European Journal of Cardiovascular Medicine

Background: Chemotherapy for tuberculosis (TB), though highly effective, is often associated with adverse drug reactions (ADRs) that may impact treatment adherence and outcomes. Pharmacovigilance studies are essential to identify and characterize these reactions in clinical practice. Objectives: To assess the incidence, pattern, causality, severity, and outcomes of chemotherapy-induced ADRs in patients with TB. Methods: This prospective observational study included 100 adult TB patients receiving anti-tubercular chemotherapy. Baseline demographics, clinical characteristics, and regimen details were recorded. ADRs were identified through active monitoring and evaluated for organ system involvement, causality (WHO–UMC criteria), and severity (Modified Hartwig scale). Outcomes were documented at follow-up. Data were analyzed descriptively. Results: The mean age was 42.6 ± 13.2 years, with a male predominance (62%). Pulmonary TB accounted for 72% of cases, and 84% received the standard HRZE regimen. ADRs occurred in 68% of patients, totaling 92 events, with a median onset of 14 days (IQR: 9–21). Multiple ADRs were noted in 19% of patients. Gastrointestinal (26.1%), hepatobiliary (21.7%), cutaneous (15.2%), and neurological (13.0%) systems were most frequently affected. Causality was probable in 47.8%, possible in 40.2%, and certain in 12.0% of cases. Severity grading showed 45.6% mild, 42.4% moderate, and 12.0% severe ADRs. Recovery occurred in 91.3%, residual effects in 6.5%, and mortality in 1.1%. Conclusions: ADRs to TB chemotherapy are common, predominantly gastrointestinal and hepatobiliary, and require early detection and management to optimize adherence and outcomes. Strengthened pharmacovigilance systems are vital in TB control programs

Background: Major trauma remains a leading cause of death worldwide, especially in individuals under 45 years. Early diagnosis and treatment are critical. WBCT (Whole-Body Computed Tomography) has been increasingly used in trauma settings due to its high diagnostic accuracy and potential to detect clinically occult injuries. However, its benefits over selective CT imaging, particularly regarding mortality, radiation exposure, and cost, remain controversial. Materials And Methods A retrospective cohort study was conducted using case records of trauma patients admitted to the emergency department between January 1, 2017, and December 31, 2018. Patients were divided into two groups: those who underwent selective CT and those who underwent WBCT. Inclusion criteria involved patients with life-threatening trauma, specific mechanisms of injury, or severe clinical suspicion. Exclusion criteria included age <18 years, pregnancy, stab wounds, and incomplete records. Data were statistically analyzed using descriptive and inferential techniques. Results: A total of 443 patients were included, with a mean age of 34.54 ± 17.88 years and a male predominance (78%). Selective CT was used in 248 patients (56%), and WBCT in 195 patients (44%). The WBCT group showed a significant reduction in emergency department stay (mean difference -32.39 minutes, p = 0.001). There was a 16% higher detection rate of intra-thoracic injuries with WBCT. However, no significant differences were observed in 24-hour mortality (WBCT 8% vs. selective 6%, p = 0.23), 30-day mortality (WBCT 17% vs. 16%, p=0.69), or overall mortality (WBCT 15.9% vs. 15.7%, p = 0.92). WBCT was associated with higher radiation exposure and cost (p<0.01). Conclusion: While WBCT offers faster diagnostic times and better detection of certain injuries, it does not significantly improve survival outcomes compared to selective imaging. Given the increased radiation and cost, WBCT should be reserved for patients with severe polytrauma or non-evaluable clinical status. Selective imaging remains sufficient for clinically stable patients based on history and physical examination.

Background: Extubation technique plays a crucial role in ensuring a smooth recovery from general anaesthesia particularly in faciomaxillary surgeries where airway complications are a concern. This study aims to compare the "No Touch" Awake Extubation technique with Conventional Extubation in terms of emergence quality, incidence of airway complications and hemodynamic stability. Methods: A randomized, double-blinded controlled study was conducted at hospitals attached to Bangalore Medical College and Research Institute over six months. Sixty adult patients (ASA I–II) undergoing elective faciomaxillary surgeries under general anesthesia were equally divided into two groups: Conventional Extubation (Group 1) and No Touch Awake Extubation (Group 2). Primary outcomes included time to spontaneous eye opening, emergence quality (20-point scale) and incidence of adverse airway events. Hemodynamic parameters were recorded at various time intervals post-extubation. Data were analyzed using SPSS, with p < 0.05 considered statistically significant. Results: The No Touch Awake Extubation group exhibited significantly shorter emergence times (4.73 ± 2.05 minutes vs. 10.20 ± 2.88 minutes; p < 0.001) and superior emergence quality scores (17.70 ± 1.47 vs. 16.10 ± 1.49; p < 0.001). Airway complications, including breath-holding, tube-biting and laryngospasm were lower in the No Touch group. While heart rate variations were comparable, the No Touch group demonstrated significantly higher mean. Conclusion: The No Touch Awake Extubation technique offers superior emergence quality, reduced incidence of airway complications and better hemodynamic stability compared to conventional extubation making it a preferable approach in faciomaxillary surgeries.

Background: Preterm birth remains a major contributor to neonatal morbidity and mortality. Women with a history of spontaneous miscarriage are at increased risk of cervical insufficiency, potentially leading to preterm delivery. Cervical length (CL) assessment via transvaginal ultrasound is an established method for predicting preterm birth, but its predictive role in women with prior miscarriage is less well explored. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College, Bhupalpally, from June 2024 to May 2025. A total of 200 pregnant women with a history of one or more spontaneous miscarriages and singleton pregnancies were enrolled between 16–24 weeks of gestation. Cervical length was measured transvaginally. Participants were followed until delivery to assess gestational age and preterm birth (<37 weeks). Statistical analysis included chi-square test, logistic regression, and ROC curve analysis. Results: Out of 200 participants, 52 (26%) experienced preterm birth. The mean cervical length in women who delivered preterm was 24.1 ± 3.8 mm compared to 32.3 ± 2.9 mm in term deliveries (p < 0.001). A cervical length <25 mm had a sensitivity of 80.8% and specificity of 78.4% for predicting preterm birth. The area under the ROC curve was 0.84 (95% CI: 0.78–0.89). Conclusion: Cervical length measurement between 16–24 weeks is a reliable predictor of preterm birth in women with previous spontaneous miscarriage. Early identification allows timely interventions such as progesterone therapy or cerclage to reduce preterm delivery risk.

Introduction: Spinal anaesthesia-induced hypotension is common during caesarean sections, potentially compromising uteroplacental perfusion. Vasopressors like phenylephrine and mephentermine are frequently used to restore blood pressure, but their efficacy and side-effect profiles differ. This study compares the effectiveness and maternal-fetal outcomes of bolus phenylephrine versus mephentermine. By understanding the differences in response profiles between these agents, clinicians can better tailor vasopressor use based on individual patient needs and optimize both maternal and fetal safety. Materials and Methods: This randomized, double-blind study was conducted over 6 months in the Department of Anaesthesiology at a tertiary care hospital consist of 100 ASA I and II parturients undergoing elective caesarean section under spinal anaesthesia. Group P received 50 µg phenylephrine IV bolus; Group M received 6 mg mephentermine IV bolus for hypotension (SBP < 100 mmHg or drop >20% from baseline). Hemodynamic parameters, number of doses required, and side effects were recorded. All patients received 10 ml/kg Ringer lactate preloading. Spinal anaesthesia was administered in the L3–L4 interspace using 0.5% hyperbaric bupivacaine (2.0 mL). Sensory block to T6 was confirmed. Results: Both groups were well-matched in terms of age, weight, baseline systolic blood pressure (SBP), and heart rate (HR). The lack of statistically significant differences (p > 0.05) indicates successful randomization. Group P (phenylephrine) restored SBP in 2.8 ± 1.2 minutes, significantly faster than Group M (4.1 ± 1.3 minutes). Group P required fewer bolus doses (1.4 ± 0.6) compared to Group M (2.3 ± 0.8), which was statistically significant. Bradycardia occurred more often in Group P (24%) vs. Group M (6%), highlighting a major side effect of phenylephrine. No significant difference in 1-minute and 5-minute Apgar scores between the groups. Conclusion: Phenylephrine is more effective in rapidly restoring blood pressure but is associated with bradycardia. Mephentermine maintains heart rate better but may require repeated dosing. Both agents are safe for fetal outcomes

Introduction: The flipped classroom model, a pedagogical approach that reverses traditional learning by providing pre-class materials for independent study and reserving in-class time for active learning, has gained considerable attention in medical education. This randomised controlled trial aimed to investigate the efficacy of the flipped classroom model compared to traditional didactic lectures in enhancing knowledge acquisition and student satisfaction among second-year medical students. Methods: This study enrolled 100 second-year medical students from Kannur Medical College, who were randomly allocated to either the flipped classroom group (n=50) or the didactic lecture group (n=50). The flipped classroom group engaged with pre-class materials (videos, readings, voice recording, quizzes) on circulatory disturbances topics, followed by in-class the didactic class on the next day. The didactic lecture group received only lectures on the same topics. Knowledge acquisition was assessed using pre- and post-intervention multiple-choice question (MCQ) tests. Student satisfaction was evaluated through a post-intervention survey utilising a 5-point Likert scale. Results: The flipped classroom group outperformed the didactic lecture group in both post-intervention Test score (mean ± SD: 15.66 ± 2.12 vs. 14.40 ± 1.92, p < 0.001) scores. Furthermore, students in the flipped classroom group reported significantly higher overall satisfaction (mean ± SD: 4.34 ± 0.72 vs. 3.56 ± 0.70, p < 0.05), particularly in engagement, perceived learning, and the ability to apply knowledge in clinical scenarios. Conclusions: The flipped classroom model demonstrates superior efficacy in enhancing knowledge acquisition and student satisfaction compared to traditional didactic lectures in medical education. These findings underscore the potential of the flipped classroom model to revolutionise medical education by promoting active learning, critical thinking, and self-directed learning, thereby better preparing future physicians for the challenges of modern healthcare.

Introduction: Menstruation is characterized by coordinated sequence of hormonal changes but the Electrocardiographic (ECG) changes have not been clearly established.  Material and Methods: The present study was carried out on 100 healthy female medical students in the age group of 18 to 23years with normal regular menstrual cycle of 27-33 days. Heart rate, PR interval, QT interval was studied on 2nd ,11th, 22nd day of menstrual cycle i.e Menstrual phase, Proliferative phase and Secretory phase of menstrual cycle respectively using AD INSTRUMENT-POWERLAB ® /30 SERIES. Result: Heart rate was significantly (P<0.05) increased in proliferative phase compared to menstrual phase but PR Interval & QT interval showed no significant changes. Conclusion: The changes may be attributed to blood volume changes due to electrolytes and hormonal changes.

Background: Effective postoperative pain control enhances recovery and patient satisfaction. The Transverse Abdominis Plane (TAP) block is an established regional anesthesia technique for abdominal surgeries. This study compares the efficacy of 0.25% Bupivacaine and 0.5% Ropivacaine in TAP blocks for postoperative analgesia. Aim: To evaluate the effectiveness of 0.25% Bupivacaine versus 0.5% Ropivacaine in TAP block in terms of duration of analgesia, time to first rescue analgesia, pain intensity, hemodynamic stability, and complications. Materials and Methods: This was a prospective, randomized, single-blinded controlled trial involving 60 patients (ASA I–II) undergoing elective abdominal surgeries under general anesthesia. Patients were randomly allocated into two groups: Group B (Bupivacaine, n=30) and Group R (Ropivacaine, n=30), receiving 15 ml of the respective drug bilaterally in the TAP block. Postoperative pain was assessed using the Visual Analog Scale (VAS) and rescue analgesia was administered when VAS >3. Results: Ropivacaine provided significantly longer analgesia (725.33 ± 18.89 min vs. 408 ± 14.10 min; p=0.001) and delayed time to first rescue analgesia (735.33 ± 18.89 min vs. 417.67 ± 15.01 min; p=0.001). VAS scores were consistently lower in the Ropivacaine group at key time intervals. Hemodynamic parameters remained stable in both groups. No complications were reported. Conclusion: 0.5% Ropivacaine is superior to 0.25% Bupivacaine for TAP block in providing prolonged postoperative analgesia with better pain control and no additional complications.

Background: Congenital heart disease (CHD) is a prevalent global health issue, affecting approximately 9 out of every 1000 newborns, with India witnessing nearly 200,000 children born with CHD each year. In 20-30% of CHD cases the genetic cause is known leaving approximately 60% unknown. TOF (Tetralogy of fallot), characterized by several cardiac anomalies, necessitates early identification and intervention. Despite genetic abnormalities identified in TOF, not all cases can be explained by known genetic changes, indicating the presence of additional contributing factors.  Methods: In this study, array CGH was employed to identify and characterize chromosomal aberrations in blood and heart tissue samples from clinically confirmed TOF cases followed by validation with RTPCR. Results: On analysis we found that several chromosomal regions were deleted and amplified across many individuals with TOF. Our study also identified unique deletions on chromosome 4, 5, 6, 7, 13. The validated regions harbour many genes (TBX1, NKX2-5, ZFPM2, and GATA4) already implicated in TOF and other congenital heart disease. Validation was also done in an independent set of subjects not included for array CGH analysis. The unique novel regions harbour many genes (UGT2B17, ZDHHC11, ZDHHC11B, TRGC2, TARP, TCRGV) implicated in development, anticipated to have active role in developing heart.  Conclusion: The findings aim to uncover signature molecular regions altered in TOF, with validation through RT-PCR from blood. The study provides valuable insights for future TOF screening and diagnostic panels, contributing to improved patient care and management.

Introduction: Menstruation is characterized by co-ordinate sequence of hormonal changes but the Anthropometric changes have not been clearly established. Objective: To compare Anthropometric changes in different phases of menstrual cycle. Materials and methods: The present study was carried out on 100 healthy female medical students in the age group of 18 to 23years with normal menstrual cycle of 27-33 days. Weight, height was recorded and Body Mass Index was calculated as weight (in Kg) divided by height in (meters)². Body Mass Index was studied during Menstrual phase, Proliferative phase and Secretary phase of menstrual cycle. Statistical analysis was done using SPSS 17.0 Software. To compare means of two independent groups, student’s t- test for independent samples was used. Results: Height (cms) was 156.85 ± 6.27. Mean ± S.D of weight in Menstrual Phase, Proliferative Phase, Secretory Phase were(53.73 ±9.49), (53.47 ±9.40) , (53.633 ±9.44) respectively. Mean ± S.D of Body Mass Index were (21.79±3.37), (21.89±4.52), (21.75±3.37) in Menstrual Phase, Proliferative Phase and Secretory Phase respectively. No statistically significant values in weight and BMI were noted.  Conclusion: Non- alteration of the BMI in different phases of menstrual cycle clearly reflects no gross physiological changes. Further study has to be conducted with large sample size. 

Background: Large language models (LLMs) like ChatGPT, enhance scientific research by processing vast amounts of data and improving personalized learning, clinical reasoning, and workflow efficiency in healthcare. Ethical considerations and reduced human interactions, highlight the need for medical education to incorporate AI literacy, data science, and bioethics to prepare future physicians for AI-integrated healthcare. Methods: As per the requirements of this study, a brief questionnaire was developed. This was a descriptive cross-sectional study and data was collected using circulation of electronic surveys and physical questionnaires via simple random sampling technique. The inclusion criteria were clinicians practicing medicine in India with different degrees (E.g. MBBS, BAMS, BHMS, etc). Clinicians who do not have access to digital platforms or technology necessary for interacting with ChatGPT were excluded. Data was documented and analysed using Microsoft Excel 2019. Chi square test was used to determine the association between various parameters and extent of familiarity with ChatGPT. Results: A total of 380 responses were collected. The majority were aged 35-44 years (30.8%), with MBBS/MD/MS or equivalent being the most common qualification (37.6%). Most respondents had 0-5 years of clinical experience (36.5%). Only 21% were very familiar with ChatGPT, while 41.8% were not familiar. Nearly half (45.5%) had interacted with a chatbot, and 65% used ChatGPT in less than 20% of their practice. While 45% viewed AI chatbots as beneficial, 28.4% were unsure of their impact. Confidence in AI accuracy was mixed, with only 20.7% being very confident. Ethical concerns were reported by 32.1% of participants. Interest in AI training was high (64.2%), though 66.6% were unaware of government policies on AI in healthcare. Familiarity with AI was significantly associated with age (p=0.004), sex (p=0.0002), qualification (p=0.003), and experience (p=0.0001). Conclusion: AI could be an excellent resource which can augment the work of physicians and make a significant impact in improving efficiency. However, currently there is much progress left to be made as AI cannot fully replace the role of a physician. Incorporation of AI training in medical education is the need of the hour.

Background: Coronary artery bypass grafting (CABG) is the standard of care for revascularization in patients with multi-vessel coronary artery disease (CAD) and is performed either with aid of cardiopulmonary bypass (on-pump) or without cardiopulmonary bypass (off-pump). One of the main reasons to offer cardiac surgery is to improve both survival and quality of life (QoL). The assessment of QoL prior to cardiac surgery has thus garnered increasing interest among clinicians as a factor to be taken into consideration when estimating the potential benefit to be gained by the patient from the intervention.  Material and Methods: The present study is prospective and observational study was conducted in the was conducted in the Department of Cardiothoracic and vascular surgery, Yashoda Hospital. We analysed the data from 60 patients who were scheduled to undergo CABG. The institutional ethics committee approved the present study and patient consent was obtained from all the patients.  Results: The mean age of the patients was 55.83±9.77, (76.67%) percentage of male and (23.33%) of female were included. Diabetes mellitus was observed in (66.67%) of patients and COPD in 5% of patients. Most of the study groups contains triple vessel disease (88.33%) followed by double vessel disease (8.33%) and single vessel disease (3.33%). Preoperative IABP was not used in any of the patients and preoperative inotropes were used in two patients (3.33%). Intraoperative and postoperative characteristics of the patients was evaluated (table 2). Off-pump surgery was done in (95%) of patients whereas (5%) of the patients underwent On-pump surgery. Mean number of grafts used were 3.36±1.02. There were no conversions from off - pump to on- pump  The mean of total chest tube drain was 685.8±138.4, intraoperative IABP support was used in 1 patient (1.67%) which was continued postoperatively, means of ventilation time and hospitals stay was 17.35±7.05, 7.50±2.56 respectively. Conclusions: In patients with coronary artery disease, CABG surgery is not only for prolonging the life of patients, it is important for improving the quality of life of CAD patients. Therefore, it is important to evaluate pre- operative conditions of cardiac surgery patients to obtain results that can be compared with post-operative quality of life outcomes.

Background: Peritonitis remains a major surgical emergency associated with high morbidity and mortality, posing significant challenges in clinical management. Peritoneal lavage, a technique involving irrigation of the abdominal cavity, is commonly employed during surgery to reduce microbial load and remove inflammatory debris. Various solutions have been used for this purpose, including normal saline and antibiotic-based preparations. Among these, metronidazole has shown promise due to its broad antimicrobial activity. This study aims to compare the clinical efficacy of saline versus metronidazole peritoneal lavage in surgically treated cases of peritonitis, to determine the more effective approach for improving patient outcomes. Material and Methods: This was a prospective, randomized comparative study conducted on 100 patients with perforation peritonitis who underwent laparotomy. Patients were divided into two groups: Group A received peritoneal lavage with metronidazole in saline, and Group B received saline alone. Postoperative outcomes, including wound dehiscence, intra-abdominal abscess, sepsis, and hospital stay, were assessed. Data were analyzed using SPSS version 25.0, with p < 0.05 considered statistically significant. Results: Both groups were comparable in terms of age and gender distribution, with no statistically significant differences observed (p > 0.05). The most common causes of peritonitis were gastric and ileal perforations, similarly distributed across both groups. Patients in the Metronidazole group showed significantly better clinical outcomes. A higher proportion of patients (72%) were discharged within 10 days compared to 32% in the Saline group (p < 0.001), and the mean hospital stay was significantly shorter in the Metronidazole group (9.23 ± 1.24 days vs. 12.46 ± 1.95 days; p < 0.001). The Metronidazole group also had lower rates of surgical site infection (20% vs. 32%; p = 0.037) and sepsis (16% vs. 44%; p = 0.001). Additionally, 40% of patients in the Metronidazole group had no postoperative complications, in contrast to 0% in the Saline group (p < 0.001). Differences in rates of intra-abdominal abscess and wound dehiscence were not statistically significant. Conclusions: This study demonstrates that peritoneal lavage with metronidazole is significantly more effective than saline lavage in reducing postoperative sepsis and shortening hospital stay in patients undergoing surgery for perforation peritonitis. The findings highlight metronidazole lavage as a safe and efficient adjunct to surgical management, contributing to fewer complications and faster recovery, thereby supporting its clinical utility in improving patient outcomes.

Background: Just as our early ancestors moved from aquatic environments to terrestrial ones, we, similarly, reside in amniotic fluid until we are born. This safeguarding liquid, referred to as amniotic fluid or "liquor amnii" in Latin, envelops the fetus within the amniotic sac and starts to develop approximately 7 to 8 days after fertilization. Objectives: To study incidence of oligohydramnios and polyhydramnios in pregnant women attending OPD and IPD.  To study obstetric outcome in pregnancies with oligohydramnios and polyhydramnios. To determine the perinatal outcome in pregnancies complicated with Oligohydramnios and polyhydramnios. Material & Methods: Study Design: A prospective observational study. Study area: mother and child hospital, Yadgir institute of medical sciences Yadgir. Study Period: 1 year. Study population: Pregnant women with abnormal AFI reporting to mother and child hospital, Yadgir institute of medical sciences Yadgir during study period. Sample size: The study consisted of a total of 450 subjects. Sampling method: convenience sampling method.    Results: Out of 80 subjects, 7.5% had AFI <3cm, 58.75% had AFI 3-5cm and 33.75% had AFI >25cm. In 450 subjects included in the study 53 had AFI less than 5cm and 27 had AFI more than 25cm. Incidence of oligohydramnios is 11.7% and that of polyhydramnios is 6% in this study. Conclusion: Isolated oligohydramnios or polyhydramnios at term often has better outcomes but requires thorough evaluation, including ultrasound and clinical assessment, to detect anomalies or underlying causes. Early detection and management improve fetal outcomes and reduce maternal complications.

Background: Ischemic heart disease is one of main causes of death in industrialized countries. PCI is efficient therapeutic approach. Objective: to evaluate whether remote ischemic post-conditioning could reduce enzymatic infarct size in patients with acute ST-segment elevation myocardial infarction undergoing PCI. Methods: Study will be conducted in 100 patients presenting with 6-12hrs of onset of chest pain and diagnosed to be having acute STEMI in SSIMS&RC, Davanagere. All patients are prepared with thigh-sized limb cuff before arterial puncture. In active treatment group, protocol will be started with thrombolysis/balloon inflation, whichever occurred first, lower limb will be exposed to 3 cycles of ischemia/reperfusion, each obtained by 5min cuff inflation at 200mmHg, followed by 5min complete deflation. End point of study will be enzymatic infarct size assessed by AUC of CK-MB release. Blood samples will be collected before PCI, every 6hrs during first 48h and at 72hrs. Result: Among cases 28 patients (56%) had blush grade 3, 15patients (30%) had blush grade 2 and 7patients (14%) had blush grade 1 respectively after PCI among control group 10patients (20%) had blush grade 3, 20 patients (40%) had blush grade 2 and 20patients (40%) had blush grade 1 respectively after PCI. There was significant statistical difference between two groups. The AUC of serum CK release during the first 72 hours of reperfusion was significantly reduced in postconditioned group compared with control group. Conclusion: Remote post conditioning of lower limb significantly improves blush grading and enzymatic infarct size reduction with a trend towards significant reduction of mean ST segment deviation. Hence RIPC reduces enzymatic infarct size obtaining beneficial effect.

Background: Emerging evidence highlights the critical role of the maternal microbiome in modulating immune, metabolic, and hormonal functions during pregnancy. Alterations in microbial communities may contribute to adverse pregnancy outcomes such as preeclampsia, preterm birth, gestational diabetes mellitus (GDM), and intrauterine growth restriction (IUGR). This longitudinal study investigates the association between maternal microbiome composition and pregnancy outcomes across the three trimesters. Materials and Methods: A prospective cohort of 120 pregnant women aged 20–35 years was recruited at <12 weeks gestation and followed through delivery. Vaginal, oral, and fecal microbiome samples were collected at each trimester. 16S rRNA gene sequencing was used for microbial profiling. Pregnancy outcomes assessed included gestational age at delivery, incidence of GDM, hypertensive disorders, and neonatal birth weight. Alpha and beta diversity indices were calculated, and associations with outcomes were analyzed using multivariate regression models. Results: Out of 120 participants, 112 completed the study. Women who developed preeclampsia (n=14) showed significantly lower vaginal microbial diversity in the second trimester (Shannon index mean: 2.1±0.4) compared to normotensive women (3.5±0.6; p<0.001). Higher relative abundance of Prevotella and Gardnerella in the vaginal microbiome was significantly associated with preterm birth (n=11; OR=2.8, 95% CI: 1.4–5.6). Gut microbial dysbiosis characterized by a lower Firmicutes/Bacteroidetes ratio was observed in GDM cases (n=16) during the third trimester (p=0.02). No significant changes were observed in oral microbiome patterns across groups. Conclusion: This study underscores the dynamic nature of the maternal microbiome and its potential predictive value for pregnancy complications. Specific microbial shifts, particularly in the vaginal and gut environments, are associated with adverse outcomes such as preeclampsia, preterm birth, and GDM. Monitoring maternal microbiome profiles may serve as a non-invasive tool for early identification of at-risk pregnancies and inform targeted interventions.

Background: Labour induction in patients with an unfavorable cervix is often challenging. Prostaglandin analogs like dinoprostone and mechanical methods such as Foley catheter insertion are commonly used for cervical ripening. This study aims to compare the efficacy and safety of intracervical dinoprostone gel versus Foley catheter insertion for labour induction in women with an unfavorable cervix. Materials and Methods: A prospective comparative study was conducted on 200 pregnant women with term singleton pregnancies and a Bishop’s score ≤4. Group A (n=100) received intracervical dinoprostone gel, while Group B (n=100) underwent mechanical dilatation with a Foley catheter. Primary outcomes were induction-to-delivery interval, mode of delivery, and maternal-fetal outcomes. Results: Dinoprostone achieved delivery 3.6 hours faster on average (10.2 hours) compared to the Foley catheter (13.8 hours). The narrower standard deviation (SD) for dinoprostone (±3.6 vs. ±4.2) suggests more consistent/predictable delivery times with prostaglandin use. Dinoprostone group had a shorter induction-to-delivery interval (mean 10.2 ± 3.6 hours) compared to the Foley catheter group (mean 13.8 ± 4.2 hours). Vaginal delivery rates were higher in the dinoprostone group (76% vs. 62%). Maternal complications such as hyperstimulation were more common with dinoprostone, whereas mechanical method had a higher incidence of infection. Conclusion: Dinoprostone gel is more effective for cervical ripening and shortening induction-to-delivery time, although associated with higher rates of uterine hyperstimulation. Foley catheter is safer with fewer systemic side effects.

Background: Liver cirrhosis is a chronic, progressive disease marked by systemic complications including autonomic nervous system (ANS) dysfunction, which has been increasingly recognized as a contributor to morbidity and mortality. Despite its prognostic significance, autonomic dysfunction in cirrhosis remains under-assessed. Aim: To evaluate the presence, pattern, and severity of autonomic dysfunction in patients with hepatic cirrhosis and correlate findings with the Child-Pugh classification. Methods: This hospital-based case-control study was involved 30 cirrhotic patients and 30 age- and sex-matched healthy controls. Cirrhotic patients were categorized into Child-Pugh Classes A, B, and C. Parasympathetic and sympathetic functions were evaluated using standardized tests including E/I ratio, Valsalva ratio, Lying/Standing ratio, postural fall in SBP, cold pressor response, and hand grip test. Mean values were calculated from three consecutive recordings. Statistical significance was set at p<0.05. Results: Autonomic dysfunction was found in 73.3% of cirrhotic patients. Parasympathetic tests showed early and more frequent abnormalities, with E/I ratio abnormal in 60% of cases. Sympathetic dysfunction became prominent in advanced stages (Child Class C), where 73.3% exhibited combined impairment. All parameters worsened significantly with increasing Child-Pugh class (p<0.001). Conclusion: Autonomic dysfunction, particularly of parasympathetic origin, is prevalent in hepatic cirrhosis and correlates with disease severity. Given its prognostic implications and potential reversibility, routine autonomic assessment should be integrated into cirrhosis management protocols.

Background: Studies linking microalbuminuria with ECG and 2D Echo parameters of CVD risk are few in Indian literature.

Objective: The study aimed to identify the prevalence of microalbuminuria in predicagtges, prehypertension and predicabetes and prehypertension coexistent and its association with ECG and Echocardiographic manifestations a indicative of cardiovascular risk. Methods: In this prospective observational study carried in 50 subjects with prehypertension, prediabetes and prehypertension and prediabetes coexistent, who satisfied the inclusion criteria, detection of microalbuminuria was done using MICRAL test. All the patients were evaluated with ECG and Echocardigoraphy. Pre HTN and Pre DM patients were diagnosed using JNC8 guidelines and American Diabetes Association criteria respectively Results: The prevalence of microabuminuria was 40% in the overall study population. The mean systolic blood pressure was 122.04±3.6mmHg. Diastolic blood pressure was 79.24±1.6mmHg and fasting blood sugar was 116.79±4.29 mg/dl. The prevalence of microalbuminuria was 10% in isolated prediabetes. 10% in isolated pre-hypertensives and 20% in subjects with both prehypertension and prediabetes. 26% subjects of microalbuminuria positive were showing ECG changes in the form of ST Segment and T wave changes and in 22% subjects of micoalbuminuria positive were showing 2DECHO. Changes in the form of increased LVMI in the total study populations. In our study of ECG abnormalities, ST and T wave changes were observed in subjects of 40-60 age groups, the increased LVMi in 2DECGI was observed predominantly in the 40 to 60 years age group. Increased LVMI was observed higher in males than females. Cardiac involvement was more commonly observed in prehypertensive and prehypertension and prediabetes compared to isolated prediabetes in the total study population. Cardiac changes were significantly higher in Microalbuminuria positive subjects compared to Microalbuminuria negative subjects<0.001 for ST and T wave changes in ECG and p<0.001 for increased LVMI in 2DECHO Conclusion: Microalbuminuria may prove as a bio measure for individalising treatment regiments in subjects with CVD risk. Microalbuminuria may be an ideal target for early primary prevention using cardiovascular protective therapy regiments.

Introduction: Objectives: ‘‘Code Blue’ is a standardised hospital emergency system for rapid response to cardiorespiratory arrest. Conventional Code Blue systems (CBS) rely on overhead paging, manual team mobilisation, and paper-based documentation, leading to slower communication, delayed response, and limited quality improvement. In contrast, mobile-based Code Blue systems enable silent, real-time activation, automated documentation, and seamless communication through secure messaging and voice calls. This study aimed to evaluate the efficiency of a basic single mobile voice call-based Code Blue activation at a 200-bedded cardiothoracic centre and assess its effectiveness while analysing factors influencing patient survival.

Design: Retrospective audit of a functioning code-blue system. Setting: 200-bed tertiary care cardiothoracic unit with cardio-thoracic surgical, cardiology and respiratory medicine units supported by laboratory and imaging services. The code blue activation system studied is a cell phone voice-based code-blue system where a simple voice call was made to a designated mobile phone number to activate a code. This cellphone was carried by the code-blue team stationed in a centrally located operation theatre at all times. This ensured trained responders could be rapidly mobilised without relying on centralised announcements, improving response times and minimising delays. Participants: An analysis of all ‘Code Blue’(CB) feedback forms filled up after completing a cell phone-based ‘Code Blue’ call during the study period (Aug 2021 to Dec 2023). Interventions: No interventions were performed. A retrospective analysis of all cellphone-based code blue calls and data from code blue forms was conducted. Measurements Data from the forms recorded, including response times, patient condition, interventions performed, and outcomes, was systematically tabulated and analysed using standard statistical methods to assess the effectiveness of the mobile-based system. Key performance metrics, such as response time, interventions, and survival outcomes, were compared with previously published studies on conventional Code Blue systems (CBS) to determine the system’s efficiency. Main Results: 149 code-blue calls during the study period were analysed, 85% of which originated from acute care areas. The response time of the code-blue team to reach the site along with defibrillators, equipment and medications (2.22±1.43 minutes) was similar to conventional code-blue response times previously reported in the literature from other centres (2.83 ± 1.30 minutes). 26.8% of cases did not require CPR. The most common presenting rhythms were severe bradycardia and asystole (54.3%), while chest compressions (53.6%) and endotracheal intubation (7.3%) were the most frequent pre-arrival interventions noted. Adrenaline was administered in 66.4% of cases, and 17.4% required defibrillation. ROSC was achieved in 18.4% of asystole cases. Poor outcomes were linked to age >60 years and asystole. Despite 57.7% of calls occurring outside working hours, there was no difference in outcomes between working and non-working hours. CPR duration (p<0.001) and adrenaline doses (p<0.001) were significantly higher in patients who did not achieve ROSC.  Conclusion: The cellphone-based voice call-activated Code Blue system demonstrated satisfactory response times. It is a viable alternative to conventional systems in compact hospital settings with a single response team, ensuring efficient emergency activation. In the era of the Internet of Things, with real-time guidance by mobile maps, innovative cell phone-based solutions will be able to cater even for larger widespread patient care areas.

Background: Type 2 Diabetes Mellitus (T2DM) is associated with chronic low-grade inflammation, which may elevate plasma fibrinogen levels—an established risk marker for cardiovascular and microvascular complications. Objective: To evaluate fibrinogen levels in T2DM patients and examine their association with glycemic control (HbA1c), microalbuminuria, and other cardiovascular risk factors. Methods: This cross-sectional analytical study included 50 T2DM patients and 50 age- and sex-matched controls. Clinical data, HbA1c, urinary albumin excretion, lipid profile, and plasma fibrinogen levels (via Clauss method) were assessed. Statistical analysis included t-tests, correlation coefficients, and multivariate logistic regression to identify independent predictors of elevated fibrinogen. Results: Diabetic patients had significantly higher fibrinogen levels than controls (396.64 ± 164.73 vs. 252.6 ± 79.26 mg/dL, p < 0.05). Fibrinogen correlated strongly with HbA1c (r = 0.622), microalbuminuria (r = 0.647), and diabetes duration (r = 0.482). Patients with poor glycemic control (HbA1c > 7%) and microalbuminuria exhibited markedly elevated fibrinogen levels. Significant associations were also observed with dyslipidemia and diabetic retinopathy. Multivariate analysis identified duration of diabetes > 5 years (OR = 2.8, p = 0.008), total cholesterol > 200 mg/dL (OR = 2.5, p = 0.024), and microalbuminuria (OR = 3.6, p = 0.003) as independent predictors of elevated fibrinogen. Conclusion: Fibrinogen levels are significantly elevated in T2DM and correlate with poor glycemic control, nephropathy, and dyslipidemia. These findings support the potential utility of fibrinogen as a marker of cardiovascular and microvascular risk in diabetic populations.

Background: Necrotizing soft tissue infections (NSTIs) are rapidly progressive and life-threatening. Timely diagnosis is critical. This study aimed to compare the diagnostic performance of radiological imaging versus microbiological testing in NSTIs. Methods: This retrospective review included 100 patients treated at Patna Medical College and Hospital between January 2024 and May 2025. Data were analyzed to assess diagnostic sensitivity, specificity, predictive values, time to diagnosis, inter-modality agreement, and clinical outcomes. Confirmed NSTI status was used as the reference standard. Results: Radiological imaging demonstrated superior sensitivity (79.4%) and a significantly faster mean time to diagnosis (5.8 ± 3.8 hours) compared to microbiological testing (sensitivity 57.1%; time to diagnosis 18.8 ± 8.2 hours; p < 0.001). Microbiology had higher specificity (94.6%) and positive predictive value (94.7%). The modalities showed only fair agreement (Cohen’s κ = 0.25), indicating they often identified different cases. Microbiological positivity was significantly associated with mortality in univariate analysis (p = 0.006), but neither modality independently predicted mortality in multivariate regression. Confirmed NSTI status was the only independent predictor of in-hospital mortality (OR = 3.40, p = 0.003). No significant association was found between test modality and limb amputation. Conclusions: Radiological imaging enables faster and more sensitive detection of NSTIs, while microbiological testing offers greater specificity. The limited agreement between modalities underscores their complementary roles. Early and accurate diagnosis remains essential, with confirmed NSTI status being a strong independent predictor of mortality.

Background: Surgical site infections (SSIs) remain a major cause of postoperative morbidity in ventral hernia repair. The choice between open and laparoscopic approaches may influence infection rates and recovery outcomes. Objectives: To compare the incidence of SSIs and other postoperative outcomes between open and laparoscopic ventral hernia repair, and to identify associated patient-related risk factors. Methods: This randomized comparative study was conducted over a two-year period at Raja Rajeswari Medical College and Hospital, involving 60 patients with clinically diagnosed ventral hernias. Participants were allocated into two groups: 30 underwent open mesh repair, and 30 underwent laparoscopic repair. Demographic and clinical parameters were recorded, and postoperative outcomes including SSI incidence, hospital stay, and readmission rates were analyzed. Statistical tests included chi-square, Fisher’s exact, and independent t-tests. Results: SSI occurred in 20% of patients in the open repair group versus 3.3% in the laparoscopic group (p = 0.045). The mean hospital stay was significantly shorter for the laparoscopic group (3.1 ± 1.2 days) compared to the open group (5.4 ± 2.3 days; p = 0.002). Diabetes mellitus was significantly associated with SSI occurrence (p = 0.013), while smoking and anaemia showed trends toward increased risk. Conclusion: Laparoscopic ventral hernia repair significantly reduces SSI incidence and shortens hospital stay compared to open repair. Preoperative optimization of comorbidities such as diabetes may further reduce infection-related morbidity.

Background: Urinary tract infections (UTIs) are among the most common bacterial infections globally, with Escherichia coli and Klebsiella pneumoniae being predominant pathogens. The emergence of extended-spectrum beta-lactamase (ESBL)-producing strains of these organisms has significantly complicated treatment due to their multidrug resistance. Objective: This study aimed to evaluate the effectiveness of selective antibiotics against ESBL-producing E. coli and Klebsiella pneumoniae isolated from urine samples over a two-month period. Methods: A prospective observational study was conducted in the Department of Microbiology, Sarvodaya Hospital and Research Center, Faridabad, from February to March. A total of 234 ESBL-positive isolates were obtained from urine samples. Antibiotic susceptibility testing (AST) was performed using the VITEK 2 Compact system. The susceptibility patterns of both E. coli and Klebsiella pneumoniae were analyzed for commonly used antibiotics. Results: The highest sensitivity among E. coli isolates was observed for amikacin (91.67%), meropenem (90.00%), and imipenem (87.50%). Klebsiella pneumoniae showed the greatest sensitivity to imipenem (93.33%), ertapenem (86.67%), and meropenem (86.67%). Both organisms demonstrated high resistance to ciprofloxacin and amoxicillin-clavulanic acid. Nitrofurantoin and piperacillin-tazobactam also retained significant efficacy against both pathogens. Conclusion: Carbapenems and amikacin remain the most effective antibiotics for the treatment of UTIs caused by ESBL-producing E. coli and Klebsiella pneumoniae. The study underscores the need for continuous local antimicrobial surveillance to guide empirical therapy and antibiotic stewardship.

Background: Chylothorax is the accumulation of chyle, a lymphatic fluid, within the pleural cavity, which is the anatomical space between the lungs and the chest wall. This fluid generally has a high concentration of fat and lymphocytes. Aims: To investigate the incidence, etiology, diagnosis, and treatment of chylothorax in non-Hodgkin lymphoma (NHL) patients, with a focus on the condition's clinical relevance and effect on patient outcomes. Materials & Methods: The present study was an Observational study. This Study was conducted from One year (January 2024 - December 2024) at Nil Ratan Sarkar Medical College and Hospital, Kolkata, West Bengal. Total 30 patients were included in this study. Result: The pleural fluid analysis revealed a white blood cell count of 1100 ± 1120/µL, with a polymorphonuclear cell count of 110 ± 18/µL (8 ± 4%), and a mononuclear cell count of 990 ± 17/µL (88 ± 12%). The adenosine deaminase (ADA) level was 279 ± 2.3 U/L, lactate dehydrogenase (LDH) was 327 ± 27 U/L, triglyceride level was 742 ± 69 mg/dL, cholesterol was 115 ± 18 mg/dL, glucose (sugar) was 92.2 ± 6.5 mg/dL, and protein was 4.1 ± 0.8 g/dL. Conclusion: Chylothorax is a rare but important complication in patients with non-Hodgkin lymphoma (NHL), often resulting from lymphatic obstruction or infiltration by malignant cells. It presents as a lymphocyte-predominant exudative pleural effusion with elevated triglyceride levels.

Background: Hypothyroidism is a prevalent endocrine disorder known to affect cardiac structure and function, often leading to subclinical left ventricular (LV) dysfunction before the onset of overt cardiovascular disease. This study assessed LV systolic and diastolic functions in hypothyroid patients to detect early myocardial involvement. Methods: A cross-sectional observational study was conducted on 149 subjects (74 hypothyroid cases and 75 euthyroid controls) aged 18–65 years. All participants underwent detailed clinical evaluation, thyroid function tests, and echocardiography including tissue Doppler imaging (TDI). LV systolic and diastolic parameters were compared between groups. Statistical analysis was performed using appropriate tests, with a p-value <0.05 considered significant. Results: Diastolic dysfunction was significantly more prevalent in hypothyroid patients, evidenced by reduced E wave velocity (65.95 ± 7.17 vs. 76.2 ± 8.75 cm/s; P=0.01), increased A wave velocity (70.2 ± 8.44 vs. 60.85 ± 7.92 cm/s; P=0.01), and decreased E/A ratio (0.96 ± 0.16 vs. 1.27 ± 0.21; P=0.04). Deceleration time was prolonged (179.45 ± 22.56 ms vs. 156.39 ± 25.64 ms; P=0.01). TDI revealed significantly reduced systolic velocities (lateral s′ and septal s′) in cases. LV mass index was higher in hypothyroid subjects (P=0.04), while conventional systolic parameters remained preserved. A positive association was observed between higher TSH levels, longer disease duration, and worsening LV dysfunction. Conclusion: Hypothyroidism, even in its subclinical stage, is associated with early LV dysfunction, particularly diastolic impairment. TDI detects subtle systolic abnormalities not evident on conventional echocardiography. Routine cardiac evaluation in hypothyroid patients is essential for early diagnosis and prevention of progression to overt cardiac disease.

Background: CA125 (Cancer Antigen 125) is a tumor marker associated with ovarian cancer. It is gradually becoming apparent that it is also elevated in various conditions associated with inflammation or fluid overload. Similar to heart failure patients (Núñez et al., 2016),1 in chronic kidney disease patients on hemodialysis, who experience both fluid overload and inflammation, CA125 may potentially serve as a prognostic marker. Experimental evidence demonstrates that mechanical stretch directly upregulates expression of “MUC16” , the gene for CA125, secreted from mesothelial cells (Huang et al., 2013),2 providing a mechanistic basis for CA125 elevation in volume overload states. Objective: To investigate the correlation between CA125 levels and routine biochemical parameters (albumin and sodium) in maintenance hemodialysis patients, explore its potential as an early warning biomarker for patients at risk of developing hypoalbuminemia, and to explore gender-based differences in these relationships. Methods: This cross-sectional study analyzed 122 maintenance hemodialysis patients at a tertiary care government hospital in Eastern India. Complete data for CA125, albumin, and sodium was available for 87 patients. Serum albumin and sodium were measured using Beckman Coulter AU480, while CA125 was measured by chemiluminescent immunoassay. Statistical analysis included correlation analysis and ANOVA using R software version 3.6.1. To assess the diagnostic value of CA125 in identifying hypoalbuminemia, an analysis using receiver operating characteristic (ROC) curves was conducted (4.0 g/dL based on KDOQI). Multiple regression examined factors independently associated with log(CA125).A Results: The study population had a mean age of 47.9 ± 12.8 years with balanced sex distribution (M:F ratio 1.1:1). CA125 showed a log-normal distribution (p<10⁻¹⁶) with median 12.45 U/ml. Albumin demonstrated significant negative correlation with log CA125 (r=-0.47, p=0.000006). Among patients with elevated CA125 (>35 U/ml), 22.2% (4/18) had hypoalbuminemia (<3.5 g/dl) compared to only 1.4% (1/69) in those with normal CA125 (p<0.05). The albumin-sodium correlation was positive overall (r=0.20, p<0.00001) but showed progressive strengthening across CA125 tertiles, with only the high CA125 group showing significant correlation. Patients with hypoalbuminemia or hyponatremia had 5-fold higher mean CA125 (129.8 vs 26.1 U/ml). Gender analysis revealed stronger albumin-sodium correlation in females (r=0.35) compared to males (r=0.12). ROC analysis revealed that CA125 had excellent diagnostic accuracy for predicting hypoalbuminemia (<4.0 g/dL), with an AUC of 0.861 (95% CI: 0.791-0.932, p<0.001). The optimal cutoff value of 12.25 U/ml yielded a sensitivity of 77.1% and specificity of 80.7%. In multiple analysis, albumin remained significantly associated with log(CA125) after adjusting for confounders. Conclusion: High CA125 levels in hemodialysis patients correlate with dysregulation of albumin and sodium homeostasis, suggesting its potential as an early warning biomarker rather than a diagnostic replacement for albumin. CA125 reflects underlying pathophysiological processes (mesothelial stress, inflammation, volume overload) that precede overt hypoalbuminemia, making it valuable for risk stratification and targeted intervention. The stronger correlations observed in females warrant further investigation into gender-specific applications of CA125 monitoring in dialysis patients.

Background: The most frequent hospital-acquired illness (HAI) is still catheter-associated urinary tract infections (CAUTI). This highlights the necessity of putting in place and keeping an eye on efficient infection management measures in order to lower the risk of CAUTI. Aims: The current study's objectives were to compute CAUTI rat and identify the etiology with drug susceptibility. Materials & Methods: Catheter-associated urinary tract infections (CAUTIs) are a common healthcare-associated infection caused by prolonged catheter use. Effective prevention methods include maintaining sterile insertion techniques, ensuring proper catheter care, minimizing catheter use, and prompt removal when no longer needed. The antibiotic sensitivity pattern of uropathogens causing CAUTIs highlights the importance of monitoring local resistance trends to guide treatment. Common uropathogens include Escherichia coli, Klebsiella spp., and Pseudomonas aeruginosa, which often exhibit resistance to multiple antibiotics. Empirical therapy should be tailored based on antibiograms to avoid resistance development and ensure effective treatment. Result: Antimicrobial resistance (AMR) among uropathogens is a significant global challenge, with varying resistance profiles across pathogens. E. coli demonstrated moderate susceptibility to ampicillin and piperacillin-tazobactam but showed high resistance to amoxicillin-clavulanate and ceftriaxone. K. pneumoniae exhibited extensive resistance, including 100% resistance to several antibiotics, though partial susceptibility to some aminoglycosides and ceftazidime was observed. P. aeruginosa displayed multidrug resistance, with susceptibility limited to carbapenems like imipenem and meropenem. Acinetobacter species showed pan-resistance to all tested antibiotics, highlighting a severe clinical threat. These findings stress the urgent need for antimicrobial stewardship, novel therapies, and robust resistance surveillance systems. Conclusion:  We concluded that CAUTI continued to pose a serious threat to patient safety and to the infection control team. A major factor in lowering CAUTI rates, which in turn lowers patient morbidity and hospital stays, is the implementation of appropriate care bundles and ongoing training for healthcare professionals. Multidrug-resistant uropathogens such as E. coli and Klebsiella spp.

Background: Polycystic ovary syndrome (PCOS) and thyroid disorders are two of the most common endocrine disorders in the general population. Both of these endocrine disorders share common predisposing factors, gynaecological features and have found effect on reproductive function in women. Objectives: The aim of the study is to find out the association between Gonadotropin hormone and thyroid function in PCOS patients.  Methods: This is a Cross-sectional observational study done on 180 patients with polycystic ovarian syndrome based on revised Rotterdam’s criteria. Serum Gonadotropin level and thyroid profile was measured using chemiluminescent Immunoassay (CLIA). Results: women with PCOS had significant higher LH level and slightly low FSH and significant high in TSH level. A strong association was found between hypothyroidism and Gonadotropin hormones in affected women with PCOS. Conclusions: Our results concluded that the women suffered with PCOS had slightly low or normal FSH level, higher LH, LH/FSH ratio and higher TSH level as compare to women without PCOS. Gonadotropin and Thyroid function are closely associated in PCOS and their coexistence may identify patients with higher reproductive and metabolic risk.

Background: The incidence of spinal anesthesia-induced hypotension has been reported to be as high as 80-85 % in patients undergoing elective caesarean section under spinal anaesthesia; hence, vasopressors play a vital role in their management. The choice of the most effective vasopressor for SAIH during caesarean section continues to be one of the main challenges in obstetric anesthesia.The present study compared intravenous norepinephrine and mephentermine for the maintenance of blood pressure during spinal anaesthesia for caesarean section in pregnant females. Materials & Methods: After approval from ethical committee and registration in Clinical Trials Registry India (CTRI/2022/10/046224), the present study was conducted on 60 pregnant females undergoing lower segment caesarean section under subarachnoid block. Patients were divided into 2 groups of 30 each. Group N received bolus intravenous norepinephrine 6µg and group M received mephentermine 6mg for the maintenance of intraoperative systolic blood pressure. HR, SBP and DBP were recorded at every 1 min interval till delivery of the baby and thereafter at every 5 min interval till the completion of surgery. Complications were also recorded. Results:The number of bolus of norepinephrine required was significantly higher than number of bolus of mephentermine Proportion of patients with number of drug boluses:- 4, 5, 6, 7 was significantly higher in group N as compared to group M. (4:- 3.33% vs 0% respectively, 5:- 36.67% vs 0% respectively, 6:- 50% vs 0% respectively, 7:- 13.33% vs 0% respectively). Proportion of patients with number of drug boluses:- 1, 2, 3 was significantly lower in group M as compared to group N. (1:- 0% vs 36.67% respectively, 2:- 0% vs 56.67% respectively, 3:- 0% vs 6.67% respectively). (p value <0.0001).Patients in both groups (GroupM vs Group N) were found to be comparable, with no statistical significance in terms of maternal complications (Headache:-30% vs 10% respectively (p value=0.104), Shivering:- 33.33% vs 16.67% respectively (p value=0.136), Local tissue ischemia:- 0% vs 0% respectively) (p-value=0.104)and neonatal APGAR scoreat 1 minute (p value=0.145)(6.47 ± 1.01 vs 6.83 ± 0.65), and at 5 minutes (p-value 0.254) (8.3 ± 1.32 vs 8.77 ± 0.9) between group M and group N. Conclusion: Authors found that intravenous norepinephrine controls blood pressurein parturients after SAB however, needs more drug as compared to mephentermine.

Background: Chronic obstructive pulmonary disease (COPD) is characterized by persistent airway obstruction caused by chronic inflammation. It is a significant contributor to early mortality and morbidity among adults. Anemia is recognized as a common comorbidity in COPD, similar to other chronic conditions. This retrospective hospital-based study aimed to evaluate the prevalence of anemia among a cohort of individuals diagnosed with COPD. Materials and Methods: The study included 567 COPD patients clinically diagnosed at a teaching hospital affiliated with an Indian medical college. Of these, 234 patients who met the inclusion criteria were analyzed. Anemia was defined using the World Health Organization (WHO) criteria: hemoglobin (Hb) levels <13 g/dL in males and <12 g/dL in females, with hematocrit (Hct) levels <39% in males and <36% in females. Statistical analysis was conducted using SPSS version 21.0.   Results: The mean age of male COPD patients was 67.28 years, while that of females was 66.35 years. Among the 234 participants, 60 males (25.64%) had Hb levels below 13 g/dL, and 79 females (33.76%) had Hb levels below 12 g/dL. Hematocrit values below 39% were observed in 59 males (25.21%), while levels below 36% were found in 79 females (33.76%). Conclusion: Based on Hb levels, the prevalence of anemia was 25.64% in males and 33.76% in females. When assessed using Hct values, anemia was observed in 25.21% of males and 33.76% of females. The occurrence of anemia was higher among older age groups in both genders.

Background: With the advent of antiretroviral therapy (ART) and improved follow-up strategies through ICTC services, the incidence of opportunistic infections in people living with HIV (PLHIV) has declined. However, there has been a concurrent rise in non-communicable diseases, particularly cardiovascular disorders. Electrocardiography (ECG) is a non-invasive tool for detecting early cardiac abnormalities, while serum C-reactive protein (CRP), an inflammatory biomarker, has been increasingly recognized for its prognostic role in cardiovascular risk among PLHIV. Materials and Methods: This prospective observational study was conducted at a tertiary care hospital from December 2020 to October 2022. A total of 50 HIV-positive patients aged above 18 years attending the ART center were enrolled after obtaining informed consent. Patients with known cardiovascular diseases, hypertension, or chronic alcoholism were excluded. All participants underwent 12-lead ECG and serum CRP testing to identify potential associations between ECG abnormalities and inflammatory status. Results: Out of the 50 participants, ECG abnormalities were noted in 48 (96%) patients. T wave inversions were the most prevalent, observed in 29 patients (58%), followed by ST-segment elevations in 12 (24%). Other findings included sinus tachycardia (4%), irregular rhythm (4%), left ventricular hypertrophy (4%), and electrical alternans (2%). Only 2 patients (4%) had normal ECGs. Elevated serum CRP levels were observed in 93% of patients with T wave inversions and in all cases with ST-segment elevations, where 60% had CRP levels exceeding 100 mg/L. Among patients with ST-T changes, 95% demonstrated elevated CRP levels, indicating a strong correlation (p < 0.001). In contrast, all patients with normal ECGs had normal CRP levels, suggesting lower cardiovascular risk. Conclusion: Cardiovascular abnormalities are emerging complications among PLHIV in the ART era. ECG serves as an effective preliminary tool for assessing these complications. Elevated serum CRP levels show a significant association with electrocardiographic abnormalities and can be used as a predictive marker for cardiovascular morbidity and mortality in this population. Regular ECG and CRP monitoring may enhance early detection and management of cardiovascular risks in PLHIV.

Background: Cochlear synaptopathy, often referred to as "hidden hearing loss," is characterized by damage to synapses between inner hair cells and auditory nerve fibers without significant changes in audiometric thresholds. This condition is increasingly associated with noise-induced hearing loss (NIHL), particularly among young adults with high exposure to recreational noise. Standard audiometry often fails to detect such neural deficits. Hence, objective and behavioral measures such as electrocochleography (ECochG) and speech-in-noise (SIN) tests are being explored for better assessment. Materials and Methods: A cross-sectional analytical study was conducted involving 60 young adults aged 18–25 years, divided into two groups: Group A (n=30) included participants with a history of prolonged noise exposure (e.g., frequent use of headphones >4 hours/day for >2 years), and Group B (n=30) included age-matched controls with minimal noise exposure. Pure tone audiometry was performed to confirm normal hearing thresholds. ECochG was used to assess the amplitude of the summating potential (SP) and action potential (AP), and the SP/AP ratio was calculated. Speech-in-noise testing was conducted using the QuickSIN test at signal-to-noise ratios (SNRs) of +5 dB and 0 dB. Results: Group A showed significantly higher SP/AP ratios (mean ± SD: 0.54 ± 0.08) compared to Group B (0.34 ± 0.06, p<0.01), indicating potential cochlear synaptopathy. In the speech-in-noise test, Group A demonstrated reduced SIN performance, with mean scores of 9.3 ± 1.4 dB SNR loss, compared to 3.7 ± 1.2 dB in Group B (p<0.001). A positive correlation (r = 0.72, p<0.001) was observed between SP/AP ratio and SNR loss, suggesting electrophysiological and behavioral coherence in detecting neural deficits. Conclusion: Despite having clinically normal audiograms, young adults with chronic noise exposure exhibited signs of cochlear synaptopathy through elevated SP/AP ratios and poorer speech-in-noise comprehension. ECochG and SIN testing may serve as valuable tools in early diagnosis and prevention strategies for hidden hearing loss in at-risk populations

Background: Invasive gynecological surgeries often require tailored anesthetic approaches to optimize patient outcomes, reduce postoperative discomfort, and minimize intraoperative complications. The effectiveness of different anesthetic techniques—such as general anesthesia (GA), regional anesthesia (RA), and combined spinal-epidural (CSE)—in influencing perioperative parameters remains a subject of clinical interest. Materials and Methods: A prospective, comparative observational study was conducted on 90 patients undergoing invasive gynecological surgeries, such as abdominal hysterectomy and laparoscopic myomectomy. Patients were divided equally into three groups (n=30 per group): Group A received general anesthesia, Group B received regional anesthesia (spinal), and Group C received combined spinal-epidural anesthesia. Parameters assessed included intraoperative hemodynamic stability, duration of surgery, postoperative pain scores (VAS scale), and incidence of complications. Statistical analysis was performed using ANOVA and Chi-square tests. Results: Mean surgical duration was comparable across all groups (Group A: 95.6 ± 12.4 min, Group B: 92.8 ± 14.1 min, Group C: 94.3 ± 13.7 min; p=0.68). Postoperative pain scores at 6 hours were significantly lower in Group C (3.1 ± 0.9) compared to Group A (5.8 ± 1.1) and Group B (4.6 ± 1.0); p<0.01. Hemodynamic fluctuations were more frequent in Group A (26.6%) compared to Group B (10%) and Group C (6.6%). Nausea and vomiting were most prevalent in Group A (30%) versus Group B (6.6%) and Group C (3.3%). Conclusion: Combined spinal-epidural anesthesia offers superior postoperative analgesia and better hemodynamic stability in comparison to general and regional anesthesia alone for invasive gynecological surgeries. It should be considered a preferred technique when feasible.

Background: Hyponatraemia is one of the most prevalent forms of electrolyte imbalance observed in hospitalised patients. It frequently occurs in patients who have experienced neurosurgical injury or intervention. Various central nervous system disorders, such as subarachnoid haemorrhage, traumatic brain injury, spinal cord injury, meningitis, neurosurgical procedures, and others, have been shown to predispose neurosurgery patients to hyponatraemia. Hyponatraemia in craniotomy cases requires prompt intervention, as it may lead to altered mental status, seizures, vasospasm, cerebral oedema, and potentially fatal outcomes. This study aims to identify risk variables linked to hyponatraemia in patients undergoing surgery for intracranial conditions and to provide a standardised strategy for managing hyponatraemia in this patient population.

Background: Objectives: To evaluate the morphological spectrum and complications associated with ovarian teratomas in our institution over two years duration. Materials and Methods: This is a retrospective analysis of ovarian teratomas reported in a tertiary care hospital in Visakhapatnam between January 2021 to December 2023. Statistical analysis: The outcome has been presented in terms of frequency distribution and the results were designated as percentages. Results: In these two years, from 2021 to 2023, 380 ovarian neoplasms were documented, of which 59 were ovarian teratomas. Among the 59 cases of teratomas, 53 were mature cystic teratoma, 1 was immature teratoma, 2 were monodermal teratoma and 3 had malignant change. Conclusion: Mature cystic teratomas are the most widely encountered germ cell tumor of the ovary, seen significantly in reproductive age group. Torsion is the most frequently encountered complication. It is imperative to take into account the potential for malignant transformation, especially in patients who are elderly and have large tumors.

Background: Breast lesions are very common diseases worldwide. Benign breast disease (BBD) account for most breast problem in females. Carcinoma breast is one of the most common human neoplasms rapidly replacing cancer cervix as leading site of cancer in urban populations of India. A panel of antibodies, improved antigen retrieval techniques have all contributed to the use of immunohistochemistry (IHC) in solving diagnostic problems in breast pathology. This is a cross-sectional study done in  hospital in Tumkur, Karnataka for 1.5 years. Total of 41 benign and 41 malignant biopsies of breast neoplasm from female patients were studied. All breast masses were analyzed systematically by clinical history, physical examination, histo-pathological examination along with the immunohistochemical study of CK5/6.All collected data were entered into a master sheet and fed into computer software for statistical analysis using Pearson’s Chi-square test. In our study patients belonged to the age group of 15–70years.Benign lesions were common in the age group of 21–30 years, and malignant lesions were common in the age group of 51–60 years. The most frequent benign neoplasm was fibroadenoma (74%)and in malignancy, IDC-NOS (85%). Most of the malignant cases were of size T2 (76%) and grade II (66%) and without any lymph node metastatic deposits (83%). All benign breast lesions showed positive expression for CK 5/6; the staining index of benign lesions varied from 5–9. Fibroadenomas showed stain index range of 6–8. Highest stain index of 9 was seen in fibrocystic with ductal epithelial hyperplasia. In malignant lesions, all cases were negative for CK5/6 expression except IDC-NOS cases which were grade III (poorly-differentiated) and showed weak CK5/6 expression with stain index of 2.There was a statistically significant association between CK5/6 stain index with grading and lymph node metastasis. Immunohistochemistry (IHC) is an integral part of the pathology. Although hematoxylin and eosin (H&E)stain remain gold standard method for diagnosis, IHC provides useful vital information in grey zone cases.CK5/6, as a component of panels along with AE1/AE3 and myoepithelial markers, help to differentiate benign and malignant breast lesions in cases of interobserver variability. Grade III breast carcinoma cases, if positive for CK 5/6, imply a ‘basal-like’ molecular phenotype and signify a poor prognosis. These tumors require aggressive intervention. CK 5/6 can help provide prognostic information and better treatment modalities.

Background: Staphylococcus lugdunensis, a coagulase-negative Staphylococcus, is increasingly recognized as a significant pathogen involved in severe infections. This study assessed the microbiological characteristics, identification methods, and antibiotic susceptibility profiles of clinical isolates of Staphylococcus lugdunensis. Material and Methods: Seventy-five coagulase negative Staphylococcus isolates collected from various clinical specimens at Amrita Institute of Medical Sciences, Kerala, India were screened. Isolates underwent identification tests including ornithine decarboxylase, pyrrolidonyl arylamidase, slide coagulase, and antibiotic susceptibility testing via the VITEK automated system.  Results: Among 75 isolates, one isolate (1.33%) was positively identified as Staphylococcus lugdunensis. This isolate was ornithine decarboxylase and pyrrolidonyl arylamidase positive, slide coagulase positive, and tube coagulase negative. The isolate showed susceptibility to penicillin, oxacillin, gentamicin, ciprofloxacin, vancomycin, and linezolid, but was resistant to erythromycin and clindamycin.  Conclusion: Although rare, accurate identification of Staphylococcus lugdunensis is crucial as its pathogenic potential resembles Staphylococcus aureus. Misidentification could lead to inappropriate clinical management, highlighting the importance of differentiating Staphylococcus lugdunensis from another coagulase-negative Staphylococcus.

Background: After heart surgery, arrhythmias are common side effects that contribute significantly to morbidity and death. The purpose of this study is to examine the effectiveness of amiodarone and magnesium for the prevention of arrhythmias and to prevent arrhythmias after the removal of aortic cross-clamp. Method: This prospective observational study included 100 patients with aortic stenosis being operated on for aortic valve replacement. All patients were randomly divided into two groups. Group A(n=50) received Amiodarone 5mg/kg and Group M(n=50) received Magnesium sulfate 40mg/kg during the rewarming period of CPB. Both of the groups were monitored and observed for the total CPB and aortic cross-clamp duration, resumption of spontaneous rhythm, the occurrence of an arrhythmia, use of anti-arrhythmic drugs, inotropic supports, the need for pacemaker usage and need of defibrillation. Result: The mean hours to wean from ventilator support in group A was 10.03 and in group M was 19.42. The mean length of ICU stay in hours in group A was 43.08 and in group M was 54.44, P=<0.001. The number of patients where the occurrence of arrhythmia detected in group A was 12 and in group M was 36, P=<0.001. The usage of a defibrillator in group A was in 10 patients and group M was 34, P=0.0014. Conclusion: From the observation we have found that usage of amiodarone during the rewarming phase of CPB has been found to be more effective in arrhythmia prevention following weaning off CPB. The Amiodarone group also showed a good spontaneous recovery of sinus rhythm after weaning off CPB.

Background: Congenital hypothyroidism (CH) is one of the most common preventable causes of intellectual disability. Early identification through newborn screening (NBS) and prompt initiation of levothyroxine therapy are critical for optimal neurodevelopmental outcomes. This study aimed to evaluate the cognitive, motor, and language development in children diagnosed with CH through NBS. Materials and Methods: A prospective cohort study was conducted at a tertiary care center. A total of 60 children diagnosed with primary CH via NBS were enrolled and followed up at 6, 12, 24, and 36 months of age. Neurodevelopment was assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Serum TSH and free T4 levels were monitored regularly. Children with co-existing neurological disorders or syndromic features were excluded. Results: Of the 60 children, 54 (90%) achieved normal neurodevelopmental scores across all domains by 36 months. The mean cognitive composite score was 98.4 ± 7.6, motor score was 95.2 ± 8.1, and language score was 93.7 ± 9.3. Children who started treatment within 14 days of birth had significantly better cognitive outcomes (mean score: 101.2 ± 6.8) compared to those treated after 21 days (mean score: 91.5 ± 7.9; p < 0.01). No cases of severe developmental delay were observed. Conclusion: Early detection of congenital hypothyroidism through newborn screening and timely initiation of treatment result in favorable neurodevelopmental outcomes. Adherence to follow-up protocols and optimal dose titration are essential for preventing developmental delays.

Background: Cutaneous Lupus Erythematosus (CLE) represents a spectrum of autoimmune skin disorders with varying clinical and histological manifestations. Early and accurate diagnosis is essential to prevent progression to systemic lupus erythematosus. While histopathological examination remains a cornerstone in diagnosis, the adjunct use of immunohistochemical (IHC) markers may enhance diagnostic precision by identifying early immune-mediated alterations. Materials and Methods: This cross-sectional study was conducted on 40 skin biopsy samples clinically suspected of CLE and collected over a period of one year. Histopathological evaluation included hematoxylin and eosin (H&E) staining for epidermal atrophy, basal cell degeneration, follicular plugging, and dermal inflammation. IHC analysis was performed using markers such as CD123, MXA, and CD3 to assess plasmacytoid dendritic cell infiltration and T-cell distribution. The results were analyzed for correlation between histopathological findings and IHC marker expression. Results: Histopathological analysis revealed epidermal atrophy in 85% of cases, basal cell degeneration in 75%, and perivascular lymphocytic infiltration in 90%. Follicular plugging was noted in 60% of biopsies. IHC showed strong CD123 positivity in 78% of CLE samples, indicating significant plasmacytoid dendritic cell presence. MXA positivity, reflective of type I interferon activity, was seen in 70% of cases. CD3 demonstrated a diffuse T-cell infiltration pattern in 88% of the CLE specimens. Statistical correlation revealed that CD123 and MXA had significant association with early histological changes (p < 0.05). Conclusion: The combination of histopathological features and immunohistochemical markers, particularly CD123 and MXA, enhances the early detection of CLE. Incorporating IHC into routine diagnostic workflows may improve diagnostic accuracy in ambiguous or early-stage cases, allowing for timely therapeutic intervention.

Background: Cervical cancer remains one of the leading causes of morbidity and mortality among women, particularly in developing countries. The Papanicolaou (Pap) smear is a vital screening tool used to detect precancerous and cancerous changes in cervical epithelium. However, histopathology remains the gold standard for definitive diagnosis. This study aims to correlate abnormal Pap smear findings with histopathological outcomes in order to assess diagnostic accuracy and guide clinical decision-making. Materials and Methods: A cross-sectional observational study was conducted over 12 months at a tertiary care center. A total of 120 women aged between 25 and 65 years presenting with abnormal cervical cytology were included. Pap smear results were classified using the Bethesda system, and colposcopically directed biopsies were taken for histopathological examination. The correlation between cytological and histopathological findings was statistically analyzed using the Chi-square test, and sensitivity, specificity, PPV, and NPV were calculated. Results: Out of 120 cases, 30 (25%) showed ASC-US, 40 (33.3%) had LSIL, 30 (25%) had HSIL, and 20 (16.7%) showed features suggestive of carcinoma. Histopathology confirmed chronic cervicitis in 28 cases, CIN I in 36 cases, CIN II/III in 34 cases, and invasive carcinoma in 22 cases. The overall concordance rate between cytology and histology was 81%. The sensitivity and specificity of Pap smear for detecting high-grade lesions (CIN II or worse) were 88.2% and 76.4%, respectively. The positive predictive value was 84.3%, and the negative predictive value was 80.5%. Conclusion: There is a significant correlation between abnormal Pap smear results and histopathological findings. While Pap smear is an effective preliminary screening tool, histopathological confirmation is essential for accurate diagnosis and treatment planning. Integration of cytology with colposcopy and biopsy enhances early detection and improves patient outcomes.

Background: With the rise of remote work models, especially post-pandemic, there has been a notable increase in sedentary behavior among professionals. Prolonged sitting is increasingly recognized as an independent risk factor for cardiovascular disease, giving rise to the phrase “sitting is the new smoking.” This study investigates the relationship between sedentary behavior and cardiovascular health among work-from-home professionals in India. Methods: A cross-sectional observational study was conducted among 112 adults working remotely for over 6 months. Data were collected using a structured questionnaire assessing sitting duration, physical activity, and cardiovascular health indicators. A subset (n=40) wore fitness trackers to objectively measure sedentary time and heart rate. Statistical analyses included chi-square tests and t-tests using SPSS v25. Results: Participants averaged 9.3 ± 2.1 hours of sitting daily; only 18% met WHO physical activity guidelines. Cardiovascular symptoms were reported by 39%, with a significant association between sitting duration >9 hours and symptom prevalence (p = 0.02). Higher sedentary time correlated with elevated resting heart rate and self-reported blood pressure. Conclusion: Extended sedentary behavior among WFH professionals poses a substantial cardiovascular risk. Interventions promoting active work routines are urgently needed to prevent lifestyle-related morbidity in digitally active populations.

Background: Acute myocardial infarction (AMI) among young adults is increasingly prevalent, posing unique diagnostic, therapeutic, and preventive challenges due to distinct risk profiles. This study aimed to evaluate risk factors and management challenges specific to AMI patients aged 18–45 years. Methods: A prospective observational study involving 150 young adults admitted with AMI was conducted. Data collected included demographic information, clinical presentations, cardiovascular risk factors, management approaches, and encountered challenges. Clinical evaluation involved standard ECG, cardiac biomarkers, echocardiography, and coronary angiography. Statistical analysis was performed using SPSS software (version 25), employing Chi-square tests, independent t-tests, and multivariate logistic regression. Results: The majority of participants were males (82%), and prevalent risk factors included smoking (64.7%), dyslipidemia (42%), obesity (37.3%), and psychosocial stress (26.7%). Illicit drug use was noted in 11.3% of cases. Management primarily involved primary PCI (58%). Significant challenges were delayed hospital presentation (34%), atypical symptomatology leading to diagnostic delays (20.7%), medication non-adherence (18%), and referral difficulties (16.7%). Conclusion: AMI in young adults predominantly arises from modifiable lifestyle and psychosocial risk factors, compounded by systemic management challenges. Emphasizing preventive strategies, early intervention, and public awareness campaigns is crucial to reduce cardiovascular morbidity in this demographic.

Background: Tibial plateau fractures, particularly Schatzker Type V and VI, are complex intra-articular injuries resulting from high-energy trauma such as road traffic accidents and falls from height. These fractures often involve significant comminution and soft tissue damage, posing challenges in management. Immediate internal fixation may increase the risk of wound complications, necessitating a staged approach for optimal outcomes. Aim and objectives: The aim of this study was to evaluate the functional outcomes of complex proximal tibial plateau fractures managed with an initial spanning external fixator followed by internal fixation using locking compression plates, with a focus on joint function and soft tissue recovery. Methods This retrospective observational study was conducted at Dr. B. R. Ambedkar Medical College and Hospital between June 2022 to January 2024. A total of 30 patients aged 18–65 years with Schatzker Type V and VI fractures were included in the study. Initial management involved temporary external fixation, followed by internal fixation with locking plates once soft tissue conditions allowed. Patients were evaluated clinically and radiologically, with follow up at 3, 6 and 9 months. Functional outcomes were assessed using the Modified Rasmussen Criteria. Results: Most patients were males (76.67%) in the 31–50-year age group. Road traffic accidents accounted for 60% of cases, and right-sided injuries predominated (63.33%). Type VI fractures were more frequent (56.67%). Partial and full weight bearing were initiated by 8 and 12 weeks respectively. Radiological scores showed 33.33% excellent and 60% good outcomes, with no poor results. Conclusion: Staged surgical management using external and internal fixation produced favorable functional outcomes and minimized complications in complex tibial plateau fractures.

Onchomycosis is the most common fungal infections of nail commonly caused by dermatophytes. Till nineteenth century it was difficult to cure as several attempts failed to deliver drug due to rigid structural nail barrier. Not only prolonged duration of treatment but also high cost of therapy involved a great problem of treatment.  In recent times continuous ongoing research with the intervention of novel drug delivery systems like nanoparticles to deliver antifungal drugs has overcome those challenges. Although oral drugs are effective but most of them are hepatotoxic. Local treatment tried with nail liqueur contained antifungal drugs amorolfine and ciclopirox but was not very successful. This underscores the need of some innovative drug delivery system, In this article we will review   some novel drug delivery system of topical antifungals for treatment of onychomycosis  

Background: Timely intervention in emergency surgeries is critical to reducing morbidity and mortality. However, various patient, disease, and hospital-level factors contribute to delays. Limited data are available from Indian tertiary care centers that quantify delays across defined intervals. Aim: To assess total waiting time and analyze contributing factors responsible for delays in emergency surgeries. Methods: A prospective observational study was conducted over 60 days in the Department of Emergency medicine in a tertiary care hospital. A total of 100 patients requiring emergency surgery were included. Patients were evaluated from the time of emergency arrival to the surgical incision. Waiting time was divided into five intervals. Contributing factors were categorized as patient-related (e.g., consent delay, financial constraints), disease-related (e.g., diagnosis, pre-op investigations), and hospital-related (e.g., OT availability, staff, consultations).  Results: Mean total waiting time was 737 minutes (12.3 hours). The most significant contributor to delay was operation theatre unavailability (61%), followed by interdepartmental consultations (26%) and preoperative interventions (25%). Patient-related delays included consent (6%), financial/logistic issues (14%), and blood arrangement (11%). General surgery accounted for 84% of cases; 48% underwent general anesthesia. Conclusion: Delays in emergency surgery are multifactorial, with hospital system issues being most prominent. Structural reforms such as dedicated emergency OTs, improved scheduling, and better coordination can significantly reduce waiting times and improve surgical outcomes.

Background: Type 2 diabetes mellitus (T2DM) and pre-diabetes are major global health concerns characterized by insulin resistance and impaired glucose metabolism. Vitamin D has been implicated in glucose homeostasis, and moderate physical activity is a well-established intervention to improve insulin sensitivity. This study investigates the combined effects of vitamin D supplementation and moderate exercise on plasma insulin levels in individuals with pre-diabetes and T2DM. Objective: To evaluate whether vitamin D supplementation in conjunction with moderate exercise enhances plasma insulin levels in pre-diabetic and T2DM patients. Methods: A randomized controlled trial was conducted with 200 participants (100 pre-diabetics, 100 T2DM patients) aged 30–65 years. Subjects were randomly assigned to four groups: Control (no intervention), Vitamin D only, Exercise only, and Combined (Vitamin D + Exercise). Vitamin D3 was administered at a dose of 4000 IU/day for 6 months. Exercise consisted of 45 minutes of moderate-intensity aerobic activity five days per week. Fasting plasma insulin levels were measured at baseline, 3 months, and 6 months. Results: The combined group showed a statistically significant increase in plasma insulin levels compared to the control and individual intervention groups (p<0.01). Improvements were more pronounced in the pre-diabetic subgroup. Multivariate analysis indicated synergistic effects of vitamin D and exercise on insulin secretion. Conclusion: Vitamin D supplementation combined with moderate exercise significantly enhances plasma insulin levels in pre-diabetic and T2DM patients. These findings support a multi-modal approach to diabetes prevention and management.

Background: Acute respiratory failure (ARF) frequently necessitates ventilatory support in intensive care units. Non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV) are primary modalities, but their comparative outcomes remain critical for optimizing patient management. Aim: To compare clinical outcomes of NIV versus IMV in medical ICU patients with acute respiratory failure. Methods: A retrospective observational study was conducted on 200 adult patients admitted to the Medical ICU with ARF requiring ventilatory support. Patients were divided equally into NIV (n=100) and IMV (n=100) groups. Baseline demographics, duration of ventilation, complications, ICU length of stay, and mortality were compared. Statistical analyses included t-tests and chi-square tests with significance at p<0.05. Results: Mean age and gender distribution were comparable between groups. APACHE II scores were significantly higher in the IMV group (20.2 ± 6.3 vs. 17.4 ± 5.6; p=0.0004). NIV patients had significantly shorter ventilation duration (42.6 ± 18.7 hours vs. 91.8 ± 34.2 hours; p<0.0001). Complications such as ventilator-associated pneumonia (7% vs. 29%, p<0.0001), barotrauma (3% vs. 12%, p=0.0072), and tracheal injury (0% vs. 8%, p=0.0016) were significantly lower in NIV. ICU length of stay (7.4 ± 3.1 days vs. 13.6 ± 5.4 days; p<0.0001) and mortality (15% vs. 34%; p=0.0006) favored NIV. Conclusion: NIV in acute respiratory failure is associated with better clinical outcomes, fewer complications, shorter ICU stays, and reduced mortality compared to IMV. Early use of NIV should be considered in eligible patients to improve prognosis.

Background: Introduction: Sedation is a critical component in the management of mechanically ventilated patients in intensive care units (ICU). Optimal sedation practice aims to balance patient comfort with minimizing adverse outcomes such as prolonged ventilation and delirium. This study analyzed sedation practices and their association with clinical outcomes in mechanically ventilated ICU patients. Aim: To analyze sedation practices and their clinical outcomes in mechanically ventilated patients admitted to the ICU. Methods: A cross-sectional observational study was conducted involving 120 mechanically ventilated patients at a tertiary care ICU. Data on demographic and clinical characteristics, sedation agents used, sedation depth (Richmond Agitation-Sedation Scale), duration of mechanical ventilation, ICU length of stay, incidence of delirium, and ICU mortality were collected. Statistical analysis was performed to identify associations between sedation practices and outcomes. Results: Midazolam was the most frequently used sedative (46.7%), followed by propofol (32.5%) and dexmedetomidine (20.8%) (p=0.007). Deep sedation was observed in 34.2% of patients (p=0.002). Midazolam use was associated with longer mechanical ventilation (8.6 ± 3.4 days) and ICU stay (12.3 ± 4.5 days) compared to propofol and dexmedetomidine (p<0.01). Delirium incidence was highest with midazolam (37.5%) and lowest with dexmedetomidine (12.0%) (p=0.006). ICU mortality did not differ significantly between groups (p=0.24). Conclusion: Sedation practices significantly influence ventilation duration, ICU stay, and delirium incidence in mechanically ventilated patients. Dexmedetomidine appears favorable in reducing ventilation time and delirium risk. Tailored sedation protocols may improve ICU outcomes.

Background: Peripheral blood film examination plays a very crucial role in the diagnosis of many haematologic diseases. Conventional Leishman staining requires 15-20 minutes approximately which cannot meet emergency needs in very sick patients. Modified Leishman stain in which phenol helps in ripening of the Leishman staining solution and in turn shortens fixing and staining time.It also change the pH of the solution thereby increasing the rate of stain uptake by the tissue. This will help in overall reduction in turnaround time (TAT) of peripheral smear reporting. Method: Cross sectional observational study of peripheral smears was conducted in 60 participants with normal complete blood count (CBC). Two smears were made each sample and were stained by conventional Leishman stain which took about 15 to 20 minutes and modified Leishman (phenol: Leishman powder ratio pf 1:3) staining about 2.5 minutes. The staining parameters like Rbc’s, WBC’s, leucocyte granules, platelets and background of the smear were examined by two pathologists. Results: The conventional and modified Leishman stain peripheral smear were studied for following features like RBC Pattern, Nuclear pattern, Neutrophil granules, Eosinophil granules, Platelets and Background clarity and the ‘p’value were 1.00; 0.625; 1.00; 0.791; 1.00; 0.727 respectively. There was no significant difference between modified and conventional method. Conclusion: Study showed that overall staining property of modified Leishman stain was satisfactory and the time required was very less when compared to conventional method. The short turnaround time and satisfactory staining property helps in emergency hematological cases where rapid diagnosis with peripheral smear examination is highly essential.

Following thorough chemo mechanical preparation, the administration of an intracanal medication may be beneficial in getting rid of any germs that remained inside root canals. The current research assessed the antibacterial properties of medications that work by touch rather than vapour release versus facultative and obligate anaerobic bacteria that are frequently present in endodontic diseases. The medications included calcium hydroxide plus distilled water, calcium hydroxide plus camphorated paramonochlorophenol (CPMC), calcium hydroxide plus glycerine, and 0.12% chlorhexidine gel and 10% metronidazole gel. The zones of bacterial inhibition surrounding each medication were noted and compared using an agar diffusion test. According to the findings, calcium hydroxide/CPMC paste worked well against every bacterial strain that was examined. Additionally, chlorhexidine inhibited every strain. For the majority of varieties, it was about as effective as calcium hydroxide/CPMC paste. Metronidazole was more effective than calcium hydroxide/CPMC against two strains and inhibited the replication of all obligate anaerobes studied. Due to the limitations of the agar diffusion test, calcium hydroxide combined with distilled water or glycerine did not exhibit zones of bacterial suppression.

Background: Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, presents with a wide clinical spectrum ranging from asymptomatic illness to severe respiratory failure. Identifying reliable biomarkers to predict disease severity remains critical, especially in resource-constrained settings. Serum ferritin, an acute-phase reactant, has emerged as a potential marker reflecting systemic inflammation and disease progression. Objective: To evaluate the correlation between serum ferritin levels and disease severity in patients with COVID-19 and to assess its association with demographic factors, comorbidities, and other inflammatory markers. Methods: This hospital-based, observational, cross-sectional study was conducted over one year at a tertiary care center in Central India. Eighty RT-PCR-confirmed adult COVID-19 patients were enrolled. Serum ferritin and inflammatory markers (CRP, IL-6, D-Dimer) were measured within 24 hours of admission. Patients were categorized into mild, moderate, and severe groups based on MoHFW guidelines. Statistical analysis included ANOVA, t-tests, and Pearson correlation using SPSS software. Results: The mean age of patients was 51.2 ± 14.6 years, with 45 males and 35 females. A significant rise in serum ferritin levels was observed across increasing severity groups (mild: 210 ± 45 ng/mL; moderate: 460 ± 110 ng/mL; severe: 890 ± 185 ng/mL). Male patients showed consistently higher ferritin levels than females within each severity category. Ferritin levels correlated positively with CRP, IL-6, and D-Dimer, all of which also rose progressively with disease severity. Conclusion: Serum ferritin levels are significantly associated with disease severity and inflammatory burden in COVID-19 patients. As a readily available biomarker, ferritin can aid early risk stratification and guide clinical decision-making. However, further multicentric studies are warranted to validate these findings and explore ferritin’s mechanistic role in COVID-19 pathogenesis.

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is a common liver condition associated with Type 2 Diabetes Mellitus (T2DM). The high prevalence of NAFLD in diabetic patients is a growing concern due to its potential to progress to more severe liver conditions, such as non-alcoholic steatohepatitis (NASH), fibrosis, and cirrhosis. This study aimed to assess the prevalence and risk factors associated with NAFLD in T2DM patients in Central India. Methods: A cross-sectional observational study was conducted over 12 months at a tertiary care hospital in Central India. A total of 100 adult T2DM patients aged 40-70 years were included. Data were collected through structured questionnaires, physical examinations, and biochemical tests. Liver ultrasound was used to diagnose NAFLD and assess its severity. The risk factors for NAFLD, including age, gender, obesity, hypertension, dyslipidemia, family history of NAFLD, and duration of diabetes, were analyzed. Results: The prevalence of NAFLD in T2DM patients was found to be 65%. Significant risk factors for NAFLD included obesity (69.2%), hypertension (76.9%), dyslipidemia (73.8%), a family history of NAFLD (61.5%), and longer duration of diabetes (mean 8.5 years). Liver ultrasound showed that 46.2% of patients had mild NAFLD, 30.8% had moderate NAFLD, and 23.1% had severe NAFLD. Biochemical markers, including elevated ALT and AST levels, and higher fasting blood glucose, were significantly associated with NAFLD. Lifestyle modifications, weight loss, and regular monitoring of liver function were the primary management approaches. Conclusion: This study highlights the high prevalence of NAFLD in T2DM patients and identifies key risk factors such as obesity, hypertension, and dyslipidemia. Early detection and management through lifestyle interventions, regular monitoring of liver function, and appropriate pharmacotherapy are crucial for mitigating the adverse effects of NAFLD and improving long-term outcomes in diabetic patients.

Background: Varicose veins are a common venous disorder often associated with venous reflux. Colour Doppler ultrasonography is a reliable non-invasive tool for evaluating venous insufficiency. This study aimed to assess the correlation between the presence of venous reflux and the diameter of the great saphenous vein (GSV) in patients presenting with varicose veins. Methods: A prospective observational study was conducted on patients presenting with clinically suspected varicose veins. Colour Doppler ultrasound was performed to evaluate the GSV diameter at standard anatomical points (SFJ, mid-thigh, knee, and calf) and the presence and duration of venous reflux. Patients were grouped based on the presence or absence of reflux, and statistical analysis was used to determine the correlation between GSV diameter and reflux. Results: A total of 144 extremities were evaluated. GSV reflux was observed in 110(76%) of cases. The largest difference was observed at the 2 cm distal to the SFJ in both the groups (6.33 mm vs. 3.97 mm).). The smallest difference is observed below the knee (4.80 mm vs. 3.30 mm).(P=0.001) Highest Accuracy (AUC = 0.979) was observed at 2 cm distal to SFJ with Cutoff value of 5.25 mm, Sensitivity of 80%, and specificity of 98%. Conclusion: There is a significant association between GSV diameter and venous reflux in patients with varicose veins. The diameter of GSV can serve as a useful predictor of reflux and aid in clinical decision-making for intervention.

Introduction: In order to support patients during the initial phases of their recovery following knee surgery, effective pain management is essential. One Peripheral nerve blocks are frequently used to reduce pain, reduce dependency on opioids, and lower the possibility of negative side effects from opioid use Aims: To evaluate the total opioid consumption in the first 24 hours postoperatively in patients receiving PMP block versus those receiving FNB. Materials & Methods: Randomized controlled study. Place of study were Department Anaesthesia Abvims and Dr. RML Hospital. Period of study 1 year and total sample size was 100 Result: The incidence of nausea and vomiting was significantly higher in the PMPB group (40.0%) compared to the FNB group (20.0%, p = 0.0096). While sedation (20.0% vs. 10.0%) and urinary retention (20.0% vs. 50.0%) showed notable differences between groups, and dizziness occurred equally in both (20.0%), p-values for these outcomes were not reported. Conclusion: We came to the conclusion that, after knee surgery, the Pectineus Muscle Plane Block (PMPB) provides better postoperative analgesia and improved recovery than the Femoral Nerve Block (FNB).  PMPB was linked to a superior overall recovery profile, a decreased incidence of urine retention, and noticeably lower pain levels at 6 and 12 hours after surgery.

Introduction: The coronavirus disease (COVID-19) pandemic has had a worldwide impact on the population and heath care systems. Coronavirus pandemic has seen the introduction of novel methods of delivering education to medical students using various platforms such as Zoom. The present study was conducted to assess the effectiveness of online learning among medical students during COVID-19. Materials and methods:  This cross-sectional study was conducted in Department of Physiology, Dr. B.R. Ambedkar Medical College & Hospital, Bengaluru, Karnataka, India. This was a questionnaire-based study and the questions were based on a pre-validated questionnaire from a study done in UK. The questions included general information of the student and related to advantages and disadvantages of online learning during COVID-19. There were 20 questions and were of various styles including 5-point Likert scale ranging from strongly disagree to strongly agree. Few questions had single answer and few had multiple answers. This study invited 300 undergraduate medical students belonging to 2nd year, 3rd and final year during 2022. In this study, a total of 270 undergraduate medical students were participated, among them, 2nd year students were 94, 3rd year students were 96 and final year students were 80. Informed consent was obtained from all the study participants. Data was downloaded from google form in Microsoft excel and was used for analysis.  Results: Out of 270 students, females were 159 (58.8%) and males were 111 (41.1%). Before COVID-19 pandemic, 95 (35.1%) of the students never used online platforms for learning whereas 86 (31.8%) were using to some extent and 87 (32.2%) were using to great extent. When students were asked about most effective method of online learning, their first priority was combined videos and tutorials then followed by you tube videos and live tutorials alone. When they were asked if teaching was stimulating, 46 (17%) of them disagreed, 148 (54.8%) were neutral and 76 (28%) students agreed to that. When asked if it was easy to concentrate on online lectures, 120 (44.4%) strongly disagreed, 81 (30%) were neutral and 69 (25.5%) agreed to that. Students felt 121 (44.8%) free to ask doubts during online lectures than offline. Majority of the students around 168 (62.2%) disagreed that online teaching was as effective as offline teaching and also around 151 (55.9%) of them preferred offline teaching. When students were asked to choose the advantageous aspects of online learning, most of them (82%) opted for no travel, 50% of them said that they were more comfortable and were able to learn at own pace. Some students also felt that it was more flexible and cost saving. Among various options provided for barriers to online learning, majority of them had problems with internet connection and many had family distractions. Lack of devices, lack of space and anxiety were other barriers faced by the students. Majority of the students (38.8%) felt that online learning cannot replace the clinical teaching by direct patient contact whereas 33% of them said it has replaced only to some extent, 15% agreed that it replaced to great extent and only 12% of them opined that online learning can completely replace offline clinical teaching.  In this, 41% of the students were not able to learn clinical skills through online demonstrations whereas 47% were able to learn only to some extent and 10% of them to great extent. Conclusion: The present study may conclude that majority of the students used online platform during COVID 19. Online teaching has enabled the continuation of medical education during these unprecedented times. Moving forward from this pandemic, in order to maximise the benefits of both face-to-face and online teaching and to improve the efficacy of medical education in the future.

Background: Primary open-angle glaucoma (POAG) leads to progressive retinal ganglion cell loss and structural changes detectable through optical coherence tomography (OCT). While peripapillary RNFL thinning is well established, macular thinning has gained attention as a potentially sensitive biomarker. Objectives: To compare macular thickness parameters in patients with POAG and healthy controls using spectral-domain OCT, and to evaluate their association with clinical glaucoma severity markers and diagnostic performance. Methods: This cross-sectional observational study included 100 participants (50 POAG patients and 50 age- and sex-matched healthy controls) from Dr. D.Y. Patil Medical College, Navi Mumbai, conducted over one year in 2015. Average and quadrant-specific macular thicknesses were recorded using SD-OCT. Correlations with vertical cup-to-disc ratio (CDR) and visual field mean deviation (MD) were assessed in the POAG group. Diagnostic performance of macular parameters was evaluated using ROC analysis. Results: The mean central subfield thickness (CST) was significantly lower in POAG patients (237.4 ± 11.2 µm) than in controls (252.8 ± 10.4 µm, p < 0.001). Similar thinning was noted in the inner (279.3 ± 12.7 µm vs. 295.4 ± 13.6 µm, p < 0.001) and outer macular rings (258.5 ± 11.4 µm vs. 268.6 ± 10.9 µm, p < 0.001). The inferior and superior quadrants showed the most pronounced loss (p < 0.001 for both). In the POAG group, CST negatively correlated with vertical CDR (ρ = -0.52, p < 0.001) and positively with MD (ρ = 0.47, p < 0.001). ROC analysis showed that CST (AUC = 0.84), inner ring average (AUC = 0.88), and inferior quadrant thickness (AUC = 0.91) had high diagnostic accuracy for POAG detection. Conclusion: Macular thickness parameters, especially inferior and inner ring measurements, are significantly reduced in POAG and show strong correlation with disease severity. These OCT-based markers may enhance early glaucoma detection and complement peripapillary RNFL analysis in clinical practice.

Introduction:  Melasma is a condition characterized by the development of light to dark-brown spots and patches on areas of the skin that are frequently exposed to sunlight. While it predominantly affects women of reproductive age with darker skin types, individuals of all ages, ethnicities, and skin tones can experience this condition. Tranexamic acid, an antiplasminogen agent, has shown considerable effectiveness in treating melasma. This study compares the efficacy and safety of intradermal injections versus systemic administration of tranexamic acid for treating melasma.  Materials And Methods:  A total of 60 female patients with melasma were randomly assigned to two groups, Group A and Group B. The changes in mMASI scores before and after treatment were not significantly different between the two groups. However, Group A, which received oral tranexamic acid at a dosage of 250 mg twice daily for three months demonstrated a better treatment response compared to Group B, which was given intradermal injections of tranexamic acid (4mg/ml). Results:  In Group A, an excellent response was observed in 9 patients (30%), a good response in 9(30%), a moderate response in 6(20%), a mild response in 3(10%), and no response in 3 patients (10%). Conversely, in Group B, there were no excellent responses, with 6 patient (20%) showing a good response, 12 patients (40%) showing moderate responses, 6 patients (20%) showing mild responses, and 6 patients (20%) exhibiting no response.  Conclusion:  Tranexamic acid appears to be a promising new treatment option for melasma, demonstrating safety, tolerability, and effectiveness.

Background: Proper biomedical waste (BMW) management is crucial to prevent healthcare-associated infections, reduce environmental contamination, and ensure occupational safety. However, knowledge gaps among healthcare professionals and undergraduate medical students, the future workforce of the healthcare system, contribute to unsafe waste disposal practices. This study aimed to assess the impact of a structured training program on knowledge and awareness of BMW management among undergraduate medical students in a tertiary care hospital in West Bengal. Materials and Methods: This cross-sectional study was conducted over three weeks in the Department of Microbiology, Burdwan Medical College and Hospital, West Bengal. A total of 200 Professional MBBS candidates (4th semester) were selected using purposive sampling. A pre-validated, self-administered questionnaire was used to assess knowledge of BMW management before and after a structured training intervention. Training included lectures on national guidelines, standard operating procedures, and infection control measures related to BMW handling. Data were analyzed using descriptive statistics and paired t tests. Results: A total of 146 students participated in the pre-training assessment and 126 completed the post-training evaluation. The mean pre-test score was 6.77, which increased significantly to 7.92 post-training (p<0.0001). Significant improvements were observed in recognizing the biohazard symbol (59.6% to 78.6%, p<0.05) and in awareness of the updated BMW Rules of 2016 (67.8% to 83.3%, p<0.05). However, understanding the correct procedural sequence in BMW management and the legal duration for safe storage showed minimal change post-training. Conclusions: The structured training program significantly enhanced the medical students' knowledge of BMW management. Integrating regular, targeted educational interventions into medical curricula is crucial for promoting safe and compliant waste-handling practices among healthcare professionals. Future studies should explore long-term knowledge retention and the impacts of diverse educational methodologies.

Background: Multidrug-resistant Staphylococcus aureus (MDR-SA) remains a critical global health threat because of its high resistance and morbidity. Despite newer antimicrobials, MDR-SAs cause severe infections, significant mortality and financial burden. The global and regional prevalence varies, with limited data from West Bengal. This study addresses this gap by evaluating the prevalence and antimicrobial susceptibility patterns of multidrug-resistant (MDR) S. aureus isolates from a tertiary care hospital, with the aim to inform local infection control strategies and guide effective empirical therapy. Materials and Methods: In this cross-sectional study, clinical samples were collected over a nine-month period and processed for isolation and identification of Staphylococcus aureus using standard microbiological procedures. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method and also using automated system. Multidrug resistance was defined as non-susceptibility to at least one agent in three or more antimicrobial categories. Results: In this study, among the 539 Staphylococcus aureus isolates, 253 (46.9%) were methicillin-resistant S. aureus (MRSA) and 286 (53.1%) methicillin-sensitive S. aureus (MSSA) isolates. Of the 286 MSSA isolates, 85 (29.7%) fulfilled the criteria of multidrug resistance. Of the 539 isolates, 338 (62.7%) were identified as MDR-SA, comprising all 253 MRSA isolates and 85 MDR-MSSA isolates. MDR-SA isolates exhibited high resistance to commonly used antibiotics, with notable differences compared with non-MDR-SA isolates. However, all the isolates were susceptible to vancomycin, linezolid, and teicoplanin. Conclusions: The high prevalence of MDR-SA, particularly MRSA, and the distinct susceptibility patterns of MDR-SA and non-MDR-SA isolates in this tertiary care setting highlight the need for robust antimicrobial stewardship programs, regular surveillance, and targeted infection control measures.

Background: Type 2 diabetes mellitus (T2DM) is a growing global health concern, associated with substantial morbidity and mortality due to its metabolic and vascular complications. Among the markers of insulin resistance, the triglyceride-glucose (TyG) index has emerged as a validated surrogate indicator. Zinc and magnesium, as essential trace elements, are intricately involved in insulin function, glucose metabolism, and lipid regulation. The present study was undertaken to evaluate the correlation between serum zinc, magnesium, and TyG index in individuals with type 2 diabetes, in comparison to healthy controls. Methods: This cross-sectional study was conducted in the Department of Biochemistry at Mahavir Institute of Medical Sciences, Vikarabad. A total of 50 subjects were enrolled after informed consent, comprising 25 type 2 diabetic patients and 25 healthy controls. Fasting venous samples were collected and analyzed for serum triglycerides, fasting glucose, zinc, and magnesium levels. The TyG index was calculated using the formula: Ln [Triglyceride (mg/dL) × Glucose (mg/dL)/2]. Statistical significance between groups was determined using the unpaired t-test. Results: The TyG index was significantly elevated in the diabetic group (10.253 ± 0.5131) compared to controls (8.792 ± 0.178), with a p-value of 0.0037. Serum magnesium and zinc levels were significantly lower in diabetics (Mg: 1.396 ± 0.2346 mg/dL, Zn: 38.961 ± 7.8713 μg/dL) than in controls (Mg: 2.532 ± 0.154 mg/dL, Zn: 129.96 ± 34.536 μg/dL), with p-values of 0.0023 and 0.0069, respectively. Conclusion: The results show significant inverse correlation among the serum zinc and magnesium concentrations and the TyG index in type 2 diabetes patients. These trace element deficiencies could be partly responsible for greater insulin resistance and cardiovascular complication risk. Multicentric larger studies are required to assess the therapeutic role of trace element supplementation in the treatment of diabetes.

Background: Anemia in chronic kidney disease (CKD) arises from insufficient erythropoietin production and functional iron deficiency, significantly impairing quality of life and disease prognosis. Recombinant human erythropoietin (rh-EPO) remains the cornerstone of therapy, though associated with parenteral administration burdens and resistance. Desidustat, an oral hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), offers a novel mechanism by stimulating endogenous erythropoiesis and enhancing iron metabolism. Aims and Objectives: To evaluate and compare the efficacy and safety of oral Desidustat monotherapy against injectable rh-EPOs in CKD-associated anemia in terms of hematological indices, iron profile, renal function (eGFR), and cardiovascular risks, within a multidisciplinary framework. Materials and Methods: A prospective interventional cohort study was conducted on 150 CKD stage 3b–5 patients (October–December 2024) already on rh-EPO, who were switched to Desidustat. Regular monitoring of hemoglobin, reticulocyte parameters (ARC, ARI), ferritin, transferrin saturation (TSAT), eGFR, serum erythropoietin, and HEART score (MACE prediction) was done. Statistical analysis involved paired sample t-tests using SPSS v17, with p<0.05 considered significant. Results: Desidustat significantly improved hemoglobin (mean increase: 0.609 g/dL, p<0.05), eGFR (mean increase: 1.828 mL/min/1.73m², p<0.05), ARC (mean increase: 20.9×10⁹/L, p<0.05), ARI (mean increase: 0.16%, p<0.05), ferritin (mean increase: 7.86 ng/mL, p<0.05), and TSAT (mean increase: 4.91%, p<0.05). Peripheral smear confirmed effective erythropoiesis. No significant increase in MACE risk was observed. Compared to rh-EPOs, Desidustat demonstrated superior tolerability, oral convenience, and reduced need for adjunctive iron therapy. Conclusion: Desidustat presents a compelling oral alternative to rh-EPO injectables in managing CKD-associated anemia. Beyond hematological improvements, it shows promise in renal function stabilization and iron metabolism enhancement, with a favorable safety and compliance profile. This study reinforces the therapeutic potential of HIF-PHIs in nephrology and warrants further multicenter validation.

Background: Chronic liver disease (CLD) represents different liver disorders of varying severity and etiology in which hepatic inflammation and fibrosis continue at least for 6 months. It progresses from an asymptomatic phase to a decompensation condition within a variable range of periods with the development of symptoms of Portal Hypertension (PHTN). Esophageal varices (EV) are one of the most associated complications of PHTN. Elastography can be compared with Upper gastrointestinal findings for early prediction of the presence of Esophageal varices. Aims and objectives: To correlate the Elastographic findings for liver stiffness with Upper Gastrointestinal Endoscopic findings for the presence of esophageal varices. Methods: This was a hospital-based cross-sectional study carried out on CLD patients of age more than 13 years with satisfied inclusion and exclusion criteria. All patients were evaluated  by thorough history taking, examination, and investigations. Statistical data were analyzed using an independent sample t-test and ROC curve. Results: A total of 60 patients were included in our study. Most cases were in the age group of 40-60 years with a slightly higher male-to-female ratio. Alcoholic liver disease was the most common cause (60%). Mean values of elastography, APRI score, and Platelet counts in patients were 25.9 Kpa, 1.83, and 098 lakhs/cumm in cases with Gastroesophageal varices respectively. P value was calculated to be < 0.05 and it is statistically significant. Similarly, Mean Elastography values were correlated with the grading of Gastroesophageal varices and its association was found to be statistically significant. The cutoff values for liver stiffness using Elastography was 19.3 Kpa; Sensitivity of 82.1% and Specificity of 66.7 % for Elastography to detect the esophageal varices. Conclusion: Elastography of the liver is a good non-invasive method to predict esophageal varices and possible grading with sensitivity.

Introduction: Co-infection with tuberculosis (TB) and COVID-19 poses a significant threat to public health, especially in TB-endemic countries like India. The interaction between these two respiratory infections may lead to worse clinical outcomes. Understanding the factors that influence the severity of COVID-19 in TB patients is essential for effective management. Methods: A cross-sectional study was conducted among 132 TB patients diagnosed with COVID-19 at a tertiary care hospital in Kalaburagi, Karnataka, from January to June 2022. Demographic and clinical data including comorbidities, TB history, chest radiographic findings, vaccination status, and COVID-19 outcomes were collected. COVID-19 severity was classified as per MOHFW guidelines. Statistical analysis was performed using chi-square tests and logistic regression to identify predictors of severe disease. Results: Out of 132 patients, 45 (34.1%) developed moderate-to-severe COVID-19. Factors significantly associated with severity included age >60 years (OR=3.2, 95% CI: 1.4–7.3), diabetes mellitus (OR=2.7, 95% CI: 1.2–6.0), and cavitary pulmonary TB (OR=2.9, 95% CI: 1.1–7.5). COVID-19 vaccination was associated with reduced severity (OR=0.42, 95% CI: 0.18–0.98). Discussion: The severity of COVID-19 in TB patients is significantly influenced by age, comorbidities, and lung damage due to TB. These findings highlight the importance of targeted interventions and prioritization of vaccination in TB patients to mitigate poor outcomes.

Background: Spinal anesthesia is the most commonly used technique for cesarean sections, with patient positioning playing a critical role in anesthesia effectiveness and onset characteristics. While the sitting and lateral positions are both practiced, their comparative efficacy and safety profiles require further exploration. Aim: To compare the lateral and sitting positions during spinal anesthesia induction using plain levobupivacaine in elective cesarean sections, in terms of block characteristics, maternal hemodynamics, and neonatal outcomes. Methods: This was a prospective, observational study involving 100 parturients undergoing cesarean section under spinal anesthesia. Fifty patients were assigned to the sitting position group and fifty to the lateral position group. Spinal anesthesia was administered using 12.5 mg of 0.5% plain levobupivacaine. Data on block onset, maximum sensory level, motor block duration, maternal hypotension, and Apgar scores were recorded and analyzed. Results: The lateral group showed faster onset of sensory block (mean: 3.2 ± 0.6 min vs. 4.1 ± 0.5 min; p < 0.01), longer duration of motor block (175 ± 22 min vs. 160 ± 20 min; p < 0.05), and reduced incidence of hypotension (30% vs. 46%; p < 0.05) compared to the sitting group. Apgar scores at 1 and 5 minutes were comparable in both groups. Conclusion: The lateral position provides a faster onset and prolonged motor blockade with better hemodynamic stability compared to the sitting position for spinal anesthesia using plain levobupivacaine in cesarean sections.

Background: Postdural puncture headache, often classified as a minor complication, can be severe and debilitating and has been considered the neurological complication of spinal anesthesia. Aim: To determine the incidence of postdural puncture headache with and without reinsertion of stylet before removing spinal needle in patients undergoing LSCS under spinal anesthesia. Methods: After obtaining the ethical clearance from the Institutional Ethical Committee the present prospective observational study was conducted in the Department of Anaesthesiology, Critical Care and Pain Management. Data was collected from all patients who received spinal anesthesia for LSCS according to our routine protocol.  Written informed consent was taken from all patients for participation in this study. Patients who fulfilled the inclusion and exclusion criteria we observed two groups viz. Group A (without Stylet reinsertion) and Group B (with Stylet reinsertion) after receiving spinal anesthesia for LSCS. Patients from both the study groups were observed intraoperatively and postoperatively. Patients not fulfilling criteria for postdural puncture headache or having other causes of headaches were dropped from the study. Patient were asked about onset of headache, duration of headache, severity of headache (VAS), associated symptoms like nausea, vomiting, neck stiffness, aggravating and relieving factors, history of fever with headache. The recorded data was compiled and entered in a spreadsheet (Microsoft Excel) and then exported to data editor of SPSS Version 20.0 (SPSS Inc., Chicago, Illinois, USA). Chi-square test or Fisher’s exact test, whichever appropriate, was applied for comparing categorical variables. A P-value of less than 0.05 was considered statistically significant. All P-values were two tailed.  Results:  Incidence of PDPH in Group A was 10% (n=11) with none of the patients in Group B. The association between PDPH and the two study groups was statistically significant with a p value of 0.003. In Group A patient’s onset of PDPH was within 24-48 hours in 5 (45.5%) followed by within 24 hours in 4 (36.4%), 48-72 hours in 2 (18.2%). None of the patients had PDPH at or after 72 hours. Out of 11 patients with PDPH, severity was mild in 7 (63.6%) patients, moderate in 4 (36.4%). None of the patients in Group A had severe PDPH. Duration of PDPH was 1-4 days in majority of patients i.e. 8 (72.7%), 2 (18.2%) had PDPH for 8-10 days while only 1 (9.1%) patient had PDPH for 5-7 days with a mean duration of 4.2+1.56 days.  Conclusion:  We concluded that reinsertion of the stylet before spinal needle removal after spinal anaesthesia has a significant impact on incidence of PDPH. To understand the response of stylet reinsertion before removing spinal needle in patients undergoing LSCS under spinal anaesthesia further large sample studies are needed.

Introduction: Ropivacaine, a pure S (-) enantiomer of bupivacaine has a better safety profile due to its reduced neurotoxicity and cardiotoxicity. Various adjuvants like opioids, clonidine, dexamethasone etc have been used to improve the quality of blockade. Dexmedetomidine is a selective alpha-2 agonist and has been used widely in recent studies. Nalbuphine, a mixed opioid receptor agonist-antagonist, provides analgesia through κ-receptor activation and mitigates side effects such as respiratory depression, pruritus, nausea, and vomiting by antagonizing μ-receptors. Very few studies have compared intrathecal dexmedetomidine and nalbuphine as adjuvants to hyperbaric ropivacaine. Aim: This prospective, randomised, double blinded study was done to determine and compare the effects of adding dexmedetomidine or nalbuphine to 0.75% hyperbaric ropivacaine in patients undergoing infraumbilical surgeries. Methods: This study was done on 80 patients undergoing elective infraumbilical surgeries. Patients were randomly allocated into two groups: Group RD recieved 3.2ml of 0.75% hyperbaric ropivacaine along with 10 μg of Inj. Dexmedetomidine (0.1ml of dexmedetomidine reconstituted with 0.2ml normal saline) while Group RN received 1mg of inj. Nalbuphine (0.1 ml of nalbuphine reconstituted with 0.2ml normal saline) along with 3.2ml of 0.75% hyperbaric ropivacaine The time for onset of sensory, motor blockade, duration of sensory and motor blockade, hemodynamic variability and side effects were recorded. Results: Onset of sensory and motor blockade was significantly faster in group RD (7.93 and 4.2 minutes respectively) than that of group RN. The duration of sensory and motor blockade was significantly longer in group RD (647.38 and 524.88 minutes) than that of group RN with P value <0.01. Also, the highest level of sensory blockade was T4 in 12.8% and T6 in 87.5% individuals with dexmedetomidine. Both the groups showed hemodynamic stability with no side-effects. Conclusion: We conclude that dexmedetomidine, as an adjuvant to hyperbaric ropivacaine, provided superior blockade and analgesia compared to nalbuphine

Background: Spinal anaesthesia has become a cornerstone of modern obstetric anaesthesia with ongoing research and development aiming to optimize its use and reduce any potential complications. Objective: to compare 2 doses of phenylephrine i.e. 75mcg and 50mcg in prevention of oxytocin induced hemodynamic changes in caesarean section under spinal anesthesia Methods: A randomized controlled trial was carried out on 64 patients, aged 20-40 years, classified as ASA grade II, scheduled for elective or emergency lower segment caesarean section. The study received approval from the Ethical Committee of Rohilkhand Medical College and Hospital, Bareilly. The 64 participants were randomly assigned to two groups, Group 1 and Group 2, with 32 patients in each group. Result: The differing hemodynamic responses to the two phenylephrine doses. The 75mcg bolus dose of phenylephrine was more effective in stabilizing blood pressure, including systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), especially during the critical period after oxytocin administration and cord clamping. Statistically significant differences were observed at various time points. For example, at 2 minutes post-cord clamping, phenylephrine demonstrated a significant advantage in SBP (p=0.019), and this trend continued at 4 minutes (p=0.037), 6 minutes (p=0.007), 8 minutes(p=0.005) and 10 minutes (p=<0.001). Similarly, phenylephrine consistently maintained higher MAP values, with significant differences at 1 minute (p=0.002), 2 minutes (p<0.001), and 3 minutes (p=0.0023) post-cord clamping. These results underscore 75mcg phenylephrine’s efficacy as a vasopressor that provides robust blood pressure control in the perioperative period. Conclusion: phenylephrine 75mcg is better suited for ensuring hemodynamic stability during the perioperative period, particularly for blood pressure control. These results provide valuable insights for anesthesiologists in tailoring intraoperative management strategies for caesarean sections under spinal anesthesia.

Background: Heart Failure with Preserved Ejection Fraction (HFpEF) is a growing clinical challenge globally, especially among elderly patients with multiple comorbidities. Indian data on its clinical profile and outcomes remain limited. Aim: To evaluate the clinical characteristics and short-term outcomes of patients diagnosed with HFpEF in a tertiary care hospital. Methods: A prospective observational study was conducted on 100 patients with HFpEF (LVEF ≥ 50%). Clinical presentation, comorbidities, echocardiographic findings, and 30-day outcomes were recorded and analyzed using descriptive and inferential statistics. Results: HFpEF was more common in elderly females (mean age 66 years). Hypertension (82%), diabetes (61%), and obesity (66%) were the most prevalent comorbidities. Echocardiography showed diastolic dysfunction, left atrial enlargement (64%), and LV hypertrophy (57%). At 30 days, 84% improved symptomatically, while 11% were readmitted, and 5% died, with worse outcomes among those with diabetes, atrial fibrillation, and CKD (p < 0.05). Conclusion: HFpEF patients frequently present with multiple comorbidities that contribute to early adverse outcomes. Targeted management of risk factors and structured follow-up are crucial for improving prognosis in these patients.

Introduction: The rise of life expectancy as a result of the antiretroviral therapy (ART) in subjects with human immunodeficiency virus (HIV) has increased the prevalence of chronic medical conditions, such as kidney disease. Kidney disease prevalence in subjects with HIV infection is reported between 3.5% and 48.5%. Second-generation INSTIs are currently the class of choice in ART regimens due to their high potency, good tolerability, low toxicity and high genetic barrier to resistance. INSTIs are believed to work by chelating magnesium ion to prevent HIV from integrating into host DNA. Magnesium is involved in the regulation of mitochondrial function, inflammatory process and immune defense, allergy, growth and stress and in the control of neuronal activity, cardiac excitability, neuromuscular transmission, vasomotor tone and blood pressure. Magnesium is an intracellular component of bone cells. A number of studies have reported changes in bone density accompanied by changes in serum levels of phosphate, alkaline phosphate and serum magnesium.  Thus, this study is being conducted to estimate the Serum Magnesium levels in people living with HIV on ART. Materials: This case-control study was performed among 25 People living with HIV on ART and 25 age and sex matched controls attending the department of general medicine, Kempegowda institute of medical sciences during an 18-month period. Serum Magnesium levels were evaluated among all the cases and controls. The data was collected and compiled in MS Excel. Descriptive statistics has been used to present the data. To analyse the data SPSS (Version 26.0) was used. Significance level was fixed as 5% (α = 0.05. Qualitative variables are expressed as frequency and percentages and Quantitative variables are expressed as Mean and Standard Deviation. To compare the association between numerical and categorical variables, student t test was used and to compare the association between categorical variables chi square test was used.  Observation: The mean age of the cases and controls were found to be 49.32+7.587 and 49.28+7.531 respectively. 84% of the study participants in each group were males. 4% of the study participants in each group had type 2 diabetes mellitus. The mean duration of ART among the cases was found to be 13.48+4.736 months. The mean serum magnesium among the cases and controls were found to be 1.7188+0.238 and 2.0300+0.232 respectively. The mean serum magnesium levels were found to be lower among the cases than the controls with statistical significance (P<0.05). Conclusion: Serum magnesium levels have to be routinely checked among all HIV patients to prevent bone complications. Serum bone profiling a potentially non-invasive, inexpensive method that can be used routinely to detect changes in bone metabolism in the HIV infected patients.

Background: Type 2 diabetes mellitus (T2DM) is associated with a significantly increased risk of cardiovascular disease (CVD). Inflammation plays a critical role in the pathogenesis of atherosclerosis, and high-sensitivity C-reactive protein (hs-CRP) is an established marker of systemic inflammation. This study aimed to assess the association between hs-CRP levels and cardiovascular risk in patients with T2DM. Methods: A cross-sectional study was conducted among 100 patients with T2DM attending a tertiary care hospital. hs-CRP levels were measured, and cardiovascular risk was assessed using the Framingham Risk Score. Patients were categorized into low, moderate, and high cardiovascular risk groups. Statistical analysis included ANOVA and Pearson’s correlation coefficient. Results: Among 100 participants, 35% were categorized as high cardiovascular risk. Mean hs-CRP levels significantly increased across low (2.1 ± 0.9 mg/L), moderate (3.8 ± 1.2 mg/L), and high (6.2 ± 2.0 mg/L) risk groups (p < 0.001). A strong positive correlation (r = 0.684, p < 0.001) was observed between hs-CRP levels and Framingham scores. Conclusion: Elevated hs-CRP levels are strongly associated with higher cardiovascular risk in T2DM patients. hs-CRP may serve as an effective adjunctive marker in cardiovascular risk prediction and management in diabetic individuals.

Background and Objectives: Coronary artery disease (CAD) results from interaction of many risk factors, environmental influence and genetic predisposition. Endothelial and vascular smooth muscle dysfunctions are early abnormalities in atherosclerosis development in cardiometabolic disease. Diabetes is a significant risk factor for cardiovascular disease due to elevated oxidant levels contributing to vascular dysfunction and impaired vasodilatory effect mediated through release of nitric oxide (NO). Endothelial function assessed by brachial artery Flow mediated dilatation (FMD), a non-invasive test has been shown to be impaired in patients of CAD. As diabetes has been CAD risk equivalent, this study is being done to evaluate the mean FMD value in patients with and without diabetes mellitus and to correlate endothelial dysfunction in these patients through FMD. Methods: A cross-sectional study was done from January 2020 to June 2021, in which 84 patients of CAD were enrolled after informed consent. The patients were divided into 2 groups of diabetics and non-diabetics. Statistical analysis was done to compare mean FMD value between the 2 groups of diabetes and non-diabetes patients by using independent sample t test and correlation of endothelial dysfunction in diabetes through FMD was done by chi square analysis.  Results: The mean age of patient was 53.81±9.52 years, males were predominant than females in the study with sex ratio of 1:4. The mean duration of diabetes was 4.91 with SD 1.22 years. The mean FMD in SVD (Single vessel disease) was 9.43± 4.48%, in DVD (Double vessel disease) mean was 8.55±2.83% and in TVD (Triple vessel disease) was 5.707±1.93%. Among the various biochemical parameters, increased creatinine, FBS, PPBS and TG was found to be statistically significant with respect to diabetes (p<0.01). The mean FMD (%) was found to be lower with values of 5.87 ±2.03% ( p<0.001) in diabetic group than in non-diabetic group, whose mean FMD was 11.51±3.27%. Conclusion: The mean FMD was found to be lower in diabetic group than in non-diabetic group, suggesting increased endothelial dysfunction in diabetic patients compared to non-diabetics in   patients with known CAD. Also, FMD was found to be negative correlated with risk of cardiovascular disease in diabetic patients, where lower FMD was found to be associated with higher risk of endothelial dysfunction. Therefore, FMD is a non-invasive, simple, reliable technique which serves as an alternative to invasive procedures and can help to identify patients with endothelial dysfunction who are at a higher risk of CAD, and initiate early and appropriate management.

Background: Chronic tonsillitis is a recurrent inflammatory condition of the palatine tonsils often characterized by persistent throat pain, halitosis, and tonsillar hypertrophy. Conventional treatments, including antibiotics and tonsillectomy, carry limitations such as resistance, adverse effects, and surgical risks. Cold plasma therapy has emerged as a promising non-thermal, minimally invasive modality with antimicrobial and tissue-regenerative properties.  Materials and Methods: A randomized controlled trial was conducted on 60 patients aged 10–40 years diagnosed with chronic tonsillitis. Participants were divided into two groups: Group A (n=30) received cold plasma therapy using a helium-based plasma device, while Group B (n=30) received standard medical therapy (antibiotics and analgesics). Treatments were administered over four weekly sessions, and patients were followed up for three months. Clinical outcomes were assessed using the Tonsillitis Severity Index (TSI), Visual Analog Scale (VAS) for pain, frequency of episodes, and tonsillar size grading. Results: At the end of 12 weeks, Group A demonstrated a significant reduction in TSI scores (baseline: 7.8 ± 1.2; post-treatment: 2.1 ± 0.9) compared to Group B (baseline: 7.6 ± 1.3; post-treatment: 4.9 ± 1.4), p < 0.01. Mean VAS pain scores decreased from 6.4 ± 1.1 to 1.5 ± 0.6 in Group A and from 6.2 ± 1.0 to 3.7 ± 1.2 in Group B (p < 0.05). Tonsillar size was reduced in 76% of Group A patients compared to 42% in Group B. No major adverse events were reported in either group. Conclusion: Cold plasma therapy significantly improves clinical outcomes in patients with chronic tonsillitis, offering a non-invasive, well-tolerated alternative to conventional medical management. Further longitudinal studies are recommended to confirm long-term efficacy and safety.

Background: Interstitial lung diseases (ILDs) comprise a heterogeneous group of diffuse parenchymal lung disorders characterized by inflammation and fibrosis. High-resolution computed tomography (HRCT) plays a pivotal role in their non-invasive diagnosis and pattern recognition. This study aimed to assess the HRCT patterns among patients with suspected ILD and correlate them with clinical and demographic data. Materials and Methods: A prospective observational study was conducted involving 100 patients clinically suspected to have ILD. All patients underwent HRCT chest scanning, and radiological features were evaluated systematically. Data on age, gender, smoking status, and HRCT patterns were recorded. Specific ILD subtypes were identified based on characteristic imaging features, laboratory investigations and clinical correlation. Results: Idiopathic Interstitial Pneumonias (IIPs) accounted for the majority (50%) of ILD cases, with usual interstitial pneumonia (UIP/IPF) being the most prevalent subtype. The predominant HRCT findings included interlobular and intralobular septal thickening, honeycombing, and traction bronchiectasis. Non-specific interstitial pneumonia (NSIP) and hypersensitivity pneumonitis (HP) were the next most frequent patterns. HRCT also identified rare subtypes such as desquamative interstitial pneumonia (DIP), lymphangioleiomyomatosis (LAM), and sarcoidosis. Smoking was noted in 24% of patients and was significantly associated with smoking-related ILDs such as DIP and pulmonary Langerhans cell histiocytosis (LCH). Gender distribution showed a slight female predominance (54%). Conclusion: HRCT is an essential diagnostic modality in ILD evaluation, offering detailed pattern recognition critical for subtype classification. It enables early, non-invasive diagnosis and guides further management by delineating characteristic radiologic findings. Integrating HRCT findings with clinical and exposure histories enhances diagnostic accuracy and obviates the need for invasive procedures in many cases.

Background: Medical education is evolving to balance theoretical knowledge with practical skills. In the context of obstetrics and gynaecology, both bedside clinics and simulation-based learning serve as vital teaching methods. This study compares their effectiveness in knowledge retention, clinical skill acquisition, student confidence, and satisfaction. Objectives: To evaluate and compare the educational outcomes of simulation-based learning and bedside clinic-based teaching among undergraduate medical students in obstetrics and gynaecology. Methods: A descriptive cross-sectional quasi-experimental study was conducted among 450 undergraduate MBBS students who underwent two-week postings in both simulation-based and bedside clinic-based learning modules. Formative assessments and validated feedback questionnaires were used to assess knowledge retention, skill proficiency, confidence levels, and student satisfaction. Data were analyzed using descriptive statistics and p-values for significance testing. Results: Students in the simulation group had significantly higher knowledge scores (81.6 ± 6.4) than those in the bedside group (76.2 ± 7.8, p < 0.01). OSCE scores also favored the simulation group (84.2 ± 5.1 vs. 77.5 ± 6.3, p < 0.001). While 78% of students in the simulation group reported being “very confident,” only 58% from the bedside group reported the same. Simulation-based learning received higher satisfaction ratings (85% vs. 71%). Bedside learning was preferred for real-time decision-making and communication skills. Conclusion: Simulation-based learning significantly enhances knowledge and procedural skills, while bedside clinics excel in communication and patient interaction. A blended teaching approach may provide optimal learning outcomes

Objective: Bladder leiomyomas are rare, benign mesenchymal tumours of the urinary bladder. We present a case series of three patients diagnosed and treated for bladder leiomyoma. Design: Case series study. Setting: Department of Urology, SPMC, Bikaner. Participants: Three patients (two males, one female) presenting with varied symptoms of bladder leiomyoma. Outcome Measures: Clinical presentation, imaging findings, histopathology, surgical approach, and outcomes.

Background: A key aspect of general anesthesia, laryngoscopy and endotracheal intubation, commonly induces significant hemodynamic responses including elevated blood pressure and heart rate.  Effective management of these responses is essential particularly in patients with pre-existing cardiovascular risks. Aim: This study aimed to compare how effectively and safely Esmolol and Dexmedetomidine reduce the hemodynamic responses (changes in heart rate and blood pressure) caused by laryngoscopy and intubation. Methods: This study involved 100 patients, randomly assigned to 2 groups, each receiving one of the esmolol and dexmedetomidine agents were assessed and their impact on hemodynamic parameters, specifically heart rate (HR), systolic, diastolic, and mean blood pressure (SBP, DBP, and MBP). These measurements were taken at baseline, during laryngoscopy, and then at 1, 3, 5, 7, and 10 minutes.  Adverse events including bradycardia, hypotension, nausea, respiratory depression, and drowsiness were evaluated. Results Both agents effectively reduced hemodynamic responses, with varying efficacy and side effect profiles. Dexmedetomidine provided the most stable hemodynamic control with minimal side effects. HR at T1 was 77.6 ± 8.2 bpm, significantly lower compared to 82.0 ± 8.8bpm HR in esmolol group during laryngoscopy (p<0.05). Esmolol significantly reduced HR (82.0 ± 8.8 bpm at T1) but had a higher incidence of bradycardia. Hemodynamic parameters were lower in dexmedetomidine group compared to esmolol group. Conclusion: Dexmedetomidine proved to be the most effective drug for managing hemodynamic responses while causing the fewest side effects, making it a preferred option in clinical settings. We recommend further research in larger and more diverse patient groups to confirm these results.

Background: Diabetic ketoacidosis (DKA) is a serious complication of diabetes, occasionally triggered by acute pancreatitis due to hypertriglyceridemia. We report a rare case of a young male with undiagnosed T1DM presenting with DKA, hypertriglyceridemia-induced pancreatitis, AKI, and ARDS. Case Presentation: A 23-year-old male presented with abdominal pain, respiratory distress, and altered consciousness. He was hypotensive, hyperglycemic (CBG 428 mg/dL), with a GCS of E2V1M3. Investigations revealed high anion gap metabolic acidosis, triglycerides of 730 mg/dL, elevated lipase, positive urinary ketones, and renal impairment. Imaging confirmed pancreatitis with renal parenchymal disease. He was intubated and treated in ICU with insulin infusion, fluids, vasopressors, antibiotics, and dialysis. He later developed ARDS, which was managed appropriately. The patient recovered fully and was discharged with counselling on lifelong insulin therapy, glucose monitoring, and dietary adherence. Conclusion: Early multidisciplinary management in severe DKA cases with organ dysfunction can result in full recovery.

Purpose: To report incidence and management of secondary Glaucoma persisting for more than 2 weeks after Scleral fixation (Sutured,group A and Sutureless,group B ) of PC-IOLs. Methods: 37 eyes of 35 patients underwent SF-IOLs (16 in group A and 21 in group B), following anterior/ pars plana vitrectomy. No patient had preexisting Glaucoma. IOP was recorded daily for one week,weekly for 6 weeks.Follow-up ranged from 3 months to 1 year. Results:Glaucoma persisting for more than 2 weeks was seen in 7 eyes (19%). It was similar in A (3/16) and B (4/21) group. However, all 3 eyes in group A and 1 eye of group B recovered completely within 2 months on medical management.  In group B, 1 patient required Trabeculectomy with MMC, 2nd was controlled on oral and topical therapy and 3rd patient was controlled on topical therapy alone. Conclusions: A high incidence of persistent secondary glaucoma is seen after implanting SF IOLs, both sutured as well as sutureless, mainly because of complicated multiple surgeries.

Background: Bone marrow aspiration and trephine biopsy are two most important techniques which are complementary for diagnosing both neoplastic and non- neoplastic haematological diseases. The present study was conducted in the department of pathology to compare the role of bone marrow aspirate and trephine biopsy for diagnosing the haematological diseases.  Methods: The study was conducted in the department of pathology The study was one-year retrospective and one year prospective. Bone marrow aspiration was done in 626 cases out of which biosy was done in 300 cases.  Results: Out of the selected 300 cases were both aspiration and trephine biopsy were available, diagnostic material on bone marrow aspirate was adequate in 288 cases. 12 cases were a particulate. Biopsy was inadequate in 8 cases. Overall megaloblastic anaemia (26.6%) was most common followed by dual deficiency anemia. Multiple myeloma was the most common neoplastic pathology (13%) followed by followed by acute leukaemia’s (6%) and Chronic lymphoproliferative disorders (CLPDS) (5%). 1 case each of visceral leishmaniasis and malarial parasite were also noted. 4 cases (1.3%) of granulomatous pathology and 2 cases (0.6%) of Hodgkins lymphoma were diagnosed exclusively on bone marrow biopsy.  Conclusions: Bone marrow aspiration and biopsy are complimentary to each other in diagnosing hematological disorders with biopsy being gold standard in the assessment of cellularity, pattern, extent of tumor infiltration and focal infiltration. It is more helpful in diagnosing granulomatous pathology and metastatic deposits of tumors eliciting fibrotic response.

Background: Diabetic Peripheral Polyneuropathy (DPN) is a debilitating complication of diabetes mellitus characterized by progressive nerve damage, leading to sensory disturbances and neuropathic pain. Pharmacologic management includes anticonvulsants, serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs). However, comparative data on combination therapies for DPN, particularly Pregabalin plus Nortriptyline (Preg-Nort) versus Pregabalin plus Duloxetine (Preg-Dul), remains limited. Methods: A double-blind, randomized controlled trial was conducted on 80 patients diagnosed with DPN. Participants were assigned to either the Preg-Nort (Pregabalin 75 mg + Nortriptyline 10 mg) or Preg-Dul (Pregabalin 75 mg + Duloxetine 20 mg) group for 12 weeks. Primary outcomes included pain reduction (VAS score), while secondary outcomes evaluated insomnia severity (ISI), anxiety (HADS-A), depression (HADS-D), and incidence of adverse effects. Data were analyzed using SPSS v24, with significance set at p < 0.05. Results: Both groups exhibited significant pain reduction, with Preg-Dul achieving faster pain relief at 4, 6, and 8 weeks (p < 0.05), though long-term efficacy converged. Preg-Nort improved insomnia scores earlier (4 weeks, p < 0.001), but differences diminished over time. Anxiety reduction was comparable between groups, whereas Preg-Dul demonstrated greater depression improvement by 8 and 12 weeks (p < 0.05). Adverse events differed: Preg-Dul had higher nausea and vomiting incidence, while Preg-Nort caused more dry mouth (p < 0.01). Conclusion: Pregabalin plus Duloxetine provided superior early pain relief and greater depression improvement, whereas Pregabalin plus Nortriptyline exhibited faster insomnia relief. Safety profiles varied, necessitating individualized treatment selection. These findings support the tailored use of combination therapy for DPN, factoring in symptom priorities and side effect tolerability.

Introduction: Mid-face defects resulting from trauma, tumor excision, or infection pose a significant reconstructive challenge due to the complex anatomical and aesthetic considerations involved. The forehead flap remains a cornerstone in facial reconstruction due to its robust vascularity and tissue characteristics. Objectives: To evaluate the effectiveness and outcomes of the forehead flap technique in reconstructing mid-face defects. Methods: A prospective observational study was conducted on 25 patients with mid-face defects treated using forehead flap reconstruction at Deccan College of Medical Sciences, Princess Esra Hospital, between May 2022 and May 2025. Clinical evaluation, aesthetic outcomes, patient satisfaction, and complication rates were assessed. Results: Infection (8%), trauma (24%), and oncologic resections (68%), accounted for the majority of errors. Eighty percent of patients had excellent cosmetic results, with just two cases of flap congestion and one case of wound dehiscence. There was no flap loss noted. Eighty-eight percent of patients were satisfied. Conclusion: The forehead flap is a reliable and aesthetically favorable option for reconstructing mid-face defects, with a high rate of patient satisfaction and low complication rates.

Background: The aim of this study was to determine whether different concentrations of intratympanic (IT) injection of dexamethasone at a dose of 4 and 10 mg/mL have an effect on hearing outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Results: Our study was conducted on 30 adult patients with unilateral ISSNHL who failed to respond or had contraindications to systemic steroids. Patients were categorized into two groups; each one included 15 patients. IT injection of 4 mg/mL dexamethasone was done in one group (IT dexamethasone (Dex) 4 mg/mL), while 10 mg/mL dexamethasone was administered intratympanically in the other group (IT Dex 10 mg/mL). IT injection was performed twice weekly for two successive weeks. PTA thresholds were assessed at 0.5, 1, 2 and 4 kHz before and 1 month after the treatment.

In the group with IT Dex 10 mg/mL, the average PTA improved significantly from 75.50 ± 12.59 to 49 ± 24.04 dB with an average gain of 26.50 ± 14.25 (p = 0.0007). In the group with IT Dex 4 mg/mL, there was a significant change of PTA from a pretreatment value of 76.92 ± 11.89 dB to a post-treatment value of 59.27 ± 92.10 dB with an average gain of 17.65 ± 8.36 dB.

A comparison of the post-treatment gain of PTA in both groups showed better improvement of hearing in the group treated by IT Dex 10 mg/mL compared with 4 mg/mL. Conclusion: This study demonstrated that IT injection of dexamethasone at a dose of 10 mg/mL was associated with better hearing outcomes compared with 4 mg/mL for the treatment of ISSNHL.a

Introduction: Sepsis is a serious kind of life-threatening complications arising out of extreme reaction induced in the body to fight infection. Materials And Methods: This retrospective study was conducted from the data available at the records of Assam Medical College Dibrugarh during the period of January 2024 to December 2024. Results: Total 80 numbers of patients were included in the study comprising patients with age group from >18 years to 77 years. The patients were grouped into sepsis and severe sepsis. Conclusion: The study concluded that both PCT and NLR can be used for early diagnosis of bacterial sepsis however, the individual performance of PCT is better than NLR

The landscape of undergraduate medical education is undergoing a transformation with the integration of advanced technologies such as Artificial Intelligence (AI) and Virtual Reality (VR). These innovations offer new ways of delivering content, assessing competencies, and enhancing student engagement. This review explores recent trends, applications, and the pedagogical impact of AI and VR in medical education, especially in undergraduate training. It emphasizes the role of Medical Education Units (MEUs) in facilitating this digital transformation through faculty development, curricular integration, and institutional research. The review also addresses challenges, including infrastructure needs, faculty resistance, ethical concerns, and the necessity for rigorous outcome-based evaluation. Finally, the article provides future directions for sustainable and scalable technology adoption. 

Background: Respiratory distress remains one of the leading causes of neonatal morbidity and mortality, particularly in preterm infants. Bubble Continuous Positive Airway Pressure (CPAP) is a simple, cost-effective, and non-invasive ventilation strategy widely used in resource-limited settings. This study aimed to evaluate the clinical profile and outcomes of neonates treated with bubble CPAP for respiratory distress at a tertiary care hospital in South India. Objective: To assess the clinical characteristics and treatment outcomes of neonates with respiratory distress managed using bubble CPAP at KIMS and RF General Hospital, Amalapuram. Methods: This was a prospective cohort study conducted over one year, enrolling 100 neonates admitted to the NICU with respiratory distress. Neonates with Downes scores between 3 and 6 were initiated on bubble CPAP. Relevant clinical data, including gestational age, gender, mode of delivery, diagnosis, PEEP levels, duration of CPAP, Downes score, antenatal steroid exposure, complications, and outcomes were recorded. Statistical analysis was performed using SPSS v30.0, with p-values <0.05 considered significant. Results: Of the 100 neonates studied, 56% were female and 44% were male. Respiratory Distress Syndrome was the most common diagnosis (38%), followed by meconium aspiration syndrome (25%). A total of 62% responded to CPAP therapy, while 38% required mechanical ventilation. Better outcomes were significantly associated with higher gestational age (p=0.001), vaginal delivery (p<0.001), complete antenatal steroid administration (p<0.001), and lower Downes scores (p<0.001). Complications were noted in 43% of cases, the most common being nasal injury and pneumothorax. Conclusion: Bubble CPAP is an effective and safe initial modality for managing respiratory distress in neonates. Favorable outcomes are associated with timely initiation, antenatal steroid use, and lower disease severity.

Background: Diabetes mellitus is one of the most common chronic diseases has been related to various liver illnesses such as liver enzyme derangements, non-alcoholic fatty liver disease, hepatocellular carcinoma, and cirrhosis. There has been increased interest on the contribution of liver enzymes to prediction of diabetes and glycemic control.  Aims and Objectives: The aim is study was to correlate liver enzymes with type 2 diabetes mellitus (T2DM) and non-diabetic individuals.  Materials and Methods: Diabetic patients seen on Outpatient Department basis or admitted as inpatients are included in this study. Information is collected and detailed history is taken using pre-formed proforma at the time of admission. Liver function tests are measured to all participants, and HbA1C value is measured. Liver enzymes are correlated with HbA1C values. Results: Majority of the participants were males (64% in cases & 60% in control). The mean age among cases was 53.5 ± 9.3 and among control was 49.8 ± 5.6 years. The mean duration of diabetes is 7.86±5.38, mean HbA1c is 8.48±3.25. Mean fasting blood sugar and post-prandial blood sugar were 169.5±91.3 and 242.3±133.6, respectively. Liver enzymes like Aspartate transferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) were statistically significantly raised in diabetes mellitus cases (p<0.05) as compared to non-diabetic cases Conclusion: We have found significant association among AST, ALT, ALP and GGT with type 2 diabetes mellitus; all were negatively correlated with HbA1C level, Hence the monitoring the liver function tests in uncontrolled T2DM patients was essential.

Background: Percutaneous transluminal coronary angioplasty (PTCA) is a cornerstone procedure in the treatment of coronary artery disease. Guidewire technique selection plays a critical role in procedural success, especially in complex lesions. This study compares the efficacy and safety of the double wire technique versus the conventional single wire method. Methods: A prospective study was conducted on 1000 patients undergoing PTCA. Of these, 392 underwent the double wire technique, while 608 were treated with the single wire approach. Key procedural endpoints included total procedure time, guide support and stent crossing time (left and right coronary systems), and complication rates such as vessel dissection and wire perforation. Results: The double wire technique significantly reduced procedural time in both coronary systems—45 minutes vs. 1.2 hours in the left system and shorter stent crossing times in the right. Complications such as left main dissection and wire perforation were markedly lower in the double wire group. Fewer guide adjustments and easier balloon/stent delivery were noted. Conclusion: The double wire technique offers superior procedural efficiency and safety compared to the single wire method. Its technical simplicity supports broader adoption, especially in complex cases and among less experienced operators, enhancing overall PTCA outcomes.

Background: Chronic Kidney Disease (CKD) is a progressive condition characterized by gradual loss of kidney function and is associated with multiple systemic complications. Obstructive Sleep Apnoea (OSA), a disorder involving recurrent episodes of partial or complete upper airway obstruction during sleep, has been increasingly recognized as a common yet underdiagnosed comorbidity among CKD patients. The pathophysiological relationship between OSA and CKD is complex and bidirectional, with emerging evidence suggesting that OSA may exacerbate renal dysfunction through mechanisms such as intermittent hypoxia, oxidative stress, and sympathetic activation. Objective: This study aimed to determine the prevalence of OSA among patients with CKD and to evaluate the clinical correlations and risk factors associated with OSA in this patient population. Methods: A two-year cross-sectional observational study was conducted at Jawaharlal Nehru Medical College, Aligarh Muslim University, enrolling 70 CKD patients. Each patient underwent comprehensive overnight polysomnography (PSG) to diagnose OSA. Detailed clinical and demographic data, including comorbidities, body mass index (BMI), and CKD stage, were systematically collected and analysed. Results: The prevalence of OSA in the studied CKD population was found to be 54.3%. The occurrence of OSA progressively increased with CKD severity, from 28.6% in Stage 3, 57.1% in Stage 4, to 85.7% in Stage 5, showing a significant association (p < 0.01). Patients diagnosed with OSA had statistically higher BMI values and significantly greater prevalence of hypertension and diabetes mellitus compared to those without OSA (p < 0.05). Conclusion: OSA is highly prevalent in CKD patients, especially in advanced stages. Routine screening and timely management of OSA in this vulnerable group could potentially improve clinical outcomes and mitigate progression of renal impairment

Background: Contraceptive use remains suboptimal in rural India despite ongoing public health initiatives. Understanding patterns of awareness, use, and preferences is crucial for addressing gaps in reproductive health access. Objectives: To assess contraceptive awareness, continuity, and preferences among women in a rural population of North 24 Parganas, West Bengal. Methods: A cross-sectional study was conducted over one year among 300 women attending the College of Medicine and Sagore Dutta Hospital. Data were collected on socio-demographic factors, contraceptive knowledge, continuity of use (≥90 days), and preferences across age groups. Descriptive statistics and cross-tabulations were used for analysis. Results: The majority of participants were aged 20–30 years, with primary education being the most common educational level. Age of marriage was below 20 years in 66% of participants. Awareness of oral pills and condoms was high (>80%) across most age groups, but awareness of methods such as PPIUCD, Chhaya, and Antara was low, especially among women under 20. Continuity of use was highest for condoms and PPIUCD among the 21–30 age group. Willingness to use long-acting methods remained limited. A significant proportion (47%) had undergone more than one MTP, indicating gaps in effective contraceptive use. Conclusions: While awareness of basic contraceptive methods exists, uptake of modern and long-term methods remains inadequate. Strengthening reproductive health education and access—particularly among adolescents and low-literate populations—is essential for improving contraceptive behaviour in rural India.

Introduction: Ropivacaine, being less lipophilic than bupivacaine leads to a reduced motor blockade allowing for sensory-motor differentiation. This makes ropivacaine particularly useful in situations where lesser muscle relaxation is desired. Various adjuvants have been used to prolong the duration of analgesia. Dexmedetomidine, a newer α2 agonist is currently gaining attention for its sedative, anxiolytic, and analgesic properties. Aim: This prospective, randomised, double blinded study was done to determine the efficacy of lower concentration of ropivacaine (0.2%) in providing adequate blockade and to determine the effects of adding dexmedetomidine to 0.2% ropivacaine for enhancing the analgesic properties. Methods: This study was done on 60 patients undergoing elective below elbow surgeries. Patients were randomly allocated into two groups: Group RN received 40ml of 0.2% ropivacaine with 1ml of normal saline and Group RD received 40ml of 0.2% ropivacaine with 1mcg/kg dexmedetomidine. The time for onset of sensory, motor blockade, duration of sensory and motor blockade, hemodynamic variability and side effects were recorded. Results: There was no statistical difference in the time for onset of sensory blockade between the groups. Onset of motor blockade was significantly faster in group RD (5.4 +/- 2.4 minutes) than that of group RN. The duration of sensory blockade was significantly longer in group RD (1440+/- 360 minutes) than that of group RN with P value <0.01. There was no significant difference in the duration of motor blockade between the two groups. Total duration of analgesia was longer with group RD (894 minutes). Minimal variations in hemodynamic parameters observed without any side effects. Conclusion: We conclude that 0.2% ropivacaine is sufficient to provide adequate anesthesia for below elbow surgeries and profound prolongation of analgesia was obtained on addition of perineural dexmedetomidine to 0.2% ropivacaine.

Background: Cervical vertebrae are distinguished by the presence of foramen transversarium, which transmits the vertebral artery, vein, and sympathetic nerves (except in C7). Variations in its number, size, or shape can alter the course of vertebral vessels, potentially leading to vertebrobasilar insufficiency. As the inner ear is supplied by these arteries, such changes may also cause hearing or balance disturbances along with neurological symptoms. This study aimed to investigate the incidence of double foramen transversarium in dried cervical vertebrae from the population of Bihar. Materials And Methods: A cross-sectional osteological study was conducted on 150 human cervical vertebrae, including 100 typical (C3–C6) and 50 atypical (C1, C2, C7) vertebrae, collected from medical institutions in Bihar, India. Each vertebra was examined macroscopically for the presence, number, laterality, and morphology of double foramina transversaria. Data were statistically evaluated with GraphPad Prism 9; p < 0.05 was considered significant. Results: Out of the total 150 cervical vertebrae studied, a double foramen transversarium was observed in 23 vertebrae (15.33%). Among these, 15 vertebrae (10%) were identified as typical cervical vertebrae, while 8 vertebrae (5.33%) were atypical. Unilateral double foramen transversarium was more frequently observed than bilateral, with a total of 14 cases on the right side (9.33%) and 6 cases on the left side (4%), whereas bilateral occurrence was noted in only 3 vertebrae (2%). Although typical vertebrae showed a higher frequency of double foramina transversaria, the difference between typical and atypical cervical vertebrae was not statistically significant. Conclusion: Double foramen transversarium can alter the path of vertebral vessels and nerves, leading to clinical implications during diagnosis or surgery. Its recognition is important for surgeons, radiologists, anatomists, and anthropologists to avoid complications and ensure accurate assessments.

Introduction: Polycystic Ovary Syndrome (PCOS) is a common endocrine-metabolic disorder characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. Insulin resistance (IR) plays a central role in PCOS pathogenesis. Fetuin-A, a hepatic glycoprotein, negatively regulates insulin signaling and has been linked to IR and metabolic syndrome. This study aims to compare serum Fetuin-A levels in women with PCOS and healthy controls, and explore its association with metabolic parameters. Materials and Methods: A comparative study was conducted from January 2021 to June 2022 at a Tertiary care centre, including 180 women aged 18–40 years: 90 with PCOS (Rotterdam criteria) and 90 healthy controls. Clinical assessments, anthropometry, and laboratory investigations including fasting/postprandial glucose and insulin, lipid profile, HOMA-IR, and serum Fetuin-A (via ELISA) were performed. Data were analyzed using SPSS v25 with p < 0.05 considered significant. Results: Demographic parameters including age and BMI were comparable between groups (p > 0.05). Women with PCOS showed significantly elevated fasting/postprandial glucose, insulin levels, HOMA-IR, cholesterol, triglycerides, and LDL (p < 0.05). Serum Fetuin-A levels were significantly higher in PCOS cases (8.3 ± 4.3 µg/mL) than controls (3.1 ± 3.2 µg/mL, p < 0.001). Fetuin-A levels correlated positively with fasting glucose, insulin, HOMA-IR, cholesterol, triglycerides, and LDL in PCOS patients, indicating strong association with metabolic dysfunction. Conclusion: Serum Fetuin-A levels are significantly elevated in women with PCOS and strongly correlate with markers of insulin resistance and dyslipidemia, suggesting its potential role as a biomarker in PCOS-related metabolic disturbances.

Left ventricular diastolic dysfunction (LVDD) is a common and early manifestation of hypertensive heart disease, often preceding systolic impairment. While echocardiography remains the gold standard for evaluating diastolic function, increasing interest has been placed on electrocardiographic (ECG) markers such as Tpeak-Tend interval, Ventricular Activation Time (VAT), P-terminal force in V1 (PTFV1), and P-wave dispersion (PWD) due to their accessibility, non-invasiveness, and cost-effectiveness. This article explores the diagnostic and prognostic potential of these ECG parameters in comparison to echocardiographic findings in hypertensive patients with suspected diastolic dysfunction

Introduction: The use of smokeless tobacco (ST) is a global phenomenon and represents a major health threat, mainly to the cardiovascular/ haematological system. Its negative effects on heart rate and blood pressure are well-known but whether antioxidants like Vitamin C will counteract these effects or not, is unknown .This study was conducted to observe the effects of smokeless tobacco on cardiovascular (heart rate, blood pressure, Valsalva  ratio, sustained hand grip) parameters and haematological (white blood cell, platelet, red blood cell indices) parameters before and after the supplementation of 1 gm Vitamin C daily for 45 days. Methodology: A case-control design was conducted experimentally on 220 controls and 180 ST chewers, aged between 31-60 yrs. Inclusion criteria consisted of participants with experience of chewing smokeless tobacco for less than or equal to one year. Control group consisted of people with similar age and sex who have never smoked or chewed smokeless tobacco before. Exclusion criteria include participants with the history of cardiovascular disease, diabetes, cancer, liver illness, endocrinological problems, neurological problems, alcoholism or any medication. The effects of ST use and Vitamin C supplementation on the parameters were evaluated by statistical analysis, including unpaired t-tests, one way ANOVA and Pearson’s correlation.  Results: ST chewers had significantly greater heart rate (73.21 ± 5.69), increased systolic (123.35 ± 8.35) and diastolic blood pressure (82.06 ± 6.31) compared with controls (71.98 ± 5.13, 121.52 ± 6.30, 78.20 ± 7.57) respectively. ST chewers had elevated white blood cell counts (7851±1204) as compared to control (7568±1369) and lower platelet counts (2.31±0.64) as compared to control (2.63 ± 0.55) on haematological analysis. Vitamin C supplementation significantly decreased diastolic (80.64 ± 8.32) blood pressure in ST chewers as compared to the diastolic (77.52 ± 6.12) blood pressure of control. Serum Cotinine was positively correlated with heart rate (r-value 0.16) and inversely correlated with the Valsalva ratio (r-value -0.18); Valsalva ratio (r-value 0.24) was positively correlated with Serum Vitamin C. Conclusion: In conclusion, active smokeless tobacco use has been associated with significant cardiovascular and haematological effects, including inflammation as increase in heart rate, blood pressure and total leucocyte counts were observed in ST chewers. Although vitamin C supplementation can help to lower blood pressure level in ST users, it may be able to alleviate some of the cardiovascular effects induced by smokeless tobacco. Longer supplementation and larger sample sizes are required to confirm these findings.

Background: Chronic suppurative otitis media (CSOM), with or without cholesteatoma, often leads to ossicular destruction, resulting in conductive hearing loss. Ossiculoplasty aims to restore the auditory mechanism after complete eradication of middle ear disease. In this study, a ventilation grommet was utilized as a partial ossicular replacement prosthesis (PORP) for ossicular chain reconstruction, particularly in cases with a mobile stapes. The objective was to evaluate the degree of hearing improvement following the use of a grommet as PORP in type III tympanoplasty. Methods: This observational study was conducted from July 2023 to July 2024 and included 20 patients with CSOM undergoing canal wall up or canal wall down mastoidectomy. All patients had intraoperative ossicular chain erosion with an intact stapes suprastructure. Postoperative hearing gain and graft uptake were assessed at the third month using pure tone audiometry. Results: Of the 20 patients, 15 underwent canal wall up mastoidectomy and 5 underwent canal wall down procedures, all with type III tympanoplasty. Ossicular erosion involved the incus in 17 cases, the malleus in 2 cases, and both the incus and malleus in 1 case. The mean preoperative air-bone gap was 38 dB, with a mean hearing improvement of 12 dB at the three-month follow-up. Conclusions: The grommet tube, when used as a PORP, appears to be a cost-effective and efficient alternative for ossicular chain reconstruction in type III tympanoplasty, demonstrating satisfactory hearing outcomes.

Electrical storm is a rare, life-threatening condition characterized by recurrent ventricular arrhythmias requiring immediate and aggressive management. We report the case of a 46-year-old female presenting with multiple episodes of ventricular tachycardia (VT), leading to cardiac arrest and an electrical storm. Despite 60 minutes of cardiopulmonary resuscitation (CPR), the patient was successfully resuscitated using early defibrillation, dual sequential external defibrillation (DSED), and overdrive pacing. Remarkably, she recovered without neurological deficits and was discharged within a week.  This case highlights the importance of persistent resuscitative efforts and advanced techniques in managing refractory ventricular arrhythmias.

Hypertension is one of the most important risk factors for cardiovascular diseases (CVD), particularly ischemic heart disease and stroke (sequelae of hypertension). By compromising endothelial function and encouraging atherosclerosis, inflammatory markers like C-reactive protein (CRP), interleukins (ILs), and tumour necrosis factor-alpha (TNF-α) have been associated with a poor prognosis in individuals with hypertension in CVD studies. A straightforward, affordable, and generally available haematological measure, the neutrophil-to-lymphocyte ratio (NLR) has garnered increasing attention in recent years. Neutrophils and lymphocytes make up NLR, which represents a balance between immunological responses and inflammation. While lymphocytes play a significant role in controlling immunological responses, neutrophils are crucial for the acute inflammatory response. There is no study available about Neutrophil to lymphocyte ration in newly detected hypertension patient. In addition to this correlation of NL Ratio is never studied with Staging of Hypertension hence this is an area of interest. Material and Methods: The present cross-sectional study was conducted from May 2023 to November 2024 in the Department of General Medicine, School of Medical Sciences & Research, Sharda Hospital, Greater Noida, Uttar Pradesh among 100 newly detected hypertensive patients as per inclusion and exclusion criteria, with Age & Sex matched 100 controls.  Results: Of the individuals in the case and control groups, 56% and 4%, respectively, had left ventricular hypertrophy (LVH) was seen amongst 56% of cases and 4% of controls which was statistically significant with p-value <0.01 when the chi square test was used. The case group had higher mean neutrophil %, lymphocyte %, and NLR than the control group. Mean NLR in stage 1 and stage 2 hypertension showed statistically significant increase in value as the BP rises. Hence mean NLR was significantly more in stage 2 hypertension as compared to stage 1 hypertension as p-value=0.007. The Pearson correlation test revealed a substantial positive link between NLR and hypertension staging (r=0.44, p<0.01), meaning that when NLR increases, so do SBP and DBP.  Conclusion: Our study demonstrated a rise in NLR levels as the severity of hypertension increases. Our findings suggest that neutrophils and lymphocytes may be implicated in inflammation, which may be a significant factor in the development of hypertension. These results could be helpful in elucidating the pathophysiological process of hypertension and in the creation of novel treatment strategies that target low-grade inflammation in order to manage hypertension and hypertensive damage.

Introduction: WHO defines QOL as individuals’ perception of their position in life in the context of culture in which they live and interaction to their goal, expectation, standard and concerns.  Numerous variables separated from physical and mental wellbeing like business status, age, sexual orientation, wage, education, HIV stage, seriousness of HIV disease, etc. are found to encroach on the QOL of PLHIV. Quality of life (QOL) of HIV/AIDS patients is becoming an important component of overall assessment of health care and management in health care settings. It is one of the indicators effectiveness of management of PLHIV.  Materials And Methods: This is a Descriptive and Cross-sectional study. Data was collected from patient file available in ART centre as mentioned in annexure 1 and Quality of Life was assessed by WHO questionnaire as mentioned in annexure 2. Study was initiated after approval was obtained from the institutional ethics committee. Study related procedures and enrolment of eligible subjects was done only after obtaining an informed consent from the patient. Confidentiality of patient’s details was maintained at all levels using appropriate coding. Results: Domain 1 is 16.93 indicating good QOL Domain 2 is 13.428 indicating good QOL Domain 3 is 13.20 indicating good QOL Domain 4 is 8.39 indicating poor QOL. Domain 5 is 14.349 indicating good QOL Domain 6 is 11.93 indicating average QOL. p-value is 0.474 indicates no statistical significance of smoking with quality of life.  P-value is 0.027 is significant statistically; indicates statistically significant association of number of years on ART with quality of life. This implies that increased number of years on ART is associated with better quality of life. Range of deviation of Domains 1, 2,3,4,5, 6 was between 11-20, 8-17, 9-16, 7-11, 13-16.5 and 8-16 respectively. Conclusion: In our study Major age group affected are between age 31-40 years. Overall quality of life assessed by WHO in QOL bref scale is 13.04 which indicates good overall quality of life. Except sexual activity & social inclusion in domain 4 is low otherwise remaining domain (1, 2, 3, 5 & 6) carry good QOL.

Background: To study the impact of ultrasound-assessed Diaphragmatic impairment on predicting the need for invasive mechanical ventilation in patients with Acute Exacerbations of Chronic Obstructive Pulmonary disease (AECOPD) and also, its impact on duration of invasive mechanical ventilation, length of ICU stay and outcome. Methodology: A total 95 patients with AECOPD requiring NIV support in the Intensive care unit (ICU) were included in the study in our hospital from April 2023 to November 2024. This was a prospective observational study. Ultrasound-assessed Diaphragm Thickness Fraction (DTF) was done to assess the Diaphragmatic Impairment (DI). Either the patient was weaned off from NIV or put on IMV based on clinical condition and ABG analysis. Results: Receiver operating characteristic (ROC) curve analysis of diaphragmatic thickness fraction on the Right & Left-side gives a cut off <31.88% and <28.2% with 100% sensitivity and 20.9% specificity for the need of Invasive mechanical ventilation (IMV). Out of 43 patients that were put on IMV, 34 were below and 9 were above this cut-off. Mean Duration of IMV was significantly higher in deceased patients compared to patients who survived. (8.56+/-2.11 vs 2.78+/-0.83 days). Mean Duration of ICU stay was also significantly higher in deceased patients compared to survived patients. (9.95+/-2.46 vs 5.37+/-1.17 days). Conclusion: we conclude that ultrasound-assessed Diaphragmatic thickness fraction is a good indicator in determining the diaphragmatic impairment and predicting the need for invasive mechanical ventilation in AECOPD patients with 100% sensitivity and 20.9% specificity. DI as assessed by DTF can be used as a prognostic factor for determining Invasive Mechanical Ventilator days, ICU stay and Outcome of the patient.

Acute chest pain is a common and potentially life-threatening presentation in emergency medical settings. Early recognition and appropriate management are crucial to reduce morbidity and mortality, especially when associated with cardiac etiology. We report the case of a 56-year-old Hindu male who presented with acute onset chest pain persisting for two days, accompanied by shortness of breath for one day. The chest pain was sudden in onset, retrosternal, diffuse, heavy, and constricting in nature, with radiation to the jaw and left upper limb. The pain was unrelieved by rest, positional changes, or forward bending, and was associated with nausea, diaphoresis, and a sense of restlessness. Notably, there were no symptoms suggestive of respiratory infection, gastrointestinal reflux, or neurological involvement. On the second day, the patient developed exertional dyspnea (NYHA Class II) and occasional palpitations, with no features of orthopnea, paroxysmal nocturnal dyspnea, or peripheral edema. The patient had no prior history of ischemic heart disease, diabetes, hypertension, thyroid dysfunction, or other chronic illnesses. He denied previous episodes of similar chest pain and had no history of prior hospitalizations or surgeries. The clinical presentation was highly suggestive of a cardiac origin of chest pain, necessitating urgent evaluation and management. This case highlights the importance of comprehensive symptom analysis and prompt referral in patients with atypical chest pain, especially in the absence of prior comorbidities.

Background: Drug-resistant epilepsy (DRE) remains a significant clinical challenge, with approximately 30% of patients not achieving adequate seizure control despite optimal pharmacotherapy. Vagus nerve stimulation (VNS) has emerged as a neuromodulatory option for such patients. This multicenter prospective study aimed to evaluate the impact of VNS on seizure frequency and health-related quality of life (HRQoL) in individuals with DRE. Materials and Methods: A total of 120 patients diagnosed with DRE were enrolled across four tertiary care centers. All participants underwent VNS implantation and were followed for 12 months post-implantation. Seizure frequency was recorded using patient diaries, and HRQoL was assessed using the QOLIE-31 questionnaire at baseline, 6 months, and 12 months. Statistical analysis was conducted using paired t-tests and repeated measures ANOVA, with significance set at p<0.05. Results: At the 12-month follow-up, 78 patients (65%) exhibited ≥50% reduction in monthly seizure frequency. The mean seizure frequency declined from 12.4 ± 3.1 episodes/month at baseline to 5.2 ± 2.8 episodes/month post-intervention (p<0.001). Additionally, QOLIE-31 scores improved significantly, from a mean of 48.7 ± 6.5 at baseline to 69.2 ± 5.8 at 12 months (p<0.001). Adverse effects were generally mild, with hoarseness (9%) and throat discomfort (6%) being the most commonly reported. Conclusion: Vagus nerve stimulation appears to be an effective and well-tolerated adjunctive therapy for seizure control in patients with drug-resistant epilepsy. It also significantly enhances quality of life, underscoring its utility in comprehensive epilepsy management strategies.

Introduction: Granular cell tumours are rare, usually benign neoplasms that can be located anywhere in the body. They are usually found in the oral cavity (40%), skin and subcutaneous tissue (30%), breast (15%), or respiratory tract (15%).1 In the gastrointestinal tract, the most common site being the esophagus. Involvement in other gastrointestinal locations such as the duodenum, anus, stomach, biliary tree, and colon4 are much more uncommon. Case Presentation: We report a unique case of Granular cell tumour located in the hepatic flexure of colon. A 70-year-old male presented with complaints of altered bowel habits to gastroenterology OPD. Colonoscopy was done which revealed a polyp in ascending colon and hepatic flexure of colon. Histopathological examination showed the polyp in ascending colon as tubular adenoma with low grade dysplasia and the polyp in hepatic flexure as Granular cell tumour. Immunohistochemistry (IHC) for S100 was done, which was positive. The tumour was completely excised and the patient was asymptomatic during the follow-up period of 6 months. Discussion: Granular cell tumours are rare, benign neoplasms that occur rarely in the gastrointestinal tract. They are most commonly found in stomach and small intestine. Colonic granular cell tumours, particularly located in hepatic flexure of colon are exceedingly rare. The diagnosis is solely based on histopathologic examination and confirmation by immunohistochemistry. Management involves complete surgical excision. Conclusion: Granular cell tumours of colon are rare and can present as a diagnostic challenge. Even though it is a benign entity, it has a potential for malignant transformation. Hence awareness about this condition and its histopathological features are needed for arriving at a correct diagnosis and management.

Introduction: Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality globally, with an increasing incidence in developing countries like India. Tumour microenvironment, especially the desmoplastic reaction (DR), plays a crucial role in cancer invasion, progression, and prognosis. Histological evaluation of DR offers an accessible and cost-effective prognostic marker, especially in resource-limited settings. Aims and Objectives: To assess the histopathological characteristics of desmoplastic reaction in colorectal cancer specimens and to correlate them with clinicopathological parameters and patient outcomes. Methodology: This prospective study was conducted at a tertiary care hospital in Andhra Pradesh over 2 years. A total of 62 cases of resected colorectal adenocarcinoma were included. Tumour sections were evaluated for DR and categorized into mature, intermediate, and immature patterns based on the presence of keloid-like collagen and myxoid stroma. Correlations with tumor grade, depth of invasion, lymphovascular invasion, lymph node status, and TNM stage were statistically analyzed. Results: Among the 62 cases, mature DR was observed in 46%, intermediate in 36%, and immature in 18%. Immature DR significantly correlated with higher tumor grade (p<0.01), lymphovascular invasion (p=0.03), deeper invasion (p<0.01), and advanced TNM stage (p=0.02). Mature DR was associated with favorable histopathological parameters. Conclusion: Desmoplastic reaction grading provides valuable prognostic insight in colorectal cancer and should be routinely incorporated in histopathological reporting. Its simplicity and reproducibility make it especially suitable for low-resource settings.

Background: The HIV infection burden is increasing day by day, especially in women of reproductive age groups. This subgroup of people is the potential candidates for whom effective ART in pregnancy can prevent mother-to-child transmission and decrease the new cases of neonatal HIV infection.  This study aims to observe the incidence of HIV infection in pregnancy and its effect on maternal and fetal outcomes.   Methods: This is a retrospective case record analysis of 31 HIV-positive pregnant patients during a period of five years from 2019 to 2024 in the Govt. Medical College, Kathua. Results: 31 patients were included in the study, and the incidence was 0.14%. The mean age of patients was 25.06 years, and 45.1% of patients were aged 26-30 years. The majority of patients had at least primary school education (67.7%), while serodiscordance was seen in 25.8% of couples. About 58.1% of patients were new cases detected during pregnancy, with the highest detection rate in the third trimester (29%). Primigravida was more common (48.4%) in the study. LSCS rate was about 55%. Preterm birth and low birth weight were seen in 3.2% and 25.5% of the babies. Neonatal mortality was 6.8%. No case of mother-to-child transmission was noted.  Conclusion:  HIV infection had adverse effects on pregnant women in terms of low-birth-weight newborns, prematurity, and neonatal deaths. All these contribute to neonatal morbidity, which predisposes to increased chances of mother-to-child transmission.

Introduction: Digital media is rapidly penetrating the lives of young children owing to increased accessibility resulting in increased screen time. According to WHO guidelines the recommended daily screen time for the ages 2 to 5 years is not more than an hour a day and discourage screen time for children less than 2 years. Objectives: This study was conducted to assess the problematic device usage and its association with behavioral changes in children of 2 to 5 years age. Methods: This is a community-based cross-sectional study conducted for 2 months from February 2023 to April 2023 among children of 2-5 years of age residing in Balaji Nagar which is an urban field practice area of Government Medical College, On gole. Results: Out of 116 children, 66 (56.9%) were males and 50 (43.1%) are females and the mean age of the children was 3.5  1.2 years. 39(33.62%) of the children have both parents who were working either part-time or full time. The association between Age, mother’s Education, Mother’s occupation, father education, working parents with PMUM present found to be significant (P<0.05). 55% children were watching television for 2 hours or more in week days and 77.5% weekend time. 63.2% children were involved with mobile phone for 2 hours or more in week rime and 81.6% weekend time. Mean screen time was found to be 102.46 ± 14.7 minutes and 18% of the parents were always co-viewed with the Children. PMUM presence seen with screening time more than 1 hour among 50% of Children and its association found to be significant (P<0.05). Over all Positive association (P<0.0000017) was noticed between Problematic media and SDQ scale total score. Problematic device usage and behavioral problems were found to be moderate to strongly positive (high positive correlation), with r (114) =0.6825 and P value <0. 001.Conclusions: This study findings will be helpful for better understanding of the relationship between screen time and behavioral changes and to provide effective community-based awareness interventions.

Background: Anterior cruciate ligament (ACL) injuries are prevalent among competitive athletes, often necessitating surgical reconstruction for optimal recovery and return to sport. Autografts (patient's own tissue) and allografts (donor tissue) are commonly used graft options. The efficacy of these grafts in terms of isokinetic muscle strength recovery remains a topic of ongoing research. This study aims to compare the isokinetic strength recovery outcomes following ACL reconstruction using autografts versus allografts in competitive athletes. Materials and Methods: A prospective cohort study was conducted on 60 competitive athletes (aged 18–30 years) undergoing primary ACL reconstruction. Participants were equally divided into two groups: Group A (n=30) received autograft (hamstring tendon), and Group B (n=30) received allograft (tibialis anterior). Isokinetic strength testing of quadriceps and hamstrings was performed at 60°/sec and 180°/sec using a dynamometer at 3, 6, and 12 months postoperatively. Peak torque to body weight ratio and limb symmetry index were calculated. Statistical analysis was performed using repeated measures ANOVA and independent t-tests, with significance set at p<0.05. Results: At 3 months, Group A demonstrated higher quadriceps strength (peak torque/body weight ratio: 1.37 ± 0.12) compared to Group B (1.21 ± 0.15; p=0.018). At 6 months, hamstring strength recovery was significantly better in Group A (1.45 ± 0.10) than Group B (1.28 ± 0.11; p=0.009). By 12 months, both groups showed comparable limb symmetry indices (Group A: 92.3%; Group B: 90.7%; p=0.42). However, a faster recovery trajectory was observed in the autograft group. Conclusion: Autografts facilitate a more rapid isokinetic strength recovery in the early postoperative period compared to allografts in competitive athletes following ACL reconstruction. Although long-term outcomes converge, early rehabilitation milestones favor autograft use for athletes aiming for quicker return to sports.

Background: A quick and easy method of estimation of foetal weight in utero is an obvious benefit to the clinician practicing modern obstetrics as the perinatal mortality and morbidity is affected not only by foetal age but also by the foetal weight Materials and Methods: symphysiofundal height (SFH) and abdominal girth (AG) was measured in 196 pregnant women attending the OPD or Maternity ward at term. The station of the head was found and various methods of calculation of baby weight was used to estimate the baby weight. The actual weight of the baby was measured at the time of birth and statistical analysis done. Results: All the method of clinical estimation of foetal weight, overestimated the actual birth weight by 1 to 2 gms / 100gms (table I). Estimation of foetal weigh by different method shows that the clinical method is the best method (table ii, & table iii). 38% of babies could be estimated within 100 gms of their actual birth weight (table ii) and 64% of foetuses could be estimated within 10% of their actual birth weight (table iii). This was better than that obtained by Tivari and Sood (1989) ⁷ which was 59% by the same method, where the correct was not defined as within 10% of actual birth weight. Conclusion: The sample comprised of 195 patients. The age group of the patients were from 18 to 38 yrs. There were 38 primigravidas, 56 second gravidas, and 4 grand multiparas. Height varied from 141 cm to 168 cm, weightwas between 44 kg to 72 kgs. Of the 195 gravidae studied, the mean actual birth weight of their babies was 2781 grams. Which was lower than mean birth weight estimated by various clinical methods. All the clinical estimation of the birth weight overestimated the actual birth weight by 1 to 2 gm/100gms.

Background: Peripheral arterial pseudoaneurysms (PAPs) are vascular anomalies that frequently result from iatrogenic trauma, especially following catheter-based interventions. Given the rising prevalence of such procedures, a systematic evaluation of PAPs is warranted to guide optimal management strategies, particularly in resource-constrained settings. Methods:  This retrospective study was conducted at two tertiary care centres in Eastern India and included 43 patients diagnosed with PAPs between January 2020 and December 2023. Demographic, clinical, etiological, and management data were collected using a structured proforma. Diagnosis was confirmed via Doppler ultrasound and CT angiography. Treatment modalities included conservative management for small, uncomplicated lesions and surgical repair for larger or symptomatic cases. Outcomes were assessed over a 6-month follow-up period. Results: The mean age was 55 years, with a male predominance (72.1%). Iatrogenic injury, primarily post-catheterization, accounted for 95.3% of PAPs, with femoral (72.1%) and radial (27.9%) arteries being the most affected sites. The most frequent presentation was a pulsatile mass (97.7%), followed by pain (65.1%) and thrill (14%). Eight patients with pseudoaneurysms <3 cm were managed conservatively, with success in six. Surgical intervention was required in total number (8+42) is more than n (43), with primary repair being the most common technique. There were no postoperative mortalities or cases of limb ischemia. 3 patients presented with skin necrosis. Follow-up data were available for 60.5% of the cohort, with no late complications observed. Conclusion: Iatrogenic pseudoaneurysms, especially following endovascular procedures, constitute many PAPs in tertiary care settings. Prompt diagnosis, size-based stratification, and appropriate intervention whether conservative or surgical yield excellent outcomes with minimal complications. This study reinforces the value of protocol-driven management and highlights the need for increased vigilance as interventional procedures become more common.

Diabetes mellitus, the most common endocrine disorder is characterised by metabolic abnormalities and long-term microvascular and macrovascular complications. Diabetic nephropathy is first recognized as proteinuria. The reason for performing the test for proteinuria is for the early detection of diabetic nephropathy in a patient with diabetes for many years.  Aim and Objectives: 1. Screening of microalbuminuria in patients with diabetes mellitus. 2. To correlate microalbuminuria with the duration of diabetes mellitus and association with other microvascular and macrovascular complications of diabetes mellitus. Materials and Methods: 82 patients were selected randomly selected from outpatient and medical wards of a tertiary care hospital. Patients will be considered diabetic as per WHO criteria for diagnosis of diabetes mellitus All patients were evaluated in detail along with the testing for microalbuminuria with dipsticks (Micral). Results: The overall occurrence of microalbuminuria was 41.41 %. The occurrence of microalbuminuria showed a direct relationship with increasing age and increasing duration of diabetes since diagnosis. An HbA1c value above 7% is associated with 50% or higher incidence of microalbuminuria. The incidence of microalbuminuria is significantly associated with the presence of retinopathy, peripheral neuropathy, ischemic heart disease and hypertension.  Conclusions: Screening for Microalbuminuria in diabetic patients is essential for intervention and prevention of further complications like end stage renal disease and other cardiovascular risk factor.  By Early detection of Microalbuminuria in diabetic patients, various complications can be prevented by good control of sugar.

Background: AIM: To retrospectively find the different pathologies of heart disease in the cases examined at Mortuary of Bundelkhand Medical College, Sagar, M.P and district hospital Sagar M.P. Objectives: To find the incidence of heart disease in different age groups and different sex To find the incidence of different pathologies of heart   Materials And Methods: 2250 autopsies were performed during the time period of July. 2023 to Dec. 2024 out of that 83 cases of cardiac deaths were found. Deaths due to non-cardiac causes, such as trauma were excluded.  Study design – Cross sectional study, retrospective, Study area – Sagar Bundelkhand region, Study population – All autopsy cases which came to Bundelkhand medical college mortuary  and district hospital Sagar during the time period of July 2023 – December 2024.  Results: Out of total 2250 autopsies conducted  83 cases of heart disease deaths were recorded. Among them 81.93% were due to coronary artery disease (CAD). 59.04% cases had cardiomegaly and heart weight was more (>420 gms) in 59.04 % cases. Among 83 cases of cardiac deaths 92 % victims were males and 8 % were females. The peak incidence of heart diseases was found to be in the age group of 40-49 yrs (27.71 %) followed by 50-59 yrs (26.51%). Least incidence were found in the age group below 19.  Conclusion: Most of the heart disease deaths examined were due to coronary artery disease (CAD). Majority of victims were males. Hence this data shows us the quintessential requirement of intervention in the prevention of heart diseases 

Background: Aim: The aim of the present study was to optimize the off pump coronary artery bypass grafting by the use of graft flow meter based on transit time flow principle and revision of grafts when the values are abnormal and there is associated haemodynamic instability as seen on TEE, ECG changes and rise in Trop I levels. Methods: 75 patients undergoing isolated off-pump CABG at LPS Institute of Cardiology and Cardiac Surgery were included in the study from January 2017 to June 2018. The study was conducted on all the cases who were admitted for CABG and who met the inclusion criteria. Results: Out of 75 patients undergoing off pump CABG, 67 were males and 8 were females. The majority of patients (37.3%) were in the age group of 51 – 60 years followed by 32% patients in the age group of 61 - 70 years. Out of the 75 patients 18 were suffering from Diabetes, 28 from hypertension, 12 were both diabetic as well as hypertensive, 3 had previous PTCA, 5 were suffering from COPD. Out of the total 75 patients 46 had triple vessel disease, 22 had double vessel disease and 7 had single vessel disease. 6 had significant LMCA disease. The mean flow with standard deviation in the left coronary territory was 35.54 + 16.35 ml/min and in the right coronary territory was 31.05 +15.12 ml/min with a p value of 0.4 which is not significant. The Pulsatility index (PI) in the left coronary territory was 1.99 + 0.75 and in right coronary territory was 1.94 + 0.81 with a p value of 0.06 which is not significant. Conclusion: The present study concluded that transit time flow measurement is simple, reliable and easy to perform. Low flow and raised PI require reexploration of the anastomosis unless severe spasm of the conduit or poor runoff is strongly suspected. Redoing the distal anastomosis leads to significant improvement in flow and decreases pulsatility index in the presence of anastomotic failure. Mean graft flow of >10 ml/min can be considered satisfactory in Indian population where the native coronary size ranges between 1- 2mm , whereas in Western population it is between 3 to 4mm, cutoff value of >20 ml/min has been described. In this light, heamodynamic stability as assessed by intraoperative ECG and TEE, is important as low flow per se does not signify graft failure.

Background: Connective tissue disorders (CTDs) are systemic autoimmune diseases that frequently involve the lungs, leading to interstitial lung disease (ILD), which is a major cause of morbidity and mortality. High-resolution computed tomography (HRCT) has emerged as a critical tool for the non-invasive assessment of ILD patterns and severity. This study aims to evaluate the HRCT imaging spectrum of CTD-associated ILD and correlate imaging findings with pulmonary function test (PFT) results.Objectives: To determine the predominant HRCT patterns in ILD associated with CTDs, quantify fibrosis severity using a scoring system, and correlate these scores with spirometric parameters. Methods: A prospective observational study was conducted at the Departments of Respiratory Medicine and Radiodiagnosis at Government Medical College and Hospital, Nizamabad and Nirmal. A total of 40 patients diagnosed with CTDs and suspected ILD underwent HRCT imaging. Fibrosis severity was scored based on zonal involvement (upper, middle, lower zones). PFTs were performed, and parameters such as FVC, FEV₁, and FEV₁/FVC ratio were recorded. Pearson’s correlation was used to assess relationships between HRCT scores and PFT values. Results: Among the 40 participants, systemic sclerosis (42.5%) and rheumatoid arthritis (37.5%) were the most common CTDs. NSIP was the predominant HRCT pattern, seen in 80% of cases. Quantitative fibrosis scores averaged 26.5 in systemic sclerosis and 28.8 in rheumatoid arthritis. A weak to moderate positive correlation was observed between fibrosis scores and FEV₁/FVC ratio (r = 0.43), suggesting that HRCT grading reflects pulmonary functional impairment. Conclusion: HRCT is a reliable tool for detecting and classifying ILD in CTD patients, with NSIP being the most common radiological pattern. The fibrosis scoring system offers a semi-quantitative method to estimate disease burden and demonstrates correlation with functional parameters. These findings support HRCT’s role in disease monitoring and prognosis in CTD-associated ILD.

Background: Stroke remains one of the foremost causes of mortality and long-term disability worldwide, with hypertension serving as the most significant modifiable risk factor. Carotid artery intima-media thickness (CIMT) is a validated non-invasive marker of subclinical atherosclerosis and has shown potential in predicting future cerebrovascular events. Methods: A hospital-based case-control study was conducted at a tertiary care center in Kanpur, North India, involving 200 hypertensive patients—100 with acute stroke (cases) and 100 without stroke (controls). CIMT was measured using B-mode ultrasonography. Statistical analyses were performed using SPSS version 26, and a p-value <0.05 was considered significant. Results: CIMT was significantly higher in ischemic stroke patients (1.03 ± 0.11 mm) compared to haemorrhagic stroke patients (0.98 ± 0.13 mm; p = 0.040). Elevated CIMT (>0.9 mm) was strongly associated with dyslipidaemia—total cholesterol (p = 0.0022), triglycerides (p = 0.018), LDL (p = 0.024)—as well as diabetic markers such as fasting blood glucose (p = 0.015), postprandial glucose (p = 0.004), and HbA1c >10% (p = 0.022). Longer duration of hypertension (>10 years) and higher blood pressure stages were also significantly linked with increased CIMT values. Conclusion: CIMT is a reliable early indicator of atherosclerotic vascular changes in hypertensive patients, especially those with coexisting diabetes and dyslipidaemia.

Background: Antimicrobial resistance (AMR) is a growing global health concern, largely driven by irrational and inappropriate antibiotic prescribing. Assessing the knowledge, awareness, and prescribing behavior among healthcare professionals, especially medical interns and practicing clinicians, is crucial for designing targeted antimicrobial stewardship programs (ASPs). Materials and Methods: A cross-sectional, questionnaire-based study was conducted over three months in a tertiary care teaching hospital. The study included 100 participants: 50 medical interns and 50 practicing clinicians. A validated semi-structured questionnaire assessed knowledge on AMR, attitude towards antimicrobial prescribing, and adherence to treatment guidelines. Data were analyzed using SPSS version 25. Descriptive statistics and Chi-square tests were used to compare responses between the two groups, with p<0.05 considered statistically significant. Results: Among interns, 68% demonstrated adequate knowledge about AMR, compared to 84% of practicing clinicians. However, only 40% of interns adhered consistently to institutional antibiotic guidelines, whereas 72% of clinicians followed the guidelines. Notably, 54% of interns admitted to prescribing antibiotics based on senior advice rather than clinical judgment, while 26% of clinicians did the same. Awareness regarding the WHO’s AWaRe classification was significantly higher among clinicians (60%) compared to interns (28%) (p<0.01). Conclusion: Practicing clinicians exhibited higher awareness and better prescribing practices regarding antimicrobials than medical interns. The study highlights the need for structured antimicrobial stewardship education in undergraduate and internship training programs to bridge the knowledge-practice gap and combat the AMR threat.

Background: The supratrochlear foramen (STF) is a common anatomical variation at the distal humerus formed by perforation of the septum between the olecranon and coronoid fossae. Though once considered an anatomical curiosity, STF holds clinical relevance due to its potential to complicate intramedullary nailing and mimic pathological lesions radiologically. This study aimed to analyze the prevalence, shape, and dimensions of STF in humeri from the Indian population, highlighting its surgical and diagnostic importance. Materials And Methods: A cross-sectional study was conducted on 100 adult dry humeri (50 right, 50 left) of unknown age and gender from Indian populations, collected from anatomy departments in Jaipur and Patna, India. The presence and shape of the supratrochlear foramen (oval, round, irregular) were recorded. Transverse and vertical diameters were measured twice using a digital vernier caliper (0.01 mm sensitivity), and averages were analyzed. Data were statistically evaluated with GraphPad Prism 9; p < 0.05 was considered significant. Results: Out of 100 humeri examined, the supratrochlear foramen (STF) was present in 29% of specimens, with a higher occurrence on the left side (17%) compared to the right (12%). Three STF shapes were identified: round (48.27%), oval (41.38%), and irregular (10.35%), with no significant side-wise variation. The mean transverse diameter was significantly greater on the right side (4.64 ± 1.02 mm) than the left (3.23 ± 0.89 mm; p < 0.0001), while the vertical diameter showed no significant difference between sides (p = 0.248). Conclusion:  The supratrochlear foramen (STF), often overlooked clinically, is important for orthopaedic surgeons in distal humerus fracture management and for radiologists to differentiate from pathological lesions. Understanding the STF benefits anatomists, anthropologists, and clinicians alike.

Background: Laparoscopic cholecystectomy demands effective airway management due to the physiological changes caused by pneumoperitoneum. While endotracheal intubation (ETT) is the gold standard, the I-gel a second-generation supraglottic airway device, offers a potentially less invasive alternative. Since its introduction has become common modality of airway management in short duration surgeries. It does not only provide adequate ventilation, oxygenation and delivery of anesthetic agents but also lowers risk of respiratory adverse events. Objectives: To determine the efficacy of I-gel compared to ETT in terms of ease of insertion, hemodynamic changes as well as ventilation efficacy in adults undergoing elective laparoscopic cholecystectomy under general anesthesia. Methods: A hospital based observational study was conducted under Department of Anesthesiology, Assam Medical College, Dibrugarh for 2 months. Sixty ASA I-II patients aged 20-60 years scheduled for elective laparoscopic cholecystectomy were randomized into two groups: Group A (I-gel) and Group B (ETT). The insertion time, number of attempts, ease of insertion, hemodynamic parameters, and End-tidal CO₂ (EtCO₂) were compared between the two groups. Statistical significance was determined using appropriate tests. Results: Mean insertion time was significantly shorter in I-Gel (11.73±1.62 sec) than ETT (16.50±1.07 sec, p<0.0001). Ease of insertion was significantly better with I-gel (96.6% vs. 80%, p=0.0444). I-gel was also associated with higher first attempt success rate (96.67% vs 86.67%). Hemodynamic responses (HR and MAP) at 1minute post-insertion were significantly higher in the ETT group (p=0.011 and 0.02). EtCO₂ values were comparable between both groups. Conclusion: I-gel offers faster, easier insertion with less hemodynamic changes than ETT. We conclude that I-Gel can be a suitable alternative in short-duration laparoscopic surgeries in healthy adults.

Congenital common origin of the left circumflex artery and right coronary artery (RCA) from right coronary sinus is an extremely rare coronary anomaly, but can have significant clinical implications. Therefore, early detection, correct diagnosis, and appropriate treatment are important. We present a unique case of a 44-year-old male presenting with chief complaints of chest pain and breathlessness. CT coronary angiography findings typically demonstrate origin of left circumflex artery (LCX) from right coronary sinus following a retroaortic course and supplying its territory and absent left main coronary artery (LMCA).

Background: Anemia during pregnancy is a major public health concern, particularly in developing countries, and is associated with adverse maternal and fetal outcomes. Iron deficiency is the leading cause of anemia in pregnancy. Oral iron therapy remains the conventional treatment, but intravenous iron preparations, particularly ferric carboxymaltose (FCM), have gained attention due to better compliance and rapid hemoglobin improvement. Materials and Methods: This prospective, randomized comparative study was conducted at a tertiary care hospital over a 12-month period. A total of 120 pregnant women (gestational age between 14–28 weeks) with moderate iron deficiency anemia (hemoglobin 7–9.9 g/dL) were enrolled and randomly assigned into two groups: Group A (n=60) received intravenous ferric carboxymaltose (1000 mg in a single infusion), and Group B (n=60) received oral ferrous sulfate tablets (100 mg elemental iron twice daily) for 6 weeks. Hemoglobin (Hb), serum ferritin, and patient-reported gastrointestinal side effects were evaluated at baseline and after 6 weeks. Results: At 6 weeks, the mean rise in hemoglobin was significantly higher in Group A (3.2 ± 0.6 g/dL) compared to Group B (2.1 ± 0.5 g/dL) (p < 0.001). Serum ferritin levels also increased markedly in Group A (from 12.4 ± 3.8 ng/mL to 56.3 ± 9.7 ng/mL), compared to Group B (from 13.2 ± 4.1 ng/mL to 32.7 ± 6.5 ng/mL). Gastrointestinal side effects were significantly less in the FCM group (10%) compared to the oral iron group (38%). Conclusion: Ferric carboxymaltose is more effective than oral iron in rapidly correcting hemoglobin and improving iron stores in pregnant women with moderate anemia. It is also associated with better tolerability and fewer gastrointestinal adverse effects, suggesting its suitability as a preferred option in antenatal anemia management.

Background: Culture-negative sepsis refers to cases where patients exhibit clinical signs of sepsis, but no causative pathogens are identified through standard microbiological cultures4. This complicates clinical decision-making and may influence outcomes. Objective: To compare the clinical outcomes between culture-positive and culture-negative sepsis patients. Methods: A six-month observational study at Assam Medical College and Hospital included 80 adult patients with sepsis, divided into culture-positive and culture-negative groups. Outcomes assessed were ICU admission, mechanical ventilation, vasopressor use, and mortality. Results: Of 80 patients, 33 were culture-positive and 47 were culture-negative. Mortality was higher in the culture-positive group (75.8% vs 42.5%), while ICU admission, mechanical ventilation and vasopressor uses were similar between the groups. Conclusion: Culture-negative sepsis carries comparable severity to culture-positive cases, highlighting the need for early, aggressive management regardless of culture results.

Background: Noncommunicable diseases (NCDs), particularly cardiovascular disease (CVD), have become a predominant global health burden, and WHO/International Society of Hypertension (WHO/ISH) non-laboratory-based risk assessment tool predict major cardiovascular events over 10 years. Hence the present study aims to Assessing cardiovascular risk among individuals aged 40 years   Methodology: The study employed a cross-sectional design to evaluate cardiovascular risk among adults aged over 40 years attending the Government General Hospital in Ongole, Andhra Pradesh, using the WHO non-laboratory-based cardiovascular disease risk assessment tool. Data collection involved 365 eligible participants, with measurements including blood pressure, BMI, and smoking status, and the results indicated significant gender differences in cardiovascular risk profiles  Results: Among the participants, 39.0% were categorized as having <5% risk, 30.1% presented a 5-10% risk, and 27.4% had a moderate risk (10-20%), with males showing a higher prevalence of smoking (52.8%) compared to females (5.3%) and a higher history of diabetes (35.6% vs. 26.5%) and also there is a Results indicated significant gender differences in cardiovascular risk profiles. Conclusion: The study highlights significant gender differences and behavioral influences on cardiovascular disease risk and emphasizes the need for targeted interventions and gender-sensitive strategies to mitigate cardiovascular risk.

Background: Recovery heart rate (HRR), the rate at which the heart returns to baseline after exercise, serves as a practical, low-cost indicator of cardiovascular fitness and autonomic function. Faster HRR is typically observed in physically active individuals and reflects superior cardiac health. Given the growing sedentary tendencies in university populations, HRR provides a simple yet effective means to assess cardiovascular status in this age group. Objective: This study aimed to evaluate the efficacy of recovery heart rate as a physiological marker of cardiovascular fitness among physically active and inactive male students. Methodology: A comparative cross-sectional design was used over one year, involving 150 healthy male students aged 18–25. Participants were classified into physically active (n = 75) and inactive (n = 75) groups based on activity levels. All underwent a standardized submaximal exercise protocol, with heart rate measurements taken at rest, immediately post-exercise, and at one- and two-minute recovery intervals. Exclusion criteria included pre-existing medical conditions, use of cardioactive medications, and professional athletic training. Data analysis was conducted using IBM SPSS Statistics, with significance set at p < 0.05. Results: Physically active individuals demonstrated significantly lower resting heart rates and faster recovery post-exercise compared to inactive peers (p < 0.001). The mean reduction in heart rate during the first recovery minute was greater in the active group (45.7 ± 7.2 bpm) versus the inactive group (31.5 ± 6.9 bpm). A strong positive correlation (r = 0.721) was found between physical activity and HRR, and a negative correlation (r = –0.603) between physical activity and resting heart rate. Conclusion: Regular physical activity is associated with improved cardiovascular responsiveness and autonomic recovery. Recovery heart rate is an effective, field-friendly measure of cardiovascular fitness, reinforcing the need for structured physical activity programs in university settings.a

This case report details the 6-year follow-up of a 75-year-old woman with chronic rheumatic heart disease (CRHD) with severe aortic stenosis (AS) who underwent trans-catheter aortic valve replacement (TAVR) with a 23 mm Myval™ trans-catheter heart valve (THV). She underwent mitral valve replacement (MVR) few years ago. She has co-morbid conditions like obesity, obstructive sleep apnea (OSA), hypertension, and hypothyroidism. Considering her advanced age and multiple co-morbid conditions with prohibitive surgical risk, TAVI was offered after discussing with the heart team. Significant improvement in her symptoms was observed following TAVR. This case shows the feasibility, durability and effectiveness of TAVI in severe rheumatic aortic stenosis [AS].

Substance use among construction workers has emerged as a significant public health concern, especially in developing countries like India. This study aimed to assess the prevalence and patterns of substance use among construction workers in North India and explore its implications on occupational health and safety. A cross-sectional descriptive study was conducted among 500 construction workers using structured questionnaires. The study revealed high rates of alcohol and nicotine use, particularly among young, male, and less-experienced workers. Findings underscore the need for targeted workplace interventions and policy reforms.

: Introduction: Respiratory tract infections are commonly encountered in clinical practice and are often complicated by the presence of underlying comorbidities such as Chronic Obstructive Pulmonary Disease, Bronchial asthma, and Diabetes Mellitus. These can alter the respiratory microbiological profile. Moraxella catarrhalis, considered a commensal organism of human upper respiratory tract, has emerged as a notable pathogen in lower respiratory tract infections, particularly in individuals with chronic respiratory diseases. Understanding the relationship between specific comorbidities and the isolation of Moraxella catarrhalis can help improve clinical management and targeted therapy. Objectives: This study aimed (1) To establish the pathogenicity of Moraxella catarrhalis through microbiological identification using microscopy, culture, and biochemical reactions (2) To assess the incidence of Moraxella catarrhalis and to analyse the association between comorbidities like Chronic Obstructive Pulmonary Disease & Bronchial Asthma (3) To determine its antibiotic susceptibility profile to various antibiotic classes. Methodology: A cross-sectional study was conducted involving 250 bacteriologically significant respiratory samples. Participants were categorized based on the presence of no comorbidity, with Chronic Obstructive Pulmonary Disease, Bronchial Asthma, or Diabetes Mellitus. The isolates were identified conventionally and antibiotic susceptibility testing done with various classes of antibiotics. Results: Out of the 250 bacteriologically significant respiratory sample, 38 clinically significant Moraxella catarrhalis were isolated and accounted for 15.2% of total isolates. Antibiotic susceptibility testing showed 100% resistance to ampicillin and 100% sensitivity to amoxicillin -clavulanic acid correlating with the production of beta-lactamase enzyme by the isolates. Moraxella catarrhalis was isolated predominantly among Chronic Obstructive Pulmonary Disease patients (26.8%) followed by, Bronchial Asthma patients (17.1%). The Chi-square test showed a significant association between comorbid conditions and bacterial isolates (χ² = 14.92, p = 0.002). Conclusion: Moraxella catarrhalis should be considered as a lower respiratory tract pathogen especially in elderly patient with underlying comorbidity like Chronic Obstructive Pulmonary Disease & Bronchial Asthma.

Background: Hepatitis B virus (HBV) is a major global public health concern, particularly in intermediate endemic regions like India. Early detection through preoperative screening helps prevent intra-hospital transmission and informs appropriate clinical management. Objectives: To estimate the seroprevalence of hepatitis B surface antigen (HBsAg) among preoperative patients in a rural tertiary care centre. Methods: A retrospective cross-sectional study was conducted over one year (May 2023 to April 2024), involving 11,131 patients undergoing elective surgeries across multiple departments. Serum samples were screened for HBsAg using a rapid immunochromatographic test. Demographic data and coinfections with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) were also assessed. Statistical analysis was performed using Chi-square tests, with P ≤ 0.05 considered significant. Results: The overall HBsAg seroprevalence was 2.07% (231/11,131). Among these, 170 (73.6%) were males and 61 (26,4%) were females, with gender-based seroprevalence of 2.42% and 1.48%, respectively. The highest seropositivity was observed in the 21–40 years age group (37%), followed by 41–60 years (33%), >60 years (24%), and 0–20 years (6%). None of the seropositive individuals presented with clinical signs or symptoms of hepatitis; all were asymptomatic and incidentally detected during routine preoperative screening. Most seropositive patients were married, illiterate, and engaged in agricultural work. Coinfections included 2 cases with HCV (1.29%) and 1 case with HIV (0.4%). Conclusion: Preoperative screening for HBV is essential in identifying asymptomatic carriers and minimizing occupational and nosocomial transmission. The results highlight the need for continued surveillance and enhanced HBV vaccination and awareness programs, especially in rural populations.

Background: Dengue fever is a widespread mosquito-borne viral illness that poses a significant global health challenge. While primarily self-limiting, it can progress to severe forms such as dengue hemorrhagic fever and dengue shock syndrome. Hepatic dysfunction is a frequently observed complication, present in up to 90% of hospitalized cases, and may serve as an early prognostic marker for disease severity. Methods: This prospective observational study included 100 adult patients (≥18 years) with laboratory-confirmed dengue fever at a tertiary care center in central India over six months. Clinical presentation, liver function tests (AST, ALT, bilirubin, albumin), hematological parameters (WBC, platelet count, hematocrit), and ultrasound findings were recorded. Hepatic involvement was defined as elevated transaminases (>2× upper limit of normal), hyperbilirubinemia, or clinical signs of liver dysfunction. Patients were stratified by severity using WHO dengue classification criteria. Results: Elevated AST and ALT levels were noted in 88% and 81% of patients, respectively, with AST predominance. Hepatomegaly was seen in 26%, and jaundice in 8% of cases. Thrombocytopenia (91%) and leukopenia (76%) were prevalent hematological abnormalities. According to WHO criteria, 12% developed severe dengue, while 42% had warning signs. Elevated transaminases and low platelet counts showed significant correlation with severe disease. Conclusion: Hepatic dysfunction is a common and early feature in dengue infection, with elevated transaminases—particularly AST—and thrombocytopenia serving as key indicators of severity. Early identification of these abnormalities can facilitate risk stratification and timely intervention, potentially improving clinical outcomes.