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