Background: Open fractures are highly susceptible to contamination and subsequent surgical site infections (SSIs), posing significant challenges in orthopaedic management. Understanding the microbiological profile at different stages of wound management is crucial for effective infection control. Objective: To evaluate and compare the microbiological profile of open fracture wounds at pre-debridement, post-debridement, and during surgical site infection, and to assess factors influencing microbial growth. Methods: This observational study was conducted at the Department of Orthopaedics, SRM Medical College Hospital, from August 2023 to August 2024. A total of 50 patients with open fractures were included. Microbiological cultures were obtained at three stages: pre-debridement, post-debridement, and during SSI. Demographic data, injury characteristics, comorbidities, and clinical parameters were analyzed for association with microbial growth. Results: The majority of patients were males (56.7%) and belonged to the 40–50-year age group. Road traffic accidents were the most common cause of injury (40%). Pre-debridement cultures showed minimal microbial growth (3.3%), whereas post-debridement cultures demonstrated a significant increase in microbial positivity (76.7%). Gram-negative organisms, particularly Klebsiella species, were predominant. A subset of patients developed SSI, with Staphylococcus aureus being the most common isolate. Statistical analysis revealed no significant association between microbial growth and most demographic or clinical variables; however, gender showed a significant correlation. Conclusion: The microbiological profile of open fractures changes dynamically during treatment, with a notable increase in bacterial growth following debridement, suggesting possible nosocomial contamination. Early and targeted antimicrobial therapy, along with strict aseptic protocols, is essential to reduce infection rates and im-prove outcomes in open fracture management.

Background: Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine-metabolic disorder with variable reproductive and metabolic manifestations across different phenotypes. Aim: To evaluate the correlation of PCOS phenotypes with insulin resistance, obesity, and menstrual abnormalities among reproductive-age women. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology, KIMS, Narketpalli, from November 2025 to February 2026. Reproductive-age women diagnosed with PCOS according to the Rotterdam criteria were enrolled and classified into phenotypes A, B, C, and D. Clinical history, anthropometric parameters, menstrual profile, and ultrasound findings were recorded. Fasting blood glucose, fasting serum insulin, and HOMA-IR were assessed to evaluate insulin resistance. Statistical analysis was performed using chi-square test, t-test, and ANOVA as appropriate. Results: Classical phenotypes, particularly phenotype A, showed significantly higher body mass index, waist circumference, fasting insulin, and HOMA-IR values compared with non-classical phenotypes. Menstrual abnormalities were significantly more frequent in phenotypes A and B. Insulin resistance was significantly associated with obesity, menstrual disturbances, and hyperandrogenic phenotypes. Conclusion: PCOS phenotypes differ significantly in their metabolic and menstrual profile, and phenotype-based assessment may improve risk stratification and individualized management.

Background: Effective postoperative pain management is essential in lower limb surgeries to enhance recovery, reduce complications, and improve patient satisfaction. Epidural analgesia is widely regarded as a superior modality due to its ability to provide targeted and continuous analgesia. However, systemic analgesia remains commonly used because of its ease of administration and lower technical requirements. Comparative evaluation of these modalities remains clinically relevant. Aim: To compare the efficacy of epidural analgesia and systemic analgesia in patients undergoing lower limb surgeries. Methods: This prospective, randomized comparative study included 120 patients undergoing elective lower limb surgeries under regional or general anesthesia. Patients were divided into two groups: Group E (epidural analgesia, n=60) and Group S (systemic analgesia, n=60). Pain was assessed using the Visual Analog Scale (VAS) at predefined intervals postoperatively. Secondary outcomes included duration of analgesia, total analgesic consumption, hemodynamic parameters, and incidence of adverse effects. Results: Patients receiving epidural analgesia demonstrated significantly lower VAS scores at all postoperative intervals compared to the systemic analgesia group (p<0.05). The duration of analgesia was longer in Group E, with reduced requirement for rescue analgesics. Hemodynamic parameters remained more stable in the epidural group. The incidence of nausea and vomiting was higher in the systemic analgesia group, whereas mild hypotension was observed more frequently in the epidural group. Conclusion: Epidural analgesia provides superior postoperative pain relief, prolonged analgesic effect, and better hemodynamic stability compared to systemic analgesia in lower limb surgeries, making it a preferred modality in appropriate clinical settings.

Background: Perforation peritonitis remains a life-threatening abdominal surgical emergency with diverse aetiology and variable outcomes depending on regional, socioeconomic, and healthcare-related factors. Timely operative intervention is the cornerstone of management, and understanding institutional disease patterns is essential for optimising outcomes. Methods: A prospective observational study was conducted over 18 months in the Department of General Surgery at Oxford Medical College, Hospital and Research Centre, Bangalore. A total of 75 consecutive patients with clinical and radiological evidence of perforation peritonitis who underwent emergency laparotomy were enrolled. Demographic data, clinical presentation, comorbidities, site and cause of perforation, operative procedure, postoperative complications, length of hospital stay, and in-hospital mortality were systematically recorded and analysed. Results: The mean age of the study population was 43.2 ± 11.8 years with a male predominance (70.7%). Comorbidities were present in 62.7% of patients, most commonly diabetes mellitus (17.3%) and hypertension (14.7%). Universal presentation with acute abdominal pain was noted; 74.7% had abdominal distension or constipation, 44.0% vomited, and 34.7% were febrile. The appendix was the most frequent site of perforation (28.0%), followed by the duodenum (22.7%), ileum (20.0%), and stomach (16.0%). Modified Graham’s omentoplasty (34.7%) and primary closure (33.3%) were the most common operative procedures, followed by open appendectomy (28.0%). Postoperative ICU care was required by 46.7% of patients. Wound infection (20.0%) was the most common complication. In-hospital mortality was 5.3%, predominantly in patients with comorbidities, advanced age, and delayed presentation. Conclusions: Appendicular and peptic ulcer perforations are the predominant causes of perforation peritonitis in this tertiary care teaching hospital cohort. Prompt surgical intervention coupled with aggressive perioperative care results in acceptable morbidity and mortality. Advanced age, comorbidities, and delayed presentation are key determinants of adverse outcomes and warrant early recognition and referral.

Introduction: Ocular toxicity refers to adverse effects on the eye caused by drugs, chemicals, or environmental factors, potentially leading to visual impairment. Ethambutol, a first-line antitubercular drug, is known to cause optic neuropathy, affecting visual acuity and colour discrimination. Aim & Objectives: To report a case of Ethambutol-induced ocular toxicity in a tuberculosis patient and highlight the need for early detection and monitoring of adverse drug reactions (ADRs). Methods: A 59-year-old male with pulmonary tuberculosis presented with decreased vision after three months of Anti-Tubercular Therapy (ATT). Due to nausea and abdominal discomfort, he discontinued ATT, which was later reintroduced in a modified regimen. His medical history included chronic alcohol and masala consumption. Clinical evaluation and patient history suggested Ethambutol-induced optic neuropathy. Results: The patient exhibited symptoms of impaired visual acuity and night blindness, which are characteristic of Ethambutol-induced optic neuropathy. Upon discontinuation of Ethambutol and appropriate management, the patient showed gradual recovery. Summary & Conclusion: Ethambutol, though essential in tuberculosis treatment, can lead to serious ocular toxicity. Regular ophthalmic monitoring is crucial for early detection and prevention of irreversible vision loss. Caution is advised in high-risk patients, including those with pre-existing optic conditions.

Introduction: Hepatitis B virus (HBV) infection remains a major global public health problem and an important cause of chronic liver disease, cirrhosis, and hepatocellular carcinoma. Molecular testing has emerged as an essential tool for accurate diagnosis and monitoring of chronic HBV infection. Materials and Methods: This prospective observational study was conducted at the Department of Microbiology, GMERS Medical College and Hospital, Sola, Ahmedabad. A total of 300 HBsAg-positive blood samples were analyzed. Serological testing and HBV DNA quantification by real-time polymerase chain reaction (PCR) were performed to evaluate the role of molecular testing in chronic HBV infection. Results: Out of 300 HBsAg-positive samples, HBV DNA was detected in 226 cases (75.33%), while 73 cases (24.33%) were negative and 1 case (0.33%) was inconclusive. Male patients constituted 59.30% of positive cases, and the highest positivity was observed in the 21–40 years age group (46%). Viral load >20,000 IU/ml was observed in 38.05% of patients. Follow-up analysis demonstrated changes in viral load levels, highlighting the importance of serial molecular monitoring. Conclusion: Real-time PCR is a valuable tool for detection and monitoring of chronic HBV infection and provides accurate assessment of viral replication and disease activity.