European Journal of Cardiovascular Medicine

Introduction: Type 2 Diabetes Mellitus (T2DM) has severe motor impairments with negative implications on hand dexterity and quality of life. Although there are long-term effects of yoga practices proving to be beneficial at the metabolic and psychological level in T2DM, the acute effects of pranayama (yogic breathing) on fine motor function are yet to be explored. The purpose of this research was to determine the acute effect of one session of pranayama on hand dexterity among patients with uncomplicated T2DM and also to compare metabolic and demographic factors with motor performance results. Methodology: Fourteen subjects (mean age 48.2 ± 6.2 years) with uncomplicated T2DM were included. Each was exposed to a baseline trial and measurement by means of the Modified O'Connor Tweezer Dexterity Test. Participants next practiced 5 minutes of Anuloma Viloma and 5 minutes of Bhramari pranayama, in alternating order, with a 2-minute break between. Post-intervention dexterity was tested again. Statistical analysis involved paired t-tests to compare pre- and post-test scores and Spearman correlation to examine associations between age, BMI, HbA1c, and dexterity parameters. Results: Post-pranayama, the hand dexterity improved considerably (mean difference: –81.1 seconds; p < 0.001; Cohen's dz = –2.01). All of them improved, with decrease in time varying from 31 to 193 seconds. The exploratory analysis demonstrated strong negative correlation between BMI and dexterity improvement (r = –0.77, p = 0.001), and between age and HbA1c (r = –0.85, p < 0.001), suggesting possible modulatory influence of metabolic factors on motor function. Conclusion: One session of pranayama increased hand dexterity in uncomplicated T2DM patients significantly. The results advocate including pranayama as an adjunctive, non-pharmacological treatment to enhance fine motor function. Yet, because of the limited sample and absence of a control group, larger cohorts of randomized controlled trials need to be performed to substantiate the outcomes and clarify underlying mechanisms.

Introduction: Bier’s block is widely used for anesthesia in upper limb surgeries. The choice of local anesthetic influences onset time, duration, and safety, but comparative data are limited. Aim: To compare the efficacy, onset, duration, and safety profiles of Lidocaine, Prilocaine, Bupivacaine, and Ropivacaine used in Bier’s block. Methods: A prospective randomized study was conducted on 200 patients undergoing upper limb surgery, divided into four groups (n=50 each) receiving one of the local anesthetics. Onset times for sensory and motor blockades, duration of anesthesia and postoperative analgesia, and adverse effects were recorded and analyzed. Results: Lidocaine had the fastest sensory (105.4 ± 14.3 sec) and motor block onset (150.8 ± 18.2 sec), significantly quicker than Bupivacaine and Ropivacaine (p<0.001). Bupivacaine provided the longest anesthesia duration (95.4 ± 20.5 min) and postoperative analgesia (130.8 ± 25.7 min), significantly exceeding Lidocaine and Prilocaine (p<0.001). Adverse effects were minimal; however, methemoglobinemia was significantly more frequent with Prilocaine (p=0.043). Conclusion: Lidocaine is preferable for rapid onset, while Bupivacaine offers prolonged anesthesia and analgesia. Safety profiles were comparable except for increased methemoglobinemia risk with Prilocaine. Choice of agent should be tailored to surgical and patient needs.

Introduction: Alcoholic liver disease (ALD) remains a major global health concern, progressing from steatosis to alcoholic hepatitis, fibrosis, and cirrhosis. Growing evidence highlights the gut–liver axis—particularly the gut microbiota—as a critical modulator of ALD through immune, metabolic, and barrier-related mechanisms. Objective: This narrative review explores the role of gut microbiota in the pathogenesis of ALD and evaluates current and emerging microbiota-targeted therapeutic strategies. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science for studies published between 2008 and 2023. Search terms included "gut microbiota," "alcoholic liver disease," "gut–liver axis," "probiotics," and "fecal microbiota transplantation." Findings: Chronic alcohol consumption induces gut dysbiosis, increases intestinal permeability, and promotes microbial translocation—particularly lipopolysaccharides—which activate hepatic inflammation via Toll-like receptor (TLR) pathways. Alcohol also disrupts microbial metabolites such as short-chain fatty acids (SCFAs) and bile acids, further contributing to liver injury. Therapeutic interventions like probiotics, prebiotics, synbiotics, and fecal microbiota transplantation (FMT) have shown promise in modulating these pathways, improving liver function, and reducing inflammation in both animal models and early human trials. Conclusion: The gut microbiota is a pivotal factor in the pathophysiology of ALD and represents a novel therapeutic target. While preliminary outcomes from microbiota-based interventions are promising, future research should prioritize large-scale, multi-omics-integrated, and personalized clinical trials to optimize efficacy and long-term safety.

Introduction: Post-cholecystectomy syndrome (PCS) is a collection of chronic or new-onset abdominal complaints after gallbladder surgery. The pathogenesis of these symptoms after cholecystectomy may be explained by the interaction of Helicobacter pylori infection with abnormal biliary dynamics. The present study was designed to evaluate the relationship between H. pylori infection, endoscopic appearance, and PCS in a tertiary care facility. Methods: An observational cross-sectional study was carried out at Chhatrapati Shivaji Subharti Hospital, Subharti Medical College, SVSU, Meerut on 120 patients with PCS. Upper gastrointestinal endoscopy and gastric biopsies were done in all patients. Histopathological analysis for H. pylori was carried out by using routine and special stains. Endoscopic features and symptom profiles were correlated with H. pylori status.  Results: Of 120 patients, 61 (50.8%) were H. pylori positive. Bile reflux was observed in 45% of the cases, and there was a strong association between H. pylori infection and endoscopic gastritis (p < 0.001), gastric erosions (p = 0.045), and duodenogastric reflux (p = 0.002). The H. pylori-positive patients also showed a higher percentage of OLGA stage II or higher. Epigastric pain, bloating, and nausea were strongly prevalent in the infected group. Conclusion: There is a significant correlation between H. pylori infection and mucosal pathology in PCS patients. Screening in the form of routine testing and selective eradication of H. pylori can enhance symptom control and potentially avoid progression to complicated gastric disease in this group.

Introduction: Intrahepatic cholestasis of pregnancy is most common pregnancy related liver disorder and unique to pregnancy. It is characterised by pruritus with onset in the 2nd or 3rd trimester of pregnancy without skin rash, elevated serum amino transferases and bile acid levels and spontaneous relief of signs and symptoms within 2-3 weeks after delivery. Aims: To find out the adverse effects of intrahepatic cholestasis of pregnancy on feto- maternal outcomes. Materials & Methods: The present study was a prospective observational study. This Study was conducted from 1 ½ years (March 2018 to July 2019) at department of obstetrics and gynaecology in Chittaranjan Seva Sadan College of Obstetrics & Gynecology and Child Health. Total 100 patients were included in this study. Result: At 1 minute, 20% of new-borns had an APGAR score <6, while 80% had scores ≥6, indicating good initial adaptation. The occurrence of low APGAR scores was relatively limited but clinically significant. The result was statistically significant with a P value < 0.0001, suggesting a non-random distribution. At 5 minutes, 8.5% of new-borns had an APGAR score <6, while 91.5% showed improved scores ≥6, indicating better postnatal recovery. Though fewer new-borns had low scores at this stage, it remains clinically relevant. The distribution was statistically significant with a P value < 0.0001. Conclusion: Intrahepatic cholestasis of pregnancy (ICP) significantly impacts feto-maternal outcomes, predominantly affecting women in their prime reproductive age. This study highlights that ICP is associated with increased risks of adverse fetal events, including low birth weight, low APGAR scores, and a higher rate of NICU admissions, emphasizing the need for vigilant fetal monitoring.

Introduction: Sedation is routinely administered during targeted temperature management (TTM) in comatose cardiac arrest survivors. However, the optimal depth of sedation for improving neurological outcomes remains unclear. This retrospective observational study explores the association between sedation depth and neurological outcomes in post-cardiac arrest patients admitted to the intensive care unit (ICU). To evaluate the impact of sedation depth, measured using the Richmond Agitation and Sedation Scale (RASS), on neurological recovery and short-term survival in patients undergoing TTM after cardiac arrest. A total of 150 adult patients who achieved return of spontaneous circulation (ROSC) after in-hospital or out-of-hospital cardiac arrest and were subsequently treated with TTM between January 2024 and May 2025 were retrospectively analyzed. Patients were categorized into two groups based on average RASS scores over the first 48 hours of ICU stay: lighter sedation (RASS −4; n = 55) and deeper sedation (RASS −5; n = 95).  The primary outcome was favorable neurological status at ICU discharge, defined as a Cerebral Performance Category (CPC) score of 1 or 2. Secondary outcomes included ICU survival and 30-day all-cause mortality.  Favorable neurological outcomes were observed in 49.1% of patients in the lighter sedation group compared to 34.7% in the deeper sedation group. Multivariate analysis showed that lighter sedation was independently associated with better neurological outcomes (adjusted OR 2.07; 95% CI: 1.01–4.27; p = 0.045). Although ICU survival rates were similar between groups, 30-day mortality was significantly lower in the lighter sedation group (29.1% vs. 42.1%; p = 0.041). Lighter sedation during the initial 48 hours of TTM is associated with improved neurological outcomes and reduced short-term mortality. These findings support the implementation of individualized, lighter sedation strategies in post-cardiac arrest care.

Introduction: Atherosclerotic cardiovascular disease (ASCVD) is a major cause of mortality globally. Coronary calcification is the main features of the disease progression. Objective: To know the correlation between CT calcium score and coronary stenosis among suspected coronary artery disease (CAD) patients. Methods: The current prospective study was done on 100 patients (both symptomatic and asymptomatic) with suspected CAD who underwent angiography followed by invasive coronary angiography (CAG). Severity of CAD is assessed using Gensini score. Baseline demographics and Gensini scores were recorded. Correlation was assessed using Pearson’s test, and diagnostic accuracy was assessed. Results: Mean age of patients was 62.1 ± 9.5 years. 72% are          male. Mean CT calcium score was 607.3, and mean Gensini score was 36.3. There is a   significant positive correlation (r = 0.345, p < 0.001) between CT calcium score and Gensini score. Conclusion: The study showed a statistically significant moderate, correlation between CT calcium score and angiographic CAD severity. Serum calcium score is a main initial stratification tool, especially when integrated with clinical risk factors

Introduction: Urinary calculi are third most common affliction of the urinary tract, exceeded only by urinary tract infections and pathologic condition of prostate.  PCNL (percutaneous nephrolithotomy) become gold standard form of the management for large stones in upper urinary tract. Most of the urologists generally prefer usual prone position during percutaneous nephrolithotomy despite theoretical advantages of supine position during PCNL. Aims and objectives: Our aim and objective in this study is to evaluate safety and efficacy of prone PCNL versus supine PCNL comparing number of puncture, operative time, perioperative complications, post-operative hemoglobin drop, requirement of blood transfusion, days in hospital, stone free rate (SFR) and requirement of relook PCNL or secondary procedures. Materials and Methods: This is a randomized, double blinded, single center, prospective, experimental comparative study conducted in a tertiary care hospital in Eastern India. After considering inclusion and exclusion criteria, 120 patients with renal calculi were randomly assigned to two groups, each with 60 patients, all demographic, operative, and post-operative characteristics were recorded. Results: A total of 120 patients were included in this study. In our study, 52.5 % (63 patients) were male and 47.5 % (57 patients) were female. In 64 patients (53.3%) stone was located to the right side and in 56 (46.7%) patients stone was located to the left side. The mean age was 44.21±15.32 years in prone PCNL and it was 42.82±18.14 years in supine PCNL. The mean BMI was 23.24±2.68 kg/m2 and 22.68±2.86 kg/m2 in prone and supine PCNL, respectively. 38 patients (63.3%) of prone group and 35 patients (58.3%) of supine group fulfills the criteria ASA (American Society of Anesthesiologist’s) category I health status. Stone size varies from 11 mm to 53 mm with a mean stone size of 268.214±174.342 mm² in prone PCNL and 238.4±198.2 mm² in supine PCNL (Table 1). There were no significant difference in stone size between the two groups.  In prone and supine  PCNL grade I Hydronephrosis 2(11%) and 2(9%) respectively. Grade II, III, IV hydronephrosis in prone and supine PCNL 6(32%) and 9(41%),7(37%) and 6(27%) and 4(21%),5(23%) respectively. Location of stones were 21(35 %) and 20(33%) in renal pelvis, 15(25%) and 18(30%) in lower calyx, 6(10%) and 7(12%) in middle calyx, 4(7%) and 3(5%) in upper calyx, and 6(10%) and 5(8 %) in multiple calyxes in prone and supine PCNL respectively. 7 patients (7%and 5%) had partial and 8 patients (7% each) had complete staghorn calculus in prone and supine PCNL respectively.  The mean intra operative time was 55-145 (85±29.28) min in prone PCNL and 50-125 (62±25.36) min in supine PCNL with a p value of 0.032. In prone PCNL, 51(85 %) patients had complete stone clearance and 9(15%) had residual stone. In supine PCNL, 53(88.33%) patients had complete clearance and 7(11.27%) patients had residual stone. The difference between the two groups was statistically insignificant with p value of 0.346. The mean post operative hospital stay was 3.52±1.03 and 3.65±1.08 days in prone and supine group respectively. 5 patients in prone group and 4 patients in supine group had Clavein- Dindo grade I complications and 4 patients in each group had grade II complications. The complications were fever and nausea in grade I and requirement of blood transfusion in grade II complication. The mean hemoglobin drop was 0.53 g/dl and 0.51 g/dl in prone and supine position respectively (p value >0.05). Post operative blood transfusion required in 8 patients in prone group and 5 patients in supine group. There were no serious (grade 3 or 4) complications in either group. 2 patients require relook PCNL in prone and 1 patient in supine PCNL. ESWL require in 4 patients in prone and 3 patients in supine PCNL. Conclusion: Supine PCNL is an effective and safe procedure as to prone PCNL with the added advantages of reduced operative time as well as simultaneous retrograde, antegrade and bilateral access and beneficial to high -risk cardiovascular patients.

Introduction: Anesthesia for daycare surgeries demand rapid recovery with no residual anesthetic effects and minimal perioperative side effects. Chlorprocaine is an amino ester local anesthetic with short half-life, regained its importance in the recent past in day care surgeries¹. Opioids as adjuvant to Chlorprocaine have shown to prolong the duration of postoperative analgesia without much effect on motor block, favoring early mobilization. The optimal dose of Chlorprocaine which can ensure efficacy without prolonging recovery remains unclear.  Objective: To compare the efficacy, safety, and recovery profiles of 20 mg versus 30 mg intrathecal Chlorprocaine with 25 mcg fentanyl in patients undergoing lateral anal sphincterotomy as daycare procedures under spinal anesthesia. Methods: A randomized, double-blind study was conducted on 60 patients undergoing elective lateral anal sphincterotomy. Patients were assigned into two groups: Group A (20 mg chlorprocaine + 25 mcg fentanyl) and Group B (30 mg chlorprocaine + 25 mcg fentanyl). Primary outcomes included onset and duration of sensory and motor block, duration of effective analgesia and time to ambulation and discharge readiness. Secondary outcomes included patient satisfaction, need for rescue analgesia, and adverse effects. Results: Group B had faster onset and prolonged sensory and motor blocks compared to Group A (p < 0.05). However, Group A demonstrated significantly earlier ambulation (p = 0.03) and discharge readiness (p = 0.02). Both groups showed comparable analgesia quality and patient satisfaction. No major adverse events were recorded. Conclusion: Intrathecal 20 mg chloroprocaine with 25 mcg fentanyl is adequate for daycare lateral anal sphincterotomy, providing satisfactory surgical anaesthesia with faster recovery compared to 30 mg with 25mcg fentanyl. It may be preferred for procedures requiring early ambulation and discharge

Introduction: Nerve conduction velocity (NCV) is a critical diagnostic tool used to assess peripheral nerve function. While factors such as age, height, and body mass index (BMI) are known to influence NCV, the impact of limb length—particularly independent of height—remains under-explored, especially in Eastern India. This study aimed to evaluate the correlation between limb lengths and NCV in healthy adults from an urban population of West Bengal. Methods: A cross-sectional observational study was conducted over one year in the Department of Physiology, Burdwan Medical College and Hospital. Sixty healthy adult volunteers (30 males, 30 females), aged 18–60 years, were recruited. Participants with systemic illnesses, neurological disorders, or prior limb trauma were excluded. Anthropometric data, including limb lengths, were collected using standardized techniques. Nerve conduction studies of the median and tibial nerves were performed bilaterally under controlled conditions using the NIHON KOHDEN system. Pearson’s correlation and multivariate regression analyses were applied to evaluate associations between limb lengths and NCV, adjusting for age, sex, height, and BMI. Results: Males had significantly greater upper limb lengths and higher NCV values for both median and tibial nerves compared to females (p < 0.001). A significant negative correlation was found between upper limb length and median NCV, especially among females (right side r = –0.42, p = 0.007; left r = –0.40, p = 0.037). In females, lower limb length also showed a significant negative correlation with right tibial NCV (r = –0.32, p = 0.014). Regression models identified upper limb length as an independent predictor of median NCV. Conclusion: Limb length, particularly upper limb length, is inversely correlated with NCV. These findings suggest that incorporating limb measurements may improve the interpretation of nerve conduction studies and support the development of population-specific normative data

Background: Hemoglobinopathies represent a significant public health challenge in tribal populations of India. High-performance liquid chromatography (HPLC) is a highly reliable and standardized technique widely used for the identification and quantification of various hemoglobin types, both normal and abnormal variants. Its accuracy and reproducibility make it an indispensable tool in the diagnosis of Hemoglobinopathies such as sickle cell disease and thalassemia. Aim: The present study was undertaken to evaluate the pattern and prevalence of Hemoglobinopathies in the tribal population attending a tertiary care center in Paderu, Andhra Pradesh using high-performance liquid chromatography (HPLC). Methods: A total of 900 individuals from tribal communities were screened using HPLC for abnormal hemoglobin patterns. Demographic data, including age, gender distribution, social communities, and region were also collected and analyzed. Results: Among the 900 subjects, 308 (34.2%) were males and 592 (65.8%) were females. Abnormal hemoglobin patterns were detected in 88.2% (794) of cases. Normal hemoglobin patterns were observed in only 11.78% (106) of tested cases. In patients with abnormal hemoglobin patterns, the most common abnormality observed was Sickle Cell Trait, present in 65.5% (520) of individuals. This was followed by S β-thalassemia (22.92%, 182), Sickle Cell Anemia (9.57%, 76), and β-thalassemia Trait (1.51%, 12). Other less frequent variants included HPFH/Other variants (0.25%), Compound Hb D with β-thalassemia (0.12%), and β-thalassemia Major (0.12%).  The highest burden was observed in the 1–10 year age group, accounting for over 35% of total cases. Blood group distribution revealed the highest prevalence among B+ve, O+ve, and A+ ve individual. Regionally, Koyyuru, Chinthapalli, and Hukumpeta reported the highest number of affected cases. Rare hemoglobinopathies such as HbD + Thalassemia and HPFH were documented in 3 individuals. Conclusion: The study highlights a high burden of hemoglobinopathies, particularly Sickle Cell Trait and S β-thalassemia, among the tribal population in Paderu especially among younger age groups. The findings emphasize the need for routine neonatal and antenatal screening, genetic counseling, and community-level interventions. HPLC proves to be an effective tool for mass screening and early detection in tribal health programs.

Introduction: During pregnancy, maternal thyroid hormones are essential for placental function and fetal brain development, particularly in the first trimester before the fetal thyroid becomes functional. Maternal hypothyroidism has been linked to various adverse outcomes, including neonatal jaundice, hypocalcemia, respiratory distress, and increased risk of congenital anomalies.Early diagnosis and appropriate treatment with levothyroxine significantly reduce these risks, making maternal thyroid health crucial for optimal pregnancy outcomes. Materials And Methods: A hospital-based observational study was conducted over 1.5 years in the Department of paediatrics of Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala. The study included 50 neonates with hypothyroid mother.Another set of 50 neonates born to pregnant subjects with absence of maternal hypothyroidism or any other thyroid related disorder were included as controls.. Infants with birth asphyxia, congenital anomalies, sepsis, metabolic disorders, or born to diabetic or anticonvulsant- using mothers were excluded. Results: The number of neonates born by LSCS  was significantly higher in hypothyroid mothers (66% vs. 14%, p=0.001). Preterm deliveries (18% vs. 4%, p=0.001), low birth weight (30% vs. 2%, p=0.000), and small for gestational age neonates (20% vs. 0%, p=0.000) were significantly more common in the hypothyroid group. Mean birth weight was significantly lower in the hypothyroid group (p=0.001), while no significant differences were found in neonatal gender, APGAR scores, cord/serum TSH, NICU admission or stay, or respiratory complications. Conclusion: Neonates born to hypothyroid mothers had higher rates of cesarean delivery, low birth weight, SGA, and neonatal jaundice requiring phototherapy.

Background: Benign breast diseases (BBD) represent a heterogeneous group of disorders affecting up to 30% of women, often mimicking malignant conditions and causing significant patient anxiety. The ANDI (Aberrations of Normal Development and Involution) classification system offers a standardized approach to categorize and manage these conditions.

Objective: This study aimed to assess the utility of the ANDI classification in diagnosing and guiding treatment for BBD. Methods: A prospective clinical study was conducted on 100 female patients presenting with BBD at a tertiary care center from October 2024 to February 2025. Patients were classified using ANDI criteria, and data were analyzed for clinical presentation, imaging (ultrasonography, mammography), cytology (FNAC), histopathology, and treatment outcomes. Inflammatory conditions and malignancies were excluded.

Results:

• Disease distribution: Fibroadenoma (60%, *n*=60) was the most common diagnosis, followed by cyclical mastalgia with nodularity (30%, *n*=30), incapacitating mastalgia (5%, *n*=5), duct ectasia (3%, *n*=3), and giant fibroadenoma (2%, *n*=2).
• Age correlation: Peak incidence occurred in women aged 21–30 years (56%), with fibroadenoma predominating in this group (42%). Cyclical mastalgia was most frequent in ages 31–40 (16%).
• Clinical features: 50% of fibroadenomas presented as painless lumps; mastalgia cases typically involved bilateral breast pain (35%).
• Management: Surgical excision was performed for fibroadenomas (55/60) and duct ectasia (3/3), while mastalgia cases (30 cyclical, 5 incapacitating) responded to medical therapy (analgesics, hormonal modulation).

Conclusion: The ANDI classification effectively stratifies BBD, enabling tailored management. Fibroadenoma and mastalgia are the most prevalent entities, with age and symptom patterns aiding diagnosis. Conservative therapy suffices for functional disorders, while surgery remains definitive for localized lesions.

Introduction: Respiratory allergies such as allergic rhinitis and bronchial asthma are major global health burdens, with rising prevalence, particularly in developing countries. Eosinophils play a pivotal role in the pathophysiology of allergic diseases, and Absolute Eosinophil Count (AEC) is considered a potential biomarker reflecting disease activity and severity. Objectives: To evaluate the correlation between Absolute Eosinophil Count and the clinical severity of respiratory allergic conditions. Materials and Methods: This cross-sectional observational study was conducted over 1.5 years at RKDF Medical College and Maharishi Devraha Baba Autonomous State Medical College. A total of 200 patients clinically diagnosed with respiratory allergies (allergic rhinitis and bronchial asthma) were included. AEC was measured and compared across mild, moderate, and severe grades of disease severity. Statistical analyses including correlation coefficients were applied. Results: The mean AEC values were significantly higher in patients with severe allergic symptoms (mean AEC 650 ± 82 cells/µL) compared to those with moderate (410 ± 65 cells/µL) and mild (270 ± 49 cells/µL) symptoms (p < 0.001). A strong positive correlation (r = 0.81) was observed between AEC and clinical severity score. Additionally, asthmatic patients demonstrated higher AEC values than those with isolated allergic rhinitis. Conclusion: AEC is significantly correlated with the clinical severity of respiratory allergy, particularly bronchial asthma. It serves as a simple, cost-effective, and readily available marker that may aid in disease monitoring and stratification of patients for appropriate therapeutic intervention

Background: Diabetic foot complications remain a major contributor to morbidity, disability, and amputations, particularly in resource-constrained settings. Despite being preventable, these complications remain prevalent due to inadequate awareness and suboptimal foot care practices. This study assessed the knowledge, attitude, and practice (KAP) related to foot care among individuals with diabetes in rural Chennai and identified the associated factors. Methods: An analytical cross-sectional study was conducted between May and November 2019 at a rural health center in Chennai, Tamil Nadu. A total of 832 adults aged ≥30 years with a type 2 Diabetes Mellitus were selected through systematic random sampling. Data was collected using pre-tested semi-structured questionnaire adapted from validated tools. KAP scores were categorized using modified Bloom’s criteria. Descriptive and analytical statistics were done, with p-values <0.05 considered statistically significant. Results: Of the 832 participants, 54.3% had adequate knowledge of foot care, while only 41.4% followed good foot care practices. While most participants recognized the importance of medication adherence (88.1%) and daily foot inspection (83%), only a few were aware of sensory loss risks (25.7%) and correct nail care practices (9.5%). Although 88.6% supported lifestyle changes, only 57.1% endorsed regular self-foot examination. Risk behaviors like walking barefoot indoors (90%) and outdoors (68.6%) were common. Adequate knowledge was significantly associated with good practices (OR = 3.71; 95% CI: 2.75–4.99; p<0.0001). Male gender, higher socioeconomic status, and history of foot ulcers were linked to adequate knowledge and good practices. Conclusion: Significant gaps exist between foot care knowledge and practices among diabetics in rural Chennai, despite favorable attitude. This emphasizes the urgent need for integrating culturally tailored health education, behavior change strategies and regular foot screening into routine diabetic care. Strengthening community-level approaches and empowering frontline health workers are essential to reduce the burden of diabetic foot complications in rural settings.

Background: Diabetic foot ulcers (DFUs) remain a major complication of diabetes, often leading to significant morbidity, including lower limb amputations. A practical and reliable tool to predict DFU outcomes is crucial for early intervention. The Diabetic Ulcer Severity Score (DUSS), a wound-based classification developed by Beckert et al., offers a simplified clinical method to assess ulcer prognosis using four parameters: number of ulcers, ulcer site, probing to bone, and pedal pulses. Objective: This study aimed to clinically validate the DUSS in predicting outcomes of diabetic foot ulcers, particularly healing versus amputation. Methods: A prospective observational study was conducted on 100 patients with diabetic foot ulcers. Each patient was evaluated for DUSS parameters, and outcomes were categorized into healing (with or without skin grafting) or amputations (minor and major). Follow-up visits were conducted weekly, and statistical analyses including Cox regression and Kaplan-Meier survival were performed. Results: The highest proportion of patients had a DUSS score of 2 (41%). Healing was observed in 75% of patients with DUSS score 0 and 70.7% with score 2, while no healing occurred in those with score 4. Amputations increased with higher DUSS scores: 100% of patients with a score of 4 and 90.5% with a score of 3 underwent amputations. Cox regression revealed statistically significant associations between scores 0, 3, and 4 with outcomes (p<0.05). Kaplan-Meier analysis supported the inverse relationship between DUSS score and probability of healing. Conclusion: The DUSS is an effective, easy-to-use clinical tool for predicting outcomes in patients with diabetic foot ulcers. It facilitates risk stratification and guides referral decisions, particularly in resource-limited settings. Patients with higher scores require prompt specialist care to reduce the risk of major amputations.

Introduction: Oropharyngeal candidiasis (OPC) is the most common opportunistic infection observed in HIV seropositive patients. It has been perceived that low CD4 counts and high plasma HIV RNA levels, both significantly correlate with oral candidiasis in HIV patients.  Aim: To determine the antifungal susceptibility testing of the Candida isolates by disc diffusion method. Materials and Methods: The present study is a cross-Sectional study that included 100 clinical samples processed for speciation of Candida isolates by using standard mycological techniques and antifungal susceptibility of the Candida isolates was done by using disc diffusion method and MICs was done by ‘E’ strip test for fluconazole resistant isolates. CD4 count was estimated by using Flow cytometry method & viral load was estimated by using Real time PCR, Abbott M2000SP and correlated with oral thrush.  Results: Out of 100 Candida isolates, Candida albicans 84 (84%) was the predominant species followed by Candida krusei 7 (7%), Candida glabrata6 (6%), Candida tropicalis3 (3%). Among the antifungals used in this study, the most sensitive agent was voriconazole 99(94.4%) and the least was Itraconazole 59 (19.6%). CD4 count was less than 200 cells/μl in 45(45%). Viral load varied from 1,62409 to 58 copies/ml of blood in the patients with oral thrush with significant association. Conclusions: To conclude, though Candida albicans was the common species, the emergence of non-albicans candida species and the increasing rate of azole resistance, emphasizes the need for speciation and determination of susceptibility pattern to provide appropriate treatment for HIV patients with oral candidiasis

Introduction: Diabetes is a chronic metabolic condition marked by elevated blood glucose levels due to either insufficient insulin production or resistance to insulin, leading to widespread damage to various organs over time. Aim: To compare the proportion of dry eye disease in diabetics and non-diabetics. Methodology: This observational study was conducted over a period of 18 months in the outpatient departments of Ophthalmology and Medicine at Mahatma Gandhi Medical College and Hospital, Sitapura, Jaipur. Result: In this study, dry eye disease was significantly more prevalent and severe among diabetic patients compared to non-diabetics, as confirmed by OSDI score, Schirmer test, and TBUT test. The findings support diabetes as a strong risk factor for dry eye disease. Conclusion: This study demonstrated a significantly higher prevalence and severity of dry eye disease in diabetic patients compared to non-diabetic controls. The results highlight diabetes as a major risk factor, emphasizing the need for regular ocular screening and early intervention

Introduction: Sudden unexpected natural death (SUND) refers to death in adults who did not have any known illness. Natural death means that the death was caused entirely by the disease, and trauma or poison did not play any part in bringing it about.  There are various definitions of SUND but the most explaining and describing definition is the one which states that natural death occuring without any illness or that occuring within 24 hours of symptom onset. The causes of sudden death depend upon the various factors like location, socio-economic status, lifestyle, hereditary and genetic factors, etc. There has been a considerable curiosity in the medical field regarding SUND owing to the unanticipated and suddeness of death. So, an autopsy study was conducted in a tertiary care hospital to find out the causes and risk factors associated with SUND through gross and histopathological examination.   Methodology: A retrospective autopsy-based study was performed in the department of Pathology, in a tertiary health care hospital of Mumbai for two years after Ethical approval. Based upon the inclusion and exclusion criteria, a sample size of 100 adult cases was obtained. The gross and histopathological findinge were noted and special stains were performed wherever needed. Results: Eight three percent cases were brought dead and 17 % cases died within 24 hrs of hospital admission. Maximum cases had history of sudden unconsciousness.    Most predominant system involved was respiratory system (75%) followed by cardiovascular system (44%). The present study also highlighted eight cases with incidental findings. There were no pathological lesions seen in four cases of sudden death.  Conclusion: Autopsy and histopathology are crucial in determining the cause of death in SUND cases. They also provide important insights with respect to medico-legal aspects, medical research and public health related issues. The value of histopathology cannot be underestimated in such cases.

Introduction: Pancreatitis, characterized by inflammation of pancreatic tissue and release of proteolytic enzymes, can lead to severe local and systemic complications. Vascular complications, occurring in approximately 25% of cases, range from asymptomatic thrombosis to life-threatening hemorrhage or pseudoaneurysm rupture. Early diagnosis is crucial for patient survival. Objectives: This study aimed to evaluate vascular complications associated with pancreatitis and characterize the types of vascular involvement. Materials and Methods: A retrospective analysis was conducted on 126 patients diagnosed with acute or chronic pancreatitis at Basaveshwara Medical College, Chitradurga, over 18 months. Triple-phase MDCT (basal, arterial, portal venous, and excretory phases) with axial, coronal, sagittal, and 3D-reformatted images was used for diagnosis. Vascular complications assessed included venous thrombosis, arterial pseudoaneurysms, arterial thrombosis, and other vascular events. Data were analyzed using descriptive statistics (percentages, frequencies) in MS Excel. Results: mong 126 pancreatitis patients, vascular complications were identified in 30 cases (23.8%), with venous thrombosis being predominant in 27 patients (21.4%). Splenic vein thrombosis was the most common complication, occurring in 15 patients (50% of thrombotic cases), followed by portal vein involvement in 4 patients (13.3%). Arterial complications were observed in 3 patients (2.4%), including splenic artery pseudoaneurysms in 2 cases and common iliac artery thrombosis in 1 case. Associated findings included collateral circulation in 15 patients, splenomegaly in 28 patients, and ascites in 30 patients, emphasizing the systemic impact of pancreatitis-induced vascular pathology. Conclusion: Vascular complications in pancreatitis are diverse and potentially fatal. Timely diagnosis using multiphase CT imaging is essential for improving patient outcomes. This study highlights the importance of recognizing these complications to guide appropriate management

Introduction: Unexplained infertility accounts for approximately 10–30% of infertility cases in women undergoing assisted reproductive technologies. Recent research highlights the potential role of the vaginal microbiota in modulating reproductive outcomes. A predominance of Lactobacillus species is generally associated with favorable gynecological health, whereas microbial dysbiosis may negatively impact implantation and pregnancy rates. This study aimed to assess the correlation between vaginal microbiota composition and in vitro fertilization (IVF) success in women with unexplained infertility. Materials and Methods: A prospective observational study was conducted involving 100 women aged 25–38 years diagnosed with unexplained infertility and scheduled for IVF treatment. Vaginal swabs were collected prior to controlled ovarian hyperstimulation. Microbiota profiling was performed using 16S rRNA gene sequencing. Patients were categorized into Lactobacillus-dominant (Group A, n=58) and non-Lactobacillus-dominant (Group B, n=42) based on microbial diversity. IVF outcomes, including fertilization rate, implantation rate, and clinical pregnancy rate, were compared between groups. Statistical analysis was performed using chi-square and t-tests with p<0.05 considered significant. Results: Group A exhibited significantly higher clinical pregnancy rates (56.9%) compared to Group B (28.6%) (p=0.004). The implantation rate was also notably greater in the Lactobacillus-dominant group (41.3% vs 22.5%; p=0.03). No significant difference was observed in fertilization rates between the two groups (83.2% vs 81.1%; p=0.21). Alpha diversity indices revealed increased microbial heterogeneity in Group B, often characterized by Gardnerella, Atopobium, and Prevotella species. Conclusion: A Lactobacillus-dominant vaginal microbiota is positively associated with higher implantation and pregnancy rates in women with unexplained infertility undergoing IVF. Vaginal microbial profiling may serve as a non-invasive prognostic tool for IVF success and guide potential microbiome-modulating interventions.

Introduction: 15 - 20% of upper limb arterial injuries involve trauma to the axillary artery. 94% are due to penetrating wounds and 6% are caused by blunt traumas. This report presents three cases of traumatic axillary artery injury. Materials and Methods:  This study includes surgical outcomes of three patients with traumatic axillary artery injury who presented to a tertiary care center between June 2024 and June 2025. Results: All three patients sustained penetrating injuries, with no detectable brachial or radial pulse in the affected limb. CT angiography identified trauma to the second part of the axillary artery in two patients and to the third part in one patient. Each patient had a concurrent brachial plexus injury, and one patient also had an associated bone injury. Vascular repair was performed using a reverse saphenous vein graft in two patients, while one patient underwent axillary artery embolectomy. Associated injuries were managed alongside the arterial repairs. All patients achieved favorable postoperative vascular outcomes. Conclusion:  Trauma to the periclavicular region should be thoroughly evaluated for potential axillary artery injury. Timely surgical exploration and skilled arterial repair result in favorable postoperative outcomes.

Background: Sleep is a fundamental physiological necessity, crucial for maintaining physical, emotional, and cognitive health. Despite its vital role, sleep health remains an underexplored public health concern in India. With Punjab undergoing rapid socio-economic and lifestyle transitions, understanding the prevalence and determinants of poor sleep quality among its general population is imperative. Materials and Methods: A descriptive, community-based cross-sectional study was conducted from March to May 2025 among 400 adults (aged ≥18 years) residing in both urban and rural regions of Punjab. Data were collected via an online questionnaire, which included socio-demographic variables, lifestyle factors, and the Pittsburgh Sleep Quality Index (PSQI)—a validated tool assessing sleep quality over the past month. A global PSQI score >5 was used to classify poor sleep. Descriptive statistics and Chi-square tests were performed using SPSS Version 26, with a p-value <0.05 considered statistically significant. Results: Of the 400 participants, 66.5% were found to have poor sleep quality. Component-wise analysis showed the highest proportion of poor scores in sleep disturbances (47.0%), habitual sleep efficiency (44.5%), and sleep latency (41.5%). Significant associations were found between sleep quality and age (p = 0.002), education level (p = 0.021), and residence (p = 0.047). Poor sleep was most prevalent among older adults (81.6% in those aged ≥46 years), those with lower educational attainment, and rural residents. Gender and occupation showed no statistically significant association with sleep quality. Conclusion: Poor sleep quality is alarmingly prevalent in Punjab and is significantly influenced by key socio-demographic factors, particularly age, education, and place of residence. These findings underscore the urgent need for public health initiatives that incorporate sleep hygiene education and targeted interventions, especially for high-risk groups such as rural populations and older adults.

Background: Lower limb amputation is life-changing surgery. Shorter residual limbs are known to impose great physiological and psychological strain on patients. The study aimed to assess and compare outcomes across different levels of below-knee amputations. Materials and methods: This prospective observational study was carried out in the Department of General Surgery for a period of 15 months. Study included all patients admitted for lower limb amputations below the knee joint during the study period. Patient’s demographic data, etiology and type of amputation were noted, along with intraoperative and post-operative complications. Data thus collected was subjected to statistical analysis. Results: The mean age of patients was 55.65 years, with a nearly equal gender distribution. The most common cause of amputation was diabetes mellitus (51.02%), followed by vascular disease (24%), and toe amputations were the most frequent, representing 46% (21 cases) of the procedures. Immediate postoperative issues included pain (46.67%), surgical site infections (40%), phantom limb phenomenon (8.89%), and flap blackening (8.89%). Late complications such as wound contracture (6.67%), ill-fitting prosthesis (4.44%) were also reported. Revision surgery was performed in 22.22% of cases most of which occurred in diabetic etiology group. Conclusion: This study found diabetes mellitus to be the leading cause of lower limb amputations, with diabetic patients experiencing higher rates of pain, infections, revision surgeries, and longer hospital stays.

Background: Globally, surgical site infections are the most reported healthcare-associated infection and a common surgical complication. In developing countries such as India, there is a paucity of published reports on the microbiologic profile and resistance patterns of isolates. Objective: This study aimed to assess the bacterial profile and antimicrobial susceptibility patterns of isolates among patients diagnosed with surgical site infection at a tertiary teaching hospital in Northeast India. Methods: A hospital-based study was employed among adult patients who underwent either elective or emergency surgical procedures. All the eligible patients were followed for 30 days for the occurrence of surgical site infection (SSI). From those who developed SSI, infected wound specimens were collected and studied bacteriologically. Results: Of 251 study participants, 122 (48.6%) were females. The mean ± SD age of the patients was 38 ± 16.30 years. The overall postoperative surgical site infection was observed in 118 patients, and of these, 73.7% (87/118) were culture positive. On Gram stain analysis, 71.1% of them were Gram-negative, 25.3% were Gram-positive, and 3.6% were a mixture of two microbial growths. Escherichia coli accounted for 34.48% followed by Staphylococcus aureus (20.69%), Klebsiella pneumoniae (19.54%), Proteus mirabilis (4.59%), Acinetobacter spp (4.59%), Citrobacter spp (4.59%), Pseudomonas aeruginosa (3.44%), Enterococcus faecium (2.29%), Klebsiella oxytoca (2.29%), and Proteus vulgaris (1.15%) Conclusion: Gram-negative bacteria were the most dominant isolates from surgical sites in the study area. Among the Gram-negative bacilli, Escherichia coli was the most common bacterium causing surgical site infections. Given the high antibiotic resistance observed in the current study, it is necessary to conduct routine microbial analysis of samples and their antibiogram.

Background: General anaesthesia (GA) with endotracheal intubation is the mainstay of anaesthesia for elective coronary bypass surgeries. The study was aimed to compare a new indigenous TAS (The anaesthesia society) scope with conventional Macintosh laryngoscope in Cormack Lehane grading (CLG) of larynx and ease of intubation along with hemodynamic response. Materials and Methods 120 patients undergoing coronary artery bypass surgery with GA were randomized into two groups and named after A device which was used for both laryngoscope and intubation. In Group TAS, patients were intubated with TAS Scope after initial laryngoscopy with Macintosh. In Group MAC, Intubated with Macintosh after initial laryngoscope /CLG with TAS scope. CLG, Time to intubate, number of attempts, hemodynamic parameters were noted. Results: Patients having Cormack Lehane grading of gr 3 and 4 (11.6%) in MAC group changed gr 1 and 2 when laryngoscopy was performed with TAS scope and none had gr 3 and 4 when TAS scope was performed. Mean time to intubate were 23.73 ±3.48 and 12.50 ±2.50 (p=0.006) seconds in TAS and MAC groups respectively. Conclusion: Indigenous TAS can be used to get better visualization of larynx with improved Cormack Lehane gradings with acceptable hemodynamic changes.

Background: Proximal humerus fractures represent a significant proportion of upper limb injuries, especially among the elderly. PHILOS (Proximal Humerus Internal Locking System) plate fixation has become a popular surgical option. Smoking is known to negatively affect bone healing, but its specific impact on functional and radiological outcomes following PHILOS fixation remains underexplored. Objective: To evaluate whether smoking influences the functional and radiological outcomes following PHILOS plate fixation in patients with Neer’s Type 2 and Type 3 proximal humerus fractures. Methods: This prospective study included 22 patients (15 males, 7 females) aged 30–70 years with Neer’s Type 2 and 3 proximal humerus fractures treated with PHILOS plating via deltopectoral or deltoid split approaches. Patients were categorized into smokers (n=14) and non-smokers (n=8). Functional outcomes were measured using the Constant-Murley score at 3, 12, and 24 weeks. Radiological assessments included head-shaft angle, tuberosity positioning, and signs of callus formation. Statistical significance was assessed using independent t-tests and Chi-square tests (p<0.05). Results: At 6 months, the mean Constant score for non-smokers was 81.3 ± 6.7 (good), compared to 71.2 ± 8.5 (fair) for smokers (p = 0.023). Radiological union was achieved in 100% of non-smokers versus 78.6% of smokers by 12 weeks (p = 0.041). Smokers also showed increased rates of complications such as delayed union (21.4%) and implant-related issues (14.3%). Conclusion: Smoking is associated with significantly inferior functional and radiological outcomes following PHILOS plate fixation for proximal humerus fractures. Smoking cessation should be encouraged in preoperative counseling and perioperative care.

Background: Proximal humerus fractures are among the most prevalent upper limb injuries, especially in the elderly population. Locking compression plating using PHILOS (Proximal Humerus Internal Locking System) has gained acceptance due to its biomechanical stability. However, the optimal surgical approach—Deltopectoral (DP) versus Deltoid Split (DS)—remains debated, particularly concerning complication rates and predictive factors influencing outcomes. Materials and Methods: This prospective observational study was conducted at a tertiary care center between February and September 2022. A total of 22 patients (15 males, 7 females) with Neer’s type 2 and type 3 proximal humerus fractures were enrolled and underwent PHILOS plate fixation via either the DP or DS approach (11 patients per group). Preoperative, intraoperative, and postoperative variables including operative time, blood loss, side affected, comorbidities, and complications were recorded. Functional outcomes were assessed at 3 weeks, 3 months, and 6 months using the Constant-Murley Score. Results: A total of 22 patients with proximal humerus fractures were enrolled, equally distributed into two groups based on surgical approach: deltopectoral (DP) and deltoid split (DS). Baseline demographic and clinical variables were comparable between the two groups (p > 0.05). Operative time was similar (DP: 112 ± 23 min vs. DS: 115.8 ± 21.93 min; p = 0.672), while intraoperative blood loss was significantly lower in the DS group (DP: 210 ± 71.96 ml vs. DS: 156.67 ± 57.58 ml; p = 0.049). Radiological union was achieved in all patients, and the complication rate was minimal and comparable. At 6 months, functional outcomes favored the DS group, particularly in Constant shoulder scores (DP: 71.6 ± 13.99 vs. DS: 73.92 ± 15.43; p = 0.04), indicating superior recovery. Conclusion: Both deltopectoral and deltoid split approaches provide satisfactory radiological and functional outcomes in proximal humerus fractures treated with PHILOS plating. While the deltoid split approach may offer slightly lower operative time and fewer complications, the difference is not statistically significant. Surgical approach may be chosen based on surgeon preference and fracture morphology.

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by persistent synovial inflammation, joint destruction, and systemic manifestations. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are commonly used inflammatory markers for assessing disease activity. However, their ability to reflect true joint inflammation remains debated. Magnetic Resonance Imaging (MRI), “with its high sensitivity, enables early detection of synovitis, bone marrow edema, and erosions. This study aimed to evaluate the correlation between inflammatory markers (CRP, ESR) and MRI findings in RA patients. Methods: A prospective observational study was conducted over one year at the Department of Rheumatology and Radiodiagnosis, Gouri Devi Institute of Medical Sciences. Fifty patients diagnosed with RA based on 2010 ACR/EULAR criteria were enrolled; 44 completed the study. CRP and ESR levels were measured at baseline and every three months. MRI of the hand and wrist joints was performed and assessed using the RAMRIS scoring system. Correlation analyses were conducted between inflammatory markers and MRI scores for synovitis, bone marrow edema, and erosions. Results: MRI detected synovitis in 82%, bone marrow edema in 66%, and erosions in 54% of patients. CRP and ESR showed moderate correlations with synovitis (r = 0.52 and r = 0.47, respectively; p < 0.01) and mild correlations with bone marrow edema (r = 0.44 and r = 0.41; p < 0.05). No significant correlation was found between CRP/ESR and erosion scores. MRI revealed active inflammation in several patients with normal CRP and ESR levels. Conclusion: CRP and ESR moderately correlate with MRI-detected synovitis and bone marrow edema but are insufficient as standalone indicators. MRI adds value in detecting subclinical inflammation, supporting a combined clinical, serological, and imaging approach for optimal RA management.

Background: Fistula-in-ano is one of the most common anorectal conditions encountered in adults, with a higher incidence in men than in women. It typically develops due to obstruction of the anal glands, leading to the formation of a secondary abscess that eventually ruptures externally. Magnetic Resonance Imaging (MRI) is a valuable diagnostic tool that plays a crucial role in the preoperative assessment and surgical planning for patients with fistula-in-ano. Aim-To study the efficacy of magnetic resonance imaging and its correlation with per-operative findings, in patients of Fistula-in-Ano.  Materials and Methods- This prospective study was conducted on patients with fistula-in-ano presenting to the Department of Surgery. A total of 50 clinically diagnosed cases were included using a non-random, convenient sampling method. All patients underwent MRI, and the fistulas were graded according to the St. James’s University Hospital MRI-based classification system. The MRI findings were then compared with the preoperative clinical characteristics. Results- Maximum incidence of Fistula-in-Ano was in the age group 31-40 years. MRI finding revealed primary fistulous tracts and internal openings in all our patients and secondary tracts in 32% of the patients with abscess in 10% and horseshoe tracts in 8%. the findings correlated well at surgery to provide an accurate road map in 96 percent (48 out of 50) patients. Conclusion- Fistula-in-Ano is a complex clinical entity. MRI can be helpful in providing a road map at the time of surgery thus help reduce the complications like recurrence and incontinence.

Background: Type 2 diabetes mellitus (T2DM) is associated with various systemic complications, but its impact on pulmonary function remains underexplored. Poor glycemic control may lead to pulmonary dysfunction through mechanisms including protein glycosylation, microangiopathy, and chronic inflammation. Objective: To evaluate the correlation between pulmonary function tests and glycemic control (HbA1c) in patients with type 2 diabetes mellitus. Methods: This cross-sectional study included 143 patients with T2DM aged 30-60 years. Demographic data, anthropometric measurements, and HbA1c levels were recorded. Pulmonary function tests including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, and peak expiratory flow rate (PEFR) were performed using computerized spirometry. Pearson correlation analysis was used to assess the relationship between HbA1c and pulmonary function parameters. Results: The study included 82 males (57.3%) and 61 females (42.7%) with mean age distribution across 30-60 years. Restrictive pulmonary dysfunction was observed in 81 patients (56.6%). HbA1c showed significant negative correlations with FVC % predicted (r=-0.213, p=0.01), FEV1 % predicted (r=-0.202, p=0.02), and PEFR % predicted (r=-0.172, p=0.04). A positive correlation was found between HbA1c and FEV1/FVC ratio (r=0.178, p=0.03). Patients with HbA1c >8% demonstrated lower pulmonary function parameters compared to those with better glycemic control. Conclusion: Poor glycemic control in T2DM patients is significantly associated with reduced pulmonary function, predominantly showing a restrictive pattern. Regular pulmonary function assessment should be considered in diabetic patients, particularly those with poor glycemic control.

Background: Cardiac Autonomic Neuropathy (CAN) is a common form of Diabetic Autonomic Neuropathy (DAN) that causes abnormalities in heart rate control as well as central and peripheral vascular dynamics. CAN is clinically important form of DAN, as it is associated with increased risk of mortality responsible for silent myocardial infarction and sudden death in diabetics. Recognizing CAN early, which is asymptomatic, can be helpful to arrest its progression and adverse outcomes related to it.  Objective: Prospective cross-sectional study of 50 Type II Diabetes Mellitus patients to evaluate the prevalence of CAN and to find the correlation between CAN with duration of diabetes was carried out. Results: Prevalence of CAN in the study was 60 % of which 36 % had definite CAN and 24% had borderline/early CAN. The Prevalence of CAN increased with increased duration of DM. From the patients with duration of DM >10 years, 75 % had definite CAN.Conclusion: As development of CAN is more prevalent in patients with longer duration of DM, early detection can prevent a patient from worst outcomes. With the help of Ewing’s criteria, a physician can diagnose CAN at the earliest. So, identifying early CAN patients who are at risk of developing major neuropathy can direct us to have better outcomes.

Background: Effective postoperative analgesia in cardiac surgery is essential for recovery. Pecto-intercostal fascial block (PIFB) offers an opioid-sparing regional technique. This study compared levobupivacaine and bupivacaine (both with fentanyl) for PIFB in cardiac surgery patients. Methods: In this prospective, randomized, double-blind study, 110 adult patients undergoing elective cardiac surgery via median sternotomy were randomized to receive bilateral ultrasound-guided PIFB using either 0.25% levobupivacaine + fentanyl (n = 56) or 0.25% bupivacaine + fentanyl (n = 54). The block was administered twice: once after induction (preoperative) and again at the end of surgery before shifting patients to ICU. VAS pain scores, fentanyl requirements, extubation time, ICU stay, and complications were recorded. Results: No statistically significant difference was found between the groups in postoperative VAS scores (both ≤ 3 till 16 hrs), total fentanyl consumption (Levobupivacaine: 161.6 ± 21.3 mcg; Bupivacaine: 165.74 ± 27.17 mcg; P = 0.376), extubation time (P = 0.227), or ICU stay (P = 0.479). No block-related complications were observed. Conclusion: Both levobupivacaine and bupivacaine are equally effective and safe when used twice for PIFB during cardiac surgery. The technique provides reliable analgesia and supports fast-tracking without complications.

Background: Maternal diabetes, encompassing both gestational diabetes mellitus (GDM) and pregestational diabetes, significantly elevates the risk of congenital heart disease (CHD) in neonates. The teratogenic effect of maternal hyperglycaemia, particularly during the critical period of foetal organogenesis, is linked with structural cardiac anomalies in infants. Objective: To review the types of congenital heart defects seen in neonates born to diabetic mothers at Kempegowda Institute of Medical Sciences Hospital and Research Centre. Methods: A retrospective observational study was conducted, in which infants born to diabetic mothers from January to December 2023 were included. 56 neonates born to mothers diagnosed with either GDM or pregestational diabetes were enrolled in the study. Echocardiographic details were retrieved from records, variables such as maternal age, type of diabetes in mother and treatment regimen, delivery method, and neonatal factors (sex, birth weight, and gestational age) were collected from records and were analysed using statistical tools including Chi-square and Fisher’s exact test. Results: Among 56 echocardiographically evaluated cases, 47 (83.9%) exhibited congenital heart anomalies. Atrial septal defect (ASD) was the most prevalent (58.9%), followed by patent ductus arteriosus (16%), and ventricular septal defect (3.6%). No statistically significant association was found between CHD occurrence and maternal age, type of diabetes, treatment modality, parity, type of delivery, or gestational age (p > 0.05). Most mothers were aged 20–30 years (78.6%), majority had GDM (83.9%), the rest with pregestational diabetes. Conclusion: The high prevalence of CHD, particularly ASD, among infants of diabetic mothers underscores the importance of prevention and early identification of diabetes in mothers. Stringent glycaemic control and adherence to treatment during pregnancy should be ensured. Given the lack of significant associations with other demographic or clinical variables, routine echocardiographic screening is strongly recommended for all neonates of diabetic mothers, regardless of other risk factors.

Background: Acute pancreatitis is one of the most prevalent diseases detected in individuals presenting with stomach discomfort in the emergency room. Quick, precise, and early evidence-based risk assessment of patients enables the early beginning of intensive care therapy for patients with severe acute pancreatitis (SAP).  Objective: The most commonly used scores for determining the severity of acute pancreatitis are BISAP and Ranson's score.  So, the purpose of this study was to identify the severity and predict severe acute pancreatitis using BISAP and Ranson's scores, and to compare these two scores.  Methodology: This prospective descriptive study was conducted on 60 patients with acute pancreatitis. After taking all the clinical, laboratory, and radiological data, patients were assessed for severity using BISAP score at the time of admission and Ranson’s scores at admission & 48 hrs. In both the scores, ≥3 score was considered as severe acute pancreatitis. Results: As a result, BISAP and Ranson’s scores were statistically significantly associated with patients’ outcomes and ICU stay using Spearman’s correlation test (p≤0.05). Also, it was found that BISAP and Ranson’s scores were good predictors of patients’ outcomes and ICU stay (p≤0.05) whereas they were not good predictors of patients’ hospital stay using logistic regression analysis (p>0.05). On assessing ROC-AUC, it was found that the BISAP score had more accuracy, specificity, and AUC i.e., 90%, 94.23%, and 0.78 respectively in comparison with Ranson’s score which accuracy, specificity, and AUC are 65%, 61.54% and 0.61 respectively. However, Ranson’s score has more sensitivity i.e., 87.5% in comparison with BISAP Score (62.5%). There was statistically significant difference was found between both the scoring systems using the McNemar test (p≤0.05).  Conclusion: Both BISAP and Ranson's scores are good predictors of patient outcomes and ICU stay in acute pancreatitis (AP), with BISAP being more precise and specific. Ranson's score, on the other hand, has a higher sensitivity for severe AP, indicating that both scores should be used together in clinical practice for better decision-making and patient care.

Background: Appendicitis is one of the commonest causes of abdominal pain requiring emergency surgery. Often, it is difficult to reach a proper diagnosis.  Diagnosing acute appendicitis clinically still remains a common surgical problem. Hyperbilirubinemia is a new diagnostic tool for perforation of appendix.  Aims And Objectives: To evaluate the role of pre-operative hyperbilirubinemia in the prediction of complicated appendicitis. To analyze the sensitivity, specificity, positive predictive value and negative predictive value of pre-operative hyperbilirubinemia in acute appendicitis. Material And Methods: This study was performed in 71 patients who were underwent emergency appendectomy.   Patients were admitted with features of acute appendicitis or suspected appendicular perforation in the emergency were included in this study. The criteria for the selection of cases were based on clinical history, physical findings, radiological study, hematological, and biochemical investigations.  Results There were 50 males and 21 females with the male to female ratio being 2.38:1. Majority of the patients in the present study were males (70.4%).. Out of 50 males, 34 had acute appendicitis and 16 had appendicular perforation/gangrene. And out of 21 females, 14 had acute appendicitis and 7 had appendicular perforation/gangrene. In the patients with acute uncomplicated appendicitis, around 82% had normal serum total bilirubin levels pre-operatively whereas only 18% of these patients had hyperbilirubinemia.  Conclusion Serum bilirubin is an important adjunct in diagnosing the presence of gangrenous/perforated appendicitis.  Patients with hyperbilirubinemia and clinical symptoms of appendicitis should be identified as having a higher probability of appendicular perforation than those with normal bilirubin levels

Background: Automobile transportation is crucial for economy of the Indian road transport sector. Bus drivers like other professional drivers, are at higher risk of developing respiratory disorders in our country especially due to poor air quality index, extended hours of work in outdoor air pollution, traffic congestion, improper fuel usage and poor maintenance of the vehicle etc. This makes occupation as a bus driver an everyday struggle for the drivers; cumulatively affecting their general health and wellbeing. Aims and objectives: To compare pulmonary functions & respiratory health among state transport bus drivers and a comparison group. Materials and Methods: A case control study was carried out among 231 bus drivers registered with a randomly selected bus depot in the city and a comparison group was formed with 231 age and gender matched participants working in any other profession other than driving from administrative staff of the medical institution after fulfillment of inclusion and exclusion criteria. Interview sessions were conducted using pre-tested, pre-validated questionnaire, followed by clinical examination (including PFT) for data collection. Chi square test & student’s t test were applied using Epi-Info (V.7.2) and Open-Epi software for statistical analysis. Results & Conclusion: Most prevalent respiratory symptom was recurrent cough and phlegm. FVC & FEV1 were more severely impaired among the drivers when compared to the non-drivers. Restrictive dysfunction was more prominent among drivers

This research contrasts classical pharmacology and network pharmacology based on their unique targeting strategies, disease suitability, mechanisms of action, and technological platforms. Classical pharmacology relies heavily on a single-target, linear mechanism that is suitable for infectious diseases and monogenic diseases but tends to experience high failure rates in clinical trials and more side effects. Conversely, network pharmacology employs a systems-level, multi-target method facilitated by omics, bioinformatics, and network visualization, rendering it more suitable for multifactorial, complex diseases and supporting personalized medicine. Target prediction, pathway analysis, and drug discovery are improved by incorporation of databases like DrugBank, STRING, KEGG, and sophisticated AI models. The conclusions highlight the promise of network pharmacology to enhance therapy efficacy, minimize side effects, and enable precision medicine, with future work aimed at multi-omics integration, machine learning improvements, and validation of network-based hypotheses for clinical translation.

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a progressive hepatic condition characterized by the accumulation of fat, primarily in the form of triglycerides, in more than 5–10% of the liver’s weight. Aim: This study sought to elucidate the correlation between non-alcoholic fatty liver disease and hypothyroid individuals. Methodology: This cross-sectional observational study was conducted at Mahatma Gandhi Medical College & Hospital in Jaipur from March 2023 to August 2024. The study included patients diagnosed with hypothyroidism who presented to the hospital during the study period. Result: This study found a strong association between hypothyroidism and NAFLD, with elevated serum ferritin, TSH, and BMI identified as independent predictors. NAFLD was more prevalent in older, obese, and physically inactive individuals, with a higher occurrence in females (p = 0.007). Significant correlations were observed between ferritin and liver enzymes (ALT, AST). Family history showed no significant link to NAFLD (p = 0.59), suggesting lifestyle factors play a greater role. Conclusion: This study concludes that NAFLD is highly prevalent among hypothyroid patients, with serum ferritin, TSH, and BMI serving as significant predictors. Elevated ferritin levels were strongly associated with liver enzymes, BMI, and insulin resistance, indicating its role in disease progression. Routine screening for thyroid function and ferritin may aid in early detection and management of NAFLD.

Introduction: Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease affecting 0.5–1% of the population. It primarily presents as symmetrical polyarthritis but also involves extra-articular organs, including the kidneys. Renal involvement in RA may result from the disease process itself or from medications like DMARDs and NSAIDs. Microalbuminuria, defined as urinary albumin excretion of 30–300 mg/day, serves as an early, non-invasive marker of glomerular injury and subclinical renal dysfunction. Objectives: This study aimed to assess subclinical renal dysfunction in RA patients through microalbuminuria and correlate it with disease activity parameters such as DAS28, ESR, CRP, RF, anti-CCP antibodies, and tender/swollen joint counts. A comparison with healthy controls was also made to evaluate microalbuminuria's role as a predictive marker. Methods: A hospital-based observational study was conducted from March 2023 to August 2024 in the Department of General Medicine, Mahatma Gandhi Medical College & Hospital. A total of 75 diagnosed RA patients (≥18 years), meeting the 2010 ACR-EULAR criteria, were included along with 75 age- and sex-matched healthy controls. Exclusion criteria included pre-existing renal or cardiovascular conditions, diabetes, UTI, pregnancy, or prolonged immobility. All subjects underwent clinical assessment and laboratory investigations, including urine microalbumin, inflammatory markers, and DAS28 scoring. Data were analyzed using SPSS Version 25. Results: The prevalence of microalbuminuria was significantly higher in RA patients compared to controls. A strong correlation was observed between microalbuminuria and disease activity indicators. Early detection of microalbuminuria may help in identifying RA patients at risk of renal complications, enabling timely intervention and better clinical outcomes.

Introduction: Sepsis is a major global cause of ICU mortality. Scoring systems like APACHEII are widely used for prognostication, but simpler biomarkers like red cell distribution width (RDW) are emerging as potential alternatives. Aim: To evaluate the prognostic value of RDW and compare it with the APACHE IIscore in patients admitted with severe sepsis. Methods: This prospective study included 70 adult ICU patients with severe sepsis admitted between March 2023 and August 2024 at a tertiary care center. Clinical parameters, RDW,and APACHE II scores were recorded on admission. Outcomes were classified as survival or mortality. ROC analysis, logistic regression, and correlation tests were applied. Result: The study found that higher APACHE II scores and RDW values were significantly associated with increased sepsis severity and mortality, particularly in older patients. These findings underscore the prognostic value of both parameters in predicting poor outcomes in sepsis. Conclusion: APACHE II score and RDW are valuable prognostic indicators in sepsis, with higher values correlating with increased mortality. Early recognition and prompt intervention based on these markers can significantly improve patient outcomes.

Introduction: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) significantly impact morbidity, mortality, and healthcare resource utilization. Identifying clinical and biochemical predictors of AECOPD can aid in early intervention and better patient outcomes. Materials and Methods: A prospective observational study was conducted over six months in a tertiary care hospital. A total of 120 patients diagnosed with COPD and admitted with acute exacerbations were included. Clinical variables such as smoking history, comorbidities, prior exacerbation frequency, and baseline oxygen saturation were recorded. Laboratory parameters like C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), Eosinophil count and arterial blood gas (ABG) values were analyzed. Logistic regression was used to determine independent predictors for AECOPD. Results: Among 120 patients (mean age: 66.5 ± 9.3 years), 82 (68.3%) were male and 38 (31.7%) female. History of frequent past exacerbations (≥2/year) was present in 54 patients (45%). Elevated CRP levels (>30 mg/L) were found in 72 patients (60%), high NLR (>3.5) in 64 patients (53.3%), and high eosinophil count (>300 cells/µL) in 84 patients (70%). Multivariate analysis revealed that prior exacerbations (OR: 3.21, 95% CI: 1.78–5.84, p=0.002), CRP >10 mg/L (OR: 2.89, 95% CI: 1.45–4.73, p=0.005), NLR >3.5 (OR: 2.56, 95% CI: 1.39–4.21, p=0.008) and eosinophil count>300 cells/µL (OR: 2.59, 95% CI:1.44-5.27, p=0.002) were significant independent predictors of in-hospital AECOPD. Conclusion: Frequent previous exacerbations, elevated CRP, increased NLR and eosinophil count levels are significant predictors for in-hospital acute exacerbation of COPD. Routine assessment of these markers can guide timely interventions to reduce disease burden and hospital stay.

Introduction: Cardiovascular diseases have emerged as a significant health burden and became leading cause of mortality in developing countries like India. The Global Burden of Disease study and age-standardized estimates in India showed nearly a quarter (24.8%) of all deaths in India is attributable to cardio vascular Disease (CVD) out of which coronary artery disease (CAD) is the leading cause of mortality and morbidity. Aims and Objectives: The aim of this study is to evaluate the clinical and angiographic profile of women presenting with coronary artery disease (CAD) at a tertiary cardiac care center. The objectives include assessing the demographic and socioeconomic characteristics, as well as identifying major risk factors such as hypertension, diabetes, dyslipidaemia, smoking, and family history. Material and Methods: This single-centre prospective study was conducted in the Department of Cardiology at King George Hospital, Visakhapatnam. The study population comprised 707 patients who presented to the department between December 2021 and June 2023 with a diagnosis of coronary artery disease (CAD) and subsequently underwent coronary angiography for further evaluation. Result:In this prospective study of 707 women with CAD, the mean age was 55.4 ± 10.9 years, BMI averaged 25.3 ± 4.9 kg/m², and mean haemoglobin was 10.7 ± 1.1 g/dL. Dyslipidaemia was common, with mean TC 189.4 ± 63.7 mg/dL, TG 124.2 ± 74.9 mg/dL, HDL 40.8 ± 8.3 mg/dL, and LDL 114.1 ± 52.6 mg/dL. Most women were postmenopausal (92.5%), 41.7% had diabetes, and 60.3% had hypertension. Clinically, STEMI was the most common presentation (46.1%), followed by unstable angina (29.8%). Angiography showed obstructive CAD was significantly associated with age >55 years (62.6% vs. 37.4%; p<0.001), BMI <30 (88.8%; p<0.001), diabetes (49.8% vs. 29.2%; p<0.001), hypertension (66.3% vs. 50.9%; p<0.001), and menopause (80.9% vs. 61.4%; p<0.001). Higher rates of moderate and mild anaemia, high TC (56.7% vs. 18.1%), high TG (44.2% vs. 10.8%), high LDL (68.8% vs. 29.2%), and at-risk TC/HDL (48.6% vs. 19.5%) and TG/HDL ratios (43.5% vs. 13.0%) were also significantly associated with obstructive CAD. Tobacco use, family history, and metabolic syndrome showed no significant association. Conclusion: In conclusion, this study demonstrates that in women with coronary artery disease, factors such as older age, higher BMI, diabetes, hypertension, and postmenopausal status were significantly linked to obstructive CAD. Anaemia and adverse lipid profiles—including raised total cholesterol, triglycerides, LDL, and higher TC/HDL and TG/HDL ratios—were also more common among those with obstructive disease. In contrast, tobacco use, family history, and metabolic syndrome showed no significant association. These findings highlight the key influence of age, metabolic, and hematological factors on the severity and angiographic pattern of CAD in women.

Purpose: Acute pancreatitis is a disease with a wide spectrum of severity, complications, and outcome with severe life-threatening complications develop in patients leading to high mortality in severe acute pancreatitis. The rationale of this study is to diagnose the severity of acute pancreatitis in patients at a new teaching hospital in Central India. Methods All those patients with age group 16–80 years from Jan 2024 to December 2024 who were diagnosed with acute pancreatitis and admitted subsequently to ICU were included. Severe pancreatitis was determined as CT severity score above 7 Results: About 41% patients out of total 450 had severe pancreatitis. CRP/albumin ratio >4.35 had a sensitivity of 87% and accuracy of 76% to predict acute severe pancreatitis. Elevated CRP/albumin ratio was also associated with complications like multi-organ failure OR: 2.31 [1.3–4.2], duodenal thickening OR: 2.25 [1.2–4.2], and ascites OR: 2.90 [1.5–5.6]. Although, the severity of this elevation varied with different age groups, such non-invasive and readily available parameters should be relied upon admission to risk stratify the patients suffering from pancreatitis. CRP/albumin ratio has higher sensitivity and negative predictive value to predict severe pancreatitis than CRP alone and hence give additional advantage as a prognostic marker, although Delong's test to compare AUROC was indifferent (P-value: 0.22).

Background: Acute kidney injury (AKI) remains a critical challenge for nephrologists, especially in tropical regions where infectious diseases significantly contribute to its burden. Aim: To evaluate the clinical profile and outcomes of acute kidney injury in patients with tropical acute febrile illness. Methodology: This hospital-based prospective observational study will be conducted over a period of 18 months following approval from the Institutional Ethics Committee (IEC) at Mahatma Gandhi Medical College and Hospital, Jaipur. Result: The study found dengue as the primary cause of AKI with severity-linked positivity, while scrub typhus and enteric fever showed milder AKI associations. Most patients recovered well with conservative management, reflected by low dialysis rates and significant improvement in renal function markers. Conclusion: Early diagnosis and targeted management of tropical febrile illnesses can effectively reduce the severity and dialysis need of AKI, improving patient outcomes in endemic regions.

Background: Helicobacter pylori is a common infection globally, and its association with type 2 diabetes mellitus (T2DM) is still unclear. Objectives: To assess the prevalence and clinical profile of H. pylori infection in T2DM patients and its relationship with glycemic status. Methods: This hospital-based observational study included 150 T2DM patients assessed using the rapid urease test and standard glycemic parameters. Results: H. pylori was detected in 45.3% of patients. No significant correlation was found between infection and FBS, PPBS, or HbA1c. GI symptoms like reflux and diarrhea were less frequent in infected individuals. Conclusion: While H. pylori infection is common in T2DM, its association with glycemic control is not statistically significant. Further studies are needed to clarify this relationship.

Background: Tuberculosis (TB) remains one of the most widespread infectious diseases globally, with approximately 10.6 million cases reported in 2022, as per WHO. Aim: Study of Initial Drug Resistance in Newly Detected Cases of Pulmonary TB by CBNAAT in Tertiary Care Hospital Methodology: This hospital-based observational study was conducted at Mahatma Gandhi Medical College & Hospital, Jaipur, over a period extending from March 2023 to August 2024.Result:In the present study, resistance to rifampicin was found in 10% of cases, INH resistance in 4%, and multidrug-resistant TB (MDR-TB) in 4% of newly diagnosed pulmonary TB patients. These findings highlight the concerning presence of primary drug resistance even among new cases. Conclusion: Early detection of drug resistance using CBNAAT is essential for effective treatment and control of tuberculosis.

Background: Ascites is the most frequent complication seen in patients with decompensated cirrhosis, with approximately half of those with compensated cirrhosis developing ascites over a ten-year span. The accumulation of ascitic fluid significantly increases the risk of infections due to weakened host defense mechanisms, including immune system dysfunction and reduced bactericidal capacity of the ascitic fluid. Aim: To study the diagnostic significance of Ascitic fluid lactate dehydrogenase (LDH) as a diagnostic marker of spontaneous bacterial peritonitis ( SBP). Methodology: This hospital-based prospective observational study will be conducted over a period of 18 months following approval from the Institute Ethics Committee (IEC) at Mahatma Gandhi Medical College & Hospital. Prior to enrolment, written and informed consent will be obtained from all participating patients. Result: In our study, 32.1% of ascitic patients were diagnosed with spontaneous bacterial peritonitis (SBP), with a statistically significant association (p = 0.001). Gram staining showed no pus in all 137 cases, while bacterial cultures were sterile in 61.3% and polymicrobial in 38.7%. Conclusion: Ascitic fluid LDH serves as a useful diagnostic marker for spontaneous bacterial peritonitis (SBP), particularly in cases with polymicrobial growth. Early detection using bedside methods like leukocyte esterase strips can significantly reduce SBP-related morbidity and mortality

Background: Cerebral venous sinus thrombosis (CVST) is a rare neurovascular disorder characterized by thrombosis in cerebral veins or dural sinuses, primarily affecting young individuals and accounting for 0.5% to 1% of all strokes. Aim:  A study of the ―Biomarkers and their correlation with Cerebral venous sinus thrombosis at Tertiary care center. Methodology: This prospective, observational hospital-based study was conducted at the Department of General Medicine, Mahatma Gandhi Medical College and Hospital (MGMC\&H), Jaipur. Result: In our study of CVST patients, 52% had hyperhomocysteinemia linked to vitamin B12 and folic acid deficiencies, with significant associations between elevated homocysteine, altered lipid profiles, nutritional factors, and clinical symptoms, highlighting the complex interplay of metabolic and lifestyle factors in thrombotic risk. Conclusion: Our study highlights the multifactorial causes of CVST, stressing the importance of integrating biochemical, nutritional, and lifestyle assessments for timely prevention and management.

Background: Medication adherence plays a crucial role in achieving optimal glycemic control among patients with Type 2 Diabetes Mellitus (T2DM). This study aimed to assess real-world patterns of medication adherence, treatment regimens, and glycemic outcomes in patients using oral hypoglycemic agents (OHAs). Methods An observational, cross-sectional study was conducted among 100 patients with T2DM who had been on OHAs for a minimum of six months. Data were collected through structured interviews, medical records, and laboratory reports. Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8). Glycemic control was evaluated using recent HbA1c levels. Statistical analysis was performed to assess the association between adherence levels and glycemic outcomes. Results The mean age of participants was 56.4 ± 9.2 years, with 60% males. High, medium, and low adherence were observed in 28%, 46%, and 26% of patients, respectively. Forgetfulness (54%), medication cost (18%), and lack of awareness (14%) were the main reasons for poor adherence. Glycemic control was good (HbA1c <7%) in 32% of patients, moderate in 40%, and poor in 28%. A significant association was found between higher adherence and better glycemic control (p < 0.01). The most common regimen was metformin monotherapy (38%). Adverse effects were reported by 15% of patients, with gastrointestinal issues being most frequent. Lifestyle factors like regular exercise and diet adherence were present in 45% and 52% of patients, respectively. Conclusion Higher medication adherence is significantly associated with improved glycemic control in T2DM patients. Strategies to enhance adherence, such as patient education and routine follow-up, are essential for better treatment outcomes

Background: Acute biliary pancreatitis (ABP) is one of the most common forms of acute pancreatitis, predominantly caused by gallstones obstructing the biliary outflow. Understanding the demographic trends and clinical severity among affected patients is essential for timely intervention and outcome prediction. Aim: To assess the demographic distribution and clinical profile of patients diagnosed with acute biliary pancreatitis. Material and Methods: A hospital-based observational study was conducted on 70 patients diagnosed with ABP over a period of 12 months. Data on age, disease severity (as per the Revised Atlanta Classification), outcomes, and duration of illness before presentation were collected. Laboratory investigations and imaging modalities were used to confirm diagnosis and monitor progress. Statistical significance was set at p<0.05. Results: The majority of patients were in the 40–60-year age group. Mild disease was most common (n=55), while only 6 patients had severe disease. A statistically significant association was found between age and severity (p=0.087) and between severity and outcome (p=0.000). All mortalities occurred in patients aged over 60 with severe disease. Duration of illness did not significantly affect outcome (p=0.712). Conclusion: Middle-aged individuals are most commonly affected by ABP, with increasing age correlating with higher severity and poorer outcomes. Early recognition and severity stratification are essential for optimal patient care.

Background: Heart failure is often complicated by renal dysfunction and lipid abnormalities, conditions that frequently share underlying risk factors such as hypertension, diabetes, and obesity. Heart failure and renal dysfunction are closely interlinked due to their common underlying risk factors like hypertension, diabetes mellitus and age. Dyslipidemia characterized by abnormal levels of cholesterol and triglycerides are prevalent in patients with heart failure due to shared risk factors like obesity, diabetes mellitus, and metabolic syndrome. Objective:  This study aimed to assess the relationship between serum lipid profiles and renal dysfunction in individuals newly diagnosed with heart failure at a tertiary care hospital in Gujarat. Methods:  A total of 168 patients diagnosed with heart failure were enrolled in a cross-sectional study conducted at GMERS Medical College and Hospital, Gotri, Vadodara. Renal function was evaluated using the Cockcroft-Gault equation, while lipid abnormalities were identified based on established clinical criteria. Data analysis was performed using SPSS software, with a p-value of less than 0.05 considered statistically significant. Results:  Among the participants, 47.02% were found to have renal dysfunction, and 51.79% had dyslipidemia. Notably, 72.15% of those with renal impairment also exhibited lipid abnormalities. A statistically significant association was observed between renal dysfunction and dyslipidemia (χ² = 24.77; p < 0.00001). Common comorbid conditions included hypertension and diabetes, and most patients were classified as overweight or obese. Conclusion:  The study findings suggest a strong association between renal dysfunction and dyslipidemia in heart failure patients. Monitoring lipid profiles may play a critical role in identifying patients at greater risk for renal complications, potentially guiding more targeted interventions.

Background– cardiovascular disease (CAD)is one of the leading causes of morbidity and mortality. There is a need to diagnose CAD at subclinical stage so that appropriate lifestyle and pharmacological measures be taken to prevent CAD and its complications. This study was done to find association between CIMT and presence and severity of CAD.  Method -It was a case control study in which120 subjects were enrolled and divided into 2 groups which includes 60 cases and 60 controls respectively. Cases comprise individuals that coronary angiography proven CAD and controls include asymptomatic subjects with normal ECG and echocardiogram or individuals with normal coronary angiography study. Carotid artery intima media thickness was measured in all 120 subjects using carotid artery doppler. Result -The mean age of cases and controls was 62.6 years and 60.05 years respectively. Male to female ratio was not statistically significant (cases1:1 and controls and was 1.6:1). The mean CIMT of right and left carotid artery in cases were1.06±0.26 mm and 1.06±0.28 mm respectively which was significantly higher than mean CIMT of controls which was0.63±0.23 mm and 0.60±0.28 mm on respective sides. Mean CIMT in patients of single, double and triple vessel disease on coronary angiography were1mm, 1.07mm and 1.14mm in right carotid artery and 0.97 mm, 1.04 mm and 1.2mm in left carotid artery respectively which depicts that higher CIMT was associated with increased number of vessels involvement based on coronary angiography. Additionally, CIMT exhibited significant associations with established cardiovascular risk factors including DM, smoking, hypertriglyceridemia, hypercholesterolemia, low HDL levels, and elevated LDL levels.  Conclusion Increase in CIMT is associated with both the presence and severity of coronary artery disease. Therefore, measuring CIMT may be a valuable tool for predicting CAD at an early stage.

Background: Neonatal seizures are most prevalent and recognisable clinical symptom of neurological dysfunction in any newborn baby. Neonatal seizures manifests as abnormal muscular activity or an autonomic change. Neonatal brain is immature and is more prone for seizures. Neonates who have risks factors has increased rate of Neonatal seizures & risks further increases if gestational age at time of birth is also less, whereas preterm with low birth weight & extremely LBW have a greater incidence. Objective: To analyse associated risk factors for development of neonatal seizures in admitted patients in NICU. Methods: Our study was carried out upon patients admitted in NICU at Rohilkhand Medical College and Hospital, Bareilly (U.P.). There was total 50 study participants. Result: Maximum study subjects i.e. 36% had APGAR score of 5 at 5 minutes. Maximum study subjects i.e. 46% had APGAR score of 6 at 10 minutes. There was no statistical association of etiology with type of seizures (p-value = 0.210). There was no statistical association of etiology with day of onset of seizures (p-value = 0.122).There was no statistical association of types of neonatal seizures with gestational age (p-value = 0.409).There was no statistical association of types of neonatal seizures with day of onset of seizures (p-value = 0.416). Conclusion: There was no statistical association of etiology with type of seizures or day of onset of seizures. There was no statistical association of type of seizures with gestational age or day of onset of seizures. (p-value > 0.05)

Background: Beta-thalassemia major (B-TM) is a hereditary hemoglobinopathy requiring lifelong transfusions, predisposing patients to iron overload and metabolic disturbances. Emerging evidence links B-TM to early vascular dysfunction and atherosclerosis, traditionally considered age-related. Altered lipid profiles and atherogenic indices may serve as early cardiovascular risk markers, yet comprehensive studies in pediatric populations remain limited. This study aims to assess lipid abnormalities and cardiovascular risk markers in transfusion-dependent B-TM children, enabling early intervention to mitigate long-term atherosclerotic complications and improve risk stratification in this vulnerable group. Methods: This prospective observational study was conducted at Hassan Institute of Medical Sciences (HIMS), Hassan, over five months (May–September 2023), involving 70 pediatric participants (35 beta-thalassemia major, 35 healthy controls). Eligibility criteria included children aged 2–18 years with transfusion-dependent beta-thalassemia receiving at least eight transfusions annually. Demographic, clinical, and biochemical parameters (CBC, lipid profile, serum ferritin, CRP, liver enzymes, blood glucose) were assessed. Results: Children with transfusion-dependent beta-thalassemia presented with significant hematological abnormalities, including lower hemoglobin (8.06 g/dL vs. 11.37 g/dL, p < 0.001) and severe iron overload (serum ferritin: 2080.70 ng/mL vs. 128.03 ng/mL, p < 0.001). They also show altered lipid metabolism, with higher total cholesterol, LDL, triglycerides, and VLDL, and lower HDL, contributing to increased cardiovascular risk. Atherogenic indices (TG/HDL ratio, Castelli’s Risk Index, AIP) were significantly elevated, indicating a greater propensity for premature cardiovascular complications. Liver dysfunction markers were also raised. These findings underscore the need for regular monitoring, early interventions, and optimized management strategies to mitigate long-term complications in beta-thalassemia patients. Conclusion: Children with transfusion-dependent B-TM major exhibit significant lipid profile abnormalities with higher LDL, triglycerides, and atherogenic indices, and lower HDL, increasing cardiovascular risk. These findings justify the need for regular lipid monitoring and early interventions to mitigate long-term cardiovascular complications in affected children.

Background: Caudal Epidural was initially introduced in 1901 by Cathelin and Sicard. In 1993, Meredith Campbell, a urologist, was the first to report the application of caudal anaesthesia for cystoscopies in pediatric patients. The postoperative pain experienced by children and adolescents is often overlooked, even though it can sometimes result in significant morbidity and mortality.  AIM: To assess the efficacy and extent of postoperative analgesia of paracetamol rectal suppository with caudal bupivacaine, in paediatric subjects undergoing subumbilical surgeries in comparison with caudal bupivacaine alone. Material & Methods: Study Design: A prospective randomized study. Study area: The study was conducted in Department of Anaesthesiology, SVRRGH, Tirupati. Study Period: 1 year. Study population:  This study comprised of pediatric patients undergoing sub umbilical surgeries, aged from 3 to 8 years weighing less than 20 Kg of either gender, ASA-1.    Results: When compared with Group S, the incidence of post-operative nausea and vomiting, as well as an increase in temperature, is significantly higher in Group C. The first postoperative urine voiding time in the study group is 5.41 hours, while the time in the control group is 4.38 hours. This difference is statistically significant (t = 3.434, p 0.05).  Conclusion: We conclude, based on the results of the previously mentioned research, that incorporating a paracetamol suppository with caudal bupivacaine enhances the quality of post-operative pain relief and prolongs its duration more effectively than caudal bupivacaine on its own in pediatric patients undergoing surgeries below the umbilical region, thus meeting the criteria outlined in the study's objectives

Introduction: In recent times Scrub typhus has spread in all parts of India and has emerged as a significant cause of severe febrile illness with a case fatality rate of 30% and above. As Primary care physicians are the first point of contact in cases of febrile illnesses, their knowledge regarding the disease can help in increasing the index of suspicion. Hence the present study aims to assess the knowledge, perceptions and treatment practices on scrub typhus among Primary care physicians. Objectives: To assess the knowledge, perceptions and treatment practices on scrub typhus among Primary care physicians. Methodology: It is a Cross-sectional study conducted in Prakasam District of Andhra Pradesh among the medical officers working in the Primary Health Centres during June-July 2024.Pretested semi-structured questionnaire containing questions on knowledge, perceptions and practices of Scrub typhus disease were distributed among the medical officers on the day of monthly meeting to be filled by them. The data thus collected from them was entered and analyzed using MS Excel. Results: Among the physician’s majority of them are having less than 5 years’ experience. More than 90% had good Knowledge on Scrub typhus whereas coming to practice of identifying and treating cases is only 65%. Practice is significantly associated with place of working majority of them opined that availability of RDT Kits as barrier in early identification of cases. Conclusion: High index of suspicion scrub typhus in a case with febrile illness can reduce the mortality and morbidity to disease. Though having knowledge implementing the knowledge to practice is lacking that too in endemic districts. Placing emphasis on this, trainings of Physicians can be helpful in early identification of disease and treatment.

Prostatic carcinoma is an important growing health problem in India and is at present the most common malignant tumor in elderly males over the age of 65 years. Serum prostate-specific antigen (PSA) screening along with Gleason's microscopic grading aims to detect prostate cancer at an early, intervenable stage and are important for diagnosis, management and prognosis of carcinoma. Material and Methods: Postoperative histopathology specimens were fixed in 10% formalin. 4-to-5-micron thick sections were cut with microtome and stained with haematoxylin and eosin (H&E) stain. Total PSA was estimated by using chemiluminescent immunoassay method. Results: Total 70 cases were prospectively examined for various prostatic pathologies.Among 70 cases selected, 23(32.85%) cases were benign prostatic hyperplasia, 8(11.42%) cases were benign prostatic hyperplasia with chronic prostatitis, 1(1.42%) case of prostatic intraepithelial neoplasm & 38(54.28%) cases were of prostate adenocarcinoma. Gleason score was analyzed in the grade groups of patients with prostatic adenocarcinoma with respect to increased tPSA. Conclusion: The commonest pathology encountered was of adenocarcinoma of prostate. Common age group of prostatic lesions including benign as well as malignant was 61-70 years with commonest symptoms of frequency, urgency and acute retention of urine. Serum PSA was significantly raised in all malignant lesions

Background: Pulmonary hypertension (PH) is a significant complication in chronic obstructive pulmonary disease (COPD), contributing to increased morbidity and mortality. Limited data exist on PH phenotypes in Indian COPD populations. Objective: To estimate the prevalence of PH phenotypes in COPD patients and evaluate their clinical profiles. Methods: This cross-sectional study, conducted at a tertiary hospital in Dharwad, India, enrolled 336 COPD patients diagnosed per Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Assessments included spirometry, echocardiography, arterial blood gas (ABG) analysis, chest X-rays, and BODE index evaluation. PH was defined as mean pulmonary artery pressure (mPAP) >20 mmHg via echocardiography. Patients were classified into no PH, mild PH (mPAP 21–30 mmHg), moderate PH (mPAP 31–40 mmHg), and severe PH (mPAP >40 mmHg). Statistical analyses included descriptive statistics, ANOVA, and chi-square tests. Results: PH prevalence was 19.35% (65/336 patients), with mild PH in 11.90% (40/336), moderate PH in 3.87% (13/336), and severe PH in 3.57% (12/336). No significant associations were found between PH prevalence and age, gender, or body mass index (BMI) (p>0.05). Small airway dysfunction (forced expiratory flow 25–75% [FEF25– 75] <50% predicted) was significantly associated with PH (p=0.02). PH patients had lower forced expiratory volume in 1 second (FEV1) (mean 42.3% vs. 58.7% predicted, p<0.001) and higher partial pressure of carbon dioxide (PCO2) (mean 48.2 vs. 41.5 mmHg, p=0.01). Conclusion: PH affects nearly one in five COPD patients, with small airway dysfunction as a key predictor. Routine PH screening is recommended for COPD management.

Introduction and Background: Epilepsy is a prevalent neurological disorder characterized by recurrent unprovoked seizures, with a significant burden in low- and middle-income countries like India. Neuroimaging, particularly Magnetic Resonance Imaging (MRI), plays a pivotal role in identifying structural causes of epilepsy. The advent of 3 Tesla (3T) MRI has markedly improved lesion detectability due to its superior spatial resolution, aiding in accurate diagnosis and treatment planning. Despite its benefits, there is paucity regarding data on the application of 3T MRI and its utility in evaluation of epilepsy in semi-urban region of western Uttar Pradesh. Aim & Objective: To assess the diagnostic utility of 3T MRI in detecting epileptogenic lesions among patients within a tertiary care teaching hospital in the western Uttar Pradesh. Results: Among 75 patients studied, 56% showed abnormal MRI findings. Granulomatous lesions (Neurocysticercosis & Tuberculomas) (13.3%) were the most common, followed by mesial temporal sclerosis (10.7%) and focal cortical dysplasia (9.3%). Generalized tonic-clonic seizures were the most common seizure type (48%), though partial seizures had a higher rate of MRI abnormalities. A moderate correlation was observed between EEG and MRI findings. Conclusion: 3 Tesla MRI significantly enhances detection of structural abnormalities in epilepsy, especially in patients with partial seizures. Its integration with EEG improves diagnostic accuracy. Routine use of 3T MRI in epilepsy evaluation is recommended for better clinical outcomes, particularly in resource-constrained regions.

Background: Aims And Objective: - To study the patterns of Pulmonary function abnormalities using spirometry and DLCO in Rheumatoid arthritis patient and to correlate spirometry abnormalities with rheumatoid arthritis disease activity. Type Of Study: -A Teritary Hospital based single center cross sectional study. Materials And Methods: - A total of 117 RA patients diagnosed as per ACR/EULAR 2010 criteria were included and spirometry and DLCO were performed. Disease activity was assessed using the DAS28- CRP score. Statistical analyses were performed using descriptive statistics, pearson’s correlation. Results: -Among 117 patients (mean age 46.73 ± 13.28 years; 84.62% female), spirometry abnormalities were detected in 27 (23.07%) patients, with restrictive patterns being most common (16.24%), followed by mixed (4.27%) and obstructive (2.56%) patterns. DLCO was reduced in 23 patients (17.94%), with varying degrees of severity. A negative correlation was observed between disease activity (DAS28-CRP) and both DLCO (r = -0.26) and FVC (r = -0.22), though not statistically significant. Respiratory symptoms such as cough and breathlessness were more common in patients with abnormal spirometry. Conclusion: - Routine use of spirometry and DLCO in symptomatic RA patients, or those with high disease activity, may facilitate early detection and management of pulmonary involvement.

Background: Electrolyte imbalance is a common and critical complication in patients with end-stage renal disease (ESRD), particularly concerning sodium and potassium levels. Hemodialysis serves to correct these imbalances and improve clinical outcomes. Aim and Objective: To assess the pre- and post-hemodialysis levels of sodium and potassium among ESRD patients and analyze additional biochemical parameters including urea, creatinine, calcium, and phosphorus in a tertiary care setting. Material and Methods: This was a Cross-sectional study carried out in the Department of Biochemistry for a period of 24 months.  A total of 101 ESRD patients undergoing routine hemodialysis were enrolled. Pre- and post-dialysis sodium and potassium levels were recorded. Associated parameters such as urea, creatinine, calcium, and phosphorus were analyzed. Statistical analysis was done using SPSS version 26.0, employing t-tests and chi-square tests. Results: In the present study it was observed that significant decrease in potassium levels post-dialysis was observed (mean pre: 5.58±0.66 vs. post: 4.23±0.63, p < 0.001), while sodium levels showed a non-significant change (mean pre: 145.67±7.68 vs. post: 144.98±6.48, p = 0.140). Significant alterations were also found in serum urea, creatinine, calcium, and phosphorus. Conclusion: Hemodialysis significantly reduces hyperkalemia in ESRD patients but does not produce a statistically significant change in sodium levels. Continued biochemical monitoring is essential to mitigate complications and optimize treatment.

Background: Laparoscopic cholecystectomy (Lap Chole) has become the gold standard for treating symptomatic gallstone disease due to its minimal invasiveness and quicker recovery. However, patient outcomes may vary across different age groups due to physiological differences, comorbidities, and healing capacities. This study aims to assess postoperative outcomes and recovery patterns in patients of various age groups undergoing Lap Chole. Materials and Methods: A prospective observational study was conducted at a tertiary care center. A total of 150 patients undergoing elective Lap Chole were categorized into three age groups: Group A (18–39 years), Group B (40–59 years), and Group C (≥60 years). Parameters assessed included operative time, postoperative pain (VAS score), duration of hospital stay, incidence of complications, and time to return to normal activities. Statistical analysis was performed using ANOVA and Chi-square tests with p < 0.05 considered significant. Results: Group A (n=50) had a mean operative time of 48.2 ± 6.1 minutes, Group B (n=50) 51.4 ± 5.3 minutes, and Group C (n=50) 56.8 ± 7.4 minutes (p=0.01). Postoperative pain scores were lowest in Group A (3.1 ± 0.6) and highest in Group C (4.8 ± 0.7; p=0.02). Mean hospital stay was 1.8 ± 0.4 days for Group A, 2.4 ± 0.5 days for Group B, and 3.2 ± 0.6 days for Group C (p<0.001). Postoperative complications were observed in 4%, 10%, and 16% of patients in Groups A, B, and C respectively (p=0.04). Return to daily activity was fastest in Group A (6.2 ± 1.1 days) and slowest in Group C (9.7 ± 1.3 days; p<0.001). Conclusion: Age significantly influences recovery and postoperative outcomes after laparoscopic cholecystectomy. Younger patients experience shorter recovery periods, lower complication rates, and reduced postoperative discomfort compared to older individuals. These findings emphasize the importance of age-specific preoperative evaluation and postoperative care strategies.

Background: Effective management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) necessitates accurate evaluation of respiratory status. While arterial blood gas (ABG) is the gold standard, its invasive nature limits its frequent use. This study investigates the correlation of venous blood gas (VBG) parameters and pulse oximetry (SpO₂) with ABG in AECOPD patients, aiming to identify less invasive alternatives. Methods: This prospective study included 119 AECOPD patients admitted to Department of Medicine, Shyam Shah Medical College associated Sanjay Gandhi Memorial Hospital, Rewa. Simultaneous ABG and VBG samples were collected, and SpO₂ was recorded. Key parameters compared included pH, partial pressure of carbon dioxide (PCO₂), bicarbonate (HCO₃⁻), and oxygen saturation (SaO₂). Correlation analysis using Pearson’s coefficient and agreement analysis through Bland-Altman plots were performed. Results: Strong correlations were observed between VBG and ABG for pH (r = 0.88, p < 0.001), PCO₂ (r = 0.79, p < 0.001), PO₂ (r = 0.64, p < 0.001), and HCO₃⁻ (r = 0.90, p < 0.001). SaO₂ from ABG moderately correlated with SpO₂ (r = 0.92, p < 0.002), with a mean bias of ±1.73%. SpO₂ showed a sensitivity of 88% and specificity of 85% in detecting hypoxemia (SaO₂ < 80%). Bland-Altman plots demonstrated acceptable limits of agreement for all comparisons, with minimal clinically significant biases. Conclusion: VBG provides a reliable and minimally invasive alternative to ABG for assessing pH, PCO₂, and HCO₃⁻ in AECOPD patients. SpO₂ moderately correlates with SaO₂ but may be less reliable for precise hypoxemia detection. Incorporating VBG and SpO₂ into clinical practice can reduce the dependency on ABG, enhancing patient comfort while maintaining diagnostic accuracy.

Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) is closely linked to metabolic dysregulation, particularly dyslipidemia. Around 50–80% of NAFLD patient’s exhibit lipid abnormalities such as elevated triglycerides (TG), increased low-density lipoprotein cholesterol (LDL-C), and decreased high-density lipoprotein cholesterol (HDL-C). Insulin resistance in NAFLD promotes lipolysis, increasing free fatty acids (FFAs) delivered to the liver, leading to triglyceride accumulation and hepatic steatosis. Enhanced hepatic de novo lipogenesis further contributes to fat buildup. This imbalance results in atherogenic dyslipidemia, increasing cardiovascular risk the leading cause of death in NAFLD patients. Lipid abnormalities also correlate with disease severity, including progression to NASH and cirrhosis. Material and method: The present study was carried out in the Department of Biochemistry at Index medical college hospital and research centre in Indore, Madhya Pradesh. A total of 246 subjects were selected for study. Out of 125 were having normal echotexture of liver and121 were having NAFLD. Informed consent was taken from all the participants included in the study.  Result: The prevalence of NAFLD in this study was approximately 50%. NAFLD was most prevalent in the age group of 31-60 years (56%), among females (57%), and among overweight individuals (55%). Patients diagnosed with NAFLD underwent a Fibro Scan for disease staging. About 56% of patients were at Stage I (Grade I) fatty liver, 40% were at Stage II (Grade II) fatty liver disease, and 4% were at Stage III (Grade III) fatty liver disease. Similarly, we estimated the lipid profile and performed a chi-square test to find the association between NAFLD and lipid profile, which also showed a significant association with a p-value of <0.0001. Conclusion: Present study concludes that abnormal lipid metabolism results in fat accumulation in the liver, which in turn increases the production of various adipokines, inflammation, and oxidative stress, all of which play an important role in the NAFLD pathogenesis. Most of the patients of NAFLD in India is asymptomatic, non-diabetic and non-hypertensive. Ultrasonography which is non-invasive, simple tool can be used for early detection of NAFLD in asymptomatic patients.

Background: Idiopathic left fascicular ventricular tachycardia (ILFVT) is an uncommon, verapamil-sensitive arrhythmia that typically occurs in structurally normal hearts. Its presentation during pregnancy is rare, and management becomes more complex when accompanied by underlying congenital valvular abnormalities such as bicuspid aortic valve (BAV), aortic regurgitation (AR), and mitral valve prolapse (MVP). Prompt recognition and individualized multidisciplinary care are critical to ensure optimal maternal and fetal outcomes. Case Summary: We present the case of a 26-year-old primigravida at 32 weeks gestation who presented with palpitations and dizziness. Electrocardiogram revealed regular monomorphic ventricular tachycardia with right bundle branch block morphology and right axis deviation, consistent with ILFVT. Echocardiography incidentally revealed a bicuspid aortic valve with moderate aortic regurgitation and mitral valve prolapse. Initial pharmacological therapy with verapamil, amiodarone, and beta-blockers was ineffective; however, transcutaneous pacing successfully terminated the arrhythmia, followed by a positive response to oral verapamil. The patient was managed medically throughout pregnancy, with continuous fetal monitoring and serial echocardiography. At 38 weeks, she underwent elective cesarean section. Postpartum electrophysiological study confirmed reentrant ILFVT localized to the left posterior fascicle. Successful radiofrequency ablation was performed using CARTO 3D mapping with irrigated-tip catheter technology. She remained arrhythmia-free during a subsequent pregnancy and at three-year follow-up. Conclusion: This case highlights the rare occurrence of ILFVT in pregnancy complicated by valvular abnormalities. Transcutaneous pacing and verapamil can be effective in acute management. Definitive ablation postpartum offers excellent long-term outcomes. Early recognition, multidisciplinary coordination, and timing of intervention are key to successful management in such complex scenarios.

Background: Free radicals are involved in many physiological functions of chondrocytes, such as intracellular signaling, apoptosis, cytokine production and extracellular matrix remodeling. However, increased oxidative stress due to the imbalance of antioxidants and oxidants can be harmful to the chondrocytes. Aims: To evaluate the efficacy of Vitamin E, an antioxidant, as a therapeutic agent in reducing pain severity and improving clinical outcomes in patients experiencing pain. Materials & Methods: The present study was Randomized Controlled Trial study. This Study was conducted from Jan 2024 to Dec 2024 for one year at Department of Orthopaedics of Calcutta National Medical College and Hospital. Total 100 chronic pain patients were included in this study. Result: Post-intervention clinical scores were significantly higher in Group B (Vitamin E) (33.52 ± 16.96) compared to Group A (Placebo) (25.31 ± 14.33), with a p-value of <0.01.Post-intervention functional scores were significantly higher in Group B (Vitamin E) (51.61 ± 19.60) compared to Group A (Placebo) (41.43 ± 16.11), with a p-value of 0.02. Conclusion: This study highlights the potential therapeutic role of Vitamin E, a powerful antioxidant, in managing chronic pain. Supplementation with Vitamin E significantly reduced pain severity, decreased the number of painful days and analgesic use, and improved clinical and functional outcomes.

Background: Diabetes mellitus, a major public health concern, is closely linked to chronic kidney disease (CKD), traditionally assessed through albuminuria. However, emerging evidence highlights the presence of renal impairment even in normoalbuminuric patients. This cross-sectional observational study, conducted at a tertiary care hospital in South India, evaluated glomerular filtration rate (GFR) using the MDRD formula in 185 normoalbuminuric diabetic patients (25 with Type 1 and 160 with Type 2 diabetes). A striking 79.5% of participants exhibited reduced GFR despite the absence of albuminuria—60% in the Type 1 group and 82.5% in the Type 2 group. The study revealed that early renal dysfunction is common among diabetics without proteinuria, particularly in newly diagnosed Type 2 diabetics, many of whom also presented with cardiovascular and microvascular complications. These findings challenge the classical reliance on albuminuria as a sole marker for diabetic kidney disease and underscore the clinical relevance of non-albuminuric diabetic kidney disease (NA-DKD). The integration of GFR estimation into routine diabetes care is strongly recommended for timely detection and intervention. While the study was limited by its single-center, cross-sectional design and reliance on the MDRD formula, it contributes valuable insight into the early detection of renal compromise in the diabetic population.

Background: Guillain Barré Syndrome (GBS) is an acute immune mediated polyneuropathy¹, with diverse clinical manifestations. While classical GBS presents with ascending weakness, areflexia, and sensory disturbances², atypical variants demonstrate varied patterns, including pure motor involvement, bulbar dysfunction, recurrent episodes, and treatment related fluctuations³. These atypical presentations pose diagnostic and therapeutic challenges. This case series presents six patients with atypical GBS, highlighting the importance of early recognition, appropriate diagnostic testing, and individualized management approaches.

Background: Hemophilia and other rare inherited bleeding disorders (IBDs) pose significant management challenges in resource-limited settings, with limited regional data on acute bleeding events. Methods: This retrospective observational study analyzed 214 acute bleeding events in patients with hemophilia A, hemophilia B, or other rare inherited bleeding disorders at a tertiary care center in Kerala, India, from May 2023 to April 2025. Data were extracted from the institutional hemophilia registry, focusing on bleed types, management settings, inpatient duration, regional distribution, and clotting factor usage. Descriptive statistics were used for analysis. Results: Hemophilia A accounted for 76% of cases, with joint bleeds predominant (64%). Outpatient management was feasible for 66.8% of events, while internal/mucosal bleeds required inpatient care in 85% of cases (p=0.036). Median inpatient stay was 4.5 days, with significantly higher factor concentrate usage in inpatient settings (13,150 vs. 1,086 units, p<0.001). Most cases (65%) originated from Kottayam district, and 47% of bleeds occurred during the monsoon season. Conclusion: Outpatient management is effective for most bleeding events, but resource-intensive inpatient care is needed for complex cases. These findings highlight the need for decentralized care and comprehensive treatment centers in resource-limited settings.

Introduction: Peripheral Vascular Disease (PVD), predominantly due to atherosclerosis, poses a significant risk for limb loss and cardiovascular morbidity. Clinical staging using the Rutherford Classification and physiological assessment via arterial Doppler ultrasonography are both commonly employed, yet their comparative prognostic efficacy remains under-evaluated. Methods: A prospective observational study was conducted on 75 patients diagnosed with PVD at a tertiary care center. Each patient underwent clinical staging using Rutherford classification and arterial Doppler evaluation including Ankle-Brachial Index (ABI) and waveform analysis. Concordance between clinical and Doppler findings, and their association with disease progression and need for intervention, was assessed. Results: The majority of patients were male (76%) with a mean age of 50.67 years. Common symptoms included claudication (49.33%) and rest pain (33.33%). Major risk factors identified were smoking (60%), hypertension (53.33%), and diabetes (40%). Rutherford Stages 1 and 2 were most common (22.67% and 25.33%, respectively). Doppler detected arterial stenosis/occlusion in 36% of patients. A strong positive correlation was observed between increasing Rutherford stages and Doppler-confirmed stenosis (p < 0.05), with 100% Doppler positivity in Stage 6. Doppler sensitivity and specificity were 75% and 82.35%, respectively, with a high negative predictive value (87.5%). Conclusion: The Rutherford classification effectively reflects clinical severity, while arterial Doppler provides objective evidence of vascular compromise. Both tools complement each other—Rutherford aids clinical stratification, and Doppler offers anatomical and physiological confirmation. Their combined use enhances prognostication and guides tailored interventions in PVD management.

Background: Hypertensive crisis is a preventable complication of uncontrolled hypertension which carries significant mortality and morbidity. Management of hypertensive crisis should be tailored to the individual patient based on the initial elevated blood pressure and also the presence or absence of end-organ damage or the imminent threat of damage. The choice for the appropriate medication(s) depends on the clinical picture and the associated co-morbidities. It would be desirable to collect further data to augment information / evidence-based recommendations regarding the therapeutic aspects of drugs used in these conditions. This study was therefore taken up to study the pattern of drug(s) used and to assess the effectiveness of the drug(s) used in hypertensive crisis in the South Indian population. Objectives To study the pattern of drug(s) used in hypertensive crisis. To assess the effectiveness of the drug(s) used. Methods A total number of 100 subjects with hypertensive crisis were taken-up and subjected to a thorough physical examination. Relevant laboratory investigations were undertaken for the management of hypertensive crisis. The drug therapy received by the study subjects was recorded. The treatment response to the prescribed medications was assessed at specific intervals. Results Drugs of various therapeutic classes were used in management of hypertensive crisis based on the clinical presentation, either as monotherapy or as combination therapy. Drugs such as labetolol, nitroglycerin and furosemide were administered by parenteral route and amlodipine, cilnidipine, clonidine, metoprolol by oral route in subjects with hypertensive crisis. The response to drug therapy was good in majority of the subjects. Conclusion The therapeutic objectives in the management of hypertensive crisis can be achieved by judicious selection of appropriate drugs in optimized doses individualized to the patient needs.

Background: The dietary habits and nutritional status of healthcare students are critical for their academic performance, clinical efficiency, and overall health. As future health role models, their nutrition-related behaviors are of particular importance. Objectives: This study assesses the dietary habits and nutritional status of medical and paramedical students using anthropometric and dietary intake data, and identifies associated sociodemographic and lifestyle factors. Methods: A cross-sectional study was conducted among 300 undergraduate students (150 medical, 150 paramedical) at a health sciences university in Tamilnadu, India, from July 2023 to June 2024. Data on sociodemographic characteristics, dietary habits (via food frequency questionnaire and 24-hour dietary recall), and anthropometric measurements (Body Mass Index [BMI] and Waist-Hip Ratio [WHR]) were collected using a validated questionnaire. Hemoglobin levels were measured to assess anemia. Statistical analysis was performed using SPSS v24, with Chi-square tests and logistic regression (p ≤ 0.05 considered significant). Results: Of the participants, 68% consumed breakfast daily, but only 25% met the WHO recommendation for fruit and vegetable intake. Fast-food consumption (    ≥2 times/week) was reported by 42%, and 35% skipped meals due to time or academic stress. BMI distribution showed 12.3% underweight, 58.7% normal, 18.3% overweight, and 10.7% obese. Anemia was prevalent in 28.6% of students (34% females, 21% males; p=0.01). Nutritional knowledge was adequate in 62% (mean score 62.4/100), but poor dietary practices persisted. Males had higher odds of irregular meal times (OR=1.5, p=0.046) and fast-food consumption (OR=1.7, p=0.012). Hostel residents were more likely to skip meals (OR=2.1, p=0.003). Conclusion: Suboptimal dietary habits and nutritional status among medical and paramedical students highlight the need for targeted nutrition education and campus-based interventions to foster healthier behaviors in future healthcare professionals.

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice, affecting millions worldwide. Its prevalence increases with age and is frequently associated with comorbid conditions such as hypertension, heart failure, diabetes mellitus, and vascular disease. One of the most serious complications of AF is the increased risk of thromboembolic events, particularly ischemic stroke, which can lead to significant disability or death. Patients with AF are estimated to have a fivefold increased risk of stroke compared to those without the arrhythmia. Method This prospective observational cohort study was conducted at the District Teaching Hospital, Koppal, over a period of 18 months from July 1st, 2023, to December 31st, 2024, with a total sample size of 50 patients. Adult patients aged over 18 years, diagnosed with atrial fibrillation (AF), who were admitted to KIMS, Koppal and provided informed consent, were included in the study. The inclusion criteria comprised patients with AF undergoing cardioversion, with available data on recurrence of AF and CHA₂DS₂-VASc score, while those with atrial arrhythmias other than AF or with hemodynamically unstable conditions were excluded. Results: The study revealed that 56.0% of AF patients were aged 65–74.9 years, with a slight female predominance (56.0%) and prevalent comorbidities including heart failure (60.0%), hypertension (56.0%), and chronic obstructive pulmonary disease (COPD) (36.0%). The CHA₂DS₂-VASc score stratified 82.0% of patients as high risk, 14.0% as moderate risk, and 4.0% as low risk, with a sensitivity of 87.21% (95% CI: 76.23%–88.42%), specificity of 83.32% (95% CI: 74.23%–89.21%), PPV of 87.50% (95% CI: 73.23%–92.03%), NPV of 63.20% (95% CI: 54.12%–80.21%), and diagnostic accuracy of 85.71% (95% CI: 76.32%–94.29%). ROC curve analyses demonstrated good discriminatory power, with AUCs of 0.823 (95% CI: 0.521–0.974; p = 0.002) for mortality, 0.718 (95% CI: 0.613–0.783; p < 0.001) for systemic embolism in females, and 0.737 (95% CI: 0.621–0.797; p < 0.001) in males, with optimal cut-off scores of 4 and 5. Conclusion: This clinical study demonstrates that the CHA₂DS₂-VASc score is a highly effective tool for risk stratification in patients with atrial fibrillation (AF) attending a tertiary care hospital, showing high sensitivity (87.21%) , specificity (83.32%) , and overall diagnostic accuracy of 85.71% in predicting stroke, thromboembolism, and mortality.

Background: Pediatric lower abdominal surgeries often necessitate effective intraoperative and postoperative pain control. Opioid-based analgesia, though effective, is associated with adverse effects. Caudal anesthesia, a regional technique, may offer effective analgesia and reduce the need for systemic opioids. Aim: To evaluate the effect of caudal anesthesia on intraoperative opioid (fentanyl) requirements and hemodynamic parameters in pediatric patients undergoing lower abdominal surgeries. Methods: This prospective study enrolled 60 pediatric patients aged 1–10 years, undergoing elective lower abdominal surgeries. Patients were randomized into two groups: Group 1 received caudal anesthesia using ropivacaine 0.5 ml/kg, while Group 2 received no caudal block. All patients were administered fentanyl at induction and additionally intraoperatively as required. Hemodynamic parameters and total fentanyl consumption were recorded and analyzed. Results: Group 1 showed significantly reduced intraoperative fentanyl requirements compared to Group 2 (mean 0.8 ± 0.3 mcg/kg vs. 2.2 ± 0.4 mcg/kg, p<0.001). Hemodynamic stability was superior in Group 1 with fewer fluctuations in heart rate and blood pressure. Conclusion: Caudal anesthesia with ropivacaine significantly reduces intraoperative opioid consumption and maintains better hemodynamic stability in pediatric patients undergoing lower abdominal surgeries.

Background: Peripheral vascular disease (PVD) significantly contributes to diabetic foot ulcer (DFU) complications. Ankle-Brachial Pressure Index (ABPI) is a widely used screening tool, whereas Duplex ultrasound is a more definitive but costlier modality. Objectives: To evaluate the diagnostic accuracy of ABPI compared to Duplex ultrasound in detecting PVD in patients with DFU. Methods: A prospective study was conducted on 100 DFU patients at Mamata General Hospital between August 2022 and July 2024. ABPI was measured using handheld Doppler, and findings were compared with duplex ultrasonography. Sensitivity, specificity, and predictive values of ABPI were calculated using Color doppler ultrasonography (CDU) as the gold standard. Results: Among 100 patients, 78 had abnormal ABPI (<1.0), and 70 had abnormal Duplex scans. ABPI showed a sensitivity of 97.14%, specificity of 66.67%, positive predictive value of 87.18%, and negative predictive value of 90.91%. The most common arterial involvement was both anterior and posterior tibial arteries. Conclusion: ABPI is a highly sensitive, cost-effective screening tool for PVD in DFU, although its specificity is lower than duplex ultrasound. ABPI can be effectively used in resource-limited settings for early detection of PVD

Background: Airway management is essential in perioperative and emergency care. Endotracheal intubation (ETI) remains a gold standard, whereas supraglottic airway devices (SGAs) offer less invasive alternatives. This study compares the hemodynamic response and efficacy of ETI versus SGA insertion in elective surgeries. Methods: A cross-sectional observational study was performed at Parbhani Medical College over 12 months. Two hundred patients (ASA I–II), aged 18–60 years, scheduled for elective surgeries under general anesthesia, were equally allocated to ETI (Group E, n = 100) or SGA (Group S, n = 100). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded at baseline, pre-insertion, during insertion, immediately post-insertion, and at 1, 3, and 5 minutes post-insertion. Device insertion success rate, time to secure airway, ease of insertion, and complications were documented. Results: Baseline demographics were comparable. During device placement, Group E exhibited significantly higher increases in HR, SBP, DBP, and MAP compared to Group S (p < 0.05). Peak HR rise in Group E was +25 bpm vs. +10 bpm in Group S; peak SBP increase was +35 mmHg vs. +18 mmHg. Group E required longer insertion time (mean 25 ± 5 s) than Group S (15 ± 4 s, p < 0.001). First-attempt success was 95% in Group E and 98% in Group S. Complications (sore throat, minor blood staining) were more common in Group E (15%) than Group S (5%). Conclusions: SGAs offer a favorable hemodynamic profile, quicker placement, and fewer complications compared to ETI in elective surgical patients. SGAs may be preferred in those at risk from hemodynamic fluctuations.

Purpose:  To obtain and compare the information on causes and incidence of sudden natural death due to all causes in all age groups in cases of medico-legal autopsy. METHODS: Present study was done in a retrospective manner the at department of Forensic medicine, Assam medical College & hospital, Dibrugarh, Assam for a period of two years from January 2023 to December 2024. A total of 3623 numbers of post-mortem examinations was done during these periods out of which 205 cases were found to be sudden natural deaths. Results: A total of 205 (5.65%) sudden natural deaths were reported, with 160 (78.04%) being male and 45 (21.95%) being female. The age range of 41–60 years had the highest number of cases of Sudden death, with 103 (50.24%) cases. Cardiovascular diseases accounted for 53.65% of deaths, making them the most prevalent cause, especially among males aged 41 to 60 years. Respiratory disorders, which represented 17.56%, were the second most common cause of death, Neurological conditions, comprising 12.68% of fatalities. Conclusion: The research offers important insights into the trends and reasons behind sudden natural deaths (SNDs), underscoring the urgent necessity for focused preventive healthcare strategies. Cardiovascular diseases were identified as the leading cause, representing 53.65% of the cases, especially in middle-aged men. This underscores the substantial impact of pre-existing medical conditions, lifestyle choices, and a lack of awareness regarding early warning signs

Background: Ovarian cancer is often diagnosed in advanced stages due to the absence of specific symptoms. Yet, there are no reliable screening tests for ovarian malignancies. However, improvements in imaging techniques such as ultrasonography and color Doppler increased the probability of early detection. Aims & Objective: The purpose of this study was to compare between the ultrasonographic and color Doppler findings of ovarian masses with their histopathological diagnosis. Materials and Methods:  A Prospective observational study conducted in an out-patient and in patient department of OBG after obtaining institutional ethical committee clearance from the institute, in Madhubani Medical College, Madhubani,Bihar. The study was done for a period of 1 year. Study Period:  September 2023to August 2024.A pre-designed study pro-forma was filled in relevant investigations and clinical assessments were carried out in all cases.      Results: A total of 76 patients were included in the study with 43 patients in group A and 33 patients in group B. Of the 43 adnexal masses studied in group A, 8 (19.0%) were malignant, 33 (78.6%) were benign and 1 (2.4%) was borderline. Ultrasound had a sensitivity of 89.0%, a specificity of 100.0%, a positive predictive value (PPV) of 100.0%, a negative predictive value (NPV) of 97.0% and accuracy of 97.0%. On the other hand, of the 32 masses examined in Group B, 7 (21.9%) were malignant, 23 (71.9%) were benign and 2 (6.3%) were borderline. Color Doppler had a sensitivity of 55.6%, a specificity of 95.5%, a PPV of 83.0%, a NPV of 84.0% and accuracy of 84.0%. When using color Doppler in addition to morphology score, the sensitivity was 100.0%, specificity 95.5%, PPV 90.0%, NPV 100.0% and accuracy 96.6%. Conclusion:  Ultrasound combined to color Doppler improves the diagnosis of ovarian tumors with accurately detecting malignant from benign ones

Introduction: Sleep-related breathing disorders (SRBDs) are a group of ventilatory disorders during sleep which includes sleep apnea (SA), obstructive sleep apnea (OSA), central sleep apnea (CSA), and sleep related hypoventilation. Present study was aimed to study sleep related breathing disorders (SRBD) in patients of pulmonary arterial hypertension (PAH) in central India. Material and Methods: Present study was single Centre, cross-sectional study., conducted in patients aged more than 18 years, newly diagnosed patients with PAH. Results: Majority of patients were male (60.20%), aged ≥ 40 years (87.76%), and had normal BMI (75.51%). Moreover, patients were predominantly smokers (71.18%). The prevalence of SRBDs in patients with PH was 77.55%. Nocturnal desaturation was present in 83.67% of patients with PH. Based on type, SRBDs was predominantly OSA (81.57%) followed by CSA (13.15%) followed by OHS (5.26%). Types of sleep apnea was not significantly associated with sex (both p- values > 0.05). Mild sleep apnea was significantly associated with normal BMI (p-value = 0.013). However, severe sleep apnea was significantly associated with overweight and obese (p-value < 0.0001). Majority of the patient with PH had mild sleep apnea (60%) fallowed by moderate and severe (40%). Severity of PH was not significantly associated with types of sleep apnea (p-value = 0.690). Both Group II and Group III PH were significantly associated with OSA (both p-values < 0.0001). Significantly greater proportion of patients with mild and severe sleep apnea had low (p-value = 0.009) and high risk (p-value < 0.0001), respectively. Conclusion: The findings suggest high prevalence of SRBDs (77.55%) in patients with PH. These patients should be actively evaluated for SRBDs and simultaneously treated, as presence of SRBDs further increases the severity of PH and raises both morbidity and mortality.

Background: Chronic obstructive pulmonary disease (COPD) poses a significant risk for postoperative respiratory complications, particularly in patients undergoing major surgeries such as spinal procedures. These individuals may experience prolonged dependence on mechanical ventilation, increasing their risk for pulmonary infections and other complications. This study aimed to evaluate the association between COPD severity and the incidence of postoperative respiratory failure in patients undergoing spinal surgery under general anaesthesia. Materials and Methods: This observational study included 67 COPD patients who underwent spinal surgery. Data were retrospectively collected from hospital medical records, including demographic information, spirometry results, arterial blood gas analyses, comorbid conditions, and perioperative variables. The primary outcome assessed was the occurrence of respiratory failure within one-week post-surgery. Results: Patients with mild COPD required longer durations of anaesthesia, while comorbidities were prevalent across all COPD severity levels. Severe COPD patients exhibited prolonged hospital stays, delayed extubation, and higher rates of re-intubation postoperatively. Pulmonary infections were noted in all COPD severity groups. Despite these trends, statistical analysis revealed no significant association between COPD severity and the development of postoperative respiratory failure. Conclusion: The findings suggest that while certain clinical outcomes vary with the severity of COPD, the direct correlation between COPD severity and postoperative respiratory failure remains inconclusive. Further prospective studies with larger cohorts and standardized outcome measures are essential to clarify this relationship and inform clinical decision-making for improved perioperative management in COPD patients.

Introduction: Adrenal metastasis is a common manifestation in patients with carcinoma of the lung. Understanding the laterality (right, left, or bilateral) of adrenal involvement has clinical implications for diagnosis, staging, and management, yet remains underexplored in the Indian context. Aim: To determine the laterality of adrenal metastasis in patients with carcinoma of the lung attending a tertiary cancer center. Materials and Methods: A retrospective observational study was conducted at a tertiary cancer center, including 200 patients with histopathologically confirmed carcinoma lung and radiologically detected adrenal metastasis. Demographic, clinical, imaging, and tumor-related data were collected and analyzed. Laterality patterns were correlated with tumor characteristics, clinical features, and imaging findings using appropriate statistical methods. Results: Among 200 patients, right-sided adrenal metastasis was observed in 44.5%, left-sided in 31.0%, and bilateral in 24.5%. Right lung tumors predominantly metastasized to the right adrenal gland, while central tumors showed a higher rate of bilateral involvement. Bilateral adrenal metastases were associated with larger lesion size, higher PET-CT SUVmax, more frequent distant metastasis, and increased symptomatic presentation. Significant associations were found between laterality and primary tumor location, stage, and imaging features (p < 0.05). Conclusion: Right-sided adrenal metastasis is the most common pattern in lung cancer patients, with laterality influenced by primary tumor location and disease stage. Bilateral adrenal metastases signify more aggressive disease. These findings emphasize the importance of detailed imaging evaluation and individualized management strategies in patients with lung cancer and suspected adrenal involvement.

Introduction: Thyroid dysfunction is a common endocrine disorder that can significantly affect the management of type 2 diabetes mellitus (T2DM). This study aimed to investigate the prevalence, characteristics and factors associated with thyroid dysfunction in T2DM patients. Methods: This retrospective observational study included 250 T2DM patients admitted to a tertiary care hospital between October 2018 and February 2020. Demographic data, clinical characteristics and laboratory parameters were collected and analyzed. Findings: The prevalence of thyroid dysfunction in T2DM patients was 23.6%. Subclinical hypothyroidism was the most common type, followed by overt hypothyroidism and hyperthyroidism. The incidence of thyroid dysfunction was significantly higher in women than in males. Age, duration of diabetes, glycemic control and dyslipidemia were not significantly associated with thyroid dysfunction. Anti-TPO positivity is more prevalent in females with thyroid dysfunction Conclusion: Thyroid dysfunction is a common co-morbidity in T2DM patients, particularly in females. Screening for thyroid dysfunction is recommended in T2DM patients, especially those with risk factors such as female gender and a family history of thyroid disease. The early detection and treatment of thyroid dysfunction can improve glycemic control and reduce the risk of complications in T2DM patients.

Introduction: "Pre-emptive" analgesia implies analgesics given prior to surgical nick changes the processing of the obnoxious stimulation by the peripheral and central nervous system. Magnesium Sulphate antagonise (NMDA) receptor non-competitively to produce analgesic effects. Its perioperative use reduces anaesthetic requirements and improves postoperative analgesia. AIM: To detect the optimal useage of magnesium sulphate preoperatively and its effect on post-surgical pain, analgesic demand in major spine surgeries. Objectives: 1) To compare the Analgesia grading by Numerical Rating Score (NRS) postoperatively 2) To note the consumption of analgesics 3) To monitor the hemodynamic changes and adverse effects if any. METHODOLOGY: 100 patients divided into two groups, Group M received i.v. magnesium sulfate and Group C received i.v. isotonic saline 0.9% in the same quantity as the study drug. Pain assessment was performed. Analgesic consumption and adverse effects were noted. Observation And Results: The comparison of mean age of the subjects, distribution as per gender, comorbidities, type of surgery, duration of surgery, intraoperative vitals, fluid requirement, post-op nausea vomiting among Group C and M was not found to be statistically significant.  A statistically significant higher intraoperative requirement of analgesics, muscle relaxant was seen in Group C. Also, high pain score and high post-op Opioid requirement was found in Group C. Conclusion: Group M who received MgSO4 experienced better analgesia compared to Group C and their postoperative opioid requirements reduced significantly without any increase in adverse effects. This helped them in early ambulation, reduced hospital stays and provided better overall satisfaction.

Introduction: Duodenal and esophageal eosinophilia are characterized by the infiltration of eosinophils in the gastrointestinal mucosa, often resulting in chronic inflammation. While more commonly seen in the pediatric population, these conditions can also present in adults and are frequently linked to food allergies, parasitic infections, or autoimmune processes. Case Presentation: We present a case of a 36-year-old South Asian male with a four-month history of chronic throat soreness, pressure sensation after swallowing, pressure-like headaches, and an unintentional weight loss of 12 kg. Despite a healthy lifestyle and absence of typical allergic history, the patient experienced persistent upper GI symptoms. Upper gastrointestinal endoscopy revealed ring-like formations throughout the esophagus and inflammatory changes in the duodenum. Histopathological examination of duodenal biopsies demonstrated a significantly elevated eosinophil count. Subsequent food allergy testing was positive for multiple allergens, confirming a diagnosis of eosinophilic duodenitis and suspected eosinophilic esophagitis. The patient was advised to eliminate specific allergens from the diet and was started on medical therapy, with regular follow-up and surveillance endoscopy planned. Conclusion: This case emphasizes the importance of maintaining a high index of suspicion for eosinophilic gastrointestinal disorders in adult patients, even in the absence of classical atopic history. Early endoscopic evaluation and targeted allergy workup can be pivotal in diagnosing and managing these conditions effectively, preventing long-term gastrointestinal damage and improving patient outcomes.

Background: Intertrochanteric femur fractures are a significant cause of morbidity among the elderly. Surgical fixation using either Proximal Femoral Nail (PFN) or Dynamic Hip Screw (DHS) is the standard treatment. However, there remains a clinical debate regarding the optimal fixation method offering better outcomes in terms of operative time, functional recovery, and complication rates. Materials and Methods: This prospective cohort study was conducted at a tertiary care hospital over 18 months and included 80 elderly patients (>60 years) with intertrochanteric femur fractures. Patients were randomly assigned to two groups: Group A (n=40) treated with PFN and Group B (n=40) with DHS. Preoperative parameters, intraoperative variables (duration, blood loss), and postoperative outcomes (time to full weight-bearing, union time, Harris Hip Score, and complication rate) were recorded and analyzed. Results: The mean operative time was significantly shorter in the PFN group (58.2 ± 8.4 minutes) compared to the DHS group (72.5 ± 10.1 minutes) (p<0.01). Average intraoperative blood loss was lower in the PFN group (145.6 ± 30.5 mL) than in the DHS group (210.4 ± 42.3 mL) (p<0.001). Time to full weight-bearing was earlier in Group A (9.2 ± 2.3 weeks) compared to Group B (11.5 ± 2.9 weeks). The mean Harris Hip Score at 6 months was higher in the PFN group (82.4 ± 6.5) than in the DHS group (76.1 ± 7.3) (p=0.002). Complication rates were lower in the PFN group (12.5%) compared to the DHS group (25%). Conclusion: Proximal Femoral Nail offers superior outcomes over Dynamic Hip Screw in the management of intertrochanteric femur fractures in elderly patients, with reduced operative time, less blood loss, faster mobilization, and better functional recovery. PFN may be considered the preferred fixation method in such cases.

Background: Cesarean scar pregnancy (CSP) is a rare but increasingly prevalent form of ectopic gestation implanted within a previous cesarean section scar. Early and accurate diagnosis is crucial to prevent severe complications such as uterine rupture, hemorrhage, and subsequent infertility. Traditional transvaginal ultrasound (TVUS) has limitations in early CSP detection.  Methods: A prospective cohort study was conducted on 150 women presenting with suspected CSP based on clinical presentation and initial TVUS findings. All participants underwent standard TVUS, 3D power Doppler TVUS, and MRI within 48 hours of initial presentation. The diagnostic performance of each imaging modality, and their combinations, was assessed using histopathological examination or clinical follow-up as the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each technique. Results: Of the 150 women, 45 were confirmed to have CSP. Standard TVUS demonstrated a sensitivity of 78% and a specificity of 85%. 3D power Doppler TVUS significantly improved diagnostic accuracy, exhibiting a sensitivity of 91% and a specificity of 93% (p < 0.001). MRI alone showed a sensitivity of 89% and a specificity of 95%. The combination of 3D power Doppler TVUS and MRI yielded the highest diagnostic accuracy, with a sensitivity of 96% and a specificity of 98%. The PPV for the combined approach was 97%, and the NPV was 97%. Conclusion: 3D power Doppler TVUS and MRI are valuable adjuncts to standard TVUS for the early and accurate diagnosis of CSP. The combination of these techniques significantly improves diagnostic performance, potentially leading to earlier intervention and reduced morbidity associated with CSP. These findings support the incorporation of 3D power Doppler TVUS and MRI into the diagnostic algorithm for women at risk of CSP

Background: Long COVID, characterized by persistent symptoms following acute SARS-CoV-2 infection, poses a significant public health challenge. Vitamin D deficiency, prevalent globally, has been implicated in immune dysregulation and inflammatory processes, potentially influencing the development and severity of Long COVID. This study aimed to investigate the association between vitamin D deficiency at hospital discharge and the incidence and severity of Long COVID symptoms in post-hospitalized patients. Methods: A prospective cohort study was conducted involving 350 adult patients hospitalized for COVID-19. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured at hospital discharge. Vitamin D deficiency was defined as 25(OH)D < 20 ng/mL. Participants were followed up at 6 months post-discharge to assess for the presence and severity of Long COVID symptoms using a standardized questionnaire encompassing fatigue, dyspnea, cognitive dysfunction, and musculoskeletal pain. Multivariable logistic regression was used to assess the association between vitamin D deficiency and Long COVID, adjusting for age, sex, BMI, comorbidities, and disease severity during hospitalization. Results: At hospital discharge, 185 (52.9%) patients were vitamin D deficient. At 6-month follow-up, 196 (56%) patients reported at least one Long COVID symptom. Vitamin D deficient patients had a significantly higher prevalence of Long COVID (68.1%) compared to vitamin D sufficient patients (42.9%) (p < 0.001). After adjusting for confounders, vitamin D deficiency was independently associated with an increased risk of Long COVID (Adjusted Odds Ratio [aOR] = 2.35, 95% Confidence Interval [CI]: 1.48-3.72). Furthermore, vitamin D deficient patients reported significantly higher severity scores for fatigue (p = 0.012) and cognitive dysfunction (p = 0.035). Conclusion: Vitamin D deficiency at hospital discharge is independently associated with an increased risk and severity of Long COVID symptoms at 6-month follow-up in post-hospitalized COVID-19 patients. These findings suggest that vitamin D status may be a modifiable risk factor for Long COVID, warranting further investigation into the potential benefits of vitamin D supplementation in this population.

Background: Distal radius fractures are common injuries in the elderly, often resulting from low-energy trauma. Stable internal fixation using volar locking plates (VLPs) has gained popularity due to early mobilization and improved anatomical restoration. This study aimed to assess the functional and radiological outcomes of VLP fixation in elderly patients with intra-articular distal radius fractures. Materials and Methods: A prospective interventional study was conducted on 40 elderly patients (≥60 years) with intra-articular distal radius fractures treated with volar locking plate fixation. Patients were evaluated clinically using the Disabilities of Arm, Shoulder and Hand (DASH) score and radiologically by measuring radial inclination, volar tilt, and radial height preoperatively and postoperatively. Assessments were made at 6 weeks, 3 months, and 6 months post-surgery. Results: Out of 40 patients, 24 were female and 16 were male, with a mean age of 67.3 years. The mean DASH score improved from 78.5 at 6 weeks to 18.2 at 6 months, indicating significant functional recovery (p < 0.001). Radiological parameters at final follow-up showed acceptable alignment: mean radial inclination was 21.6°, volar tilt was 10.2°, and radial height was 11.8 mm. No major complications were observed, except for mild stiffness in 4 cases and transient paresthesia in 2 cases. Conclusion: Volar locking plate fixation offers excellent functional and radiological outcomes in elderly patients with intra-articular distal radius fractures. Early mobilization and anatomical reduction contribute to improved recovery and patient satisfaction, making it a preferred option in this demographic

Background: Stress hyperglycemia is common in patients presenting with ST-elevation myocardial infarction (STEMI). However, single admission glucose fails to differentiate acute stress hyperglycemia from chronic poor glycemic control. The glycemic gap, defined as the difference between admission plasma glucose and estimated average glucose derived from HbA1c, has emerged as a potentially superior prognostic marker. Aim of the study: The aim of this study was to evaluate the association between glycemic gap and the development of in-hospital heart failure and mortality among patients presenting with their first episode of acute STEMI. Methods: This cross-sectional comparative type of observational study was conducted in Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh, during the period from October, 2019 to March, 2021. This study included 287 patients admitted with first STEMI. Patients were divided into two groups: Group-I included patients with glycemic gap level >40 mg/dl and Group-II included patients with glycemic gap level ≤40 mg/dl. Result: Patients with glycemic gap >40 mg/dl had significantly higher mean admission blood glucose and glycemic gap values. Heart failure incidence was significantly higher in the high glycemic gap group (60.2% vs. 28.3%, p<0.001), as was cardiogenic shock (35.16% vs. 17.75%, p<0.001) and in-hospital mortality (13.28% vs. 5.66%, p=0.025). Pearson correlation showed a positive relationship between glycemic gap and both heart failure and mortality. Conclusion: This study demonstrates that an elevated glycemic gap is significantly associated with higher rates of in-hospital heart failure, cardiogenic shock, and mortality among first ST-elevation myocardial infarction (STEMI) patients.

Background: Sepsis remains a critical global health challenge, contributing substantially to morbidity and mortality worldwide. Early and accurate prognostication is essential to guide clinical management, yet current tools like APACHE scores are often time-consuming and less accessible in resource-limited settings.  Aim: To estimate the prognostic significance of serum albumin, plasma fibrinogen, neutrophil-to-lymphocyte ratio (NLR), and red cell distribution width (RDW) in patients with sepsis. Methods: An observational hospital-based study was conducted over 18 months at Mahatma Gandhi Medical College & Hospital, Jaipur. Adults aged 18–65 years with suspected sepsis admitted to ICU/HDU were enrolled after ethical clearance and consent. Clinical and laboratory parameters including CBC, biochemistry, coagulation profile, SOFA scores, and microbiological cultures were assessed on admission and at 48 hours. Statistical analysis employed SPSS v2022 with significance set at p < 0.05. Results: Among 120 patients, NLR and RDW values were significantly higher in non-survivors at admission and 48 hours, while serum albumin was significantly lower. Plasma fibrinogen showed no significant prognostic value. SOFA scores increased significantly in non-survivors at 48 hours. ROC curve analysis revealed NLR and RDW had good predictive accuracy for mortality, especially at 48 hours (NLR AUC 0.848; RDW AUC 0.877). Serum albumin and fibrinogen demonstrated poor predictive performance. Other parameters like GCS, platelet count, bilirubin, and creatinine had variable associations with outcomes. Conclusion: RDW and NLR are simple, cost-effective biomarkers that reliably predict sepsis severity and mortality, outperforming traditional markers such as serum albumin and fibrinogen. These findings support their utility in early risk stratification, especially in resource-limited settings

Introduction: Coronary risk factors in type 2 diabetes patients vary significantly between urban and rural populations due to differences in lifestyle, socioeconomic status, and healthcare access. AIM: To study the occurrence of coronary risk factors in urban and rural patients with type 2 diabetes mellitus in a tertiary care hospital. Methodology: The study was initiated after obtaining approval from the Institute’s Scientific Research Committee and the Institute’s Ethical Committee. It was conducted in the Department of General Medicine at Mahatma Gandhi Medical College & Hospital, Jaipur. Result: This study found high rates of CHD risk factors in T2DM patients, including dyslipidemia, hypertension, microalbuminuria, and sedentary lifestyle, with urban populations showing worse lipid profiles. Overall, microalbuminuria emerged as the strongest independent predictor of CHD, highlighting the urgent need for early screening and risk-factor management. Conclusion: This study underscores the urgent need for early, targeted interventions addressing dyslipidemia, microalbuminuria, and modifiable risk factors to lower CHD risk in T2DM. Microalbuminuria emerged as the strongest independent predictor of CHD, highlighting its critical role in cardiovascular risk assessment.

Introduction: Cataract surgery, though considered low-risk, is often performed in elderly patients with multiple comorbidities that may increase perioperative cardiovascular risk. Preoperative electrocardiography (ECG) serves as a valuable screening tool to identify asymptomatic cardiac conditions and guide perioperative planning. Aims and Objectives: To evaluate the prevalence and pattern of preoperative ECG abnormalities in patients scheduled for cataract surgery, and to assess their association with clinical comorbidities, risk stratification and the need for further cardiac evaluation or surgical deferral. Materials and Methods: A cross-sectional observational study was conducted among patients scheduled for cataract surgery. Detailed clinical histories were taken, and preoperative ECGs were analysed. Patients were categorized into normal and abnormal ECG groups. Associations between ECG findings, comorbidities (hypertension, diabetes, CAD, smoking), and need for cardiology referral or surgery delay were assessed using appropriate statistical tests. Results: Out of the total patients, 50% showed abnormal ECG findings. ECG abnormalities were significantly associated with hypertension (p=0.001), diabetes (p=0.008), CAD (p<0.001), and smoking (p=0.049). Furthermore, 36.8% of those with abnormal ECGs required cardiology referral, and 13.2% experienced surgical postponement or cancellation (p<0.001). Conclusion: Preoperative ECG screening in cataract surgery patients, especially in the elderly with comorbidities, reveals a high prevalence of clinically significant abnormalities. Routine ECG evaluation can aid in identifying at-risk patients, reducing perioperative complications, and improving surgical outcomes through timely cardiac intervention and risk stratification

Introduction: Robotic-Assisted Thoracic Surgery (RATS) has revolutionized minimally invasive thoracic procedures by enhancing surgical precision, visualization, and ergonomics. While international data on RATS outcomes are growing, limited evidence exists from Indian public healthcare settings. This retrospective study aimed to evaluate the clinical outcomes, procedural details, and complications of RATS at VMMC-SJH. Materials and Methods: A retrospective analysis was conducted on 21 patients who underwent RATS at the Department of Cardiothoracic and Vascular Surgery, VMMC-SJH, between 2018 and 2024. Procedures were performed using the da Vinci Xi system. Data were extracted from operative records, anesthesia charts, and follow-up documentation. Variables included demographics, surgical type, operative time, blood loss, conversion to open surgery, postoperative complications, ICU stay, and chest drain duration. Descriptive statistics were applied using SPSS version 25. Results: The study included 21 patients (mean age 39.4 ± 16.8 years; 62% females). The most common procedures were thymectomy (33%) and lobectomy (24%). Conversion to open thoracotomy occurred in 19% of cases, primarily due to adhesions and anatomical challenges. Postoperative complications were observed in 24% of patients, with prolonged air leak and atelectasis being the most frequent. The mean ICU stay was 1.6 ± 0.6 days. The majority of patients (76%) had an uneventful recovery.Conclusion: RATS is a feasible and safe minimally invasive approach for thoracic surgery in a public tertiary-care setting. Our initial experience demonstrated acceptable conversion rates, low morbidity, and rapid postoperative recovery. Further prospective studies with larger cohorts are warranted to validate these findings and assess long-term outcomes.

Atrioventricular (AV) block is a frequent complication in acute coronary syndrome (ACS) and can predict widespread myocardial damage. In this prospective observational study, the prognostic value of QRS morphology was assessed in 116 patients with AV block in ACS at a tertiary care (TC) hospital from December 2018 to March 2020. Patients were classified according to QRS duration into narrow (<120 ms) and broad (≥120 ms) complex groups and were evaluated for clinical outcomes, infarct location, angiographic findings, pacing needs, and AV conduction recovery following revascularization. The most frequent presentation was inferior wall myocardial infarction (78.5%), and complete heart block was seen in 65.5% of patients. Broad QRS morphology was strongly correlated with anterior infarction, involvement of the LAD, higher-grade AV block, and a significantly increased requirement for temporary pacemaker implantation (84% vs. 3.3%, p < 0.0001). Recovery of AV conduction was seen in the majority of patients within 24 hours of revascularization, and permanent pacing was needed in 6.8% of patients. At one-year follow-up, 88.7% showed complete recovery, 6.8% remained pacemaker-dependent, and 4.3% had died. These observations emphasize that QRS morphology is a useful prognostic indicator in patients with AV block in ACS, helping to stratify risk early and direct pacing in the revascularization era.

Acute coronary syndrome (ACS) complicated by atrioventricular (AV) block is a challenging clinical condition, requiring timely assessment and directed intervention to ensure the best outcome for the patient. This study examines the influence of different revascularization techniques, such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), in patients with ACS and associated AV block. Clinical and functional results were compared with an emphasis on mortality, myocardial recovery, and restoration of the cardiac conduction system. The study population included patients with ACS-related AV block stratified according to the treatment modality. We compared the effectiveness of early vs. delayed revascularization, with a focus on its potential to enhance conduction recovery and survival. The findings suggest that prompt revascularization, specifically PCI or CABG, dramatically improves survival rates and allows for conduction system recovery. Yet, the selection of intervention is still very much based on individual patient factors, such as infarct site, hemodynamic stability, and severity of conduction abnormalities. In addition, we noted that patients who received PCI had a greater probability of recovery of conduction, especially in those with transient AV block, while CABG was favored in extensive coronary artery disease. These results highlight the value of a patient-specific, individualized approach to the management of ACS with AV block, affirming the pivotal role of early and proper revascularization in enhancing clinical outcomes

Background: Urinary bladder lesions both non-neoplastic and neoplastic are common. These diseases are more disabling than lethal. Urinary Bladder cancer is the 7th most common cancer worldwide, with an estimated 2,60,000 new cases occurring each year in men and 76,000 in women. Although progress has been made in the field of non-invasive imaging, histopathological analysis of biopsy material is the mainstay for cancer diagnosis and treatment. Urothelial carcinoma is the commonest type accounting for 90% of all primary tumors of the bladder. The clinical significance of bladder tumor depends on their histological grade, differentiation and depth of invasion of the lesions. Material And Methods:  Study included a total of 34 transurethral resection specimens, conducted over a period of 12 months, extending from January 2023 to December 2023. Hematoxylin & Eosin (H&E) stained sections were examined for morphologic diagnosis of urothelial lesions. Results:  In our study, there was male preponderance with male to female ratio of 3.2:1. Maximum number of patients were in the age group of 61-70 years. The most frequent neoplastic finding in the Urinary bladder was Invasive Papillary Urothelial carcinoma (52.94%), high grade being more common than low grade. Among other lesions, 36.3% cases were of non-invasive urothelial carcinoma, 10% cases were of benign urothelial neoplasm and 4.6% cases of non-neoplastic lesions. Conclusion: This study revealed that neoplastic lesions are more common than non-neoplastic lesions. Urothelial carcinoma is the most common primary bladder carcinoma. Males are affected more commonly than females with the peak incidence seen in sixth decade of life

Introduction: Manual methods are low cost but labor intensive and peripheral smear examination alone carries disadvantages of interobserver variation and increased turnaround time. Hence it is important to compare the values generated by the automated method with findings of peripheral smear which will supplement each other in the diagnosis of anemia.  Objectives: To compare the hematology parameters determined by manual and automated method in the diagnosis of anemia. Materials and Methods: First 200 EDTA blood samples with. Hb<12gm/dl by automated method were included in the study population. After morphological categorization of anemia by peripheral smear, it was compared with values generated by automated hematology analyser Sysmex XS Series. The values generated by manual and automated method were then compared. Results: On Automated analysis 44 cases were Microcytic hypochromic, of which 42 cases (95.5%) were microcytic on peripheral smear and 2 cases (4.5%) were normocytic. Out of 14 macrocytic anemia by automated method, all were macrocytic in peripheral smear also. On statistical analysis p value was found to be less than 0.0001 according to chi square test implying significant association between parameters obtained by manual and automated method. Kappa Measure of Agreement between manual and automated method was 0.87 with a p value <0. 0001.So, there was statistically almost perfect agreement. Conclusion: Our study showed a significant association between the values generated by automated method and peripheral smear with an almost perfect agreement between two methods. Thus, the values generated by automated method is useful for the initial diagnosis of anemia and can be used as a screening tool for large population

Background: Compliance to hand hygiene (HH) is an important measure in preventing infections to patients in health care settings. Wellness and safety of patients and health care workers (HCWs) can be achieved by promoting best practices in infection control. Hospital-acquired infections (HAIs) are considered as undesirable outcome and since they are preventable, they are considered as a quality indicator of patient care.. Methods: This study will be conducted in the Department of Microbiology and all the clinical wards of Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram Andhra Pradesh. Conclusion: Over the past few years, scientific evidence to support the role of hand hygiene in the improvement of patient safety has increased considerably, but some key controversial issues still challenge care practitioners and researchers. HH compliance is associated with the decrease in HAIs. HH could be a simple and cost-effective method in prevention of HAIs and also reduce the patient hospital stay, financial burdens and mainly the resistance strains that could spread through hands of HCWs and finally reduce AMR.

Introduction-It is observed that promoting healthy physical activity behaviors in children has immediate impacts on health and well-being of children and serves as powerful strategy to prevent or minimize the occurrence of chronic disease in later life. Objectives-To estimate the scores of various fitness tests performed by the study subjects and its relation with anthropometric measurements. Methods- This prospective study included 270 children of 8 to 12 years age who fulfilled all inclusion criteria. They were selected randomly from six schools in Gwalior. Their height, weight and BMI were noted. Fitness tests included in this study were - curl ups, shuttle run, v-sit and reach, Endurance run and walk, pull-ups.  Results-Among 270 children between 8-12 years age 62.6% were male and majority of the subjects belong to lower middle class (45.9%). It was observed that boys performed better than girls in curl-ups, shuttle run, Endurance run- walk, pull-up(p<0.001). Girls performed better in v sit reach test (p<0.001). Mean value for boys in curl-up test-39.12±3.71 repetitions, in shuttle run-11.292±0.5 seconds, endurance run walk-8.9479±0.6minutes, pull-ups- 3.28±1.091repetetions, v sit reach- 3.186±0.5779 cm. Mean value for Girls in curl-up test-36.13±3.507repetetions, shuttle run-11.658±0.805 seconds, endurance run walk-10.1564±0.78 minutes, pull-ups-0.96±0.665repetetions, v sit reach-5.617±0.9222cm. Difference among various BMI groups was not significant for both boys and girls except for shuttle run and endurance run/walk in boys and curl-ups in girls. Conclusion- The present study concludes that age and sex significantly correlate with physical fitness test. Boys perform better in all physical fitness tests except v- sit and reach. Girls perform better in flexibility test. BMI showed weak correlation with all physical tests.

Background: Timely reperfusion in ST-segment elevation myocardial infarction (STEMI) via primary percutaneous coronary intervention (PCI) is critical to reduce mortality and morbidity. Door-to-balloon (D2B) time, a key quality metric, is recommended to be ≤90 minutes by the American College of Cardiology/American Heart Association (ACC/AHA). This study evaluates D2B times and associated factors in a tertiary emergency department (ED) in North Kerala, India. Methods: A prospective observational study was conducted from January 2024 to December 2024 at a 750-bed tertiary care hospital in North Kerala. We enrolled 300 consecutive STEMI patients undergoing primary PCI. Time segments (door-to-ECG, ED-to-coronary care unit [CCU], consent, and post-consent-to-balloon) were recorded. Spearman’s correlation and multivariable logistic regression identified factors influencing D2B delays. Results: The mean D2B time was 62 ± 14.5 minutes, with 92% of patients achieving D2B ≤90 minutes. Consent time (mean 25.4 ± 11.3 minutes) showed a strong correlation with D2B time (ρ = 0.89, p < 0.001). Nighttime presentation (00:01–08:00) and prolonged consent time were independent predictors of D2B >90 minutes (odds ratio [OR]: 2.95, 95% CI: 1.45–6.02; OR: 1.12 per minute, 95% CI: 1.07–1.18). In-hospital mortality was 3.7%, higher in patients with D2B >90 minutes (12.5% vs. 2.9%, p = 0.02). Conclusion: The tertiary ED achieved commendable D2B times, but consent delays and nighttime presentations remain challenges. Targeted interventions, including streamlined consent processes and enhanced nighttime staffing, could further optimize outcomes

Background: Background: This study is aimed to analyze the clinical profile of patients with pulmonary TB sequelae and types of lung resection surgeries required forpulmonary TB sequelae with its postoperative outcome. Methods: Between 2017 and 2020, 27 patients with postpulmonary TB sequelae underwent lung resection surgeries at our institute. Various indications for these surgeries werelung cavities with aspergillomas, bronchiectasis, destroyed lung and chronic empyema. Results: The cohort included 27 patients: cavitary lesions with aspergillomaswas the most common finding (48.1%), followed by bronchiectasis (25.9%),destroyed lung (18.5%) and chronic empyema (7.4) %Lobectomy was the most frequently performed surgery (70.3%), followed by pneumonectomy (18.5%) and segmentectomy (11.1%). Postoperative morbidity was observed in very few patients, with common complications including prolonged air leak, bleeding, wound infection. No perioperative mortality was recorded. Conclusion: Surgical management of pulmonary TB sequelae remains essential in selected patients, especially when medical therapy fails or complications like significant hemoptysisarise. Proper patient selection, thorough preoperative optimization, and postoperative care significantly improve outcomes. Lobectomy remains the most commonly required procedure in such cases.

Background: A Caesarean Section (CS) is a significant procedure commonly performed in obstetric practice ⁽¹⁾. It serves as a life-saving intervention when warranted and helps to avert complications for both mothers and newborns, including the risk of neonatal death. The frequency of CS is escalating due to various factors such as maternal traits (age extremes, obesity, etc.), requests from mothers, labor induction, and the use of epidural anaesthesia ^(2-4).

Objectives:

1. To assess the various risk factors in mothers requiring re-laparotomy after caesarean section in our hospital during the given period.
2. To evaluate maternal outcomes in this study in terms of mortality and morbidity.

Material & Methods: Study Design: A prospective observational study. Study area: Department of Obstetrics and Gynecology, R.G.KAR Medical College and Hospital, Kolkata. Study Period: December, 2022 to May, 2024 (18 months). Study population: All women undergoing re-laparotomy after caesarean section deliveries in the stipulated time frame in R.G.KAR Medical College and Hospital, Kolkata.   Results: Among the booked cases most of the re-laparotomies were performed due to PPH (atonic uterus) (45.45%) followed by rectus sheath hematoma and broad ligament hematoma. Among the referred cases, most of the re-laparotomies were performed due to rectus sheath hematoma (27.59%) followed by PPH (24.14%0 and hemoperitoneum (13.79%). Conclusion: Finally, it can be concluded that exposure to CS is itself a definitive risk factor with complications such as need of re-laparotomy which is done as a procedure in cases of near miss fatality of mother. Every effort must be made to make the procedure safe. If the personnel and adequate blood products are available, re-laparotomy should not be delayed for the management of intractable hemorrhage and unstable vital signs after CS. Strict post -operative vigilance and timely intervention can reduce both maternal morbidity and mortality

Cardiometabolic health starts deteriorating in women with the onset of menopause. Metabolic syndromes in women undergoing menopause make them more susceptible to develop diabetes mellitus and life-threatening cardiovascular diseases (CVDs). Post-menopausal women with pre-existing diabetes or diabetic women experiencing an early menopause are highly susceptible to develop a CVD. Understanding of the complicated interplay between menopause, diabetes and CVDs is crucial for selecting treatment strategies and to guarantee a long active life for middle-aged and elderly women. The reproductive-menopause transition phase is the key time to implement CVD-risk preventive strategies. This paper reviews the various menopausal stages and associated challenging CVD risk factors. The pathways depict decreased estrogen levels and increased follicular hormones that onset insulin resistance in menopause. Biomarkers and the prediction models reviewed are the prime tools for prediction of the onset of menopause. Electing non-pharmacological approaches like lifestyle modification can mitigate CVD progression. Menopausal hormone therapy is recommended by national and international guidelines for controlling vasomotor symptoms, improving lipid profile and management of CVDs. In addition, efficacy of statin and aspirin has been investigated in menopausal women with CVD risk that showed positive outcomes. However, antidiabetic medications must be recommended in post-menopausal women, considering all the comorbidities. In conclusion, early menopause increases risk of diabetes and CVD in women. Further studies are required on women at different stages of menopause to circumvent the challenges related to diabetes and CVD prevention.

Background: Blood transfusion remains an essential but potentially risky medical intervention. While national haemovigilance programs exist, regional data from tertiary care centres like Kurnool General Hospital are scarce. This study aimed to comprehensively analyze transfusion reaction patterns to improve patient safety protocols in this resource-limited setting. Materials and Methods: We conducted a 5-year retrospective analysis (June 2020-May 2025) of all transfusion reactions documented at our 1200-bed tertiary care hospital. Data were systematically collected from blood bank records, patient case files, and incident reports. Reactions were classified according to standard definitions and analysed for incidence rates, clinical patterns, and outcomes. Results: Our analysis of 12,450 blood component transfusions revealed 142 adverse reactions (1.14% incidence). The clinical landscape was dominated by febrile non-hemolytic reactions (47.9%) and allergic manifestations (36.6%), typically presenting within the first four hours post-transfusion. Packed red cells accounted for the majority of reactions (69%), particularly among female patients of reproductive age (65% of cases aged 20-40 years). While most events were mild, we identified 16 severe reactions (11.2%) including 6 cases of acute haemolysis, 6 TRALI events, and 10 cases of circulatory overload. Notably, whole blood transfusions showed higher reaction rates per unit compared to other components. The obstetric department reported the highest frequency of reactions (58%), likely reflecting both transfusion volume and patient susceptibility factors. Conclusion: This study highlights the substantial burden of preventable transfusion reactions in our setting; particularly febrile and allergic events associated with packed red cells. The findings emphasize the urgent need for targeted interventions including universal leukoreduction, improved premedication protocols, and enhanced staff training to recognize early warning signs. Our results provide a benchmark for quality improvement initiatives and underscore the value of robust haemovigilance systems in resource-limited hospitals

Background: Aim: The aim of the present study was to compare the demographic and anthropomteric measurements with and without NAFLD. Methods: The prospective study was conducted at SGT Medical College, Hospital, and Research Institute over a period of 18 months, encompassing both outpatient and inpatient settings. Consecutive 50 newly diagnosed patients of hypothyroidism were included using convenient sampling, adhering to specific inclusion and exclusion criteria.  Results: The age distribution of the study participants had a mean age of 45.78 years, a median age of 45 years, a standard deviation of 13.9654 years, and ages ranging from a minimum of 22 years to a maximum of 80 years. The age distribution of participants showed that 20 individuals (40.0%) were under 40 years old, 24 participants (48.0%) were between 41 and 60 years old, and 6 participants (12.0%) were over 60 years old, with a total of 50 participants (100.0%). The distribution of participants according to gender revealed that there were 29 females, making up 58.0% of the total, and 21 males, accounting for the remaining 42.0%, with a total of 50 participants (100.0%). The distribution of anthropometric measurements among study participants showed that the mean weight was 77.06 kg, with a standard deviation of 8.41 kg, ranging from 58.00 kg to 92.00 kg. Conclusion: The current study investigated the prevalence of nonalcoholic fatty liver disease (NAFLD) and explored the association between various clinical factors with the presence of NAFLD in this population. Participants with NAFLD had significantly higher body weight, BMI.

Background: Staphylococcal infections pose significant therapeutic challenges due to biofilm-mediated antibiotic resistance. This study characterizes biofilm production and antimicrobial resistance profiles of Staphylococcus isolates recovered from diverse clinical samples at a tertiary care hospital, with particular emphasis on resistance pattern variations between biofilm-producing and non-producing strains. Methods: We conducted a laboratory-based cross-sectional study analyzing 100 consecutive, non-duplicate Staphylococcus isolates (35 sputum, 40 urine, 25 pus samples) collected between [May-2024] to [October-2024]. Biofilm production was detected by tube adherence method.  Antimicrobial susceptibility testing was performed by Kirby-Bauer disk diffusion method following CLSI 2023 guidelines against antibiotics including β-lactams (AMP, AMC), glycopeptides (VA, TEI), fluoroquinolones (CIP, OF), and others. Statistical analysis employed Chi-square and Fisher's exact tests (p<0.05 significant). Results: Among 100 clinical Staphylococcus isolates, 48% demonstrated biofilm production, with notable variation across sample types: pus samples showed the highest prevalence (56%, 14/25), followed by urine (50%, 20/40) and sputum (40%, 14/35). Biofilm-producing strains exhibited significantly greater antibiotic resistance compared to non-producers, particularly to ampicillin (85% vs. 60%, p<0.01), vancomycin (25% vs. 10%, p=0.03), and cotrimoxazole (50% vs. 30%, p=0.02). Resistance to cefixime was also markedly higher in biofilm producers (65% vs. 45%, p=0.01). In contrast, susceptibility to linezolid (92%) and teicoplanin (88%) remained high across all isolates. Demographic analysis revealed a predominance of biofilm production among male patients (60%) and individuals aged 40-60 years (55%). These findings underscore a strong association between biofilm formation and multidrug resistance, while identifying key antibiotics that retain efficacy against both biofilm-producing and non-producing Staphylococcus strains. Conclusions: Our findings demonstrate that biofilm-producing Staphylococcus isolates exhibit significantly higher resistance rates to first-line antibiotics including ampicillin, vancomycin, and cotrimoxazole compared to non-producers. The high prevalence of biofilm production (48%) coupled with emerging vancomycin resistance (25% in producers) underscores the need for:Routine biofilm screening in chronic infections, Preference for linezolid/teicoplanin in biofilm-associated cases, Enhanced antimicrobial stewardship targeting empirical therapy protocols. These results provide critical insights for managing biofilm-mediated Staphylococcal infections in clinical settings

Background: Civilian vascular trauma constitutes a significant proportion of emergency cases managed in worldwide emergency departments. In the last decade vascular trauma-related deaths increased by significantly, underscoring the urgent need for early diagnosis and management. Timely recognition and revascularization not only decrease mortality but also significantly reduce amputation rates and associated morbidity. This retrospective study aims to compare the epidemiology, management, and outcomes of upper and lower limb vascular trauma at a tertiary care centre in Delhi. Materials and Methods: This retrospective study was conducted at Safdarjung Hospital, New Delhi over a 15-month period. 30 patients each with upper and lower limb vascular trauma, who presented to the emergency department and underwent surgery by the Department of Cardiothoracic and Vascular Surgery, were randomly selected. Data collected included demographic details, type of procedure performed (ligation, primary repair, or interposition vein graft repair), postoperative outcomes (presence of palpable pulses), associated injuries, neurological deficits, and amputation rates. These parameters were analyzed and compared between the two groups. Results: A male predominance was observed in both groups (66.6% in upper limb trauma and 86.6% in lower limb trauma, p = 0.067). Lower limb vascular trauma was more frequently associated with concomitant bony injuries compared to upper limb trauma. The most commonly affected vessels were the brachial artery in the upper limb and the superficial femoral artery in the lower limb. Revascularization outcomes were significantly better in upper limb trauma, with higher rates of palpable postoperative pulses (63.3% vs. 36.6%, p = 0.039) and lower rates of gangrene and amputation (2.2% vs. 36.6%, p = 0.001). However, neurological deficits and nerve injuries were more commonly observed in upper limb trauma (10% vs. 3.33%, p = 0.37). Conclusion: Upper limb vascular trauma demonstrates better outcomes following revascularization compared to lower limb injuries, with higher rates of postoperative distal pulse restoration and lower amputation rates. However, neurological deficits are relatively more common in upper limb injuries. Further research is needed to validate these findings and explore the underlying mechanisms.

Background: Surgical removal of impacted mandibular third molars is routinely performed using rotary burs. However, piezoelectric surgery has emerged as a minimally invasive alternative offering enhanced soft tissue protection and postoperative comfort. This study compares the clinical efficiency and postoperative outcomes between bur and piezo-assisted osteotomy. Methods: A prospective study was conducted on 60 patients with similar types of mandibular third molar impactions, divided into two equal groups: Group A (bur) and Group B (piezo). Parameters assessed included operative time, postoperative pain (VAS), facial swelling, mouth opening (trismus), and patient satisfaction. Data were analyzed using SPSS with significance set at p < 0.05. Results: Group A demonstrated significantly shorter operative time (21.6 ± 3.4 mins) compared to Group B (32.8 ± 4.2 mins). However, Group B exhibited significantly reduced postoperative pain, swelling, and trismus on Days 3 and 7. No complications were observed in either group. Conclusion: While bur-based surgery is faster, piezoelectric surgery offers superior postoperative outcomes and greater patient comfort. It is particularly beneficial in cases requiring precision, soft tissue preservation, and reduced morbidity, though operative time and equipment cost must be considered.

Background: Non-alcoholic fatty liver disease (NAFLD) is an increasingly recognized hepatic complication of Type 2 Diabetes Mellitus (T2DM), particularly in resource-limited settings where routine screening remains low. This study aimed to estimate the prevalence of NAFLD and its correlation with glycemic control among T2DM patients at a private referral hospital in northern Gujarat. Methods: A cross-sectional observational study was conducted in Dhanera, Gujarat, between August 2023 and August 2024, enrolling 25 adult T2DM patients. Clinical data, BMI, HbA1c levels, and ultrasonography findings were recorded. Chi-square test and Pearson’s correlation were used to assess statistical significance. Results: NAFLD was present in 68% of the participants. Grade I steatosis was most common. A statistically significant association was found between poor glycemic control (HbA1c ≥9%) and the presence of NAFLD (p = 0.031). Most patients with NAFLD were also overweight or obese. Conclusion: The study highlights a high burden of NAFLD among diabetic patients, even in semi-urban areas, and its significant correlation with poor glycemic control. Regular screening for NAFLD and tighter glycemic control should be emphasized in diabetes care.

Background: Bronchogenic carcinoma is a leading cause of cancer-related deaths worldwide. Early and accurate staging is essential for effective treatment planning and prognostication. Multi-Detector Computed Tomography (MDCT), particularly when enhanced with contrast, offers high-resolution imaging crucial for evaluating tumor characteristics and staging. This study aimed to assess the diagnostic accuracy of contrast-enhanced MDCT in the evaluation and staging of bronchogenic carcinoma, with histopathological correlation. Materials and Methods: This prospective observational study was conducted over a 2-year period at the Department of Radiodiagnosis, KIMS, Bhubaneswar. Fifty patients clinically suspected of bronchogenic carcinoma and referred for contrast-enhanced MDCT were enrolled using a non-probability consecutive sampling method. Imaging was performed with a minimum 16-slice MDCT scanner using both pre-contrast and post-contrast protocols. Tumor staging was done according to the AJCC 8th edition TNM system. Histopathological correlation was established through bronchoscopic or CT-guided biopsies. Data were analyzed using SPSS v20, and diagnostic validity metrics of MDCT were calculated. Results: Out of 50 patients, 54% were aged >60 years, and 70% were male. The most common presenting symptom was cough (70%), followed by weight loss (58%) and appetite loss (58%). Lesions sized 3–5 cm were predominant (36%), with 86% showing bronchus cut-off sign and contrast enhancement. Homogeneous attenuation was observed in 74% of lesions. Mediastinal lymphadenopathy was present in 88% of cases, and metastasis was seen in 52%. Adenocarcinoma was the most frequent histological subtype (44%), followed by squamous cell carcinoma (32%). According to TNM staging, T3 lesions were most common (28%), N2 nodal involvement was seen in 38%, and 36% had M1 stage disease.

MDCT demonstrated a sensitivity of 95.74%, specificity of 33.3%, positive predictive value (PPV) of 95.74%, negative predictive value (NPV) of 33.3%, and overall diagnostic accuracy of 92% when compared with histopathological findings. Conclusion: Contrast-enhanced MDCT is a reliable imaging modality with high sensitivity and diagnostic accuracy for evaluating and staging bronchogenic carcinoma. Despite limited specificity, MDCT remains valuable in identifying tumor extent and guiding clinical decision-making. Histopathological confirmation is essential to overcome false positives and refine treatment strategies.

Background: Major open abdominal surgeries are associated with significant postoperative morbidity. Serum albumin, traditionally considered a nutritional marker, is also a dynamic indicator of surgical stress and systemic inflammation. While preoperative hypoalbuminemia is a known predictor of poor outcomes, the prognostic value of a postoperative drop in serum albumin remains underexplored. This study aimed to correlate postoperative serum albumin decline with the development of postoperative complications. Materials and Methods: A prospective observational study was conducted in the Department of General Surgery, KIMS, Bhubaneswar, from February 2023 to January 2025. Eighty-four adult patients undergoing elective major open abdominal surgeries (>2 hours duration) were included. Serum albumin levels were recorded preoperatively and at 6 hours, postoperative day (POD) 1, and POD 3. A drop ≥1 g/dL in serum albumin on POD1 was considered significant. Postoperative complications such as wound infections, sepsis, and anastomotic leaks were recorded. Statistical analyses included chi-square, t-test, ANOVA, and diagnostic accuracy metrics. Results: Postoperative complications were observed in 45 patients (53.6%). Significant associations were found between complications and age >60 years (p=0.018), male gender (p<0.001), BMI >25 (p=0.027), presence of comorbidities (p<0.001), surgery duration >3 hours (p<0.001), and blood loss >200 mL (p<0.001). A ≥1 g/dL drop in serum albumin on POD1 occurred in 71.1% of patients with complications, versus only 2.6% in those without (p<0.001). This drop showed strong predictive power: sensitivity 71.1%, specificity 97.4%, positive predictive value (PPV) 97%, negative predictive value (NPV) 74.5%, and diagnostic accuracy 83.3%. Moreover, a high correlation was observed between decreased albumin and elevated MPASS scores (p<0.001), reinforcing its role as a surgical stress marker. Conclusion: A postoperative serum albumin declines of ≥1 g/dL within 24 hours is a strong, early, and cost-effective predictor of postoperative complications in major open abdominal surgeries. Routine monitoring of serum albumin levels can significantly aid in identifying high-risk patients and guide timely interventions to improve clinical outcomes

Background: To study relative preponderance of critical obstetrical emergencies with various maternal factor-like quality of antenatal care during pregnancy, regular antenatal checkup during pregnancy, socioeconomic status, education and area wise distribution and to study the contribution of each emergency to maternal mortality and morbidity and fetal outcome. Methods: The present study was conducted on a prospective basis for one year, from 1st Feb 2022 to AUGUST2023 in the department of Obstetrics and Gynaecology, GGH Kadapa. All the cases referred as critical emergency from nearby areas during their antenatal period or within 42 days of delivery were included in the study. A detailed history including age, parity, gestational age, antenatal care during pregnancy, socioeconomic status, obstetrical history, medical or surgical disorders was taken into account. Attention was paid on the management received by each case including blood transfusion, surgical interventions, ICU admission etc.  RESULTS: Total deliveries during this period were 2223. Total obstetric emergencies came out to be 252. Thus, the incidence of obstetric emergencies came out to be 11.3%. Various obstetric emergencies that were encountered –Antepartum Hemorrhage (25%), PROM(21%),12% with abortion , severe anemia ( 9%), Hypertensive disorders of pregnancy (13%), Malpresentation (6%), Hyperemesis gravidarum (3%), Heart diseases(1%),ectopic pregnancy (2%), eclampsia (2%), , Postpartum haemorrhage (3%),Intrauterine death(2%) ,There were 67% Live births, 6%in IUD,2% in neonatal mortality, 4% in perinatal mortality, 2% in Congenital anomalies  Conclusions: It was concluded that obstetric emergencies are more common in unbooked cases and women with low socioeconomic status with poor access to antenatal care

Background: Tobacco use is one of the important preventable causes of death and a leading public health problem all over the world. Globally, it kills nearly 7 million people. If current trends continue, by 2030 tobacco use is estimated to kill more than 8 million people worldwide each year. The present study was carried out to determine prevalence and pattern of tobacco usage among urban slum dwellers of Burla NAC. Materials and Methods: A community based cross-sectional study was conducted in urban slums of Burla, NAC under the field practice area i.e. Urban Health & Training Centre of VIMSAR, Burla. 350 participants were selected by simple random sampling among adults aged 18 years and above. Results: 48.2% were using some or other forms of tobacco. Among users,62.4% were consuming smokeless form while 12.9% were consuming smoking form & 24.7% were using both forms. Most of the tobacco users were in the age group of 38-47 years. Males outnumbered females in all the three forms of tobacco use. Prevalence of current tobacco users is 41% of which 18% are daily users. The commonest cause for starting tobacco was to pass time (21%) and peer pressure (19.8%). Cigarettes (7.4%) and Bidis (8.3%) were common smoking forms of tobacco. Most common smokeless form of tobacco consumed were Gutkha (14.86%) and Khaini (11.7%). Conclusions: We observed a high prevalence of tobacco usage as compared to national average. A focussed and effective health education strategy is needed according their age, gender and education status to increase the knowledge and awareness about harmful effects of tobacco and its products in urban slums of Burla.

: Background: Endotracheal intubation is a routine part of delivering general anesthesia. Post operative sore throat is the most common complaint following tracheal intubation. Endotracheal tube cuff design, cuff pressure lubrication and tube size are the important factors that affect the incidence and severity of sore throat. Present study was aimed to compare incidence of sore throat after endotracheal cuff inflation with air (or) lignocaine. Material and Methods: Present study was prospective, comparative study, conducted in 60 Consenting patients undergoing general anaesthesia, will be randomly assigned to one of the following two groups as Group A (n = 30): Endotracheal tube cuff inflated with lignocaine & Group B (n = 30): Endotracheal tube cuff inflated with air. Results: It was noted that ETT Cuff with Lignocaine is effective than ETT Cuff with AIR in reducing the Sore throat. Consenting patients undergoing general anaesthesia were randomly assigned to Group A (n = 30): Endotracheal tube cuff inflated with lignocaine OR Group B (n = 30), Endotracheal tube cuff inflated with air. Conclusion: t is concluded that ETT Cuff with Lignocaine is effective than ETT Cuff with AIR in reducing the Sore throat.

Background: Non-lactational breast abscesses (NLBA) are uncommon inflammatory breast conditions, typically affecting perimenopausal women. Unlike lactational abscesses, they exhibit distinct etiological and microbiological characteristics, and their management presents unique clinical challenges. Objectives: To evaluate the clinical spectrum, associated risk factors, microbiological profile, and treatment outcomes of NLBA in women presenting to a tertiary care center. Methods: This hospital-based, cross-sectional observational study was conducted in the Department of General Surgery, Assam Medical College and Hospital, over a period of one year (July 2024–June 2025). Twenty patients aged over 14 years with clinically and radiologically confirmed non-lactational breast abscesses were included. Data on demographics, risk factors, clinical presentation, hematological and microbiological investigations, imaging, management, and follow-up outcomes were collected and analyzed. Results: The majority of cases (85%) occurred in women aged 31–50 years. Common risk factors included tobacco use (20%), diabetes mellitus (15%), tuberculosis (10%), and HIV infection (5%). Anaemia and leucocytosis were noted in 25% and 35% of patients, respectively. Central and subareolar abscesses predominated. Staphylococcus aureus, including MRSA strains, was the most frequently isolated organism. Incision and drainage was the most employed treatment modality, followed by catheter drainage and ultrasound-guided aspiration. Lactiferous duct excision was performed in recurrent cases and had no recorded recurrences. The highest recurrence rate was seen with catheter drainage. Conclusion: NLBA predominantly affects perimenopausal women and is frequently associated with identifiable risk factors such as smoking, diabetes, and immunosuppression. Central localization and S. aureus infection are common. Surgical incision and drainage remains the cornerstone of treatment, while duct excision offers excellent outcomes in recurrent or chronic cases. Early diagnosis, appropriate antimicrobial therapy, and individualized treatment strategies are vital to prevent recurrence and improve prognosis.

Background: Local skin infiltration of 2% lignocaine is a standard procedure which is usually used prior to lumbar puncture. It is invasive and itself leads to fear and anxiety in patients before application and is also associated with pain during the procedure. EMLA cream provides surface analgesia, hence the fear, anxiety and pain of analgesic infiltration is prevented. Against this background, the present study aimed to find out the efficacy of topical EMLA cream in comparison to the standard infiltration technique in reducing pain of needle insertion during lumbar subarachnoid block and have better patient satisfaction level.Methods: This prospective, single blinded, randomized controlled study was conducted in the Department of Anaesthesiology and Critical Care, Pt. B. D. Sharma PGIMS, Rohtak after obtaining approval from Institutional Ethical Committee. Patients aged 18-60 years, of either sex undergoing elective lower abdominal, pelvic and lower limb surgeries belonging to ASA grade I and II were selected. Sixty patients were divided into two groups of 30 each: Group1 EMLA- 2.5 gms of 5% EMLA cream per 10sq.cm was applied for a minimum of 60 minutes prior to lumbar puncture and covered with an occlusive dressing; Group 2 Lignocaine - skin and deeper structures were infiltrated with 2ml of 2% lignocaine just prior to lumbar puncture. Hemodynamic parameters, pain scores and patient satisfaction were recorded. Results: Demographic characteristics were comparable between the two groups. The heart rate and mean arterial pressure values before and after lumbar subarachnoid block were statistically similar between the two groups (p>0.05). VAS scores in both groups were comparable with no significant difference amongst the two groups. The 4-point pain scale was comparable with no statistical difference between the two groups (p=0.59). There was a significant difference in patient satisfaction score in the two groups (p=0.03). Conclusion: EMLA cream is an effective alternative to lignocaine infiltration for analgesia during administration of spinal anaesthesia when using a 25G spinal needle.

Introduction: Myeloneuropathy is a complex condition impacting both the spinal cord and peripheral nerves. Diagnosing this syndrome is often challenging, even for experienced clinicians, as its symptoms can resemble those of either spinal cord or peripheral nerve diseases. Furthermore, clinical examination may predominantly indicate either myelopathy or neuropathy. This article presents the varied causes of myeloneuropathy observed in a tertiary care hospital in Northeast India. Methods: This was a prospective observational study involving 14 patients diagnosed with myeloneuropathy at Gauhati Medical College and Hospital, Guwahati, Assam, India from November 2021 to October 2023. Diagnostic procedures included routine blood tests, chest X-rays, urinalysis, nerve conduction studies, MRI of the brain and spinal cord, cerebrospinal fluid analysis, and evaluation of immunological, infectious, and metabolic profiles. Results: The etiological analysis revealed Vitamin B12 deficiency in 42.8% of cases. Chronic liver disease was identified in 14.2%, HIV in 7.1%, Neurosarcoidosis in 7.1%, and Hashimoto’s disease in 7.1%. Folate deficiency was found in 7.1% of patients. Notably, 14.2% of cases had an unknown etiology. Conclusion: The study highlights a diverse etiological spectrum of myeloneuropathy. Vitamin B12 deficiency emerged as the predominant cause. The significant proportion of cases with unknown etiologies emphasizes the complexity of myeloneuropathy, necessitating a comprehensive and multidisciplinary diagnostic approach.

Background: Warts, also known as verrucae, are a prevalent kind of viral infection of the skin caused by the human papillomavirus. Benign tumors commonly occur in the skin and other epithelial tissues. Despite the availability of various therapies, effectively treating warts can be challenging, particularly when they are numerous and resistant to treatment. Recently, the treatment of warts has included the use of different immunotherapeutic drugs. Initially, Aktas et al studied the use of intralesional Vitamin D3 (Vit. D3) injection and documented encouraging results. Aim: To evaluate the efficacy of intralesional administration of Vit. D3 in the management of cutaneous warts. Objectives: 1. To provide a comprehensive analysis of the age distribution, sex distribution, number, duration, and kinds of cutaneous warts. 2. To evaluate the reduction in size and quantity of skin warts following each session of intralesional administration of Vit. D3. Material and Methods: This study comprised 30 patients with cutaneous warts who visited the Dermatology Outpatient Department (DVL OPD) at SVRRGG Hospital, Tirupati. The patients were treated with intralesional administration of Vit. D3 into the warts.  Results: The overall rate of total dissolution of cutaneous warts following the administration of Vit. D3 by injection was 66.67%.  Conclusion: Intralesional administration of Vitamin D3 injection is a novel therapeutic choice for the treatment of warts. The intervention is economically efficient, safe, and has shown significant benefits, especially in underdeveloped nations.

Background: Amongst all AMI anterior wall myocardial infarction (AWMI) is the most common variant and inferior wall myocardial infarction (IWMI) the second most common. It is now recognized with increased frequency of right ventricular infarction as an extension of inferior wall infarction, especially after proximal right coronary artery occlusion. ST segment elevation of ≥ 0.1mv in right precordial leads (V3R, V4R) on Electrocardiography is a readily available finding to diagnose RV infarction. Aims and objectives: To study the clinical features, risk factors, complications & overall mortality in acute inferior wall myocardial infarction (IWMI). To study the incidence of right ventricular infarction in patients with acute inferior wall myocardial infarction (IWMI). To study & compare the incidence & mortality rate in relation to various conduction abnormalities in between patients with acute inferior wall myocardial infarction (IWMI) & right ventricular infarction. Materials and methods: 100 patients with acute inferior wall myocardial infarction having a history of chest pain of any duration were included in the study. Standard 12 leads electrocardiography along with right side chest leads RV2, RV3, RV4 were taken on admission and on daily morning routinely for the first three days. Details of study was explained to patients & relatives. Written consent was taken from both. Permission of study was approved from ethical committee of Prakash Institute of medical sciences & research, Islampur. A detailed clinical history, examination & proper investigations were done to find out the presence of acute inferior wall myocardial infarction, right ventricular infarction, left & right ventricular failure, hypotension and cardiogenic shock at the time of admission & till discharge of patient. Each patient was subjected to investigations viz. 12 lead ECG & Right sided leads VR2, VR3, VR4, Chest X-ray, Echocardiography & cardiac enzymes. Results: In present study out of the total studied 100 patients of acute inferior wall myocardial infarction (AIWMI) 66% were male & 34% were female patients with M: F ratio 1.9:1, with mean age 57.4 years. The highest incidence of IWMI was noted in 51 to 60 years age group (44%). 41% were admitted within 12 hrs. of onset of symptoms, 87% of patients had chest pain, 34% patients had sinus bradycardia & 40% had AV conduction defects. Total mortality rate was 25% with highest incidence of 33.3% in age group 61-70 yrs. Mortality was highest 38.4% in patients without chest pain group compaired with chest pain group i.e. 22.9%. Incidence of IWMI & mortality was higher in risk factor groups. Incidence of mortality out of 100 cases & out of 25 total deaths in our study showed Tobacco users – 22.8% & 32%, Hypertension – 21.8% & 28%, Diabetes Mellitus – 34.6% & 36%, Alcohol users – 31.5% & 24% respectively. Mortality rate in relation to Killip’s class was 19.2% in class II, 41.6% in class III, 75% in class IV. Incidence of atrioventricular defects & intraventricular defects was 45% & 11% with mortality rate of 26.6% & 63.6% respectively. Highest mortality was in non Thrombolysed group i.e. 27.38% & in Q wave infarct group it was 28%. In present study out of 100 cases 46 had RV infarction with higher mortality rate (17 out of 46 - 36.9%) than Inferior wall infarction (8 out of 54 - 14.81%). Incidence & mortality in class IV (Cardiogenic shock) in Group A & B was 5/3 (60%), 15/13(86.6%), Bradycardia 14/4 (28.57%), 20/10(50%), Nodal rhythm 4/2 (16%) & 16/4 (43.7%) respectively. In conduction blocks especially IIIrd degree, incidence & mortality was higher 12% & 50% respectively suggesting higher incidence & mortality in RV infarction than IWMI. Conclusion: Considering clinical presentation in acute inferior wall myocardial infarction with no chest pain MI having high mortality, also high complications & mortality rate in risk groups like Tobacco users, Diabetics & Hypertensive patients, and proper educational programs are needed. Complications and in-hospital mortality rates were more in patients with conduction blocks, especially it is higher in right ventricular infarction so immediate & proper investigations, interventions & treatment is needed to reduce adverse outcomes.

Introduction: Tuberculosis (TB) is the most common opportunistic infection associated with HIV in India, posing a significant public health challenge. AIM: Study of Clinical Profile of Tuberculosis in HIV/AIDS patients and its relationship with CD4 count.  Methodology: The study was conducted in the Department of General Medicine at Mahatma Gandhi Medical College & Hospital, Jaipur, from April 2023 to September 2024. The study population included all HIV-infected patients attending the Anti-Retroviral Treatment (ART) clinic in the Department of Medicine during this period. Result: In this study of 156 HIV-positive patients, the majority were males (62.2%) and aged 30–39 years, with 54.5% from rural areas. Fever (87.8%) was the most common symptom, and pleural effusion (35.9%) was the most frequent radiological finding. Extra-pulmonary TB was more prevalent (51.9%) than pulmonary (38.5%) or disseminated TB (9.6%), and lower CD4 counts were associated with more severe forms, including MDR-TB. Conclusion: HIV-TB co-infection commonly affects younger, high-risk individuals, with extra-pulmonary TB being more prevalent and diagnostically challenging. Early recognition of varied clinical presentations is crucial for prompt diagnosis and effective management.

Introduction: Acute myocardial infarction (AMI), commonly known as a heart attack, remains a significant global health burden and one of the leading causes of mortality worldwide. AIM: Study of relationship of Serum Ferritin in Acute Myocardial Infarction. Methodology: This hospital-based observational case-control study was conducted in the Department of Medicine at Mahatma Gandhi Medical College and Hospital, Jaipur, a tertiary care centre, over a period of 18 months from April 2023 to September 2024. Result: The study found significantly elevated serum ferritin levels (≥200 μg/L) in 63.8% of MI patients versus 18.2% of non-MI individuals (p < 0.0001), highlighting its strong association with myocardial infarction. Serum ferritin also showed strong positive correlations with Troponin-I, CK-MB, and hs-CRP, supporting its role as an inflammatory marker in acute myocardial injury. Conclusion: Serum ferritin levels were significantly elevated in acute MI patients and showed strong correlations with key cardiac biomarkers, indicating its role in myocardial injury and inflammation. These findings support ferritin’s potential as a reliable adjunctive biomarker for MI diagnosis and risk assessment.

Background: Hypertensive emergencies in pregnancy, especially severe preeclampsia and eclampsia, are critical contributors to maternal and fetal morbidity. Prompt control of blood pressure is essential to prevent complications. In developing countries like India, where maternal deaths due to preeclampsia are still unacceptably high, evaluating cost-effective and practical protocols for hypertensive emergencies becomes essential. This study compares the efficacy of intravenous labetalol and oral nifedipine in achieving rapid BP control in pregnant women presenting with hypertensive emergencies. Materials and Methods: This is a Prospective, comparative, randomized study conducted in the Department of Obstetrics and Gynecology at a tertiary care hospital over 12 months involving 100 pregnant women with hypertensive emergencies was conducted. Group A received intravenous labetalol; Group B received oral nifedipine. Both groups were monitored for time to achieve target BP, maternal side effects, and fetal outcomes. Data analyzed using SPSS v20. Mean, SD, t-tests, and chi-square used. P < 0.05 was considered significant. Results: Group A (IV labetalol) showed faster BP control (mean time: 25 ± 8 min) compared to Group B (nifedipine: 35 ± 10 min). Adverse effects were minimal in both groups. Perinatal outcomes were comparable. Conclusion: Intravenous labetalol offers faster blood pressure control with fewer maternal side effects in hypertensive emergencies of pregnancy, though both labetalol and nifedipine are safe and effective. Drug choice can be guided by clinical setting, availability, and patient-specific factors.

Introduction: Hypoalbuminemia has been found to be associated with increased morbidity and mortality in acute surgical patients. Any surgical procedure induces a stressful and catabolic state. Wound healing is also a catabolic process requiring adequate protein and energy reserves. Severely malnourished patients often demonstrate impaired wound healing and an increased predisposition to infection and other postoperative complications. Aims: To evaluate the role of preoperative serum albumin levels as a predictor of postoperative outcomes in patients undergoing emergency surgeries. Materials and Methods: This hospital-based prospective study was conducted in the Department of General Surgery, AGMC & GBP Hospital, from January 2021 to June 2022. A total of 64 patients undergoing emergency abdominal surgeries were included. Serum albumin levels were measured preoperatively. Postoperative outcomes, including surgical site infection, pulmonary complications, ventilatory support, sepsis, ileus, cardiac events, hospital stay duration, and mortality, were recorded and analyzed in relation to albumin levels. Results: Patients with hypoalbuminemia (<3.5 gm/dL) had a significantly higher incidence of postoperative complications, including surgical site infections (p < 0.001), sepsis (p < 0.001), prolonged hospitalization (p < 0.001), and mortality (p < 0.001), compared to those with normal albumin levels. Mean serum albumin levels were significantly lower in patients with complications than those without. Conclusion: Preoperative serum albumin level is a simple, cost-effective, and reliable biochemical marker that can predict postoperative morbidity and mortality in emergency surgical patients. Early identification and nutritional optimization may improve surgical outcomes.

Introduction: Congenital heart disease (CHD) is the most common congenital malformation worldwide. Approximately, 1 in every 100 babies are born with CHD, with 1 in 4 births with critical CHD. Aims: To analyze the epidemiology and identify the key contributing factors associated with the delayed diagnosis of congenital heart disease (CHD) in pediatric patients. Materials & Methods: The present study was Retrospective study. This Study was conducted from Jan 2024 to Dec 2024 for one year at Department of Paediatric Cardiology, Sri Satya Sai Sanjeevani center for child heart care, Kharghar, Navi Mumbai, a tertiary care center. Total 1991 patients were included in this study. Result: The data shows the distribution of participants across age groups: 7.10% are 0 to 1 month, 36.60% are 1 month to 1 year, 30.20% are 1 to 5 years, 16.70% are 5 to 10 years, and 9.30% are more than 10 years. The total sample size is 1991, with the p-value being less than 0.00001, indicating statistically significant results. The gender distribution of the sample shows that 46.00% are female and 54.00% are male, with a total of 1991 participants. The p-value is less than 0.00001, indicating a statistically significant difference. This suggests a notable gender imbalance in the sample. The data on who provided the information shows that 38.30% of responses came from both parents, 26.80% from fathers, 30.50% from mothers, and 4.40% from others. The total sample size is 1991, with a p-value less than 0.00001, indicating statistical significance. This suggests a meaningful difference in who provided the information. Conclusion: We concluded that, delayed diagnosis of congenital heart disease (CHD) is influenced by multiple epidemiological and socio-demographic factors. Our study highlights significant delays based on age, parental involvement, and living environment, with the highest delays observed in rural and slum areas.

Introduction: Congenital heart disease (CHD) is the most common congenital anomaly in children, and early diagnosis is critical for timely management and improved outcomes. However, many cases are diagnosed late, particularly in resource-constrained settings. Identifying the clinical patterns and risk factors associated with delayed detection is essential for enhancing early recognition and referral. Aims: To evaluate the clinical profiles and determine the risk factors associated with delayed detection of congenital heart disease in children attending a tertiary cardiac care center. Materials and Methods: This was a hospital-based cross-sectional observational study conducted at a tertiary cardiac care center. A total of 1991 pediatric patients diagnosed with CHD were enrolled. Data regarding age at diagnosis, clinical presentation, family history, birth term, consanguinity, and other relevant demographic and clinical factors were collected and analyzed. Patients were categorized into delayed and non-delayed diagnosis groups based on the age at diagnosis, and comparisons were made to identify associated risk factors. Results: Out of 1991 children with CHD, 706 (35.5%) had a delayed diagnosis. Family history ofCHD, birth term, and consanguinity were analyzed. No significant association was found between delayed diagnosis and family history (p = 0.688) or consanguinity (p = 0.699). However, birth term showed a statistically significant association (p = 0.029), with full-term births being more likely to have delayed diagnosis compared to preterm or 9th-month deliveries. The most common clinical presentations in delayed cases included failure to thrive, recurrent respiratory infections, and cyanosis. Conclusion: Delayed diagnosis of CHD remains a significant issue in pediatric cardiology. Although family history and consanguinity were not significantly associated, birth term was a contributing factor. Awareness and routine screening during early infancy may help in early detection and intervention, particularly in full-term babies who may not show early signs.

Background: Chronic Kidney Disease (CKD) is a significant public health concern, and early detection is crucial for preventing disease progression. Ultrasound is an ideal imaging modality for CKD due to its non-invasive nature and accessibility. This study aimed to evaluate the correlation between renal cortical thickness, renal echogenicity, and renal size with eGFR in CKD patients. Research Question: Is there a correlation between renal cortical thickness, renal echogenicity, and renal size with eGFR in CKD patients? Methods: A one-year observational study was conducted at the Department of General Medicine, Mahatma Gandhi Medical College and Research Institute, Pondicherry, from January 2024 to December 2024. Ninety-one CKD stage 1-5 patients attending the General Medicine OPD were included in the study. Socio-demographic profiles, hemoparameters (eGFR, hemoglobin, serum sodium, serum potassium, serum calcium, serum phosphorus, serum creatinine, and blood urea), and ultrasound parameters (renal cortical thickness, renal echogenicity, and renal size) were studied. Results: The study population had a mean age of 55 years, with a higher burden of disease between 41-60 years (66%). Males (77%) had higher morbidity compared to females (23%). The mean values of hemoparameters were: hemoglobin (8.87 ± 1.94 g/dl), serum calcium (7.75 ± 1.04 mg/dl), serum phosphorus (3.89 ± 1.04 mg/dl), serum sodium (134.3 ± 3.14 mmol/L), serum potassium (6.17 ± 13.04 mmol/L), serum creatinine (3.57 ± 2.33 mg/dl), and blood urea (59.57 ± 23.16 mg/dl). The mean eGFR value was 24.92 ± 13.77 ml/min/1.73m². Significant abnormal values of hemoparameters were observed in relation to decreased eGFR and grading of renal echogenicity. There was a significant (P<0.01) reduction in mean values of eGFR, renal size, and renal cortical thickness with increasing renal echogenicity grade. A significant correlation was observed between renal cortical thickness, renal echogenicity, and renal size with eGFR. Conclusion: This study demonstrates a significant correlation between renal cortical thickness, renal echogenicity, and renal size with eGFR in CKD patients. These ultrasound parameters can be useful in monitoring disease progression and predicting renal function decline.

Background: Surgical closure of intracardiac left to right shunt in children with pre-existing Pulmonary Atrial Hypertension (PAH) can aggravate the elevated Pulmonary Atrial Pressure (PAP) and exacerbate episodes of hypertensive crisis and acute right ventricular dysfunction. Pulmonary vasodialators like Milrinone and Levosimendan when used in systemic route also cause systemic hypotension and their feasibility as selective pulmonary vasodialator when administered in inhaled route is subject of investigation.  Objectives: To compare the efficacy of inhaled milrinone and inhaled levosimendan in reducing elevated PAP in such children.  Methods: In this one-way, parallel group,single blinded, Randomised Trial, child of 1 to18 years of age with left to right shunt with mean PAP more than 30mm Hg have been studied. They were randomly allocated two equal groups, Group 1 received inhaled milrinone (50 μg/kg) and group 2 received inhaled Levosimendan (24 μg/kg) after arrival in the post-operative cardiac ICU room post-surgical correction and evaluated for Transthoracic Echo variables like changes in Pulmonary Artery Systolic Pressure (PASP) at different time points up to 6 hr after completion of inhalation of study drug. Numerical variables have been compared by Student’s t-test. Results: Although both Inhaled Milrinone and Inhaled Levosimendan are effective in reducing elevated pulmonary artery systolic pressure without causing systemic hypotension in children with congenital heart disease with left to right intra cardiac shunt with pulmonary hypertension undergoing surgical correction under CPB, inhaled levosimendan has longer duration of action. Conclusion: Inhaled levosimendan lowered pulmonary artery pressure like inhaled milrinone in post-surgical closure in such children but for longer duration making Inhaled Levosimendan a better option.

Background: Hepatobiliary mass lesions present a diagnostic challenge due to their varied etiology and imaging characteristics. Triple phase multidetector computed tomography (MDCT) has emerged as a reliable non-invasive imaging modality for evaluating vascular patterns, lesion characterization, and anatomical delineation essential for diagnosis and treatment planning. Materials and Methods: This prospective observational study included 60 patients clinically suspected of having hepatobiliary masses. All patients underwent triple phase MDCT imaging using a standardized protocol including arterial, portal venous, and delayed phases. Imaging features such as enhancement patterns, lesion margins, vascular involvement, biliary obstruction, and presence of metastasis were analyzed. Final diagnoses were established through histopathological correlation or clinical follow-up. Sensitivity, specificity, and diagnostic accuracy of MDCT were calculated. Results: Out of 60 cases, 38 were malignant (63.3%) and 22 were benign (36.7%) lesions. Common malignant lesions included hepatocellular carcinoma (n=20), cholangiocarcinoma (n=10), and metastatic lesions (n=8). Benign lesions included hemangiomas (n=9), focal nodular hyperplasia (n=6), and simple cysts (n=7). MDCT demonstrated an overall sensitivity of 92%, specificity of 85%, and diagnostic accuracy of 89% in differentiating malignant from benign lesions. Characteristic arterial phase hyperenhancement with washout in the venous phase was noted in 85% of HCC cases. Biliary tract dilatation and delayed enhancement were typical findings in cholangiocarcinoma. Conclusion: Triple phase MDCT is a highly effective diagnostic modality for hepatobiliary mass lesions, enabling accurate characterization and aiding in therapeutic decision-making. Its ability to delineate vascular and biliary anatomy is especially valuable in surgical planning.

Background: Blood donation can save someones life .Normally blood donation is a safe procedure. But some times adverse reactions can occur. Adverse donor reaction is  an event or complication experienced by the donor before, during, or after the blood donation process. Objective: To estimate the proportion of adverse events occurring due to blood donation in healthy donor, To assess the type of adverse events during blood donation and to look for associated factors with adverse reaction. Materials and Methods: This study was a record based cross sectional study at Blood centre of Dr.Somervell Memorial CSI Medical College &Hospital, Karakonam in Thiruvananthapuram, Kerala from 1st January 2019 to 31st december 2023 after getting approval from Institutional Ethics Committee .Whole Blood donors from outreach camp s and those who attend the blood center were included. Parameters assessed were type of ADR,Gender,reaction in first time donors or repeat donors . Results: From 1 January 2019 to 31 December 2023 total number of donors was 7777 in which 7453 were males(95.8%) and 324 were females(4.2%). Among 7777 total donors 25 donors had adverse donor reaction (0.32%). Out of which 24 are males and 1 female. There were 15 first time donors and 10 repeat donors. Vasovagal syncope was the most common systemic donor reaction developed in 23 donors.One donor developed Local reaction mainly numbness  Conclusion: The adverse donor reaction  can be reduced by improving screening protocols . By reducing the adverse reactions during and after donation, the donor return rate can be improved

Background: The perimenopausal age is a transitional period marked by decreasing ovarian follicular reserve and drop in estrogen and progesterone levels. Along with the hormonal changes, women are more susceptible to micronutrient deficiency like anaemia and non-communicable diseases like osteoporosis, arthritis, hypertension, obesity, diabetes, cancer and mental health problems during this period. Tea garden community especially the women represent one of the most socioeconomically marginalized ethnic groups in Assam. This study tries to compare the women from tea garden with that of the women from non tea garden village areas to differentiate risk factors for health status and morbidity profile. Methodology: This is a community based cross sectional comparative study. The study universe is women in the age group 35-55 years. Cluster sampling technique used for obtaining the given sample size. The sampling units for data collection were the tea gardens or villages. The participants of the tea garden community were selected from two blocks having majority of the tea garden population and the participants of the non tea-garden community were selected from the other two blocks. Results: The mean age among tea-garden women was 45±5.7 years and among non tea-garden women was 47±6.3 years (p=0.023, t-test=4.708). Majority of the tea garden women were financially independent (72.5%) but majority of the non tea garden women were financially dependent on their spouse or other family members (69.75%) [P<0.0001, 95%CI= 2.105-2.958]. Body Mass Index (BMI) among the tea-garden women was low in 32.75%,; whereas among the non tea-garden women BMI was low in 24% (P=0.0001, chi square= 17.946). Blood pressure among the tea-garden women was pre-hypertensive in 37.5% and hypertensive in 34.25% of participants, whereas among the non tea-garden women blood pressure was pre-hypertensive in 32.25% and hypertensive in 25.75% of participants (P=0.0002, chi square= 17.162). Conclusion: In our study, majority of the tea garden women had low education (p<0.0001), economically backward (p<0.0001). On the other hand, perimenopausal women in non tea garden areas had access to better housing and environment, higher proportion of overweight (p=0.0001). Among the morbidities, higher prevalence of anaemia (p<0.0001) and hypertension (p=0.0002) was observed among the women in tea garden; whereas, joint pain, muscle cramp, Mood swing, disturbed sleep were more common among the women in non tea garden areas.

Background: Ethics and professionalism are fundamental components of medical education. Traditional lecture-based methods often fail to engage students meaningfully in these complex domains. This study evaluates the effectiveness of Problem-Based Learning (PBL) as an innovative approach to teaching ethics and professionalism among Phase II MBBS students. Objective: To enhance knowledge, ethical decision-making, attitudes, and communication skills related to ethics and professionalism through the introduction of PBL. Methods: A descriptive interventional study was conducted among 138 Phase II MBBS students at KIMS & RF, Amalapuram. Pre-test and post-test assessments were carried out using validated questionnaires covering four key domains: Knowledge Understanding, Ethical Decision Making, Attitudes & Perceptions, and Communication & Skills. Data were analyzed using descriptive statistics and paired t-tests, with significance set at p < 0.05. Results: Significant improvements were observed across all parameters following the PBL intervention. Mean Knowledge Understanding scores increased from 2.68±0.68 to 7.64±0.71. Ethical Decision Making improved from 2.65±0.66 to 7.59±0.72. Attitudes & Perceptions rose from 2.78±0.68 to 7.38±0.91, and Communication & Skills improved from 2.74±0.67 to 7.49±0.90. Paired t-tests revealed statistically significant differences (p < 0.001) in all domains, confirming the effectiveness of PBL. Conclusion: The introduction of PBL significantly enhanced ethical knowledge, decision-making, attitudes, and communication skills among medical students. This learner-centered approach can be a valuable addition to undergraduate medical education to prepare students for ethical challenges in clinical practice.

Background: Helicobacter pylori (H. pylori) infection is a key etiological factor in chronic gastritis, contributing significantly to gastric mucosal alterations that can progress to peptic ulcer disease and gastric carcinoma. Histopathological examination of gastric biopsies provides essential insights into the spectrum of mucosal changes and aids in appropriate clinical management. Materials and Methods: A total of 150 gastric biopsy specimens from patients with clinically suspected chronic gastritis were analyzed. The specimens were fixed in 10% formalin, processed routinely, and stained with Hematoxylin and Eosin (H&E). Modified Giemsa stain was used to identify H. pylori. Histological features such as chronic inflammation, activity (neutrophilic infiltration), glandular atrophy, intestinal metaplasia, and lymphoid aggregates were assessed using the Updated Sydney System Results: Out of 150 biopsies, H. pylori was detected in 93 cases (62%). Chronic inflammation was seen in 135 cases (90%), while neutrophilic activity was noted in 78 cases (52%). Glandular atrophy was observed in 36 cases (24%), and intestinal metaplasia in 21 cases (14%). Lymphoid aggregates were present in 60 biopsies (40%). Among H. pylori-positive cases, 85% showed moderate to severe chronic inflammation, 70% exhibited active inflammation, and 32% had glandular atrophy. A statistically significant association was found between H. pylori infection and the presence of glandular atrophy and intestinal metaplasia (p < 0.05). Conclusion: H. pylori-associated chronic gastritis presents with a broad histopathological spectrum ranging from mild inflammation to atrophic changes and intestinal metaplasia. Early detection and histological grading are vital for the prevention of long-term complications including gastric malignancies. Routine gastric biopsies in dyspeptic patients enhance diagnostic accuracy and guide therapeutic decisions

Background: Muscle oxygen saturation (SmO₂) reflects local oxygen utilization during exercise and is a vital indicator of muscular and cardiovascular efficiency. Near-infrared spectroscopy (NIRS) offers a non-invasive method to monitor real-time changes in SmO₂. This study aimed to compare SmO₂ dynamics during graded exercise in trained and untrained individuals to evaluate the impact of physical conditioning on oxygen kinetics. Materials and Methods: A total of 30 participants (15 trained athletes and 15 untrained healthy individuals) aged 18–30 years were recruited. All participants underwent a standardized incremental cycling protocol on an ergometer. Muscle oxygen saturation was continuously measured using portable NIRS devices placed on the vastus lateralis muscle. Heart rate, perceived exertion (RPE), and SmO₂ were recorded at baseline, each workload stage, and immediately post-exercise. Data were analyzed using repeated-measures ANOVA with significance set at p<0.05. Results: At rest, the mean SmO₂ was significantly higher in trained individuals (78.4% ± 3.2) compared to untrained individuals (72.1% ± 4.5). During peak exercise, SmO₂ decreased to 42.5% ± 5.3 in the trained group and 35.2% ± 6.1 in the untrained group (p=0.01). Trained participants demonstrated faster recovery in SmO₂ values post-exercise (return to baseline in 90 ± 12 seconds) compared to untrained individuals (130 ± 18 seconds). Heart rate and RPE were also significantly lower in the trained group at comparable workloads. Conclusion: Trained individuals exhibit higher baseline muscle oxygen saturation, reduced desaturation during exercise, and faster post-exercise recovery, indicating more efficient oxygen utilization. NIRS can serve as a reliable tool for assessing training status and monitoring exercise performance

Background: Early enteral feeding after bowel resection may preserve gut integrity, reduce catabolism, and accelerate recovery, but traditional protocols delay intake until return of bowel function. Aim and Objectives: Aim  To evaluate whether initiating clear-liquid feeding at 24 hours postoperatively (early enteral feeding, EEF) versus delaying oral intake until clinical return of gastrointestinal function (delayed feeding, DF) improves recovery in adults aged 18–60 years undergoing elective bowel resection. Primary Objectives: 1. Compare time to first flatus. 2. Compare time to first bowel movement. 3. Compare total postoperative hospital stay. Secondary Objectives: 4. Compare 30-day complication rates (anastomotic leak, wound infection, pneumonia, ileus). 5. Measure serum albumin and prealbumin on postoperative day 5. 6. Compare VAS pain scores on postoperative days 1–5. 7. Compare 30-day readmission rates. 8. Assess patient satisfaction at discharge. 9. Explore subgroup effects by age (18–39 vs. 40–60 years) and resection type (small vs. large bowel). Methods:  In this randomized trial during the period of January 2020 to December 2025, 200 patients (18–60 y) undergoing elective bowel resection were allocated 1:1 to EEF (clear liquids at 24 h) or DF (clear liquids after flatus + bowel sounds). Sample size (90 per arm + 10 % dropout) provided 80 % power to detect a 1.5-day difference in stay (σ = 3 days) at α = 0.05. Primary endpoints: time to first flatus, first bowel movement, and length of stay; secondary endpoints as above. Results: Of 200 randomized (100 EEF, 100 DF), 20 (10 %) withdrew (10 per arm), leaving 180 evaluable (90 / 90). EEF reduced time to flatus by 18 h (36 ± 12 h vs. 54 ± 16 h) and to bowel movement by 24 h (60 ± 18 h vs. 84 ± 20 h; both p < 0.001), and shortened stay by 2.3 days (6.2 ± 1.8 d vs. 8.5 ± 2.3 d; p < 0.001). Complication rates were similar (13.3 % vs. 15.6 %; p = 0.68). On POD 5, serum albumin (3.8 ± 0.4 vs. 3.4 ± 0.5 g/dL; p = 0.002) and prealbumin (18.2 ± 3.1 vs. 15.7 ± 3.4 mg/dL; p = 0.001) were higher with EEF. Pain scores improved from POD 2 onward (p ≤ 0.04). Patient satisfaction was greater (88.9 % vs. 75.6 %; p = 0.01) with a trend to fewer readmissions (5.6 % vs. 11.1 %; p = 0.18). Conclusion:  Early feeding at 24 h post-resection safely accelerates GI recovery, shortens stay, and improves nutrition, pain, and satisfaction without increasing complications.

Background: Appendectomy is among the most frequently performed emergency surgical procedures. Correlating the surgeon’s intraoperative assessment with definitive histopathology can identify unexpected disease and improve patient management. Objective: To describe the histopathological spectrum of 1,500 appendectomy specimens from patients aged 5–45 years treated between January 2022 and June 2025 at a tertiary care hospital, and to assess concordance between intraoperative findings and histopathological diagnoses. Methods: This retrospective study included all patients aged 5–45 years who underwent appendectomy from January 1, 2022, through June 30, 2025, at Katihar Medical College Hospital, Katihar, Bihar. A total of 1,500 specimens were reviewed. Intraoperative appearance was categorized as inflamed, gangrenous, perforated, or normal. Histopathological examination classified specimens as acute appendicitis, chronic appendicitis, follicular hyperplasia, parasitic infestation, neoplasm, or normal appendix. Agreement between intraoperative and histopathological diagnoses was measured using Cohen’s kappa statistic. Results: Of 1,500 patients, mean age was 28.4 years (range 5–45), with 840 (56.0%) males. Intraoperatively, 1,200 (80.0%) appeared inflamed, 150 (10.0%) gangrenous, 100 (6.7%) perforated, and 50 (3.3%) macroscopically normal. Histopathology confirmed acute appendicitis in 1,300 (86.7%), chronic appendicitis in 100 (6.7%), follicular hyperplasia in 40 (2.7%), parasitic infestation in 30 (2.0%), neoplasm in 20 (1.3%), and normal appendix in 10 (0.6%). Overall concordance between intraoperative assessment and histopathology was substantial (κ = 0.82; 95% CI, 0.79–0.85). Conclusion: Surgeons’ intraoperative assessments demonstrated high concordance with histopathology. However, a subset of macroscopically normal appendices harbored unexpected pathology, supporting routine histological examination of all appendectomy specimens.

Background: Hypertension (HTN) is a growing non-communicable disease burden in India, often diagnosed late due to its asymptomatic nature. Early clinical and metabolic profiling of newly detected hypertensive patients is crucial for timely intervention and prevention of long-term complications. Aim: To assess the clinical and metabolic profile of patients newly diagnosed with hypertension in an outpatient setting. Methods: This prospective observational study was conducted at Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai, over one year. A total of 100 adult patients newly diagnosed with hypertension, as per JNC 8 guidelines, were enrolled after informed consent. Patients with diabetes, CKD, ischemic heart disease, pregnancy, or on interfering medications were excluded. Detailed clinical history, anthropometric measurements, laboratory parameters, ECG, and 2D echocardiography were recorded and analyzed using appropriate statistical methods. Results:Among the 100 participants, 77% were male and 23% female, with the highest age group representation in those ≥60 years. Stage I hypertension was more common (70%), and headache was the most frequently reported symptom. Overweight and obesity were noted in the majority, with a statistically higher BMI in females. Metabolic assessment revealed elevated cholesterol in 71% and abnormal HDL levels in 88%, with significantly lower HDL and higher cholesterol in females. ECG abnormalities, particularly left ventricular strain and hypertrophy, were frequent. Cardiac involvement showed significant gender variation, with RWMA more prevalent in females. Renal artery Doppler abnormalities were detected in 11% of patients. Conclusion: Newly diagnosed hypertensive patients exhibit a range of clinical and metabolic abnormalities at presentation. Early detection, lifestyle modification, and comprehensive evaluation, including lipid profiling and cardiac assessment, are essential in guiding effective management and reducing long-term cardiovascular risk.

Background: Thoracic injury represents a leading indication for emergency surgical admission and is responsible for a significant proportion of morbidity and mortality related to trauma. Early diagnosis and the delivery of appropriate interventions are critical to optimizing patient results, especially within the context of a resource-limited environment. Objective: The objective of the current research was to assess the clinical presentation, management, and outcome of chest trauma patients who were admitted to a tertiary care facility. Method: We had a one-year prospective observational study on all patients with thoracic injury admitted under the general surgery, cardiothoracic, and orthopedic services. We had emergency procedures, radiological investigations, and complete clinical assessment whenever required. Descriptive statistics were used to compare data on mode of treatment, nature of trauma, complications, and outcomes, and demographics. Result: A total of 70 patients were studied with a significant predominance of males (91.4%) and a mean age of 31.3 years. Blunt trauma was the most frequent (80%), mainly due to road traffic accidents (60%), and followed by assaults and falls. The most frequent injury was rib fractures (68.6%). Intercostal chest tube drainage was the primary management in 77.1% of the cases, and 10% needed thoracotomy. Complication was 19.3%, and the most frequent infection was. Mortality occurred in 5.7% of the cases, mostly due to related head injuries. The mean hospital stay was 8.9 days, and the majority of the patients had complete recovery in follow-up. Conclusion: In summary, blunt chest trauma due to road traffic accidents is the most frequent cause of thoracic injuries. Early diagnosis and timely surgical repair are crucial in minimizing complications and maximizing patient survival.

Background: Intestinal stomas are surgically created openings on the abdominal wall to divert fecal matter. They are essential in managing gastrointestinal pathologies but are associated with various complications. Objective: To analyze the indications for stoma creation, identify associated complications, and evaluate strategies for effective management. Methods: A prospective and retrospective observational study was conducted between October 2021 and September 2023 at Osmania General Hospital and Niloufer Hospital. Data from 100 patients undergoing intestinal stoma construction were analyzed. Results: Most common age group for stoma creation was 26–35 and 46–55 years. Males accounted for 61% of the study population. Loop ileostomy was the most frequent procedure (60%). Common indications included gastrointestinal malignancies (25%) and abdominal trauma (22%). Complications occurred in 82% of patients, with skin excoriation being the most common (52.4%). Mortality was reported in 2 cases (2%). Conclusion: Loop ileostomy remains the most common form of stoma, often performed in emergency settings. Early identification and management of complications—especially skin-related—can improve outcomes. Preoperative education and careful stoma site selection are essential preventive measures

Background: Renal transplantation remains the preferred therapeutic intervention for end-stage renal disease (ESRD), providing enhanced survival and significant improvements in quality of life (QoL). Accurate evaluation of post-transplant QoL is essential for optimizing long-term care strategies. Objective: To assess the QoL in post-renal transplant patients using the WHOQOL-BREF tool and analyze its association with demographic and clinical variables. Methods: This cross-sectional study was conducted at Manipal Hospital, Whitefield, Bangalore, between February 2021 and July 2022. A total of 103 renal transplant recipients who underwent transplantation within the last three years were evaluated through telephonic interviews. WHOQOL-BREF was used to assess four QoL domains. Data were analyzed using SPSS v25; statistical significance was set at p<0.05. Results: The mean global QoL score was 73.9±9.3. Domain-specific means were: Physical (77.2±10.1), Psychological (79.1±9.4), Social (75.4±11.1), and Environmental (69.6±10.4). Participants aged below 35 years and those more than two years post-transplant reported higher scores. Gender-wise, males showed marginally better QoL across domains. Conclusion: QoL following renal transplantation was observed to be high, especially among younger recipients and those further along in the post-transplant phase. Structured follow-up, personalized interventions, and holistic care can contribute to further improving QoL outcomes in this group.

Background: Mucormycosis, a life-threatening fungal infection caused by Mucorales, witnessed a surge during the COVID-19 pandemic in India. Accurate and timely identification of the etiological agent is crucial for effective management. Aim: This study compares conventional mycological methods with MALDI-TOF mass spectrometry for the identification of fungal isolates in clinically suspected COVID-19-associated mucormycosis (CAM). Methods: A total of 100 biopsy samples from suspected CAM cases were analyzed using KOH/Calcofluor staining, cultured on SDA/DRBC, and identified using both conventional techniques and MALDI-TOF MS. Patient demographics, risk factors, and clinical profiles were documented. Results: Most patients were middle-aged males (77%) with diabetes (97%). Rhizopus spp. was the predominant genus (44%). MALDI-TOF achieved 100% concordance with conventional methods at the genus level and identified R. microsporus (40%) and R. arrhizus (32%) as the most common species. One isolate identified as A. flavus conventionally was reclassified as A. ochraceous by MALDI-TOF. Conclusion: MALDI-TOF offers a rapid and reliable means of species-level identification of filamentous fungi, enhancing our understanding of molecular epidemiology and supporting targeted antifungal therapy.

Background: Yoga practices are time–honored stress management/health promotion techniques whose health benefits are being validated by modern medical science. Modern life style stresses have been shown to be a major contributory factor to many diseases including coronary vascular diseases(CVD). Aim and objective: The present study was done to know the effect of practicing yoga for 6 months on heart rate and blood pressure in healthy individuals above the age group of 35 years. Materials and methods: A prospective study was carried out in 100 healthy individuals, aged above 35 years. The subjects were first trained under the guidance of a certified yoga trainer. Then they carried out yoga for 6 months which included various asanas, pranayamas and meditaton. Cardiovascular status of the subjects was assessed clinically in terms of resting heart rate and blood pressure before the start of yoga and then after 2 months, 4 months and again after 6 months of yoga practice.  Results:  regular practice of yoga for 6 months resulted in significant reduction in heart rate, systolic blood pressure, diastolic blood pressure and weight. The results were statistically highly signiuficant.(p<0.001) Coclusion: Regular practice of yoga for six months reduced the Cardiovascular hyper-reactivity possibly by inducing parasympathetic predominance and cortico-hypothalamomedullary inhibition.

Background: Type 2 diabetes mellitus (T2DM) is increasingly prevalent among young individuals due to sedentary lifestyles and unhealthy dietary habits. While awareness regarding diabetes prevention exists, there is often a gap between knowledge and its application in daily life. This study assesses the knowledge, attitude, and practice (KAP) of young students in Ghaziabad regarding diet and exercise in diabetes prevention. Methods: A cross-sectional survey was conducted among 300 students (mean age: 21.3 ± 1.9 years) between January and June 2024. A self-administered questionnaire measured KAP using a 5-point Likert scale. Statistical analyses, including t-tests, ANOVA, Pearson correlation, and linear regression, were performed to assess the relationships between demographic variables and KAP scores. Results: The findings revealed intermediate knowledge (Mean = 3.6 ± 0.8), positive attitudes (Mean = 4.1 ± 0.6), but poor practices (Mean = 3.3 ± 0.7). Male students, those with a family history of diabetes, and postgraduates had significantly higher knowledge and practice scores (p < 0.05). Pearson’s correlation showed significant positive relationships between knowledge-attitude (r = 0.42, p < 0.01) and knowledge-practice (r = 0.39, p < 0.01). Regression analysis identified knowledge score, gender, and family history as significant predictors of healthy practices (p < 0.05). Conclusion: Despite good knowledge and attitudes, students demonstrated poor implementation of preventive behaviors. Educational interventions targeting behavioral changes are essential for reducing diabetes risk among youth.

Background: Intrauterine Growth Restriction (IUGR) is a significant obstetric complication characterized by fetal growth below the 10th percentile for gestational age, leading to increased perinatal morbidity and mortality. Abnormal maternal lipid metabolism has been implicated in its pathogenesis. Objective: To assess the association between maternal and cord blood lipid profiles and IUGR in pregnant women at a tertiary care hospital. Methods: Sample size was calculated using the formula for comparison of two means: N = [(Z₁-α/2 + Z₁-β)² × (SD₁² + SD₂²)] / d² Based on Kwaeri et al., with SD₁ = 20.3 mg/dL, SD₂ = 14.8 mg/dL, and d = 10 mg/dL, the sample size was 49.8 per group (rounded to 50), totaling 100 participants. Consecutive sampling was employed. This analytical observational case-control study included 100 pregnant women (50 with IUGR and 50 controls with adequate-for-gestational-age fetuses). Maternal fasting blood samples were collected during the third trimester, and cord blood samples were obtained immediately after delivery. Lipid profiles, including total cholesterol, triglycerides, HDL, LDL, and VLDL, were analyzed. Statistical comparisons were performed using Student’s t-test and Chi-square test, with p < 0.05 considered significant. Results: Maternal cholesterol, triglycerides, LDL, and VLDL levels were significantly higher, and HDL levels were lower in the IUGR group compared to controls (p < 0.001). Similarly, cord blood from IUGR neonates showed elevated triglycerides and VLDL, and reduced cholesterol and HDL levels (p < 0.05). Lower maternal BMI and shorter gestational age were also associated with IUGR. Conclusion: Abnormal maternal and fetal lipid profiles are strongly associated with IUGR, suggesting dyslipidemia’s role in its pathophysiology. Early lipid screening and nutritional interventions during pregnancy may reduce IUGR risk and improve neonatal outcomes.

Background: Chemotherapeutic agents, though indispensable in oncological therapeutics, often precipitate a triad of neurotoxicity, cognitive dysfunction, and cardiotoxicity, significantly impacting patient morbidity and quality of life. This study delineates the incidence, clinical profile, and inter-correlation of chemotherapy-induced peripheral neuropathy (CIPN), cognitive decline, and cardiotoxicity using a multimodal, clinical, and biochemical approach. Methods: A prospective, single-centre, observational cohort study was conducted over 18 months in a tertiary care hospital in Eastern India. A total of 150 patients receiving neurotoxic and cardiotoxic chemotherapeutic regimens (including platinum agents, taxanes, anthracyclines, and targeted agents) were enrolled. Neurological assessments included the Total Neuropathy Score - Clinical (TNSc), Michigan Neuropathy Screening Instrument (MNSI), nerve conduction studies, serum vitamin B12, homocysteine, and serum NSE levels. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA) at baseline and 3-month intervals. Cardiotoxicity was assessed using serial electrocardiograms (ECG), echocardiography (Left Ventricular Ejection Fraction - LVEF), serum cardiac troponins (hs-TnI), NT-proBNP, and the New York Heart Association (NYHA) classification. Brain CT scans were performed at baseline, 3, 6, and 12 months to assess structural cognitive changes. Results: Of the 150 patients, 94 (62.7%) developed varying grades of CIPN, with higher incidence in patients exposed to platinum and taxane-based regimens (p < 0.001). Cognitive decline (MoCA score <26) was observed in 57 patients (38%) at 6 months, with statistically significant correlations between CIPN severity and cognitive impairment (Pearson's r = -0.51, p < 0.001). Cardiotoxicity, defined as an absolute LVEF reduction ≥10% or elevation in hs-TnI, was documented in 46 patients (30.7%), predominantly in those receiving anthracyclines and HER2-targeted agents (p < 0.001). Multivariate regression demonstrated CIPN and cognitive decline as independent predictors of cardiotoxicity (OR 2.46, 95% CI: 1.41–4.29, p = 0.002). Conclusions: This study underscores a significant association between chemotherapy-induced neurotoxicity, cognitive decline, and cardiotoxicity. The incorporation of affordable clinical scores, biochemical markers, and periodic imaging provides a robust, reproducible strategy for early detection and risk stratification.

Background: Sickle cell disease (SCD) is a chronic hemoglobinopathy with diverse clinical manifestations and regional variation in India. Understanding its clinicodemographic distribution and crisis-related risk factors is crucial for effective management. This study aimed to assess the demographic profile and clinical presentation of adult SCD patients and examine factors associated with vaso-occlusive crises (VOC). Materials and Methods: A hospital-based cross-sectional study was conducted among 157 adult SCD patients at a tertiary care center in Eastern India from May 2023 to December 2024. Data on demographics, geographic origin, clinical features, and treatment history were collected. Clinical manifestations including VOC, hemolytic crisis, cholelithiasis, and acute chest syndrome were documented. Associations between VOC and demographic or clinical factors were analyzed using appropriate statistical tests. Results: Most participants were aged 21–30 years (49%), with a slight female predominance (52.9%). A significant proportion hailed from Nayagarh, Angul, and Khordha districts. VOC was the most common complication (61.8%), followed by hemolytic crisis (25.5%). VOC was significantly associated with younger age (p < 0.001), presence of splenomegaly (p = 0.001), and history of blood transfusions (p < 0.001). No significant association was observed with gender or hydroxyurea therapy. Other acute complications were infrequent. Conclusion: VOC is the most prevalent clinical manifestation among adult SCD patients in Eastern India, particularly affecting younger individuals with splenomegaly and a transfusion history. Geographical clustering suggests the need for targeted regional interventions. Identification of VOC-associated factors can guide individualized patient monitoring and resource allocation.

Background: Postoperative nausea and vomiting (PONV) remains a prevalent and distressing complication following ear, nose, and throat (ENT) surgeries. Multiple factors such as anesthetic agents, airway management strategies, patient characteristics, and surgical procedures have been implicated in influencing PONV incidence. This study aimed to evaluate the incidence and identify the potential risk factors associated with PONV in ENT surgeries, with a special focus on anesthetic techniques and airway instrumentation. Materials and Methods: A prospective observational study was conducted on 150 patients undergoing elective ENT surgeries under general anesthesia at a tertiary care hospital. Patients aged 18–65 years with ASA physical status I and II were included. Data were collected on demographics, type of surgery, anesthetic agents used (inhalational vs. total intravenous anesthesia), and airway instrumentation (endotracheal tube vs. laryngeal mask airway). PONV was assessed within the first 24 hours postoperatively using a standard scoring system. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. Results: The overall incidence of PONV was 38.6% (n=58). Female gender (p=0.01), history of motion sickness (p=0.03), use of inhalational anesthesia (p=0.001), and endotracheal intubation (p=0.005) were significantly associated with increased PONV. In multivariate analysis, inhalational anesthesia (OR 2.8, CI 1.4–5.6, p=0.002) and endotracheal tube use (OR 2.2, CI 1.1–4.3, p=0.01) remained independent predictors. Total intravenous anesthesia and use of laryngeal mask airway were associated with lower PONV rates. Conclusion: PONV is a common postoperative complication in ENT surgeries, with significant associations observed with inhalational anesthetics and endotracheal airway instrumentation. Adoption of total intravenous anesthesia and use of laryngeal mask airways may reduce PONV incidence and improve patient comfort in the postoperative period