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Background: Wormian bones or sutural bones, are small, irregularly shaped bones most commonly found in the lambdoid suture of skull, but they may also appear in other cranial sutures. These bones develop due to multiple ossification centers within the sutures of skull during development. The knowledge of Wormian bones plays a major role for the neurosurgeons, neuro-anatomists, radiologists, forensic experts and anthropologists. Presence of few wormian bones is normal. But multiple Wormian bones need attention as it may have underlying skeletal or central nervous system pathology. Objective: To determine morphologic and morphometric characteristics of wormian bones in Southern Odisha population. Materials and Methods: The study was conducted on 53 dry human skulls of unknown gender and age in the Department of Anatomy, MKCG MCH, Berhampur, Odisha. The deformed skulls and skulls of paediatric age group were excluded. The location, shape, number and side of wormian bones were determined. Results: In the present study; wormian bones were observed in 38 (71.7%) skulls out of 53 skulls, and the total number of the observed wormian bones were 129. More than five wormian bones were found in 8 skulls (28%), four in two skulls (5.2%), three in 9 skulls (23.6%), two in 10 skulls (26.3%) and one in nine skulls (23.6%). The wormian bones were seen uniformly distributed both on right and left sides, at a rate of 44.2 %. Maximum number of bones were seen at lambdoid suture (n=78, 60.4 %); followed by lambda 11.6%, pterion 10.8 %, asterion 8.5%, parieto-mastoid suture 6.2 %, squamous suture 2.3% and occipito-mastoid suture 2.3%. The mean values of wormian bones were15.27 ± 5.99 mm vertical diameter and 18.13 ± 7.9 mm horizontal diameter. The mean cranial breadth and cranial length were found as 134.53 ± 6.38 mm and 164.81 ± 7.12 mm respectively. In terms of cephalic index values, 11.3 % were dolicocephalic, 28.3 % mesocephalic, 39.6% brachycephalic and 20.7 % were hyperbrachycephalic skulls. The most common types of skulls in the wormian bone presence group were brachycephalic. Conclusion: Greater cephalic index, higher incidence of wormian bones, large size wormian bones in our study may indicate the influence of genetic and environmental factors over development of skull bones in Southern Odisha population. Keywords: wormian bone, suture, interparietal bone, pterion, asterion, lamba

Background: Being short of health care provisions and preventive measures is a major reason for outbreaks of communicable diseases and delay in controlling its spread. An outbreak of jaundice along with diarrhoea and fever in a cluster mostly among children was investigated. The objective is to identify children suffering from jaundice and to investigate for hepatitis A outbreak. To assess control measures and to analyse epidemic curve for forecasting. Materials and Methods: An epidemic case sheet was used to collect data from the community and health centre laboratory to do basic investigations. Discharge summary of those admitted was used to collect details of confirmation of hepatitis A illness. The Local Primary Health Centre was called in for control activities. Non- Government Organization and their trained work force engaged in health education and surveillance activities. Results: A slum in Bengaluru had an outbreak of Hepatitis A, where 92% of the households had no drainage. 88% was practicing indiscriminate waste disposal and 12% had no toilet facility, 32% practiced open air defaecation. 48 % followed handwashing practice. Total of 25 cases reported from 3 to 16 years. Conclusion: The study revealed sanitation and hygiene deficits. Control measures implemented with community involvement and forecasting tools can significantly improve outbreak response when combined with intersectoral coordination. Keywords: Hepatitis A, Outbreak, Migrants, Slum Area, Forecast.

Background: Cervical cancer remains a leading cause of morbidity and mortality among women in low- and middle-income countries, primarily due to persistent infection with high-risk human papillomavirus (HPV) and limited access to organized screening. This study evaluated cytological abnormalities, HPV prevalence, and associated risk factors in women attending a tertiary care hospital in North India. Materials and Methods: A prospective cross-sectional study was conducted over 18 months at Government Doon Medical College and Hospital, Dehradun. The study received approval from the Institutional Ethics Committee prior to commencement. A total of 250 women aged 25–65 years underwent Pap smear examination, and 125 samples were tested for HPV DNA using PCR. Demographic, clinical, and viral co-infection data (HIV, HBV, HCV, syphilis) were collected and statistically analyzed. Results: Of the 250 Pap smears, 54% were negative for intraepithelial lesion, while 7.6% showed ASC-US, 4.4% ASC-H, and 6.4% HSIL. Among 125 women tested, 30.4% were HPV-positive, with HPV-16 as the predominant genotype. ASC-US smears showed the highest HPV positivity (42.1%). HPV infection was significantly associated with younger age (25–40 years; p=0.04), early sexual debut (p=0.003), and co-infections with HIV, HBV, HCV, and syphilis (all p<0.01). Conclusion: The study demonstrates a substantial HPV prevalence in this population, with HPV-16 as the dominant oncogenic strain. Cytology alone failed to detect several HPV infections, highlighting the need for integrated HPV DNA testing in screening programs. Comprehensive strategies combining cytology, HPV testing, vaccination, and sexual health services are essential to reduce the cervical cancer burden in India. Keywords: Cervical cancer, Human papillomavirus (HPV), Pap smear.

Background: Situation analysis of existing health care infrastructure and diagnostic facilities in any geographical area forms an important determinant of the quality of overall health status of that particular area. It helps in identifying the gaps in the health system which need redressal. At the same time it forms an important input for the policy makers for planning and designing healthcare services. Objective: To conduct the situation analysis of the health care and diagnostic facilities within selected rural and urban underprivileged populations of Kashmir valley. Materials and Methods: It was a cross-sectional study conducted in rural and urban underprivileged population. A situational analysis of the existing health care infrastructure and diagnostic facilities available in the study areas was done by a team of researchers gathering information using a predesigned questionnaire as well as making on-site observations. Results: Out of total 24 health care facilities (HCF) within a radius of 3kms of the study sites, 21 were available in the urban sites and only 3 were available in the rural study sites. 17 Health care facilities belonged to govt. sector, 5 to private and 2 to NGO’s. In rural sites all the facilities were of primary level whereas in urban sites 21.4% were of secondary level and 78.0% of primary level. Out of the total 190 doctors at the study sites 183 were available at the urban health care facilities and only 7 in rural health care facilities. A total of 38 lab facilities were available with 36 in urban and only 2 in rural sites. Almost all the tests like Hb and blood sugar, lipid profile, LFT, KFT, routine urine examination, HBSAg, Widal test, ESR and HIV testing was being done in all the labs. Except for a few, majority of tests in government facilities were paid. There was cent percent acceptance of the proposed home health guide (HHG) intervention in government and NGO’s and 60.0 % in private facilities. There was 82.0% and 35 .0% acceptance respectively for proposed interventions of Mobile lab and health dairies in government HCFs while as the same was cent percent for NGO’s. Health ID creation was supported by 60.0% of the private facilities and 23.5 % of government facilities. Conclusion: There is a gross disparity in availability of health and diagnostic facilities in the study area with a wide rural urban gap in availability of services. One way of addressing this financial and physical inaccessibility is the introduction of Labikes, which aims to revolutionize health care access in the underprivileged areas. Keywords: Healthcare, underprivileged, diagnostic facility, Health care facility.

Background: Hepatitis B virus (HBV) infection remains a global health concern, with significant variability in clinical course depending on viral replication and host immune response. Among these, precore mutant strains represent an important subgroup due to their potential association with more severe outcomes, including hepatocellular carcinoma (HCC). Objectives: To prospectively interpret the viral markers (serological markers) in patients with hepatitis B surface antigen (HBsAg) positivity and to identify cases suggestive of precore mutant HBV strains. Materials and Methods: A prospective observational study was conducted including both acute and chronic HBsAg-positive patients. Viral markers including HBeAg, anti-HBe, and additional HBV DNA polymerase chain reaction (PCR) testing were analyzed. Special attention was given to cases with negative HBeAg and anti-HBe, which were further subjected to PCR for HBV DNA. Results: Out of 100 total HBsAg-positive patients, 70 were classified as chronic carriers. Among these, the majority were either HBeAg-positive or anti-HBe-positive. However, 1–2 patients were identified as negative for both HBeAg and anti-HBe, yet HBV DNA was detectable on PCR. These findings suggest the presence of precore mutant strains. Conclusion: Precore mutant HBV strains, though uncommon, were identified in our cohort. Such patients may remain undetected by conventional serological markers but demonstrate ongoing viral replication. This subgroup is at higher risk of progressive liver disease and hepatocellular carcinoma, underlining the importance of molecular testing in addition to routine serology in HBV patients. Keywords: Hepatitis B, HBsAg, precore mutant, HBeAg, anti-HBe, HBV DNA, hepatocellular carcinoma.

Background: Aim: To evaluate the retinal changes in patients with diabetic macular edema and correlating with visual acuity. Materials and Methods: This is a hospital based cross-sectional observational case study conducted between February 2024 - August 2025 in Department of Ophthalmology, Father Colombo Institute of Medical Sciences, Medicare General Hospital, Warangal. During the above mentioned period a sample of 50 type 2 diabetic patients detected to have clinically significant macular edema were included in the study. The Eyes with clinically significant macular edema were evaluated by OCT examination. Morphological Pattern and macular thickness of DME were documented and evaluated. The data recorded was tabulated and evaluated using SPSS software and statistical techniques. Results: Ratio between patients with NPDR and PDR was 3.47:1. Among the NPDR patients, moderate and severe types were common (38.2% and 36.8% respectively). PDR was relatively less common with PDR without HRC in 1.3% and PDR with HRC in 17.1%. Four different patterns of DME were found on evaluation of the OCT scans. Cystoid Macular Edema was the most common morphology (40.8%), followed by DRT (38.2%), and SRD (17.1%). Least common morphological type was VMIA (3.9%). The mean central macular thickness in all the 76 eyes is 364.34 microns. Mean thickness varied among various groups, being highest in Serous Retinal Detachment 421.77 microns and least among diffuse retinal thickening 283.86 microns. On statistical analysis of variance of mean thickness among various groups a statistically significant difference was observed (p<0.0001). The mean Visual acuity among 76 eyes was observed to be 0.48 log MAR units. Worse visual acuity was found in SRD pattern (0.61 log MAR). Visual acuity was better in DRT pattern (0.36 log MAR) compared to other patterns.CME pattern was also associated with worse visual acuity. There was a significant linear relation between Central Macular Thickness and Visual Acuity with r=0.841 and p Value <0.0001. Conclusion: The present study concluded that OCT can perform micrometre- resolution, cross sectional imaging of retina that closely approximates its histological layers. It is a very comfortable, non invasive procedure with very short measurement time. It facilitates quantification of macular oedema, assessment of vitreomacular interface and detection of VMT that is not clinically identified. It helps to understand the anatomy of DME and the intraretinal damage and is the technique of choice for early detection of DME. Keywords: Diabetic macular edema, OCT, CME, DRT, NPDR.

Background: Post-extubation stridor (PES) is a common complication in paediatric patients after mechanical ventilation, often caused by laryngeal oedema. Timely intervention is essential to prevent respiratory distress and to avoid reintubation. This study compared the effectiveness of nebulised adrenaline and budesonide in reducing stridor symptoms. Materials and Methods: A total of 92 children with stridor were randomly assigned to receive nebulised adrenaline (Group A) or budesonide (Group B) in a paediatric ICU setting. Stridor scores and physiologic parameters were monitored at baseline and at 20, 40, and 60 min, and 2, 4, 8, and 12-hours post-treatment. Results: Baseline mean stridor scores were 6.80 ± 1.49 in Group A and 7.05 ± 1.27 in Group B (p = 0.391). Both groups showed consistent improvements over time. At 20 minutes, scores were 5.61 ± 2.24 in Group A and 5.49 ± 2.39 in Group B (p = 0.798); by 40 minutes, 5.92 ± 2.23 and 6.35 ± 2.35 (p = 0.369); and at 60 minutes, 5.82 ± 2.19 and 5.07 ± 2.38 (p = 0.121), respectively. At 2 h, Group A scored 5.00 ± 1.70 and Group B 4.60 ± 1.55 (p = 0.167). At 12 h, the scores were reduced to 2.08 ± 1.45 and 2.02 ± 1.37 (p = 0.892), with no significant differences observed between the groups in stridor scores. Physiologic parameters remained stable and comparable between the groups throughout the study period. Conclusion: Epinephrine and budesonide showed similar effectiveness in treating post-extubation stridor in paediatric patients, with no significant outcome differences. Both therapies were well tolerated, and the baseline parameters remained comparable. Broader studies with extended follow-up and reintubation analyses are needed for stronger validation. Keywords: Postextubation stridor, Adrenaline, Budesonide, Paediatric ICU, Nebulisation, Stridor.

Background: Rational prescribing is essential to ensure patient safety, minimize adverse drug reactions, and reduce healthcare costs. This study aimed to assess the prescription patterns in the Department of Obstetrics and Gynaecology, focusing on prescribing trends, drug utilization, and adherence to World Health Organization (WHO) guidelines. Materials and Methods: This is an observational cross-sectional study conducted in the Department of Obstetrics and Gynaecology of Tomo Riba Institute of Health and Medical Sciences, Naharlagun, Arunachal Pradesh, India. A total of 198 prescriptions comprising 1014 drugs were retrospectively analyzed. Data on patient demographics, disease categories, polypharmacy, and prescribing indicators were collected and compared with WHO recommended standards. Results: Among the study population, 73.74% were aged 20–39 years. Obstetric complications accounted for 40.91% of cases and Gynecological benign conditions constituted 39.39. Polypharmacy was noted in 61.11% of prescriptions. Antibiotics were the most prescribed drug class (29.49%), followed by proton pump inhibitors (20.41%). The average number of drugs per prescription was 5.12. 36.29% of drugs were prescribed by generic name, 57.58% of encounters included injections and 90.91% included antibiotics. Furthermore, 79.88% of drugs were from the National List of Essential Medicines and fixed-dose combinations accounted for 21.01% of prescriptions. Conclusion: The study highlights considerable gaps in prescribing practices within the obstetrics and gynecology department, including polypharmacy, irrational antibiotic use, low generic prescribing, and excessive injection utilization. Keywords: Prescription pattern, Obstetrics and gynecology, Polypharmacy, Rational drug use, WHO prescribing indicators.

Background: Video-laryngoscopy has revolutionized airway management by improving glottic visualization and intubation success rates. Blade designs vary between channeled and non-channeled types, with limited data comparing their effectiveness with the BPL video-laryngoscope. Aim: To compare the effectiveness of channeled versus non-channeled blades of the BPL video-laryngoscope on glottic visualization and successful oro-tracheal intubation. Materials and Methods: In this prospective randomized controlled study, 134 adult patients (Group CH = 67; Group NC = 67) undergoing elective surgeries under general anesthesia with endotracheal intubation were enrolled. Primary outcomes included time to optimal glottic view and time to successful intubation. Secondary outcomes were first attempt success rate, modified Cormack-Lehane grade, and complication rates. Results: Mean laryngeal exposure time was significantly longer in the channeled blade group (6.03 ± 0.76 s) compared to non-channeled group (3.85 ± 0.68 s; p < 0.001). Time to successful intubation was comparable between groups (16.04 ± 1.09 s vs 15.85 ± 1.05 s; p = 0.296). Both groups had 100% first attempt success with no airway trauma observed. Conclusion: Both channeled and non-channeled blades of BPL video-laryngoscope are effective and safe for oro-tracheal intubation. Non-channeled blades enable faster glottic visualization whereas overall intubation times are similar. Keywords: Video-laryngoscope. Channeled blade. Oro-tracheal intubation.

Congenital Hypertrophic Pyloric Stenosis (CHPS) is a common cause of gastric outlet obstruction in infants, classically presenting with projectile, non-bilious vomiting. Timely diagnosis and surgical management are essential for favorable outcomes. We present a case series of six male infants with CHPS managed at a tertiary care hospital in Arunachal Pradesh. Clinical presentation, laboratory findings, imaging results, surgical management, and outcomes were analyzed. All infants presented with projectile, non-bilious vomiting. Three had severe dehydration and electrolyte imbalance, while others had mild or no biochemical disturbances. A palpable pyloric mass was identified in most cases, though absent in one, where an upper GI contrast study confirmed the diagnosis after inconclusive ultrasonography. USG findings in other cases demonstrated pyloric muscle thickness between 5.6–7 mm and length 1.8–2.5 cm. All infants underwent open Ramstedt’s pyloromyotomy, with uneventful postoperative recovery and favorable follow-up outcomes. CHPS should be suspected in infants with persistent non-bilious vomiting. Early diagnosis using USG or contrast studies, correction of fluid-electrolyte imbalance, and timely pyloromyotomy result in excellent outcomes. Our case series reinforces the clinical spectrum of CHPS and the importance of prompt surgical management. Keywords: Congenital hypertrophic pyloric stenosis, projectile vomiting, infant surgery, Ramstedt’s pyloromyotomy, case series.

Background: Osteoarthritis of the knee is a prevalent degenerative joint disorder causing significant pain and disability. While corticosteroids injections provide short-term relief, platelet-rich plasma (PRP) has emerged as a promising alternative offering longer-lasting benefits. The aim is to compare the analgesic and functional outcomes of USG-guided intra-articular injections of PRP and triamcinolone in patients with grades I–II knee osteoarthritis Materials and Methods: This prospective randomized controlled study enrolled 68 patients who were allocated to receive either PRP or triamcinolone injection under ultrasound guidance. Pain relief was assessed using the Visual Analogue Scale (VAS), and functional outcomes were measured by KOOS scores at baseline, 6 weeks, 3 months, and 6 months. Analgesic requirement reduction was also recorded. Results: Both groups showed significant pain reduction at early follow-up; however, PRP demonstrated superior long-term analgesic effect and functional improvement, with reduced analgesic dependence at 3 and 6 months compared to triamcinolone. Conclusion: PRP is a safe and effective biological alternative for knee osteoarthritis, offering sustained pain relief and better functional outcomes compared to corticosteroids injections. Keywords: Knee osteoarthritis, Platelet-rich plasma, Triamcinolone, Intra-articular injection.

Background: Osteoporosis is a major global health concern, particularly affecting postmenopausal women due to estrogen deficiency. Serum estradiol and bone turnover markers (BTMs) are reliable biochemical indicators for early changes in bone metabolism. While the individual effects of menopause and obesity on bone health have been studied, limited data exist on their combined impact on BTMs. This study aimed to assess serum estradiol and BTMs among lean and obese women, stratified by premenopausal and postmenopausal status. Materials and Methods: A cross-sectional, two-arm, parallel-group study was conducted from February 2019 to September 2020 in the Department of Biochemistry, Government Medical College. A total of 100 women were enrolled and divided equally into premenopausal (Group A) and postmenopausal (Group B) groups. Each group was further subdivided into lean (BMI 18.5–22.99 kg/m²) and obese (BMI >25 kg/m²) subgroups. Serum estradiol, ionized calcium, alkaline phosphatase, phosphorus, and albumin were measured using chemiluminescent immunoassay and standard biochemical methods. Data were analyzed using appropriate statistical tests. Results: Obese women showed significantly higher estradiol levels compared to lean women in both premenopausal (380.01 ± 24.81 vs. 291.08 ± 19.3 pg/mL, p=0.03) and postmenopausal (207.14 ± 11.29 vs. 84.83 ± 6.63 pg/mL, p<0.05) groups. Bone turnover markers including alkaline phosphatase, calcium, and phosphorus were also elevated in obese subgroups. Significant inverse correlations were found between estradiol and BTMs such as ionized calcium and phosphorus, particularly in postmenopausal women. Conclusion: Menopausal status and BMI significantly influence serum estradiol and BTMs. Obese postmenopausal women exhibit heightened bone turnover, underscoring the importance of early biochemical screening for osteoporosis prevention. Keywords: Estradiol, Bone Turnover Markers, Obesity, Menopause, Osteoporosis.

Background: Obesity is a major driver of metabolic and cardiovascular disorders. Body mass index (BMI) is widely used to assess obesity, but it fails to distinguish fat from lean mass. Body fat percentage may serve as a superior biomarker of metabolic risk, particularly with respect to lipid abnormalities. Objective: To investigate the association between body fat percentage and lipid profile parameters and to compare the predictive capacity of body fat percentage and BMI for dyslipidaemia. Materials and Methods: A cross-sectional study was conducted among 80 adults aged 30-50 years. Anthropometric measurements including BMI, waist-to-hip ratio (WHR), and body fat percentage were obtained. Fasting venous blood samples were analyzed for total cholesterol, LDL-C, HDL-C, and triglycerides. Dyslipidaemia was defined according to ATP III criteria. Statistical analysis included t-tests, Pearson correlation, ROC curve analysis, and logistic regression. Results: Participants with dyslipidaemia (n = 37) had significantly higher BMI (29.1 ± 3.6 vs. 26.8 ± 3.1 kg/m², p = 0.002), WHR (0.93 ± 0.07 vs. 0.89 ± 0.06, p = 0.010), and body fat percentage (33.1 ± 6.3% vs. 28.4 ± 5.7%, p = 0.001) compared to those without (n = 43). Body fat percentage correlated positively with total cholesterol (r = 0.46, p < 0.001), LDL-C (r = 0.49, p < 0.001), and triglycerides (r = 0.43, p < 0.001), and negatively with HDL-C (r = -0.38, p < 0.001). ROC analysis showed body fat percentage had higher discriminatory power for dyslipidaemia (AUC 0.79, 95% CI 0.69-0.88) than BMI (AUC 0.68, 95% CI 0.56-0.79, p = 0.018). Logistic regression indicated both BMI and WHR were associated with lipid abnormalities, but WHR showed stronger predictive value. Conclusion: Body fat percentage is more strongly associated with dyslipidaemia than BMI and provides superior predictive capacity for lipid abnormalities. Incorporating body fat percentage into cardiovascular risk assessment may enhance early detection and preventive strategies. Keywords: Body fat percentage. Dyslipidaemia. Cardiovascular risk.

Background: Cervical cancer is a leading cause of morbidity and mortality among women in developing countries. Conventional Pap smear (CPS) has been the cornerstone of screening but is limited by unsatisfactory smears and obscured cellular morphology. Liquid-based cytology (LBC) was developed to address these limitations. This study compares the diagnostic efficacy of LBC and CPS in detecting cervical intraepithelial neoplasia (CIN), with histopathology as the gold standard. Materials and Methods: A prospective comparative study was conducted on 60 women attending the gynecology outpatient department of a tertiary-care hospital. Each participant underwent both CPS and LBC, followed by colposcopically guided biopsy for histopathological correlation. Cytology was reported using the Bethesda System 2014. Diagnostic efficacy, smear adequacy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Statistical analysis included McNemar’s test, Chi-square, and odds ratios with 95% confidence intervals. Results: LBC detected ≥LSIL in 43.3% compared to 33.3% with CPS (p=0.210). Sensitivity and specificity of LBC were 86.4% and 81.6%, respectively, versus 72.7% and 89.5% for CPS. LBC significantly outperformed CPS in smear adequacy (95.0% vs 81.7%, p=0.021), presence of transformation zone component (76.7% vs 61.7%, p=0.035), and lower unsatisfactory rate (5.0% vs 18.3%, p=0.021). Association with histopathology was highly significant for both LBC (OR=28.05, p<0.000001) and CPS (OR=22.67, p<0.00001). Conclusion: Both LBC and CPS are effective in detecting CIN; however, LBC provides superior sample adequacy, morphology, and sensitivity. While CPS remains reliable and economical, wider implementation of LBC could enhance the quality of cervical cancer screening programs. Keywords: Liquid-based cytology, Conventional Pap smear, Cervical intraepithelial neoplasia

Background: Iron deficiency is the most prevalent micronutrient deficiency in children worldwide and often precedes the onset of anemia. Latent iron deficiency (LID) refers to iron depletion where hemoglobin remains within normal limits, yet biochemical and hematological markers suggest deficiency. If undetected and untreated, LID can lead to iron deficiency anemia (IDA) and long-term neurodevelopmental consequences. This study aimed to determine the prevalence of latent iron deficiency in children with normal hemoglobin levels and to evaluate associated hematological indices and nutritional status. Materials and Methods: A prospective observational study was conducted on 100 children aged 6 months to 12 years admitted to a tertiary care hospital in Navi Mumbai. Children with normal hemoglobin but with one or more abnormal red cell indices (low MCV, MCH, MCHC, or elevated RDW) were further evaluated with serum iron testing. A serum iron level of <50 mcg/dL was considered diagnostic of LID. Results: Out of 100 children with normal hemoglobin, 66% were found to have low serum iron levels. Additionally, 41% had low MCV, 38% had low MCH/MCHC, and 28% had elevated RDW. Most children (67%) had normal anthropometric status, suggesting that LID can exist independently of undernutrition. Conclusion: A significant number of children with normal hemoglobin levels have underlying latent iron deficiency. Reliance on hemoglobin alone may delay diagnosis and treatment. Incorporating red cell indices and serum iron analysis into routine screening could enable early intervention and prevent progression to anemia and associated developmental issues. Keywords: Latent iron deficiency, serum iron, pediatric anemia, red cell indices, MCV, MCH, RDW.

Background: Hip fragility fractures are a major cause of morbidity and mortality among the elderly, primarily resulting from osteoporosis and minor trauma. Vitamin D plays a crucial role in bone health and its deficiency has been implicated in osteoporosis & fracture severity. This study aimed to assess serum vitamin D levels and their association with osteoporosis & fracture site comminution in elderly patients with hip fractures. Materials and Methods: This prospective study was conducted at a tertiary care centre on 100 patients aged >60 years with hip fractures due to trivial trauma. Serum vitamin D levels were measured using an enzyme-linked fluorescent immunoassay (ELFA). Osteoporosis was classified using Singh’s Index, and fracture site comminution was assessed by plain radiograph. Results: Vitamin D deficiency (<20 ng/mL) was observed in 54% of patients, while 27% had insufficient levels (20–30 ng/mL). A significant association was found between vitamin D levels and Singh’s Index (p = 0.002), as well as between vitamin D deficiency and fracture site comminution (p ≤ 0.001). Conclusion: Serum vitamin D deficiency was significantly associated with osteoporosis severity and fracture site comminution in elderly hip fracture patients. Singh’s Index remains a useful tool for osteoporosis assessment in resource-limited settings. Early detection of osteoporosis and vitamin D deficiency is essential for timely intervention and fracture prevention. Keywords: Hip fractures, osteoporosis, vitamin D deficiency, Singh’s Index, fracture comminution, elderly patients.

Background: Lateral epicondylitis is characterized by chronic degeneration of the common extensor tendon attachment to the lateral epicondyle of the humerus. It is a prevalent overuse injury, frequently seen in primary care, affecting between 1% to 3% of the general population. This can result in a significant social and economic burden, as it often leads to lost workdays and may incapacitate some patients for several weeks. This study presents our experience in evaluating the clinical & functional outcomes following local administration of autologous platelet-rich plasma (PRP) injection supplemented with adjuvant dry needling for the management of chronic or recurrent idiopathic tennis elbow. Materials and Methods: The study was carried out over a period of 18 months at Maharaja Agrasen Medical College, Agroha, in 35 patients of age 18 years and above with lateral epicondylitis for more than 3 months and already managed with brace, analgesics, various physiotherapy modalities & with or without local injections. The patients were injected with a single dose of PRP with adjuvant dry needling. Assessment of the clinical and functional outcomes was done by the PRTEE (Patient-Rated Tennis Elbow Evaluation) score at the end of 4th week,12th week and 24th week. Results: Most participants were male, with mean age of 42.6±4.8 years. Most patients presented with involvement of the right side with average pain duration of 12.2 months. The assessment was done using the PRTEE score. Pain score decreased from mean of 40.6 to 5.4 (p-value <0.001) and functional score decreased from mean of 40.2 to 4.1 (p-value <0.001) over a 24-week follow-up period. There were no post procedure complications. Conclusion: This study underscores the considerable therapeutic potential of combining autologous platelet-rich plasma (PRP) injection with adjuvant dry needling in the management of chronic or recurrent idiopathic lateral epicondylitis of humerus. Significant improvements in clinical and functional outcomes were demonstrated by reduction in PRTEE score with no significant post procedure complications. Keywords: Chronic lateral epicondylitis, PRP (Platelet rich plasma), Dry Needling, PRTEE (Patient-Rated Tennis Elbow Evaluation) score, MTrPs (Myofascial trigger points).

Background: Trace elements such as copper and zinc play vital roles in oxidative balance and glucose metabolism. Their imbalance, particularly the copper/zinc ratio, may contribute to early glycemic dysregulation in type 2 diabetes mellitus (T2DM). This study evaluated the correlation between serum copper, zinc, and copper/zinc ratio with glycemic indices in newly diagnosed T2DM patients. Materials and Methods: A cross-sectional study was conducted from May 18th to August 14th at the Department of General Medicine, NRI Medical College & General Hospital, Chinakakani, Guntur. Eighty treatment-naïve patients aged 30–65 years with newly diagnosed T2DM were enrolled. Fasting blood glucose (FBG), postprandial glucose (PPG), HbA1c, and serum copper and zinc levels were measured. Copper/zinc ratios were calculated. Correlation analysis and quartile-based comparisons were performed using Pearson's r and ANOVA. Results: Mean serum copper and zinc levels were 112.5 ± 18.4 µg/dL and 72.3 ± 11.7 µg/dL, respectively. Copper/zinc ratio averaged 1.56 ± 0.24. Serum copper positively correlated with HbA1c (r = 0.43, p = 0.001), FBG (r = 0.36), and PPG (r = 0.31). Zinc showed negative correlations with HbA1c (r = -0.38, p = 0.007), FBG (r = -0.29), and PPG (r = -0.25). The copper/zinc ratio had the strongest correlation with HbA1c (r = 0.47, p < 0.001). Quartile analysis showed a progressive increase in glycemic indices across rising copper/zinc quartiles (p < 0.001). Conclusion: Copper/zinc imbalance is significantly associated with poor glycemic control in early-stage T2DM. The copper/zinc ratio may serve as a sensitive biomarker for metabolic dysfunction in newly diagnosed diabetic patients. Keywords: Copper, Zinc, Copper/Zinc Ratio, Type 2 Diabetes Mellitus, Glycemic Control, HbA1c.

Background: Recurrent respiratory infections (RRIs) are among the most frequent health problems in children and represent a major cause of morbidity, school absenteeism, and healthcare utilization. While most acute respiratory infections are self-limiting, a subset of children experience repeated episodes, raising concerns about underlying risk factors. Identifying these factors is crucial for guiding preventive strategies, timely interventions, and reducing the overall burden on families and healthcare systems. Aim: This study aimed to identify and analyze the risk factors associated with recurrent respiratory infections in children, with emphasis on demographic, environmental, nutritional, and clinical determinants. Materials and Methods: A case-control study was conducted involving children aged 1–12 years attending the pediatric outpatient department of a tertiary care hospital. Cases included children with a history of recurrent respiratory infections, defined as ≥6 episodes of upper respiratory tract infection per year or ≥2 episodes of pneumonia in 12 months. Controls were age- and sex-matched children without such history. Data were collected using structured questionnaires and medical records, focusing on sociodemographic characteristics, nutritional status, exposure to environmental risk factors (such as passive smoking, indoor air pollution, and overcrowding), birth history, breastfeeding practices, vaccination status, and presence of comorbidities. Statistical analysis was performed to identify significant associations between risk factors and recurrent infections. Results: The study found that recurrent respiratory infections were significantly associated with multiple risk factors. Malnutrition, lack of exclusive breastfeeding in the first six months of life, incomplete immunization, and micronutrient deficiencies (especially vitamin A and iron) were important contributors. Environmental factors such as household overcrowding, exposure to tobacco smoke, indoor cooking with biomass fuels, and poor ventilation were strongly linked to increased risk. Children with a history of prematurity, low birth weight, or underlying conditions such as allergic rhinitis and asthma were also more susceptible. Socioeconomic status and parental education were found to be indirect but significant determinants, influencing both nutrition and healthcare-seeking behavior. Conclusion: Recurrent respiratory infections in children are influenced by a complex interplay of biological, nutritional, environmental, and socioeconomic factors. Targeted interventions including nutritional supplementation, promotion of exclusive breastfeeding, complete immunization, reduction of indoor pollutants, and parental education can substantially reduce the incidence of recurrent infections. Early recognition of high-risk children and implementation of preventive measures at the community level are essential for reducing morbidity and improving child health outcomes. Keywords: Recurrent respiratory infections, Children, Case-control study, Risk factors, Malnutrition, Passive smoking, Indoor air pollution, Breastfeeding, Immunization, Socioeconomic determinants.

Background: Tibial plateau fractures are challenging intra-articular injuries that may result in long-term functional impairment if not optimally treated. While conservative management is sometimes advocated, surgical fixation using locking plates aims to restore articular congruity, provide stable fixation, and allow early mobilization. This study assessed the evaluational and functional outcomes of tibial plateau fractures managed with locking compression plates. Materials and Methods: This observational study included 30 adult patients aged 18–65 years with closed tibial plateau fractures classified according to Schatzker’s system. Open fractures and medically unfit patients were excluded. All patients underwent open reduction and internal fixation (ORIF) or minimally invasive percutaneous plate osteosynthesis (MIPPO) with locking compression plates. Postoperative rehabilitation included early knee mobilization. Patients were followed for 12–60 weeks, with outcomes assessed by fracture union, range of motion, complications, and functional grading. Results: ORIF was performed in 67% and MIPPO in 33% of cases. Mean union time was 14.6 weeks, with union duration significantly associated with fracture type (p<0.05). At final follow-up, outcomes were excellent in 63%, good in 33%, and poor in 3%. Functional range of motion >120° was achieved in 63%. Complications occurred in 16.7%, including valgus malalignment, instability, and knee stiffness. Conclusion: Locking compression plate fixation of tibial plateau fractures ensures stable osteosynthesis, early mobilization, and favorable functional outcomes, with minimal complications when performed using proper surgical technique. Keywords: Tibial plateau fracture, locking compression plate, functional outcome, internal fixation

Background: Inflammatory bowel disease (IBD) in children often leads to significant growth failure due to chronic inflammation, malnutrition, and treatment-related factors. Growth impairment is particularly concerning in Crohn’s disease (CD), but can also be seen in ulcerative colitis (UC). Objective: To assess the impact of IBD on growth parameters in children and adolescents and determine associations with disease severity and clinical profile. Materials and Methods: This descriptive observational study was conducted at a tertiary care centre. Children aged 1 month to 18 years with confirmed IBD were enrolled. Clinical, epidemiological, and anthropometric details were collected. Growth parameters were measured using WHO/IAP charts. Disease activity indices, laboratory parameters, and treatment details were recorded. Associations between growth impairment and clinical features were analysed. Results: Among 42 children with IBD, 88.1% had CD and 11.9% had UC. Growth impairment was significant: 35.7% of children had both stunting and low BMI (<3rd centile). Only 9.5% had normal height, and 14.3% adequate BMI. Loose stools were correlated significantly with stunting (p=0.04) and low BMI (p=0.007). Early-onset and very-early-onset IBD had a higher prevalence of growth failure compared to adolescents. Nearly all patients had anaemia (100%) and weight loss (97.6%). Biologics (mostly infliximab) were used in 52% of CD patients, especially those with severe disease and marked growth failure. Conclusion: Growth impairment is common in paediatric IBD in India, particularly in CD and in those with early disease onset. Frequent diarrhoea and severe disease activity were significantly associated with growth failure. Early recognition and aggressive management, including using biologicals when indicated, are essential to improve growth outcomes. Keywords: Paediatric IBD, Crohn’s disease, ulcerative colitis, growth failure, Anthropometry.

Background: Chronic Rhinosinusitis (CRS) is a common condition, and anatomical variations of the osteomeatal unit (OMU) are considered important predisposing factors. Identifying these variants is essential for diagnosis and surgical planning. The objective is to determine the prevalence of anatomical variations in the osteomeatal unit among patients with CRS without nasal polyposis and to assess their association with specific sinus involvement Materials and Methods: This cross-sectional observational study was conducted on 110 patients with clinically and radiologically diagnosed CRS without nasal polyposis. All patients underwent diagnostic nasal endoscopy and high-resolution computed tomography (HRCT) of the paranasal sinuses. Anatomical variations including deviated nasal septum (DNS), concha bullosa, agger nasi cells, paradoxical middle turbinate, Haller cells, and uncinate process variations were evaluated. Results: The most common variation was DNS (82.7%), followed by concha bullosa (35.5%), paradoxical middle turbinate (31.8%), and uncinate process hypertrophy (30%). Agger nasi cells (12.7%), Haller cells (8.2%), and pneumatized uncinate (3.6%) were less frequent. DNS showed a significant association with maxillary sinusitis (p = 0.042), while agger nasi cells were more frequently associated with frontal sinusitis (42.9%), though not statistically significant. Conclusion: Anatomical variations of the osteomeatal unit are highly prevalent in CRS patients without nasal polyposis, with DNS, concha bullosa being the most frequent. Recognition of these variants on preoperative CT scans is crucial for accurate diagnosis, prevention of complications, and improving surgical outcomes in functional endoscopic sinus surgery (FESS). Keywords: Chronic Rhinosinusitis, Osteomeatal unit, Anatomical variations, deviated nasal septum & Concha bullosa.

Background: Aim: To compare the period of stay, period of wound healing, time period to return to daily activities and cost factor between open fistulectomy and primary closure technique. Materials and Methods: Patients admitted in all surgical units of J.J.M Medical College and Hospital were included in the study without bias on a serial basis. This is a study comprising 50 patients (n =50) of Fistula in ano over a period of 26 months from May 2018 to July 2020. Results: Majority of parients in both groups presented with discharge and swelling in perianal region. There is significant difference between duration of stay of patients of open (11 days) and primary closure (7 days) (p value 0.0001). There is significant difference between duration of wound healing of open (27 days) and primary closure (9 days) (p value 0.0001). Patients who had undergone fistulectomy with primary closure had a mean VAS pain score of 5.2 while patients who had undergone open fistulectomy had a mean VAS pain score of 8.7 on the first post-operative day. Conclusion: The study proved that the primary closure after fistulectomy showed better results in terms of lesser pain management, short hospital stay and lesser period of wound healing as compared to the open fistulectomy. From this study it can be concluded that fistulectomy with primary closure is ideal for low level fistula in ano. Keywords: Primary closure, Open fistulectomy.

Background: Abnormal Uterine bleeding (AUB) is bleeding from the uterus that is longer than usual or occurs at an irregular time. Transvaginal Sonography (TVS) is the initial diagnostic modality in assessment of patients presenting with AUB. It is inexpensive, non- invasive way to visualize the endometrium and endometrial cavity. This study was undertaken to find out the diagnostic accuracy of TVS in diagnosing normal and abnormal endometrium in patients presenting with AUB, by comparing the ultrasound findings with histopathology, to measure endometrial thickness and pattern, to find out any intraluminal pathologies and to evaluate cut off values for endometrial thickness for identifying normal and abnormal endometrium. Materials and Methods: This prospective, comparative study is done over period of 2 years. A total of 196 women, above the age of 18 years presenting with complaints of abnormal bleeding uterine were included in the study. Any vaginal or cervical cause of bleeding, blood dyscrasias, pregnancy related causes of bleeding, patient with history of drug intake like anticoagulants and hormone replacement therapy were excluded. These women underwent clinical examination, investigations and TVS, followed by endometrial sampling/ pipelle sampling / hysteroscopy with biopsy or hysterectomy. Results: 120(61.22 %) of patients presented with HMB or menorrhagia as clinical symptom. By histopathology, 128 (65.3%) cases had normal endometrium and 68 (34.69%) had abnormal endometrium. TVS diagnosed endometrium as normal in 138 (70.4%) cases with Sensitivity, Specificity, PPV, NPV and diagnostic accuracy of 91.2%, 98.3%, and 89.7%, 84% and 87.7% respectively. TVS diagnosed endometrium as abnormal in 58 (29.6%) cases with Sensitivity, Specificity, PPV, NPV and Diagnostic Accuracy of. 79.1, 93.2%, 79.1% 93.2% and 89.7% respectively. Type A endometrium was seen in 127 (64.7%) cases and Type B in 71 (35.3%) cases. Type B was more associated with endometrial pathologies. A cut off value of 14mm of endometrial thickness on TVS has better Sensitivity, Specificity, PPV, NPV and diagnostic accuracy of TVS is 91.3%, 88.2%,86.8% , 90% and 88.7% (P value <0.001) as compared to a cut off value of 12mm on TVS with Sensitivity, Specificity, PPV, NPV and diagnostic accuracy of 84.1%, 64.5%,82.6% , 71.4 % and 71.4 % respectively. Conclusion: Transvaginal Sonography is the initial diagnostic modality in assessment of patients presenting with AUB. Transvaginal Sonography can predict normal and abnormal endometrium with overall Sensitivity, Specificity, PPV, NPV and diagnostic accuracy of 91.3%, 88.2%, and 86.8%, 90% and 88.7% respectively. Type B endometrium is more associated with endometrial abnormalities. A cut off value of 14mm gives better Sensitivity, Specificity, PPV and NPV and Diagnostic accuracy of 91.3%, 88.2%, and 86.8%, 90% and 88.7% respectively. Keywords: AUB, premenopausal, PALM COEIN, Histopathology, Transvaginal Sonography, Endometrial thickness, Endometrial Pattern, Cut off Values.

Background: Infants with low birth weight (LBW) are defined as those weighing under 2500 grams at birth, and are at higher risk of infections, feeding and growing problems, and hospitalization due to LBW during the first few days of life. These contribute to neonatal and infant morbidity in developing countries. Exclusive breastfeeding (EBF), defined operationally as infants receiving only breast milk (with no other liquids or solids) for the first six months, is endorsed and is the standard of care. Breast milk supplies complete nutrition with added anti-infective and immunological properties that may reduce the incidence of illness in LBW infants. The practice of EBF for LBW infants is frequently not done, and there are few prospective studies on exclusively breastfeeding LBW infants to prevent morbidity. Objectives: This study's purpose was to determine the impact of exclusive breastfeeding on morbidity patterns among LBW infants during the first six months of life. Specific objectives included comparing rates of diarrhoea diseases, acute respiratory infections, febrile illnesses, hospitalization status, and growth parameters between low birth weight infants who were exclusively breastfed and infants who were not exclusively breastfed. Materials and Methods: An observational study was carried out prospectively over twelve calendar months (July 2024 to June 2025) in Department of Paediatrics, Malabar Medical College Hospital and Research Centre, Ulliyeri, Kozhikode, Kerala, India. Following informed parental consent, 120 LBW infants were enrolled. Baseline maternal and infant data were collected, and infants were divided into two groups: those exclusively breastfed (the EBF group) and those mixed breastfed/formula fed (the non-EBF group). All infants were followed for the duration of six months with monthly visits until the infants reached six months of age. Information about feeding practices, morbidity episodes (diarrheal illness, respiratory infections, skin infections, and hospitalizations) and anthropometric measurements (weight and length) were collected. Results: Of the 120 infants, exclusively breastfed infants were 68 (56.7%) while non-exclusively breastfed infants were 52 (43.3%). The episodes of diarrhoea occurred significantly less in EBF infants than non-exclusive infants (p < 0.05). Acute respiratory infections were prevalent for fewer EBF infants compared to non-exclusive infants (p < 0.01). Fewer hospital admissions for infection were seen for EBF infants compared to non-exclusive infants (p < 0.05). Weight gain and linear growth trends were more favourable for EBF infants compared to the non-exclusive infants, however, the values were not statistically significant between the two groups. The cumulative morbidity burden was markedly lower for infants who were EBF compared to infants who were non-EBF. Conclusion: Exclusive breastfeeding is an important public health intervention to reduce morbidity in LBW infants during the first six months of life, especially associated with infections and hospitalizations. The findings underscore the need to continue to promote and support exclusive breastfeeding among LBW infants as an

Background: Medical interns are subjected to multifaceted stressors, including rigorous work schedules, clinical obligations, academic demands, and little time to relax. The emotional toll of patient care, a lack of work-life balance, and insufficient mentoring are additional pressures. All of these elements work together to cause mental exhaustion and burnout throughout the internship. The objective is to estimate the prevalence of stress among medical interns. To assess the coping strategies used by them. To analyse the association between stress levels and different coping strategies. To identify factors influencing stress and coping mechanisms in medical interns. Materials and Methods: A cross-sectional study was done amongst 228 medical interns of Chhatrapati Sambhajinagar, Maharashtra, wherein a questionnaire was given to them to determine the prevalence of stress along with its association with coping strategies. Results: The results indicate the majority of participants rated their stress level as 3 on Likert scale with overall 60% of them reporting recurring stress, with 37% often experiencing burnout. Notably, the primary source of stress reported by participants were long working hours (54%) and academic demands (48%). The most commonly reported coping strategies for managing stress among participants were social support from friends, family, orcolleagues (55%) and taking breaks or naps (50%). Also, a subset of participants (21%) reported engaging in maladaptive coping mechanisms, specifically substance abuse, highlighting a concerning trend in stress management among medical interns. Conclusion: The presence of stress among medical interns underscores the need for targeted interventions and support systems to foster resilience, self-advocacy, and effective coping strategies, ultimately enhancing their well-being and professional fulfilment. Keywords: COPE Inventory, Stress, Coping strategies, Interns, Burnout.

Background: Shoulder arthroscopy is a minimally invasive, day-care procedure used to diagnose and treat a wide range of glenohumeral and peri-articular disorders. Among regional techniques for shoulder surgery, the interscalene brachial plexus block (ISB) is most commonly used, as it provides superior postoperative analgesia and reduces opioid requirements. Hence, the present study was conducted for comparative evaluation of efficacy of postoperative analgesia of shoulder block versus interscalene block in arthroscopic shoulder surgeries at a tertiary care hospital. Materials & Methods: This study compared the analgesic efficacy of shoulder block (Group A) and interscalene block (Group B) in 40 patients undergoing elective unilateral arthroscopic shoulder surgery under general anaesthesia. Anaesthesia was induced with fentanyl, propofol, and vecuronium, then maintained with nitrous oxide and isoflurane, with supplemental fentanyl given if haemodynamics rose more than 20% above baseline. Sensory and motor block were graded, VAS scores recorded for 24 hours, and data analysed using SPSS with chi-square and t-tests. Results: In this study, patients were randomized to receive either shoulder block (SHB) or interscalene block (ISB), with both groups comparable in baseline demographics and surgical profiles. ISB was associated with a shorter block procedure, longer analgesic duration, and significantly lower VAS scores at 2 and 4 hours, while SHB showed similar outcomes at later intervals. Overall, ISB provided superior early postoperative analgesia, whereas SHB remained effective in the later postoperative period. Conclusion: Interscalene block demonstrated advantages over shoulder block by offering shorter procedure time, prolonged analgesia, and better early postoperative pain control. Both groups were comparable in demographics and safety outcomes, with no significant difference in complications. Thus, while ISB proved superior for early analgesia, SHB remained a safe and effective alternative with comparable late postoperative results. Key words: Shoulder Block, Interscalene Block, Arthroscopic Surgeries.

Background: Traumatic brain injury (TBI) is a major cause of long-term disability worldwide. In addition to cognitive and motor deficits, moderate to severe TBI can disrupt the hypothalamic-pituitary axis, resulting in pituitary dysfunction that often goes undetected. These hormonal deficiencies can significantly impair rehabilitation, mood, and quality of life. This study aims to assess the prevalence and extent of pituitary dysfunction in patients recovering from moderate and severe TBI. Materials and Methods: A retrospective observational study was conducted at Chandramma Dayanand Sagar Institute of Medical Education and Research, reviewing records of 100 patients (age 18–65 years) who sustained moderate (GCS 9–12) or severe (GCS ≤8) TBI between October 2023 and June 2025. Hormonal profiles were evaluated at the time of injury and again after 1 year. Functional outcomes were assessed using the Functional Independence Measure (FIM). Results: At injury, 42% had at least one pituitary hormone deficiency, including 18% with multiple pituitary hormone deficiency (MPHD). At 1-year follow-up, 48% had at least one deficiency, and 22% had MPHD. Dysfunction was significantly more common in severe TBI patients (60%) than moderate TBI (24%, p < 0.001). Patients with dysfunction had lower mean FIM scores (78.4 ± 9.2 vs. 90.6 ± 8.7; p = 0.002) and longer rehabilitation stays (32.5 vs. 21.3 days; p = 0.01). Conclusion: Pituitary dysfunction is a frequent and underrecognized complication of moderate and severe TBI, particularly in severe cases. It is associated with poorer functional outcomes and prolonged rehabilitation. Routine endocrine screening is essential for timely diagnosis and intervention. Keywords: Traumatic Brain Injury, Pituitary Dysfunction, Hypothalamic-Pituitary Axis, Multiple Pituitary Hormone Deficiency, Functional Independence Measure, Rehabilitation Outcomes.

Background: The aim of this study was to compare intravenous Magnesium sulphate and Dexmedetomidine for attenuation of pressor response to video laryngoscopy and intubation under general anaesthesia. Materials and Methods: The present study was a double blinded, prospective, randomized study conducted in Government general hospital, Kadapa during the period 2023-24. After obtaining institutional ethical committee approval and informed consent, 60 ASA I and II subjects in the age group of 20-60 years planned for elective surgeries were enrolled in this study. They were randomly allocated to one of the two study groups by using computer generated random numbers, Group D (Dexmedetomidine group) and Group M (Magnesium sulphate group). Results: The study aimed to determine the effectiveness of dexmedetomidine (1 μg/kg) and magnesium sulphate (30 mg/kg) in reducing video laryngoscopy-induced hemodynamic responses when using the King Vision device for subsequent endotracheal intubation. In the present study, both groups showed equivalent demographic profiles during baseline measurements since they had no substantial differences in age, sex, body weight, Mallampati classification and ASA physical status. The agents proved effective in reducing the hemodynamic changes that occur when using video laryngoscopy with the King Vision device before endotracheal intubation. Dexmedetomidine proved to control heart rate and blood pressure better than magnesium sulphate did after endotracheal tube intubation. Heart rate decreased by 17% below the baseline after dexmedetomidine administration while magnesium sulphate maintained a decrease of only 5.5%. The research data demonstrated significant differences between groups during both the intubation process and next three-minute period (p < 0.001). Dexmedetomidine showed better blood pressure control of systolic and diastolic pressure and mean arterial pressure (p < 0.05 across all parameters) which confirmed its strong sympatholytic properties in this context. Treatment with both agents revealed good results regarding safety conditions. Among the group receiving dexmedetomidine, 2 patients (6.7%) developed bradycardia while no such occurrences were observed in the patients treated with magnesium sulphate (p = 0.492). This difference was not statistically significant. Dexmedetomidine produced significantly higher sedation (RSS 2.80 ± 0.48) than Magnesium Sulphate (RSS 2.07 ± 0.69; p < 0.001). Conclusion: The randomized controlled trial evidence shows dexmedetomidine together with magnesium sulphate provides efficient stabilization of the hemodynamic response occurring during video laryngoscopy and endotracheal intubation procedures. Dexmedetomidine controls heart rate and blood pressure better than magnesium sulphate does initially after intubation yet magnesium provides gentle stabilization benefits. Keywords: Dexmedetomidine, Laryngoscopy, Endotracheal intubation, Magnesium sulphate, Hemodynamic parameters

Background: The present study attempts to study the tissue based Desarda technique in terms of postoperative pain, complications and recurrence, with the study of Desarda technique done worldwide. Materials and Methods: This is a prospective and interventional study examining Desarda‘s inguinal hernia repair technique in adults. Patients fulfilling the inclusion criteria were taken in the study. Clinical profile of the participants and postoperative factors like postoperative pain, time required to return to basic activity, time required to return to home activity, incidence of chronic groin pain, and recurrence rate were studied. Results: The peak age incidence of hernia was seen in the age group of 51-60 years [23.33%] followed by 31-40 years [20.66%]. There was a male preponderance in the total number of cases. Right sided hernia patients were commonly seen. Around 82% of patients had an indirect type of inguinal hernia, which was dominant in the group. 21.66% were chronic smokers and 12.5% patients had chronic cough in this group. Hypertension, diabetes, and urinary obstructive symptoms were seen in 34.16% 14.16% and 18.3% patients. The mean operative time was 60 Min [40-80min]. Post-operative pain score according to visual analogue scale on Day 1, 7 and 30 was 3.35, 0.95 and 0.008, respectively. Time taken to return to basic activities was 24 hours which is significantly less. Out of 120 patients, cord oedema [5%] was commonly seen complication following seroma [2.5%], surgical site infection. Conclusion: Desarda‘s inguinal hernia repair technique can be considered in adults with a lesser complication rate. Keywords: Inguinal hernia, Desarda‘s inguinal hernia repair technique , Complications, Post-operative pain.

Background: This study was conducted with an aim to assess the utility of CT attenuation values in differentiating enostosis from untreated osteoblastic metastases using mean and maximum Hounsfield Unit (HU) measurements. Materials and Methods: This prospective observational study included 78 patients divided equally into two groups—enostosis and osteoblastic metastasis—based on clinical and radiologic criteria. CT examinations were performed using a 16-slice CT scanner (GE Revolution). For each lesion, four-quadrant ROI measurements were taken to calculate mean and maximum attenuation values. Statistical analysis included t-tests, chi-square tests, and ROC curve analysis to determine diagnostic performance. Results: Mean CT attenuation was significantly higher in the enostosis group (1053.91 ± 73.59 HU) compared to the metastasis group (938.41 ± 56.96 HU) (p < 0.001). Similarly, maximum attenuation values were higher in enostosis (1171.41 ± 58.00 HU vs. 999.23 ± 56.69 HU, p < 0.001). ROC curve analysis demonstrated excellent diagnostic accuracy, with visually estimated AUCs exceeding 0.95 for both parameters. A cutoff of approximately 885 HU for mean and 1060 HU for maximum attenuation yielded high sensitivity and specificity, aligning with published literature. Conclusion: CT-based attenuation values, especially the maximum and mean HU measurements, differentiate the enostosis from osteoblastic metastases. Incorporating these measurements into day-to-day CT interpretation aids in enhancing diagnostic accuracy. Abbreviations: CT =Computed tomography, HU= Hounsfield units, ROC = receiver operating characteristics, AUC= Area under curve Key words: Enostosis, Bone Island, Osteoblastic Metastasis, CT Attenuation, Hounsfield Unit, ROC Curve, Bone Lesions.

Background: Tuberculosis (TB) remains a significant public health issue in India, with high disease burden, stigma, and poor awareness, especially in rural communities. Adolescents represent an underutilized target group for community-based awareness initiatives. This study evaluates the effectiveness of a structured school-based health education intervention on TB-related knowledge, stigma, and practices among secondary school students in a rural setting. Objectives: To assess the effectiveness of a health education intervention in improving TB knowledge, reducing stigma, and enhancing preventive practices among students. Materials and Methods: A single-group pre-post interventional study was conducted among 157 students (grades 7–10) from a rural secondary school in Koproli Village, Uran, and Maharashtra. A validated, pre-tested questionnaire measured knowledge, stigma, and practice domains before and immediately after a structured TB health education session. Data were analyzed using paired t-tests in SPSS v25.0; p < 0.05 was considered statistically significant. Results: post-intervention scores significantly improved across all domains. The mean total score increased from 11.66 ± 3.01 to 14.04 ± 2.43 (p = 0.0001). Knowledge scores rose from 7.91 ± 2.18 to 9.73 ± 1.76 (p = 0.0001). Stigma scores decreased from 1.10 ± 0.70 to 0.81 ± 0.63 (p = 0.0001), and practice scores improved from 2.59 ± 0.82 to 3.50 ± 0.71 (p = 0.0001). Subgroup analysis showed greater stigma reduction among younger students and stronger behavioural improvement in older students. Conclusion: The health education intervention was effective in enhancing TB awareness, reducing stigma, and promoting preventive practices. Integrating TB education into school curricula in rural India can empower adolescents as informed health advocates and support national TB elimination goals. Keywords: Tuberculosis, Health Education, School-based Intervention, Adolescents, Public Health, Stigma Reduction, Preventive Practices, Rural Health.

Background: Menstrual Hygiene Management (MHM) is a culmination of various strategies adopted by women to maintain cleanliness, acquire appropriate menstrual absorbents, use them, clean & safe reuse and appropriate disposal during menstruation. Menstrual Hygiene depends upon these strategies adopted during monthly periods. The methods girls and women have developed for management of menstruation varies across as well as within countries. The variations can largely be attributed to an individual’s personal preferences, availability, accessibility, affordability, local traditions, cultural beliefs, and most importantly knowledge Interplay of a multitude of factors channelizes the appropriateness of choices made by women. The objective is to assess the knowledge and the practices of menstrual hygiene among rural school going adolescent girls. Materials and Methods: It is a community based cross sectional observational study involving girls of standard 8th to 10th from the randomly selected Government school from rural field practice area of Latur district during the study period from June to August 2023. Results: Majority of the girls attained the menarche at the age of 13-14 years i.e. 73.5%. Majority of them had blood flow of duration 3-5 days i.e. 65.9%. Menstrual hygiene practices revealed that 76.5% girls use sanitary pads. Majority of them were disposing the absorbent material in dust bin i.e. 72%. Not a single participant worshiping the God during the period of menstruation. Conclusion: Menstrual hygiene practices revealed that 76.5% girls use sanitary pads. Majority of them were disposing the absorbent material in dust bin i.e. 72%. Keywords: Knowledge, Practices, Menstrual Hygiene, Rural, Adolescent Girls.

Background: Aim: To study clinical, laboratory and imaging markers of patients of dengue fever and to correlate severity of disease with early presentation (NS1 Antigen positive) and late presentation (IgM Antibody positive). Materials and Methods: The study was performed on patients with Dengue fever admitted in medicine department of a tertiary care teaching hospital. A total of 200 dengue positive patients were evaluated. The study was conducted during the period between May 2023 to July 2024. This was an observational descriptive study. Results: In our study of 200 dengue patients, laboratory and imaging evaluation proved pivotal for early diagnosis and risk assessment. NS1 antigen positivity showed a significant positive correlation with radiological findings, particularly ascites, pleural effusion, and gallbladder wall thickening detected by ultrasonography and chest radiography, underscoring its value in identifying plasma leakage. However, NS1 positivity alone did not reliably predict complications such as bleeding, shock, or multi-organ dysfunction. Conclusion: This study shows dengue severity correlates with early NS1 positivity, warning signs, and imaging abnormalities. Young adults, especially males, were more affected. Combining chest radiography, ultrasonography, and laboratory findings provides a cost-effective strategy for early detection, risk stratification, and improved outcomes, thereby reducing dengue-related morbidity and mortality. Keywords: NS1 Antigen Levels, Dengue, Imaging Markers, clinical and laboratory.

Background: Diabetes mellitus is a chronic metabolic disorder frequently complicated by microvascular and macrovascular manifestations. Alterations in hematological parameters are increasingly recognized as potential indicators of disease progression and risk of complications. This study investigates the association between routine hematological indices and the presence of complications in patients with type 2 diabetes mellitus (T2DM). Materials and Methods: A hospital-based cross-sectional pilot study was conducted at Madha Medical College, enrolling 24 adults with confirmed T2DM. Participants were divided into two groups: those with diabetes-related complications (n=12) and those without complications (n=12). Demographic, clinical, and laboratory data including white blood cell (WBC), red blood cell (RBC), and platelet indices were collected and analyzed. Group comparisons employed independent samples t-tests, with p<0.05 considered statistically significant. Results: The complication group exhibited significantly higher hemoglobin (11.95 ± 1.82 g/dL vs. 9.98 ± 2.19 g/dL, p=0.026) and hematocrit (35.76 ± 5.54% vs. 29.63 ± 7.31%, p=0.030). WBC counts trended lower in the complication group (p=0.056). Platelet indices showed no significant intergroup differences, though subtle shifts were noted. Conclusion: Significant elevations in hemoglobin and hematocrit were identified among patients with diabetes-related complications, while other hematological indices demonstrated suggestive, but non-significant, trends. These findings imply that standard hematological parameters may provide supplementary information for identifying T2DM patients at increased risk for complications. Larger, longitudinal studies are warranted to validate these pilot findings and explore their clinical utility. Keywords: Diabetic complications, Hematology, RBC parameters, WBC parameters, Platelet parameters, Hemoglobin, Hematocrit, PDW.

Background: Hepatitis E virus (HEV) is a major cause of acute viral hepatitis in developing countries, with significant public health implications due to its waterborne transmission and potential for outbreaks. Despite improvements in sanitation, HEV remains underdiagnosed, especially in tertiary care centers where patients often present with acute hepatitis of unknown etiology. Understanding the seroprevalence of HEV among clinically suspected cases is essential for guiding diagnostic strategies and public health interventions. Materials and Methods: This cross-sectional observational study was conducted in the Department of Medicine from January 2024 to December 2024. A total of 180 patients with clinical suspicion of acute viral hepatitis were enrolled. Serum samples were tested for anti-HEV IgM antibodies using enzyme-linked immunosorbent assay (ELISA). Demographic, clinical, and biochemical data were collected. Statistical analysis was performed using chi-square and Student’s t-test, with p < 0.05 considered significant. Results: Of 180 patients, 35 (19.4%) were seropositive for HEV. The mean age of HEV-positive patients was 32.6 ± 10.8 years, and seropositivity was most common in the 21–40 years age group (42.9%). No significant differences were observed with respect to age, gender, or residence, although a numerical predominance was noted in rural areas (71.4%). Clinical symptoms, including jaundice and fatigue, were common in both groups, but none showed statistical significance. Biochemical analysis revealed significantly higher ALT (632.5 ± 211.3 U/L vs. 418.6 ± 187.9 U/L, p = 0.001) and AST (588.7 ± 198.5 U/L vs. 402.1 ± 176.4 U/L, p = 0.002) levels in HEV-positive patients, while bilirubin and alkaline phosphatase levels did not differ. Conclusion: HEV accounted for nearly one-fifth of acute viral hepatitis cases in this cohort. Elevated transaminase levels were the most consistent biochemical feature, while clinical and demographic factors did not show significant associations. These findings support the inclusion of HEV IgM testing in diagnostic panels for acute hepatitis and highlight the importance of preventive strategies such as safe water access and community awareness in endemic regions. Keywords: Hepatitis E virus, acute viral hepatitis, seroprevalence, ELISA, tertiary care, India.

Background: Acne vulgaris is a common inflammatory skin disorder of adolescence, influenced by hormonal, genetic, microbial, and environmental factors. Vitamin D3, known for its immunomodulatory and anti-inflammatory properties, has been implicated in skin health. However, its association with acne severity in Indian adolescents remains underexplored. This study aimed to assess the relationship between serum vitamin D3 levels and the severity of acne vulgaris in adolescents attending a tertiary care hospital in North India. Materials and Methods: A prospective cross-sectional study was conducted in the Department of Dermatology in collaboration with the Department of Biochemistry at a tertiary care teaching hospital in North India from March 2024 to April 2025. A total of 139 adolescents aged 10–19 years with clinically diagnosed acne vulgaris were enrolled. Acne severity was graded using the Global Acne Grading System (GAGS). Serum vitamin D3 (25-hydroxyvitamin D) levels were estimated using a Chemiluminescence Immunoassay (CLIA) analyser. Data were analysed using SPSS version 21.0, with p < 0.05 considered statistically significant. Results: Of the 139 participants, 72 (51.8%) were females and 67 (48.2%) were males, with the majority (66.9%) in the 15–19 years age group. Acne severity distribution was mild in 30.2%, moderate in 36.7%, and severe in 33.1% of cases. Mean serum vitamin D3 levels were significantly higher in males (23.5 ± 4.8 ng/mL) than in females (20.6 ± 4.5 ng/mL; p = 0.004). Vitamin D3 levels showed a significant decreasing trend with increasing acne severity—26.0 ± 2.1 ng/mL in mild, 24.5 ± 2.0 ng/mL in moderate, and 17.8 ± 1.7 ng/mL in severe acne (p = 0.001). A negative correlation was observed between serum vitamin D3 levels and GAGS scores in severe acne cases (r = –0.047, p = 0.003). Conclusion: Lower serum vitamin D3 levels were significantly associated with increased severity of acne vulgaris in adolescents. These findings suggest that vitamin D status assessment and correction could be considered as an adjunctive strategy in acne management. Keywords: Acne vulgaris, Vitamin D3, Adolescents, GAGS score, Acne severity, India.

Background: A common and potentially hazardous side effect after coronary artery bypass graft (CABG) surgery is postoperative atrial fibrillation (AF). Numerous factors have been proposed to raise the risk of post-operative AF following CABG. Estimating the percentage of patients who experience AF following off-pump CABG (OPCABG) and identifying potential predictors of AF following OPCABG were the goals. Materials and Methods: A fixed sample size of 328 was chosen since the incidence of postoperative atrial fibrillation after CABG was 23%, according to a research by Arribas-Leal et al. Results: The proportion of patients who developed post-operative atrial fibrillation was 56 (17.07%). The mean age was 61.38±10.24 years and there were 67 (20.42%) females and 261 (79.57%) males. While 32 developed AF on the third postoperative day, 19 developed it on the 2nd day, 03 developed AF on the first day and 02 developed it on the 4th post-operative day. Preoperative, postoperative, and demographic characteristics of the AF and non-AF groups were compared. Conclusion: Our research revealed that after OPCABG, older age was an independent predictor of atrial fibrillation. The incidence of AF following OPCABG was linked to males, large atrial size, low ejection fraction, and prolonged hospital and intensive care unit stays. Keywords: Predictor, Postoperative Atrial fibrillation, Intensive care units, Off pump CABG and Prognosis.

Background: The clinical manifestation of Vitiligo, an acquired pigmentary condition, is depigmented macules brought on by melanocyte loss. Although there are many other treatment options, fractional carbon dioxide (CO2) lasers, which operate on the basis of photothermolysis, have lately been tested with positive results. Objective: To evaluate the effectiveness of topical 0.1% tacrolimus ointment plus fractional CO2 laser versus topical 0.1% tacrolimus ointment alone in non-segmental vitiligo. Materials and Methods: Eighty patients with stable non-segmental vitiligo were enrolled in this interventional prospective study conducted over a period of two years. They were divided into two groups of forty patients each. For three months, Group A received topical 0.1% tacrolimus twice daily and fractional CO2 laser treatments every month while Group B received only 0.1% topical tacrolimus twice daily. Re-pigmentation was evaluated clinically and dermoscopically at monthly intervals for the first three months and again at the conclusion of six months. Results: Of the eighty patients in this study, thirty-two were males, and forty-eight were females. Group A's mean age was 33.25 ± 11.8 years, while group B's was 31.98 ± 11.13 years. In both groups, the average duration of disease was 4.8 ± 4.83 years. According to the Quartile Grading Scale (QGS), at six months, there was a statistically significant difference (p < 0.05) in QGS with fifteen patients (60%) in Group A and nine patients (27.2%) in Group B showing more than 50% re-pigmentation. On dermoscopic evaluation at the end of six months, eighteen patients (72%) in Group A and fourteen patients (42.4%) in Group B showed moderate to good response in DAG which was statistically significant (p < 0.05). Conclusion: Both clinical and dermoscopic assessments demonstrated that re-pigmentation was significantly enhanced with the combination of fractional CO₂ laser and topical tacrolimus 0.1%. These findings suggest that fractional CO₂ laser may serve as an effective therapeutic option for the management of stable vitiligo. Keywords: Fractional CO2 laser, 0.1% Tacrolimus, Vitiligo.

Background: The advantages of the FNA procedure include a fairly precise diagnosis, exceptional patient acceptance, and also a minimal to no morbidity so this was compared with gold standard Histopathology for its accuracy of Diagnosis. Materials and Methods: After approval from institutional ethical committee this cross-sectional study was carried out in the patients who were referred to Department of Pathology for FNAC. Study period – from sept 2016 to April 2017. during this period total 160 cases were studied. Age range was from from 14 yrs to 70 yrs. Out of the 160 cases 40 were available for histopathological examination. All the FNAC slides and Biopsy slides were fixed and stained by standard pathological protocols. All details of the patients like age, FNAC and Histopathological diagnosis etc. was noted. Cyto-histo correlation was done by calculating the sensitivity and Specificity, Positive predictive value and negative predictive value of FNAC calculated by Medcalc software. Results: The majority of the patients were in the age group of 21-30 were 33.75%. The majority of the patients were Female i.e. 97.50% followed by Male 2.50%. The majority of the Patients were with the location of left side i.e. 52.50 Lump was the most common symptom i.e. in 100%, followed Pain in 75%, Fever in 68%, Nipple discharge in 59%. the majority of the patients were Benign i.e. 33(20.62%), Malignant were 20(12.50%), Inflammatory lesions were 5 (3.13%), Unsatisfactory were 8 (5.00%). Sensitivity was 100.00% (CI-39.76% to 100.00%), Specificity - 97.22 % (CI-85.47% to 99.93%), Positive Predictive Value was 80.00% (CI-36.67% to 96.51%), Negative Predictive Value- 100.00%. Conclusion: It can be concluded from our study that the FNAC is a rapid, accurate, safe, reliable and cost effective method for preoperative diagnosis of breast lesions. It is having high sensitivity and specificity. Hence FNAC should be used as a routine diagnostic procedure to provide effective healthcare to patients. Among breast lesions benign lesions are more common than malignanat ones. Benign lesions are more common in younger age group and malignant lesions are more common in older age group. Keywords: Cytomorphological study, Breast lesions, FNAC (Fine Needle Aspiration Cytology), Ca-Breast.

Background: Gallstone disease remains one of the major causes of morbidity and mortality throughout the world. Gallstone Disease is a frequent health problem in developing countries. It is a chronic recurrent hepatobiliary disease as an effect of impaired metabolism of cholesterol and Bile acids resulting in bile stone formation. Materials and Methods: The present study was a single-center, observational Study conducted on all the patients admitted, diagnosed and managed with Cholelithiasis above age of 12 years in the department of General Surgery for a period 2 years. Prior to initiation of the study, ethical and research Committee approval has been obtained. During the present study a total of 61 Patients were reviewed in surgical out patient department among which 50 patients were enrolled for the study according to the inclusion criteria and 11 patients were excluded to the exclusion criteria. Results: There is an increased incidence of cholelithiasis in the 3rd and 4th decade with the peak in the 2nd decade of life. Among 50 cases group, 32% were male and 68% were female. The female to male ratio is 2.1:1. In present study pain was the commonest symptom presenting in 40% patients, 32% patients had dyspepsia and 14 patients had other symptoms. Ultrasonography of the abdomen showed 40% patients had solitary stone and 60% patients had multiple stones. The percentage of patients who underwent laparoscopic cholecystectomy was 94% and open cholecystectomy 6%. Overall prevalence of Prolonged Ileus postoperatively was 22%. Of the 3 open surgeries, one patient had Prolonged Ileus and with Laparoscopic surgeries 10 had Prolonged Ileus. Of 3 open surgeries 1 (33%) patient had wound infection and with Laparoscopic surgeries 1 (2%) had wound infection postoperatively. Overall incidence of wound infection was 4%. Conclusion: In my study the youngest patient was 12 years and the oldest patient was 66 years old. The present study shows cholelithiasis as a more common problem in female population. Pain was the predominant symptom. Ultrasonography of the abdomen was done in all the patients, where 40% had solitary stone and 60% had multiple stones. Keywords: cholelithiasis, gallbladder, Laparoscopic surgery, Magnetic Resonance Cholangiopancreatography, Magnetic Resonance Cholangiopancreatography.

Background: Non-alcoholic fatty liver disease (NAFLD) is a prevalent liver condition, often linked with metabolic disorders, while hypothyroidism is a common endocrine disorder characterized by insufficient thyroid hormone production. Both conditions have significant implications for overall health. The objective is to investigate the presence of NAFLD in individuals with overt and subclinical hypothyroidism at a tertiary care centre in South India. Materials and Methods: This prospective observational study was conducted among 160 patients aged 18 years and older with overt or subclinical hypothyroidism. Patients with excessive alcohol consumption, BMI greater than 25 kg/m², pre-existing liver disease, diabetes mellitus, chronic kidney disease and other factors were excluded. Data collected included thyroid function tests (T3, T4, TSH), liver function tests (LFTs), anthropometric measurements, and abdominal ultrasonography for NAFLD diagnosis. Results: The study population's mean age was 48.9 years, with a significant female predominance (94.4%). The prevalence of NAFLD in hypothyroid patients was 60.6%. Patients with NAFLD had significantly higher mean TSH levels and lower mean T3 levels compared to those without NAFLD (p<0.001). While there was no significant difference in T4 levels, AST levels were significantly higher in the NAFLD group (p<0.001). Conclusion: This study demonstrates a high prevalence of NAFLD in hypothyroid patients and identifies distinct associations between thyroid hormone levels and NAFL. These results underscore the importance of considering NAFLD in the management of hypothyroid individuals. Keywords: Hypothyroidism, Non-alcoholic fatty liver disease, Thyroid hormones, Liver function tests, NAFLD.

Background: Malnutrition in under-five children is a critical public health concern, particularly in rural India, where socioeconomic factors significantly influence nutritional status. This study aims to identify the factors contributing to malnutrition among under-five children in rural Indore. Materials and Methods: A cross-sectional study was conducted involving 300 children aged 6 months to 5 years, assessing demographic characteristics, dietary intake, cultural practices, and maternal education. Nutritional status was evaluated using weight-for-age, height-for-age, and weight-for-height z-scores. Statistical analyses, including multivariate logistic regression, were performed to determine the relationship between various factors and malnutrition prevalence. Results: The study found that 55% of the children were malnourished, with the highest prevalence in the 24–35 months age group (25%). Significant associations were observed between malnutrition and maternal education (p < 0.001) and family income (p < 0.001). Inadequate dietary intake was prevalent, particularly in protein-rich foods (60%) and vitamin A-rich vegetables (55%). Cultural practices, such as delayed introduction of complementary foods (35%) and dietary restrictions, also contributed to malnutrition. Conclusion: Malnutrition among under-five children in rural Indore is influenced by a combination of inadequate dietary intake, socioeconomic factors, and cultural practices. Targeted interventions addressing these factors, alongside improved maternal education and income, are essential for reducing malnutrition rates in this vulnerable population. Keywords: Malnutrition, under-five children, dietary intake, socioeconomic factors, rural India, maternal education, cultural practices.

Background: Objective: To study the Vitamin B12 and folate deficiency in anemic children of age group 6 months to 5 years attending the tertiary care pediatric hospital. Materials and Methods: Present study was a cross-sectional observational hospital-based study. It was done in patients admitted in Pediatric department of Deen Dayal Hospital Upadhyay Hospital, Delhi in 2015-2017 of age group 6 month to 5 years. Total 252 children were included in present study. Out of the 252 children 112 (44.5%) were female and 140 (55.56%) were male. In each group male outnumber the female except in 37-60 month. Maximum number of children 121(48%) were present in age group 13-36 month. Out of total 252 children, 184 (73.01%) were Lower lower socioeconomic class and 68(26.98%) were upper lower Results: In our study out of the 252 children the Pure or mixed vitamin B12 deficiency was seen 95(37.7%). Pure or mixed folate deficiency was found in 37(14.7%) children. vitamin B12 deficiency 74 (29.3%) and folate deficiency 22(8.7%) alone or combination 4 (1.5%) was seen in our study. Conclusion: The prevalence of vitamin B12 is more common in age group in 6-12 months anemic children who were on breast fed, the reason may be maternal deficiency of vitamin B12. So, there is a strong need to supplement the Vitamin B12 in infancy for the normal development and healthy life of children. We recommend in policy making in fortification of food to prevent nutritional anemia secondary to vitamin B12 and folate deficiency. Keywords: National Family Health survey [NFHS], nutritional anemia, vitamin B12 and folate deficiency.

Background: Neonatal Respiratory Distress Syndrome (RDS) is a leading cause of neonatal morbidity and mortality. Early and accurate diagnosis is essential to initiate prompt treatment. Traditionally, chest X-ray has been the standard imaging modality; however, concerns regarding radiation exposure in neonates have prompted investigation into alternative imaging techniques such as lung ultrasound (LUS). Objective: To evaluate the diagnostic value of lung ultrasound in RDS in newborn infants and its correlation with X-ray imaging in assessing disease severity. Materials and Methods: This was a hospital-based prospective observational study conducted over one year (April 2015–March 2016) in the NICU of Government Medical College, Srinagar. A total of 59 newborns with suspected RDS were enrolled based on clinical features. All underwent both chest X-ray and lung ultrasound within 24 hours of admission. The severity of RDS was staged using respective imaging criteria. Statistical analysis included sensitivity, specificity, predictive values, diagnostic accuracy, and correlation assessment. Results: Lung ultrasound showed a sensitivity of 100%, specificity of 93.33%, PPV of 97.78%, NPV of 100%, and diagnostic accuracy of 98.31%. Significant correlation was observed between LUS and chest X-ray in staging RDS, though LUS could not differentiate between stage III and IV. Conclusion: Lung ultrasound is a highly accurate and non-invasive diagnostic tool for neonatal RDS. It offers a reliable alternative to chest X-ray and has the potential to reduce radiation exposure in neonates. Keywords: Lung ultrasound, Neonatal RDS, NICU, Diagnostic imaging, Chest X-ray.

Background: Type 2 diabetes mellitus (T2DM) is a progressive metabolic disorder characterized by insulin resistance and β-cell dysfunction, often leading to inadequate glycemic control and long-term complications. Timely initiation of insulin therapy has been proposed as a strategy to overcome therapeutic inertia, improve glycemic control, and reduce the risk of diabetes-related complications. However, the clinical impact of early versus delayed initiation of insulin therapy in newly diagnosed patients remains debated. Aim: This study aimed to compare the effects of early versus delayed initiation of insulin therapy in patients with newly diagnosed T2DM in terms of glycemic control and the occurrence of diabetes-related complications. Materials and Methods: A comparative observational study was conducted at a tertiary care hospital, enrolling 96 newly diagnosed T2DM patients. Participants were divided equally into two groups: early initiation (insulin started within one month of diagnosis) and delayed initiation (insulin introduced only if glycemic targets were not achieved with lifestyle and oral hypoglycemic agents). Baseline demographic, clinical, and biochemical parameters were recorded. Glycemic control (fasting plasma glucose [FPG], postprandial plasma glucose [PPG], glycated hemoglobin [HbA1c]) and complications were evaluated. Data were analyzed using SPSS version 26.0, with a p-value <0.05 considered statistically significant. Results: Baseline characteristics, including age (51.23 ± 8.45 vs. 52.18 ± 9.12 years, p = 0.64), BMI (27.56 ± 3.12 vs. 28.04 ± 3.28 kg/m², p = 0.48), and HbA1c (8.92 ± 1.12 vs. 8.87 ± 1.15%, p = 0.81), were comparable between groups. At 6 months, early initiation significantly improved glycemic outcomes: FPG (118.54 ± 18.62 vs. 134.78 ± 20.41 mg/dL, p = 0.001), PPG (162.43 ± 28.17 vs. 181.64 ± 30.22 mg/dL, p = 0.002), and HbA1c (6.82 ± 0.72% vs. 7.34 ± 0.85%, p = 0.004). Target HbA1c <7% was achieved in 70.83% of early patients versus 47.92% in delayed (p = 0.02). Hypoglycemia (12.50% vs. 6.25%, p = 0.30) and weight gain (+1.24 vs. +0.72 kg, p = 0.19) were slightly higher with early insulin. Complications, though not statistically significant, were lower in the early initiation group. Conclusion: Early initiation of insulin therapy in newly diagnosed T2DM provides superior glycemic control and trends toward fewer complications, supporting its role as a proactive strategy in diabetes management. Keywords: Type 2 diabetes mellitus; insulin initiation; glycemic control; hypoglycemia; complications.

Background: Anaemia is a major global health concern with significant clinical and socioeconomic consequences, often presenting in adults as a common finding in general medicine clinics. It is associated with reduced quality of life, impaired productivity, and increased morbidity, particularly when coexisting with chronic illnesses. Understanding its prevalence and clinical profiles in outpatient populations is crucial to guide timely diagnosis and targeted management. Aim: The present study aimed to determine the prevalence of anaemia and to assess the associated clinical and laboratory profiles among adults attending general medicine outpatient clinics in a tertiary care hospital. Materials and Methods: This hospital-based observational study included 98 adult patients (aged ≥18 years) attending the general medicine outpatient department who fulfilled the inclusion criteria. Patients with recent blood transfusion, ongoing hematinic therapy, bleeding disorders, or pregnancy were excluded. Clinical history and demographic details such as age, sex, occupation, socioeconomic status, and comorbidities were recorded. Laboratory investigations included complete blood count, peripheral smear, and, where indicated, iron profile, vitamin B12, and folate levels. Anaemia was defined and graded using World Health Organization (WHO) criteria. Data were analysed using SPSS version 26.0, with descriptive statistics and appropriate tests of association applied; p <0.05 was considered significant. Results: The overall prevalence of anaemia was 63.27% (62/98 patients). Among anaemic individuals, 24.49% had mild, 26.53% moderate, and 12.24% severe anaemia. Females demonstrated a higher prevalence (69.23%) compared to males (56.52%), though the association was not statistically significant (p=0.214). Prevalence increased significantly with age (p=0.041), being 45.45% in 18–30 years, 58.82% in 31–50 years, and 76.19% in >50 years. Mean haemoglobin (9.82 ± 1.45 g/dL), haematocrit, MCV, and MCH values were significantly lower in anaemic patients compared to non-anaemic counterparts (p<0.001 for all), while platelet counts showed no significant difference (p=0.342). Conclusion: Anaemia is highly prevalent in adults attending tertiary care outpatient clinics, with greater burden among females and older age groups. The significant proportion of moderate and severe cases underscores the need for routine screening, early etiological evaluation, and prompt management to reduce morbidity and improve patient outcomes. Keywords: Anaemia, prevalence, adults, clinical profile.

Thyroid storm is a rare but life-threatening endocrine emergency, often triggered by systemic infections. Fournier’s gangrene, a rapidly progressive necrotizing fasciitis of the perineum, has a high mortality rate, particularly in uncontrolled diabetes mellitus. The coexistence of thyroid storm with Fournier’s gangrene is exceptionally rare and poses significant diagnostic and therapeutic challenges. A case is presented of a 53-year-old male with uncontrolled type 2 diabetes mellitus (HbA1c 9.5%) who was admitted with high-grade fever (102°F), altered sensorium, and atrial fibrillation with rapid ventricular response (150 bpm), intubated for respiratory failure and admitted to the ICU. Laboratory investigations revealed severe thyrotoxicosis (TSH 0.21 µIU/mL, FT4 2.73 ng/dL, FT3 6.34 pg/mL), hyperglycemia, and markedly elevated procalcitonin (13.6 ng/mL), indicating severe bacterial sepsis. Local examination demonstrated extensive necrotic perineal lesions, and Fournier’s gangrene was confirmed, prompting urgent surgical debridement. Based on a Burch-Wartofsky Point Scale score of 100, a diagnosis of thyroid storm was established. The patient underwent prompt multidisciplinary management with antithyroid agents, beta-blockers, corticosteroids, insulin infusion, and broad-spectrum antibiotics, with procalcitonin levels guiding risk assessment and antimicrobial adjustments. This case emphasizes the need for vigilance for endocrine emergencies in critically ill patients, as the coexistence of thyroid storm, Fournier’s gangrene, and uncontrolled diabetes markedly elevates morbidity and mortality. Early recognition, biomarker-driven evaluation, and timely surgical and medical intervention are essential to improve outcomes in such complex presentations. Keywords: Thyroid Storm, Thyrotoxicosis.

Background: Lung carcinoma is one of the most common malignancies in the industrialized countries and now a leading cause of death in developing countries like India. There are different methods to diagnose lung carcinoma. Broncho-alveolar lavage cytology, bronchial brush cytology and bronchial biopsy are three important techniques which are becoming more popular. Aim & Objectives: 1. To assess diagnostic utility of BAL, bronchial brushings cytology and lung biopsy in diagnosing various pulmonary lesions. 2. To compare the bronchoalveolar lavage and brush cytology with biopsy in patients with lung diseases. Materials and Methods: This is a Hospital based observational study carried out tertiary care centre in known patients with lung cancer, during a period of 18 months from January 2023 and June 2024.The materials obtained from Broncho-alveolar lavage, bronchial brushings and bronchial lung biopsy are studied and their efficacy in diagnosing lung malignancy is compared. Results: The present study showed that sensitivity of Broncho-alveolar lavage and Bronchial brushings are 65.4%, 80.2% respectively. Whereas specificity are 83% and 91.4% respectively. Conclusion: This study suggests that the biopsy along with bronchial brush gives better cellularity and yield when compared to BAL. The probability of finding the histological sub types is higher in biopsy when compared with brushings and BAL samples. Keywords: Lung cancer, BAL, bronchial brushings cytology, Sensitivity, Specificity, Biopsy.

Background: The conventional cardiovascular risk factors and inflammatory pathways have been shown to contribute to the development of acute myocardial infarction (AMI). The objective is to compare serum fibrinogen and conventional coronary artery disease (CAD) risk factors between AMI patients and healthy controls. Materials and Methods: A cross-sectional study was conducted in Aurangabad, including 60 participants: 30 AMI patients and 30 age- and sex-matched controls free of CAD risk factors. The study parameters included serum fibrinogen, lipid profile [triglycerides, low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C)], obesity, smoking, alcohol, hypertension, and diabetes. Results: Serum fibrinogen was markedly elevated in AMI patients (497.17 ± 57.31 vs 167.87 ± 13.19 mg/dL, p<0.001). Conventional risk factor prevalences in AMI were: hypertriglyceridemia 50%, LDL-C 33%, hypercholesterolemia 20%, low HDL-C 17%, obesity 50%, smoking 43%, alcohol 40%, hypertension 17%, and diabetes 17%; all controls were risk-free by design. Conclusion: AMI patients exhibited clustering of inflammatory and metabolic risk factors, underscoring the multifactorial and inflammatory basis of AMI. Keywords: Acute myocardial infarction, fibrinogen, dyslipidaemia, obesity, smoking, systemic inflammation

Background: The objective is to evaluate the impact of incision site and size on surgically induced astigmatism (SIA) and postoperative visual acuity in patients undergoing manual small incision cataract surgery (MSICS). Materials and Methods: The prospective comparative study included 113 eyes of 112 patients on whom MSICS was done. There was variation in incision sites (superior, supero-temporal, and temporal) and incision sizes (5.5 mm, 6 mm, and 6.5 mm). Patients were grouped based on site and size of incision. The postoperative uncorrected visual acuity (UCVA) and SIA were assessed at 6 months after surgery. SIA was evaluated using Jaffe and Clayman’s vector analysis. ANOVA (Analysis of Variance) was used for statistical analysis. Results: At 6 months post-surgery, UCVA ≥6/12 was achieved in 70% of patients with a 5.5 mm incision, 66% of patients with a 6 mm incision, and 58% of patients with a 6.5 mm incision. Among incision sites, the supero-temporal group showed the best outcomes (79% UCVA ≥6/12), followed by the temporal group (64%) and superior group (61%). SIA was lowest in the supero-temporal group (0.54 D to 0.72 D), followed by the temporal group (0.70 D to 1.10 D), and highest in the superior group (1.02 D to 1.33 D). A significant shift toward against the rule astigmatism was noted in 62% of cases. Differences among the study groups were statistically significant (p < 0.05). Conclusion: The site and size of incision significantly affects visual outcomes and SIA in MSICS. Supero-temporal incisions and smaller incision sizes (5.5 mm) are associated with lower surgery-induced astigmatism and better uncorrected visual outcomes. Keywords: Manual small incision cataract surgery, surgically induced astigmatism, incision site, incision size, vector analysis, visual acuity.

Background: MRI and MRS have demonstrated remarkable utility in characterizing brain lesions and differentiating between inflammatory and neoplastic processes. The objective is to determine the role of magnetic resonance imaging and magnetic resonance spectroscopy in the assessment of inflammatory and neoplastic lesions of the brain. Materials and Methods: This hospital based observational study was conducted among Subjects with clinical neurological symptoms and referred to the Department of Radiodiagnosis for MR brain imaging in PESIMSR, KUPPAM and found inflammatory and neoplastic lesions in MRI brain. Study period was 18 months (Sep 2022 – Feb 2024). Results: MRI with MRS is the most sensitive modality in the characterization of intracranial neoplastic and inflammatory lesion and in differentiating neoplastic from neoplastic looking lesions–RELs. MRI alone has sensitivity of 74 % and 66 % in neoplastic and inflammatory lesion respectively when combined with MRS sensitivity is upto 81% and 86% in neoplastic and inflammatory lesion respectively. On T1 weighted sequence in 67% of cases the lesions were hypointense in both neoplastic and inflammatory lesions and the remaining (27.5%) shows iso/mixed/hyperintense signal. On T2 weighted sequence, 78%of neoplastic and 67% of inflammatory lesions are hyperintense. On DWI, restricted diffusion is seen in 74% of cases with neoplastic lesion. Expect NCC all other inflammatory lesions show diffusion restriction in upto 60 to 75 % of cases and NCC shows no diffusion restriction in all cases. Conclusion: The integration of MRS with routine imaging, rather than relying solely on these studies, enhances diagnostic yield, eliminates the need for unnecessary biopsies, and aids clinicians in immediate management. This conclusion aligns with the findings of our research work. Keywords: Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Inflammatory, Neoplastic Lesions, Brain.

Background: Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), have been implicated in xerostomia, which may adversely affect dental caries and periodontal health. This study compares the impact of SSRI-associated xerostomia on caries and periodontal status between SSRI users and non-users. Aim: To assess and compare the impact of antidepressant-associated xerostomia on caries and periodontal status among SSRI users and non-users. Materials and Methods: A comparative cross-sectional study was conducted on 136 participants (68 SSRI users, 68 controls). Clinical examinations included xerostomia assessment, DMFT index for caries, and plaque index, gingival index, and probing depth for periodontal status. Statistical analyses involved Chi-square and t-tests with significance set at p < 0.05. Results: Xerostomia prevalence was significantly higher among SSRI users (57.4%) versus non-users (29.4%) (p = 0.002). SSRI users showed greater caries experience (mean DMFT 9.39 vs. 6.48, p < 0.001) and elevated periodontal disease indicators including plaque index (1.70 vs. 1.10), gingival index (1.41 vs. 0.91), and probing depth (3.39 mm vs. 2.71 mm) compared to non-users (all p < 0.001). Conclusion: SSRI use is significantly associated with xerostomia, contributing to increased caries risk and poorer periodontal health. Dental professionals should implement targeted prevention and management strategies for patients under SSRI therapy. Keywords: Xerostomia, SSRIs, Dental Caries, Periodontal Disease, Antidepressants.

Background: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder with a rising prevalence, particularly among sedentary working populations. Awareness and preventive practices are crucial for reducing long-term complications. This study aimed to assess T2DM awareness, lifestyle practices, and barriers among IT employees. Materials and Methods: A cross-sectional questionnaire-based study was conducted among 150 IT employees aged ≥18 years at a tertiary care hospital in India, using a structured, pre-validated tool to assess knowledge, attitudes, and health practices related to T2DM. Data were analysed using descriptive statistics, correlation, and ANOVA to examine associations with demographic factors. Results: Among participants, 98 (65.3%) had good knowledge, 45 (30%) moderate, and 7 (4.7%) poor knowledge. Correct knowledge of recommended exercise and HbA1c was reported by 86 (57.3%) and 72 (48%), respectively. Regarding health practices, 102 (68%) engaged in ≥150 minutes of physical activity weekly, 114 (76%) consumed high-fibre foods, 105 (70%) limited high-sugar/junk foods, and 86 (57.3%) underwent annual health check-ups, with 67 (44.7%) demonstrating overall good practice. Knowledge and practice showed a weak positive correlation (r=0.155, p=0.058). Practice scores were significantly higher among postgraduates (F=26.67, p<0.001) and older age groups (F=11.50, p<0.001), while gender differences were not significant. The most common barriers were lack of time (33.3%) and fatigue (22.7%). Conclusion: Most IT employees had good knowledge of T2DM, fewer translated this into effective preventive practices. Targeted workplace interventions addressing knowledge, motivation, and contextual barriers are essential for promoting healthier lifestyle behaviours. Keywords: Awareness, Cross-sectional Study, Health Practices, IT Employees, Type 2 Diabetes Mellitus, Workplace Intervention.

Background: We compared the efficacy of Esmolol versus Dexmedetomidine in achieving and maintaining controlled hypotension in Functional Endoscopic Sinus Surgery under General Anaesthesia. Materials and Methods: Sixty patients of ASA-I/II scheduled for B/L functional endoscopic sinus surgery were selected and were randomly allotted into two groups of thirty each. Group D received loading dose of Dexmedetomidine 1µg/kg over 10 min followed by infusion of 0.2-0.7µg/kg/hr and Group E received Esmolol in loading and maintenance dose of 1mg/kg over 1min and 0.2-0.7 mg/kg/hr, respectively. Both the infusions were titrated to maintain a mean arterial blood pressure between 65-75 mmHg. Visibility of surgical field was assessed by surgeon using Average Category Score. Hemodynamic variables, emergence time, number of additional intermittent doses of vecuronium and time to first analgesic request were recorded. Postoperative sedation was assessed using Ramsay Sedation Score. Adverse effects if any were noted. Results: Dexmedetomidine was associated with more stable hemodynamic parameters like MAP, SBP, DBP and HR intra- operatively and following stoppage of study drugs. Conclusion: We concluded that both dexmedetomidine and Esmolol are effective in providing ideal surgical conditions during FESS. Dexmedetomidine is preferred over Esmolol. Keywords: Fess, controlled hypotension, Dexmedetomidine, Esmolol. Average category score, Ramsay sedation score, Emergence time.

Background: The objective of the study was to determine the level of literacy of urinary stone disease and factors associated with literacy among adults in the United Arab Emirates. Materials and Methods: This cross-sectional study was conducted amongst the residents of the United Arab Emirates. After obtaining informed consent, data were collected using a self-administered questionnaire from participants who met the inclusion criteria, which included 18 years of age and above, of any gender, nationality, and willingness to participate. The gathered data were analyzed using SPSS version 28. Descriptive and inferential statistics were performed, and p value was set 0.05 for statistical significance. Results: This research involved the participation of 3588 adults. Furthermore, 45.6% exhibited a good level of literacy about the treatment and management of urinary stone disease. And 55.1% had a good knowledge about the complications related to urinary stone disease. The factors associated with the level of good literacy were history of urinary tract infection (UTI), family history of urinary stone disease, employment status and adequate water consumption daily. Conclusion: The findings indicate a good level of literacy among participants regarding risk factors, management, and prevention of urinary stone disease. A significant association was seen between good levels of literacy and adults age greater than 40. In addition, employed participants, participants who experienced urinary stones or UTI exhibited good levels of literacy. Furthermore, participants with a positive family history as well as those with adequate water intake also demonstrated good levels of literacy. Keywords: Urinary stone disease, Adults, Level of Literacy, United Arab Emirates.

Background: Uterine leiomyomas are the most common benign tumours of the female genital tract, often presenting with abnormal uterine bleeding, pelvic pressure, pain, and infertility, though many cases remain asymptomatic. Correlating clinical and radiological findings with endometrial histopathology is crucial for risk stratification and management. Materials and Methods: A cross-sectional study was conducted over 18 months at a tertiary care hospital, including 200 women aged 20–49 years with ultrasound-confirmed fibroid uterus. Clinical details, radiological findings, and endometrial biopsy/histopathology results were analyzed. Statistical tests, including Chi-square and t-test, were applied, with p< 0.05 considered significant. Results: The mean age was 41.7 ± 4.8 years. Comorbidities were present in 60% of patients, most commonly diabetes (38.3%) and anemia (32.5%). The leading symptoms were abdominal pain (67%), pressure symptoms (65%), and dysmenorrhea (60%). Radiologically, most fibroids measured 1–4 cm (59.9%), followed by 5–10 cm (33.5%) and >10 cm (6.6%). Uterine size on bimanual examination significantly correlated with fibroid size on imaging (p< 0.05). Medical management was effective in 55% of patients, particularly those with fibroids ≤4 cm, while larger fibroids (≥5 cm) frequently required surgical intervention, with histopathology confirming leiomyoma in 43.5% and adenomyosis in 0.5%. Conclusion: Fibroid uterus was most prevalent in the perimenopausal age group, with pain and pressure symptoms as dominant complaints. Strong clinical–radiological correlation was observed, and fibroid size was a key determinant of management outcome. While smaller fibroids responded well to medical therapy, larger ones were significantly associated with surgical management. Endometrial biopsy remains essential to exclude atypical pathology, but clinical features and fibroid dimensions primarily guide treatment strategies. Keywords: Fibroid uterus, leiomyoma, abnormal uterine bleeding, ultrasonography, endometrial biopsy, management outcome.

Background: Purpose: To evaluate changes in subfoveal choroidal thickness (SFCT) using enhanced-depth imaging optical coherence tomography (EDI-OCT) in patients with sight-threatening diabetic retinopathy (DR) before and 12 weeks after standard management, and to correlate these changes with best-corrected visual acuity (BCVA). Materials and Methods: This prospective study enrolled 86 subjects (146 eyes) with proliferative diabetic retinopathy (PDR) or diabetic maculopathy between August 2022 and July 2023 at Government Headquarters Hospital, Cuddalore. Consecutive sampling was used. SFCT, BCVA, duration of diabetes mellitus (DM), and glycemic indices were recorded at baseline and 12-week follow-up after intravitreal anti–vascular endothelial growth factor (VEGF) therapy and/or pan-retinal photocoagulation (PRP). Results: Mean baseline SFCT was 239 ± 41.6 µm, reducing to 202.1 ± 43.2 µm at three months (P < 0.001). Median logMAR BCVA improved from 0.78 (Snellen 6/36) to 0.60 (Snellen 6/24) (P < 0.001). SFCT positively correlated with BCVA at follow-up (rho = 0.206; P = 0.013), indicating that thicker choroid was associated with reduced vision. Conclusion: SFCT decreases significantly after intravitreal anti-VEGF/PRP therapy and correlates with functional visual outcome. SFCT measurement by EDI-OCT can serve as a non-invasive biomarker to monitor treatment response in diabetic macular edema (DME) and proliferative DR. Keywords: sub foveal choroidal thickness, Diabetic retinopathy, Pan- retinal Photocoagulation.

Background: Chronic liver disease (CLD) is a progressive condition that alters hepatic lipid metabolism and leads to characteristic changes in serum lipid levels. The Child–Turcotte–Pugh (CTP) score is widely used to grade liver dysfunction, and correlation of lipid parameters with this score may provide a simple adjunct for assessing disease severity. The objective is to study serum lipid profiles in patients with chronic liver disease and evaluate their correlation with Child-Pugh score. Materials and Methods: This hospital-based cross-sectional study was conducted on 250 patients with diagnosed CLD at Dr. Susheela Tiwari Memorial Government Hospital, Haldwani. Clinical evaluation, laboratory investigations, and fasting lipid profiles were performed. Disease severity was graded by the Child-Pugh classification. Spearman’s rank correlation was applied to assess the relationship between lipid fractions and Child-Pugh score. Results: Of the 250 patients, 68.4% were male and 31.6% female. The majority belonged to Child-Pugh class C (56%), followed by class B (36.8%) and class A (7.2%). Mean lipid values were: total cholesterol 136.44 ± 12.40 mg/dL, LDL 89.43 ± 19.20 mg/dL, HDL 31.50 ± 19.85 mg/dL, and triglycerides 114.07 ± 15.50 mg/dL. A statistically significant negative correlation was observed between Child-Pugh score and HDL, LDL, and total cholesterol, while triglycerides showed a weak, non-significant positive correlation. Ascites was the most common complication (64.4%). Conclusion: Lipid abnormalities, particularly reduced cholesterol and HDL levels, were common in CLD patients and correlated inversely with Child-Pugh score. Lipid profile estimation may serve as a cost-effective adjunct to clinical and biochemical assessment of disease severity. Keywords: Chronic liver disease, lipid profile, Child-Pugh score, cirrhosis, dyslipidemia.

Background: Laparoscopic cholecystectomy, a common minimally invasive procedure, poses hemodynamic challenges due to pneumoperitoneum and CO₂ insufflation. The choice of volatile anesthetic plays a key role in ensuring hemodynamic stability and rapid recovery. This study compares the intraoperative hemodynamic responses and postoperative recovery profiles between sevoflurane and desflurane anesthesia in laparoscopic cholecystectomy. Aim: To compare the effect of sevoflurane and desflurane on intraoperative hemodynamic parameters and postoperative recovery characteristics in patients undergoing laparoscopic cholecystectomy. Materials and Methods: A prospective, randomized, single-blind study was conducted on 60 adult patients (ASA I-II) undergoing elective laparoscopic cholecystectomy. Patients were randomized into two groups: desflurane group (n=30) and sevoflurane group (n=30). Hemodynamic parameters (HR, MAP, BP, SpO₂, EtCO₂) were recorded at predefined intervals. Emergence characteristics-eye opening, verbal response, extubation, and orientation times-along with Modified Aldrete scores were assessed. Postoperative side effects and PACU discharge times were also compared. Data was analyzed using t-tests and Chi-square tests, with p<0.05 considered significant. Results: Both agents maintained comparable intraoperative hemodynamic stability (p>0.05). However, desflurane showed significantly faster recovery, with shorter mean times for eye opening (5.6±1.4 vs 7.9±1.8 min), verbal response (6.9±1.6 vs 9.2±1.9 min), and extubation (7.5±1.5 vs 9.6±1.7 min) compared to sevoflurane (p<0.001). Early and intermediate recovery scores were higher in the desflurane group, and PACU discharge was earlier (37.8±6.5 vs 45.6±7.4 min, p<0.001). The incidence of postoperative nausea, vomiting, and agitation was similar between groups. Conclusion: Both sevoflurane and desflurane provided stable hemodynamic conditions during laparoscopic cholecystectomy, but desflurane demonstrated faster emergence and recovery without increasing adverse effects. Its use may enhance perioperative efficiency, especially in ambulatory and short-stay surgical settings. Keywords: Desflurane; Sevoflurane; Hemodynamic stability; Emergence recovery; Laparoscopic cholecystectomy

Background: Teenage pregnancy remains a significant public health concern, particularly in low- and middle-income countries, where it is often associated with adverse maternal and neonatal outcomes. Despite declining adolescent fertility rates globally, the absolute number of teenage pregnancies remains high due to population growth and persistent socio-culture practices such as child marriage, poverty, and lack of sexual education. Objective: To study the maternal and fetal outcomes associated with teenage pregnancies in a tertiary centre GGH, Nandyal, Andhra Pradesh, India. Materials and Methods: This is a prospective analysis of maternal and fetal outcomes in teenage pregnancy database (September 2023-August 2024) Results: Majority of adolescent mothers were in the age group of 18-19 years and their mean age was found to be 19 years. Study showed the incidence of teenage pregnancy at term is 8.5%. Majority (74%) were booked cases. Conclusion: Teenage pregnancy is significantly associated with higher maternal and fetal morbidity and mortality. The findings highlight the need for comprehensive adolescent reproductive health programs, improved access to antenatal care, and policy initiatives aimed at delaying early marriage and first pregnancies through education, empowerment, and contraception access. Keywords: Teenage Pregnancy, Maternal Outcome, Fetal Outcome

Cytomegalovirus infection (CMV) is a global infection, even if there are significant differences in seroepidemiologic between and within countries. Present study was carried out in SGT medical college in the department of microbiology. A total of 180 blood samples were collected from non- pregnant females of child bearing age belonging to 18-40 years at SGT Hospital. These samples were tested for IgG antibodies against Cytomegalovirus and Rubella virus by ELISA. Prevalence of CMV IgG antibodies among non-pregnant females was recorded as 88.9% (160/180) and prevalence of Rubella IgG antibody recorded as 75% (135/180). Those 180 females were divided into three age group 18-25, >25 – 32 and >32 - 40 years as well as according to their residential community. Out of 180 females 160 were positive for CMV IgG antibody and out of 180 females 135 were positive for Rubella IgG antibody. Keywords: Cytomegalovirus infection (CMV), Rubella virus and Seroprevalence.

Background: This study is designed to determine the relationship between Doppler results in gestational diabetes mellitus and perinatal outcomes. Materials and Methods: This cross-sectional observational study aimed to investigate the relationship between Doppler ultrasound findings and perinatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM). Conducted over 18 months at the antenatal clinic of Modern Government Maternity Hospital in Hyderabad, the study included 156 pregnant women diagnosed with GDM in their second or third trimester. Participants, recruited via convenience sampling, underwent biweekly Doppler ultrasound examinations from 24 weeks of gestation until delivery to measure blood flow in uterine, umbilical, and middle cerebral arteries. Results: The majority of participants underwent Doppler assessments of the umbilical artery, uterine artery and middle cerebral artery with high percentages of completion across these categories. Findings such as the umbilical artery PI >95th percentile and the absence or reversal of end- diastolic velocities highlighted specific fetal circulation concerns. Moreover, arterial blood flow redistribution and the absence of end diastolic velocities were significant findings, with notable percentages of participants exhibiting these abnormalities. Mode of delivery analysis showed a higher rate of vaginal deliveries compared to cesarean sections. Conclusion: This study concludes that vigilant prenatal monitoring and timely interventions are essential to reduce the high incidence of IUGR and cesarean deliveries. Strengthening comprehensive maternal and neonatal care can significantly improve perinatal outcomes. Keywords: Maternal outcomes, Neonatal outcomes, Intrauterine growth restriction (IUGR), Umbilical artery PI, Middle cerebral artery.

Background: The global burden of cutaneous disease continues to rise, yet the epidemiology of rare or histologically unusual dermatoses remains poorly characterised, particularly in South Asian referral centres. Precise histopathological categorisation is indispensable for optimal patient management, but overlap with common mimics and limited tissue in small biopsies frequently hamper diagnosis. Materials and Methods: We undertook a descriptive, cross sectional study of all skin biopsies accessioned between January 2022 and August 2024 (n = 117). Formalin fixed paraffin embedded tissue was processed routinely; haematoxylin–eosin (H&E) sections were examined by two senior Pathologists. Special stains (Alcian blue, Perl’s Prussian blue, Ziehl–Neelsen, Fite–Faraco) and immunohistochemistry (CD3, CD4, CD8, CD20) were applied when indicated. Lesions were categorised as “usual” (commonly encountered inflammatory, infectious, autoimmune or tumour like processes) or “unusual” (rare entities, atypical variants or diagnostically challenging lesions). Clinicopathological concordance was assessed for all uncommon cases. Results: Of 117 biopsies, 102 (87.2 %) were usual and 15 (12.8 %) were unusual. Leprosy (22/117, 18.8 %) was the single most frequent diagnosis. The uncommon cohort comprised: pseudopelade of Brocq (2), scleroderma of Buschke (1), Majocchi pigmented purpura (1), inverse psoriasis (1), Stevens–Johnson syndrome (1), PLEVA (1), Hailey–Hailey disease (1), Darier’s disease with basal cell downgrowth (1), poikiloderma of Civatte (1), nevus comedonicus (1), pigmented eccrine poroma (1), mycosis fungoides (1) and lupus miliaris disseminatus faciei (LMDF; 1). Clinicopathological concordance was complete in 8/15 (53 %) cases; two required clinico histological re review to reach the final diagnosis. Ancillary tests were decisive in 5/15 (33 %): Alcian blue confirmed dermal mucin in Buschke scleroderma, Perl’s stain disclosed dermal haemosiderosis in pigmented purpura, and negative acid fast stains together with perifollicular granulomas supported LMDF. Mycosis fungoides expressed CD3/CD4 and lacked CD8 or B cell markers. Conclusion: Unusual dermatoses constituted 12.8 % of cutaneous biopsies in our centre. Their accurate recognition requires meticulous correlation of history, morphology, special stains and, when necessary, immunohistochemistry. Early multidisciplinary dialogue remains pivotal to avoid missed or delayed diagnoses. Keywords: Unusual skin disease; dermatopathology; clinicopathological correlation; histopathology; special stains; India.

Background: Medical students are experiencing high levels of stress due to their course length and academic demands which in turn leads to physical and mental health issues, anxiety, depression, and burnout. The objective is to determine the levels of stress among the medical students from 1st to Final Year in GMC, Thrissur in 2024, and to explore the perceived reasons for their stress. Materials and Methods: A mixed methodology study with initial quantitative phase conducted among 644 students from all years using a structured questionnaire and PSS scale and the next qualitative phase as Focus Group Discussion (FGD) conducted among selected 8 students from initial phase having moderate or high stress. Results: Among the 644 study participants, 514 (79.8%) experienced moderate stress, while 73 (11.3%) experienced low stress and 57 (8.9%) experienced high levels of stress. From the FGD, the themes related to perceived reasons for stress generated were “Academic-related reasons”, “Adaptation issues related to transition from school to college”, “Communication issues”, “Time management issues”, “Societal pressures”. Conclusion: This study showed that the vast majority of medical students face moderate to high levels of stress in their academic life. Hence, there is a need to identify possible ways to reduce their stress levels in order to ensure better physical and mental health. Keywords: Stress, Medical students, Mixed methodology.

Background: Aims: To study the Neuroimaging findings in patients presenting with various patterns of Seizure disorder using Magnetic Resonance Imaging and to measure the Hippocampal volume in MRI in seizure disorder patients with no structural lesions or any visually detectable changes on routine assessment. Materials and Methods: A descriptive observational study was conducted in the Department of General Medicine at Mediciti Institute of Medical Sciences, Telangana, from May 2023 to January 2025. Sixty adult patients (>18 years) with seizure disorders were evaluated using clinical examination, EEG, and neuroimaging (MRI/CT). Patients with acute secondary causes or chronic systemic illnesses were excluded. MRI brain with hippocampal volumetry and EEG were key diagnostic modalities. Results: Generalized tonic-clonic and simple partial seizures were the most prevalent seizure types. A notable association was observed between abnormal MRI findings and concurrent EEG abnormalities. However, hippocampal volumes showed no significant difference between MRI-normal and MRI-abnormal groups. A weak positive correlation between age and hippocampal volume was noted, indicating minimal agerelated influence in this cohort. Conclusion: While EEG and neuroimaging abnormalities frequently co-occur in seizure patients, hippocampal volume does not significantly differentiate those with structural lesions. Further longitudinal studies are needed to clarify the role of hippocampal volumetry in seizure evaluation and prognosis. Keywords: Brain Imaging, Seizure Disorder.

Background: Shift work is increasingly recognized as a major occupational stressor, particularly among healthcare workers, where irregular schedules disrupt circadian rhythms and predispose to poor sleep and psychiatric morbidity. Aim: To study the association between shift work, sleep patterns, and psychiatric morbidity among healthcare workers in government hospitals. Materials and Methods: This cross-sectional study was conducted among 368 participants (Cases: 184 shift-working nurses; Controls: 184 office staff) employed in government hospitals under Andhra Medical College, Visakhapatnam. Data were collected using a structured proforma, the Pittsburgh Sleep Quality Index (PSQI), and the General Health Questionnaire-12 (GHQ-12). Group differences were analyzed using Chi-square and t-tests, and logistic regression identified predictors of poor sleep quality. Results: Poor sleep quality was significantly more prevalent in shift workers than controls (71.7% vs. 40.2%, p < 0.001). Psychiatric morbidity was higher among cases (53.2% vs. 25.0%, p < 0.001). Shift workers had shorter sleep duration (5.3 ± 1.2 vs. 6.8 ± 1.1 hours), longer sleep latency (32.5 ± 14.8 vs. 21.2 ± 11.6 minutes), and lower sleep efficiency (74.2% vs. 82.1%), all p < 0.001. Poor sleep was strongly associated with higher GHQ-12 scores, anxiety, depression, and stress (p < 0.001). Logistic regression identified high night-shift frequency (aOR 2.75), job stress (aOR 3.42), longer service (>10 years, aOR 1.89), and age >40 years (aOR 1.65) as significant predictors of poor sleep. Conclusion: Shift work is strongly associated with disrupted sleep and increased psychiatric morbidity among healthcare staff. Occupational health strategies focusing on shift scheduling, stress management, and early screening are vital to mitigate these risks. Keywords: Shift work. Sleep patterns. Psychiatric morbidity.

Background: Aims: Effective, motor-sparing analgesia after total hip arthroplasty (THA) remains challenging, especially in elderly patients. The pericapsular nerve group (PENG) block targets articular branches to the anterior hip capsule. We evaluated early (0–12 h) postoperative analgesia and rescue-analgesic requirements after ultrasound-guided PENG block in THA. Material and Methods: In this prospective observational study at a tertiary teaching hospital (ethics approved; written consent obtained), adults (18–70 years; ASA I–III) undergoing THA under spinal anaesthesia received an adjunct ultrasound-guided PENG block (30 mL total: 15 mL lignocaine with adrenaline + 15 mL 0.5% bupivacaine). Pain was recorded on the Numeric Rating Scale (NRS, 0–10) every 4 h for 12 h. Rescue-analgesia (NSAID and/or opioid) use and adverse effects were documented. Descriptive statistics with 95% confidence intervals (CIs) were reported; Fisher’s exact test compared opioid use between moderate and severe pain categories. Results: Seventy patients were included. Within 12 h, 41/70 (58.5%; 95% CI 46.4–70.6) reported mild pain (NRS 1–4) and required no rescue analgesia. Sixteen (22.8%; 95% CI 12.7–32.9) had moderate pain (NRS 5–7) and received diclofenac 75 mg IV. Thirteen (18.6%; 95% CI 9.4–27.6) had severe pain (NRS 8–10) and received tramadol 100 mg plus diclofenac 75 mg. Opioid rescue was used in 0/16 moderate-pain patients vs 13/13 severe-pain patients (Fisher’s exact p < 0.001). No motor block was observed. Conclusion: PENG block provided effective early analgesia after THA with motor sparing and reduced opioid use. Incorporation into multimodal fast-track pathways is supported; randomized comparisons and longer follow-up are warranted. Keywords: pericapsular nerve group block; hip arthroplasty; postoperative analgesia; ultrasound-guided regional anaesthesia; opioid-sparing.

Background: Adolescence is a crucial dynamic period for intervention since adolescent behaviours often become a habit in adulthood. Evidence suggests that early detection and lifestyle changes focusing on balanced nutrition, daily physical activity or exercise, and appropriate sleep can avoid adult obesity and its compications. Understanding the incidence and causes of overweight and obesity in varied teenage populations is crucial for school- and community-based solutions. Objective: 1.To estimate the prevalence of obesity and overweight among adolescents; 2.To find the determinants associated with obesity and overweight. Materials and Methods: This analytical cross sectional study included 518 adolescents from Government higher secondary schools. The multistage sampling used to recruit participants. The semistructured questionnaire, PQLI scale, DASS 21 scale and anthropometric measurements were used to collect data. The data analyzed using Epi info 7. Results: 54 (10.4%) and 21(4.05%) were overweight and obese in our study. Totally 75 adolescent out of 518 were obese or overweight. Frequent skipping breakfast, frequent intake of fast food, frequent intake of sweetened beverages, increased screen time, less physical activity, stress, anxiety, depression and poor sleep quality were significant risk factors in our study. Conclusion: The higher prevalence of obesity and overweight in our study suggest a earlier prevention and screening to combat this new epidemic of public health problem among adolescents. Also its association with unhealthy dietary practice, increased screen time, less physical activity, stress, anxiety, depression and poor sleep quality recommends the need of multidisciplinary approach to prevent obesity in adolescents. Keywords: Adolescents, obesity, determinants, overweight.

Background: Tobacco smoking is harmful habit or addiction which leads to many health problems. Smoking may be status for some, or may be recreation or way to let out their stress, despite knowingly its harmful effects on health. Health hazards of smoking have become more prevalent in present days affecting more and more young individuals. Smoking has got deleterious effects on health like COPD, Cardiovascular diseases Malignant diseases, glaucoma etc. Aim of the present study is to compare IOP between smokers & Non-Smokers. Materials and Methods: Present cross-sectional study consists of 250 smokers & 250 non-smokers (control group) both group at par aged between 20-70 years. Intra Ocular Pressure (IOP) of both eyes was measured by rebound (I-care) tonometry in both groups. Results: IOP of both eyes in smokers & non-smokers groups were subjected to statistical analysis was done using SPSS software. It is found that IOP of Smokers was significantly raised than the non-smokers (control group) p-value <0.001. Conclusion: Smoking is a modifiable risk factor, early detection of rise in IOP helps in preventing further damage to eyes & vision due to glaucoma, macular degeneration or cataract. Keywords: Glaucoma, IOP, Non - Smoker, Smoking, Tobacco.

Background: Erector spinae plane block (ESPB) has emerged as an effective regional anesthesia technique for spine surgeries, providing postoperative analgesia with reduced opioid consumption. Dexmedetomidine, a selective α2-adrenergic agonist, has been investigated as an adjuvant to local anesthetics for prolonging block duration and improving analgesic outcomes. This study aimed to evaluate the efficacy of dexmedetomidine as an adjuvant to bupivacaine in ESPB for patients undergoing lumbar spine surgery. Materials and Methods: A prospective, randomized, double-blind study was conducted in the Department of Anaesthesia between August 2024 and July 2025. Eighty adult patients (ASA I–II) scheduled for elective lumbar spine surgery were randomized into two groups (n=40 each). Group B received ESPB with 20 mL 0.25% bupivacaine plus 2 mL saline, while Group BD received 20 mL 0.25% bupivacaine plus dexmedetomidine 1 μg/kg diluted to 2 mL. Primary outcome was duration of analgesia. Secondary outcomes included total postoperative opioid consumption, visual analogue scale (VAS) scores, hemodynamic parameters, and adverse events. Results: Mean duration of analgesia was significantly longer in Group BD (872 ± 115 min) compared to Group B (462 ± 102 min, p<0.001). Total 24-hour opioid requirement was lower in Group BD (38.6 ± 7.9 mg morphine equivalent) versus Group B (58.2 ± 9.4 mg, p<0.001). Mean VAS scores at 4, 8, and 12 hours were consistently lower in Group BD (p<0.05). Hemodynamic stability was comparable between groups, although Group BD had a higher incidence of bradycardia (10% vs 2.5%, p=0.04), which was easily managed with atropine. Conclusion: Dexmedetomidine as an adjuvant to bupivacaine in ESPB significantly prolongs postoperative analgesia, reduces opioid consumption, and improves pain scores in spine surgery patients, with minimal manageable side effects. Keywords: Dexmedetomidine, erector spinae plane block, spine surgery, adjuvant, postoperative analgesia, randomized trial.

Background: Incisional hernia is a common long-term complication of abdominal surgery, occurring in 2–11% of laparotomy incisions. It results from multifactorial causes including patient-related comorbidities and surgical factors, and is associated with significant morbidity and recurrence. Objective: To analyze the risk factors, clinical features, and outcomes of different management strategies in patients with incisional hernia. Materials and Methods: This prospective observational study was conducted at the Department of General Surgery, HIMS, Varanasi, from November 2022 to May 2024, enrolling 100 patients with incisional hernia. Data on demographics, comorbidities, clinical presentation, location of hernia, previous surgical complications, and operative details were recorded. Patients underwent either open mesh repair or laparoscopic mesh repair. Outcomes including operative time, hospital stay, return to work, postoperative pain, and complications were compared. Results: The mean age of patients was 48.9 years, with peak incidence in the 41–50-year group, and female predominance (60%). Wound infection (37%), diabetes (27%), obesity (21%), and hypertension (23%) were major risk factors. The infraumbilical region was the most common site (48%). Compared to open repair, laparoscopic repair showed significantly shorter operative time (52.6 vs 64.5 min; p<0.0001), earlier ambulation, shorter hospital stay, faster return to work, lower pain scores, and fewer complications. Conclusion: Incisional hernia is most common in middle-aged females, often associated with wound infection and comorbidities. Laparoscopic mesh repair demonstrated superior short-term outcomes over open repair, making it the preferred strategy. Long-term follow-up is needed to assess recurrence. Keywords: Incisional hernia, risk factors, mesh repair, laparoscopic surgery, wound infection.

Background: Diabetes mellitus is a chronic condition that requires consistent management. However, compliance with treatment regimens can be adversely affected by psychological distress. Understanding the relationship between distress and compliance is crucial for developing effective management strategies. This study investigates the relationship between compliance with diabetes management and the psychological distress experienced by patients. Materials and Methods: A descriptive cross-sectional study was conducted involving 116 participants diagnosed with diabetes. Data were collected on demographics, socioeconomic status, literacy levels, and comorbidities. The Diabetes Distress Scale (DDS) was utilized to measure various dimensions of distress, including emotional burden, physician distress, regimen distress, and interpersonal distress. Compliance was assessed using a dichotomous measure (good/poor compliance). Results: The results indicate that 83.6% of participants demonstrated good compliance with diabetes management, while 16.4% exhibited poor compliance. Notably, participants with poor compliance reported significantly higher levels of distress across all dimensions measured by the DDS. Emotional burden was reported by 60.3% of participants, while regimen distress affected 34.5% of those with poor compliance. Conclusion: The study highlights a critical link between psychological distress and compliance in diabetes management. These findings underscore the importance of addressing emotional and psychological factors in diabetes care. Recommendations include implementing routine screening for diabetes-related distress, providing psychological support services, and developing individualized care plans to enhance patient compliance and improve health outcomes. Keywords: Diabetes management, compliance, psychological distress, Diabetes Distress Scale, individualized care, interventions.

Background: POSSUM (Physiologic and Operative Severity Score for the Study of Mortality and Morbidity) is used for Surgical Assessment in Patients Undergoing Emergency Abdominal Surgeries. This study aimed to evaluate the efficacy of POSSUM score in predicting the mortality and morbidity in patients with perforation peritonitis. Materials and Methods: A prospective observational study was conducted among patients aged 18 years and above with established peritonitis following hollow viscus perforation and those willing to participate for a period of one year. A detailed clinical history was obtained. Using a predesigned data tool and, results from investigations done preoperatively and operative findings and post operative histology were collected. Results: 31 patients satisfied the inclusion criteria and were included in the study. Mean age of patients was 54.8±18.7 years. Most common site of perforation noted was prepyloric region (n=18) followed by ileal perforation (n=8). Thirteen patients had no complications accounting for 41.9 percentage. Among the dead patients four patients had POSSUM score ranging between 40 and 49 and three patients had POSSUM score ranging between 50 and 59. Conclusion: It can be concluded that the POSSUM score demonstrates a moderate capacity to forecast mortality and morbidity rates among patients undergoing emergency abdominal surgery. The POSSUM scoring system serves as a valuable tool for evaluating surgical outcomes, thereby aiding in the effective management of patients. Implementing the POSSUM score in our setting can enhance patient counselling, improve surgical results, and optimize the use of limited resources and personnel. Keywords: POSSUM score, peritonitis, Emergency Abdominal Surgeries.

Background: HELLP syndrome an acronym for hemolysis, elevated liver enzymes, and low platelet count is widely regarded as a severe form of pre-eclampsia”. This condition is life-threatening and represents a critical challenge for tertiary healthcare centers that frequently manage high-risk pregnancies. In a tertiary healthcare facility, the current study was conducted to assess the sociodemographic traits, gestational age at presentation, clinical complaints, blood pressure patterns, proteinuria, and Bishop scores of pregnant women with HELLP syndrome. Materials and Methods: This prospective, hospital-based observational study was conducted in the Department of Obstetrics and Gynecology at Hi-Tech Medical College & Hospital from June 2022 to March 2025. Women aged 18–40 years with pregnancy ≥20 weeks and diagnosed with HELLP syndrome using the Mississippi classification were included. Detailed history, clinical examination, obstetric evaluation, laboratory investigations, and ultrasonography were performed. Data were analyzed to identify significant associations with maternal and perinatal outcomes. Results: The majority of patients were between 21–30 years of age, primigravida, and from lower socioeconomic backgrounds. Most were referred cases with irregular antenatal check-ups. Abdominal pain, seizures, and headache were the most common presenting complaints, while pedal edema and visual disturbances were also noted. Severe hypertension (SBP ≥160 mmHg and DBP ≥110 mmHg) was observed in a substantial proportion. Bishop score assessment showed nearly 39% of women with a score >8, indicating favorable conditions for induction. Conclusion: Understanding sociodemographic factors, gestational age, presenting symptoms, blood pressure, proteinuria, and Bishop score in HELLP syndrome is crucial for early identification and timely management. Recognizing these characteristics enables rapid intervention and tailored care, ultimately improving maternal and neonatal outcomes. Keywords: HELLP syndrome; Preeclampsia; Eclampsia; Maternal morbidity; Perinatal outcome; Blood pressure; Proteinuria: Bishop score.

Background: Hepatorenal syndrome (HRS) represents a severe, functional renal failure in advanced cirrhosis, driven by profound renal vasoconstriction without intrinsic kidney damage. Traditional diagnostic methods relying on serum creatinine are often delayed and insufficiently specific in cirrhotic populations due to altered creatinine metabolism. Non-invasive imaging modalities, particularly Doppler ultrasonography and shear wave elastography (SWE), offer promising alternatives for early recognition of HRS by detecting functional and hemodynamic changes. Objectives: To evaluate the diagnostic efficacy of renal resistive index (RRI), difference in resistive indices between spleen and kidney (DI-RISK), and organ stiffness parameters obtained via SWE in distinguishing HRS from other cirrhotic patients with deranged renal function. Materials and Methods: This prospective case-control study included 70 cirrhotic patients with elevated serum creatinine, divided into HRS and non-HRS groups based on International Club of Ascites (ICA-AKI) criteria. All participants underwent Doppler ultrasound evaluation of renal and splenic arteries and SWE of the liver and spleen. Key parameters—RRI, splenic RI, DI-RISK, liver stiffness, and spleen stiffness—were compared between groups and analyzed for diagnostic performance. Results: HRS patients showed significantly elevated RRI (0.79 ± 0.07 vs. 0.67 ± 0.04; p < 0.0001), splenic RI (0.67 ± 0.07 vs. 0.59 ± 0.05; p < 0.0001), and DI-RISK (0.13 ± 0.07 vs. 0.09 ± 0.04; p = 0.0175). Liver and spleen stiffness values were also significantly higher in the HRS group (32.79 ± 9.16 kPa and 38.69 ± 5.60 kPa, respectively). ROC analysis revealed excellent diagnostic performance for RRI > 0.74 (AUC = 0.92), with 89.6% sensitivity and 92.7% specificity. Conclusion: Doppler and SWE-based ultrasonographic parameters demonstrate strong diagnostic utility in differentiating HRS from other causes of renal dysfunction in cirrhotic patients. This multi-parametric imaging approach can serve as a valuable adjunct to clinical criteria, facilitating earlier diagnosis and targeted management. Keywords: Hepatorenal syndrome, Doppler ultrasound, Resistive index, Shear wave elastography, Cirrhosis, Renal dysfunction.

Background: Pancytopenia, defined as the reduction of all three blood cell lines— red blood cell (RBC) deficiency, white blood cell (WBC) deficiency, and platelet (PLT) deficiency—arises from a variety of hematological and non-hematological disorders. Etiology varies according to geographic, nutritional, and socioeconomic factors, and early recognition is crucial for prognosis and management. This study aimed to evaluate the etiopathogenesis of pancytopenia in afebrile patients confirmed by bone marrow examination and to describe their clinical and hematological profile. Materials and Methods: A prospective hospital-based study was conducted in the Department of General Medicine, GMERS Medical College and Hospital, Ahmedabad, between February 2023 and February 2024. Thirty afebrile patients aged 18 years or older with pancytopenia were included. Detailed history, clinical examination, hematological investigations, biochemical markers, and bone marrow examination were performed. Data were analyzed using descriptive statistics, and the results are presented as frequencies and percentages. Results: The most affected age group was 31–40 years (33.3%), with a female predominance (70%). Fatigue and weakness (93.3%) were the most common symptoms, while splenomegaly (73.3%) and pallor (60%) were the most frequent signs. Severe anemia (hemoglobin level <7 g/dL) occurred in 46.7% of patients, and severe thrombocytopenia (platelet count <50,000/mm³) in 66.7%. Macrocytosis (MCV >100 fL) was observed in 53.3%, and macrocytic anemia was the predominant peripheral smear finding (46.7%). Vitamin B12 deficiency was detected in 73.3% of patients. Bone marrow examination revealed hypercellularity in 80% of cases, confirming megaloblastic anemia as the predominant etiology. Conclusion: Megaloblastic anemia due to vitamin B12 deficiency is the most common and reversible cause of pancytopenia in afebrile patients. Clinical assessment, hematological evaluation, and bone marrow examination are essential for accurate diagnosis and effective management. Keywords: Pancytopenia, Megaloblastic anemia, Vitamin B12 deficiency, Bone marrow, Nutritional intervention.

Background: Lung lesions can range from infectious to neoplastic, making diagnosis difficult at times for patient care. Therefore, a precise diagnosis is crucial for receiving the right care. An important part of diagnosing these patients is the use of FNAC and biopsies. Lung biopsy is now required even for molecular analysis, in addition to making a diagnosis of the histologic subtypes of lung cancer with immunohistochemistry for therapeutic purposes. AIM: To determine the experience at a tertiary care hospital in the use of Computed Tomography (CT) guided transthoracic lung biopsies in the diagnosis of various lung diseases. Materials and Methods: This 3.5-year hospital-based descriptive study was conducted in the pathology department of the Sheri Kashmir Institute of Medical Sciences in Soura, Srinagar. It lasted from January 2021 to June 2024. A total of 136 CT-guided biopsies were carried out. Data analysis and histopathologic analysis were done. Results: 3.7:1 male-to-female ratio. Patients ranged in age from 25 to 83 years old, with the majority of instances occurring in the fifth and sixth decades of life. 105 (77%) were neoplastic, compared to 21 (15.6 %) who were not, and 10 (7.4%) who had unclear results. The most common malignancy of the lung was squamous cell carcinoma, constituting 38.2%. The 4 benign neoplasms diagnosed in our study included two cases of solitary fibrous tumor. In non-neoplastic cases, granulomatous inflammation was the most common diagnosis, accounting for 6% of cases, followed by nonspecific inflammation in 5% of cases. Conclusion: CT-guided lung biopsy is reliable with high accuracy for diagnosis and subtyping of lung tumors. Histopathological examination is pivotal in making an accurate diagnosis of various lung lesions. Although the Hematoxylin and eosin (H&E) stain is the gold standard used for diagnosis. For targeted chemotherapeutic options, Immunohistochemistry (IHC) has an important complementary role in the classification of Non-small cell Lung Cancer (NSCLC). Keywords: Computed Tomography, Lung cancer, Percutaneous transthoracic needle biopsy.

Background: Aim: To Identify and isolate various pathogenic bacteria from all Pulmonary tuberculosis positive patients and to know their pattern of anti-microbial susceptibility. Objective: Pulmonary tuberculosis (TB) remains a major global health challenge and is frequently complicated by secondary bacterial infections that worsen morbidity and treatment outcomes. These infections, driven by host factors such as smoking, alcohol use, and comorbidities, along with emerging antimicrobial resistance, pose significant clinical and therapeutic challenges. Understanding their prevalence, microbial spectrum, and resistance patterns is essential for guiding effective management and antibiotic stewardship. Materials and Methods: This is a hospital based cross sectional observational study conducted in the Microbiology department of R. D. GARDI Medical College and C.R.G. Hospital in Ujjain, (M.P.) from March 2023 to February 2025. Study was started after obtaining the approval of the institutional ethical committee and IEC Ref. number is 02/2023. A total of 525 clinical samples (sputum, BAL and ETT) from pulmonary tuberculosis patients were received in a sterile container were processed and antimicrobial susceptibility testing performed as per standard guidelines. Analyzed the association between demographic (age, sex), risk factors, co-morbidities with secondary bacterial infection in pulmonary tuberculosis patients by using chi square test and if p-value <0.05 is considered as statistically significant. Isolates were classified as MDR and XDR as per standard definitions. Results: Among 525 pulmonary tuberculosis patients, 72 (13.7%) developed secondary bacterial infections, more frequent in males 381(73%) and 144 (27%) female. Smoking 52 (19%) and alcohol use 34(14%) were the predominant behavioral factors. Among the co-morbidities, HIV 14 (9.3%), diabetes mellitus 8(12.7%), chronic kidney disease 2(17%), and chronic liver disease 1(12.5%) were observed. The overall association of these factors with secondary bacterial infections was statistically highly significant (p < 0.05).Pseudomonas aeruginosa was predominant 35 (49%), followed by Klebsiellapneumoniae 20 (28%), E. coli 8 (11%), S. aureus 5 (7.1%), Acinetobacter spp. 1 (1.4%), and Candida spp. 3 (4.2%). MDR was highest in K. pneumoniae 18 (90%) and E. coli 7 (88%). XDR strains were detected in S. aureus 1(20%), E. coli 1(12.5%), P. aeruginosa 2 (6%), and K. pneumoniae 1(5%). ESBL production was common in E. coli 4 (50%), K. pneumoniae 7 (35%), and P. aeruginosa 7 (20%). P. aeruginosa remained fully susceptible to piperacillin–tazobactam and meropenem, 35(100%) while K. pneumoniae and E. coli showed poor susceptibility to cephalosporins and carbapenems. In S.aureus, MRSA 4(80%) retained complete sensitivity to vancomycin, linezolid, and teicoplanin. Conclusion: Secondary bacterial infections in tuberculosis patients were significantly associated with demographic, behavioral, and co-morbid factors (p < 0.05). Predominantly caused by P. aeruginosa and K. pneumoniae, with high rates of MDR, XDR, and ESBL production. Preserved susceptibility of P. aeruginosa to carbapenems and anti-MRSA agents highl

Background: Spondylolisthesis is a spinal condition characterized by the forward displacement of one vertebra over another, leading to instability and associated symptoms. Surgical intervention is often recommended for patients with symptomatic spondylolisthesis unresponsive to conservative treatment. The objective of this study was to analyze the functional outcomes of surgical management utilizing posterior stabilization and fusion techniques in patients with spondylolisthesis. Materials and Methods: This is a prospective study conducted on 30 patients who underwent surgical treatment for spondylolisthesis with posterior trans-pedicular screw fixation with conventional or reduction screws and fusion. Meyerding’s grade of listhesis, Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI) score and pain scores such as visual analog scale (VAS), numerical rating scale 11 (NRS-11), and pain relief rate were used to analyze the functional outcome. Results: Postoperatively, Meyerding’s grade of listhesis and the JOA score had improved significantly. The ODI score and pain scores such as VAS, NRS-11, and pain relief rate were better after surgical interventions. There was full motor recovery in 13 patients and 14 patients had full sensory recovery, while six patients had sensory blunting at the time of the time of the last follow-up. Twenty-six (80.7%) patients had clinically successful results and radiological/clinical fusion while four of the patients did not achieve a clinically successful result and radiological/clinical fusion. The average time for bony fusion was 5.58 months with the earliest being 4 months and the latest 12 months. Intraoperatively, one patient had screw slippage and one had a dural tear. Postoperatively, four patients had infection, two patients were presented with deep infection, and the instrumentation had been removed. Conclusion: This study demonstrated favorable functional outcomes and improvements in pain, disability, and quality of life measures following surgical intervention. Keywords: Low back pain, spondylolisthesis, posterior stabilization and fusion, functional outcome.

Background: Lack of established screening programs for Cancer Uterine cervix in the developing countries shifts the onus of public education on the primary health care providers and their support staff. The attempt here is to note the education in healthcare female support staff in a rural medical college in Southern India about screening and prevention of cervical cancer. Materials and Methods: All female health care support staff between 18 to 65 years was asked to fill a questionnaire regarding their views on screening and prevention of cancer cervix. A total of 242 women participated in the study. Results: A total of 73.96% women were aware of Cancer cervix and 58.67% women staff knew it to be a preventable malignancy. Viral etiology of Cancer cervix was known by 46.69% women. Screening by Viral DNA tests and Pap smear was known by 42.56% and 60.33% subjects. Only 38.42% women had heard of vaccine against cancer cervix and its availability in India. Positively, 80.16% were aware that safe sexual practices prevent Carcinoma Cervix. But, only 9.5% had tested and 30.99% women had a Pap smear themselves. The main hurdle for Pap testing was found to be awareness of the procedure. On counselling, 71.48% women agreed to Pap testing and 80.16% favored Vaccination. Conclusion: The gap in the awareness and practice of cancer prevention may be bridged by Education of the health care support staff to improve their personal practices and subsequently to motivate the society to participate in screening and vaccination programs. Keywords: Cancer, cervix, screening, prevention, healthcare, women, HPV, vaccination.

Background: Urolithiasis is a prevalent illness affecting males and females alike. With modern day armamentarium of instrumentation, the technique of stone removal has become minimally invasive however the character of alpha-1 adrenergic blockers like tamsulosin still have a role to play in spontaneous expulsion of small (<5mm) lower ureteric stones thereby decreasing treatment cost and morbidity of patients. Materials and Methods: In this research, we prospectively examined 100 consecutive patients presenting with the distal ureteric stones. The participants were categorized into 2 distinct groups namely control and tamsulosin group, by randomization. A thorough clinical history was obtained, and a detailed clinical evaluation was carried out as per the standard proforma. Expulsion rate, expulsion time and analgesic dose were noted and compared for both the groups. Results: Among 50 patients in the control group, 21 successfully passed the lower 1/3rd ureteric and uretero-vesical junction calculus within four weeks of diagnosis, conversely 29 patients did not experience expulsion, resulting to expulsion rate of 42%. In comparison, an 82% expulsion rate was achieved in the tamsulosin group, where 41 out of 50 patients spontaneously expelled the calculus. In the tamsulosin class, the mean duration of expulsion of stones was 4.48 days, in contrast to 7.38 days in the control group. In another group, the average analgesic dosage was 813 mg, while for the patient consuming tamsulosin, the mean analgesic dose was 282 mg. Conclusion: Tamsulosin has demonstrated an ability to elevate and expedite expulsion rates of stones, mitigate the acute attacks by acting as an spasmolytic, reduce the overall duration of expulsion of stone, and also reduce utilization of analgesic doses. Keywords: Urolithiasis, Distal Ureteric Stones, Uretero Vesical Junction, Tamsulosin, Alpha 1 Adrenergic Blockers.

Background: Pancreatitis is an inflammatory condition of the pancreas that occurs when digestive enzymes activate prematurely and begin damaging pancreatic tissue. This leads to both exocrine and sometimes endocrine dysfunction, with symptoms ranging from mild, self-limiting illness to severe, life-threatening inflammation. Materials and Methods: This was a hospital-based, observational cross-sectional study conducted in the Department of General Surgery over a period of one year. The study aimed to analyze the clinical presentations, etiological factors, and diagnostic profiles of adult patients diagnosed with non-alcoholic pancreatitis. Results: The study included 50 non-alcoholic pancreatitis patients, mostly aged 31–40 years, with a slight female predominance. Gallstones (50%) and metabolic issues were the main causes; all patients had abdominal pain, with vomiting (74%), fever (26%), and jaundice (16%) also noted. Most cases were mild to moderate in severity based on BISAP, HAPS, and Balthazar scores. Conclusion: This study concludes that non-alcoholic pancreatitis, mainly affecting middle-aged adults, is often linked to gallstones and metabolic issues, highlighting the need for early evaluation and preventive public health measures. Keywords: non-alcoholic pancreatitis, Gallstones, BISAP, HAPS, and Balthazar scores.

Background: Hand hygiene (HH) is a fundamental component of infection prevention and control (IPC), with a well-established role in reducing healthcare-associated infections (HAIs). Despite its proven effectiveness, adherence among healthcare workers (HCWs) remains variable, particularly in low- and middle-income countries like India. Structured training has emerged as a key strategy to improve compliance, addressing both behavioural and systemic barriers. Aim: This study evaluates the impact of a training on HH adherence among doctors and nurses, aiming to enhance patient safety and strengthen IPC practices. Materials and Methods: A quasi-experimental pre–post study was conducted from August 2024 to February 2025 in Medicine, Gynaecology, and Surgery wards of Adarsh Multispecialty Hospital. Hand hygiene (HH) adherence among doctors and nurses was assessed using WHO’s “Five Moments” framework via direct, unannounced observation by trained microbiologists. A structured training was provided between phases. Data were analyzed using chi-square tests and mixed-effects logistic regression. Ethical approval was obtained from the Ananya Institutional Ethical Committee (AIEC). Results: A total of 1,711 hand hygiene (HH) opportunities were observed (857 pre-training, 854 post-training). Overall compliance improved significantly from 38.8% pre-training to 57.0% post-training. Among doctors, adherence increased from 42.0% (192/457) to 65.5% (224/342; χ² = 13.46, p < 0.001), while nurses improved from 35.3% (140/397) to 52.6% (271/515; χ² = 10.53, p = 0.001). Department-wise, adherence rose significantly in Medicine (38.5% to 54.1%; p = 0.0067) and Surgery (41.7% to 62.9%; p = 0.016), whereas Gynaecology showed a non-significant increase (56.7% to 59.4%). Across WHO “Five Moments,” the greatest gains were observed before patient contact and after procedures, though compliance before aseptic procedures remained lowest. Conclusion: Structured training significantly improved hand hygiene (HH) compliance, increasing from 42.0% to 65.5% among doctors and from 35.3% to 52.6% among nurses, with overall adherence rising to 57%. While compliance improved across departments and WHO “Five Moments,” rates remained below the WHO target of 80%, emphasizing the need for sustained, multimodal strategies to achieve optimal infection prevention. Keywords: HH adherence rate, HH compliance, WHO five moments of HH, Healthcare workers.

Background: Acute kidney injury (AKI), is a syndrome with a wide variety of aetiologies and pathophysiologic processes. The observed incidence of AKI was eight per 1000 admissions as per recent study in India. Given the complexity and diversity of the aetiology of AKI, it can be challenging to diagnose AKI, with no direct pharmacologic therapies for AKI, prevention is of paramount importance. An understanding of the potentially modifiable risk factors that may be unique to different patient groups is critical to the prevention of AKI. Hence this study was undertaken to understand the demography of patients with AKI which would guide clinicians for early diagnosis and appropriate care. Materials and Methods: A prospective study was done in 200 adult patients of either sex diagnosed with AKI in a tertiary care during April 2023 to April 2025. Institutional ethical committee clearance and patients’ consent was obtained. KDIGO criterion was used for defining AKI. All patients were followed for 3 months from enrolment and determinants of mortality were assessed. Outcome was assessed as complete recovery, partial recovery, dialysis dependency and death. Evaluation included a detailed history taking (includes past medical and/or surgical history, signs of azotemia (nausea and vomiting), altered sensorium, or other symptoms associated with AKI), and laboratory investigations. Hemodialysis was conducted as and when required. Chi square test and students t test was used with P<0.05 considered as statistically significant. Results: Mean age was 52.5 and range 18 – 75 years. Males were 60.5%. Residence was rural in 55.5%. Severity of AKI as per KDIGO criteria in stage 1, 2, and 3 were 17.5%, 31.5% and 51% respectively. Community acquired AKI and Hospital acquired AKI was seen in 91% and 9% patients. Patient outcome was assessed as complete recovery, dialysis dependency, partial recovery in 61%, 18%, 9% and death in 12% patients respectively. Conclusion: AKI is more common in elderly. Sepsis is the commonest cause of AKI. AKI is largely a CA-AKI and the lesser percentage is due to HA-AKI. Mortality is associated with hypertension, diabetes mellitus, CAD, CLD, lower SES and higher stages of AKI as per KDIGO criteria. Keywords: Acute kidney injury, KDIGO, Demography, mortality.

Typhoid fever continues to pose a major public health challenge in endemic regions such as South Asia, where inadequate sanitation, overlapping febrile illnesses, and limited diagnostic resources complicate timely detection. Although blood culture remains the gold standard, its sensitivity is compromised by prior antibiotic use and logistic constraints. The Widal test, widely used in resource-limited settings, has well-recognised limitations, whereas newer immunoassays such as Typhidot promise improved diagnostic performance. This study was undertaken to evaluate and compare the diagnostic accuracy of Widal and Typhidot tests against blood culture in suspected cases of enteric fever. A prospective observational study was conducted at tertiary care hospitals between March 2018 and February 2019. A total of 300 patients with clinically suspected enteric fever were enrolled. Blood samples were collected for culture, Widal slide agglutination, and Typhidot testing. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using blood culture as the gold standard. Statistical analysis was performed using SPSS version 25.0, with p<0.05 considered significant. The mean age of participants was 23.79 years, with a predominance of cases in the 0–10-year age group (32%). Blood culture positivity was 22%, highest during 6–10 days of fever (71.2%). The Widal test showed a sensitivity of 72.7%, specificity of 76.5%, PPV of 46.6%, and NPV of 90.9%. In contrast, Typhidot demonstrated a markedly higher sensitivity of 98.5% and NPV of 99.2%, but lower specificity of 53.8% and PPV of 37.6%. Notably, all three tests were simultaneously positive in only 16% of cases, while 41.6% tested negative across all modalities. Blood culture remains the gold standard but is limited by sensitivity and resource demands. The Widal test showed only moderate reliability, whereas Typhidot demonstrated excellent sensitivity and NPV, making it useful for rapid screening but limited by low specificity. No single test is sufficient; a multimodal approach combining rapid assays, culture, and clinical evaluation is the most effective strategy for accurate diagnosis in endemic, resource-limited settings. Keywords: Typhoid fever; Widal test; Typhidot test; Sensitivity; Specificity.

Background: The aim is to assess the outcome of pertrochanteric fractures treated with cephalomedullary nails. To compare the results between two nailing systems: ZNN (Zimmer Natural Nail) and PFNA (Proximal Femoral Nail Antirotation). Materials and Methods: A total of 43 patients who underwent either ZNN or PFNA between January 2014 to October 2015 were included in the study. Fractures were classified according to the AO system. The parameters assessed were type of reduction, TAD, position of screw in the Cleveland zone, amount of sliding, complication and mortality. Multivariate analysis was done. Functional outcome assessed by Harris Hip score was also compared between the groups. Results: Out of 43 patients, 5 were lost to follow-up. Of the 38 patients followed up 50% were women. The average age was 67 years (range20-87). The 1-year mortality was 9(24%). There were no significant differences in the use of either nail in terms of TAD, amount of nail sliding and screw penetration into joint. There was a significant difference in the position of screw in Cleveland zone (p = 0.04). Functional outcome was comparable between the groups. Conclusion: There is predominantly excellent outcome of Pertrochanteric fractures treated with cephalomedullary nails. The ZNN and PFNA have no difference in outcome. Keywords: TAD, Per trochanteric fractures, Haris Hip score

Background: Preterm premature rupture of membranes (PPROM) is the spontaneous rupture of the foetal membranes before 37 completed weeks and the onset of labour. It is responsible for 40% of all preterm births and is associated with a high perinatal mortality rate of 60-80%. Thus, it is important to diagnose the correct causative organism and aim for targeted therapy. Aims and objectives: To study vaginal flora pattern in patients with presenting preterm premature rupture of membrane and study most common microorganism responsible for bacterial vaginosis. Materials and Methods: A hospital-based cross-sectional observational study on 73 clinically diagnosed cases of preterm premature rupture of membranes, the GMCH Department of Obstetrics and Gynaecology was conducted after written consent. Detailed history, examination, high vaginal swab and relevant investigations was done and recorded. Result: In the High Vaginal Swab Culture, Normal flora was seen in 67(91.8%) cases, E. coli was seen in 4(5.5%) cases, and in each 1 case, Klebsiella species and S. aureus were seen. It was observed that a positive high vaginal swab was statistically significantly associated with maternal complications. Higher level of CRP >5 mg/L was associated with higher maternal (p=0.018) and neonatal (p=0.18) complications. A positive growth was statistically significantly associated with a higher level of CRP >5 mg/L (p = 0.005). Conclusion: The most common isolate in our study was E. coli. We observed positive high vaginal swab is associated with high CRP levels. Keywords: Vaginal Flora, Preterm Premature Rupture of Membranes.

Background: Isthmic spondylolisthesis is a leading cause of chronic low back pain and radiculopathy in the active adult population¹. Transforaminal Lumbar Interbody Fusion (TLIF) is a proven technique for neural decompression and spinal stabilization. This study evaluates the functional and radiological outcomes following TLIF in South Indian patients using standard clinical tools and X-rays alone. The objective is to assess the functional recovery and radiographic improvements in patients with isthmic spondylolisthesis treated with TLIF without relying on advanced imaging modalities such as CT scans. Materials and Methods: This prospective study involved 40 patients with single-level Grade I or II isthmic spondylolisthesis treated surgically using TLIF⁴. Functional outcomes were measured using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for back and leg pain. Radiographic assessments were performed using standing and dynamic lumbar spine X-rays to evaluate slip percentage, segmental lordosis, disc height, and fusion status based on motion criteria and evidence of trabecular bridging. Results: There was significant improvement in ODI (mean score reduced from 54.6 to 18.3) and VAS (mean score reduced from 7.2 to 2.1) at 12-month follow-up (p < 0.001). Slip percentage reduced from 32% to 9%, and segmental lordosis increased significantly¹¹¹². Radiographic fusion was evident in 92.5% of patients based on motion stability and bone continuity seen on follow-up X-rays¹³. No major complications occurred. Conclusion: TLIF provides excellent functional and radiological results in patients with isthmic spondylolisthesis¹⁴¹⁵. Standard radiographs are effective for postoperative monitoring, offering a cost-effective, reliable alternative to CT-based evaluation in resource-constrained settings. Keywords: TLIF, isthmic spondylolisthesis, ODI, slip percentage, lumbar fusion, X-ray assessment, South Indian population.

Background: The intestines, comprising the small and large intestines, play a crucial role in nutrient absorption and overall body function. Pathological conditions affecting the bowels can disrupt the body's delicate balance. During abdominal surgery, normal abdominal functions are temporarily halted and restoring them quickly is a primary goal. Postoperative ileus (POI), characterized by gastrointestinal motility inhibition, significantly impacts patients' recovery, causing discomfort, pain, and delayed hospital discharge. This prospective study aims to investigate the prevalence of POI and assess risk factors associated with its occurrence and progression. Understanding POI is vital for improving patient outcomes and promoting faster recovery after abdominal surgeries. Materials and Methods: This hospital-based prospective study included patients who underwent surgery at Rabindranath Tagore Medical College, Udaipur during July, 2023 to Sept.,2024. Data was collected using a standardized proforma, including relevant clinical history, pre-operative and post-operative investigations. Statistical analysis involved descriptive statistics, t-tests, nonparametric tests, chi-square tests, and multivariate logistic regression analysis. Results: In this study males (59.03%) were predominant in numbers than females (40.96%). Bowel motility appeared earlier in females (91.17%) compared to males (89.79%). Factors significantly associated with POI in the univariate analysis were stoma (p≤0.001), blood transfusion p=0.048), peritoneal contamination (p≤0.001), higher preoperative haemoglobin (p=0.009), Duration of surgery (p=0.005), postoperative chloride (p<0.001). Conclusion: In the present study appearance of bowel motility was found to be significantly earlier in patients with shorter duration of surgery, less intraperitoneal contamination, presence of stoma, not receiving intra- or post-operative blood transfusion, shorter duration of surgery, higher preoperative haemoglobin and higher postoperative chloride. This study recommends use of passage of flatus over auscultation of bowel sounds for purpose of starting oral intake in patients undergoing laparotomy as the latter can be positive even in regional return of bowel activity. Keywords: Intestines, Postoperative Ileus, Risk Factors, Bowel Function.

Background: Ventricular septal defect (VSD) is the most common congenital heart defect in children, therefore, VSD closure is the most commonly performed surgical procedure in congenital heart disease patients. The aim of this study was to find out the outcome, morbidity, and mortality data following surgical closure of isolated VSD in the pediatric age group at single tertiary care hospital. Materials and Methods: This is a retrospective study which included patients aged from 3 months to 18 years operated between August 2017 and August 2025 at Sawai Man Singh Hospital (SMS), Jaipur, Rajasthan, India. A total number of 157 patients were included in this study. Results: out of 157 patients, male outnumbered the female gender with slight margin (male – 81, female – 76). Most common age at surgery was 1 to 5 years. Weight at the time of surgery was ranging from 5 to 10 kg. Most common type of VSD is perimembranous type. No patient required re-exploration for residual VSD and permanent pacemaker. None of the patients had sternal wound dehiscence. Patients were extubated within 3 – 6 hours after surgery with ICU stay was between 3-5 days. Mortality was seen in 2 patients (1.27%). Hospital stay after surgery was 5 to 6 days. No residual VSD was found at 1 year follow up. Conclusion: surgical closure of isolated VSD remains a very safe procedure with low morbidity and mortality. A dedicated team approach with good surgical technique, good perfusion management, and effective postoperative care culminates into better results in pediatric population. Keywords: Ventricular Septal Defect, Congenital, Pacemaker, Perimembranous, ICU.

Background: Multinodal strategies used in postoperative pain relief in surgical patients such as opioids, NSAIDS, local infiltration and epidural analgesia among them epidural analgesia provide superior outcomes with fewer complications. This study was conducted to analyze complications and hemodynamic stability during epidural anaesthesia by dexmedetomidine with bupivacaine v/s fentanyl with bupivacaine in orthopedic lower limb surgeries. Materials and Methods: The study included 40 ASA I–II patients aged 20–50 years, randomized into two groups: Group A received bupivacaine with dexmedetomidine, and Group B received bupivacaine with fentanyl epidurally. Standard preoperative preparation and intraoperative monitoring were performed, with hemodynamic parameters recorded at baseline and regular intervals. Postoperative pain was assessed using VAS, and data were analyzed statistically using SPSS. Results: Both groups were demographically comparable with similar age, gender, and ASA grading distribution. Group A showed significantly faster onset and regression of sensory and motor block compared to Group B, It indicate that group A has superior block characteristics. Hemodynamic parameters were largely stable, with Group B showing transient reductions in heart rate, SBP, and DBP at 20–25 minutes, while complication rates remained similar across both groups. Conclusion: Dexmedetomidine with bupivacaine proved more effective than fentanyl with bupivacaine, offering faster block onset and stable hemodynamics with similar complication rates. Keywords: Dexmedetomidine, Bupivacaine, Fentanyl, Bupivacaine.

Background: The WHO-modified Partograph has been widely used for intrapartum monitoring for decades, particularly in low- and middle-income countries. However, its reliance on rigid thresholds, including the “1 cm/hour” cervical dilatation rule, and limited scope in documenting supportive care have raised concerns about its effectiveness and clinical relevance. In 2020, WHO introduced the Labour Care Guide (LCG), a next-generation monitoring tool designed to provide individualized, evidence-based, and woman-centered intrapartum care. Objective: To critically compare the WHO Labour Care Guide with the traditional Partograph, highlighting conceptual differences, clinical outcomes, maternal and neonatal impact, user acceptability, and implementation feasibility. Materials and Methods: A comprehensive literature review was conducted using PubMed, Scopus, Cochrane Library, and Google Scholar up to August 2025. Eligible studies included randomized controlled trials, observational studies, systematic reviews, and WHO technical documents comparing the Partograph and LCG, or evaluating their role in intrapartum monitoring. Data were synthesized narratively under four domains: conceptual framework, clinical performance, maternal–neonatal outcomes, and user acceptability. Results: Forty-two publications met the inclusion criteria. The Partograph demonstrated utility in reducing prolonged labour when properly applied, but evidence for improved maternal or neonatal outcomes was inconsistent, and real-world compliance remained low. In contrast, early evaluations of the LCG indicated improved recognition of abnormal labour patterns, potential reduction in cesarean section rates, and higher user acceptability due to its structured, checklist-based design and integration of respectful maternity care practices. Neonatal outcomes appeared comparable between the two tools, though large-scale randomized trials are still lacking. Conclusion: The WHO Labour Care Guide represents an evolution in intrapartum monitoring, offering a more comprehensive and patient-centered alternative to the Partograph. While preliminary evidence is promising, particularly regarding user compliance and early detection of complications, further multicountry implementation studies and large-scale randomized trials are required to confirm its effectiveness and guide policy adoption globally. Keywords: Labour Care Guide, Partograph, intrapartum monitoring, maternal outcomes, neonatal outcomes, WHO, respectful maternity care.

Artificial intelligence (AI) combined with wearable devices is moving healthcare away from episodic measurements and towards continuous and comprehensive care. This expanded review synthesizes the technological foundations, practical applications, demonstrated benefits, and outstanding challenges for AI-enabled wearables. We will discuss the architecture that powers these devices, the analytical approaches used to extract clinically useful insights, and the ethical and regulatory constraints that decides their use. Here we will emphasize more on how clinicians, patients, engineers, and policymakers can work together to responsibly develop and manage wearables for prevention, early detection, management of chronic disease, and population health. Recommendations for research priorities, policy harmonization, and design practices are provided to support translation into routine care. Keywords: Artificial Intelligence, Wearable Technology, Digital Health, Remote Patient Monitoring.

Background: Surgical site infections are complications associated with caesarean section leading to a substantial effect on the mother’s health and significant association has been observed between repeat caesarean deliveries and wound infection. Asepsis bundle includes a set of evidence-based measure that have shown a significant improvement in patient care. Therefore, this study aims to determine the impact of ASEPSIS bundle on caesarean surgical site among women undergoing repeat caesarean delivery. Materials and Methods: This was a randomized controlled trial, where woman undergoing repeat elective caesareans were randomized in two groups (n=130) i.e., Asepsis bundle group (n=65); and control group (n=65). Women in the Asepsis bundle group (Group A) were managed according to bundle components which included hair removal by clippers, Preoperative chlorhexidine bath, antimicrobial prophylaxis, skin preparation with 4% chlorhexidine and 70% isopropyl alcohol and preoperative vaginal cleansing by chlorhexidine only, Skin closure with Nylon sutures, bath with chlorhexidine till suture removal with enhanced patient education. In control group (Group B), the patients will be managed according to the standard hospital protocol. Results: The total incidence of surgical site infection in this study was 26 (20%). In Asepsis bundle group 8 (12.3%) patients and in the control group 18 (27.7%) patients were diagnosed with surgical site infections. Conclusion: Implementing Asepsis bundle minimises the surgical site infection in women undergoing repeat caesarean delivery. Keywords: Surgical site infection, caesarean delivery, chlorhexidine gluconate, Asepsis bundle.

Background: Healing of mandibular third molar extraction sockets often occurs by secondary intention, leading to alveolar ridge resorption. Preserving bone is crucial for long-term rehabilitation. Simvastatin, a lipophilic HMG-CoA reductase inhibitor, has shown osteoinductive effects by upregulating bone morphogenetic protein-2 (BMP-2) and other osteogenic markers. This study evaluated its local effect on bone regeneration post-extraction. Materials and Methods: Forty patients requiring mandibular third molar extraction were randomized into two groups. The study group (n=20) received 10 mg simvastatin powder with gel foam in the socket, while the control group (n=20) received gel foam with saline. Pain was assessed on days 1 and 7 using the Visual Analog Scale (VAS). Bone regeneration was evaluated radiographically at 1, 6, and 12 weeks by mean gray-level histogram values. Statistical significance was set at p < 0.05. Results: Demographic variables were comparable (p > 0.05). VAS scores showed no significant difference between groups (1.9 vs. 1.8 on day 1; both 0 on day 7, p > 0.05). Radiographic analysis demonstrated significantly higher mean gray-level values in the simvastatin group at week 1 (64.43 ± 12.42 vs. 56.61 ± 10.26), week 6 (85.46 ± 9.45 vs. 77.54 ± 6.33), and week 12 (102.05 ± 10.48 vs. 89.58 ± 8.65) (p < 0.05). Conclusion: Local simvastatin did not influence postoperative pain but significantly enhanced bone density and regeneration in extraction sockets. It may serve as a cost-effective adjunct for alveolar bone preservation. Larger clinical trials are warranted to refine dosage and delivery methods. Keywords: Lipophilic HMG CoA Reductase Inhibitor, Simvastatin, Alveolar Bone Regeneration, Bone Remodeling, Dental Extraction.

Background: Phacoemulsification, apart from restoring visual function, has been associated with lowering intraocular pressure (IOP) through anatomical and hydrodynamic changes in the anterior segment. This study aimed to evaluate the effect of phacoemulsification on IOP and its association with anterior chamber depth (ACD) and biometric parameters among cataract patients attending a tertiary care hospital in India. Materials and Methods: A prospective observational study was conducted on 412 patients undergoing uncomplicated phacoemulsification with intraocular lens implantation. Comprehensive ophthalmic evaluation, including IOP measurement using Goldmann applanation tonometry and A-scan biometry, was performed preoperatively and at postoperative day 1, 1 week, 1 month, 3 months, and 6 months. Statistical analyses included paired t-test, repeated measures ANOVA, and correlation analysis. Results: The mean preoperative IOP was 15.8 ± 2.9 mmHg, which rose transiently on postoperative day 1 (16.5 ± 3.5 mmHg, p < 0.001) and subsequently declined significantly at 1 week (15.0 ± 3.0 mmHg), 1 month (14.2 ± 2.8 mmHg), 3 months (14.0 ± 2.7 mmHg), and 6 months (13.9 ± 2.6 mmHg, all p < 0.001). The overall mean IOP reduction at 6 months was 1.9 ± 2.6 mmHg (12%). Greater reductions were noted in eyes with higher baseline IOP and greater postoperative ACD increase (r = 0.42, p < 0.001). Age ≥60 years showed slightly higher IOP reduction (p = 0.034), while gender and cataract type had no significant influence. Conclusion: Phacoemulsification results in a statistically significant and sustained reduction in IOP, particularly in eyes with higher preoperative pressure and greater postoperative anterior chamber deepening. The procedure thus provides dual benefits of visual rehabilitation and long-term ocular pressure modulation. Keywords: Phacoemulsification, Intraocular Pressure, Cataract Surgery, Anterior Chamber Depth, Ocular Hypertension, Indian Population, Biometric Correlation.

Background: The study was conducted to enhance our understanding of pediatric head trauma and inform clinical practices aimed at improving survival and recovery. Materials and Methods: The study was conducted in a tertiary care center, a high-level medical facility capable of handling complex cases involving traumatic brain injury in pediatric patients Results: Among 180 children with head trauma, 169 (93.9%) were discharged home and 11 (6.1%) died, reflecting generally favorable outcomes with current management protocols. Discharge rates underscore that the majority of pediatric head traumas—particularly mild (GCS 13–15) cases—have excellent prognoses when treated promptly and appropriately. Mortality, while low, highlights that a critical minority with severe physiologic and structural injuries remains at high risk Conclusion: Most cases are mild and managed conservatively, with excellent outcomes. Key predictors of poor prognosis include low GCS, pupillary abnormalities, and high-energy mechanisms. Prevention through home safety, caregiver education, and road-safety enforcement remains essential. Optimized triage, judicious imaging, and timely neurosurgical intervention can further improve survival and recovery. Keywords: pediatric head trauma, mortality, discharge, prognosis