European Journal of Cardiovascular Medicine

Background: Invasive fungal infections (IFIs) are associated with high morbidity and mortality, particularly among immunocompromised and critically ill patients. Timely and accurate diagnosis is essential for improving outcomes. Histopathology and microbiological methods, including culture and molecular diagnostics, remain the principal modalities for diagnosing IFIs; however, their relative diagnostic yield and concordance vary across studies. Objective: To systematically compare the diagnostic yield of histopathology versus microbiological methods in invasive fungal infections and to evaluate their complementary roles in establishing proven infection. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed/Medline, Embase, Scopus, and PubMed Central were searched from inception to January 2025 for studies reporting paired histopathology and microbiological findings on tissue or sterile site specimens from patients with suspected IFIs. Data on diagnostic yield, concordance, and the contribution of molecular techniques were extracted. Due to heterogeneity in study design, specimen types, and reporting of diagnostic accuracy measures, results were synthesized narratively, with quantitative tabulation where feasible. Results: Forty-two studies met the inclusion criteria. Histopathology consistently demonstrated a higher diagnostic yield for detecting fungal elements and tissue invasion compared with fungal culture alone, particularly in patients with prior antifungal exposure and in infections caused by fastidious organisms. Microbiological culture showed variable sensitivity but remained essential for species identification and antifungal susceptibility testing. Molecular diagnostic methods significantly enhanced detection rates and improved concordance with histopathology, especially in culture-negative cases. Considerable variability in concordance between histopathology and microbiology was observed across studies. Conclusion: Histopathology remains indispensable for establishing invasive fungal infection through demonstration of tissue invasion, while microbiological and molecular methods are critical for etiological identification and therapeutic guidance. An integrated diagnostic approach combining histopathology, culture, and molecular techniques provides the highest diagnostic yield and should be considered the standard strategy for the diagnosis of invasive fungal infections.

Background: Coronary arterial dominance describes which coronary artery gives rise to the posterior descending artery (PDA) and largely perfuses the inferior interventricular septum and adjacent diaphragmatic myocardium. Objectives: To document the dominance pattern and related morphological features of the PDA and crux cordis in adult human hearts. Methods: A descriptive cross-sectional study was conducted on 80 adult human hearts examined in the Department of Anatomy, Government Medical College, Karimnagar, Telangana, India (February–November 2025). The right coronary artery (RCA) and left circumflex artery (LCx) were traced to identify the origin of the PDA, the vessel reaching/crossing the crux cordis, and the predominant inferior ventricular supply. Dominance was categorized as right, left, or co-dominant. Results: Right dominance was observed in 70% of hearts, left dominance in 20%, and co-dominance in 10%. The PDA arose from the RCA in 70% and from the LCx in 20%, while dual contribution was seen in 10%. At the crux cordis, the RCA crossed the crux in 70% and the LCx reached the crux in 20%; both vessels reached the crux in 10%. Inferior wall supply was predominantly by the RCA in 70%, by the left coronary system in 20%, and balanced in 10%. Conclusion: Right coronary dominance predominated, with consistent correspondence between dominance category, PDA origin, crux reach, and inferior ventricular supply. These baseline data support safer interpretation of coronary imaging and procedural planning in the regional context

CIN  is the impairment of renal function gauged as either a 25% rise in serum creatinine from baseline or an increase of 0.5 mg/dL (44 µmol/L) in absolute serum creatinine value within 48-72 hours following intravenous contrast administration.The renal impairment that is linked with the administration of contrast is acute, usually occurring within 2-3 days. However, it has been recommended that renal impairment developing up to seven days post-contrast administration should be considered CIN if it is not attributable to any other possible cause of kidney failure.The incidence of contrast-induced nephropathy is calculated to be more than 2% in the general population. However, in high-risk groups with risk factors for kidney disease, the incidence is as high as 20% to 30%. It is reported that there is a lower risk of contrast-induced nephropathy when low osmolar contrast media is used.Additionally, it decreases water reabsorption, causing an increase in interstitial pressure.The study aimed to predict the CIN after PCI in comparision with Meharan score. METHODS A cross-sectional study was conducted in the Department of Cardiology at a multispecialty teaching hospital. A total of 300 patients were taken undergoing PCI including  elective and emergency PCI , were creatinine was done at admission and at 48hrs after PCI.survivors of a first episode of AMI who returned for follow-up one month after discharge were included. .  Data were analyzed using SPSS version 26. Descriptive statistics, z-test, Chi-square test, Spearman’s correlation, and binary logistic regression were applied. A p-value < 0.05 was considered statistically significant. RESULTS A total of 300 study participants based on inclusion and exclusion criteria were included in the study. Majority of the study participants were between the age group of 51-70 constituting to 61.3% (n=184), followed by 20.3% (n=61) in 31-50 years, 18% (n=54) in 71-90 years and 0.3% (n=1) in 18-30 years group. Among the study participants, 70.3% (n=211) were male and 29.7% (n=89) were female.The Very High modified score group shows a spread: ~57% remain Low, ~31% shift to Moderate, and ~12% distribute into High/Very High by the original score.This indicates that the Modified Mehran Score reclassifies higher-risk patients more aggressively, while the original Mehran Score tends to under-classify risk.Almost all patients with High or Very High original scores are classified as Very High by the modified score.Patients with Low original scores are spread across Moderate, High, and Very High modified categories, highlighting some reclassification. CONCLUSIONS  Our study showed a significant positive results with modified mehran score for better prediction of CIN and its complications.Most patients classified as Moderate or High by the modified score fall almost entirely into the Low risk category of the original Mehran score.The Very High modified score group shows a spread: ~57% remain Low, ~31% shift to Moderate, and ~12% distribute into High/Very High by the original score

Background: Type 2 diabetes mellitus (T2DM) is frequently associated with metabolic syndrome (MS), a constellation of metabolic abnormalities that significantly increases cardiovascular morbidity and mortality. Gamma-glutamyl transferase (GGT), traditionally regarded as a hepatic enzyme, has emerged as a potential biomarker of oxidative stress and metabolic risk. Elevated GGT levels have been linked to individual components of MS and cardiovascular disease, even in the absence of overt liver pathology. Aim & Objective: To evaluate serum Gamma-glutamyl transferase levels in patients with Type 2 diabetes mellitus with metabolic syndrome and to assess its association with metabolic syndrome in comparison with T2DM patients without metabolic syndrome and healthy controls. Materials & Methods: This cross-sectional analytical study was conducted at a tertiary care hospital in Tamil Nadu from April to July 2024. A total of 105 participants aged 30–60 years were enrolled and divided into three groups: healthy controls (n=35), T2DM patients without metabolic syndrome (n=35), and T2DM patients with metabolic syndrome (n=35), diagnosed using NCEP-ATP III criteria. Anthropometric measurements, blood pressure, fasting and postprandial glucose, lipid profile, and serum GGT levels were assessed. Statistical analysis was performed using SPSS version 16.0, with ANOVA and Bonferroni post-hoc tests applied. A p-value <0.05 was considered statistically significant. Results: Serum GGT levels were significantly higher in T2DM patients with metabolic syndrome (52.58 ± 48.10 U/L) compared to T2DM patients without metabolic syndrome (24.97 ± 14.62 U/L) and healthy controls (20.16 ± 8.37 U/L) (p < 0.001). Waist circumference, systolic and diastolic blood pressure, total cholesterol, and triglyceride levels were also significantly elevated in the metabolic syndrome group. No statistically significant difference in GGT levels was observed between T2DM patients without metabolic syndrome and healthy controls. Conclusion: Serum Gamma-glutamyl transferase levels are significantly elevated in T2DM patients with metabolic syndrome. Incorporating GGT estimation into routine evaluation of patients with Type 2 diabetes mellitus may facilitate early identification of metabolic syndrome and help reduce future cardiovascular morbidity and mortality.

Background: The foramen magnum (FM) is a key osteological landmark at the craniovertebral junction. Its dimensions and contour influence surgical corridors and inform radiologic and forensic interpretation. Objectives: To describe FM morphometry and shape patterns in adult skulls from Telangana, and to evaluate sex-related differences in FM dimensions. Methods: This cross-sectional observational study examined 80 adult dry human skulls (42 male, 38 female) from the Department of Anatomy, GMC Karimnagar, Telangana, India (February 2025–November 2025). Anteroposterior diameter (basion–opisthion) and transverse diameter (maximum width) were measured using a digital vernier caliper. FM index was calculated as (transverse/anteroposterior)×100, and FM area was estimated using an ellipse-based formula. FM shape was categorized as oval, round, tetragonal, pentagonal, or irregular. Results: Mean anteroposterior and transverse diameters were 34.8±2.6 mm and 29.6±2.4 mm, respectively; mean FM index was 85.1±6.9 and mean area was 810.5±98.7 mm². Oval shape was most frequent (45.0%), followed by round (27.5%). Males had larger diameters and area than females, with statistically significant differences. Conclusion: FM morphometry in this sample showed clear sexual dimorphism, with oval and round shapes predominating. These regional baseline data support skull-base surgical planning and provide context for imaging and forensic applications

Background: Chronic serous otitis media associated with Eustachian tube dysfunction (ETD) is commonly managed with long-term ventilation tube (grommet) insertion. Balloon Eustachian tuboplasty (BET) has emerged as a novel therapeutic option aimed at improving Eustachian tube function. This study compares the outcomes of BET alone versus BET combined with grommet insertion in patients with chronic serous otitis media and ETD. Aim and Objectives: To evaluate and compare the effectiveness of Balloon Eustachian Tuboplasty (BET) alone and BET combined with grommet insertion in patients with chronic serous otitis media associated with Eustachian tube dysfunction (OME-ETD). Methods: This prospective comparative study included 72 patients with OME-ETD treated between October 2024 and November 2025. Patients were divided into two groups: BET group (n = 36) and BET + Grommet group (n = 36). Postoperative outcomes assessed at 6 and 12 months included air-bone gap (ABG), Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), Eustachian tube inflammation scale, Chronic Otitis Media Outcome Test-15 (COMOT-15), Valsalva maneuver results, and patient satisfaction. Results: Postoperative ABG improvement was significantly greater in the BET + Grommet group compared to the BET group at both 6 and 12 months. The ETDQ-7, Eustachian tube inflammation scale, and COMOT-15 scores showed a significant reduction in the BET + Grommet group at follow-up intervals. The proportion of patients able to perform a positive Valsalva maneuver was significantly higher in the BET + Grommet group at both 6 and 12 months. Overall patient satisfaction was also superior in the combination therapy group. Conclusion: Balloon Eustachian Tuboplasty combined with grommet insertion demonstrates superior efficacy compared to BET alone in patients with OME-ETD. The combined approach results in better hearing outcomes, improved Eustachian tube function, reduced inflammation, and enhanced quality of life

Background: Diabetes mellitus is a major chronic health condition associated with significant morbidity, mortality, and healthcare burden worldwide. Achieving optimal glycaemic control is critical to preventing complications, and adherence to prescribed antidiabetic medications plays a pivotal role in this process. Despite the availability of effective therapies, poor adherence remains a leading cause of uncontrolled diabetes and adverse outcomes. Objective: This study examines the interaction between controlling blood sugar levels and taking diabetes medicines as prescribed in Type 2 Diabetes Mellitus patients from India, attending the Medicine Department, Central Hospital, Kalla. Methods: From June 2024 to June 2025, EMR records from 100 adults with diabetes were used in a retrospective observational study. For type 2 diabetes, six months of diabetes medicine and HbA1c statistics were required. Patients' adherence was rated as high, average, or low by the Medication Possession Ratio (MPR). HbA1c numbers (<7%, ≥7%) show the way glucose levels are controlled. For statistical research, we used SPSS and Pearson's coefficient (p < 0.05) to find correlations. Results: Patient adherence was 46% strong, 32% moderate, and 22% poor. Lower HbA1c levels were associated with higher adherence, decreasing the connection between poor glycaemic management (p < 0.05). Conclusion: Higher blood sugar results with better medicine adherence. Patient education, follow-ups, and adherence-monitoring technology are needed to improve diabetic management in India.

Macro Creatine Kinase (CK) is a rare cause of elevated serum CK levels that can mimic myocardial injury. We present a case of a 56-year-old male with persistently elevated CK-MB by immunoinhibition method, initially raising concerns for silent myocardial ischemia. Extensive cardiac evaluation revealed normal coronary anatomy and cardiac function. Further testing ultimately identified Macro CK Type 1 as the etiology, highlighting the importance of considering macroenzymes in the differential diagnosis of elevated CK-MB levels without clinical correlation.

Background: The cardiovascular diseases are the primary cause of morbidity and death globally. A significant increase in obesity rates has been linked to the accelerating increase in cardiovascular disease around the world. Excessive body fat accumulation is the hallmark of obesity, a metabolic illness that is closely linked to cardiovascular disease.  Material & Methods: The study was conducted in a sample of 113 healthy medical students age between 18 and 24 years. Evaluation of body composition (weight, BMI and body fat percentage—BFP) was done by using Omron HBF 375 body composition analyser. Two measurements were taken for each subject, and mean BFP was calculated. A twelve-lead ECG monitor was used for recording of ECG ventricular parameters (HR, QT, QTc, TQ, TQc, RR, TQ/QT, RR/ TQ, TQc/QTc and RRc/TQc). Correlation analysis was done between the body composition parameters and ECG parameters. Linear Regression Analysis was done for the variables with relevant associative relationships.  Results and Discussion: The results of the study revealed that the regression models for BFP (independent variable) and the dependent variables weight, QTc, TQc and TQc/QTc, were statistically significant (p < 0.01). The regression models for BFP (independent variable) significantly predicted each dependent variable: QTc, TQc, TQc/QTc. QTc interval has positive association with BFP whereas TQc and TQc/QTc showed negative association with BFP. Conclusion:  Ventricular electrical activity in young adults is influenced by the body composition, which implies the risk for ventricular impairment in medical students with high body composition and suggests for an early intervention.

Background: Seizures are common neurological emergencies in children, with febrile seizures (FS) being the most frequent, particularly in those aged below five years. While generally benign, FS may recur and contribute to later epilepsy in some children. Zinc, an essential trace element, plays a crucial role in neuronal excitability and GABA synthesis. Reduced zinc levels have been implicated in lowering seizure thresholds; however, the evidence remains inconsistent. This study aimed to evaluate serum zinc levels in children with seizures compared to febrile controls without seizures. Methods: A hospital-based case-control study was conducted in the Department of Paediatrics in a tertiary care Centre. A total of 80 children aged 5 months to 12 years were enrolled, including 40 cases with seizures (simple febrile, atypical febrile, and other types) and 40 age- and sex-matched febrile controls without seizures. Three millilitres of venous blood were collected, and serum zinc levels were estimated using the colorimetric method. Data were analyzed using SPSS software, and p < 0.05 was considered statistically significant. Results: Most participants were between 1–5 years of age, with a male predominance (60%). Simple febrile seizures were the most common (57.5%), followed by atypical febrile seizures (27.5%). The mean serum zinc level in seizure cases was 59.6 µg/dl compared to 101.4 µg/dl in controls (p < 0.0001). Zinc deficiency was observed in 52.5% of cases versus 10% of controls. Both simple and atypical febrile seizure groups showed significantly lower zinc levels compared with controls, whereas other seizure types did not demonstrate significant differences. Conclusion: Serum zinc levels are significantly reduced in children with febrile seizures compared to febrile controls, suggesting zinc deficiency may play a role in seizure pathogenesis. Larger multicentric studies are recommended, and zinc supplementation could serve as a cost-effective preventive measure in susceptible pediatric populations.

Background: Background: Varicose veins are increasingly recognized as an occupational health issue, particularly among professionals with prolonged standing hours. Medical residents, due to long working hours and extended duty shifts, may be at heightened risk. Aim: To assess the incidence and contributing factors of varicose veins among newly joined residents in clinical branches at a tertiary care institute. Materials and Methods: This retrospective study analyzed data collected from 50 newly joined residents (January 2023–June 2025) at Vilasrao Deshmukh Government Medical College, Latur, using a structured questionnaire assessing demographics, work hours, lifestyle, preventive awareness, and symptoms of varicosities. Results: Out of 50 residents, 6 (12%) showed symptoms suggestive of varicose veins. The majority reported prolonged standing (>8 hours/day) and extended working shifts. Three affected residents were from the Pediatrics discipline. Awareness of varicose vein prevention was noted in 70% of participants; however, only 20% practiced preventive measures such as limb elevation or compression stocking use. Conclusion: The incidence of varicose veins among newly joined residents was 12%, with prolonged standing hours and inadequate preventive practices identified as key contributing factors. Occupational modifications, awareness programs, and preventive strategies should be implemented to safeguard the vascular health of residents.

Background: Early and accurate diagnosis of Acute Coronary Syndrome (ACS) remains crucial for optimal outcomes. While cardiac Troponin I (cTnI) is the gold standard biomarker, its delayed rise limits early diagnosis. Heart-type Fatty Acid-Binding Protein (H-FABP) is a promising early marker, with potential diagnostic and prognostic utility. Aim: To evaluate the diagnostic and prognostic significance of H-FABP in ACS and compare its performance with cTnI and NT-proBNP across ACS subtypes and severities. Methods: This prospective observational study included 130 patients with ACS. H-FABP and cTnI were measured at 0 and 6 hours post-admission; NT-proBNP was analyzed once. Echocardiography assessed left ventricular ejection fraction (LVEF), and coronary angiography quantified disease extent using SYNTAX score. Statistical analyses included ROC curves, logistic regression, and correlation tests. Results: H-FABP positivity (>9 ng/mL) was observed in 100% of STEMI and NSTEMI and 6.9% of unstable angina cases (p < 0.001). H-FABP (0h and 6h) showed excellent diagnostic accuracy for left ventricular dysfunction (AUC = 0.937 and 0.949), outperforming Troponin I (AUC = 0.768 and 0.756). HFABP correlated significantly with SYNTAX score (r = 0.320, p < 0.001). NT-proBNP also showed strong predictive performance (AUC = 0.948). Conclusion: H-FABP demonstrates superior early diagnostic accuracy and prognostic significance in ACS compared to Troponin I and performs comparably to NT-proBNP. Its integration with conventional biomarkers may enhance early risk stratification and management in ACS.

Background: Many Local anaesthetics have been tried and tested to enhance the safety and efficacy in subarachinoid block. From previous studies, bupivacaine is widely used because of its excellent motor blockade but because of its side effects of cardiotoxicity and neurotoxicity, there is a search for a better alternative which provides similar effects with significantly reduced cardiotoxicity and neurotoxicity. Objectives: To study and compare the effects of equal volume of 0.75% Hyperbaric Ropivacaine with 0.5% Hyperbaric Bupivacaine for lower abdominal surgeries. Materials & Methods: A Prospective randomized double-blind study. Control study done on 60 patients in the Department of Anaesthesiology, Khaja Banda Nawaz Teaching and General Hospital, Kalaburagi.  Patients were randomly divided into 2 groups of 30 each. Group A: Hyperbaric Ropivacaine 0.75% 3ml, Group B: Hyperbaric Bupivacaine 0.5% 3ml.  Results: Ropivacaine significantly produced slower onset but shorter time to peak effect (4.01 ± 0.83, 13.43 ± 0.77) than bupivacaine (3.06 ± 0.69, 14.36 ± 0.99); however, level of sensory block achieved was similar and duration of sensory block was significantly lesser with ropivacaine (154.93 ± 6.45 min).The onset of pinprick analgesia at T10 was more rapid in bupivacaine Group B than in ropivacaine Group A. (P <0.001) However, the time to (peak) maximum extent of cephalad spread and the level achieved were similar in both groups. The mean duration of sensory block was shorter in Group A (154.93 ± 6.45) than in Group B (190.00 ± 7.20). (P<0.001) The time to maximum motor blockade was statistically similar Conclusion: Ropivacaine is comparable to the hyperbaric 0.5% bupivacaine in terms of quality of block, but with a shorter recovery profile, it is a useful agent for Spinal Anaesthesia for intermediate duration of surgeries.

Background: Early recognition of sepsis remains a major clinical challenge. Conventional clinical scoring systems such as qSOFA, SOFA, SIRS, and NEWS have limited sensitivity for early detection. Machine learning (ML)–based early warning systems have been increasingly developed to leverage electronic health record data for earlier and more accurate sepsis . Objectives: To systematically evaluate and quantitatively synthesize the diagnostic performance of ML-based early warning systems for early sepsis prediction in hospitalized adult patients. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Scopus, Web of Science, and related databases were searched for studies published between 2015 and 2025 that evaluated ML-based models for early sepsis prediction in adult populations. Pooled estimates of sensitivity, specificity, area under the receiver operating characteristic curve (AUC), accuracy, precision, and F1 score were calculated using random-effects models. Risk of bias was assessed using the ROBINS-I tool. Results: Thirty studies encompassing approximately 5.5–6.0 million adult patient encounters were included. ML-based early warning systems demonstrated high pooled sensitivity (0.89), specificity (0.87), and overall accuracy (0.88). Discriminative performance was excellent, with a pooled AUC of 0.93. Precision and F1 score indicated balanced diagnostic performance but showed substantial heterogeneity across studies, largely driven by differences in sepsis prevalence, clinical settings, and model thresholds. Most studies exhibited a moderate risk of bias, primarily related to retrospective design. Conclusions: ML-based early warning systems demonstrate robust and superior diagnostic performance for early sepsis prediction compared with conventional clinical scoring tools. While heterogeneity across studies remains substantial, the consistency of pooled estimates supports the potential clinical value of ML-driven approaches. Prospective validation and context-specific calibration are essential for successful real-world implementation.

BACKGROUND: Surface epithelial tumors constitute the majority of ovarian neoplasms and exhibit a wide histological spectrum ranging from benign to highly aggressive malignant lesions. Accurate differentiation between benign, borderline, and malignant tumors is essential for prognosis and management. Conventional histopathology alone may be insufficient in borderline cases. Immunohistochemical biomarkers such as p53, a tumor suppressor gene product, and Ki-67, a marker of cellular proliferation, have emerged as valuable tools in assessing tumor behavior, aggressiveness, and prognosis. MATERIALS AND METHODS: This prospective observational study was conducted in the Department of Pathology in collaboration with the Department of Obstetrics and Gynecology at Rangaraya Medical College, Kakinada, from November 2022 to November 2024. A total of 150 surface epithelial ovarian tumors were analyzed after histopathological confirmation. Tumors were classified according to the WHO 2020 classification into benign, borderline, and malignant categories. Immunohistochemistry for p53 and Ki-67 was performed in 31 selected cases of borderline and malignant tumors using standard peroxidase–antiperoxidase techniques. The expression patterns of p53 and the Ki-67 labeling index were evaluated and correlated with tumor subtype, grade, and FIGO stage. Statistical analysis was performed using the chi-square test.RESULTS: Surface epithelial tumors constituted 91.4% of all ovarian neoplasms, with serous tumors being the most common, followed by mucinous and endometrioid tumors. Benign tumors predominated overall. Borderline tumors consistently demonstrated wild-type p53 expression with a low Ki-67 index, indicating low proliferative activity. In contrast, malignant serous and mucinous tumors showed mutant p53 expression (overexpression, null, or cytoplasmic patterns).  A High Ki-67 index was significantly associated with malignant serous tumors and advanced FIGO stage (p < 0.001), reflecting aggressive tumor behavior.CONCLUSION: The combined assessment of histomorphology with p53 and Ki-67 immunohistochemistry provides valuable diagnostic and prognostic information in surface epithelial ovarian tumors. p53 mutations and a high Ki-67 index reliably correlate with malignancy and tumor aggressiveness, aiding in differentiation between borderline and malignant lesions and supporting improved clinical decision-making.

Background: Postoperative pain remains a significant clinical challenge that affects recovery, mobility, and overall patient outcomes. Although opioids have historically served as the primary analgesic agents, their adverse effects including respiratory depression, nausea, ileus, and potential for dependency have prompted a shift toward multimodal analgesia (MMA). Incorporating anesthetic interventions such as peripheral nerve blocks and neuraxial (epidural or spinal) anesthesia into MMA regimens offers an opportunity to improve analgesic efficacy while reducing opioid consumption. Methods: This systematic review was conducted following PRISMA 2020 guidelines. A comprehensive search of PubMed, the Cochrane Library, and ScienceDirect databases identified studies published between 2015 and 2025 that evaluated multimodal analgesia protocols including anesthetic techniques for postoperative pain control. Eligible studies included randomized controlled trials, cohort studies, and meta-analyses assessing pain intensity, opioid use, and functional recovery. Data were synthesized narratively due to heterogeneity in protocols and outcome measures. Results: Eight key studies were included, comprising randomized trials, cohort analyses, and systematic reviews across orthopedic, abdominal, and spinal surgeries. Consistently, MMA protocols that integrated anesthetic methods such as adductor canal, transversus abdominis plane, erector spinae, and epidural blocks resulted in significantly lower pain scores and reduced opioid consumption. For instance, epidural local anesthetics provided superior analgesia and faster gastrointestinal recovery compared to systemic opioids, while adductor canal block preserved mobility with comparable analgesic efficacy. In ERAS-based cohorts, structured MMA bundles reduced median opioid use by up to 70%. Additionally, improved patient satisfaction, earlier ambulation, and shorter hospital stays were observed. Discussion: Regional and neuraxial anesthesia enhances multimodal analgesia by blocking nociceptive transmission and reducing central sensitization. When combined with non-opioid agents—such as acetaminophen, NSAIDs, gabapentinoids, ketamine, and dexamethasone these techniques provide synergistic pain relief while minimizing opioid-related complications. Despite consistent benefits, variability in study design and dosing regimens highlights the need for procedure-specific standardization and further trials on long-term outcomes such as chronic postsurgical pain and sustained opioid abstinence. Conclusion: Evidence strongly supports the integration of anesthetic techniques into multimodal analgesia for effective postoperative pain control. These strategies reduce opioid requirements, enhance functional recovery, and align with ERAS principles of patient-centered and opioid-sparing care. Future research should focus on optimizing multimodal combinations, evaluating continuous versus single-shot techniques, and developing individualized analgesic pathways to maximize efficacy and safety across diverse surgical populations.

Background: Intraabdominal infections remain one of the most serious postoperative complications following gastrointestinal surgery, contributing significantly to morbidity, prolonged hospital stay, and mortality. Early diagnosis is often challenging as clinical signs may be nonspecific in the immediate postoperative period. Biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) have been increasingly studied for their role in the early detection of infective complications. Aim: To evaluate the role of serum C-reactive protein and procalcitonin levels in the early diagnosis of intraabdominal infections in patients undergoing gastrointestinal surgery. Materials and Methods: This prospective observational study was conducted at Government Medical College, Kadapa, over a period of one year. Adult patients undergoing elective or emergency gastrointestinal surgery and requiring postoperative intensive care monitoring were included. Serum CRP and PCT levels were measured at 1^st, 24^th, 48^th, and 72^nd postoperative hours. Patients were monitored clinically and radiologically for the development of intraabdominal infections such as anastomotic leaks and intraabdominal abscesses. Diagnostic accuracy of CRP and PCT was assessed using sensitivity, specificity, and receiver operating characteristic (ROC) curve analysis. Results: A significant proportion of patients developed postoperative intraabdominal infections. Both CRP and PCT levels were significantly higher in infected patients compared to non-infected patients, particularly at 48 and 72 hours postoperatively. Procalcitonin demonstrated higher sensitivity and specificity than CRP at these time points, indicating superior predictive value for early diagnosis of intraabdominal infections. Conclusion: Serial measurement of serum procalcitonin and C-reactive protein is valuable in the early detection of postoperative intraabdominal infections. Procalcitonin, especially at 48 and 72 hours, is a more reliable biomarker than CRP and can aid clinicians in early diagnosis and timely intervention.

Background: Sleep disturbances are increasingly recognized as an important factor influencing glucose metabolism and metabolic control in patients with Type 2 Diabetes Mellitus (T2DM). While HbA1c reflects average glycemic control, glycemic variability provides additional insight into short-term glucose fluctuations that contribute to diabetic complications. Objectives: To evaluate the association between sleep quality and glycemic variability in patients with Type 2 Diabetes Mellitus. Methods: This prospective observational study was conducted over one year at PDU Medical College and attached group of Hospital (Dedraj Bhartiya Hospital -Churu). A total of 100 patients with T2DM were enrolled. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and patients were categorized into good and poor sleep quality groups. Glycemic variability was evaluated using fasting blood glucose, standard deviation of glucose values, coefficient of variation, and mean amplitude of glycemic excursions. HbA1c was measured to assess overall glycemic control. Statistical analysis was performed to determine the association between sleep quality and glycemic variability. Results: Poor sleep quality was observed in 54% of the study participants. Patients with poor sleep quality demonstrated significantly higher fasting blood glucose levels, greater glycemic variability, and higher HbA1c compared to those with good sleep quality. Increased glycemic variability was present in a substantially higher proportion of patients with poor sleep quality, indicating a strong association between impaired sleep and glucose instability. Conclusion: Poor sleep quality is common among patients with Type 2 Diabetes Mellitus and is significantly associated with increased glycemic variability and suboptimal glycemic control. Routine assessment of sleep quality may serve as an important component of comprehensive diabetes management and may help identify patients at higher risk for glycemic instability and related complications.

Background: Type 2 Diabetes Mellitus (T2DM) is a major public health problem and is frequently associated with microvascular and macrovascular complications that significantly increase morbidity and mortality. Magnesium plays an essential role in glucose metabolism, insulin action, and vascular function. Hypomagnesemia is commonly observed in patients with T2DM and has been implicated in the development of diabetic complications. Objectives: To evaluate serum magnesium levels in patients with Type 2 Diabetes Mellitus and to assess their role in predicting the presence of diabetic complications. Methods: levels were This prospective observational study was conducted over a period of one year at PDU Medical College and attached group of Hospital (Dedraj Bhartiya Hospital -Churu). A total of 100 patients with Type 2 Diabetes Mellitus were enrolled. Serum magnesium measured at baseline, and patients were assessed for the presence of diabetic microvascular and macrovascular complications using standard clinical and laboratory criteria. Data were analyzed to determine the association between serum magnesium levels and diabetic complications using appropriate statistical tests, with a p-value of <0.05 considered statistically significant. Results: Hypomagnesemia was observed in 37% of the study participants. Diabetic complications were present in 54% of patients and were significantly more common among those with low serum magnesium levels. The prevalence of hypomagnesemia was markedly higher in patients with complications compared to those without complications. Mean serum magnesium levels were significantly lower in patients with complications than in those without. A significant association was also observed between longer duration of diabetes and the presence of complications, while gender showed no significant association. Conclusion: Hypomagnesemia is common in patients with Type 2 Diabetes Mellitus and is significantly associated with diabetic complications. Serum magnesium estimation may serve as a simple and cost-effective tool for early identification of patients at higher risk for complications, supporting its inclusion in routine diabetic evaluation and management.

Background: In obstetric critical illness, distinguishing hypoperfusion from venous congestion is challenging. VExUS-based POCUS and endothelial biomarkers may support individualized hemodynamic decisions, but feasibility data are limited. Objectives: To assess feasibility of integrating VExUS POCUS with endothelial biomarkers in critically ill obstetric patients and explore early management and organ-outcome signals. Methods: Prospective 1-year feasibility study (N=50) at Mahabodhi Medical College & Hospital, Bihar. Within 6 hours of ICU/HDU admission, participants underwent IVC, hepatic, portal, and intrarenal venous Doppler to assign VExUS grade (0–3) and biomarker sampling (syndecan-1; sFlt-1/PlGF where available). Feasibility endpoints were completion rate, scan time, biomarker acquisition, and documented management changes attributable to findings. Exploratory outcomes included KDIGO-AKI and fluid balance. Results: POCUS protocol completion was 47/50 (94%) with median scan time 15 min (IQR 12–17); biomarkers were obtained in 46/50 (92%). Management change attributed to POCUS/biomarkers occurred in 29/50 (58%), most often diuretics (13/29, 44.8%) or fluid restriction (11/29, 37.9%). VExUS 2–3 occurred in 24/50 (48%). AKI occurred in 16/50 (32%), higher in VExUS 2–3 vs 0–1 (45.8% vs 19.2%; OR 3.55). Fluid balance differed at 24 h (+0.81 L vs −0.81 L) and 48 h (+0.74 L vs −1.15 L). Syndecan-1 correlated with VExUS grade (ρ=0.48, p=0.0008). Conclusions: Combined VExUS POCUS and endothelial biomarker integration was feasible and frequently influenced hemodynamic decisions. Higher congestion aligned with greater AKI and distinct fluid balance patterns, supporting larger validation studies.

Introduction: Hypothyroidism is one of the most common endocrine disorders in India, with varying clinical and biochemical presentations. It remains underdiagnosed, especially in peripheral regions such as Jammu & Kashmir.

Objectives: To evaluate the clinical profile and biochemical patterns of hypothyroidism and to assess the association of anaemia, obesity, and menstrual irregularities with disease severity. Methods: A descriptive cross-sectional study was conducted among 500 newly diagnosed hypothyroid patients attending the Medicine Department of a district hospital in Jammu and Kashmir from January 2023 to December 2024. Detailed history, clinical examination, and laboratory evaluation including serum TSH, T4, and haemoglobin levels were performed. Patients were classified as subclinical or overt hypothyroidism based on biochemical criteria. Statistical analysis was done using SPSS v26.0, with p < 0.05 considered significant. Results: Of 500 patients, 370 (74%) were females and 130 (26%) males, with a mean age of 38.9 ± 11.6 years. Subclinical hypothyroidism constituted 64.4% and overt 35.6%. Common symptoms were fatigue (78.4%), weight gain (71%), and dry skin (62.4%). Anaemia was found in 27.4% and obesity in 22.2%, both significantly associated with overt disease (p=0.002 and p=0.03, respectively). Menstrual irregularities occurred in 40% of females (p=0.001). Conclusion: Hypothyroidism predominantly affects middle-aged females. Early screening, especially in women with menstrual or metabolic symptoms, is essential for timely diagnosis and treatment.

Background: The clinical profile and outcomes of severe COVID-19 vary across regions and health-care settings. We evaluated the clinico-demographic characteristics and in-hospital outcomes of patients with severe COVID-19 pneumonia admitted to a tertiary hospital in North India. Methods: We performed a prospective observational study of RT-PCR–confirmed COVID-19 patients meeting severity criteria (respiratory rate >24/min, SpO₂ <94% on room air, or organ dysfunction) over seven months. Demographics, symptoms, comorbidities, laboratory tests, and HRCT findings were recorded. Outcomes included in-hospital mortality. Results: Of 179 severe cases, 95 were men (53.1%) and 100 were from rural areas (55.9%). Fever was the most common symptom, followed by cough and breathlessness; universal hypoxaemia was documented on admission. Tachycardia occurred in 89.4%, tachypnoea in 50.3%, bradycardia in 7.3%, and hypotension in 1.7%. Hypertension (48.0%) and diabetes (9.5%) were the leading co-morbidities; one-third had none. Lymphopenia was seen in 19.0% and leukocytosis in 11.2%; HRCT showed a CT severity index >6 in all patients. Overall mortality was 13.4% (24/179) and was higher in males (62.5% of deaths), in those ≥60 years (58.3%), with comorbidities (66.7%), and from rural areas (75%). Conclusion: Severe COVID-19 pneumonia at our centre was characterised by fever with hypoxaemia, frequent hypertension and lymphopenia, and a moderate fatality rate. Male sex, older age, rural residence, co-morbidities, lower SpO₂, and higher CT severity were associated with death, underscoring the need for early risk stratification and intensified management in these subgroups.

Background: The fibular incisura of the distal tibia is essential for ankle stability and proper syndesmotic function. Variations in its morphology can affect ankle biomechanics and the management of ankle fractures. As morphometric data from the Eastern Indian population are limited, this study aimed to evaluate the dimensions of the fibular incisura in adult tibiae and to assess sex-wise and side-wise differences for clinical relevance. Materials And Methods: A cross-sectional observational study was carried out on 60 adult human dry tibiae of known gender. The sample comprised equal numbers of male and female tibiae, with both right- and left-sided specimens included, but not paired. Only well-preserved tibiae with intact distal ends and without any deformity or pathological changes were selected. Morphometric parameters of the fibular incisura, including width, depth, height, and the lengths of the anterior and posterior tubercles, were measured using a digital vernier calliper with an accuracy of 0.01 mm. All measurements were recorded in millimetres following standard anatomical landmarks. The data were analysed using SPSS software, and sex-wise and side-wise comparisons were performed using the unpaired Student’s t-test. A p-value of less than 0.05 was considered statistically significant. Results: Among the 60 adult tibiae studied, males showed significantly larger dimensions of the fibular incisura than females. The mean width was 23.6 mm in males and 21.0 mm in females, while the mean depth was 3.30 mm and 3.05 mm, respectively. The height of the fibular incisura was also greater in males (31.9 mm) compared to females (29.5 mm). The anterior tubercle length showed a significant gender difference, whereas the posterior tubercle did not show statistical significance. No significant differences were observed between right and left sides for any parameter, indicating bilateral symmetry of the fibular incisura. Conclusion: The present study demonstrates significant sexual dimorphism in most morphometric parameters of the fibular incisura, with male tibiae showing greater dimensions than female tibiae. In contrast, no significant side-wise differences were observed, indicating bilateral symmetry. These findings provide useful baseline anatomical data that may assist in the interpretation of imaging, surgical planning, and management of ankle and syndesmotic injuries.