European Journal of Cardiovascular Medicine

Background: Acute Coronary Syndrome (ACS) results from atherosclerotic plaque rupture, ulceration, or erosion, leading to intraluminal thrombus formation, myocardial ischemia, and necrosis. Platelet activation plays a central role in its pathogenesis, with larger platelets exhibiting greater reactivity. Mean platelet volume (MPV) and plateletcrit (PCT) are simple, cost-effective markers of platelet activation and may aid in early diagnosis and risk stratification of ACS. Objectives: To evaluate platelet indices, including MPV, plateletcrit, platelet distribution width (PDW), and platelet count (PC), in ACS patients and compare them with healthy controls, and to assess differences between STEMI and NSTEMI subtypes. Methods: This matched case–control analytical study included 87 ACS patients aged 18–60 years and 87 age- and sex-matched healthy controls. Blood samples were collected in EDTA vacutainers and analyzed using an automated hematology analyzer. Statistical analysis was performed using SPSS 27, with Student’s unpaired t-test; p < 0.05 was considered significant. Results: MPV and PCT were significantly higher in ACS patients compared to controls (8.95 ± 0.63 fL vs. 6.98 ± 0.43 fL, p < 0.001; 0.23 ± 0.27 vs. 0.17 ± 0.01, p = 0.024, respectively). PDW showed no significant difference. Among ACS subtypes, STEMI patients had higher MPV (9.10 ± 0.61 fL) than NSTEMI (8.52 ± 0.49 fL, p < 0.001), while other indices did not differ significantly. These findings support MPV and PCT as reliable indicators of platelet activation in ACS. Conclusion: MPV and plateletcrit are significantly elevated in ACS, particularly in STEMI, and may serve as inexpensive, routinely available markers for early detection and risk stratification. Incorporating these indices into clinical practice could aid timely diagnosis and management of ACS.

Background: Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive cutaneous sarcoma with high recurrence due to its infiltrative spread. Early identification of tumour margins is essential for surgical planning. Although multiple imaging modalities are used in DFSP, limited studies have correlated clinical findings with multimodal imaging features. This study evaluated clinical, dermoscopic, ultrasound, and MRI characteristics of DFSP and examined their correlation to improve diagnostic accuracy and pre-operative assessment. Materials and Methods: A prospective observational study was conducted on 30 clinically suspected or biopsy-confirmed DFSP cases in the Departments of DVL and Radiology, Mamata Medical College, Khammam, from May 2022 to June 2024. Clinical details including size, duration, and site were recorded. All patients underwent dermoscopy and ultrasound; MRI was performed for lesions >2 cm, deeper involvement, or complex sites, while CT was used selectively for suspected bone invasion. Imaging parameters included echotexture, vascularity, depth, margins, signal patterns, and tissue infiltration. Data were analysed using descriptive and correlation statistics. Results: Majority of lesions involved trunk and extremities, mean age was 38.6 ± 12.4 years, and mean duration was 28.3 ± 14.9 months. Ultrasound showed hypoechoic lesions with infiltrative margins in 73.3% and subcutaneous fat involvement in 70%. MRI revealed T1 hypointensity (70%), T2/STIR hyperintensity (86.7%), moderate to intense enhancement (73.4%), and fascial invasion in 43.3%. Dermoscopy commonly showed pink to skin-coloured background, linear irregular or arborising vessels, and shiny white lines. Significant correlations were noted between lesion size and imaging depth (p < 0.001), duration and infiltrative margins (p < 0.05), and dermoscopic vascularity with MRI enhancement (p < 0.01). CT in six cases showed soft-tissue extension in 50% and cortical irregularity in 33%. Conclusion: Multimodal imaging in DFSP demonstrates consistent clinical and radiological patterns reflecting depth and infiltrative behaviour. Dermoscopy and ultrasound are useful screening tools, while MRI provides definitive pre-operative mapping. Integrating clinical and imaging findings can enhance early diagnosis and assist in selecting appropriate surgical margins, reducing recurrence risk

Background: Regional anaesthesia offers distinct advantages over general anaesthesia in infra-umbilical surgeries by providing superior analgesia, reduced opioid use, early ambulation, and improved patient satisfaction. Ropivacaine, a long-acting amide local anaesthetic with reduced cardiotoxicity, is commonly used in epidural anaesthesia. Adjuvants such as clonidine and fentanyl can further enhance block characteristics, but comparative evidence remains limited. Aim: To compare the analgesic efficacy, block characteristics, haemodynamic stability, and side effect profiles of clonidine versus fentanyl as adjuvants to 0.75% ropivacaine administered epidurally in infra-umbilical surgeries. Methods: This prospective, randomized, single-blind study included 60 ASA I–II patients aged 18–60 years undergoing elective infra-umbilical surgeries. Patients were randomized into two groups: Group C (ropivacaine 0.75% + clonidine 30 μg) and Group F (ropivacaine 0.75% + fentanyl 75 μg). Parameters assessed included onset and duration of sensory and motor block, two-segment regression, duration of analgesia, haemodynamic trends, and complications. Results: The onset of sensory block was slightly faster with clonidine, though not statistically significant. Two-segment regression and duration of analgesia were significantly prolonged in the clonidine group (p < 0.05). Motor block regression was earlier with clonidine, allowing faster recovery. Fentanyl produced a faster onset of motor block and greater haemodynamic stability, whereas clonidine was associated with a more pronounced but manageable decline in MAP and pulse rate. Complications were minimal and comparable between groups. Conclusion: Clonidine as an epidural adjuvant provides prolonged analgesia, denser sensory block, and earlier motor recovery, making it suitable for prolonged procedures. Fentanyl ensures faster motor block onset and superior haemodynamic stability, favoring patients with cardiovascular comorbidities. Choice of adjuvant should be individualized based on patient profile and surgical needs

Background: Psoriasis is increasingly recognized as a chronic inflammatory disorder with significant systemic implications. Understanding the broader metabolic and cardiovascular burden requires a coordinated Medicine–Dermatology approach. Material and Methods: A cross-sectional study was conducted in a tertiary care center, enrolling 180 adults with clinically confirmed psoriasis. Dermatologic evaluation included PASI scoring and assessment of nail and joint involvement. Systemic assessment comprised metabolic profiling, cardiovascular risk evaluation, inflammatory markers, and screening for common comorbidities. Statistical analyses included descriptive statistics and correlation testing between PASI and systemic parameters. Results: The mean age of participants was 42.7 ± 12.4 years, with males accounting for 62.2%. The mean disease duration was 8.6 ± 6.1 years, and the average PASI score was 11.8 ± 6.3. Nail involvement was noted in 35.6%, and 21.1% reported joint-related symptoms. Metabolic abnormalities were frequent, with mean BMI of 27.3 ± 4.6 kg/m² and waist circumference of 92.5 ± 10.8 cm. Metabolic syndrome was identified in 30.0%, dyslipidemia in 53.3%, hypertension in 32.2%, and impaired fasting glucose or diabetes in 26.1%. The mean hs-CRP and ESR values were 5.8 ± 3.6 mg/L and 22.4 ± 11.3 mm/h, respectively. Significant correlations were observed between PASI and BMI (r = 0.28), waist circumference (r = 0.31), triglycerides (r = 0.22), hs-CRP (r = 0.35), and ESR (r = 0.18). Renal function remained largely preserved across the cohort. Conclusion: A substantial proportion of individuals with psoriasis demonstrated metabolic, cardiovascular, and inflammatory abnormalities. The correlations between cutaneous severity and systemic parameters highlight the need for integrated Medicine–Dermatology evaluation to enable timely identification and management of comorbidities

Background:  High-risk pregnancies contribute significantly to perinatal morbidity and mortality. Cardiotocography (CTG) remains a vital tool for intrapartum fetal monitoring, enabling early detection of distress and timely obstetric intervention. However, its predictive accuracy and effect on perinatal outcomes require further evaluation. Methods A prospective cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Tezpur Medical College and Hospital, from September 2023 to August 2024. A total of 180 antenatal women with ≥37 weeks of gestation and one or more high-risk factors were included. Admission CTG was performed for 20 minutes and categorized as reactive, non-reactive, or pathological. Maternal outcomes (mode of delivery) and neonatal outcomes (Apgar score, NICU admission, perinatal mortality) were recorded. Statistical analysis was done using SPSS v20.0, with p < 0.05 considered significant. Results Reactive CTG was observed in 70.55% of cases, non-reactive in 19.44%, and pathological in 10%. A significant association existed between CTG findings and mode of delivery (p < 0.0001), with 90.5% of reactive CTG cases delivering vaginally, while 97.47% of pathological CTG required caesarean section. Pathological CTG correlated with low Apgar scores (<7) and increased NICU admissions. CTG showed 80% sensitivity and 80.74% specificity, with a high negative predictive value (99.09%). Conclusion Abnormal CTG patterns are strongly linked to adverse perinatal outcomes, especially in conditions like PIH and IUGR. Although CTG is a sensitive tool for detecting fetal distress, its low positive predictive value necessitates adjunctive methods for accurate fetal assessment and minimizing unnecessary interventions

Hypertensive disorders of pregnancy (HDP), particularly preeclampsia, remain among the leading causes of maternal and perinatal morbidity and mortality globally. Early identification of women at risk allows preventive interventions such as low-dose aspirin therapy and closer surveillance. Uterine artery Doppler velocimetry in the first trimester provides a non-invasive assessment of uteroplacental circulation and may help predict preeclampsia before clinical onset. Abnormal uterine artery pulsatility index (PI) reflects impaired trophoblastic invasion and high vascular resistance, which precede the development of HDP and adverse perinatal outcomes. Aim: To evaluate the predictive value of mean uterine artery PI measured at 11–14 weeks of gestation in primigravida women with singleton pregnancies for the development of hypertensive disorders of pregnancy and adverse perinatal outcomes. Materials and Methods: A prospective cohort study was conducted on 75 primigravida women with singleton pregnancies between 11–14 weeks of gestation attending the antenatal clinic of a Tezpur Medical College and Hospital. Mean uterine artery PI was measured by transabdominal color Doppler ultrasonography. Participants were followed up till delivery and 7 days postpartum. Based on Doppler results, women were categorized into normal PI (≤95th percentile) and abnormal PI (>95th percentile) groups. The primary outcome was the development of HDP, and secondary outcomes included preterm delivery, intrauterine growth restriction (IUGR), mode of delivery, NICU admission, and perinatal mortality. Data were analyzed using the Chi-square test for categorical variables and independent t-test for continuous variables. A p-value <0.05 was considered statistically significant. Results: Out of 75 par0ticipants, 15 (20%) had abnormal mean uterine artery PI. Preeclampsia developed in 33.3% of women with abnormal PI compared to 6.6% with normal PI (p<0.01). The abnormal PI group also showed significantly higher rates of preterm delivery (33.3% vs. 10%; p=0.04), IUGR (26.6% vs. 8.3%; p=0.045), and NICU admissions (26.6% vs. 11.6%; p=0.05). Mean birth weight was significantly lower in the abnormal PI group (2.41 ± 0.42 kg) than in the normal PI group (2.87 ± 0.36 kg). No significant difference was found in mode of delivery or perinatal mortality. Discussion: Abnormal uterine artery PI in early pregnancy was strongly associated with subsequent HDP and adverse perinatal outcomes, supporting its role as an early screening marker of placental insufficiency. These findings are consistent with those of Papageorghiou et al. [9], Gómez et al. [10], and Plasencia et al. [12], who reported significantly higher rates of preeclampsia and IUGR among women with elevated first-trimester uterine artery PI. In accordance with the ASPRE trial by O’Gorman et al. [14] and recommendations by WHO and ACOG [15,17], early identification of at-risk women can guide the initiation of low-dose aspirin prophylaxis before 16 weeks to reduce the incidence of preeclampsia and its complications. Conclusion: Mean uterine artery PI measured at 11–14 weeks of gestation is a significant early predictor of preeclampsia and adverse perinatal outcomes. Incorporating first-trimester uterine artery Doppler screening into routine antenatal care can enable early risk stratification, timely prophylaxis, and improved maternal and neonatal outcomes, particularly in primigravida women

Introduction: Determination of age is prerequisite for personal identification in living as well as dead. Age estimation becomes a valuable tool to assist in administration of many civil and criminal procedure codes in deciding the age of majority. Questions of juvenility are often a question that has to be answered correctly in connection with criminals of younger age group in cases where biological study of maturity of a child has to be performed to access the development of a child, age estimation is of paramount importance.  Material and Methods  The present study was carried out on 217 healthy students (101 males&50 females) in Haryana region. The subjects aged between 13-20 year of age of school going children and also of college, were subjected  to radiological examination  of both  hand and with wrist- in AP view and stages of epiphysis fusion was noted. Result & Conclusion  Average age of fusion of the base of the first metacarpals complete in 15-16 years in females and 18-19 years in males. Epiphysis fusion was earlier in females as compared to males and it was simultaneously on both sides.

Objective: This cross-sectional radiological study aimed to determine the prevalence and patterns of C2 vertebral artery groove anomalies—including high riding vertebral artery and narrow pedicle width—among South Indian adults undergoing CT scans.  Methods: Conventional CT images from 120 randomly selected patients were analyzed for C2 pedicle width, isthmus height, internal height of lateral mass, and presence of C1 arcuate foramen. Side variations and associations between these anomalies were evaluated.  Results: Narrow pedicle width of C2 was found in 30% of subjects, high riding vertebral artery in 19.2%, and arcuate foramen in 5.8%. The anomalies frequently coexisted and showed significant side and age-related variation.  Conclusion: A substantial proportion of the South Indian population harbors vertebral artery groove anomalies, warranting thorough preoperative CT assessment and multidisciplinary collaboration to prevent vertebral artery injury during cervical spine stabilizations

Background: Atrial fibrillation (AF) is a common supraventricular tachyarrhythmia affecting 1% to 2% of the general population. The risk of AF generally increases with aging, hypertension, coronary artery disease, diabetes mellitus, alcohol use. However, the valvular disease is the most common substrate for AF in areas with a high prevalence of rheumatic heart disease and is a risk factor for embolic stroke and heart failure. Aim: The aim of the present study is to determine the clinical profile and echocardiographic abnormalities in patients of AF in Indian perspective. It will help in better management and diagnosis of patients with atrial fibrillation. Methods: This hospital-based cross-sectional study was conducted in the Department of Cardiology, Medical College and Hospital, Kolkata, from January 2022 to December 2022. Consecutive adult patients diagnosed with atrial fibrillation by clinical features and confirmed by 12-lead ECG were included. Both outdoor and indoor patients were evaluated for their clinical profile and echocardiographic abnormalities. Result: In the present study comprising 471 patients with atrial fibrillation, the majority of cases were of the persistent type, accounting for 410 patients (87%), while paroxysmal atrial fibrillation was observed in 61 patients (13%). This indicates that persistent atrial fibrillation was the predominant form encountered in the study population. Conclusion: We concluded that, a comprehensive evaluation of patients with atrial fibrillation (AF) revealed distinct clinical and echocardiographic patterns between valvular and non-valvular types. Non-valvular AF was more common, particularly among older males, and was frequently associated with higher BMI and comorbidities such as hypertension and ischemic heart disease

Background: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder associated with long-term complications, including cognitive dysfunction. Prolonged hyperglycemia, insulin resistance, and vascular comorbidities may impair attention, memory, and executive function. Despite the growing burden of diabetes, cognitive assessment is often overlooked in routine care, particularly in developing countries. The study aimed to assess cognitive function among patients with T2DM using the Mini-Mental State Examination (MMSE) and to evaluate its association with clinical and biochemical parameters. Methods: This cross-sectional study was conducted at a tertiary care centre from January 2024 to June 2025. A total of 100 adults aged 40–75 years with T2DM of at least one-year duration were enrolled. Individuals with Type 1 diabetes, neurological or psychiatric disorders, alcohol dependence, sensory impairments, or medications affecting cognition were excluded. Sociodemographic and clinical data were collected, and anthropometric measurements and blood pressure were recorded. Glycemic control was assessed via fasting and postprandial glucose and HbA1c levels. Cognitive function was evaluated using the MMSE, with scores ≥27 considered normal, 21–26 indicating mild impairment, 10–20 moderate impairment, and <10 severe impairment.  Results: Among participants, 25% exhibited cognitive impairment, predominantly mild (22%) and moderate (3%). Impaired individuals were older (61.1 ± 7.5 vs. 56.1 ± 8.8 years), had longer diabetes duration (9.5 ± 4.6 vs. 6.4 ± 3.7 years), higher HbA1c (8.5 ± 1.3 vs. 7.9 ± 1.1%), and elevated systolic blood pressure (138.4 ± 14.6 vs. 131.2 ± 12.9 mmHg). MMSE scores negatively correlated with age (r = –0.39), diabetes duration (r = –0.36), HbA1c (r = –0.28), and systolic BP (r = –0.20) (all p < 0.05). Conclusion: Cognitive impairment affects a significant subset of patients with T2DM and is associated with older age, longer disease duration, poor glycemic control, and higher blood pressure. Routine cognitive screening with MMSE may facilitate early identification and intervention to improve diabetes management and quality of life.

Placenta Accreta Spectrum (PAS) is a condition associated with high maternal morbidity and mortality rate with unique challenges in its diagnosis and management. The main complication of PAS is due to its massive obstetric hemorrhage that requires prompt intervention to save the patient’s life. We report here a series of three cases of placenta accrete spectrum managed by subtotal caesarean hysterectomy at our tertiary care hospital within a span of three hours, each operation lasting for around 45 minutes reflecting the importance of a shorter time interval in the intra operative management of PAS

Background:  Primary cardiac lymphoma (PCL) is a rare extranodal lymphoma comprising <2% of all cardiac tumors. Clinical manifestations are nonspecific and often mimic pulmonary embolism (PE) or intracardiac thrombus. We report a rare case of right atrial (RA) diffuse large B-cell lymphoma (DLBCL) initially suspected as a large intracardiac thrombus/clot-in-transit with clinical features resembling PE. Materials and Methods A 69-year-old male presented with progressive dyspnea, presyncope, and tachycardia. Emergency evaluation with ECG, 2D echocardiography, CT pulmonary angiography, venous Doppler, Holter monitoring, and laboratory investigations was performed. The patient underwent right atrial mass excision through midline sternotomy. Postoperative recovery, complications, atrial fibrillation episodes, anticoagulation management, and oncologic referral were documented. All data were prospectively collected from hospital records (Feb–Mar 2025). Results Echocardiography showed a 4×3×5 cm RA mass protruding into the right ventricle (RV) causing tricuspid inflow obstruction with a mean gradient of 9 mmHg. CT angiography revealed a lobular RA lesion suspicious for clot-in-transit vs neoplasm, without pulmonary artery thrombosis. Surgical excision achieved complete removal of the mass. Histopathology confirmed DLBCL (CD20+, BCL6+, Ki-67 ~70%). Postoperatively, the patient developed transient atrial fibrillation managed medically and was discharged in stable condition on antiplatelet and anticoagulation therapy. Conclusion This case highlights that primary cardiac lymphoma may masquerade as pulmonary embolism. Early multimodal imaging, high clinical suspicion, and urgent surgical exploration in obstructive cases are lifesaving. Combined cardiology–cardiac surgery–oncology management is essential for optimal outcomes

Total abdominal hysterectomy is a common gynaecological surgery which is often found to be associated with quite significant blood loss, leading to higher morbidity and requirement of blood transfusion. Tranexamic acid (TXA), which is an antifibrinolytic agent, inhibits fibrin clot breakdown and has shown efficacy in reducing bleeding in other surgical fields. This study was conducted to evaluate its role in hysterectomy. Objective To examine the effectiveness of prophylactic intravenous TXA versus placebo in reducing perioperative blood loss. Methods A prospective randomized controlled trial was conducted on 80 women who had undergone abdominal hysterectomy in entirety for benign indications. The placebo group (n=40) received normal saline, while the TXA group (n=40) received 1 g TXA intravenously 5 minutes before incision. Estimated blood loss, preoperative transformation in haemoglobin levels, requirement of blood transfusion, and adverse effects were recorded.  Results TXA was found to have significantly reduced mean blood loss (113.25 ± 33.92 mL vs 231.50 ± 56.68 mL; p<0.001) and hemoglobin drop (–0.25 ± 0.09 g/dL vs –0.53 ± 0.13 g/dL; p<0.001). Blood transfusion was needed in 7.5% versus 15 % (p=0.479).  Conclusion Prophylactic TXA safely and efficiently reduces perioperative blood loss and haemoglobin decline during total abdominal hysterectomy.

Background: Total abdominal hysterectomy is a common gynaecological surgery which is often found to be associated with quite significant blood loss, leading to higher morbidity and requirement of blood transfusion. Tranexamic acid (TXA), which is an antifibrinolytic agent, inhibits fibrin clot breakdown and has shown efficacy in reducing bleeding in other surgical fields. This study was conducted to evaluate its role in hysterectomy. Objective To examine the effectiveness of prophylactic intravenous TXA versus placebo in reducing perioperative blood loss. Methods A prospective randomized controlled trial was conducted on 80 women who had undergone abdominal hysterectomy in entirety for benign indications. The placebo group (n=40) received normal saline, while the TXA group (n=40) received 1 g TXA intravenously 5 minutes before incision. Estimated blood loss, preoperative transformation in haemoglobin levels, requirement of blood transfusion, and adverse effects were recorded.  Results TXA was found to have significantly reduced mean blood loss (113.25 ± 33.92 mL vs 231.50 ± 56.68 mL; p<0.001) and hemoglobin drop (–0.25 ± 0.09 g/dL vs –0.53 ± 0.13 g/dL; p<0.001). Blood transfusion was needed in 7.5% versus 15 % (p=0.479).  Conclusion Prophylactic TXA safely and efficiently reduces perioperative blood loss and haemoglobin decline during total abdominal hysterectomy

Background: Acne is a common dermatological problem in late adolescence, and its psychosocial impact is often underestimated. Visible lesions can influence self-perception, disrupt body image, and contribute to emotional distress. Understanding how acne severity relates to body-image disturbance and depressive symptoms may help guide early psychological support. Objectives To assess the association between acne severity, body-image disturbance, and depressive symptoms among late adolescents attending an outpatient dermatology service. Methods A cross-sectional observational study was conducted among 100 adolescents aged 16–19 years. Acne severity was graded using a standardized clinical scale. Body-image disturbance was measured with a validated questionnaire, and depressive symptoms were assessed using a recognized depression inventory. Descriptive statistics, ANOVA, and Pearson correlation analysis were used to evaluate relationships between variables. Results The mean age of participants was 18.7 ± 1.2 years, and females represented 56% of the sample. Mild acne was present in 34%, moderate acne in 41%, and severe acne in 25%. Body-image disturbance increased steadily with acne severity, with mean scores of 18.4 ± 4.2 (mild), 24.7 ± 5.1 (moderate), and 31.6 ± 6.4 (severe) (p < 0.001). Depressive symptoms showed a similar gradient, rising from 6.8 ± 3.1 in mild acne to 15.7 ± 5.3 in severe acne (p < 0.001). Correlation analysis revealed significant associations between acne severity and body-image disturbance (r = 0.61), acne severity and depressive symptoms (r = 0.54), and between body-image disturbance and depressive symptoms (r = 0.58), all with p < 0.001. Conclusion Increasing acne severity was strongly linked with heightened body-image concerns and greater depressive symptoms in late adolescents. These findings highlight the need for early psychosocial screening and combined dermatological-psychological support for young individuals with visible or severe acne.

Background: Acute coronary syndrome (ACS) includes unstable angina, NSTEMI, and STEMI, all resulting from reduced myocardial blood flow, commonly due to plaque rupture and thrombosis. Early diagnosis relies heavily on electrocardiography (ECG) and cardiac biomarkers, particularly troponin I. This study assessed the correlation between various ECG changes and troponin I levels in patients presenting with chest pain to the emergency department. Methods: A cross-sectional study was conducted among 200 adult patients (>18 years) presenting with chest pain and specific ECG abnormalities over a 12-month period. ECG findings were categorized into ST-segment elevation, ST-segment depression, T-wave inversion, hyperacute T waves, and bundle branch block. Troponin I was measured using a rapid qualitative immunoassay. Demographic characteristics were analyzed to identify age and sex trends. Results: Of the 200 patients, 134 were male and 66 were female. The majority belonged to the 45–65-year age group (n=106). Troponin I positivity was seen in 76 males (56.7%) and 37 females (56%). Age-wise, troponin positivity was highest in the 45–65-year group (n=66), followed by >65 years (n=33) and <45 years (n=12). ST-segment elevation showed the strongest correlation with troponin I positivity (98%). Troponin positivity was also seen in patients with ST-segment depression (46%), hyperacute T waves (50%), T-wave inversion (33%), and bundle branch block (25%). Conclusion: ST-segment elevation on ECG is highly predictive of troponin I positivity and acute myocardial infarction. Middle-aged males demonstrated the highest burden of ACS. The combined use of ECG interpretation and troponin I testing remains essential for early identification and management of ACS in emergency care.

Quantification DNA from the hepatitis B virus (HBV) is essential for treating persistent HBV infections But because HBV is a DNA virus with a lot of genetic variety, using antiviral medications has led to the emergence of drug-resistant mutations.About 400 million individuals have a chronic infection with the hepatitis B virus, and between 500,000 an 1,200,000 people may away each year from illnesses linked to the virus. The objective of our research was to look at the HBV DNA results in patients who tested positive for HBsAg.ELISA was used to find HBsAg positive in individuals who were suspected of having hepatitis and admitted to our hospital. Real-time PCR was used to analyse HBV DNA. In this regard, a retrospective analysis was conducted to determine the HBV DNA in the serum samples of 128 HBsAg-positive patients who were sent to our laboratory. 102 (79.6%) of the patients had positive HBV DNA. HBV DNA was found to be positive in 29.4% of female patients and 69.6% of male patients. 96% of adult patients and 4% of children in the child age group were positive for HBV DNA. Therefore, in order to monitor the effectiveness of antiviral medication, we recommend that viral replication be shown in HBsAg-positive cases and that the quantity of HBV DNA be determined

Introduction: Self-directed learning (SDL) is a learner-centered approach that fosters autonomy, critical thinking, and lifelong learning—skills essential for medical professionals. While SDL has shown promise in medical education, its effectiveness among first-year MBBS students, who are transitioning from teacher-dependent to self-regulated learning, requires further evaluation. Aim: To evaluate the effectiveness of SDL as a teaching-learning strategy in Biochemistry among first-year MBBS students and to assess perceptions of students and faculty regarding its implementation. Materials & methods: This interventional study was conducted among 175 first-year MBBS students at ACSR Government Medical College, Nellore, from July to September 2023. Two SDL approaches were compared: Session A: SDL-only Session B: Traditional Lecture followed by SDL. For both sessions, pre- and post-tests were administered to assess knowledge gain. Student and faculty perceptions were collected using structured Likert-scale questionnaires via Google Forms. Data were analyzed using paired t-tests, and p < 0.05 was considered statistically significant. Results: Both teaching approaches resulted in significant improvement in post-test scores compared to pre-test values (p < 0.001). The mean post-test score was higher in the Traditional Lecture + SDL group (14.2 ± 2.1) than in the SDL-only group (12.5 ± 2.3), with a statistically significant difference (p = 0.02). Student feedback indicated that SDL improved understanding, motivation, and long-term retention, with most preferring lecture-supported SDL. Faculty agreed that SDL promotes active learning but emphasized the need for structured guidance in early learners. Conclusion: SDL is an effective teaching-learning strategy in Biochemistry for first-year MBBS students. However, combining SDL with a traditional lecture yields superior outcomes compared to SDL alone, particularly for novice learners who benefit from guided scaffolding. A blended approach is recommended to enhance knowledge acquisition, engagement, and the gradual development of self-directed learning skills.

Background:  Post-dated pregnancy, defined as gestation extending beyond 42 completed weeks (294 days), poses significant risks to both maternal and fetal health. Despite advances in obstetric care, post-term pregnancies continue to be associated with increased perinatal morbidity and mortality. This study aimed to evaluate the effects of post-dated pregnancy on maternal and fetal outcomes in a tertiary care setting. Methods A prospective observational study was conducted from June 2023 to July 2024 at the Department of Obstetrics and Gynaecology, Tezpur Medical College and Hospital. A total of 106 pregnant women with gestational age beyond 40 weeks were included. Detailed maternal and fetal assessments were performed, including biophysical profile, non-stress test, and Doppler studies. Maternal outcomes assessed included mode of delivery, induction of labour, and maternal complications. Fetal outcomes evaluated were birth weight, Apgar scores, meconium-stained liquor, neonatal intensive care unit (NICU) admissions, and perinatal mortality. Results The mean gestational age at delivery was 41.2 ± 0.8 weeks. The caesarean section rate was 48.1%, with fetal distress being the most common indication (35.3%). Labour induction was required in 67.9% of cases. Meconium-stained amniotic fluid was observed in 42.5% of deliveries. Macrosomia (birth weight >4000g) occurred in 16.0% of neonates. Low Apgar scores (<7 at 5 minutes) were documented in 13.2% of newborns. NICU admission rate was 28.3%, significantly higher compared to term pregnancies. Maternal complications included postpartum haemorrhage (11.3%), perineal trauma (23.6%), and operative delivery morbidity. Conclusion Post-dated pregnancy is associated with increased maternal and fetal complications. Higher rates of operative delivery, meconium aspiration, macrosomia, and neonatal morbidity were observed. Active management with timely induction of labour and continuous intrapartum monitoring are essential to improve perinatal outcomes in post-term pregnancies

Background: Handgrip strength is increasingly recognized as a practical indicator of overall muscular fitness and a potential marker of cardiovascular well-being. However, its relationship with hemodynamic parameters in healthy adults remains less clearly defined. This study assessed the association between handgrip strength and key cardiovascular measures in an adult population without known comorbidities. Material and Methods: A cross-sectional study was conducted among 117 apparently healthy adults aged 18–60 years. Anthropometric measurements, dominant- and non-dominant-hand grip strength (using a digital dynamometer), and resting cardiovascular parameters—including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate—were recorded under standardized conditions. Pearson correlation coefficients were used to evaluate the relationship between grip strength and cardiovascular variables. Results: The mean age of participants was 32.8 ± 9.4 years, and males comprised 53.0% of the cohort. Dominant-hand grip strength averaged 32.4 ± 8.6 kg, with a maximum recorded value of 33.0 ± 8.9 kg. Mean SBP and DBP were 122.6 ± 11.3 mmHg and 78.9 ± 8.2 mmHg, respectively, while the mean heart rate was 76.4 ± 9.7 beats per minute. Significant inverse correlations were observed between dominant-hand grip strength and SBP (r = –0.26, p = 0.004), DBP (r = –0.18, p = 0.048), and MAP (r = –0.22, p = 0.017). Grip strength also showed a stronger negative correlation with resting heart rate (r = –0.31, p = 0.001). Conclusion: Higher handgrip strength is associated with lower blood pressure indices and reduced resting heart rate in healthy adults, indicating that muscular fitness may reflect favorable cardiovascular status. Handgrip testing may serve as a simple adjunct tool for early cardiovascular risk assessment

Background: Occupation and eating patterns play a vital role in the risk of cardiovascular disease (CVD). Some jobs, especially those characterised by limited physical activity or high stress, can elevate the risk of CVD. Meanwhile, food selections are essential in both the onset and prevention of heart disease. The objective of the study was to find out the relationship between food and occupation with cardiovascular risk. Materials and Methods: This cross-sectional, community-based study was conducted among reproductive-aged women in 25-45 years, with 200 working women and 200 nonworking women. A stratified random sampling technique recruited study participants from different districts of West Bengal. Mann-Whitney U and Kruskal-Wallis H Test were calculated by using SPSS software. P value ≤ 0.05 was considered statistically significant. Results: Positive family history of lifestyle disorders, consumption of processed food, reduced dietary fibers, fruits and vegetables, and increased smoking statistically correlated with type 2 diabetes, angina, hypertension and hyperlipidemia in both the groups, with subtle differences in manifestation. Biochemical parameters correlated well with ECG findings and adverse cardiovascular events in the follow-up period. Conclusions: Major proportion of asymptomatic women between 25 and 45 years of age, inhabiting the southern part of West Bengal, were exposed to cardiovascular risk factors, which might take the shape of overt disease in future, posing a significant public health burden. Findings are significant for policymakers and various stakeholders in implementing measures that effectively reduce the increasing prevalence of coronary heart disease in this age group.

Background: Stable coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide, with percutaneous coronary intervention (PCI) and optimal medical therapy (OMT) constituting the primary management strategies. Despite widespread use of PCI for symptom relief and prevention of adverse cardiac events, its efficacy in reducing mortality and myocardial infarction compared to OMT remains debated. Objectives: This systematic review and meta-analysis aimed to critically evaluate and compare the effectiveness of PCI versus OMT in patients with stable CAD, focusing on all-cause mortality, incidence of myocardial infarction, quality of life, and need for repeat revascularization. Methods: A systematic search of PubMed, Embase, Cochrane Library, and Scopus was conducted for randomized controlled trials and high-quality cohort studies published between 2000 and 2025. Inclusion criteria encompassed adults with stable CAD, comparing PCI and OMT, and reporting at least one of the following outcomes: all-cause mortality, myocardial infarction, quality of life, or repeat revascularization. Risk of bias was assessed using the Cochrane and Newcastle-Ottawa tools. Meta-analytic pooling was performed using random-effects models, with summary effect estimates presented as risk ratios or standardized mean differences. Results: Eighteen studies encompassing over 15,000 patients were included. Meta-analysis demonstrated no statistically significant difference between PCI and OMT for all-cause mortality (RR: 0.97, 95% CI: 0.89–1.06) or overall myocardial infarction (RR: 0.98, 95% CI: 0.87–1.11). PCI was associated with a modest short-term improvement in quality of life (SMD: 0.25, 95% CI: 0.14–0.36) and a lower risk of repeat revascularization (RR: 0.61, 95% CI: 0.47–0.80), though these advantages did not translate into improved long-term survival or MI prevention. Heterogeneity was low to moderate and no significant publication bias was detected. Conclusions: In patients with stable CAD, PCI does not reduce mortality or myocardial infarction compared to OMT but does offer short-term symptomatic relief and lowers repeat revascularization rates. These findings reinforce current guideline recommendations prioritizing comprehensive medical therapy as the foundation of care, reserving PCI primarily for those with refractory symptoms

Introduction: Acute coronary syndrome (ACS) remains a major cause of morbidity and mortality worldwide. Cardiovascular risk factors vary with age, affecting both presentation and prognosis. Identifying these variations is crucial for tailored prevention and management. Aims: To assess the distribution and significance of cardiovascular risk factors in ACS patients across different age groups. Materials & Methods: This hospital-based comparative study included 200 ACS patients admitted to a tertiary care center, divided into Group A (<45 years, n=100) and Group B (>45 years, n=100). After ethical approval and informed consent, patients with ACS were included, while those with rheumatic heart disease, cardiomyopathy, stable angina, liver or kidney disease were excluded. All patients underwent history, clinical examination, ECG, echocardiography, and laboratory evaluation including complete blood count, renal and liver function, lipid profile, Lp(a), ApoA, ApoB, homocysteine, and hsCRP. AMI was diagnosed based on clinical, ECG, echocardiographic, and biomarker criteria. Diabetes, hypertension, smoking, and family history of CAD were defined by standard guidelines. Results: The mean age was 37.0±4.6 years in Group A and 58.0±6.8 years in Group B, with male predominance in both (94% vs 84%). Hypertension (10% vs 39%, p<0.001) and diabetes (10% vs 28%, p=0.001) were significantly higher in older patients, while positive family history was more frequent in younger patients (34% vs 16%, p=0.003). Smoking (58% vs 48%) and obesity (8% vs 13%) were similar. HDL-C and ApoA1 were lower in younger patients; other lipid parameters and biomarkers showed no significant differences. Conclusion: Cardiovascular risk factors in ACS differ with age. Younger patients more often have positive family history and lower HDL-C/ApoA1, whereas older patients have higher hypertension and diabetes prevalence. Age-specific risk assessment is vital for targeted prevention and management

Background:- The purpose of this systematic review was to assess and compare the safety and effectiveness of ERASH and SM in the treatment of hypertrophic obstructive cardiomyopathy, with an emphasis on improvements in the NYHA functional class, changes in the LVOT gradient, and IVST across published clinical studies. Materials and Methods- The authors searched the PubMed, Science Direct, and Cochrane Library databases using both combined Medical Subject Headings (MeSH) terms and non-MeSH terms "Endocardial Radiofrequency Ablation" or "Septal Myectomy" and "Hypertrophia Obstructive Cardiomyopathy" to find the studies from inception to September 10, 2025. Results- Patients were divided into two groups: those who received SM treatment and those who received ERASH treatment. Adults and children with hypertrophic obstructive cardiomyopathy were included in both groups. While ERASH is a minimally invasive catheter-based treatment and SM is a surgical operation, both methods sought to enhance NYHA functional class and lower LVOT gradient. In both the ERASH and septal myectomy groups, the percentage with improved NHYA was 46.7 and 46.4, respectively. Conclusion- According to the results of this comprehensive review, patients with HOCM can improve their functional ability and lower their LVOT gradient with both SM and ERASH. However, especially in adult patients, SM showed a higher decrease in LVOT gradient and septal thickness than ERASH

Background:: Venous leg ulcers are chronic, recurring wounds of the lower limbs caused by venous hypertension and valvular incompetence. They represent a major cause of morbidity and impaired quality of life. Although conservative measures such as compression therapy and wound care promote healing, recurrence is common. Surgical correction of venous reflux may offer better long-term outcomes. This study aimed to compare conservative and surgical management in the treatment of venous leg ulcers with respect to healing rate, ulcer size reduction, and duration of recovery. Aim of the study was to evaluate and compare the efficacy of conservative and surgical management in venous ulcer healing, analyze changes in ulcer size at 1 and 2 months, and assess overall healing at 6 months. Materials and Methods: A prospective comparative study was conducted on 60 patients with venous leg ulcers, divided into two groups of 30 each. Group I (Conservative) received regular wound dressing, compression therapy, and sclerotherapy. Group II (Surgical) underwent ligation and stripping of incompetent veins or subfascial perforator ligation. Parameters such as ulcer size, duration, site, and healing status were recorded at baseline, 1 month, 2 months, and 6 months. Statistical analysis was done using unpaired t-test, Chi-square test, and ANOVA, with p < 0.05 considered significant. Results: The mean age was 58.4 ± 7.43 years in the conservative group and 56.1 ± 5.66 years in the surgical group. The medial malleolus was the most common ulcer site (82%). Mean ulcer size reduction was significantly greater in the surgical group (p < 0.0001). After two months, ulcer size decreased to 12.73 ± 2.85 mm in the surgical group and 27.73 ± 4.72 mm in the conservative group. Complete ulcer healing at six months was achieved in 90% of surgical patients and 63.3% of conservative patients (p = 0.0146). Conclusion: Surgical management provides faster and more complete healing compared to conservative methods. While conservative therapy is effective for symptom control, surgical correction of venous incompetence significantly improves healing outcomes and reduces recurrence, making it the preferred treatment modality

Background: Infraorbital space infections are rare but significant odontogenic infections that often result from the spread of infection from the canine space, commonly due to carious upper anterior teeth. Delayed intervention can lead to orbital and systemic complications. Case Presentation: A 65 -year-old female presented with a 5-day history of right infraorbital swelling, pain, and low-grade fever. Clinical and radiographic examination revealed a carious maxillary canine and lateral incisor with associated canine and infraorbital space infection. Surgical drainage via an intraoral vestibular incision was performed, approximately 5 mL of purulent exudate was evacuated, and the offending teeth were extracted. A corrugated drain was placed for 48 hours, and the patient was prescribed broad-spectrum antibiotics. Results: By the third postoperative day, there was a noticeable decrease in both discomfort and swelling. Within seven days, there was total remission, and a one-month follow-up revealed no signs of recurrence. Conclusion: Prompt recognition and early surgical drainage, combined with elimination of the source of infection and appropriate antibiotic therapy, provide excellent clinical outcomes and prevent complications associated with infraorbital space infections

Background: Atherosclerosis is driven by complex metabolic disturbances, and biomarkers such as serum homocysteine and lipid fractions play a central role in plaque formation and progression. Understanding the interplay between these biochemical parameters and histologically verified vascular disease helps refine risk assessment and clinical interpretation. Objectives: To evaluate serum homocysteine levels and lipid profile alterations in patients with histologically proven atherosclerotic vascular disease and to examine their association with the severity of vascular lesions. Methods: This observational study included 80 patients with biopsy-confirmed atherosclerosis. Demographic information, comorbidities, serum homocysteine concentration, and complete lipid profiles were recorded. Histological severity was categorized as mild–moderate or severe based on standard microscopic criteria. Data were analyzed to determine the distribution of biochemical abnormalities and their relationship with lesion severity. Results: The mean age of the participants was 56.8 ± 9.4 years, and 62.5% were males. Elevated homocysteine was present in 58 patients (72.5%), with higher values noted in the severe lesion group (22.4 ± 5.8 µmol/L) compared with the mild–moderate group (17.2 ± 4.9 µmol/L). Dyslipidemia was identified in 83.7% of the population. Low HDL-C was the most common abnormality (72.5%), followed by raised LDL-C (61.2%) and elevated triglycerides (55.0%). Patients with high homocysteine demonstrated a clustering of lipid abnormalities, particularly elevated LDL-C (84.5%) and triglycerides (75.9%). Severe histological lesions corresponded with more pronounced biochemical alterations. Conclusion: Serum homocysteine elevation and significant dyslipidemia are highly prevalent in patients with histologically proven atherosclerosis. The association between higher homocysteine levels, atherogenic lipid patterns, and severe vascular lesions underscores their value as complementary biochemical indicators in assessing disease burden

Background: Anemia is a common and clinically significant complication of chronic kidney disease (CKD), particularly in stages 3-5, where progressive renal impairment leads to reduced erythropoietin production, iron dysregulation, and chronic inflammation. Understanding anemia patterns and iron profile alterations is essential for effective management. Aim: To evaluate anemia patterns and iron indices among patients with CKD stages 3-5. Methods: A hospital-based cross-sectional study was conducted among 120 adults diagnosed with CKD stages 3-5. Detailed demographic, clinical, and laboratory data were collected. Hemoglobin levels, anemia prevalence, anemia morphologic types, and iron indices (serum iron, ferritin, TSAT, TIBC) were assessed. Statistical analyses included chi-square tests, t-tests, ANOVA, and correlation coefficients, with p < 0.05 considered significant. Results: The mean age of the study population was 56.7 ± 11.3 years, with 59.2% males. Anemia prevalence was 78.3%, increasing significantly with CKD stage (68.4% in stage 3, 80.5% in stage 4, 85.4% in stage 5; p = 0.041). Normocytic normochromic anemia was the most common type (55.3%), followed by microcytic hypochromic (22.3%) and mixed-pattern anemia (12.8%). Anemic patients had significantly lower serum iron (42.8 ± 15.7 µg/dL) and TSAT (18.7 ± 7.3%) than non-anemic patients (p < 0.001). Ferritin was lower in anemic individuals but remained elevated overall, suggesting combined absolute and functional iron deficiency. Hemoglobin showed a significant positive correlation with eGFR (r = +0.41, p < 0.001) and TSAT (r = +0.36, p < 0.001). Age ≥60 years was associated with significantly lower hemoglobin levels (p = 0.023). Conclusion: Anemia is highly prevalent in CKD stages 3-5 and becomes more severe as renal function declines. Normocytic normochromic anemia predominates, but a substantial proportion of patients exhibit iron-deficiency patterns. The significant alterations in iron indices highlight the importance of early detection, regular monitoring, and individualized management of anemia in CKD patients

Background: Delayed gastric emptying is a known complication in diabetic patients due to autonomic neuropathy, which may predispose them to an increased risk of aspiration during anesthesia induction. Ultrasonographic evaluation of gastric volume is a reliable, non-invasive method to assess gastric contents preoperatively. Methods: A prospective observational study was conducted on 100 patients (50 diabetics and 50 non-diabetics) individuals scheduled for elective surgeries. After confirming 8 hours of fasting, gastric antrum was sonographically (USG) scanned in both supine and right lateral decubitus (RLD) positions using a low frequency curved array probe. Qualitative and quantitative analysis of gastric contents were performed. The gastric antral cross-sectional area (CSA) and gastric volume (GV) were measured. Gastric antral grading was done based on sonographic appearance as empty antrum in both supine and RLD positions, empty antrum in supine and fluid detected in RLD position, fluid detected in both RLD and supine positions, which were designated as grade 0,1 and 2 respectively. Results: On qualitative assessment, 13 and 37 diabetic patients demonstrated grade 0 and grade 1 antral findings respectively. In contrast, among non-diabetic patients, 23 and 27 showed grade 0 and grade 1 antral grades respectively. No patients in either group showed grade 2 antrum findings. The mean gastric antral CSA in diabetics and non-diabetics were 5.13 + 1.31 cm2 and 3.92 + 1.12 cm2 respectively (p-value < 0.001). The mean GV in diabetics and non-diabetics were 37.30 + 16.43 ml and 32.63 + 14.60 ml respectively (p-value - 0.137). The mean GV/kg in diabetics and non-diabetics were 0.64 + 0.27 ml / kg and 0.60 + 0.26 ml / kg respectively (p-value - 0.374). Conclusion: After 8 hours of overnight fasting, despite of gastric volume being higher in diabetic group than in non-diabetics, the difference was statistically insignificant. None of the patients in either group were found to have unsafe gastric volume (> 1.5ml/kg). Hence, we conclude that standard 8 hours of preoperative fasting is adequate to ensure safe gastric volume.

Background: to compare block characteristics and postoperative analgesia between Bupivacaine – Clonidine, Bupivacaine – Fentanyl and Plain Bupivacaine in subarachnoid block.  Methods: This study was carried out in Department of Anesthesiology and Critical Care, F.H. Medical College and Hospital, Agra, U.P. A total of ninety patients fulfilling the inclusion criteria and not having any of the exclusion criteria were included in the study. The eligible patients were randomly allocated into 3 groups according to local anesthetic and adjuvant used for spinal anesthesia. Result: Onset of sensory blockade was significantly longer in Group C (4.12 ± 1.40 min) in comparison to Group A and Group B (3.97 ± 1.22 and 3.72 ± 1.23 min) respectively. Duration of sensory blockade was prolonged in Group B (139.92 ± 26.19 min) in comparison to Group A and Group C (129.85 ± 31.22 and 130.39 ± 24.73 min) respectively. The Motor Onset time was slightly delayed in Group C (5.08 ± 1.05 min) compared to Group A (4.96 ± 1.29 min) and Group B (4.83 ± 1.21 min). The Motor Duration was longest in the Group B (124.61 ± 22.80 min), followed by Group A (123.50 ± 24.91 min), and was slightly shorter in the Group C (118.76 ± 26.20 min). Conclusion: We can conclude the following statements from our study that Addition of Fentanyl to bupivacaine provides early onset and prolonged duration of sensory and motor block.

Background: An alternate location to the IJV and subclavian vein is the axillary vein, which is a readily accessible channel that can be utilised for ultrasound-guided central vascular access. The purpose of this study is to evaluate the feasibility and safety of placing a central venous catheter using a transspectral technique for the right axillary vein under ultrasound guidance. Methods: This prospective randomised interventional trial involved the enrolment of 58 patients following permission by the institutional ethics committee. After meeting the inclusion criteria, they were randomised to either in-plane (group 2, n = 29) or out-of-plane (group 1, n = 29). Using ultrasound guidance, all of the CVCs were placed into the right axillary vein. The demographics of both groups were similar in terms of age, height, weight, and BMI. Right axillary vein cannulation was performed on patients randomly assigned to group 1 using ultrasonic out-of-plane imaging, with a linear transducer held perpendicular to the vessel's long axis. The deltoid-pectoral sulcus was selected as the laterally located puncture site. Right axillary vein cannulation was performed on patients randomly assigned to group-2 using ultrasonic in-plane imaging, with a linear transducer maintained parallel to the vessel's long axis. Using an in-plane approach on the longitudinal axis, the needle was moved gently and in real time towards the vein lumen. Appropriate statistical tests were used to compare the variable distribution. Results: The Statistical Package for Social Sciences (SPSS, IBM, Bangalore) version 22.0 was used to analyse the data once it had been imported into Microsoft Office Excel. Comparing the out-of-plane approach to the in-plane technique, the first attempt at successful cannulation is higher (P-value 0.0001). There were far fewer attempts to enter the vein in group 1. Using an out-of-plane approach reduced the cannulation time. There were statistically negligible numbers of problems, needle redirections, and procedure discontinuation. Conclusions: Right axillary vein cannulation using out-of-plane ultrasound imaging is better in terms of fewer tries and is linked to a higher rate of successful cannulation on the first try.

Background: Proximal tibia extra-articular fractures are challenging injuries due to their complex anatomy and risk of complications. Surgical management primarily includes intramedullary nailing (IMN) and locking compression plate (LCP) fixation. Comparative evaluation of these methods in terms of functional outcomes, fracture healing, and complications is essential to guide optimal treatment. Aim: To compare the clinical and functional outcomes of intramedullary nailing versus locking compression plate in the management of proximal tibia extra-articular fractures. Methods: A prospective study was conducted over a period of 9 months at Government Medical College, Kathua. Forty patients with proximal tibia extra-articular fractures were enrolled and divided into two groups of 20 each. Group A underwent intramedullary nailing, while Group B underwent locking compression plate fixation. Patients were evaluated for operative time, intraoperative blood loss, time to radiological union, functional outcome using the Lysholm knee scoring system, and complications. Data were analyzed using standard statistical methods. Results: The mean age of patients was 38.5 ± 11.2 years, with a male predominance (70%). The mean operative time was 65 ± 12 minutes in the IMN group and 95 ± 15 minutes in the LCP group. Mean intraoperative blood loss was significantly lower in the IMN group (120 ± 25 mL) compared to the LCP group (250 ± 30 mL). Radiological union was achieved at a mean of 16 ± 3 weeks in the IMN group and 18 ± 4 weeks in the LCP group. Functional outcome as per Lysholm score at 6 months was superior in the IMN group (mean score 88 ± 6) compared to the LCP group (mean score 82 ± 7). Complications included superficial infection in 2 patients in the LCP group and delayed union in 1 patient in the IMN group. Conclusion: Both intramedullary nailing and locking compression plate are effective modalities for proximal tibia extra-articular fractures. IMN offers advantages of shorter operative time, less blood loss, earlier union, and slightly better functional outcomes. LCP remains a reliable alternative in cases with complex fracture patterns or where IMN is technically challenging

Background: Homocysteine metabolism is closely linked to Vitamin B12 and folate status, and disturbances in this pathway are recognized contributors to vascular pathology. Elevated homocysteine levels have been increasingly associated with ischemic stroke, particularly in individuals presenting for the first time. Understanding these biochemical patterns at initial presentation may aid in targeted prevention and secondary risk reduction. Aim: To assess serum homocysteine, Vitamin B12, and folate levels in patients with first-episode ischemic stroke and determine the prevalence of metabolic derangements. Materials and Methods: This observational study included 50 adult patients diagnosed with first-episode ischemic stroke based on clinical assessment and neuroimaging. Demographic details and clinical risk factors were recorded. Fasting blood samples were analyzed for serum homocysteine, Vitamin B12, and folate levels. Standard laboratory cut-off values were used to categorize abnormalities. Data were summarized using descriptive statistics. Results: The mean age of the participants was 58.4 ± 9.6 years, with males constituting 62%. Hypertension (56%) and Type 2 diabetes mellitus (42%) were commonly observed clinical risk factors. The mean serum homocysteine level was 19.8 ± 6.7 µmol/L, and elevated homocysteine (>15 µmol/L) was detected in 64% of subjects. Vitamin B12 deficiency was present in 56% of patients, while low folate levels were found in 36%. A noticeable proportion of patients with hyperhomocysteinemia also had concomitant Vitamin B12 or folate deficiency. Conclusion: A significant number of patients with first-episode ischemic stroke exhibited elevated homocysteine levels alongside reduced Vitamin B12 and folate status. These findings highlight the importance of routinely evaluating and correcting these metabolic parameters in acute stroke care as part of comprehensive vascular risk management

Glucose serves as fuel for metabolism and is central to producing energy for all organisms, even the most simplistic, and for humans. Its rapid conversion to ATP allows glucose to be the primary energy source for the brain, the renal medulla, the retina, and red blood cells, which are all tissues that depend on glucose. In adults, the obligatory glucose requirement is around 130–150 grams daily. For those whose work requires significant physical or mental exertion, this requirement increases to 200–250 grams. In the case of insulin-deficiency state carbohydrate restriction could be dangerous. Stabilizing carb intake helps avoid diabetes ketoacidosis or DKA, which can happen as a result of enhanced lipolysis and lack of control over ketone body formation. Carbohydrate restriction is a faulty strategy that poses risks, not benefits. Metabolic control and protection against DKA are optimal with physiologically balanced meals, ensuring adequate hydrative intake and personalized insulin. Glucose is necessary, not as a biochemical fuel, but as a central part of safe and effective diabetes control.

Background: Right ventricular dysfunction (RVD) is an under-recognized determinant of outcomes in acute ST-elevation myocardial infarction (STEMI). While left ventricular ejection fraction (LVEF) remains the standard prognostic marker, accumulating evidence highlights the independent clinical significance of right ventricular (RV) impairment. This study evaluated RV function across anterior wall MI (AWMI), inferior wall MI (IWMI), and inferior wall MI with RV involvement (IWMI+RVMI) using echocardiographic indices, and correlated these with in-hospital outcomes. Methods: This prospective observational study enrolled 120 consecutive patients with first-episode STEMI admitted to the Department of Cardiology, S.C.B. Medical College & Hospital, Cuttack, between October 2022 and September 2023. Echocardiographic assessment within 48 hours included tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), myocardial performance index (MPI), and tricuspid annular systolic velocity (S′). Patients were followed for 7 days for complications including arrhythmias, heart failure (HF), cardiogenic shock, and conduction disturbances. Results: Of 120 patients, 62 had AWMI (51.7%), 38 had IWMI (31.7%), and 20 had IWMI+RVMI (16.6%). Mean age was 59.6 ± 11.8 years, with male predominance (71.7%). At least one abnormal RV parameter was observed in 55% of AWMI, 50% of IWMI, and all (100%) IWMI+RVMI cases. Multiparametric dysfunction (all four indices abnormal) was most frequent in IWMI+RVMI (30%). TAPSE (mm) progressively declined from AWMI (20.9) to IWMI (18.9) to IWMI+RVMI (15.8) (p<0.001). FAC (%) followed a similar trend (40.1, 34.8, 24.5; p<0.001). LVEF was lowest in AWMI (41.3%) compared to IWMI (55.2%) and IWMI+RVMI (53.6%) (p<0.001). In-hospital complications included HF (10%), arrhythmias (8%), cardiogenic shock (4%), and mechanical complications (2%). Patients with abnormal RV indices had significantly higher complication rates (p<0.05). Conclusion: RV dysfunction is frequent in STEMI, extending beyond classical RV infarction. TAPSE and FAC were the most sensitive parameters for detecting RV impairment, while AWMI patients demonstrated predominant LV dysfunction. Abnormal RV indices strongly correlated with adverse in-hospital outcomes, underscoring the need for routine RV functional assessment in STEMI management protocols.

Background: Inflammation and thrombosis underlie acute coronary syndromes (ACS). Hematological indices derived from routine complete blood counts (CBC)—including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR)—may offer low-cost prognostic value, particularly in resource-limited settings. Objectives: To evaluate whether admission NLR, PLR, platelet indices (MPV, PDW, PCT), and coagulation markers (PT, aPTT) predict in-hospital mortality and morbidity among patients with ACS. Methods: We performed a hospital-based longitudinal study at S.C.B. Medical College & Hospital, Cuttack, India (1 September 2022–31 August 2023). Consecutive adults with ACS (STEMI, NSTEMI, or unstable angina) were enrolled (N=516). Exclusions included immediate pre-hospital/ED cardiac arrest and chronic inflammatory, malignant, renal, hepatic disease, or pregnancy. Admission CBC-derived indices (NLR, PLR, MPV, PDW, PCT) and PT/aPTT were measured. Outcomes were in-hospital mortality and major adverse events: ventricular tachyarrhythmia, cardiogenic shock, left ventricular failure (LVF), and prolonged hospitalization (>5 days). Associations were tested using t-tests/χ², univariate and multivariable logistic regression, and ROC analysis. Results: Cohort mean age was 60.6±12.3 years; 64.1% were male; STEMI comprised 53.3%. Mortality was 5.8% (30/516). Morbidity included cardiogenic shock 20.9%, LVF 10.9%, ventricular tachyarrhythmia 3.5%, and prolonged hospitalization 10.9%. On multivariable analysis, NLR independently predicted all outcomes—mortality (adjusted OR 1.130 per unit; 95% CI 1.044–1.223), ventricular tachyarrhythmia (1.221; 1.097–1.359), cardiogenic shock (1.150; 1.071–1.234), LVF (1.104; 1.032–1.181), and prolonged hospitalization (1.224; 1.140–1.314). PLR independently predicted mortality (1.003; 1.001–1.006), cardiogenic shock (1.006; 1.003–1.009), and LVF (1.003; 1.001–1.006). MPV, PDW, and PCT were not independent predictors. PT prolongation was strongly associated with mortality. Discrimination was highest for NLR: AUC 0.909 for mortality (cut-off 9.38; sensitivity 87.5%, specificity 88.8%), with robust AUCs for other morbidities (≥0.774). PLR showed good but consistently lower performance (mortality AUC 0.862 at cut-off 201). Conclusions: Admission NLR—and to a lesser degree PLR—provides powerful, inexpensive prognostic information for in-hospital mortality and complications in ACS, outperforming platelet volume indices. PT adds complementary risk signal for mortality. Incorporating NLR/PLR into routine assessment and existing risk models may enhance early stratification, especially where advanced biomarkers are inaccessible

Background: Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal morbidity and mortality. Alterations in lipid metabolism have been implicated in their pathogenesis through endothelial dysfunction and oxidative stress. This study evaluated and compared serum lipid profiles in hypertensive and normotensive pregnant women and correlated them with maternal and fetal outcomes. Objectives: To evaluate serum lipid profiles in hypertensive and normotensive pregnant women. To compare lipid parameters between both groups. To correlate abnormal lipid levels with maternal and fetal outcomes. Methods: A comparative prospective study was conducted among 100 pregnant women (50 hypertensive and 50 normotensive) attending the Department of Obstetrics and Gynaecology at a tertiary care hospital. Fasting venous blood samples were analyzed for total cholesterol, triglycerides, HDL-C, LDL-C, VLDL-C, and non-HDL-C using enzymatic methods. Maternal and neonatal outcomes were recorded. Statistical analysis included Welch’s t-test, chi-square test, relative risk, and 95% confidence intervals, with p < 0.05 considered significant. Results: Hypertensive women showed significantly higher mean values of total cholesterol (224.7 ± 32.9 mg/dL), triglycerides (204.3 ± 41.8 mg/dL), LDL-C (139.8 ± 27.6 mg/dL), and non-HDL-C (183.0 ± 31.8 mg/dL) and lower HDL-C (41.7 ± 6.9 mg/dL) compared with normotensive women (p < 0.001). Adverse neonatal outcomes such as preterm birth, low birth weight, and IUGR were more frequent among those with abnormal lipid levels. Elevated TC/HDL ratio (≥4.5) conferred the highest risk (RR = 3.02; p = 0.0007). Conclusion: Dyslipidemia is significantly associated with hypertensive disorders of pregnancy and adverse perinatal outcomes. Early lipid screening and targeted management may aid in reducing maternal and neonatal complications.

Background: Post-dated pregnancy, defined as gestation extending beyond 40 weeks, is associated with an increased risk of maternal and perinatal morbidity. The optimal management of such pregnancies—whether to await spontaneous onset or to induce labour—remains a critical obstetric consideration. Aim: To compare the maternal and fetal outcomes between spontaneous and induced labour among post-dated pregnancies. Methods: This prospective interventional study included 100 women with post-dated singleton pregnancies admitted to the Department of Obstetrics and Gynaecology at a tertiary care centre. Participants were divided into two groups: Group I (spontaneous onset of labour, n=50) and Group II (induced labour, n=50). Induction was performed using prostaglandin E₂ gel followed by oxytocin as needed. Maternal outcomes such as mode and duration of delivery, perineal injuries, and postpartum haemorrhage were compared. Fetal outcomes assessed included Apgar scores, meconium aspiration, NICU admissions, and perinatal mortality. Statistical analysis was performed using SPSS version 20.0, with p<0.05 considered significant. Results: Cesarean section rates were significantly higher in the induced group (50%) than in the spontaneous group (16%) (p<0.001). Vaginal delivery was more common in spontaneous labour (70% vs 42%; p=0.003). The mean duration of labour was longer in induced cases (10.48 ± 3.50 h vs 8.72 ± 3.81 h; p=0.018). Maternal complications and neonatal outcomes, including Apgar <7 at 5 minutes (12% vs 10%), meconium aspiration (10% each), and NICU admission (12% vs 10%), did not differ significantly between groups. Conclusion: Induction of labour in post-dated pregnancies is associated with an increased cesarean delivery rate and prolonged labour duration but does not adversely impact maternal or fetal outcomes when managed appropriately. Vigilant monitoring and individualized decision-making are essential for optimizing perinatal results

Background: It is vital to assess, report, record, and document the rate of stillbirths in India for accurate estimation of the concern. Also, for decrease in preventable stillbirths, it is needed to determine its etiology. However, existing literature data is scarce in Indian context. Aim: The present study was aimed to identify the risk factors and causes of stillbirths utilizing the histopathology of placenta in females delivering at Indian healthcare centers and to classify the cause of fetal death using Causes of Death and Associated Conditions (CODAC) simplified classification. Methods: The study assessed the cases of stillbirths at the Institute within the defined study period. In all the cases, clinical data were gathered for mothers and stillbirths were recorded on preformed structured proforma. At birth, heart blood or cord blood along with wedge of placenta were taken and assessed for bacterial culture. Remnant placenta was assessed histopathologically. Reports and data were collected and assessed to determine the cause of death and classified using CODAC simplified classification. Results: The study results showed that the rate of stillbirth in the present study was 26.2 per 1000 total birth. The most common cause of stillbirths in the study subjects was placental factors seen in 51.7% (n=88) mothers followed by maternal factors as recorded in 28.2% (n=48) mothers. Among placental factors, common causes were placental insufficiency, placental abruptions, and placental infarction in 5.9% (n=10), 17.6% (n=30), and 28.2% (n=48) subjects. The most common maternal cause of stillbirths was hypertensive disorders as seen in 22.4% (n=38) subjects.   Conclusion: The present study concludes that classification of stillbirths using CODAC classification depicts vital role of placenta in stillbirths directly as reason for stillbirth or was related indirectly to placental causes as hypertension. Histopathology of placenta identified placenta factors as reason for death in subjects when no other apparent clinical reasons can be assigned and can be classified as unknown when not present.

Background: The oral mucosa often reflects a person overall health. The oral cavity often exhibits notable signs of systemic disease, highlighting the crucial role of oral examination in diagnosing and managing dermatological conditions." Aims and Objectives: To examine the epidemiological and clinical profiles of oral mucosal lesions in patients with diseases attending the DVL outpatient department Materials and Methods: This hospital-based observational study enrolled patients who met specific inclusion and exclusion criteria. Comprehensive data collection involved detailed histories, thorough clinical examinations, and photographic documentation, followed by data analysis, tabulation, and interpretation of results. Results: Out of 160 cases, Age group of 18-80 years were included and most common age group were 31-50 years. Males were more common than in Females in Gender distribution. Erosions and Pigmentation were the most common clinical presentations of oral dermatoses. Oral Lichen Planus was the most common oral dermatological condition observed in this study

Dementia imposes profound cognitive, emotional, and physical burdens on affected individuals and their caregivers, particularly as global and Indian populations age. Informal caregivers in urban India often lack access to formal training, increasing the risk of inadequate patient support and high caregiver stress. This study was designed to evaluate the effectiveness of a photobook intervention aimed at enhancing dementia caregiving skills and knowledge among caregivers in Gurugram.A quasi-experimental, non-randomized study was conducted with 60 informal dementia caregivers, divided equally into experimental (photobook intervention) and control (no intervention) groups. Socio-demographic data were collected, and caregiver knowledge was measured using a structured questionnaire before and after a two-week intervention period. Statistical analysis included paired t-tests and chi-square tests to determine changes in knowledge and any demographic associations. The experimental group demonstrated a significant improvement in post-intervention knowledge scores compared to the control group (p<0.001). Prior to the intervention, the majority of caregivers exhibited inadequate knowledge regardless of group. After using the photobook, experimental participants showed a pronounced shift towards moderate and adequate knowledge categories, as illustrated by graphical analysis. No significant knowledge improvement was observed in the control group, and demographic variables such as age and gender were not significantly associated with score changes.Photobook interventions proved highly effective in broadening caregivers’ understanding and capability in key dementia care activities. These findings support previous research on the value of visual and structured educational resources for both professional and informal caregivers. The study highlights the importance of integrating accessible educational tools into community-based caregiver programs but notes limitations related to sample size and geographic focus

Background:  Anaemia is a frequent hematological abnormality observed in patients with hypothyroidism, attributed to reduced thyroid hormone–mediated erythropoietin production, impaired iron metabolism, and bone marrow suppression. This study aimed to assess the prevalence, types, and clinical correlation of anaemia among hypothyroid patients and to evaluate the relationship between thyroid hormone levels and hematological indices. Methods: A cross-sectional study was conducted on 100 clinically and biochemically confirmed hypothyroid patients attending a tertiary care hospital. Detailed clinical history, thyroid profile (TSH, FT4, FT3), and complete blood count (Hb, RBC indices) were analyzed. Anaemia was classified based on WHO criteria and red-cell indices. Statistical analysis included t-test, ANOVA, Chi-square, and Pearson’s correlation using SPSS version 25.0, with p < 0.05 considered significant. Results: Out of 100 patients, 78% were female and 62% had overt hypothyroidism. Anaemia was present in 58% of cases, with normocytic normochromic anaemia being the most common (44.8%), followed by microcytic (34.5%) and macrocytic (20.7%) types. Anaemic patients had significantly higher TSH (18.94 ± 7.12 µIU/mL) and lower FT4 (0.68 ± 0.21 ng/dL) and FT3 (2.31 ± 0.51 pg/mL) compared to non-anaemic patients (p < 0.001). TSH showed a negative correlation with haemoglobin (r = –0.412), while FT4 and FT3 showed positive correlations (r = +0.438 and +0.406, respectively). Conclusion: Anaemia is highly prevalent in hypothyroidism, especially in overt disease, with normocytic normochromic anaemia being most frequent. The severity of anaemia correlates inversely with thyroid hormone levels, emphasizing the need for routine hematological assessment in hypothyroid patients for early detection and management

Background: Head and neck positioning is critical for optimizing laryngeal exposure and facilitating safe, efficient endotracheal intubation. The sniffing position (SP) has been the conventional standard, yet recent investigations highlight that modest modifications to head elevation may significantly influence glottic visualization. This study evaluates three head elevations—0 cm (no pillow), 3 cm, and 6 cm—assessing their effects on Cormack–Lehane (CL) grade, Percentage of Glottic Opening (POGO), and Intubation Difficulty Scale (IDS). Methods: In this prospective randomized analytical study conducted between May 2023 and November 2024, 159 adult patients (ASA I–II) undergoing elective surgery were evaluated. Each patient underwent laryngoscopic assessment in all three positions; the best glottic view was chosen for intubation. CL grade and POGO scores were recorded for each position (n=159 per position). IDS and intubation-related outcomes were analyzed in patient groups where a given pillow height provided the best view and was used for intubation (n=21 for 0 cm, n=110 for 3 cm, n=28 for 6 cm). Statistical significance was set at p<0.05. Results: The 3 cm pillow position provided superior glottic visualization—CL grades 1–2 were observed in 94.3% of 3 cm assessments compared to 56.6% (0 cm) and 48.4% (6 cm) (p<0.001). POGO distribution favored 3 cm: high POGO (100%) observed in 47.2% vs. 12.6% (0 cm) and 11.9% (6 cm) (p<0.001). IDS outcomes in intubation groups showed easier intubation at 3 cm (67.3% classified as 'easy') compared to 0 cm (57.1%) and 6 cm (57.1%) (p<0.001). Mucosal trauma and postoperative complications were also lowest in the 3 cm intubation cohort. Conclusion: Moderate head elevation (3 cm) optimizes airway alignment, enhances laryngeal exposure, reduces intubation difficulty, and lowers mucosal injury—supporting its routine consideration as a refined modification of the sniffing position in elective cases

Background: With changing lifestyle patterns, obesity is increasingly being seen even among young adults who are otherwise presumed to be healthy. Medical students, despite their health literacy, often experience irregular routines and stress-related habits that quietly affect their cardiovascular system. This study set out to explore how excess body weight might be linked to early changes in heart rate regulation and blood pressure among first-year MBBS students in South India. Objective: To examine the association between obesity and resting cardiovascular parameters, specifically heart rate, blood pressure, and short-term heart rate variability (RMSSD), as indicators of autonomic modulation in young adults. Methods: Over eight months (September 2024 to April 2025), 100 undergraduate medical students were recruited at Dhanalakshmi Srinivasan Medical College, Perambalur. Participants were grouped using Asia-Pacific BMI guidelines into normal weight (18.5–22.9 kg/m², n = 50) and obese (≥25 kg/m², n = 50) categories. Resting heart rate and blood pressure readings were obtained under standardized morning conditions. Autonomic function was assessed noninvasively through RMSSD derived from lead II ECG. Statistical comparisons between groups were made using unpaired t-tests, and associations were explored through Pearson correlation. Findings: Students in the obese category showed a consistently higher mean heart rate (83.87 ± 4.67 bpm), elevated systolic (129.69 ± 8.12 mmHg) and diastolic blood pressure (85.91 ± 6.55 mmHg), and reduced parasympathetic tone (RMSSD: 25.16 ± 3.87 ms) when compared to their normal-BMI counterparts (heart rate: 72.09 ± 4.37 bpm; SBP: 118.59 ± 6.26 mmHg; DBP: 74.89 ± 5.40 mmHg; RMSSD: 41.09 ± 5.91 ms). All differences were statistically significant (p < 0.001). Conclusion: The findings highlight an early pattern of autonomic imbalance in obese young adults, suggesting increased cardiovascular strain even in the absence of clinical disease. These subtle shifts, detectable through noninvasive screening, underscore the need for proactive monitoring and health counseling tailored to medical students’ unique academic pressures.

Background: Incidental adrenal masses are a common clinical finding, present in 4-6% of abdominal imaging studies. While most are benign adenomas, differentiation from malignant or hyper-functioning lesions is critical for patient management. Computed Tomography (CT) is the primary imaging modality, but lipid-poor adenomas can mimic aggressive pathologies, necessitating advanced quantitative techniques like contrast washout analysis. This study aimed to validate the diagnostic performance of a dedicated tri-phasic CT protocol in a clinically diverse patient population.  Materials and Methods: An observational, hospital-based study was conducted on 42 consecutive patients with adrenal masses. All patients underwent a tri-phasic adrenal CT protocol (unenhanced, 65 to 70-second portal venous, and 15-minute delayed phases). Quantitative analysis included unenhanced attenuation in Hounsfield Units (HU) and calculation of Absolute and Relative Percentage Washout (APW and RPW, respectively). Radiological diagnoses were correlated with the histopathological gold standard in 34 cases.  Results: The study cohort (N=42) had a mean age of 48.2 years and a slight female predominance (52.4%). A significant portion of lesions were large (42.9% >4 cm), indicating a high-risk population. The CT protocol demonstrated a sensitivity of 94.0%, specificity of 100.0%, a positive predictive value (PPV) of 100.0%, and an overall accuracy of 94.12% in differentiating benign from malignant or other non-adenoma lesions (p<0.01). Histopathology confirmed a complex case mix, with pheochromocytoma (21.4%) and adrenocortical carcinoma (7.1%) being prominent diagnoses alongside adrenal cortical adenomas (26.2%).  Conclusion: A strictly implemented tri-phasic quantitative CT protocol demonstrates exceptionally high specificity and positive predictive value, establishing it as a robust and reliable tool for the non-invasive characterization of adrenal masses. Its stellar performance, particularly in a high-risk cohort, validates its role as a critical gatekeeper in the clinical algorithm. This high-fidelity imaging serves as an indispensable bridge, confidently triaging patients toward appropriate surveillance, further investigation, or immediate, specialized management pathways, including definitive guidance for complex interventional radiology procedures.

Background: Residual neuromuscular blockade can delay the recovery in paediatric patients and lead to postoperative complications. Both neostigmine & sugammadex are commonly used for reversing the neuromuscular blockade; however, onset, mechanism of action and recovery profile is significantly different. It is important to compare their efficacy in paediatric tonsillectomy to facilitate faster and safer recovery with minimal postoperative complications. Aims And Objective:  To evaluate the effectiveness of sugammadex versus neostigmine in paediatric adenotonsillectomy by comparing extubation time and postoperative complications such as hypotension, hypertension, bradycardia, anaphylactic reaction, vomiting & nausea in order to evaluate overall recovery and haemodynamic stability between the two groups. Methods:  This prospective, randomized study enrolled 128 paediatric patients (ASA grade I–II, aged 3–17 years) scheduled for adenotonsillectomy. Participants were randomly allotted into two different groups: Group S received sugammadex 2 mg/kg, while Group N received neostigmine 0.05–0.09 mg/kg combined with glycopyrrolate 0.008–0.15 mg/kg. General anaesthesia was standardized using propofol, fentanyl, and vecuronium. Recovery indices, extubation time, and postoperative clinical parameters were carefully recorded and compared.  Results:  A total of 128 paediatric patients were included in the study, with no significant differences in demographic characteristics between the two groups (p > 0.05). The mean extubation time was significantly shorter in the sugammadex group (2.6 ± 0.7 min) compared to the neostigmine group (7.0 ± 1.8 min; p < 0.001) Hemodynamic parameters remained stable in both groups; however, postoperative stability was better in the sugammadex group (p < 0.05).  Postoperative nausea and vomiting were reported only in the neostigmine group (40.6% and 12.5%; p < 0.001, p = 0.003). Overall, sugammadex achieved faster recovery and a lower incidence of adverse effects than neostigmine. Conclusion:  Compared to neostigmine, sugammadex is more effective in reversing vecuronium induced neuro muscular blockade. Sugammadex provides shorter extubation time with higher safety profile and less post operative complications. The incidence of PONV is very less with sugammadex as compared to neostigmine.

Background: Veno-lymphatic malformations in head and neck region pose significant clinical challenges, due to high morbidity and recurrences associated with traditional surgical management. Bleomycin sclerotherapy has emerged as a first-line treatment modality for such lesions. Methods: This retrospective observational study was conducted in the division of interventional radiology at a tertiary care hospital where twenty patients with slow-flow vascular and lymphatic malformations in the head and neck region who underwent bleomycin sclerotherapy were included. Primary outcome measures included lesion size reduction and treatment response rates. Secondary outcomes encompassed patient satisfaction, complication rates and safety profile.  Results: The study cohort comprised 20 patients with a mean age of 18.5 years, with 65% being female. The facial region was most commonly affected (35%), followed by periorbital region (20%), oral cavity (15%), scalp (15%) and salivary glands (15%). Patients received a mean of 2.9 treatment cycles. Overall response (≥25% reduction) was achieved in 95% of patients, with substantial response (≥50% reduction) in 50%. Three treatment cycles demonstrated optimal efficacy with 100% achieving ≥50% reduction, while two cycles showed 100% patient satisfaction. Complications occurred in 40% of patients, all classified as minor, like swelling (20%) and hyperpigmentation (10%). Statistical analysis revealed highly significant associations between cycle number and size reduction (p<0.001) and patient satisfaction (p=0.034).Conclusions: Bleomycin sclerotherapy is a highly effective and safe first-line treatment for head and neck veno-lymphatic malformations. The study identifies 2-3 treatment cycles as optimal for balancing efficacy, safety, and patient satisfaction, providing valuable guidance for clinical practice and treatment protocols.

Background: Head and neck positioning is critical for optimizing laryngeal exposure and facilitating safe, efficient endotracheal intubation. The sniffing position (SP) has been the conventional standard, yet recent investigations highlight that modest modifications to head elevation may significantly influence glottic visualization. This study evaluates three head elevations—0 cm (no pillow), 3 cm, and 6 cm—assessing their effects on Cormack–Lehane (CL) grade, Percentage of Glottic Opening (POGO), and Intubation Difficulty Scale (IDS). Methods: In this prospective randomized analytical study conducted between May 2023 and November 2024, 159 adult patients (ASA I–II) undergoing elective surgery were evaluated. Each patient underwent laryngoscopic assessment in all three positions; the best glottic view was chosen for intubation. CL grade and POGO scores were recorded for each position (n=159 per position). IDS and intubation-related outcomes were analyzed in patient groups where a given pillow height provided the best view and was used for intubation (n=21 for 0 cm, n=110 for 3 cm, n=28 for 6 cm). Statistical significance was set at p<0.05. Results: The 3 cm pillow position provided superior glottic visualization—CL grades 1–2 were observed in 94.3% of 3 cm assessments compared to 56.6% (0 cm) and 48.4% (6 cm) (p<0.001). POGO distribution favored 3 cm: high POGO (100%) observed in 47.2% vs. 12.6% (0 cm) and 11.9% (6 cm) (p<0.001). IDS outcomes in intubation groups showed easier intubation at 3 cm (67.3% classified as 'easy') compared to 0 cm (57.1%) and 6 cm (57.1%) (p<0.001). Mucosal trauma and postoperative complications were also lowest in the 3 cm intubation cohort. Conclusion: Moderate head elevation (3 cm) optimizes airway alignment, enhances laryngeal exposure, reduces intubation difficulty, and lowers mucosal injury—supporting its routine consideration as a refined modification of the sniffing position in elective cases

Purpose: To study clinicodemographic profile of patients undergoing MRI with Focal Liver Lesions.. Methods: Sixty-four consecutive patients with liver lesions underwent DWI using standardized MRI protocols. Lesions were characterized by both qualitative signal intensity and quantitative ADC measurement. Final diagnosis, based on histopathology or imaging follow-up, was used as reference. Statistical analysis included sensitivity, specificity, and ROC curve assessment. Results: 64 patients with ages 27-80 with a mean age of 51.42 years with sex ratio M/F of 29/35 underwent MRI in which 24 lesions were found to be benign and 40 were found to be malignant. The average lesion size was 4.6. Conclusion: DWI with ADC quantification provides robust, non-invasive discrimination between benign and malignant FLLs, facilitating clinical management and reducing reliance on invasive biopsy.

Background: Purpose: To quantitatively assess the diagnostic value of DWI and ADC mapping in distinguishing liver metastases from primary hepatic malignancies (hepatocellular carcinoma and cholangiocarcinoma). Methods: DW-MRI data from patients with biopsy-proven malignant liver lesions were retrospectively analyzed. ADC values of metastatic lesions were compared to those of HCC and cholangiocarcinoma using t-tests and ROC analysis. Results: Mean ADC of metastases (0.81±0.19×10−3 mm2/s0.81±0.19×10−3mm2/s) was significantly lower than that of HCC (1.03±0.23×10−3 mm2/s1.03±0.23×10−3mm2/s), p=0.01. ROC analysis produced an AUC of 0.83 and an optimal cutoff of 0.90×10−3 mm2/s0.90×10−3mm2/s for identifying metastases Conclusion: DW-MRI ADC quantification is a practical adjunct for differentiating metastatic lesions from primary hepatic cancers, supporting more precise patient management

Background Palpable breast swelling, whether benign or malignant, results from hormonal influences. Most cases are benign. Triple assessment-clinical, histological, and radiological-enables accurate detection and evaluation, guiding effective interventions. The research aimed to compare the patterns of breast swelling in premenopausal and postmenopausal women and identify the most common breast lumps in each group. Methods One hundred female patients with palpable breast lumps were evenly divided into premenopausal (50 patients) and postmenopausal groups (50 patients). Each patient underwent clinical examination, fine-needle aspiration cytology (FNAC), and core needle biopsy if necessary. Ultrasonography (USG) of the breast was conducted for all patients, and mammograms were performed for selected cases. All postoperative specimens underwent histopathological examination. Results Among the total 100 patients, 60 were diagnosed with benign breast disease, and 40 had malignant breast disease. In premenopausal women, 82% were diagnosed with benign disease, while in postmenopausal women, 38% had a benign diagnosis. Conversely, premenopausal women showed an 18% incidence of malignant breast disease, while postmenopausal women exhibited a 62% incidence. Among malignant breast diseases, 60% were invasive ductal carcinoma, 32.5% were invasive lobular carcinoma, 5% were invasive medullary carcinoma, and 2.5% were inflammatory carcinoma. Conclusion The study finds a higher prevalence of malignant breast disease in postmenopausal women, while premenopausal women commonly experience benign breast disease, notably fibrocystic cystic disease. Premenopausal women exhibit a higher percentage of invasive lobular carcinoma than the general population, while postmenopausal women predominantly face invasive ductal carcinoma breast NST/NOS with increased invasive lobular carcinoma.

Background Twin pregnancies are associated with increased maternal and perinatal risks compared to singleton gestations. They contribute significantly to maternal morbidity, obstetric complications, and adverse neonatal outcomes. This study aimed to evaluate the maternal and perinatal outcomes of twin pregnancies at a tertiary care hospital in Tezpur, Assam. Objectives To determine the incidence of twin pregnancies and analyse maternal complications, maternal morbidity and mortality, as well as neonatal morbidity and mortality. Methods This study was conducted over one year at Tezpur Medical College and Hospital. A total of 100 women with twin pregnancies beyond 28 weeks of gestation were included, fulfilling inclusion and exclusion criteria. Data were collected through structured proformas, clinical examinations, ultrasonography, and perinatal monitoring. Maternal and neonatal outcomes were analysed using descriptive statistics. Results The incidence of twin pregnancy was 0.7% among 13,737 deliveries. Most women were aged 20–29 years (73%), with nearly equal distribution between primigravida (49%) and multigravida (51%). Preterm delivery occurred in 84% of cases, and anemia (72%) was the most common maternal risk factor. Premature labour (76%) was the leading complication, with maternal mortality recorded in 2%. Caesarean delivery was slightly more common (54%) than vaginal birth (46%). Perinatal outcomes were marked by low birth weights (s (<2.5 kg in 80–90% of twins), intrauterine deaths (3–5%), and a high NICU admission rate (52–56%). Conclusion Twin pregnancies are high-risk with significant maternal and perinatal complications. Strengthening antenatal care, early risk identification, and skilled intrapartum management are essential to improve outcomes.

Background Type 2 diabetes mellitus (T2DM) has been increasingly linked to cognitive dysfunction through mechanisms involving chronic hyperglycemia, microvascular disease, and neurodegeneration. Magnetic Resonance Imaging (MRI) provides an objective method to assess these brain changes.  Aim: To compare MRI brain changes in Type 2 diabetic patients with and without cognitive impairment. Materials and Methods: A hospital-based cross-sectional comparative study was conducted on 120 Type 2 diabetic patients divided into two groups: 60 with cognitive impairment (CI+) and 60 without (CI-). Cognitive assessment was performed using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE). MRI scans were analyzed for white matter hyperintensities (Fazekas score), hippocampal volume, cortical thickness, lacunes, microbleeds, and diffusion tensor imaging parameters (FA and ADC). Data were statistically analyzed using Student’s t-test, Chi-square test, and correlation analyses, with p < 0.05 considered significant. Results: Patients with cognitive impairment were older (64.1 ± 7.8 vs 60.3 ± 7.5 years; p = 0.007), had longer diabetes duration (12.3 ± 4.6 vs 9.7 ± 4.1 years; p = 0.0015), and higher HbA1c (8.7 ± 1.1 vs 7.9 ± 1.0; p < 0.001). MRI revealed higher Fazekas WMH scores (2.4 ± 0.8 vs 1.6 ± 0.7; p < 0.001), lower hippocampal volume (6.2 ± 0.7 vs 6.8 ± 0.6 cm³; p < 0.001), and thinner cortex (2.38 ± 0.12 vs 2.46 ± 0.11 mm; p < 0.001) in CI+ patients. WMH and hippocampal volume correlated significantly with MoCA scores (r = -0.56 and +0.49, respectively; p < 0.001). Logistic regression identified diabetes duration, HbA1c, hypertension, and LDL as independent predictors of MRI changes. Conclusion: T2DM patients with cognitive impairment exhibit distinct MRI abnormalities indicating both vascular and neurodegenerative pathology. Poor glycemic control and longer disease duration significantly contribute to these brain changes. Early neuroimaging screening in diabetic individuals may aid in detecting subclinical brain injury and preventing cognitive decline.

Purpose: To compare corneal biomechanical parameters in eyes with keratoconus and post-refractive surgery ectasia using Scheimpflug-based imaging and to evaluate whether distinct biomechanical signatures can aid in differentiating the two entities. Methods: This observational cross-sectional study included 80 eyes of 60 subjects — 40 with keratoconus (Group A) and 40 with post-refractive surgery ectasia (Group B). All participants underwent corneal assessment with Pentacam HR and Corvis ST. Parameters such as stiffness parameter (SP-A1), deformation amplitude (DA ratio), integrated radius, and Ambrosio Relational Thickness (ARTmax) were compared between groups. Data were analyzed using independent t-test, with p < 0.05 considered statistically significant. Results: Mean SP-A1 was significantly lower in post-refractive ectasia (67.8 ± 12.5) compared to keratoconus (75.6 ± 14.2, p = 0.01), indicating greater biomechanical weakness post-surgery. DA ratio and integrated radius were both higher in ectasia (1.12 ± 0.04 and 8.23 ± 0.6 respectively) than in keratoconus (1.05 ± 0.03 and 7.68 ± 0.5; p < 0.01). ARTmax was significantly reduced in both groups but lowest in post-refractive ectasia (230.4 ± 35.2 µm vs 258.7 ± 32.5 µm). Conclusion: Scheimpflug-based biomechanical assessment demonstrates quantifiable differences between keratoconus and post-refractive ectasia. Post-refractive ectasia shows greater structural destabilization and lower corneal stiffness, suggesting different pathophysiological mechanisms despite overlapping topographic features.

Introduction: Vaginal discharge is one of the most common reasons for gynecologic visits. Infectious etiologies—bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), Trichomonas vaginalis (TV), and less frequently Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG)—predominate, yet local etiologic profiles and resistance patterns vary, necessitating setting-specific data for empirical therapy. Materials and Methods: This is a Cross-sectional study conducted was conducted in the Department of Gynecology and Microbiology at tertiary-care teaching hospital over 12 months. Non-pregnant women (18–49 years) attending a tertiary-care gynecology OPD over 12 months. Standardized clinical proforma, pH/whiff tests, saline/KOH microscopy, Gram stain with Nugent scoring, wet-mount and Giemsa staining for TV, culture/identification for yeasts and aerobic vaginitis (AV) bacteria, and staining and culture for NG and serological tests for CT were performed. Antimicrobial susceptibility of aerobic isolates followed CLSI guidelines; antifungal susceptibility used broth microdilution for fluconazole, itraconazole, voriconazole, and amphotericin B. Primary outcomes were etiologic prevalence and susceptibility profiles. Results: Among 300 women (mean age 31.2 ± 7.1 y), BV (33.0%), VVC (29.7%), TV (7.7%), AV (13.7%), CT (4.3%), and NG (2.3%) were identified; 14.0% had mixed infections. Candida albicans comprised 58% of yeasts; non-albicans Candida (NAC) included C. glabrata (22%), C. tropicalis (12%), and others (8%). Among AV isolates, E. coli (34%), Enterococcus faecalis (23%), and S. aureus (16%) predominated. High nitrofurantoin (92%) and fosfomycin (88%) susceptibility were observed in Enterobacterales; fluoroquinolone resistance was frequent. NAC showed reduced fluconazole susceptibility (28%) versus C. albicans (86%). Conclusion: BV and VVC accounted for most symptomatic discharge, with meaningful burdens of AV and TV. Given high fluoroquinolone resistance among aerobic isolates and reduced azole activity against NAC, empiric choices should align with guideline-concordant regimens for BV/TV and reserve targeted agents for culture-proven AV or recurrent VVC. Routine microscopy plus targeted culture and serological tests improve accuracy and stewardship

Fetal aortic stenosis (AS) is a congenital cardiac defect characterized by narrowing of the aortic valve, impairing blood flow from the left ventricle to the aorta. The condition varies from mild to severe and can progress to hypoplastic left heart syndrome (HLHS), a critical, often lethal state where left heart structures are underdeveloped. Early diagnosis and multidisciplinary management are vital for optimizing outcomes. We report a case of a 33-year-old primigravida diagnosed antenatally with gestational hypothyroidism and fetal aortic stenosis, which was successfully managed

Background: The saphenofemoral junction (SFJ) is a crucial anatomical landmark for high ligation and stripping procedures in varicose vein surgery. Unrecognized anatomical variations may result in incomplete ligation, intraoperative injuries and recurrence. This study aimed to compare the anatomy of the SFJ, its relationship with the superficial external pudendal artery (SEPA), and tributary patterns between normal cadavers and patients with chronic venous insufficiency (CVI). Methods: An ambispective comparative study was conducted involving 46 cadaveric lower limbs (Group C) and 40 patients undergoing high ligation and stripping (Group S) from January 2023 to March 2024. The relation of SEPA to SFJ and pattern of venous tributaries were studied, along with demographics. Statistical analysis was performed using Independent t-test, Chi-square test, and Pearson correlation. p≤0.05 was considered significant. Results: The position of SFJ was found to be below junction of medial one-third and lateral two-third of inguinal ligament, occurring lower down in cadaveric population vs surgical population (3.1cm vs 2.8cm, p=0.006). The distance between SFJ location and inguinal ligament showed a positive correlation with the femur length (r=0.58, p=0.00002 for Group C, r=0.6, p=0.0003 for Group S).  The venous anatomy was found similar in the cadaveric groups with normal limbs and surgical group with CVI in terms of SEPA position and tributary pattern. In relation to SFJ, SEPA was found to posterior in 58.7% vs 60%, anterior in 19.6% vs 20%, absent in 15.2% vs 15% and duplicated, occurring anteriorly and posteriorly in 7% vs 5% when comparing Group C and Group S respectively (p>0.05). Major tributaries at SFJ in Group C and Group S were identified as the superficial pudendal vein (84.8% vs 87.5%), superficial epigastric vein (76.1% vs 80%), superficial circumflex iliac vein (76% vs75%), anterior accessory vein (54.4% vs 45%) posteromedial thigh vein (37% vs 35%) and additional veins (26.1% vs 47.5%)(p>0.05). Conclusion: Location of SFJ varies as per stature of person. The SFJ shows consistent anatomical relationships across cadaveric and surgical groups. SEPA is found posterior to insertion of great saphenous vein at SFJ in approximately 65% of population. Superficial pudendal vein is the tributary most consistently found at SFJ in North Indian population.

Background: The no-reflow phenomenon and suboptimal TIMI (Thrombolysis in Myocardial Infarction) flow following percutaneous coronary intervention (PCI) are critical predictors of adverse outcomes in ST-elevation myocardial infarction (STEMI). While pharmacoinvasive strategies offer an effective alternative in resource-limited settings, the timing of PCI post-thrombolysis may influence both pre-procedural thrombus burden and post-procedural microvascular reperfusion. Objective: To evaluate the impact of timing of pharmacoinvasive PCI on pre- and post-procedural TIMI flow grades and the incidence of the no-reflow phenomenon in patients presenting with anterior wall STEMI. Methods: This prospective observational study enrolled 480 patients with anterior STEMI who received thrombolysis followed by planned PCI within 24 hours. Patients were divided into three groups based on time from thrombolysis to PCI: Group A (3–10 hours), Group B (10.1–17 hours), and Group C (17.1–24 hours). Pre- and post-procedural TIMI flow grades were assessed angiographically. TIMI flow <3 post-PCI was considered indicative of no-reflow. Comparative analyses across groups were performed using chi-square and ANOVA tests with significance at p<0.05. Results: Baseline pre-PCI TIMI 0/I flow was observed in >65% across all groups, with no significant intergroup difference (p=0.998), indicating similar initial thrombotic burden. However, post-procedural TIMI III flow was highest in Group A (96.0%) compared to Group B (91.7%) and Group C (90.7%), though the difference was not statistically significant (p=0.135). The incidence of no-reflow (post-PCI TIMI <3) was numerically lower in Group A (4.0%) versus Group B (8.3%) and Group C (9.3%). Conclusion: Early pharmacoinvasive PCI (within 3–10 hours) is associated with a higher rate of achieving optimal post-procedural TIMI III flow and a lower, albeit not statistically significant, incidence of no-reflow. These findings support the clinical utility of early PCI in improving myocardial perfusion and limiting microvascular damage in anterior STEMI managed via a pharmacoinvasive strategy.

Meditation and breathing-based mind–body practices have been increasingly investigated for their potential to improve cardiovascular and respiratory health through autonomic and mechanical mechanisms. This systematic review aimed to synthesize evidence from randomized controlled trials, controlled physiological studies, and systematic reviews examining the effects of meditation, mindfulness, pranayama, and integrated yoga interventions on cardio-respiratory parameters. Literature searches were conducted in PubMed, Scopus, and Web of Science for English-language studies published. Nineteen studies meeting predefined eligibility criteria were included and grouped thematically into mindfulness and meditation-based programs, breathing and pranayama-focused interventions, and integrated yoga approaches. Across studies, meditation and mindfulness training resulted in significant reductions in systolic and diastolic blood pressure, improved heart rate variability, and enhanced emotional regulation among both healthy and hypertensive participants. Breathing and pranayama techniques, including slow breathing, Bhrāmarī, and OM chanting, consistently improved forced vital capacity, forced expiratory volume in one second, and peak expiratory flow rate, while increasing baroreflex sensitivity and parasympathetic activity. Integrated yoga interventions combining postures, breathing, and meditation demonstrated synergistic benefits across cardiovascular and pulmonary domains, reflected by lower resting heart rate, reduced blood pressure, and improved ventilatory efficiency. Collectively, these findings support that meditation and related mind–body techniques can beneficially modulate autonomic and respiratory physiology, offering safe and accessible adjuncts for prevention and rehabilitation in cardiometabolic and pulmonary disorders. However, heterogeneity in study design, small sample sizes, and limited long-term follow-up underscore the need for larger, standardized trials to establish dose–response relationships and sustainability of benefits