1c levels and poorer glycemic control. Conclusion: This study explores the potential correlation between maternal BMI and HbA1c levels in early pregnancy. Identifying such a relationship may support early risk stratification for hyperglycemia in pregnancy and enhance preventive strategies aimed at improving maternal and neonatal health outcomes. Keywords: BMI, HbA1c, first trimester, pregnancy, hyperglycemia, maternal health, correlation study.

Background: Older adults frequently require long-term pharmacotherapy due to the rising burden of chronic diseases and multimorbidity. Evaluation of drug utilization patterns in the geriatric population is essential to promote rational prescribing and reduce medication-related risks. Materials and Methods: A prospective observational study was conducted among 500 individuals aged 65 years and above residing in Anand district, Gujarat, from September 2017 to October 2019. Participants of either sex who were on medication were included. Data were collected through home-based interviews using a structured case record form after obtaining informed consent. Demographic details, body mass index, disease profile, number of co-morbid conditions, drug utilization pattern, number of drugs per participant, and routes of drug administration were recorded. Data analysis was performed using descriptive statistics and expressed as frequencies and percentages. Results: Most participants belonged to the 65–74-year age group, with a slight male predominance. The majority were living with family members and had normal to increased body mass index as per Asian criteria. A total of 1,272 disease conditions were identified, with cardiovascular and endocrine disorders being the most common. Multimorbidity was prevalent, with most participants having two or more co-existing conditions. A total of 2,639 drugs were prescribed, predominantly acting on the cardiovascular, endocrine, and musculoskeletal systems. Polypharmacy was frequently observed, with many participants receiving multiple medications. Oral administration was the most commonly used route, while parenteral formulations were rarely prescribed. Conclusion: Drug utilization among the geriatric population in Anand district is largely driven by chronic disease burden and multimorbidity, resulting in frequent polypharmacy. Emphasis on rational prescribing and periodic medication review is essential to optimize therapeutic outcomes and reduce potential medication-related complications in elderly patients. Keywords: Geriatric population, drug utilization, polypharmacy, multimorbidity, prescribing pattern.

Background: Hepatitis C virus (HCV) infection remains a major public health concern, particularly in rural populations where low literacy levels, limited access to healthcare, and unsafe traditional practices contribute to continued transmission. Lack of awareness and widespread misconceptions further hinder early detection and prevention efforts. This study aimed to assess the awareness of HCV transmission and prevention among the rural population, identify common misconceptions, and determine the association between socio-demographic factors and awareness levels. Materials and Methods: A community-based, cross-sectional study was conducted in selected rural villages of province - Sindh, Districts - Tando Allahyar, Hyderabad, Mirpurkhas and Lahore district, Punjab province, Pakistan. A total of 200 adults aged 18–50 years, residing in the area for at least one year, were selected using random sampling. Data were collected using a pre- tested, structured questionnaire administered through face-to-face interviews by trained investigators in the local language. The questionnaire assessed demographic characteristics, knowledge of HCV transmission routes, preventive measures, and misconceptions. Descriptive statistics were used to summarize awareness levels, while chi-square test, Fisher’s exact test examined associations between socio-demographic variables and awareness. Results: Knowledge level showed no significant association with sex, age, marital status, or education (p > 0.05), but was significantly associated with occupation (p = 0.023), with doctors demonstrating the highest good knowledge (81.8%). Higher knowledge was strongly associated with positive attitudes, including perceiving Hepatitis C as very serious and non- discriminatory views toward infected individuals (p = 0.001). Knowledge was also significantly related to selected preventive practices—receiving injections in the past year, use of sealed sterile syringes, and household use of injectable drugs (p < 0.05)—but not with blood transfusion history, tattooing/ear piercing, or sharing sharp instruments, indicating partial translation of knowledge into practice.. Conclusion: Awareness of hepatitis C transmission and preventive measures among the rural population remains suboptimal, with persistent misconceptions that may contribute to ongoing transmission. Strengthening targeted health education, improving access to reliable information, and promoting safe practices at the community level are essential to reduce the burden of HCV in rural settings. Keywords: Hepatitis C, awareness, rural population, transmission, prevention, misconceptions, cross-sectional study.

Background: Adequate sleep is essential for optimal physical growth, cognitive development, and emotional regulation in infants and toddlers. With the widespread availability of televisions, smartphones, tablets, and other digital devices, screen exposure has become increasingly common even in early childhood. Growing evidence suggests that excessive screen use may interfere with normal sleep patterns, yet data in infants and toddlers remain limited. Objectives: To assess the impact of screen exposure on sleep quality in infants and toddlers and to evaluate the association between duration and timing of screen exposure and sleep-related disturbances. Materials and Methods: This prospective observational study was conducted over a period of 12 months. A total of 120 infants and toddlers aged 6 months to 3 years were enrolled. Caregivers provided information on daily screen exposure, including duration, type of device, and timing of use, using a structured questionnaire. Sleep quality was assessed using caregiver-reported parameters such as total sleep duration, sleep onset latency, frequency of night awakenings, and overall sleep disturbances. Associations between screen exposure patterns and sleep quality indicators were analyzed. Results: Infants and toddlers with higher daily screen exposure demonstrated reduced total sleep duration, delayed sleep onset, and increased night awakenings compared to those with minimal or no screen exposure. Evening and pre-bedtime screen exposure was more strongly associated with poor sleep quality. Children exposed to screens for longer durations showed a higher prevalence of irregular sleep schedules and caregiver-reported sleep difficulties. Conclusion: Increased screen exposure is associated with poorer sleep quality in infants and toddlers, particularly when screen use occurs during evening hours. Limiting screen exposure and avoiding screen use before bedtime may improve sleep quality and promote healthy sleep habits in early childhood. Keywords: Screen exposure; Sleep quality; Infants; Toddlers; Sleep disturbances; Digital media; Early childhood.

Background: Lung parenchymal opacities represent a significant challenge in pulmonary medicine, being indicative of a wide array of underlying conditions ranging from benign infections to life-threatening malignancies [1]. Among the diagnostic tools available, ultrasound-guided fine-needle aspiration cytology (FNAC) has emerged as a minimally invasive yet highly effective method for evaluating lung parenchymal opacities, particularly peripheral lesions [2]. The objective is to study the diagnostic utility and efficacy of USG-guided FNAC in lung parenchymal opacities. Materials and Methods: This is a prospective observational study among 112 in-patients of Pulmonology Dept, GGH, Kakinada. Patients with suspected lung carcinoma, non-resolving pneumonia, non-vascular peripheral lung lesions within 8cm from skin surface on ultrasound and incidental lesions on radiograph are taken for the study. Diagnosed infections, recent myocardial infarction, vascular lesions, suspected hydatid cysts and deep lesions >8cm from skin surface on ultra-sound & severe PAH are excluded. Patients were subjected to USG-FNAC and data was summarized & analysis was done using SPSS software. Results: Radiological distribution involved right lower (32.1%), left lower (24.1%) and right middle lobes (17.0%). USG-FNAC demonstrated a high adequacy rate of 94.6% whereas inadequate samples are 5.4%. Among these, malignancy 58.03% was common, followed by infective 36.6% and inconclusive 4.5%, while benign cases are at 0.9%. While 91.9% of procedures are uneventful, mild haemoptysis (3.6%) and pneumothorax (4.5%) are only complications. Conclusion: USG-FNAC proved to be safe, minimally invasive and effective diagnostic tool for evaluating lung parenchymal opacities, especially peripheral lesions. It achieved a high diagnostic yield and accuracy 94.6%, with minimal complications. Keywords: Fine-needle aspiration cytology, lung ultrasound, malignancy, Peripheral lung lesions, pulmonary infections.

Background: HIV infection imposes significant psychological challenges, particularly among young adults who face stigma, uncertainty, and disruptions in social, emotional, and occupational functioning. Coping strategies play a crucial role in determining psychological resilience and vulnerability to psychiatric morbidity. The aim is to assess coping skills and their association with psychiatric morbidity among HIV-infected young adults. Materials and Methods: A cross-sectional study was conducted among 50 HIV-infected young adults attending an ART center. Coping strategies were evaluated using the Ways of Coping Scale (50-item version), and psychiatric morbidity was assessed using ICD-10 diagnostic criteria. Socio-demographic variables, positive and negative coping scores, and their relationship with psychiatric morbidity were analyzed using Mann-Whitney U test, Wilcoxon signed-rank test, and independent t-tests, with significance set at p < 0.05. Results: Participants with psychiatric morbidity (n=14) had significantly lower positive coping scores (43.9 ± 11.8) compared to those without morbidity (53.4 ± 14.2; p = 0.016). Negative coping scores were markedly higher among individuals with psychiatric morbidity (57.1 ± 12.1 vs. 46.8 ± 13.9; p = 0.008). The difference between positive and negative coping (−13.2 vs. +6.6) was highly significant (p < 0.001). Socio-demographic factors did not show statistically significant associations with coping, though trends suggested influence of age, gender, education, and socioeconomic status. Conclusion: Psychiatric morbidity among HIV-infected young adults is strongly associated with maladaptive coping and reduced use of positive coping strategies. Integrating mental health assessment and coping-skills interventions into HIV care may enhance psychological well-being and improve long-term outcomes. Keywords: HIV-infected young adults; psychiatric morbidity; coping strategies.

Background: Hypertension remains a leading modifiable risk factor for cardiovascular morbidity and mortality worldwide. While earlier evidence suggested a lower burden of hypertension in rural India, recent epidemiological transitions indicate a rising prevalence. A community-based survey conducted in rural Tamil Nadu in 2016 documented the prevalence of hypertension among adults. The present study was undertaken a decade later to assess temporal changes in hypertension prevalence and to identify associated risk factors. Materials and Methods: A community-based cross-sectional follow-up study was conducted in the same rural clusters surveyed in 2016. A total of 800 adults aged ≥18 years were selected using systematic random sampling. Blood pressure was measured using standardized protocols, and socio-demographic characteristics, lifestyle factors, and medical history were collected through structured interviews. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or current use of antihypertensive medication. Prevalence estimates were calculated and compared with 2016 data. Multivariable logistic regression was performed to identify independent predictors of hypertension. Results: The prevalence of hypertension increased significantly from 21.4% in 2016 to 29.8% in 2026 (p < 0.01). Hypertension was significantly associated with increasing age, obesity, low physical activity, and family history of hypertension. Adults aged ≥45 years had more than threefold higher odds of hypertension compared to younger individuals. Obesity and physical inactivity emerged as key modifiable risk factors. Conclusion: The findings demonstrate a substantial rise in hypertension prevalence over the past decade in rural Tamil Nadu, reflecting an ongoing epidemiological transition. Strengthening community-based screening, promoting lifestyle modification, and integrating non-communicable disease prevention into primary healthcare services are urgently required to mitigate future cardiovascular risk. Keywords: Hypertension; prevalence; risk factors; rural health; non-communicable diseases; Tamil Nadu.

Background: Osteoarthritis (OA), disease of cartilage degradation, results in pain, especially in knee joint. Clinical symptoms and radio-diagnosis are used for diagnosis of OA. Conducting radiological investigation on a large scale is cumbersome, hence this study was done using the American College of Rheumatology (ACR) criteria for finding prevalence of knee osteoarthritis. The aim is to estimate the prevalence of knee osteoarthritis among adults aged above 40 years using ACR clinical criteria and to assess its associated factors, health-seeking behaviour, and socio-demographic correlates. Materials and Methods: Participants were interviewed about socio-demographic details, personal history, details of knee pain and associated factors, followed by examination of knee joint and classifying as knee osteoarthritis based on ACR criteria. Its association was checked with socio-demographic & details. Results: Prevalence of knee osteoarthritis was 38%. Factors showing association was being female, among Muslims, being over-nourished, having central obesity, having non sedentary lifestyle, lifting heavy weights, kneeling. Majority visited public hospital for treatment, and had restricted movement. Conclusion: Osteoarthritis of knee, a multifactorial disease affecting general population, should be detected at an early stage to prevent damage to the joint and improve quality of life. Keywords: Knee Osteoarthritis, Age, Urban slum, ACR clinical criteria.

Background: Acute appendicitis is a common surgical emergency, yet its diagnosis remains challenging, especially in atypical presentations. Delayed diagnosis can lead to perforation and peritonitis, while overdiagnosis increases negative appendectomy rates. The neutrophil–lymphocyte ratio (NLR), a simple inflammatory marker derived from routine complete blood count, has been proposed as a useful adjunct in improving diagnostic accuracy. Materials and Methods: This prospective observational study was conducted over six months at a tertiary care center. A total of 120 adult patients (≥18 years) with clinical suspicion of acute appendicitis who underwent appendectomy were included. Preoperative hematological parameters, including total leukocyte count, absolute neutrophil count, absolute lymphocyte count, and NLR, were recorded. NLR was calculated as the ratio of absolute neutrophil to lymphocyte count. Histopathological examination of appendectomy specimens was considered the gold standard. Statistical analysis included ANOVA and receiver operating characteristic (ROC) curve analysis. Results: Histopathology revealed acute appendicitis in 65.0% cases, complicated appendicitis in 18.3%, and normal appendix in 16.7%. Mean NLR values increased significantly with disease severity and were highest in complicated appendicitis (p < 0.001). ROC analysis showed good diagnostic performance with an AUC of 0.81. An NLR cut-off ≥3.5 demonstrated 84.0% sensitivity and 70.0% specificity. Conclusion: NLR is a simple, cost-effective, and reliable marker for diagnosing acute appendicitis and correlates well with disease severity. Its routine use may aid early diagnosis and reduce negative appendectomy rates. Keywords: Acute appendicitis, Neutrophil–lymphocyte ratio, Complete blood count.

Background: Effective postoperative pain management is a key determinant of perioperative quality of care and patient satisfaction. Pregabalin, a gabapentinoid, has gained attention as a pre-emptive analgesic due to its opioid-sparing properties and anxiolytic effects. However, the optimal dose that balances analgesic efficacy with adverse effects remains unclear. The objective is to compare the analgesic efficacy, quality of blockade, sedation profile, and adverse effects of oral pregabalin 150 mg versus 300 mg administered preoperatively in patients undergoing elective lower abdominal surgeries under subarachnoid block. Materials and Methods: This prospective, randomized, double-blind study was conducted over 1.5 years in 70 ASA physical status I–II patients aged 20–60 years undergoing elective lower abdominal surgeries. Patients were randomly allocated into two groups: Group P150 received oral pregabalin 150 mg and Group P300 received oral pregabalin 300 mg, one hour before surgery. Spinal anesthesia was administered using 0.5% hyperbaric bupivacaine. Parameters assessed included onset and duration of sensory and motor blockade, time to two-segment regression, duration of postoperative analgesia, Visual Analog Scale (VAS) scores at 4, 8, and 12 hours, Ramsay sedation score, and incidence of adverse effects. Statistical analysis was performed using SPSS version 22.0, with p < 0.05 considered significant. Results: There was no statistically significant difference between the groups in terms of onset of sensory and motor blockade, time to maximum block, or duration of surgery. The 300 mg pregabalin group demonstrated a significantly prolonged duration of postoperative analgesia, longer motor blockade, delayed two-segment regression, lower VAS scores at all postoperative intervals, and higher sedation scores compared to the 150 mg group (p < 0.001). However, the incidence of dizziness was significantly higher in the 300 mg group (p = 0.02). Conclusion: Preoperative oral pregabalin 300 mg provides superior postoperative analgesia and better sedation compared to 150 mg in patients undergoing elective lower abdominal surgeries under spinal anesthesia, albeit with a higher incidence of dizziness. Clinicians must balance enhanced analgesic benefits against increased side effects when selecting the appropriate dose. Larger, procedure-specific studies are recommended for broader generalization of results. Keywords: Pregabalin; Postoperative analgesia; Subarachnoid block; Spinal anesthesia; Lower abdominal surgery; Visual Analog Scale; Pre-emptive analgesia.

Background: Social media, defined as interactive, network-based platforms for user-generated content, has transformed how young people connect and learn. While it can support collaboration and access to information, excessive use disrupts attention, working memory, and self-regulation. The instant gratification from likes and notifications triggers dopamine release, reinforcing habitual use and diminishing motivation for academic tasks. The aim and objective are to estimate the prevalence of smartphone addiction among Undergraduate medical students , to find the association between smartphone use and sleep quality and to find the association between smartphone use and academic performance. Materials and Methods: The cross-sectional study was conducted among 300 medical students from Naraina medical college, Kanpur. The online data was collected through a questionnaire consisting of four sections. The first section concerned the demographic characteristics of the participants with Pittsburgh sleep quality index (PQSI), Smartphone Addiction Scale Short Version (SAS-SV), and Academic Performance Scale. Results: The prevalence of smartphone addiction is found out to be 57.44% in males and 65.17% in females. The sleep data show that 62.23% of males and 67.86% of females are getting poor-quality sleep. There is a positive correlation between overall PQSI scores and SAS-SV scores and Academic performance score. Conclusion: This study illustrates the need for self-regulation of smartphone use among the medical undergraduates and the youth in general. It reveals not only the smartphone addiction of medical undergraduates, but also its impact on their academic performance and sleep quality. Empowering students to express emotions without bias would facilitate self-awareness and help-seeking behaviors. There should also be strong support for them. A change needs to be made in the academic curriculum regarding these issues to raise awareness. Classrooms should be designated as no smartphone zones to deal with the problem. Keywords: Smartphone, addiction, sleep quality, academic performance.

Background: Fluid resuscitation is a cornerstone of critical care management. However, excessive positive fluid balance may adversely affect organ function and clinical outcomes. The impact of cumulative fluid balance on morbidity and mortality among critically ill patients remains an area of active investigation. The objective is to evaluate the association between cumulative fluid balance and clinical outcomes in critically ill patients admitted to the intensive care unit (ICU). Materials and Methods: This prospective observational study included 250 adult critically ill patients admitted to a tertiary care ICU. Daily fluid input and output were meticulously recorded, and cumulative fluid balance was calculated over the first seven days of ICU stay. Patients were stratified into three groups based on cumulative fluid balance: negative/neutral, mildly positive, and markedly positive. Primary outcomes included ICU mortality and length of ICU stay. Secondary outcomes were duration of mechanical ventilation, incidence of acute kidney injury, and need for renal replacement therapy. Results: Patients with markedly positive cumulative fluid balance demonstrated significantly higher ICU mortality, prolonged mechanical ventilation, longer ICU stay, and increased incidence of organ dysfunction compared to patients with neutral or negative fluid balance. A positive correlation was observed between increasing fluid balance and adverse clinical outcomes. Conclusion: Excessive cumulative positive fluid balance is independently associated with poorer clinical outcomes in critically ill patients. Judicious fluid management and regular reassessment of fluid status may improve outcomes in this population. Keywords: Cumulative fluid balance, critical illness, intensive care unit, mortality, organ dysfunction.

Background: Functional Endoscopic Sinus Surgery (FESS) requires an anesthetic technique that ensures hemodynamic stability and rapid postoperative recovery. Desflurane and sevoflurane are commonly used volatile agents with favorable pharmacokinetic profiles; however, comparative data regarding recovery characteristics and intraoperative hemodynamics in FESS remain limited. Material and Methods: In this prospective comparative study, 100 ASA I-II patients scheduled for elective FESS were allocated into two groups (n=50 each). After standardized induction, anaesthesia was maintained with either end-tidal desflurane 3% (Group D) or sevoflurane 1% (Group S) in 66% nitrous oxide and oxygen. Heart rate (HR) and mean arterial pressure (MAP) were recorded at baseline and 15-minute intervals. Upon cessation of anaesthesia, time intervals to response to painful stimulus, verbal commands, extubation, recall of name, hand grip, limb lift, and achievement of a Post-Anaesthesia Recovery Score (PARS) >10 were recorded. Statistical analysis was performed using unpaired t-test and chi-square test, with p < 0.05 considered significant. Results: Baseline demographic and perioperative variables were comparable between groups (p > 0.05). Early recovery was significantly faster in the desflurane group, with higher proportions achieving response to painful stimulus within 9 minutes (88% vs 62%), extubation within 10 minutes (84% vs 46%), and PARS >10 within 12 minutes (82% vs 38%) compared to the sevoflurane group (all p < 0.001). Neuromuscular recovery milestones were also achieved earlier with desflurane, including hand grip ≤11 minutes (76% vs 36%) and limb lift ≤12 minutes (72% vs 32%) (p < 0.001). Intraoperatively, MAP reduction >30% of baseline occurred less frequently with desflurane (18%) than with sevoflurane (54%) (p < 0.001). Conclusion: Desflurane provides faster early recovery and superior hemodynamic stability compared to sevoflurane in patients undergoing FESS, making it a favorable choice when rapid emergence and controlled hypotension are clinical priorities. Keywords: Desflurane, Sevoflurane, Functional Endoscopic Sinus Surgery (FESS), Post-Anaesthesia Recovery Score (PARS).

Background: The non-recurrent laryngeal nerve (NRLN) is a rare anatomical variant with profound surgical implications, particularly in thyroidectomy, where it increases the risk of vocal cord paralysis. Preoperative imaging modalities such as computed tomography (CT), ultrasonography, and barium swallow, combined with intraoperative neuromonitoring (IONM), are essential for its detection. Anatomical variations of the inferior laryngeal nerve, including the non-recurrent form, pose significant risks during neck surgeries. Data on NRLN and associated vascular complexes from Indian cadaveric studies remain limited. Awareness of its course and vascular associations can mitigate iatrogenic injuries. This study aimed to analyze the anatomical variations of the NRLN and associated vascular anomalies, including their incidence, in adult human cadavers. Materials and Methods: Twenty embalmed adult cadavers (40 sides) of both sexes were dissected at the Department of Anatomy, SVIMS-SPMCW, Tirupati. Variations were documented photographically. Dissections followed a layered anterior cervical approach, with NRLN variants classified according to Toniato et al. Associated vascular anomalies were measured and photographed in situ. Results: A unilateral right-sided NRLN was identified in one male cadaver (2.5% prevalence across 40 sides), associated with an aberrant right subclavian artery (arteria lusoria). Additionally, two male cadavers exhibited an absent brachiocephalic trunk with a common trunk for both common carotid arteries. No left-sided NRLN was observed. The NRLN was classified as Type 2B, originating from the cervical vagus at C6 level and entering the larynx 2.5 cm inferior to the cricothyroid joint. Conclusion: These findings highlight the rarity and right-sided predominance of NRLN, along with its vascular associations, and underscore the value of preoperative imaging and IONM in surgical practice. The study contributes to anatomical knowledge for surgeons, radiologists, and anatomists in the Indian context. Keywords: Non-recurrent laryngeal nerve; aberrant right subclavian artery; brachiocephalic trunk; common carotid artery; thyroidectomy.

Background: Magnesium is a major intracellular divalent cation essential for numerous physiological processes, including neuromuscular conduction, vascular tone regulation, and enzymatic activity. Pregnancy is associated with significant physiological alterations in mineral metabolism, and magnesium deficiency has been implicated in adverse maternal and fetal outcomes, particularly pre-eclampsia. Objectives: To study the correlation between serum magnesium levels during pregnancy and the development of pre-eclampsia. Materials and Methods: A hospital-based cross-sectional study was conducted over a period of 10 months at Mallareddy Institute of Medical Sciences. A total of 100 pregnant women across all three trimesters were enrolled based on predefined inclusion and exclusion criteria. Serum magnesium levels were estimated using the Xylidyl Blue method on a Mindray autoanalyzer. Statistical analysis was performed using descriptive statistics, Chi-square test for proportions, and Student’s t-test for comparison of means. Results: The majority of participants were aged 18–25 years (42%). Serum magnesium levels below 1.7 mg/dl were observed in 13%, 22%, and 30% of women in the first, second, and third trimesters respectively. Among women with pre-eclampsia, 75% had serum magnesium levels below 1.7 mg/dl. A progressive decline in magnesium levels was observed with advancing gestation. Conclusion: Serum magnesium levels decrease progressively during pregnancy and are significantly lower in women with pre-eclampsia. Monitoring magnesium levels during pregnancy may help identify women at increased risk for hypertensive disorders and adverse outcomes. Keywords: Magnesium, Pregnancy, Pre-eclampsia, Serum Magnesium, Hypertensive Disorders of Pregnancy.

Background: Thyroid swellings are more common in women than in men, with a reported prevalence of 12% in the general population. The patient frequently ignores the swelling's development for a considerable amount of time. It frequently remains undetected until the patient experiences symptoms brought on by the swelling. In order to minimise patient morbidity, the clinician must make the right diagnosis as quickly as possible. Ultrasound is a non-invasive, quick, simple, reproducible, and minimally uncomfortable modality. Most significantly, it doesn't use any ionising radiation, which is bad for the patient. High resolution ultrasonography makes it possible to quickly analyse the thyroid gland and its relationship to surrounding tissues, including the neck's major lymph node chains. An effective supplement to greyscale ultrasonography in the assessment of thyroid swellings is colour Doppler evaluation, which aids in the investigation of vascularity. Materials and Methods: Patients who satisfied the inclusion and exclusion criteria had their clinical history, physical examination, investigations, including thyroid function tests, entered into a standardised, pre-made case proforma. The GE Voluson 730 Pro Ultrasound machine's high resolution, 7.5–12 MHz linear array transducer was used to perform the ultrasound examination of the thyroid gland in both greyscale and colour Doppler modes. After obtaining informed consent and completing a coagulation profile, fine needle aspiration cytology of the thyroid enlargement was performed. The sensitivity, specificity, positive predictive value, and negative predictive value of the high resolution ultrasonography results were determined by correlating them with the fine needle aspiration cytology report. Results: Thyroiditis, colloid goitre, multinodular goitre, hyperplastic nodular colloid goitre, and benign adenomatous nodular goitre are examples of benign thyroid abnormalities. Papillary carcinoma, medullary carcinoma, follicular carcinoma, and anaplastic carcinoma are examples of malignant thyroid lesions. The thyroid nodule's marked hypoechogenicity was 88% specific and 100% sensitive in identifying a malignancy nodule. Thyroid nodule hyperechogenicity achieved 100% specificity and 19.2% sensitivity in identifying benign nodules. The presence of macrocalcification was 12.77% sensitive and 100% specific in predicting the benign nature of the nodular lesion, while the presence of microcalcification was 100% sensitive and 70% specific in identifying malignant lesions. The thyroid nodule's taller than wide dimensions is a 100% sensitive and 100% specific indicator of cancer. The presence of spiculated margin is 100% sensitive and 100 % specific in the diagnosis of a malignant thyroid lesion. Intralesional vascularity was 100% sensitive and 100 % specific in the diagnosis of malignant thyroid nodule. Lymphadenopathy is 100% sensitive and 100% specific in the diagnosis of a malignant thyroid nodule. Conclusion: High-definition Duplex ultrasonography is a non-invasive, safe, quick, simple, repeatable procedure that causes the patient little discomfort. Above all, it doesn't use any ionising radiation that c

Background: Bithalamic lesions are uncommon yet clinically significant because of the thalamus’s central role in cognition, consciousness, and sensorimotor integration. Bilateral involvement often produces varied and nonspecific neurological manifestations, complicating the early aetiological diagnosis. This study aimed to analyse the clinical profile, neuroimaging patterns, and aetiological spectrum of bithalamic lesions and associate clinical presentations with underlying causes and outcomes. Materials and Methods: This retrospective descriptive study was conducted in the Department of Neurology at a tertiary care centre from December 2023 to November 2025. A total of 26 patients with neurological symptoms and bilateral thalamic involvement on brain CT or MRI were included. Demographic details, clinical presentations, neuroimaging patterns, aetiological diagnoses, and clinical outcomes were analysed. Data were summarised using descriptive statistics and expressed as frequencies and percentages. Results: Most patients were aged <30 years (84.6%) and were female (53.8%). Wilson’s disease was the most common aetiology (38.5%), followed by Wernicke’s encephalopathy (15.4%), deep cerebral venous thrombosis, and Fahr’s disease (11.5% each). Altered sensorium or encephalopathy was the most frequent clinical presentation (53.8%), followed by movement disorders (46.2% of patients). Bilateral thalamic T2/FLAIR hyperintensity was observed in all patients, whereas diffusion restriction was noted in 34.6% of patients. Treatable or potentially reversible conditions accounted for 73.1% of the cases. Mortality was observed in 15.4% of patients, predominantly in those with progressive neurodegenerative and mitochondrial disorders. Conclusion: Bithalamic lesions demonstrate heterogeneous clinical and aetiological profiles. Neuroimaging plays a central role in the early diagnosis and aetiological differentiation of these conditions, facilitating timely intervention in reversible conditions and potentially improving clinical outcomes. Keywords: Diagnostic Imaging, Magnetic Resonance Imaging, Nervous System Diseases, Thalamus, Computed Tomography

Background: Neonatal sepsis remains a major cause of morbidity and mortality in the first month of life. Its clinical features are often nonspecific, and pathogen distribution varies across regions. Understanding local microbial profiles and antibiotic susceptibility is essential for guiding empirical therapy and preventing antimicrobial resistance. Aim: To assess risk factors, clinical presentation, causative organisms, and antibiotic susceptibility patterns in culture-proven neonatal sepsis. Materials and Methods: This prospective observational cross-sectional study was conducted from 1st October2021 to 31st March 2022 in the Departments of Paediatrics and Microbiology, Tezpur Medical College and Hospital. Neonates aged 0–28 days with clinical features or risk factors for sepsis and a positive blood culture were included. Those with congenital anomalies or prior antibiotic use were excluded. Relevant demographic, clinical, microbiological, and antibiotic sensitivity data were recorded and analysed. Results: Of 106 neonates with suspected sepsis, 46 (43.3%) were culture-positive. Early-onset sepsis accounted for 60.9%, and males comprised 56.5%. Term neonates formed 56.5%, and low-birth-weight neonates 52.1%. Frequent risk factors included premature rupture of membranes (39.1%), perinatal asphyxia (36.9%), and prolonged labour (28.2%). Common presentations were respiratory distress (52.1%), jaundice (45.6%), refusal to feed (41.3%), and convulsions (32.6%). Gram-positive organisms accounted for 50% of isolates, Gram-negative for 41.3%, and fungi for 8.6%. Staphylococcus aureus (43.4%) and Klebsiella spp. (30.4%) were predominant. S. aureus showed highest sensitivity to Vancomycin (100%) and Linezolid (85%). Gram-negative isolates were fully sensitive to Meropenem and Imipenem but resistant to Cephalosporins and commonly used antibiotics. Conclusion: Nearly half of clinically suspected cases were culture-positive. High resistance to commonly used antibiotics and better sensitivity to Carbapenems and Vancomycin highlight the need for local antibiogram-based empirical therapy and strong antibiotic stewardship. Keywords: Neonatal Sepsis, SCNU, Risk factors, Blood culture.

Through their grassroots connections between communities and government healthcare institutions, community health workers are integral to India's healthcare system. Despite the size and diversity of this workforce, there are still significant disparities between the training they get and the challenging circumstances they encounter on the job. Employees may not be adequately prepared for the many challenges of delivering community health care, including cultural variations, few resources, and shifting disease patterns, by training programs that usually follow the same curriculum The training and field experience disparities across four key groups—Accredited Social Health Activists (ASHAs), Auxiliary Nurse Midwives (ANMs), Anganwadi Workers (AWWs), and Multipurpose Health Workers (MPHWs)—are examined in this narrative analysis. In order to identify systemic issues between standardized training programs and the complex reality of providing community health care, this study examines recent research and policy articles. The most significant findings indicate that the training is too brief, that there are insufficient opportunities for skill development, that the compensation structures are inadequate, and that there are insufficient channels for community input. The assessment makes research-based policy recommendations to increase the likelihood that India's community health workforce will achieve universal health coverage. Redesigning training, developing performance-based incentive programs, and enhancing supervisory frameworks are some of these modifications. Keywords: Community health workers, Training gaps, Field experience, Health workforce, India, Universal health coverage.

Background: Spinal anaesthesia is the preferred technique for elective cesarean section due to its safety and rapid onset. However, hypotension after spinal anaesthesia is still a common and potentially serious complication. Its incidence is reported to be above 50%. Ketamine, has sympathomimetic properties that may help mitigate hypotension by maintaining vascular resistance and cardiac output. This study was undertaken to evaluate the effect of two intravenous low-dose ketamine regimens on the incidence of post-spinal hypotension in women undergoing elective cesarean section. Materials and Methods: A prospective observational study was conducted at Burdwan Medical College and Hospital over 18 months involving 100 ASA I–II full-term pregnant women scheduled for elective cesarean section under spinal anaesthesia. Participants were randomly assigned into two groups: Group Ka received 0.15 mg/kg ketamine and Group Kb received 0.25 mg/kg ketamine intravenously post-delivery. Hemodynamic parameters were recorded at defined intervals. Hypotension was defined as more than 20% fall in mean arterial pressure (MAP) from baseline. It was treated with fluid boluses and vasopressors. Postoperative analgesia, sedation, APGAR scores, and adverse effects were assessed up to 24 hours. For statistical purpose p value less than 0.05 was taken as significant. Results: The incidence of hypotension was found to be significantly lower in Group Kb (2%) as compared to Group Ka (16%) (p=0.03). At 10 minutes post-delivery, systolic blood pressure and MAP were better maintained in Group Kb as compared to Group Ka and the difference was statistically significant (p=0.001). The VAS score reached threshold of 4 or more later in Group Kb as compared to patients in Group Ka (12 hours). Ramsay Sedation Scores remained below 3 and was found to be comparable in both the groups. APGAR scores at 1 and 5 minutes were comparable and not clinically significant, as ketamine was administered after delivery. Conclusion: Intravenous low-dose ketamine, especially at 0.25 mg/kg, is effective in reducing the incidence of post-spinal hypotension and prolonging postoperative analgesia without compromising maternal or neonatal safety. It is a safe and beneficial intravenous adjunct in spinal anaesthesia for elective cesarean sections. Keywords: Ketamine, Hypotension, Spinal Anaesthesia, Cesarean Section, Postoperative Analgesia.

Background: Reliable, low-cost screening tools for identifying childhood overweight and obesity are essential in low- and middle-income countries, where resource constraints limit the use of advanced body composition techniques. Although body mass index (BMI) is widely used, its limitations in distinguishing fat mass from lean mass have prompted interest in alternative anthropometric indicators. Objective: To evaluate the validity of mid-upper arm circumference (MUAC) and mid-thigh circumference (MTC) as screening measures for overweight and obesity among School children aged 6–12 years, using BMI-for-age Z-scores as the reference standard. Materials and Methods: A cross-sectional study was conducted in Perambalur district from April 2023 to March 2024. A total of 532 children were included, and their anthropometric measurements were measured. Pearson’s correlation coefficients were used to assess the associations between BMI and alternative measures. Receiver operating characteristic (ROC) curve analysis was performed to determine the discriminatory ability and optimal cut-off values of MUAC and MTC for identifying overweight and obesity. p-value <0.05 was considered statistically significant. Results: The study found a strong positive correlation between BMI and MUAC (r=0.864 in females, r=0.875 in males) and MTC (r=0.825 in females, r=791 in males). ROC analysis indicated that MUAC had high discriminatory accuracy for males and MTC for both genders in discriminating obesity, with high sensitivity and specificity, and an AUC of more than 0.9 for these measures. Conclusion: MUAC and MTC exhibit strong agreement with BMI-based weight status classification and demonstrate high screening accuracy for identifying overweight and obesity among school-aged children. These simple, non-invasive measures may complement BMI in large-scale screening programs, particularly in resource-limited settings. Further validation against direct measures of adiposity and in diverse populations is warranted. Keywords: MUAC, MTC, BMI, Obesity, Overweight

Background: Fetuin-A, a glycoprotein secreted by the liver, has emerged as a potential metabolic biomarker associated with obesity and Type 2 Diabetes Mellitus (T2DM). Elevated serum levels of Fetuin-A have been linked to various metabolic alterations, including increased body mass index (BMI), hyperglycemia, elevated HbA1c, dyslipidemia, and insulin resistance. This study aimed to assess the association between elevated serum Fetuin-A levels and obesity in individuals with T2DM. Materials and Methods: A comparative cross-sectional study was conducted involving 100 participants, including obese T2DM patients and healthy controls. Serum Fetuin-A levels were quantified using the enzyme-linked immunosorbent assay (ELISA) method. Results: Serum Fetuin-A levels were significantly higher in obese T2DM patients compared to healthy controls (p < 0.05). A positive correlation was observed between elevated Fetuin-A levels and key metabolic parameters, including BMI, fasting blood glucose, HbA1c, and lipid profile abnormalities. Conclusion: High serum Fetuin-A levels are significantly associated with obesity and adverse metabolic profiles in patients with Type 2 Diabetes Mellitus. Fetuin-A may serve as a potential biomarker for identifying metabolic risk in obese diabetic individuals. Keywords: Fetuin-A, Type 2 Diabetes Mellitus, Obesity, Biomarker, Insulin Resistance.

Background: Surgical site infections (SSIs) are significant hospital-acquired complications with major implications for patient morbidity, mortality and healthcare resource utilization. This study describes the incidence patterns and risk factors of SSIs in a tertiary care hospital setting in India. Materials and Methods: A non-interventional prospective study was conducted from November 2024 to October 2025. All patients who underwent surgical procedures (appendectomy, laparotomy, debridement, amputation, fixation, cholecystectomy, thyroidectomy, and herniorrhaphy) and subsequently developed clinical features of postoperative wound infection were evaluated. Microbiological culture and identification were performed using standard laboratory methods. Data on demographic variables, comorbidities, operative factors and antimicrobial prophylaxis were recorded. Results: Among 150 patients with suspected postoperative wound infections, 98 (65·33%) tested positive on culture. Male predominance was observed (98 males, 52 females). Diabetes mellitus was identified in 32 patients (40% of those with recognized risk factors). Deep incisional infections (37·8%) and organ/space infections (35·2%) were more common than superficial infections (25·5%). Laparotomy accounted for the highest number of infections (56 patients, 37·33%), followed by debridement procedures (28 patients, 18·67%). Gram-negative bacilli predominated among isolated organisms. Despite 92·7% of patients receiving prophylactic antibiotics, high SSI rates persisted. Conclusion: SSIs in this cohort were significantly associated with male sex, age 41-50 years, diabetes, hypertension, smoking, presence of drains, major abdominal and orthopedic procedures, and operative duration exceeding two hours. Structured prevention bundles incorporating risk-adjusted surveillance, optimized perioperative glycemic control, evidence-based antimicrobial prophylaxis, and targeted interventions for high-risk patients are essential to reduce SSI burden. Keywords: Surgical site infections; risk factors; tertiary care; antimicrobial resistance; infection prevention.

Background: Despite advances in its management over the last few decades, severe pneumonia (SP) remains a primary cause of death from infection across the globe, with a mortality rate ranging from 20% to more than 50%.[1,2] Revised guidelines of WHO classified pneumonia into two categories A) pneumonia which can be treated at home with the oral dose of amoxicillin and, B) severe pneumonia is treated with injectable antibiotics.[3] Platelets are conventionally considered to have a role in haemostasis and thrombosis, but have received increasing attention for their role in inflammation and immune responses.[4-7] Materials and Methods: A prospective case control study was conducted in the Upgraded Department of Pathology, Osmania government general hospital, Hyderabad during July 2020 to July 2022. In present study 100 patients were evaluated fulfilling the criteria of pneumonia in paediatric age group. Detailed history, thorough clinical examination, complete hemogram through automated Haematology analyzer and peripheral smear examination was performed in all the 100 patients and controls. Platelet indices have been evaluated. Results: A total of 100 cases were studied and compared to 100 controls with same mean age. All cases admitted with pneumonia were included. The age range was 1 to 15 years with mean age being 2.8 years. Male preponderance was noted with a male: female= 2.4: 1. The mean Platelet count was found to be higher 4,21,000 in cases when compared to controls 3,29,000 respectively. Conclusion: Thrombocytosis was commonly associated with pneumonia in children. Degree of thrombocytosis directly correlated with severity of illness and subsequent complications children with pneumonia associate with thrombocytopenia must be monitored carefully and may required extended hospital stay compared to the others. Along with serial evaluation of total leukocyte count and inflammatory markers done for assessment in routine to gauge the recovery and underlying inflammatory process the platelet parameters can also be complementary for clinical decision making. Keywords: Pneumonia, Platelet, Mean platelet count.

Background: Aim to study the prevalence, clinico‑hematological profile, etiological pattern, and functional impact of anemia in the geriatric population, and to evaluate the association between anemia severity and common geriatric syndromes in a cohort of 100 patients aged 60–89 years attending a tertiary‑care hospital. Materials and Methods: This was a hospital‑based, prospective, observational study. Detailed sociodemographic and clinical data were collected using a structured proforma. Symptoms, comorbidities, nutritional history, drug intake, and functional status were recorded. Physical examination included vital parameters, anthropometry, and focused systemic examination. Laboratory evaluation comprised complete blood count with red cell indices, peripheral smear, reticulocyte count, serum iron, ferritin, total iron‑binding capacity (TIBC) was done. Results: Anemia is highly prevalent in the geriatric population and is frequently multifactorial, with iron deficiency and anemia of chronic disease being the leading causes. Increasing severity of anemia is associated with higher burden of comorbidities, functional decline, frailty, and healthcare utilization. Mild, moderate, and severe anemia were observed in 46%, 38% and 16% of patients, respectively. The predominant morphologic pattern was normocytic normochromic anemia (48%), followed by microcytic hypochromic (34%) and macrocytic (18%) patterns. Iron‑deficiency anemia was the commonest etiology, accounting for 36% of cases. Conclusion: Early recognition and systematic evaluation of anemia in older adults are essential to identify treatable causes, optimize functional outcomes and reduce morbidity. Screening for anemia should be integrated into comprehensive geriatric assessment, and management should be individualized, addressing nutritional deficiencies, chronic disease control and iatrogenic factors. Keywords: Anemia; elderly; geriatric; iron‑deficiency anemia; functional status.

Background: Secondary glaucoma is a known complication following vitreo-retinal surgeries and can adversely affect long-term visual outcomes if not detected early. The reported incidence varies widely, and data on associated risk factors remain limited, particularly in regional populations. The aim is to determine the incidence of secondary glaucoma following vitreo-retinal surgeries and identify associated risk factors influencing its development. Materials and Methods: This retrospective and prospective observational study including 76 patients who underwent vitreo-retinal surgeries between 2021 and 2023. Medical records from 2021-2022 were reviewed retrospectively, while patients operated in 2023 were followed prospectively for at least six months. Secondary glaucoma was defined as postoperative intraocular pressure >21 mmHg and/or glaucomatous optic disc and visual field changes. Demographic characteristics, surgical variables, visual acuity, intraocular pressure trends, and potential risk factors were analyzed. Independent predictors of secondary glaucoma were identified using multivariate logistic regression. Results: Secondary glaucoma developed in 14 eyes, yielding an incidence of 18.42%. Open-angle glaucoma was more common (13.16%) than angle-closure glaucoma (5.26%). Most cases (64.3%) occurred within the first postoperative month. Higher preoperative IOP (OR 2.64, p = 0.002), aphakic lens status (OR 5.23, p = 0.022), and vitreous hemorrhage as the indication for surgery (OR 4.78, p = 0.038) were identified as independent risk factors. Conclusion: Secondary glaucoma is a significant postoperative complication following vitreo-retinal surgery. Early risk stratification and vigilant postoperative monitoring are essential to prevent glaucomatous damage while preserving favorable visual outcomes. Keywords: Secondary Glaucoma, Vitreo-Retinal Surgery, Pars Plana Vitrectomy, Intraocular Pressure, Risk Factors, Visual Outcomes.

Background: Vulvar diseases may present in a variety of ways ranging from the asymptomatic to chronic disabling conditions. They may present with itching, burning, dyspareunia, pain, fissuring, bleeding after intercourse. The importance and frequency of vulvar dermatoses are often underestimated. Prompt recognition and treatment minimizes the duration of symptoms and also helps to avoid damage to self-esteem and sexual relationship. The objective is to observe the different clinical patterns of vulvar dermatoses and the epidemiological factors affecting them. Materials and Methods: A hospital-based cross-sectional study was conducted in our outpatient department (OPD) from Nov 2023 to April 2024.A total of 304 patients who attended the OPD with vulval lesions were included in the study after taking informed consent. Sociodemographic details, clinical history of the disease, examination findings and investigation findings were noted in the proforma and data analysis is done. Results: The majority of patients in the study belonged to the 31 –40 years age group (37.83%). Majority of the study subjects were married (78.95%), illiterate (67.76%) and unskilled labourers (33.8%). The most common vulvar dermatoses in our study were infections (60.53%) followed by inflammatory diseases (14.47%). Among infections, fungal infections were more common (33.55%) followed by viral infections (20.07%) and bacterial infections (6.91%). Tinea cruris was observed to be the most common infection (18.42%) followed by candidiasis (15.13%). Among the inflammatory diseases, lichen sclerosus et atrophicus was seen in 6.58% followed by lichen simplex chronicus in 3.29%. Conclusion: This study highlights the different patterns of vulvar dermatoses and the socio demographic factors affecting them. Infections being the major cause can be prevented by awareness and hygiene. Early diagnosis and proper management is important to prevent complications. Keywords: vulvar dermatoses, epidemiological factors, lichen sclerosus et atrophicus, Tinea cruris, candidiasis.

Background: Nasal polyposis is a chronic inflammatory disorder of the nasal and paranasal sinus mucosa with a high tendency for recurrence despite surgical management. Functional endoscopic sinus surgery effectively removes polypoidal disease and improves sinonasal ventilation; however, persistent inflammation often leads to postoperative recurrence. Topical nasal corticosteroids are commonly prescribed after surgery to suppress inflammation and reduce recurrence, yet their long-term efficacy warrants evaluation. Objectives: To assess the effectiveness of postoperative nasal corticosteroid therapy in preventing recurrence of nasal polyps following surgical intervention. Materials and Methods: Design: This prospective observational study was conducted in the Department of Otorhinolaryngology over a period of 18 months. A total of 60 patients diagnosed with nasal polyposis and undergoing nasal polyp surgery were included. Postoperatively, all patients received intranasal corticosteroid therapy and were followed at regular intervals. Clinical outcomes were assessed using symptom evaluation and diagnostic nasal endoscopy to identify recurrence of nasal polyps during the follow-up period. Results: Patients receiving postoperative nasal corticosteroids showed significant improvement in nasal obstruction, discharge, and olfactory symptoms. Endoscopic examination during follow-up demonstrated a reduced rate of polyp recurrence compared to expected postoperative recurrence patterns. Better disease control and delayed recurrence were observed among patients compliant with regular corticosteroid use. Conclusions: Postoperative intranasal corticosteroid therapy is effective in reducing the recurrence of nasal polyps following surgery. Regular and sustained use contributes to improved symptom control and prolonged disease-free intervals. Nasal corticosteroids should be considered an essential component of postoperative management after nasal polyp surgery. Keywords: Nasal polyps; Nasal corticosteroids; Endoscopic sinus surgery; Polyp recurrence; Chronic rhinosinusitis; Postoperative therapy.

Background: Intraventricular hemorrhage (IVH) is a serious neurological condition associated with severe morbidity and mortality. External Ventricular Drainage (EVD) is the conventional treatment; however, Ommaya reservoir insertion is now an alternative that reduces complications and improves patient outcomes. The study aims to compare the clinical outcomes and complications between patients with IVH managed by either EVD, Ommaya, or the combination of both. Materials and Methods: A retrospective study was conducted at XXXX in 22 IVH patients confirmed radiologically. The patients were divided into three groups such as EVD, Ommaya, and the combination of both. The clinical parameters such as Glasgow Coma Scale (GCS), Modified Graeb Score (mGS), Glasgow Outcomes Scale (GOS), complications, duration of hospital stay, and survival were analysed using ANOVA<, Chi-square test, and Kruskal-Wallis tests. The p-values <0.05 were considered statistically significant. Results: A total of 22 patients were included in the study, where most of the patients were between 40- 60 years, with male predominance. The combined group had significantly lower admission GCS (7.7 ± 1.6) and higher mGS (22.4 ± 7.4) (p < 0.001). The survival rate was significantly higher in the Ommaya group (88.9%) compared to the combined group (75%) and EVD (33.3%) (p = 0.041). Complications such as ventriculitis (11.1%) and blockage (77.7%) were predominantly observed in EVD patients. Conclusion: The Ommaya reservoir or both EVD and Ommaya demonstrated superior survival, fewer complications, and reduced the need for re-intervention compared to the EVD group. Keywords: Intraventricular haemorrhage, Ommaya reservoir, External ventricular drainage, Glasgow coma scale, modified Graeb score.

Background: Mesial temporal sclerosis (MTS) is the most common pathological substrate underlying medically refractory temporal lobe epilepsy. Magnetic resonance imaging (MRI) plays a pivotal role in the diagnosis and presurgical evaluation of these patients. Objectives: To evaluate the spectrum of MRI findings in patients with mesial temporal sclerosis and to assess the laterality and frequency of various imaging features in a retrospective cohort. Materials and Methods: This retrospective observational study included patients with clinically diagnosed temporal lobe epilepsy who underwent MRI brain with an epilepsy protocol at a tertiary care center between January 2024 and December 2024. MRI examinations were performed on a 1.5T scanner. Imaging features assessed included hippocampal atrophy, T2/FLAIR hyperintensity, loss of internal architecture, temporal horn dilatation, and associated findings. Descriptive statistics were used for analysis. Results: A total of 100 patients (mean age: 30-50years; M:F = 2:1) were included. MTS was unilateral in 70% and bilateral in 30%. Hippocampal atrophy was observed in 70%, T2/FLAIR hyperintensity in 80%, and loss of internal architecture in 60% of cases. Temporal horn dilatation was noted in 50%. MRI laterality showed concordance with clinical/EEG findings in 70% of patients. Conclusion: MRI is a sensitive and non-invasive modality for the detection of mesial temporal sclerosis. Hippocampal atrophy and T2/FLAIR hyperintensity are the most consistent imaging features. Dedicated epilepsy protocol MRI is essential for accurate diagnosis and surgical planning. Keywords: Mesial temporal sclerosis; Temporal lobe epilepsy; MRI brain; Hippocampus; Epilepsy protocol.

Background: Pregnancy and its outcomes are challenging issue in the field of obstetrics and gynecology, this study is aimed to assess the psychological status (stress, anxiety, depression) among women with abortion compared with women with no history of abortion. Materials and Methods: A Case-control cross sectional study was carried out in the departments of Consultants and Reception in Duhok Obstetrics and Gynecological Hospital, in the period from 2023 6th January to 2023 29th April, eighty pregnant women in the first trimester were recruited for the purpose of data collection, forty women in case group with history of two abortion and more. Other forty women were with no history of abortion. By direct interview information on sociodemographic data, obstetrical data were taken, Depression anxiety and stress were assessed by using of Scale- 21 item (DASS-21). Results: The results indicate that there were highly significant differences between case and control group in both depression and stress aspect (p. values ≤ 0.05). Also, the results indicate that there were no differences between participant’s overall depression and stress score participant's sociodemographic characteristics in both groups conclusions. Conclusion: Study concluded that psychological problems were more common among women with history of abortion, screening of psychological disturbance during pregnancy should be done in order to manage them and prevent poor outcomes. Keywords: Depression, anxiety & stress, women, abortion.

Background: Adnexal masses are a common finding on pelvic ultrasound Ultrasonography is used for preoperatively identifying an adnexal mass as benign or malignant and ultimately guiding further management. The IOTA ADNEX model introduces objectivity to facilitate this differentiation. The study aimed at evaluating the performance of IOTA ADNEX model in preoperatively discriminating the nature of adnexal masses and also comparing the performance of the IOTA ADNEX model with subjective radiological assessment in characterising the masses. Materials and Methods: The study was conducted on women presenting with symptomatic adnexal masses which were evaluated by pelvic ultrasound and characterised as benign or malignant using IOTA ADNEX Model. Simultaneously the same patient was evaluated by a sonologist who also characterised the adnexal mass as benign, indeterminate or malignant based on subjective assessment. The diagnostic performance of IOTA ADNEX model at various cut-offs was compared with sonologist’s assessment taking the histopathology of the adnexal mass as reference standard. Results: The study comprised a total of 49 patients.CA-125 level was found to be a statistically significant predictor (p-value < 0.001) in differentiating between benign and malignant adnexal pathologies. The means of “maximum diameter of lesion” and “maximum diameter of largest solid component” were also significantly higher in groups with malignant ovarian pathologies (p-values of 0.029 and <0.001 respectively).Acoustic shadow was present in 13.79% patients with benign lesions and none in malignant ovarian neoplasms with a significant p value of <0.001. The diagnostic performance ROC Curve of the IOTA ADNEX model showed an AUC of 0.707 [95% CI (0.560-0.828)] at a standard cut off of 10% and 0.962 [95% CI (0.861-0.995)] at the proposed cut off of 47.1%. At a cutoff of 47.1%, the model demonstrated a sensitivity and specificity of 95% [95% CI (75.1 - 99.9)] and 89.66% [95% CI(72.6-97.8%)] respectively. The AUC of the subjective assessment method was found to be 0.776 [95% CI(0.634 to 0.883)] with a sensitivity of 100% [95% CI (83.2 to 100)] and specificity of 55.17% [95% CI (35.7-75.6)]. When comparing the AUCs between the ADNEX model and subjective assessment method, significant difference was found between the two assessments when using the proposed cut-off of 47.1%, in which case the IOTA ADNEX model was found to be more specific (p-value = 0.002). Conclusion: IOTA-ADNEX is undoubtedly a promising ultrasound based model which can precisely differentiate adnexal masses as benign or malignant preoperatively and merits clinical application. We found 47.1% as the optimal cut-off of the model for our tertiary level oncology setup which provided both high sensitivity and specificity as compared to the standard 10% cut-off. Based on our study, we propose higher cut-offs to be used with the IOTA-ADNEX model when being applied in oncological institutes to avoid unnecessary surgeries for benign pathologies. Keywords: Adnexal Mass; Malignancy; IOTA ADNEX; Radiologist; Subjective assessment.

Background: Cardiac autonomic neuropathy (CAN) is a serious complication of type 2 diabetes mellitus (T2DM). It affects the nerves that control the heart and is associated with increased illness and death. The triglyceride-glucose (TyG) index is an easy, marker of insulin resistance that can be calculated quickly and may help in early identification of metabolic risk. Objectives: To measure TyG index levels in patients with T2DM and to assess how well it can predict the presence of CAN. Materials and Methods: This cross-sectional study included 63 patients with T2DM aged 18–60 years at MAPIMS, Tamil Nadu, from April to September 2024. We recorded clinical details, body measurements, and laboratory parameters, and performed Ewing’s cardiovascular autonomic function tests. Based on test results, patients grouped as CAN or non-CAN. Groups were compared using independent t-tests, with p<0.05 considered significant. Results: CAN was present in 41.3% of patients. Compared to those without CAN, patients with CAN had higher fasting blood glucose (242.22±29.92 vs 166.26±10.92 mg/dL), triglycerides (246.31±9.41 vs 153.08±4.37 mg/dL), HbA1c (9.14±1.27 vs 7.12±0.99%), and TyG index (10.30±0.12 vs 9.45±0.07), and all these differences were highly significant (p<0.001). Autonomic function test results were significantly worse in the CAN group. Among body measurements, only waist circumference was significantly linked with CAN (p=0.014). Conclusion: The TyG index clearly separated T2DM patients with CAN from those without CAN. Since it is simple, inexpensive, and easy to calculate, it can be used as a screening tool to identify high-risk patients early, especially in settings with limited resources. Keywords: Triglyceride-glucose index, Cardiac autonomic neuropathy, Type 2 diabetes mellitus, Ewing tests, Insulin resistance.

Background: Antimicrobial resistance (AMR) in community acquired infections (CAIs) is a growing public health concern. Materials and Methods: A retrospective study of 450 culture positive CAI cases (Jan–Dec 2023) was conducted at Patnam Mahender Reddy Institute of Medical Sciences, Chevella, Telangana. Pathogen distribution and resistance phenotypes were analyzed. Results: Gram negative organisms predominated (73.6%), with Escherichia coli (37.6%) and Klebsiella pneumoniae (27.1%) as leading pathogens. ESBL prevalence was high in urinary isolates (E. coli 40.2%; K. pneumoniae 32.0%). Carbapenem resistance was observed in K. pneumoniae (13.9%) and Acinetobacter baumannii (36.4%). MRSA accounted for 30.3% of Staphylococcus aureus isolates, while macrolide resistance was noted in 30.0% of Streptococcus pneumoniae. A modest but statistically significant upward trend in carbapenem resistance among Klebsiella pneumoniae was observed (p-trend = 0.03). Conclusion: The study demonstrates Gram negative dominance, substantial ESBL prevalence, and emerging carbapenem resistance in CAIs. MRSA and macrolide resistance further complicate management, underscoring the need for updated empirical therapy and strengthened stewardship. Keywords: Antimicrobial resistance, Community acquired infections, ESBL, MRSA, Carbapenem resistance, Gram negative pathogens, India.

Background: Topical retinoids remain the gold standard therapy for long term acne prevention, but early phase irritation often affects adherence. Dissolvable microneedle patches have emerged as a targeted, well tolerated option for rapid lesion specific treatment. Real world comparative data between these approaches remain limited. Objectives: To compare skin tolerability, user experience, adherence, and self reported improvement between individuals using dissolvable microneedle acne patches and those using topical retinoids in routine settings. Materials and Methods: A six week observational study was conducted among 63 participants, including 35 microneedle patch users and 28 topical retinoid users. Baseline characteristics, tolerability events, user experience scores, adherence rates, and self reported improvement were collected through structured weekly diaries and questionnaires. Outcomes were summarized descriptively. Results: Microneedle patch users reported substantially fewer irritation related events than retinoid users, including lower rates of erythema (17.1% vs. 53.6%), dryness (11.4% vs. 46.4%), peeling (8.6% vs. 39.3%), and burning or stinging (5.7% vs. 28.6%). User experience scores favored the microneedle group across comfort (4.4 vs. 3.0), convenience (4.5 vs. 3.1), and overall satisfaction (4.3 vs. 3.0). Adherence was higher among microneedle users (89.4%) compared with retinoid users (61.7%). By week 6, visible improvement was reported by 77.1% of microneedle users and 60.7% of retinoid users. Conclusion: In real world use, dissolvable microneedle patches demonstrated superior tolerability, higher user satisfaction, and stronger adherence compared with topical retinoids. While retinoids remain essential for long term acne prevention, microneedle patches offer a well tolerated, patient friendly option for rapid, targeted management of active lesions. Integrating both approaches may support more personalized acne care. Keywords: Acne, Retinoids, Microneedle Patches, Tolerability, Adherence, User Experience.

Background: Hollow viscus perforative peritonitis is a surgical emergency that can lead to serious complications and death. Starting the right antibiotics quickly is crucial, but the first-choice antibiotics often do not match the patterns of bacterial sensitivity found in cultures. This study aims to look at the types of bacteria in peritoneal fluid from patients with hollow viscus perforative peritonitis and evaluate antibiotic sensitivity patterns to guide treatment. Materials and Methods: This prospective observational study included 100 patients who were admitted with signs of hollow viscus perforative peritonitis at the Department of General Surgery, Raichur Institute Of Medical Sciences, India, over a period of 18 months. We collected peritoneal fluid during emergency laparotomy, cultured it for aerobic and anaerobic organisms, and performed antibiotic sensitivity tests. Results: The most affected age group was 31 to 50 years (48%), with more males (67%) than females. Duodenal perforation was the leading cause (46%). We found that culture positivity was 72%. Escherichia coli (38%) was the most common isolate, followed by Klebsiella pneumoniae (24%), Pseudomonas aeruginosa (6%), Enterococcus faecalis (2%), and Candida albicans (2%). Among antibiotics, meropenem showed the highest sensitivity (81%), followed by amikacin (72%). We observed high resistance rates for ceftriaxone (63%) and piperacillin-tazobactam (47%), both of which are used as first-line treatments here. Conclusion: First-choice antibiotic regimens often do not match the sensitivity patterns found in cultures. It is crucial to monitor local bacteria and manage antibiotic use to improve patient outcomes. Keywords: perforative peritonitis, peritoneal fluid culture, bacteriological profile, antibiotic sensitivity, empirical antibiotics, hollow viscus perforation.

Background: India is carrying a large diabetes burden and diabetic retinopathy (DR) is a common microvascular complication that can remain silent till late so patient awareness and screening behaviour matters in rural clinics. Materials and Methods: A descriptive hospital based study was done in the Department of Ophthalmology, Akash Institute of Medical Science and Research Center, rural Bangalore. Total 100 type-2 diabetes mellitus patients attending OPD or referred inpatients were included. Hypertension cases were excluded. Data were collected using a pretested semi structured questionnaire. Knowledge was recorded as Knowledge codes, attitude as Attitude scores and practice as Practice codes. Data were analysed in SPSS v20. Chi-square test was used and p<0.05 was significant. Results: Mean age was 63.65 ± 8.20 years and 67% were males. Family history of diabetes was present in 51% and family history of DR in 39%. Knowledge code 2 was most common (45%) followed by code 1 (29%) and code 3 (26%). Attitude score 1 was commonest (69%). Practice code 1 was most common (58%). Knowledge code showed significant association with family history of diabetes (p=0.003) and family history of DR (p=0.008). Knowledge code was also significantly associated with attitude score (p=0.021). Practice code did not show significant association with gender or family history variables. Conclusion: Awareness and attitude were acceptable but practice remained mid-level. Strengthening repeated counselling and simple screening linkage in rural diabetes care is needed. Keywords: diabetic retinopathy, type 2 diabetes mellitus, awareness, knowledge attitude practice, rural Bangalore, screening.

Background: Chronic kidney disease (CKD) shows stage-dependent clinical risk. Oxidative stress is considered a key non-traditional pathway in CKD progression but stage-wise deterioration of oxidative burden with parallel antioxidant depletion needs clearer description using simple biomarkers. Objectives: To compare malondialdehyde (MDA) and superoxide dismutase (SOD) across CKD stages G2–G5 and to examine whether renal indices (serum creatinine, blood urea, eGFR, urine ACR) showed a consistent stage-wise trend as biological validation. Materials and Methods: This hospital-based cross-sectional analytical study was conducted in the Department of Biochemistry, Index Medical College, Indore (12 months). Adult CKD patients (≥18 years) were staged by KDIGO 2012 eGFR categories into G2, G3a, G3b, G4 and G5 (n=20 per stage). MDA was estimated by TBARS spectrophotometry and SOD activity by NBT inhibition method in erythrocyte lysate. Non-normal variables were analysed using Kruskal–Wallis test. Dunn’s post-hoc test with Bonferroni correction was applied for pairwise stage comparisons of MDA and SOD. Categorical variables were compared using Chi-square/Fisher’s exact. Results: Baseline variables were comparable across stages (age p=0.748, BMI p=0.772, sex p=0.436, diabetes p=0.639, hypertension p=0.443). Renal indices worsened progressively from G2 to G5: creatinine median 1.51 to 6.82 mg/dL (H=92.114, p<0.001), urea 41.70 to 171.00 mg/dL (H=90.261, p<0.001), eGFR 76.40 to 9.85 mL/min/1.73 m² (H=95.055, p<0.001), urine ACR 99.95 to 1066.15 mg/g (H=76.675, p<0.001). MDA rose stage-wise from 4.23 to 11.12 nmol/mL (H=88.980, p<0.001) and SOD declined from 6.85 to 2.26 U/mL (H=87.436, p<0.001). Post-hoc testing showed significant differences mainly between early vs advanced stages (MDA: G2 vs G3b/G4/G5, G3a vs G4/G5, G3b vs G5; SOD: G2 vs G3b/G4/G5, G3a vs G4/G5, G3b vs G5; all adjusted p<0.001). Conclusion: Oxidative burden (MDA) increased and antioxidant defence (SOD) decreased in a clear severity-linked gradient across CKD G2–G5, paralleling progressive impairment of renal indices. This dual-marker framework describes stage-dependent redox imbalance and supports further longitudinal validation for monitoring and risk profiling. Keywords: chronic kidney disease, oxidative stress, malondialdehyde, superoxide dismutase, CKD staging, albumin–creatinine ratio.

Background: Rheumatoid arthritis (RA) shows wide variation by disease duration. Early disease may respond better but many patients present late. We compared early and established RA using routine clinical scores and inflammatory markers. Materials and Methods: This observational follow-up study included 60 RA patients. Early RA (n=30) and established RA (n=30) were grouped by disease duration. Baseline assessment included TJC28 SJC28 pain VAS, morning stiffness, DAS28-ESR and labs (Hb, platelets, ESR, hs-CRP, RBS, lipid profile, RF, anti-CCP). Patients received routine DMARD therapy. Same parameters were repeated at 3 months. Within-group change and between-group improvement were analysed. Spearman correlation was done for baseline hs-CRP. Results: Established RA patients were older than early RA (49.6 ± 10.8 vs 41.8 ± 11.9 years, p=0.01). Inflammatory markers were higher in established RA at baseline (ESR 58 vs 46 mm/hr, p=0.04; hs-CRP 24.8 vs 18.2 mg/L, p=0.03). Baseline DAS28-ESR was high in both groups (6.2 ± 0.8 vs 5.8 ± 0.9, p=0.07). After 3 months, both groups improved significantly in hs-CRP, ESR, DAS28 joint counts and pain (all p<0.001). Early RA showed better clinical improvement than established RA (DAS28 improvement 2.2 ± 0.9 vs 1.7 ± 0.8, p=0.02; swollen joint improvement p=0.04; pain improvement p=0.01). Baseline hs-CRP correlated with ESR (ρ=0.55) and DAS28 (ρ=0.49), p<0.001. Conclusion: Routine DMARD therapy improved inflammation and symptoms in both early and established RA, with stronger clinical gain in early RA. Keywords: rheumatoid arthritis, early RA, DAS28, hs-CRP, ESR, DMARD therapy.

Background: The purpose of this research was to compare how effective tadalafil 5mg and tamsulosin .4mg are in treating lower urinary tract symptoms (LUTS) caused by benign prostate hyperplasia (BPH). Materials and Methods: One hundred patients with LUTS secondary to BPH were prospectively studied using a random assignment design that placed patients into one of two groups of fifty patients. All patients received medication for twelve weeks, and their medication was given to them thirty minutes after dinner as directed. Each patient was evaluated at baseline and at 1 week, 4 weeks and 12 weeks during the course of the study. Maximum urinary flow rate (Qmax), Post-Void Residual Urine Volume (PVR), International Prostate Symptom Score (IPSS), IPSS Quality of Life (IPSS-QOL) and Sexual Health Inventory for Men (SHIM) scores were used as measures of treatment effectiveness. Paired-sample t-tests and independent sample t-tests were used to analyze the statistical significance of the findings of this study. Results: Twelve percent of the patients in the tadalafil treatment group had mild LUTS and seventy-six percent had moderate LUTS. Nineteen percent of the patients in the tamsulosin treatment group had mild LUTS and eighty-two percent had moderate LUTS. Baseline erectile dysfunction was present in seventeen patients in the tadalafil treatment group and thirteen patients in the tamsulosin treatment group. Conclusion: Compared to tadalafil, tamsulosin was shown to be significantly more effective in the treatment of LUTS secondary to BPH. Keywords: Benign Prostatic Hyperplasia; Lower Urinary Tract Symptoms; Tamsulosin; Tadalafil.

Background: Adolescence isthe time between childhood and maturity. There are times throughout adolescence when mental, physical, psychological, and cognitive growth happens quickly. The body's ability to operate physically, psychologically, and physiologically may be directly impacted by suboptimal nutritional status, which includes both excessive and insufficient calorie intake as well as micronutrient deficiencies. Adolescent female anaemia is thought to be mostly caused by nutrient deficits. The current study was organised. to investigate food history, demographic trends, and their effects on the incidence of anaemia in teenage females. Materials and Methods: Present cross-sectional prospective study was carried out between 2023 and 2024. 50 teenage females between the ages of 10 and 19 were included in the current study. A questionnaire was used to collect their height, weight, BMI, and comprehensive food history. Hb values below 8 g/dL were categorised as severe anaemia, 8–10.99 g/dL as moderate anaemia, 11–11.9 g/dL as mild anaemia, and ≥12 g/dL as normal according to the WHO classification. Results: Mean ± SD of Age (Years) amongst Hb ≥12 gm/dl group was found as 14.73 ± 2.81& amongst Hb <12 gm/dl group found as 14.88±3.29. Mean ± SD of BMI amongst Hb ≥12 gm/dl group is 21.02±1.40 & amongst Hb <12 gm/dl group is 21.42±0.45. amongst various dietary habits no significant correlation with occurrence of anemiafound. Conclusion: In conclusion, to avoid anaemia, effective nutritional treatments such as food fortification and supplements should be offered. Keywords: Adolescence, anaemia.

Background: Paraovarian cysts (POCs) arise from either mesothelium or from paramesonephric elements or rarely, from mesonephric remnants and accounts for 5-20% of adnexal masses. They present as lower abdominal pain or detected incidentally on ultrasound (u/s), done for some other reason or rarely present as torsion. Accurate preoperative diagnosis by ultrasound (u/s) helps in management of these cysts. Aims and objectives of the study: To evaluate the accuracy of ultrasound in diagnosis of paraovarian cysts by correlating with histopathology. To classify them as simple and complex based on ultrasound findings. Materials and Methods: A cross sectional, prospective, descriptive and Analytical study was done on 42 patients over a period of 3 yrs from January 2021 December 2023. Results: Painabdomen was most common symptom seen in 18(47.3%) cases. The most common age of presentation was seen is 4th decade and most of the POCS were seen on right side. In u/s detected cases, most of lesions were seen in between 5-10cms accounting for 13(56.5%) cases. The accuracy in detection by ultrasound is 55.5%. Among u/s detected cases, simple serous cyst was the most common POCs seen accounting for 7 (30.43%) cases. Detection rate of ultrasound in identifying POCs as simple and complex is 76.47%. Keywords: POC, histopathology, ultrasound, detection rate, simple, complex

Background: Obstructive Sleep Apnoea (OSA) is a common and underdiagnosed sleep disorder resulting in intermittent hypoxia and disrupted sleep architecture. It is associated with increased risks of cardiovascular, metabolic, and neurocognitive disorders. Polysomnography (PSG), which measures the Apnoea-Hypopnoea Index (AHI), is the diagnostic gold standard. The Oxygen Desaturation Index (ODI), defined as the number of oxygen desaturation events (≥3% in SpO₂) per hour of sleep, has emerged as a simpler, non-invasive alternative for assessing OSA. Establishing ODI as a reliable tool could enhance early detection and expand access to OSA diagnosis and treatment in resource limited settings. Materials and Methods: This cross-sectional study was conducted in a tertiary care hospital included a total of 45 adult patients suspected of having OSA using the STOP-BANG questionnaire (scores ≥3). Overnight Level III PSG was done to measure AHI and ODI. Pearson’s correlation coefficient was used to assess the relationship between AHI and ODI scores. Cronbach’s alpha was calculated to assess reliability and internal consistency. Data was analysed using Statistical Package for the Social Science (SPSS) Version 20. Results: Among 45 patients included in the study (male: 26, female: 19), mean age was 61.87 ± 10.66 years. Mean AHI and ODI values were closely aligned. A strong positive correlation was found between AHI and ODI (r = 0.871, 95% CI: 0.77–0.92, p < 0.0001), along with excellent reliability and internal consistency (Cronbach’s alpha: 0.93). Conclusion: Given strong correlation, simplicity and accessibility, ODI may serve as a valuable screening tool in primary care and resource-limited settings, potentially expanding early OSA detection and treatment. Keywords: Obstructive Sleep Apnoea, Oxygen Desaturation Index, Apnoea-HypopnoeaIndex, Polysomnography

Background: Smartphones are widely used by medical students for education and communication, but uncontrolled use may lead to behavioural dependence. Estimating self-perceived smartphone addiction and its correlates can inform targeted preventive strategies in this population. The objective is to estimate the prevalence of self-perceived smartphone addiction among undergraduate medical students and examine its association with demographic characteristics, average daily screen time, and smartphone use patterns. Materials and Methods: A cross-sectional, questionnaire-based study was conducted among undergraduate medical students (first year MBBS to internship) at a medical college in India. Data were collected using a structured, self-administered electronic questionnaire. Smartphone addiction was assessed by self-perception on a Likert scale and operationally defined as “often/always.” Associations were tested using the Chi-square test, followed by multivariable logistic regression to identify independent predictors. Statistical significance was set at p < 0.05. Results: Among 480 participants, 33.9% (163/480) reported self-perceived smartphone addiction (often/always). Addiction was significantly more common among students with screen time >4 hours/day (41.96% vs 22.16%, p < 0.001), those reporting social media as the most used activity (40.94% vs 20.00%, p < 0.001), and those with frequent smartphone use before sleep (40.29% vs 18.57%, p < 0.001). On multivariable analysis, independent predictors of smartphone addiction included screen time >4 hours/day (aOR 1.96; 95% CI 1.26–3.03; p = 0.003), social media as most used (aOR 2.07; 95% CI 1.29–3.31; p = 0.002), and smartphone use before sleep (aOR 2.13; 95% CI 1.29–3.52; p = 0.003). Age, gender, and academic year were not independently associated. Conclusion: Smartphone addiction affected about one-third of undergraduate medical students and was mainly associated with modifiable usage behaviors, particularly higher screen time, social media–dominant use, and bedtime smartphone use. Keywords: Smartphone addiction; Medical students; Screen time; social media; Sleep behaviour; Cross-sectional study.

Background: Exclusive breastfeeding for the first six months of life is a proven public health intervention for improving infant survival and development. Despite national and global recommendations, exclusive breastfeeding rates remain suboptimal in many parts of India due to various socio-demographic, cultural, and healthcare-related barriers. The objective is to evaluate exclusive breastfeeding practices among mothers attending the pediatric outpatient department. To identify barriers and challenges influencing the initiation and continuation of exclusive breastfeeding. Materials and Methods: A hospital-based cross-sectional study was conducted among 120 mothers attending the pediatric outpatient department of a tertiary care centre in Raichur. Data were collected using a pre-tested, structured questionnaire covering socio-demographic details, breastfeeding practices, antenatal counseling, and perceived barriers to exclusive breastfeeding. Data were analyzed using descriptive statistics, and associations were assessed using appropriate statistical tests. Results: The mean age of mothers was 24.8 ± 4.3 years. Exclusive breastfeeding for six months was practiced by 40.8% of mothers, while early initiation of breastfeeding within one hour was observed in 46.7%. Pre-lacteal feeds were given by 36.7% of mothers, and colostrum feeding was practiced by 68.3%. The most common barriers identified were lack of antenatal counseling (57.5%), perceived inadequate milk supply (48.3%), family pressure (38.3%), work-related constraints (34.2%), and cultural beliefs and myths (29.2%). Conclusion: Despite reasonable awareness, exclusive breastfeeding practices were inadequate among the study population due to multiple modifiable barriers. Strengthening antenatal and postnatal counseling, improving family and community support, and addressing cultural misconceptions are essential to improve exclusive breastfeeding practices. Keywords: Exclusive breast-feeding Practice, Barriers, Pediatric outpatient department.

Background: Vertigo is be defined as a sensation of motion or spinning of oneself or his surroundings. The lifetime prevalence of vertigo is found to be 3 to 10%2. Our study is aimed to find out etiology of vertigo in patients attending the ENT OPD and to evaluate the comorbidities in these patients. Materials and Methods: We conducted a cross-sectional study in the outpatient department of ENT over a period of six months. Ninety- three patients who presented to the OPD with complaints of vertigo were included in our study. We took a detailed history regarding symptoms and a detailed ENT examination including otological and vestibular evaluation was done. Results: In our study BPPV was the most common etiology (60.2%) of vertigo which was followed by migranous vertigo (10.75%). The other etiological factors were orthostatic hypotension (7.5%), Meniere’s disease (6.4%), vestibular neuritis (4.3%), labyrinthitis (5.3%), cervicogenic vertigo (3.2%) and psychogenic vertigo (2.1%). Conclusion: There are several etiological factors for vertigo. This study emphasizes the importance of multidisciplinary approach in the management of vertigo. Keywords: BPPV, vertigo.

Background: Aims: Neonatal hypoglycaemia, a common metabolic disorder, is particularly prevalent among low birth weight (LBW) neonates, contributing to significant morbidity and mortality. Despite its clinical significance, no universal consensus exists on optimal screening and management protocols. This study aimed to examine the association between neonatal hypoglycaemia and LBW, focusing on prevalence, risk factors, and clinical implications to refine management strategies and improve neonatal outcomes. Materials and Methods: This prospective longitudinal study was conducted in the Paediatric Newborn Unit of T.S. MISRA Medical College and Hospital, Lucknow, over 18 months. Fifty-eight LBW neonates (<2500 g) were enrolled. Blood glucose levels were measured at specific intervals, and neonates with blood glucose ≤40 mg/dL were classified as hypoglycaemic. Statistical analysis was performed using SPSS 25.0, with a p-value <0.05 considered significant. Results: The incidence of hypoglycaemia was 25.8%. Hypoglycaemic neonates were predominantly preterm (80%) and small-for-gestational-age (60%), both showing significant associations (p<0.05). Birth asphyxia (53.3%) was a major risk factor (p=0.017), while maternal factors, including pre-eclampsia and PROM, were not significantly associated. Multivariate logistic regression highlighted gestational age as the strongest predictor (OR = 7.943, p<0.001). Conclusion: Preterm and SGA neonates are at heightened risk for hypoglycaemia, emphasizing the need for targeted glucose monitoring and early intervention. While maternal factors were less significant, neonatal factors such as birth weight and asphyxia played critical roles. The study underscores the importance of proactive management to mitigate complications and improve neonatal outcomes. Keywords: Neonatal hypoglycaemia, Low birth weight, Preterm neonates, Small-for-gestational-age, Neonatal outcomes.

Background: Acute kidney injury (AKI is a frequent and clinically relevant complication among neonates admitted to the neonatal intensive care unit (NICU), contributing substantially to morbidity and prolonged hospital stay. Early recognition of etiological factors, severity patterns, and associated biochemical abnormalities is critical for timely intervention and outcome improvement. Objective: To identify the etiology of AKI in NICU-admitted neonates, evaluate clinical and laboratory predictors, classify AKI types, and assess immediate outcomes. Materials and Methods: This descriptive cross-sectional study included 100 NICU-admitted neonates aged 0–28 days, was conducted in Dept of Pediatrics, Rohilkhand Medial College and Hospital Bareilly, UP, India during period of 1 year. Results: AKI predominantly affected male neonates and was commonly identified in the early neonatal period. Sepsis was the leading etiology, followed by hypoxic-ischemic encephalopathy. Prerenal and intrinsic renal AKI constituted most cases, with the majority classified as early-stage disease. Elevated serum creatinine, inflammatory markers, electrolyte abnormalities, and culture positivity showed significant associations, and higher creatinine levels correlated with prolonged NICU stay. Conclusion: Neonatal AKI in the NICU is largely infection-driven, detected early in most cases, and associated with biochemical derangements and extended hospitalization, highlighting the importance of early diagnosis and focused management strategies. Keywords: Neonatal acute kidney injury; NICU; Sepsis; Serum creatinine; KIDGO criteria.

Background: Pediatric respiratory infections remain a leading cause of morbidity and mortality, particularly in developing countries. Bronchoalveolar lavage fluid (BALF) provides a reliable specimen for identifying lower respiratory tract pathogens when noninvasive samples are difficult to obtain. The above study was conducted to evaluate the microbiological and cytological profile of BALF in pediatric patients with respiratory infections and to assess antimicrobial susceptibility patterns in a tertiary care center in Karveer, Kolhapur. Materials and Methods: A prospective observational study was conducted on 100 pediatric patients undergoing bronchoscopy with BAL. BALF samples were subjected to direct microscopy, cytological examination, bacterial and fungal cultures, mycobacterial testing, and antimicrobial susceptibility testing using CLSI guidelines. Results: Of 100 BAL samples, 64% yielded bacterial growth, 2% each yielded Mycobacterium tuberculosis and Aspergillus species, and 32% showed no growth. Gram-negative bacilli accounted for 50% of isolates, and gram-positive cocci for 14%. The most common isolate was Klebsiella pneumoniae (26.56%), followed by Pseudomonas aeruginosa (21.87%) and Acinetobacter spp. (18.75%). Among gram-positive cocci, MRSA (10.93%) predominated over MSSA (9.37%), with one isolate of Streptococcus pneumoniae. Cytologically, neutrophil-predominant inflammation was observed in 64% of cases, correlating with bacterial infection. Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter spp. demonstrated 100% sensitivity to colistin and polymyxin B, with variable sensitivity to carbapenems and aminoglycosides. MRSA showed 100% sensitivity to linezolid, vancomycin, and teicoplanin. Conclusion: BALF proved to be a valuable diagnostic tool for identifying pathogens and guiding targeted therapy in pediatric respiratory infections. The predominance of multidrug-resistant gram-negative organisms underscores the need for regular institutional antibiograms and region-specific antibiotic policies to optimize empiric treatment and combat antimicrobial resistance. Keywords: Pediatric flexible bronchoscopy, Broncho alveolar lavage, pneumonia, cystic fibrosis, cytology.

Background: Total knee arthroplasty (TKA) is an effective surgical intervention for end-stage knee joint diseases. While primary TKA is associated with favorable outcomes, revision TKA remains technically demanding and often results in inferior functional recovery. Comparative evaluation of functional outcomes between primary and revision TKA is essential to guide clinical decision-making and optimize patient management. The objective is to compare functional outcomes between primary and revision total knee arthroplasty and to assess postoperative functional performance within each group. Materials and Methods: A hospital-based cross-sectional comparative study was conducted among 120 patients who underwent total knee arthroplasty, including 60 primary TKA and 60 revision TKA cases. Functional outcomes were assessed using the Knee Society Score (KSS), Oxford Knee Score (OKS), Visual Analog Scale (VAS) for pain, and postoperative range of motion measurements. Data were analyzed using independent t-tests and Chi-square tests, with statistical significance set at p < 0.05. Results: The mean Knee Society Score was significantly higher in the primary TKA group (86.4 ± 8.7) compared to the revision TKA group (74.2 ± 10.1) (p < 0.001). Similarly, the Oxford Knee Score was significantly better in primary TKA patients (40.7 ± 4.8) than in revision TKA patients (33.6 ± 6.2) (p < 0.001). Pain scores were significantly lower in the primary group (1.8 ± 0.9) compared to the revision group (3.2 ± 1.3) (p < 0.001). Postoperative range of motion was greater in primary TKA patients (118.6 ± 12.5°) than in revision TKA patients (103.4 ± 14.2°) (p < 0.001). Patient satisfaction was also significantly higher in the primary TKA group (86.7%) compared to the revision group (61.7%) (p = 0.004). Conclusion: Primary total knee arthroplasty resulted in superior functional outcomes, better pain relief, greater range of motion, and higher patient satisfaction compared to revision total knee arthroplasty. These findings emphasize the importance of preventive strategies to reduce revision rates and the need for tailored rehabilitation programs to improve functional recovery in revision TKA patients. Keywords: Total Knee Arthroplasty. Functional Outcomes. Revision Knee Replacement.

Background: Laryngoscopy and endotracheal intubation elicit sympathetic stimulation, resulting in transient hemodynamic changes. The device design and force required during laryngoscopy may influence these responses. This study compared the hemodynamic stress responses associated with Macintosh, McCoy, and King Vision video laryngoscope blades during elective surgical intubation. Materials and Methods: A prospective comparative study was conducted on 69 ASA I–II adult patients aged 19–49 years who underwent elective surgery under general anesthesia. Patients were randomized to undergo intubation using Macintosh (Group A), McCoy (Group B), or King Vision (Group C) laryngoscopes. Hemodynamic parameters (heart rate, systolic, diastolic, and mean arterial pressures) were recorded at baseline, at intubation, and at 30 s, 1 min, and 5 min post-intubation. A repeated-measures ANOVA with Greenhouse–Geisser correction was used to assess within- and between-group differences. Results: The baseline characteristics were comparable across all groups. Intubation duration was significantly longer with King Vision than with Macintosh and McCoy (p < 0.001), whereas the durations with the latter two were similar. All groups exhibited significant time-dependent increases in heart rate and blood pressure immediately after intubation (p < 0.01), which returned to baseline by 5 min. No significant interaction between the device type and time was observed for any hemodynamic variable, indicating comparable stress responses across all the laryngoscopes. Conclusion: Macintosh, McCoy, and King Vision laryngoscopes produced similar transient hemodynamic responses during intubation. Although the intubation time was longer with the King Vision, it did not confer an additional hemodynamic burden. Therefore, device selection may be guided by airway characteristics and clinician preference rather than hemodynamic considerations. Keywords: Laryngoscopes; Intubation, Intratracheal; Hemodynamics; Blood Pressure; Heart Rate; Airway Management; Laryngoscopy.

Background: Patients receiving long-term antipsychotic therapy present unique perioperative challenges due to autonomic, cardiovascular, and neurocognitive effects of psychotropic medications. Evidence from low- and middle-income settings remains limited. Materials and Methods: A prospective observational cohort study was conducted in the Department of Psychiatry over 18 months (Jan 2024–June 2025). Adult patients (18–65 years) on continuous antipsychotic therapy for ≥6 months undergoing elective surgery were enrolled. Perioperative complications were systematically recorded. Results: Among 220 participants, 58 patients (26.4%) developed at least one perioperative complication. Intraoperative hemodynamic instability was the most frequent event (15.5%), followed by postoperative delirium (10.0%), most commonly within the first 24 hours. Clinically significant arrhythmias occurred in 4.1%. A greater number of complications were observed among patients receiving general anesthesia. Median hospital stay was 5 days (IQR 4–7). Conclusion: Perioperative complications are common among patients on long-term antipsychotic therapy undergoing elective surgery. Structured perioperative planning and interdisciplinary coordination are essential to mitigate risk. Keywords: Antipsychotics; Perioperative complications; Elective surgery; Delirium; Hemodynamic instability.

Background: An ideal tooth extraction aims at painless removal of the tooth with minimal trauma to surrounding tissues, allowing uneventful healing and preservation of alveolar bone. Atraumatic extraction techniques have gained importance in modern dentistry due to their role in preserving bone and soft tissue for future implant-supported rehabilitation. The aim is to evaluate and compare the efficiency of periotome-assisted tooth extraction with conventional forceps extraction. Materials and Methods: This comparative study included 60 patients requiring extraction of single-rooted teeth. Patients were randomly allocated into two groups: Group A (conventional forceps extraction) and Group B (periotome-assisted extraction). Parameters assessed included time taken for extraction, grade of gingival laceration, postoperative healing using the Landry Healing Index, and immediate complications. Statistical analysis was performed using SPSS version 20.0. Results: The periotome group demonstrated significantly fewer gingival lacerations (p = 0.036) and a trend toward improved healing outcomes (p = 0.068 at α = 0.10). However, the time taken for extraction was significantly longer in the periotome group (p = 0.039). Immediate complications were fewer in the periotome group. Conclusion: Periotome-assisted extraction is an effective atraumatic technique that preserves hard and soft tissue architecture, though it requires a longer operative time. Keywords: atraumatic extraction, periotome gingival laceration.

Background: The etiopathogenesis of oral lichen planus (OLP) has been the center of study since a long time and a variety of etiological factors such as autoimmunity, heredity, drugs, dental materials, psychological factors, especially stress and anxiety have been associated with this disease. The aim and objective are to evaluate serum and salivary level of nitric oxide (NOx) and C - reactive protein (CRP) in patients with oral lichen planus as well as to evaluate their significant role as a prognostic marker. Materials and Methods: The study sample consisted of 40 patients and the subjects were divided into two groups. Group A included 20 cases of normal oral mucosa and Group B comprised 20 cases of oral lichen planus. Salivary and serum levels of NOx and CRP were determined. Results: In this study, serum and salivary levels of NOx and CRP increased significantly from normal oral mucosa patients to oral lichen planus. A significant correlation was found between NOx and CRP values in serum and saliva. Conclusion: Oxidative stress cause damage to a range of organs in the human body. The results of present study revealed that NOx and CRP play a very important role in the etiopathogenesis of oral lichen planus. Salivary and serum CRP and NOx may be used as a non-invasive and prognostic marker for OLP. Keywords: Oral lichen planus, C-reactive protein, Nitric oxide, oral potentially malignant disorders.

Background: MRI is a key imaging modality in evaluating seizures, but conventional protocols may miss subtle lesions like focal cortical dysplasia or hippocampal gliosis. This study assessed the diagnostic accuracy of MRI in detecting brain lesions in seizure patients. Materials and Methods: A prospective observational study was conducted on 80 patients with seizures who underwent standard MRI brain imaging. MRI findings were compared with final clinical diagnoses derived from EEG, clinical data, follow-up, and histopathology where available. Sensitivity, specificity, and accuracy were calculated. Results: MRI detected abnormalities in 52 patients (65.0%), with mesial temporal sclerosis (17.5%) and focal cortical dysplasia (15.0%) being most common. MRI was negative in 28 cases, including 8 later diagnosed with subtle pathology. MRI showed sensitivity of 85.7%, specificity of 83.3%, and diagnostic accuracy of 85.0%. Conclusion: MRI is effective in seizure evaluation but may miss subtle lesions. Incorporating advanced imaging sequences can enhance detection and guide better management. Keywords: Seizure, MRI, diagnostic accuracy, temporal sclerosis, cortical dysplasia.

Background: Psoriasis is a chronic immune-mediated inflammatory disorder increasingly recognized as a systemic disease associated with metabolic and cardiovascular comorbidities. Metabolic syndrome shares common inflammatory pathways with psoriasis and may influence disease severity and outcomes. Materials and Methods: This hospital-based cross-sectional study included 144 adult patients with clinically diagnosed psoriasis. Demographic and clinical details were recorded, and psoriasis severity was assessed using the Psoriasis Area and Severity Index (PASI). Metabolic syndrome was diagnosed using modified NCEP ATP III criteria with Asian cut-offs. Associations between metabolic syndrome and clinical severity of psoriasis were analyzed using appropriate statistical tests. Results: Metabolic syndrome was present in 40.3% of patients with psoriasis. Patients with metabolic syndrome were significantly older and had a longer duration of psoriasis. Mean PASI scores were significantly higher among patients with metabolic syndrome compared to those without (17.9 ± 7.2 vs. 10.8 ± 5.6; p < 0.001). The prevalence of metabolic syndrome increased progressively with psoriasis severity, being observed in 17.2% of patients with mild psoriasis and 41.4% of those with severe disease (p < 0.001). Conclusion: Metabolic syndrome is highly prevalent among patients with psoriasis and is strongly associated with increased disease severity. These findings emphasize the need for routine metabolic screening and a multidisciplinary approach to the management of psoriasis to reduce long-term cardiometabolic risk. Keywords: Psoriasis; Metabolic syndrome; PASI; Disease severity; Cardiovascular risk; Inflammation.

Background: During academic transitions and performance expectations students are prone to experience psychological stress and anxiety, comparing anxiety levels in different academic phases can provide insight into mental health risks and their functional consequences as in cognition. Early identification of Anxiety, and Cognitive errs and making necessary interventions targeting the alleviation of Anxiety inducing factors might result in better health outcomes. The present cross-sectional study aimed to evaluate the association between anxiety levels, cognition and academic performance in adolescent population under academic pressure. The objective is to compare anxiety levels between college freshmen and age-matched students preparing for competitive examinations, and to examine the impact of anxiety on cognitive performance and daily academic functioning. Materials and Methods: A cross-sectional comparative study was conducted which consists of 80 students, in the age group of 18 to 25 years divided into two groups: first-year college freshman students and students preparing for competitive exams. After obtaining informed-written consent, Anxiety levels were assessed using the Hamilton Anxiety Rating Scale (HAM-A) and Generalized Anxiety Disorder-7 (GAD-7). Cognitive performance was measured using the Montreal Cognitive Assessment (MoCA). Simple subjective tests to evaluate academic wellness were done. Group comparisons and correlation analyses were performed. Results: GAD-7 and HAM-A scores were significantly higher in the competitive exam group (mean GAD-7 = 12.4 ± 3.2) compared to college students (mean = 9.1 ± 2.9, p < 0.01). Higher anxiety scores were moderately negatively correlated with MoCA scores (r = –0.41, p < 0.01), particularly affecting attention and executive function domains. Students with high anxiety also reported poorer academic engagement and sleep quality. Conclusion: Pre-college students preparing for competitive exams exhibited significantly higher anxiety levels than their college freshman counterparts, with corresponding negative effects on cognition and daily academic function. These findings support the need for targeted psychological support and stress management strategies in this vulnerable population. Keywords: Anxiety, Stress, sleep quality, Cognition, Adolescents.

Background: Ocular tuberculosis (OTB) represents a broad spectrum of intraocular inflammatory disorders associated with Mycobacterium tuberculosis infection or immune sensitization. Despite tuberculosis remaining a major global health concern, the diagnosis of ocular involvement continues to pose significant challenges. Ocular disease is typically paucibacillary, direct sampling of ocular tissues is invasive and often unrewarding, and immunologic tests detect prior exposure rather than active intraocular infection. Consequently, most cases are classified as presumed or probable rather than microbiologically confirmed. This diagnostic ambiguity carries important clinical implications, including the risks of unnecessary antitubercular therapy (ATT) versus delayed treatment with irreversible visual loss. This narrative review synthesizes contemporary understanding of OTB diagnosis, with particular emphasis on microbiologic and molecular diagnostics, while integrating clinical diagnostic methods, imaging, and consensus-based frameworks. We highlight key diagnostic challenges encountered in routine practice, discuss the interpretation of laboratory results in light of ocular phenotype and epidemiologic risk, and review emerging diagnostic approaches. A balanced, phenotype-driven strategy combining clinical judgment, targeted microbiology, and multidisciplinary collaboration is emphasized. Materials and Methods: This is a narrative review carried out, over a period of six months. Data was retrieved from articles and studies available online on PubMed, Google scholar and various websites. Last 10 year data was collected and reviewed. Results: The results are tabulated in the article which rely on microbiologicak test, immunological test, and clinical presentation. Conclusion: Ocular tuberculosis remains one of the most challenging diagnoses where microbiologic confirmation is uncommon, and no single test reliably establishes disease. Advances in molecular diagnostics and biomarker research may reduce uncertainty. Consensus-based frameworks and multidisciplinary collaboration provide valuable guidance, but clinical judgment remains central. Keywords: Ocular tuberculosis; tubercular uveitis; microbiologic diagnosis; clinical diagnosis; PCR; Xpert MTB/RIF; IGRA; paradoxical reaction.

Background: Oral hygiene is a key determinant of oral and general health, particularly during childhood and adolescence when lifelong health behaviours are established. Oral diseases such as dental caries and gingivitis remain highly prevalent among school-aged children in India and are largely preventable through effective oral hygiene practices, dietary modifications, and regular dental check-ups. Knowledge, attitude and practice (KAP) studies help identify gaps between awareness and actual behaviours, thereby guiding targeted preventive strategies. Objectives: To assess the knowledge, attitude and practices (KAP) regarding oral hygiene among school-going children attending a pediatric outpatient department (OPD). Materials and Methods: A hospital-based cross-sectional study was conducted among 100 school-going children aged 8–18 years attending the Pediatric OPD of T.S. Misra Medical College and Hospital, Lucknow, India, from January 2024 to June 2025. Data were collected using a pre-tested bilingual (Hindi and English), semi-structured questionnaire comprising socio-demographic details, knowledge (12 items), attitude (11 items) and practices (7 items). Scores were categorized as good (>75%), moderate (50–75%) and poor (<50%). Data were analysed using descriptive statistics. Results: The mean age of participants was 14.67 ± 3.71 years, and 56% were males. Most participants were from urban areas (66%) and belonged to the middle socioeconomic class (40%). Good knowledge was observed in 68% of children, while 42% demonstrated a positive attitude. However, only 12% reported good oral hygiene practices. Although 86% believed that regular brushing prevents oral problems and 79% recognised the dentist’s role in maintaining oral health, practical behaviours such as twice-daily brushing (49%), tongue cleaning (32%) and mouth rinsing after meals (38%) were inadequate. Conclusion: Despite satisfactory knowledge and moderately positive attitudes, oral hygiene practices among school-going children were suboptimal, indicating a significant knowledge–practice gap. Strengthening structured oral health education in pediatric OPDs and school health programs, along with parental involvement, is recommended. Keywords: Oral hygiene; School-going children; Knowledge attitude practice; Pediatric OPD; Dental health.

Background: Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder in young adults, often underdiagnosed and influenced by stress, lifestyle, and psychosocial factors. This study aimed to estimate the prevalence of IBS and assess its association with quality of life (QOL), coping mechanisms, mental well-being, and academic performance in undergraduate students. Materials and Methods: A cross-sectional analytical study was conducted among 217 undergraduate students. Rome III criteria were used to diagnose IBS. Participants completed validated tools assessing QOL, coping skills, and academic performance impact. Statistical analyses included Chi-square tests and confidence interval estimation. Results: The prevalence of IBS was 5.1% (95% CI: 2.15%–7.99%). IBS prevalence showed an increasing trend with poorer QOL and poorer coping mechanisms, although these were not statistically significant (p = 0.105 and p = 0.087, respectively). A significant association was found between IBS and academic impact (p = 0.005); 17.4% of those reporting severe academic difficulty had IBS. Conclusion: Although the prevalence of IBS was low, its association with academic difficulties suggests the need for early psychological and academic support strategies. Larger studies are needed to further validate these associations in the Indian context. Keywords: Irritable Bowel Syndrome, Quality of Life, Coping, Academic Stress, Undergraduate Students, India.

Background: Total knee arthroplasty (TKA) is increasingly utilized in the elderly to alleviate chronic knee pain and enhance functional outcomes, demonstrating success in cases of advanced osteoarthritis. Post-operative pain hinders patient participation in physiotherapy, reduces satisfaction, extends hospital stay, and may result in chronic dysfunction. The objective is to assess the efficacy of pericapsular infiltration with adductor canal block for post- operative pain management in TKA. Materials and Methods: An observational descriptive study was conducted among patients undergoing unilateral TKA for a period of two years. After selection of participants based on the inclusion and exclusion criteria, the patients receive pericapsular infiltration intraoperatively, which will include 20cc of 0.2% Ropivacaine + 30mg Ketorolac + 80mcg Clonidine + 5mg Morphine + 0.5mg Epinephrine + 20cc of normal saline. Following surgery, under ultrasound guidance adductor canal block is achieved and catheter is inserted and fixed and post operatively Bolus dose 6cc of 0.2% Ropivacaine and 4mg Dexamethasone given twice a day. Results: The study comprised of 20 individuals with advanced osteoarthritis who had TKA. Most of our patients were women under 70 who had right knee surgery. The mean ROM was 39.50±11.91 on day 1, 61±18.32 on day 2, and 77.5±15.85 on day 3. The mean ROM difference between days 1 and 2, days 1 and 3, and days 2 and 3 was statistically significant (p<0.001). The mean VAS score was 4.67±2.082 on day 1, 6.07±1.77 on day 2, and 4.33±1.61 on day 3. The difference in mean VAS score from day 1 to day 2 was statistically significant (p<0.001), as was the difference from day 2 to day 3 (p<0.001). The difference in mean VAS score was not discovered between day 1 and day 3, which can be explained by reduced VAS score on day 1 due to the effects of analgesics given during surgery. Conclusion: The current study's findings contribute to the conclusion that PENG block combined with ACB and LIA is useful for treating postoperative pain and hastening patients' functional recovery after TKA. Keywords: Analgesis, Osteoarthitis, Total Knee Arthroplasty, Visual Analogue Scale.

Background: Split-thickness skin grafting is a commonly performed reconstructive procedure, and optimal management of the donor site is essential for early healing, pain reduction, and prevention of complications. Conventional dressings are widely used but are often associated with delayed healing and patient discomfort. Collagen dressings have emerged as a biologically active alternative that may enhance wound healing outcomes. Objectives: To compare the effectiveness of collagen dressing and conventional dressing in donor site healing following split-thickness skin grafting with respect to healing rate, epithelialization, pain, infection, and overall patient comfort. Materials and Methods: This prospective comparative observational study included 72 patients undergoing split-thickness skin grafting. Patients were divided into two groups: collagen dressing group (n = 36) and conventional dressing group (n = 36). Donor site healing parameters, epithelialization time, postoperative pain scores, infection rates, patient comfort, need for secondary interventions, and duration of hospital stay were evaluated. Statistical analysis was performed using appropriate parametric and non-parametric tests, and a p-value <0.05 was considered statistically significant. Results: Complete donor site healing by Day 14 was significantly higher in the collagen dressing group (91.7%) compared to the conventional dressing group (72.2%). The collagen group demonstrated faster epithelialization, higher healing scores, lower postoperative pain scores, and reduced infection rates. Patient comfort scores were significantly higher, and the requirement for prolonged dressing, secondary interventions, and hospital stay was significantly lower in the collagen group (p < 0.05). Conclusion: Collagen dressing provides superior donor site healing outcomes compared to conventional dressing following split-thickness skin grafting. It is associated with faster wound healing, reduced pain and infection rates, improved patient comfort, and shorter hospital stay. Collagen dressing can be considered a preferred option for donor site management in routine clinical practice. Keywords: Split-thickness skin graft. Collagen dressing. Donor site healing.

Background: Respiratory distress syndrome (RDS) remains a leading cause of morbidity and mortality among preterm neonates. Non-invasive ventilation strategies such as bubble continuous positive airway pressure (bubble CPAP) and nasal intermittent positive pressure ventilation (NIPPV) are widely used as primary respiratory support; however, comparative evidence on short-term outcomes remains limited. This study aimed to compare the clinical outcomes of neonates with RDS managed with bubble CPAP and NIPPV. Materials and Methods: This prospective observational study was conducted in the NICU of a tertiary care teaching hospital over an 18-month period. A total of 120 preterm neonates with RDS requiring non-invasive ventilation at birth were enrolled, of whom 60 received bubble CPAP and 60 received NIPPV. Baseline demographic, birth, and antenatal characteristics were recorded. Outcomes assessed included surfactant requirement, need for mechanical ventilation, duration of oxygen therapy, length of hospital stay, and survival to discharge. Data were analyzed using descriptive and comparative statistics. Results: Baseline demographic, birth, and antenatal characteristics were comparable between the two groups. Surfactant use and requirement for mechanical ventilation did not differ significantly between bubble CPAP and NIPPV. Neonates managed with NIPPV had a significantly shorter duration of oxygen requirement and hospital stay compared to those on bubble CPAP. Survival to discharge was significantly higher, and mortality was lower, in the NIPPV group. Conclusion: Both bubble CPAP and NIPPV were effective non-invasive ventilation modalities in the management of neonatal RDS; however, NIPPV was associated with improved short-term outcomes, including reduced oxygen dependency, shorter hospital stay, and higher survival to discharge. Keywords: Respiratory distress syndrome; Preterm neonates; Bubble CPAP; Nasal intermittent positive pressure ventilation; Non-invasive ventilation.

Background: An identification of key predictors in influenza epidemics is of much interest for the implementation of effective public health response strategies, The study has tried to develop causal relationships between clinico-epidemiological parameters and influenza positivity followed by identification of influenza positivity predictors among Severe Acute Respiratory Infection (SARI) cases. Materials and Methods: This is prospective study with collecting clinico epidemiology, medical history after taking consent and assent. Pearson’s chi-square test was performed to assess the association between exposure variables and influenza positivity, and logistic regression was used to examine the relationship with the outcome variables. The results are presented as odds ratios (ORs). Results: In a 6 month period, a total of 302 participants were enrolled. Off them 43 (14.2%) were influenza positive. A significant correlation was observed between influenza positivity and clinico-epidemiology parameters viz. age (p=0.005), symptoms viz. breathlessness (p=0.057), clinical parameter viz. respiratory rate (p=0.012), O2 saturation (p=0.010), wheeze (p=0.000), medical history viz. tuberculosis (p=0.037), hypertension (p=0.055) by chi square test. Sore throat (OR=2.68, 95%CI: 0.97-7.37), diarrhoea (OR=2.73, 95%CI: 0.62-11.98), respiratory rate (OR=1.38, 95%CI: 0.46-4.14), O2 saturation (1.86, 95%CI: 0.73-4.69), wheeze (OR=4.53, 95%CI: 1.38-14.83), diabetes (OR=1.17, 95%CI: 0.28-4.86) showed causal association with influenza positivity. Sore throat (p>z=0.06), wheeze (p>z=0.01) were the only predictor found to be predictor for influenza positivity. Conclusion: Although sore throat, diarrhoea, respiratory rate < 24, O2 saturation <99, wheeze, diabetes showed causal association with influenza positivity. Sore throat and wheeze were the only response variables were found to be influenza predictors. Keywords: SARI, clinico-epidemiology, influenza positivity predictors, Mumbai.

Background: Since its discovery in China in late 2019, SARS-CoV-2 has fastly spread worldwide, with significant outbreaks around the world. Multisystem Inflammatory Syndrome in Children (MIS-C), first identified in kids and young adults in April 2020, is likely to be related to SARS-CoV-2 infection. It is characterized by high fever and a range of symptoms affecting multiple organs. Diagnosis involves considering various criteria rather than a single test, and early diagnosis is crucial for timely treatment. The objective is to Study a)The Clinical profile and b)short term outcome of Multisystem inflammatory syndrome in children until 6 weeks follow up. Materials and Methods: All children aged upto 14 years of age admitted in Pediatric department of Jubilee Mission Medical College, Thrissur who fulfill the diagnostic criteria of MISC were enrolled after getting informed consent from their parents/guardian till sample size is achieved. Detailed history were taken, and clinical examination including general physical examination, relevant anthropometry and system examination were done and noted as per the proforma. Investigation reports and treatment protocol were noted. Patient was followed until 6 weeks after discharge. Those who lost to follow up were excluded from the study. Results: This study investigated the impact of Children's Multi systemic Inflammatory Syndrome (MIS-C) among 42 children, predominantly aged 1 to 5 years, with a male majority. Cutaneous and gastrointestinal symptoms were most common, followed by respiratory and neurological symptoms. Half of the children had a history of COVID- 19, and most were fully immunized. Inflammatory markers were elevated in all cases, with anemia, leucocytosis, and thrombocytopenia being common. Electrolyte imbalances, particularly hyponatremia, were also noted. Conclusion: MISC presents a novel challenge, particularly in communities with specific KD characteristics. Its significant cardiac impact at onset, coupled with the need for immunomodulatory treatments and frequent intensive care, is a cause for concern. While short-term outcomes are positive, with low mortality and recovery from cardiac problems, long-term effects remain understudied. Further research is crucial to understand MISC's pathophysiology and prognosis, and clinical trials are needed to establish optimal treatment strategies. Keywords: Misc, clinical profile, treatment, outcomes, steroids, IVIG.

Background: The role of oxidative stress in cardiovascular disease processes, such as atherogenesis, ischemic-perfusion injury and cardiac remodelling, has been increasingly recognized in the past few decades. Currently, an increasing number of studies suggest that level of oxidative stress markers in body fluids correlate with atherosclerotic disease activity this finding may lead to novel clinical approaches in patients with coronary artery disease. Assessment of oxidative stress markers could modify risk stratification and treatment of patients with suspected coronary artery disease or myocardial infarction.[1] ROS are highly reactive chemical species containing oxygen, controlled by both enzymatic and non-enzymatic antioxidant defence systems. In the heart ROS play an important role in cell homeostasis, by Modulating cell proliferation, differentiation, and excitation - contraction coupling.[2] Oxidative stress occurs ROS production exceeds the buffering capacity of the antioxidant defence systems, leading to cellular and molecular abnormalities, ultimately resulting in cardiac dysfunction.[2] Formation of atherosclerotic plaques is the major cause of coronary artery disease. The acute form of CAD is more susceptible to oxidative D, damage, suggesting the use of Antioxidant therapy may be warranted to ameliorate oxidative stress in this condition.[3] The aim of this study is to estimate the free and esterified fractions of total cholesterol of erythrocyte membrane (CEM) protein and sialic acid and phospholipid content of RBC membrane along with the measurement of the oxidative stress and anti-oxidant status in RBC and serum Malondialdehyde level, Glutathione per oxidase activity, Catalase activity, superoxide dismutase activity and Ceruloplasmin levels and interleukin (IL- 8) estimation. The aim of this study is to estimate the free and esterified fractions of total The aim of this study is to estimate the free and esterified fractions of total Materials and Methods: • Case Control Study was conducted on 100 cases and 100 healthy persons. • RBC membrane protein assay. • Estimation of esterified and free cholesterol in RBC membrane preparations is by KIT method, ELISA is used to estimate the Total phospholipid, Sialic acid, Interleukin -8, MDA, Catalase activity, Human glutathione peroxidase and Ceruloplasmin activity. Results: In the present study, RBC and WBC counts, hemoglobin, hematocrit, mean corpuscular volume (MCV), and RDW levels will be measured and especially, RDW will be focused more than others. RDW represents the variability in RBC volume distribution and can be considered as an index of heterogeneity in the size of circulating erythrocytes. Therefore, it is expected to obtain higher RDW levels in cases of coronary artery disease, especially with a higher mortality. As Coronary artery disease is associated with a sort of narrowing of artery with an overlying obstruction symptomatology interleukin-8(IL-8) is expected to rise. Conclusion: ROS represent important second messengers within the heart, since they are involved in multiple physiological processes including differentiation, proliferation, and excitation-contraction coup

Background: Aim: To systematically evaluate and compare the efficacy of semaglutide and tirzepatide in achieving weight loss and glycemic control in overweight and obese patients with type 2 diabetes mellitus (T2DM). Materials and Methods: A comprehensive systematic review and meta-analysis was conducted using PubMed, Scopus, Web of Science, and Cochrane databases from 2020 to November 2025. Randomized controlled trials (RCTs) and retrospective cohort studies comparing semaglutide and tirzepatide in overweight/obese diabetic patients were included. The primary outcomes were mean weight loss and change in HbA1c levels. Meta-analysis was performed using random-effects models with standardized mean differences (SMD) and 95% confidence intervals . Results: Fourteen studies involving 142,811 participants (106,057 in semaglutide arms and 36,754 in tirzepatide arms) were included. Meta-analysis demonstrated that tirzepatide produced significantly greater weight loss (MD = 4.23%, 95% CI: 3.22-5.25%, P < 0.001) compared to semaglutide across all doses. At 72 weeks, mean weight reduction was 20% with tirzepatide versus 14% with semaglutide (P < 0.001). Dose-response relationships were observed for both agents. Tirzepatide also demonstrated superior HbA1c reduction (−0.45%, 95% CI: −0.88 to −0.02%, P = 0.04). Gastrointestinal adverse events were more frequent with semaglutide (38.5% vs. 31.2%, P < 0.05). Conclusion: Tirzepatide exhibits superior efficacy for weight loss and glycemic control compared to semaglutide in overweight/obese patients with T2DM, with a favorable adverse event profile. The dual GLP-1/GIP mechanism of tirzepatide appears advantageous over the selective GLP-1 mechanism of semaglutide for metabolic outcomes in this population. Keywords: Semaglutide, Tirzepatide, Diabetes Mellitus.

Background: Now a days mobile phone has much impact on children, affecting daily activities of children and their health as well. Hence the present study was conducted to estimate the prevalence of mobile phone addiction and associated factors among study children and to find out the impact of smart phone addiction on physical and mental health. Materials and Methods: A cross-sectional study was conducted among 400 school going children attending OPD at tertiary care teaching hospital in Jalna, Maharashtra from July to October 2025. The questionnaire included the socio-demographic characteristics, details of pattern of mobile phone usage and its effect on physical and mental health and school performance of study participants. Results: Study participants consists of 53% boys and 47% were girls. Study found that 53.2% children were having mobile phone addiction. Related to physical health, more than half of the children (51.7%) had reduced physical activity due to excess mobile use. Regarding different psychosocial effects, 52.2% having poor concentration on their studies and various day to day activities, 51.7% parents perceived reduced social interaction in their children and 173(43.3%) children had decreased communication with others in family and school, 154(38.5%) children are disobeying their parents or elders due to impact of mobile phones and 143(35.7%) had annoyance and irritability. There was significant association of mobile phone addiction with gender more in boys than girls and it was also associated with age of children and working status of mother. Conclusion: Mobile phone addiction in school going children is important challenge for the parents and family, it has to address and awareness should be increased among children and their parents regarding its long term effects on health and wellbeing of children. Keywords: Mobile phone addiction, physical health, mental health, school children.

Background: Type 2 diabetes mellitus (T2DM) is a major public health concern in India, characterized by rising prevalence, multiple comorbidities, and variable treatment outcomes. Understanding real-world prescription trends and the extent of treatment target achievement is crucial to improving diabetes care. This study aimed to assess the prescription pattern of antidiabetic drugs and evaluate the achievement of glycemic and cardiometabolic targets among patients with T2DM attending a tertiary health center. Materials and Methods: A hospital-based cross-sectional study was conducted among 402 adult patients with T2DM attending the medicine outpatient department of a tertiary care hospital in North India from January to December 2024. Sociodemographic, clinical, and prescription data were collected using a structured proforma. Prescriptions were analyzed for drug class, combination pattern, and rationality according to ADA and RSSDI 2024 guidelines. Treatment targets were defined as HbA1c <7%, fasting plasma glucose <130 mg/dL, postprandial glucose <180 mg/dL, blood pressure <140/90 mmHg, and LDL-C <100 mg/dL. Statistical analysis was performed using SPSS version 26.0, applying chi-square test, t-test, and multivariate logistic regression, with p<0.05 considered significant. Results: The mean age of participants was 54.7 ± 10.9 years, and 56.7% were male. Metformin was the most prescribed drug (93%), followed by sulfonylureas (60.2%) and DPP-4 inhibitors (43.8%). Insulin therapy was required in 30.1% of patients, significantly increasing with longer diabetes duration (p<0.001). Fixed-dose combinations were used in 61.4% of prescriptions, with an average of 2.3 ± 0.8 drugs per patient. Only 44.5% achieved target HbA1c (<7%), while 38.8% and 35.3% attained fasting and postprandial glucose goals, respectively. Logistic regression identified duration of diabetes >10 years (AOR 2.13, p=0.001), obesity (AOR 1.67, p=0.032), insulin use (AOR 1.95, p=0.008), and use of ≥3 drugs (AOR 1.56, p=0.049) as independent predictors of poor glycemic control. Conclusion: Metformin-based combination therapy remains the cornerstone of diabetes management in tertiary care. However, less than half of patients achieved optimal glycemic and cardiometabolic targets, reflecting therapeutic inertia and disease progression. Strengthening guideline-based prescribing, early lifestyle intervention, and broader access to newer antidiabetic agents are essential to improve treatment outcomes in Indian patients with T2DM. Keywords: Type 2 diabetes mellitus, Prescription pattern, Glycemic control, Insulin therapy, Antidiabetic drugs, Treatment targets.

Background: The regenerative effect of platelet rich plasma (PRP) is primarily linked to biomolecules in platelet α-granules, but a controlled inflammatory phase is also essential for healing. Leukocytes contribute to this phase by releasing both pro- and anti-inflammatory factors, supporting a process known as "inflammatory regeneration." Macrophage plasticity, particularly the shift from M1 to M2 phenotype, plays a key role in this transition. Therefore, PRP derived from the buffy coat, which includes leukocytes, may enhance regenerative outcomes and be more beneficial than previously thought. Hence we aimed to evaluate efficacy of leucocyte rich platelet rich plasma (LR-PRP) on outcomes of knee osteoarthritis. Materials and Methods: Intra-articular LR-PRP injections were administered to 130 knees, with each patient receiving a total of six injections at 4-week intervals. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC score). Results: Most patients experienced notable improvements in both VAS scores and WOMAC scores following treatment. The severity of the deformity did not appear to significantly influence treatment outcomes, and favourable results were observed even in cases with advanced K-L classification grades. Conclusion: Based on the results of our study, we recommend considering LR-PRP as an adjunctive conservative treatment option in the non-operative management of osteoarthritis. Keywords: knee osteoarthritis, LR-PRP, VAS score, WOMAC score.

Background: Road traffic injuries pose a major global public health threat, disproportionately affecting adolescents in developing countries due to risk-taking behaviors and poor infrastructure. India contributes 11% of global fatalities (>150,000 deaths yearly), with aged 15-49 heavily impacted. Despite good safety knowledge, persistent KAP gaps undermine driving practices among rural students. Objectives: (i) To study the sociodemographic profiles of the study population, (ii) To study Knowledge, Attitude and Practices of road safety rules and regulations in higher secondary school students. Materials and Methods: A cross-sectional study was conducted in August and September 2025 among 159 students from two higher secondary schools. Participants were selected using convenience sampling based on willingness to participate. Data were collected using a pretested semi-structured questionnaire. The data were entered into Microsoft Excel and analyzed with SPSS version 25. Results: In a cross-sectional study of 159 school students, road safety KAP levels proved satisfactory, with 82.4% demonstrating adequate knowledge, 98.9% favorable attitudes, and 77.9% safe practices, though traffic sign recognition lagged at 62.1% overall. Among 76 student drivers, strong compliance emerged in honking before overtaking (97.4%) yet helmet use remained suboptimal at 69.7%, with 92.1% driving without parental knowledge and 26.3% reporting prior accidents. Conclusion: This study of 159 rural higher secondary students showed satisfactory road safety knowledge, attitudes, and practices. Gaps persisted in traffic sign recognition, overtaking, and protective gear use among drivers. Underage driving and one-third accident exposure highlight a knowledge-practice gap, necessitating school-based education, parental oversight, and rural traffic enforcement. Keywords: KAP study, Road safety measures, Secondary school students, Traffic sign recognition.

Background: Smartphone use is now becoming a mandatory part of the daily life of students; however, excessive use can adversely affect their academic self-regulation and sleep quality. The increased rate at which the youths are using smartphones has created concerns regarding the impact of smartphones on attention, performance, and overall health. Aims/Objectives: The study aimed to determine the prevalence and pattern of smartphone use; assess the level of Smartphone Addiction; examine its association with sleep quality and academic self-regulation; and identify socio-demographic and behavioral predictors of smartphone addiction among third-year undergraduate medical students. Methods and Materials: A cross-sectional study was conducted among third year MBBS students of M.R. Medical College, Kalaburagi through an online questionnaire, which was standardized and was administered using Google Forms. The tool contained some socio-demographic data, smartphone use characteristics, and some validated measures, such as the Smartphone Addiction Scale-Short Version (SAS-SV), Pittsburgh Sleep Quality Index (PSQI). Sleep disturbances were assessed using PSQI items 5–16 (each scored 0–3) and summed to generate a PSQI-derived sleep disturbance score (range 0–36) for analysis. Academic Self-Regulation Questionnaire (SRQ-A), which assesses academic self-regulation and motivation. The relationship between the variables of smartphone addiction, academic self-regulation and sleep quality was explored with descriptive statistics, chi-square tests and regression analysis. Results: Smartphone addiction was reported in 37.3% of third-year MBBS students. Regression analysis showed that higher PSQI-derived sleep disturbance scores were significantly associated with increased smartphone addiction (p = 0.0018). Nonetheless, academic self-regulation (SRQ-A) had no significant association with smartphone addiction (p = 0.53). Conclusion: The regression results showed that there was a significant association between Smartphone Addiction and sleep quality but there was no significant association between Smartphone Addiction and academic self-regulation. The findings explain why the institution needs to intervene and spread compassion messages urging people to use digital platforms ethically and in a balanced manner to improve academic achievements and welfare. Keywords: Smartphone addiction, Medical students, Cross-sectional study, quality of sleep and academic self-regulation.

Background: The aim is to compare the anaesthetic efficacy of 0.75% ropivacaine with 0.5% levobupivacaine in supraclavicular block with fentanyl as adjuvant. Materials and Methods: This is a randomized controlled interventional trial conducted at Kamineni Academy of Medical Sciences L.B Nagar Hyderabad between 2023-2025. Hundred patients between 18-60 years age of either sex, ASAI and ASAII undergoing upper limb surgeries were included in this study after approval of Institutional-ethical committee and obtaining informed consent. Results: Majority of the levobupivacaine group patients belonged to the 41-60 years age group (n=29, 58%) with a mean age of 40.54 years. In the ropivacaine group patients, majority belonged to 21-40 years age group as caudal group (n=27, 54%) with a mean age of 37.34 years. Majority of the levobupivacaine group patients belonged to the 2.51-5.00 mins onset of sensory block group (n=38, 76%) with a mean onset of sensory block time of 2.98 minutes. In the ropivacaine group patients, majority belonged to 2.51-5.00 mins onset of sensory block group (n=31, 62%) with a mean onset of sensory block time of 5.30 minutes. Majority of the levobupivacaine group patients belonged to the 4.01-8.00 mins onset of motor block group (n=48, 96%) with a mean onset of motor block time of 5.86 minutes. In the ropivacaine group patients, majority belonged to 8.01-12.00 mins onset of motor block group (n=26, 52%) with a mean onset of motor block time of 9.11 minutes. Most of the levobupivacaine group patients had mean heart rates ranging from 84.38 bpm to 74.28 bpm with an overall mean heart rate of 77.76 bpm. Similarly the ropivacaine group patients had mean heart rates ranging from 84.86 bpm to 76.30 bpm with an overall mean heart rate of 78.76 bpm. Conclusion: From this study it is concluded that in ultrasound guided supraclavicular block with fentanyl as adjuvant, levobupivacaine had faster onset of sensory and motor block compared to ropivacaine. The duration of sensory and motor blockade was also longer with levobupivacaine when compared to ropivacaine, both the groups having minimal adverse effects. Being done under ultrasound guidance, the risk of complications are minimal. Keywords: Supraclavicular block, Levobupivacaine, Ropivacaine, Fentanyl, Heart rate. Onset of Motor block.

Background: Otitis externa and otitis media are common ear infections which are encountered in both primary care and otolaryngology settings. If left untreated or managed with inappropriate empirical therapy they can lead to complications such as chronic suppuration, hearing loss, and antimicrobial resistance (AMR). This study was undertaken to identify the bacterial pathogens involved in otitis and to find out their antimicrobial susceptibility patterns. Materials and Methods: This cross-sectional study was conducted over a period of 3 months in the Department of Microbiology of a tertiary care institute. A total of 198 patients presenting with clinical features of otitis were enrolled. Ear swabs were collected with aseptic precautions and Gram staining, aerobic culture and biochemical identification was done. Antimicrobial susceptibility was done using the Kirby-Bauer disc diffusion method. Data analysis was done using SPSS v23.0. Results: Out of 198 ear swab samples, 115 (58.1%) showed positive growth on culture. Pseudomonas aeruginosa (56.5%) was the most common organism. The other common organisms were Staphylococcus aureus (22.6%), Klebsiella pneumoniae (6.1%) and Escherichia coli (5.2%). P. aeruginosa exhibited high susceptibility to Meropenem (84.6%), Amikacin (81.5%), and Piperacillin–Tazobactam (80.0%). S. aureus showed high sensitivity to Vancomycin (100%) and Clindamycin (80.8%). Methicillin resistance was noted in 35% of the isolates. Other Gram-negative were found to be highly susceptible to carbapenems. Conclusion: Pseudomonas aeruginosa and Staphylococcus aureus were the most common pathogens in otitis cases. These organisms were resistant to commonly used antibiotics such as fluoroquinolones and macrolides, whereas carbapenems and vancomycin remained highly efficacious. Regular surveillance of pathogen profiles as well as analysis of sensitivity patterns is essential to guide appropriate antibiotic choice and curb emergence of further antibiotics resistance in otitis cases. Keywords: Otitis Media, Antimicrobial Resistance, Pseudomonas aeruginosa, Staphylococcus aureus, Antibiotic Susceptibility.

Background: Benign prostatic hyperplasia (BPH) is a common condition in aging males, frequently presenting with lower urinary tract symptoms (LUTS) that adversely affect quality of life. While total prostate volume has traditionally been considered a determinant of symptom severity, emerging evidence highlights the significance of specific morphological changes, particularly involving the median lobe. This study aimed to assess the correlation between intravesical prostatic protrusion (IPP) and LUTS severity in adult males. Materials and Methods: This cross-sectional observational study was conducted at a tertiary care hospital over 18 months, involving 80 adult males aged ≥40 years presenting with LUTS. Patients were evaluated using the International Prostate Symptom Score (IPSS). Transabdominal ultrasonography was performed to measure IPP, prostate volume, and post-void residual (PVR) urine. Maximum urinary flow rate (Qmax) was also recorded. P value less than 0.05 was considered statistically significant. Results: The study population had a mean age of 63.7 ± 8.9 years. A significant positive correlation was observed between IPP and IPSS (ρ = +0.38, p = 0.002). Patients with IPP >10 mm had significantly higher IPSS scores, lower Qmax, and higher PVR volumes (p < 0.05). IPP also showed a significant correlation with prostate volume (ρ = +0.42, P <0.001). Conclusion: Transabdominal ultrasonographic measurement of IPP is a reliable, non-invasive marker correlating with LUTS severity and surrogate parameters of bladder outlet obstruction. Incorporating this measurement into routine evaluation may improve clinical decision-making in BPH management. Keywords: Prostatic Hyperplasia, Intravesical Prostatic Protrusion, Ultrasonography, Lower Urinary Tract Symptoms.

Background: Distal femur fractures account for approximately 4–6% of all femoral fractures in adult population. These fractures are becoming increasingly common due to increasing incidence of high-energy trauma in young adults and low-energy falls in the elderly individuals having osteoporotic bones. Locking compression plating (LCP) and retrograde intramedullary nailing (RIMN) are common fixation methods in these cases. Each of these methods are associated with specific advantages and limitations. The purpose of this study was to compare clinical and radiological outcomes of LCP versus RIMN in patient having extra-articular distal femur fractures. Materials and Methods: A prospective randomized comparative study was conducted over a period of 2 years at a tertiary care teaching hospital. 60 patients (≥18 years) with acute unilateral extra-articular distal femur fractures (AO/OTA type A1-A3) were included in this study. Patients were randomized into two equal groups: Group A (LCP) and Group B (RIMN). Intraoperative parameters (operative time, blood loss), union rates, complications, time to full weight bearing and functional outcomes (as assessed by Neer’s score and knee Range of motion) were evaluated. Follow-up was conducted at regular intervals for one year. Statistical analysis was done using SPSS v25. For statistical purposes p value less than 0.05 was considered as statistically significant. Results: The RIMN group was found to have a significantly shorter mean operative time (75.6 vs. 86.3 min, p<0.001) and higher blood loss (275 vs. 220 ml, p<0.001). Mean union time was significantly less in the RIMN group (11.7 vs. 17.5 weeks, p<0.001). Full weight bearing at 12 weeks was achieved in 93.3% (RIMN) vs 66.7% (LCP). Higher mean Neer’s scores (though not statistically significant) and greater knee ROM (118° vs. 112°, p=0.0007) were observed in RIMN. LCP had higher rates of infection (16.7% vs. 0%), non-union (13.3% vs. 3.3%), and delayed union (6.7% vs. 0%). Malalignment was seen in 10% of RIMN cases with none in LCP. Conclusion: RIMN provided superior outcomes in terms of operative efficiency, union time, functional recovery and early weight-bearing. However, LCP offered better alignment control but had higher infection and non-union rates. Therefore, it is important to select implant on the basis of fracture configuration, bone quality and surgeon expertise. Keywords: Distal femoral fractures, Locking compression plate, Intramedullary nailing, Fracture fixation, Functional outcome.

Background: Respiratory illnesses are a major cause of morbidity in pediatric age group. The home based nebulization therapy is commonly used in children for various respiratory diseases like asthma, bronchiolitis, upper respiratory infections and pneumonia. A caregiver's level of knowledge about how to properly utilize their child's nebulizer equipment is vital in providing an adequate level of care and minimizing the risk of acquiring an infection.[1,2] Unfortunately, the degree of caregiver understanding of nebulizers varies greatly and there are numerous common errors that can occur during the process of caring for a child requiring a nebulizer (i.e., poor cleaning of the equipment, improper dosing of medications, lack of proper hand washing) which can negatively impact both the quality of the treatment and the overall health of the child.[1,2] The purpose of this study was to assess caregivers' knowledge, attitudes and practices (KAP) related to home nebulizer treatment in children, identify the gaps in these areas and provide implications for improving the quality of pediatric respiratory care. Materials and Methods: A cross-sectional survey was conducted among 104 caregivers of children receiving home nebulizer treatment (average child age = 40 ± 46 mo.; 60% male). Participants completed a standardized questionnaires. The data collected included caregiver/child demographic information, the reasons why their child required a nebulizer and specific KAP questions (e.g., device cleaning, medication dosing, hand washing, utilization of a mask and/or spacer). Descriptive analyses and inferential statistical methods (Chi-square tests) were utilized to analyze the data using the statistical program SPSS. Correlations between caregiver characteristics (level of education, socioeconomic status) and the practice of utilizing a nebulizer correctly were also analyzed. Significance was set at p < .05. Results: Most children who received nebulizer treatments had pneumonia (n = 31, 30%), bronchiolitis (n = 24, 23%), upper respiratory tract infections (URTIs) (n = 23, 22%) or asthma (n = 21, 20%) as the primary reason for treatment. The majority of caregivers were mothers (n = 65, 63%), had at least a secondary level of education (n = 84, 81%; n = 59, 56% were graduates), and fell into middle socioeconomic classes. Although nearly all caregivers used a jet nebulizer, knowledge deficits were apparent. For example, only 19% of caregivers routinely cleaned their child's nebulizer after every use, whereas 71% of caregivers cleaned their child's nebulizer only occasionally (see Figure 1). Mask usage was reported by 72% of caregivers; however, many failed to adequately clean masks, chambers or tubing. Only 46% of cases involved administration of the prescribed amount of medication plus diluent by the child's physician (total volume 3-5 ml); many caregivers administered unspecified amounts of medication/diluent or omitted diluent entirely (see Figure 3). Importantly, 60% of caregivers did not wash their hands before nebulizing their child. Inferential statistical analysis revealed that higher levels of education among caregivers were significantly associated

Background: Characterization of focal bone lesions remains a diagnostic challenge due to overlapping imaging features between benign and malignant entities. Conventional magnetic resonance imaging (MRI) provides excellent anatomical detail but offers limited information on lesion metabolism. Proton magnetic resonance spectroscopy (¹H-MRS), particularly choline detection, provides metabolic insights related to cellular membrane turnover and tumor aggressiveness, potentially improving diagnostic accuracy. Objectives: To evaluate the diagnostic utility of MRI spectroscopy in focal bone lesions by detecting choline peaks and choline-to-creatine (Cho/Cr) ratios, and to correlate spectroscopic findings with conventional MRI anatomical features and histopathological grade. Materials and Methods: This prospective cross-sectional study was conducted over a 24-month period at a tertiary care teaching hospital. A total of 78 patients aged 12–72 years with radiologically detected focal bone lesions were included. All participants underwent routine MRI followed by single-voxel ¹H-MRS. The presence of choline peak and Cho/Cr ratios were analyzed. Conventional MRI features such as lesion margins, cortical breach, marrow edema, soft-tissue extension, and contrast enhancement patterns were evaluated. Histopathological diagnosis and grading served as the reference standard. Results: Of the 78 lesions evaluated, 42 were malignant and 36 were benign on histopathological examination. Choline peak was detected in 38 malignant lesions (90.5%) and in 6 benign lesions (16.7%). The mean Cho/Cr ratio was significantly higher in malignant lesions (3.2 ± 0.8) compared to benign lesions (1.1 ± 0.4). Elevated choline levels showed significant association with aggressive MRI features including ill-defined margins, cortical destruction, and soft-tissue extension. A positive correlation was observed between choline concentration and increasing histopathological grade among malignant tumors. Conclusion: MRI spectroscopy significantly improves the characterization of focal bone lesions by providing metabolic information complementary to conventional MRI. Choline detection and quantification correlate well with anatomical indicators of aggressiveness and histopathological grade, supporting its role as a valuable adjunct in differentiating benign from malignant bone lesions and in assessing tumor aggressiveness. Keywords: MRI spectroscopy; Focal bone lesions; Choline peak; Cho/Cr ratio; Histopathology.

Background: Trigger finger is a condition that causes painful catching or popping of the involved flexor tendon as the patient flexes and extends the fingers. This condition is also known as “stenosing tenosynovitis”. The objective is to analyse the functional outcome of percutaneous release in trigger finger under US-guidance. Materials and Methods: This prospective study was conducted among Patients with trigger finger satisfying the inclusion criteria attending OPD at Govt Rajaji hospital in the dept of Orthopaedics & Traumatology, Madurai. Duration of study was Aug 2016 to September 2018. Results: Total no of Trigger finger with Froimson grade II to IV patients came to outpatient department in our hospital was 30 patients. Out of which 25 patients were operated with this procedure out of which 10 male & 15 female patients. It shows the prevalence was increased among female patients. Post operative rehabilitation was started according to the protocol. All the patients were followed up to 2 year at regular 3 months interval to assess the functional outcome. Functional outcome by DASH score and QUINNELL’S Grading score. DASH score is 100 point score, 30 questionnaire related daily activities. Lower the score better is the outcome. In our study, pre operative mean DASH score was 24.09 and post op mean DASH score was 3.99. It indicates that the percutaneous release of A1pulley in trigger finger improve the outcome of hand functions. QUINNELL’S Grading score using clinical assessment for severity of triggering after the procedure. Grade I as Excellent, Grade II as Good, Grade III- V as poor outcome. According QUINNELL’S Grading to 23 patients had excellent outcome, 2 patients had good outcome and none of the patients had poor outcome in our study. Total complications are two. Two patients had inflammation over the procedure site. Which was settled with analgesics and antibiotics within a week time, but the same 2 patients had occasional pain at the release site in the follow up period. Another two patients had hematoma following surgery for which compression dressing and analgesic were given. Hematoma was settled with in 5 to 7 days period. Conclusion: Trigger finger Percutaneous release of first annular pulley (A1 pulley) under ultrasound-guided is a safe, pain free, effective and outpatient procedure for patients with Trigger finger. It is better alternative to open surgical procedure and can be considered as primary definitive treatment option for trigger finger. Keywords: Trigger finger, QUINNELL’S Grading score, DASH score, Complication.

Background: Avascular necrosis (AVN) of the femoral head is a debilitating condition commonly affecting younger individuals. It often progresses to end-stage arthritis. In AVN cases when conservative measures fail, surgical intervention in the form of total hip arthroplasty (THA) becomes necessary. Among fixation techniques, uncemented THA has gained prominence due to its potential for osteointegration, long-term stability, and favorable outcomes in younger patients. Materials and Methods: This prospective observational study was conducted over 18 months at a tertiary care hospital in Western Maharashtra. It included 16 patients aged up to 60 years of age with Ficat and Arlet Stage 3 or 4 AVN undergoing primary uncemented THA. Standardized preoperative planning, intraoperative techniques and postoperative rehabilitation protocols were followed. Functional outcomes were assessed by Harris Hip Score (HHS) till 3 months post-operatively. Radiographic evaluation included component positioning, limb length discrepancy and evidence of implant loosening. Data were analyzed using SPSS v29 with repeated measures ANOVA and Bonferroni correction for longitudinal assessment. Results: The mean patient age of studied cases was 44.06 years with a male predominance (87.5%). Most patients presented with Stage 3 AVN (56.25%). Femoral alignment was neutral in 87.5%, with 12.5% showing mild varus; acetabular inclination was within the ideal range in 100% cases. Mean HHS improved significantly from 40.5 preoperatively to 87.44 at 3 months (p < 0.001) follow up. All (100%) of patients achieved good-to-excellent functional outcomes. Limb length discrepancy was effectively corrected and no radiographic signs of loosening were observed. Early mobilization was achieved in the majority of patients and postoperative complications were minimal. Conclusion: Uncemented total hip arthroplasty provides excellent functional and radiological outcomes in patients under 60 years with advanced AVN. With careful surgical planning and technique this modality offers a durable and reliable solution with minimal complications and rapid postoperative recovery. However larger, long-term studies are warranted to validate these findings. Keywords: Avascular Necrosis, Total Hip Arthroplasty, Uncemented Hip Replacement, Harris Hip Score, Osteointegration.

Background: Alzheimer’s disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline and memory impairment. Current treatments provide only symptomatic relief, necessitating the exploration of alternative therapeutic approaches. This study aims to evaluate the neuroprotective effects of Citrus limon (CL) in comparison to Donepezil (a cholinesterase inhibitor) and Ezetimibe (a cholesterol-lowering agent) in an animal model of AD. Materials and Methods: Male Wistar rats (n=30) were divided into five groups: Control, AD (untreated), Donepezil-treated, Ezetimibe-treated, and CL-treated. AD was induced using AlCl3. Treatment was administered daily for six weeks. Behavioural assessments (Morris water maze and cook’s pole climbing response test) and oxidative stress markers were assessed. Results: CL significantly improved cognitive function, reduced Aβ plaque deposition, and decreased oxidative stress markers, showing effects comparable to Donepezil. Ezetimibe also demonstrated neuroprotective properties, indicating a possible role of cholesterol metabolism in AD pathology. Conclusion: CL exhibits promising neuroprotective effects, potentially serving as an adjunct therapy for AD. Further clinical studies are warranted to explore its therapeutic potential. Keywords: Alzheimer’s disease, Citrus limon, Donepezil, Ezetimibe, Neuroprotection, Oxidative stress, Beta-amyloid.

Background: Oral cancer is a major problem in the Indian subcontinent where it ranks among the top three types of cancer in the country. Medical and dental practitioners should possess basic knowledge for oral cancer as there graduation teaching curriculum. The objective is to assess the knowledge, attitude, and practices (KAPs) regarding Head & Neck Cancer (Oral cancer) among registered Medical and Dental practitioners in Agra Commissionary of Western Uttar Pradesh, India. Materials and Methods: A cross-sectional, descriptive, questionnaire-based was carried out among 304 Dental Practitioners and 612 Medical Practitioners. Questionnaires were given to them personally (hard copy of questionnaires) or through electronic media (soft copy of questionnaires via Whats app/registered e-mail). Results: Maximum practitioners were from Agra (412), followed by Firozabad (209), Mathura (176) and least from Manipuri. Knowledge and Attitude Score among both the groups i.e medical and dental was significant, while Practice Score was found non-significant. The Knowledge - Attitude Score and Knowledge – Practice score for both the groups was found to be significantly correlated. Knowledge – Attitude Score for DPs, and Knowledge-Attitude and Knowledge-Practice score of MPs were significantly correlated. Conclusion: Early detection is the key to reduce the increasing burden of oral cancer Both general MPs and DPs possess sufficient knowledge of the signs and symptoms of malignant and premalignant oral cavity lesions for the sake of early and effective diagnosis. DPs had a better knowledge and practice regarding oral cancer. Keywords: Head and Neck Cancer, Oral Cancer, Knowledge, Attitude, Practice.

Background: Type 2 diabetes mellitus (T2DM) is a major public health problem, and poor glycemic control remains a significant challenge despite advances in therapeutic options. Identifying clinico-epidemiological factors associated with inadequate glycemic control is essential for improving diabetes management. The objective is to assess the clinico-epidemiological profile of patients with Type 2 diabetes mellitus and to identify predictors of poor glycemic control. Materials and Methods: This hospital-based cross-sectional observational study included 250 patients with Type 2 diabetes mellitus attending a tertiary care center. Demographic, clinical, lifestyle, and treatment-related data were collected using a structured proforma. Glycemic control was assessed using glycated hemoglobin (HbA1c). Poor glycemic control was defined as HbA1c ≥7%. Results: Poor glycemic control was observed in 62.4% of patients. Longer duration of diabetes (≥5 years), higher body mass index (≥25 kg/m²), hypertension, physical inactivity, and poor medication adherence were significantly associated with poor glycemic control (p < 0.05). On multivariate analysis, poor medication adherence emerged as the strongest independent predictor, followed by physical inactivity, longer duration of diabetes, hypertension, and obesity. Conclusion: Poor glycemic control is highly prevalent among patients with Type 2 diabetes mellitus. Identification of modifiable risk factors highlights the need for targeted lifestyle interventions, improved treatment adherence, and individualized diabetes management strategies to achieve optimal glycemic control. Keywords: Type 2 diabetes mellitus; Glycemic control; HbA1c; Medication adherence; Risk factors.

Background: Intraoperative frozen section examination is an essential diagnostic tool in neurological practice, providing rapid pathological assessment while surgery in progress. Central nervous system tumours often exhibit overlapping clinical and radiological features, making immediate tissue diagnosis crucial for intraoperative decision-making. When combined with squash smear cytology, frozen section evaluation aids in distinguishing neoplastic from non-neoplastic lesions and in broadly grading tumours. This study aimed to assess the diagnostic concordance between intraoperative frozen section diagnosis and final histopathological evaluation of CNS tumours. Materials and Methods: A retrospective analysis of 47 CNS tumour cases subjected to intraoperative consultation over a three-year period was conducted at a tertiary care centre. Fresh, unfixed tissue samples were examined intraoperatively using frozen sections and squash smear cytology. These findings were later correlated with diagnosis established on formalin fixed, paraffin embedded sections. Diagnostic accuracy, sensitivity, specificity and predictive values were calculated. Results: High grade gliomas constituted the most frequent intraoperative diagnosis, followed by low grade gliomas and metastatic tumours. Final histopathology revealed glioblastoma as the most common lesion. Frozen section examination demonstrated a sensitivity of 91.2%, specificity of 90.9% and an overall diagnostic accuracy of 91.5%. Most discrepancies were attributed to sampling limitations and overlapping histomorphological features. Conclusion: Intraoperative frozen section examination shows high diagnostic accuracy and strong agreement with final histopathology in CNS tumours. Despite occasional discrepancies, it remains reliable and valuable tool for guiding neurosurgical management. Keywords: Frozen section, Central nervous system tumours, Intraoperative diagnosis, Histopathology, Diagnostic accuracy.

Background: Thyroid lesions encompass a broad range of benign and malignant conditions. Fine Needle Aspiration Cytology (FNAC) remains the cornerstone for initial evaluation, and the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) provides standardized terminology and malignancy risk stratification. Correlation with histopathological examination (HPE) is essential to assess diagnostic accuracy and identify potential discrepancies. Aim: To evaluate the diagnostic performance of FNAC in thyroid lesions by correlating cytological findings with histopathological diagnoses using the Bethesda System. Materials and Methods: This retrospective study included 88 patients with thyroid swellings who underwent FNAC followed by surgical excision and histopathological confirmation. Cytological diagnoses were categorized according to TBSRTC (I-VI). Cytology-histology correlation was performed, and diagnostic parameters such as sensitivity, specificity, PPV, NPV, and accuracy were calculated. Statistical analysis employed Fisher’s exact and chi-square tests, with significance set at p< 0.05. Results: FNAC and HPE correlation was observed in 74 of 88 cases (84%). There were 3 true positives, 9 false negatives, and no false positives, yielding a sensitivity of 25%, specificity and PPV of 100%, NPV of 89.4%, and overall accuracy of 89.8%. Malignancy risk increased from Bethesda II (8.2%) to IV (42.9%) and VI (100%), demonstrating a significant association between cytology category and final histopathology (p< 0.001). False negatives were mainly attributed to geographic misses and unrecognized dual pathology. Conclusion: FNAC, when interpreted via the Bethesda System, is a reliable, minimally invasive, and highly specific diagnostic technique for thyroid lesions. Although sampling limitations may yield false negatives, the progressive risk gradient across Bethesda categories validates its role in clinical decision-making. Integrating cytology-histology correlation enhances diagnostic confidence and guides optimal surgical management. Keywords: Thyroid lesions, Bethesda System, Fine Needle Aspiration Cytology, Histopathology, Diagnostic accuracy.

Background: The aim is to study the incidence, risk factors and outcome for bacterial meningitis in neonates with clinical suspicion of sepsis in Neonatal Intensive Care Unit (NICU) of tertiary care hospital. Materials and Methods: It was a prospective observational study. 100 neonates with clinical suspicion of sepsis are included. The current study was conducted in the Department of Pediatrics, Guntur Medical College, Guntur, Andhra Pradesh, India. Patients includes neonates who got admitted in the NICU with symptoms and clinical features suggestive of sepsis. Results: 18% of the neonates had meningitis. There is significant difference in term of babies between two groups of neonates. Neonates below 37 weeks are more likely to develop meningitis, and there is significant association seen. In the present study, there is significant difference in the presence of altered sensorium in between two groups of neonates. Overall, 23 neonates had altered sensorium. There is significant association between AF bulge and meningitis. There is significant association between seizures and meningitis. We found there is no significant difference in RESP distress in the presence of between two groups of neonates. We observed that there is significant difference in CSF analysis and CSF cell count in between two groups of neonates. There is significant difference in organism isolated in between two groups of neonates. There is significant difference in outcome till 1 month in between two groups of neonates. 2 neonates had post meningitic sequelae and rop 1 had abnormal oae. Conclusion: The present study concluded that, prolonged labor and PROM were found to be linked with the development of neonatal meningitis along with preterm birth and low gestational age. We recommend routine CSF analysis for all neonates suffering from sepsis irrespective of clinical features. Early diagnosis and treatment may reduce neonatal meningitis-associated complications. Further multicenter studies with intense methods are needed to develop better evidence. Keywords: Neonates, Meningitis, CSF, Sensorium,

Background: Obstructive sleep apnoea (OSA) is characterized by recurrent upper airway obstruction during sleep, leading to intermittent hypoxaemia and sleep fragmentation. While the apnoea–hypopnoea index (AHI) is the standard metric for grading disease severity, it does not fully capture the physiological impact of nocturnal hypoxia. Oxygen desaturation parameters may better reflect hypoxic burden and associated clinical risk. This study aimed to evaluate the correlation between the degree of oxygen desaturation and the severity of OSA in adults undergoing diagnostic polysomnography. Materials and Methods: This hospital-based cross-sectional study included 92 adult patients with polysomnography-confirmed OSA. All participants underwent full-night, attended, in-laboratory polysomnography. OSA severity was classified using AHI into mild, moderate, and severe categories. Oxygen desaturation parameters analyzed included minimum and mean nocturnal oxygen saturation (SpO₂), oxygen desaturation index (ODI), and percentage of total sleep time spent with SpO₂ below 90% (T90). Comparisons across severity groups were performed using appropriate parametric or non-parametric tests, and correlations between AHI and desaturation parameters were assessed using correlation coefficients. Results: The mean age of participants was 52.6 ± 10.8 years, with male predominance (72.8%). Severe OSA constituted 40.2% of cases. A progressive worsening of oxygen desaturation was observed with increasing OSA severity. Minimum SpO₂ decreased from 86.9% in mild OSA to 74.8% in severe OSA, while ODI increased from 9.6 to 38.7 events/hour (p < 0.001). Time spent with SpO₂ < 90% increased significantly across severity categories (p < 0.001). AHI showed strong positive correlations with ODI (r = 0.72) and T90 (r = 0.74), and significant negative correlations with minimum (r = −0.68) and mean SpO₂ (r = −0.61) (all p < 0.001). Conclusion: Nocturnal oxygen desaturation parameters correlate strongly with the severity of obstructive sleep apnoea. Incorporating hypoxic burden indices alongside AHI may provide a more comprehensive assessment of disease severity and aid in improved risk stratification and clinical management of patients with OSA. Keywords: Obstructive sleep apnoea; Oxygen desaturation; Hypoxic burden; Apnoea–hypopnoea index; Polysomnography

Background: The COVID-19 pandemic has imposed significant psychological stress on healthcare trainees globally. Limited data exist on the comparative assessment of fear and preventive behaviours among various cadres of medical and paramedical students during the pandemic. The objective is to assess fear related to COVID-19 and adherence to preventive behaviours among medical and paramedical students, and to compare these parameters across different professional streams and gender. Materials and Methods: A questionnaire-based cross-sectional survey was conducted during the third wave of the pandemic among 382 medical and paramedical students from a tertiary institution in Northern India. The Fear of COVID-19 Scale (FCV-19S) and Preventive COVID-19 Behaviour Scale (PCV-19BS) were used as assessment tools. Data were analysed using SPSS version 23, with statistical comparisons performed using ANOVA, the Kruskal-Wallis test, the t-test, and the Mann-Whitney U test. Results: Among 382 participants (mean age 19.6±1.6 years), 69.9% were female. The overall mean FCV-19S score was 17.42 ± 5.55, with BDS students demonstrating the highest scores (18.56 ± 5.55). Female students exhibited significantly higher emotional fear scores compared to males (11.54 ± 3.33 vs. 10.70 ± 4.07, p < 0.05). The mean PCV-19BS score was 38.49±5.69, with no statistically significant differences between professional streams. Preventive behaviour compliance was notably high across all groups (mean 76.1% adherence). Conclusion: While fear of COVID-19 was prevalent among medical trainees, particularly in females and BDS students, preventive behaviour adherence remained consistently high across all professional streams. Gender-specific mental health interventions and targeted psychological support should be integrated into medical curricula during crisis situations. Keywords: COVID-19, Fear, Preventive behaviour, medical students, FCV-19S, Mental health, Pandemic.

Background: Palatal myoclonus is a rare rhythmic movement disorder classified into essential and symptomatic subtypes. Symptomatic palatal myoclonus results from lesions disrupting the dentato-rubro-olivary pathway within the Guillain-Mollaret triangle, leading to hypertrophic degeneration of the inferior olivary nucleus. This condition is typically associated with stroke, demyelinating diseases, or posterior fossa lesions, though bilateral stroke presentations remain exceptionally rare in the literature. Case Presentation: We report the case of a 68-year-old man with poorly controlled type 2 diabetes mellitus and hypertension who presented with a three-day history of gait ataxia, urinary incontinence, and behavioral changes with emotional lability. He had experienced progressive dysarthria and tinnitus over the preceding two months. Neurological examination revealed cognitive impairment (Mini-Mental State Examination score 20/30), right-sided spastic hemiparesis with hyperreflexia and extensor plantar response, cerebellar signs including nystagmus and truncal ataxia, and characteristic rhythmic palatal myoclonus on cranial nerve examination. Magnetic resonance imaging of the brain demonstrated an acute infarct in the left frontal parasagittal region and a chronic infarct involving the Guillain-Mollaret triangle. Comprehensive cardiovascular and hematological investigations, including carotid Doppler ultrasonography, echocardiography, 24-hour Holter monitoring, and thrombophilia screening, revealed no identifiable cardioembolic source or coagulopathy. The patient was managed with antiplatelet therapy (aspirin 150 mg), statin therapy (atorvastatin 10 mg), sodium valproate for symptomatic control of palatal myoclonus, and comprehensive rehabilitation including physiotherapy, speech therapy, bladder training with pelvic floor exercises, and cognitive-behavioral therapy. Conclusion: This case highlights the clinical significance of recognizing symptomatic palatal myoclonus as a manifestation of bilateral cerebrovascular events affecting the dentato-rubro-olivary pathway. Early identification of this distinctive clinical sign, coupled with appropriate neuroimaging demonstrating lesions within the Guillain-Mollaret triangle, is essential for accurate diagnosis, risk stratification, and implementation of targeted therapeutic interventions. Clinicians should maintain heightened awareness of this uncommon presentation in patients with recurrent cerebrovascular disease. Keywords: Palatal myoclonus, Guillain-Mollaret triangle, cerebrovascular accident, hypertrophic olivary degeneration, dentato-rubro-olivary pathway.

Background: Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) frequently coexist, forming the overlap syndrome, which is associated with increased morbidity and adverse clinical outcomes. Data on the prevalence and clinical impact of co-existing OSA among COPD patients remain limited in the Indian population. This study aimed to determine the prevalence of OSA in patients with COPD and to evaluate its association with disease severity, clinical characteristics, and pulmonary function. Materials and Methods: This hospital-based cross-sectional study included 436 adult patients with spirometry-confirmed COPD. All participants underwent detailed clinical and anthropometric assessment, pulmonary function testing, and overnight attended polysomnography. OSA was diagnosed using the apnoea–hypopnoea index (AHI), and its severity was classified according to standard criteria. COPD severity was categorized using Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometric staging. Comparisons were made between COPD patients with and without OSA, and associations between sleep-related parameters and pulmonary function indices were analyzed using appropriate statistical tests. Results: OSA was diagnosed in 124 patients, yielding a prevalence of 28.4%. The prevalence of OSA increased significantly with worsening COPD severity, from 17.6% in mild COPD to 38.7% in very severe COPD (p = 0.002). Compared to patients without OSA, those with overlap syndrome were older and had significantly higher body mass index and neck circumference, greater daytime sleepiness, lower resting oxygen saturation, and a higher frequency of COPD exacerbations (all p <0.05). The apnoea–hypopnoea index showed a significant negative correlation with FEV₁ percent predicted (r = −0.42) and resting oxygen saturation (r = −0.46), and a positive correlation with body mass index, neck circumference, and Epworth Sleepiness Scale score (all p <0.001). Conclusion: Co-existing obstructive sleep apnea is common among patients with chronic obstructive pulmonary disease and is associated with greater symptom burden, worse oxygenation, increased exacerbation frequency, and more severe airflow limitation. Routine screening for OSA should be considered in COPD patients, particularly those with advanced disease or obesity, to facilitate early diagnosis and integrated management aimed at improving clinical outcomes. Keywords: Chronic obstructive pulmonary disease; Obstructive sleep apnea; Overlap syndrome; Polysomnography; Apnoea–hypopnoea index; GOLD staging.

The study aimed to find the prevalence of malarial parasitic infection among patients referred to a tertiary care hospital in Mumbai between January 2021 and December 2023. A total of 61251 samples were tested during the study period of three years. Positivity for malarial antigen was detected in 7.31%, 4.65% and 3.47% samples in years 2021, 2022 and 2023 respectively. The proportion of malaria positive samples was higher in year 2021 as compared to 2023. Infection prevalence in male patients was 2.6-fold higher than in female patients. From year 2021 to 2023, there was reduction in malarial cases in males from 9.8% to 5.50 % and in females from 3.86% to 1.55%, but there was increase in male and female ratio of malarial cases. Highest malarial cases were found in age group 21 to 30 year followed by age group 31-40 in these three years. Plasmodium vivax species was found in highest number of samples in all the consecutive three years followed by Plasmodium falciparum and mixed species. These findings compared with other findings of malaria endemic populations in India. Keywords: Retrospective, Malaria antigen, RDTs, prevalence.

Background: Severe acute malnutrition (SAM) in under-five children remains a critical public health issue globally and in India[1][2]. In Madhya Pradesh, ~35% of children are wasted and ~49% stunted[3][4]. Facility-based Nutrition Rehabilitation Centres (NRCs) were instituted (e.g. under MP’s Bal Shakti Yojana) to provide therapeutic care and reduce SAM prevalence to <1%[5]. This study evaluates the management and outcomes of SAM children admitted to the NRC at District Hospital Datia (NRC-Datia) over one year period (Apr 2021–Mar 2022). Materials and Methods: We conducted a retrospective observational analysis of 175 SAM children (88 males, 87 females) aged 0–59 months admitted to the 15-bed NRC-Datia. SAM was defined per WHO/UNICEF criteria: weight-for-height Z-score < –3, MUAC <11.5 cm, or bilateral edema. Children referred out were excluded from outcome analysis. Data from medical records were abstracted for demographics, anthropometry on admission and discharge, duration of stay, and follow-up visits. Descriptive statistics were computed (mean±SD, percentages). Key outcomes included average weight gain (g/kg/day), length of stay, recovery rate, and follow-up compliance. Results: Of 175 children (mean age 24.2±13.5 months), 35% met SAM by MUAC alone and 65% by weight-for-height criteria. Mean weight increased significantly from 6.3±1.8 kg on admission to 7.21±2.0 kg at discharge (p<0.001). The average weight gain was 8.9±1.1 g/kg/day, consistent with recommended standards over a median stay of 16 days (IQR 14–18). Overall recovery (defined as ≥15% weight gain) was achieved in 68% of children, with 100% remaining in the program until discharge (no deaths or referrals). The mean length of stay was 16.2±1.4 days. Follow-up compliance was high: 83% (145/175) attended at least one post-discharge visit. Conclusion: The NRC-Datia program yielded substantial anthropometric improvement in SAM children, with mean weight gain (~8–10 g/kg/day) and no mortality, comparable to other Indian NRC reports[4][7]. High discharge follow-up (83%) suggests effective continuity of care. Continued support for NRCs and community follow-up is recommended to sustain gains and achieve long-term nutritional recovery. Keywords: Severe acute malnutrition, NRC, weight gain, rehabilitation, under-five, India.

Background: Cesarean delivery is common worldwide and can lead to long-term uterine scar problems (e.g. niche defects, rupture, placenta accreta) if healing is suboptimal. The optimal closure technique – single-layer versus double-layer – remains controversial. Some studies suggest double-layer closure yields thicker residual myometrium, while others report no difference or favor single-layer (with shorter operative time). We evaluated these techniques in a large Indian cohort. Materials and Methods: In this prospective cohort at Pandit Deendayal Upadhyay Hospital, Varanasi (January 2023 – December 2024), 210 women undergoing primary low-transverse cesarean were enrolled (105 per group). Inclusion criteria were singleton term pregnancy and no uterine anomalies; exclusions included placenta previa/accreta and infections. Uterine incisions were closed either in a single continuous unlocked layer (group S) or a double continuous layer (group D), with non-locking absorbable sutures. Primary outcome was residual myometrial thickness (RMT) at the scar, measured by transvaginal ultrasound at 6 months postpartum. Secondary outcomes included operative time, blood loss, transfusion, postoperative infection, and niche formation. Statistical comparisons used t-tests and chi-square, with p<0.05 as significant. Results: Baseline demographics (age, BMI, parity, gestational age) were similar between groups (Table 1). The double-layer group had significantly longer mean operating time (72±12 vs 60±10 minutes, p<0.001) but no difference in blood loss or hemoglobin drop [Table 2]. Transfusion rates were low (4% vs 8%, p>0.10) and surgical-site infections were rare in both groups [Table 2]. At 6 months, mean RMT was significantly greater after double-layer closure (5.2±0.8 mm) versus single-layer (4.4±0.7 mm; p<0.001) [Table 3; Figure 1]. The incidence of sonographic niche defects was comparable (33% vs 27%, p>0.10). Niche volume was smaller in the double-layer group (mean 40 vs 60 mm³; p<0.01). There were no significant differences in wound complications or postpartum fever. Conclusion: In this 210-patient cohort, double-layer closure produced a thicker uterine scar (higher RMT) than single-layer without increasing complications. Operative time was slightly longer with double-layer closure. These findings align with several recent studies showing better scar thickness with double-layer closure.[2,6] Although niche rates were similar, a thicker myometrial bridge may theoretically reduce future rupture risk. Given no compromise in safety, double-layer closure may be preferred, especially in women contemplating future pregnancies. Keywords: Cesarean section, uterine closure, single-layer closure, double-layer closure, uterine scar, residual myometrial thickness, niche defect, prospective cohort.

Background: Self-medication provides individuals with a convenient method to address minor health issues without needing to visit a physician. Self-medication is a significant health concern in developing nations such as India. Despite the availability of healthcare services, many patients still opt for self-medication. The Objective of this study was to estimate the prevalence of self-medication and to identify the factors associated with self-medication practices in a rural field practice area. Materials and Methods: This community based cross sectional study was conducted in the rural field practice area under the Department of Community Medicine of Swami Ramanand Teerth Rural Government Medical College, Ambajogai, Maharashtra for a period of six months. A total of 347 individuals aged 30-45 years, were interviewed using a pretested, semi-structured questionnaire to collect the data. The data will be analysed using statistical software. Results: The Prevalence of self-medication among middle-aged adults in rural field practice area was found to be 58.2%, Studies often show that males may self-medicate more frequently than females, particularly for pain relief. Rural areas often have limited access to healthcare facilities and professionals, leading to higher rates of self-medication. Conclusion: The trend of Self-medication practices in India is rising. Understanding these trends can help reform public health strategies, targeting education and resources to promote safe self-medication practices. Keywords: Self-Medication, Middle Aged Adults.

Background: Antiepileptic drugs (AEDs) are essential for seizure control in children but may alter lipid metabolism, potentially increasing long-term cardiovascular risk. Evidence regarding lipid profile changes in pediatric patients receiving AED monotherapy remains limited. Materials and Methods: A hospital-based case–control study was conducted among children (<12 years) receiving single-drug AED therapy for at least six months. Thirty-eight cases and 38 age- and sex-matched healthy controls were included. Fasting serum lipid parameters—total cholesterol, LDL-C, HDL-C, triglycerides, and VLDL-C—were analyzed using standard enzymatic methods. Statistical analysis was performed using SPSS, with p < 0.05 considered significant. Results: Children receiving phenytoin showed significantly higher total cholesterol, LDL-C, and triglyceride levels and lower HDL-C compared to controls (p < 0.001). No significant lipid alterations were observed in children treated with levetiracetam or sodium valproate. Demographic factors and duration of epilepsy did not influence lipid outcomes, while a positive family history of epilepsy was more common among cases. Conclusion: Phenytoin therapy was associated with adverse lipid profile changes in children, whereas levetiracetam and sodium valproate had minimal metabolic effects. Lipid monitoring is advisable in pediatric patients receiving enzyme-inducing AEDs. Keywords: Epilepsy, Children, Antiepileptic drugs, Phenytoin, Lipid profile, Dyslipidemia.

Background: Midshaft clavicle fractures are the most frequently encountered fractures in young and active adults. Most of these fractures are managed by plating, intramedullary nailing, and conservative management. However, there is a lack of consensus on optimal management of these cases. In the current study, we tried to evaluate the clinical and functional outcomes following treatment of middle-third clavicular fractures with plating, conservative management, and intramedullary nailing. Materials and Methods: The current study was a prospective investigation of cases of midshaft clavicular fractures. The sample size was 20 cases, as reported in the duration of the study. They were allotted into three groups based on treatment modality: plating (n=9), conservative (n=7), and nailing (n=4). The functional outcomes were evaluated using the Constant-Murley Score (CMS) and the DASH Score, and the frequency of complications was recorded in each group. The statistical analysis was performed to determine the outcome. Results: The results of this study showed that the highest frequency of plating cases was with good outcomes (88.9%), followed by the nailing group (50%) and the conservative group (14.3%). Functional analysis by CMS and DASH showed the plating group had a CMS mean score of 89.56 ± 2.67, and a DASH mean score of 7.11 ± 2.33. The conservative group had a mean CMS score of 68.14 ± 7.76, a DASH mean score of 21.86 ± 7.09, and a nailing group CMS score of 82.00 ± 8.00. The nailing group CMS mean score was 82.00 ± 8.00, and the DASH mean score was 10.50 ± 5.20. ANOVA showed statistically significant differences among the groups (p < 0.001 for both scores. Conclusion: The overall results of this study showed that plating provides superior functional outcomes and lower complication rates compared to nailing and conservative treatment for displaced midshaft clavicle fractures. It is recommended particularly for active individuals or those requiring early return to function. Keywords: Midshaft clavicular fractures, Functional outcomes, Constant-Murley Score, DASH score.

Background: Antenatal care (ANC) is a critical component of maternal health that ensures early detection and management of pregnancy-related complications, thereby reducing maternal and neonatal morbidity and mortality. Despite substantial improvements in service availability, the adequacy of ANC utilization remains uneven across different sociodemographic groups. Understanding these determinants at the community level is vital for strengthening maternal health programs. Materials and Methods: A community-based cross-sectional descriptive study was conducted from March 2016 to February 2017 among 180 women residing in an urban slum field practice area of the Department of Community Medicine, [Parent Medical College]. Eligible participants were women of reproductive age who had delivered within the previous year. Data were collected through face-to-face interviews using a pre-tested, semi-structured questionnaire, with information verified through ANC cards or health post records. Adequate ANC utilization was defined as registration during the first trimester, ≥3 visits, 2 TT doses, ≥100 iron–folic acid tablets consumed, and receipt of essential ANC services. Data were analyzed using SPSS version 20.0, and associations were tested with the Chi-square test (p<0.05 considered significant). Results: Adequate ANC utilization was observed among 90% of participants. Significant associations were found between adequacy of ANC and education of women (p=0.047), education of husbands (p=0.019), and socioeconomic status (p=0.041). No significant association was noted with age, religion, or family type. Most women (95.6%) were aware of ANC services, 45% registered in the first trimester, and 89.4% had more than three ANC visits. Conclusion: The study revealed a high prevalence of adequate ANC utilization, influenced primarily by educational and socioeconomic factors. Strengthening women’s education, promoting male involvement, and prioritizing outreach to socioeconomically disadvantaged groups are recommended to sustain and further enhance ANC coverage. Keywords: Antenatal care utilization, Sociodemographic factors, Maternal health, Urban slum, Cross-sectional study.

Background: Premature rupture of membranes (PROM) is defined as spontaneous rupture of the fetal membranes before the onset of labor and remains a major cause of maternal and perinatal morbidity and mortality worldwide. The clinical outcomes of PROM depend on several determinants including gestational age, latency period, and infection status. This study aimed to identify and analyze the maternal and perinatal determinants influencing outcomes in women presenting with PROM at a tertiary care center. Materials and Methods: A prospective analytical study was conducted in the Department of Obstetrics and Gynaecology at [Name of Institution] over a period of [insert duration]. A total of 150 pregnant women beyond 28 weeks of gestation diagnosed with PROM were enrolled after ethical approval and informed consent. Cases with multiple gestation, antepartum hemorrhage, or major comorbidities were excluded. Maternal and neonatal data were collected prospectively. Statistical analysis was performed using SPSS version [XX]; Chi-square test, Fisher’s exact test, and logistic regression were applied. A p-value <0.05 was considered statistically significant. Results: Half of the participants (50%) presented with preterm PROM, and 22.6% had latency periods exceeding 24 hours. The incidence of chorioamnionitis and puerperal sepsis was 18.7% and 6.7%, respectively. Among neonates, 17.3% developed sepsis, 13.3% had respiratory distress, and 28% required NICU admission, with an overall perinatal mortality rate of 4%. Maternal morbidity and neonatal complications were significantly higher in preterm and prolonged-latency cases (p <0.05). On multivariate analysis, gestational age <37 weeks (OR = 4.35; p < 0.001) and latency >24 hours (OR = 3.86; p = 0.001) were independent predictors of adverse perinatal outcomes. Conclusion: Preterm PROM and prolonged latency significantly increase maternal infectious morbidity and neonatal complications. Early diagnosis, prompt antibiotic prophylaxis, and timely delivery decisions are essential to reduce adverse outcomes. Keywords: Premature rupture of membranes; Preterm PROM; Maternal morbidity; Perinatal outcomes; Latency period.

Background: Oral cavity lesions include a spectrum of neoplastic and non-neoplastic conditions, often clinically overlapping, making histopathology essential for diagnosis. Objective: To assess the histopathological spectrum, demographic distribution, and anatomical predilection of oral cavity lesions. Materials and Methods: A prospective cross-sectional study was conducted over 24 months (July 2023–June 2025) in the Department of Pathology. A total of 109 surgical and biopsy specimens from ENT and Dental OPD/IPD were processed, stained with hematoxylin and eosin, and analyzed histopathologically. Results: Neoplastic lesions predominated (78/109, 71.56%), with squamous cell carcinoma most common (38/109, 34.86%), mainly well-differentiated (63.16%). Premalignant lesions included severe dysplasia (55%) and oral submucous fibrosis (10%). Benign neoplasms comprised haemangioma (35%) and squamous papilloma (25%). Non-neoplastic lesions were mostly inflammatory (35.48%) and mucous retention cysts (19.35%). Buccal mucosa (46.79%) and tongue (30.27%) were the most affected sites. Neoplastic lesions were common in 41–60 years, while non-neoplastic lesions were more frequent in 21–40 years. A male predominance was observed. Conclusion: Neoplastic lesions are predominant in the oral cavity, with SCC being most frequent. Histopathological evaluation is critical for accurate diagnosis, early detection of premalignant lesions, and guiding management. Keywords: Oral cavity lesions, Squamous cell carcinoma, Dysplasia, Histopathology, Buccal mucosa.

Background: Caesarean section (CS) is one of the most commonly performed abdominal surgeries worldwide, with rising rates in both developed and developing countries. Optimal wound closure is critical to minimize complications and improve cosmetic outcomes. Monocryl (Poliglecaprone 25), a monofilament suture, and Vicryl Rapide (Polyglactin 910), a braided multifilament suture, are widely used for subcuticular closure, but comparative evidence remains limited. Objective: To compare the efficacy of Monocryl and Vicryl Rapide in subcuticular skin closure following caesarean section, focusing on pain, tenderness, swelling, wound discharge, wound dehiscence, cosmetic outcome, and surgical site infection. (p = 0.028) (p = 0.035). Materials and Methods: From November 2023 to October 2024, a prospective, randomized, single-blinded comparative study was carried out at KPC Medical College & Hospital in Kolkata. Two groups, Group A (Monocryl, n = 70) and Group B (Vicryl Rapide, n = 70), were randomly selected from among 140 term pregnant women undergoing elective caesarean sections. On surgical days 3, 10, 30, and 45, clinical outcomes were evaluated using standardized instruments such as the Modified Hollander Cosmesis Scale (MHCS) and Visual Analogue Scale (VAS). SPSS v20 was used for the statistical analysis, and p<0.05 was deemed significant. Results: After accounting for loss to follow-up, 131 participants were analyzed (Monocryl: 66; Vicryl Rapide: 65). Monocryl was associated with significantly lower wound discharge (p=0.035 at day 3; p=0.001 at day 10), reduced swelling (p=0.028 at day 3), and superior cosmetic scores (MHCS, p=0.001 at day 3). Tenderness resolved completely by day 45 in Monocryl, while two cases persisted in Vicryl Rapide. Wound dehiscence was significantly lower in Monocryl at day 10 (p=0.035) and day 45 (p=0.023). Surgical site infections occurred only in Vicryl Rapide (2 cases, 3.1%), though the difference was not statistically significant. (p = 0.028) (p = 0.035) Conclusion: Monocryl demonstrated superior outcomes compared to Vicryl Rapide in terms of pain reduction, wound healing, and cosmetic appearance, while both sutures were safe for caesarean section closure. Monocryl may be considered the preferred suture material for subcuticular closure in caesarean section, particularly when patient comfort and cosmesis are prioritized. Keywords: Caesarean section, Monocryl, Vicryl Rapide, subcuticular suturing, wound healing, cosmetic outcome.

Background: Accurate non-invasive characterization of adrenal and hepatic lesions remains a diagnostic challenge, particularly when lesions appear indeterminate on conventional ultrasonography and computed tomography. Differentiation between benign and malignant lesions is crucial, as it directly influences clinical management and the need for invasive procedures. Chemical shift imaging (CSI) is an established magnetic resonance imaging technique that exploits the precessional frequency difference between fat and water protons, enabling detection of microscopic intracellular fat that may not be appreciable on routine imaging sequences. Objectives: To evaluate the diagnostic utility of chemical shift MRI in identifying microscopic fat within adrenal and hepatic lesions, and to assess the correlation of CSI findings with lesion morphology, anatomical characteristics, contrast enhancement patterns, and relevant biochemical parameters. Materials and Methods: This prospective cross-sectional study was conducted over an 18-month period at a tertiary care referral center. A total of 96 patients with indeterminate adrenal (n = 44) or hepatic (n = 52) lesions detected on prior ultrasonography or CT were included. All patients underwent MRI with in-phase and opposed-phase gradient-echo sequences. Quantitative assessment was performed using signal intensity index and percentage signal loss calculations. Imaging findings were systematically correlated with lesion size, margins, internal architecture, and enhancement characteristics. Biochemical correlation included hormonal assays for adrenal lesions and liver function tests with relevant serum tumor markers for hepatic lesions. Final diagnosis was established based on histopathology where available, or by clinicoradiological follow-up. Results: Significant signal loss on opposed-phase imaging, indicative of microscopic fat, was observed in the majority of benign lesions. Among adrenal lesions, 30 of 34 adenomas (88.2%) demonstrated marked signal drop on opposed-phase sequences, whereas malignant adrenal lesions showed minimal or no signal loss. Similarly, 28 of 31 benign hepatic lesions, including hepatic adenomas and focal fatty lesions (90.3%), exhibited significant signal loss, in contrast to malignant hepatic lesions. The mean percentage signal intensity loss was significantly higher in benign fat-containing lesions compared to malignant lesions (p < 0.001). CSI findings showed strong concordance with biochemical profiles, including normal hormonal evaluation in lipid-rich adrenal adenomas and non-elevated tumor markers in benign hepatic lesions. Integration of CSI with anatomical MRI features improved diagnostic confidence and reduced diagnostic ambiguity. Conclusion: Chemical shift imaging is a reliable, non-invasive MRI technique for detecting microscopic fat in adrenal and hepatic lesions. When combined with detailed anatomical assessment and biochemical correlation, CSI significantly enhances lesion characterization, helps differentiate benign from malignant pathology, and reduces the need for invasive diagnostic procedures. Its routine incorporation into MRI protocols for indeterminate adrenal

Background: Childhood and adolescent overweight and obesity are increasing in India and contribute substantially to future cardiometabolic risk. Puberty is a critical developmental period during which excess adiposity may influence growth and maturation. This study assessed the prevalence of overweight and obesity among high school children and examined associated lifestyle factors and sexual maturity rating (SMR). Materials and Methods: This one-year community-based observational study included 1,000 school-going children aged 11–16 years from an urban field practice area of South India. Anthropometric measurements, including body mass index (BMI) and waist–hip ratio, were recorded. Sexual maturity was assessed using Tanner staging. Sociodemographic and lifestyle factors were documented, and associations with overweight and obesity were analyzed. Results: Girls comprised 57.4% of participants, with a boy-to-girl ratio of 1:1.34. The mean age was 14.36±1.08 years. The prevalence of obesity and overweight was 4.9% and 4.5%, respectively. Raised waist–hip ratio was observed in 3.4% of children, among whom obesity was significantly more common (p<0.001). Most participants (91.7%) were in SMR stage II. Obesity was significantly associated with reduced physical activity, increased television viewing, higher SMR stage, peer-related factors, and family history of diabetes mellitus and obesity. Conclusion: Overweight and obesity in urban Indian adolescents are closely associated with modifiable lifestyle factors and pubertal maturation. School-based preventive strategies focusing on physical activity and early risk identification during puberty are warranted. Keywords: Adolescents, Body mass index, Childhood obesity, Puberty, Sexual maturity rating.

Background: The aim is to determine the incidence, staging pattern, regression rates, and associated risk factors of retinopathy of prematurity (ROP) among high-risk neonates. Materials and Methods: This prospective study included 223 high-risk neonates (181 preterm and 42 term). Screening was performed at 4–6 weeks using indirect ophthalmoscopy, with ROP classified per ICROP guidelines.[1-3] Demographic variables, birth weight, gestational age, and systemic risk factors were recorded.[4-6] Infants requiring treatment underwent laser photocoagulation or vitreoretinal surgery.[7-9] Data was analyzed using descriptive statistics. Results: ROP was diagnosed in 42 infants (18.83%). Incidence was higher in preterm (22.65%) than term infants (2.38%), aligning with global trends.[10,11] Infants <1 kg and <28 weeks had the highest incidence. Stage II ROP was most common, and spontaneous regression occurred in 76.19% of cases.[3,12] Significant risk factors included low birth weight, prematurity, oxygen exposure, sepsis, anemia, phototherapy, and RDS.[2,4,9] Ten infants required treatment (7 laser, 3 vitreoretinal surgery). Conclusion: Low birth weight and prematurity are the strongest predictors of ROP. Early screening and timely treatment are essential to prevent advanced disease and avoidable blindness.[13,14] Keywords: Retinopathy of prematurity (ROP); prematurity; screening; incidence; risk factors.

Background: The aim is to evaluate graft survival, visual outcomes, and the key prognostic factors influencing graft clarity following penetrating keratoplasty (PK) across common corneal pathologies. Materials and Methods: This prospective study included 30 eyes that underwent PK for indications such as corneal opacity, healed keratitis, dystrophies, keratoconus, and prior graft failure. Donor characteristics (age, endothelial clarity, death-to-enucleation interval), host factors (corneal vascularisation, etiology), graft size, suturing technique, and postoperative complications were recorded. Graft clarity and visual acuity outcomes were assessed at 1, 3, and 6 months postoperatively. Results: At 6 months, 50% of grafts were clear, 30% were hazy, and 20% were opaque. Donor age between 11–20 years yielded the best results, with all grafts remaining clear. Shorter death-to-enucleation intervals and graft sizes between 7–7.5 mm were associated with superior clarity. Postoperative complications included suture-related issues (45%), epithelial defects (40%), graft vascularisation (37%), and secondary glaucoma (17%). Among eyes with clear grafts, 43% achieved an improvement of two or more Snellen lines. Conclusion: Penetrating keratoplasty continues to provide meaningful visual rehabilitation for advanced corneal disease. Donor age, preservation intervals, graft size, and early detection and management of postoperative complications play critical roles in determining graft survival and visual outcomes. Keywords: Graft Survival, Full Thickness Penetrating Keratoplasty.

Background: Neuropsychiatric systemic lupus erythematosus (NPSLE) is a serious, potentially fatal manifestation of SLE and mixed connective tissue disease (MCTD). Coexistent lupus nephritis and multidrug-resistant (MDR) infections further worsen outcomes. Case: We report a 27-year-old woman with known MCTD and biopsy-proven lupus nephritis on immunosuppression, who presented with fever, severe polyarthritis, right upper-limb cellulitis, recurrent generalized tonic–clonic seizures, and altered sensorium. She progressed to status epilepticus requiring mechanical ventilation and continuous benzodiazepine infusion. Investigations showed active lupus (high dsDNA, low complement), lymphocytic CSF with MRI features of cerebellitis, severe hypoalbuminaemia, progressive pancytopenia and rising urea. Endotracheal aspirate culture isolated MDR Acinetobacter sensitive only to tobramycin. Despite broad spectrum antibiotics, antifungals, pulse steroids, mycophenolate, rituximab and organ-supportive care, she developed refractory septic shock and succumbed. Conclusion: This case highlights the complex interplay of severe NPSLE, lupus nephritis flare, profound immunosuppression and MDR gram-negative sepsis leading to rapid multiorgan failure. Early recognition, aggressive infection control and close multidisciplinary coordination are imperative to improve outcomes. Keywords: Neuropsychiatric lupus; Lupus nephritis; Mixed connective tissue disease; Status epilepticus; MDR Acinetobacter; Sepsis.

Background: First aid, including both physical and psychological support, is an essential skill for medical students; however, Indian evidence indicates gaps in preparedness, particularly in life-saving skills and psychological first aid training. This study aimed to assess the knowledge, attitude, and practice (KAP) of undergraduate medical students regarding physical and psychological first aid, estimate the proportion who received formal first aid training, and identify the primary sources of first aid knowledge. Materials and Methods: Cross-sectional study was conducted among second year MBBS students at Government Medical College, Miraj, from August 2025 to October 2025. 191 students participated. Data collected using a structured, pretested, self-administered questionnaire via google forms, analyzed using Microsoft excel and SPSS. Results: The mean age of participants was 20.95 ± 2.30 years. Physical first aid knowledge was predominantly adequate (73.8%), with only 9.9% demonstrating good knowledge. Psychological first aid knowledge was better with 64.4% showing good knowledge. Majority (83.2%) demonstrated good attitude and good practice (60.2%). Formal first aid training was reported by 44.5% of students. Majority (56.5%) reported primary source of information was medical college. No significant association was found between sex and first aid knowledge. Conclusion: Although medical students demonstrated a positive attitude and reasonable knowledge, important gaps persist, particularly in critical physical first aid and practical application. Structured, skill-based, and integrated physical and psychological first aid training should be systematically incorporated into the undergraduate medical curriculum. Keywords: First aid, Psychological first aid, Knowledge attitude practice, Medical students, Emergency preparedness.

Background: The Biomedical waste management rules, 2016(amended 2018) by Government of India mandates the proper segregation, disposal as per color coded method and safe handling practices. Despite these strict regulations there has been an inconsistent compliance to these practices across tertiary care centers contributed by factors like insufficient training, lack of supervision and high work load etc. Aim: To assess the awareness and practice of biomedical waste (BMW) management among healthcare providers at a tertiary care centre. Materials and Methods: A cross-sectional observational study was conducted over six months among 200 healthcare providers, including nurses, interns and postgraduates. Knowledge was assessed using a structured questionnaire containing 12 questions covering essential BMW guidelines, whereas actual practices were evaluated using an observational checklist across various clinical and diagnostic departments. Results: Overall awareness regarding BMW regulations was (95%), and all participants had heard about BMW guidelines. Knowledge regarding colour coding (96%), disposal of sharps l (96%), and risk of transmission of infection from waste was (97%); however, gaps existed in identifying the biohazard symbol (80.5%) and disposal of waste within 48-hour (72%). Interns and postgraduates demonstrated higher knowledge than nurses. Department-wise practice assessment showed substantial variability across all color-coded bins. Blood bank and laboratory departments exhibited consistently high compliance, while high-workload areas such as casualty, medicine, surgery, and pulmonary medicine demonstrated fluctuating adherence. An improvement in compliance was observed following training in July, followed by a gradual decline in subsequent months, indicating reduced retention of training impact. Conclusion: This study highlights that although Health care providers demonstrated a basic level of awareness regarding biomedical waste management guidelines variability in adherence emphasizes on the need for more structured and continuous training approach. Strengthening interdepartmental coordination along with regular capacity building measures is essential to ensure a safe environment for both patients as well as health care workers. Keywords: Biomedical waste, awareness, healthcare providers, infection control practices, compliance.

Background: Tibial plateau fractures are intra-articular injuries in which restoration of joint congruity, alignment and stability is essential to achieve good long-term knee function. Anatomical locking compression plates (LCP) provide fixed-angle stabilisation and may help maintain reduction while permitting early rehabilitation. Objectives: To evaluate the functional outcome of tibial plateau fractures treated surgically with an anatomical locking compression plate using the International Knee Documentation Committee (IKDC) subjective knee score and to document radiological outcomes and complications. Materials and Methods: This prospective observational study included 40 adults (≥18 years) with acute tibial plateau fractures managed operatively using an anatomical LCP (lateral plating alone or dual plating when indicated). Fractures were classified by Schatzker system. Patients were followed at 6 weeks, 3 months, 6 months and 12 months. Primary outcome was IKDC subjective score recorded at each follow-up and categorised at final review (Excellent ≥80, Good 70–79, Fair 60–69, Poor <60). Secondary outcomes included time to radiological union, maintenance of reduction (articular step-off >2 mm, malalignment >5°) and complications. Results: The mean age was 39.6 ± 12.8 years and 70% were male. Road traffic accident was the commonest mechanism (65%). Schatzker II was the most frequent pattern (25%); Schatzker V–VI comprised 37.5%. Median time to surgery was 4 (IQR 2–6) days; 75% underwent single lateral plating and 25% dual plating. Mean IKDC improved from 44.8 ± 9.5 at 6 weeks to 81.2 ± 9.7 at 12 months. At final follow-up, 80% achieved good–excellent outcome (Excellent 45%, Good 35%). Mean time to union was 15.0 ± 3.0 weeks; delayed union occurred in 5%. Articular step-off >2 mm was seen in 7.5% and malalignment >5° in 5%. Superficial infection occurred in 7.5%, deep infection in 2.5%, knee stiffness in 10%, implant failure/loss of reduction in 2.5% and reoperation in 2.5%. Conclusion: Anatomical LCP fixation for operatively indicated tibial plateau fractures resulted in predominantly good-to-excellent knee function at 12 months, with timely union, acceptable maintenance of reduction and a low rate of major complications. Keywords: Tibial plateau fracture; Locking compression plate; IKDC; Functional outcome; ORIF; Complications.

Background: Postpartum hemorrhage (PPH) is a major contributor to maternal morbidity and mortality worldwide, with uterine atony being the most common cause. Oxytocin is routinely used for prophylaxis; however, its short half-life and need for continuous infusion may limit effectiveness. Carbetocin, a long-acting oxytocin analogue, provides sustained uterine contraction after a single dose and may offer advantages in PPH prevention. The study aimed to compare the efficacy and safety of intravenous carbetocin with intravenous oxytocin in the prevention of postpartum hemorrhage following delivery. Materials and Methods: A prospective comparative study was conducted at Government Medical College, Mancherial, from January 2024 to June 2025. One hundred women with singleton term pregnancies were enrolled and allocated into two groups: Group A received 100 µg intravenous carbetocin (n=50) and Group B received 10 IU intravenous oxytocin (n=50) after delivery. Hemodynamic parameters and hemoglobin levels were assessed pre- and post-operatively. Postpartum blood loss, need for blood transfusion, additional uterotonics, uterine tone at 5 minutes, and adverse effects were recorded. Results: Baseline demographic and obstetric characteristics were comparable between groups. The incidence of blood loss ≥1000 ml was significantly lower in the carbetocin group (8.0%) compared with the oxytocin group (18.0%). The requirement for blood transfusion and additional uterotonics was also significantly reduced with carbetocin. Uterine tone at 5 minutes was significantly better in the carbetocin group. Hemodynamic parameters and hemoglobin levels did not differ significantly between groups. Adverse effects were infrequent and comparable in both groups. Conclusion: Carbetocin was more effective than oxytocin in reducing postpartum blood loss and the need for additional interventions, while maintaining a similar safety profile. Keywords: Postpartum hemorrhage; Carbetocin; Oxytocin; Uterine atony; Maternal outcomes.

Background: Knee osteoarthritis (KOA) is a whole-joint disorder with a variable low-grade inflammatory component. Routine complete blood count (CBC) derived hematological biomarkers such as NLR, PLR and composite indices may provide low-cost inflammatory profiling in basic hospital settings. The objective is to compare CBC parameters and derived hematological biomarkers between KOA cases and healthy controls and to assess correlation of these markers with KOA severity using Kellgren–Lawrence (KL) grading. Materials and Methods: This hospital-based case–control study included 90 KOA cases (KL Grade I–III) and 90 controls. CBC parameters were recorded and ratios/indices were calculated: NLR, PLR, MLR, LMR, NMR, PLT/N, systemic immune-inflammation index (SII), systemic inflammation response index (SIRI) and aggregate index of systemic inflammation (AISI). Group comparisons were performed using appropriate parametric or non-parametric tests. Correlation of biomarkers with KL grade among cases was assessed using Spearman rho. Results: Mean age was comparable between groups (cases 57.1 ± 9.4 years, controls 55.6 ± 8.6 years). KL Grade II was most frequent (57.8%). Compared with controls, KOA cases showed lower lymphocyte count and higher neutrophils and monocytes, with mildly lower platelets and lower hemoglobin/RBC. NLR and PLR were higher in KOA cases. Among derived indices, SII was higher and PLT/N was lower in KOA cases. In correlation analysis, KL grade showed significant negative correlation with lymphocytes (rho −0.569, p<0.001), platelets (rho −0.361, p<0.001), RBC (rho −0.283, p=0.007) and PLT/N (rho −0.351, p<0.001) and positive correlation with ESR (rho 0.286, p=0.006), NLR (rho 0.494, p<0.001), PLR (rho 0.297, p=0.004), MLR (rho 0.240, p=0.023), SII (rho 0.319, p=0.002) and SIRI (rho 0.308, p=0.003). Age, total WBC, CRP, NMR and AISI did not show significant correlation with KL grade. Conclusion: KOA is associated with altered CBC-derived hematological biomarkers and NLR with SII demonstrated clinically useful associations with radiographic severity. These low-cost markers may serve as practical adjuncts to KL grading in routine care, though further multicentre validation is recommended. Keywords: Knee osteoarthritis; Complete blood count; Neutrophil–lymphocyte ratio; Platelet–lymphocyte ratio; Systemic immune-inflammation index; Kellgren–Lawrence grading.

Background: Chronic liver disease (CLD) is a progressive disease marked by compromised liver function and structural deterioration. Vitamin D insufficiency is commonly noted in CLD patients due to compromised hydroxylation in the liver, malabsorption, and diminished sunshine exposure. Reduced serum 25-hydroxyvitamin D [25(OH)D] concentrations have been linked to increased disease severity, comorbidities, and unfavorable clinical outcomes in these patients. Aim: This study aimed to estimate serum 25(OH)D levels in patients with chronic liver disease and evaluate their correlation with clinical outcomes. Materials and Methods: This prospective observational study was carried out over seven months in the Department of General Medicine at Government Sivagangai Medical College. A total of 55 individuals diagnosed with CLD, according to clinical, biochemical, and imaging criteria, were included. Serum 25(OH)D concentrations were quantified utilizing standard chemiluminescent immunoassay methodologies. Patients were categorized based on vitamin D status (adequate, insufficient, and deficient), and their clinical outcomes—including liver disease severity, complication development, and hospitalization duration—were documented and studied. Statistical associations between serum vitamin D concentrations and clinical indicators were conducted. Results: Of the 55 patients, the majority had low or insufficient serum levels of 25(OH)D. A notable negative connection was identified between serum vitamin D concentrations and illness severity, evaluated using the Child-Pugh score (p < 0.05). Patients with diminished vitamin D levels demonstrated increased incidences of sequelae including ascites, hepatic encephalopathy, and spontaneous bacterial peritonitis. Moreover, diminished 25(OH)D levels correlated with extended hospitalizations and inferior overall outcomes. Conclusion: Vitamin D insufficiency is common in CLD and is associated with heightened disease severity and negative clinical outcomes. Routine evaluation of serum 25(OH)D concentrations may function as an effective prognostic indicator in individuals with CLD and assist in directing supplementation approaches to potentially enhance outcomes. Keywords: Child-Pugh score, Chronic liver disease, complications, 25-hydroxyvitamin D, Vitamin D deficiency.

Background: Type 2 Diabetes Mellitus (T2DM) is a significant metabolic illness closely linked to accelerated atherosclerosis and heightened risk of coronary artery disease (CAD). Traditional lipid metrics, including total cholesterol, low-density lipoprotein cholesterol (LDL-C), and triglycerides, typically fail to fully elucidate the risk profile in diabetic individuals, who commonly exhibit unusual lipid irregularities. The Lipid Tetrad Index (LTI) has been suggested as a more comprehensive indicator of atherogenic load. Aim: This study was conducted to evaluate the role of LTI as a marker for CAD in patients with Type 2 Diabetes Mellitus attending a tertiary care hospital. Materials and Methods: This observational cross-sectional study was performed in the Department of General Medicine in the outpatient clinic of a tertiary care hospital. One hundred forty individuals with T2DM were enrolled throughout an eight-month period. Clinical history, demographic information, and risk factor profiles were documented. Patients were categorized into two groups: Group A (T2DM patients with angiographically or clinically confirmed CAD) and Group B (T2DM patients without CAD). Fasting blood specimens were collected to assess total cholesterol, triglycerides, HDL-C, and lipoprotein(a). The LTI was computed utilizing the conventional formula. Statistical analysis was conducted utilizing suitable methods, with p < 0.05 being significant. Results: Among 140 individuals, 72 (51.4%) were male and 68 (48.6%) were female, with a mean age of 56.7 ± 8.9 years. Group A consisted of 70 patients with CAD, while Group B contained 70 patients without CAD. Mean LTI values were markedly elevated in Group A relative to Group B (p < 0.001). A positive association was noted between LTI and the number of coronary vessels affected, indicating that LTI increases with the severity of CAD. Lipid parameters (LDL-C, triglycerides) exhibited a diminished association with CAD in comparison to LTI. The receiver operating characteristic (ROC) curve study indicated that LTI exhibited enhanced sensitivity and specificity in predicting CAD in individuals with T2DM compared to individual lipid markers. Conclusion: The LTI serves as a valuable and dependable indicator for evaluating the risk of CAD in individuals with T2DM. It has superior predictive value compared to traditional lipid markers and exhibits a significant association with the severity of CAD. Keywords: Atherosclerosis, Cardiovascular Risk, Coronary Artery Disease, Dyslipidemia, Lipid Tetrad Index.

Background: Neurovascular conflict (NVC) is an important cause of cranial neuralgias. High-resolution MRI plays a critical role in identifying nerve–vessel relationships and guiding management. The objective is to evaluate the role of 3D FIESTA-C MRI in detecting, grading, and characterising neurovascular conflicts involving cranial nerves and to correlate imaging findings with clinical presentation and management. Materials and Methods: This prospective observational study included 50 patients with clinically suspected neurovascular conflict. All patients underwent MRI on a 1.5T scanner using conventional sequences along with 3D FIESTA-C. The involved cranial nerve, offending vessel, site and grade of conflict, trigeminal-pontine angle, and signal intensity changes in nerves were assessed. Imaging findings were correlated with clinical features and treatment outcomes. Results: Neurovascular conflict was identified in all cases on 3D FIESTA-C images. The mean age was 52 years, with maximum cases in the 51–60-year age group, and a slight female predominance. Trigeminal nerve was the most commonly involved nerve, with the superior cerebellar artery (SCA) being the most frequent offending vessel. In over 80% of trigeminal NVC cases, vascular contact was located near the trigger zone. The mean trigeminal-pontine angle was 39.2° on the affected side and 42.4° on the unaffected side. Grade I NVC was most common and managed conservatively. Eight patients with high-grade compression and refractory symptoms underwent microvascular decompression, with good correlation between imaging and surgical findings in most cases. Conclusion: 3D FIESTA-C MRI is a highly sensitive and reliable sequence for diagnosing neurovascular conflict, accurately depicting nerve–vessel relationships, grading severity, and assisting in therapeutic decision-making. Keywords: Neurovascular conflict; Trigeminal neuralgia; Cranial nerve compression; 3D FIESTA-C; Magnetic resonance imaging; Microvascular decompression; Cerebellopontine angle; Superior cerebellar artery

Background: Acute abdomen is a common surgical emergency with overlapping clinical presentations, making accurate diagnosis challenging. Imaging plays a pivotal role in identifying the underlying cause and guiding timely management. Objectives: To evaluate and compare the diagnostic performance of X-ray, ultrasound (USG), computed tomography (CT), and magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) in patients presenting with non-traumatic acute abdominal conditions. Materials and Methods: This prospective observational study was conducted in the Department of Radiodiagnosis at a tertiary care center from May 2022 to May 2024. A total of 100 consecutive patients with suspected non-traumatic acute abdomen were evaluated using plain radiography, ultrasound, CT, and MRI/MRCP as indicated. Imaging findings were correlated with clinical, laboratory, and surgical outcomes where applicable. Diagnostic accuracy parameters were calculated for common conditions. Results: The most frequent diagnoses were ureteric colic (21%), acute appendicitis (18%), intestinal obstruction (10%), and pancreatitis (10%). Ultrasound demonstrated good diagnostic accuracy in acute appendicitis with a sensitivity of 82.35% and specificity of 98.80%, though CT showed 100% sensitivity. In renal/ureteric colic, CT KUB accurately detected all cases, outperforming X-ray and ultrasound. For small bowel obstruction, CT identified both the level and cause in all patients, whereas ultrasound was superior to plain radiography. In acute pancreatitis, CT was essential for evaluating severity and complications, while MRCP showed 100% accuracy in detecting choledocholithiasis. Conclusion: CT is the most accurate and comprehensive imaging modality for evaluating non-traumatic acute abdomen, particularly in diagnostically equivocal or life-threatening conditions. Ultrasound remains a valuable first-line tool, while MRCP is the modality of choice for biliary pathology. Appropriate imaging selection significantly improves diagnostic confidence and patient management. Keywords: Acute abdomen; Diagnostic imaging; Ultrasound; Computed tomography; Magnetic resonance imaging; MRCP; Acute appendicitis; Renal colic; Intestinal obstruction; Pancreatitis; Choledocholithiasis; Non-traumatic abdominal pain; Emergency radiology.

Background: Accurate non-invasive characterization of adrenal and hepatic lesions remains a diagnostic challenge, particularly when lesions appear indeterminate on conventional ultrasonography and computed tomography. Differentiation between benign and malignant lesions is crucial, as it directly influences clinical management and the need for invasive procedures. Chemical shift imaging (CSI) is an established magnetic resonance imaging technique that exploits the precessional frequency difference between fat and water protons, enabling detection of microscopic intracellular fat that may not be appreciable on routine imaging sequences. Objectives: To evaluate the diagnostic utility of chemical shift MRI in identifying microscopic fat within adrenal and hepatic lesions, and to assess the correlation of CSI findings with lesion morphology, anatomical characteristics, contrast enhancement patterns, and relevant biochemical parameters. Materials and Methods: This prospective cross-sectional study was conducted over an 18-month period at a tertiary care referral center. A total of 96 patients with indeterminate adrenal (n = 44) or hepatic (n = 52) lesions detected on prior ultrasonography or CT were included. All patients underwent MRI with in-phase and opposed-phase gradient-echo sequences. Quantitative assessment was performed using signal intensity index and percentage signal loss calculations. Imaging findings were systematically correlated with lesion size, margins, internal architecture, and enhancement characteristics. Biochemical correlation included hormonal assays for adrenal lesions and liver function tests with relevant serum tumor markers for hepatic lesions. Final diagnosis was established based on histopathology where available, or by clinicoradiological follow-up. Results: Significant signal loss on opposed-phase imaging, indicative of microscopic fat, was observed in the majority of benign lesions. Among adrenal lesions, 30 of 34 adenomas (88.2%) demonstrated marked signal drop on opposed-phase sequences, whereas malignant adrenal lesions showed minimal or no signal loss. Similarly, 28 of 31 benign hepatic lesions, including hepatic adenomas and focal fatty lesions (90.3%), exhibited significant signal loss, in contrast to malignant hepatic lesions. The mean percentage signal intensity loss was significantly higher in benign fat-containing lesions compared to malignant lesions (p < 0.001). CSI findings showed strong concordance with biochemical profiles, including normal hormonal evaluation in lipid-rich adrenal adenomas and non-elevated tumor markers in benign hepatic lesions. Integration of CSI with anatomical MRI features improved diagnostic confidence and reduced diagnostic ambiguity. Conclusion: Chemical shift imaging is a reliable, non-invasive MRI technique for detecting microscopic fat in adrenal and hepatic lesions. When combined with detailed anatomical assessment and biochemical correlation, CSI significantly enhances lesion characterization, helps differentiate benign from malignant pathology, and reduces the need for invasive diagnostic procedures. Its routine incorporation into MRI protocols for indeterminate adrenal

Background: The family adoption program in MBBS is an innovative initiative introduced in medical education in India. With its emphasis on patient-centred care and holistic understanding, this program seeks to bridge the gap between theoretical knowledge and practical application. In this program, medical students are assigned to adopt a patient’s family, immersing themselves in the patient’s social and cultural context. By forming a bond with the adopted family, students gain valuable insights into the psychosocial aspects of patient care, communication skills, and empathy development. This program aims to equip future doctors with a deeper understanding of the patient experience and enhance their ability to deliver compassionate and effective healthcare. Objectives: To assess the current knowledge, attitude and practices of Family adoption programme in CBME Curriculum among medical undergraduates in the Department of Community Medicine. Materials and Methods: The target population consists of medical undergraduates from a medical college in Western Maharashtra. A purposive sampling technique was used to select participants who were currently enrolled in the 1st year of MBBS Batch of 2022. Sample size- 122 returned questionnaires in a batch of 150 students. A pre-structured questionnaire was used to collect data on participants’ perceptions of family adoption programs using Google forms. Qualitative analysis using Thematic analysis was used to summarize the qualitative data obtained from open & closed-ended questions. Use of tables & charts is done to represent the relevant data. Results: Of the 150 students, 122 responses were completely obtained. The ratio of Female: Male participants was almost similar. Most students had various complaints with the programme design which is explained in open-ended questions in the questionnaire. Conclusion: The Family Adoption Programme has shown promise as an effective tool to enhance community-based medical education, bridging the gap between theoretical learning and practical exposure to rural health. The thematic analysis of this study highlights its positive impact on students' communication skills, empathy, and understanding of the socio-cultural determinants of health. However, challenges such as inadequate resources, faculty shortages, and logistical barriers continue to hinder its uniform implementation. Addressing these challenges through strategic planning, improved infrastructure, and faculty support is essential to sustain and scale the FAP. With collaborative efforts and continued evaluation, the FAP can become an integral component of competency-based medical education in India, contributing to the training of socially accountable and community-oriented medical professionals. Keywords: Family adoption programme, MBBS Students, CBME, undergraduate medical education, community medicine.

Background: Bloodstream infections (BSIs) are a major cause of morbidity and mortality in patients with haematological malignancies, particularly those with neutropenia. Early diagnosis remains challenging due to nonspecific clinical features and delayed blood culture results. Procalcitonin (PCT) has emerged as a promising biomarker for early detection of bacterial infections. Materials and Methods: A prospective study was conducted from November 2014 to August 2015 at Government Rajaji Hospital, Madurai. A total of 106 patients with haematological malignancies and clinical suspicion of bloodstream infection were included. Blood cultures were performed using standard microbiological techniques. Antimicrobial susceptibility testing was done as per CLSI 2014 guidelines. Serum procalcitonin levels were measured using a semi-quantitative immunochromatographic assay. Results: Out of 106 patients, 27 (25.47%) had culture-positive bloodstream infections. Gram-negative organisms (55.55%) predominated over Gram-positive organisms (44.44%). Klebsiella pneumoniae was the most common isolate (25.9%). ESBL production was observed in 7.4% of E. coli and 14.81% of Klebsiella species. Procalcitonin demonstrated a sensitivity of 85.1%, specificity of 97.5%, positive predictive value of 92%, and negative predictive value of 95% for diagnosing bloodstream infections. Conclusion: Bloodstream infections remain common in patients with haematological malignancies, with Gram-negative organisms predominating. Procalcitonin is a valuable adjunctive biomarker for early diagnosis and may help guide timely initiation of antimicrobial therapy. Keywords: Bloodstream infection, Haematological malignancy, Procalcitonin, Bacteremia, Neutropenia.

Background: Thrombocytopaenia is a common hematological abnormality in pregnancy, with outcomes varying widely depending on etiology and severity. While gestational thrombocytopaenia is generally benign, pathological forms such as immune thrombocytopaenic purpura (ITP) and hypertensive disorder–related thrombocytopaenia are associated with adverse maternal and neonatal outcomes. This study aimed to evaluate the clinical profile and pregnancy outcomes among women presenting with thrombocytopaenia at a tertiary care center. Materials and Methods: This hospital-based prospective observational study included 69 pregnant women with platelet counts <150 ×10⁹/L. Etiology was classified as gestational thrombocytopaenia, ITP, or hypertensive disorder–related thrombocytopaenia in Faridabad. Severity was categorized as mild (100–150 ×10⁹/L), moderate (50–99 ×10⁹/L), or severe (<50 ×10⁹/L). Maternal outcomes (mode of delivery, postpartum hemorrhage, transfusion, ICU admission) and neonatal outcomes (preterm birth, low birth weight, NICU admission, neonatal thrombocytopaenia) were recorded. Data were analyzed using SPSS 20.0, with chi-square and ANOVA tests applied; p<0.05 was considered statistically significant. Results: Gestational thrombocytopaenia accounted for 69.6% of cases, followed by hypertensive disorders (20.3%) and ITP (10.1%). Mild thrombocytopaenia was most common (66.7%). Hypertensive disorder–related thrombocytopaenia was associated with significantly higher cesarean delivery (71.4%, p=0.030) and postpartum hemorrhage rates (35.7%, p=0.016). ITP demonstrated the highest transfusion requirement (71.4%, p<0.001). Increasing severity correlated with rising rates of postpartum hemorrhage (6.5% mild vs. 37.5% severe; p=0.020), transfusion (4.3% mild vs. 62.5% severe; p<0.001), and ICU admission (2.2% mild vs. 37.5% severe; p=0.004). Neonatal thrombocytopaenia occurred in 14.5% overall, significantly higher in infants of mothers with ITP (57.1%, p<0.001). Preterm birth and low birth weight were more frequent in ITP and hypertensive groups (p=0.020 and p=0.003, respectively). No maternal deaths were recorded. Conclusion: Maternal and neonatal outcomes in thrombocytopaenia vary significantly by etiology and severity. Gestational thrombocytopaenia remains benign, whereas hypertensive disorder–related thrombocytopaenia and ITP are associated with higher morbidity. Early identification, close monitoring, and multidisciplinary management are essential to improving outcomes in pregnancies complicated by pathological thrombocytopaenia. Keywords: Pregnancy; Immune thrombocytopaenic purpura; Preeclampsia; Gestational thrombocytopaenia; HELLP syndrome; Neonatal thrombocytopaenia.

Background: Obstructive Sleep Apnoea Syndrome (OSAS) is increasingly recognized as a multisystem disorder characterized by recurrent upper airway obstruction during sleep, resulting in intermittent hypoxia, oxidative stress, and systemic inflammation. These pathophysiological mechanisms contribute to elevated cardiovascular and metabolic risk. Identifying reliable circulating biomarkers could aid in assessing disease severity and associated systemic effects, particularly in resource-limited settings. This study aimed to evaluate the utility of selected serum markers—representing inflammation, oxidative stress, and adipokine imbalance—in patients with OSAS compared with healthy controls. Materials and Methods: A hospital-based case–control study was conducted at a tertiary care center in North India among 167 participants, including 84 newly diagnosed OSAS patients and 83 age- and sex-matched controls. All participants underwent overnight polysomnography to confirm diagnosis and determine the Apnoea–Hypopnoea Index (AHI). Fasting venous blood samples were analyzed for serum C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), malondialdehyde (MDA), leptin, and adiponectin using standardized immunoassay techniques. Between-group comparisons were performed using t-tests or Mann–Whitney U tests, analysis of variance (ANOVA) assessed severity-based differences, and Spearman’s correlation evaluated associations with AHI. Results: Mean serum levels of CRP (4.9 ± 1.7 vs. 2.3 ± 1.0 mg/L), IL-6 (6.8 ± 2.3 vs. 3.2 ± 1.1 pg/mL), TNF-α (10.4 ± 3.1 vs. 6.1 ± 2.0 pg/mL), MDA (4.1 ± 1.2 vs. 2.8 ± 0.9 nmol/mL), and leptin (14.2 ± 4.6 vs. 9.4 ± 3.2 ng/mL) were significantly higher in OSAS cases than in controls (all p < 0.001), while adiponectin was significantly lower (6.1 ± 2.3 vs. 8.9 ± 2.8 µg/mL; p < 0.001). Biomarker levels increased progressively with disease severity (ANOVA p < 0.001). Significant correlations were observed between AHI and CRP (ρ = 0.58), IL-6 (ρ = 0.61), TNF-α (ρ = 0.54), MDA (ρ = 0.49), leptin (ρ = 0.56), and adiponectin (ρ = –0.42) (all p < 0.001). Conclusion: Patients with OSAS exhibit a distinct biochemical profile characterized by systemic inflammation, oxidative stress, and altered adipokine regulation, which worsen with increasing disease severity. These serum markers may serve as useful adjuncts for disease assessment and cardiovascular risk stratification, especially where polysomnography resources are limited. Keywords: Obstructive Sleep Apnoea Syndrome; Serum biomarkers; Inflammation; Oxidative stress; Adiponectin.

Background: Seizures are among the most frequent neurological emergencies in children and represent a heterogeneous group of disorders with diverse clinical presentations and etiologies. Understanding the seizure spectrum and underlying causes is essential for rational diagnostic evaluation and targeted management in pediatric practice. The objective is to study the spectrum of seizures in children aged 1–18 years and to determine the etiological and diagnostic profile of pediatric seizures presenting to a tertiary care hospital. Materials and Methods: This cross-sectional study included 210 children aged 1–18 years presenting with seizures over a one-year period. Detailed clinical evaluation was performed, followed by appropriate laboratory investigations, electroencephalography (EEG), and neuroimaging (CT/MRI brain) as indicated. Data were analyzed using SPSS version 23.0, and p-values <0.05 were considered statistically significant. Results: Generalized seizures predominated (54.76%, p=0.012), followed by focal seizures (30.95%). Infectious and idiopathic/unknown etiologies were most common (26.67% each, p=0.018), while structural causes constituted 22.86%. Metabolic etiologies accounted for 13.33%, with hypoglycemia being most frequent (4.76%, p=0.026). Among lumbar punctures, 42.3% had abnormal CSF findings. EEG abnormalities were noted in 54.3% (p=0.015) and neuroimaging abnormalities in 47.1% (p=0.017), highest in structural etiologies (89.58%). Conclusion: Pediatric seizures exhibit a broad clinico-etiological spectrum, with generalized seizures and infectious or idiopathic causes predominating. EEG serves as a key diagnostic tool, while neuroimaging should be selectively employed based on etiology, emphasizing an etiology-driven diagnostic approach. Keywords: Pediatric seizures, generalized seizures, seizure etiology, electroencephalography, neuroimaging.

Background: Intracranial tuberculosis (TB) is a severe form of extrapulmonary tuberculosis associated with high morbidity and mortality. Early diagnosis remains challenging due to nonspecific clinical features and limited sensitivity of microbiological tests. Magnetic resonance imaging (MRI) plays a pivotal role in detecting and characterizing intracranial TB lesions. The objective is to evaluate the role of MRI in intracranial tuberculosis, analyze various imaging presentations, classify tuberculomas based on morphology, and correlate MRI findings with cerebrospinal fluid (CSF) parameters. Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis, Rohilkhand Medical College & Hospital, Bareilly, over one year. A total of 144 patients with clinical suspicion of intracranial tuberculosis underwent MRI using a 1.5 Tesla scanner. Imaging findings were analyzed and correlated with CSF parameters including lymphocytic pleocytosis, protein, glucose, ADA, and PCR for Mycobacterium tuberculosis. Statistical analysis was performed using SPSS version 23.0. Results: The majority of patients were aged 11–30 years. Fever (69.4%) and headache (50.7%) were the most common clinical symptoms. MRI revealed iso- to hypointense lesions on T1-weighted images in 55.2% and hyperintense lesions on T2-weighted images in 63% of cases. Diffusion restriction was present in 87% of patients, ring enhancement in 53.2%, and meningeal enhancement in 48.7%. CSF analysis showed lymphocytic pleocytosis in 61% and elevated protein, low glucose, positive PCR, or raised ADA in 60.4%. Meningeal enhancement demonstrated significant association with lymphocytic pleocytosis (p = 0.02), elevated CSF protein (p = 0.001), positive PCR for MTB (p = 0.01), and raised ADA (p = 0.01). Conclusion: MRI is an indispensable diagnostic modality for intracranial tuberculosis, capable of detecting diverse parenchymal and meningeal manifestations. Meningeal enhancement on MRI shows strong correlation with CSF inflammatory markers and serves as a reliable indicator of disease severity. MRI should be routinely employed in all suspected cases of CNS tuberculosis. Keywords: Intracranial tuberculosis, MRI, tuberculoma, tuberculous meningitis, diffusion restriction, CSF correlation.

Background: Fear of falling (FoF) is a pervasive concern among older adults that can precipitate functional decline, social isolation, and reduced quality of life. Functional ability—measured by Instrumental Activities of Daily Living (IADL)—is both a marker of independence and a potential predictor of fear of falling. This study aimed to assess the prevalence of fear of falling and to examine the association and correlation between functional decline (IADL) and fear of falling among community-dwelling elderly in Amritsar. Materials and Methods: A community-based, descriptive cross-sectional study was conducted from August 2023 to July 2024 among 360 participants aged ≥65 years, recruited equally from rural Majitha Block and urban slums of Amritsar, using stratified random sampling. Data were collected via face-to-face interviews using a pre-tested semi-structured questionnaire. Fear of falling was assessed using the 16-item Falls Efficacy Scale-International (FES-I; score range 16–64). Functional status was measured by the IADL scale (score range 0–8). Spearman’s rank correlation and chi-square tests evaluated relationships and associations. p<0.05 was considered to be statistically significant. Results: Overall, 81% reported some concern about falling (mild: 43%, moderate: 28%, high: 10%). Only 11% were fully independent by IADL, while 33% were highly dependent. A strong inverse correlation was found between FES-I and IADL scores (rs = –0.98, p<0.001). Chi-square showed a significant association between fear of fall categories and IADL levels (χ²=178.25; p<0.001). Conclusions: Functional decline is a potent determinant of fear of falling. Early identification of functional impairments and targeted interventions—such as balance training and home hazard modification—are essential to mitigate fear of falling among the elderly. Keywords: fear of falling, functional decline, FES‑I, IADL, elderly, India.

Background: Hypertension represents a major public health burden globally and in India, with significant disparities in control and awareness, particularly in low- and middle-income countries. Community-based profiling of hypertensive patients is essential for tailoring management strategies and optimizing resource utilization in primary healthcare settings. Objective: To describe the socio-demographic, behavioral, and clinical profile of adult hypertensive patients in an urban field practice area of a government medical college in Thiruvananthapuram, Kerala. Materials and Methods: A community-based cross-sectional study was conducted among 360 hypertensive adults aged ≥18 years with diagnosed hypertension for ≥1 year, residing in the Pangappara Medical College Health Unit area, Thiruvananthapuram. Participants were selected using cluster sampling from ten sub-centre areas. Data on socio-demographic characteristics, health behaviors, and clinical parameters were collected through structured interviews. Blood pressure was measured using a standardized Omron digital sphygmomanometer. Descriptive statistics and chi-square tests were used for analysis. Results: The mean age was 60.3±10.95 years; 55.6% were female. Education was primary or below in 46.7%, and 61.7% belonged to above-poverty-line households. Physically sedentary behavior was reported by 31.9%, while 79.2% were non-smokers and 73.3% were non-alcohol users. Clinically, 42.2% were obese and 24.7% overweight. The average disease duration was 5.9±5.3 years; 51.9% had hypertension for 5–10 years. Comorbidities were prevalent: diabetes mellitus in 48.6%, dyslipidemia in 34.7%, and thyroid disorders in 10.3%. Most participants (87.2%) were on antihypertensive medications; 59.2% practiced salt restriction and 51.1% reduced oil intake. Public healthcare services were utilized by 62.8%. Conclusions: The study population consisted predominantly of older females with high prevalence of overweight/obesity and metabolic comorbidities. Despite favorable non-communicable disease behaviors in certain domains (low smoking/alcohol use), the population carries substantial cardiovascular risk. High utilization of public health services presents an opportunity for integrating structured lifestyle counseling, regular metabolic screening, and digital health interventions through existing primary healthcare networks. Keywords: Hypertension, Clinical profile, Comorbidities, Epidemiology, Community-based study, Public health services.

Background: Effective postoperative pain management is crucial for upper limb surgeries. This study compared buprenorphine and tramadol as adjuvants to bupivacaine in ultrasound-guided axillary brachial plexus block. Materials and Methods: 60 patients were randomized into two groups: Group A (bupivacaine + buprenorphine 150 µg) and Group B (bupivacaine + tramadol 100 mg). Primary outcome was duration of postoperative analgesia. Results: Group A had longer analgesia (21.2 vs 14.1 hours, P < 0.0001), while Group B had faster onset (P < 0.0001). Group A required less rescue analgesic (67.5 vs 132.5 mg, P < 0.001). Adverse effects were manageable. Conclusion: Buprenorphine provided longer and more reliable postoperative analgesia, while tramadol had faster onset but shorter duration. Both are safe and effective adjuvants with bupivacaine. Keywords: Buprenorphine, tramadol, bupivacaine, axillary brachial plexus block, postoperative analgesia, upper limb surgery.

This case report details the unexpected discovery of a plastic cap covering the external cervical os during routine cervical cancer screening (Visual Inspection with Acetic Acid - VIA) of a 60-year-old asymptomatic woman in a community outreach program. The patient reported no history of recent foreign body insertion, or symptoms such as discomfort, discharge, or bleeding, with her last cervical examination dating back decades. The 2 cm plastic cap was removed, and subsequent screening tests (VIA, Pap smear, and HPV DNA) were negative for neoplasia. This rare presentation highlights the critical role of systematic, hands on cervical cancer screening even in the absence of symptoms as a key public health strategy. Undetected vaginal foreign bodies (VFBs) pose a risk for chronic inflammation, fibrosis, and potential malignancy, underscoring the necessity of routine preventive check-ups, particularly for older, asymptomatic women who may not be accessing regular care. Keywords: Asymptomatic Foreign Body; Cervical Cancer Screening; Public Health Outreach; Vaginal Foreign Body (VFB); Preventive Oncology.

Background: Self-medication is becoming a common practice in many developing countries like India mainly due to lack of access to health care, easy availability of OTC (Over The Counter) drugs in market and poor drug regulatory practices. Unaware of the appropriate drugs for the particular illness, their doses and adverse effects, the misuse of medications as prescribed by the pharmacist or a family member or influenced by the social media becomes an important health issue specially as drug resistance. The aim of the study was to determine awareness & practices related self-medication in urban community. The objective is to determine the knowledge & extent of Self Medication & attitude towards OTC drugs. To determine factors related to self-medication & to create awareness about demerits of self-medication. Materials and Methods: An observational, cross sectional community based study was conducted in Kolhapur. 348 participants were selected based on the inclusion and exclusion criteria. Predesigned, pretested, structured questionnaire was used based on survey in urban community of Kolhapur city. Mean, percentage and other statistical analysis was conducted using SPSS version 24.0. Results: Out of total 348 study participants, 285 had practiced self-medication at least once out of which maximum 208 had tried for Respiratory illness. 181 participants selected medications depending on their cost. 90 subjects experienced vomiting as most common side effect. Conclusion: More than two third among study participants had tried self-medication. Awareness regarding self-medication hazards needs to be created & promoted. Keywords: OTC, Self-medication, side effects.

Background: Echocardiography can facilitate early identification of cardiovascular compromise that can facilitate clinical management and improves the short term outcomes in neonates. The aim and objective is to compare the ventricular dimensions and valvular dimensions between preterm and term infants in a tertiary care teaching hospital. Materials and Methods: An Analytical cross-sectional study was conducted in a hospital setting. The data collection was done for 2 month period between January and September2021 from adequate sample of study group including preterm and term infants in a tertiary care teaching hospital. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables. Results: Among the study population, 25 (50%) participants were term neonates and 25 (50%) were preterm neonates .Among the most important echocardiographic parameters ,The mean IVSd was 3.29 ± 0.53 in term neonates and it was 2.55 ± 0.4 in preterm neonates.The mean IVSs was 4 ± 0.76 in term neonates and it was 3.38 ± 0.45 in preterm neonates.The mean LVIDd was 19.35 ± 1.73 in term neonates and it was 13.54 ± 2.67 in preterm neonates.The mean LVIDs was 13.36 ± 3.32 in term neonates and it was 8.87 ± 1.71 in preterm neonates.. There is a significant difference in dimensions between study group. (P value <0.001). Conclusion: This study found Echocardiographic parameters and values significantly less in preterm babies compared to the term babies with no significant difference in the physical parameters between the groups. Keywords: Neonate, echocardiography, cardiac, systole, valve.

Background: Antimicrobial resistance (AMR) is a global threat today and has overshadowed the potential gain in reducing deaths due to infections.[1] Throughout their evolution, bacteria have developed versatile resistance mechanisms to antibiotics.[2] Now it is important to know to the susceptibility pattern of our region to give empiric treatment. Aims & objectives: To identify the antimicrobial susceptibility pattern of bacterial pathogens isolated from various clinical specimens in our centre. Materials and Methods: Various samples requested by clinical departments for culture and sensitivity were processed by conventional method and data recorded on registers and WHOnet. Retrospectively data was collected from January 2024 to December 2024 and analysed. Results: 3,649 bacterial pathogens isolated from 2,183 patients. Blood is 29.4% followed by genital, respiratory, soft tissue, stool, urine and other samples. Aerobic Gram-positive bacteria were 35.3% and aerobic Gram-negative bacteria were 58.6%. Most Gram-positive bacteria are seen to be sensitive for Linezolid and Vancomycin and Gram-negative bacteria for Polymyxin-B and Colistin. Doxycycline and Gentamicin are also giving good response against both. Conclusion: This study highlights the need of antibiograms in every institute to know the local susceptibility pattern. Also, the requirement of antimicrobial stewardship is necessary to decrease multi drug resistant bugs in hospital environment. It is the duty of every health care worker to input in reducing the resistance of antibiotics in bacteria to reserve the treatment options to future patient care. Keywords: Antimicrobial susceptibility, multi drug resistant, antibiotics, clinical specimens.

Background: Anaemia remains a major public health concern among school-going children in India, with important implications for growth, cognitive development, and future health outcomes. Facility-based evidence on gender-specific patterns in early adolescence is limited. The present study evaluates the burden of anaemia and gender disparities among children aged 10–14 years attending a Community Health Centre in Western India. Materials and Methods: This retrospective record-based observational study included 173 school-going children who attended outpatient services between July and October 2025. Haemoglobin values were extracted from medical records and classified according to World Health Organization criteria. Age-wise haemoglobin levels were analysed using descriptive statistics, and gender differences were assessed using the chi-square test. Results: Females constituted 62.4% of participants and males 37.6%. The overall prevalence of anaemia was 41.0%. Anaemia was more frequent among females (46.3%) than males (32.3%), with a statistically significant association between gender and anaemia status (χ² = 4.12, p = 0.04). Mean haemoglobin levels demonstrated a gradual increase with age, from 11.78 g/dL at 10 years to 12.56 g/dL at 14 years. Conclusion: The findings indicate that anaemia remains highly prevalent in early adolescence, with a disproportionately higher burden among female children. Strengthening routine haemoglobin screening, nutritional counselling, and gender-sensitive iron supplementation strategies at community and school levels is essential to address this persistent public health problem. Keywords: Anaemia; School-going children; Community health centre; Gender disparities; Public health; Retrospective study.

Background: Antimicrobial resistance (AMR) is a major global health threat with devastating outcomes if not acted upon efficiently. Data on AMR in the state of Meghalaya, India, is limited. The objective is to map the antibiotic susceptibility patterns of the commonly isolated pathogenic bacterial isolates from clinical specimens received from several hospitals across four regions of the State. Materials and Methods: Clinical specimens were collected from both outpatients and inpatients from several hospitals in four regions of Meghalaya for Culture and Antibiotic Susceptibility testing (AST). Identification and AST were performed using the Vitek-2 Compact Automated system (Biomerieux), and data were analysed using Microsoft Excel. Results: Out of 3053 isolates, Gram-negative bacilli were more frequently isolated than Gram-positive bacteria. Urine yielded the majority of bacterial isolates. Variable susceptibility pattern is exhibited by various isolates, notably among which is very low susceptibility to Fluoroquinolones among Escherichia coli and Klebsiella species, but high susceptibility among Pseudomonas species and Acinetobacter species. Carbapenems and Aminoglycosides have good susceptibility patterns against most gram-negative isolates. The Methicillin-Resistant Staphylococcus aureus (MRSA) rate is 35.26%, only slightly lower than the National prevalence rate of 37%. Among the Enterococcus species, Enterococcus faecium predominates over other species. Conclusion: Implementation of the Antimicrobial Stewardship Programme across the State, coupled with a robust AMR surveillance system, is imperative to further the prevention and containment of Antimicrobial Resistance. Keywords: Antibiotic, Susceptibility, Meghalaya, AMR.

Background: AI is rapidly changing in clinical practice and medical education worldwide. Healthcare applications include diagnosis, documentation, and decision assistance; education applications include individualized learning, adaptive simulations, and efficient exams. AI literacy, ethics, and professionalism are still missing from medical education in many countries, including India, despite their potential benefits. This study uses a pre-tested questionnaire at a Western Maharashtra tertiary teaching hospital to assess medical faculty and students' self-reported knowledge and barriers to AI adoption. Materials and Methods: A cross-sectional survey involving 261 participants was carried out, including 174 medical students (66.7%) and 87 faculty members (33.3%), using a pre-tested questionnaire. The data collection process encompassed various demographic characteristics, levels of awareness and usage of AI, as well as the barriers faced in its application. Additionally, it gathered participants’ opinions and attitudes concerning the integration of AI into the medical curriculum, particularly emphasizing their assessments of its inclusion. A thorough statistical examination was conducted to evaluate the awareness, utilization, and obstacles related to AI among both students and faculty members. Results: A significant 80% of 261 participants (79.7% men and 20.3% females) used AI tools for academic purposes. Note that 38.3% of these participants considered themselves AI novices. Students use AI technologies 85.6% more than instructors, according to research. ChatGPT is the most popular tool, used by 70.7% of students. AI was most commonly used by students to improve study performance (66.9%) and enable interactive learning (49.1%). In contrast, 35.6% of professors used AI for curriculum development and literature reviews. Lack of expertise (37.5%), ambiguous AI efficacy proof (33.7%), and limited testing time (27.2%) are the main challenges. A large 87.7% of respondents supported incorporating AI into the medical curriculum, suggesting its educational potential. Conclusion: The study emphasizes the need to integrate AI into medical education to prepare doctors for future difficulties. The findings emphasize the need for well-structured AI courses, focused faculty development, interdisciplinary collaboration, and ethical behaviours. These approaches will enable responsible and successful AI technology use, improving education and patient care. Keywords: Artificial Intelligence, Faculty, Curriculum, Awareness, Barriers.

Background: Menstrual cups are a cost-effective, safe, and environmentally sustainable alternative to pads and tampons. Despite their benefits, adolescent usage in India—especially Kerala—remains low due to stigma, cultural myths, and fear. Aim: To evaluate the levels of stigma, fear, and misconceptions associated with menstrual cup usage among late adolescents in Kochi and identify factors influencing willingness to adopt menstrual cups. Materials and Methods: A descriptive quantitative study was conducted among 260 adolescent girls aged 16–19 years selected using simple random sampling. A validated structured questionnaire measured awareness, knowledge, stigma, fear, and willingness to use menstrual cups. Data were analyzed using descriptive statistics, chi-square tests, Pearson correlation, and logistic regression (SPSS v25). Results: Awareness of menstrual cups was high (73.8%), but actual usage remained very low (7.3%). Major fears included insertion (59.2%), discomfort (51.5%), hygiene concerns (44.6%), and leakage (39.6%). Stigma was also notable: 34.2% felt menstrual cups were socially discouraged, and 29.6% reported parental disapproval. Higher knowledge significantly reduced fear (p < 0.01), while stigma did not correlate with knowledge (p = 0.23). Prior menstrual health education significantly increased willingness to try menstrual cups (OR = 3.41; CI: 1.9–6.1; p < 0.001). Conclusion: Fear and myths remain major barriers to menstrual cup acceptance among adolescents in Kochi. School-based menstrual health education, peer-led demonstrations, and parental awareness programs can significantly improve acceptance. Keywords: Menstrual cup, adolescents, stigma, fear, menstrual hygiene, Kerala.

Background: Nail disorders comprise approximately 10% of all dermatologic conditions and have always been a challenge to dermatologists, with the crux being an accurate diagnosis. Because diagnosis is not always possible by clinical means alone, there has always been a quest for efficient and efficacious diagnostic methods. Nail dermoscopy (onychoscopy) has emerged as a valuable diagnostic tool in recent times for evaluating diseases in the nail apparatus and has shown promising results in diagnosing various nail disorders. It also avoids time-consuming investigations such as culture and biopsy. The aim is to determine the clinical and onychoscopic patterns in various nail disorders in patients attending the skin OPD. Materials and Methods: 120 patients with clinically evident nail diseases were recruited for the cross-sectional descriptive study. After clinical examination, all nails were subjected to dermoscopic examination. Each patient was examined for different types of nail pathologies, onychoscopic features, nail unit affected, and age and gender were noted. The student t-test and Pearson's correlation test were applied with a significance threshold of p<0.05. Results: Onychomycosis (n = 47) was the commonest nail disorder. The majority of patients were diagnosed with distal and lateral subungual onychomycosis i.e., 35 (29.2%), followed by 17.5% (21) for psoriasis vulgaris. Also, 10% (12) was for acute paronychia, 5% (6) was for melanonychia, SWO, scleroderma, and TDO, 4.2% (5) was for alopecia areata and congenital pterygium. The lower proportion of 3.3% (4) was for Darier disease, green nail syndrome, and onychomadesis and the least 2.5% (3) for 20 Nail dystrophy and Erythroderma, Adverse drug reactions respectively. Conclusion: Dermoscopy is an easy, inexpensive, rapid, simple, and efficient diagnostic method that permits visualization of morphologic features that are not visible to the naked eye, allows accurate diagnosis of the common nail, and hence could serve as an important diagnostic tool. Keywords: nail disorders, dermoscopy, onychoscopy, inflammatory nail disorders.

Background: Mesalamine is a first-line agent used for treatment of ulcerative colitis. This study aims to evaluate mesalamine concentrations in different parts of the gastrointestinal tract, especially the colon, from four brands including test products. For this purpose, physiologically based pharmacokinetic modelling (PBPK) was used for determination of mesalamine concentration in GIT and colon. Materials and Methods: Four commercially available mesalamine (1g and 2 g) sachets (Brand P, Vegaz OD, Brand M, and Brand R) were modelled. A physiologically based biopharmaceutics model (PBBM) was applied for determination of mesalamine concentration, total dose of mesalamine in colon from different sachet (1/2g) formulations. The dissolution conditions used were 0.1 N HCl for 2 hours, pH 6.4 phosphate buffer for 1 hour, and pH 7.2 phosphate buffer for 24 hours. The model was validated with in vivo plasma concentration time profiles in fasting condition, obtained from in-house bioequivalence study (2x500mg) for reference product Brand P capsule. Further, the validated PBBM was used to compare various brands of mesalamine to predict local concentrations in various parts of gastrointestinal tract. Mesalamine concentration (i.e. Cmax, concentrations), in vivo release in various parts of intestine together with colon concentration and T/R ratios in colon for various formulations in fasting and fed conditions were simulated. Results: Similar luminal and enterocytic concentrations of mesalamine between Vegaz OD and Brand P in the colon were achieved with both 1g and 2g Vegaz OD sachets in a fasting state whereas for other brands, lower concentrations were observed. In fed state, concentrations in colon for Vegaz OD were equivalent or higher than Brand P and other two brands. In vivo release and concentrations of mesalamine in Vegaz OD is similar to Brand P and other two brands exhibited lower release. Conclusion: Vegaz OD sachet had total mesalamine levels similar to brand P and thus this generic formulation is equivalent to branded innovator formulation. Keywords: Mesalamine, Pentasa, Vegaz, colon, PBBM.

Road traffic accidents (RTAs) are a leading cause of mortality and morbidity, particularly among young adults in the whole world. This descriptive study, conducted at the Department of Forensic Medicine, Kokrajhar Medical College & Hospital from March 2024 to September 2025, analyzed 237 autopsies of RTA victims. Males constituted 85.7% of cases, with the highest incidence in the 21–30 years age group (32.5%). Most accidents occurred between 6:00 AM and 12:00 Noon on highways and in rural areas. Motorcyclists (40.5%) were the most affected road users. Head and neck injuries were predominant both externally (36.7%) and internally (35.0%), with combined subdural and subarachnoid hemorrhages (59.1%) being most common. Head injury with intracranial hemorrhage (34.2%) was the commonest cause of death. The study underscores the need for strict enforcement of helmet laws, improved rural road safety, and timely trauma care to reduce fatalities. Keywords: Road traffic accident, injury pattern, head injury, Forensic autopsy.

Background: As antiretroviral therapy (ART) extends the lifespan of people living with HIV (PLHIV), older adults increasingly face a dual burden of HIV-related complications and age associated comorbidities. This study evaluated the spectrum of abdominal ultrasonographic (USG) findings in PLHIV aged > 50 years, assessing the prevalence of abnormalities in asymptomatic individuals and their correlation with CD4 cell counts. Materials and Methods: A prospective observational study was conducted at Tertiary care hospital, Delhi (April 2024 – August 2025), involving 100 HIV-positive participants. Clinical evaluations, viral load assessments, and CD4 counts were paired with standardized abdominal USG. Data were analyzed using descriptive statistics and Pearson’s correlation. Results: The cohort (mean age 59.4 years; 70% male) was largely stable, with 99% achieving viral suppression and 87% maintaining CD4 counts >350cells/mm³. While 89% of the population was asymptomatic, USG detected abnormalities in 38% of all participants. This included 90.9% of symptomatic patients and a significant 31.4% of asymptomatic individuals. Prevalent findings included fatty liver, hepatomegaly, benign prostatic enlargement, splenomegaly, cholelithiasis, and medical renal disease. Although abnormalities occurred more frequently at lower CD4 levels, the correlation did not reach statistical significance. Conclusion: A substantial proportion of older PLHIV—including those without clinical symptoms—exhibit abdominal pathologies. These findings suggest that routine USG screening is a valuable tool for the early detection and management of comorbidities in aging HIV populations, potentially enhancing long-term health outcomes and quality of life. Keywords: HIV; elderly; ultrasonography; abdominal findings; CD4 count; fatty liver.

Background: Domestic violence which includes physical abuse, sexual abuse, verbal and emotional abuse and economic abuse can lead to fatal outcomes like homicide or suicide, lead to mental health problems like depression, anxiety disorders, unintended pregnancies, induced abortions and risk of getting STDs and HIV especially among women. This study was conducted to to estimate the prevalence of domestic violence in Chennai and how domestic violence impacts the women and what barriers are present while seeking help. Material and Methods: This was a Descriptive cross sectional study conducted among women who were married for at least one year period in an Urban field practice area of a Medical college in Chennai. Sample size was calculated to be 385 and Simple random sampling with lottery method was used to select study participants. Data was collected by interview method using structured interview schedule. Results: About 65.7% of the women have experienced domestic violence. 65.5% of women have said that they are unable to spend money. 35.6% of women reported that they have experienced emotional distress, Loss of appetite and reduced sleep. 29.4 % of women have told that violence at home affected their children’s academics. Only 24.2 % of participants have asked for help from their family and friends. Conclusion: In spite of many advancements, the high prevalence of domestic abuse and low help seeking behaviour among our participants suggests a high need of awareness on womens rights. Keywords: Domestic violence, abuse, help seeking, married women.

Background: Knowing the importance of improving maternal health and reducing the maternal mortality globally and nationally, assessing the utilization and factors influencing the utilization of antenatal health care services are essential. Materials and Methods: A Community based cross-sectional study was carried out among the antenatal mothers in Singupuram area of Srikakulam district. Details were collected using a pretested and validated questionnaire and data analyzed using SPSS v21. Results: The study included 300 antenatal mothers, of which 39% were illiterates, 64.7%pregnancies were registered at Government hospital, 67.3% received 2 doses of TT(Tetanus Toxoid), 38% had taken more than 100 Iron folic acid tablets. Factors which were identified to have statistically association with better utilization of antenatal healthcare services were religion, caste, type of family, level of education. Occupation, birth order of child, socioeconomic status, age at child birth. Conclusion: The study has revealed the fact that inspite of a number of maternal health programs being implemented by the government and the large number of health personnel being employed in our country, antenatal healthcare services have not reached everyone in the community and there are areas which have been still underserved. Keywords: Antenatal care, rural area, maternal health, health care services, health care provider

Background: The prostate is the largest accessory sex gland in males, comprising a collagenous, fibromuscular, and glandular structure. It functions as an exocrine gland, secreting a fluid (with a pH > 7) that constitutes approximately 20–30% of the seminal fluid produced. Objective: To establish a correlation between sonographic prostatic volume and IPSS, potentially leading to better management of patients with BPH. Material and Methods: This cross-sectional observational study was conducted among male patients aged 40 years and above who presented with LUTS and were referred to the Department of Radio Diagnosis at Rohilkhand Medical College, Bareilly, Uttar Pradesh, for transabdominal sonography. Results: Majority of patients (35.0%) were in the 60-69 age group, with a significant association between higher age and larger prostate volumes. Prostate volume was categorized into four grades, with Grade II (31-50 cc) representing the highest proportion of patients. There was a significant correlation between increasing prostate volume and severity of IPSS, with patients with severe symptoms (IPSS ≥20) exhibiting larger prostate volumes. Additionally, significant associations were found between prostate volume, nocturia, weak stream, incomplete emptying, and other lower urinary tract symptoms. Multivariate regression analysis revealed that larger prostate volume & age ≥60 were significant predictors of severe IPSS. Conclusion: The severity of IPSS symptoms was positively correlated with prostate volume. A p-value of <0.001 signifies a highly significant correlation between prostate volume and the severity of IPSS symptoms. A direct correlation between QoL and IPSS scores was observed, with patients having worsening QoL scores showing higher IPSS. A significant p-value of <0.001 was observed for nocturia and prostate volume grades. A statistically significant positive correlation was observed between prostate volume and IPSS indicating larger prostate volumes are associated with increased severity of lower urinary tract symptoms. Keywords: Sonographic Prostatic Volume, International Prostate Symptom Score (IPSS), Benign Prostatic Hyperplasia.

Background: The liver is the largest gland of the human body and plays a vital role in metabolism, detoxification, bile secretion, and immunological functions. Although classical anatomical descriptions provide a standard framework for hepatic structure, numerous morphological variations exist in the external configuration, lobar anatomy, fissures, and surface features of the liver. These variations may pose challenges in radiological interpretation, surgical planning, and intraoperative orientation, particularly in hepatobiliary and transplant procedures. Cadaveric studies remain an important method for accurately documenting these variations, as they allow direct visualization and precise morphometric assessment of the liver. The present study was undertaken to analyse the morphological variations in human cadaveric liver and its clinical significance. Materials and Methods: This descriptive observational cadaveric study was conducted on 54 adult human livers obtained from routine dissection obtained from the Department of Anatomy, Phulo Jhano Medical College, Dumka (Jharkhand) and Department of Anatomy, Shri Jagannath Medical College and Hospital, Puri (Odisha). Livers that were grossly intact and suitable for assessment were included. Specimens showing severe decomposition, traumatic distortion, or pathological changes were excluded. Each liver was examined for overall shape, surface contour, inferior border characteristics, lobar morphology, accessory fissures and lobes, notches, and porta hepatis features. Standardized morphometric measurements including liver weight and dimensions were recorded using calibrated instruments. Data were analyzed using SPSS version 26.0. Categorical variables were expressed as frequencies and percentages, while continuous variables were summarized as mean and standard deviation. Appropriate statistical tests were applied, with p < 0.05 considered statistically significant. Results: Wedge-shaped livers were most common (66.67%), followed by triangular (25.93%) and irregular forms (7.40%). A smooth surface contour was observed in 83.33% of specimens, and a sharp inferior border in 70.37%. Accessory fissures were the most frequent anatomical variation (38.89%) and showed statistical significance. Inferior border notches demonstrated significant variability, with a single classical notch being the most common pattern (44.44%). The mean liver weight was 1286.45 ± 214.32 g, and all morphometric parameters followed a normal distribution. No significant differences were observed between dissection and autopsy specimens. Conclusion: The study highlights considerable variability in the external morphology of the human liver, despite an overall predominance of typical anatomical features. Recognition of these variations is essential for anatomists, radiologists, and surgeons to avoid diagnostic errors and to ensure safer hepatobiliary interventions. Keywords: Human Liver; Cadaveric Study; Morphological Variations; Accessory Fissures; Liver Morphometry.

Background: Diabetes is associated with a pro-inflammatory state and endothelial dysfunction. Various markers of inflammation like C Reactive Protein (CRP) are elevated significantly in diabetic population. Hence understanding the role of CRP in inflammation process among diabetics with poor glycemic control is relevant to early identification and prevention of complications of diabetic people and enhance the quality of life in all aspects. Materials and Methods: This is a hospital based prospective study done on patients of type 2 diabetes mellitus, attending the outpatient Department of General Medicine in a tertiary care hospital, Dausa, Rajasthan, India during one-year period. Total number of 120 subjects were included in this study with age range from 30 to 60 years of both sexes. Among them 60 were cases of type 2 diabetes mellitus patients having HbA1C level >6.5% and 60 were age-matched with healthy controls having HbA1C level <6.5%. All the analyses were done using SPSS version 23.0. Results: Patients with diabetes exhibited significantly higher mean BMI (28.3±4.13 kg/m²) compared to controls (23.2±2.7 kg/m²; p < 0.05*). Similarly, both systolic (138.26 ± 12.38 vs. 127.60 ± 11.82 mmHg; p < 0.05*) and diastolic blood pressure (86.50 ± 11.23 vs. 77.50 ± 8.54 mmHg; p < 0.05*) were significantly elevated in the diabetic group. Inflammatory burden was notably greater in diabetics, as reflected by CRP levels (7.32 ± 5.15vs. 5.36 ± 0.44 mg/L; p < 0.05*). Glycemic control markers confirmed poor control in diabetics, with a mean HbA1c of 8.12% compared to 5.78% in controls (p < 0.05*). Conclusion: Elevated CRP levels are significantly associated with poor glycemic control in T2DM, suggesting a critical role of low-grade inflammation in the development of diabetic complications. CRP may serve as a valuable adjunct marker for identifying high-risk patients Keywords: CRP, HbA1c, Glycemic control, Diabetes mellitus, BMI.

Background: Kangaroo Mother Care (KMC) applied after stabilization of the infant has been shown to reduce mortality by 40% among hospitalized infants with a birth weight of less than 2.0 kg. In these studies, infants were randomly assigned and KMC was initiated after about 3 days of age, when the majority of neonatal deaths would have already occurred. The aim of this study to evaluate the safety and efficacy of continuous KMC initiated immediately after birth for neonates with a birth weight of less than 2 kg compared with initiating KMC after stabilization in improving survival. Materials and Methods: our study is prospective randomised controlled trial, conducted in the Department of Pediatrics, Shri Jagannath Pahadiya Medical College, Bharatpur. Neonates with birth weight less then 2 kg were enrolled in this study and randomly assigned to immediate KMC (intervention) and control group (KMC after stabiliztaion). The intervention involves initiating continuous skin-to-skin contact as soon as possible after birth, encouraging and supporting early exclusive breastfeeding, and delivering health care for both mother and baby with minimal separation. The main outcomes measured were mortality rates from enrollment to 28 days of age and from enrollment to 72 hours of age. Results: Our study showed that 1000 infants from 1060 mothers met the weight criteria for enrolment. The median time to initiation of skin-to-skin contact in the intervention group was 1.3 hours (interquartile range, 0.3 to 2.8) and that in the control group was 53.6 hours (interquartile range, 32.5 to 90.6). The median duration of NICU stay was 6.5 days in both groups. During the NICU stay, the median daily duration of skin-to-skin contact in the intervention group was 16.5 hours and that in the control group was 1.48 hours. From enrolment to 28 days of age, 60 infants (12.0%) in the intervention group and 80 infants (16%) in the control group died (P<0.05*). From enrolment to 72 hours of age, 24 infants (4.8%) in the intervention group and 30 infants (6%) in the control group died (P>0.05). Conclusion: We resulted in a significantly lower risk of neonatal death than the currently recommended initiation of kangaroo mother care after stabilization. Keywords: Immediate kangaroo mother care, Conventional care, Infants, Low birth weight, Neonatal death, NICU.

Background: Systemic Lupus Erythematosus (SLE) represents a complex autoimmune disorder with multifactorial etiology. Members of the Herpesviridae family, particularly Cytomegalovirus (CMV), Epstein-Barr virus (EBV) and Herpes Simplex virus (HSV) have been implicated as environmental triggers in SLE pathogenesis. The primary aim of this study was to determine the prevalence of CMV and EBV infections in SLE patients attending a tertiary care hospital in Chennai. This study also aims to determine the association between clinical manifestations and seropositivity of CMV, EBV and HSV in these patients. Materials and Methods: Fifty patients with confirmed SLE were enrolled in this Cross-Sectional study conducted at a tertiary care hospital in South India, between February-July, 2024. Serum samples were tested for CMV, EBV, HSV IgG and IgM antibodies using ELISA. Results: Among 50 SLE patients (90% were female, mean age 31.2 years), CMV IgG seropositivity was 88%, while CMV IgM was 38%. EBV IgG and IgM seropositivity rates were 86% and 4%, HSV IgG and IgM seropositivity rates were 76% and 32%, respectively. Co-infections were seen with CMV & EBV (2%), CMV & HSV (26%), CMV& EBV & HSV (2%). Statistical analysis revealed significant association between IgM seropositivity and disease activity in SLE patients. Conclusion: High seroprevalence of CMV, EBV and HSV in patients with SLE suggest potential role of herpes viruses in SLE pathogenesis and clinical manifestations in South Indian population. Keywords: CMV – Cytomegalovirus, EBV – Epstein-Barr virus, HSV – Herpes simplex virus, SLE – Systemic Lupus Erythematosus.

Background: Advance Medical Directives (AMDs) allow competent individuals to express future healthcare preferences when decision-making capacity is lost. They enhance autonomy and reduce unwanted interventions but remain underutilised globally. The objective is to systematically review international evidence on the awareness, effectiveness, legal frameworks, and clinical implementation of AMDs. [18–24] [25–28] [41–46]. Materials and Methods: Literature from 2000–2024 was searched across PubMed, Scopus, and Google Scholar using PRISMA methodology. Inclusion criteria: original research, systematic reviews, cohort/cross-sectional studies addressing AMD knowledge, attitudes, clinical outcomes, or legal aspects. Exclusion criteria: editorials, commentaries, non-clinical legal papers. [3] Results: Forty-six studies met eligibility criteria. AMDs consistently improved patient autonomy, reduced futile end-of-life interventions, improved patient–family satisfaction, and reduced surrogate stress. Barriers included low public awareness, clinician discomfort, cultural taboos about death, and legal or administrative complexities. High-income countries showed greater AMD adoption due to strong legal frameworks. [18–24] [35–40] Conclusion: AMDs significantly improve end-of-life care quality but remain poorly adopted. Legal simplification, public education, and clinician training are essential for scaling AMD implementation, especially in developing nations. [35–40] [41–47] Keywords: Advance Medical Directive, Living Will, Advance Care Planning, Patient Autonomy, End-of-Life Care, Systematic Review.

Background: Parkinson’s disease is a progressive neurodegenerative disorder in which non-motor symptoms, particularly sleep disturbances, significantly contribute to morbidity and impaired quality of life. Sleep-related problems are frequently underrecognized despite their high prevalence and strong association with other non-motor symptoms. This study aimed to evaluate the prevalence and pattern of sleep disturbances in patients with Parkinson’s disease and to analyze their association with non-motor symptoms, disease severity, and quality of life. Materials and Methods: A hospital-based cross-sectional observational study was conducted at RIMS, Ranchi, including 50 patients with clinically diagnosed Parkinson’s disease. Demographic details, disease duration, and clinical characteristics were recorded. Sleep disturbances were assessed using validated Parkinson’s disease–specific sleep assessment tools, while non-motor symptoms were evaluated using standardized non-motor symptom scales. Disease severity and quality of life were assessed using appropriate rating scales. Data were analyzed using descriptive and inferential statistics, with a p-value <0.05 considered statistically significant. Results: Sleep disturbances were observed in a majority of patients, with insomnia being the most common, followed by excessive daytime sleepiness, REM sleep behavior disorder, and restless legs syndrome. Non-motor symptoms such as depression, anxiety, cognitive impairment, and autonomic dysfunction were highly prevalent. Sleep disturbances were significantly more common in patients with moderate to severe disease and were associated with higher non-motor symptom burden. Patients with sleep disturbances demonstrated significantly poorer quality-of-life scores compared to those without sleep-related problems. Conclusion: Sleep disturbances are highly prevalent in Parkinson’s disease and are strongly associated with non-motor symptoms, disease severity, and reduced quality of life. Routine assessment and early management of sleep disturbances should form an integral part of comprehensive Parkinson’s disease care. Keywords: Parkinson’s disease, Sleep disturbances, non-motor symptoms, Quality of life, REM sleep behavior disorder.

Background: Hypertension represents a major public health challenge world-wide, with evidence suggesting an increased risk of cardiovascular diseases and related mortality.India is undergoing both epidemiological and nutritional transition. Rapid urbanization and westernization often increase unhealthy lifestyle behaviours including sedentary lifestyle, and intake of energy-dense food. Studies in South India prompted us to investigate the association between BMI indices and obesity in our students in a tertiary teaching medical college. Material and Methods:An observational Cross-Sectional study was conducted among Final MBBS Part-1 students of Narayana Medical College using convenient sampling method, Nellore after taking institutional ethics committee approval, for a period of 5 months from July to November with sample size of 250. Results: Out of 253 students,about 8.7% of the study participants were prehypertensive and 3.2% of them had grade 1 hypertension (Figure 1). The proportion of students who were obese was 36.5% (n=92), while 17.5% were overweight (n=44) and9.9% (n=25) were underweight. Only 36.1% (n=91) were in the normal range (Figure 2).There was a statistically significant difference in the distribution of truncal obesity between male and female students (p=<0.006). 32.5% of the study participants had a positive family history of hypertension Keywords: Correlation, Hypertension, Obesity, BMI, Waist Circumference.

Background: Diabetic kidney disease (DKD) is one of the most common microvascular complications of type 2 diabetes mellitus (T2DM) and a leading cause of end-stage renal disease in India. Conventional biomarkers such as albuminuria and estimated glomerular filtration rate (eGFR) often identify DKD only after significant renal damage has occurred. Inflammation is increasingly recognized as a key mechanism in the pathogenesis of DKD. The neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR), derived from routine complete blood counts, have emerged as novel inflammatory markers. This study aimed to evaluate NLR and PLR as potential indicators of DKD in patients with T2DM. Material and Methods: A hospital-based cross-sectional study was conducted among 487 patients with T2DM attending a tertiary care hospital in central India. Participants were categorized into two groups: Group I – T2DM without DKD (n=243), and Group II – T2DM with DKD (n=244), based on urine albumin–creatinine ratio (UACR) and eGFR. Demographic, biochemical, and hematological parameters were analyzed, and NLR and PLR were calculated from complete blood counts. Correlations between these ratios and renal parameters were assessed using Pearson’s correlation test. Results: Patients with DKD were older and had longer diabetes duration, higher blood pressure, and poorer glycemic control compared to those without DKD (p<0.001). Mean serum creatinine and blood urea were significantly elevated, while eGFR was lower in the DKD group (p<0.001). Both NLR (2.93 ± 1.02 vs. 2.06 ± 0.74) and PLR (146.8 ± 39.2 vs. 118.4 ± 31.5) were significantly higher among DKD patients (p<0.001). NLR showed a strong negative correlation with eGFR (r = −0.46) and a positive correlation with UACR (r = +0.52), while PLR correlated inversely with eGFR (r = −0.38) and positively with UACR (r = +0.44) (all p<0.001). Conclusion: Elevated NLR and PLR are significantly associated with the presence and severity of DKD in patients with T2DM. These easily obtainable, cost-effective inflammatory markers may serve as useful adjuncts for early detection and risk stratification of diabetic kidney disease, especially in resource-limited clinical settings. Keywords: Type 2 diabetes mellitus; Diabetic kidney disease; Neutrophil–lymphocyte ratio; Platelet–lymphocyte ratio; Inflammatory markers.

Background: Lateral tibial plateau fractures significantly impair knee function and long-term quality of life, particularly when articular congruity and stability are compromised. Locking compression plates (LCP) provide angular stability and improved fixation in metaphyseal bone, potentially enabling early rehabilitation and improved outcomes. The objective is to evaluate functional and clinico-radiological outcomes in Schatzker type I–III lateral tibial plateau fractures treated with LCP fixation and to determine post-operative complications. Materials and Methods: A prospective observational study was conducted at a tertiary care hospital from April 2023 to December 2024. Thirty-two adult patients (18–75 years) with closed Schatzker type I–III lateral tibial plateau fractures underwent fixation with a locking compression plate using ORIF or MIPPO techniques. Follow-up assessments included knee range of motion, Rasmussen clinical and radiological scoring, time to union, time to full weight bearing, complications, and SF-36v2 physical and mental component scores. Descriptive and inferential statistics were performed using SPSS, with p < 0.05 considered significant. Results: Mean age was 48.4 ± 13.3 years, with male predominance (65.6%). Schatzker type II fractures were most common (56.25%). Mean knee flexion achieved was 128.1 ± 13.3 degrees. Rasmussen clinical outcomes were excellent in 31.3% and good in 68.8%. Mean time to full weight bearing was 12.56 ± 2.5 weeks, and mean fracture union time was 13.1 ± 3.9 weeks. Complications occurred in 37.5%, most commonly wound infection (15.6%). Mean SF-36v2 physical and mental component scores were 53.78 ± 5.62 and 58.56 ± 5.33, respectively. Conclusion: Locking compression plate fixation for Schatzker type I–III lateral tibial plateau fractures demonstrated favorable functional recovery, reliable union, and acceptable complication rates, supporting its effectiveness in restoring knee function. Keywords: Tibial plateau fracture; Schatzker classification; Locking compression plate; Rasmussen score; SF-36.

Background: Endemic fluorosis has remained a significant public health concern in India due to prolonged exposure to elevated fluoride levels in drinking water, leading to dental, skeletal, and non-skeletal manifestations. Several districts of Tamil Nadu, including Theni district, have been identified as fluoride-endemic zones. Rural populations are particularly vulnerable due to dependence on groundwater sources. Identification of endemic areas and assessment of disease burden were considered essential for planning preventive and remedial public health interventions. This study was undertaken to estimate the prevalence of fluorosis and its determinants thereby estimating the fluoride levels in drinking water across villages of Aundipatti Community Development Block. Materials and Methods: A community-based cross-sectional analytical study was conducted in all 18 villages of Aundipatti Community Development Block, Theni district, Tamil Nadu, over a two-year period from May 2018 to April 2020. A multistage clustered sampling technique was employed. In the first stage, villages were selected using Probability Proportional to Size (PPS) sampling, followed by systematic random sampling of households within each selected cluster. Data were collected after obtaining verbal consent using a pre-designed interviewer-administered questionnaire covering socio-demographic details, drinking water sources, dietary patterns, and clinical features suggestive of fluorosis. Clinical examination was performed to identify dental, skeletal, and non-skeletal fluorosis using standard case definitions. Drinking water samples were collected in pre-cleaned containers and analysed on the same day for fluoride concentration using the SPADNS spectrophotometric method at the MDRU laboratory, GTMCH, Theni. Data were entered in Microsoft Excel and analysed using Epi info version 7.2. Descriptive statistics and inferential analyses, including logistic regression, were performed, with a p-value <0.05 considered statistically significant. Results: Fluorosis of at least one type was identified in 132 participants, yielding an overall prevalence of 22.6%. Dental fluorosis was observed in 15.6%, non-skeletal fluorosis in 14.5%, and skeletal fluorosis in 1.7% of participants. Fluoride levels between 1.5 and 3.0 mg/L were detected in 23.1% of drinking water samples. Multivariate analysis revealed that higher drinking water fluoride levels (OR = 3.27; 95% CI: 2.09–5.09), absence of water purification (OR = 3.85; 95% CI: 2.29–6.49), use of fluoridated toothpaste (OR = 3.59; 95% CI: 2.19–5.89), and higher socioeconomic status were independently associated with fluorosis. Conclusion: The study findings emphasize the need for routine monitoring of drinking water fluoride levels, early detection of fluorosis, and implementation of preventive strategies such as provision of safe drinking water and community-based awareness programs. Keywords: Fluorosis, Drinking water fluoride, Dental fluorosis, Skeletal Fluorosis, Rural population.

Background: Chronic NSAID (Nonsteroidal anti-inflammatory drug) use substantially increases peptic ulcer disease (PUD) and upper gastrointestinal (GI) bleeding risk. Gastroprotective strategies (PPIs {Proton Pump Inhibitors}, misoprostol, COX-2 {cyclooxygenase-2} inhibitors) aim to mitigate this injury. The objective is to systematically review PUD burden among chronic NSAID users and evaluate gastroprotective strategy efficacy. To examine real-world implementation gaps in gastroprotection and identify opportunities to improve risk stratification and clinical outcomes in chronic NSAID users. Materials and Methods: MEDLINE, Embase, Scopus, and Cochrane Library were searched (1994–2024) using terms "NSAIDs," "peptic ulcer disease," "gastroprotection," "proton pump inhibitors," "COX-2 inhibitors," "misoprostol." RCTs (Randomized control trials), cohort/case-control studies, meta-analyses, review articles and guidelines reporting PUD risk/gastroprotection in adults were included. Non-English papers without extractable data, Lacked clear outcome measures or evaluable results, editorials, commentaries, conference abstracts, were excluded. Following PRISMA 2020 guidelines, 3,214 records were identified; 2,187 remained after deduplication; 1,912 excluded at title/abstract; 275 full-texts assessed, excluding 254 (paediatric/acute n=78; no outcomes n=92; other n=84). Narrative synthesis of 21 studies conducted due to heterogeneity. Results: Chronic NSAID use increased serious GI complications 3–5-fold (annual incidence 1–2% high-risk). PPIs, misoprostol, and COX-2 inhibitors significantly reduced ulcers/complications; COX-2+PPI combination most protective. Real-world gastroprotection remained suboptimal. Conclusion: Gastroprotective strategies effectively reduce NSAID-induced PUD, but implementation gaps persist. Enhanced risk stratification and adherence are needed. Keywords: NSAIDs, peptic ulcer disease, gastroprotection, proton pump inhibitors, COX-2 inhibitors, misoprostol, upper gastrointestinal bleeding.

Background: Soil-transmitted helminths (STH) infections are a neglected tropical disease affecting two billion people worldwide. Purpose: To identify the prevalence of Soil Transmitted helminthes among children living in remote and poverty-stricken areas with poor sanitation and low education. Materials and Methods: we used the wet mount method, saline and iodine, Formol ether concentration technique, Kato-Katz method, and Multiplex PCR to identify STH. Results: In this cross-sectional study, out of 350 stool samples collected from children aged 5-10 years in the villages of Chengalpattu District, 58(16.57%) were positive for STH infections. Out of the total positives, 51.7% of the STH infections were in the age group 6- 7 years. In this study, the male-to-female ratio was 2:1.4. Out of the total STH-affected children, 60.34% were found to be females. The prevalence rate of STH infection is estimated to be 16.57 % by Kato-Katz and Multiplex PCR methods. Among the Individual STH infections, Hookworm was the most common STH (10.87%), followed by Ascaris lumbricoides & Hookworm coinfection (2.57%), A. lumbricoides (1.71%), and Trichuris trichiura (1.4%) co-infection out of 350 samples. Conclusions: On comparison of various methods, the sensitivity of the a) Wet mount method was 62.24% (95% CI 53.66-78.99%). b) Formal-ether concentration method was 82.76% (95% CI 70.57-91.41%), and c) Multiplex PCR assay was 100% (95% CI 98.74-100.0%) in comparison with the Kato-Katz method out of the 350 samples analyzed. Compared with other methods, the Kato-Katz method and the Multiplex PCR assay showed better and equal detection of soil-transmitted Infections with a significant P value (>0.0001). Keywords: Soil Transmitted Helminthes(STH), Hookworm, Kato Katz method, Formol-Ether Concentration Technique, Ascaris lumbricoides.

Background: In developing countries Glomerulonephritis is the most common cause of morbidity and mortality. Nephrotic Syndrome is a pentad of proteinuria more than 3.5g/24hr, hypoalbuminemia, edema, hyperlipidemia, and lipiduria. The present study was conducted to study the histopathological spectrum of nephrotic syndrome based on light microscopy and immunofluorescence findings. Materials and Methods: Renal biopsies were taken from patients who presented with Nephrotic syndrome at Nephrology ward of Thanjavur Medical College and Hospital for a period of one year from 2020-2021. Based on inclusion and exclusion criteria the sample size calculated was 60 cases. All patients underwent routine biochemical tests concerned with nephrotic syndrome. Data were entered in the excel sheet and analyses were done using Graph pad Prism version 5 software. p<0.05 were measured as statistically significant Results: Majority of our study participants belongs to 16-29 years of age (66.7%). Female preponderance was observed (55%). 49(81.7%) of the study participants gets affected due to primary cause. The most common histopathologic finding was Minimal Change Disease (28.3%). Sex had a significant association with the etiology. Histopathological diagnosis has significant association with gender. Significant association was found between histopathological diagnosis and 24 hr urine protein gram per day. Conclusion: The study concluded that the most common histopathological finding was Minimal Change Disease (28.3%) followed by Focal segmental glomerulosclerosis (21.7%). Among the secondary glomerular diseases, Lupus Nephritis was common and that too majority of patients belong to Class IV A and Class V Lupus Nephritis. Significant association was found between histopathological diagnosis and 24 hr urine protein gram per day. Keywords: Proteinuria, Nephritis, Nephrotic syndrome, Hypoalbuminemia, Lipiduria.

Background: Rabies is a fatal viral disease that remains a significant public health challenge in India. Despite the availability of post-exposure prophylaxis (PEP), knowledge, attitude, and practices (KAP) regarding rabies prevention remain inadequate, leading to poor adherence to PEP. This study evaluates the KAP of dog bite patients to identify gaps and improve preventive strategies. Objectives: To assess the knowledge, attitudes, and practices regarding rabies prevention and PEP among individuals seeking treatment at an urban health training centre of Government Medical College, Miraj, Maharashtra, Materials and Methods: A facility-based cross-sectional study was conducted at the Urban Health Training Centre, Government Medical College Miraj. Data were analysed using MS Excel, applying chi-square tests to compare proportions between literate and illiterate participants, with p < 0.05 considered significant. Results: Among 150 participants, 92.7% had heard of rabies but only 36.7% recognised its symptoms. Misconceptions were common (86.7% believed in human-to-human transmission). Although 86% sought healthcare promptly and 89.3% completed the anti-rabies vaccine schedule, only 32% knew the correct vaccine injection site. Cost and cultural beliefs hindered adherence: 25.3% managed wounds at home - illiterate respondents mainly applied traditional remedies (e.g., turmeric, neem-leaf paste, alum, limestone powder) or consulted religious healers, whereas literate respondents predominantly washed wounds with soap and water or used antiseptic ointment. Conclusion: Despite high overall awareness, critical knowledge gaps and misconceptions persist, leading to delays and incomplete adherence to post-exposure prophylaxis (PEP). Strengthening community awareness, improving provider communication, and ensuring free and timely availability of anti-rabies vaccine and immunoglobulin are essential to improve adherence and meet India’s NAPRE 2030 targets. Keywords: Rabies, Post-Exposure Prophylaxis, Dog Bites.

Background: Large osseous defects encountered in orthopaedic surgery often require bone grafting. Autologous grafts are limited by donor site morbidity and availability, prompting the use of fresh frozen bone allografts as biological alternatives. Objectives: To evaluate radiological union, functional outcomes, and complications associated with fresh frozen bone allografts in orthopaedic trauma patients. Materials and Methods: A prospective cohort study was conducted on 45 patients aged 16–80 years undergoing orthopaedic procedures requiring bone grafting. Fresh frozen allografts were obtained from a certified tissue bank following stringent donor screening and processing. Radiological union was assessed at 3 and 6 months, and functional outcomes were evaluated using the Modified Enneking Functional Scoring System. Results: Radiological union was observed in 51.1% of patients at 3 months and increased significantly to 86.7% at 6 months (p < 0.001). Functional outcomes improved markedly, with 95.6% of patients achieving good-to-excellent scores by six months. Complications occurred in 8.9% of cases, including non-union and infection. No graft-related disease transmission was recorded. Conclusion: Fresh frozen bone allografts provide reliable radiological consolidation, excellent functional recovery, and a low complication rate. When combined with stable fixation and rigorous tissue-banking protocols, they represent safe and effective alternatives to autografts in orthopaedic reconstruction.

Background: Allergic rhinitis is a prevalent atopic condition that can lead to ocular surface irregularities resulting from persistent inflammation and modified tear film dynamics. Individuals with allergic rhinitis often experience ocular manifestations, including itching, dryness, and irritation, which can negatively impact their quality of life. The current study sought to assess tear film stability and ocular surface alterations in patients with allergic rhinitis, while comparing these results to those of healthy persons. Materials and Methods: A prospective observational research was performed with 60 patients diagnosed with allergic rhinitis and 30 healthy controls matched for age and sex. All subjects had comprehensive ophthalmic assessment, encompassing Schirmer’s test, tear film breakup time (TBUT), ocular surface staining with fluorescein, and the Ocular Surface Disease Index (OSDI) questionnaire. The data were evaluated and presented as mean ± standard deviation, facilitating comparisons between groups. Results: Patients with allergic rhinitis had an average age of 29.8 ± 8.6 years, and 58.3% of them were male. Patients with allergic rhinitis had a considerably lower mean TBUT (8.4 ± 2.1 seconds) when compared to controls (12.6 ± 2.4 seconds). The study group also had lower Schirmer's test scores (14.2 ± 4.5 mm) compared to the controls (19.1 ± 3.8 mm). Of the patients with allergic rhinitis, 46.7% showed positive ocular surface staining, while just 20% of the controls showed only mild staining. Compared to controls (14.3 ± 6.1), patients had a substantially higher mean OSDI score (32.5 ± 9.7), suggesting that they experienced more ocular discomfort. Conclusion: There are noticeable alterations to the ocular surface and instability of the tear film in patients with allergic rhinitis compared to healthy persons. Preventing the worsening of ocular surface illness and increasing patient comfort may be possible with prompt ophthalmic examination and proper care of ocular involvement in allergic rhinitis. Keywords: Allergic rhinitis; Tear film; Ocular surface; Tear breakup time; Dry eye.

Background: Chronic sinusitis is a long-lasting inflammatory disease of the paranasal sinuses that can spread beyond nasal symptoms to affect the orbit, causing eye problems as watering, pain, pressure, and visual discomfort. These symptoms have a major impact on quality of life and may not go away even with the best medical treatment. The current study sought to assess the efficacy of endoscopic sinus surgery (ESS) in alleviating ocular symptoms in individuals with chronic sinusitis. Materials and Methods: A prospective interventional study was performed on 50 individuals diagnosed with chronic sinusitis with concomitant ocular symptoms. All patients received thorough otorhinolaryngological and ophthalmic assessments prior to surgery. Before surgery and three months after ESS, a standardized symptom scoring method was used to measure ocular complaints like epiphora, peri-orbital pain, eye strain, and visual discomfort. To see how well ESS worked, we evaluated the symptom scores before and after the surgery. Results: The majority of the patients were male (60%), and their average age was 38.6 ± 11.4 years. Epiphora (60%), eye strain (46%), and peri-orbital pain (72%) were the most frequent ocular symptoms before surgery. At three months postoperatively, ocular symptoms showed a considerable improvement following ESS, with peri-orbital pain decreasing by 16%, epiphora by 14%, and eye strain by 10%. After the operation, the average score for ocular symptoms dropped dramatically from 6.8 ± 1.9 before to 1.9 ± 1.2 (p < 0.001). In total, 42 patients (84%) reported significant improvement in their eye problems following surgery. Conclusion: The ocular discomfort caused by chronic sinusitis can be greatly alleviated by endoscopic sinus surgery. Surgical surgery improves the quality of life for patients by alleviating sinonasal illness and helping with orbital and ocular problems. Keywords: Chronic sinusitis; Endoscopic sinus surgery; Ocular symptoms; Epiphora; Quality of life.

Background: Tinea corporis is one of the most prevalent dermatophytic infections worldwide, with increasing reports of treatment failure and recurrence due to changing fungal epidemiology and emerging antifungal resistance. Antifungal susceptibility testing using minimum inhibitory concentration (MIC) values has gained importance in guiding effective therapy. This study was undertaken to evaluate the clinicomycolgical profile of tinea corporis and correlate antifungal susceptibility patterns with clinical outcomes. Objectives: To study the clinical and mycological characteristics of tinea corporis, assess antifungal susceptibility patterns using MIC values, and correlate these findings with treatment response. Materials and Methods: This prospective observational study included 52 clinically diagnosed cases of tinea corporis attending a tertiary care hospital. Clinical severity of pruritus, erythema, and scaling was assessed at baseline, 2 weeks, and 4 weeks. Skin scrapings were examined using KOH mount and fungal culture, followed by antifungal susceptibility testing using broth microdilution method as per CLSI guidelines. Patients were treated with different antifungal agents and followed up to assess clinical improvement, mycological clearance, adverse effects, and relapse. Statistical analysis was performed using appropriate tests, and a p-value <0.05 was considered significant. Results: At baseline, the majority of patients presented with moderate to severe symptoms. At 4 weeks, itraconazole showed the highest pruritus resolution rate (81.82%) and mycological clearance (54.55%), followed by terbinafine. Percentage improvement in pruritus, erythema, and scaling was significantly higher with itraconazole and terbinafine compared to griseofulvin, ketoconazole, and fluconazole (p<0.001). Higher MIC values for fluconazole and ketoconazole correlated with poorer clinical outcomes and higher relapse rates. Adverse effects were more frequent in the ketoconazole group. Overall relapse was observed in 84.62% of patients, with the lowest relapse rate noted in the itraconazole group. Conclusion: Itraconazole and terbinafine demonstrated superior clinical efficacy and lower MIC values, correlating well with improved treatment outcomes. Antifungal susceptibility testing plays a critical role in optimizing therapeutic strategies and addressing the growing problem of antifungal resistance in dermatophytosis. Keywords: Tinea corporis. Antifungal susceptibility testing. Minimum inhibitory concentration (MIC).

Background: Postoperative nausea and vomiting (PONV) remains a common complication following laparoscopic surgeries, adversely affecting patient satisfaction, recovery, and healthcare costs. While ondansetron is widely used for prophylaxis, dexmedetomidine—an α₂-adrenergic agonist with sedative, analgesic, and antiemetic properties—has emerged as a potential alternative. The objective is to compare the efficacy and safety of dexmedetomidine versus ondansetron in preventing PONV in patients undergoing elective laparoscopic surgery. Materials and Methods: In this prospective, randomized, double-blind trial, 90 patients (ASA I–II) scheduled for laparoscopic procedures under general anesthesia were divided into two groups. Group I (n=45) received dexmedetomidine 1 μg/kg diluted in 100 mL normal saline over 10–15 minutes after intubation, while Group II (n=45) received ondansetron 4 mg intravenously. PONV incidence, severity, need for rescue antiemetics, hemodynamic parameters, sedation scores, and adverse events were recorded at 0, 4, and 12 hours postoperatively. Results: At 0 hours, significantly more patients in the dexmedetomidine group were free from PONV symptoms compared to the ondansetron group (68.9% vs. 40%, p=0.034), with vomiting occurring in only 8.9% vs. 26.7%, respectively. Rescue antiemetic use was also lower in the dexmedetomidine group at 0 hours (15.6% vs. 40%, p=0.010). No significant differences were observed at 4 and 12 hours. Dexmedetomidine was associated with a lower heart rate during surgery but without significant hemodynamic instability. Sedation profiles were comparable, and adverse events were minimal in both groups. Conclusion: Dexmedetomidine is more effective than ondansetron in preventing early postoperative nausea and vomiting following laparoscopic surgery and reduces the immediate need for rescue antiemetics, without causing excessive sedation or clinically significant hemodynamic compromise. It may be preferred in settings where early PONV control is crucial, though vigilant monitoring for bradycardia is advised. Keywords: Dexmedetomidine, ondansetron, postoperative nausea and vomiting (PONV), sedation.

Background: Iatrogenic radial nerve injury remains a persistent challenge in posterior humeral surgery, with reported rates up to 18% in complex fractures. Traditional reliance on bony landmarks is often unreliable due to fracture displacement, comminution, or anatomical variability. Soft-tissue landmarks that are consistently identifiable may offer a safer, more practical guide for nerve localization, yet their clinical utility remains underexplored. The aim is to prospectively quantify the anatomical relationship between the radial nerve and the triceps aponeurosis confluence, a soft-tissue landmark readily identifiable during posterior humeral approaches, and evaluate its potential to reduce iatrogenic injury. Materials and Methods: Forty patients (18–60 years) with closed middle- or distal-third humeral shaft fractures underwent posterior open reduction and internal fixation. The confluence point of the triceps aponeurosis was marked intraoperatively, and the distance to the radial nerve in the spiral groove was measured. Arm length, laterality, and postoperative radial nerve function were recorded. Results: The radial nerve was located a mean of 2.53 cm (range 2.3–2.8 cm) proximal to the aponeurosis confluence. No intraoperative or postoperative nerve injuries occurred. Distances were consistent across left- and right-sided fractures (p > 0.05), and all fractures achieved radiological union without complications. Conclusion: The triceps aponeurosis confluence is a reliable, reproducible soft-tissue landmark for anticipating radial nerve location, offering a clinically relevant adjunct to bony references. Its use may enhance operative safety during posterior humeral approaches, particularly in complex or comminuted fractures. Prospective studies are warranted to validate its impact on surgical outcomes and nerve protection. Keywords: Bony Landmarks, Triceps Aponeurosis, Radial Nerve.

Background: Subarachnoid block using ropivacaine is commonly employed for lower abdominal and lower limb surgeries due to its favourable safety profile and reduced cardiotoxicity. The use of adjuvants such as dexmedetomidine has been shown to enhance the quality of spinal anaesthesia by prolonging the duration of sensory and motor blockade and improving postoperative analgesia. Aims: To evaluate the effect of adding dexmedetomidine (10 micrograms) to intrathecal ropivacaine 0.75% heavy, on sensory and motor block characteristics, duration of postoperative analgesia, and intraoperative hemodynamic parameters, and to compare it with ropivacaine 0.75% heavy alone. Materials and Methods: This was a prospective, comparative observational study conducted in a tertiary care hospital in Mumbai after approval from the Institutional Ethics Committee. A total of 74 patients scheduled for elective surgeries under subarachnoid block were enrolled after obtaining written informed consent. Patients were randomly allocated into two groups of 37 each. Group 1 received intrathecal Inj.ropivacaine 0.75% heavy alone, while Group 2 received intrathecal Inj.ropivacaine 0.75% heavy with 10 micrograms Inj. Dexmedetomidine. Sensory block characteristics, motor blockade (Modified Bromage Scale), duration of analgesia, and hemodynamic parameters were assessed and statistically analysed. Results: The addition of 10 micrograms dexmedetomidine to intrathecal Inj.ropivacaine(0.75%) heavy resulted in a significantly prolonged duration of sensory and motor blockade and extended postoperative analgesia compared to Inj. ropivacaine (0.75%) heavy alone. The onset of sensory and motor block was comparable between the two groups. Hemodynamic parameters remained stable in both groups, with no significant increase in adverse effects in the dexmedetomidine group. Conclusion: Dexmedetomidine 10 micrograms is an effective intrathecal adjuvant to ropivacaine 0.75% heavy for subarachnoid block, providing prolonged sensory and motor blockade and improved analgesia without compromising hemodynamic stability. Keywords: Dexmedetomidine; Ropivacaine; Subarachnoid block; Spinal anaesthesia; Adjuvant; Motor block.

Background: Acute appendicitis is a common surgical emergency, and laparoscopic appendectomy is the standard of care. While early appendectomy is traditionally recommended to reduce complications, recent evidence suggests that short, controlled delays may not adversely affect outcomes. This study aimed to compare the clinical outcomes of early versus delayed laparoscopic appendectomy in adults. Materials and Methods: This prospective observational study was conducted at the Department of General Surgery, [Tertiary Care Center], including 100 adult patients with confirmed acute appendicitis. Patients were divided into two groups: early appendectomy (≤8 hours from admission, n=50) and delayed appendectomy (>8 hours, n=50). Demographic, clinical, imaging, perioperative, and postoperative outcomes—including complications, length of stay, and 30-day readmission—were analyzed. Statistical analysis was performed using Chi-square and t-tests, with p<0.05 considered significant. Results: Baseline demographics, clinical presentation (except nausea), and imaging findings were comparable between groups. Early appendectomy was associated with a significantly shorter mean operative time (53.45 ± 21.38 min vs. 66.58 ± 31.17 min; p = 0.015). Overall postoperative complications, length of stay, and 30-day readmission rates did not differ significantly. Wound infections were more frequent in the delayed group (20% vs. 6%; p = 0.05), while other complications were similar. Conclusion: Early and delayed laparoscopic appendectomy for acute appendicitis yield comparable postoperative outcomes. Short, controlled delays beyond 8 hours from admission appear safe and may allow for optimized perioperative planning without increasing morbidity. These findings support flexibility in surgical timing for selected patients while maintaining safety and quality of care. Keywords: Acute appendicitis, laparoscopic appendectomy, early appendectomy, delayed appendectomy, postoperative outcomes.

Background: Preoperative fasting is defined by the American Society of Anaesthesiologists (ASA) as the prescribed period of time before a surgical procedure when patients are not allowed the oral intake of liquids and solids. Objective: to evaluate the effect of different intervals of preoperative fasting on the gastric volume and pH and assess its effects on the perioperative hemodynamic parameters and patient’s symptoms and signs of wellbeing. Material and Methods: This prospective, double blind, randomized, comparative study was conducted at Sri Sathya Sai institute of higher medical sciences, Whitefield, Bengaluru. Duration of study was 2 years - (August 2019- August 2021). One hundred and twenty patients belonging to ASA grade I and II of ages between 18-60 years undergoing elective surgeries under general anaesthesia with endotracheal intubation. Results: From our study it was observed that there was statistically significant difference in the gastric volume between the three groups. The highest value was noted in group B and the least value was noted in group C. No statistically significant difference was noticed among the three groups with respect to the pH of the aspirated gastric fluid. Clinical signs of dehydration and symptoms of patient morbidity showed statistically significant difference between the three groups with favorable outcome in group C. Conclusion: In conclusion it was apparent that reduced preoperative fasting periods would benefit patients with decreased gastric volumes, normal range of gastric pH, stable hemodynamic parameters and increased patient comfort without increasing the risk of pulmonary aspiration in the perioperative period. Keyword: Durations of preoperative fasting, Gastric ph, Volume.

Background: Type 2 diabetes mellitus (T2DM) and hypothyroidism—two of the most prevalent endocrine disorders—frequently coexist. Their combination may synergistically worsen dyslipidaemia and cardiovascular risk. The objective is to evaluate the lipid profile patterns in patients with T2DM with coexisting hypothyroidism over a one-year study period. Materials and Methods: A cross-sectional observational study was conducted over 12 months in 150 adults diagnosed with T2DM and hypothyroidism. Fasting lipid profile, thyroid profile (TSH, FT4), and glycaemic parameters (FBS, PPBS, HbA1c) were assessed. Standard enzymatic colorimetric methods were used. Patients were categorized into controlled vs uncontrolled thyroid and glycaemic status. Results: Mean age was 54.8 ± 9.6 years, and 60% were females. Dyslipidaemia was present in 82% of participants. Patients with uncontrolled TSH (>4.5 mIU/L) showed significantly higher mean total cholesterol (228.4 ± 38.5 mg/dL), LDL-C (146.7 ± 32.4 mg/dL), and triglycerides (192.6 ± 48.7 mg/dL) compared to well-controlled thyroid group (p < 0.05). Poor glycaemic control (HbA1c >7%) further aggravated elevation of TG and VLDL. HDL-C was significantly lower in females with uncontrolled hypothyroidism. Conclusion: Coexistent hypothyroidism in T2DM amplifies dyslipidaemia, particularly elevating LDL-C and TG. Regular thyroid screening and early correction of hypothyroidism can significantly improve lipid abnormalities and reduce cardiovascular risk. Keywords: Lipid Profile, Type Ii Diabetes Mellitus Patients, Hypothyroidism.

Background: Respiratory complications such as lung atelectasis are common in critically ill patients and contribute to prolonged mechanical ventilation and ICU stay. Flexible fiberoptic bronchoscopy offers both diagnostic and therapeutic benefits in this population. The objective is to evaluate the radiographic response and therapeutic effectiveness of flexible fiberoptic bronchoscopy in ICU patients with lung atelectasis. Materials and Methods: A prospective observational study was conducted in 77 ICU patients undergoing bronchoscopy for respiratory complications. Chest radiographs were assessed before bronchoscopy and at 6 and 24 hours post-procedure to evaluate lung re-expansion. Results: Lobar collapse was the most common initial radiographic finding. Significant radiographic improvement was observed at 6 hours, with further increase in complete lung re-expansion at 24 hours following bronchoscopy. Conclusion: Flexible fiberoptic bronchoscopy is an effective and safe therapeutic intervention for lung atelectasis in critically ill patients, resulting in significant and sustained radiographic improvement. Keywords: Fiberoptic bronchoscopy, Atelectasis, Intensive care unit, Lung re-expansion.

Background: Autopsy aids to the knowledge of pathology by unveiling the rare lesions which are the source of learning from a perspective. Autopsies are essential for retrospective quality assessment of clinical diagnosis and medical education providing insights into disease pathology and treatment efficacy. Histopathology remains the gold standard for direct morphological and Histological diagnosis. Aim of the study: To study the various histopathological lesions in the organs that are submitted for autopsy evaluation and also to identify the incidental finding in them. Materials and Methods: A retrospective study of 67 cases of autopsy specimen submitted at Dr B R Ambedkar Medical college for a Period of 6 months from May 2022 to oct 2022 Results: In the present study the most age group of autopsies was in the age group of 21-40 years. Atherosclerosis was the most common lesion involved followed by congestion. Few incidental cases of metastasis, silicofibrosis and miliary tuberculosis and intracranial hemorrhage was also noted. Conclusion: This study contributed a handful of finding to the pool of rare lesions in pathology. Autopsy has significant implications for understanding disease mechanism and improving clinical practices. Sudden death due to cardiac lesion was the most common cause of death with atherosclerosis being the most common cause. Keywords: Autopsies, Histopathological spectrum, Incidental findings.

Background: Type 2 diabetes mellitus (T2DM) is a major non-communicable disease with long-term implications extending beyond glycemic control. With increasing life expectancy among individuals with diabetes, assessment of quality of life (QoL) has become an important outcome of diabetes care. Objectives: To assess the quality of life among patients with type 2 diabetes mellitus attending outpatient departments of a tertiary care hospital and to determine its association with selected socio-demographic and clinical factors. Materials and Methods: A hospital-based cross-sectional study was conducted among 91 patients with type 2 diabetes mellitus over a period of three months. Quality of life was assessed using the WHOQOL-BREF questionnaire covering physical, psychological, social, and environmental domains. Domain scores were calculated according to WHO guidelines and categorized as good or poor based on mean values. Associations were tested using the chi-square test. Results: The mean overall QoL score was 57.6. Good quality of life was observed in 54.9% of participants in the physical domain, 58.2% in the psychological domain, 62.6% in the social domain, and 50.5% in the environmental domain. Educational status showed a statistically significant association with physical quality of life (p < 0.05). Conclusion: A substantial proportion of patients with type 2 diabetes mellitus reported satisfactory quality of life. Educational status emerged as an important determinant of physical quality of life, emphasizing the role of patient education in comprehensive diabetes care. Keywords: Type 2 diabetes mellitus; Quality of life; WHOQOL-BREF; Cross-sectional study.

Background: Primary objective of the study: To assess the clinical, functional and radiological outcomes of uncemented total hip arthroplasty performed for failed primary hip replacement. Secondary Objectives of the study: 1. To assess improvement in pain and functional mobility after surgery. 2. To analyse implant stability and osseointegration on follow-up imaging. 3. To determine the incidence of perioperative and postoperative complications. Material and Methods: This prospective study was carried out on 32 patients, who underwent revision total hip arthroplasty in our institute, Sri Balaji Medical College, Hospital & Research Institute, Tirupati from October 2024 to November 2025. Patient follow up was for a minimum of 6 weeks to maximum of 24months. Results: In the present study, about 50% of cases underwent uncemented revision total hip arthroplasty are less than 3years old postoperative case of primary total hip replacement or hemiarthroplasty. In 28 cases modular series was used for uncemented total hip arthroplasty, of which calcar replacement was done in seven cases, one case with only stem revision was done and in one case constrained liner was placed. 90% the patients were satisfied with the outcome of the uncemented total hip arthroplasty and considered their hip to have better function than prior to surgery. The limitation in our study is a relatively short follow-up period and therefore, we could not come to a conclusion about the long term radiological complications of revision total hip arthroplasty. Conclusion: The present study concluded that uncemented revision total hip arthroplasty is the procedure of choice for the patients with failed primary total hip arthroplasty or hemiarthroplasty providing pain relief, preservation of mobility, range of motion and easy rehabilitation. The S-ROM (stability, range of motion) modular prosthesis is the implant of choice for uncemented revision total hip arthroplasty as it provides stability and in growth, as well as the ability to control leg length, offset and version. This study has shown the outcome of the uncemented total hip arthroplasty in failed primary replacement as good to fair results in terms of pain relief, increased walking distance, and functional capabilities of the patients. Keywords: Total hip arthroplasty, S-ROM, modular prosthesis, Pain relief, Mobility.

Background: Spinal anaesthesia induced hypotension (SAIH) is a frequent and important complication of regional anaesthesia, especially in elective caesarian deliveries and major orthopaedic surgery. The mechanism effect is sympathetic blockage, resulting in hemodynamic instability. Objectives: This is a study of the role of Heart Rate Variability (HRV) as a predictive marker of hypotension during spinal and general anaesthesia. Specifically, it addresses the question of if high baseline sympathetic tone or low autonomic reserve is the main predictor of develop hypotension, and to evaluate the role of HRV in the quality of post-operative recovery. Methods and Materials: A thorough systematic search of PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus was performed, which were interested in studies that assessed HRV as a predictor of hypotension during spinal or general anaesthesia. The search was based on prospective observational studies, diagnostic accuracy studies and randomized controlled trials with a focus on HRV parameters such as LF/HF ratio, SDNN, RMSSD and Total Power. Results: A total of 16 studies were included in the analysis based on the inclusion criteria. High baseline sympathetic tone (elevated LF/HF ratio) was found to be a significant predictor of hypotension in spinal anaesthesia. In accordance, low autonomic reserve (low Total Power) was found to predict hypotension in general anaesthesia. Additionally, dynamic monitoring of HRV, postural change and intra-operative, predicted more accurate hypotension than static HRV baselines especially in complex patient populations with comorbidities. Conclusion: HRV is a good predictor of a drop in blood pressure (hypotension) in spinal anaesthesia as well as general anaesthesia, and the risk profile differs according to anaesthesia type. Keywords: Heart Rate Variability, Spinal Anaesthesia, Hypotension, General Anaesthesia, Autonomic Nervous System, Recovery Quality, Predictive Biomarkers.

Background: Adrenal gland tumors are uncommon neoplasms with diverse clinical, biochemical, and histopathological features. Among these, pheochromocytoma and adrenocortical carcinoma represent tumors of medullary and cortical origin respectively, with significant diagnostic and prognostic implications. Aim: To study the clinicopathological and histomorphological features of adrenal gland tumors with emphasis on pheochromocytoma and adrenocortical carcinoma. Materials and Methods: A cross-sectional observational analysis of six cases of adrenal gland tumors received in the Department of Pathology over a period of 2 years was performed. Clinical details, radiological findings, gross morphology, histopathology, and immunohistochemistry (where available) were reviewed. Results: Of the six cases, four were diagnosed as pheochromocytoma and two as adrenocortical carcinoma. Pheochromocytomas showed characteristic Zellballen architecture, while adrenocortical carcinomas exhibited features of malignancy as per Weiss criteria. Conclusion: Histopathological examination remains the gold standard for definitive diagnosis of adrenal tumors. Recognition of characteristic morphological features is essential for accurate classification and prognostication. Keywords: Adrenal gland tumors, Pheochromocytoma, Adrenocortical carcinoma, Weiss criteria, Case series.

Background: Antinuclear antibodies (ANAs) are key serological markers in connective tissue disorders (CTDs). Indirect immunofluorescence assay (IIFA) on HEp-20-10 cells remains widely used because it provides both ANA positivity and clinically informative staining patterns. The objective is to determine the prevalence of ANA positivity by IIFA on HEp-20-10 cells in patients with clinically suspected CTDs at a tertiary care center in Western India and to describe the spectrum of ANA patterns and end-point titers. Materials and Methods: This observational cross-sectional study was conducted over nine months at a tertiary care center in Pune, India. Consecutive patients with clinical suspicion of CTDs for whom ANA testing was ordered were included (N = 226). ANA testing was performed by IIFA on HEp-20-10 cells. Patterns were classified as per International Consensus on ANA Patterns (ICAP), and positive samples underwent serial dilutions to determine end-point titers. Descriptive statistics were reported with 95% confidence intervals (CI). Results: Of 226 patients, 134 were ANA positive (59.29%; 95% CI, 52.78–65.49) and 92 were ANA negative (40.71%; 95% CI, 34.51–47.22). Fever (32.74%), generalized weakness (26.99%), breathlessness (19.47%), and joint swelling (15.04%) were the most frequent presenting symptoms. Among ANA-positive patients, nuclear-only staining occurred in 62.69%, cytoplasmic-only in 16.42%, and combined nuclear–cytoplasmic staining in 20.90%. The most common ICAP patterns were nuclear speckled coarse (AC-5; 42.54%) and nuclear speckled fine (AC-4; 31.34%); cytoplasmic reticular/AMA (AC-21) was observed in 26.12%. Most reactivities occurred at a titer of 1:100. Conclusion: ANA positivity by IIFA was common among patients with suspected CTDs. Nuclear speckled patterns predominated, and cytoplasmic patterns were also frequent, supporting the utility of IIFA pattern interpretation and titer reporting in routine CTD evaluation. Keywords: Antinuclear antibodies, Indirect immunofluorescence assay, HEp-20-10 cells, Connective tissue disorders, ICAP patterns.

Background: River Ganga pollution in Varanasi coincides with intense human–water contact at ghats, potentially increasing exposure to microbial contamination and related morbidity, while community perceptions and constraints may sustain risky practices. The objective is to assess health impacts associated with ghat-related exposure, characterize household WASH vulnerabilities, measure site-level water quality indicators, and explore community perceptions driving continued river contact. Materials and Methods: A convergent mixed-methods study was conducted in Varanasi across pre- and post-monsoon periods. A community-based cross-sectional survey (N=634) measured exposure patterns, WASH conditions, risk perception, and self-reported water-related morbidity (2–4-week recall), alongside concurrent ghat water sampling for fecal indicator and physicochemical parameters. Qualitative data were collected via in-depth interviews and focus group discussions (N=87) and analyzed using reflexive thematic analysis; quantitative and qualitative findings were integrated using joint displays. Results: Any water-related morbidity was reported by 242/634 (38.2%). Frequent ghat contact and WASH vulnerabilities were associated with morbidity: daily ghat contact (aOR 2.45; 95% CI 1.58–3.79), occupational exposure (aOR 1.71; 95% CI 1.15–2.55), unimproved/open sanitation (aOR 1.96; 95% CI 1.34–2.86), and no household water treatment (aOR 1.42; 95% CI 1.01–2.00). Post-monsoon season showed modestly higher odds (aOR 1.38; 95% CI 1.00–1.90). Water sampling indicated elevated fecal contamination and higher microbial contamination post-monsoon. Qualitative themes highlighted religio-cultural obligation, livelihood dependence, visible pollution cues, mixed trust in governance, and constraint-driven risk negotiation sustaining exposure despite awareness. Conclusion: River-contact intensity and household WASH deficits jointly shaped morbidity risk, while structural and cultural constraints sustained exposure. Interventions should integrate pollution control with ghat-level sanitation services, feasible household protection, and context-sensitive risk communication. Keywords: Ganga; Varanasi; water pollution; water-related morbidity; mixed-methods.

Background: Diabetes care in out-of-pocket (OOP) dominant settings can create financial distress, disrupt care-seeking, and precipitate cost-related nonadherence. This mixed-methods study explored how costs shape lived experiences and coping among adults with diabetes in Puducherry. Materials and Methods: A sequential explanatory mixed-methods design was used (Phase I: community-based cross-sectional component; Phase II: qualitative in-depth interviews). Phase II was conducted in one urban and one rural PHC field-practice area using purposive sampling. Ten adults with diabetes (5 urban/5 rural; age 38–68 years; 7 men; diabetes duration 5–20 years) participated in Tamil interviews lasting ~30–40 minutes. Interviews were audio-recorded, transcribed verbatim, back-translated, participant-validated, and analysed using manual qualitative content analysis to thematic saturation. Results: Four themes emerged: (1) Domains of economic burden—direct costs (medicines, tests, consultations, travel) constrained continuity and reduced investigation frequency; indirect/intangible costs included productivity loss and psychosocial impacts. (2) Interplay of factors—income loss and limited insurance reinforced OOP stress; participants reported cost-related nonadherence (dose reduction/skipping). (3) Cost escalators—public-sector access barriers and complication-related referrals increased spending and opportunity costs. (4) Coping strategies—borrowing, pledging/selling assets, relying on family labour, and occasional traditional remedies/treatment modification. Conclusion: Adults with diabetes described medicine and investigation costs as a pervasive burden that can drive nonadherence and financially damaging coping. Strengthening primary care delivery and financial risk protection may reduce avoidable hardship. Keywords: Diabetes mellitus, Economic burden, Out-of-pocket expenditure, Cost-related nonadherence, Coping strategies.

Full-thickness rectal prolapse is a distressing condition, especially in elderly or comorbid patients. Delorme’s procedure—a perineal approach involving mucosal sleeve resection with muscular plication—offers a minimally invasive solution for short-segment prolapse. It is particularly suitable for patients unfit for abdominal surgery due to its lower physiological impact. This case series presents three patients with full-thickness rectal prolapse treated with Delorme’s procedure at our tertiary care center. One patient had significant comorbidities (ASA II) and underwent the standard technique of circumferential mucosal resection followed by rectal muscle plication. Postoperative outcomes were favorable: all patients had uneventful recoveries, resumed oral intake early, and were discharged within 3-4 days. No operative complications, recurrence, or new functional impairments were observed during 1-3 years of follow-up. One patient reported subjective improvement in fecal incontinence. None developed anal stenosis, fecal impaction, or sexual dysfunction. These findings support the role of Delorme’s procedure as a safe and effective surgical option for short-segment rectal prolapse in elderly or high-risk patients. Our experience aligns with existing literature highlighting its durability, minimal morbidity, and suitability when abdominal approaches are contraindicated. Proper patient selection and surgical technique are key to achieving optimal outcomes. Keywords: Rectal prolapse, Delorme’s procedure, Perineal surgery, Full- thickness prolapse, Fecal incontinence

Background: Extubation often induces significant sympathetic activation, leading to tachycardia, hypertension, coughing, and agitation, which can be harmful, especially in patients having laparoscopic procedures. Dexmedetomidine, a highly selective α2-adrenergic agonist, has demonstrated the ability to mitigate stress responses during airway manipulation without inducing considerable respiratory depression. The ideal dosage necessary to effectively mitigate the extubation reaction while reducing unwanted effects is yet uncertain. Aims: The present study aimed to compare the effectiveness of three different doses of dexmedetomidine in attenuating extubation response and associated hemodynamic changes in patients undergoing elective laparoscopic surgeries under general anesthesia. Materials and Methods: This prospective, randomized, double-blind comparative study was conducted over a period of 10 months in a tertiary care teaching hospital. A total of 105 adult patients scheduled for elective laparoscopic surgeries under general anesthesia, were included. Patients were randomly allocated into three equal groups (n = 35 each). Group A received dexmedetomidine 0.5 μg/kg, Group B received dexmedetomidine 0.75 μg/kg, and Group C received dexmedetomidine 1 μg/kg, each diluted to 10 ml and administered as an intravenous infusion over 10 minutes, starting 10 minutes prior to extubation. Hemodynamic parameters were recorded at baseline, before infusion, at extubation, and at predefined intervals after extubation. The quality of extubation was assessed using a standardized extubation response scale. Sedation level, recovery characteristics, and adverse effects were also recorded. Results: The demographic features and surgical duration were similar across the three groups. All doses of dexmedetomidine significantly reduced the extubation response relative to baseline values. Group C (1 μg/kg) exhibited the most pronounced reduction in heart rate and blood pressure responses during and post-extubation, succeeded by Group B (0.75 μg/kg), while Group A (0.5 μg/kg) shown relatively weaker attenuation. The extubation quality was markedly more seamless in Groups B and C, characterized by less coughing and agitation. Group C had elevated sedation levels, although recovery was deemed good across all groups. Conclusion: Administering dexmedetomidine prior to extubation significantly mitigates hemodynamic and airway reactions during laparoscopic surgeries. A dosage of 0.75 μg/kg provides maximum effectiveness with minimum side effects, rendering it appropriate for regular clinical application. Keywords: α2-agonist, Dexmedetomidine, Extubation response, General anesthesia, Hemodynamic stability, Laparoscopic surgeries.

Background: Anemia in adult males is an important yet often underdiagnosed clinical condition that may indicate underlying nutritional deficiencies, chronic diseases, or occult blood loss. Unlike women and children, anemia in males is less frequently screened, leading to delayed diagnosis and increased morbidity. Understanding the clinical presentation, laboratory characteristics, and etiological patterns of anemia in adult males is essential for timely diagnosis and targeted management. Aim: To evaluate the clinical presentation and laboratory profile of anemia in adult male patients and to identify common etiological and morphological patterns. Materials and Methods: This hospital-based observational cross-sectional study was conducted in the Department of General Medicine at a tertiary care hospital in Ahmedabad over a period of two years (January 2023 to January 2025). A total of 108 adult male patients aged ≥18 years with hemoglobin levels <13 g/dL were included. Comprehensive laboratory tests, including complete blood counts, peripheral smears, iron studies, vitamin B12 and folate levels, inflammatory indicators, and pertinent imaging, were carried out in addition to a thorough clinical examination, socioeconomic assessment, and lifestyle evaluation. Anaemia was categorised according to its aetiology, morphology, and severity. Descriptive and inferential statistical techniques were used, and a p-value of less than 0.05 was deemed significant. Results: The mean age of patients was 54.8 ± 17.36 years, with the highest prevalence in the 51–70-year age group. Moderate anemia (52.78%) was most common, followed by severe anemia (41.67%). Nutritional anemia was the predominant etiology (75%), with iron deficiency being the most frequent cause (49.07%). Normocytic normochromic and microcytic hypochromic anemia were the most common morphological patterns (38% each). Significant associations were observed between anemia severity and socioeconomic status, inflammatory markers, gastrointestinal blood loss, and addiction history. Conclusion: Anemia in adult males is predominantly nutritional and multifactorial, commonly presenting at moderate to severe stages. Early detection, etiological evaluation, and addressing nutritional, inflammatory, and lifestyle factors are essential to reduce disease burden. Keywords: Anemia; Adult males; Iron deficiency anemia; Morphological classification; Etiological profile; Nutritional anemia.

Background: Indians outstand in the prevalence of both vitamin D deficiency and diabetes. Studies have shown that the vitamin D level is inversely proportional to the level of FBS and HbA1c. Type II diabetics have lower vitamin D levels than healthy people. The objective of the study is to find out prevalence of vitamin D deficiency in diabetic persons and then to find out if there is any correlation between serum vitamin D levels with FBS, HbA1c, insulin and insulin resistance. Materials and Methods: This study was a hospital based cross sectional study. A total of 85 participants having type II DM aged 35-75 years were recruited from OPD patients attending Non-Communicable Disease (NCD) clinic. Estimation of serum levels of 25-(OH) vitamin D with FBS, HbA1C, insulin levels and HOMA-IR in type II DM patients was done to find out the correlation. Results: Mean BMI was found to be higher in females compared to males. Mean FBS and HbA1c were found higher than standard reference range in all study participants. HOMA-IR value was found to be higher indicating insulin resistance across overall study population. It was noted that 25(OH) vitamin D levels were significantly reduced compared to normal standard range. Conclusion: Negative correlation between vitamin D with FBS and HbA1c levels was observed. Therefore, lower the vitamin D levels higher will be the levels of FBS & HbA1c. Hence, vitamin D supplementation should be considered in patients with type 2 diabetes for better glycemic control. Keywords: Type II Diabetes, Vitamin D, Correlation, Glycemic control.

Background: Tuberculosis (TB) is a considerable worldwide health concern, particularly in underdeveloped nations. Globally in 2024, there were an estimated 1.08 million TB deaths among HIV-negative people (95% uncertainty interval [UI]: 0.99–1.18 million) and an estimated 1,50,000 TB deaths among people with HIV (95% UI: 1,20, 000–1,83, 000)1. A significant percentage of tuberculosis cases are sputum-negative, challenging diagnosis and delays suitable treatment. BAL fluid analysis serves as a crucial diagnostic instrument when sputum samples are inadequate or consistently negative for acid-fast bacilli (AFB). Aims and Objectives: Aim of the study is to study the efficacy of bronchoalveolar lavage Adenosine Deaminase Levels, and CBNAAT in presumptive pulmonary tuberculosis patients. Materials and Methods: The study was an Observational study, done at Government Hospital for Chest and Communicable Diseases, Visakhapatnam, over a period of 1year i.e November 2024 to October 2025. Study population includes Patients attended the Pulmonary Medicine department with symptoms of presumptive Pulmonary Tuberculosis. The Broncho alveolar lavage fluid was dispatched to the laboratory for liquid culture, ADA determination, and CBNAAT, while diagnostic investigations of BAL fluid and other specimens were submitted for examination based on clinical suspicion. Upon obtaining the analysis results, each test variable was compared with one another, leading to the formulation of conclusions. ADA cut off was obtained by using receiver operator curve. The liquid culture of Mycobacterium tuberculosis was utilized as the gold standard test. Results: A significant association was found between ADA levels and culture results. CBNAAT showed strong concordance with culture results, supporting its diagnostic utility. Conclusion: Our study concluded that the combination of BAL ADA + CBNAAT increases diagnostic confidence in smear-negative PTB and also early initiation of ATT without waiting for culture results. Keywords: Tuberculosis, CBNAAT, Adenosine De Aminase

Background: Percutaneous nephrolithotomy (PCNL) is the standard treatment for large and complex renal calculi. Conventional PCNL involves nephrostomy tube placement, which may contribute to postoperative pain, prolonged hospital stay, and delayed recovery. Tubeless PCNL has emerged as a modified technique aimed at reducing postoperative morbidity while maintaining surgical efficacy. Objectives: To compare postoperative outcomes between tubeless and standard PCNL, with emphasis on pain, perioperative parameters, recovery outcomes, and complication rates. Materials and Methods: This prospective comparative study included 54 patients undergoing PCNL, divided into two equal groups: standard PCNL (n=27) and tubeless PCNL (n=27). Demographic, operative, perioperative, and postoperative parameters were recorded. Outcomes assessed included operative duration, postoperative pain (VAS score), analgesic requirement, hemoglobin drop, hospital stay, complications, return to normal activity, and need for ancillary procedures. Statistical analysis was performed using appropriate parametric and non-parametric tests, with a p-value <0.05 considered statistically significant. Results: The tubeless PCNL group demonstrated significantly shorter operative time (67.41 ± 18.75 vs 87.70 ± 16.09 minutes; p<0.01), reduced hospital stay (3.54 ± 1.44 vs 5.40 ± 1.56 days; p<0.01), lower postoperative pain scores (4.26 ± 1.43 vs 6.22 ± 1.09; p<0.01), and decreased analgesic requirement (85.19 ± 58.53 mg vs 122.22 ± 34.90 mg; p<0.01). Time to return to normal activity was also significantly shorter in the tubeless group (4.82 ± 1.27 vs 7.44 ± 2.24 days; p<0.01). Perioperative hemoglobin drop, blood transfusion requirement, postoperative fever, bleeding, urinary leakage, and ancillary procedure rates were comparable between the two groups. Conclusion: Tubeless PCNL offers significant advantages in postoperative recovery and patient comfort without increasing complication rates. It represents a safe and effective alternative to standard PCNL in selected uncomplicated renal stone cases. Keywords: Percutaneous nephrolithotomy (PCNL). Tubeless PCNL. Postoperative outcomes.

Background: Smartphone addiction is increasingly prevalent among college students. Academic demands, social networking, and entertainment-oriented smartphone use make this population particularly vulnerable. Excessive smartphone use has been associated with adverse effects on mental health and sleep quality. Objectives: To estimate the prevalence of smartphone addiction and examine its association with mental health status and sleep quality among college students. Materials and Methods: A cross-sectional study was conducted among 150 undergraduate college students using stratified random sampling. The Smartphone Addiction Scale–Short Version (SAS-SV), Depression Anxiety Stress Scale-21 (DASS-21), and Pittsburgh Sleep Quality Index (PSQI) were administered. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression. Results: The prevalence of smartphone addiction was 46.7% (n=70). Students with smartphone addiction had significantly higher odds of depression (OR=2.4, 95% CI: 1.2–4.9), anxiety (OR=2.1, 95% CI: 1.1–3.9), and poor sleep quality (OR=3.0, 95% CI: 1.5–5.9) compared to non-addicted peers. Mean PSQI score was significantly higher among addicted students (7.2±2.9) than non-addicted students (4.8±2.2; p<0.001). Conclusion: Nearly half of the college students were found to be addicted to smartphones. Smartphone addiction was significantly associated with poor mental health and impaired sleep quality. Early interventions such as digital literacy programs, counseling services, and promotion of healthy sleep practices are recommended in college settings. Keywords: Smartphone addiction, College students, Mental health, Sleep quality, Cross-sectional study.

Background: Tubal reversal remains an important fertility-restoring option for women following tubal sterilization. Surgical success is influenced by multiple factors, including postoperative tubal length, anastomotic site, and surgeon experience. With increasing use of minimally invasive techniques, evaluation of outcomes following laparoscopic tubal reversal is essential. Objective: To assess reproductive and perioperative outcomes following laparoscopic tubal reversal and to evaluate the impact of postoperative tubal length, anastomotic site, and surgeon experience on clinical pregnancy rates. Materials and Methods: This single-center cohort study included 720 women who underwent laparoscopic tubal reversal between January 2022 and October 2025. All procedures were performed using a standardized laparoscopic single-layer, full-thickness Tubo tubal anastomosis with four equidistant sutures using 5-0 or 6-0 polypropylene round-body sutures. Tubal patency was confirmed intraoperatively by photoperturbation with methylene blue. The primary outcome was clinical intrauterine pregnancy within 12 months of surgery. Secondary outcomes included live birth, ectopic pregnancy, time-to-pregnancy, and perioperative parameters. Multivariable logistic regression and Cox proportional hazards models were used to identify factors associated with pregnancy outcomes. Results: Clinical intrauterine pregnancy was achieved in 55.8% of patients within 12 months of surgery. Postoperative tubal length ≥7 cm was independently associated with higher pregnancy rates. Isthmic–isthmic anastomosis demonstrated the most favorable reproductive outcomes, while cornual anastomosis was associated with lower pregnancy rates and a higher incidence of ectopic pregnancy. Increased surgeon experience was significantly associated with improved pregnancy outcomes and reduced complication rates. Laparoscopic tubal reversal demonstrated acceptable perioperative outcomes with minimal morbidity. Conclusion: Laparoscopic tubal reversal using standardized microsurgical principles yields favourable reproductive outcomes. Postoperative tubal length, anastomotic site, and surgeon experience are key determinants of success. When performed by experienced surgeons, laparoscopic tubal reversal represents an effective fertility-restoring option with the benefits of minimally invasive surgery. Keywords: Tubal reversal; Laparoscopic tubal anastomosis; Tubo tubal anastomosis; Postoperative tubal length; Anastomotic site; Fertility surgery.

Background: Intestinal obstruction represents a common surgical emergency requiring prompt and accurate diagnosis for optimal patient management. While spiral computed tomography (CT) is considered the gold standard imaging modality, ultrasonography offers advantages in terms of accessibility, cost-effectiveness, and radiation avoidance. Comparative data regarding diagnostic performance and practicability between these modalities in Indian healthcare settings remain limited. Material and Methods: A prospective diagnostic accuracy study was conducted at Bharti Hospital, Pune, involving 100 patients presenting with clinically suspected intestinal obstruction between June 2023-June 2025. All patients underwent both abdominal ultrasonography and spiral CT examination. Diagnostic accuracy parameters and practicability indices were evaluated and compared between modalities. Results: Among 100 patients (mean age: 48.6 ± 16.4 years; 62% male), intestinal obstruction was confirmed in 84 cases. Spiral CT demonstrated significantly higher sensitivity (95.2% vs. 78.6%; p=0.002), specificity (93.8% vs. 81.3%; p=0.038), and overall accuracy (94.0% vs. 79.0%; p=0.001) compared to ultrasonography. CT showed superior performance in determining obstruction etiology (88.1% vs. 61.9%; p<0.001) and level (92.9% vs. 71.4%; p<0.001). However, ultrasonography demonstrated advantages in mean examination time (12.4 ± 3.2 vs. 18.6 ± 4.8 minutes; p<0.001), cost (₹850 ± 120 vs. ₹3,200 ± 450; p<0.001), and immediate bedside availability. Conclusion: Spiral CT demonstrates superior diagnostic accuracy for intestinal obstruction compared to ultrasonography. However, ultrasonography remains a valuable initial screening tool due to its practicability advantages, particularly in resource-limited settings and for unstable patients. Keywords: Intestinal obstruction, spiral computed tomography, ultrasonography, diagnostic accuracy, bowel obstruction, acute abdomen

Background: Aim: Genitofemoral neuralgia is neurological pain observed in both men and women, presented with lower abdominal pain, mostly unilateral, due to nerve entrapment at its origin or along their course in the abdomen or in the inguinal canal. Knowledge about genitofemoral nerve helps orthopaedic surgeons, laparoscopic surgeon, general surgeon and for urologist to avoid injury to the genitofemoral nerve and thereby preventing surgical applied aspects of genitofemoral nerve. Materials and Methods: 25 embalmed cadavers preserved in formalin were utilized for present study. Transperitoneal approach method was applied to dissect the genitofemoral nerve on both sides of the cadaver and anatomical variations in its origin was tabulated. Results: In four cadaveric specimens,the genitofemoral nerve arose from ventral rami of first and second lumbar spinal nerve, within the substance of psoas major muscle, shown the higher division and the nerve divides at origin level as genital and femoral nerve. Conclusion: This study guide the clinicians to diagnose the genitofemoral neuralgia and helps the surgeons to preserve the genitofemoral nerve during any abdominal and pelvic surgical procedures. Keywords: genitofemoral nerve, genitofemoral neuralgia, lumbar spinal nerve, psoas major muscle, higher division, anatomical variation.

Background: Type 2 diabetes mellitus (T2DM) is associated with various cardiovascular complications, among which left ventricular diastolic dysfunction (LVDD) is an early and often asymptomatic manifestation. Early detection of LVDD may help in preventing progression to overt heart failure. Glycemic control, reflected by HbA1C levels, is believed to play a significant role in the development of diabetic cardiomyopathy. The objective is to determine the incidence of left ventricular diastolic dysfunction in newly diagnosed type 2 diabetes mellitus patients and to evaluate the correlation between LVDD and HbA1C levels. Materials and Methods: This hospital-based prospective observational study was conducted at BARC Hospital, Mumbai, among patients attending dispensaries, medical outpatient departments, and inpatient wards. A total of 110 newly diagnosed T2DM patients were included. Demographic data, anthropometric measurements, biochemical parameters, and echocardiographic findings were recorded. LVDD was assessed using standard echocardiographic criteria. Statistical analysis was performed to evaluate associations between LVDD and clinical as well as biochemical parameters. Results: The mean age of participants was 56.9 ± 12.6 years, with a male predominance (57.3%). The mean BMI was 25.6 ± 2.6 kg/m². LVDD was observed in 53 patients (48.2%). No statistically significant association was found between LVDD and age or gender. However, LVDD showed a significant association with higher fasting blood sugar, postprandial blood sugar, HbA1C levels, microalbuminuria, total cholesterol, and triglycerides. The diagnostic accuracy of HbA1C for predicting LVDD was 92.2%, which was statistically significant. Conclusion: Nearly half of newly diagnosed type 2 diabetes patients had LVDD. Poor glycemic control, as indicated by elevated HbA1C, was strongly associated with LVDD, highlighting the importance of early cardiovascular evaluation and strict glycemic control in newly diagnosed T2DM patients. Keywords: Diabetes mellitus (DM), T2DM, LVDD.

Background: Pancreatic cancer is the fourth leading cause of cancer-related death, with poor survival, making accurate diagnosis essential. EUS-guided FNA has been the standard for tissue acquisition since the 1990s, but limitations include insufficient cytology for lesions requiring preserved architecture, multiple passes, and variable impact of ROSE. Second-generation EUS-FNB needles provide larger core samples with better histological yield, potentially reducing dependence on ROSE, though comparative data with FNA remain variable. Materials and Methods: This retrospective study included all consecutive patients aged ≥18 years who underwent EUS-guided tissue acquisition for solid pancreatic lesions between June 2019 and June 2025. Data were obtained from institutional registries and medical records, including demographics, lesion characteristics, needle type and gauge, access route, number of passes, use of ROSE, cytological/histological adequacy, and clinical follow-up. The primary outcome was diagnostic accuracy; secondary outcomes included sample adequacy, number of passes, ROSE utility, and procedure-related adverse events. Results: In this study of 120 patients with solid pancreatic lesions, 60 underwent EUS-FNA and 60 EUS-FNB, with rapid on-site evaluation (ROSE) performed in 45 cases (37.5%). The mean age was 59.4 ± 10.8 years, and the male-to-female ratio was 1.6:1. Lesions were most commonly located in the pancreatic head (43%) with a mean size of 34.6 ± 11.8 mm; 72% were hypoechoic and 65% heterogeneous. FNA with ROSE achieved the highest sample adequacy (100%) compared with FNB (98%) and FNA without ROSE (88%; p = 0.02), with diagnostic accuracy also highest for FNA plus ROSE (95%). Pancreatic ductal adenocarcinoma (PDAC) was the most frequent diagnosis (70%), predominantly in the head/uncinate (58%), and adequacy for PDAC reached 100% with FNA plus ROSE. Mean needle passes were lowest with FNA plus ROSE (2.0 ± 0.6), reflecting procedural efficiency. Procedure-related adverse events were mild and occurred in 5% of FNA with ROSE and 10% of FNB cases, with no severe complications or mortality. Conclusion: FNA performed with rapid on-site evaluation (ROSE) demonstrated superior performance across all evaluated parameters, achieving a 100% sample adequacy, compared with 98% for FNB. The real-time cytopathological feedback provided by ROSE enabled more precise targeting and minimized unnecessary needle passes, ensuring consistently optimal tissue acquisition. FNA with ROSE also delivered highly reliable diagnostic material for solid pancreatic lesions, including pancreatic ductal adenocarcinoma (PDAC), with specimens suitable for accurate cytological interpretation and ancillary testing. These findings reinforce that FNA with ROSE remains the most effective and dependable diagnostic approach, outperforming FNB even in contexts where larger core samples are traditionally considered advantageous. Keywords: Endoscopic Ultrasound (EUS), Fine-Needle Biopsy (FNB) Fine-Needle Aspiration (FNA).

Background: Ventilator-associated pneumonia (VAP) is one of the most common healthcare-associated infections in intensive care units (ICUs), significantly contributing to morbidity, mortality, and increased healthcare costs. Identification of its prevalence and associated determinants is essential for effective prevention strategies. Aim: To determine the prevalence and identify determinants of ventilator-associated pneumonia among mechanically ventilated ICU patients. Materials and Methods: A hospital-based cross-sectional study was conducted among 200 mechanically ventilated ICU patients over an 18-month period. Patients ventilated for ≥48 hours were included. Clinical, demographic, and microbiological data were collected using a structured proforma. VAP was diagnosed based on clinical, radiological, and microbiological criteria. Statistical analysis was performed using SPSS version 25. Chi-square test, independent t-test, and multivariate logistic regression were applied. A p-value <0.05 was considered statistically significant. Results: The prevalence of VAP was 31.5% (95% CI: 25.3–38.2). Patients with VAP were significantly older and had longer durations of mechanical ventilation and ICU stay (p<0.001). Diabetes mellitus, prior antibiotic use, re-intubation, prolonged sedation, and supine positioning were significantly associated with VAP. Multivariate analysis identified prolonged ventilation (AOR 2.46, p<0.001) and sedation >5 days (AOR 1.92, p=0.024) as independent determinants. Gram-negative organisms, particularly Acinetobacter baumannii (33.3%) and Pseudomonas aeruginosa (25.4%), predominated. Multidrug resistance was observed in 58.7% of isolates. Mortality among VAP patients was 34.9% and was significantly higher compared to non-VAP patients (p=0.012). Conclusion: VAP remains a prevalent and serious complication in mechanically ventilated ICU patients. Prolonged ventilation and sedation are key modifiable risk factors. Strengthening infection control practices and ventilator care bundle adherence is essential to reduce the burden of VAP. Keywords: Ventilator-associated pneumonia; Mechanical ventilation; ICU infection; Risk factors.

Background: An ideal academic environment may be defined as one that best prepares students for their future professional life and contributes towards their personal and psychosomatic development along with social well-being as well. A learning environment study is one way to improve the quality of an education programme. Materials and Methods: A cross sectional study was conducted among first year MBBS and B.Sc. Nursing students in a Medical college in Firozabad between June and July 2025 using DREEM questionnaire. Data was analyzed in the form of percentages. Results: More than half (57.7%) of the total participants perception of learning environment was more positive than negative with overall DREEM score of 135.8+26.83. Student’s perception of learning was more positive with mean score of 33.3+6.10 followed by students’ perception of institute’s with a mean score of 32.6. Conclusion: MBBS students perception of learning and social self perception score was more higher than BSc Nursing students. Keywords: Learning Environment, MBBS students, B.Sc Nursing Students, DREEM Score.

Background: Extra-articular distal femur fractures are challenging orthopedic injuries that require stable fixation to enable early mobilization and functional recovery. While locking compression plates (LCP) and distal femoral nails (DFN) are both widely used surgical options, there remains ongoing debate regarding their relative efficacy in terms of clinical and radiological outcomes. Aim: To compare the functional, radiological, and rehabilitative outcomes of retrograde intramedullary nailing versus locking plate fixation in the treatment of extra-articular distal femur fractures. Materials and Methods: This prospective observational study was conducted at the Department of Orthopaedics, J.A. Group of Hospitals, Gwalior. A total of 40 adult patients with AO type 33-A distal femur fractures were randomly assigned to receive either retrograde intramedullary nailing (DFN, n=20) or distal femoral locking plate fixation (LCP, n=20). Patients were followed for 12 months postoperatively. Outcome measures included knee flexion, time to full weight-bearing, Neer score, total anatomical score, and complication profile. Statistical comparisons were made using Student’s t-test and chi-square test. Results: The DFN group demonstrated significantly shorter operative time (76.1 ± 7.8 vs 105.4 ± 9.9 minutes; p<0.001) and earlier weight-bearing (16.6 ± 3.6 vs 26.1 ± 3.8 weeks; p<0.001). DFN also showed superior knee flexion (17.6 ± 2.4 vs 12.6 ± 4.0; p<0.001), higher Neer scores (83.1 ± 11.3 vs 73.7 ± 16.2; p=0.012), and better anatomical alignment. While complication rates were comparable, DFN patients experienced better outcomes even in the presence of complications. Conclusion: Retrograde intramedullary nailing offers superior functional and radiological outcomes compared to locking plate fixation in extra-articular distal femur fractures, with the added advantages of earlier rehabilitation and greater complication resilience. It should be considered the preferred technique when anatomically and clinically appropriate. Keywords: Distal femur fracture; retrograde intramedullary nailing; locking compression plate; functional outcome; orthopedic fixation.

Background: Cardiovascular disease is the leading cause of mortality in patients with chronic kidney disease (CKD) undergoing maintenance hemodialysis. Prolongation of corrected QT (QTc) interval and increased QTc dispersion are established markers of ventricular repolarization abnormalities and predictors of malignant arrhythmias. Hemodialysis-induced electrolyte shifts may further influence ventricular repolarization. Aim: To determine the effects of hemodialysis on corrected QT interval and QTc dispersion in CKD patients without clinically manifest heart disease. Materials and Methods: This prospective observational study included 125 stable CKD patients on maintenance hemodialysis for ≥3 months. Patients with structural heart disease, arrhythmias, or drugs affecting QT interval were excluded. Twelve-lead ECGs and serum electrolytes (calcium, potassium, and magnesium) were measured before and after hemodialysis. QTc was calculated using Bazett’s formula. Statistical analysis was performed using SPSS v25. Paired t-test and Pearson correlation were applied. P <0.05 was considered significant. Results: Post-dialysis, serum potassium significantly decreased while serum calcium significantly increased (p<0.001). QTc minimum and QTc maximum showed significant prolongation after hemodialysis (p<0.05). QTc dispersion increased numerically but was not statistically significant. Pre-dialysis QTc dispersion correlated significantly with serum potassium and hemoglobin levels. Conclusion: Hemodialysis significantly influences ventricular repolarization, particularly QTc minimum and QTc maximum, potentially increasing arrhythmic risk. Electrolyte shifts, especially potassium changes, play an important role in QT dynamics. Keywords: Chronic kidney disease, Hemodialysis, QTc interval, QTc dispersion, Electrolytes, Ventricular arrhythmia.

Background: Spinopelvic mobility plays a critical role in determining functional acetabular orientation during postural changes and has important implications for biomechanics following total hip arthroplasty (THA). Abnormal spinopelvic motion may influence early functional recovery and postoperative stability; however, prospective data evaluating its impact on functional outcomes remain limited. Objective: To evaluate the effect of preoperative spinopelvic mobility on early functional outcomes following primary total hip arthroplasty. Materials and Methods: This prospective single-center observational study included 50 consecutive patients undergoing primary total hip arthroplasty between March 2025 and August 2025. Preoperative spinopelvic mobility was assessed using standing and seated lateral radiographs, with mobility quantified by the change in sacral slope (ΔSS). Patients were classified as stiff (ΔSS < 10°), normal (ΔSS 10°–30°), or hypermobile (ΔSS > 30°). Functional outcomes were assessed using the Harris Hip Score (HHS) and visual analog scale (VAS) for pain preoperatively and at 4 months postoperatively. The primary outcome was improvement in HHS at 4 months. Secondary outcomes included postoperative instability and complications. Results: Among the 50 patients, 28 (56%) demonstrated normal spinopelvic mobility, 12 (24%) had stiff mobility, and 10 (20%) were hypermobile. Mean HHS improved from 45.6 ± 7.8 preoperatively to 85.1 ± 7.9 at 4 months. Patients with normal spinopelvic mobility showed significantly greater functional improvement compared with those with stiff or hypermobile mobility (p = 0.004). Stiff spinopelvic mobility was independently associated with reduced functional improvement after adjustment for demographic and clinical variables (p = 0.007). Hip dislocation occurred in 2 patients (4%), both in the abnormal mobility groups. Conclusion: Preoperative spinopelvic mobility is significantly associated with early functional outcomes following total hip arthroplasty. Routine assessment of spinopelvic motion may help identify patients at risk for suboptimal early recovery and postoperative instability, thereby aiding surgical planning and patient counseling. Keywords: Total hip arthroplasty; spinopelvic mobility; sacral slope; pelvic tilt; functional outcomes; prospective study.

Background: Tonsillectomy is a common ENT procedure for recurrent tonsillitis, sleep-disordered breathing, and obstructive sleep apnoea. Coblation tonsillectomy uses controlled radiofrequency energy at relatively low temperatures, potentially reducing thermal tissue damage and postoperative morbidity. This study evaluated postoperative outcomes following coblation-assisted tonsillectomy. Materials and Methods: This retrospective study was conducted at the Department of ENT, SVIMS–Sri Padmavathi Medical College for Women, Tirupati, between January 2018 and March 2022. Forty-five patients aged 5–35 years undergoing coblation tonsillectomy were included. Postoperative pain was assessed using the Wong-Baker FACES Pain Rating Scale, and quality of life using the Tonsillectomy Outcome Inventory-14 (TOI-14). Patients were followed for six months. Data were analysed using SPSS version 20. Results: Among 45 patients, 57.7% were males and 77.8% were paediatric. Mean operative time was 15.8 ± 4.5 minutes. Mean pain score reduced from 5.58 ± 1.2 on postoperative day one to 2.73 ± 0.8 at one week. No primary, reactionary, or secondary haemorrhage occurred. Mean time to resume normal diet and routine activities was 5.44 ± 1.5 and 6.1 ± 1.7 days. TOI-14 scores improved significantly at 1, 3, and 6 months (p < 0.0001). Conclusion: Coblation tonsillectomy is safe, effective, and provides faster recovery, less postoperative pain, and significant quality-of-life improvement overall. Keywords: Coblation, tonsillitis, tonsillectomy, adenotonsillectomy

Background: Oxidative stress, resulting from an imbalance between reactive oxygen species and antioxidant defense mechanisms, plays a crucial role in the pathogenesis of chronic non‑communicable diseases such as essential hypertension. Objective: To assess association of oxidative stress with antioxidant defense status in patients with essential hypertension and compare them with healthy controls. Materials and Methods: A cross‑sectional study included 120 subjects aged 35–60 years, divided into controls (n=60) and more than 5 years’ duration of essential hypertension patients (n=60). Serum malondialdehyde (MDA) was estimated as a marker of lipid peroxidation. Antioxidant defense was assessed by measuring superoxide dismutase (SOD), catalase, and reduced glutathione (GSH) using standard biochemical methods. Results: Hypertensive patients showed significantly higher MDA levels (4.2 ± 0.8 nmol/mL) compared to controls (2.1 ± 0.4 nmol/mL) (p <0.001). Antioxidant enzymes SOD (3.6 ± 0.6 vs 5.6 ± 0.8 U/mL), catalase (45.2 ± 5.4 vs 62.4 ± 6.5 kU/L), and GSH (34.8 ± 3.5 vs 48.2 ± 4.1 mg/dL) were significantly reduced in hypertensive subjects (p <0.001). Conclusion: Essential hypertension is characterized by increased oxidative stress and compromised antioxidant defense. Assessment of oxidative stress markers and antioxidant enzymes may serve as useful adjuncts in risk stratification and management of hypertensive patients. Keywords: Oxidative stress; Antioxidants; Free radicals; Essential Hypertension; Malondialdehyde (MDA); Superoxide dismutase (SOD).

Background: Prelabour rupture of membranes (PROM) at term, a common obstetric problem, raises the risk of infections in mothers and newborns. The results of high vaginal swab (HVS) cultures usually tell doctors what antibiotics to give to people with genital tract infections. This study focused on pregnant women with PROM at term, aiming to evaluate the relationship between HVS culture results and fetal-maternal outcomes. Materials and Methods: This prospective observational study involved forty pregnant women admitted to a tertiary care hospital with prelabor rupture of membranes (PROM) at term. Upon admission, high vaginal swabs were collected aseptically and subsequently evaluated for sensitivity and microbiological development. We kept track of the mother's and baby's health during the follow-up period leading up to the birth. This included the baby's Apgar score, neonatal sepsis, NICU admission, chorioamnionitis, postpartum fever, and endometritis. The relationship between cultural positivity and adverse fetal-maternal outcomes was investigated using data analysis. Results: Out of 40 instances, 22 (or 55%) had positive HVS cultures and 18 (or 45%) had negative ones. The most common organisms found were E. coli (31.8%), Staphylococcus aureus (22.7%), Klebsiella species (18.2%), and Group B Streptococcus (13.6%). The group that tested positive for cultures had a much higher prevalence of infectious morbidity in mothers (27.3% vs. 5.6%). There were more difficulties with newborns, like neonatal sepsis and being admitted to the neonatal intensive care unit (NICU), when the culture was positive (31.8% vs. 11.1% when it was negative). A significantly significant connection (p < 0.05) was established between a positive HVS culture and adverse fetal-maternal outcomes. Conclusion: Maternal and neonatal morbidity are both enhanced in cases of preterm birth when vaginal swab cultures are positive. Improving feto-maternal outcomes in cases of PROM can be achieved through routine HVS culture and the timely administration of suitable antibiotics. Keywords: Prelabour rupture of membranes, High vaginal swab, Feto-maternal outcome, Neonatal sepsis, maternal infection, Term pregnancy.

Background: Myopia is one of the leading causes of visual impairment worldwide and is increasing rapidly, particularly among young adults. Laser-assisted in situ keratomileusis (LASIK) is widely performed for refractive correction, but outcomes may vary depending on the severity of myopia. Evaluating visual acuity, refractive predictability, and corneal parameters across different myopia grades is essential for optimizing surgical planning and patient selection. Objectives: To evaluate and compare the visual outcomes, refractive correction, and safety of LASIK among patients with mild, moderate, and high myopia. Material and Methods: This prospective hospital-based study was conducted in the Department of Ophthalmology at Santhiram Medical College and General Hospital from April 2023 to March 2025. Eighty patients (160 eyes) aged 18–35 years undergoing LASIK were enrolled using simple random sampling after informed consent. Patients were categorized into mild (≤ −3.00 D), moderate (−3.00 to −6.00 D), and high myopia (> −6.00 D). Preoperative and postoperative assessments included uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), spherical equivalent (SE), and corneal thickness. Statistical analysis was performed using paired t-tests, with p < 0.05 considered significant. Results: The study included 45 females and 35 males, with the majority (63.75%) aged 18–25 years. Mild and moderate myopia predominated in younger patients, while high myopia was more frequent in the 26–30 year age group. Postoperatively, significant improvement in BCVA was observed across all myopia grades, with the greatest gain in high myopia (0.35 to −0.144 logMAR). Corneal thickness showed a decreasing trend with increasing myopia severity (540.2 µm in mild vs 522.8 µm in high myopia). Visual and refractive outcomes were consistent between both eyes, demonstrating high predictability and procedural accuracy. Conclusion: LASIK is a safe, effective, and predictable refractive procedure for correcting mild, moderate, and high myopia. Even patients with high myopia achieved substantial visual and refractive improvement, provided adequate preoperative corneal assessment is performed. These findings support the use of advanced LASIK platforms in achieving near-emmetropic outcomes across varying degrees of myopia. Keywords: LASIK, Myopia, Refractive Surgery, Visual Acuity, Spherical Equivalent, Corneal Thickness, High Myopia.

Background: Apnea of prematurity (AOP) is a common and clinically significant problem in preterm neonates due to immaturity of respiratory control mechanisms. Recurrent apneic episodes are associated with hypoxemia, bradycardia, increased need for respiratory support, prolonged neonatal intensive care unit (NICU) stay, and higher morbidity. Caffeine citrate is the drug of choice for the management of AOP because of its efficacy, safety, and wide therapeutic window. While routine-dose caffeine is commonly used, evidence regarding the benefit of higher or rescue-dose caffeine in symptomatic apnea remains limited, particularly in low- and middle-income settings. Aim: To compare the effectiveness and safety of routine-dose versus rescue-dose caffeine citrate in the management of apnea of prematurity in preterm neonates between 26 and 36 weeks of gestation. Materials and Methods: This open-labelled randomized controlled trial was conducted in the Neonatology Unit of Coimbatore Medical College Hospital from December 2019 to December 2020. A total of 56 preterm neonates with apnea of prematurity were enrolled and randomly allocated into two equal groups: Group A (routine-dose caffeine) and Group B (rescue-dose caffeine). Group A received a loading dose of 20 mg/kg followed by a maintenance dose of 10 mg/kg/day, while Group B received a loading dose of 40 mg/kg followed by a maintenance dose of 20 mg/kg/day of caffeine citrate. Neonates were monitored for frequency and duration of apnea, need for respiratory support, duration of ventilation, neonatal morbidities, length of hospital stay, and adverse effects. Results: The rescue-dose group showed a significant reduction in the severity and frequency of apneic episodes, with 82.1% having fewer than three episodes compared to 14.3% in the routine-dose group (p<0.001). The need for mechanical ventilation was significantly lower in Group B (14.3%) compared to Group A (60.7%) (p<0.001). Duration of level 3 NICU stay was also significantly shorter in the rescue-dose group. There were no statistically significant differences between the groups in chronic lung disease, necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, or mortality. Rescue-dose caffeine was well tolerated with no increase in clinically significant adverse effects. Conclusion: Rescue-dose caffeine citrate is more effective than routine-dose caffeine in reducing apneic episodes and the need for mechanical ventilation in preterm neonates with apnea of prematurity, without added safety concerns. Larger, well-powered trials are needed to further validate these findings and refine optimal caffeine dosing strategies. Keywords: Apnea of prematurity; Caffeine citrate; Preterm neonates; Mechanical ventilation; Rescue dose.

Background: Dermatophytoses is a superficial cutaneous fungal infection with major public health importance across the globe causing a significant morbidity with disfigurement of the areas involved and also recurrence. Hence, the characterisation of dermatophytic isolates and its epidemiological profile in a region are crucial for the early diagnosis, appropriate treatment and also to minimize the economical burden of treatment cost. The objective is to analyse in detail about the epidemiology, prevalence of different species of dermatophytes from newly diagnosed patients with dermatophytoses attending the Department of Dermatology in a Tertiary Care Hospital. Materials and Methods: This cross sectional study was conducted in patients with suspected dermatophytosis attending the Dermatology OPD of Tertiary Care Hospital. A detailed history, clinical examination and specimen collection for mycological examination was done. Skin scraping, epilated hair and nail clipping were subjected to direct microscopy by using 10%, 20% ,40% potassium hydroxide (KOH) respectively and also cultured on Modified Sabourauds Dextrose Agar with cycloheximide & chloramphenicol and Dermatophyte Test Medium (DTM). Identification of the causative pathogen was done by performing slide culture, lacto-phenol cotton blue (LPCB) mount, hair perforation tests and urease tests. Results: There was 100 newly diagnosed dermatophytosis patients were included in the study, with the male: female ratio of 1.8:1. The most commonly affected age group was 21 to 30 years followed by 31 to 40 years. Tinea corporis was the most common type observed. KOH positivity was seen in 62 samples (61%) and culture positivity was found in 43 samples (43%). The most common species isolated was Trichophyton rubrum (22 isolates) followed by Trichophyton mentagrophytes (10 isolates). Conclusion: Dermatophyte infections are extremely common in our country where hot and humid climate along with the poor hygiene are predisposing conditions that favour the growth of these fungi. There is varying divergence in isolation of different species across the different parts of India. In this study, the predominant species isolated was the Trichophyton rubrum followed by Trichophyton mentagrophytes. Keywords: Dermatophyte, KOH, DTM, Slide culture, LPCB, Tinea corporis, Trichophyton rubrum, Trichophyton mentagrophytes.

Background: Psychological distress is highly prevalent among patients with cancer and has a significant impact on treatment adherence, quality of life, healthcare utilization, and survival. Despite its importance, distress often remains under-recognized in busy oncology outpatient settings due to time constraints, stigma, and lack of systematic screening. The Distress Thermometer (DT) is a simple, validated screening tool recommended by the National Comprehensive Cancer Network for identifying distress in cancer patients. Aim: To evaluate the impact of routine distress screening using the Distress Thermometer on referral rates to clinical psychology services in an oncology outpatient department Materials and Methods: This prospective observational study was conducted in the Medical Oncology OPD at PKDIMS, Ottapalam, from 24 January 2024 to 23 January 2025 after institutional ethical approval. All patients attending the OPD during the study period were screened using the Distress Thermometer. A cut-off score of ≥4 was used to identify clinically significant distress. Patients scoring above the cut-off were referred for psychological evaluation. Referral rates before and after the implementation of routine DT screening were compared. Results: Prior to routine distress screening, only 2 out of 500 patients attending the oncology OPD over six months were referred for psychological consultation. After implementation of the Distress Thermometer, 2000 patients were screened, of whom 200 (10%) scored ≥4, indicating significant distress. All patients above the cut-off were referred for psychological services, resulting in 60 referrals during the study period. This represented a substantial increase in referral rates following the introduction of systematic distress screening. Conclusions: Routine implementation of the Distress Thermometer in the oncology OPD significantly improved identification of psychological distress and increased referrals to clinical psychology services. The Distress Thermometer is an effective, feasible, and time-efficient screening tool that should be incorporated into routine oncology practice to ensure comprehensive, patient-centred cancer care. Keywords: Psychological distress; Distress Thermometer; Cancer patients; Oncology outpatient department; Distress screening; Psycho-oncology; Referral to psychological services.

Background: Fine needle aspiration cytology (FNAC) is a minimally invasive and useful procedure for evaluating salivary glands lesions worldwide. Diverse morphological patterns in salivary gland lesions make diagnosis challenging at times hence the Milan system of reporting was introduced to overcome this difficulty. Material and Methods: This is a three-year retrospective study from January 2023 to January 2026 conducted on 49 cases of salivary gland lesions and smears were stained with May-Grünwald Giemsa stain, Haematoxylin & Eosin and Papanicolaou stains. Smears of old cases were retrieved from records and reclassified according to Milan system for reporting sal̥ivary gland cytology. Histopathological comparison was done wherever possible and sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy of FNAC for diagnosing benign and malignant lesions and risk of malignancy for each category was calculated. Results: 49 salivary gland lesions were included in the study with most common age group being 61-70 years (23.28%) and male to female ratio of 2:1. Acute and chronic sialadenitis (10.2% each) were the most common non-neoplastic lesions and Pleomorphic adenoma (16.32%) was the most common benign lesion. The commonest malignancy was mucoepidermoid carcinoma (8.16%). Histopathology was received for 30 cases. Statistical analysis revealed the Sensitivity, Specificity, Positive predictive value, Negative predictive value and Diagnostic accuracy as 79.3% ,100%, 100%, 93.75% and 94.73% respectively. Conclusion: FNAC is a simple and cost-effective procedure with high sensitivity, specificity and accuracy which makes it a reliable diagnostic tool for rapid and early diagnosis of salivary gland lesions. Keywords: Salivary gland lesions, Pleomorphic adenoma, Mucoepidermoid carcinoma, Milan system.

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a frequent cause of emergency department (ED) morbidity, admissions, and mortality, especially in high-burden regions such as Western Rajasthan where environmental dust, pollution peaks, and seasonal temperature extremes may amplify risk. Materials and Methods: A retrospective observational analysis of ED admissions from January–December 2025 was conducted at Dr. S.S. Tantia Medical College Hospital. AECOPD cases were identified using ICD-10 coding and clinical documentation consistent with GOLD criteria. Seasonal clustering, documented triggers, clinical severity (including acute respiratory failure), and in-hospital outcomes were analyzed using descriptive statistics and chi-square testing (p<0.05). Results: Of 687 total ED admissions, 515 (75.0%) were respiratory-related; 170 cases met AECOPD criteria (24.7% of total ED volume; 33.0% of respiratory cases). AECOPD showed significant seasonal clustering (χ²=12.45, p=0.014), peaking in Oct–Dec (29.4%) and Mar–May (23.5%), with a monsoon nadir (Jun–Jul, 8.2%). Documented triggers included respiratory tract infection (52.4%), air pollution/dust exposure (37.6%), temperature extremes (22.4%), and medication non-adherence (20.0%). Acute respiratory failure occurred in 20.6%; NIPPV was used in 28.2% (success 70.8%); mechanical ventilation was required in 12.9%. Mortality was 4.7%; mean length of stay was 6.2±4.1 days. Conclusion: AECOPD constitutes a major ED burden in Western Rajasthan with clear seasonal surges. Infection and environmental exposures dominate triggers, enabling targeted seasonal preparedness, standardized ED pathways, and community interventions to reduce severity and mortality. Keywords: COPD exacerbation; emergency department; seasonality; infection; air pollution; dust exposure; non-invasive ventilation; India.

Background: Age determination at the threshold of 18 years holds paramount significance in the Indian legal system, influencing criminal culpability under the Indian Penal Code, protection under the Juvenile Justice (Care and Protection of Children) Act, 2015, applicability of the Protection of Children from Sexual Offences Act, 2012, and numerous civil rights. Dental age estimation using third molar development has emerged as a valuable forensic tool, with Cameriere's method offering a quantitative approach using the 0.08 cut-off for legal age determination. Objectives: To evaluate the forensic validity and diagnostic accuracy of Cameriere's third molar maturity index with the 0.08 cut-off for determining legal age (18 years) in the Mumbai Metropolitan Region population. Materials and Methods: A retrospective cross-sectional study was conducted on 196 orthopantomographs (94 males, 102 females) aged 15-20.83 years. Binary classification was performed using the 0.08 cut-off (estimated age ≥18 years = adult; <18 years = minor). Diagnostic metrics including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated with 95% confidence intervals. Results: The method demonstrated accuracy of 71.43% (95% CI: 64.74-77.29%), sensitivity of 72.02%, and specificity of 67.86%. The PPV was notably high at 93.08% (95% CI: 87.37-96.32%), while NPV was low at 28.79%. Nine false positives (minors misclassified as adults) and 47 false negatives (adults misclassified as minors) were identified. Conclusion: The high PPV indicates reliability when the method classifies an individual as an adult. However, the low NPV and presence of false positives (potential human rights violations) necessitate that the Cameriere method be used only as one component within a multi-factorial forensic age assessment, never as a standalone determinant of legal age. Keywords: Forensic age estimation; Legal age determination; Cameriere method; Third molar; Juvenile Justice Act.

Background: Short-form video (SFV) platforms are designed to deliver rapidly changing, algorithm-driven audiovisual content that sustains high levels of attentional engagement. Unlike traditional long-form media, SFVs demand continuous cognitive processing, rapid visual scanning, and anticipatory responses, which may inadvertently interfere with automatic physiological functions such as breathing. Emerging anecdotal and preliminary evidence suggests that intense screen engagement may disrupt normal respiratory rhythms, a phenomenon increasingly described as “screen apnea.” However, objective physiological data examining the acute respiratory and autonomic effects of continuous SFV consumption remain limited. Aims: The present study aimed to evaluate the impact of uninterrupted SFV viewing on spontaneous respiratory rate, respiratory variability, breath-holding behavior, and autonomic regulation in healthy young adults. Materials and Methods: A randomized, counterbalanced cross-over study was conducted in 60 healthy adults aged 18–30 years. Participants underwent two 20-minute conditions: (1) continuous viewing of algorithm-driven short-form videos and (2) passive viewing of neutral, non-stimulating visual content (control), separated by a washout period. Respiratory parameters were continuously recorded using respiratory inductance plethysmography. Heart rate variability and peripheral oxygen saturation were assessed as secondary outcomes. Paired statistical analyses were performed to compare physiological responses between conditions. Results: Short-form video viewing resulted in a significant increase in respiratory rate variability and frequency of breath-holding events compared with the control condition (p < 0.001). Mean respiratory rate was significantly elevated, accompanied by a reduction in vagally mediated heart rate variability, indicating sympathetic predominance. A small but significant decrease in peripheral oxygen saturation was also observed during SFV exposure. Conclusion: Continuous consumption of short-form video content induces measurable respiratory dysregulation characterized by irregular breathing rhythms, increased breath-holding frequency, and autonomic imbalance in healthy young adults. These findings provide objective physiological evidence supporting the concept of “screen apnea” and underscore the potential health implications of prolonged engagement with highly stimulating digital media. Keywords: Autonomic nervous system; Breath-holding; Digital media physiology; Respiratory rate variability; Short-form video; Screen apnea.

Background: Unintentional childhood injuries have short—and long-term impacts on affected children and families. As children are curious about their environment, they tend to fall and have accidents. Parents are the main caregivers responsible for their physical safety. In the Indian context, in a low-economic setting, existing literature data is scarce concerning the type and prevalence of injury types and the parental perspective. The present study aimed to evaluate parents' perceptions, attitudes, and knowledge concerning the risk of unintentional childhood injuries. Materials and Methods: The present study assessed 680 subjects, 298 fathers and 382 mothers. All the subjects were given a structured questionnaire that collected all the necessary data, including demographics and percentage analysis. The data gathered were analyzed statistically for results formulation. Results: The results of the present study showed that the majority of subjects including mothers and fathers agreed on similar components of attitude and knowledge concerning unintentional childhood injuries. However, study results showed a statistically significant difference concerning the hazard and risk of perception for the severity of unintentional childhood injuries. Conclusion: The present study concludes that the findings of the present study form the basis for making the outline of customized programs to equip parents in assisting with the safety aspects of their child subjects. The findings of the present study have healthcare policy, social, and domestic level implications. Keywords: Attitude, children, childhood injuries, knowledge, unintentional injuries.

Background: Hand infections are frequently encountered in clinical practice and may involve structures such as flexor tendon sheaths, bite-related wounds, interdigital spaces, subcutaneous tissues, nail folds, joints, bone, and skin. If these infections extend to deeper tissues or cause structural damage, surgical management may be required. Recent literature reports a significant rise in methicillin-resistant infections of the hand over the past two decades. The purpose of this study is to evaluate the causative factors, clinical complications, and therapeutic approaches associated with acute hand infections Materials and Methods: Study design is an observational study. This study was conducted at Liaquat University Hospital Hyderabad / Jamshoro from September 2024 to September 2025. This study is a prospective observational study which was conducted on the patients who were presented with hand infection. All age group patients were a part of this study. Demographic data of the patients along with type of infection and duration of the infection was gathered. The outcomes that were assessed in this study are the following: type of infection, etiological factors, type of treatment, and common microorganisms. Results: There were a total of 80 patients included in this study. All of the patients were presented with hand infection. The majority of the participants were males, representing 72.5% of the total population. The majority of the participants (26.25%) who were infected with hand infection were gardeners/farmers by occupation. 70% of the participants had a penetrating injury. The majority of the participants were adults from the age group of 21 to 30 years and 41 to 50 years. Conclusion: It is important to diagnose hand infections early so that it would reduce the risk of partial or total hand amputation. Keywords: infections of the hand, skeletal damage or underlying deep soft tissue.

Background: Diabetes mellitus (DM) is a group of common metabolic disorders which shares the features of hyperglycemia. Complex interaction between environmental factors and genetics causes several distinct types of DM. The objective is to Assess the association between bone turn over markers in obese diabetic and healthy adults. Materials and Methods: This hospital based analytical Cross-sectional study was conducted in OPD of Rajiv Gandhi Centre for Diabetes and Endocrinology and Department of Physiology, JNMCH, A.M.U., Aligarh on patients of Type 2 Diabetes Mellitus(T2DM) who were obese as well, having BMI more than 30 Kg/m². The period of study was from 2018 to 2020. Results: Obesity is a modifiable risk factor for development of diabetes. Obese diabetic individuals are at greater risk of various types of fractures as compared to healthy individuals because of decreased bone strength as serum calcium, phosphorus and vitamin D decreases and Parathormone and alkaline phosphatase increases in diabetes as well as in obesity. Conclusion: Data obtained from the current study shows how diabetes and obesity is associated with bone turn over markers. Keywords: Bone Turnover Markers, Obese, Type 2 Diabetic, BMI, Calcium, Phosphorus, Alkaline Phosphatase, Parathormone, Vitamin D.

Background: Severe valvular pulmonary stenosis (PS) presenting beyond childhood is uncommon and technically challenging due to large annular dimensions, dysplastic or calcified leaflets, and suboptimal performance of conventional low-pressure balloons. The Accura balloon—originally designed for percutaneous mitral commissurotomy—offers high-pressure inflation, predictable waist formation, and enhanced stability, which may be advantageous in such anatomies. Materials and Methods: We report five cases of severe valvular PS across a wide age spectrum: an adult with a large annulus,[1] an elderly patient with calcified PS, right ventricular (RV) dysfunction and secundum atrial septal defect (ASD),[2] a low-weight child with combined PS and ASD,[3] a young female with severe PS and large ASD undergoing BPV followed by device closure⁴, and a young adult with large-annulus PS⁵. In all cases, conventional balloons were ineffective or unsuitable, and balloon pulmonary valvotomy (BPV) was performed using the Accura balloon. Results: In all five cases, [1-5] Accura balloon valvotomy achieved clear waist formation with complete disappearance at peak inflation, resulting in significant reduction of transvalvular gradients and stable hemodynamics without major complications. The balloon was effective in large annuli (24–25 mm), fibrotic or calcified valves, and complex scenarios including staged and combined BPV with ASD closure. Conclusion: The Accura balloon is a feasible, safe, and effective option for BPV in resistant, large-annulus, calcified, or complex pulmonary valve anatomy across age groups, [1-5] serving as a valuable bailout and selective primary device when conventional balloons fail. Keywords: Accura balloon, balloon pulmonary valvotomy, pulmonary valve stenosis, transcatheter intervention, congenital heart disease.

Background: Xanthogranulomatous inflammation (XGI) is an uncommon chronic inflammatory condition that frequently presents as a mass-forming lesion, closely simulating malignant tumors on clinical and radiological evaluation. This misleading presentation often results in aggressive surgical management despite its benign nature. This study analyzes a series of Xanthogranulomatous lesions involving multiple organ systems and emphasizes the diagnostic challenges encountered in differentiating these lesions from malignancy. Materials and Methods: Nine histopathologically confirmed cases of Xanthogranulomatous inflammation from different organ systems were reviewed for the clinical features, radiological impressions, operative findings and histopathological characteristics were analyzed. Results: The study included nine patients (five-females and four-males; age range 29–63 years). Organs involved were gallbladder, kidney, endometrium, fallopian tube, testis, and prostate. All cases were clinically suspected as severe infective pathology or malignancy. Histopathology consistently demonstrated foamy macrophages, multinucleated giant cells, lymphoplasmacytic infiltrate, fibrosis with or without necrosis and no evidence of malignancy. Conclusion: Xanthogranulomatous inflammation represents a significant diagnostic pitfall due to its close resemblance to malignancy. Awareness of its clinicopathological spectrum is essential to prevent unnecessary radical surgical interventions. Keywords: Xanthogranulomatous inflammation; chronic inflammation, diagnostic mimic, histopathology, foamy macrophages, case series.

Background: One of the known side effects of metformin treatment among type 2 diabetes patients is vitamin B12 deficiency. This deficiency is widely used, yet its clinical implications in comparison with diabetic neuropathy is neglected. It is necessary to clarify this association since neuropathy is one of the primary causes of morbidity among diabetic patients. Objective: To determine the association between the status of vitamin B12 and diabetic neuropathy amongst patients with type 2 diabetes under metformin therapy. Duration and place of study: This study was conducted at Jinnah Post Graduate Medical Center Karachi from December 2024 to December 2025 Material and Methods: This analytical study involved 120 patients with type 2 diabetes who took metformin. A chemiluminescent immunoassay was used to determine the levels of serum vitamin B12 as normal, insufficient, or deficient. The Michigan Neuropathy Screening Instrument was used to evaluate diabetic neuropathy. The statistical analysis was conducted to find out the correlation between vitamin B12 and neuropathy. Results: Out of 120 respondents, 64 (53.3) were females and 56 (46.7) were males, with an average age of 62 10 years. The 34 (28.3) patients had vitamin B12 below the normal range (≤300 pg/mL), with 9 (7.5) of them being deficient and 25 (20.8) insufficient. Twenty-six (21.7) patients were found to have diabetic neuropathy. Among them, 18 (69.2%) were below normal vitamin B12, 9 (34.6) with deficiency and 9 (34.6) below normal. The presence of neuropathy was significantly associated with a negative correlation with the levels of vitamin B12, but not with the levels and metformin exposure parameters. Conclusion: Reduced levels of vitamin B12 are closely related to diabetic neuropathy among patients on metformin. Deficiency of Vitamin B12 seems to be a potentially treatable risk factor of neuropathic complications and thus regular screening and prompt supplementation of this group is essential. Keywords: Type 2 diabetes, metformin, vitamin B12, diabetic neuropathy, deficiency.

Background: Postoperative morbidity and recurrence are associated with pilonidal sinus disease, a frequent benign illness of the sacrococcygeal area. Two of the most popular surgical treatments are the Karydakis flap and the Limberg flap. Patients suffering from pilonidal sinus illness were the subjects of this study, which sought to compare the surgical results of the Karydakis flap with those of the Limberg flap. Materials and Methods: A prospective comparison study included 50 individuals who were diagnosed with primary sacrococcygeal pilonidal sinus. At random, 25 patients were assigned to the Karydakis group and 25 to the Limberg group; each group received a different type of flap. Time spent operating, VAS-measured postoperative pain, duration of hospital stay, time to resume normal activities, postoperative complications, and recurrence were among the parameters that were gauged. After six months, patients were followed up with. When the p-value was smaller than 0.05, the statistical analysis was considered significant. Results: The Limberg group had a mean operating time of 46.9 ± 7.2 minutes, which was far longer than the Karydakis group's mean operating time of 38.6 ± 6.4 minutes (p = 0.001). The Karydakis group had a lower average pain score (3.1 ± 0.9) on the first day following surgery than the Limberg group (3.8 ± 1.0, p = 0.018). The Karydakis group stayed in the hospital for an average of 2.1 ± 0.6 days, while the Limberg group stayed for an average of 2.6 ± 0.7 days (p = 0.021). The Karydakis group took an average of 13.4 ± 2.8 days to get back to their normal activities, which was far less than the Limberg group (16.2 ± 3.1 days, p = 0.002). There was no statistically significant difference in postoperative complications between the two groups. In the Karydakis group, four patients (16.0%) had wound infections and two had seroma infections. In the Limberg group, six patients (24.0%) had wound infections and two had seroma infections. In the partial flap edge necrosis group, one patient had one. One patient (4.0%) in the Karydakis group and two patients (8.0%) in the Limberg group suffered recurrence throughout the follow-up period (p = 0.55). Conclusion: Both the Karydakis flap and the Limberg flap are safe and effective ways to treat pilonidal sinus disease with surgery. The complication and recurrence rates were comparable between the two techniques; however, the Karydakis flap demonstrated significantly reduced surgical time, diminished postoperative pain, abbreviated hospitalizations, and expedited resumption of normal activities. Keywords: Pilonidal sinus; Karydakis flap; Limberg flap; postoperative complications; recurrence; comparative study.

Background: Aberrant right subclavian artery (ARSA), or arteria lusoria, is the most common aortic arch anomaly. While often asymptomatic, aneurysmal degeneration or compressive symptoms require intervention. Modern management increasingly favours hybrid repair combining surgical debranching and endovascular techniques. The objective is to systematically evaluate the outcomes of surgical and hybrid management of ARSA from 2015–2025, assessing perioperative morbidity, mortality, and long-term efficacy. Materials and Methods: Following PRISMA 2020 guidelines, databases including PubMed, Scopus, Cochrane Library, and Consensus were searched for studies between 2015–2025. Inclusion criteria encompassed surgical, endovascular, or hybrid repair of ARSA in adults. Quality assessment used the Newcastle–Ottawa Scale and Joanna Briggs Institute tools. Data synthesis was primarily narrative. Results: Out of 152 screened studies, 34 met inclusion criteria (n = 487). Hybrid repair demonstrated lower perioperative morbidity (3.2%) and mortality (1.8%) compared with open repair (morbidity 14.5%, mortality 4.7%). Long-term graft patency exceeded 95% for carotid–subclavian bypasses. Conclusion: Hybrid repair offers superior short-term outcomes with comparable durability to open surgery, representing the preferred strategy for suitable ARSA anatomy. Keywords: Aberrant Right Subclavian Artery, Arteria lusoria, Aortic arch variations, Dysphagia Lusoria, Kommerell’s Diverticulum

Background: Accurate estimation of postmortem interval (PMI) is a crucial aspect of forensic investigation. Traditional methods based on physical changes are often influenced by environmental and intrinsic factors, limiting their precision. Biochemical analysis of vitreous humor, particularly electrolyte estimation, has emerged as a more objective approach for determining time since death. Material and Methods: A facility-based analytical cross-sectional study was conducted on 100 medico-legal autopsy cases with reliably documented time of death. Vitreous humor samples were collected aseptically and analyzed for potassium, sodium, and chloride concentrations using an ion-selective electrode method. Pearson correlation and linear regression analyses were performed to assess the relationship between electrolyte levels and PMI. Multivariate regression analysis evaluated the influence of age, ambient temperature, cause of death, and storage delay on potassium-based PMI estimation. Results: A progressive increase in vitreous potassium concentration was observed with increasing PMI, demonstrating a strong positive correlation (r = 0.94, p = 0.001). Sodium and chloride showed weak negative correlations with PMI. Linear regression analysis revealed that potassium was the strongest independent predictor of PMI (R² = 0.89), and the derived predictive equation was: PMI (hours) = −3.12 + 1.08 × (K⁺ mmol/L). Multivariate analysis improved model performance (R² = 0.92), with age and ambient temperature showing modest but significant effects. Conclusion: Vitreous potassium concentration is a robust and reliable biochemical marker for estimating postmortem interval. Incorporation of demographic and environmental factors may enhance predictive accuracy in forensic applications. Keywords: Postmortem interval, Vitreous humor, Potassium, Forensic biochemistry, Time since death.

Background: Atraumatic electrode insertion is a key determinant of successful cochlear implantation, and its predictability largely depends on detailed preoperative anatomical assessment. High-resolution computed tomography (HRCT) provides critical insight into the orientation of the cochlear basal turn and the round window (RW) niche-structures that show considerable interindividual variability. Among radiologic markers, the alpha angle, representing the angular relationship between the basal turn axis and the RW trajectory, has gained increasing clinical relevance for anticipating surgical exposure, selecting the optimal insertion route, and minimizing intracochlear trauma. Despite its growing importance, comprehensive evidence correlating alpha angle orientation with real-time intraoperative parameters remains limited in large, heterogeneous cochlear implant populations. Aim: To assess the orientation of the alpha angle on high-resolution computed tomography (HRCT) of the temporal bone in cochlear implant candidates and to correlate these radiological measurements with intraoperative surgical parameters in patients undergoing implantation. Materials and Methods: In a retrospective observational study, 100 consecutive cochlear implant candidates at GMERS Medical College & Hospital Sola Civil Hospital (Ahmedabad, India) underwent preoperative HRCT of the temporal bones. The alpha angle was measured on standardized axial cochlear imaging planes. During surgery, surgeons documented intraoperative variables including round window visibility, requirement for additional drilling (e.g., niche or posterior tympanotomy extension), ease of electrode insertion and final electrode placement. Radiological and surgical parameters were statistically analyzed to determine correlation. Results: Alpha angle values demonstrated measurable individual variation. Smaller alpha angles were associated with reduced round window exposure and greater need for extended posterior tympanotomy or niche drilling. Larger alpha angles correlated with easier round-window identification and smoother electrode insertion. A statistically significant relationship was observed between alpha angle orientation and intraoperative difficulty markers. Conclusion: The alpha angle is a reproducible and clinically informative radiological parameter that offers valuable predictive insight into round window accessibility and electrode insertion challenges during cochlear implantation. Incorporating alpha angle assessment into routine preoperative HRCT evaluation enhances surgical preparedness, supports tailored approach selection, and may improve atraumatic insertion outcomes. These findings reinforce the importance of detailed preoperative imaging analysis in optimizing cochlear implant surgery. Keywords: Alpha angle, cochlea morphology, cochlear implant, electrode insertion, hrct temporal bone, radiological correlation, round window.

Background: Contraception is an effective simple, primary preventive care strategy available to improve the health of a woman and her family. Many governmental schemes are available free of cost or even incentivised in order to facilitate contraception and family planning which is also a part of sustainable developmental goals for any nation. However, the actual practice and utilisation of these services is suboptimal. There are many sociodemographic barriers as also myths, prejudices and misconceptions regarding contraceptive methods which create obstacles in the utilization of the available services. This study aims to assess and compare the knowledge, attitude, and practice (KAP) regarding contraceptive use among married and unmarried sexually active women presenting to the OPD in a tertiary care hospital in Mumbai who volunteered to participate in an online survey. Materials and Methods: A cross-sectional study was conducted from October 2025 to December 2025 using a pre-validated, structured questionnaire shared as a google form through whatsapp /social media platforms . A total of 420 women aged 18 years and above who consented to participate and responded were included and their responses filed. Those who had a medical background or connection were excluded from the trial as they were likely to be better informed and confound results. All who could read, write and respond in English, Hindi or Marathi were included. Confidentiality was ensured as none of the respondents were asked to share their name. Data were analyzed using IBM SPSS version 26.0. Descriptive statistics summarized socio-demographic and KAP data, and Chi-square tests were used to determine associations between KAP levels and demographic variables, with p < 0.05 considered significant. Results: Among 420 respondents, 59% were married and 41% unmarried. Overall, 25.2% demonstrated excellent knowledge, 41.9% good knowledge, and 9.1% poor knowledge of contraceptive methods. Married women had higher mean knowledge scores (13.9 ± 3.2) than unmarried women (12.4 ± 3.5). Attitude assessment showed 32.9% of participants had highly positive and 44.3% had positive attitudes toward contraception, with married women again scoring higher (14.3 ± 3.1 vs. 13.1 ± 3.4). In practice, 26.7% showed excellent contraceptive behavior and 42.4% good practice; however, only 47.1% reported consistent contraceptive use. Education, income, and age were significantly associated with better KAP outcomes (p < 0.05). Conclusion: The study revealed satisfactory awareness and favorable attitudes toward contraception amongst women in the centre; however, a substantial gap persists between knowledge and consistent practice, particularly among unmarried women. Education and socioeconomic empowerment were key determinants of positive contraceptive behavior. Targeted interventions focusing on health education, male involvement, and culturally sensitive counseling are essential to improve contraceptive uptake and reproductive autonomy. Keywords: Contraceptive use, Knowledge–attitude–practice (KAP), Online survey, Reproductive health.

Background: Skin adnexal tumours have been recognized from the later part of the 19th century. Tumours of cutaneous appendages are not so common. The classification of these tumour is also more complex. Adnexal tumours (ATs) includes a large spectrum of skin epithelial tumours including hamartoma, hyperplasia, benign, and malignant tumours that originate from or show differentiation toward adnexal epithelial structures, namely, pilosebaceous unit, eccrine, and apocrine. To study the incidence of skin adnexal tumors and describe it's variants, thus thereby helping us to ease the diagnosis of skin adnexal tumours as they serve a marker for some internal malignancies. Methods and Materials: This study design was a prospective study, which included all excision biopsy specimens which were diagnosed as tumours arising from skin adnexa as outlined in the WORLD HEALTH ORGANISATION classification of skin tumours were studied. The specimens were received in the Department of Pathology, Thanjavur Medical College over a period of 2020 to 2021.Data were entered in the excel sheet and analyses were done using Graph pad Prism version 5 software. p<0.05 were measured as statistically significant Results: The mean age was 47.1years with SD of 16.7. The age range of 3-80years. Majority of the study participants were in age group of 41-50 years 15(24.2%). The second common age group among the study participants were 51-60 years 12(19.4%). Females were predominant in our study 35(56.5%). Benign lesions (95.20%) are commoner than malignant lesions (4.8%). Eccrine differentiation was most common 27 (44%) followed by Pilar differentiation 20(32%). Conclusion: Our study concluded that Morphological assessment is very important in evaluating skin adnexal tumours, and histochemical and/or immunohistochemical stains may occasionally serve as ancillary tools. Eccrine differentiation is characterised by the presence of uniform small basaloid cells which are smaller than keratinocytes arising from eccrine duct. Follicular differentiation is characterised by the presence of proliferation of basaloid bulbar germinative cells, peripheral nuclear palisading and adjacent papillary mesenchymal cells and shadow cells. Keywords: Adnexal, hyperplasia, eccrine, pilosebaceous.

Background: Though dermatophytoses is considered to be a trivial superficial fungal infection globally, it is a universal intractable infection deleteriously affecting the eminence of life through communal dishonour and distressing the day-to-day behaviour. It can be acquired by direct contact with soil, animals or humans infected with fungal spores. The pre disposing factors include humid skin and tight ill fitting under garments. The psychosomatic effects of the disease are vastly significant and because of its high morbidity, it provides monetary burden to the affected population in provisions of loss of working hours and treatment. Due to risk factors, ineffective treatment and emerging drug resistance, there has been an increase in the incidence and non-responsiveness of dermatophytes to conventional antifungal agents which suggest the need of antifungal sensitivity testing. Objective: To analyse in detail about the risk factors of dermatophytoses and their antifungal susceptibility pattern from newly diagnosed patients with dermatophytoses attending the Dermatology Out Patient Department in a tertiary care hospital. Materials and Methods: This cross-sectional study was conducted in 100 newly diagnosed patients with suspected dermatophytoses attending the Dermatology OPD in a tertiary care hospital. A detailed history, clinical examination and specimen collection for mycological examination for identification and speciation of dermatophyte was done. In vitro antifungal susceptibility testing was performed on dermatophyte species isolated from culture as per CLSI-M38A2 guidelines with micro broth dilution method. Results: Totally 100 newly diagnosed patients with dermatophytoses were included in this study. Tinea corporis was the most common type observed. KOH positivity was seen in 62 samples and culture positivity was found in 43 samples. The most common species isolated was Trichophyton rubrum (22 isolates) followed by Trichophyton mentagrophytes (10 isolates). It was more prevalent in agriculturers (33%) followed by outdoor labourers (22%). Risk factors like Close family contacts mainly affected (34%) followed by hyperhidrosis (23%). Majority of affected patients having history of wearing Synthetic garments and tight fitting garments like leggings &jeans (34%) followed by not wiping body after bath (21%) and sharing of fomites (21%), The Minimum inhibitory concentration (MIC) of griseofulvin, fluconazole, ketoconazole, itraconazole, terbinafine and sertaconazole were compared. Three isolates of Trichophyton rubrum were found to be resistant in which itraconazole (1 isolate), terbinafine (1 isolate), fluconazole and ketoconazole (1 isolate). Sertaconazole was the most efficient drug among the tested anti fungal. Griseofulvin was also an effective antifungal drug. Conclusion: Inadequate, irregular, in appropriate application, irrational use of antifungal drugs and self medication has led to the emergence of resistant strains which cause poor treatment outcome. Thus, it is very essential to perform antifungal susceptibility testing to check for resistance pattern of antifungal agents. Keywords: CLSI (Clinical and Laboratory Standards In

Background: Aim of the study: To evaluate the association of serum high sensitivity C- reactive protein (hsCRP) and Gamma glutamyl transferase (GGT) with Body mass index (BMI), HbA1c and Dyslipidemia in persons with metabolic syndrome. Materials and Methods: It was a Cross sectional observational study, conducted at SRM Medical College Hospital and Research Centre (TSRMMC&RC) during the period one year (June 2019 to May 2020) . The study participants both males and females of age ≥ 18 years, came for master health check up and those who fulfilled the criteria of metabolic syndrome were included. Persons with history of diabetes mellitus and on antidiabetic medications, known cases of hepatobiliary disorder, Renal disease, patients with acute or Chronic Infectious and inflammatory diseases, malignancy, autoimmune disorders, patients with history of recent trauma or surgery and pregnant individuals were excluded from this study. Results: Among the study population of metabolic syndrome, 79% belonged to 35-60 years of age group, 13% and 8% belonged to 18-35 years and above 60 years of age respectively. The estimated mean age was 48.1 ± 10.0 years. 59% of participants were males and 42% were females. 85% and 11% of participants were obese and were overweight respectively and remaining 4% belonged to normal BMI (18.5-22.99 kg/m2). 44% of the study population had normal HbA1c < 5.6 gm%, whereas 56%had elevated HbA1c and mean HbA1c was5.7 which was in the prediabetic (≥ 5.6 - 6.4 gm%) range. About 63% of participants had elevated total Cholesterol concentration. 69%had elevated serum triglycerides concentration. 89% of participants had low serum HDL-C concentration. 16% of participants had elevated serum LDL-C concentration.68% of participants had hsCRP values > 3 mg/ L and 21% had values between 1mg/ L to 3mg/L. Mean hsCRP value was 7.0 mg/ L. Among the 68 participants having CRP value > 3mg/L, majority (56%) were the age group of 35 to 60 years. When we analysed the association of hsCRP with BMI, HbA1C, lipid profiles, there was highly statistically significant positive correlation between hsCRPand BMI, which was in agreement with the well-established biochemical link between the adipocyte metabolism, obesity and systemic inflammation. The positive correlation with HbA1C revealed the interrelationship between hyperglycemic status and chronic, low grade inflammation. statistically significant association of hsCRPwith LDL-C, and statistically significant negative correlation with HDL-C were observed. 87% of study participants had normal GGT and 13% had elevated values. Mean GGT activity was 35.7 U/L. Analysis revealed statistically highly significant association of GGT with alcoholism and smoking status. Though insignificant, a positive correlation between GGT and BMI was observed. When we analysed the association of GGT with HbA1C, GGT showed statistically significant positive correlation with HbA1c. There was a positive correlation between GGT and all cholesterol values except HDL with which it shows negative correlation. But they are not statistically significant. Conclusion: In the present study, we evaluated the relationship of hs-CRP and insu

Background: Diffuse Large B-Cell Lymphoma (DLBCL) is a biologically heterogeneous and clinically aggressive form of non-Hodgkin lymphoma. Gene expression profiling has identified Germinal Centre B-cell (GCB) and Activated B-cell (Non-GCB) subtypes with distinct prognostic implications. Immunohistochemical algorithms, such as the Hans algorithm, provide a practical surrogate for molecular classification in routine clinical practice. Aim: To evaluate the prognostic impact of Germinal Centre (GCB) and Non-Germinal Centre (Non-GCB) subtypes in patients with Diffuse Large B-Cell Lymphoma. Materials and Methods: A retrospective observational study was conducted on 107 histopathologically confirmed cases of DLBCL. Immunohistochemical staining for CD10, BCL6, and MUM1 was performed, and cases were classified into GCB and Non-GCB subtypes using the Hans algorithm. Clinicopathological parameters, International Prognostic Index (IPI), treatment response, and follow-up data were analyzed. Statistical analysis was performed using chi-square test, independent t-test, and calculation of odds ratios with 95% confidence intervals. A p-value <0.05 was considered statistically significant. Results: Of the 107 cases, 67 (62.6%) were classified as GCB subtype and 40 (37.4%) as Non-GCB subtype. The Non-GCB subtype was significantly associated with older age (p=0.039), advanced stage disease (p=0.036), and higher IPI scores (p=0.009). Patients with GCB subtype demonstrated significantly better treatment outcomes (74.6% good prognosis) compared to Non-GCB patients (55.0%) (OR=2.41, p=0.034). Relapse rates did not differ significantly between subtypes. Conclusion: The study confirms that molecular subtype, as determined by immunohistochemistry, has significant prognostic implications in DLBCL. The GCB subtype is associated with more favorable clinical outcomes, whereas the Non-GCB subtype correlates with adverse prognostic features. Immunohistochemical classification remains a valuable and practical prognostic tool in routine clinical settings. Keywords: Diffuse Large B-Cell Lymphoma; Germinal Centre Subtype; Prognosis.

Background: Preeclampsia is a hypertensive disorder of pregnancy associated with abnormal placentation and significant maternal and perinatal morbidity. Structural and vascular alterations in the placenta may result in increased tissue stiffness, which can be assessed non-invasively using Acoustic Radiation Force Impulse (ARFI) elastography. This study was designed to compare placental elasticity between normotensive and preeclamptic pregnant women using ARFI elastography and to evaluate its diagnostic utility. Materials and Methods: This hospital-based comparative cross-sectional study included 76 pregnant women (38 normotensive and 38 with preeclampsia) attending Maheshwara Medical College and Hospital, Telangana. Placental shear wave velocity (SWV) was measured using ARFI elastography. Three measurements were obtained from different placental regions and averaged. Clinical and demographic parameters were recorded. Statistical analysis was performed using independent t-test and chi-square test, with p<0.05 considered significant. Results: Mean placental SWV was significantly higher in the preeclampsia group (1.86 ± 0.27 m/s) compared to the normotensive group (1.21 ± 0.18 m/s) (p<0.001). A positive correlation was observed between SWV and both systolic and diastolic blood pressure. Receiver operating characteristic analysis demonstrated high diagnostic accuracy for differentiating preeclampsia. Conclusion: Placental stiffness measured by ARFI elastography is significantly increased in preeclampsia and correlates with disease severity. ARFI elastography may serve as a valuable adjunct tool for assessing placental changes in hypertensive disorders of pregnancy. Keywords: Preeclampsia, Placental elasticity, Acoustic Radiation Force Impulse (ARFI), Shear Wave Velocity, Obstetric Ultrasound, Placental Stiffness.

Background: Craniocerebral trauma (CCT) is a major cause of morbidity and mortality worldwide, particularly among young adults. Prompt identification of intracranial lesions is essential for effective management and improved outcomes. Computed tomography (CT) has become the primary imaging modality in the acute evaluation of head injury due to its rapid acquisition, wide availability, and high diagnostic accuracy. This study was designed to evaluate the role of computed tomography in patients with craniocerebral trauma and to analyse the spectrum of CT findings in relation to clinical severity. Materials and Methods: This prospective cross-sectional study included 200 patients with craniocerebral trauma who underwent non-contrast CT of the brain at a tertiary care center. Clinical severity was assessed using the Glasgow Coma Scale (GCS). CT findings were evaluated for skull fractures, extra-axial haemorrhages, intra-axial lesions, diffuse cerebral edema, and mass effect. Data were analysed using descriptive statistics. Results: Young adult males were the most commonly affected group, and road traffic accidents were the predominant mode of injury. Abnormal CT findings were observed in 92% of cases. Linear skull fractures were the most frequent fracture type. Subdural hematoma and cerebral contusions were the most common intracranial lesions. Moderate and severe head injuries showed a higher prevalence of significant CT abnormalities, including diffuse cerebral edema and midline shift. Conclusion: Computed tomography plays a crucial role in the early detection and characterization of intracranial injuries in craniocerebral trauma. It facilitates timely intervention, aids in prognostication, and remains the imaging modality of choice in the acute setting. Keywords: Craniocerebral trauma, Traumatic brain injury, Computed tomography, Glasgow Coma Scale, Intracranial hemorrhage, Multidetector CT.

Background: Susceptibility Weighted Imaging is an advanced magnetic resonance technique that exploits magnetic susceptibility differences to enhance visualization of venous structures, hemorrhage, iron deposition, and calcification. With the advent of 3 Tesla MRI systems, SWI provides superior spatial resolution and improved signal-to-noise ratio, expanding its role in neuroimaging. This study was designed to evaluate normal deep cerebral venous anatomy using 3D SWI at 3 Tesla and to assess its clinical utility in a spectrum of intracranial pathologies. Materials and Methods: This prospective cross-sectional study included 100 patients with clinically suspected intracranial lesions and 30 healthy volunteers. All subjects underwent MRI brain on a 3T scanner including T1, T2, FLAIR, DWI, and 3D SWI sequences. SWI images were reconstructed using filtered phase data and minimum intensity projection techniques. Imaging findings were correlated with conventional MRI sequences, and venous anatomical variants were analysed. Results: SWI demonstrated superior sensitivity in detecting cerebral microbleeds, haemorrhagic transformation in stroke, cortical vein thrombosis, diffuse axonal injury, intratumoral hemorrhage, and developmental venous anomalies. Additional occult lesions were identified in cavernomas and traumatic brain injury cases. Evaluation of deep venous anatomy revealed predominance of Type I thalamostriate vein configuration and single-trunk anterior caudate vein pattern. Conclusion: 3D SWI at 3 Tesla significantly enhances diagnostic accuracy in neuroimaging by improving detection of hemorrhage, thrombus, and venous anatomy. Incorporation of SWI into routine MRI protocols provides valuable clinical and preoperative information. Keywords: Susceptibility Weighted Imaging, 3 Tesla MRI, Cerebral microbleeds, Venous anatomy, Stroke, Neuroimaging.

Background: Preoperative prediction of meningioma consistency is crucial for surgical planning, as tumor texture influences operative technique, duration, and risk of complications. Conventional MRI provides essential anatomical details but has limited reliability in determining tumor consistency. Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) measurements may offer additional quantitative insights into tumor microstructure. This study was designed to evaluate the role of conventional MRI and diffusion parameters, particularly normalized ADC (NADC), in predicting the preoperative consistency of intracranial meningiomas and to correlate imaging findings with intraoperative assessment and histopathology. Materials and Methods: This prospective analytical study included 30 patients with histopathologically confirmed meningiomas who underwent preoperative 3T MRI. Conventional sequences, DWI, and post-contrast imaging were performed. Tumor characteristics, peritumoral edema, edema index, and T2-weighted signal intensity were assessed. ADC values were obtained from solid tumor components, and NADC ratios were calculated using contralateral normal white matter as reference. Imaging findings were compared with intraoperative tumor consistency. Statistical analysis included sensitivity, specificity, and ROC curve evaluation. Results: Conventional MRI features showed limited predictive value for tumor consistency. T2-weighted signal intensity demonstrated moderate correlation with intraoperative findings. NADC exhibited higher diagnostic accuracy than absolute ADC values, with superior area under the ROC curve. Soft tumors showed high sensitivity, whereas hard tumors demonstrated high specificity on diffusion analysis. Conclusion: Quantitative diffusion parameters, particularly NADC, improve the preoperative prediction of meningioma consistency beyond conventional MRI features. Incorporation of normalized diffusion metrics into routine imaging protocols may enhance surgical planning and optimize patient outcomes. Keywords: Meningioma, Magnetic Resonance Imaging, Diffusion-Weighted Imaging, Apparent Diffusion Coefficient, Normalized ADC, Preoperative Assessment.

Background: The aim is to document demographic trends, clinical manifestations, etiological patterns, and HIV seropositivity in genital ulcer disease (GUD) patients at a tertiary care center to guide syndromic management and screening strategies. Materials and Methods: This descriptive cross-sectional study enrolled 245 consecutive patients aged ≥18 years with genital ulcers lasting ≥2 weeks. Clinical history, examination, and lab tests (serology for HSV, syphilis, H. ducreyi, C. trachomatis, K. granulomatis; HIV per NACO guidelines) were performed. Data analysis used SPSS v.26.0 with chi-square tests and logistic regression (p<0.05 significant). Results: Mean age was 34.2±11.8 years; males predominated (78.4%, n=192). Etiologies: HSV (32.7%, n=80), syphilis (28.2%, n=69), chancroid (18.4%, n=45), mixed (12.2%, n=30), LGV (8.2%, n=20), donovanosis (3.7%, n=9), non-STI (8.5%, n=21). HIV positivity was 22.8% (n=55), higher than hospital baseline (2.1%, p<0.001; OR 12.1). Syndromic therapy showed 89.4% improvement at 4 weeks. Conclusion: HSV and syphilis dominated etiologies with high HIV co-infection, especially syphilis (45.7%). Integrated STI-HIV screening is essential for control in tertiary settings. Keywords: Genital ulcer disease, HSV, syphilis, HIV co-infection, etiological spectrum.

Background: This study aimed to determine the incidence and identify independent predictors of progression from pre-diabetes to type 2 diabetes mellitus over a 12-month period in an Indian tertiary care population. Materials and Methods: Retrospective cohort study at an Indian tertiary care hospital using electronic medical records. Included adults aged ≥18 years with pre-diabetes per American Diabetes Association criteria (fasting plasma glucose 100–125 mg/dL, impaired glucose tolerance, or HbA1c 5.7–6.4%). Excluded patients with prior diabetes, glucose-lowering medications, or incomplete 12-month follow-up. Extracted baseline demographics, anthropometrics, and biochemistry (fasting glucose, HbA1c, lipids). Progression defined as fasting glucose ≥126 mg/dL, HbA1c ≥6.5%, or new pharmacotherapy. Analyzed with SPSS v25.0: t-tests/chi-square for group comparisons, multivariate logistic regression for predictors (P<0.05). Results: Of 842 patients, 112 (13.3%) progressed to type 2 diabetes. Rate aligns with Indian estimates (3.9–7.9% annually). Progressors had higher baseline BMI, waist circumference, fasting glucose, HbA1c, and dyslipidemia (P<0.05); multivariate analysis identified key independent predictors including elevated HbA1c and central obesity. Conclusion: High short-term progression underscores need for risk stratification using clinical/biochemical markers to guide targeted interventions in Indian settings. Keywords: Pre-diabetes, Type 2 diabetes, Progression predictors, Incidence, Indian population.

Background: Anemia constitutes a major hematological challenge in tertiary care settings, where it frequently complicates patient management and correlates with adverse clinical outcomes. This retrospective laboratory analysis delineates the prevalence, severity distribution, morphological classifications, and red cell index alterations in adult patients, offering granular insights into patterns that inform targeted diagnostic and therapeutic pathways. Materials and Methods: Retrospective review of complete blood count (CBC) records from 1,256 eligible adult patients (≥18 years) at a tertiary care hospital spanning January 2020 to December 2024. Anemia adhered to WHO definitions (Hb <13 g/dL males, <12 g/dL females). Exclusion applied to incomplete datasets, hematological malignancies, or recent transfusions. Red cell indices (MCV, MCH, MCHC, RDW) facilitated morphological categorization (microcytic <80 fL, normocytic 80–100 fL, macrocytic >100 fL) and severity grading (mild, moderate, severe). Etiological inferences derived from index constellations. Analysis employed SPSS v27 with chi-square, t-tests, ANOVA, and correlations (p<0.05 significance). Results: Anemia prevalence reached 48.2% (n=605), elevated in females (52.4% vs. 43.1% males, p=0.012) and older adults (≥65 years: 62.3%, p<0.001). Moderate anemia dominated (54.7%), microcytic morphology prevailed (46.3%), followed by normocytic (38.5%) and macrocytic (15.2%). Anemic patients exhibited MCV 78.4±12.6 fL, MCH 25.1±4.8 pg, MCHC 31.2±3.1 g/dL, RDW 16.8±2.9% (all p<0.001 vs. non-anemic). Index patterns inferred iron deficiency (38.5%), chronic disease (32.1%), and nutritional causes (15.4%), with RDW elevations marking severity and anisocytosis. Conclusion: Nearly half of adult tertiary attendees manifest anemia, chiefly moderate-microcytic, with red cell indices revealing predominant iron-related patterns and prognostic utility. These observations advocate routine index-integrated screening to preempt complications and optimize resource allocation in high-burden settings. Keywords: Anemia, Red cell indices, Prevalence, Tertiary care, Retrospective analysis.

Background: Dengue is a major mosquito-borne viral infection and a significant public health problem in India, with frequent outbreaks reported from urban regions. Early laboratory diagnosis using serological markers is essential for timely clinical management and surveillance. Objectives: To determine the seroprevalence of dengue infection and analyze the serological patterns among suspected dengue cases tested at a diagnostic laboratory in Hyderabad. Materials and Methods: This laboratory-based cross-sectional study was conducted between August and October 2019. A total of 733 serum samples from clinically suspected dengue cases were tested for dengue NS1 antigen and dengue-specific IgM and IgG antibodies using ELISA (Panbio Diagnostics). Based on the combination of serological markers, cases were categorized into seven groups. Primary and secondary dengue infections were differentiated using the IgM:IgG index value ratio, with a ratio <1.78 indicating secondary infection. Results: Out of 733 samples, 299 (40%) were confirmed as dengue positive. NS1 antigen alone was detected in 88 cases (29.4%), while IgM antibody alone was detected in 84 cases (28%). Combined IgM and IgG positivity was observed in 30 cases (10%). The highest number of dengue-positive cases was seen in the 21–30-year age group (35%), with a clear male predominance (70%). Secondary dengue infection was identified in 15 (50%) of the IgM- and IgG-positive cases. Conclusion: The study demonstrates a high seroprevalence of dengue among suspected cases in Hyderabad, particularly among young adults and males. ELISA-based detection of NS1 antigen and dengue-specific antibodies remains a reliable and practical approach for early diagnosis and surveillance in routine laboratory practice. Keywords: Dengue, Seroprevalence, NS1 antigen, IgM, IgG, ELISA, Hyderabad.

Background: Sciatic nerve blocks play a vital role in providing effective perioperative analgesia for lower limb surgeries. The use of ultrasound guidance has improved precision, safety, and success rates in regional anesthesia. Selecting an optimal local anesthetic combination is essential to achieve rapid onset, prolonged analgesia, and minimal adverse effects. This study compares two commonly used anesthetic combinations to determine their relative efficacy and safety profiles. Aims and Objectives: The study aimed to compare the onset time, duration of analgesia, overall analgesic efficacy, and safety profile of 0.5% Bupivacaine with Clonidine versus 0.75% Ropivacaine with Clonidine when used for ultrasound-guided sciatic nerve blocks in patients undergoing lower limb surgery. Materials and Methods: This randomized controlled trial included 60 patients scheduled for elective lower limb surgeries. Participants were randomly assigned into two equal groups: Group B (Bupivacaine + Clonidine) and Group R (Ropivacaine + Clonidine). Ultrasound-guided sciatic nerve blocks were performed under standardized conditions. Parameters assessed included onset time of sensory block, duration of analgesia, Visual Analog Scale (VAS) scores, motor block using the Modified Bromage scale, autonomic effects, and any adverse events. Data were analyzed statistically. Results: The Ropivacaine plus Clonidine group demonstrated a significantly faster onset of analgesia compared to the Bupivacaine group (p < 0.05). However, Bupivacaine with Clonidine provided a significantly longer duration of analgesia (p = 0.0107). VAS scores, motor block characteristics, autonomic effects, and incidence of adverse events were comparable between groups. Conclusion: Ropivacaine with Clonidine offers a quicker onset of analgesia, whereas Bupivacaine with Clonidine provides prolonged postoperative pain relief. Both combinations are safe, effective, and suitable for lower limb surgeries, enabling clinicians to tailor anesthetic choice according to surgical duration and patient requirements. Keywords: Sciatic nerve block, Ultrasound-guided, Bupivacaine, Ropivacaine, Clonidine.

Background: Epidural anesthesia is a cornerstone technique for lower abdominal surgeries. While 0.5% bupivacaine has long been considered the gold standard, its cardiotoxicity profile has prompted the search for safer alternatives. Ropivacaine, a pure S(-)-enantiomer, offers potentially reduced toxicity with comparable efficacy. This study compares the clinical profiles of these two agents focusing on three key variables: sensory block characteristics, motor block characteristics, and hemodynamic parameters. Materials and Methods: A randomized, double-blind controlled trial was conducted on 60 ASA I/II patients undergoing elective lower abdominal surgeries. Patients were randomly allocated to receive either 20 mL of 0.75% ropivacaine (Group R, n=30) or 20 mL of 0.5% bupivacaine (Group B, n=30) via epidural catheter. The three primary outcome variables assessed were: (1) sensory block characteristics (onset time, maximum level achieved, duration), (2) motor block characteristics (onset time, Bromage grade, duration), and (3) hemodynamic parameters (pulse rate, systolic/diastolic/mean arterial pressure, SpO₂) measured at predetermined intervals. Results: Both groups were demographically comparable. No statistically significant differences were observed in sensory block onset (Group R: 11.89 ± 0.74 min vs. Group B: 10.50 ± 0.92 min; p=0.267), maximum sensory level achieved (T4-T6 in both groups; p=0.439), or sensory block recovery time. Motor block onset was similar between groups (Group R: 16.58 ± 0.90 min vs. Group B: 15.68 ± 0.74 min; p=0.125), with comparable Bromage grade distribution and motor recovery duration. Hemodynamic parameters remained stable throughout the procedure in both groups, with no clinically significant differences in pulse rate, blood pressure, or oxygen saturation at any measured time point (p>0.05 for all comparisons). Conclusion: Epidural 0.75% ropivacaine provides sensory and motor block characteristics equivalent to 0.5% bupivacaine with comparable hemodynamic stability. Ropivacaine offers the additional advantage of a theoretically safer cardiotoxicity profile, making it a clinically effective and safe alternative for epidural anesthesia in lower abdominal surgeries. Keywords: Epidural anesthesia, Ropivacaine, Bupivacaine, Sensory block, Motor block, Hemodynamic stability.

Background: First pass tracheal intubation is particularly crucial in patients with a predicted difficult airway, as repeated laryngoscopic attempts are associated with increased risks of hypoxia, mucosal trauma, aspiration, sympathetic stimulation, and airway related complications. Video laryngoscopes such as the King Vision video laryngoscope have been introduced to enhance glottic visualization, reduce the need for airway manipulation, and improve overall intubation success compared with conventional Macintosh direct laryngoscopy techniques. The aim and objective are to compare the efficacy of the King Vision video laryngoscope and Macintosh laryngoscope in anticipated difficult airway with respect to first attempt intubation success. Secondary objectives included comparison of laryngoscopic view, intubation time, number of attempts, hemodynamic response, and complications. Materials and Methods: This prospective randomized controlled study included 60 adult patients aged 20 to 60 years with anticipated difficult airway undergoing elective surgery under general anaesthesia. Patients were randomly allocated into two groups of 30 each: King Vision video laryngoscope and Macintosh laryngoscope. Primary outcome was first attempt success rate. Secondary outcomes included Cormack Lehane grade, intubation time, attempts, and peri intubation complications. Results: First attempt success was identical in both groups at 93.3 percent. Glottic visualization and complication rates were comparable. Mean intubation time was significantly shorter with King Vision 27.42 ± 8.31 seconds compared to Macintosh 34.18 ± 9.64 seconds, p = 0.026. Hemodynamic parameters showed no significant intergroup difference. Conclusion: Both devices demonstrated comparable first pass success and safety profiles; however, King Vision facilitated faster intubation, making it an effective alternative to Macintosh in anticipated difficult airway management. Keywords: King Vision video laryngoscope; Macintosh laryngoscope; anticipated difficult airway; first attempt intubation success; video laryngoscopy.

Hepatorenal dysfunction is a serious complication of decompensated chronic liver disease (DCLD) associated with poor prognosis and increased mortality. This prospective observational study aimed to evaluate the diagnostic accuracy of serum Cystatin C compared to serum creatinine for detecting hepatorenal dysfunction and assessing renal function using estimated glomerular filtration rate (eGFR). A total of 50 patients with DCLD were included, with a mean age of 48.72 ± 8.30 years and male predominance (76%). Hepatorenal dysfunction was present in 60% of patients. Serum creatinine levels were elevated (>2 mg/dL) in 52% of patients, with a sensitivity of 83.33%, specificity of 100%, and diagnostic accuracy of 90%. In contrast, serum Cystatin C levels were elevated (>1.3 mg/L) in 66% of patients and demonstrated superior diagnostic performance, with 100% sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy. Receiver operating characteristic curve analysis showed a higher area under the curve for serum Cystatin C (0.997) compared to serum creatinine (0.917), indicating superior diagnostic accuracy. Cystatin C-based eGFR also showed higher diagnostic accuracy compared to creatinine-based eGFR. Hepatorenal dysfunction was significantly associated with worsening liver disease severity, lower serum albumin levels, and higher bilirubin, prothrombin time, and INR levels. These findings suggest that serum Cystatin C is a more sensitive and reliable biomarker than serum creatinine for detecting renal dysfunction in patients with decompensated chronic liver disease and may be useful for early diagnosis and improved clinical management. Keywords: Cystatin C; Serum creatinine; Hepatorenal dysfunction; Decompensated chronic liver disease.

Background: Type 2 DM, which accounts for around 90% of all cases of DM, is now a global health challenge. TSP-1, a multifunctional glycoprotein is released from macrophages, platelets, and adipocytes. Hyperglycaemia promotes up regulation of TSP-1, which is an important mediator of obesity induced inflammation and resistance. It activates various inflammatory markers including Toll-like receptor 4 (TLR-4), Transforming growth factor-beta (TGF-β), and Plasminogen activator inhibitor-1 (PAI-1) & inhibits Nitric Oxide (NO) signalling pathway. Chronic hyperglycaemia, hypertension and dyslipidemia are major contributor of morbidity and mortality in T2DM. TSP-1 also serves as a pro-thrombotic and pro-inflammatory mediator in cardiovascular diseases. Aim and Objective: To estimate the level of serum TSP-1 in Type 2 diabetic patients & to find its association with cardiovascular risk factors. Materials and Methods: The present Cross Sectional Analytical Study was conducted among 40 diabetic patients and 40 healthy subjects within age group 35-60 years, attending the OPD of general medicine VIMSAR, Burla between November 2025 to January 2026. Serum TSP-1 was measured in ELISA and FBS, lipid profile were measured in fully automated analyzer. HbA1C & hsCRP were calculated using turbidimetric assay. Statistical analysis was performed with SPSS software version 21.0 and the p value <0.05 was taken for statistical significant. Results: The mean value of serum TSP-1, TG, hsCRP was (37142±3640), (170±11.8), (2.8±0.3) respectively in diabetic patients. Serum HDL (32±4.6) was found to be lower in Diabetic patients as compared to control. Serum TSP-1 showed strong positive correlation with cardiovascular risk factors like hsCRP, TG, BMI, SBP but correlated negatively with HDL. Conclusion: As the present study revealed positive correlation of TSP-1with cardiovascular risk factors, so it may serve as a valuable early biomarker for assessing and preventing cardiovascular complications in patients with Type 2 DM. Keywords: TSP-1, Type 2 DM, cardiovascular risk factors.

Background: Type 2 diabetes mellitus (T2DM) is a chronic, progressive cardiometabolic disorder associated with substantial cardiovascular and renal morbidity and mortality worldwide. Traditional glucose-centric treatment paradigms, focused on stepwise glycaemic control, have proven insufficient to address the broader cardiometabolic risk profile of individuals with T2DM. In recent years, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as transformative therapies, demonstrating benefits that extend beyond glucose lowering to include weight reduction and significant cardiovascular and renal risk mitigation. Materials and Methods: This narrative review examines the evolving role of GLP-1 receptor agonists in contemporary T2DM management, with particular emphasis on their transition from second-line therapies to first line and early combination treatment strategies. A comprehensive literature search of PubMed/MEDLINE, Embase, and the Cochrane Library was conducted to identify randomized controlled trials, cardiovascular and renal outcome trials, real-world evidence, and international clinical practice guidelines published between 2019 and 2025. Evidence was synthesized descriptively to contextualize emerging trends in global diabetes care. Results: Findings from large cardiovascular outcome trials demonstrate that several GLP-1 receptor agonists significantly reduce major adverse cardiovascular events, with benefits observed across diverse patient populations, including those without established cardiovascular disease. Additional evidence supports favorable effects on renal outcomes, particularly reductions in albuminuria and slowing of kidney function decline. GLP-1 RAs also provide durable glycaemic control, clinically meaningful weight loss, and a low intrinsic risk of hypoglycaemia, supporting their suitability for early initiation. Combination strategies involving metformin, sodium–glucose cotransporter-2 inhibitors, and basal insulin further enhance metabolic durability and treatment flexibility. Conclusion: In conclusion, GLP-1 receptor agonists have evolved into cornerstone therapies within modern, outcomes-driven T2DM treatment algorithms. Their integration into representized, patient-centered care pathways represent a paradigm shift toward proactive cardiometabolic risk reduction. Continued research improved global access, and long-term outcome data will be essential to fully realize their potential in improving population-level diabetes outcomes. Keywords: Type 2 diabetes mellitus, Glucagon-like peptide-1 receptor agonists, Cardiometabolic risk reduction, Cardiovascular outcomes, Renal outcomes, First-line therapy, Combination therapy, Treatment algorithms, Obesity management, Global diabetes care.

Background: India’s rapid urbanization has led to a proportional increase in slum populations, where access to healthcare remains limited despite their proximity to medical facilities. The urban poor face challenges such as weak referral systems, low awareness of government health programs, and financial constraints, resulting in poor health-seeking behavior. Health insurance serves as a key mechanism to mitigate financial barriers and enhance healthcare accessibility. However, limited awareness and systemic barriers continue to hinder insurance uptake and renewal. Objectives: This study aimed to assess the prevalence of health insurance coverage among adults residing in urban slums of Bangalore and to identify the major barriers preventing enrolment and renewal of health insurance schemes. Material and Methods: A community-based cross-sectional study was conducted among 1,124 adult residents of 16 randomly selected urban slums near an Urban Health Training Centre of a medical college between August and December 2024. Participants aged 18 years and above were interviewed using a pre-tested, semi-structured questionnaire covering demographic characteristics, insurance coverage, and barriers to enrolment. Data were analyzed using descriptive statistics and Chi-square tests, with a p-value <0.05 considered statistically significant. Results: Among the 1,124 respondents, 39.5% were enrolled in a health insurance scheme, while 60.5% remained uninsured. Of those insured, 29.5% had not renewed their policy, primarily due to low awareness (70.99%) about the importance of continuous coverage. The main reasons for non-enrolment included lack of awareness of insurance benefits (57.49%), complex enrolment procedures (19.89%), mistrust in providers (9.67%), high premium costs (7.90%), and inadequate documentation (5.04%). Significant associations were observed between education, income, socioeconomic status, and insurance coverage (p<0.000). Conclusion: The study reveals substantial gaps in health insurance awareness, enrolment, and renewal among urban slum populations. Strengthening targeted awareness programs, simplifying administrative procedures, enhancing affordability, and improving trust in insurance systems are essential to expand coverage and achieve equitable healthcare access. Keywords: Health insurance, Urban slums, Barriers to healthcare, Out-of-pocket expenditure, Health policy, Bangalore.

Background: Tuberculosis (TB) in pregnancy remains a significant public health issue in India. There is an urgent need for early detection, proper antenatal care, and consistent follow-up to mitigate adverse maternal and perinatal outcomes in patients diagnosed with TB. Primary Objective: To evaluate maternal and perinatal outcomes among antenatal women diagnosed with tuberculosis in relation to their adherence to treatment and follow up. Materials and Methods: We present a case series of five pregnant women diagnosed with tuberculosis at various gestational ages over a one-year period at a tertiary care Centre in South India. Clinical presentation, diagnostic modality, treatment adherence, obstetric course, and perinatal outcomes were analyzed. All patients received standard anti-tubercular therapy (ATT) as per national guidelines, along with individualized obstetric management and coordinated follow-up through the antenatal and postnatal periods. Results: Outcomes were strongly influenced by the timing of diagnosis and treatment adherence. Women diagnosed early in pregnancy and maintained on regular follow-up had favorable maternal recovery and live term deliveries, in contrast to those diagnosed late or on irregular follow-up. Conclusion: Tuberculosis in pregnancy demands vigilant screening, prompt initiation of therapy, and structured follow-up to ensure optimal maternal and perinatal outcomes. Strengthening antenatal TB surveillance and integrating obstetric and pulmonary care are critical to reducing preventable complications in endemic regions. Conflict of interest: No Keywords: Tuberculosis, Pregnancy, Maternal outcome, Perinatal outcome, Follow-up, Antenatal care.

Background: Osteoarthritis (OA) is the second most common rheumatologic problem and the most common joint disease in India. The burden of OA must be addressed to diminish the quality of life lost due to disability and functional restrictions as well as the resulting economic effect. The objective was to assess the quality of life and to study the distribution of the risk factors associated with knee OA. Materials and Methods: A Cross-sectional study was conducted among the patients for a period of two years diagnosed with knee osteoarthritis attending the clinics of tertiary care hospital between age of 18-50 years with a sample size of 200. A Standard validated SF 36 Questionnaire was used for assessment of the Quality of Life. Results: Majority were female (72%) and married (92%), aged between 41-50 years (80%) with mean age of 45.15 + 5.51 years. Mostly illiterates (59%) and belonging to upper lower class (60%). The assessment of quality of life, where 78% and 60% of the study population had poor quality of life in physical and mental components of quality of life respectively. Conclusion: Excessive physical activity, repetitive knee bending, menopause and its duration in females, high BMI, H/O knee injury, were some of the significant risk factors associated with early onset of OA knee. Overall, physical health was involved more than mental health. Health education can help prevent osteoarthritis and improve quality of life. A health programme for osteoarthritis is recommended to prevent the early onset of OA. Keywords: Young Knee OA, Obesity, excessive physical activity, knee bending, Andhra Pradesh.

Background: Cervical lymphadenopathy is a frequent clinical presentation seen in a wide range of infectious, inflammatory, and neoplastic conditions. Fine Needle Aspiration Cytology (FNAC) has emerged as a reliable, minimally invasive, and cost-effective diagnostic tool for evaluating the etiology of cervical lymph node enlargement, aiding early diagnosis and management without the need for more invasive procedures. This retrospective study aimed to analyze the spectrum of lesions in patients presenting with cervical lymphadenopathy at GMERS Medical College and Hospital, Vadnagar, Mehsana, Gujarat over a two-year period (January 2023 – December 2025), and to determine the relative frequencies of non-neoplastic, granulomatous, reactive, and neoplastic lesions identified on FNAC. Materials and Methods: The records of 328 patients who underwent FNAC for palpable cervical lymphadenopathy between 2023 and 2025 were reviewed. Aspirates were obtained using standard FNAC techniques and processed for cytological evaluation. Smears were stained using routine cytologic stains, and additional staining (e.g., Ziehl-Neelsen for acid-fast bacilli) was performed when indicated. Cytological diagnoses were categorized into reactive lymphoid hyperplasia, infectious/granulomatous lymphadenitis (including tuberculosis), metastatic malignancy, lymphoproliferative disorders, and other rare lesions. Results: FNAC provided diagnostic material in the majority of cases and successfully classified lesions into benign and malignant categories. Reactive lymphadenitis and granulomatous lymphadenitis, most notably tuberculous lymphadenitis, were the predominant non-neoplastic findings. Metastatic carcinoma constituted the most common neoplastic category among malignant lesions. Less frequent diagnoses included lymphoproliferative disorders and other rare cytological entities. These findings are consistent with previously reported patterns in similar tertiary care settings, where infection and reactive changes predominate in developing regions. Conclusion: FNAC is a valuable diagnostic modality in the evaluation of cervical lymphadenopathy, facilitating rapid and accurate distinction between infectious, reactive, and neoplastic processes. Its high diagnostic yield and safety profile make it particularly useful in tertiary care practice. This study highlights the importance of FNAC in routine cytopathological assessment and supports its continued use for guiding clinical management in resource-limited environments. Keywords: Cervical lymphadenopathy, Fine Needle Aspiration Cytology, Tertiary care institute.

Background: Urinary tract infections (UTIs) are more frequent and often more severe in patients with diabetes mellitus due to impaired immune response, autonomic neuropathy, and glycosuria that favors bacterial growth. Recurrent infections in diabetics may accelerate renal impairment and contribute to progression toward chronic kidney disease. The aim is to compare the spectrum of uropathogens in diabetic and non-diabetic patients and evaluate their effect on renal function parameters. Materials and Methods: This prospective comparative study was conducted over a period of one year at a tertiary care medical college in Ayodhya. A total of 100 patients presenting with clinical features of urinary tract infection were enrolled, comprising 50 diabetic and 50 non-diabetic individuals. Midstream urine samples were collected for culture and sensitivity testing using standard microbiological techniques. Renal function was assessed by measuring serum creatinine, blood urea, and estimated glomerular filtration rate (eGFR). Statistical analysis was performed to compare microbiological profiles and renal parameters between the two groups. Results: Culture positivity was higher among diabetic patients compared to non-diabetics. Escherichia coli was the predominant organism in both groups, followed by Klebsiella, Enterococcus, and Candida species. Diabetic patients showed a higher prevalence of multidrug-resistant isolates. Renal function tests revealed significantly higher serum creatinine and blood urea levels and lower eGFR values in diabetics compared to non-diabetics, particularly among those with recurrent infections. Conclusion: Diabetic patients demonstrate a higher burden of urinary infections, more resistant uropathogens, and greater renal function impairment compared with non-diabetic individuals. Early microbiological diagnosis and monitoring of renal function are essential to prevent long-term renal complications in diabetic patients. Keywords: Diabetes mellitus, urinary tract infection, uropathogens, renal function, creatinine, eGFR.

Background: Very low birth weight (VLBW) neonates (<1500 g) account for a disproportionate share of neonatal morbidity and mortality, particularly in low- and middle-income countries (LMICs). Contemporary prospective data describing their clinical profile and early outcomes are essential for benchmarking and quality improvement. Objectives: To describe maternal characteristics, neonatal clinical profile, respiratory burden, and early in-hospital outcomes of VLBW neonates requiring respiratory support. Materials and Methods: This prospective observational study was conducted in a tertiary-care neonatal intensive care unit (NICU) in India. Neonates with birth weight <1500 g, admitted within 24 hours of life and requiring respiratory support, were enrolled. Maternal and neonatal variables, cumulative duration of respiratory support, surfactant use, neonatal morbidities, and outcomes until discharge, death, or leaving against medical advice (LAMA) were recorded. Adverse outcome was defined as death or LAMA. Univariate logistic regression was performed to assess the association between birth weight and culture-positive sepsis. Results: Forty-three VLBW neonates were included. Mean gestational age was approximately 31 weeks and mean birth weight approximately 1150 g. The median cumulative duration of respiratory support was 7 days. Culture-positive sepsis occurred in approximately one-fifth of neonates. Overall survival to discharge was around three-quarters of the cohort. Lower birth weight was significantly associated with culture-positive sepsis. Conclusions: VLBW neonates requiring respiratory support experience substantial respiratory and infectious morbidity in LMIC settings. Birth weight remains a key determinant of early adverse outcomes. Keywords: Preterm, VLBW, Respiratory distress, surfactant, neonatal morbidity.

Background: Breast cancer is the most common malignancy among women in India, affects not only physical health but also deeply disrupts a woman’s sense of femininity, sexuality, and identity. The breast holds strong symbolic significance related to womanhood, body image, and intimate relationships. Despite their substantial impact, psychiatric comorbidities frequently remain underrecognized in oncology settings, adversely affecting treatment adherence and overall quality of life (QOL). This study aimed to estimate the prevalence and pattern of psychiatric comorbidities and to evaluate their association with quality of life among breast cancer patients undergoing active treatment. Materials and Methods: A cross-sectional study was conducted at a tertiary care hospital, from May 2024 to May 2025. A total of 131 histopathologically confirmed female breast cancer patients receiving surgery, chemotherapy, radiotherapy, or combination therapy were enrolled using consecutive sampling. Psychiatric diagnoses were assessed using the Mini International Neuropsychiatric Interview (MINI), and quality of life was evaluated using the WHOQOL-BREF questionnaire. Statistical analysis was performed using SPSS v23, with p < 0.05 considered statistically significant. Results: Psychiatric comorbidity was identified in 56.5% of patients. Generalized Anxiety Disorder (23.7%) and Major Depressive Episode (13.7%) were the most prevalent diagnoses, with notable overlap of anxiety and depressive disorders. Psychiatric comorbidity was significantly associated with lower socioeconomic status, longer duration of illness, advanced cancer stage, combined treatment modalities, and multiple hospitalizations. Patients with psychiatric comorbidities demonstrated significantly poorer quality of life across all WHOQOL-BREF domains—physical, psychological, social, and environmental—compared to those without comorbidity. QOL scores declined progressively with advancing cancer stage and more intensive treatment modalities. Conclusion: The findings underscore that the importance of identifying psychiatric comorbidities in breast cancer patients undergoing various treatment modalities cannot be underestimated. Incorporating routine psychiatric assessment and adopting a holistic, multidisciplinary approach to cancer care can lead to better psychosocial outcomes, improved quality of life, and enhanced overall treatment effectiveness. Keywords: Breast cancer; psychiatric comorbidity; anxiety; depression; quality of life; WHOQOL-BREF.

Background: Antibiotic resistance (ABR) is a major global health challenge driven largely by inappropriate antibiotic use in both healthcare and community settings. Public awareness and behavior significantly influence antibiotic consumption patterns. Objective: To assess awareness, attitudes, and practices related to antibiotic use and resistance among the general public and to identify demographic factors associated with inappropriate use. Materials and Methods: A community-based survey was conducted among 1,200 adults aged ≥18 years from urban and rural areas. Data were collected using a structured, pre-tested questionnaire assessing knowledge of antibiotics, attitudes toward their use, practices, and understanding of antibiotic resistance. Descriptive statistics, chi-square tests, and logistic regression analyses were performed. Results: While 78% of participants had heard of antibiotics, only 55% correctly identified their appropriate use for bacterial infections. Approximately 65% incorrectly believed antibiotics are effective against viral infections. Self-medication was reported by 41%, and 58% admitted discontinuing antibiotics once symptoms improved. Only 34% had heard of antibiotic resistance, and among them, understanding was limited. Lower education level and rural residence were significantly associated with poor knowledge and inappropriate practices (p < 0.05). Conclusion: Significant gaps exist in public knowledge and practices related to antibiotic use. Misconceptions and risky behaviours contribute to antibiotic resistance. Targeted education campaigns and stricter regulatory policies are urgently needed to promote rational antibiotic use. Keywords: Antibiotic resistance, public awareness, self-medication, antibiotic misuse, antimicrobial stewardship.

Background: Laparoscopic transabdominal preperitoneal (TAPP) repair is an established technique for inguinal hernia, but its learning curve and short-term outcomes continue to be evaluated, particularly in comparison to totally extraperitoneal (TEP) repair. This study analyzes the learning curve and perioperative outcomes of TAPP inguinal hernia repair performed by a single surgeon. Materials and Methods: This retrospective study included 55 patients (53 males, 2 females; mean age 53.3 years) who underwent 79 consecutive TAPP repairs (31 unilateral, 24 bilateral) between July 2018 and January 2020. Data on operative time, intraoperative complications, conversion rate, hospital stay, and postoperative complications (seroma, neuropathy, recurrence, etc.) were analyzed. Patients were followed up for 6 months to 2 years. Results: Hernia types included 50 direct, 23 indirect, and 6 combined; sizes were large (26), moderate (40), and small (13). Mean operative time decreased markedly over the series: from 186 min to 84 min for bilateral repairs and from 138 min to 66 min for unilateral repairs in the first versus last third of cases. Operative time stabilized after approximately 16 procedures. Mean hospital stay was 2.1 days. No visceral/vascular injuries, infections, or orchitis occurred. Two cases (2.5%) required conversion to open surgery. Postoperative complications included seroma in 7 cases (8.8%), neuropathy in 2 cases (2.5%), and one recurrence (1.2%) after 2 years. Conclusion: TAPP inguinal hernia repair demonstrates a relatively short learning curve, with operative time stabilizing after about 16 cases. The technique is safe and effective, with low rates of major complications and recurrence comparable to reported TEP outcomes. These findings support TAPP as an accessible and reliable option, particularly for large or complex hernias. Keywords: Inguinal hernia, Laparoscopic hernia repair, TAPP, Learning curve, Operative time, Postoperative complications, Recurrence

Background: Type 2 diabetes mellitus (T2DM) is a major contributor to chronic microvascular complications, including nephropathy, retinopathy and neuropathy. The risk of these complications increases with longer disease duration and poor glycaemic control, yet the pattern and burden vary across populations. This study assessed renal, retinal and neurological status in patients with T2DM and examined their association with duration of diabetes and glycaemic control in an Indian tertiary-care setting. Materials and Methods: A cross-sectional study was conducted among 263 adults with T2DM. Demographic and clinical parameters were recorded, and laboratory investigations included fasting glucose, postprandial glucose, and HbA1c measured via HPLC. Renal status was evaluated using urine albumin excretion and eGFR (CKD-EPI). Retinal assessment was performed using dilated fundus examination and graded according to ETDRS criteria. Peripheral neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI), 10-g monofilament, vibration perception and ankle reflex testing. Associations were analysed using chi-square tests and correlation analysis (Pearson/Spearman). A p-value <0.05 was considered significant. Results: Albuminuria was present in 28.1% and reduced eGFR (<60 mL/min/1.73 m²) in 12.1% of participants. Diabetic retinopathy was detected in 25.1%, and clinical peripheral neuropathy in 33.8%. All complications showed a significant stepwise increase with duration of diabetes: albuminuria (10.9% to 46.0%), retinopathy (10.9% to 47.6%), and neuropathy (18.2% to 61.9%) (all p<0.001). Poor glycaemic control (HbA1c ≥9%) was similarly associated with higher rates of albuminuria (47.1%), retinopathy (42.9%) and neuropathy (51.4%) compared with good control (<7%) (all p<0.001). Correlation analysis demonstrated significant relationships between duration of diabetes and eGFR decline (r = −0.36), albuminuria (ρ = 0.44), and HbA1c levels (r = 0.31), as well as between HbA1c and both eGFR (r = −0.29) and albuminuria (ρ = 0.41) (all p<0.001). Conclusion: Renal, retinal and neurological complications were highly prevalent in this T2DM cohort and showed strong associations with both longer diabetes duration and poorer glycaemic control. These findings highlight the need for early detection, stringent glycaemic management, and routine integrated screening for microvascular complications to prevent long-term morbidity in patients with T2DM. Keywords: Type 2 diabetes mellitus; Microvascular complications; Glycaemic control; Albuminuria; eGFR.

Background: Leprosy continues to persist in endemic pockets of India despite national elimination. Active case-finding strategies such as the Leprosy Case Detection Campaign (LCDC) have been implemented to identify hidden cases. Evaluating the contribution of LCDC in comparison to routine National Leprosy Eradication Programme (NLEP) surveillance is essential for guiding elimination strategies. Objectives: To describe the socio-demographic and clinical profile of newly detected leprosy cases, compare cases detected through LCDC and routine NLEP surveillance and assess epidemiological indicators in a district of Western Maharashtra. Materials and Methods: A cross-sectional study was conducted among all new leprosy cases registered between January 2020 and December 2024. Data was collected from district leprosy records and patient interviews using a structured case record form. Socio-demographic, clinical and programmatic variables were analysed using descriptive statistics. Results: Out of 652 new leprosy cases 32.36% were detected through LCDC and 67.64% through routine NLEP surveillance. Most cases belonged to the 15-59 year age group, with male predominance (62.6%). Rural residents constituted 68.3% of cases; however, LCDC identified a higher proportion of urban cases. Multibacillary leprosy accounted for 66.4% of cases. Treatment completion rate was 91.6%, and post-exposure prophylaxis coverage among contacts was 94.0%. Conclusion: LCDC significantly complements routine surveillance by identifying hidden cases, particularly in underserved populations. Sustained integration of active and passive surveillance is crucial for achieving district-level interruption of leprosy transmission. Keywords: Leprosy, LCDC, NLEP, Active case detection.

Background: Delay in initiation of anti-tuberculosis treatment contributes to continued transmission and poor outcomes. The objective is to identify factors associated with delay in initiation of treatment among tuberculosis patients. Materials and Methods: A prospective cross-sectional study was conducted among 200 newly diagnosed TB patients registered under NTEP. Results: Delay was significantly associated with distance >5 km from hospital (p=0.02). Conclusion: Distance from healthcare facility remains a key determinant of treatment delay. Keywords: Tuberculosis; Treatment Delay; NTEP; Distance; India

Background: Even though, the prevalence of anemia is decreasing in Southern states of India and its impact on maternal morbidity and mortality is being seen less affecting, still anemia leads the overall morbidity and mortality table. Even though the community nutrition program is in place and the iron folic acid tablets are being supplied under the program, it is necessary to carry out more studies to throw light on the prevalence trends and risk factors of anemia under different settings and locations. The objective is to study the prevalence and risk factors of anemia among pregnant women at a tertiary care hospital in Vizianagaram. Materials and Methods: Hospital based cross sectional study was carried out among 124 pregnant women. Detailed history, thorough clinical examination was carried out. For all women, hemoglobin was estimated using the Sahli’s hemoglobinometer. Results: Majority of the women (59.7%) belonged to the age group of 15-24 years of age. Majority (92.7%) were from rural area. Majority (38.7%) were home-makers. 40.3% had education level of secondary school and above. 34.7% had income level of 5001 to 10000 INR per month. 37.2% had menarche at the age of 13 years. Most of them were married at the age of 22-25 years and most of them had regular menstrual cycles. The prevalence of mild anemia was 36.3% and that of moderate anemia was 21.8%. overall prevalence of anemia was 58.1%. Among all the factors studied, no factor was found out to be significantly associated with anemia. However, the prevalence of anemia was significantly more in the third trimester. Thus, as the trimester of pregnancy increased, the prevalence of anemia increased which was statistically significant. (p<0.05). Conclusion: The prevalence of anemia is still very high in the hospital settings among the pregnant women. As the trimester of pregnancy increased, the prevalence of anemia also increased. Keywords: Anemia, prevalence, associated factors.