Current Issue

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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