Vol 15, Issue 3, July-September, 2025

Background: The aim is to assess functional outcome of extra articular deformities corrected with intra articular corrections in primary total knee replacement. Materials and Methods: A prospective study was conducted over 18 months at Osmania General Hospital, Hyderabad, Telangana, India, involving 20 patients aged 50-70 years with extra- articular varus deformity of less than 20 degrees in the femur and less than 30 degrees in the tibia. Preoperative evaluations included sociodemographic details, blood investigations, imaging results, Knee Society scores, and Hungerford scores. Surgical corrections involved intra-articular bone resections and soft tissue release. Results: A majority of participants (75%) had their alignment fully corrected, and 85% reported advantages from the single-stage procedure. Radiological corrections were observed in varying degrees, with 50% of participants showing moderate improvement and 40% showing significant improvement. Notably, there were no reported complications, demonstrating the safety and efficacy of the interventions. The absence of complications and the high rates of alignment and radiological improvements reinforce the positive impact of the surgical procedures on the participants' health and quality of life. Conclusion: One-stage total knee arthroplasty is a viable and effective option for correcting extra-articular varus deformities, providing significant clinical and functional improvements while maintaining a favourable safety profile. Keywords: Functional outcome, Extra-articular varus deformities, Radiological corrections, Quality of life.

Background: Coronary artery disease is one of the leading causes of death globally, with coronary artery bypass grafting remaining the gold standard of treatment, especially in multivessel disease. However, diffuse disease poses an unforeseen difficulty of distal revascularisation by standard Coronary Artery Bypass Grafting (CABG) alone. Coronary endarterectomy as an adjuvant, even if unplanned preoperatively is essential in these cases for adequate revascularisation. In this study, we have compared the technical procedures and outcomes of coronary endarterectomy. Materials and Methods: In this retrospective observational study, we intend to compare the technique used, the vessel addressed and the outcomes recorded in patients who have undergone CABG with Coronary Endarterectomy at two separate tertiary care speciality hospitals between the period from February 2023 to February 2025, done by a single surgeon. Results: Data of 57 patients who had undergone CABG with coronary endarterectomy during the study period were analysed and assessed. There was a male preponderance in the study population, with the majority of patients falling in the 50 – 60-year age group. More patients underwent closed endarterectomy with off-pump or on-pump beating heart CABG while open endarterectomy was more common in on-pump arrested heart CABG. RCA was the most commonly endarterectomised vessel in our study. Conclusion: This study shows that successful coronary endarterectomy with CABG can show a drastic improvement in cardiac function and symptom relief of the patients due to improved perfusion and distal run off as the plaque causing obstruction is completely removed. However adequate postoperative anticoagulation and antiplatelet regimen as well as strict follow-up are necessary to ensure adequate maintenance of vessel patency and prevent reocclusion. Key Words: Coronary Artery Bypass Grafting, Coronary Endarterectomy, Coronary Artery Disease

Background: Student-centric teaching methods like Problem-Based Learning (PBL) and Small Group Discussions (SGD) focus on interactive, particularly beneficial in teaching clinical medical subjects. These methods help in developing diagnostic and decision-making skills which are essential in clinical practice. However, literature comparing the efficacy of these methods in undergraduate clinical teaching is limited. Materials and Methods: A quasi-experimental study was conducted among 124 final-year MBBS students at Dr Moopen’s Medical College, Wayanad, from October to December 2024. Students were divided into PBL (n=61) and SGD (n=63) groups based on roll numbers. Each group underwent three sessions on topics: Rickets, Osteosarcoma, and Osteomyelitis. Pre-tests and post-tests (MCQs) were used to assess knowledge gain and a Likert scale evaluated student perception. Data was analyzed using paired and unpaired t-tests with SPSS v26. A p-value < 0.05 was considered significant. Results: Pre-test scores were comparable between groups except for Osteomyelitis, where SGD scored higher (p=0.012). Both groups showed statistically significant improvements from pre- to post-test scores across all topics (p<0.001). Post-test comparisons between PBL and SGD revealed no significant differences between these two groups indicating both methods were equally effective. More than 90% of students reported improved understanding, engagement, critical thinking, and overall satisfaction with both methods. Conclusion: Both PBL and SGD are effective teaching-learning methods for clinical subjects in undergraduate medical education, promoting knowledge application to real-time clinical scenarios, and enhancing collaborative and problem-solving skills. Keywords: Problem Based Learning, Small Group Discussion, Medical education, Undergraduate teaching, Learning outcomes

Background: The aim is to establish the diagnostic usefulness of Delta Neutrophil Index as an early marker of disease severity in patients with acute pancreatitis. Materials and Methods: Single centre, non-interventional, prospective observational study in department of medicine for a period of 2 years in acute pancreatitis cases admitted diagnosed through clinical, laboratory and radiological parameters. Results: Mean heart rate was lesser in mild cases (79.20±9.7 bpm) compared to total population (85.05±12.1 bpm). This suggests that heart rate increases with severity of acute pancreatitis. Delta neutrophil index (DNI) had strong positive correlation with CRP, ANC, ATLANTA and BISAP scores , stronger correlation of DNI with severity was seen in mild cases compared to moderate-severe cases. Conclusion: DNI measured at presentation in emergency has the potential to function as an adjunctive marker for prediction of severity of acute pancreatitis. Keywords: Delta neutrophil index, Absolute neutrophil count , High sensitivity C reactive protein.

Background: Candida species have emerged as significant opportunistic pathogens, causing a wide spectrum of infections in hospitalized patients. The increasing prevalence of non-albicans Candida species along with rising antifungal resistance poses substantial challenges in clinical management. Aim and Objective: The present study aimed to determine the distribution of Candida species isolated from various clinical samples and to assess their antifungal susceptibility patterns in a tertiary care hospital setting. Materials and Methods: This observational study was conducted over a period of 18 months in a tertiary care hospital. Clinical samples such as blood, urine, respiratory secretions, vaginal swabs, and pus were collected and processed for fungal culture. Isolated Candida species were identified using conventional and automated identification methods. Antifungal susceptibility testing was performed using the CLSI broth microdilution method for commonly used antifungal agents, including fluconazole, voriconazole, amphotericin B, and caspofungin. Results: A total of 210 Candida isolates were obtained. Candida albicans accounted for 45% of isolates, while non-albicans Candida species constituted 55%, with Candida tropicalis (22%), Candida glabrata (15%), Candida parapsilosis (10%), and Candida krusei (8%) being predominant. Antifungal susceptibility revealed 18% resistance to fluconazole, primarily among non-albicans species. Voriconazole and amphotericin B exhibited high susceptibility rates across all species, while emerging resistance to caspofungin was observed in 6% of isolates. Conclusion: The increasing prevalence of non-albicans Candida species with variable antifungal resistance patterns underscores the need for routine species identification and susceptibility testing to guide effective antifungal therapy and improve patient outcomes. Keywords: Candida species, antifungal susceptibility, non-albicans Candida, fluconazole resistance, tertiary care hospital, candidiasis.

Background: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, and its accurate diagnosis is crucial for effective management. Objective: This study aims to evaluate the semiquantitative expression of CK19 in different thyroid lesions, including PTC, the follicular variant of PTC (FVPTC), follicular adenoma, and multinodular goiter (MNG), and to assess its diagnostic accuracy. Materials and Methods: This cross-sectional study was conducted at tertiary care hospital from June 2020 to June 2023. The sample size for this study comprised 50 thyroid cases. Tissue samples were collected from patients who underwent thyroid lobectomy or total thyroidectomy. The samples were then processed and fixed in formalin, followed by paraffin embedding. Serial tissue sections were prepared for IHC staining. Results: The study revealed that CK19 expression was strongly positive in 80% of usual-type PTC cases (moderate to strong expression). In the FVPTC group, CK19 was moderately expressed in 75% of cases. The follicular adenoma and MNG groups showed minimal to no CK19 expression, with 66.7% and 77.3% of cases, respectively, showing no CK19 staining. The sensitivity of CK19 in diagnosing PTC was 84%, with a specificity of 91%. The positive predictive value (PPV) was 82%, and the negative predictive value (NPV) was 89%. Conclusion: It is concluded that CK19 is a highly sensitive and specific marker for diagnosing papillary thyroid carcinoma, particularly in distinguishing it from benign thyroid lesions such as follicular adenoma and multinodular goiter. The semiquantitative assessment of CK19 expression demonstrated strong, diffuse positivity in usual-type PTC and moderate expression in FVPTC, making CK19 a valuable diagnostic tool. Keywords: Carcinoma, Patients, PTC, FNAC, Metastasis, Diagnosis.

Background: Acute abdomen is a medical emergency with diverse etiologies requiring rapid diagnosis for timely intervention. Imaging plays a pivotal role, with ultrasonography (USG) and plain abdominal radiography (X-ray) being the most accessible first-line modalities in emergency settings. The objective is to evaluate and compare the diagnostic efficacy of ultrasonography and plain radiography in identifying the underlying causes of acute abdomen and to correlate imaging findings with clinical and surgical outcomes. Materials and Methods: A hospital-based cross-sectional study was conducted over one year, including 200 patients aged 18–85 years presenting with features of acute abdomen. All patients underwent USG and plain radiography. Imaging findings were recorded and correlated with final diagnoses. Data were analyzed using SPSS version 23.0, with p < 0.05 considered statistically significant. Results: USG demonstrated high diagnostic accuracy in detecting cholelithiasis (99.9%), appendicitis (90%), pancreatitis (92.8%), and abscesses (99.9%). X-ray was more effective in bowel obstruction (99.9%) and radiopaque calculi (99.9%). Both modalities showed complementary diagnostic value. Conclusion: Ultrasonography and plain radiography serve as valuable complementary tools in evaluating acute abdomen. Integrating both enhances diagnostic precision and supports timely management in emergency care. Keywords: Acute abdomen; Ultrasonography; Radiography; Diagnostic imaging; Abdominal emergencies.

Background: Otomycosis is fungal infection of external ear and middle ear, commonly seen in tropical and subtropical regions. It is common condition encountered in ENT practice. Objective: To study mode of presentation, predisposing factors and types of fungi causing otomycosis. Materials and Methods: This observational study was included 166 patients (90 females and 76 males), 18-60 years of age group who were clinically diagnosed patients of otomycosis, and was carried out in Tertiary Care Hospital & Medical College of India over period of six months from July to December. A detailed history was taken including symptoms and various predisposing factors. Two swab samples were taken from affected ear and were sent to microbiology for identification of fungi causing otomycosis. After that patients were treated by ear cleaning and given antifungal drops/tablets according to presentation. Results: Our study showed maximum patients were of 21-40 years of age (77.71%), female preponderance (54.22%) and unilateral ear involvement (96.98%). Itching (83.13%) was the most common presentation in present study. Most common pre-disposing factor was self-cleaning by unsterile object (83.53%). Aspergillus Niger (79.08%) was found to be the commonest isolated fungus causing otomycosis. Conclusion: Present study highlights the commonest isolation of Aspergillus species in cases of clinically diagnosed otomycosis with common risk factor like self-cleaning to get relief from ear itching. Keywords: Otomycosis, Aspergillus, Candida.

Background: Child malnutrition is a major public health issue worldwide. An estimated 144 million children under age 5 are stunted, 47 million are wasted, and 38.3 million are overweight or obese. Around 45% of deaths among children under 5 years of age are linked to undernutrition. Malnutrition throughout the first five years of life cannot just have a poor effect on a child's physical and mental growth, but can also result in death. While malnutrition is a multifaceted issue, improper feeding habits account for more than two-thirds of cases globally. The present study is an attempt to identify the barriers and facilitators to optimal practices faced by the parents / primary caregivers of these children in the urban slum areas of Delhi. The objective is to study the barriers and enabling factors associated with IYCF practices among children aged 6 – 23 months. Materials and Methods: A community-based cross-sectional study was conducted among 400 children aged 6-23 months residing in the field practice areas of the medical college using simple random sampling. Data was obtained using a semi-structured questionnaire through the researcher-administered interview to parents/caregivers of study participants using good clinical and ethical practices. Data obtained was thus compiled using MS Excel and analysed using SPSS version 26.0. Results: Advice of healthcare workers and family members, as well as prior knowledge of the benefits of good breastfeeding and complementary feeding practices, were the major enablers for appropriate IYCF practices. whereas existing myths, ill-advice given by family members and traditional practices were the barriers identified under study. The study emphasises the pivotal role of healthcare workers. Conclusion: Traditional myths and practices should be addressed to combat inappropriate feeding practices, not just with parents / primary caregivers but also with other members of the family. This can be achieved by community health education programs, as well as one-on-one counselling by local ASHAs, ANMs, AWWs and skilled birth attendants. Keywords: Infant and Young Child Feeding Practices, Enablers and Barriers, Urban Slums.

Background: Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. Early detection and risk stratification are crucial for improving patient outcomes. Among the various biomarkers under investigation, Red Cell Distribution Width (RDW), which measures the variation in red blood cell size, has emerged as a potential indicator for the severity of CAD. This study aimed to explore the relationship between RDW levels and CAD severity, hypothesizing that elevated RDW values correlate with more advanced stages of CAD. Materials and Methods: This prospective observational study was conducted at Government Theni Medical College over 18 months, enrolling 100 patients diagnosed with acute coronary syndrome (ACS) and other CAD-related conditions. Data were collected using clinical history, examination, and laboratory tests, including complete blood count (CBC) with RDW measurements. Statistical analysis was performed using SPSS software, employing the Chi-square test, Spearman’s rank correlation, and Karl Pearson correlation methods. Results: The study cohort had a mean age of 56.04 years, with 65% male patients. RDW scores were significantly higher in patients with STEMI compared to those with Non-STEMI or Unstable Angina (p < 0.001). RDW was also strongly associated with systolic and diastolic blood pressures (p < 0.001). Patients with greater RDW scores exhibited higher blood pressure levels and more severe left ventricular dysfunction (LVEF). A significant correlation was found between RDW scores and the severity of left ventricular dysfunction, with higher RDW values associated with poorer LVEF (p < 0.001). Discussion: RDW levels correlate with the severity of CAD, particularly in patients with STEMI. The findings suggest that RDW could serve as a simple, inexpensive marker to assess CAD severity, particularly when combined with other clinical indicators like LVEF and blood pressure. Conclusion: Elevated RDW levels are significantly associated with more severe forms of coronary artery disease, including STEMI, higher blood pressure, and worse left ventricular function. RDW may be a useful adjunctive biomarker for assessing the severity of CAD, providing valuable prognostic information for clinical decision-making. Keywords: Coronary Artery Disease, Red Cell Distribution Width, Acute Coronary Syndrome, Prognostic Biomarker, Coronary Angiography.

Background: Suicide is a major global health issue, strongly linked to psychiatric disorders. Both common mental disorders (CMD) and severe mental illness (SMI) significantly increase suicide risk. Early detection of high-risk individuals is critical for prevention. Aim: To assess and compare the prevalence of suicidal ideation and attempts among individuals with CMD and SMI, and identify associated sociodemographic and clinical factors. Materials and Methods: A cross-sectional study was conducted on 80 adults with CMD (n = 40) or SMI (n = 40). Depression and anxiety severity were assessed using the Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale. Obsessive-compulsive symptoms were measured using the Yale-Brown Obsessive Compulsive Scale. General psychiatric symptoms were evaluated with the Brief Psychiatric Rating Scale. Suicidal ideation and intent were assessed using Beck’s Suicidal Ideation Scale and Suicide Intent Scale. Data were analysed using SPSS; p < 0.05 was considered significant. Results: Suicidal ideation was present in 38.6% of patients with CMD and 36.1% of patients with SMI. Suicide attempts were more frequent in the CMD (18.2%) than in the SMI (5.6%) group, although this difference was not significant. Major depressive disorder was most commonly associated with both ideation (60%) and suicide attempts (30%). Females exhibited higher suicidal ideation (55.6%), whereas males had more attempts (66.7%). Suicidal behaviour was more common among younger individuals and those from lower-middle socioeconomic backgrounds. Conclusion: Suicidal ideation and attempts were common and comparable in CMD and SMI. Risk factors such as age, gender, and family history underline the importance of routine suicide risk screening in psychiatric care. Keywords: Suicide, Suicidal Ideation, Suicide Attempt, Common Mental Disorders, Severe Mental Illness, Depression, Risk Factors.

Background: There is an increase in incidence of knee osteoarthritis among middle-aged individuals, leading to pain and functional limitation. Medial Open Wedge High Tibial Osteotomy (MOWHTO) is a joint-preserving surgical procedure designed to realign the mechanical axis and offload the diseased compartment. The usage Tomofix plate offers better biomechanical stability and prevents the loss of correction thus allowing early mobilization and reliable healing. This study aims to evaluate the functional and radiological outcomes of MOWHTO using the Tomofix plate. Materials and Methods: This prospective interventional study was conducted at NRI Institute of Medical Sciences, Visakhapatnam, over a period of 24 months. 20 patients with symptomatic medial compartmental OA were selected based on strict inclusion criteria. Functional outcomes were assessed using the Knee Society Score, Visual Analogue Scale and Range of Motion. Radiological outcomes were evaluated via Hip-Knee-Ankle (HKA) angle measurements pre- and post-operatively. Results: The mean age of population in this study is 54.45 with 60% females and 40% males. The mean BMI is 25.17. The mean HKA angle improved significantly from 170.5° preoperatively to 184.2° postoperatively indicating successful correction of varus deformity. VAS scores decreased from a mean of 6.8 to 2.6. The KSS score improved from 54.1 to 90.6 and Functional KSS scores also showed significant improvement from 50.2 to 85.5. The overall complication rate is 10%. Conclusion: MOWHTO using the Tomofix plate is a safe and effective procedure for selected patients with medial compartmental OA. It significantly improves pain, alignment, and functional outcomes with minimal complications, reinforcing its role as a viable alternative to knee arthroplasty in active, physiologically young individuals. Keywords: High Tibial Osteotomy, Tomofix Plate, Osteoarthritis, KSS score, VAS score.

Background: Brachial plexus blockade is the cornerstone of regional anaesthesia practice of most anaesthesiologists. The supraclavicular approach is one of several techniques used to accomplish anaesthesia of the brachial plexus and is performed at the level of the brachial plexus trunks where almost entire sensory, motor and sympathetic nerve supply of the upper extremity is carried. Consequently, typical features of this block include its rapid onset, predictability and density. the objective is to compare dexmedetomidine and clonidine when added to a local anaesthetic solution for Supraclavicular brachial plexus block for upper limb orthopaedic surgeries with respect to Onset of sensory blockade, Onset of motor blockade, Duration of sensory blockade and Duration of motor blockade Materials and Methods: The present Randomized Controlled Trial was carried out at Anaesthesia department involving patients to be posted for upper extremity orthopaedic surgeries in RK Damani Medical College SRIMS Chhatrapati Sambhajinagar, Maharashtra during the study period from January 2024 to December 2024. Results: Proportion of females in Group C were 40% as compared with 22.2% in Group D. Proportion of males in Group C were 60% as compared with 77.8% in Group D. Sensory blockade onset was earlier in Group D as compared with Group C. Motor blockade onset was earlier in Group D as compared with Group C. Duration of sensory blockade was prolonged in Group D as compared with Group C. Duration of motor blockade was prolonged in Group D as compared with Group C. Conclusion: Sensory and motor blockade onset was earlier in Group D as compared with Group C. Duration of sensory and motor blockade was prolonged in Group D as compared with Group C. Keywords: Dexmedetomidine, clonidine, supraclavicular brachial plexus block for upper limb orthopaedic surgeries.

Background: The histogenesis and progression of cervical carcinoma is well documented. It is possible to prevent the development of invasive carcinoma by identifying and treating pre invasive lesions. This study was a prospective study conducted from 01 July 2014 to 01 July 2016. The objectives of the study were to evaluate and interpret the cases of precancerous and cancerous lesions according to The 2001 Bethesda System and to correlate cytology diagnosis with histopathology diagnosis. Materials and Methods: Pap Smears were received along with their corresponding cervical biopsies or hysterectomy specimens in the Department of Pathology, Raja Rajeswari Medical College and Hospital, Bangalore. The Pap smears were stained with Papanicolaou stain and the corresponding biopsies or hysterectomy sections were stained with H & E stain and examined for microscopic details. Results: The cytological evaluation of 200 pap smears was done and 61.5% of lesions were reported as Negative for intraepithelial lesion or malignancy, 15% as ASCUS, 11% as LSIL, 5.5% each as HSIL and SCC and the remaining 1.5% as positive for malignancy. Majority of the women were from the age group of 41-50 years and the commonest presenting complaint was white discharge per vaginum. Of 200 specimens received for histopathology, 137 (68.5%) were reported as Benign, 37 (18.5%) as Premalignant and 26 (13%) as Malignant. Amongst the 37(18.5%) premalignant lesions encountered on histopathology, 11% cases were reported as koilocytic atypia, 43% cases as CIN 1, 27% cases as CIN 2, 16% cases as CIN 3 and 3% cases as CIS. The total number of malignant lesions were 26 (13%) in number. Out of these, 92% were reported as Squamous cell carcinoma and 4% cases each of microinvasive SCC and Adenocarcinoma. Of these 24 cases of SCC, 58% cases were moderately differentiated SCC, 33% were well differentiated SCC and 9% cases were diagnosed as poorly differentiated SCC. Conclusion: The regular screening of population by Pap smear and reporting as per The 2001 Bethesda System is a cost-effective method for early detection of premalignant and malignant cervical lesions. The procedure is simple, inexpensive and can be performed in the outpatient department which is useful in a country like ours. It also has an important role in the diagnosis of inflammatory lesions including the identification of causative organism and atrophic changes and helps in the definitive management of patients. All lesions on Pap smears should be followed by repeat Pap smear examination and cervical biopsies hysterectomy which will improve the diagnostic accuracy and help in staging of malignant lesions. Keywords: The 2001 Bethesda System, Papanicolaou stain, cervical biopsy.

Background: Irrational drug prescriptions frequently occur in clinical practice, primarily due to insufficient knowledge regarding medication prescribing. Developing nations possess constrained financial resources for healthcare and pharmaceuticals, making it imperative to prescribe medications judiciously. The data on WHO core drug use indicators (prescribing indicators, patient care indicators, and facility care indicators) was collected prospectively through prescriptions, registration books, patient interviews, and patient observations, all conducted with prior consent. This study aimed to evaluate drug utilisation patterns in paediatrics by assessing prescribing indicators, patient care indicators, facility indicators, and complementary indicators. Materials and Methods: A total of 149 prescriptions for paediatric patients aged from newborn to 12 years were collected. This study aims to assess prescription patterns based on the key drug use indicators set by the World Health Organisation (WHO). Results: The examination of prescribing indicators indicated an average of three medications per prescription encounter. The proportion of medications prescribed from the Essential Drug List reached a full 100%. The percentage of medications prescribed using their generic names was documented at 97.98%. Antibiotics comprised a notable category of prescribed medications, accounting for 19.46%, followed by vaccines at 16.77%. Conclusion: The imperative to fortify logical prescribing practices and elevate awareness among physicians and medical students. This initiative should involve comprehensive training programmes that highlight the importance of evidence-based medicine and the potential risks of irrational prescribing. Additionally, continuous monitoring and evaluation of prescribing patterns will be essential to ensure compliance with the newly established standards and to promote a culture of responsible medication use. Keywords: Drug Utilisation, World health organization, Prescription, Antibiotics.

Background: The aim is to study the accuracy of MDCT in the diagnosis of paediatric abdominal tumours and its effectiveness in differentiating benign from malignant tumours. Materials and Methods: Pediatric Patients referred to the radiology department with USG findings suggestive of abdominal tumors and others clinically indicated. 70 Patients Both genders of Pediatric age group (0-18 years) who came to the Radiodiagnosis in the period of 24 months with relevant history and clinical examination were subjected to this study. Results: In this study, out of 70 patients, most common pediatric abdominal tumour is Wilms tumour (n=17), followed by hepatoblastoma (n=13) and germ cell tumours (n=10). Equal number of Neuroblastoma and Lymphoma (n=8) is seen. In this study, sex distribution of 60% males and 40% females noted. Among NB cases, extending cross midline, 50% are adrenal in origin, 75% showed vascular encasement, 25% patients had distant metastasis. Coarse, amorphous calcifications are common in Neuroblastoma. All Teratoma cases are heterogenous with mixed solid cystic areas with calcifications and fat. Majority of hepatoblastoma cases are seen in males (84.6%). Mass and pain abdomen were common symptom/sign of hepatoblastoma after abdominal distension. 38% of hepatoblastoma showed associated tumour thrombus. 60% of RMS cases are females, most of them presenting with very large mass and had their origin in pelvic structures predominantly (60%) in bladder. Retroperitoneal lymphoma showed low attenuation on plain CT and homogenous enhancement on contrast studies and encasing vascular structures. 10 (14.28%) cases were of germ cell origin with 2 each of sacrococcygeal and retroperitoneal teratoma. Conclusion: Contrast enhanced CT accurately localized site of origin, morphology of tumour relationship with neighbouring structures, vascular encasement or infiltration, tumour characteristics with necrotic areas. Besides CT also being considerably cost effective and widely available, it is preferred preoperative method of evaluating retroperitoneal mass in a child. Keywords: Multidetector Computed Tomography, Ultrasonography, Neuroblastoma, Rhabdomyosarcoma.

Background: Lipohypertrophy (LH) frequently occurs in people with type 2 diabetes mellitus (T2DM) treated with insulin, which may negatively affect insulin absorption and glycemic control. This study aimed to identify the prevalence of LH and its associated risk factors among patients with T2DM who inject insulin. Materials and Methods: This cross-sectional observational study included a sample of 40 patients with T2DM who were undergoing insulin therapy. Demographic and clinical parameters, methods of insulin administration, and glycemic control data were obtained. LH was evaluated through physical assessment. Relevant statistical tests and multivariate logistic regression analyses were used to analyze the associations. Results: LH was prevalent in 60. LH was found to be closely related to increased duration of diabetes (p<0.001), insulin therapy for > 5 years (OR=6.85, p=0.001), needle reuse > 5 times (OR=5.92, p=0.003), irregular rotation of sites (OR=4.37, p=0.01), and longer needles (OR=3.95, p=0.02). HbA1c (9.4+1.5% vs 8.1+1.2%, p=0.003), insulin doses, and hypoglycemic episodes were also increased in Conclusion: LH is common in T2DM patients who inject insulin and have poor injection technique, along with poor glycemic outcomes. Regular education on insulin administration to lower LH levels and achieve better metabolic control should be conducted. Keywords: Lipohypertrophy, Prevalence, Type 2 Diabetes Mellitus, Insulin injection.

Background: Aim: To study the clinical, etiological and radiological profile of Cerebral Venous Thrombosis in male patients. Materials and Methods: This cross-sectional study was carried out in the Neurology department. study subjects were adult male patients who were admitted with acute headache and other neurological features with CT/ MRI/ MRV (brain) findings of Cerebral Venous Thrombosis Results: The majority of patients were of 3rd and 4th decade, with a mean age of 35.5 + 11.75 years. Headache was the most common symptom, reported by all patients, followed by seizures (74%), vomiting (62%), and blurred vision (32%). Focal neurological deficits (45%) and papilledema (32%) were the most frequently observed clinical signs. Elevated serum homocysteine levels were found in 59% of patients, of which 52% were alcoholics. A statistically significant link was found between alcoholism and elevated serum homocysteine. Additional risk factors for CVT in males include infections (10%), connective tissue disorders (6%), protein C deficiency (6%), protein S deficiency (5%), dehydration due to diarrhea (3%), anemia (3%), antithrombin-III deficiency (1%), and antiphospholipid antibody syndrome (1%). The cause was unknown in 6% of cases. The superior sagittal sinus (SSS) was the most frequently affected sinus (69%), in males followed by the transverse sinus (45%), either individually or in combination. Conclusion: There is a need to increase the awareness among people regarding the effects of alcohol and necessary steps to reduce the consumption of alcohol. Keywords: Superior sagittal sinus (SSS), Straight sinus(SS), Magnetic Resonance Venography (MRV).

Background: Chronic liver disease (CLD) significantly contributes to morbidity. In the case of CLD, high levels of plasma glucose and HbA1c are linked to both severe disease and poor prognosis, independently of each other. Materials and Methods: This cross-sectional and observational study, conducted in the Department of General Medicine at World College of Medical Sciences Research and Hospital in Jhajjar, was based in a teaching hospital. The study included sixty known diabetic patients, both with and without CLD, who met the criteria for chronic hepatitis C. Results: The current study involved 60 participants, who were split into groups I and II. Group I consisted of 30 participants with chronic hepatitis C and diabetes, with a mean age of 58.64±12.24 years, while Group II included 30 participants without chronic hepatitis C but with diabetes, having a mean age of 52.32±10.16 years. Low levels of fasting blood glucose were seen in group I than group II (144.29±26.24 mg/dl vs. 202.12±28.67 mg/dl p<0.02). Low levels of fasting blood glucose were seen in group I than group II (144.29±26.24 mg/dl vs. 202.12±28.67 mg/dl p<0.04).Group I also exhibited lower HbA1c levels compared to group II (6.62±1.34% vs. 8.67±2.64%, p<0.04). Group I had a significantly higher serum ALT level compared to group II (78.21±21.36 IU/L vs. 36.54±12.34 IU/L, p<0.05). Group I exhibited a significantly elevated serum AST level in comparison to group II (62.58±18.36 IU/L vs. 28.32±12.52 IU/L, p<0.04). In group I, HbA1c levels showed a significant negative correlation with ALT (r=0.42, p<0.02), whereas in group II, this correlation was not statistically significant (r=0.12, p=0.52). Conclusion: These findings suggest that HbA1c levels are significantly lower in diabetic patients with chronic hepatitis C compared to those without chronic liver disease. As a result, HbA1c cannot be trusted as an accurate predictor for long-term glycemic monitoring in diabetic patients with chronic liver disease. Keywords: Chronic liver disease, hepatitis C, FBS, HbA1c, AST & Diabetes mellitus.

Background: Subarachnoid and epidural blocks are widely used regional anesthesia techniques for lower abdominal and limb surgeries. Epidural anesthesia offers effective surgical anesthesia, extended duration, and prolonged postoperative analgesia with fewer hemodynamic changes. Ropivacaine, a newer amide local anesthetic, has lower cardiovascular toxicity than Bupivacaine but causes less motor block. Dexmedetomidine, a highly selective α2 agonist, provides sedation, stable hemodynamics, and prolonged analgesia. This study compares 0.75% Ropivacaine with and without Dexmedetomidine in epidural anesthesia for enhanced postoperative pain control. Materials and Methods: One hundred patients, scheduled for various elective lower abdominal and lower limb surgical procedures belonging to ASA class I and II were included in the study. The patients were normotensive with ages varying from 18 to 65 years. The study population was randomly divided into two groups with 50 patients in each group Group R - 15ml of 0.75%Ropivacaine Group RD - 15ml of 0.75% Ropivacaine + 0.6µg/kg of Dexmedetomidine. Onset and duration of sensory blockade, Onset and duration of motor blockade, Haemodynamic changes, Maximum dermatomal level of analgesia, Intensity of motor blockade, and any adverse effects. Results: The dexmedetomidine group had a rapid onset of action (p<0.05), prolonged duration of sensory and motor block (p<0.05), better sedation score and postoperative analgesia (p<0.05), and more intense motor block (p<0.05). There was no difference in the maximal dermatomal level of analgesia, incidence of hypotension, and bradycardia (p>0.05). The occurrence of side effects (tremors, nausea, and SpO2<90%) was low and similar between groups(p>0.05). Conclusion: There is a clear synergism between Dexmedetomidine and Ropivacaine compared with plain Ropivacaine in epidural anesthesia without increased morbidity. Keywords: Dexmedetomidine, Epidural Anaesthesia, Ropivacaine, Lower Abdominal Surgeries.

Antimicrobial resistance (AMR) is a looming global threat that compromises the efficacy of life-saving drugs in both human and veterinary medicine. The exaggerated misuse of antibiotics in humans, animals, as well as agriculture have led to the evolution and spread of multidrug-resistant organisms. This paper explores AMR from a One Health perspective, emphasizing the interconnectedness of human, animal, and environmental health. It examines drivers of resistance, surveillance challenges, and policy gaps, while also highlighting potential strategies for mitigation. Strengthening cross-sectoral collaboration and data sharing, particularly in low- and middle-income countries, is essential to address AMR sustainably. Keywords: Antimicrobial Resistance; Human-Animal-Environment; Antibiotic stewardship; Cross-sectoral Collaboration; AMR Policy Gaps; Multidrug Resistance; AMR Surveillance; Public Health; Global Health

Background: Benign Paroxysmal Positional Vertigo (BPPV) is characterized by brief episodes of vertigo, nausea and/or positional nystagmus upon head movements, is produced by the inadequate presence of statocone particles coming from the utriculus macula floating in the endolymph of the semi-circular canal or attached to their cupule. BPPV is one of the most common peripheral vestibular disorders leading to balance difficulties and increased fall risks. Most patients complain of a loss of equilibrium and unstable gait during and between the vertigo attacks. Materials and Methods: This study was performed to investigate the correlation between subjective residual dizziness and objective postural imbalance in subjects with BPPV by using DHI and modified Clinical Test of Sensory Integration and Balance (mCTSIB). A total of 40 patients with BPPV were included prospectively in the study. All patients were asked to fill out the questionnaire including both DHI and mCTSIB was measured. Results: There were no significant differences in age; study results showed significantly higher DHI score and abnormal mCTSIB. DHI score and the number of abnormal mCTSIB showed a statistically significant correlation. Conclusion: Better static and dynamic balance represents better performance in Physical, Functional Tasks. Study concluded that Better functional independence and community integration reduces stress and anxiety in BPPV patients irrespective of their stage of recovery. Keywords: Benign Paroxysmal Positional Vertigo; Dizziness; Posture Balance; Surveys, Questionnaires.

Background: Low back pain (LBP) is a widespread complaint in outpatient clinics globally. As a crucial component of the kinetic chain, LBP affects the biological infrastructure that supports movement. This study aimed to investigate the correlation between LBP and lumbosacral angle in overweight patients. Materials and Methods: This study was conducted on 200 patients with LBP at the Department of Orthopaedics, Jawaharlal Nehru Medical College, and Acharya Vinoba Bhave Rural Hospital. Patients were divided into test and control groups. Anthropometric measurements, including height and weight, were taken, and BMI was calculated. Self-reported pain was assessed using a visual analog scale (VAS). Radiographs of the lumbosacral spine were evaluated for angle measurements. Results: The mean age of the test group was 46.48 years, and the control group was 43.52 years. Average VAS scores were significantly higher in the test group (p=0.0375), indicating more severe pain. Lumbosacral angles were also significantly higher in the test group. Notably, females in both groups had significantly higher lumbosacral angles (p<0.001). Conclusion: This study demonstrates that overweight and obesity are potential risk factors for LBP, as they cause biomechanical alterations in the lumbosacral spine. Maintaining a healthy weight is crucial to prevent LBP. The findings of this study highlight the importance of weight management in reducing the risk of LBP. Key Words: Low back pain, Overweight.

Background: Chronic rhinosinusitis is a complex disease that has previously been used to describe conditions ranging from unilateral single sinus disease, odontogenic sinusitis, fungal sinusitis to widespread airway inflammation. The present study was conducted to evaluate the role of concha bullosa in chronic rhinosinusitis. Materials and Methods: The prospective cross-sectional study was carried out in the Department of Otorhinolaryngology, Parul Sevashram Hospital, Parul Institute of Medical Sciences and Research, Vadodara, Gujarat (India) from April 2024 to March 2025 among 120 patients who were clinically and radiologically diagnosed as having chronic rhinosinusitis. Patients were evaluated with the help of CT scan paranasal sinuses and by nasal endoscopy. The collected data were evaluated and analysed statistically. Results: Maximum patients (25%) with chronic rhinosinusitis and with concha bullosa belong to age group 21-30years followed by 11-20 years (15%). Maximum patients (15%) with chronic rhinosinusitis and without concha bullosa belong to age group 21-30years followed by 11-20years (12.5%). Out of 120 patients 72.5% were male and 27.5% were female. 45% male patients were with chronic rhinosinusitis and with concha bullosa and 15% female patients were with chronic rhinosinusitis and with concha bullosa. Conclusion: The present study concluded that 60% patients were with chronic rhinosinusitis and with concha bullosa. Keywords: Chronic Rhinosinusitis, Concha Bullosa, Airway Inflammation

Background: A study of primary emergency caesarean delivery between booked and unbooked cases at Tertiary Center. Materials and Methods: Prospective observational study in subjects admitted in the given study done for a period of 18 months. Booked and unbooked antenatal cases admitted and who underwent emergency caesarean delivery, Term gestation (early and late term) and singleton pregnancy are enrolled in study. Results: Total 2336 patients with booked cases in 1408 and unbooked 928 cases are studied. Emergency caesarean sections were more frequent among booked mothers as most of the cases are of high risk category landing in Caesarean section. most of the patients belonging to Socio-economic status of II and III . Severity of the SE Status is associated with the booking status of mothers. Teenage pregnancy is more in unbooked group. Hypotension and PPH were the most common intraoperative complications among both booked and unbooked mothers. The proportion of cases indicates, albeit relatively small, required NICU admission, with a higher percentage observed in the unbooked group compared to the booked group. Maternal outcomes between booked and unbooked cases, with booked cases with much lower incidence of maternal mortality. Conclusion: Booked antenatal patients have better maternal outcome and perinatal outcome in terms of mortality when compared to Unbooked patients. Keywords: National Rural Health Mission(NRHM), Haemolysis , Elevated Liver Enzymes, Low Platelets (HELLP), unbooked cases.

Background: The aim is to assess safety and efficacy of laparoscopic to open varicocelectomy in terms of duration of surgery, hospital stay, postoperative analgesia requirement, postoperative recovery and complications. Materials and Methods: Single centre, prospective study was conducted on 50 Patients admitted in the Department of General Surgery with varicocele requiring surgical intervention, for a period of 2 years in All patients with clinical or radiological evidence of varicocele, Patients with Primary varicocele. cases were randomly grouped in to two groups as Group A patients had Open Varicocelectomy and Group B had Laparoscopic Varicocelectomy. Results: In our study we noted, in laparoscopic varicocelectomy group mean operative time was 58min and in open varicocelectomy group mean operative time was 93.3min. In both the groups, no vascular or intestinal complications are noted. Conversion from laparoscopic to open approach also didn’t occur either. In our study of 50 patients, 3 patients from group A and 1 patient from group B developed hydrocele. Scrotal oedema was noted in 4 patients from group A and 2 patients from group B. Wound infection was noted in 2 patients from group A and none developed any wound infection group B. 22 patients from group B stayed for 2 days and 7 patients for 3 days. In group A zero patients for 2 days, 12 patients stayed for 3 days and 13 patients stayed for 4 days. We have analysed the mean sperm count and mean % motility of sperm in preoperative period and 3 months after the surgery. We have noted improvement in sperm count and motility in post operative period. Duration to return to normal activity after surgery was 6-7 days in group A and 3-4 days in group B. Conclusion: Laparoscopic varicocelectomy is safe and effective procedure when compared to open varicocelectomy with significant reduction in operative time, minimal post-operative complications and decreased hospital stay, increasing the patient satisfaction and comfort towards the procedure. Keywords: Laparoscopic varicocelectomy, open varicocelectomy, wound infection, post-operative complications.

Background: Intensive care plays a central role in the management of critically ill patients, especially those requiring advanced airway, respiratory, and hemodynamic support. Hence; the present study was conducted to analyze pattern of patients admitted to intensive care. Materials and Methods: A total of 200 patients admitted during the study period were included based on specific eligibility criteria. Data collection was facilitated using a structured questionnaire designed to capture comprehensive information, including socio-demographic details, reasons for ICU admission, sources of referral, and clinical outcomes. Patient information was systematically gathered through chart reviews and documented medical records. The collected data were thoroughly cleaned, coded, and entered into the Statistical Package for the Social Sciences (SPSS) software for analysis. Results: A total of 200 patients were evaluated. 66 percent of the patients belonged to the age group of more than 50 years. 71 percent of the patients were males while 59 percent were of rural residence. Source of admission to ICU was medical ward in 50.5 percent followed by emergency department (32 percent), surgical ward (16.5 percent) and gynaecology ward (1 percent). Myocardial infarction was the most common diagnosis followed by Congestive heart failure and Acute respiratory distress syndrome. Other specific diagnosis included Septic shock, Diabetic ketoacidosis, stroke and pneumonia. Conclusion: Assessing the pattern of patients admitted to intensive care units (ICUs) is essential for optimizing resource allocation, guiding clinical decision-making, and improving patient outcomes. Ultimately, such assessments contribute to reducing ICU mortality and enhancing the overall efficiency and responsiveness of healthcare systems. Key words: Intensive Care Unit, Critically Ill, Myocardial Infarction.

Background: In medical education, particularly in subjects such as biochemistry, students face challenges in managing vast amounts of content. Selecting effective self-directed learning strategies is crucial for enhancing knowledge retention. Among the various techniques, mind mapping and conventional note-making are widely used, but their comparative effectiveness remains underexplored. Objectives: Primary Objective: To compare the immediate and one-month delayed post-test scores following mind mapping versus conventional note-making for learning Biochemistry among Phase I MBBS students. Secondary Objective: To determine student perceptions regarding the effectiveness of mind mapping and conventional note-making as learning strategies. Materials and Methods: A comparative interventional study was conducted among 110 Phase I MBBS students at Government Medical College, Manjeri. Students were divided into two groups: one group used mind mapping, and the other used conventional note-making to study selected Biochemistry topics. A pre-test, an immediate post-test, and a one-month delayed retention test (MCQ-based) were conducted. Students’ perceptions were assessed using a validated questionnaire with a 10-point Likert scale. Data were analyzed using independent t-tests and descriptive statistics. Results: Both learning strategies significantly improved post-test scores compared to pre-test scores (p < 0.0001). However, there was no statistically significant difference in the immediate or delayed post-test scores between the mind-mapping and conventional note-making groups (p > 0.05). Notably, a higher proportion of students perceived mind mapping as more effective in clarifying objectives, enhancing conceptual understanding, and increasing engagement. Conclusion: Mind mapping and conventional note-making are equally effective in improving learning outcomes and knowledge retention in Biochemistry. However, mind mapping is more positively perceived by students for its clarity, engagement, and support in conceptual understanding. Integrating mind mapping as a supplementary tool in medical education may enhance learner motivation and comprehension. Keywords: Mind Mapping, Note-Making, Biochemistry Education, Medical Students, Self-Directed Learning, Knowledge Retention, Learning Strategies, Competency-Based Medical Education (CBME), Active Learning, Undergraduate Medical Education.

Background: Elderly patients have higher incidence of renal diseases; renal biopsy plays vital role in the diagnosis. The aim is to study the clinical profile and the spectrum of histopathological findings in the elderly patients undergoing renal biopsy. Materials and Methods: This retrospective study includes all patients (age ≥60 years) undergoing native renal biopsies from January 2022 to June 2023. The clinical profile, laboratory parameters & renal biopsy findings were recorded from the Departmental Data. Results: Out of 763 renal biopsies, 72 (9.43%) were performed on the elderly patients. Mean age was 65.8 ± 4.5 years, Male: Female Ratio was 1.5:1. The commonest indication for biopsy was nephrotic syndrome (NS) (49%) followed by rapidly progressive renal failure (RPRF) (25%) and acute kidney injury (AKI) (14%). On histopathology, 54% patients had primary glomerulonephritis (GN), 22% secondary GN, 17% tubulo-interstitial and 7% had vascular disease. Membranous nephropathy (MN) (25.4%) was the commonest findings in primary GN followed by Focal segmental glomerulosclerosis (10.9%), IgA nephropathy (10.9%) and Membranoproliferative glomerulonephritis (9.09%). Amyloidosis (12.7%), Anti GBM disease (9.09%), Diabetic Nephropathy (5.4%) followed by Lupus nephritis (1.81%) were the commonest secondary GN. MN and Crescentic GN were most common findings of NS and RPRF respectively. Conclusion: The commonest indication for renal biopsy in elderly was nephrotic syndrome. Primary glomerular disease was more common than secondary glomerular disease. Membranous nephropathy was the commonest histopathological diagnosis in glomerular diseases. Keywords: Elderly, Nephrotic Syndrome, Renal Biopsy.

Background: Isolated supraspinatus tendon tears are a common cause of shoulder dysfunction and pain, particularly in middle-aged and active populations. While arthroscopic techniques are widely used, the mini-open repair offers direct tendon visualization with favorable outcomes, especially in resource-constrained settings. This study aimed to assess the functional outcomes and recovery patterns following mini-open repair of isolated supraspinatus tendon tears over a 12-month postoperative period. Materials and Methods: This prospective interventional study included 94 patients with MRI-confirmed isolated supraspinatus tears undergoing mini-open repair at a RAMA MEDICAL COLLEGE HAPUR tertiary care center in India. Patients were evaluated preoperatively and postoperatively at 6 weeks, 3 months, 6 months, and 12 months using the Visual Analog Scale (VAS), Constant-Murley Score (CMS), University of California Los Angeles (UCLA) Score, and range of motion (ROM) parameters. Functional grading, time to return to work, complications, and patient satisfaction were also recorded. Results: The mean age of patients was 52.6 ± 8.3 years, with 61.7% being male and 70.2% having dominant-arm involvement. The mean CMS improved significantly from 41.5 ± 6.9 preoperatively to 88.5 ± 5.7 at 12 months (p < 0.001), and UCLA scores improved from 15.2 ± 3.4 to 32.1 ± 2.3 (p < 0.001). VAS scores decreased from 7.8 ± 1.2 to 1.3 ± 0.6. Range of motion improved markedly, with forward flexion increasing from 92.3° to 158.2°, and internal rotation improving from L5 to T10 level. At 12 months, 93.6% of patients were satisfied or very satisfied; 86.2% returned to pre-injury work levels within a mean of 9.1 ± 2.3 weeks. Complications were minimal, with tendon re-tear occurring in 2.1% of cases. Conclusion: Mini-open repair of isolated supraspinatus tendon tears results in excellent functional outcomes, substantial pain relief, improved shoulder mobility, and high patient satisfaction. It remains a viable and effective option, particularly in Indian healthcare settings with limited arthroscopic resources. Keywords: Supraspinatus tendon tear, Mini-open repair, Shoulder function, Rotator cuff, Constant-Murley Score, Postoperative outcomes.

Background: Adolescent girls are highly vulnerable group that prone for many health related issues. Adolescent pregnancy is one of most common issues that lead to maternal and fetal morbidity and mortality. Aims and Objectives: (a) to study the maternal complications specific to teenage mothers during ante partum, intra partum and postpartum period; (b) to analyse the mode of delivery to know whether caesarean section rate is increased in teenage pregnancy; (c) to study the neonatal outcome in teenage pregnancy; and (d) to analyse the factors contributing to teenage pregnancy. Materials and Methods: a) Study place: Lakhimpur Medical College and Hospital, North Lakhimpur, Assam b) Study period: 01-01-2024 to 31-03-2024 (three months) c) Study design: Hospital record based retrospective cross-sectional study d) Source of data: This is a hospital record based retrospective cross-sectional study. Results: In our study it was found that 47.37% pregnant women are in the age group of 19 years, 97.11% women are primi gravida and 52.97 % women are in 39-40 weeks of gestation. 32.6% women have not done ANC. 87.95% women have delivered babies via normal vaginal delivery and 15.28% women have opted for post partum sterilization. In this study it was observed that fetal complication are there after birth out of which 10.02% IUGR, 19.5% LBW babies, 10.07% prematurity, 9.51% respiratory distress, 11.71% neonatal jaundice, 7.98% sepsis, 23.09% NICU/SNCU admission and 5.43% neonatal death. Regarding maternal outcome of adolescent pregnancy, it was found that 44.14% women are moderate anemic while 16.81% women have hypertensive disorders and 2.5% women have ante partum haemorrhage. Regarding post partum complications of pregnant women, it was found that 3.9% women have post partum haemorrhage, 7.47% having fever, 2.72% having urinary tract infection and 2.55% women have local sepsis. 1.19% women got admitted in ICU. Conclusion: fetal and maternal complications are much more amongst adolescent women. Health education and proper guidance is always necessary to tackle the situation of teenage pregnancy. Keywords: adolescent pregnancy, delivery, Lakhimpur.

Background: Now a days the prevalence of diabetes is beyond the expected values in the developing countries. In India, there are estimated 77 million people aged >18 years are suffering from type 2 diabetes and nearly 25 million are prediabetics. Awareness, knowledge, Screening, prediction of risk and treatment of diabetes is mandatory to reduce the premature deaths due to diabetes and other non-communicable diseases. Objective of this study is to assess the diabetic risk among healthy adults aged >20 years and its associated factors those are residing in rural area of Srikakulam. Materials and Methods: community based cross sectional study was done among adult rural population of Srikakulam district, Andhra Pradesh. House to house survey was done and the participants was selected randomly; risk assessment of diabetes was done by Indian diabetes risk score among adults >20 years of age and not a known diabetic patient. Results: Out of 243, assessment of risk is 58 (23.9%) were high risk, 165 (67.9%) medium risk and 20 (8.2%) were low risk of diabetes. Those who are non-smokers has 46(18.9%) high risk of diabetes than smokers 12(4.9%) with p value (0.01), it is statistically significant. Conclusion: This study was found that, 23.9% was high risk of getting diabetes and many participants were not knowing their health status. Assessment of health status at community one of the important steps to early identification of the chronic diseases, and prevent their complications in advanced age. Keywords: Screening of diabetics, IDRS, Non-communicable diseases, Cross sectional study.

Background: Acute Kidney Injury (AKI) is a critical condition in pediatric intensive care units with significant morbidity and mortality. Early biomarkers for AKI prediction remain limited. This study aimed to evaluate serum bicarbonate, sodium and calculated serum osmolality as markers for predicting early AKI within three days of admission and analyze their correlation with pRIFLE and KDIGO criteria. Materials and Methods: This hospital-based observational study was conducted at Mahatma Gandhi Medical College & Hospital, Jaipur from April 2023 to August 2024. Ninety pediatric patients aged 1-15 years admitted to PICU through emergency room were included. Patients with pre-existing kidney disease were excluded. Serum bicarbonate, calculated serum osmolality, and eGFR were measured at 0, 24, and 48 hours. AKI staging was performed using both pRIFLE and KDIGO criteria. Results: The study included 90 patients with mean age 4.93±3.92 years, predominantly males (68.9%). Mean AKI duration was 5.30±3.49 days with 67.8% recovering within 1-5 days. Serum bicarbonate showed significant correlation with AKI progression, declining from 22.09±3.42 mmol/L at baseline to 17.18±3.11 mmol/L in pRIFLE Failure group at 48 hours (p=0.001). Serum osmolality increased significantly with AKI severity, reaching 402.70±23.62 mOsm/kg in Failure group. Strong positive correlations were observed between bicarbonate and eGFR (r=0.279-0.303, p<0.05) and between osmolality and eGFR (r=0.706-0.750, p<0.001). pRIFLE identified 85.1% patients as Risk category while KDIGO showed more distributed staging (47.8% Stage I, 34.4% Stage II, 17.8% Stage III). Conclusion: Serum bicarbonate and calculated serum osmolality serve as valuable early biomarkers for AKI prediction and staging. Bicarbonate levels correlate inversely with AKI severity while osmolality increases with disease progression. Both biomarkers complement traditional criteria in early AKI detection and risk stratification. Keywords: Acute kidney injury, bicarbonate, serum osmolality, pRIFLE, KDIGO, pediatric intensive care.

Background: The aim is to study efficacy of heat stable oxytocin analogue injection carbetocin in prevention of PPH in comparision to injection oxytocin by an observational study in 300 patients delivering both vaginally and by caesarean section. Materials and Methods: The study was conducted at Deccan College of Medical Sciences (Owaisi Hospital and Research Centre and Princess Esra Hospital). The study was conducted from JULY 2023- DEC 2024(18 MONTHS). It is a prospective study comparing injcarbetocin and inj oxytocin in prevention of PPH.300 woman delivering vaginally and by caesarean section were given injcarbetocin and inj oxytocin alternately after delivery of the baby. PPH is preventable and important cause for maternal morbidity and mortality. Patients were divided into two groups 150 each. Group A received injcarbetocin and group B received inj oxytocin after the delivery of the baby. Results: The dose of injcarbetocin was 1 ml containing 100 microgram carbetocin which was administered by I.M route after the delivery of the baby in vaginal and caesarean deliveries. The dose of inj oxytocin was 10 IU by I.M administration after the delivery of the baby in vaginal and caesarean deliveries. In both the groups the blood loss intrapartum and postpartum was not of much difference. The heat stable carbetocin does not require cold chain for maintenance in contrast to oxytocin which needs cold chain maintainance. Hence its use can be encouraged in developing countries where maintaining cold chain can be challenging. Conclusion: From this study we come to a conclusion that both injcarbetocin and inj oxytocin are equally efficacious in preventing PPH with equal amount of blood loss intra partum and postpartum. Keywords: PPH, Carbetocin, Intrapartum, Oxytocin, Ceaserean Section, Postpartum Haemmorhage.

Background: The uterus is composed of two primary layers: the myometrium and the endometrium. The endometrium undergoes cyclical transformations during the menstrual cycle, influenced by steroid hormones. Uterine leiomyomas, also known as fibroids, are benign tumors found in many women of reproductive age. These tumors are hormone-sensitive, particularly to steroids, which drive their growth and persistence. Consequently, the endometrium can show reactive changes in the presence of these uterine tumors. Objectives: This study aims to assess the histopathological alterations in the endometrium in the context of myometrial abnormalities, with a focus on identifying features that may help differentiate leiomyomas, adenomyosis, or coexisting conditions using endometrial curettage samples. Materials and Methods: This cross-sectional study involved 200 hysterectomy specimens obtained from women of reproductive age presenting with myometrial pathology. Upon receipt, each specimen underwent a thorough gross examination after fixation in formalin. Standard tissue processing techniques were applied, and sections of 5 microns thickness were prepared for microscopic analysis using hematoxylin and eosin (H&E) staining. Results: Leiomyomas were predominantly seen in women aged between 40 and 49 years, especially those with a history of multiple childbirths. Menorrhagia emerged as the most common presenting symptom. The endometrial histology varied with age and underlying lesion, with secretory phase changes being more frequent in women aged 45–49 years, and proliferative changes more commonly observed in the 40–44 age group. Degenerative features were noted in cases with both leiomyomas and adenomyosis. Conclusion: Given their dependence on steroid hormones, leiomyomas are typically associated with a proliferative or hyperplastic endometrium, reflecting an estrogen-dominant milieu. The link to multiparity suggests a contributory role of progesterone in tumor stability. Endometrial curetting showing features such as hyperplasia, cystically dilated or elongated glands, and interspersed smooth muscle fibres may point towards a diagnosis of leiomyoma, adenomyosis, or both. Keywords: Myometrial Lesions, Histopathology, Reproductive Age Group, Leiomyoma, Adenomyosis, Endometrial changes.

Background: Multiple sclerosis (MS) is a chronic autoimmune neurological disease marked by inflammation and demyelination in the central nervous system. Despite available immunosuppressive therapies, current treatments are insufficient in preventing disease progression. Ayurveda, particularly Panchakarma therapy, offers a holistic, detoxifying, and rejuvenative approach that may provide symptomatic relief and improve quality of life in MS patients. This study aims to develop an evidence-based algorithm for pain management in MS using Panchakarma. Materials and Methods: A four-year observational clinical study was conducted at Jeewakberg Rehabilitation Centre, Ranchi, involving 120 female patients aged 19–50 years diagnosed with MS. Panchakarma modalities—including Snehana, Swedana, Vamana, Virechana, Basti, Nasya, and Rasayana—were administered following classical protocols. Patients also received complementary interventions such as Yoga, Meditation, and Rasayana therapy. A stepwise treatment algorithm was developed based on classical Ayurvedic principles and tailored to patient-specific factors like disease stage, strength, and comorbidities. Results: Among the 120 participants, 80% of patients reported satisfactory improvement in pain, functional mobility, and overall well-being, with reduced dependence on corticosteroids. The remaining 20% showed limited benefit, mainly due to underlying psychiatric comorbidities such as depression, substance use, and social stigma. The Panchakarma regimen proved effective in reducing Vata aggravation, clearing Aama (toxins), and restoring Dhatu balance, thus supporting the pathophysiological framework of MS as Anukta Vatavyadhi. Conclusion: Panchakarma therapy, when systematically applied based on Ayurvedic diagnostics and protocols, can significantly enhance pain management and quality of life in MS patients. The proposed algorithm integrates classical Ayurvedic chikitsa with evidence-based practice and may serve as a complementary or alternative therapeutic pathway for long-term MS care. Further studies with larger sample sizes and control groups are warranted. Keywords: Multiple Sclerosis, Anukta Vatavyadhi, Panchakarma, Pain Management, Ayurveda, Autoimmune Neurological Disorder, Vata Vyadhi, Detoxification, Rasayana, Yoga

Background: Menstrual hygiene is an essential component of adolescent health, particularly in rural settings where cultural stigma and lack of education limit access to safe practices. Despite menstruation being a natural biological function, misconceptions and poor menstrual hygiene practices are still prevalent among adolescent girls. Objectives: To evaluate menstrual hygiene awareness and practices among school-going adolescent girls aged 15–19 years in the Hagare rural field practice area of a tertiary care center. Materials and Methods: A community-based cross-sectional study was conducted among 400 school-going adolescent girls selected through Probability Proportionate to Size (PPS) sampling. Data were collected via a structured, validated questionnaire. Descriptive and inferential statistics were applied using SPSS version 29.0.2.0. Results: Of the 400 participants, 76.75% had prior information on menstrual hygiene, predominantly from family and school. Sanitary pads were the most commonly used absorbent (82.25%). While 87.5% maintained genital hygiene, only 43.5% correctly identified the uterus as the source of menstrual blood. A statistically significant association was found between sanitary pad usage and age (p=0.013) and education level (p=0.0296). No significant associations were observed with mother’s education, type of school, or socioeconomic-status. Conclusion: The study reveals encouraging use of hygienic practices but highlights persistent knowledge gaps. Comprehensive menstrual health education programs are necessary to dispel myths and ensure access to safe hygiene facilities. Keywords: Menstrual hygiene, adolescent girls, sanitary pads, Menstrual practices, awareness.

Background: Acute respiratory distress syndrome (ARDS) is a serious postoperative complication following cardiac surgery under cardiopulmonary bypass (CPB), with systemic inflammation playing a pivotal role in its pathogenesis. Serum procalcitonin (PCT), a biomarker of inflammatory response, may have prognostic value in identifying patients at higher risk for ARDS in the postoperative period. The aim is to evaluate the association between elevated serum procalcitonin levels and the incidence of ARDS in patients undergoing cardiac surgery under cardiopulmonary bypass. Materials and Methods: This prospective observational study was conducted on 160 adult patients undergoing elective cardiac surgery under CPB. Based on 24-hour postoperative serum PCT levels, patients were divided into two groups: Group A (PCT <7 ng/mL) and Group B (PCT >7 ng/mL), with 80 patients in each group. Clinical, intraoperative, and postoperative parameters were compared. ARDS was diagnosed using the Berlin definition. Data were analyzed using SPSS v25, with p <0.05 considered statistically significant. Results: Group B patients had significantly longer CPB time (167.3 ± 80.1 min vs. 107.4 ± 34.6 min, p<0.001), higher incidence of ARDS (37.5% vs. 10%, p=0.001), and prolonged ICU stay (42.10 ± 33.2 hrs vs. 23.35 ± 3.7 hrs, p<0.001) compared to Group A. Mechanical ventilation time and hospital stay were also significantly increased. ROC analysis showed that a serum PCT level >10 ng/mL had an AUC of 0.891 for predicting ARDS, with 80.6% sensitivity and 76.1% specificity. Conclusion: Elevated serum procalcitonin levels are significantly associated with higher incidence and severity of ARDS in patients undergoing cardiac surgery under CPB. Procalcitonin may serve as a useful biomarker for early risk stratification and targeted monitoring in the postoperative period. Keywords: Procalcitonin, ARDS, Cardiopulmonary Bypass.

Background: The diagnosis of nephrotic syndrome in children often triggers significant psychological stress and anxiety in parents, especially during the initial episode. Emotional turmoil may affect their ability to make informed medical decisions and provide adequate care. Evaluating the degree of anxiety and distress among parents during this critical phase is essential for improving parental support systems and pediatric outcomes. Materials and Methods: A total of 50 parents of children diagnosed with the first episode of nephrotic syndrome were enrolled. Parental psychological distress was assessed using the Distress Thermometer (DT), and anxiety levels were measured using the Taylor Manifest Anxiety Scale (TMAS). Data on demographic characteristics, coping strategies, and psychological impact were recorded through structured interviews. Scores were categorized into mild, moderate, and severe levels of distress/anxiety, and correlations with coping behaviors were analyzed. Results: Out of 50 parents, 36% exhibited severe anxiety on the TMAS (score > 70), while 48% showed moderate levels (score 55–70), and only 16% reported mild anxiety (score < 55). On the Distress Thermometer, 60% scored ≥7, indicating high emotional distress. Common coping mechanisms included seeking social support (70%), information gathering (58%), and reliance on spiritual practices (42%). A significant correlation was observed between higher distress scores and maladaptive coping responses such as denial and emotional withdrawal (p < 0.05). Conclusion: The first episode of nephrotic syndrome in a child significantly impacts parental mental health, with a high prevalence of anxiety and distress. Psychological screening and timely counseling interventions are vital to support parents and optimize disease management. Incorporating routine mental health assessments in pediatric nephrology settings is recommended. Keywords: Distress, anxiety, first episode, nephrotic syndrome, parental coping, Taylor Manifest Anxiety Scale, Distress Thermometer.

Background: Anterior knee pain persists in 10–15% of patients following total knee arthroplasty (TKA) and can compromise patient satisfaction and function. Circumpatellar denervation using electrocautery to interrupt peripatellar nociceptive fibers has been proposed to reduce postoperative anterior knee pain without patellar resurfacing. Aim: To compare functional outcomes of primary TKA with versus without circumpatellar denervation, using measures of pain, range of motion, clinician‐rated scores, and patient‐reported outcomes. Materials and Methods: In this single‐center, prospective observational study, 40 osteoarthritic knees (20 undergoing circumpatellar denervation and 20 without) were evaluated over 18 months. Outcomes recorded preoperatively and at 6 weeks, 3 months, and 6 months postoperatively included Visual Analog Scale (VAS) for walking and stair‐climbing pain, range of motion (ROM), Objective and Functional Knee Society Scores (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Feller’s patellar score. Between‐group comparisons employed independent‐samples t-tests; paired t-tests assessed pre- versus postoperative changes. A p-value <0.05 denoted significance. Results: Pain Relief: Walking VAS decreased from 8.25 to 0.65 with denervation versus 8.55 to 1.25 without (p = 0.0178); stair‐climbing VAS fell from 9.30 to 0.45 versus 9.00 to 0.95 (p = 0.0136). Range of Motion: Mean postoperative ROM was 20.05° versus 19.60° (p = 0.0697). Clinician-Rated Scores: Objective KSS improved from 56.25 to 95.60 versus 57.40 to 92.85 (p = 0.0500); Functional KSS rose from 35.50 to 96.95 versus 34.05 to 93.55 (p = 0.0250). Patient-Reported Outcomes: WOMAC scores decreased from 68.35 to 9.70 versus 65.70 to 11.50 (p = 0.0250); Feller’s patellar score increased from 6.75 to 25.75 versus 7.15 to 24.00 (p = 0.0008). Conclusion: Circumpatellar denervation during primary TKA yields significantly greater early reductions in anterior knee pain and superior functional gains both clinician‐rated and patient‐reported—compared to standard TKA without denervation, without adversely affecting knee mechanics. These findings support its use as a simple adjunct technique to enhance postoperative recovery. Keywords: Knee osteoarthritis, total knee arthroplasty, patellar denervation, anterior knee pain.

Background: The lymphatic filariasis disease have become a serious and growing public health problem. Objectives: 1. To independently get coverage and compliance and to find out the reasons for non-compliance among the households surveyed. 2. To recommend corrective measures to enhance the treatment coverage in future rounds of MDA. Materials and Methods: The coverage surveys were conducted at the MDA implementation unit level blocks of the Durg district. Data collection was done with the help of standard questionnaire of state program officer. Results: The post MDA CES assessment of Durg district was carried out by using cross sectional study design. The result are highly significant differences (p-value<0.05) among the locations regarding the consumption of both Albendazole and DEC, prior information about MDA and awareness of Lymphatic Filariasis. Conclusion: The overall observations about the diseases of LF was considered to be good among the cross sectional study design. Based on present study despite consumption defferences, ther is no statistically significant difference in the proportion of people offered Albendazole or DEC across location. Keywords: Lymphatic filariasis, Awareness, Coverage, Compliance, Effective Compliance.

Background: Anesthesia techniques for lower limb surgery are critical in ensuring patient comfort, safety, and optimal surgical outcomes. Among the various anesthetic approaches, balanced combined spinal epidural anesthesia (BCSEA) has gained popularity for its efficacy and ability to provide both motor and sensory blockade. However, its comparative effectiveness against other regional anesthesia techniques, particularly in lower limb surgery, has not been thoroughly studied. This study aims to evaluate the clinical outcomes, advantages, and limitations of BCSEA in lower limb surgery by comparing it with other commonly used anesthesia techniques. The objective is to assess the efficacy, safety, and clinical outcomes of balanced combined spinal epidural anesthesia (BCSEA) in patients undergoing lower limb surgery, in comparison with traditional anesthesia methods such as general anesthesia (GA) and single spinal anesthesia (SSA). Materials and Methods: A prospective, randomized, controlled study was conducted on 100 patients scheduled for elective lower limb surgery. Patients were divided into three groups: Group A (BCSEA), Group B (General Anesthesia), and Group C (Single Spinal Anesthesia). Clinical outcomes including the onset and duration of sensory and motor blockade, intraoperative analgesia, and postoperative recovery times were evaluated. Side effects and complications, including hypotension, nausea, vomiting, and failure of anesthesia, were also compared. Results: Group A (BCSEA) showed faster onset and longer duration of both sensory and motor blockade compared to Group C (SSA), with minimal intraoperative complications. Group B (GA) had a higher incidence of nausea and vomiting, and longer recovery times compared to both regional anesthesia groups. The BCSEA group also reported better postoperative analgesia and a lower incidence of complications such as hypotension and respiratory depression. Conclusion: Balanced combined spinal epidural anesthesia is an effective and safe option for lower limb surgeries, providing superior sensory and motor blockade, fewer complications, and faster recovery compared to general anesthesia and single spinal anesthesia. BCSEA offers significant advantages in terms of postoperative analgesia and patient recovery, making it a preferred choice for lower limb surgical procedures. Keywords: Balanced combined spinal epidural anesthesia, lower limb surgery, regional anesthesia, general anesthesia, sensory blockade, motor blockade, postoperative analgesia.

Background: Laparoscopic appendectomy has become the standard surgical approach for the management of acute appendicitis in adults. Although minimally invasive, postoperative pain remains a significant concern, often requiring systemic opioids which may be associated with undesirable side effects. The transversus abdominis plane (TAP) block has emerged as a promising regional anesthesia technique to provide effective postoperative analgesia by targeting the nerves of the anterior abdominal wall. This randomized controlled trial was conducted to evaluate the analgesic efficacy of transversus abdominis plane block in adult patients undergoing elective laparoscopic appendectomy. Materials and Methods: In this prospective randomized study, 80 adult patients scheduled for elective laparoscopic appendectomy were randomly allocated into two groups. Group A received ultrasound-guided bilateral TAP block with 20 mL of 0.25% bupivacaine on each side at the end of surgery, while Group B received standard care without TAP block. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 1, 4, 8, 12, and 24 hours. Total opioid consumption and incidence of opioid-related side effects were recorded. Results: VAS scores at all postoperative intervals were significantly lower in Group A compared to Group B (p<0.05). The mean total opioid consumption in 24 hours was markedly reduced in the TAP block group. Additionally, the incidence of nausea, vomiting, and sedation was lower in Group A. No adverse effects related to TAP block were reported. Conclusion: The use of transversus abdominis plane block provides superior postoperative analgesia, reduces opioid requirement, and minimizes opioid-related side effects in adult patients undergoing laparoscopic appendectomy. TAP block is a safe, effective, and valuable component of multimodal analgesia for enhanced recovery in minimally invasive abdominal surgery. Keywords: TAP block, laparoscopic appendectomy, postoperative analgesia, randomized controlled trial, opioid-sparing, regional anesthesia.

Background: Inguinal hernia repair, particularly the Lichtenstein tension-free mesh repair, is one of the most commonly performed general surgical procedures worldwide. While highly effective, concerns remain regarding its potential impact on testicular perfusion due to mesh placement and manipulation of spermatic cord structures during surgery. The present study was undertaken to evaluate alterations in testicular perfusion following Lichtenstein hernia repair using Doppler ultrasonography as a non-invasive assessment tool. Materials and Methods: This prospective observational study was conducted over a period of 18 months and included adult male patients undergoing elective unilateral Lichtenstein inguinal hernia repair. Patients with bilateral hernias, recurrent hernias, or pre-existing testicular disorders were excluded. Testicular perfusion was assessed preoperatively and at postoperative intervals (1 week and 3 months) using color Doppler ultrasonography, evaluating parameters such as resistive index (RI), peak systolic velocity (PSV), and end diastolic velocity (EDV). Results: A total of 60 patients were enrolled. Preoperative Doppler studies demonstrated normal testicular perfusion parameters. Postoperative assessments revealed a transient increase in resistive index and decrease in diastolic flow at 1-week follow-up, suggestive of mild perfusion changes. However, at 3-month evaluation, Doppler parameters largely returned to baseline values, indicating restoration of testicular blood flow. No significant long-term alterations in testicular perfusion were observed. Conclusion: Lichtenstein hernia repair may cause transient alterations in testicular perfusion in the immediate postoperative period, but long-term testicular blood flow remains largely unaffected. Doppler ultrasonography serves as a reliable, non-invasive tool for monitoring testicular perfusion following inguinal hernia surgery. Keywords: Inguinal hernia repair, Lichtenstein mesh repair, testicular perfusion, Doppler ultrasonography, resistive index, spermatic cord.

Background: Uterine fibroids are a leading cause of hysterectomy worldwide. An efficacious and cost-effective medical treatment option may reduce hysterectomy-associated morbidity. The present study was undertaken to evaluate the efficacy of ormeloxifene in the medical management of AUB-L and compare it with combined hormonal contraceptives (CHC). Materials and Methods: It was a Prospective comparative study. A total of 76 women in the age group 35-45 years, having abnormal uterine bleeding due to leiomyoma (PBAC score >100) were included, and randomized into two groups. Women in one group were given Ormeloxifene 60 mg twice weekly for 6 months and in another group combined hormonal contraceptives containing ethinyl estradiol 30 μg with levonorgestrel 150 μg for 21 days starting from day 1 or 2 of the cycle, were given for 6 months. Participants were followed after 3months, 6 months and then at 9 months, that is 3 months after completion of treatment. Primary outcome measure was change in PBAC Score. Other outcomes noted were change in hemoglobin concentration, change in leiomyoma size and volume, changes in dysmenorrheal VAS score and satisfaction with treatment. Results: There was statistically significant decrease in PBAC score in both the groups at each follow-up visit, however the improvement was significantly more in ormeloxifene group (p value <0.05). The decrease in mean PBAC scores was 80.63 % in group 1 at 6 months and 63.45% in group 2. Similar observation was made in mean hemoglobin concentration. However, there was no statistically significant change in leiomyoma volume in either of the group at 6 months and at 9 months. prolonged cycles was the most common side-effect seen with ormeloxifene. Conclusion: Ormeloxifene is a non-steroidal, non-hormonal drug and an effective, safe and acceptable option for medical management of heavy menstrual bleeding associated with leiomyoma uterus. Keywords: Ormelexifene; Combined hormonal contraceptives (CHCs); Leiomyoma; Abnormal uterine bleeding.

Background: The aim is to evaluate the efficacy of dexmedetomidine and fentanyl as an appropriate sedative drug for Monitored Anaesthesia Care in Tympanoplasty (ENT surgeries). Materials and Methods: A total of 60 patients between the age group of 18-60 years were included in the study. They were ASA I &II and scheduled for the elective Tympanoplasty surgery under Monitored anaesthesia care. Patients were randomized into 2 groups, as group F (Fentany group) received Inj.Fentanyl 1μ/kg bodyweight I.V and group D (Dexmedetomidine) received dexmedetomidine 1μ/kg body weight infusion over 10 mins. Patients fasted at least 8 hours before operation and did not receive any pre-operative sedative drug. Results: Intra operatively & Post operatively SBP levels were relatively high in Dexmedetomidine group than fentanyl group and difference was statistically significant. DBP levels high at all times among dexmedetomidine group than fentanyl and diference was statistically significant and Post operatively there was statistically insignificant. MAP levels intra operatively higher at all times noted among dexmedetomidine group than the fantanyl Group and difference was statistically significant, Post operatively insignificant. Heart rate and SPO2 were Statistically insignificant intraoperatively and Post operatively. Pain and Discomfort scores are less at all times intraoperatively in dexmedetomidine group and there were statistically significant. Post operatively insignificant. sedation scores were less in dexmedetomine group at all till 45 mins s urgery and these were statistically significant than Fentanyl group. after 45 mins pain scores were similar and statistically insignificant. Conclusion: The present study demonstrates that dexmedetomidine is a safe and effective alternative to fentanyl for sedation in patients undergoing tympanoplasty under monitored anesthesia care. Keywords: Dexmedetomidine, Fentanyl, Tympanoplasty, Amaesthesia.

Background: Venous malformations (VMs) are the most common type of low-flow vascular malformation, often affecting the head and neck. These congenital lesions may not become symptomatic until later in life and can cause functional or cosmetic concerns. The aim is to determine the effectiveness of surgery for the treatment of venous malformations of the head and neck. Materials and Methods: A retrospective/prospective analysis was conducted on patients diagnosed with venous malformations of the head and neck who underwent surgical intervention. Data collected included demographic information, lesion location and size, type of surgical approach, adjunct treatments (e.g., sclerotherapy), intraoperative findings, and post-operative outcomes. Imaging modalities such as MRI and Doppler ultrasound were used for diagnosis and surgical planning. Results: Most lesions were localized in the cheek, lips, or tongue. Complete excision was achieved in a majority of cases with minimal functional compromise. Some patients required combined treatment with preoperative sclerotherapy. Complications included minor wound infections and temporary nerve weakness in a few cases. A significant improvement in cosmetic and functional outcomes was observed post-surgery. Conclusion: Surgical excision remains a reliable and effective modality for treating symptomatic venous malformations in the head and neck. Multidisciplinary planning, proper imaging, and case selection are essential to optimize outcomes and minimize complications. Keywords: Venous malformation, head and neck, vascular anomaly, surgical management, low-flow malformation.

Background: Congenital anomalies are a significant cause of neonatal morbidity and mortality, particularly in low-resource settings. Genetic counselling plays a crucial role in educating parents about inherited disorders, associated risk factors, and available preventive and management options for these disorders. This study aimed to assess the types and risk factors of congenital anomalies and to evaluate the impact of genetic counselling on parental awareness. Materials and Methods: A descriptive observational study was conducted at Mahatma Gandhi Memorial Government Hospital, Tiruchirappalli, from February 2018 to July 2019, involving 182 neonates with congenital anomalies. Maternal history, clinical examinations, and imaging studies were used for the diagnosis. A structured questionnaire was used to assess parental awareness before and after the counselling sessions. Results: Cardiovascular anomalies were the most common (42.9%), with acyanotic lesions comprising 64.1% of these anomalies. Multiple anomalies were present in 31.4% of neonates, and consanguinity was reported in 31% of the cases. Maternal hypothyroidism and gestational diabetes were observed in 9.9% of pregnancies. Only 13.2% of mothers took folic acid preconceptionally, while 14.3% did not take it at all. Antenatal anomaly scans were performed in 68.1% of the cases. Genetic counselling was attended by 95.6% of the parents. Pre-counselling, 34.5% of parents scored below 7 in awareness, while 81% scored a maximum of 13 post-counselling. The neonatal survival rate was 64.8%, and 55.5% of families adhered to follow-up. Conclusion: This study highlights the high prevalence of congenital heart defects and multiple risk factors, including consanguinity and maternal metabolic conditions. Genetic counselling significantly improved parental awareness and understanding of congenital anomalies, as evidenced by marked post-intervention score improvements. Keywords: Congenital anomalies, Genetic counselling, Parental awareness, Consanguinity, Folic acid deficiency.

Background: Maternal diabetes mellitus and malnutrition are prevalent metabolic insults known to adversely affect placental development and fetal outcomes. This study was designed to compare the gross morphological changes in full-term placentas from these two distinct pathological conditions against those from normal pregnancies and correlate them with neonatal birth weight. Materials and Methods: A prospective, comparative study was conducted on 100 full-term placentas collected post-delivery. A systematic gross examination documented placental weight, diameter, umbilical cord length, and neonatal birth weight. Results: The results showed that the diabetic group exhibited a significant increase in mean placental weight, diameter, umbilical cord length, and neonatal birth weight when compared to the control group. Conversely, the malnourished group demonstrated a significant reduction in all these parameters. No significant differences were observed in the umbilical cord insertion site or the number of vessels across the groups. Conclusion: These findings demonstrate that maternal diabetes and malnutrition induce divergent morphological changes in the placenta, leading to fetal overgrowth (macrosomia) and growth restriction, respectively. This highlights the critical role of the maternal metabolic environment in determining feto-placental health and underscores the importance of targeted nutritional and glycemic management to ensure favorable neonatal outcomes. Keywords: Placenta, Diabetes, Malnutrition, Pregnancy, Malnourished.

Background: Trauma scoring systems, such as the Trauma and Injury Severity Score (TRISS), integrate physiological, anatomical, and age-related factors to quantify the severity of injury and predict patient outcomes. TRISS provides a standardised framework for trauma care, facilitating accurate prognostication. This study aimed to evaluate the effectiveness of TRISS in predicting mortality and morbidity outcomes in multiple trauma patients and compare its predictive accuracy with that of ISS and RTS. Materials and Methods: This longitudinal observational study included 100 patients with multiple traumas at Thiruvarur Medical College and Hospital over one year. The data collected included patient demographics, injury characteristics, RTS and ISS scores, initial and subsequent TRISS scores, and clinical outcomes (mortality, ICU admission, surgical intervention, and hospital stay duration). Results: Males predominated (60%), and the most affected age group was 41–50 years (22%). Blunt injuries were the most common, primarily caused by road traffic accidents (64%), and affected the extremities (55%), abdomen (56%), and head (52%). The ICU admission rate was 30%, and mortality occurred in 13% of the patients. The mean ISS was significantly higher in fatalities (40.08) than in survivors (6.34, P < 0.001). ROC analysis demonstrated high predictive accuracy for all scoring systems, with AUC values of 1.00 for ISS and TRISS and 0.95 for RTS. An ISS cutoff of 27.5 and a TRISS cutoff of 82.5 demonstrated perfect discrimination for mortality prediction. Conclusion: This study validated the high accuracy of the TRISS in predicting trauma outcomes, showing strong correlations with ISS and RTS scores. These findings reinforce the value of the TRISS in guiding trauma care decisions, although periodic recalibration is necessary to adapt to evolving trauma management practices. Keywords: Trauma and Injury Severity Score (TRISS), Injury Severity Score (ISS), Revised Trauma Score (RTS), Trauma severity assessment, Mortality prediction, ROC curve analysis.

Background: Age-related macular degeneration (AMD) and cataract frequently coexist in the elderly, contributing to significant visual disability. While cataract surgery is known to improve visual acuity, its impact on quality of life (QoL) in patients with concurrent AMD remains an area of clinical interest. Objective: To evaluate the effect of cataract surgery on visual outcomes and quality of life in elderly patients diagnosed with AMD. Materials and Methods: This prospective observational study included 100 patients aged ≥60 years with clinically significant cataract and concurrent AMD. All patients underwent standard Small Incision Cataract Surgery (SICS) with intraocular lens implantation. Best corrected visual acuity (BCVA) and vision-related quality of life were assessed preoperatively and at 3 months postoperatively using the NEI VFQ-25 questionnaire. Subgroup analysis was performed for dry and wet AMD cohorts. Results: The mean age of participants was 71.6 ± 6.4 years, with 58% males. Dry AMD was present in 76% and wet AMD in 24% of patients. Postoperative BCVA showed significant improvement (0.86 ± 0.21 vs. 0.49 ± 0.19 logMAR; p < 0.001). NEI VFQ-25 composite score increased from 41.2 ± 6.4 to 64.7 ± 8.9 (p < 0.001), with marked gains across all domains. Patients with dry AMD had greater QoL improvement than those with wet AMD (66.4 vs. 58.2; p = 0.02). Conclusion: Cataract surgery significantly enhances visual function and quality of life in elderly patients with AMD, particularly in those with dry AMD. It should be considered a valuable intervention despite underlying macular pathology. Keywords: Cataract surgery, macular degeneration, quality of life, elderly, NEI VFQ-25, visual acuity.

Background: Neuroendocrine Tumours (NETs) are a heterogeneous group of tumours with diverse biology and clinical behaviours that vary according to tumour site, type of neuroendocrine cells and grading of the tumour. Materials and Methods: A retrospective, observational study was carried out at the Department of Pathology, Shri Ram Murti Smarak (SRMS) Institute of Medical sciences (IMS), Bareilly. All the cases diagnosed as neuroendocrine tumour or neuroendocrine carcinoma (NEC) from January 2022 to December 2024 were included. Typing of the tumour was done according to WHO classification. We used Chromogranin A (CgA), Synaptophysin, CD56 and Ki67 Immuno-histochemical markers for confirmation of neuroendocrine etiology. Results: The study composed of total 52 cases which were archived from the Hospital Information System. The maximum number of cases were belonged to gastrointestinal tract (28.84%) followed by lung and gall bladder each comprised of 11.53%. In our study 25% cases are of grade 1 NET, 15.4% of grade 2 NET, 13.4% of grade 3 NET and 46.20% of poorly differentiated neuroendocrine carcinoma. Most of the grade 1 and 2 tumours are positive for all the three markers with strong and diffuse positivity and Ki67 proliferative index was in the range of 2-3% and 6-15% respectively. Grade 3 tumours, small cell NEC and large cell NECs were also showed positivity for all the neuroendocrine markers with somewhat reduced intensity as compared to grade 1 & 2 tumours and Ki67 proliferative index was in the range of 40-90%. Conclusion: The effective application of WHO grading and immunomarkers like Chromogranin A, Synaptophysin, CD56, and Ki-67 proved essential for accurate diagnosis and classification. Overall, the findings offer valuable insight into regional NET patterns and call for further multicentric and longitudinal research to improve patient management. Keywords: Neuroendocrine Tumours (NETs), Immunohistochemistry markers, Chromogranin A (CgA), Synaptophysin, CD56, Ki67.

Background: Diabetic ketoacidosis (DKA) is an acute complication of uncontrolled diabetes mellitus (DM). Abdominal symptoms and elevated pancreatic enzyme levels are common. The elevations of serum amylase and lipase levels in DKA can mimic acute pancreatitis, making diagnosis a challenge. This study aimed to compare serum amylase and lipase levels in DKA and non-DKA cases. Materials and Methods: This cross-sectional observational study included 40 patients with diabetes, of whom 9 had DKA and 31 did not. They were evaluated clinically using biochemical variables (serum amylase and lipase), arterial blood gases, and abdominal imaging (ultrasound and CT as needed). The enzyme levels of the groups were compared, and correlations with indicators of DKA severity were analyzed. Results: Patients with DKA showed a significant increase in blood glucose and anion gap levels and a decrease in pH and bicarbonate levels (p<0.001). Serum amylase and lipase levels were also significantly higher in the DKA group (248.6 ± 102.7 U/L and 162.4 ± 78.5 U/L, respectively; p<0.001). The higher the acidosis, the higher the enzyme levels. However, no pancreatic inflammation was detected by imaging studies in any of the cases, even in those with enzyme concentrations >3X above the upper limit of normal. Cases of abdominal pain were strikingly more common in DKA, which was not unique to pancreatitis. Conclusion: Elevated serum amylase and lipase levels are common in DKA and correlate with the severity of metabolic derangement rather than true pancreatitis. Clinicians should interpret these enzyme elevations cautiously and rely on clinical and imaging findings to avoid misdiagnosis and unnecessary interventions. Keywords: Diabetic Ketoacidosis (DKA), Serum Amylase, Serum Lipase, Acute Pancreatitis.

Background: Timely and accurate monitoring of labor is critical for preventing maternal and fetal complications. The WHO-modified partograph is a visual tool designed to aid in assessing labor progression and identifying deviations that may necessitate intervention. This study aimed to evaluate the effectiveness of the WHO-modified partograph in monitoring labor patterns and improving maternal outcomes. Materials and Methods: A prospective observational study was conducted over 18 months at Northern Railway Central Hospital, New Delhi, involving 100 women (50 primigravida, 50 multigravida) with uncomplicated singleton term pregnancies and spontaneous labor onset. Labor progression was recorded using the WHO-modified partograph. Patients were categorized based on labor progression zones: Zone A (left of alert line), Zone B (between alert and action lines), and Zone C (right of action line). Outcomes were analyzed in terms of labor duration, mode of delivery, and maternal morbidity. Results: Normal labor progression was seen in 85% of cases, with 97.4% in Zone A having normal labor pattern. Abnormal labor patterns (15%) were significantly associated with delivery in Zones B and C. Cesarean and instrumental delivery rates increased markedly beyond the alert line, with maternal morbidity (fever, wound sepsis) significantly higher in the abnormal labor group (p < 0.001). The average labor duration was significantly shorter in the normal group (9.57 hours vs. 17.05 hours, p < 0.001). Conclusion: The WHO-modified partograph is a reliable, low-cost, and effective tool for monitoring labor. It enables early detection of deviations from normal labor, facilitating timely interventions that can reduce the risk of complications and improve maternal outcomes. Keywords: Partograph, Maternal outcomes, Abnormal labor.

Background: Acute kidney injury (AKI) in neonates is a serious and potentially life-threatening condition that often arises in the context of sepsis, perinatal asphyxia, and other neonatal complications. Early identification and appropriate management are crucial to reduce morbidity and mortality. This study aimed to determine the aetiological profile, clinical characteristics, and outcomes of AKI among neonates admitted to a tertiary care NICU in India. Materials and Methods: A Retrospective observational study was conducted in the NICU of a tertiary care hospital over a 24-month period (August 2022 to July 2024). A total of 3200 neonates were screened, of whom 168 met the criteria for AKI based on modified KDIGO definitions. Demographic data, clinical and laboratory parameters, etiology of AKI, interventions, and outcomes (recovery, mortality, and progression to chronic kidney disease) were recorded and analyzed. Results: Among 168 neonates with AKI, the mean age was 5.3 ± 3.1 days, with a male predominance (58.3%). The leading causes of AKI were sepsis (48.8%), perinatal asphyxia (32.1%), and dehydration/ hypovolemia (26.2%). The majority of cases were intrinsic renal AKI (56%), followed by prerenal (41.1%) and postrenal (3%). Laboratory findings showed elevated serum creatinine (1.8 ± 0.5 mg/dL) and BUN (48.5 ± 12.7 mg/dL), with 36.3% showing metabolic acidosis. Interventions included antibiotics (88.1%), fluid resuscitation (60.7%), and peritoneal dialysis in 14.3%. Complete renal recovery was seen in 64.2% of cases, while 4.8% progressed to chronic kidney disease. The overall mortality rate was 30.9%, significantly higher among those with intrinsic renal AKI (p < 0.0001). Conclusion: Sepsis and perinatal asphyxia remain the most common etiological factors for neonatal AKI in Indian NICUs. Intrinsic renal AKI is associated with significantly higher mortality. Early diagnosis and prompt management are essential to improve outcomes and reduce long-term renal complications in this vulnerable population. Keywords: Neonatal acute kidney injury, NICU, sepsis, perinatal asphyxia, renal outcome, intrinsic renal AKI, neonatal mortality, India.

Background: The treatment for plantar fasciitis (PF), a prevalent cause of heel discomfort, is not yet standardized. Despite being the two most often utilized methods, platelet-rich plasma (PRP) and corticosteroid (CS) injections, little attention has been paid to comparing their contributions to long-term functional improvement. Materials and Methods: 56 cases of plantar fasciitis in all, divided into two groups of 28 participants each, were included in the study from the outdoor orthopaedics department. Following a straightforward randomization process using computerized random numbers, participants were randomized to one of two treatment groups. Results: There were no notable differences between the therapy groups, according to demographic data. When compared to corticosteroid therapy, PRP therapy consistently produced lower Visual Analog Scale (VAS) pain scores at all follow-up intervals. Furthermore, PRP-treated patients had higher Foot and Ankle impairment Index (FADI) ratings, indicating a larger improvement in functional impairment. Over the course of the trial, patient satisfaction was noticeably better in the PRP group. The two groups experienced comparable adverse effects. Conclusion: When compared to corticosteroid injection therapy for plantar fasciitis, PRP injection therapy is more effective at lowering pain intensity, improving functional impairment, and raising patient satisfaction.Moreover, the safety profile of PRP therapy is similar.These results support the use of PRP as a recommended therapeutic alternative in clinical settings. Keywords: Injections of corticosteroids, plantar fasciitis, platelet-rich plasma, the degree of pain, and functional impairment

Background: Alpha 2 adrenergic agonists are added to local anaesthetics to increase the duration of block and provide better analgesia. The present study was aimed at comparing dexmedetomidine and clonidine as adjuvants to levobupivacaine in nerve stimulator guided supraclavicular brachial plexus block (SCBPB) in patients undergoing upper limb surgeries. Materials and Methods: 80 adult patients of age group 18-60 years, belonging to American society of anesthesiologists (ASA) grade I & II undergoing upper limb surgeries under nerve stimulator guided supraclavicular block were included in the study. Each group consisting of 40 patients received 30 ml of 0.5% levobupivacaine with clonidine 1 μg/kg diluted to 1 ml of NS (Group LC) and 30 ml of 0.5% levobupivacaine with dexmedetomidine 1μg/kg diluted to 1 ml of NS (group LD) with nerve stimulator guided supraclavicular brachial plexus block. The onset and duration of sensory and motor block and VAS score was compared in both the groups. Results: The onset of motor and sensory block was comparable in both the groups. The duration of sensory block and motor block was significantly prolonged in group LD in comparison to group LC (p <0.0001, p <0.0001). VAS score was significantly lower in group LD at 5,6 and 9 hrs (p <0.0001) Conclusion: 1mcg/kg dexmedetomidine is superior to 1 mcg/kg clonidine as an adjuvant to levobupivacaine in nerve stimulator guided supraclavicular brachial plexus block as it provides longer duration of sensory block, motor block and lower VAS score. Keywords: Dexmedetomidine, clonidine, sensory block, motor block, analgesia.