Background: Effective analgesia during positioning and postoperative recovery is essential in femur fracture surgery. The Pericapsular Nerve Group (PENG) block has recently emerged as a targeted technique with potential advantages over the Fascia Iliaca Compartment Block (FICB). Material and Methods: This prospective comparative study included 30 patients undergoing femur fracture surgery, who received either a PENG block or an FICB. Pain during positioning for spinal anaesthesia, postoperative analgesia duration, and hemodynamic parameters were recorded. Results: The PENG block provided lower pain scores during positioning, prolonged postoperative analgesia, and greater hemodynamic stability compared with the FICB. Conclusion: The PENG block may be considered a more effective regional anaesthesia technique for femur fracture surgery due to its superior analgesic and physiological profile.

Background: Type 2 Diabetes Mellitus (T2DM) is a growing global health concern, with poor glycemic control leading to serious complications. Emerging evidence suggests a role of vitamin D in glucose metabolism. Aim: To evaluate the correlation between serum vitamin D levels and glycemic control (HbA1c) in T2DM patients. Methodology: A cross-sectional study was conducted on 50 T2DM patients aged 30–70 years. Serum 25(OH)D levels were measured using CLIA and HbA1c by HPLC. Vitamin D status was categorized as deficient, insufficient, or sufficient. Correlation was analyzed using Pearson’s coefficient. Results: Vitamin D deficiency was observed in 62% of patients, while 72% had poor glycemic control. Mean HbA1c was highest in deficient (8.4±1.1%) and lowest in sufficient groups (6.7±0.6%). Most deficient patients (26/31) had poor control, whereas better control was seen with sufficient vitamin D levels. Conclusion: An inverse relationship exists between vitamin D levels and HbA1c. Vitamin D deficiency is associated with poor glycemic control, suggesting its potential role in T2DM management.

Background: Recent demographic and epidemiological trends indicate that populations are living longer with an increasing burden of chronic diseases worldwide. Metabolic disorders such as fatty liver changes, hypercholesterolemia and impaired glycemic control are rising globally and may influence ocular refractive status through biochemical and osmotic mechanisms. However, the relationship between metabolic disorders and refractive errors has not been adequately explored. Objective: To evaluate the prevalence and age-wise concurrence of metabolic disorders (fatty liver changes, hypercholesterolemia, and elevated HbA1c levels) with refractive errors (normal vision, myopia, presbyopia and astigmatism). Methods: A cross-sectional observational study was conducted among adults aged 20–60 years. Participants were stratified into four age groups. Metabolic parameters were assessed using ultrasonography for fatty liver changes, serum cholesterol estimation for hypercholesterolemia and HbA1c levels for glycemic status. Other investigations such as blood pressure monitoring, electrocardiography (ECG) and treadmill test (TMT) were performed but excluded from the present analysis. Refractive status was determined using standard refractive examination techniques. The association between metabolic disorders and refractive errors was analyzed using the chi-square test. Results: Fatty liver changes and hypercholesterolemia peaked in the 30–50 years age group, while elevated HbA1c predominated in the 50–60 years group (88.9%). Refractive errors showed a transition from myopia in younger subjects to presbyopia in the older age group (81.5% in 50–60 years). Significant associations were observed between age group and metabolic disorders (p < 0.0001) and between age group and refractive errors (p < 0.0001). Conclusion: The present study highlights the association between metabolic disorders and refractive errors across different age groups, emphasizing the importance of metabolic evaluation in patients presenting with refractive abnormalities.

The medial collateral ligament (MCL) is commonly injured in the setting of anterior cruciate ligament (ACL) injuries. Because the MCL has better healing capacity than the ACL, the general perception is that MCL inju-ries can be treated conservatively. Treating these injuries conservatively, however, can lead to residual valgus laxity. Furthermore, it delays time to surgery, which prevents acute treatment of concomitant ACL injuries us-ing primary repair or acute reconstruction. Several treatment methods for MCL injuries have been proposed, including primary repair, augmented repair with autograft tissue, or primary reconstruction. In this surgical technique article, we present the technique of acute primary MCL repair with internal bracing with 2 lim-ited/mini-open incisions. With this technique, early surgical intervention is possible, and early rehabilitation is safe because of the internal bracing. Advantages include fast recovery, avoidance of muscle atrophy because of early mobilization, prevention of residual valgus instability, and maintenance of proprioception.

Purpose: To evaluate the efficacy of posterior subtenon interferon alpha-2b (IFN-α2b) combined with intravitreal bevacizumab (IVB) on central macular thickness (CMT) and best-corrected visual acuity (BCVA) in patients with macular edema. Methods: This observational analytical study included 40 eyes diagnosed with macular edema secondary to diabetic macular edema (DME), retinal vein occlusion (RVO), or age-related macular degeneration (ARMD). All patients received a single session of intravitreal bevacizumab (1.25mg/0.05ml) with posterior subtenon IFN-α2b (1mlU/ml). Outcomes were evaluated through CMT using spectral-domain optical coherence tomography (OCT) and BCVA on the LogMAR scale at baseline and post-injection follow-up. Results: Mean CMT decreased significantly from 507.9 ± 162.8 µm to 286.5 ± 78.6 µm (mean change −221.4 µm, p < 0.001) changes seen on October one month post injection. Mean BCVA improved from 1.13 ± 0.36 to 0.78 ± 0.25 LogMAR (mean gain −0.35 LogMAR, p < 0.001). All etiological groups (DME, RVO, and ARMD) showed significant anatomical and visual improvement. Severe macular edema (>500 µm) showed the largest CMT reduction (−354.4 µm) and BCVA improvement (−0.46 LogMAR). CMT reduction correlated strongly with visual improvement (ρ = 0.689, p < 0.001). Conclusion: Posterior subtenon IFN-α2b combined with intravitreal bevacizumab significantly reduces macular edema and improves visual outcomes. It is a promising steroid-sparing adjunct especially in severe or refractory cases.

Background: Benign prostatic hyperplasia (BPH) remains one of the most common causes of bladder outlet obstruction in ageing men. Among electrosurgical methods, transurethral bipolar enucleation of the prostate (B-TUEP/BipolEP/TUEB) and monopolar transurethral enucleation of the prostate (M-TUEP/mTUEP) use similar mechanical principles but differ in current delivery, irrigation environment, hemostatic profile, and electrolyte safety. Aim: The present paper aims to compare bipolar and monopolar prostate enucleation for BPH with respect to perioperative efficiency, safety, early and intermediate functional outcomes, and practical applicability in resource-variable settings. Materials and Methods: This paper is a structured comparative review based on guideline statements, technical descriptions, and comparative clinical literature addressing transurethral prostate enucleation with bipolar and monopolar energy for symptomatic BPH. Extracted outcome domains included operative time, resected tissue weight, symptom scores, peak urinary flow, catheterization duration, length of stay, bleeding, electrolyte changes, irrigation-related risk, and postoperative complications such as acute retention, urinary tract infection, and incontinence. Results: The most consistent finding across the comparative literature is that bipolar and monopolar transurethral enucleation provide broadly comparable efficacy in terms of adenoma clearance and postoperative symptom relief, but bipolar technology offers a more favorable intraoperative safety profile. The bipolar arm had significantly less intraoperative bleeding, shorter catheterization, shorter hospitalization, and higher intraoperative serum sodium stability, while the monopolar arm showed lower mean sodium and one case of transurethral resection syndrome. Conclusion: The available comparative evidence indicates that bipolar enucleation should be preferred because it reduces bleeding risk, shortens catheterization and admission time, and avoids the electrolyte vulnerability associated with non-saline monopolar systems. Monopolar enucleation nevertheless remains a clinically valid and pragmatic alternative in settings where bipolar technology is unavailable or unaffordable, provided that the surgeon is experienced and perioperative monitoring is meticulous. Future comparative work should strengthen the evidence base with multicenter randomized trials, standardized reporting of complications, and longer follow-up for durability, retreatment rates, and functional recovery.

Aim: This study evaluates serum levels of vascular endothelial growth factor-A (VEGF-A), endothelin-1 (ET-1), and magnesium in DR patients compared to controls and non-retinopathic diabetics to assess their diagnostic and prognostic utility. The primary aim was to determine if these biomarkers correlate with DR severity, particularly proliferative DR (PDR), and establish cut-off values for clinical use. Materials and Methods: A prospective case-control study was conducted at a Department of Biochemistry Chirayu Medical College and Hospital, Bhopal India, from January 2025 to December 2025, involving 120 participants: 40 healthy controls, 40 type 2 diabetics without retinopathy (NODR), 20 with non-proliferative DR (NPDR), and 20 with PDR. Inclusion criteria included age 40-70 years, confirmed type 2 diabetes >5 years, and fundoscopic grading per Early Treatment Diabetic Retinopathy Study (ETDRS) criteria. Exclusion criteria encompassed other ocular diseases, renal failure, or recent anti-VEGF therapy. Results: VEGF-A levels were significantly elevated in PDR (1521 ± 450 ng/mL) vs NPDR (850 ± 250 ng/mL), NODR (450 ± 150 ng/mL), and controls (250 ± 80 ng/mL; p<0.001). ET-1 was higher in DR groups (PDR: 16 ± 4 pg/mL; NPDR: 12 ± 3 pg/mL) vs NODR (8 ± 2 pg/mL) and controls (5 ± 1.5 pg/mL; p<0.001), with SMD 1.73 (95% CI 0.90-2.56). Magnesium was reduced in PDR (1.62 ± 0.13 mg/dL) vs NPDR (1.75 ± 0.14 mg/dL), NODR (1.92 ± 0.15 mg/dL), controls (2.25 ± 0.16 mg/dL; p<0.001). ROC analysis yielded AUC 0.975 for VEGF-A (cut-off 1521 ng/mL), 0.96 for ET-1 (16 pg/mL), and 0.837 for magnesium (1.7 mg/dL). Conclusion: Elevated VEGF-A and ET-1, alongside hypomagnesemia, are robust biomarkers distinguishing DR stages, with high predictive accuracy for PDR. These findings support their integration into screening protocols for high-risk diabetics, potentially enabling early intervention and reducing vision loss burden. Longitudinal studies are recommended to validate prognostic value.

Background: Prosthetic joint infection (PJI) is one of the most serious complications following total knee arthroplasty, leading to significant morbidity, prolonged hospitalization, and increased healthcare costs. Despite advances in surgical techniques and infection control measures, the burden of PJI remains substantial, particularly in patients with associated comorbidities. Objectives: To study the clinico-demographic profile, microbiological spectrum, management strategies, and outcomes of prosthetic joint infection in patients undergoing total knee arthroplasty. Methods: A hospital-based observational study was conducted over a period of two years at a tertiary care hospital in Western India. A total of 50 patients diagnosed with prosthetic joint infection following total knee arthroplasty were included. Data regarding demographic characteristics, comorbidities, clinical presentation, microbiological findings, treatment modalities, and outcomes were collected using a structured proforma. Statistical analysis was performed using appropriate tests, and p-value < 0.05 was considered significant. Results: The majority of patients belonged to the elderly age group with a female predominance. Osteoarthritis (80.0%) was the most common indication for surgery. Diabetes mellitus and obesity were the most frequent comorbidities and showed a significant association with poor outcomes. Pain (100%) was the most common presenting symptom. Staphylococcus aureus (40.0%) was the predominant organism isolated. Debridement, antibiotics, and implant retention (DAIR, 40%)) was the most commonly employed treatment modality, while two-stage revision (30.0%) was used in chronic cases. A favourable outcome was observed in the majority of patients; however, adverse outcomes were associated with delayed presentation, gram-negative infections, and presence of comorbidities. Conclusion: Prosthetic joint infection remains a challenging complication of total knee arthroplasty. Early diagnosis, appropriate surgical intervention, and optimization of risk factors are crucial for improving outcomes. Strengthening infection control practices and adopting standardized management protocols can further reduce the incidence and impact of PJI.

Background: Acne vulgaris is a common chronic inflammatory disorder of the pilosebaceous unit affecting adolescents and adults, often leading to significant clinical and psychosocial burden. Aim: To evaluate the clinical profile, severity patterns, and therapeutic outcomes of patients with acne vulgaris. Methodology: This hospital-based retrospective observational study included 80 patients aged ≥12 years attending the Department of Skin & VD, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar. Medical records were reviewed for demographic data, duration, family history, site of involvement, Investigator Global Assessment (IGA) severity grading, treatment modalities, and follow-up outcomes. Statistical analysis was performed using SPSS version 27. Results: The majority of patients were aged 17–25 years (60%) with female predominance (57.5%). Most had disease duration of 1–3 years (42.5%) and positive family history (65%). Moderate acne (IGA Grade 3) was most common (37.5%). Combination therapy (oral antibiotics with topical agents) was the preferred treatment (35%). At follow-up, 72.5% showed moderate to marked improvement. Conclusion: Acne vulgaris predominantly affects young adults with moderate severity and demonstrates favorable response to guideline-based combination therapy, though individualized management remains essential.

Background: Hyperpigmented skin disorders are common dermatological conditions, particularly in populations with darker skin types, and have significant cosmetic and psychosocial impact. Aim: To analyze the prevalence and patterns of hyperpigmented skin disorders in a dermatology OPD. Methodology: A retrospective, hospital-based descriptive study was conducted over 8 months in the Department of Skin & VD, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar. A total of 90 patients with clinically diagnosed hyperpigmented disorders were included. Data were analyzed using descriptive statistics. Results: The majority of patients belonged to the 21–30 years age group (24.44%), with female predominance (57.78%). Melasma (28.89%) was the most common disorder, followed by post-inflammatory hyperpigmentation (24.44%). The face was the most frequently affected site (44.44%). Most patients (31.11%) presented within 6 months of lesion onset. Conclusion: Hyperpigmented disorders are highly prevalent, especially among young females, with melasma and post-inflammatory hyperpigmentation being the most common. Early presentation and predominant facial involvement highlight the need for timely diagnosis and preventive strategies.

Background: Leprosy remains a public health concern in India, with a high proportion of multibacillary (MB) cases indicating ongoing transmission and delayed diagnosis. Aim: To evaluate the clinical and epidemiological profile of admitted leprosy patients and assess disease patterns over seven months. Methodology: This retrospective, descriptive study included 90 admitted leprosy patients at a Department of Skin & VD, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India from July 2025–January 2026. Data on demographics, clinical spectrum, smear status, disabilities, and treatment were collected from medical records and analyzed using descriptive statistics. Results: Most patients were males (62.2%) and belonged to 21–60 years (66.6%). MB forms predominated, with borderline lepromatous (33.3%) being most common. Smear positivity was high (64.4%). Type I reaction (31.1%) and disabilities (27.8%) were frequent. Although 68.9% had no disability, claw hand was the most common deformity. Over half (53.3%) were newly diagnosed. Most patients presented within 6–12 months (31.1%), but 18.9% had delays >2 years. Conclusion: The predominance of MB cases, reactions, and delayed presentation highlights the need for early diagnosis, improved surveillance, and timely treatment to reduce transmission and disability.

Background: Autoimmune bullous disorders (ABDs) are rare, chronic mucocutaneous diseases characterized by autoantibody-mediated blister formation and significant morbidity. Aim: To analyze the epidemiological, clinical, laboratory profile, and treatment patterns of ABDs in a tertiary dermatology department. Methodology: This retrospective observational study at Department of Skin & VD, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India.  included 67 patients with histopathology- and direct immunofluorescence-confirmed ABDs. Demographic, clinical, laboratory, comorbidity, therapeutic, and relapse data were extracted from medical records and analyzed using descriptive statistics. Results: Intraepidermal (n=34) and subepidermal (n=33) diseases were nearly equally distributed. Pemphigus vulgaris (82.4%) predominated among intraepidermal disorders (mean age 48.9 years; M:F 1.25:1), while bullous pemphigoid (72.7%) was most common among subepidermal disorders (mean age 62.8 years; slight female predominance). Hypertension and diabetes were frequent, particularly in subepidermal cases. Azathioprine was the most commonly used adjuvant in both groups. Relapses were more frequent in intraepidermal disorders (35.3% single relapse). Conclusion: ABDs showed distinct age and comorbidity patterns. Intraepidermal diseases had higher relapse rates, highlighting the need for individualized long-term management.