European Journal of Cardiovascular Medicine

Background: Thrombocytopenia is a common haematological abnormality frequently encountered in clinical practice. However, it can often be overlooked if specific investigations are not conducted. Acute febrile illness (AFI) accompanied by thrombocytopenia presents a significant diagnostic and therapeutic challenge, as the severity of thrombocytopenia is inversely related to the mortality and morbidity associated with various febrile illnesses. Vector-borne and zoonotic diseases such as malaria, dengue, scrub typhus, and leptospirosis are prevalent causes of fever with thrombocytopenia. Additionally, infections and sepsis are notable contributors to this clinical presentation. Proper identification and management of these conditions are crucial in improving patient outcomes, especially in tertiary care settings where a diverse array of infectious agents can be encountered. The clinical and etiological profile of patients presenting with acute febrile illness and thrombocytopenia in a tertiary care hospital highlights the importance of thorough investigation and targeted treatment strategies. Objectives:

1. To evaluate the clinical and etiological profile of acute febrile illness with thrombocytopenia patients
2. To find out the prevalence of organ specific complications in acute febrile illness with thrombocytopenia cases
3. To determine the relationship between platelet, count and bleeding manifestation according to underlying cause.

Methods: This cross-sectional study was conducted at Hassan Institute of medical sciences Hassan.  , Karnataka. A total of 140 patients with acute febrile illness and thrombocytopenia, meeting inclusion criteria and willing to participate, were assessed. Socio-demographic data and clinical history were recorded using a semi-structured proforma. Past illnesses were confirmed by blood investigations. Data were meticulously entered into an Excel spreadsheet for statistical analysis using R version 4.2.2 statistical software. P value < 0.05 was considered as statically significant. Results: The study included 140 patients with acute febrile illness and thrombocytopenia, consisting of 63 females (45%) and 77 males (55%), with a mean age of 44.89±17.40 years. The most affected age group was >40≤60 years, comprising 43.57% of patients. Blood pressure anomalies were minimal, with only 5% (7 patients) hypertensive and 12% (17 patients) hypotensive (Figure 6). Tachycardia was observed in 30 patients. The mean lowest platelet count was 70,514±36,642.84 cells/mm³. Thrombocytopenia severity varied, with 86 patients (61.43%) classified as mild, 48 as moderate, and 6 as severe. Among the patients, 80 (57.14%) were diagnosed with dengue fever, followed by Rickettsia (22.14%), leptospirosis (10%), viral infection (7.1%), and unexplained cases (6.43%). All patients presented with fever; other common symptoms included headache (85%), body ache (84.29%), vomiting (75%), abdominal pain (50%), altered sensorium (10.71%), and bleeding manifestations (5.7%). Physical findings showed that 37.86% of patients had rashes, and 15% had breathlessness. Severe thrombocytopenia patients exhibited the highest incidence of rashes (66%) and bleeding manifestations (50%). Abdominal pain was most prevalent among dengue patients (56.25%). Comparisons between different thrombocytopenia grades revealed that severe grade patients had significantly higher mean blood urea and serum creatinine levels than mild and moderate grade patients (p-value = 0.041). Ultrasound imaging showed gallbladder stones in 22.14%, xvii ascites in 22.57%, and pleural effusion in 20.71% of patients. Gallbladder stones were more common in males (31.17%) than females (11.11%) (P-value = 0.05). Ascites was present in 42.86% of males, but not in females (p-value < 0.0001). Pleural effusion was observed in 32.47% of males and 6.35% of females (p-value = 0.0002). Severe thrombocytopenia was associated with higher incidences of gallbladder stones (66.67%), ascites (66.67%), and pleural effusion (50%) compared to moderate and mild cases (p-values = 0.00003, 0.0008, and 0.022, respectively). Patients with severe thrombocytopenia also had significantly higher mean total bilirubin levels and SGOT compared to those with mild and moderate thrombocytopenia. Conclusion: Acute Febrile Illnesses (AFI) have a variety of causes, and accurate diagnosis is critical. The degree of thrombocytopenia in infections has predictive significance. It can also aid in the differential diagnosis and accurate identification of the etiology of acute febrile diseases. Detecting and managing thrombocytopenia in acute febrile sickness on time can improve the patient's overall outcome

Background:  Huntington's disease (HD) is a debilitating, hereditary neurological condition that results in the gradual degeneration and death of brain neurons. This neurodegenerative process primarily impacts the brain regions responsible for movement, cognition, and emotion. Ancient medicine in India, “Charak Samhita”, has also mentioned movement disorders, including Huntington’s disease (HD). Despite being regarded as an uncommon condition worldwide, Huntington's disease varies greatly in incidence depending on the region and population. Usually reported as 2–9 per 100,000, the frequency is higher among populations of European heritage (generally 5–10 per 100,000). The exact prevalence rate in India is not definitively known due to a lack of large-scale, population-level studies. Estimates by Indian researchers suggest a prevalence rate similar to European populations (approximately 3–7 per 100,000 people), which would translate to tens of thousands of affected individuals and over 200,000 people at risk in the country. However, its prevalence rate in India is not known. It is a progressive neurodegenerative illness that affects 2–9/100.000 of the general population. The usual onset is at around age 35–40 years, disease manifests clinically with many neurological and psychiatric symptoms. HD is caused by an expanded polyglutamine stretch in the N-terminal part of a 350 kDa protein called huntingtin (HTT). This stretch is encoded by a trinucleotide CAG repetition in exon 1 of HTT. An expansion of greater than 36 repeats results in HD. The number of repeats is inversely correlated with the age of onset of motor symptoms and the onset of disease. Neuropsychiatric symptoms may delay the appropriate diagnosis of HD and have major implications for disease management, prognosis and quality of life for patients and families. This study is about a 51-year-old male who came to the psychiatric outpatient department with late identification of Huntington’s disease after attending various clinics for the last 5 years, leading to a three-generation family tree of the disease in a small village near Ujjain, India. Methodology Patients were administered standardised measures of cognition, psychiatric symptoms, motor abnormalities, and a neuropsychological inventory (MMSE, UHDRS, DSR).  Patient (N=10) in the family started on treatment with regular evaluation. Counselling is being done among successors to prevent the propagation of the disease and raise awareness against the “family curse” label for illness. Results The study has brought to light a spectrum of psychiatric symptoms leading to more disability in the course of HD, with all the patients exhibiting mild to moderate neuropsychiatric symptoms with/without chorea& dementia. Conclusions Available data suggest that there is a tendency for the affected descendant to present a larger CAG repeat expansion. Timely medical intervention and counselling have helped the affected family members and reduced propagation. The rural setting and limited financial resources have hindered medical management and research in this sample size.

Background: Labor induction is an obstetric procedure performed routinely across the globe including in India and it initiate labor before its onset spontaneously. Labor induction is advisable when benefits of termination of pregnancy are higher compared to the risks of pregnancy continuation. Concerning Indian context, incidence of labor induction are in the range of 5-22%. Aim: The present study was aimed to assess the impact of Induction Indications on Delivery Outcomes and modes. The study also assessed the degree of perinatal, fetal, and maternal morbidity with each indication for labor induction. Methods: The present study assessed 200 pregnant females that underwent induction of labor at the Institute within the defined study period for delivery modes and indications. The data gathered were assessed statistically for results formulation. Results: Among 200 subjects assessed, operative vaginal delivery, cesarean section, and vaginal delivery was done in 22% (n=44), 41% (n=82), and 37% (n=74) subjects respectively. Highest rate of induction was seen with PROM with 27%. Other conditions with high induction rate were hypertension, diabetes, and past dates with 10%, 14%, and 2% respectively. Normal vaginal delivery rates were high in hypertension, polyhydramnios, and PROM and were lowest with IUGR and diabetes. Highest cesarean rate was seen with IUGR and diabetes. High maternal morbidity was seen with operative vaginal delivery highest NICU admission was seen with cesarean section. Conclusion: The present study concludes that indications for induction of labor are affected greatly with the mode of delivery and also decrease the rate of emergency cesarean section and morbidity linked with it. The study outcomes were inefficient owing to a smaller sample size. Further, large randomized trials are needed to assess the impact of labor induction indication on the mode of delivery

Background: Chronic obstructive pulmonary disease (COPD) is a progressive, irreversible respiratory disorder characterized by airflow limitation, primarily caused by smoking, environmental exposure, and chronic airway inflammation. Globally, COPD is the third leading cause of death and contributes significantly to healthcare costs. Acute exacerbations (AECOPD) are defined as sudden worsening of respiratory symptoms—mainly dyspnea, cough, and sputum production—requiring changes in regular medication. Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are major causes of morbidity, hospitalizations, and health-care burden. Among various treatment modalities, antibiotics play a critical role when bacterial infection is suspected. Azithromycin and doxycycline are widely prescribed owing to their efficacy, safety, and cost-effectiveness. Objective: To compare the clinical efficacy and safety of azithromycin versus doxycycline in patients with moderate to severe AECOPD. Materials and Methods: This is a prospective and comparative study, conducted by Department of Respiratory Medicine and Pharmacology at Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka from August 2024 to July 2025. Group A received azithromycin (500 mg OD for 3 days) and Group B received doxycycline (100 mg BD for 5 days). Both the groups received standard therapy according to Global initiative for Chronic Obstructive Lung Disease(GOLD) guidelines. Clinical improvement, symptom scores, FEV₁ changes, duration of hospital stay, and adverse drug reactions (ADRs) were analyzed. Results: Out of 160 patients, 152 completed the study (76 in each group). The mean age was 59.2 ± 6.8 years with male predominance (68%). Both groups showed significant improvement in clinical symptoms and spirometric parameters (p < 0.05). Azithromycin group showed faster resolution of dyspnea (4.1 ± 1.2 days vs 5.3 ± 1.5 days; p = 0.002) and shorter hospital stay (5.7 ± 1.8 days vs 7.1 ± 2.1 days; p = 0.01). ADRs were mild and comparable. Conclusion: Both azithromycin and doxycycline are effective in treating AECOPD; however, azithromycin demonstrates a faster clinical response and shorter hospitalization without increased adverse events

Introduction: Metabolic syndrome (MetS) is a global health challenge characterized by central obesity, insulin resistance, hypertension, and dyslipidemia. Identifying simple, cost-effective markers for early detection of cardiometabolic risk is crucial. Neck circumference (NC) has recently emerged as a marker of upper-body adiposity, while serum uric acid (SUA) has been implicated in oxidative stress and endothelial dysfunction. This study aimed to evaluate the association between NC and SUA levels in patients with MetS and their relationship with individual cardiometabolic risk factors. Methods: A cross-sectional observational study was conducted among 127 patients diagnosed with MetS at a tertiary-care hospital. Anthropometric parameters, blood pressure, fasting glucose, lipid profile, and SUA were recorded. NC was measured at the level of the cricoid cartilage. Statistical analyses included Pearson’s correlation, t-tests, ANOVA, and linear regression to assess associations between NC, SUA, and MetS components. Results: The mean NC was 38.5 ± 3.4 cm and mean SUA was 6.2 ± 1.0 mg/dL. A significant positive correlation was observed between NC and SUA (r = 0.241, p = 0.012). Linear regression showed that each 1 cm increase in NC corresponded to a 0.18 mg/dL rise in SUA (p = 0.001). Higher NC and SUA were associated with elevated waist circumference (p = 0.002), fasting glucose (p = 0.003), triglycerides (p = 0.018), and blood pressure (p = 0.015). Patients with ischemic heart disease and stroke had significantly greater NC and SUA levels (p < 0.05 for both). Conclusion: Neck circumference and serum uric acid are significantly interrelated and independently associated with cardiometabolic risk factors in MetS. Their combined assessment provides a practical and efficient screening tool for identifying individuals at heightened risk of cardiovascular complications.

Background: Hypertension is a growing global health concern, with genetics, sedentary lifestyle, obesity, and high salt intake playing significant roles. Family history is an important risk factor associated with autonomic dysfunction, reflected in decreased heart rate variability (HRV). Objective: To assess heart rate variability in young adults with and without a parental history of hypertension. Methods: A cross-sectional study was conducted on healthy young adults aged 18–25 years. Participants were divided into two groups: Group 1 (normotensive subjects with normotensive parents) and Group 2 (normotensive subjects with hypertensive parents). HRV parameters including VLF, LF, HF, and LF/HF ratio were recorded and compared. Results: VLF, LF, and HF components showed no statistically significant difference between the two groups. However, the LF/HF ratio was significantly higher in the offspring of hypertensive parents, indicating sympathetic dominance. Conclusion: The study suggests early autonomic imbalance in young adults with a family history of hypertension, even before clinical elevation of blood pressure becomes apparent.

Background: Oxidative stress following coronary artery bypass grafting (CABG) contributes to postoperative morbidity. Non‑enzymatic antioxidants—uric acid, albumin and bilirubin—may serve as preoperative prognostic markers. Objective: To assess predictive value of preoperative uric acid, albumin and bilirubin on adverse postoperative outcomes in CABG patients. Methods: In this prospective observational study, 120 elective CABG patients were enrolled. Preoperative serum levels were measured and correlated with postoperative acute kidney injury (AKI), atrial fibrillation (AF), ICU stay >72 h and 30‑day mortality. ROC curve was used to assess combined antioxidant score (ARS). Results: Elevated uric acid (>6.5 mg/dL) was significantly associated with increased AKI risk (p = 0.02), and hypoalbuminemia (<3.5 g/dL) correlated with prolonged ICU stay and infection (p = 0.01). Lower bilirubin (<0.7 mg/dL) was significantly linked with higher AF rates (p = 0.04). ARS had AUC of 0.81 (95% CI: 0.74–0.88), outperforming individual markers. Conclusion: Preoperative serum uric acid, albumin and bilirubin levels are cost‑effective prognostic indicators in CABG. A combined antioxidant risk score shows promise for risk stratification and optimizing perioperative care.

Introduction: Hypertension remains one of the foremost modifiable risk factors for cardiovascular and renal morbidity and mortality worldwide. Chronic elevated blood pressure promotes structural and functional changes in multiple organs even before clinical disease becomes evident; these so-called preclinical or subclinical target organ damage (TOD) include left ventricular hypertrophy (LVH), microalbuminuria, increased carotid intima-media thickness, arterial stiffness, and reduced renal function. Aims & Objectives: A study of correlation of serum uric acid with preclinical target organ damage in the hypertensive population. Materials & Methods: Cross-sectional observational study at the Department of General Medicine, St. Stephen’s Hospital, Delhi, from February 2023 to July 2024. Result: In our study of 159 hypertensive patients, most were middle-aged with a slight male predominance. Headache, chest pain, and shortness of breath were common complaints. Around two-thirds had normal uric acid, while abnormal uric acid was associated with higher rates of microalbuminuria, LVH, and retinopathy. Lipid profiles showed no significant differences. Conclusion: Elevated serum uric acid in hypertensive patients was associated with increased risk of preclinical target organ damage, including renal, cardiac, and retinal changes, independent of lipid levels, highlighting its potential as a biomarker for early detection and risk management

Background: Cerebral ring-enhancing lesions represent a heterogeneous group of pathologies — infectious, inflammatory, and neoplastic — that are often indistinguishable on conventional MRI. Magnetic Resonance Spectroscopy (MRS) provides metabolic information that may improve differential diagnosis and guide management. Objective: To assess the diagnostic utility of proton MRS in characterizing cerebral ring-enhancing lesions and to correlate metabolite profiles with common pathologies to inform prognosis and treatment planning. Methods: This prospective observational study included 50 patients (age range 3–82 years) with ring-enhancing lesions identified on contrast MRI at Government Erode Medical College between February 2020 and April 2021. Single-voxel 1H-MRS (TE 20 ms and 144 ms) was performed; metabolite peaks (choline, creatine, N-acetyl aspartate [NAA], lipid, lactate, succinate, amino acids) and choline/creatine ratios were recorded. Data were analyzed descriptively. Results: Of 50 patients, 31 (62%) were male. Seizures were the most frequent presentation (42/50, 84%). Lesion distribution included tuberculoma (18/50, 36%), neurocysticercosis (11/50, 22%), abscess (5/50, 10%), metastasis (4/50, 8%), primary tumor (3/50, 6%), tumefactive demyelination (1/50, 2%), and other lesions (8/50, 16%). MRS patterns: tuberculoma — prominent lipid peak and choline/creatine ratio typically 1–2; neurocysticercosis — elevated lactate and succinate with insignificant lipid peak; primary neoplasm and metastasis — markedly increased choline with choline/creatine ratio >2 in many high-grade tumors; abscess — amino acid and lactate peaks. Figures and tables summarize numerical findings. Conclusion: MRS is a valuable adjunct to MRI for differentiating ring-enhancing lesions, particularly in distinguishing tuberculoma from neurocysticercosis and separating neoplastic from infectious etiologies, thereby aiding treatment planning. Standardization of acquisition and interpretation protocols is recommended for wider clinical adoption

Background: Parkinson's disease (PD) is associated with elevated brain iron levels, particularly in the nigrostriatal dopaminergic pathway. This study evaluates iron deposition patterns in the fascicula nigrale (FN) and substantia nigra (SN) in PD patients compared to healthy controls using quantitative susceptibility mapping (QSM). Methods: From March 2025 to September 2025, this prospective study at Government Erode Medical College, Perundurai, enrolled 25 newly diagnosed idiopathic PD patients (15 males, 10 females; mean age 58.6 ± 10.7 years) and 25 age- and sex-matched healthy volunteers (HVs; 9 males, 16 females; mean age 61.4 ± 7.3 years). Participants underwent 3T brain MRI with QSM. Regions of interest (ROIs) for FN (rostral/caudal segments), SN, and other deep gray matter structures were delineated on susceptibility-weighted imaging (SWI) maps by blinded investigators. Susceptibility values were analyzed using t-tests, ANOVA, and Pearson correlations (P < 0.05). Results: Intra- and inter-rater reproducibility was high (r = 0.761–0.972). PD patients showed significantly higher susceptibility in the SN (P = 0.011), SN pars compacta (SNc), internal globus pallidus (GPi), red nucleus (RN), putamen, and caudate nucleus (P < 0.05). Both groups exhibited an anterior-to-posterior FN iron gradient, accentuated in PD, with a significant age correlation (r = 0.62, P < 0.05). Mean FN susceptibility was lower in PD (1123.78 ± 21.00 ppm) than HVs (1179.55 ± 15.16 ppm; P = 0.055); caudal FN showed similar trends (1125.13 ± 55.8 ppm vs. 1163.00 ± 18.8 ppm; P = 0.083). Conclusion: PD features increased iron in nigrostriatal structures and an exaggerated FN gradient, suggesting tract dysfunction and age-related cumulative effects. QSM is a promising PD biomarker, warranting further mechanistic studies.

Background and objectives: Tuberculosis is a major public health problem in India. India is reported to have the highest burden of TB globally, with 2.4 million cases reported in the National TB Program of India in 2019^. Both type 2 diabetes (T2DM) and tuberculosis (TB) are prevalent in India. There is a bidirectional relationship between Diabetes Mellitus and infections, and it is true for TB as well. This study was planned to find out any association between Diabetes Mellitus and sputum conversion at 2 months. Methods: This prospective observational study enrolled new and previously treated sputum smear positive patients coming under NITRD DOTS area from 1^st September 2019 to 31^st October 2019 and the history of Diabetes Mellitus and sputum smear conversion rate were assessed at the end of 2 months. Results: The mean age ± standard deviation of the study sample was 33.52 ± 15.90 years. Among the 100 patients, 60 (60%) were male and 40 (40%) were female. The study found a statistically significant association between a history of diabetes mellitus and delayed sputum smear conversion in pulmonary tuberculosis patients at the end of the intensive phase (2 months), with a p-value < 0.01. Conclusion: In our study, we found that Diabetes Mellitus was associated with delayed sputum smear conversion at the end of the second month of treatment, and this association was statistically significant.

Background: Effective anticoagulation after mechanical heart valve replacement is essential to mitigate thromboembolic and hemorrhagic complications. The combination of warfarin and low-dose aspirin provides enhanced protection; however, the optimal dosage of aspirin is still a subject of debate. This study analyzed the clinical outcomes of warfarin in comparison to 75 mg and 150 mg aspirin following mechanical valve replacement. Method: A prospective observational study was performed at Pt. B. D. Sharma PGIMS, Rohtak, involving 60 patients who underwent mechanical valve replacement. Patients were assigned randomly to two groups: Group A received warfarin in combination with 75 mg of aspirin, while Group B received warfarin with 150 mg of aspirin. The quality of anticoagulation was evaluated through Time in Therapeutic Range (TTR) utilizing the Rosendaal method. Thromboembolic and bleeding events, the necessity for fluoroscopy, and mortality were assessed over a six-month period. Results: The majority of patients demonstrated moderate INR control, with TTR values of 64.1% for Group A and 73.4% for Group B (p = 0.53). Prosthetic valve thrombosis was observed in 3 patients (10%) in Group A, while none were reported in Group B (p = 0.05). All cases were associated with TTR < 50%. Bleeding complications were similar (8.3% overall; p = 0.53), and no significant hemorrhage was observed. Fluoroscopy was necessary for 5% of patients, all of whom were in Group A. The mortality rate was 1.7%, confined to patients experiencing valve thrombosis. Conclusion: the combination of warfarin and 150 mg aspirin offers enhanced thromboembolic protection and improved time in therapeutic range (TTR) without elevating the risk of bleeding. It is crucial to maintain a TTR greater than 60% to avert valve thrombosis. Individualized anticoagulation, accompanied by consistent INR monitoring and patient education, is essential for achieving optimal postoperative outcomes

Introduction: Hypertension is one of the most significant risk factors for atrial fibrillation (AF), primarily due to left atrial (LA) structural and functional remodeling. Conventional echocardiographic parameters such as LA diameter and volume are widely used but have limited predictive accuracy for AF. Speckle-tracking echocardiography (STE) derived LA strain has emerged as a sensitive tool to assess atrial function and may serve as an early predictor of AF in hypertensive patients. Objectives: To evaluate the role of LA strain parameters, particularly LA reservoir, conduit, and contractile strain, in predicting the occurrence of atrial fibrillation among hypertensive patients. Methods: This was a prospective observational study conducted at RIMS, Ranchi, over a period of one year. The study included 100 hypertensive patients without a prior history of atrial fibrillation or significant structural heart disease. The variables assessed were age, sex, body mass index (BMI), presence of diabetes mellitus, left ventricular ejection fraction (LVEF), left atrial reservoir, conduit, and contractile strain, and duration of hypertension. All participants underwent clinical evaluation and echocardiographic assessment, including measurement of left atrial strain parameters, to identify structural and functional predictors of atrial fibrillation. Results: Patients who developed atrial fibrillation were older (62.8 ± 8.5 vs. 56.2 ± 7.9 years, p = 0.021) and had longer hypertension duration (11.6 ± 4.8 vs. 7.8 ± 3.9 years, p = 0.013). They had larger LA size (diameter 42.1 ± 3.8 vs. 38.4 ± 3.2 mm, p = 0.004; volume index 38.6 ± 6.2 vs. 32.1 ± 5.1 mL/m², p = 0.001) and higher E/e′ ratio (13.4 ± 2.8 vs. 10.6 ± 2.3, p = 0.006). LA strain was markedly reduced (reservoir 19.2 ± 3.6 vs. 28.7 ± 4.1%, p < 0.001), and multivariate analysis showed hypertension duration (OR 1.12), LA volume index (OR 1.09), and reduced reservoir strain (OR 0.81) independently predicted AF. Conclusion: LA strain assessment using speckle-tracking echocardiography provides superior predictive value for atrial fibrillation in hypertensive patients compared to conventional LA size measurements. Early detection of subclinical atrial dysfunction may allow timely risk stratification and guide preventive strategies in this high-risk group.

Cardiac sarcoidosis (CS) is a rare but potentially fatal condition characterized by granulomatous inflammation of the myocardium, leading to arrhythmias, conduction abnormalities, and heart failure. Diagnosing CS in tuberculosis (TB)-endemic regions poses significant challenges due to overlapping clinical and pathological features, complicating differentiation and management. This report presents a 37-year-old male who was admitted with ventricular tachycardia (VT) and subsequently diagnosed with CS and latent tuberculosis. The diagnosis was confirmed through advanced imaging, including fluorodeoxyglucose positron emission tomography (FDG-PET), cardiac magnetic resonance imaging (MRI), and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), which revealed non-caseating granulomas and TB-PCR positivity. The patient was treated with corticosteroids, anti-tubercular therapy (ATT), and anti-arrhythmic medications, leading to clinical stabilization. Follow-up imaging demonstrated resolution of mediastinal lymphadenopathy and stable myocardial fibrosis. This case underscores the importance of a multidisciplinary approach integrating imaging, histopathology, and microbiological testing to optimize diagnosis and treatment in patients with granulomatous myocarditis.

Background: Coronary artery disease (CAD) is a leading cause of morbidity and mortality, requiring accurate diagnostic tools for risk stratification. The treadmill test (TMT) is a widely used non-invasive modality, while coronary angiography (CAG) remains the gold standard. This study aimed to assess the correlation between TMT and CAG findings in predicting the severity of CAD. Methods: This cross-sectional observational study included 120 patients with suspected CAD who underwent both TMT and CAG at a tertiary care hospital between October 2024 and September 2025. TMT was performed using the Bruce protocol and interpreted by Selzer’s criteria, while CAG findings were classified as normal, single, double, or triple vessel disease. Additional parameters included Duke Treadmill Score (DTS), clinical risk factors, and angiographic severity (SYNTAX score). Results: The mean age of participants was 56.7 ± 9.4 years; 70.8% were male, 40.8% diabetic, and 55% hypertensive. Angiographically proven CAD was present in 63.3% of patients. Strongly positive TMT correlated with CAD in 76.7% of cases, while DTS showed a strong inverse correlation with CAD severity (p <0.05). TMT sensitivity and specificity were 79.2% and 61.4%, respectively, with higher diagnostic accuracy in males compared to females. Diabetes significantly increased CAD severity. Conclusion: TMT demonstrates good sensitivity for predicting CAD and, when integrated with DTS and clinical risk factors, serves as a valuable screening tool in resource-limited settings

Background: Transdermal drug delivery systems provide a steady and continuous release of medication into the systemic circulation, offering sustained therapeutic effects. However, due to their delayed onset of action, transdermal patches must be applied preoperatively to ensure effective postoperative analgesia. Aim of the study was to compare the effectiveness of intrathecal injection of buprenorphine with buprenorphine transdermal patch in providing postoperative analgesia for patients undergoing lower abdominal surgeries under spinal anesthesia. Materials and Methods: A simple randomized double-blind study was conducted in the Department of Anaesthesia at Khaja Banda Nawaz Teaching and General Hospital, Kalaburagi, over 18 months (December 1, 2019 to May 31, 2021). A total of 130 patients aged 18–60 years, classified as ASA I or II, scheduled for elective lower abdominal surgery under spinal anesthesia, were included and divided into two groups of 65 each. Group I (Intrathecal Group): Received 3 ml of 0.5% hyperbaric bupivacaine with 60 µg of intrathecal buprenorphine, and a placebo patch applied 24 hours before surgery. Group T (Transdermal Group): Received 3 ml of 0.5% hyperbaric bupivacaine with 0.2 ml of normal saline intrathecally, and a 10 µg buprenorphine transdermal patch applied 24 hours before surgery. The patch was applied over the lateral aspect of the upper arm, chest, or upper back. Results: Most patients in both groups were between 20 and 30 years of age, with Group I showing a mean age of 39.45 ± 10.97 years and Group T showing a mean age of 39.14 ± 10.76 years. The requirement for rescue analgesia appeared earlier in Group I at 2, 3, and 4 hours postoperatively, while no rescue analgesia was needed at the same time intervals in Group T (p < 0.0001, < 0.0001, 0.0132 respectively). Conversely, rescue analgesia was required later in Group T at 12 and 24 hours, compared to Group I (p = 0.0062, < 0.0001 respectively). Conclusion: Buprenorphine administered via transdermal patch provided prolonged and effective postoperative analgesia compared to intrathecal administration, reducing the early need for rescue analgesia and ensuring sustained pain relief during the postoperative period.

Brugada syndrome is a rare hereditary ion channelopathy associated with ventricular arrhythmias and sudden cardiac death, most commonly linked to mutations in the SCN5A gene. We report the case of a 47-year-old Hispanic male who experienced out-of-hospital cardiac arrest due to ventricular fibrillation. Post-resuscitation electrocardiogram revealed a Type I Brugada pattern with coved ST-segment elevations in leads V1–V3. Echocardiography showed mildly reduced left ventricular systolic function, and coronary angiography demonstrated no obstructive disease. The patient underwent successful implantable cardioverter-defibrillator placement and was referred for genetic evaluation. Sepsis was identified as the precipitating factor for his malignant arrhythmia. Although Brugada syndrome has been described more frequently in Asian populations, its occurrence in Hispanic patients is rare and underrecognized. This case highlights the importance of considering Brugada syndrome in patients presenting with unexplained ventricular arrhythmias and anterior ST-segment elevation, even in demographics where the condition is less commonly reported.

Chronic postsurgical pain (CPSP) is a major contributor to long-term postoperative morbidity, affecting up to 50% of surgical patients depending on the procedure type. Lidocaine, an amide local anesthetic with systemic analgesic and anti-inflammatory properties, has been proposed as a perioperative adjuvant to mitigate the transition from acute to chronic pain. This systematic review aimed to evaluate the efficacy and safety of perioperative intravenous lidocaine infusions for the prevention of CPSP in adult surgical populations. Comprehensive searches of PubMed, Embase, Scopus, and the Cochrane Library were performed up to August 2025 to identify randomized controlled trials comparing lidocaine infusion with placebo or standard care. Twenty-two trials encompassing 2,945 patients met the inclusion criteria. The pooled analysis demonstrated a significant reduction in the incidence of chronic postsurgical pain among patients receiving lidocaine infusions compared with controls (relative risk 0.74; 95% CI 0.59–0.93; p = 0.01). The greatest benefit was observed in abdominal and breast surgeries, while effects were less consistent in orthopedic and cardiac procedures. Lidocaine infusion also significantly lowered early postoperative pain scores and opioid consumption, indicating both short- and long-term analgesic benefits. Adverse effects were infrequent, mild, and comparable between groups, with no serious cardiac or neurological toxicity reported. Overall, perioperative intravenous lidocaine infusions appear to be a safe, cost-effective, and beneficial adjunct for reducing the development of chronic postsurgical pain, particularly following abdominal and breast surgery. However, further large-scale, standardized trials are warranted to define optimal dosing regimens, duration, and long-term outcomes.

Background: Stroke is classified as ischemic when confirmed by imaging or clinical evidence, excluding hemorrhagic stroke. Carotid artery disease is a significant risk factor for ischemic stroke and Transient Ischemic Attack (TIA), with carotid stenosis and plaque formation being primary causes. Carotid artery Doppler ultrasound offers a non-invasive, accurate method for assessing stenosis and plaque morphology, while MRI Brain provides high sensitivity for ischemic stroke diagnosis. Magnetic Resonance Angiography (MRA) can assess the carotid bifurcation, Circle of Willis, and vertebrobasilar system, aiding in stroke management. Methods A prospective cross-sectional study was conducted between July 2023 and July 2024 at our institution, involving 76 patients with ischemic stroke and TIA. Exclusion criteria included with hemorrhagic stroke, head trauma, cardiac disease, and patients under 18 years. Brain imaging was performed using a PHILIPS ACHIEVA 1.5 Tesla MRI, and carotid/vertebral Doppler was done using a PHILIPS AFFINITI 50G system. Data were analyzed using SPSS 23, and chi-square tests were applied to compare proportions. Results The mean age of participants was 64.07±10.3 years, and 61.8% were males. Of the patients, 6.6% had TIA. Carotid artery stenosis was present in 82.9% of patients, while 98.7% had posterior circulation flow abnormalities. Most stroke patients exhibited significant stenosis and plaque formation, with 82.9% showing increased intima-media thickness (IMT). TIA patients showed normal vertebral artery flow, while 31% of stroke patients had abnormal vertebral artery flow. MRA revealed significant flow abnormalities in MCA, ACA, and PCA territories. Conclusion Carotid Doppler and MRI Brain play a critical role in diagnosing ischemic stroke and TIA, with early detection of carotid artery stenosis crucial for stroke prevention. The study emphasizes the importance of early plaque detection in the South Indian population for better management of stroke and TIA.

Background: Laryngoscopy and endotracheal intubation during general anaesthesia (GA) is associated with hemodynamic stress response. Fentanyl and dexmedetomidine helps attenuate this response. This study was conducted with an aim to compare these two drugs in effectively attenuating the hemodynamic parameters of stress response.  Method: A prospective study was conducted at the Department of Anaesthesiology for a duration of one year. Patients aged between 18-60 years admitted for surgery under GA were enrolled for the study. The patients were randomly separated into two groups. Before starting the procedure, baseline heart rate (HR), mean arterial blood pressure (MAP), systolic and diastolic BP, (SBP, DBP) and SpO₂ were recorded. Patients in group I received 1 µg/kg dexmedetomidine IV. Group II received 2 µg/kg Fentanyl IV. Vital signs were recorded again after 5 mins. Intubation was completed within 30 seconds of laryngoscopy in first attempt. HR, MAP, SBP, DBP and rate pressure product (RPP) were measured immediately after intubation followed by at 2, 3, 5, 7, and 10 minutes. P<0.05 was considered significant. Results: Total 58 patients were enrolled in the study. There was a significant reduction in HR in group I at all time points compared to group II. Patients in both groups had reduced SBP and DBP after drug infusion, the difference between the groups was highly significant statistically. Group II consistently showed significantly higher MAP compared to group I. Group II consistently exhibited significantly higher RPP values compared to group I. After extubation, patients in group I were significantly more tranquil and co-operative compared to group II.  Conclusion: Dexmedetomidine more effectively suppressed the hemodynamic stress response to laryngoscopy and intubation compared to fentanyl.

Background: Pulmonary aspiration of gastric contents is a feared perioperative complication. Patients with diabetes mellitus and obesity are considered high-risk due to potential gastroparesis and altered gastric physiology. Standard fasting guidelines may not be sufficient for these populations. Bedside gastric ultrasonography offers a real-time, non-invasive method to assess gastric volume and aspiration risk. Aim: This study aimed to compare preoperative fasting gastric volume (GV) among diabetic, non-diabetic, and obese patients using ultrasonography. Materials and Methods: A prospective, single-blind, observational study was conducted at a tertiary care hospital over one year. One hundred fifty patients scheduled for elective surgery were allocated into three groups: Diabetic (Group D, n=50), Non-diabetic Control (Group C, n=50), and Obese (Group O, n=50). Preoperatively, gastric antrum was scanned in the supine and right lateral decubitus (RLD) positions. The cross-sectional area (CSA) was calculated, and GV was estimated using a validated formula. The risk of aspiration was categorized as low or high based on GV and the presence of solid contents. Data were analyzed using ANOVA with post-hoc Tukey's test for continuous variables and Chi-square test for categorical variables. A p-value of <0.05 was considered statistically significant. Results: The mean estimated GV was significantly higher in Group D (45.6 ± 15.2 ml) and Group O (38.9 ± 12.8 ml) compared to Group C (28.3 ± 9.5 ml) (p < 0.001). The proportion of patients classified as "high risk" for aspiration was significantly greater in Group D (18%) and Group O (10%) compared to Group C (0%) (p < 0.01). There was no significant correlation between fasting duration and GV across all groups. Conclusions: Despite adhering to standard fasting guidelines, diabetic and obese patients have a significantly higher residual gastric volume and a correspondingly higher risk of aspiration compared to non-diabetic controls. Preoperative gastric ultrasonography is a valuable tool for individualized risk assessment in these high-risk populations.

Background: End Stage Renal Disease (ESRD) is characterized by irreversible loss of renal function, necessitating lifelong renal replacement therapy. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in ESRD patients. Apart from traditional risk factors such as age and gender, chronic kidney disease (CKD)–specific factors like anaemia, hyperparathyroidism, hyperhomocysteinemia, proteinuria, hypoalbuminemia, and activation of the renin–angiotensin system contribute significantly to cardiovascular dysfunction. Methods This cross-sectional study was conducted among 75 ESRD patients undergoing haemodialysis at a tertiary care hospital in South India. Detailed clinical evaluation, laboratory investigations, and echocardiographic assessment were performed after obtaining informed consent. Echocardiographic parameters were analyzed to determine the presence and type of cardiovascular dysfunction and correlated with the severity of renal impairment. Results The majority of patients were males aged 31–40 years, with hypertension being the most common comorbidity. Most patients were newly initiated on haemodialysis. Echocardiographic evaluation revealed cardiovascular dysfunction in a significant proportion of patients, showing a positive correlation with the severity of renal failure. Diastolic dysfunction was the most prevalent abnormality, observed in 60% of patients, followed by left ventricular hypertrophy (48%) and systolic dysfunction (29%). Conclusion Cardiovascular dysfunction is highly prevalent among ESRD patients undergoing haemodialysis. Routine echocardiographic evaluation is essential even in asymptomatic patients to detect early cardiac involvement. Early identification and management of cardiovascular risk factors during the initial stages of renal insufficiency may significantly reduce morbidity and mortality.

Background: Re-exploration following cardiac surgery is a critical postoperative event associated with significant morbidity and mortality. Understanding its incidence, perioperative risk factors, and prognostic impact is essential for improving outcomes. Aim: To evaluate the incidence, determinants, and prognostic impact of re-exploration after cardiac surgery in a tertiary care setting. Materials and Methods: This single-institution prospective observational study was conducted at the Department of Cardiovascular and Thoracic surgery, Government Rajaji Hospital, Madurai, over 12 months. All patients undergoing cardiac surgery were screened, and those requiring re-exploration were included. Demographics, operative details, indications, timing, and postoperative outcomes were recorded. Data were analyzed using SPSS version 26. Continuous variables were expressed as mean ± SD, categorical variables as frequencies/percentages, and comparisons were performed using appropriate statistical tests, with p < 0.05 considered significant. Results: Among 22 patients requiring re-exploration, the mean age was 48.82 ± 12.75 years, with males predominating (68.2%). Bleeding (72.7%) was the leading indication, followed by ventricular tachycardia/ ventricular arrhythmia (27.3%). ICU-based re-exploration and VT indication were significantly associated with higher mortality (p = 0.001 and p = 0.04, respectively). Mortality was also associated with fewer ICD days (p = 0.001) and lower postoperative transfusion requirements (p = 0.02). No significant differences were observed in baseline laboratory parameters between survivors and non-survivors. Conclusion: Re-exploration after cardiac surgery is associated with substantial early mortality, particularly when performed in the ICU or for hemodynamic instability. Early recognition, standardized protocols, and expedited return-to-theatre pathways may improve outcomes

Background: Severely calcified coronary lesions present significant challenges in percutaneous coronary inter-vention (PCI), often requiring specialized plaque modification techniques before stent deployment. This study compares the efficacy and safety of rotational atherectomy (RA) versus cutting balloon angioplasty (CBA) in managing severely calcified coronary artery lesions. Methods: A prospective, single-center study was conducted at IPGME&R, Kolkata, enrolling 50 consecutive pa-tients with severely calcified coronary lesions from August 2024 to February 2025. Patients were allocated to ei-ther RA (n=25) or CBA (n=25) based on lesion morphology and operator preference, followed by drug-eluting stent implantation. The primary endpoint was procedural success, defined as successful stent delivery with TIMI 3 flow without crossover to alternative techniques. Secondary endpoints included in-stent late lumen loss at 9-month angiographic follow-up and major adverse cardiac events (MACE). Results: Baseline demographics were similar between groups (mean age 63.2±8.4 years, 68% male). RA was pref-erentially used for larger vessels (3.2±0.4 vs 2.8±0.3 mm, p<0.01) and longer lesions (18.5±4.2 vs 14.2±3.8 mm, p<0.05). Procedural success was achieved in 96% of RA patients versus 92% of CBA patients (p=0.74). TIMI 3 flow was restored in 96% versus 96% respectively (p=1.00). At 9-month follow-up, target lesion revasculariza-tion rates were 8% versus 12% (p=0.58), and in-stent late lumen loss was 0.42±0.18 versus 0.38±0.16 mm (p=0.48). Major complications were rare in both groups. Conclusions: Both rotational atherectomy and cutting balloon angioplasty demonstrate comparable efficacy and safety profiles for severely calcified coronary lesions. Technique selection should be individualized based on le-sion characteristics, with RA preferred for concentric calcification in larger vessels and CBA for eccentric pat-terns in smaller vessels.

Background: Spinal anaesthesia with Ropivacaine is common for lower limb surgeries, but its duration can be limited. This study investigated the efficacy of intrathecal Dexmedetomidine as an adjuvant. Objective: To evaluate the effects of adding 5 mcg Dexmedetomidine to isobaric Ropivacaine on block characteristics and postoperative analgesia. Methods: In a prospective, double-blind trial, 60 patients undergoing lower limb surgeries were randomized to receive spinal anaesthesia with either 22.5 mg isobaric Ropivacaine plus saline (Group R) or the same dose of Ropivacaine plus 5 mcg Dexmedetomidine (Group RD). Results: The addition of Dexmedetomidine did not significantly alter the onset of sensory or motor blockade. However, it significantly prolonged the total duration of sensory block (374.67 ± 50.50 vs. 217.17 ± 25.62 min, p<0.001), motor block (327.67 ± 45.16 vs. 189.50 ± 22.45 min, p<0.001), and analgesia (379.50 ± 57.27 vs. 225.17 ± 29.11 min, p<0.001). Time to two-segment regression was also longer in Group RD, and VAS scores were significantly lower for up to 6 hours postoperatively. Conclusion: Low-dose intrathecal Dexmedetomidine is a safe and effective adjuvant that significantly prolongs the duration of sensory and motor blockade, and provides excellent, prolonged postoperative analgesia for lower limb orthopaedic surgeries.

Background: Dengue causes characteristic hematological and biochemical abnormalities during acute infection. The presence of diabetes mellitus may modify these laboratory patterns through underlying metabolic and endothelial dysfunction. Objectives: To compare hematological and biochemical parameters between dengue patients with and without diabetes mellitus and assess whether diabetes is associated with distinct laboratory abnormalities during acute dengue infection. Methods: This cross-sectional analytical study was conducted in the Department of General Medicine at K. B. Bhabha Municipal General Hospital, Mumbai, over one year (June 2023–June 2024). A total of 100 confirmed dengue patients (25 diabetics and 75 non-diabetics) were included. Hematological indices (hemoglobin, hematocrit, leukocyte count, and platelet count) and biochemical parameters (liver function tests, renal markers, and electrolytes) were measured at presentation. Diabetes mellitus was defined by previous diagnosis or HbA1c ≥ 6.5%. Statistical comparisons were made using the t-test and Chi-square test, with p < 0.05 considered significant. Results: Both groups exhibited comparable hemoglobin levels, leukocyte counts, and overall platelet reduction. Severe thrombocytopenia was marginally more frequent among people with diabetes, though not statistically significant. Biochemical profiles showed more pronounced elevation of AST and ALT levels in diabetic patients (p < 0.05), along with a mild trend toward higher serum urea and creatinine and lower sodium levels. These differences indicate greater hepatic and metabolic stress in the diabetic subgroup. Conclusion: While hematological abnormalities were similar in dengue patients irrespective of diabetes status, biochemical derangements—particularly liver enzyme elevation—were more prominent among people with diabetes. This suggests that diabetes may potentiate hepatic vulnerability during dengue infection, warranting closer biochemical monitoring in this comorbid population

Background: Laparoscopic cholecystectomy requires secure airway management due to pneumoperitoneum and altered respiratory mechanics. Endotracheal intubation is standard, but supraglottic devices such as I-gel may offer advantages. Aims: To compare the efficacy and safety of I-gel versus endotracheal tube (ETT) in elective laparoscopic cholecystectomy. Settings and Design: Prospective, randomized study at a tertiary-care hospital on 64 ASA I–II patients aged 18–60 years. [I-gel (n=32) or ETT (n=32)]. Outcomes included insertion ease and time, hemodynamic responses, ventilatory parameters (end-tidal CO₂, peak airway pressure), and postoperative complications. Data were analysed using SPSS v22; p<0.05 was considered significant. Results: Baseline demographics were comparable. I-gel insertion was easier (p=0.043) and faster (14.8 ± 9.5 s vs. 22.8 ± 11.4 s; p<0.001). Hemodynamic stability was greater with I-gel, with significantly lower heart rates at several perioperative points (p<0.05). Peak airway pressures and end-tidal CO₂ were lower with I-gel both after insertion and 20 minutes post-pneumoperitoneum (p<0.05). Oxygenation remained adequate in both groups. Postoperative sore throat and airway trauma occurred more frequently in the ETT group.  Conclusion: I-gel is an effective and safe alternative to ETT for airway management in low-risk patients undergoing laparoscopic cholecystectomy. It offers benefits of faster insertion, better hemodynamic stability, and fewer airway-related complications

Purpose: Cancer of the prostate (CaP) is now recognized as one of the most important medical problems facing the male population. As there are only few studies about this entity in eastern India, here we wish to present the experience with demographic profile, clinical features, stage and treatment protocol offered to prostate carcinoma patients. Materials and Methods: It was a retrospective study of a total sixty-four patients, who were diagnosed with prostate carcinoma between August 2023 to August 2025 in the Department of Urology and General Surgery of our hospital which is a tertiary care centre in eastern India. The case records of these sixty-four cases were analyzed for demographic profile clinical presentation, stage & treatment. An online literature search was made from Pub MED indexed journal. Results: Most of the patients were in the 8th decade of life (median age was 73). Most of the patients were positive for at least one risk factor. Prostatism was the most common presentation (75%). 88% of patients were pale. Obstructive uropathy was present in 26.5%. D.R.E was suspicious in 34.6% cases and first P.S.A. value was more than 10n.g./ml in 93.7% cases. Forty nine out of sixty-four cases were locally advanced stage at the time of presentation. Conclusions: Ca prostate is a disease of advance age with the nonspecific presentation. By judicious screening with combination of Prostate Specific Antigen (PSA) and Digital Rectal Examination (DRE), clinically localized disease can be diagnosed early which results in better prognosis and better chance of cure. Although most patients have more than one risk factor, further studies are needed to confirm the role of modifiable risk factor and preventive agents in its management.

Background Contemporary data on the clinical profile, diagnostic evaluation and real-world treatment patterns of patients with pulmonary hypertension (PH) are limited in many settings. We describe the demographics, diagnostic testing, haemodynamic findings (where available), use of PH-directed therapies and short-term outcomes in a single-center cohort. Methods This retrospective observational cohort study analysed 61 consecutive patients with PH enrolled in Maurya Hospital, Mysuru in General medicine, cardiology & respiratory wards for a period of  9 months. Demographics, comorbidities, functional class, noninvasive testing, right-heart catheterisation (RHC) data when performed, PH-specific therapies (phosphodiesterase-5 inhibitors, endothelin receptor antagonists, prostacyclin analogues), supportive treatments (oxygen, anticoagulation) and outcomes (alive at 90 days, alive at 1 year, heart-failure hospitalisation) were extracted from the registry and summarised descriptively. Median (IQR) or mean ± SD are presented as appropriate. Results Sixty-one patients were included (mean age 53.0 ± 14.4 years; 30 males [49.2%]). Median six-minute walk distance was 370 m (IQR 315–437). WHO diagnostic group distribution was: Group 1, 14 (23.0%); Group 2, 34 (55.7%); Group 3, 9 (14.8%); Group 4, 3 (4.9%); Group 5, 1 (1.6%). Right-heart catheterisation was recorded in 11 patients (18.0%); among those with RHC data the median invasive mean pulmonary arterial pressure was approximately 43.6 mmHg and median pulmonary vascular resistance ≈10.57 Wood units. Overall, 28/61 (45.9%) received at least one PH-targeted therapy: phosphodiesterase-5 inhibitors 14 (23.0%), endothelin receptor antagonists 14 (23.0%), and prostacyclin analogues 5 (8.2%). Anticoagulation was recorded in 7 (11.5%) and domiciliary oxygen in 14 (23.0%). Short-term outcomes were favourable: 61/61 (100%) alive at 90 days and 56/61 (91.8%) alive at 1 year; 37/61 (60.7%) had at least one heart-failure hospitalisation recorded. Conclusions In this single-center cohort of 61 patients with PH, the majority were classified as WHO Group 2 and a minority underwent invasive haemodynamic assessment. Less than half received PH-specific targeted therapy overall, with the highest uptake among Group 1 patients. Short-term survival was high but heart-failure hospitalisation was frequent. These descriptive findings highlight patterns of diagnostic testing and treatment that may inform service planning and prospective studies; further work is needed to examine determinants of therapy use and longer-term outcomes

Introduction: There is a scarce of data about the characteristics of patients with acute exacerbations of obstructive airway diseases in our study setting. Aim: To study the effect of acute exacerbations of obstructive airway diseases on pulmonary artery systolic pressure and to access the effect of bronchodilation on changes in forced expiratory volume (FEV) and forced vital capacity (FVC) in patients with acute exacerbations of obstructive airway diseases in our tertiary care centre. Methods: This is a prospective study conducted with total of 50 patients with history of exacerbations of obstructive airway diseases attending OPD or admitted in the wards of Department of Pulmonary Medicine at our tertiary care centre. The FEV₁ and FVC values were measured pre- and post-bronchodilator treatment and accessed. Results: The mean age of patients enrolled was 50.86 years with male predominance (52%). The mean (±SD) PASP, PaO₂, and FEV₁/FVC of patients were found to be 40.78 (±15.29), 78.76 (±10.41), and 0.82 (±0.39) respectively. In patients with exacerbation of obstructive airway diseases there was a statistically significant increase in FEV₁ (58.82 vs. 62.66; p<0.001) and FVC (60.14 vs. 63.74; p<0.001) values were observed post-bronchodilation as compared to pre-bronchodilation. Conclusion: Pulmonary arterial pressure is a frequent and important complication in patients with acute exacerbations of obstructive airway diseases. Bronchodilation improves forced expiratory volume and forced vital capacity, and thereby improves pulmonary functions in patients with acute exacerbations of obstructive airway diseases.

Introduction: Electrolytes such as potassium, magnesium, calcium, and phosphate play an important role in cell membrane potential regulation. Dsyelectrolemia in the setting of cardiac diseases and subsequent on pump cardiac surgery may be life threatening  AIM: To evaluate the incidence of electrolyte depletion in cardiac surgery patients, its correction and implications in intraoperative and intensive care unit management. Methods: We measured serially serum levels of magnesium, phosphate, potassium, calcium and sodium in 100 consecutive patients. 50 who were undergoing cardiac surgical interventions (group 1) and the rest 50 underwent lung/peripheral vascular surgery.  Results: Group 1 (cardiac surgery patients) had levels of potassium, magnesium, phosphate and calcium that were significantly lower than group 2 (control individuals). Potassium levels were 10.4 ± 4.6 mmol/ hour for group 1 versus only 1.6 ± 1.4 mmol/hour for group 2 (P < 0.001). A similar observation was observed for magnesium, with 38 patients in group 1 receiving an average amount of 2.1 g due to arrhythmias as opposed to only one patient in group 2 (P < 0.001). 8 patients in the cardiac surgery group received calcium as a treatment or preventive measure compared to one in the control group (P < 0.001). Group 1 had 23 patients (46%) whose magnesium levels were below 0.70 mmol/l, compared to 8 patients (16%) in group 2 (P < 0.001). In group 1, 42 patients (84%) had phosphate levels lower than 0.60 mmol, compared to 6 patients (12%) in group 2 (P < 0.001). Conclusion: In patients undergoing cardiopulmonary bypass cardiac surgery, electrolyte depletion is a high risk. This study partly explains the elevated risk of tachyarrhythmia in cardiac surgery. Hence, we recommend frequent measurement of electrolytes mainly magnesium, potassium, phosphorus and calcium levels in perioperative period. Careful and frequent monitoring with meticulous correction even preemptive of electrolytes shall be beneficial to prevent postoperative tachyarrhythmia. This will result in better outcomes in patients undergoing cardiac surgery. Prophylactic administration of potassium, magnesium and phosphate should be taken into account intraoperatively and postoperatively in all cardiac patients. 

Background: Organ failure remains a leading cause of morbidity and mortality worldwide, with donor shortages severely limiting transplantation and rehabilitation outcomes. Advances in stem-cell technology, tissue engineering, and 3D bioprinting have enabled the creation of lab-grown organs that could revolutionize regenerative rehabilitation. Methods: A systematic review was conducted following PRISMA 2020 guidelines. Electronic databases (PubMed, Scopus, ScienceDirect, NIH) and grey literature (HRSA, ALA, ALF, UCSF Health) were searched from January 2010 to October 2025. Studies reporting preclinical or clinical outcomes of lab-grown tissues with rehabilitation relevance were included. Results: Of 3,394 records identified, 82 met inclusion criteria (34 preclinical, 21 clinical, and 27 institutional). Functional organoids have been developed for the kidney, heart, liver, skin, and pancreas, demonstrating physiological performance and potential clinical utility. Early trials, such as autologous skin grafts and pancreatic islet implants, showed improved function, faster recovery, and reduced rehabilitation times. Conclusion: Lab-grown organs represent a transformative advancement in regenerative medicine. Their integration into rehabilitation practice could enable true biological restoration of function, reducing disability and improving quality of life. Ethical, regulatory, and economic barriers must be addressed to ensure equitable global access

Background: Epicardial fat lies in close proximity to myocardium, and its metabolic activity correlates with the heart and coronary vessels. Epicardial fat thickness (EFT) reflects visceral adiposity rather than general obesity. It correlates with metabolic syndrome, insulin resistance, coronary artery disease (CAD), and subclinical atherosclerosis; therefore, it may serve as a simple tool for cardiometabolic risk prediction. Echocardiographic measurement of EFT is low-cost, rapid, and reproducible. Prior studies have shown conflicting results regarding correlation of EFT with severity of coronary stenosis. Hence, this study evaluated the hypothesis that echocardiographic EFT correlates with CAD severity. Objectives: To assess the association between epicardial fat thickness measured using transthoracic echocardiography and CAD severity by coronary angiography (modified Gensini score). Methods: A single-centre observational cross-sectional study conducted in the Department of Cardiology, Government Medical College, Kozhikode. Patients undergoing coronary angiography for suspected CAD (meeting inclusion criteria) were enrolled. All patients underwent clinical evaluation, ECG, 2D echocardiography with EFT measurement, and coronary angiography. Results: A total of 151 patients were included (mean age 53.4 years; 74.8% male). Of these, 53 (35.1%) had normal CAG and 97 (64.9%) had CAD. Normal CAG patients showed good LV function in 96.2% vs 36.7% in CAD patients; LV dysfunction was significantly more common in CAD (60.2%, p = 0.001). Among CAD patients, single-vessel disease (SVD) was found in 33.8%, double-vessel disease (DVD) in 18.5%, and triple-vessel disease (TVD) in 11.9%. Risk factors (DM, HTN, smoking, BMI) were not significantly different between groups. Mean Gensini score was 0 in normal vs 5.8 in CAD. Mean EFT was 3.2 mm in normal vs 7.1 mm in CAD patients (p < 0.001). EFT increased stepwise with CAD severity: SVD 6.56 mm, DVD 7.56 mm, TVD 7.82 mm vs 3.2 mm in normal (p < 0.001). Dyslipidemia patients had higher EFT (7.89 mm) than those with normal lipids (6.22 mm). Conclusion: Echocardiographic EFT was significantly higher in CAD patients than in those with normal coronaries and correlated with the severity of CAD (SVD/DVD/TVD). EFT is a simple, low-cost marker of coronary artery stenosis severity

Background: The Deep External Pudendal Artery (DEPA) is a deep branch of the femoral artery (FA) that is vital for supplying the skin of the perineum and external genitalia, making it clinically relevant for reconstructive procedures like perineal perforator flaps. Knowledge of its precise and varying anatomy is essential to prevent complications during surgical and interventional procedures in the femoral triangle. Objectives: To determine the origin, side of origin, and the distance of the DEPA from the mid-inguinal point in the femoral triangle, and to document any anatomical variations. Methods: This cadaveric observational study utilized 40 lower limbs from embalmed cadavers. Standard dissection techniques were employed to expose the femoral artery and its branches. The origin type, side of origin relative to the FA, and the distance of origin (in cm) from the mid-inguinal point were meticulously measured and recorded for the DEPA.

Results:

• The DEPA arose as a separate branch from the femoral artery in 97.5% (39 specimens).
• A rare variation showed the DEPA arising from the Medial Circumflex Femoral Artery (MCFA) in one specimen (2.5%).
• The DEPA almost universally arose from the medial side of the femoral artery in 97.5% (39 specimens).
• The mean distance of origin from the mid-inguinal point was 4.12 cm.
• The majority of origins (85% or 34 specimens) occurred at a distance between 3.1 cm and 6 cm from the mid-inguinal point.

Conclusion: The DEPA consistently originates from the medial side of the femoral artery but typically arises at a greater distance (mean 4.12 cm) from the inguinal ligament compared to the superficial branches. The documented rare variant originating from the MCFA is a crucial finding for reconstructive plastic surgeons utilizing perineal perforator flaps and for vascular surgeons operating in the femoral triangle

Background: Endovascular aneurysm repair (EVAR) and open surgical repair (OSR) are definitive treatment of choice for infrarenal abdominal aortic aneurysm (AAA). EVAR has demonstrated reduced peri-operative mortality but issues persist with late rupture, reintervention and long term durability versus OSR. Materials and Methods: We conducted a multicenter, retrospective cohort of patients who underwent elective EVAR and OSR between January 2015 and December 2020 with follow-up to June 2025. Primary outcome was all-cause mortality at 6 years; secondary outcomes were 30-day mortality/complications, ARM (aneurysm-related mortality), late rupture, reintervention, sac behavior and surveillance burden. Cox and Fine–Gray multivariable models were adjusted for age, sex, ASA class, aneurysm diameter, renal function and smoking. Results: Among 1,040 patients (EVAR 640; OSR 400), EVAR had lower 30-day mortality (1.4% vs 3.8%) and complications (18% vs 32%), but higher 6-year all-cause mortality (29% vs 24%), late rupture (3.9% vs 1.8%), and reintervention (16% vs 9%). Sac regression ≥5 mm at 1 year was found in 54% after EVAR and associated with improved long-term survival and fewer reinterventions. The rate of surveillance imaging encounters was ~2.4× higher with EVAR. Conclusion: EVAR confers an early survival/complication advantage but demands lifelong surveillance and has higher late failure signals (reintervention and rupture) than OSR. Patient selection, adherence to device instructions for use, and sac-based risk-adapted follow-up are key to optimizing long-term outcomes.

Introduction: Congenital heart diseases (CHDs) remain the primary cause of structural cardiac morbidity in children, with significant regional disparities in detection and outcomes driven by healthcare access and awareness levels. Objectives: To analyze the clinical characteristics, demographic profile, and spectrum of congenital heart diseases among pediatric patients in a tertiary hospital in West Maharashtra. Methodology: A retrospective, hospital-based study was conducted in the Department of Pediatrics, RCSM GMC, Kolhapur, enrolling 120 children aged 0–18 years diagnosed with CHD over a defined period. Clinical and demographic details—including age, gender, location, type and spectrum of CHD, and presenting symptoms—were gathered from records. Echocardiographic confirmation was mandatory. Cases were categorized as acyanotic and cyanotic. Statistical analyses included descriptive statistics and chi-square tests for group comparisons; p values below 0.05 were considered significant. Results: Acyanotic CHD was dominant (75.8%), while 24.2% of cases were cyanotic. Infants under 1 year constituted 60.8% of presentations. Gender distribution was balanced (male 50.8%, female 49.2%), and the majority were urban residents (55%). Ventricular septal defect was the most frequent lesion (17.4%). Among symptoms, murmur (90.2%), sweating (84.2%), and failure to thrive (69.1%) prevailed. No significant associations appeared for age (p=0.6569) or gender (p=0.9597), but rural patients had equal proportions of acyanotic and cyanotic CHD versus urban predominance of acyanotic cases (p<0.001). Complex lesions were more frequent in rural children, underlining access disparities. Conclusion: Acyanotic CHD predominates in West Maharashtra, most often in infants and urban areas, with major regional gaps in diagnosis and presentation. Early screening, rural outreach, and robust referral networks are crucial for bridging care gaps and improving pediatric cardiac outcomes.

This series case report examines 13 patients with native valve endocarditis (NVE) for early surgical intervention managed following current recommendations of the 2019 American Association for Thoracic Surgery (AATS) and the 2023 European Society of Cardiology (ESC). Surgical indications included 7 cases of acute heart failure, ongoing infection in 4, large vegetations that posed an embolization risk in 3, and abscess formation in 2. The number of valves repaired from the 8 attempted was 7; whereas from the remaining 5, replacement was unavoidable. The affected valves included 5 tricuspid, 4 mitral, 2 aortic, 1 pulmonary, and 1 combined mitral-tricuspid. Though the cases were of high risk, all patients survived without in-hospital deaths and no recurrence, which confirms the good outcomes of taking early surgery according to present guidelines. Key messages from the study are: (1) Early intervention in cases with heart failure, uncontrolled infection, or embolism risk dramatically improves outcomes; (2) multi-disciplinary endocarditis team helps in making the best decisions; (3) adherence to new guidelines has the potential to wipe out mortality in NVE. This series reinforces the place of early surgical treatment as a primary approach in treating high-risk infective endocardi.

Background: Purpose: To review the pulmonary thromboendarterectomies (PTE) in cases of Chronic thromboembolic pulmonary hypertension (CTEPH) done in our department with brief intermittent circulatory arrest.  Materials and methods: Data from 3 patients who underwent PTE for CTEPH between April 2021 and September 2023 in department of CTVS, IPGMER & SSKM Hospital are analysed retrospectively. Follow up was done clinically and by 2D Echocardiogram and computed tomography pulmonary angiogram (CTPA). Results: All 3 patients had severe tricuspid regurgitation (TR), and severe preoperative right ventricular (RV) dysfunction. 2 patients had diagnosed antiphospholipid antibody (APLA) syndrome. Thrombi were of Jamieson type III in 2 cases, and type I in one case. Median direct manometric mean pulmonary artery (PA) pressure decrease was from 48 mmHg to 22 mmHg. Median CPB time was 112 minutes, and median temperature 24 °C. All 3 patients were extubated next day. There was no re-exploration and no mortality. Postoperative 2D Echocardiography revealed decreased median PA systolic pressures(76 mmHg vs 32 mmHg) and improved RV function by tricuspid annular plane systolic excursion(TAPSE)(median 12 mm vs 16 mm). Postoperative room air oxygen saturation also improved (median 57% vs 97%). In follow ups ranging between 1 and 30 months, all 3 patients returned to New York Heart Association (NYHA) Class I, with improved quality of life. Conclusion & clinical significance: Operation for CTEPH can be done without profound hypothermia (18 °C) and circulatory arrest and side effects of these can be avoided.

Background: Breast cancer is a heterogeneous disease with variable clinical outcomes. Molecular subtyping using immunohistochemistry (IHC) markers—ER, PR, HER2/Neu, and Ki-67—provides valuable prognostic and therapeutic guidance. This study aimed to assess clinical outcomes and recurrence patterns of breast cancer patients based on IHC-based molecular subtypes in a tertiary care centre in North Kerala. Methods: A retrospective record-based study was conducted in the Departments of Pathology and Oncology, MES Medical College, Perinthalmanna. Female patients diagnosed with breast carcinoma between January 2015 and January 2018 and followed up for three years were included. Data on demographics, histology, TNM stage, IHC subtypes, recurrence, and survival were collected. Associations between molecular subtypes and outcomes were analyzed using Chi-square tests; p<0.05 was considered statistically significant. Results: Among 68 patients, 75% were above 40 years, and 94.1% had invasive carcinoma NST. Luminal A tumors exhibited the highest recurrence (91.7%) but the lowest mortality (8.3%). TNBC showed high recurrence (54.5%) and mortality (45.5%), while HER2-enriched and Luminal B subtypes had intermediate outcomes. Neo-adjuvant chemotherapy recipients demonstrated lower mortality (19%) compared to non-recipients, particularly in aggressive subtypes. Molecular subtyping was significantly associated with recurrence (p<0.05), though overall mortality differences among subtypes were not statistically significant. Conclusion: IHC-based molecular subtyping reliably predicts recurrence and survival patterns in breast cancer. Luminal A tumors, despite high recurrence, have favorable survival, whereas TNBC and HER2-enriched subtypes are associated with poorer outcomes. Neo-adjuvant chemotherapy reduces mortality, highlighting its role in aggressive subtypes. Integration of molecular subtyping into routine clinical practice is recommended for personalized management.

Background: Multidrug-resistant (MDR) Gram-negative bacilli are increasingly prevalent in intensive care units (ICUs) and pose a major threat to patient care due to limited therapeutic options. Objectives: To characterize MDR Gram-negative bacilli isolated from ICU patients and to determine their antimicrobial resistance patterns and molecular mechanisms of resistance. Methods: A hospital-based cross-sectional study was conducted over one year (2024–2025) at Calcutta National Medical College and Hospital. A total of 100 non-duplicate Gram-negative bacilli isolates from ICU patients were identified using standard biochemical methods and automated systems. Antimicrobial susceptibility testing was performed by the Kirby–Bauer disk diffusion method and interpreted as per CLSI guidelines. Extended-spectrum β-lactamase (ESBL), AmpC, and carbapenemase production were phenotypically detected, and molecular characterization was carried out by PCR targeting resistance genes (bla_TEM, bla_SHV, bla_CTX-M, bla_NDM, bla_KPC, bla_OXA-48). Data were analyzed statistically. Results: The most common isolates were Klebsiella pneumoniae (35%), Escherichia coli (25%), Pseudomonas aeruginosa (20%), Acinetobacter baumannii (15%), and others (5%). High resistance rates were observed against third-generation cephalosporins (82%), fluoroquinolones (76%), and carbapenems (58%). ESBL production was detected in 45% of isolates, AmpC in 20%, and carbapenemase in 35%. Molecular analysis revealed bla_CTX-M (40%), bla_TEM (32%), bla_SHV (18%), bla_NDM (22%), bla_OXA-48 (12%), and bla_KPC (8%). Colistin retained the highest susceptibility (92%).\ Conclusion: MDR Gram-negative bacilli are highly prevalent in ICU patients, with carbapenemase-mediated resistance emerging as a major concern. The predominance of ESBL and carbapenemase genes underscores the urgent need for strict antimicrobial stewardship, continuous surveillance, and infection control practices to contain the spread of these pathogens

Introduction: Guillain-Barre Syndrome (GBS) is an acute immune-mediated polyneuropathy characterized by rapidly progressive weakness and areflexia. Electrophysiological studies play a critical role in diagnosis, subtyping, and prognostication. However, the evolution of electrophysiological changes over time and their correlation with clinical outcomes remain less explored. Aims & Objectives: To evaluate the clinical spectrum of GBS and analyse the outcomes in relation to serial electrophysiological studies conducted during the disease course. Methods: This is a prospective, observational, single-centre study conducted at a tertiary care hospital. The study was carried out in the Indoor Ward, High Dependency Unit (HDU), Paediatric Intensive Care Unit (PICU), General Paediatric Ward, and Outpatient Department (for follow-up) of the Department of Paediatric Medicine, Dr B.C. Roy Post Graduate Institute of Paediatric Sciences, Kolkata-54. The study duration was 18 months, from February 2021 to July 2022, with twelve months dedicated to recruitment of cases and an additional six months for follow-up. Results: In this study of 36 patients, 61.1% presented with ascending paralysis, which was significantly associated with better outcomes compared to 38.9% presenting with simultaneous four-limb weakness (p = 0.014). Cranial nerve involvement (p = 0.049), autonomic dysfunction (p = 0.013), and need for assisted ventilation (p < 0.001) were significantly linked to poorer prognosis. Antecedent illnesses, electrophysiological parameters, complications, and hospital stay did not show significant correlation with outcomes. The Hughes Grade Disability Scale was a strong predictor of prognosis (p < 0.05), with higher grades correlating to worse recovery. Sensory symptoms were reported in 61% of patients, with paresthesia being the most common (43%) Conclusions: Serial electrophysiological studies provide valuable insights into the dynamic pathophysiology of GBS and correlate well with clinical recovery. Early identification of electrophysiological subtype may guide prognosis and therapeutic decisions.

Aim: The aim of the present study was to evaluate merits and demerits of drainage over non-drainage techniques in patients undergoing elective laparoscopic cholecystectomy. Methods: This prospective study was carried out in the Department of General Surgery, Government Medical College and Rajindra Hospital, Patiala from January 2023 to March 2024. A total of hundred patients of cholelithiasis were included in the study for analysis. Results: The mean age in group A was 40.24±12.41 years and the mean age in group B was 44.30±11.56 years. Maximum number of patients was in the age group of 31-40 years in group A and in 41-50 years in group B. there were 40 (80%) females and 10 (20%) males. In the group B, there were 43 (86%) females and 7 (14%) males. The mean operative time in group A was 34.64±3.97 minutes and the mean operative time in group B was 31.72±4.79 minutes. At 0 hour, 35 (21+14) patients (70%) in group A and 16 (9+7) patients (32%) in group B experienced abdominal pain. At 6 hours, abdominal pain was experienced by 23 patients (46%) in group A and 10 patients (20%) in group B. After 24 hours, abdominal pain was experienced by 8 patients (16%) in group A and 2 patients (4%) in group B. The mean duration of hospital stay was 1.50±0.51 days in group A and 1.08±0.27 days in group B. Statistically, there was highly significant difference (p< 0.0001). Port site infection was present in 2 patients (4%) in group A and in no patient (0%) in group B (non-significant difference; p= 0.1552). Conclusion: This study revealed that not having a drain was highly beneficial in terms of PONV, surgical duration, postoperative discomfort, and length of hospital stay. Nonetheless, there was a reduction in shoulder tip pain within the drain group. This research was not able to demonstrate the effectiveness of drains in decreasing complications in LC. Therefore, routine drains placement under the liver post- laparoscopic cholecystectomy is unnecessary for uncomplicated cases.

Background: Perforation peritonitis is amongst the most common surgical emergencies in India, differing in etiology and outcomes from Western populations. The contaminating microorganisms are usually polymicrobial, and even fungal isolates are increasingly reported. This study aimed to evaluate the microbiological profile and fungal culture positivity in perforation peritonitis. Methods: This was a prospective randomized, controlled crossover study which was conducted in the Department of General Surgery, Government Medical College & Rajindra Hospital, Patiala on 70 patients admitted with acute abdomen and were diagnosed with perforation peritonitis. Exploratory laparotomy was performed, and intraoperative peritoneal fluid was examined for bacterial and fungal cultures. Results: In this study, the mean age of patients was 38 years with a male predominance (~75%), similar to Indian series but younger than Western reports. Ileal (44%) and gastroduodenal (39%) perforations were the most common, in contrast to western data where peptic ulcer perforations predominate. Surgical management included Graham’s omental patch repair (54%), primary repair (40%), and ileostomy (20%), aligning with accepted practices. Bacterial cultures were positive in 56% of cases, with E. coli (44%) being the most frequent isolate, followed by gram-positive cocci (24%) and Klebsiella (18%). Fungal culture positivity was observed in 56% cases, most commonly Candida albicans (37%), which correlated with prolonged ICU stay, higher surgical site infection, and increased mortality. Overall mortality was 11.4%, primarily due to delayed presentation and sepsis. Conclusion: As per our study, perforation peritonitis was most commonly diagnosed in younger males and was most often due to ileal perforations. Routine bacterial and fungal culture of peritoneal fluid are essential to guide the therapy. Early surgical intervention, targeted antimicrobial treatment, and consideration of empirical antifungal therapy in high-risk cases are critical to improving outcomes.

Background: Perforation peritonitis is amongst the most common surgical emergencies in India, differing in etiology and outcomes from Western populations. The contaminating microorganisms are usually polymicrobial, and even fungal isolates are increasingly reported. This study aimed to evaluate the microbiological profile and fungal culture positivity in perforation peritonitis. Methods: This was a prospective randomized, controlled crossover study which was conducted in the Department of General Surgery, Government Medical College & Rajindra Hospital, Patiala on 70 patients admitted with acute abdomen and were diagnosed with perforation peritonitis. Exploratory laparotomy was performed, and intraoperative peritoneal fluid was examined for bacterial and fungal cultures. Results: In this study, the mean age of patients was 38 years with a male predominance (~75%), similar to Indian series but younger than Western reports. Ileal (44%) and gastroduodenal (39%) perforations were the most common, in contrast to western data where peptic ulcer perforations predominate. Surgical management included Graham’s omental patch repair (54%), primary repair (40%), and ileostomy (20%), aligning with accepted practices. Bacterial cultures were positive in 56% of cases, with E. coli (44%) being the most frequent isolate, followed by gram-positive cocci (24%) and Klebsiella (18%). Fungal culture positivity was observed in 56% cases, most commonly Candida albicans (37%), which correlated with prolonged ICU stay, higher surgical site infection, and increased mortality. Overall mortality was 11.4%, primarily due to delayed presentation and sepsis. Conclusion: As per our study, perforation peritonitis was most commonly diagnosed in younger males and was most often due to ileal perforations. Routine bacterial and fungal culture of peritoneal fluid are essential to guide the therapy. Early surgical intervention, targeted antimicrobial treatment, and consideration of empirical antifungal therapy in high-risk cases are critical to improving outcomes.

Background: Hypertension (HTN) and diabetes mellitus (DM) are major public health challenges that frequently coexist, amplifying cardiovascular and metabolic risk. Limited data are available on the comorbidity profiles of Bangladeshi patients. This study aimed to assess the comorbidity pattern, clinical characteristics, and complication profile of hypertension and diabetes among middle-aged and elderly patients who attended a tertiary care hospital. Methods: A cross-sectional study was conducted at the Department of Cardiology, Mymensingh Medical College Hospital, Bangladesh, from June 2023 to July 2024, involving 250 patients aged ≥45 years. Data on sociodemographic, anthropometric, and clinical characteristics were collected through structured interviews and verified using medical records. Statistical analyses were performed using SPSS version 25.0. Results: Of the 250 participants, 38% had both HTN and DM, 28% had HTN alone, and 20% had DM alone. The mean age was 58.6 ± 9.4 years, with 52% males. Obesity was more frequent among those with both conditions (44.2%) than among those with only one condition (14.8%) (P = 0.003). Chronic kidney disease and ischemic heart disease were found in 16% and 20% of the participants, respectively, while 41.4% of the diabetic patients had retinopathy. Conclusion: The coexistence of hypertension and diabetes is common among middle-aged and elderly patients in Bangladesh, particularly among obese urban residents. The high prevalence of complications underscores the urgent need for integrated chronic disease management and lifestyle modification interventions in clinical practice settings

Background: Oral cancer remains a significant public health problem, particularly in developing countries where lifestyle factors and limited awareness contribute to late diagnosis. Assessing awareness levels about oral cancer and its risk determinants is vital for effective prevention and early detection strategies. Aim: To evaluate the awareness of oral cancer and its associated risk factors among adults residing in a semi-urban population. Methods: A cross-sectional, community-based questionnaire study was conducted among 420 adults aged ≥18 years. Data on sociodemographic variables, lifestyle habits, and awareness of oral cancer were collected using a pretested structured questionnaire. Descriptive and inferential statistics were applied, including Chi-square and logistic regression tests. Results: Of the participants, 78.8% had heard of oral cancer, but only 52.6% demonstrated adequate awareness. Tobacco chewing (45.5%) and smoking (42.4%) were the most recognized risk factors, while only 19.8% were aware of screening programs. Education level (p < 0.001) and tobacco non-use (p = 0.021) were significant predictors of awareness in multivariate analysis. Conclusion: The study highlights a moderate level of general awareness but limited understanding of oral cancer risk factors and screening. Targeted educational interventions focusing on less-educated and high-risk populations are essential to improve prevention and early detection outcomes

Background: Diabetic foot remains one of the most serious complications of diabetes mellitus, often leading to infection, ulceration, gangrene, and limb amputation. It reflects a complex interaction between neuropathy, ischemia, and infection. Early identification of risk factors is essential for prevention and limb preservation. Aim of the study was to identify and quantify the independent risk factors associated with lower limb amputation among patients with diabetic foot disease. Materials and Methods: This prospective descriptive analytic study was conducted at the Department of General Surgery, Sri Ramakrishna Hospital, Coimbatore, from November 2014 to November 2016. A total of 150 diabetic foot patients aged 18–80 years were included. Clinical evaluation, laboratory investigations, Doppler ultrasonography, and culture studies were performed. Variables such as age, sex, duration of diabetes, HbA1C level, peripheral vascular disease (PVD), neuropathy, smoking, foot deformities, and comorbid illnesses were analyzed. Statistical analysis was done using SPSS version 17.0, with p < 0.05 considered significant. Results: Among the 150 patients, 98 (65.3%) were males and 52 (34.7%) females, with the majority in the 51–60-year age group. Neuropathy was observed in 40%, and ischemia in 35.3% of patients. Overall, 74 patients (49.3%) required amputation—24 (16%) major and 50 (33.3%) minor—while 76 (50.7%) were managed conservatively. Foot infections were present in 68.6%, with Pseudomonas (15.3%) and Staphylococcus aureus (12.7%) being the most common pathogens. Univariate analysis revealed smoking, PVD, neuropathy, higher PEDIS grade (>3), and associated comorbidities as significant predictors of amputation (p < 0.05), whereas duration of diabetes, HbA1C level, previous amputation, and foot deformities were not statistically significant. Conclusion: Neuropathy, ischemia, and infection remain the principal determinants of amputation in diabetic foot disease. Smoking and systemic comorbidities further increase the risk. Early detection, strict glycemic control, proper foot care, and a multidisciplinary approach are essential to prevent limb loss and improve outcomes in diabetic patients

Background: Assistive device uses in the subjects having mobility impairment has been widely and globally accepted with higher acceptability in developing nations as India. Wearable AART (Adaptive Assistive Rehabilitation Technologies) provide various innovative solutions to improve the quality of life and enhance motility in affected subjects. However, despite various associated benefits, these devices have various challenges concerning their long-term impact, accessibility, and usability. Aim: The present study was aimed to assess the preferences and concerns of walker users concerning wearable adaptive assistive rehabilitation. The study also assessed the involvement of the caregiver to offer improvement in support systems and device design.  Methods: The present study assessed 200 subjects that were using walkers or Adaptive Assistive Rehabilitation Technologies. In all the subjects, questionnaire was used to collect the data concerning their concerns, preferences, and approach of caregivers. The data gathered were statistically analyzed for results formulation. Results: The study results showed an 100% improvement reported by all 200 subjects concerning their quality of life after they started using the walkers. A significant association was seen for mobility support, physical discomfort, and walker usage with 77% (n=154) subjects requiring assistance for 0-2 years and 34% (n=68) users in the age range of <20 years Caregivers have a vital role in these subjects with main caregivers being children, parents, and spouses as reported in 12% (n=24), 36% (n=72), and 62% (n=124) study subjects respectively. Conclusion: The present study concludes that there is a need of improvement in public infrastructure, emotional support, training of caregivers, and customization of designs of the walker to ultimately promote the mobility and independence in walker using subjects.

Background: Abnormal coiling of the umbilical cord can result in acute fetal effects as fetal demise and fetal labor intolerance and chronic fetal effects as growth retardation. The reason of abnormal umbilical cord coiling is unknown, it can be both Hypercoiled or Hypocoiled and both are linked TO adverse perinatal outcomes as meconium staining, cesarean delivery for foetal distress, preterm delivery, and intrauterine death.  Aim: The present study was aimed to evaluate the efficacy of umbilical coiling index as a potential marker for predicting neonatal morbidity.  Methods: The present study assessed 282 subjects admitted to the Institute within the defined study period for delivery within the defined study period. In all the study subjects, they were assessed for abnormal umbilical coiling using ultrasonography. Association of umbilical cord coiling to adverse fetal outcomes. Results: The study results showed that there was a statistically significant association in intrauterine growth retardation and umbilical coiling index in the study subjects with p=0.003, IUFD (intra uterine fetal demise) with p=0.01, and meconium staining of the liquor with p=0.01 respectively.  Conclusion: The present study concludes that abnormal coiling of the umbilical cord can be either Hypercoiled or Hypocoiled. It can lead to various adverse outcomes such as intrauterine fetal demise, meconium-stained liquor, and intrauterine growth restriction; however, the cause of abnormal umbilical coiling is unknown. Further prospective longitudinal studies with larger sample size must be done to assess that cause of abnormal umbilical cord coiling and efficacy of elective delivery to decrease the adverse perinatal outcomes

Introduction: Cholesterol levels are determined by both genetic and environmental influences. Familial clustering of dyslipidemia is an important factor in identifying individuals at risk of premature coronary artery disease. Objective: To evaluate the familial clustering of dyslipidemia by screening first-degree relatives of patients with markedly elevated LDL cholesterol (≥190 mg/dL) and compare their lipid profiles with those of the general population. Methods: A hospital-based cross-sectional study was conducted over one year. Patients aged 18–80 years with LDL cholesterol ≥190 mg/dL who provided informed consent were included. First-degree relatives were screened, and their lipid parameters were compared with population-based controls. Cluster sampling was used for recruitment. Results: A total of 50 index patients were studied (31 males, 62%; 19 females, 38%) with a mean age of 58.4 ± 10.5 years. Their relatives had a mean age of 39.1 ± 10.6 years. Among the relatives, the mean total cholesterol was 215 ± 36.7 mg/dL, and mean LDL cholesterol was 135.5 ± 32.9 mg/dL. Elevated lipid values were observed in 18% of relatives for total cholesterol (≥240 mg/dL), 16% for LDL (≥160 mg/dL), and 10% for LDL (≥190 mg/dL). Compared with normal controls, relatives showed significantly higher mean total cholesterol and LDL cholesterol levels (p < 0.01). The total cholesterol/HDL ratio and the LDL/HDL ratio were also significantly elevated in relatives. Conclusion: Relatives of patients with very high LDL cholesterol demonstrate a higher prevalence of dyslipidemia compared to the general population.Therefore, cascade screening is strongly recommended in the first-degree relatives of patients with markedly elevated LDL cholesterol.

Introduction: Lower abdominal and lower limb surgeries may be performed under regional (spinal, epidural, or both) or general anaesthesia. Although levobupivacaine and ropivacaine were introduced a few years ago, to our knowledge, there are very few studies on the use of isobaric levobupivacaine 0.5% and isobaric ropivacaine 0.75% for spinal anaesthesia for obstetric, abdominal and orthopaedic surgeries. OBJECTIVES: This study aimed to compare the efficacy of isobaric Ropivacaine (0.75%) versus isobaric Levobupivacaine (0.5%) with fentanyl in elective infraumbilical surgeries in terms of onset of sensory and motor blockade, duration of sensory and motor blockade, alteration in Hemodynamics, incidence of adverse effects and requirement of additional analgesia. Methods: A prospective hospital based comparative study was carried out in 60 patients divided into two groups of 30 each receiving either 3ml of either Isobaric Levobupivacaine (0.5%) (15 mg) with fentanyl 0.3 ml (15mcg) for Group L patients or 3 ml of Isobaric Ropivacaine (0.75%) (22.5 mg) with fentanyl 0.3 ml (15mcg) for Group R. Data was collected for onset of sensory and motor blockade, duration of sensory and motor blockade, alteration in Hemodynamic, incidence of adverse effects and requirement of additional analgesia in both the groups at 5 minutes intervals. RESULTS: Levobupivacaine exhibited a significantly faster onset of both sensory (6.49 ± 3.19 min) and motor block (7.91 ± 3.64 min) compared to Ropivacaine (8.43 ± 3.67 min and 11.13 ± 3.11 min, respectively). The duration of sensory block (119.62 ± 4.09 min vs. 89.17 ± 2.69 min) and motor block (181.40 ± 4.74 min vs. 151.15 ± 4.97 min) was significantly longer in the Levobupivacaine group (p < 0.001). The peak sensory level achieved was mostly at T6 in both groups-26.67% in Levobupivacaine and 30% in Ropivacaine. Both groups demonstrated a low and comparable incidence of side effects such as bradycardia, hypotension, nausea, and shivering. Conclusion: When compared to Ropivacaine, Levobupivacaine had a faster onset of both sensory and motor block, and the Levobupivacaine group experienced sensory and motor block for a noticeably longer duration of time. Both groups demonstrated a low and comparable incidence of adverse effects.

Introduction: Premedication in paediatric anaesthesia aims to reduce anxiety, facilitate parental separation, and achieve smooth induction. Dexmedetomidine, an α2‑adrenergic agonist, is used for its sedative and anxiolytic effects without significant respiratory depression. Intranasal administration is simple and well‑accepted in children. Objective: To evaluate the efficacy and safety of intranasal dexmedetomidine spray for premedication in paediatric patients undergoing elective surgeries. Methods: A prospective observational study was carried out with 30 children who received 2 mcg/kg dexmedetomidine intranasally as spray using a mucosal atomization device. Sedation was assessed at 5‑minute intervals up to 30 minutes using the University of Michigan Sedation Scale (UMSS). Hemodynamic parameters (heart rate and SpO₂) were recorded. Results: Onset of sedation was rapid with spray administration. By 25 minutes, 73.33 % achieved UMSS 4 (deep sedation). By 30 minutes, all achieved satisfactory sedation (UMSS ≥ 3), with 86.67 % at UMSS 4 and 13.33 % at UMSS 3. Heart rate showed a gradual, safe decline within physiological limits; oxygen saturation remained above 98 % throughout. No episodes of clinically significant bradycardia or desaturation were noted. Conclusion: Intranasal dexmedetomidine spray provides earlier and more consistent sedation while maintaining hemodynamic stability, making it a preferred premedication method in paediatric patients requiring timely procedural sedation.

Introduction: Emergency surgeries present heightened anesthetic risks due to limited preparation time, patient instability, and urgent decision-making. Despite technological and procedural advancements, critical incidents related to anesthesia in such settings remain inadequately characterized. Objective: To determine the incidence, nature, and contributing factors of anesthesia-related critical incidents during emergency surgeries in a tertiary care teaching hospital, and to propose strategies for improving patient safety. Methods: This prospective, descriptive study was conducted over a one-year period (June 2023–June 2024). All patients undergoing emergency surgical procedures were included. Critical incidents—defined as preventable events that could or did result in adverse outcomes—were reported voluntarily and anonymously by anesthesia providers using structured digital forms. Data were analyzed for demographic patterns, incident types, contributing factors, and patient outcomes. Results: Among 1,334 emergency surgery patients, 22 (1.64%) experienced critical incidents. The majority were young adults aged 19–30 years (63.6%) and female (72.7%), with obstetric and gynecological surgeries accounting for 54.5% of cases. Spinal anesthesia was the most commonly associated technique (50%), and most incidents (77.3%) occurred during anesthetic administration. Human factors were the predominant cause (81.8%), primarily due to lack of skill (54.5%). Cardiovascular (18.2%), airway (13.6%), drug-related (13.6%), and regional anesthesia-related complications were frequently observed. While 63.6% of affected patients experienced no serious complications, 18.2% had prolonged procedures and 18.2% experienced delayed or difficult recovery. Conclusion: Anesthesia-related critical incidents in emergency surgeries, although infrequent, are clinically significant and largely attributable to human factors—particularly lack of technical skill and vigilance. These findings underscore the need for enhanced training, simulation-based education, protocol-driven practices, and a non-punitive incident reporting culture to improve anesthetic safety in emergency settings.

Introduction: Whipple’s surgery (pancreaticoduodenectomy), although a standardized procedure is frequently associated with high postoperative morbidity, primarily due to infectious complications. Biliary contamination, especially in patients with preoperative biliary stenting, is a known risk factor. This study evaluates the microbiological profile of intraoperative bile cultures and their correlation with antibiotic usage and postoperative outcomes. Materials and Methods: This is a retrospective observational study, conducted at a tertiary care centre. It includes 65 patients who underwent Whipple’s surgery from 2022 to 2024. Data on demographics, biliary stenting, intraoperative bile cultures, antibiotic regimens, and 30-day postoperative complications was analyzed. A p-value < 0.05 was considered statistically significant. Results: Of 65 patients (35 males, 30 females; median age 55 ± 12.7 years), 26.1% had preoperative biliary stents. Bile culture positivity was significantly higher in stented patients (88.2%) than non-stented (54.1%) (p < 0.05). E. coli and Klebsiella were the predominant organisms. Cefoperazone-sulbactam was the most commonly used empirical antibiotic (83.1%). Postoperative complications occurred in 47.7% of patients, more frequently among those with positive bile cultures (53.7%) than those without (37.5%), though not statistically significant. Notably, complication rates were significantly lower with cefoperazone-sulbactam (38.9%) compared to piperacillin-tazobactam (90.9%) (p = 0.0024). Conclusion: Preoperative biliary stenting strongly correlates with bile colonization. Cefoperazone-sulbactam showed favorable empirical efficiency, with lower complication and escalation rates. These findings support its use as a cost-effective empirical agent in Indian settings, emphasizing the importance of tailoring antibiotic strategies to local microbiological patterns.

Background: Thyroid carcinoma represents the most common endocrine malignancy worldwide, with increasing incidence rates. Despite being relatively rare, accounting for approximately 1-2% of all malignancies, thyroid cancer poses significant diagnostic and therapeutic challenges. Objectives: To evaluate the clinical presentation, pathological distribution, diagnostic accuracy of fine needle aspiration cytology (FNAC), and surgical outcomes of thyroid carcinoma patients at a tertiary care center. Methods: A prospective observational study was conducted from September 2018 to June 2020, including 49 patients with confirmed thyroid carcinoma. Clinical presentation, FNAC results, histopathological findings, surgical procedures, and postoperative complications were analyzed. Statistical analysis included sensitivity, specificity, and predictive values of FNAC compared to histopathology. Results: The mean age was 42.3 years with female predominance (71.4%). Thyroid swelling was the predominant presentation (95.9%). Papillary carcinoma constituted 79.5% of cases, followed by follicular carcinoma (16.3%). FNAC demonstrated 73.5% sensitivity and 98.7% specificity. Total thyroidectomy was performed in 83.7% of patients. According to AMES criteria, 63.8% were classified as low-risk. Transient hypoparathyroidism occurred in 20.4% of cases. Stage I disease was most common (61.2%) per AJCC 2017 classification. Conclusions: Papillary carcinoma remains the predominant thyroid malignancy with excellent prognosis when diagnosed early. FNAC serves as a reliable initial diagnostic tool despite moderate sensitivity. Total thyroidectomy remains the preferred surgical approach with acceptable complication rates.

Background: Individual variations in response to antihypertensive therapy are partly influenced by genetic factors affecting drug metabolism. The CYP3A5 enzyme plays a key role in the biotransformation of amlodipine, a commonly prescribed calcium channel blocker. This study aimed to evaluate the effect of CYP3A5 genetic polymorphism on the antihypertensive response to amlodipine in patients with essential hypertension. Material and Methods: A prospective observational study was conducted among 120 newly diagnosed hypertensive patients aged 30–65 years. All participants received amlodipine (5–10 mg daily) for eight weeks. Genomic DNA was extracted and CYP3A5 (6986A>G) polymorphism was determined by PCR-RFLP. Participants were categorized as expressors (*1/*1 or *1/3) and non-expressors (*3/3). Blood pressure was recorded at baseline and after eight weeks. Data were analyzed using SPSS version 25, with p < 0.05 considered statistically significant. Results: Of the 120 subjects, 48 (40%) were expressors and 72 (60%) were non-expressors. Baseline characteristics were comparable between the two groups. The mean reduction in systolic and diastolic blood pressures was significantly greater in expressors (17.2 ± 6.3 mmHg and 13.2 ± 4.5 mmHg, respectively) than in non-expressors (13.9 ± 6.8 mmHg and 10.8 ± 4.9 mmHg; p = 0.02 and p = 0.01). Overall, 70.8% of patients were responders, with a higher response rate among expressors (81.3%) compared to non-expressors (63.9%; p = 0.04). Adverse effects, including pedal edema and headache, were mild and comparable between groups. Conclusion: CYP3A5 polymorphism significantly influences the antihypertensive efficacy of amlodipine. Expressor genotypes exhibit better blood pressure control, indicating the potential value of pharmacogenetic profiling in optimizing hypertension management

Background: Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a rare, benign, non-neoplastic vascular lesion characterized histologically by multiple angiomatoid nodules separated by sclerotic stroma. Owing to its nonspecific clinical and radiological features, preoperative diagnosis is challenging, and definitive identification requires histopathological evaluation. Case Presentation: We report the case of a 51-year-old female who presented with abdominal pain of eight days’ duration. Contrast-enhanced computed tomography (CECT) of the abdomen incidentally revealed a primary vascular lesion of the spleen. The patient underwent laparoscopic splenectomy, and the excised specimen was submitted for histopathological examination. Grossly, the spleen showed a well-circumscribed, solitary, gray-white solid mass with peripheral hemangioma-like nodular areas, distinctly demarcated from the surrounding normal splenic parenchyma. Microscopically, the lesion comprised variably sized angiomatoid nodules and concentric sclerotic areas separated by dense fibrosclerotic stroma with mixed inflammatory infiltrates. Conclusion: Due to the absence of pathognomonic clinical or imaging findings, SANT remains a diagnostic challenge. Histopathological assessment is essential for confirmation. Correlation with previously reported cases in the literature supported the final diagnosis of sclerosing angiomatoid nodular transformation of the spleen

Background: Pneumonia remains a leading cause of childhood morbidity and mortality worldwide, particularly in low- and middle-income countries where access to advanced diagnostics is limited. Chest radiography (CXR) is the traditional imaging standard but is limited by radiation exposure, interpretive variability, and low negative predictive value. Lung ultrasound (LUS) offers a radiation-free, portable, and reliable alternative. This study evaluates the diagnostic accuracy of LUS compared to CXR in detecting community-acquired pneumonia (CAP) and related complications in children. Methods: A hospital-based prospective observational study was conducted between January 2023 and December 2024 at PGIMER & Capital Hospital, Bhubaneswar. A total of 136 children (1 month–14 years) diagnosed with CAP using IMNCI/ICMR criteria underwent both CXR and LUS. LUS findings assessed included increased B-lines, shred sign, and anechoic collections. Diagnostic parameters—sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC)—were calculated using CXR as the reference standard. Results: LUS demonstrated a sensitivity of 79.3%, specificity of 80%, and PPV of 95.8% for detecting lung pathology. Increased B-lines alone showed high specificity (78.6%) and PPV (88.9%) but low sensitivity (44.4%). The shred sign was highly specific (92.9%) but less sensitive (22.2%). Using either shred sign or increased B-lines improved sensitivity to 81.5% with an AUC of 0.80 (p<0.05). For pleural effusion, LUS achieved 100% sensitivity, 93.2% specificity, and 100% NPV, outperforming CXR in detecting small effusions. Conclusion: LUS is a highly effective, radiation-free imaging modality for diagnosing pediatric CAP, particularly for detecting consolidation and pleural effusion. Combining LUS features improves diagnostic sensitivity without compromising specificity. Given its portability, safety, and diagnostic accuracy, LUS should be considered a first-line imaging tool for pediatric pneumonia, especially in resource-limited settings.

Introduction: Thyroid nodules are a common endocrine presentation requiring accurate differentiation between benign and malignant lesions. The Thyroid Imaging Reporting and Data System (TIRADS) provides a structured ultrasound-based malignancy risk assessment, whereas serum thyroglobulin (Tg) serves as a biochemical marker reflecting follicular activity. Correlating these modalities with cytology may enhance preoperative diagnostic reliability. Aim: To compare the TIRADS scoring system with serum thyroglobulin levels in the cytological diagnosis of thyroid lesions. Methods: A cross-sectional study was conducted among 50 patients presenting with thyroid nodules at Shri Atal Bihari Vajpayee Medical College and Research Institute, Bengaluru. All patients underwent ultrasound-based TIRADS classification, fine-needle aspiration cytology (FNAC) using the Bethesda system, and serum Tg estimation by chemiluminescent immunoassay (Beckman Coulter Access 2). Data were analyzed using SPSS v21; ANOVA, chi-square, and ROC analyses determined associations and diagnostic performance. Results: Mean age was 42.7 ± 13.4 years, with females comprising 66 %. Distribution across TIRADS categories was TR2 (12 %), TR3 (34 %), TR4 (26 %), and TR5 (28 %). Mean serum Tg rose significantly with higher TIRADS grades (24.7 → 142.6 ng/mL, p < 0.001; η² = 0.55). Cytological diagnosis correlated strongly with both TIRADS (χ² = 16.04, p = 0.001) and Tg (ANOVA F = 13.91, p < 0.001). Mean Tg levels differed markedly between benign (45.3 ± 27.1 ng/mL) and malignant (138.9 ± 70.8 ng/mL) lesions (p < 0.001; AUC = 0.84). Integration of TIRADS, cytology, and Tg improved diagnostic accuracy to AUC = 0.91, surpassing cytology alone (ΔAUC = +0.09; p = 0.028). Conclusion: Serum thyroglobulin levels exhibit a significant positive correlation with increasing TIRADS category and cytological suspicion. The combined use of TIRADS scoring, cytology, and Tg estimation provides superior diagnostic precision for thyroid lesion assessment, offering a reliable, cost-effective triad for preoperative evaluation

Background: Surgical site infections (SSIs) remain one of the most common healthcare-associated infections worldwide, contributing to increased morbidity, prolonged hospital stay, and healthcare costs. Continuous surveillance and root cause analysis are vital to identify modifiable risk factors and improve surgical outcomes. Aim: To study the incidence, microbial profile, and risk factors associated with surgical site infections in a tertiary care hospital over a one-year period. Materials and Methods: A prospective observational surveillance study was conducted from June 2024 to June 2025 among patients undergoing elective and emergency surgeries in Orthopaedics, Obstetrics & Gynaecology, and General Surgery departments. Data on demographic, clinical, procedural, and environmental factors were collected. Microbiological cultures were performed, and results analysed using descriptive statistics and chi-square tests. Results: A total of 17 SSI cases were recorded. The mean age of affected patients was 54.4 ± 22.5 years, with females comprising 70.6%. Diabetes mellitus (47.1%), delayed surgical antimicrobial prophylaxis (>2 hrs before incision), and lack of HEPA filtration were significant risk factors (p < 0.05). The most common organisms isolated were Staphylococcus aureus (including MRSA) and Escherichia coli. Implementation of corrective and preventive actions led to improved compliance with infection control measures. Conclusion: SSIs are preventable through strict adherence to aseptic protocols, timely antimicrobial prophylaxis, and maintenance of operating theatre sterility. Regular surveillance, staff sensitization, and infrastructural improvements such as HEPA filtration and proper CSSD practices can markedly reduce SSI incidence.

Peripartum cardiomyopathy (PPCM) is an uncommon but life-threatening condition that occurs in the peripartum period, affecting 1 in 1,000 to 1 in 4,000 live births worldwide, with regional variation [1]. Defined by the European Society of Cardiology (ESC) as an idiopathic cardiomyopathy with reduced left ventricular ejection fraction (LVEF <45%) developing toward the end of pregnancy or in the months following delivery, PPCM remains underdiagnosed due to its nonspecific symptoms [2].

Background: Blunt abdominal trauma (BAT) is a major cause of morbidity and mortality, requiring rapid and accurate diagnosis. Imaging plays a central role, with ultrasonography (US) widely available as a first-line tool and computed tomography (CT) regarded as the gold standard. Aim: To compare the diagnostic performance of plain radiography, ultrasonography, and computed tomography in the evaluation of blunt abdominal trauma. Materials and Methods: A prospective study of 31 hemodynamically stable patients with suspected BAT was conducted between June  2022 and June 2024 at Arundathi Institute of Medical Sciences in radiology department. All patients underwent plain X-ray, Ultrasound, and CT.  Organ injuries were staged according to the Organ Injury Scaling (OIS) system. Diagnostic accuracy of each modality was correlated with operative findings and clinical outcomes. Results: X-ray Detected free air/fluid in 2 cases; sensitivity 33%, specificity 100%, accuracy 60%.US: Detected hemoperitoneum in 26 cases; sensitivity 96%, specificity 100%, accuracy 96% overall. CT Positive in all patients; sensitivity, specificity, and accuracy 100%.CT provided additional findings in 48% of cases and was decisive in 12.9% for management planning. Of 31 patients, 20 (64.5%) underwent laparotomy, with a non-therapeutic rate of 8.3%. Eleven patients (35.4%) were managed conservatively, and there were no deaths. Conclusions: Plain X-ray has a limited role in BAT evaluation. US is a reliable initial modality, but CT remains indispensable for precise delineation of injury, excluding missed lesions, and guiding management. While hemoperitoneum grading reflects severity, the choice between surgical and conservative treatment is primarily determined by hemodynamic status

Background: Cutaneous adverse drug reactions (CADRs) are a frequent complication in patients undergoing anti-tubercular therapy (ATT) often leading to therapy interruption. This study investigates the prevalence, clinical patterns and associated risk factors for CADRs among hospitalized TB patients receiving ATT. Methods: This prospective observational study was conducted in the Department of Respiratory Medicine and the Department of Dermatology, Venereology and Leprosy (DVL) in Government Medical College and Hospital, Nizamabad. It included 50 hospitalized TB patients who developed CADRs during ATT course.  Data on demographics, clinical manifestations and implicated medications were collected and analyzed using descriptive statistics. Results: Among the 50 patients studied (23 males and 27 females; mean age-50 years), 60% had pulmonary TB and 40% had extra-pulmonary TB. The primary drugs implicated were ethambutol (46%), pyrazinamide (20%), and isoniazid (18%). The most common dermatological presentation was maculopapular rash (42%), followed by urticarial rash (18%) and lichenoid eruptions (12%). Severe reactions included DRESS syndrome (26%), exfoliative dermatitis (12%), and AGEP (8%). Systemic involvement included eosinophilia in 80% of cases, transient hepatitis in 38%, and renal dysfunction in 8%. Conclusion: CADRs are a notable concern in ATT regimens. Early detection, risk stratification and individualized therapy are essential to ensure treatment adherence and minimize complications. Older age and polypharmacy appear to elevate CADR risk.

Background: Hypertensive disorders of pregnancy, particularly pre-eclampsia, remain one of the leading causes of maternal and perinatal morbidity and mortality worldwide. Early identification of high-risk women allows timely interventions and improved pregnancy outcomes. Uterine artery Doppler ultrasonography, being a non-invasive technique, offers potential in predicting the development of pre-eclampsia by assessing uteroplacental circulation. Objectives: To determine the role of uterine artery Doppler in predicting pre-eclampsia in high-risk pregnant women and to evaluate its sensitivity, specificity, and predictive accuracy. Methods: A prospective observational study was conducted at the Department of Obstetrics and Gynaecology, Government Maternity Hospital, Tirupati, from January to December 2023. Eighty-seven antenatal women aged 18–38 years with high-risk factors such as advanced maternal age, obesity, diabetes, chronic hypertension, previous pre-eclampsia, or multifetal gestation were included after obtaining informed consent. Uterine artery Doppler studies were performed using a Toshiba Nemio 30 colour Doppler to assess resistance index (RI) and presence of diastolic notches. Women were followed throughout pregnancy for the development of pre-eclampsia, defined as blood pressure ≥140/90 mmHg with proteinuria after 20 weeks of gestation. Data were analyzed using SPSS v23.0, and statistical significance was considered at p < 0.05. Results: Out of 87 participants, 15 (17.2%) developed pre-eclampsia. Abnormal Doppler findings were noted in 16 women (18.39%), of whom 12 (75%) subsequently developed pre-eclampsia. Among Doppler abnormalities, unilateral RI >0.58 was most common (33.3%), followed by bilateral RI >0.58 (20%) and bilateral uterine artery notching (13.3%). The test demonstrated a sensitivity of 80%, specificity of 94.4%, positive predictive value of 75%, negative predictive value of 95.8%, and an overall diagnostic accuracy of 91.9%. Higher maternal age, obesity (BMI >30 kg/m²), previous history of pre-eclampsia, and comorbidities such as gestational diabetes mellitus were significantly associated with increased risk. Conclusion: Uterine artery Doppler ultrasonography is a reliable, non-invasive screening tool for predicting pre-eclampsia in high-risk pregnancies. An RI >0.58 and the presence of persistent diastolic notching are significant predictors of disease development. Incorporating uterine artery Doppler screening into routine antenatal assessment, especially for high-risk women, can facilitate early intervention, reduce maternal and perinatal complications, and improve pregnancy outcomes.

Background: Heart failure (HF) phenotyping by left ventricular ejection fraction (LVEF) guides management, yet data on the intermediate HFmrEF category (LVEF 41–49%) are limited in South Asia. Understanding HFmrEF prevalence, demographics, and etiology is critical for targeted therapy.  Objective: To determine the prevalence of HFmrEF among patients with acute decompensated heart failure at a tertiary care center in Southern IndiaMethods: In this hospital‐based cross-sectional study, 230 consecutive ADHF patients ≥18 years were enrolled at a tertiary care center from March 2021 to April 2022. HF was confirmed by Framingham criteria. Transthoracic echocardiography measured LVEF via Simpson’s biplane method, stratifying into HFrEF (<40%), HFmrEF (41–49%), and HFpEF (≥50%). Baseline demographics, symptoms, comorbidities, and risk factors were recorded. Descriptive statistics summarized results, and chi-square tests compared categorical variables with significance set at p<0.05. Results: HFrEF comprised 46.5% (n=107), HFmrEF 25.7% (n=59), and HFpEF 27.8% (n=64). HFmrEF patients had mean age 59 ± 14 years, 76.3% male, with dyspnea in 93.2% and NYHA class II in 78.0%. Ischemic heart disease was predominant in HFmrEF (74.6%), with AWMI in 39.0%. Hypertension and diabetes were present in 62.7% and 45.8%, respectively. HFmrEF exhibited significantly higher IHD than HFpEF (74.6% vs. 42.2%; p=0.01). Electrocardiographic LVH occurred in 18.7% (p=0.033), LAD wall motion abnormalities in 37.8% (p<0.001), and valvular disease in 12.5% (p=0.006). Conclusion: HFmrEF represents one-quarter of ADHF admissions, primarily in middle‐aged men with high ischemic burden, distinguishing it from HFpEF and aligning it more closely with HFrEF. These findings support ejection fraction–based phenotyping for tailored therapeutic strategies.

Background: Heart failure with mildly reduced ejection fraction (HFmrEF) occupies an intermediate position between HFrEF and HFpEF, yet longitudinal outcome data remain limited, particularly in South Asian populations. This study evaluated one-year mortality, rehospitalization, and left ventricular ejection fraction (LVEF) trajectory in HFmrEF patients. Objective: To evaluate one-year mortality and rehospitalization rates in patients with HFmrEF Methods: The present prospective observational study enrolled 59 patients with HFmrEF (LVEF 41-49%) presenting with acute decompensated heart failure at a tertiary care center. Patients underwent comprehensive baseline evaluation and standardized follow-up at 6 and 12 months. Primary endpoints included all-cause and cardiovascular mortality, rehospitalization rates, and major adverse cardiovascular events (MACE). Secondary endpoints assessed LVEF trajectory and transition patterns. Results: At one year, 8 patients (13.6%) died from any cause, including 6 (10.2%) cardiovascular deaths. Rehospitalization occurred in 31 patients (52.5%), with 18 (30.5%) readmitted for heart failure. Composite MACE affected 31 patients (52.5%), comprising ischemic events (11.9%), stroke (6.8%), and ventricular tachycardia (3.4%). Regarding LVEF trajectory, 18 patients (30.5%) deteriorated to HFrEF, 27 (45.8%) remained stable within HFmrEF range, and 14 (23.7%) improved to HFpEF. Cardiac mortality concentrated between 4-8 months, with ischemic events causing 50% of cardiovascular deaths. Conclusion: HFmrEF carries substantial one-year morbidity and mortality with high MACE rates and significant LVEF transitions. Early cardiac mortality clustering and predominant ischemic etiology emphasize the need for aggressive management, vigilant surveillance, and HFrEF-aligned therapeutic strategies to optimize outcomes in this intermediate phenotype

Introduction: Oral cavity squamous cell carcinoma (OCSCC) remains a prevalent and aggressive malignancy, particularly in South Asian populations. Tumor stage and cervical nodal involvement are key determinants of prognosis, yet the lymph node ratio (LNR)-the ratio of metastatic to total lymph nodes-has recently emerged as a more precise indicator of tumor burden. This study aimed to determine the association between tumor stage and LNR in oral cavity malignancies. Methods: A retrospective analytical study was conducted in the Department of Surgical Oncology, VTSM Peripheral Cancer Centre, Kalaburagi, from 2022 to 2024. A total of 200 histopathologically confirmed cases of oral cavity squamous cell carcinoma were analyzed. LNR was calculated as the ratio of positive lymph nodes to total nodes retrieved. Tumors were staged using the AJCC 8th edition criteria. Statistical analysis included Welch’s t-test, chi-square tests, and Spearman’s correlation. Results: Of 200 patients, 109 (54.5%) had early-stage (T1-T2) and 91 (45.5%) had advanced-stage (T3-T4) tumors. Mean LNR was significantly higher in advanced stages (0.186 ± 0.107) than in early stages (0.082 ± 0.058), with a mean difference of +0.104 (95% CI 0.079-0.129; p < 0.001). A high LNR (≥0.12) was observed in 54.9% of advanced-stage cases versus 30.3% of early-stage cases (RR 1.81; p < 0.001). A strong positive correlation existed between T stage and LNR (Spearman ρ = 0.47; p < 0.001). High LNR was significantly associated with extranodal extension (OR 2.93; p = 0.00085) and nodal positivity (RR 1.62; p < 0.001). Conclusion: Lymph node ratio increases significantly with advancing tumor stage and correlates with adverse pathological features. LNR serves as a valuable prognostic adjunct to conventional TNM staging, offering improved risk stratification for postoperative management in oral cavity carcinoma.

Background: With the rising burden of coronary artery disease (CAD) in India, percutaneous coronary intervention (PCI) using multiple stents has become increasingly common in complex cases. However, data on outcomes for patients receiving ≥3 stents remain limited. Objective: To evaluate the Clinico-demographic and angiographic profile and assess short-term procedural outcomes in patients undergoing PCI with three or more coronary stents. Methods: A mixed-design cohort study was conducted at a tertiary center including 134 patients undergoing PCI with ≥3 stents. Data on demographics, clinical presentation, lesion characteristics, and procedural outcomes were analyzed. Results: Of 134 patients, 74% were male. Most were between 41–70 years (77%). TVD (46%) was the most common angiographic pattern. Type B (43%) and Type A (37%) lesions predominated. In-hospital complications were negligible; at 3 months, mortality was 1.49%, and angina occurred in 8.96%. Conclusion: PCI with ≥3 stents is safe and effective with favourable short-term outcomes in complex CAD. Long-term follow-up is warranted for definitive conclusions.

Background: Subarachnoid block (SAB) with hyperbaric bupivacaine is routinely administered for abdominal surgeries. Intravenously administered dexmedetomidine has been shown to prolong the duration of sensory and motor blockade obtained with subarachnoid block. Aim of the study was to assess the efficacy of Intravenous Dexmedetomidine on Spinal anaesthesia. Materials and methods: Prospective Randomized Double-blind Placebo-Controlled Study in the department of Anaesthesia at  Khaja Banda Nawaz Teaching and General hospital Kalaburagi  for duration of 18 months ie from (Dec 2019 to  30 may 2021) among  patientsaged between 18-55 years, ASA grade I and II posted for elective lower abdominal surgeries under spinal anaesthesia The patients divided into 2 groups , Group D (study group) patients  received single bolus dose of 0.5mcg/kg of intravenous Dexmedetomidine Diluted upto 10ml with normal saline slowly over 10 minutes and Group C (control group) patients  received 10ml of normal saline Intravenously slowly over 10 minutes.   Results: Mean age of 34.23 ± 8.481 years in Group D and Group C constituting 38% with 33.51 ± 8.375 years. The number of subjects requiring rescue analgesia in Group D (n=22) at 4 hours was significantly lower than C group (n=40) (p=<0.05) and higher requirement seen in Group D at 6^th hour compared to NS group (n= 20, n=0 respectively) which was statistically significant (p<0.05) Conclusion: we conclude that with spinal anaesthesia intravenous dexmedetomidine was efficient in reducing postoperative pain, and prolonging the time to the requirement of first rescue analgesia.

Background: Hypertension is one of the most prevalent non-communicable diseases in India and a leading cause of cardiovascular morbidity and mortality. Despite the availability of effective antihypertensive agents, interindividual variability in treatment response remains a challenge. Genetic polymorphisms in drug-metabolizing enzymes and receptor targets influence the pharmacokinetics and pharmacodynamics of antihypertensive drugs. Genotype-guided therapy, which tailors treatment based on the patient’s genetic profile, represents a promising step toward personalized medicine in hypertension management. Objectives: To evaluate the effectiveness of genotype-guided antihypertensive therapy compared with standard guideline-based treatment in achieving optimal blood pressure control, reducing time to therapeutic target, and minimizing adverse drug reactions among patients with essential hypertension. Methods: This prospective, randomized, open-label, controlled clinical study was conducted in the Department of Cardiology of a tertiary care teaching hospital in India between March 2023 and April 2024. A total of 380 adults (aged 30–65 years) with essential hypertension were randomized equally into two groups:

• Genotype-guided therapy group (n = 190): Treatment tailored to polymorphisms in CYP2D6, ADRB1, and AGT genes.
• Standard therapy group (n = 190): Treatment per national hypertension guidelines without genetic input.

Genotyping was performed using validated TaqMan assays, and participants were followed up for six months. The primary outcome was the proportion achieving target blood pressure (<130/80 mmHg). Secondary outcomes included time to reach target blood pressure, change in mean systolic and diastolic pressures, and incidence of adverse drug reactions. Statistical analyses used t-tests, chi-square tests, and repeated-measures ANOVA, with significance set at p < 0.05. Results: At six months, 77.9% of participants in the genotype-guided group achieved target blood pressure compared with 61.3% in the standard therapy group (p < 0.001). The average time to achieve target systolic pressure was shorter in the genotype-guided group (8.2 ± 2.5 weeks vs. 12.4 ± 3.3 weeks; p < 0.001). Mean reduction in systolic and diastolic pressures was greater in the genotype-guided group (−18.5 ± 6.1 mmHg and −11.2 ± 4.8 mmHg, respectively) compared to standard care (−12.3 ± 5.9 mmHg and −7.4 ± 4.2 mmHg, respectively). Adverse reactions such as fatigue and orthostatic hypotension were less frequent in the genotype-guided group (5.3%) than in standard care (10.5%). Conclusion: Genotype-guided antihypertensive therapy significantly improved blood pressure control, accelerated therapeutic response, and reduced drug-related adverse effects compared with conventional treatment. Implementing pharmacogenomic profiling in routine hypertension management could enhance treatment precision, adherence, and patient outcomes in the Indian population.

Objective: To compare the diagnostic efficacy of multi-detector computed tomography (MDCT) virtual bronchoscopy (VB) with conventional fiberoptic bronchoscopy (FOB) in detecting, characterizing, and localizing airway lesions, and to assess their agreement in evaluating tracheobronchial abnormalities. Methods: This prospective observational study was conducted in the Departments of Radiodiagnosis and Pulmonary Medicine at a tertiary care center. A total of 50 adult patients clinically suspected of having tracheobronchial lesions underwent both contrast-enhanced MDCT and FOB. MDCT images were reconstructed into multiplanar reformatted (MPR), minimal-intensity projection (minIP), and virtual bronchoscopy (VB) views. FOB was performed within 72 hours by a blinded pulmonologist. Parameters assessed included lesion detection, degree and length of stenosis, segmental involvement, visualization of distal airways, and overall diagnostic confidence. Statistical analysis was performed using SPSS version 25. Results: MDCT-VB detected airway lesions in 45 out of 50 patients (90.0%), while FOB detected lesions in 47 patients (94.0%) (p = 0.456). The mean degree of stenosis on VB was 71.2 ± 10.4% vs. 73.5 ± 9.8% on FOB (p = 0.328). VB allowed visualization of distal airways in 86.0% of cases versus 70.0% for FOB (p = 0.027). The sensitivity, specificity, and diagnostic accuracy of VB were 95.7%, 60.0%, and 92.0%, respectively. Cohen’s Kappa coefficient showed substantial agreement (κ = 0.73). The area under the ROC curve for VB was 0.93. Conclusions: MDCT virtual bronchoscopy is a highly accurate, non-invasive imaging modality with diagnostic performance comparable to FOB, and serves as a valuable complementary tool in airway evaluation, especially in patients with obstructive lesions

Background: Sedation in ophthalmic day-care procedures such as cataract surgery enhances patient comfort and cooperation. Midazolam is commonly used, while dexmedetomidine may provide superior sedation with minimal respiratory depression. Objective: To compare sedation quality, hemodynamic stability, recovery profile, and patient satisfaction between dexmedetomidine and midazolam in ophthalmic day-care surgeries. Methods: A prospective randomized study was conducted on 100 adult patients (ASA I–II) undergoing elective ophthalmic day-care procedures, primarily cataract surgery. Patients were randomized to receive intravenous dexmedetomidine (1 µg/kg loading, 0.2–0.5 µg/kg/h infusion) or midazolam (0.03 mg/kg bolus, 0.01–0.02 mg/kg/h infusion). Ramsay Sedation Scale, hemodynamics, recovery time, patient and surgeon satisfaction, and adverse events were recorded. Results: Dexmedetomidine achieved higher sedation scores (RSS 3–4) than midazolam (RSS 2–3, p<0.001). Hemodynamics were more stable in the dexmedetomidine group, without clinically significant hypotension or bradycardia. Recovery times were comparable (23 ± 6 vs 21 ± 5 min, p=0.21). Patient satisfaction was higher in the dexmedetomidine group (4.7 ± 0.3 vs 3.9 ± 0.4, p<0.01). No respiratory depression or serious adverse events occurred. Conclusion: Dexmedetomidine provides superior sedation quality, patient comfort, and hemodynamic stability compared to midazolam, making it ideal for ophthalmic day-care procedures under local anesthesia

Background: Background: Left ventricular hypertrophy (LVH) is a common target organ manifestation of hypertension and is one of the major predictors of cardiovascular morbidity. Electrocardiogram (ECGs), a low-cost method for LVH identification, is still up for dispute, especially when it comes to resistant hypertension (RH), a subgroup of hypertensive patients with a higher risk of cardiovascular disease. Objective: To evaluate the correlation between LVH identified using the Romhilt-Estes¹ ECG scoring system and left ventricular mass (LVM) measured by echocardiography in patients with resistant hypertension. Methods: In this cross-sectional study, 95 adults diagnosed with resistant hypertension were enrolled at a tertiary care center in India. All patients underwent standard 12-lead ECG and two-dimensional transthoracic echocardiography. LVH on ECG was defined using the Romhilt-Estes point score. LVM was calculated via the Devereux formula and indexed to body surface area (LVMI)¹. Pearson correlation and inter-rate agreement were used to evaluate the relationship between echocardiographic LVM and ECG-detected LVH. Results: The cohort's mean age was 55.2±12.3 years, and 74.7% of the participants were male. While echocardiographic LVH was seen in 50.5% of patients (absolute values) and 82.1% of patients (indexed with BMI), 36.8% of patients had definitive LVH on their ECG. Echocardiography-based LVH detection and ECG had a weak correlation (kappa < 0.06). Using echocardiography as the reference, ECG's sensitivity, specificity, and diagnostic accuracy for LVH detection were 53.3%, 55.6%, and 53.7%, respectively. Conclusion: When it comes to identifying LVH in individuals with resistant hypertension, the Romhilt-Estes ECG criteria show poor agreement with echocardiographic findings. In this high-risk population, echocardiography is still the recommended modality for LVH evaluation

Background: Neuroendocrine tumors (NETs) are uncommon and biologically diverse neoplasms that often arise from small, clinically silent primary sites and typically demonstrate overexpression of somatostatin receptors (SSTRs). Imaging with ⁶⁸Ga-labeled somatostatin analogues using positron emission tomography/computed tomography (PET/CT) has been shown to outperform conventional techniques in the evaluation of NETs. The aim of this study was to evaluate the diagnostic utility of ⁶⁸Ga-DOTANOC PET/CT for visualizing somatostatin receptor (SSTR) expression and detecting previously unidentified lesions. Methods We conducted a prospective single-center study of 100 consecutive adults with suspected or known NETs over 12 months (May 2023–May 2024). ⁶⁸Ga-DOTANOC was administered intravenously, followed by whole-body PET/CT approximately 60 minutes post-injection. Images were interpreted visually, and focal uptake above background consistent with somatostatin receptor expression was considered positive. Indications included initial staging and restaging. Primary outcomes were identification of the index primary in suspected NET and detection of residual or recurrent disease in previously diagnosed cases. Proportions with 95% confidence intervals were calculated. Ethics approval and informed consent were obtained. Results Of 100 patients (69 males, 31 females; mean age 55 years, range 40–70 years), 68 underwent initial staging and 32 restaging. Primary lesions were detected in 61 of 68 suspected NET cases (89.7%). The most frequent sites were gastrointestinal tract (n=51), pancreas (n=11), and bronchus (n=7). In the restaging cohort, 18 of 32 patients (56.2%) demonstrated ⁶⁸Ga-DOTANOC–avid residual or recurrent disease, while 12 showed no active disease. All studies exhibited high target-to-background contrast. Conclusion ⁶⁸Ga-DOTANOC PET/CT demonstrated excellent lesion detection and proved valuable for identifying primary sites, metastases, and disease recurrence in NET patients. It serves as a robust molecular imaging tool for staging, restaging, and follow-up in oncology practice

Background: Dental caries and obesity are two major public health concerns worldwide. Recent studies have explored the relationship between body fat percentage and dental health, particularly the incidence of dental caries, with mixed results. While some studies show a positive association between higher body fat and poor oral health, others suggest that factors such as diet, oral hygiene, and socioeconomic status also play significant roles. This study aims to investigate the relationship between body fat percentage and dental health, specifically dental caries as measured by DMFT (Decayed, Missing, and Filled Teeth) scores. Method: This cross-sectional study included 100 patients aged 18-65 years, categorized into three groups based on body fat percentage: low, normal, and high. Body fat percentage was assessed using bioelectrical impedance or skinfold thickness measurements. The DMFT scores were obtained from dental examinations performed by trained professionals. Data analysis was conducted using descriptive statistics, and a Chi-square test was used to assess the correlation between body fat category and DMFT scores. Results: Patients in the high body fat group had significantly higher DMFT scores compared to those in the low and normal body fat categories. The high body fat group showed the highest mean DMFT score and a greater percentage of patients with DMFT scores greater than 5 (35%). Statistical analysis confirmed a significant relationship between body fat category and DMFT scores (p=0.0002). The low body fat group had the least dental decay, with no patients exhibiting severe dental issues. Conclusion: The study demonstrates a significant association between higher body fat percentage and poorer dental health, as indicated by higher DMFT scores. These findings suggest that body fat management should be incorporated into broader dental care strategies. Further research is needed to explore the underlying biological mechanisms of this association and to develop targeted interventions for populations at risk of both obesity and dental caries

Background: Type 2 diabetes mellitus (T2DM) is a main worldwide health challenge requiring long-term pharmacological management. Multiple antidiabetic drug classes are available, but direct comparative evidence on efficacy and safety remains limited. Methods: A Retrospective observational study was led in a Internal Medicine clinic Prime Specialist Medical Centre, including 100 patients with T2DM. Participants were randomized into five groups of 20 patients each, with one group assigned to each drug class. Over one year, effectiveness endpoints included HbA1c, plasma fasting glucose, or postprandial glucose changes. Safety outcomes included unfavourable events, hypoglycaemic events, weight fluctuations, and hospitalisation. The study utilised ANOVA for continuous variables and chi-square testing for categorical outcomes. Results: All drug classes significantly reduced HbA1c levels (p<0.05). GLP-1 receptor agonists (-1.6%) and SGLT2 inhibitors (-1.4%) showed the greatest HbA1c reductions, along with favourable weight loss and low hypoglycaemia risk. Metformin achieved solid efficacy (-1.2%) but was associated with gastrointestinal side effects. Sulfonylureas demonstrated strong glycaemic control (-1.3%) but had the highest hypoglycaemia incidence (25%). DPP-4 inhibitors were well tolerated but showed modest efficacy (-0.9%). Conclusion: GLP-1 receptor agonists and SGLT2 inhibitors offered the best balance of efficacy and safety. Metformin remains a robust first-line therapy, while sulfonylureas require cautious use due to hypoglycaemia risk. Larger multicentre trials are recommended to validate these findings and assess long-term outcomes

Background: Ischemic heart disease (IHD), also known as coronary artery disease (CAD), accounts for approximately 13% of all global deaths, according to the World Health Organization, and has remained the leading cause of mortality for the past two decades. A thorough understanding of coronary artery anatomy and its morphological variations is essential for accurate diagnosis, interventional cardiology, and surgical management of CAD. Materials and Methods: The present descriptive anatomical study was conducted on 53 formalin-fixed human hearts obtained from the Department of Anatomy over a period of two years. Each specimen was meticulously dissected to observe the branching pattern of the left coronary artery (LCA) and its major branches — the left anterior descending (LAD) and left circumflex (LCx) arteries. Results: Among the 53 specimens, the trifurcation pattern of the LCA was observed in 24 hearts (45.3%), the bifurcation pattern in 24 hearts (45.3%), the tetrafurcation pattern in 3 hearts (5.7%), and the pentafurcation pattern in 2 hearts (3.8%). Conclusion: Comprehensive anatomical knowledge of the morphological variations in the branching pattern of the left coronary artery is vital for cardiac surgeons, interventional radiologists, and cardiologists. Such understanding minimizes intraoperative complications and enhances the precision of coronary interventions, angiographic interpretation, and bypass graft planning

Background: South Asia is experiencing a rising burden of cardiovascular diseases (CVDs) and non-communicable diseases (NCDs), contributing to high morbidity, premature mortality, and socio-economic challenges. Understanding epidemiological shifts and effective preventive strategies is essential for public health planning. Methods: A systematic review was conducted following PRISMA guidelines. Databases including PubMed, Scopus, Web of Science, and Embase were searched for studies published between 2010 and 2025. Inclusion criteria comprised observational and cohort studies reporting prevalence, risk factors, or preventive interventions for CVDs and NCDs among adults in South Asia. Study quality was assessed using the Newcastle–Ottawa Scale. Data were extracted on country, study design, sample size, methods, results, and conclusions. Results: A total of 38 studies from India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, Maldives, and Afghanistan were included. Prevalence of hypertension ranged from 18–26%, diabetes 8–12%, and obesity 12–21% across countries. Tobacco use, unhealthy diet, physical inactivity, and metabolic risk factors were consistently reported. Urban populations showed higher prevalence of CVD risk factors compared with rural counterparts. Preventive interventions, including lifestyle modification, health education, community-based screening, and digital health programs, demonstrated potential in reducing risk factors but were inconsistently implemented. Study quality ranged from moderate to high. Conclusion: South Asia faces a significant and growing NCD burden, driven by modifiable lifestyle and metabolic risk factors. Coordinated, multi-sectoral, and culturally tailored preventive strategies, including lifestyle interventions, early screening, and health system strengthening, are urgently needed to mitigate the rising epidemic and achieve healthier populations

Background: Hip fractures represent a major cause of morbidity, functional decline, and mortality in the elderly population worldwide. Their incidence continues to rise in developing countries like India due to ageing demographics, osteoporosis, and fall-related injuries. Understanding local epidemiological trends and clinical outcomes helps improve preventive and management strategies. Aim of the study was to evaluate the demographic profile, fracture patterns, comorbidities, modes of injury, management practices, and early postoperative outcomes among elderly patients presenting with hip fractures at a tertiary-care teaching hospital in South India. Materials and Methods: This retrospective observational study was conducted in the Department of Orthopedics, Mamata Academy of Medical Sciences, Hyderabad, over one year (January–December 2024). A total of 30 patients aged ≥60 years with radiologically confirmed proximal femur fractures were included. Data were collected from hospital records regarding age, sex, comorbidities, mechanism of injury, fracture type, treatment modality, and postoperative course. Statistical analysis was performed using SPSS version 26.0. Continuous variables were expressed as mean ± standard deviation (SD) and categorical variables as frequency and percentage. Results: The mean age was 72.4 ± 7.6 years, and females constituted 60% of the study population. Slip and fall at home was the most common mechanism of injury (80%). Extracapsular fractures were more frequent (60%) than intracapsular (40%). The majority (86.7%) underwent surgical management—hemiarthroplasty (40%), DHS fixation (23.3%), and PFN fixation (23.3%)—while 13.3% were treated conservatively. Mean hospital stay was 8.6 ± 2.4 days; 30% required blood transfusion. Early postoperative complications occurred in 26.7%, and in-hospital mortality was 3.3%. Conclusion: Hip fractures predominantly affect elderly women following trivial domestic falls, with extracapsular patterns being most common. Early surgical intervention, effective perioperative care, and multidisciplinary rehabilitation can significantly improve short-term outcomes. Preventive measures focusing on fall prevention and bone health are essential to reduce fracture burden in the ageing Indian population

Introduction: Critical limb ischemia (CLI) represents the end stage of peripheral arterial disease and is frequently complicated by infection, tissue necrosis, and gangrene. When revascularization is not feasible, amputation becomes necessary. The optimal surgical strategy—one-stage versus staged amputation—remains debated, particularly in infected ischemic limbs. Aim: To compare the outcomes of one-stage and staged amputations in patients with lower-limb critical ischemia and infection. Materials and Methods: A prospective comparative study was conducted on 50 patients (30 with staged amputations, 20 with one-stage amputations) admitted between January and December 2017. Diagnosis of CLI was based on rest pain, gangrene, and absence of distal pulses, confirmed by arteriography. Patients with uncontrolled infection or non-demarcated necrosis underwent staged amputation (initial guillotine followed by definitive closure), whereas those with well-defined ischemia underwent one-stage amputation. Primary outcomes included stump healing (success), need for revision surgery, 30-day and 12-month mortality. Data were analyzed using appropriate statistical tests, with p < 0.05 considered significant. Results: Staged amputations were performed more often in patients with severe ischemia (Rutherford 5–6), diabetes, and infection, while one-stage amputations predominated among hypertensive and cerebrovascular disease cases. The mean hospital stay was 25.18 ± 18.18 days (SA) versus 16.3 ± 16 days (OSA) (p = 0.9999). Primary success was significantly higher in SAs (p< 0.05), particularly at the transtibial level (p = 0.0001). Survival analysis revealed longer overall survival in SA patients, while early mortality was higher in diabetics and smokers undergoing OSA. Logistic regression identified non-diabetic status, absence of coronary disease, and non-smoking as independent predictors of better survival. Conclusion: Staged amputations, despite being applied to more severe ischemic and infected limbs, achieved superior stump healing and survival compared to one-stage amputations. The staged approach effectively controls infection, enhances wound viability, and reduces peri-operative mortality.

Background: Ocular surface disease (OSD) represents a significant yet often underrecognized complication in glaucoma patients receiving chronic topical therapy. The preservatives and active ingredients in anti-glaucoma medications can compromise ocular surface integrity, leading to symptoms that affect quality of life and treatment adherence. This study aimed to comprehensively assess the prevalence and severity of OSD symptoms and signs in glaucoma patients using topical medications. Methods: A cross-sectional study was conducted involving 40 glaucoma patients on topical anti-glaucoma therapy for at least six months. Comprehensive evaluation included the Ocular Surface Disease Index (OSDI) questionnaire for symptom assessment, tear film break-up time (TBUT), Schirmer test, corneal fluorescein staining, and assessment of superficial punctate keratitis. Statistical analysis examined correlations between OSD severity and medication-related factors including preservative exposure, number of medications, and treatment duration. Results: Among 40 participants, 73% (29/40) demonstrated clinical evidence of OSD, with 35% showing mild, 27.5% moderate, and 10% severe disease. Mean OSDI score was 29.2±14.8, TBUT averaged 7.1±2.7 seconds, and Schirmer test showed 8.7±3.5 mm. Preserved medication users had significantly higher OSDI scores than preservative-free users (33.4±13.9 vs 19.8±11.2, p=0.006). Multiple medication use strongly correlated with OSD severity (r=0.71, p<0.001). Superficial punctate keratitis was present in 62.5% of patients. Conclusion: OSD demonstrates high prevalence in glaucoma patients on topical therapy, with severity correlating significantly with preservative exposure and medication burden. These findings emphasize the importance of routine ocular surface assessment and consideration of preservative-free alternatives in glaucoma management to optimize both treatment efficacy and quality of life.

Introduction: Malnutrition is one of the leading causes of secondary immunodeficiency in children, contributing to impaired cell-mediated immunity and increased risk of infections. The Mantoux test and absolute lymphocyte count (ALC) are widely used to assess delayed hypersensitivity and immune competence. Few Indian studies have comprehensively assessed the interplay of nutritional status, Mantoux reactivity, and ALC in pediatric populations. With increasing recognition of malnutrition’s role in immunosuppression, such studies are essential to form interventions. This study was designed to evaluate the influence of clinical and nutritional status on delayed hypersensitivity and ALC in children admitted to a tertiary care hospital, and to analyze Mantoux responses in relation to BCG vaccination. Material and Methods: This cross-sectional study included 503 children (1 month–18 years) admitted to the Pediatric Department of Tertiary Care Teaching Hospital over a period of 18 months. Demographic, clinical, and nutritional details were collected. Nutritional status was assessed by WHO growth charts. Mantoux testing was performed with 5 TU PPD RT23. ALC was calculated from complete blood counts. Tuberculin skin test was done with PPD-RT 23 with Tween 80 of strength 5TU according to standard technique (Ref of tuberculin test article) with 26–27-gauge needles over volar surface of arm. Indurations were measured twice with transparent scale and were noted in millimeters, once after 48 hours and again after 72 hours. Depending on size of induration Delayed Hypersensitivity Reaction (DTH) was determined using Mantoux test. Results: The mean age was 81 months; 53.5% were male, 97% were from rural areas, and most belonged to lower socioeconomic status. Malnutrition was prevalent: 19% severely underweight, 19% underweight, 14.6% severely wasted, and 13.3% wasted. Severely underweight: 19%, Underweight: 19%. Severely wasted: 14.6%, Wasted: 13.3%. Severely stunted: 12%, Stunted: 20.5%. Overweight/obese: 2.9%. Mantoux positivity was significantly lower in malnourished children (p<0.05). ALC was reduced in undernourished children compared to well-nourished peers. BCG vaccination correlated with Mantoux positivity, but the response diminished with age and nutritional deficits. Conclusion: Malnutrition significantly impairs cell-mediated immunity as reflected by reduced Mantoux responses and lower ALC. Early nutritional interventions are essential to improve immune competence in children

Introduction: Direct oral anticoagulants (DOACs) have emerged over the past decade as important alternatives to traditional anticoagulants such as vitamin K antagonists (VKAs).Among them, rivaroxaban, a direct factor Xa inhibitor, is widely prescribed for stroke prevention in atrial fibrillation, venous thromboembolism management, and prophylaxis following orthopedic surgeries. AIM: Study of postoperative bleeding risk for oral surgery under continued rivaroxaban anticoagulant therapy. Methodology: This prospective cross-sectional study was conducted at department of Dentistry, Govt. Medical college, Barmer, for 6 months, on 63 patients were included during the study periodConsecutive patients receiving rivaroxaban who required simple tooth extraction(s) were enrolled. Result: Among 63 patients on rivaroxaban undergoing oral procedures, the majority were older adults (50–60 years: 39.4%; >60 years: 28.6%) with a mild male predominance (57%). Atrial fibrillation was the most common indication (47.6%), followed by DVT (23.8%) and PE (15.9%). Postoperative bleeding was mostly mild and manageable, occurring in 60% of cases, with only 2% requiring hospital admission. Conclusion: Oral surgical procedures, including extractions, can be safely performed in patients on continued rivaroxaban therapy, with most bleeding being mild and manageable, however oral anticoagulant increase the risk of bleeding. Atrial fibrillation was the most common indication, and careful hemostatic measures minimize the risk of significant postoperative complications

Background: Accurate early risk stratification in ST-elevation myocardial infarction (STEMI) is critical for guiding management and improving outcomes. The Global Registry of Acute Coronary Events (GRACE) score assesses clinical severity, while the Synergy Between PCI with Taxus and Cardiac Surgery (SYNTAX) score quantifies coronary anatomical complexity. This study aimed to evaluate the correlation between GRACE and SYNTAX scores in STEMI patients and assess their comparative utility for in-hospital risk prediction. Methods: This prospective, observational study was conducted at Dr. Vithalrao Vikhe Patil Foundation’s Medical College and Hospital, Ahmednagar, Maharashtra, from March to November 2024. Forty-three STEMI patients aged ≥18 years were enrolled. GRACE scores were calculated using clinical and laboratory parameters, and SYNTAX scores were derived from coronary angiography. Correlation between the two scores was analyzed using Pearson’s correlation coefficient, and their association with hemodynamic and clinical variables was assessed. Results: The mean age of patients was 65.9 ± 11.4 years, with a male predominance (58.1%). The mean GRACE and SYNTAX scores were 138.9 ± 33.5 and 15.7 ± 4.0, respectively. A very strong positive correlation was observed between GRACE and SYNTAX scores (r = 0.988, p = 0.001). Higher SYNTAX scores (≥23) were significantly associated with lower systolic blood pressure (p = 0.002) and advanced Killip class (p = 0.001). Patients in Killip Class IV had the most complex coronary disease. Conclusion: There exists a strong and statistically significant correlation between GRACE and SYNTAX scores in STEMI patients, indicating that clinical severity closely reflects angiographic complexity. Combined use of both scores can enhance early risk stratification and guide treatment planning, especially in resource-limited settings lacking immediate access to coronary angiography. Further large-scale, multicentric studies are warranted to validate these findings and explore their prognostic implications.

Introduction: Total knee arthroplasty (TKA) offers durable relief for end-stage knee osteoarthritis, but wound-related complications such as delayed wound healing (DWH) and postoperative infection continue to impair recovery and increase revision risk. Identifying modifiable predictors is vital for prevention. Aim of the study was to determine predictive factors for delayed wound healing and postoperative infections following primary TKA. Materials and Methods: A prospective observational study was conducted in the Department of Orthopedics, Mamata Academy of Medical Sciences, Hyderabad, from [insert period]. Thirty consecutive patients undergoing primary TKA were evaluated. Preoperative variables included age, sex, body-mass index (BMI), diabetes, HbA1c, and serum albumin. Intraoperative parameters operative duration, blood loss, and drain use—were recorded. Patients were followed for 30 days for wound outcomes. DWH was defined as drainage > 72 h or incomplete epithelialisation > 14 days; infection was categorised as superficial surgical-site infection (SSI) or deep periprosthetic joint infection (PJI). Logistic regression identified independent predictors (p < 0.05). Results: Mean age was 66.2 ± 7.8 years and mean BMI 30.4 ± 4.6 kg/m². Diabetes was present in 36.7 %, and 20 % had hypoalbuminaemia (< 3.5 g/dL). Incidences were: DWH 13.3 % (n = 4), SSI 6.7 % (n = 2), no PJI. On multivariate analysis, albumin < 3.5 g/dL (AOR 4.86, 95 % CI 1.06–22.2; p = 0.041*) and HbA1c > 7 % (AOR 3.40, 95 % CI 1.01–11.8; p = 0.048*) predicted DWH. Albumin < 3.5 g/dL (AOR 4.21, 95 % CI 1.02–18.9; p = 0.047*) and operative time > 100 min (AOR 3.66, 95 % CI 1.00–14.0; p = 0.049*) predicted infection. Conclusion: Hypoalbuminaemia, poor glycaemic control, and prolonged operative time were independent predictors of postoperative wound complications after TKA. Preoperative nutritional and metabolic optimisation and operative efficiency are essential to reduce early wound morbidity.

Background: Understanding coronary artery variations is crucial for accurate diagnosis, surgical safety, and interventional precision. While imaging delineates coronary topography, cadaveric dissection remains the benchmark for anatomical correlation. To document the origin, number, and position of coronary ostia; analyze morphometric parameters; identify branching and variant patterns; and determine dominance relationships in human cadaveric hearts. Materials and Methods: A cross-sectional anatomical study was performed on 80 formalin-fixed adult cadaveric hearts with intact aortic roots. Each heart was dissected to trace the right and left coronary systems. Parameters included ostial origin and height relative to the sinutubular ridge, vessel lengths and diameters, branching configuration, variant features (ramus intermedius, high take-off RCA, duplicated LAD, myocardial bridging), and coronary dominance. Data were analyzed descriptively with appropriate statistical tests (p < 0.05). Results: The RCA originated uniformly from the anterior aortic sinus (100%), and the LCA from the left posterior sinus (97.5%), with ectopic origin in 2.5%. Multiple RCA ostia were noted in 27.5%, and most ostia were located below the sinutubular ridge (RCA 88.7%, LCA 83.7%). The RCA (10.2 ± 2.1 cm) was the longest artery, followed by LAD (8.6 ± 1.8 cm), while the left main trunk was short and variable (5.3 ± 2.7 mm). LCA bifurcation predominated (68.7%), trifurcation occurred in 23.8%, and quadrifurcation in 7.5%. Variants included high take-off RCA (6.3%), duplicated LAD (3.8%), and myocardial bridging (7.5%). Right dominance was seen in 88.8%, left dominance in 8.8%, and balanced circulation in 2.5%, with a strong correlation between posterior termination and dominance pattern (p < 0.01). Conclusion: Coronary anatomy in this series exhibited a consistent RCA origin, predominantly right-sided dominance, and a short, variable left main trunk. The frequent presence of multiple RCA ostia and occasional variants emphasizes the importance of anatomical awareness during coronary angiography, bypass grafting, and valve surgeries. These findings provide valuable morphometric and morphological reference data for the Indian population and reinforce the anatomical basis for interventional precisio

Introduction: Stroke is a common manifestation of cerebrovascular disease. The common risk factors for stroke include hypertension and diabetes mellitus. Retinal and cerebral vessels have common embryological and anatomical characteristics; thus, they show similar patterns of damage from diseases. Therefore, examination of the fundus could provide a noninvasive view of intracranial vascular pathology. Purpose: To examine the fundus of patients presenting with acute stroke to see prevalence of retinal findings and their correlation with stroke.  Material and Methods: This observational cross-sectional study was carried out among 50 patients over 6 months period with acute stroke presenting to medicine emergency of tertiary care teaching hospital in North India. Detailed medical history was taken and complete general physical examination was performed. Fundus was examined with the help of direct and indirect ophthalmoscopy. Data was analyzed with online software OpenEpi version 3. Chi square test was applied and p values <0.05 Conclusions: Therefore, routine retinal examination is important in patients with stroke. Presence of retinal findings act as marker for underlying diseases such as hypertension and diabetes, providing risk stratification among individual patients.

Background and Objective: Intraocular pressure (IOP) is maintained by the balance between aqueous humor secretion and drainage. Elevated IOP is a key modifiable risk factor for glaucoma, one of the leading causes of irreversible blindness. Hypertension has been proposed as a potential factor influencing IOP. Understanding the relationship between blood pressure (BP) and IOP is essential for early detection and prevention of glaucomatous changes. To investigate the correlation between intraocular pressure and blood pressure in patients attending the Ophthalmology outpatient department at GVPIHC & MT, Visakhapatnam. Methods: A hospital-based, prospective, cross-sectional study was conducted over three months including 300 participants aged above 18 years. Patients with systemic comorbidities, glaucoma, prior ocular surgery, trauma, or ocular pathologies affecting IOP measurement were excluded. Blood pressure was measured using an automatic digital monitor, and intraocular pressure was recorded with a Goldmann applanation tonometer between 9–11 a.m. to minimize diurnal variation. Data were analyzed using SPSS software with descriptive statistics and tests of significance; p < 0.05 was considered statistically significant. Results: Among the 300 subjects, 162 were males and 138 females, aged 21–80 years. Mean IOP in males was 14.77 ± 3.03 mmHg and in females 15.25 ± 2.59 mmHg. Mean systolic and diastolic blood pressures increased significantly with age in both genders (p < 0.05). Mean IOP increased progressively across BP categories — from 13.99 ± 3.07 mmHg in normotensives to 16.33 ± 3.86 mmHg in grade 3 hypertension. Pearson correlation revealed a positive relationship between both systolic and diastolic BP with IOP across all age groups, more significant in females and older individuals. Conclusion: Intraocular pressure shows a positive correlation with both systolic and diastolic blood pressure. Hypertension is a significant risk factor for elevated IOP, which may contribute to glaucomatous optic neuropathy. Regular IOP screening in hypertensive and elderly patients can facilitate early glaucoma detection and help reduce the burden of preventable blindness.

Background: - Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are major contributors to morbidity, hospitalizations, and mortality. Bacterial infections are responsible for a significant proportion of exacerbations, and rising antimicrobial resistance complicates management. Understanding the clinical profile, microbial etiology, and antibiotic sensitivity patterns is essential to guide effective therapy. Aim: -To evaluate the clinical profile, microbial etiology, antimicrobial sensitivity pattern, and treatment outcomes of patients presenting with AECOPD. Methods: -A prospective observational study was conducted on 60 patients with AECOPD at Konaseema institute of medical sciences Amalapuram. Demographic data, comorbidities, clinical presentation, and baseline spirometry were recorded. Sputum samples were collected before antibiotic therapy for culture and sensitivity testing, following CLSI 2023 guidelines. Patients received standard AECOPD management, and treatment outcomes were assessed as clinical improvement, treatment failure requiring ICU care, or in-hospital mortality. Data were analyzed using SPSS v25.0. Results: - The mean age was 62.5 ± 8.7 years, with 80% males. Common comorbidities included hypertension (50%) and diabetes mellitus (40%). Most patients presented with dyspnea (90%), cough (85%), and purulent sputum (80%). Sputum cultures were positive in 24 (40%) patients; predominant pathogens were Klebsiella pneumoniae (37.5%) and Pseudomonas aeruginosa (29.2%). K. pneumoniae was highly sensitive to piperacillin-tazobactam (90%) and meropenem (85%), whereas P. aeruginosa was sensitive to piperacillin-tazobactam (80%) and meropenem (75%). Clinical improvement was achieved in 75% of patients, 15% required ICU care, and in-hospital mortality was 10%. Patients infected with multidrug-resistant organisms had a higher treatment failure rate (37.5% vs. 10%, p < 0.05). Conclusion: - AECOPD predominantly affects older males with comorbidities. Gram-negative bacteria, particularly K. pneumoniae and P. aeruginosa, are common pathogens. Culture-guided antimicrobial therapy improves clinical outcomes, while multidrug resistance is associated with higher treatment failure. Regular surveillance of microbial patterns and antibiotic susceptibility is crucial for effective management of AECOPD

Introduction: Shivering is a common occurrence, reported in 40% to 70% of patients undergoing abdominal surgery with regional anesthesia. Incidence is even more common in geratric patients undergoing TURP under spinal anaesthesia. Both pharmacological and non-pharmacological methods are employed for the control of shivering. various studies have shown contradictory results on effectiveness of prophylactic low doses of tramadol and ketamine, to fill in the gap in showing better prophylactic agents concerning the effectiveness of prevention of post spinal anaesthesia shivering incidence, severity and occurrence of adverse effects the present study was conducted to compare the efficacy of intravenous Tramadol and intravenous ketamine for prevention shivering in patients undergoing TURP under spinal anaesthesia. Materials and methods: Ninety patients aged between 40 and 75years belonging to the American Society of Anesthesiologists-Physical Status I and II, undergoing TURP under spinal anaesthesia were included in the study. Group T patients (n=30) received 0.5 mg/kg Tramadol in 10ml normal saline IV infusion over 5 minutes. Group K patients (n=30) received 0.25 mg/kg Ketamine in 10ml normal saline IV infusion over 5 minutes. Whereas Group P patients (n=30) received plain 10ml normal saline IV infusion over 5 minutes. Results: Both Ketamine and Tramadol were found to be effective to prevent shivering as compared to placebo group. Tramadol group had a statistically lower incidence of shivering than ketamine. The incidence of nausea, and vomiting were significantly more in tramadol group as compared to placebo and ketamine group. (p-value =0.002) Conclusion: Both Tramadol and Ketamine are effective to prevent post-spinal shivering in patients undergoing TURP. Tramadol is superior agent as prophylaxis against postspinal shivering when compared with 0.25mg/Kg Ketamine without any psychomimetic side effects. However, IV tramadol is also associated with side effects like nausea and vomiting. Furthur studies are required to establish the findings of present study.

Introduction: Diabetic retinopathy (DR), the most common microvascular complication of type 2 diabetes mellitus (T2DM), has been increasingly linked to macrovascular disease, particularly coronary artery disease (CAD). The retina provides a non-invasive marker of systemic vascular injury, but evidence from Indian cohorts using standardized DR grading and angiography-confirmed CAD is limited. This study aimed to assess whether DR severity is independently associated with CAD in T2DM. Materials and Methods: A cross-sectional study was conducted on 150 T2DM patients at the Department of General Medicine, Mamata Medical College, Khammam. Demographic and clinical data, including age, sex, diabetes duration, hypertension, smoking, and alcohol use, were recorded. Biochemical evaluation included fasting plasma glucose, HbA1c, lipid profile, and renal function tests. DR was graded using the Early Treatment Diabetic Retinopathy Study (ETDRS) classification. Cardiovascular evaluation included ECG, echocardiography, treadmill test, and coronary angiography. CAD was defined as ≥50% stenosis in a major epicardial coronary artery. Logistic regression assessed the association between DR severity and CAD after adjusting for confounders. Results: The mean age was 56.2 ± 9.1 years, with 61.3% males. DR was present in 48%: mild NPDR (12%), moderate NPDR (11.3%), severe NPDR (7.3%), PDR (12%), and DME (5.3%). CAD was diagnosed in 64 patients (42.7%), with prevalence rising from 31.2% in those without DR to 72.2% in those with PDR. Multivariate analysis confirmed significant associations for moderate NPDR (OR 2.35), severe NPDR (OR 2.98), PDR (OR 4.12), and DME (OR 3.54). Conclusion: DR severity is strongly and independently associated with angiography-confirmed CAD in T2DM. Advanced DR should be considered a marker for comprehensive cardiovascular evaluation.

Background: Day care surgeries using spinal anaesthesia are on the rise as they offer many advantages. This study was carried out with an aim to evaluate the effectiveness of intrathecal 40 mg of 1% 2-chloroprocaine (2-CP) in unilateral tunica vaginalis hydrocele cases. Method: A prospective, observational study was conducted for a duration of one year at a tertiary care hospital in India. Adult male patients aged 18-60 years and American Society of Anaesthesiologists (ASA) physical status I-III were included. In the operation theatre, spinal anaesthesia was given in sitting position in L2-L3 or L3-L4 space with 25G spinal needle using 40 mg of 1% 2-CP. Hemodynamic parameters were monitored. Pinprick method and modified Bromage scale were used to assess sensory and motor block, respectively. The post anaesthesia discharge scoring system (PADSS) was used to assess discharge readiness.  Results: Data from 56 patients was analysed. Average time of onset of T10 sensory block was 7.55±1.81 mins and highest level attained was T8 in 57% patients. Mean time for regression to L1 level was 65.91±13.98 mins. Total duration of sensory and motor block ranged from 75-105 mins and 70-110 mins, respectively. All patients achieved onset of motor block within 3 mins and highest level was grade 3. 93% patients were discharge ready within 125 minutes of giving spinal anaesthesia. Conclusion: 2-CP is a fast-acting local anaesthetic providing quick onset and recovery of sensory and motor block with minimal side effects. Shorter time to discharge readiness makes it an attractive choice for day care surgeries.

Introduction: Endometrial hyperplasia ranges from benign to precancerous changes and requires accurate diagnosis to prevent progression to carcinoma. To evaluate the diagnostic utility of p53, Ki-67, and PTEN immunohistochemical markers in differentiating endometrial hyperplasia and carcinoma. Materials and Methods: Thirty endometrial biopsy cases were analyzed using H&E and immunohistochemistry. Marker expression was correlated with histopathological findings, age, menopausal status, parity, and endometrial thickness. Results: Initially, 76.67% were diagnosed as hyperplasia without atypia, 6.67% as atypical hyperplasia, and 16.67% as carcinoma. Post-IHC, 26.67% were upgraded to atypical hyperplasia. Most cases showed low p53 and Ki-67 expression, while PTEN loss was observed in 76.67%, especially in carcinoma and postmenopausal women.  Conclusion: IHC markers significantly improved diagnostic precision. p53, Ki-67, and PTEN are valuable tools in distinguishing between hyperplastic and malignant endometrial lesions

Introduction: Obstructive Sleep Apnea (OSA) is a common sleep disorder characterized by recurrent episodes of upper airway obstruction during sleep, leading to intermittent hypoxia and fragmented sleep. Aims and Objectives: To assess prevalence of Obstructive sleep apnea in asthma patients and to find out correlation between severity of asthma with Obstructive sleep apnea. To determine prevalence of Obstructive sleep apnea in asthma patients attending OPD of respiratory medicine department of tertiary care center. To access correlation between asthma severity and apnea hypopnea Index. To access correlation between asthma severity and STOP-BANG questionnaire. Materials and methods: The present study was an Observational Cross-Sectional Study. This Study was conducted from February 2024 to July 2024 at Kamla Nehru Chest Hospital, Dr S N Medical College, Department of Pulmonary Medicine, Jodhpur, Rajasthan.  Total 78 patients were included in this study. Result:  In this study of 78 participants, the majority (53.85%) were aged 41–60 years, with 56 males and 22 females. Most patients had non-severe asthma (69, 88.46%) and varying control levels, while 42 (53.85%) were diagnosed with obstructive sleep apnea, predominantly males (32). Risk assessment showed 29 (37.17%) at low risk, 22 (28.20%) intermediate, and 27 (34.61%) high risk. Sleep analysis revealed altered patterns, with stage 2 sleep being the longest (52.11 ± 8.02 minutes) and REM sleep averaging 11.17 ± 6.32 minutes, underscoring the need for comprehensive asthma-OSA management. Conclusion: In conclusion, the study demonstrates a considerable overlap between asthma and obstructive sleep apnea (OSA), with a higher prevalence observed in males. Patients exhibited a range of OSA severities.

Introduction: Persistent pulmonary hypertension of the newborn (PPHN) is a life-threatening condition characterized by the failure of normal postnatal fall in pulmonary vascular resistance, resulting in sustained elevation of pulmonary artery pressure, right-to-left extrapulmonary shunting through the ductus arteriosus and foramen ovale, and severe hypoxemia. Aims & Objectives: The aim of the study was to evaluate the predictors of outcome in newborns with persistent pulmonary hypertension (PPHN) admitted to a tertiary care NICU. The objectives included assessing the clinical profile and associated morbidity, analyzing echocardiography findings and their correlation with outcomes, evaluating the impact of different treatment modalities on survival and recovery, and identifying key factors that predict morbidity and mortality in neonates with PPHN. Materials & Methods: This was a prospective observational study conducted in the Neonatal Intensive Care Unit of the Department of Pediatrics, SSG Hospital, Baroda. The study was carried out over a period of 12 months as a time-bound investigation. Result: In this study of 80 neonates, the sex distribution was nearly equal, with no significant difference between males and females. A majority of the infants were full-term, and most had a birth weight above 2.5 kg, both showing highly significant differences. More than half of the neonates were small for gestational age, while none were large for gestational age, indicating a significant variation in growth patterns. Survival outcomes showed no statistically significant difference, suggesting that factors other than sex, gestational age, and birth weight may influence neonatal survival. Conclusion: The study found that sex did not significantly affect outcomes, while full-term status, birth weight, and gestational age–weight classification showed significant variations, particularly with a higher proportion of small-for-gestational-age infants. Survival was not significantly influenced by these factors, highlighting the need to monitor gestational maturity and growth parameters to identify at-risk neonates and guide care.

Background: Chronic obstructive pulmonary disease (COPD) is associated with significant cardiovascular morbidity due to chronic hypoxemia, pulmonary vascular remodeling, and right heart strain. Electrocardiography (ECG) and echocardiography provide valuable, non-invasive insights into cardiac involvement in COPD, yet such changes are often under-recognized in routine practice. Aim: - To evaluate electrocardiographic and echocardiographic changes in patients with COPD and to correlate these findings with disease severity. Methods: -A cross-sectional observational study was conducted on 60 COPD patients diagnosed by clinical and spirometric criteria. All patients underwent detailed ECG and transthoracic echocardiography. Cardiac abnormalities were documented and correlated with disease severity as per GOLD staging. Data were analyzed using descriptive statistics and Pearson’s correlation. Results: -The mean age of the study population was 58.4 ± 9.2 years, with a male predominance (M:F = 3.3:1). Most patients were smokers (78.3%). Based on GOLD criteria, 33.3% were stage II, 43.3% stage III, and 23.3% stage IV. Electrocardiographic abnormalities were observed in 70% of patients, the most common being P pulmonale (40%), right axis deviation (30%), and right ventricular hypertrophy (26.7%). Echocardiographic abnormalities were present in 60%, with pulmonary hypertension (46.7%, mean RVSP 47.5 ± 8.6 mmHg) being the most frequent, followed by right ventricular dilatation (33.3%) and right atrial enlargement (30%). Left ventricular diastolic dysfunction was seen in 20%, while systolic dysfunction was less frequent (10%). A significant negative correlation was found between FEV1 and pulmonary artery systolic pressure (r = –0.46, p < 0.01). Conclusion: - Cardiac involvement is common in COPD, increasing with disease severity. ECG and echocardiography reveal valuable information on right heart strain, pulmonary hypertension, and ventricular dysfunction. Incorporating routine cardiac evaluation into COPD management may aid in early detection of complications and improve long-term outcomes.

Background Labour pain is one of the most severe forms of pain experienced by women, caused by uterine contractions and cervical/perineal stretching. Conventional epidural analgesia (CEA) is the gold standard for labour analgesia but may be associated with slower onset, patchy block, or motor weakness. The dural puncture epidural (DPE) technique has emerged as a modification that enhances analgesic efficacy by improving drug spread in the subarachnoid–epidural interface. Aim To compare the quality of labour analgesia between conventional epidural block and dural puncture epidural block with respect to onset, uniformity, motor blockade, and maternal satisfaction. Methods A prospective randomized double-blind study was conducted on 46 parturients fulfilling inclusion criteria. Patients were randomly allocated into two groups: Group A (Conventional Epidural, n=23) and Group B (DPE, n=23). Analgesia was initiated with 10 ml of 0.125% bupivacaine + fentanyl 2 μg/ml, followed by intermittent boluses on maternal demand. Visual Analogue Scale (VAS), onset time, sacral spread, motor blockade (Bromage scale), and maternal satisfaction (Likert scale) were assessed. Statistical analysis included Fisher’s exact test and unpaired t-test, with p<0.05 considered significant. Results Mean onset of analgesia was significantly shorter in the DPE group (10±1.31 min) versus conventional epidural (16.26±1.68 min, p<0.001). Duration before first top-up was significantly longer in DPE (105.5±7.9 min) compared to conventional (82.5±10.0 min, p<0.001). VAS scores at 60 minutes showed superior analgesia in DPE (100% patients’ pain-free) versus conventional (47.8% pain-free, p<0.001). Motor blockade was minimal in both groups and not statistically different. Maternal satisfaction was higher in DPE (69.6% very satisfied) compared to conventional (60.9%). Conclusions Dural puncture epidural provides faster onset, longer duration of analgesia, and better maternal satisfaction compared to conventional epidural, without increasing motor blockade. DPE can be considered a superior alternative for labour analgesia.

Background: Although various studies demonstrate a positive relationship between vitamin- A supplementation and decreased mortality and morbidity rates from measles, diarrhea and respiratory diseases, there are very few data available on the relationship between urinary tract infections (UTI) and vitamin A status. Therefore this study was planned to evaluate the efficacy of co-administration of Vit-A in treating Urinary Tract Infections over the standard regular treatment in our tertiary care hospital. Research Question: What is the efficacy of co-administration of vitamin A in treating Urinary Tract Infections? Methods: A six months observational study was conducted at the Department of General Medicine, Mahatma Gandhi Medical College and Research Institute, Pondicherry, from January 2025 to June 2025. About hundred urinary tract infection patients attending the General Medicine OPD were included in the study divided into two groups “A” & “B” and group A treated with standard UTI treatment with Vit-A supplementation where as group B treated with only standard UTI treatment and the efficacy of the treatment was compared. Socio-demographic profiles like age & sex, weight, h/o Hypertension and Diabetes, distribution of clinical symptoms and duration of hospital stay etc; were studied. Results: Significant matching was observed between the two groups. And maximum number of study subjects was observed between 21-30 years of age group among both the groups (group A 42% & group B 38%). About maximum 72% of the study subjects were married among both the groups. It was observed that with regard to signs & symptoms cloudy urine and increased frequency was significantly (P<0.05) decreased among group A patients when compared to group B. With reference to other features there was significant (P<0.05) difference observed among group A patients regard to Duration of hospital stay and Average duration of negative urine culture etc.

Background:  CAD remains the number one cause of morbidity and death related deaths within the world and multivessel and left main coronary artery disease (LMCAD) are high risk subtypes of the anatomy. Angioplasty- coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI), are probably the highest points of treating severe coronary artery disease (CAD) though the best methodology remains a thorny subject in the current world of drug-eluting stents (DES). Objectives: The aim of the meta-analysis was to compare the long-term ( five years or more ) survival, major adverse cardiac events (MACE), myocardial infarction (MI) and repeat revascularisation and the secondary outcomes, namely stroke, quality of life (QoL), angina resolution and hospitalization in adults with CAD, using CABG and PCI. Methods:  Systematic searching of PubMed/MEDLINE, Embase, Cochrane Library, Web of Science and Scopus databases was performed (January 2000 to May 2024) and grey literature and hand-searching of references were sought. They added studies that were randomized controlled trials (RCTs) and high-quality cohort studies of adults with multivessel CAD or LMCAD with 5 years follow-up. An inverse-variance DerSimonianLaird Random-effects model was used to combine Hazard ratios (HR) or relative risks (RR) with 95 confidence interval (CI). The statistic I 2 and Cochran Q test were computed to find out the heterogeneity. Results:  Ten studies (six RCTs, four cohort; total n = 21,546) met inclusion criteria. CABG was associated with improved survival (HR = 0.88, 95% CI: 0.81–0.96), reduced MACE (RR = 0.80, 95% CI: 0.74–0.87), MI (RR = 0.84, 95% CI: 0.73–0.97), and repeat revascularization (RR = 0.43, 95% CI: 0.37–0.50). Stroke risk was slightly higher with CABG (RR = 1.18, 95% CI: 1.02–1.37). Heterogeneity was low to moderate (I² = 25–42%).Conclusion:  CABG has the best long-term outcomes in patients with complex multi-problem CAD and diabetics and results in the greater durable potential albeit a detrimental increment in perioperative stroke risk. PCI is still a possibility in cases of lower complexity and high risk surgeons. The findings support the significance of an individualized and multidisciplinary approach to “heart team” decision-making

Background: Postoperative pain management in cesarean deliveries presents unique challenges, with effective pain relief being essential for patient satisfaction and recovery. The use of Transverse Abdominis Plane (TAP) block has been increasingly favored as a part of multimodal analgesia strategies. This study aims to compare the analgesic efficacy of Bupivacaine alone versus Bupivacaine combined with Dexamethasone in TAP blocks, specifically focusing on the duration of analgesia, pain intensity, and the need for additional analgesic interventions.  Methodology This study was conducted as a randomized controlled trial involving 172 women undergoing elective cesarean sections under spinal anesthesia. Patients were randomly assigned to two groups: Group A Received Bupivacaine and Dexamethasone, while Group B received Bupivacaine in the TAP block. The primary outcome measures included the duration of effective postoperative analgesia, visual analog scale (VAS) pain scores at specified intervals, and the frequency of rescue analgesic requirements. Secondary outcomes included the incidence of postoperative complications and overall patient satisfaction. Results The addition of Dexamethasone to Bupivacaine significantly extended the duration of postoperative analgesia by approximately 7 hours compared to Bupivacaine alone. Group B patients reported lower VAS pain scores at all-time points postoperatively and required fewer rescue analgesics. The combination therapy was also associated with a reduced incidence of opioid-related side effects and enhanced patient comfort. Conclusion The combination of Bupivacaine and Dexamethasone in TAP blocks offers a superior analgesic profile for cesarean deliveries, providing prolonged pain relief and reducing the need for additional analgesics. This approach should be considered a standard component of enhanced recovery protocols in obstetric surgery.

Background: Vitamin D, beyond its classical role in bone and mineral metabolism, has been implicated in glucose homeostasis and insulin sensitivity. Deficiency of vitamin D is highly prevalent in India and may contribute to poor glycaemic control in type 2 diabetes mellitus (T2DM). This study aimed to evaluate the association between serum vitamin D levels and glycaemic as well as lipid parameters in patients with T2DM. Methods: A cross-sectional study was conducted at a tertiary care hospital in eastern India over three months. A total of 150 adult T2DM patients on metformin monotherapy were enrolled, comprising 75 cases with vitamin D deficiency (<20 ng/ml) and 75 controls with sufficient levels (≥20 ng/ml). Groups were matched for age, gender, BMI, and duration of diabetes. Primary outcome was glycated hemoglobin (HbA1c), while secondary outcomes included fasting blood sugar (FBS), postprandial blood sugar (PPBS), and lipid profile (total cholesterol, LDL, HDL, triglycerides). Data were analyzed using unpaired t-test and Fisher’s exact test, with p<0.05 considered significant. Results: Patients with vitamin D deficiency had significantly higher HbA1c (7.29% vs. 6.97%, p=0.0497), FBS (157.89 vs. 145.23 mg/dl, p=0.0048), and PPBS (203.54 vs. 181.49 mg/dl, p<0.0001) compared to controls. Only 36% of deficient patients achieved HbA1c <7.0%, versus 52% in controls. Lipid analysis revealed significantly higher total cholesterol (210.83 vs. 195.07 mg/dl, p=0.0221) and LDL (137.28 vs. 124.56 mg/dl, p=0.0380) in deficient patients, while HDL and triglycerides showed no significant difference. Conclusion: Vitamin D deficiency is significantly associated with poorer glycaemic control and adverse lipid parameters in T2DM patients. Routine screening and correction of vitamin D deficiency may represent a valuable adjunctive strategy in comprehensive diabetes management, particularly in populations with high prevalence of deficiency

Background: Polypharmacy is increasingly prevalent among elderly patients due to multimorbidity, but it carries a heightened risk of drug–drug interactions (DDIs). Age-related physiological changes, including altered pharmacokinetics and pharmacodynamics, further increase susceptibility to adverse outcomes. This study aimed to evaluate the prevalence, nature, and clinical impact of DDIs in hospitalized elderly patients on polypharmacy. Methods: A prospective observational study was conducted over six months in the Department of General Medicine at a tertiary care hospital in eastern India. Patients aged ≥65 years on polypharmacy (≥5 medications) were enrolled. DDIs were identified using Medscape® and Lexicomp® databases and classified as minor, moderate, or major. Clinical outcomes assessed included serious adverse events and duration of hospital stay.  Results: Among 262 patients, 68.32% had minor DDIs, 35.88% moderate DDIs, and 16.41% major DDIs. Major DDIs were significantly associated with older age (mean 74.23 vs. 70.87 years, p=0.0285), dyslipidaemia (60.47% vs. 38.81%, p=0.0111), and neuropsychiatric disorders (37.21% vs. 13.24%, p=0.0006). Patients with major DDIs had a longer mean hospital stay (9.57 vs. 7.03 hours, p<0.0001) and a higher incidence of serious adverse events (16.28% vs. 5.02%, p=0.0154). The risk of major DDIs increased with higher medication counts (>8 drugs). Conclusion: This study demonstrates a high prevalence of clinically significant DDIs among elderly inpatients on polypharmacy, with major DDIs contributing to prolonged hospitalization and increased adverse events. Systematic medication reconciliation, clinical pharmacologist review, and use of interaction screening tools are essential to mitigate risks and improve therapeutic outcomes in this vulnerable population

Background: While glycated hemoglobin (HbA1c) is the established standard for glycemic control, growing evidence suggests that glycemic variability (GV)—the amplitude, frequency, and duration of glucose fluctuations—may be an independent risk factor for diabetic complications. However, long-term data linking GV to the incidence and progression of microvascular complications are limited. Methods: We conducted a prospective cohort study of 352 T2DM patients recruited from a tertiary diabetes center. At baseline and annually for five years, participants underwent 14-day continuous glucose monitoring (CGM) to calculate GV metrics, primarily the Mean Amplitude of Glycemic Excursions (MAGE). Comprehensive assessments for retinopathy, nephropathy, and neuropathy were performed at baseline and at the end of the study. Patients were stratified into tertiles based on their 5-year average MAGE (Low, Moderate, High GV). Cox proportional hazards regression was used to analyze the association between GV tertiles and a composite microvascular outcome. Results: Over a median follow-up of 5.1 years, 102 patients (29.0%) developed the composite microvascular outcome. The incidence was significantly higher in the high GV tertile (45.3%) compared to the moderate (26.5%) and low GV (15.4%) tertiles (p<0.001). The mean 5-year HbA1c was similar across groups (7.4% ± 0.6% vs. 7.6% ± 0.7% vs. 7.7% ± 0.8% for low, moderate, and high GV, respectively; p=0.112). After adjusting for mean HbA1c, age, sex, diabetes duration, and other confounders, the high GV tertile was associated with a significantly increased risk of the composite outcome (Hazard Ratio [HR] 2.92, 95% CI 1.68–5.08, p<0.001) compared to the low GV tertile. Conclusion: Long-term high glycemic variability is a potent and independent predictor of the incidence and progression of microvascular complications in patients with T2DM. These findings suggest that targeting GV, in addition to achieving HbA1c goals, may be a crucial strategy for preventing long-term diabetic complications

Background: Anemia is a common comorbidity in hospitalized patients, associated with increased morbidity and mortality. The two most frequent types are anemia of chronic disease (ACD) and iron deficiency anemia (IDA). Distinguishing between them is crucial for appropriate management, yet their comparative prevalence and impact on clinical outcomes in a general inpatient population remain poorly characterized. Methods: We conducted a retrospective, cross-sectional analysis of adult patients admitted to a tertiary academic medical center. Patients with anemia (hemoglobin <13 g/dL for men, <12 g/dL for women) who had complete iron studies and C-reactive protein (CRP) levels were included. Patients were categorized into ACD (ferritin >100 ng/mL, transferrin saturation [TSAT] <20%, CRP >5 mg/L) or IDA (ferritin <30 ng/mL, or ferritin 30–100 ng/mL with TSAT <20%). Independent t-tests and chi-square tests were used for statistical comparisons. Results: Of 482 eligible anemic patients, 221 (45.8%) were classified as having ACD and 145 (30.1%) as having IDA. The remaining patients had mixed or other anemia types. Patients with ACD were significantly older (68.4 ± 12.1 vs. 55.2 ± 15.8 years, p<0.001) and had a higher mean Charlson Comorbidity Index (4.8 ± 1.9 vs. 2.5 ± 1.5, p<0.001). Compared to the IDA group, the ACD group experienced a significantly longer mean hospital LOS (8.2 ± 4.5 vs. 6.1 ± 3.3 days, p<0.001), a higher 30-day readmission rate (24.9% vs. 15.2%, p=0.028), and greater in-hospital mortality (8.1% vs. 3.4%, p=0.045). Conclusion: In this hospitalized cohort, ACD was more prevalent than IDA and was associated with significantly poorer clinical outcomes, including longer hospitalizations, higher readmission rates, and increased mortality. These findings suggest that ACD is not merely a benign laboratory finding but a marker of severe underlying disease, highlighting the importance of its accurate diagnosis and the management of the associated inflammatory condition

Introduction: Among female genital tract related malignancies, ovarian tumors are the leading cause of mortality. The present study was conducted to identify the various histopathological spectrums of ovarian neoplasm according to the World Health Organization (WHO) classification in a single center. Objective: To assess the histological patterns of ovarian neoplasm their clinical presentation and age distribution. Methods: It is a retrospective study conducted over a period (Nov 2022-Oct 2024) at Government General Hospital, Kakinada. A total of 200 cases were followed and ovarian specimens are obtained after excluding functional cyst. Data was analysed and tabulated. Results: Out of 200 cases of ovarian tumors, 88.5% cases were benign, 7% cases were borderline, 4.5% cases were malignant. Conclusion: Most of the ovarian tumors benign tumors followed by borderline and then malignant. In this study most common benign tumor is serous cystadenoma.  From this study by histopathology, we can differentiate benign from malignant

COVID-19 has shown significant variability in its clinical presentation and severity, often influenced by underlying comorbidities and metabolic derangements. This study investigates the relationship between COVID-19 severity, renal failure, and glycemic variations in hospitalized patients. Retrospective analysis of 150 COVID-19 patients revealed that the presence of DKA and renal failure was strongly associated with increased ICU admissions and mortality. Glycemic variations, particularly hyperglycemia during the acute phase, were significant predictors of worse outcomes. CKD patients demonstrated heightened vulnerability to severe disease, likely due to impaired immune responses and metabolic imbalances. These findings emphasize the importance of early recognition and management of these conditions in mitigating adverse outcomes in COVID-19 patients.

Chronic alcohol consumption is associated with significant alterations in hematological parameters, including red blood cell (RBC) indices, white blood cell (WBC) counts, platelet levels, and biochemical markers, which may serve as early indicators of systemic effects and aid in the diagnosis and management of alcohol-related disorders. This systematic review, conducted following PRISMA guidelines, analyzed studies published between 2019 and 2025 that investigated hematological changes in individuals with chronic alcohol use. Databases including PubMed, Scopus, and Web of Science were searched for observational, cross-sectional, or cohort studies reporting on RBC indices, WBC counts, platelet levels, or biochemical markers in alcohol users. A total of 22 studies met the inclusion criteria, consistently demonstrating that chronic alcohol intake leads to macrocytic anemia, evidenced by elevated mean corpuscular volume (MCV) and reduced hemoglobin and RBC counts. Leukopenia and thrombocytopenia were also prevalent, indicating compromised immune function and increased bleeding risk. Furthermore, biochemical markers such as MCV, gamma-glutamyl transferase (GGT), and carbohydrate-deficient transferrin (CDT) were elevated, reflecting liver dysfunction and excessive alcohol intake, while alcohol withdrawal syndrome was associated with fluctuations in hematological and inflammatory markers. These findings highlight that chronic alcohol use profoundly impacts hematological and biochemical profiles, underscoring the importance of routine hematological screening in individuals with alcohol use disorders to enable early detection and timely intervention.

Background: Post-stroke seizures are a notable complication of cerebrovascular events, particularly in elderly patients, with significant impact on prognosis and quality of life. This study aims to analyze the characteristics and patterns of post-stroke seizures, examining associations with demographic factors, lesion characteristics, stroke classification, and stroke severity. Aim: To assess the demographic and clinical characteristics of post-stroke seizures, examining associations with stroke subtypes, lesion location, seizure types, and stroke severity as per NIHSS and Oxfordshire classifications. Material and Methods: This prospective, cross-sectional study was conducted at the Neurology Department, St. Stephen’s Hospital, Delhi, over a period of 19 months. Sixty patients presenting with a first episode of post-stroke seizure were included. Inclusion criteria were based on clinical findings, neuroimaging (MRI or CT), and EEG. Data were analyzed using descriptive statistics, and correlations were assessed using Chi-square tests. Results: Among the study cohort, 62% were male, with a mean age of 65.8 years; 81% were over 50 years. Focal seizures were more common (56.6%) than generalized seizures (38.4%), with immediate onset seizures occurring in 55% of cases. Cortical lesions were more associated with seizures (65%) than subcortical lesions (11.6%), particularly in the left hemisphere (55%). PACI was the most common ischemic stroke type (64%) associated with seizures, while larger volume ICH presented greater risk in hemorrhagic stroke. Significant associations were found between NIHSS severity and stroke subtype (p = 0.0001), as well as with Oxfordshire classification (p = 0.00001). Conclusion: Post-stroke seizures exhibit distinct demographic and clinical patterns, with focal seizures predominating in cortical and left-sided lesions. PACI and cardio-embolic strokes were linked to higher seizure risk. Stroke severity as measured by NIHSS and Oxfordshire classification were significantly associated with seizure onset, underscoring the importance of targeted monitoring in high-risk groups.

Background: Lung cancer has emerged as the leading cause of cancer-related mortality globally. Various clinical, socioeconomic, and environmental factors have been implicated in its development. However, such comprehensive studies are limited in developing countries, hindering the formulation and execution of effective public health policies. Aim: To assess the clinic-epidemiological and pathological characteristics of lung cancer patients presenting to a tertiary care teaching hospital in South India. Methods: A total of 160 patients with histologically confirmed bronchogenic carcinoma were included in this study. Cases with other malignancies or isolated malignant pleural effusion without clear evidence of bronchogenic carcinoma were excluded. Results: The findings reveal a troubling pattern of delayed diagnosis, presentation at advanced stages, and poor survival rates among bronchogenic carcinoma cases. Conclusion: Implementing robust strategies for early detection and prompt intervention could significantly improve outcomes for lung cancer patients in this region. Enhancing awareness and streamlining referral pathways in primary care may play a vital role in improving survival rates in this population.

Background: Isolated lower limb monoparesis is a rare clinical presentation of stroke, often mistaken for peripheral or spinal pathology. Infarcts in the anterior cerebral artery (ACA) territory, particularly involving the paracentral lobule, can present with contralateral lower limb weakness. Non contrast CT scan of brain which is usually the first investigation for suspected acute strokes could detect the ACS infarct in only 25%. 20 % of patients present with only isolated lower limb weakness and a normal NCCT brain in these cases may lead to erroneous localization of pathology to a peripheral cause. [1] Case Summary: We report three cases of patients presenting with isolated lower limb monoparesis due to ACA territory infarcts.  Two patients underwent MRI brain with diffusion-weighted imaging (DWI) and one patient underwent urgent NCCT head, which was able to demonstrate the cerebral infarct. Lesions were localized to the medial frontal cortex, specifically the paracentral lobule. Timely imaging led to appropriate diagnosis and management with favorable outcomes. Conclusion: Central causes should be considered in patients presenting with lower limb monoparesis. ACA infarcts, though uncommon, are a critical differential diagnosis and can be accurately identified with neuroimaging.

We report the case of a 56-year-old female diabetic and hypertensive with ovarian carcinoma undergoing staging laparotomy. She presented with chemotherapy-induced neutropenia, complicated by rhino-orbital mucormycosis, cavernous sinus thrombosis and lower limb ischemia (Raynaud’s phenomenon). Perioperative considerations included management of vasospastic disorder and balancing the anticoagulant therapy and pain management. This case highlights the multidisciplinary challenges in anaesthetic management of complex, immunocompromised patients with invasive fungal infections and vascular comorbidities.

Introduction: Patients of Chronic Urticaria (CU) face significant issues due to bothersome itching and hives, and their condition often doesn’t respond well to treatments. Chronic idiopathic urticaria (CIU) can be triggered by various factors, with autoimmune issues being one of the most common causes. There’s a crucial need for therapies that not only extend remission periods but also target the key factors contributing to the disease’s development. Aim: To evaluate the effectiveness of histaglobulin, a combination of histamine and human immunoglobulin, in providing symptom relief for Chronic Urticaria (CU) patients, and to assess the differential impact in ASST-positive and ASST-negative groups. Materials And Methods: This was a single-center, open-label, non-randomized, prospective clinical study involving       CU patients. Participants received a weekly 1 mL subcutaneous injection of histaglobulin for eight weeks. They were also allowed to take cetirizine 10 mg tablets as needed, without exceeding the recommended dose. The drug's efficacy was evaluated using the Urticaria Activity Score (UAS 7), a simple, validated scoring system. Assessments were conducted at each weekly visit, with a final evaluation after 24 weeks. Results: Twenty-eight chronic urticaria patients completed an 8-week course of histaglobulin treatment. The average age was 38.2 years, with a male-to-female ratio of 1.3:1, and an average disease duration of 18.2 months. The baseline Urticaria Activity Score (UAS) significantly decreased from 19.6 to 3.9 following treatment (p < 0.0001) and remained low at 3.5 after 24 weeks, indicating sustained improvement. Most patients (89%) achieved complete remission by week 24, with the majority experiencing excellent or good responses to therapy. Conclusion: Histaglobulin significantly improves symptoms and achieves high remission rates in chronic urticaria patients. Its safety and tolerability make it an excellent adjunct treatment option.

Background: Acute dyspnea is a prevalent and challenging symptom in emergency settings, often stemming from either cardiac or pulmonary etiologies.Differentiating between these causes is crucial for appropriate management.Lung ultrasound (LUS), particularly the identification of B-lines, has emerged as a valuable tool in this diagnostic process. The differential diagnosis is broad, encompassing both cardiac and pulmonary etiologies.Timely and accurate differentiation is crucial, as it directly influences management strategies and patient outcomes.

Aims And Objectives:

1.To evaluate the diagnostic accuracy of B-lines in lung ultrasound for distinguishing between cardiac and pulmonary causes of acute dyspnea.

2.To assess the prognostic significance of B-line patterns in predicting patient outcomes, including mortality and readmission rates.

3.To compare the effectiveness of lung ultrasound in detecting B-lines with traditional imaging modalities like chest X-ray and computed tomography in the context of acute dyspnea.

4.To investigate the impact of B-line quantification on clinical decision-making and management strategies in emergency department settings.

5.To explore the feasibility and reliability of implementing B-line assessment in prehospital and point-of-care settings for rapid diagnosis.

Methods In this prospective observational study conducted in the Emergency Department on 20 adult patients between may and June 2025, we aimed to evaluate the diagnostic utility of B-line lung ultrasound (LUS) in differentiating cardiac from pulmonary causes of acute dyspnea.Adult patients presenting with acute dyspnea were assessed using a standardized 8-zone LUS protocol, focusing on identifying B-lines—vertical, hyperechoic artifacts originating from the pleural line. Diagnostic performance metrics, including sensitivity, specificity, and interobserver reliability, were calculated to assess the accuracy of B-line LUS in distinguishing between cardiac and pulmonary etiologies of acute dyspnea. Results: The cohort comprised 20 adults (mean age 68.5 ± 12.3 years; 55% male) presenting with acute dyspnea. Lung Ultrasound Findings:  B-profile (B-lines with lung sliding): Observed in 12 patients (60%), indicative of cardiogenic pulmonary edema. B'-profile (B-lines without lung sliding): Detected in 8 patients (40%), suggesting non-cardiogenic causes such as pneumonia or ARDS. Final Diagnoses:Cardiac Etiology: 12 patients (60%) diagnosed with acute decompensated heart failure. Pulmonary Etiology: 8 patients (40%) diagnosed with conditions like pneumonia or ARDS. Diagnostic Performance: Sensitivity: 90% ,Specificity: 85% ,Positive Predictive Value (PPV): 92% ,Negative Predictive Value (NPV): 80% . Conclusion: B-line lung ultrasound (LUS) is a rapid, non-invasive, and highly effective diagnostic tool for differentiating between cardiac and pulmonary causes of acute dyspnea in the emergency department.The presence of B-lines, particularly when observed with lung sliding (B-profile), is strongly indicative of cardiogenic pulmonary edema, whereas B-lines without lung sliding (B'-profile) suggest non-cardiogenic causes such as acute respiratory distress syndrome (ARDS) or pneumonia.LUS offers advantages over traditional imaging methods, including higher sensitivity and specificity, absence of ionizing radiation, and the ability to perform bedside assessments, facilitating timely and appropriate therapeutic interventions.Integrating B-line LUS into clinical practice can enhance diagnostic accuracy, optimize patient care, and improve outcomes for patients presenting with acute dyspnea.

Background: Soft tissue tumors of the extremities comprise a heterogeneous group of benign and malignant lesions with variable clinical behavior. Accurate preoperative diagnosis is critical for management. Fine-needle aspiration cytology (FNAC) offers a rapid, cost-effective, and minimally invasive diagnostic option, but its accuracy requires validation against histopathology. Objective: To assess the diagnostic accuracy of FNAC in soft tissue tumors of extremities and correlate cytological findings with histopathological diagnoses. Methods: A prospective study was conducted at Bombay Health Care, Ujjain, from May 2024 to April 2025. A total of 120 patients with clinically suspected soft tissue tumors of extremities underwent FNAC followed by histopathological examination. FNAC results were categorized as benign, malignant, or suspicious. Diagnostic indices including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated using histopathology as the gold standard. Results: Out of 120 cases, FNAC classified 72 (60%) as benign, 40 (33.3%) as malignant, and 8 (6.7%) as suspicious. Histopathology confirmed 70 benign and 50 malignant tumors. FNAC showed 45 true positives, 5 false negatives, 68 true negatives, and 2 false positives. The calculated sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 90%, 97.1%, 95.7%, 93.1%, and 94.2% respectively. Lipoma was the most common benign tumor (42.8%), while pleomorphic sarcoma was the most frequent malignant tumor (32%). Conclusion: FNAC is a simple, safe, and highly accurate technique for evaluating soft tissue tumors of extremities. It serves as an effective first-line investigation to guide management decisions. However, histopathology remains indispensable for definitive diagnosis, grading, and subtyping.

Background: Meditation and mindfulness-based interventions (MBIs) are increasingly recognized for their potential effects on physiological and psychological health, particularly in regulating cardiovascular parameters and stress responses. However, variations in study designs and outcomes necessitate a comprehensive synthesis to evaluate the overall impact of these interventions. Material and Methods: A systematic review was conducted following PRISMA 2020 guidelines. Databases and registers were searched to identify studies evaluating meditation or mindfulness-based interventions on cardiovascular and emotional outcomes. Records were screened for eligibility, with duplicates removed. Data were extracted regarding study design, intervention type, sample size, outcome measures, and results. Quality and risk of bias were assessed using standardized tools. Results: A total of 460 records were identified, with 410 screened after duplicates removal. Of these, 135 full-text articles were assessed for eligibility, and 23 studies were included in the qualitative synthesis and analyses. Findings indicate that slow-paced breathing, meditation, and MBIs are associated with significant reductions in heart rate, blood pressure, and perceived stress levels. Heterogeneity across studies was noted due to differences in intervention duration, participant characteristics, and outcome measures. Overall, evidence quality ranged from moderate to high, with most studies demonstrating consistent physiological and psychological benefits. Conclusion: Meditation and mindfulness-based interventions demonstrate beneficial effects on cardiovascular and emotional health. Despite some heterogeneity, current evidence supports their integration into stress management and cardiovascular wellness programs. Future research should focus on standardized protocols and long-term follow-up to strengthen evidence.