Background: Dengue fever is a major arboviral infection causing significant morbidity in tropical countries. Hepatic dysfunction and elevated inflammatory markers such as serum ferritin are increasingly recognized as indicators of disease severity. Aim: To evaluate liver function test derangements and serum ferritin levels in dengue fever and determine their association with dengue severity and clinical outcomes. Methods: This hospital-based prospective observational study was conducted at Government Medical College, Machilipatnam, Andhra Pradesh. A total of 61 laboratory-confirmed dengue patients aged ≥18 years were en-rolled after written informed consent. Clinical details, laboratory investigations, liver function tests (AST, ALT, ALP, bilirubin, albumin), and serum ferritin levels were recorded at admission. Patients were classified accord-ing to WHO 2009 dengue severity criteria. Associations between biochemical parameters and clinical outcomes were analyzed using SPSS version 21. Results: The mean age of participants was 34.8 ± 12.6 years, and males constituted 62.3% of the study popula-tion. Elevated AST and ALT were observed in 80.3% and 67.2% of patients respectively, while AST > ALT pattern was noted in 72.1% cases. Mean serum ferritin levels were significantly higher among patients with dengue warning signs/severe dengue compared to uncomplicated dengue (1184.6 ± 472.8 vs 486.3 ± 210.5 ng/mL; p<0.001). Elevated ferritin levels were significantly associated with plasma leakage, bleeding manifesta-tions, ICU admission, and prolonged hospitalization. Conclusion: Liver function test abnormalities and elevated serum ferritin levels are significantly associated with dengue severity and adverse outcomes. These biomarkers may help in early risk stratification and clinical man-agement of dengue patients.

Background: Ovarian masses represent a spectrum of pathologies ranging from benign to malignant lesions. Accurate preoperative differentiation between benign and malignant ovarian masses is crucial for appropriate surgical planning and patient management. Diffusion Weighted Imaging (DWI) is an advanced functional MRI technique that reflects tissue cellularity by measuring the random Brownian motion of water molecules, offering quantitative data through Apparent Diffusion Coefficient (ADC) values. Objectives: To evaluate the diagnostic accuracy of DWI and ADC values in differentiating benign from malignant ovarian masses, and to determine an optimal ADC cutoff value. Materials and Methods: A retrospective observational study was conducted at the Department of Radiodiagnosis, ACSR Government General Hospital & Government Medical College, Nellore, from January 2023 to June 2025. A total of 30 patients with ovarian masses who underwent plain (non-contrast) MRI pelvis on a 1.5 Tesla Siemens Magnetom Sempra MRI machine were included. DWI was performed and ADC values were calculated. Histopathological findings served as the gold standard. Results: Of 30 patients, 24 (80%) had benign lesions and 6 (20%) had malignant lesions. DWI restriction was noted in 6 patients, of whom 5 (83.3%) were malignant and 1 (16.7%) was a false positive (endometrioma). One malignant case (low-grade mucinous cystadenocarcinoma) showed no restriction (false negative). The mean ADC value for malignant masses was 0.87 ± 0.18 × 10⁻³ mm²/s versus 1.52 ± 0.43 × 10⁻³ mm²/s for benign masses (p < 0.001). Sensitivity and specificity of DWI were 83.3% and 95.8%, respectively. Conclusion: DWI combined with ADC value measurement is a valuable, non-invasive, non-contrast adjunct to conventional MRI in characterizing ovarian masses. Combined evaluation significantly improves diagnostic accuracy for ovarian malignancies.

Aim: This review aims to systematically evaluate clinically relevant drug interactions of major antihypertensive drug classes—angiotensin‑converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta‑blockers, calcium channel blockers (CCBs), and diuretics—with other cardiovascular and non‑cardiovascular drugs, focusing on their combined effects on cardiac anatomy, hemodynamic parameters, and cardiac electrophysiological properties. Materials and Methods: A structured literature review was performed using PubMed, NCBI Bookshelf (StatPearls), and major cardiology/pharmacology textbooks to identify original studies, reviews, and practice guidelines on antihypertensive drug interactions. Inclusion criteria were: English‑language publications (2000–2026), studies reporting hemodynamic, echocardiographic, or electrocardiographic outcomes, and drug‑interaction studies involving ≥1 antihypertensive agent. Data were extracted on drug class, interacting agents, mechanism (pharmacokinetic vs pharmacodynamic), site of interaction (vascular bed, myocardium, conduction system), and clinical outcomes (BP, heart rate, QT interval, AV‑node conduction, myocardial mass, chamber size). For illustrative purposes, a hypothetical cohort dataset was constructed to simulate real‑world polypharmacy scenarios in hypertensive patients, allowing description of statistical testing methods. Results: Pharmacokinetic interactions most commonly involve CYP3A4‑dependent metabolism, particularly with verapamil and diltiazem, which inhibit CYP3A4 and increase plasma levels of co‑administered substrates (e.g., statins, antiarrhythmics, immunosuppressants). Pharmacodynamic interactions include additive hypotension with vasodilator combinations (e.g., dihydropyridine CCB + alpha‑1 blocker), enhanced AV‑nodal blockade with beta‑blocker + verapamil/diltiazem, and QT‑prolongation when some antihypertensives (e.g., certain CCBs) are combined with QT‑prolonging antiarrhythmics or psychotropics. Nonsteroidal anti‑inflammatory drugs (NSAIDs) antagonize the antihypertensive effect of ACEIs, ARBs, and diuretics by inducing sodium retention and vasoconstriction, while also increasing the risk of renal dysfunction when combined with renin–angiotensin–aldosterone system (RAAS) inhibitors. Hemodynamically, beta‑blockers and RAAS inhibitors favorably reduce myocardial wall stress and left ventricular hypertrophy, whereas unbalanced vasodilators may transiently increase shear‑stress patterns in atherosclerotic segments. Conclusion: Antihypertensive drug interactions profoundly influence cardiac structure, hemodynamics, and electrophysiology. Awareness of key pharmacokinetic (CYP3A4‑mediated) and pharmacodynamic (additive vasodilation, AV‑nodal blockade, volume‑related) interactions is essential for prescribing safely in hypertensive patients with polypharmacy. Tailoring combinations to underlying cardiac anatomy (e.g., LVH, chamber dilatation) and electrophysiological substrate (e.g., sinus node disease, QT‑interval drugs) reduces the risk of hypotension, bradyarrhythmias, and sudden cardiac events.

Background: Burn injuries continue to be a major public health concern and an important cause of unnatural deaths worldwide. Fatal burn cases frequently pose diagnostic and medicolegal challenges regarding determination of cause, manner, and timing of injuries. Clinicopathological correlation through autopsy examination provides valuable insights into burn pathology, mechanisms of death, and forensic interpretation. Objectives: To study the demographic profile, clinicopathological features, autopsy findings, causes of death, and medicolegal aspects of fatal burn cases. Materials and Methods: A prospective autopsy-based observational study was conducted on 150 consecutive fatal burn cases brought for medicolegal autopsy to the Department of Forensic Medicine of a tertiary care teaching hospital over a period of two years. Detailed information regarding age, sex, marital status, manner of death, total body surface area (TBSA) involvement, survival period, treatment history, clinical complications, and autopsy findings was collected. Histopathological examination of skin and internal organs was performed in selected cases. Data were analyzed using SPSS version 25.0. Chi-square test was used for statistical analysis and p <0.05 was considered significant. Results: The majority of victims belonged to the age group of 21–40 years (50.0%). Females constituted 62.0% of cases. Flame burns accounted for 86.0% of cases. Accidental burns were observed in 68.7%, suicidal burns in 24.0%, and homicidal burns in 7.3% cases. Septicemia (38.0%) was the most common immediate cause of death followed by shock (26.0%) and multiorgan dysfunction syndrome (14.7%). Mortality increased significantly with increasing TBSA involvement (p<0.001). Histopathological examination revealed coagulative necrosis, inflammatory infiltration, vascular congestion, edema, and granulation tissue formation. Conclusion: Fatal burn injuries predominantly affect young females and are commonly accidental in nature. Autopsy and histopathological examination provide crucial evidence regarding burn vitality, cause of death, and medicolegal interpretation. Comprehensive evaluation of burn deaths is essential for accurate forensic conclusions and administration of justice.

Background: Accurate estimation of wound age is one of the most challenging aspects of forensic pathology. Conventional histopathological methods provide only approximate estimates, particularly during the early post-traumatic period. Inflammatory cytokines such as Interleukin-6 (IL-6), Tumor Necrosis Factor-alpha (TNF-α), and Interleukin-1β (IL-1β) have emerged as promising biomarkers for wound age estimation owing to their predictable temporal expression during wound healing. Aim: To evaluate the utility of inflammatory markers IL-6, TNF-α, and IL-1β in determining wound age through histopathological and immunohistochemical examination. Materials and Methods: A prospective clinicopathological study was conducted on 100 skin wound specimens obtained during medicolegal autopsies. Cases with known survival intervals were categorized into five groups according to wound age. Routine hematoxylin-eosin staining and immunohistochemical analysis for IL-6, TNF-α, and IL-1β were performed. Expression intensity was assessed semi-quantitatively and correlated with known wound age. Results: A progressive increase in expression of IL-6 and TNF-α was observed with increasing wound age. IL-6 demonstrated the highest diagnostic accuracy with sensitivity of 88.4% and specificity of 81.6%. TNF-α showed sensitivity of 84.2% and specificity of 76.3%. IL-1β exhibited variable expression and lower predictive value. Significant positive correlations were found between cytokine expression and wound age (p<0.001). Conclusion: IL-6 and TNF-α are reliable inflammatory biomarkers for wound age estimation, especially during the early post-traumatic interval. Combining immunohistochemical markers with routine histopathology enhances the accuracy of forensic wound dating.

Background: Carcinoma rectum is one of the leading causes of cancer-related mortality worldwide. Accurate preoperative staging is essential for determining optimal treatment strategies, particularly regarding the use of neoadjuvant chemoradiotherapy and the selection of appropriate surgical techniques. Magnetic resonance imaging (MRI) has emerged as the preferred modality for locoregional staging of rectal carcinoma, offering superior soft-tissue resolution and multiplanar capability. This study is aimed to evaluate the diagnostic accuracy of 1.5-Tesla MRI in preoperative T-staging and nodal assessment of rectal carcinoma and to correlate these findings with peroperative and histopathological data. Methods: A hospital-based observational study was conducted at a tertiary care teaching hospital. Fifty patients with histologically confirmed carcinoma rectum were enrolled. MRI was performed using a 1.5-Tesla unit employing T1-weighted, T2-weighted (axial, sagittal, and coronal), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) sequences. TNM staging based on MRI findings was correlated with intraoperative findings and postoperative histopathological examination (HPE) in 26 surgically managed patients. Results: The study population comprised 37 males (74%) and 13 females (26%), predominantly aged above 50 years. Adenocarcinoma was the most common histological type (94%). Mid-rectal location was most frequent (64%). MRI identified mesorectal fascia (MRF) invasion in 6 patients (12%) and extramural vascular invasion (EMVI) in 11 patients (22%). Lymph node involvement was detected in 27 patients (54%), predominantly in the mesorectal compartment. MRI staging demonstrated a sensitivity of 89%, specificity of 71%, and overall accuracy of 86.42% for T2 stage when compared to HPE. Among 31 post-chemoradiotherapy patients, tumour regression grade (TRG) assessment showed Grade 3 response in 55% of cases. Conclusion: MRI is a highly accurate and reliable modality for preoperative staging of carcinoma rectum. It provides critical information on T-stage, circumferential resection margin, extramural vascular invasion, and nodal status with sensitivity and specificity comparable to the gold standard histopathological assessment. DWI sequences are particularly valuable in treatment response evaluation and surveillance for recurrence. MRI should be adopted as the standard first-line imaging investigation in rectal cancer management.

Aim: AI image generation is emerging as a practical adjunct in plastic surgery, especially for patient education, consultation, and expectation management. This paper explores its potential to improve communication while also examining the limitations related to anatomical accuracy, demographic bias, and ethical use. Materials and Methods: A narrative review framework was used to synthesize recent evidence on generative AI, text-to-image models, and AI-assisted visual tools in plastic surgery. Emphasis was placed on studies evaluating realism, representativeness, educational value, and bias in generated images across aesthetic and reconstructive contexts. Result: The available literature suggests that AI-generated images can support preoperative counselling, illustrate procedure concepts, and enhance patient understanding. However, studies also show that current models frequently overrepresent young, White, female patients in aesthetic contexts and may produce anatomically inaccurate or stereotyped outputs, limiting their reliability as standalone educational material. Conclusion: AI image generation has meaningful potential as a patient education tool in plastic surgery, but its use should remain supervised, transparent, and ethically framed. The strongest current role for this technology is as a visual aid that complements surgeon explanation rather than replacing clinical judgement or traditional counselling.

Background: Carbon dioxide (CO₂) pneumoperitoneum, which is integral to laparoscopic surgery, predictably induces sympathetic activation that manifests as elevated mean arterial pressure (MAP), tachycardia, and increased systemic vascular resistance (SVR). These hemodynamic perturbations, if left uncontrolled, can jeopardize patient safety, particularly in those with underlying cardiovascular morbidity. Both alpha-2 adrenergic agonists and selective beta-1 adrenergic receptor blockers have been studied as pharmacological interventions for attenuating this response. This randomized controlled trial compared the efficacy and adverse effect profiles of dexmedetomidine (an alpha-2 agonist) and metoprolol (a selective beta-1 blocker) in maintaining perioperative hemodynamic stability in patients undergoing elective laparoscopic surgery. Methods: Sixty-two patients of either sex, aged 18–65 years, classified as ASA physical status I or II, were randomly allocated into two equal groups of 31 each. Group D received a bolus dose of dexmedetomidine 1 µg/kg intravenously (IV), administered over 10 minutes, commencing 5 minutes before CO₂ pneumoperitoneum. Group M received IV metoprolol 50 µg/kg over 10 minutes, also starting 5 minutes before pneumoperitoneum. MAP and heart rate (HR) were recorded at six time points: baseline, before pneumoperitoneum, 15 minutes after pneumoperitoneum, 30 minutes after pneumoperitoneum, after release of pneumoperitoneum, and after extubation. Adverse events including hypotension, bradycardia, and hypertension were also recorded. Results: Both groups demonstrated effective attenuation of MAP and HR throughout the perioperative period. There was no statistically significant difference between the groups for MAP at any time point (P values ranged from 0.262 to 0.905). For HR, a statistically significant difference emerged from 30 minutes after pneumoperitoneum onward, with Group M showing lower heart rates (P = 0.009 at 30 min, P = 0.004 after release, P = 0.003 at extubation). However, adverse events were significantly more frequent in Group M: hypotension occurred in 4 patients (12.9%) and 0 patients in Groups M and D respectively (P = 0.000), while bradycardia requiring atropine occurred in 3 patients (9.66%) in Group M versus 1 patient (3.22%) in Group D (P = 0.000). Phenylephrine was required in 4 patients (12.9%) in Group M for intraoperative hypotension, while no patient in Group D required vasopressor support. Conclusion: Both dexmedetomidine and metoprolol effectively attenuate the hemodynamic stress response to CO₂ pneumoperitoneum during laparoscopic surgery. Comparative efficacy in MAP control is equivalent between the two agents. However, the adverse effect profile of dexmedetomidine is significantly more favourable, with lower incidences of intraoperative hypotension and bradycardia. Dexmedetomidine is therefore recommended as a safer agent for perioperative hemodynamic management in laparoscopic procedures.

Background: Cervical cancer (CC) is largely preventable through regular screening and HPV vaccination, yet awareness and utilization remain inadequate in many settings. Aim: To assess the knowledge, attitude, and practice regarding CC screening and HPV vaccination among women and health personnel. Methods: This prospective hospital-based study was conducted in the department of Obstetrics and Gynaecology, Kamineni Institute of Medical Sciences, Narketpally, from September 2025 to March 2026. A total of 240 participants, including 160 women and 80 health personnel, were enrolled using a structured pretested questionnaire. Data on sociodemographic details, knowledge, attitude, and preventive practice were collected and analysed using SPSS version 22.0. Chi-square test, Fisher’s exact test, logistic regression, and correlation analysis were applied. Results: Health personnel had significantly better awareness of CC, Pap smear, HPV infection, and HPV vaccination than women. Positive attitude towards screening and vaccination was also higher among health personnel. However, actual practice remained poor in both groups. Only a small proportion of women and health personnel had undergone Pap smear screening or received HPV vaccination. Conclusion: Despite relatively favourable awareness and attitude, preventive practices were inadequate. Focused education, counselling, and institution-based screening and vaccination strategies are essential.

Background: Epilepsy is a chronic neurological disorder requiring long-term anti-epileptic drug (AED) therapy. Prolonged AED use is often associated with adverse drug reactions (ADRs), increased treatment cost, and concerns regarding rational prescribing. Objectives: To evaluate the utilization pattern of AEDs, assess ADRs, and analyse the cost implications of AED therapy in a tertiary care teaching hospital in Assam. Methods: A prospective observational study was conducted among 328 patients receiving AED therapy over six months. Drug utilization was assessed using World Health Organization (WHO) prescribing indicators and Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology. ADRs were evaluated using Naranjo’s causality assessment scale and Hartwig’s severity assessment scale. Statistical analysis was performed using SPSS version 26.0. Results: Male patients constituted 59.76% of the study population. Generalized tonic–clonic seizures were the most common seizure type (68.29%). Polytherapy was prescribed more frequently (58.54%) than monotherapy (41.46%). Clobazam, levetiracetam, and phenytoin were the most commonly prescribed AEDs. A total of 125 patients experienced ADRs, predominantly central nervous system-related effects. Most ADRs were categorized as probable and mild in severity. Polytherapy was significantly associated with higher ADR incidence and treatment cost compared with monotherapy (p < 0.001). Logistic regression analysis showed that polytherapy independently increased the likelihood of ADR occurrence. Conclusion: Polytherapy and conventional AED use were associated with greater ADR burden and higher treatment cost. Rational prescribing and regular ADR monitoring may improve patient safety and therapeutic outcomes in epilepsy management.

Introduction: Age is an important determinant for maternal and fetal outcome. With changing lifestyles and to accomplish their professional goals, women are deliberately planning pregnancy in advanced age. Aims & Objectives: The objective of the study was to compare maternal and fetal outcomes in women with advanced maternal age and young pregnant women and to evaluate the risk factors associated with advanced maternal age and analyse the relationship between maternal age and pregnancy outcome. Methodology: This retrospective, comparative clinical study was performed in the Department of Obstetrics and Gynaecology at a tertiary care centre in Southern Rajasthan over six months. All females who delivered during this period were divided into two age groups. Group A included pregnant women of age less than 35 years & Group B included patients over 35 years or above. Data was collected from the medical record room and was analysed statistically. Results:  Most of the participants in this study were urban, educated, and booked. Significant Family history and past history (p-value .0003) were present in 40% and 68.57% of Group B females, respectively.  Artificial reproductive techniques were used by 14.28% of Group B females. First-trimester complications were present in 28.57% and 71.43% Group A and Group B women, respectively (p-value=0.000336, significant). Most common being bleeding per vaginum. Artificial feeding was opted by 20% of Group B mothers. The Fisher exact test statistic value is 0.0112. Conclusion: Despite medical advancements, age continues to be a significant factor in pregnancy. Regardless of the order of their pregnancies, middle-aged women had more first trimester and postpartum complications and chose artificial feeding more.

Aim: Sudden death in young adults is a major medico-legal and public health concern, especially when it occurs in apparently healthy individuals. The present autopsy-based study aimed to determine the demographic profile, pattern of causes, and major pathological findings among sudden death cases in the 20–40-year age group at a tertiary health care center. Sudden death in young persons is frequently linked to cardiovascular causes, but non-cardiac etiologies also contribute substantially, making postmortem evaluation essential for accurate diagnosis and prevention strategies. Materials and Methods: This retrospective descriptive autopsy study included all sudden death cases in individuals aged 20–40 years brought for medicolegal autopsy to a tertiary care center over the study period. Sudden death was defined as an unexpected natural death occurring within a short time of symptom onset in an apparently stable person. Data were collected from autopsy reports, histopathology records, and available clinical and police documentation. Variables analyzed included age, sex, residence, circumstances of death, gross autopsy findings, organ-specific causes, and histopathological correlations. Cases of traumatic death, decomposed bodies with inadequate evaluation, and incomplete records were excluded. The findings were summarized using descriptive statistics, and associations were tested using chi-square or Fisher’s exact test as appropriate. Result: The study showed male predominance among sudden death cases, with the highest frequency in the 31–40-year age group, followed by 20–30 years. Cardiovascular causes formed the largest group, especially ischemic heart disease, coronary atherosclerosis, acute myocardial infarction, and hypertrophic cardiac changes. Non-cardiac causes included pulmonary embolism, intracranial hemorrhage, bronchial asthma, and septic or infectious causes. A proportion of cases remained unascertained even after complete autopsy and histopathology, suggesting the possibility of primary arrhythmogenic disorders or subtle structural disease. Gross autopsy findings such as coronary narrowing, left ventricular hypertrophy, pulmonary edema, and thromboembolism were frequent accompanying observations. Conclusion: Sudden death in the 20–40-year age group is most often due to cardiovascular pathology, particularly premature coronary artery disease and structural cardiac abnormalities. Autopsy with histopathological examination remains the gold standard for identifying cause of death and for generating medico-legal as well as preventive health insights. Early recognition of risk factors, public awareness, and better screening of young adults may help reduce avoidable sudden deaths.

Background: Tooth eruption is a critical developmental milestone in children, influenced by genetic, nutritional, and endocrine factors. Vitamin D plays a central role in calcium and phosphorus metabolism which is vital for mineralization of bone and teeth. This study examines the association between Vitamin D deficiency and delayed tooth eruption in children. Objective: To determine whether serum Vitamin D levels are associated with the timing of tooth eruption in children aged 6–12 years. Methods: A cross-sectional observational study was conducted among 150 children attending the outpatient department at Shyam Shah Medical College, Rewa. Eruption status was assessed clinically and correlated with serum 25-hydroxyvitamin D levels. Delayed eruption was defined using standardized periodontal eruption charts and age-matched norms. Serum Vitamin D levels were categorized as sufficient (>30 ng/mL), insufficient (21–30 ng/mL), and deficient (<20 ng/mL). Results: Of the 150 subjects, 62 (41%) had Vitamin D deficiency, 45 (30%) had insufficiency, and 43 (29%) had sufficient levels. Delayed tooth eruption was observed in 48 children (32%). A significant association was found between Vitamin D deficiency and delayed eruption (p < 0.01). Children with deficient Vitamin D had 3.2 times higher odds of delayed tooth eruption compared to those with sufficient levels. Conclusion: Vitamin D deficiency is significantly associated with delayed tooth eruption in children. Early identification and correction of Vitamin D deficiency may support normal dental developmental patterns.

Background: Dental caries is the most prevalent chronic infectious disease of childhood, affecting oral health and possibly contributing to systemic conditions including recurrent upper respiratory tract infections (URTI). Few studies from Central India have explored this association. Objectives: To determine the prevalence of dental caries in children aged 3–12 years attending a tertiary care hospital in Rewa, Madhya Pradesh, and to investigate its association with the frequency of recurrent URTI. Methods: A hospital-based observational cross-sectional study was conducted at Shyam Shah Medical College & SGM Hospital, Rewa, from July 2023 to June 2024. A total of 312 children (age 3–12 years) were enrolled. Dental caries was assessed using the WHO DMFT/dmft index. URTI episodes were recorded from medical records and parental history. Logistic regression was used to assess association. Results: Dental caries prevalence was 63.5% (n=198). Mean dmft in primary dentition was 5.07 ± 2.61. Children with ≥6 URTI episodes/year had significantly higher caries prevalence (87.1%) compared to those with 0–2 episodes/year (42.9%; p<0.001). On multivariate logistic regression, frequent URTI (≥6/year) was independently associated with dental caries (aOR 6.72; 95% CI: 2.91–15.5; p<0.001), after adjusting for age, sex, socioeconomic status, and oral hygiene. Conclusions: A strong and independent association exists between dental caries and recurrent URTI in children. Integrated pediatric-dental screening programs and oral health promotion should be prioritized in tertiary care settings in Central India.

Background: The human skull exhibits numerous metrical and non-metrical traits that are important in anthropology, forensic identification, and anatomical research. Metrical traits involve measurable parameters such as cranial length and breadth, while non-metrical traits include sutural variations, foramina, and accessory bones. These features helps in sex determination and population studies. Aim: To analyze the metrical and non-metrical traits of adult human skulls and evaluate their anthropological significance. Materials and Methods: The present osteological study was conducted between 2022 and 2025 in the Department of Anatomy. Fifty adult dry human skulls of unknown sex were examined. Standard anthropometric instruments were used for recording cranial length, breadth, height, and cephalic index. Non-metrical traits such as metopic suture, wormian bones, supraorbital notch/foramen, and accessory foramina were observed and documented. Data were analyzed descriptively. Results: The mean cranial length was 176.4 ± 6.2 mm and mean cranial breadth was 132.8 ± 5.4 mm. The average cephalic index was 75.3 indicating predominance of mesocephalic skull type. Metopic suture was observed in 8% skulls. Wormian bones were present in 26% specimens. Supraorbital foramen was seen bilaterally in 42% skulls. Conclusion: Considerable variation exists in both metrical and non-metrical traits of skull. These findings are useful in forensic identification, racial classification, and clinical practices involving cranial surgeries.

Background: Acute myocardial infarction (AMI) commonly occurs in individuals with multiple coexisting cardiovascular risk factors. Serum ferritin, apart from reflecting iron stores, is increasingly recognized as a mark-er of inflammation and metabolic dysfunction. Aim: To determine the correlation between serum ferritin levels and risk factors such as hypertension, diabetes mellitus, dyslipidemia, smoking, and obesity in patients with AMI. Methods: This prospective observational study was conducted in the Department of General Medicine, Great Eastern Medical School and Hospital, Ragolu, Srikakulam, Andhra Pradesh. A total of 107 patients with AMI were included. Clinical details, demographic variables, cardiovascular risk factors, and laboratory investigations including serum ferritin estimation by chemiluminescent immunoassay were recorded. Statistical analysis was performed using descriptive and inferential methods, and associations between ferritin levels and risk factors were assessed. Results: Hypertension was the most frequent risk factor (64.5%), followed by smoking (63.6%), diabetes melli-tus (59.8%), dyslipidemia (59.8%), and obesity (57.9%). Mean serum ferritin levels were significantly higher in patients with hypertension (377.85 vs 284.55 ng/mL, p=0.009), diabetes (392.45 vs 273.67 ng/mL, p=0.001), dyslipidemia (426.37 vs 223.18 ng/mL, p<0.001), obesity (416.29 vs 246.10 ng/mL, p<0.001), and smoking (387.56 vs 270.00 ng/mL, p=0.01). Conclusion: Serum ferritin was significantly associated with all major cardiovascular risk factors in AMI, sug-gesting its utility as a marker of cumulative cardiometabolic risk burden.

Background: Thoracic epidural anaesthesia (TEA) is widely used for abdominal surgeries as it provides effec-tive segmental anaesthesia, reduces systemic opioid requirement, and improves perioperative analgesia. Levobu-pivacaine and ropivacaine are long-acting amide local anaesthetics with favourable safety profiles. Aim: To compare the anaesthetic efficacy, duration of blockade, haemodynamic stability, conversion to general anaesthesia, and early postoperative analgesia between 0.5% levobupivacaine and 0.75% ropivacaine adminis-tered through the thoracic epidural route. Methods: This comparative clinical study included 60 patients undergoing abdominal surgeries under TEA. Patients were allocated into two groups of 30 each. Group A received 15 ml of 0.5% levobupivacaine, while Group B received 15 ml of 0.75% ropivacaine. Onset of sensory block, time to maximum sensory level, dura-tion of epidural anaesthesia, intraoperative fentanyl requirement, haemodynamic parameters, conversion to gen-eral anaesthesia, adverse effects, and postoperative VAS scores were recorded. Results: Levobupivacaine produced significantly faster onset of sensory block, shorter time to maximum senso-ry level, longer duration of epidural anaesthesia, lower fentanyl requirement, and lower VAS scores at 1 and 2 hours compared with ropivacaine. Haemodynamic stability and adverse effects were comparable. Conclusion: Levobupivacaine 0.5% provided superior sensory blockade and early postoperative analgesia com-pared with ropivacaine 0.75%, with comparable safety.

Background: Acne vulgaris is a common inflammatory dermatosis in adolescents and young adults and may significantly affect psychosocial well-being in addition to producing visible skin lesions. Objective: To assess the pattern and clinical severity of acne vulgaris and to evaluate its impact on quality of life (QoL) among adolescents and young adults attending the outpatient department. Methods: This prospective hospital-based observational study was conducted at KIMS, Amalapuram, from September 2025 to February 2026 among 180 patients with acne vulgaris. Demographic and clinical details were recorded using a predesigned proforma. Acne pattern was assessed by site and lesion type, severity was graded using standard clinical criteria, and QoL was measured using DLQI/CDLQI. Data were analysed using SPSS 21.0. Chi-square test, t-test, ANOVA, and correlation analysis were applied, with P <0.05 considered significant. Results: Moderate acne was the commonest grade (41.1%). Comedones (84.4%), papules (78.9%), and pustules (52.2%) were the predominant lesions. Scarring and post-inflammatory hyperpigmentation were observed in 28.3% and 41.7%, respectively. Mean DLQI scores increased significantly with acne severity (P <0.001), and acne grade showed strong positive correlation with QoL impairment (r = 0.71, P <0.001). Conclusion: Acne vulgaris caused substantial psychosocial burden, particularly in patients with moderate-to-severe, persistent, and scarring disease, highlighting the need for comprehensive clinical and psychosocial management.

Background: Solitary thyroid nodules (STNs) are common endocrine disorders with a reported prevalence of 4–7% in the general population. Although most nodules are benign, a significant proportion may harbor malignancy. Fine Needle Aspiration Cytology (FNAC) is widely used as the primary diagnostic tool for evaluating thyroid nodules; however, histopathological examination (HPE) remains the gold standard for definitive diagnosis. Establishing the correlation between FNAC and histopathology is essential for improving diagnostic accuracy and guiding appropriate management. Aim: To assess the correlation between FNAC findings and histopathological findings in patients with solitary thyroid nodules. Materials and Methods: This prospective study was conducted over 18 months in the Department of General Surgery at a tertiary teaching hospital. Forty patients with clinically diagnosed solitary thyroid nodules were included. All patients underwent clinical evaluation, thyroid profile assessment, and ultrasonography of the neck, FNAC, and subsequent histopathological examination following surgery. Statistical analysis was performed using SPSS version 20, with a p-value ≤0.05 considered significant. Results: Among the 40 patients studied, females predominated (75%), with the highest incidence occurring between 41 and 60 years of age. Dysphagia (30%) was the most common presenting complaint. FNAC categorized 62.5% of nodules as benign, 20% as suspicious, and 17.5% as malignant, whereas histopathology revealed 70% benign and 30% malignant lesions. Colloid nodular goiter was the most frequent benign lesion, while papillary carcinoma was the most common malignancy. FNAC demonstrated a sensitivity of 88%, specificity of 57.1%, positive predictive value of 88%, negative predictive value of 57.1%, and overall diagnostic accuracy of 75% when correlated with histopathology. Discussion: The study highlights the predominance of STNs among middle-aged females and confirms the usefulness of FNAC as an effective preoperative diagnostic modality. While FNAC showed high sensitivity in detecting benign lesions and papillary carcinoma, limitations were observed in differentiating certain follicular and Hurthle cell lesions, emphasizing the continued importance of histopathological confirmation. Conclusion: FNAC is a simple, cost-effective, and reliable first-line investigation for solitary thyroid nodules, demonstrating good correlation with histopathological findings. Its routine use can facilitate early diagnosis, appropriate surgical planning, and reduction of unnecessary thyroid surgeries.

Background: Allergic rhinitis (AR) is a chronic inflammatory disorder of the nasal mucosa mediated by immunoglobulin E (IgE) after exposure to environmental allergens. It is characterized by sneezing, rhinorrhea, nasal obstruction, itching, and frequently associated ocular symptoms. Allergic rhinitis significantly impairs quality of life, sleep, school performance, and workplace productivity. Pharmacological management primarily includes intranasal corticosteroids and second-generation H1 antihistamines; however, their comparative effectiveness remains an area of clinical interest. Aim: To compare the efficacy and safety of intranasal corticosteroids and oral levocetirizine in patients with allergic rhinitis. Materials and Methods: A hospital-based observational comparative study was conducted in the Departments of Pharmacology and Otorhinolaryngology of Muzaffarnagar Medical College and Hospital, Uttar Pradesh. A total of 150 adult patients diagnosed with allergic rhinitis were enrolled. Patients were divided into two groups: Group A received intranasal corticosteroids and Group B received oral levocetirizine 5 mg. Clinical efficacy was assessed using Total Nasal Symptom Score (TNSS), Total Ocular Symptom Score (TOSS), and Total Symptom Score (TSS) at 1 week, 1 month, and 3 months. Adverse drug reactions were recorded during follow-up. Statistical analysis was performed using SPSS version 29, and p <0.001 was considered statistically significant. Results: The mean age of participants was 28.61±6.51 years. Significant reductions in TNSS, TOSS, and TSS were observed in both treatment groups during follow-up. Group A demonstrated superior improvement in TNSS at 1 week (4.27±1.65 vs 6.03±2.05), 1 month (1.49±0.95 vs 4.29±2.01), and 3 months (0.95±0.84 vs 3.76±2.00). Similarly, TSS was significantly lower in Group A at 1 month and 3 months. Adverse drug reactions occurred in 12% of patients receiving intranasal corticosteroids and 20% of patients receiving levocetirizine. Conclusion: Intranasal corticosteroids demonstrated superior efficacy in controlling nasal symptoms and overall disease burden compared to oral levocetirizine. Both therapies were safe; however, intranasal corticosteroids showed better long-term symptom control with fewer systemic adverse effects.

Background: Epilepsy is one of the most recognised neurological disorders, particularly in children, which contributes significantly to global morbidity, especially in developing countries like India. Antiepileptic drugs (AEDs) remain the cornerstone of treatment, but the variations in prescribing patterns and poor medication ad-herence can adversely affect seizure control and quality of life. Objectives: To evaluate the prescribing patterns of AEDs and assess medication adherence among paediatric patients with epilepsy. Methods: A hospital-based observational method is utilised for assessing paediatric epilepsy patients on AED therapy. Prescribing patterns, including drug selection, type of therapy and patients’ adherence to the treatment regimen are analysed. Medication adherence is assessed along with influencing factors such as adverse drug reac-tions (ADRs). Results: In comparison to polytherapy, which is associated with elevated ADR burden and reduced adherence, monotherapy remains the preferred treatment approach, achieving seizure control in most patients. Despite some behavioural adverse effects, newer antiepileptics are increasingly preferred due to better safety and tolerability profiles. Simpler regimens demonstrate better adherence compared to complex multidrug therapies. Conclusion: Therapeutic success, in paediatric epilepsy, depends on two significant determinants, namely Pre-scribing patterns and medication adherence. Rational prescribing, preference for monotherapy, and active phar-macovigilance are crucial to improve adherence and clinical outcomes.

Background: Acute bronchiolitis is the most common lower respiratory tract infection among infants and children younger than two years of age and remains a major cause of hospitalization worldwide. The disease is characterized by inflammation, edema, necrosis of epithelial cells lining the small airways, and increased mucus production, resulting in airway obstruction and respiratory distress. Respiratory Syncytial Virus (RSV) is the most frequently implicated pathogen, accounting for approximately 60–80% of cases. Although supportive care remains the cornerstone of treatment, nebulized therapies such as hypertonic saline and adrenaline are widely used to improve clinical outcomes. Aim: To compare the efficacy and duration of hospitalization associated with nebulized 3% hypertonic saline and nebulized adrenaline in pediatric patients suffering from acute bronchiolitis. Materials and Methods: A prospective observational study was conducted in the Departments of Pharmacology and Pediatrics at Muzaffarnagar Medical College and Hospital, Uttar Pradesh. A total of 100 children aged 3 months to 3 years diagnosed with acute bronchiolitis were enrolled. Fifty patients received nebulized 3% hypertonic saline and fifty received nebulized adrenaline. Clinical severity was assessed using the Wang Bronchiolitis. Statistical analysis was performed using SPSS version 29. Results: Among the enrolled patients, 96 completed the study. Hypertonic saline therapy resulted in significantly greater improvement in respiratory rate scores, wheezing scores, chest retraction scores, and general appearance scores compared to adrenaline therapy. By Day 3, respiratory rate scores decreased from 2.22±0.61 to 1.34±0.47 in the hypertonic saline group compared with 2.44±0.67 to 1.80±0.53 in the adrenaline group. Wheezing scores declined significantly by Day 3 (0.92±0.27 vs 1.31±0.27, p<0.05). Mean duration of hospitalization was significantly shorter in the hypertonic saline group (4.32±0.59 days) compared to the adrenaline group (8.72±0.72 days; p<0.001). Conclusion: Patients receiving nebulized hypertonic saline showed greater reductions in respiratory distress, wheezing, chest retractions, and overall disease severity scores, along with a significantly shorter duration of hospitalization. These findings suggest that nebulized 3% hypertonic saline is an effective and clinically beneficial therapeutic option for the management of acute bronchiolitis in pediatric patients.

Background: Preeclampsia is a multisystem hypertensive disorder of pregnancy and remains a major cause of maternal and perinatal morbidity and mortality worldwide. It is associated with significant maternal complications, including eclampsia, HELLP syndrome, postpartum hemorrhage, and adverse neonatal outcomes such as preterm birth, low birth weight, and perinatal death. Early identification and time management are essential to improve pregnancy outcomes. Aim: To evaluate the maternal and perinatal outcomes among patients diagnosed with preeclampsia at a tertiary care hospital. Methodology: This retrospective hospital-based observational study was conducted in the Department of Obstetrics and Gynecology, Patna Medical College and Hospital, Patna, Bihar, India, over a period of one year. A total of 125 pregnant women diagnosed with preeclampsia and fulfilling the eligibility criteria were included. Data were retrieved from hospital records and analyzed for demographic characteristics, severity of preeclampsia, maternal complications, mode of delivery, and perinatal outcomes. Results: Most patients were aged 26–30 years (42.4%), and 56.8% were primigravidae. Severe preeclampsia was observed in 65.6% of cases. Maternal complications included blood transfusion requirement (12.0%), eclampsia (9.6%), postpartum hemorrhage (8.0%), HELLP syndrome (6.4%), and placental abruption (5.6%). Preterm delivery occurred in 60.0% of pregnancies, while cesarean section was performed in 62.4% of cases. Low birth weight (<2.5 kg) was observed in 68.8% of neonates, 43.2% required NICU admission, and perinatal mortality was recorded in 12.0% of cases. Conclusion: Preeclampsia is associated with substantial maternal and perinatal morbidity, particularly due to severe disease, preterm birth, and low birth weight. Strengthening antenatal surveillance, early diagnosis, and timely obstetric intervention can significantly improve maternal and neonatal outcomes.

Background: Soft tissue defects around the knee joint are caused by varied etiology. They present a challenge to the treating surgeon as the flap used for these has to not only cover the defect but also has to be pliable enough to restore full mobility of the joint after healing. Moreover, due to pliable and relatively lax skin, we have used inferiorly based anterolateral and Anteromedial thigh flap to reconstruct defects around knee joint. Aims and Objectives: The aim of this study is to evaluate the use of inferiorly based anterolateral and Anteromedial thigh flap to cover soft-tissue defects over the proximal one-third of the leg, patellar region, knee, and lower thigh. Materials and Methods: This study was conducted during the period between July 2024 and March 2026. Inferiorly based anteromedial thigh fasciocutaneous flap was performed on 12 patients and inferiorly based anterolateral thigh fasciocutaneous flap on 16 patients. The sites of the soft-tissue defects included patellar regions, infrapatellar region, suprapatellar region, and over the knee joint. Results: Patients were evaluated post-operatively in terms of viability of flap, the matching of the flap with the recipient site, and donor site morbidity. All the flaps survived well except two which developed distal one centimeter marginal flap loss, two in which wound dehiscence was noticed. Two patient with wound dehiscence achieved complete healing by secondary intention. Patient who developed distal flap loss required debridement and skin grafting. No appreciable4 donor site morbidity was encountered. Skin colour and texture of the flap matched well with the recipient site. knee joint movement was adequate and according to the primary joint pathology. Conclusions: The inferiorly based anterolateral and Anteromedial thigh flap is a reliable flap to cover the defect over patellar regions, infrapatellar region, suprapatellar region, and over the knee joint.

Background: Diabetes mellitus (DM) and tuberculosis (TB) are among the leading global public health concerns, with multidrug-resistant tuberculosis (MDR-TB) representing a major challenge to effective disease management. Diabetes mellitus alters carbohydrate and lipid metabolism and weakens host immunity, thereby increasing susceptibility to tuberculosis infection and worsening treatment outcomes. Patients with concurrent diabetes mellitus and MDR-TB frequently exhibit abnormalities in blood glucose regulation and lipid metabolism, which may contribute to increased morbidity and poor prognosis. Therefore, assessment of lipid profile and blood sugar levels in such patients is important for appropriate clinical management and prevention of complications. Aim and Objectives: To evaluate the lipid profile and blood sugar levels in patients with diabetes mellitus and multidrug-resistant tuberculosis attending Government Medical College, Nirmal, and Telangana. Materials and Methods: This hospital-based observational study was conducted in the Department of General Medicine and associated departments at Government Medical College, Nirmal, Telangana, over a period of 12 months. The study included 120 patients diagnosed with diabetes mellitus and MDR-TB who fulfilled the inclusion and exclusion criteria. After obtaining informed consent, detailed demographic and clinical data were collected from all participants. Venous blood samples were collected under aseptic conditions for estimation of fasting blood sugar (FBS), postprandial blood sugar (PPBS), and serum lipid profile parameters including total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL). The collected data were analysed statistically using suitable methods, and the results were expressed as mean, standard deviation, frequencies, and percentages. Results: The study findings revealed that a majority of patients with diabetes mellitus and MDR-TB had poor glycaemic control and abnormal lipid profiles. Elevated fasting and postprandial blood glucose levels were observed in most participants. Significant dyslipidaemia characterized by increased total cholesterol, triglycerides, LDL, and VLDL levels along with reduced HDL levels was also noted. These metabolic abnormalities may adversely influence the clinical course and therapeutic response in MDR-TB patients with diabetes mellitus. Conclusion: The present study demonstrates a high prevalence of dyslipidaemia and uncontrolled blood sugar levels among patients with diabetes mellitus and MDR-TB. Routine monitoring of glycemic status and lipid profile is essential for early identification of metabolic derangements and effective patient management. Integrated therapeutic approaches targeting both diabetes mellitus and MDR-TB may improve treatment outcomes and reduce disease-related complications.

Background: In developing countries, organized screening programs for cervical cancer are scarce, and the disease is a significant contributor to morbidity and mortality among women. Cervical cytology, colposcopy and histopathological examination are important in early detection of pre-cancerous lesions and to prevent progression of disease. In the present study the correlation between the above-mentioned diagnostic modalities was assessed in women with cervical lesions. Objective: To determine the correlation between the colposcopy findings, cervical cytology and histopathological diagnosis in the evaluation and management of cervical lesions among women attending Gynecology OPD, Nalanda Medical College and Hospital, Patna. Methodology: It is a cross-sectional study conducted at hospital with 90 women suspected of cervical pathology who attended in Gynecology OPD for one year. All were examined by Pap smear and colposcopy, and when needed, were biopsied with a colposcopy. Histopathological examination was used as the gold standard method of diagnosis. Result: Indicated that majority of the participants were multiparous and aged between 31-40 years. Chronic cervicitis was the most frequent histopathological diagnosis while in considerable percentage of women, the pathological lesions were of pre-cancerous and cancerous nature. The Pap smear’s sensitivity and specificity were 77.8% and 91.7%, respectively, with a PPV of 70.0% and an NPV of 94.3%. Colposcopy showed higher sensitivity (94.4%), specificity (90.3%), PPV (70.8%), and NPV (98.5%). The results of the combined application of cytology and colposcopy gave a total diagnostic accuracy of 82.2%. Conclusion: It was concluded that colposcopy had the highest sensitivity than cervical cytology and histopathology was the most definitive diagnostic tool. Cervical cytology in combination with colposcopy with follow-up of suspicious lesions by a biopsy enhances the accuracy of the diagnosis and aids in the timely management of cervical premalignant and malignant lesions.

Background: Soft ^‘tissue lesions comprise a heterogeneous group of non-epithelial tumors ranging from benign reactive processes to aggressive malignant neoplasms. Histopathological evaluation plays a crucial role in accurate diagnosis and management. Aim: To analyze the histopathological spectrum of soft tissue lesions and correlate them with clinical and demographic parameters in a tertiary care center. Methodology: This retrospective observational study was conducted in the Department of Pathology, Bhagwan Mahavir Institute of Medical Sciences, Bihar, over a period of two years. A total of 60 Histoclinicaly/ Radiologicaly confirmed cases were included. Clinical details, radiological findings, and microscopic features were reviewed. Data were analyzed using SPSS version 27.0. Results: The majority of cases occurred in the 41–60 years age group (36.7%) with a slight male predominance (56.7%). Painless swelling was the most common clinical presentation (63.3%). Benign lesions constituted 66.7% of cases, while malignant tumors accounted for 30%. Lipoma was the most frequent diagnosis (25%), followed by fibroma and schwannoma. Conclusion: Benign soft tissue lesions predominate, but malignant tumors form a significant proportion, highlighting the essential role of^’ histopathology in diagnosis and management.

Background: Breast carcinoma remains the most commonly diagnosed malignancy among women worldwide and a leading cause of cancer-related mortality. Immunohistochemical (IHC) markers such as estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2/neu) provide crucial prognostic and predictive information, enabling personalized treatment strategies. Differences in receptor expression according to menopausal status may influence disease behaviour and therapeutic outcomes. Aim and Objectives: To evaluate the expression of ER, PR, and HER2/neu in breast carcinoma and assess their association with menopausal status. The study also aimed to compare receptor expression patterns between premenopausal and postmenopausal women and determine their utility in guiding prognosis and treatment. Methodology: This prospective observational study was conducted over 22 months in the Department of General Surgery, Government General Hospital, Guntur. Sixty women with histologically confirmed breast carcinoma were enrolled and categorized into premenopausal (n=30) and postmenopausal (n=30) groups. Clinical, demographic, pathological, and reproductive data were collected using a structured proforma. Immunohistochemical analysis for ER, PR, and HER2/neu expression was performed using standardized protocols, and comparative statistical analysis was undertaken. Results: The mean age was significantly lower in premenopausal women (42.8±3.4 years) than postmenopausal women (62.1±7.6 years; p<0.001). Invasive ductal carcinoma was the predominant histological subtype in both groups (90%). ER positivity was observed in 36.7% of premenopausal and 53.3% of postmenopausal patients, while PR positivity was noted in 33.3% and 50%, respectively. HER2/neu positivity was significantly higher among premenopausal women (43.3% vs. 20%; p=0.05). Triple-negative breast cancer was identified in 20% of premenopausal and 23.3% of postmenopausal patients. Hormonal therapy eligibility was higher among postmenopausal women (50% vs. 33.3%). Conclusion: Postmenopausal women demonstrated higher ER and PR expression, indicating greater responsiveness to endocrine therapy, whereas premenopausal women exhibited increased HER2/neu positivity, suggesting more aggressive tumor biology. Routine assessment of IHC markers is essential for prognostication and individualized management of breast carcinoma.

Background: Cutaneous adverse drug reactions (CADRs) are among the most frequently encountered adverse drug reactions and represent an important challenge in clinical practice and pharmacovigilance. They range from mild self-limiting eruptions to severe life-threatening conditions, contributing significantly to patient morbidity and healthcare burden. Monitoring the pattern and causative agents of CADRs is essential for improving patient safety and promoting rational drug use. Aim: To evaluate the pattern, causality, severity, and outcomes of cutaneous adverse drug reactions reported at a tertiary care teaching hospital in Southern Rajasthan. Methods: This retrospective observational study was conducted at a tertiary care teaching hospital in Southern Rajasthan. All suspected CADRs reported by the Department of Dermatology between January 2023 and De-cember 2025 under the Pharmacovigilance Programme of India (PvPI) were analysed. Incomplete reports were excluded. Data regarding demographic profile, clinical presentation, suspected drugs, severity, outcomes, and causality assessment were collected and analysed using descriptive statistics. Causality assessment was per-formed using the WHO–UMC causality assessment scale. Results: A total of 127 CADR reports were analysed. The majority of patients belonged to the 21–40 years age group (43.5%), with male predominance (55.2%). Fixed drug eruption was the most commonly reported CADR (43.3%), followed by hyperpigmented patches, urticaria, erythematous plaques, and maculopapular rashes. Of-loxacin (37.0%) and ornidazole (34.6%) were the most frequently implicated drugs, followed by paracetamol and diclofenac. Most suspected drugs were administered orally (98.4%). According to WHO–UMC causality assessment, 86.6% of ADRs were classified as probable and 13.4% as possible. Most reactions were non-serious (93.7%), and the majority of patients were recovering or had recovered following withdrawal of the suspected drug. Conclusion: Fixed drug eruption was the most common CADR observed in the study, with antimicrobials and non-steroidal anti-inflammatory drugs being the major causative agents. Most reactions were non-serious and showed favourable outcomes after prompt withdrawal of the offending drug. Strengthening pharmacovigilance activities and increasing awareness regarding early recognition and reporting of CADRs can significantly im-prove patient safety and rational drug use.

Background: Supraclavicular brachial plexus block is commonly used for upper limb surgeries. Levobupivacaine provides effective regional anaesthesia, but its duration may be limited. Dexamethasone has been used as an adjuvant to prolong postoperative analgesia. Aim: To compare the efficacy of 0.5% levobupivacaine with 8 mg dexamethasone and 0.5% levobupivacaine with normal saline in terms of onset of sensory and motor blockade and duration of postoperative analgesia. Methods: This prospective randomized study was conducted in the Department of Anaesthesiology, Rangaraya Medical College, Government General Hospital, Kakinada, over 18 months. Fifty ASA I and II patients aged 18–60 years undergoing upper limb surgery were randomized into two groups. Group S received 25 mL of 0.5% levobupivacaine with 8 mg dexamethasone, while Group M received 25 mL of 0.5% levobupivacaine with 2 mL normal saline. Sensory and motor block onset, block duration, VAS scores, and rescue analgesia requirement were assessed. Results: Group S showed significantly faster sensory and motor block onset, longer sensory and motor block duration, delayed first rescue analgesia, and lower postoperative VAS scores compared with Group M. No major complications were observed. Conclusion: Dexamethasone significantly enhanced the efficacy of levobupivacaine in supraclavicular brachial plexus block.

Background: The Heidelberg triangle operation has emerged as an important surgical approach for achieving radical clearance of periarterial, neural, and lymphatic tissue in periampullary malignancies. However, data regarding the frequency and clinical significance of tumour positivity within the Heidelberg triangle specimen remain limited, particularly in patients with periampullary carcinoma. Aim: To determine the tumour positivity rate in the Heidelberg triangle specimen and evaluate its association with preoperative, operative, histopathological, nodal, and postoperative variables in patients undergoing triangle operation for periampullary carcinoma. Methodology: This prospective observational study was conducted in the Department of Surgical Gastroenterology, IGIMS, Patna, from February 2024 to April 2026. Fifty consecutive patients with periampullary carcinoma who underwent triangle operation were included. Demographic, clinical, operative, pathological, nodal, and postoperative data were analyzed. Comparisons between triangle tissue-positive and triangle tissue-negative groups were performed using the Mann–Whitney U test and Fisher’s exact test, with p<0.05 considered statistically significant. Results: The mean age of the patients was 54.0 ± 12.0 years, and 62.0% were male. Heidelberg triangle tissue positivity was identified in 4 of 50 patients, yielding a positivity rate of 8.0% (95% CI: 2.2%–19.2%). Triangle-positive patients had significantly higher CA 19-9 levels (950.0 ± 500.0 vs. 381.8 ± 520.7 U/mL; p=0.037), longer operative time (427.5 ± 15.0 vs. 379.6 ± 47.0 minutes; p=0.027), increased perineural invasion (75.0% vs. 8.7%; p=0.007), higher positive lymph node count (4.00 ± 2.94 vs. 0.41 ± 1.24; p=0.002), greater nodal positivity (75.0% vs. 17.4%; p=0.029), and universal triangle lymph node positivity (100.0% vs. 0.0%; p<0.001). Conclusion: Tumour positivity within the Heidelberg triangle specimen was uncommon but strongly associated with aggressive locoregional disease characteristics, including elevated CA 19-9, perineural invasion, and increased nodal burden. Separate assessment of Heidelberg triangle tissue may provide valuable prognostic information and improve pathological staging in periampullary carcinoma.

Schizophrenia is a chronic and complex psychiatric condition marked by positive symptoms (such as hallucinations and delusions), negative symptoms (such as reduced emotional expression and social withdrawal), and a range of cognitive impairments. Dysregulation of various neurotransmitters has been extensively discussed as a core feature of its pathogenesis, with dopamine traditionally holding a central position. However, accumulating data suggest that other transmitter systems—including glutamate, gamma-aminobutyric acid (GABA), and serotonin—also significantly influence the emergence and maintenance of schizophrenic symptoms. This meta-analysis aims to integrate findings on key neurotransmitters (dopamine, glutamate, GABA, and serotonin) in schizophrenia, particularly focusing on differences between those with schizophrenia and unaffected individuals. We performed systematic searches in PubMed, Scopus, and Web of Science for literature published from January 2015 to May 2023. Eligible studies included those with a formal diagnosis of schizophrenia, robust measures of neurotransmitter or receptor function, and sufficient numerical data to calculate standardized effect sizes. A total of 62 studies (comprising 4,857 people with schizophrenia and 3,211 comparison subjects) met the criteria. Results revealed that dopaminergic markers (notably, D2 receptor availability) exhibited a strong pooled effect size (~0.91), reinforcing long-standing dopaminergic models. Glutamatergic findings, especially reductions in NMDA receptor activity, showed a moderate-to-large effect (~0.67). GABAergic anomalies (e.g., decreased inhibitory markers like GAD67) displayed a moderate effect (~0.59). Meanwhile, serotonergic alterations (often elevated 5-HT2A receptor activity) yielded a modest but statistically significant effect (~0.48). Substantial variability was noted across study approaches and participant characteristics. In conclusion, while dopamine remains pivotal, significant disruptions in glutamate, GABA, and serotonin also appear to shape the symptom profile of schizophrenia. Future research, employing multimodal and longitudinal designs, is essential to unravel how these neurotransmitter interactions may inform more nuanced treatment strategies.

Background: Thyroid disorders are associated with autonomic nervous system dysfunction, resulting in altered cardiovascular regulation and postural hemodynamic responses. The vestibulo-sympathetic reflex (VSR) plays a crucial role in maintaining cardiovascular stability during postural changes; however, its involvement in thyroid disorders remains poorly understood. This study aimed to assess vestibulo-sympathetic reflex dysfunction in patients with thyroid disorders using caloric temperature stimulation and orthostatic cardiovascular testing. Materials and Methods: A hospital-based comparative cross-sectional study was conducted over 12 months in the Departments of Physiology and Otorhinolaryngology. A total of 120 participants were enrolled into three groups: hypothyroidism (n=40), hyperthyroidism (n=40), and healthy euthyroid controls (n=40). Thyroid function was assessed using serum TSH, FT3, and FT4 levels. Vestibulo-sympathetic reflex function was evaluated by caloric temperature stimulation, while autonomic cardiovascular responses were assessed using orthostatic testing. Heart rate and blood pressure responses were compared among the three groups. Results: Patients with hypothyroidism demonstrated reduced orthostatic heart rate responses and attenuated cardiovascular responses during caloric stimulation, whereas patients with hyperthyroidism exhibited enhanced sympathetic responses compared with healthy controls. Orthostatic cardiovascular parameters and caloric test responses differed significantly among the study groups (p<0.05). Serum TSH showed a significant negative correlation with orthostatic heart rate response, while FT3 and FT4 demonstrated positive correlations with vestibulo-autonomic parameters. Conclusion: Assessment of the vestibulo-sympathetic reflex using caloric temperature stimulation and orthostatic testing appears to be a simple and non-invasive approach for detecting autonomic dysfunction in thyroid disorders. These findings suggest that vestibulo-autonomic assessment may complement routine clinical evaluation and facilitate early identification of autonomic impairment.

Background: Emergency laparotomy for gastrointestinal conditions is associated with significant postoperative morbidity and mortality. Early identification of patients at risk of adverse outcomes remains a major challenge. Serum albumin is not only a nutritional marker but also an indicator of surgical stress and systemic inflammatory response. A postoperative decline in serum albumin may serve as an early predictor of complications. Aim: To evaluate the correlation between postoperative serum albumin drop and postoperative morbidity and mortality in patients undergoing emergency laparotomy for gastrointestinal conditions. Materials and Methods: This was a prospective observational study conducted on 84 patients undergoing emergency laparotomy for gastrointestinal conditions in Department of General Surgery, Siddhartha Medical College & Hospital, and Vijayawada. Serum albumin levels were measured preoperatively, at 6 hours postoperatively, on postoperative day (POD) 1, and POD 3. A decline of ≥1 g/dL on POD1 was considered significant. Postoperative complications including surgical site infection (SSI), sepsis, anastomotic leak, respiratory complications, and mortality were recorded. Statistical analysis was performed using chi-square test, t-test, and ANOVA. Results: Among 84 patients, 45 (53.6%) developed postoperative complications. The mean preoperative albumin level was 3.92 ± 0.34 g/dL, decreasing to 2.79 ± 0.41 g/dL on POD1. A significant albumin drop (≥1 g/dL) was observed in 32 of 45 patients (71.1%) with complications compared to only 1 of 39 patients (2.6%) without complications (p<0.001). Mortality occurred in 8 patients (9.5%), all of whom demonstrated an albumin decline exceeding 1 g/dL. The sensitivity, specificity, positive predictive value, and diagnostic accuracy of albumin drop for predicting postoperative complications were 71.1%, 97.4%, 97.0%, and 83.3%, respectively. Conclusion: A postoperative serum albumin decline of ≥1 g/dL within 24 hours is a reliable, inexpensive, and early predictor of postoperative morbidity and mortality following emergency laparotomy for gastrointestinal conditions. Routine monitoring may facilitate early intervention and improved outcomes.

Background: Locally advanced breast cancer (LABC) remains a common presentation among Indian women. Neoadjuvant chemotherapy (NACT) has become an integral component of multimodality treatment due to its ability to downstage tumors and improve surgical outcomes. Objectives: To compare treatment outcomes among patients with locally advanced breast cancer managed with neoadjuvant chemotherapy followed by surgery versus upfront surgery followed by adjuvant chemotherapy. Materials and Methods: A combined retrospective and prospective observational study was conducted in a tertiary cancer care centre over 18 months. A total of 120 patients with Stage IIIA–IIIC breast cancer were included. Seventy patients received NACT followed by surgery, while fifty patients underwent upfront surgery followed by adjuvant chemotherapy. Clinical response, pathological response, surgical outcomes, recurrence, disease-free survival (DFS), and overall survival (OS) were analyzed. Results: The mean age was 49.8±10.6 years. Clinical response to NACT was observed in 80% of patients. Pathological complete response (pCR) was achieved in 17.1% of patients. Breast conservation surgery was feasible in 20% of patients in the NACT group compared to 4% in the upfront surgery group (p=0.01). Axillary nodal down staging occurred in 58.6% of NACT patients. Two-year DFS and OS were 84.3% and 91.4% respectively in the NACT group compared to 74.0% and 84.0% in the upfront surgery group. Conclusion: Neoadjuvant chemotherapy significantly improves operability, breast conservation rates, and nodal down staging in patients with locally advanced breast cancer. Patients achieving pathological complete response demonstrated superior survival outcomes.

Background: The long-term success of endodontic treatment depends not only on effective disinfection of the root canal system but also on the preservation of tooth structure and resistance to fracture. Different instrumentation systems and irrigation activation techniques may influence the biomechanical properties of root dentin and ultimately affect the fracture resistance of endodontically treated teeth. Reciprocating file systems such as R-Motion have been introduced to minimize dentinal stress, while advanced irrigation activation methods including diode laser and ultrasonic activation aim to enhance canal disinfection. Aim: To evaluate and compare the fracture resistance of endodontically treated teeth following root canal preparation using R-Motion and ProTaper Next file systems with diode laser and ultrasonic irrigation activation techniques. Materials and Methods: This in vitro experimental study was conducted on 58 extracted human permanent single-rooted teeth. The specimens were randomly allocated into four groups: Group I (ProTaper Next + Ultrasonic Activation, n=14), Group II (ProTaper Next + Diode Laser Activation, n=15), Group III (R-Motion + Ultrasonic Activation, n=14), and Group IV (R-Motion + Diode Laser Activation, n=15). Root canal preparation was performed according to manufacturers’ instructions. All specimens received irrigation with 3% sodium hypochlorite and 17% EDTA. Following irrigation activation, canals were obturated using gutta-percha and resin-based sealer. Fracture resistance testing was performed using a Universal Testing Machine, and the maximum fracture load was recorded in Newtons (N). Data were analyzed using one-way ANOVA and Tukey’s post hoc test with a significance level of p < 0.05. Results: The highest mean fracture resistance was observed in Group IV (R-Motion + Diode Laser) (964.76 ± 41.83 N), followed by Group III (R-Motion + Ultrasonic) (905.18 ± 45.27 N), Group II (ProTaper Next + Diode Laser) (861.42 ± 48.36 N), and Group I (ProTaper Next + Ultrasonic) (812.35 ± 52.41 N). One-way ANOVA revealed a statistically significant difference among the groups (F = 27.85, p < 0.001). Pairwise comparisons demonstrated significant differences between all groups. Teeth instrumented with the R-Motion system showed significantly greater fracture resistance than those prepared with ProTaper Next. Similarly, diode laser activation produced significantly higher fracture resistance than ultrasonic activation (p = 0.001). Conclusion: Both instrumentation system and irrigation activation technique significantly influenced the fracture resistance of endodontically treated teeth. The R-Motion reciprocating file system demonstrated superior fracture resistance compared with ProTaper Next, while diode laser activation resulted in higher fracture resistance than ultrasonic activation. The combination of R-Motion instrumentation and diode laser activation provided the most favourable biomechanical outcome and may be considered a promising approach for preserving the structural integrity of endodontically treated teeth.

Background: Chronic suppurative otitis media (CSOM) is a common middle ear infection associated with persistent ear discharge and hearing impairment, particularly in developing countries. Increasing antimicrobial resistance among bacterial pathogens has made the treatment of ear infection more challenging. Aim: To determine the bacteriological profile and antimicrobial susceptibility pattern of bacterial isolates obtained from ear discharge samples of patients with ear infections. Methodology: A retrospective observational study was conducted at Department of Pharmacology, Anugrah Narayan Magadh Medical College, Gaya ji, Bihar, India.A total of 90 ear discharge samples were analyzed using standard microbiological culture and antibiotic sensitivity testing methods. Data regarding bacterial isolates and resistance patterns were recorded and statistically analyzed. Result: Out of 90 samples, 68 were culture positive. Female patients and children were more commonly affected. Staphylococcus aureus, Escherichia coli, and Pseudomonas species were the predominant isolates. High resistance was observed against amoxicillin, cefixime, erythromycin, and cotrimoxazole, whereas better sensitivity was noted with gentamicin, ceftriaxone, levofloxacin, and ciprofloxacin. Conclusion: The study highlights the importance of routine culture and antibiotic sensitivity testing for effective management of CSOM and prevention of antimicrobial resistance.

Background: Type 2 Diabetes Mellitus (T2DM) is a major chronic disorder and an increasing public health concern worldwide. Appropriate utilization of antidiabetic drug is essential for achieving good glycemic control and preventing long-term complications. Drug utilization studies help in assessing prescribing trends and rationality of therapy. Aim: To investigate the drug utilization pattern of antidiabetic drug in patients with Type 2 Diabetes Mellitus attending a tertiary care teaching hospital. Methodology: A prospective, observational, cross-sectional study was conducted among 86 patients diagnosed with T2DM in the Medicine Outpatient Department of Pharmacology, Anugrah Narayan Magadh Medical College, Gaya ji, Bihar, India. Data regarding socio-demographic details, clinical characteristics, and prescribing patterns were collected using a structured proforma and analyzed using descriptive statistics. Result: The mean age of patients was 55.2 ± 9.8 years, with females constituting 58.1% of the study population. Weakness/fatigue was the most common symptom (76.7%). Metformin was the most frequently prescribed drug (86.0%), followed by sulfonylureas (65.1%). Glimepiride + Metformin was the most commonly prescribed combination therapy (48.8%). Conclusion: The study showed that prescribing practices were largely rational and consistent with standard treatment guidelines, with metformin being the preferred first-line antidiabetic drug.

Background: Accurate preoperative assessment of mandibular invasion in oral squamous cell carcinoma (OSCC) is essential for surgical planning and prognosis determination. Multi-detector row computed tomography (MDCT), particularly with 16-slice CT technology, offers high-resolution imaging capable of detecting cortical and medullary bone involvement. This study evaluated the diagnostic performance of 16-slice MDCT in assessing mandibular invasion in OSCC patients, using histopathology as the reference standard. Materials and Methods: A prospective study was conducted on 40 patients diagnosed with OSCC involving or adjacent to the mandible. All participants underwent preoperative 16-slice MDCT scanning with thin-slice axial images, multiplanar reconstructions, and bone window settings. Two experienced radiologists independently evaluated the scans for evidence of cortical erosion and medullary invasion. Surgical resection was performed, and histopathological examination served as the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MDCT were calculated. Results: Histopathology confirmed mandibular invasion in 26 out of 40 cases (65%). MDCT correctly identified invasion in 24 of these cases, yielding a sensitivity of 92.3% and specificity of 88.9%. The PPV and NPV were 92.3% and 88.9%, respectively, with an overall diagnostic accuracy of 90%. Interobserver agreement was excellent (κ = 0.87). False positives (n=2) were attributed to reactive bone changes, while false negatives (n=2) involved early medullary involvement without cortical breach. Conclusion: Sixteen-slice MDCT demonstrates high diagnostic accuracy in detecting mandibular invasion by OSCC, making it a valuable tool in preoperative assessment. However, early medullary involvement may still pose a diagnostic challenge, and correlation with other imaging modalities or histopathology remains advisable.

Background: Pediatric dermatoses are among the most common health problems in children and contribute significantly to dermatology outpatient visits. Their pattern varies according to demographic, socioeconomic, and environmental factors. Aim: To evaluate the clinical and epidemiological profile of pediatric dermatoses among children attending a tertiary care center. Methodology: A hospital-based descriptive cross-sectional study was conducted in the Department of Skin & VD, ANMMCH, Gaya ji , Bihar. Eighty children aged 0–18 years presenting with dermatological disorders were enrolled. Demographic details, clinical history, examination findings, and relevant investigations were recorded and analyzed using descriptive statistics. Results: The majority of patients belonged to the 6–10 years age group (31.3%) and were males (58.8%). Most participants were from rural areas (65%) and lower socioeconomic status (45%). Infectious dermatoses were the most common category (30%), followed by eczematous disorders (22.5%) and infestations (15%). Scabies (15%), atopic dermatitis (13.8%), and tinea infections (12.5%) were the most frequent individual disorders. Most children had illness duration of 1–6 months (40%), while 26.3% reported a positive family history. Conclusion: Infectious and eczematous dermatoses predominated among pediatric patients, particularly in rural and socioeconomically disadvantaged populations. Early diagnosis, health education, and improved hygiene practices are essential to reduce disease burden.

Background: Postmenopausal Bleeding is an important gynecological symptom in the elderly and may be associated with either benign, premalignant or malignant disease process. Early evaluation is critical to the timely diagnosis and treatment, particularly in the tertiary care setting where there are many such cases. Objective: To determine the clinicopathological profile and histopathological spectrum of women presenting with postmenopausal bleeding and common underlying aetiology of the women. Method: Retrospective observational study in Department of obstetrics and Gynecology of Nalanda Medical College & Hospital for a period of 1 year. There were a total of 90 women with a history of postmenopausal bleeding. The clinical information, comorbidities, ultrasonographic data and histopathological reports were retrieved from hospital records and subsequently analyzed by descriptive and inferential statistical methods. Result: Most of the patients were over 60 years and multiparous. Common comorbidities were hypertension and obesity as well as diabetes. Often, increased thickness of the endometrium was noted on ultrasonography. The most frequent histopathological finding was atrophic endometrium, followed by endometrial hyperplasia and polyps and then by malignant lesions in a few cases. Conclusion: Although many pathologies are associated with postmenopausal bleeding, benign lesions are much more common, but the fact that there is a possibility of premalignant or malignant lesions means that thorough evaluation is warranted. Definitive diagnosis and guidance for management is best obtained from histopathological examination.

Background: Hysterectomy is a commonly performed surgical procedure for benign gynecological conditions. Laparoscopic hysterectomy has increasingly been adopted as a minimally invasive alternative to open abdominal hysterectomy due to its potential advantages in postoperative recovery and reduced morbidity. Aim: To compare the clinical outcomes and recovery following laparoscopic versus open abdominal hysterectomy for benign gynecological conditions. Methodology: This prospective comparative study included 125 women undergoing hysterectomy, comprising 62 laparoscopic and 63 open abdominal procedures. Baseline characteristics, intraoperative outcomes, postoperative recovery, complications, and patient satisfaction were assessed and compared. Results: Baseline demographic and clinical characteristics were comparable between the groups (p>0.05). Although operative time was longer in the laparoscopic group (108.4±22.6 vs 92.5±18.4 minutes; p<0.001), blood loss (148.6±62.8 vs 322.7±104.2 ml; p<0.001) and transfusion requirements (4.8% vs 17.5%; p=0.026) were significantly lower. Laparoscopic hysterectomy resulted in lower pain scores, earlier ambulation, shorter hospital stay, and faster return to daily activities (p<0.001 for all). Overall complications were significantly lower (11.3% vs 38.1%; p<0.001), while excellent recovery (71.0% vs 36.5%) and patient satisfaction scores (8.9±1.1 vs 6.8±1.6) were significantly higher. Conclusion: Laparoscopic hysterectomy offers superior recovery, fewer complications, and greater patient satisfaction than open abdominal hysterectomy, despite requiring a longer operative time.

Introduction: Sedentary lifestyle, which is now more common among youngsters, especially college students, is associated with many diseases like obesity, cardiovascular diseases, diabetes, hypertension etc. This study deals with relationship between BMI and blood groups. Objectives: To determine relationship between BMI and blood group. Methods: This cross-sectional study was done among 171 first year MBBS students of Government Medical College, Thrissur, between 18-25 years, of who were willing to participate.  Students were given a proforma to fill their name, age, sex, blood group and history of blood dyscrasias, recent bone marrow transplantation and physical disability. Height in centimeters and weight in kilograms were measured using standard scales. Blood groups were recorded from college identity card and physiology practical record. Data was coded in MS Excel and appropriate statistical analysis was done using SPSS software. Results: Age of the study group was in the range between 18 to 25 with mean age 19.77 and standard deviation 1.31. Of the 171 study population, 99 were females and 72 males. 63.7% were normal weight, 19.3% underweight, 13.5% overweight and 3.5% obese. 45.1% were having O blood group, 32.2% B group, 16.9% A group and 5.8% AB group. 29.1% of students with B blood group and 13% of students with O blood group were found to have high BMI. The students with AB blood group had normal BMI and none of the students with A blood group were in the obese category.

Background: Conservative surgical approaches for managing postpartum haemorrhage (PPH) involve procedures designed to control bleeding while preserving fertility and avoiding the need for hysterectomy. These methods are valued for their safety and effectiveness, with effectiveness defined as the successful cessation of bleeding following the haemostatic intervention. This study aimed to evaluate how well these conservative surgical techniques reduce blood loss and manage PPH in order to prevent hysterectomy. Methods: In this interventional cohort study, stepwise uterine devascularization and uterine compression sutures were performed on 50 patients to manage intractable postpartum haemorrhage (PPH) unresponsive to standard treatment. The study involved four surgical techniques: Uterine compression sutures, Bilateral Uterine artery ligation, Bilateral Utero-Ovarian artery ligation, and Bilateral Internal iliac artery ligation. Patients were divided into four groups, with each group initially receiving one specific procedure. If bleeding persisted, subsequent procedures were applied in a stepwise manner—second, then third, and finally fourth—until effective haemostasis was achieved. Results: We observed that the combined use of three methods of conservative surgical management achieved a success rate of 80%. Overall, the use of all four conservative surgical techniques together resulted in a 66.6% success rate, there was need of hysterectomy in one case. The most common intraoperative and postoperative complication was hypovolemic shock occurring in 14% of cases. Conclusion: To ensure a higher success rate in the conservative surgical management of early PPH, we recommend that obstetricians opt for timely initiation of these procedures.

Background: Locally advanced carcinoma cervix is commonly treated with external beam radiotherapy (EBRT) followed by high-dose-rate (HDR) intracavitary brachytherapy. Accurate estimation of cumulative radiation dose to the target and organs at risk is essential for optimizing tumour control while minimizing treatment-related toxicity. Aim: This study aimed to evaluate the cumulative equivalent dose in 2 Gy fractions (EQD2) delivered to the target volume and organs at risk following EBRT and CT-guided HDR intracavitary brachytherapy in patients with locally advanced carcinoma cervix. Materials and Methods: This prospective observational dosimetric study included 22 patients with histopathologically confirmed locally advanced carcinoma cervix, FIGO stage IIB–IIIB. All patients received EBRT to a dose of 50 Gy in 25 fractions, followed by CT-guided HDR intracavitary brachytherapy of 7 Gy per fraction for three fractions. Dose–volume histogram parameters were recorded for the target volume, bladder and rectum. Cumulative EQD2 was calculated using the linear–quadratic model, with an α/β ratio of 10 Gy for the target and 3 Gy for organs at risk. Results: The mean age of patients was 59.1 ± 7.7 years. Stage IIB disease was present in 59.1% of patients, while 40.9% had stage IIIB disease. The mean target D90 was 8.05 ± 1.59 Gy per brachytherapy fraction. The mean cumulative EQD2 to the target was 86.90 ± 10.11 Gy. The mean cumulative EQD2 to the bladder and rectum, calculated using D2cc, was 93.93 ± 13.41 Gy and 78.39 ± 9.14 Gy, respectively. Conclusion: CT-guided HDR intracavitary brachytherapy combined with EBRT provided satisfactory target dose coverage and enabled accurate volumetric assessment of organs at risk in patients with locally advanced carcinoma cervix. Cumulative EQD2-based evaluation is a useful method for biologically meaningful dose assessment and treatment optimization. Larger multicentric studies with long-term follow-up are required to correlate cumulative EQD2 with clinical outcomes and late radiation toxicity.

Background: Head and neck cancer (HNC) is a major public health problem in India and is strongly associated with lifestyle-related risk factors that adversely affect patients’ quality of life (QOL). Aim: To assess the quality of life and lifestyle-related risk factors among head and neck cancer patients attending the Ear, Nose and Throat (ENT) Outpatient Department. Methodology: A hospital-based descriptive cross-sectional observational study was conducted among 80 histopathologically confirmed HNC patients attending the ENT Department of Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, from feb 2025 to January 2026. Data on socio-demographic characteristics, clinical profile, and lifestyle-related risk factors were collected using a structured questionnaire. Quality of life was assessed using the University of Washington Quality of Life (UW-QOL) questionnaire. Statistical analysis was performed using SPSS version 27.0, with p<0.05 considered significant. Results: Most participants were males (75.0%) aged 41–60 years (52.5%). Oral cavity cancer (42.5%) and advanced-stage disease (65.0%) predominated. Smokeless tobacco use (67.5%), smoking (57.5%), poor oral hygiene (55.0%), and alcohol consumption (47.5%) were common. The mean overall UW-QOL score was 63.6±12.8. Smoking, smokeless tobacco use, alcohol consumption, and poor oral hygiene were significantly associated with lower QOL scores (p<0.05). Conclusion: Head and neck cancer patients demonstrated moderate quality of life, with lifestyle-related risk factors significantly impairing well-being. Comprehensive management incorporating lifestyle modification, tobacco and alcohol cessation, oral health promotion, rehabilitation, and psychosocial support is essential to improve patient outcomes.

Background: Gestational hypertension is one of the most common hypertensive disorders of pregnancy and is associated with increased maternal and perinatal morbidity. Although considered less severe than preeclampsia, it still contributes significantly to adverse pregnancy outcomes, particularly in developing regions. Aim: To assess the maternal and perinatal outcomes in pregnancies complicated by gestational hypertension at a tertiary care centre in Ananya College of Medicine & Research, Gandhinagar, Gujarat level. Methodology: A retrospective cross-sectional study was conducted over one year in the Department of Obstetrics and Gynecology, Ananya College of Medicine & Research, Gujarat, India. A total of 115 pregnant women were included, comprising 45 cases of gestational hypertension and 70 normotensive pregnancies. Data were collected from hospital records and analyzed using SPSS version 24. Statistical tests such as chi-square and logistic regression were applied. Results: The incidence of cesarean section was significantly higher in women with gestational hypertension (51.1%) compared to normotensive women (28.6%) (p = 0.01). Although low birth weight (22.2%) and preterm birth (22.2%) were more frequent in the hypertensive group, these associations were not statistically significant. Advanced maternal age and maternal co-morbidities were more commonly observed in affected women. Conclusion: Gestational hypertension is associated with an increased risk of cesarean delivery, while its impact on fetal outcomes such as low birth weight and preterm birth appears limited. Early diagnosis and appropriate management are essential to improve maternal and neonatal outcomes.

Background: Cervical cancer remains the second leading cause of cancer mortality among women in India, with an exceptionally high burden in socioeconomically marginalized rural regions such as Bihar. Early detection via effective secondary prevention is critical given that nearly 60–70% of patients present at advanced clinical stages. While Visual Inspection with Acetic Acid (VIA) is widely implemented as a low-cost, point-of-care screening tool, its low specificity can strain resource-constrained health infrastructure. This study evaluates the dual utilization of VIA and conventional Papanicolaou (Pap) smear cytology to streamline referral pathways for cervical pre-malignancies in an environment lacking advanced molecular and liquid cytology platforms. Aims and Objectives: To evaluate the institutional efficacy of a dual cervical screening pathway utilizing Visual Inspection with Acetic Acid (VIA) and conventional Papanicolaou (Pap) smear cytology in a resource-limited tertiary care ecosystem in rural Bihar. Methods: A two-year retrospective, descriptive epidemiological study was conducted under the academic guidance of Dr. Seema Singh, Head of Department (HOD) using clinical records from 2024 and 2025 at the tertiary care teaching hospital of the Bhagwan Mahavir Institute of Medical Sciences, Pawapuri. Documented screening outcomes from a total population of 1,839 women who underwent VIA testing, alongside a parallel subset of 510 women who received conventional Pap smear cytological profiling, were systematically extracted from institutional datasets. Advanced testing modalities such as Liquid-Based Cytology (LBC) and high-risk Human Papillomavirus (hr-HPV) DNA testing were entirely unavailable due to resource limitations. Data were analyzed for cytological grading via the Bethesda system and correlated with VIA positive findings. Results: Data compiled over the 24-month study period revealed a notable increase in clinical screening volume from 2024 to 2025. Out of 1,839 women screened via VIA, 67 tested positive (VIA+), yielding an overall visual screen-positive rate of 3.64%. Year-on-year analysis showed a rising detection trend: 2024 recorded 24 VIA+ cases out of 870 (2.76%), while 2025 recorded 43 VIA+ cases out of 969 (4.44%). Parallel conventional Pap smear cytology performed on 510 symptomatic or high-risk women classified 482 cases as Negative for Intraepithelial Lesion or Malignancy (NIELM; 94.51%). Pre-malignant transformations were caught across a stratified spectrum: 24 cases of Atypical Squamous Cells of Undetermined Significance (ASCUS; 4.71%), 3 cases of Low-Grade Squamous Intraepithelial Lesion (LSIL; 0.59%), and 1 case of High-Grade Squamous Intraepithelial Lesion (HSIL; 0.20%). Baseline profiling showed that 77.92% of the screened population belonged to low socioeconomic brackets, and 54.27% presented with multi-parity (≥3 children). Conclusion: Dual screening strategies utilizing low-cost VIA for mass population-level triage, reinforced by reflex conventional Pap smears, significantly optimize the early capture of high-risk cervical pre-malignancies in infrastructure-limited settings. The lack of advanced molecular tools (HPV DNA) and LBC limits precise, single-visit risk stratification and results in an increased clinical burden for ambiguous cytological findings (ASCUS). However, a structured, tiered referral pathway combining conventional modalities remains foundational to mitigating advanced oncological mortality in rural India.

Background: Vitamin D deficiency is a major public health concern worldwide and remains highly prevalent in India despite abundant sunlight exposure. Age and gender are important factors influencing vitamin D status, but regional data from eastern India are limited. Aim: To determine the prevalence of vitamin D deficiency and evaluate its association with age and gender among patients undergoing serum vitamin D testing at a tertiary care center. Methodology: This retrospective observational study was conducted at Department of Biochemistry, Viraat Ramayan Institute of Medical Science, Koyla Belwa, Chakiya, Motihari, Bihar, India. A total of 105 adult patients who underwent serum 25-hydroxyvitamin D [25(OH)D] testing were included. Demographic details and serum vitamin D levels were obtained from medical records. Vitamin D deficiency was defined as serum 25(OH)D levels <30 ng/mL. Statistical analysis was performed using SPSS version 25.0. Results: The mean age of participants was 44.8 ± 15.2 years, and 55.2% were females. The overall prevalence of vitamin D deficiency was 68.6% (72/105). Deficient participants were significantly younger than vitamin D-sufficient individuals (41.7 ± 13.8 vs. 51.2 ± 15.4 years; p=0.003). Females had a significantly higher prevalence of deficiency than males (62.5% vs. 37.5%; p=0.024). Younger age (OR=0.96, p=0.012) and female gender (OR=2.38, p=0.031) were independent predictors of vitamin D deficiency. Conclusion: Vitamin D deficiency was highly prevalent and was significantly associated with younger age and female gender, highlighting the need for targeted screening and preventive strategies.

Background: The first two years of life represent a critical window for optimal growth and neurodevelopment. Appropriate Infant and Young Child Feeding (IYCF) practices, including early initiation of breastfeeding, exclusive breastfeeding for six months, and timely complementary feeding, are pivotal in preventing undernutrition. Despite national nutrition programs, suboptimal feeding practices and childhood malnutrition remain major public health challenges in India. Objectives: To assess IYCF practices among children aged 6–23 months, determine the prevalence of malnutrition, and explore barriers and facilitators influencing optimal feeding practices. Methods: A mixed-methods study was conducted at a tertiary care centre in Villupuram district between May and November 2024. Quantitative data were collected from 550 mother–child pairs using structured questionnaires and WHO-standard anthropometric measurements. Nutritional status was assessed using weight-for-age, height-for-age, and weight-for-height Z-scores. Associations between feeding practices and nutritional outcomes were analysed using chi-square tests and logistic regression. Qualitative data were obtained through focused group discussions (FGDs) and analysed thematically. Results: Exclusive breastfeeding for six months was reported by 92% of mothers, and 89.1% initiated breastfeeding within one hour of birth. However, underweight (41.1%), stunting (46.2%), and wasting (41.5%) were highly prevalent. Exclusive breastfeeding was significantly associated with reduced odds of underweight (OR = 0.33; p < 0.0001), whereas early initiation alone showed no significant association with anthropometric outcomes. Bottle feeding was reported in 97.1% of infants, and only 55.5% had regular weight monitoring. Qualitative findings revealed cultural practices, misconceptions regarding infant satiety, and gaps in follow-up care as major barriers. Conclusion: Despite high adherence to recommended breastfeeding practices, a substantial burden of malnutrition persists. Exclusive breastfeeding remains a strong protective factor, but sustained nutritional gains require integrated strategies addressing bottle feeding, growth monitoring, complementary feeding quality, and health-system follow-up.

Background: The prominent, centralized projection of the nasal architecture makes it highly vulnerable to external mechanical forces.Nasal bone fractures represent the most prevalent facial skeletal injury, contributing significantly to emergency department admissions and healthcare costs. Objectives: This review synthesizes current epidemiological trends across diverse demographic groups, outlines the primary distinct mechanisms of injury, and discusses public health measures required to minimize chronic functional and aesthetic morbidity. Methods: A comprehensive review of established retrospective studies and clinical trial literature evaluating patient demographics, injury mechanisms, and concurrent craniofacial trauma patterns. Results: Young adult males consistently represent the highest-risk cohort, with an overall male-to-female ratio exceeding 2:1. Interpersonal violence, motor vehicle collisions, and sports-related impacts constitute the primary etiologies in adults. Conversely, pediatric and geriatric populations exhibit specialized presentation patterns dominated by accidental falls. Comminuted, displaced fractures frequently involve adjacent midfacial components, including the frontal process of the maxilla and the bony nasal septum, requiring prompt tomographic classification and management. Conclusion: Nasal skeletal trauma remains an essential public health concern. Standardized reporting metrics and the proactive application of regional preventative measures are critical to refining surgical outcomes and lowering injury rates.

Background: Hemoglobinopathies are inherited disorders affecting hemoglobin synthesis and structure and represent an important public health concern in India. High-Performance Liquid Chromatography (HPLC) is widely used for rapid screening and identification of hemoglobin variants. This study was undertaken to determine the spectrum of hemoglobinopathies diagnosed by HPLC at a tertiary care centre in the Andaman and Nicobar Islands. Methods: A retrospective observational study was performed in the Department of Pathology, ANIIMS & GB Pant Hospital, Port Blair for a Period of one year. HPLC records from 1 April 2025 to 31 March 2026 were reviewed. Demographic details, hemoglobin concentration, HPLC fractions and final HPLC diagnosis were analysed. Hemoglobin fraction analysis was performed on a Lifotronic HPLC analyzer. Descriptive statistics were used. Results: A total of 156 cases were analysed. Age was recorded in 145 cases, with a mean age of 23.64 ± 15.42 years. Sex was available for 148 cases. Females constituted 101 cases (64.7%) and males 47 cases (30.1%). Normal HPLC pattern was observed in 87 cases (55.8%), while 69 cases (44.2%) showed abnormal or variant patterns. The most frequent abnormality was sickle cell trait (34 cases, 21.8%), followed by beta-thalassemia trait (20 cases, 12.8%) and sickle cell disease/HbS homozygous pattern (9 cases, 5.8%). Rare patterns included HbS/beta-thalassemia, HbD trait, HbE trait, HbE/beta-thalassemia and possible alpha-thalassemia. Conclusion: HPLC is an effective and reliable technique for screening and characterization of hemoglobinopathies. The present study highlights the occurrence of different hemoglobin variants in the island population and supports the importance of screening and genetic counseling programs.

Purpose: To study the relation between plasma level of fibrinogen and neonatal sepsis and its outcome. Methods: A prospective case control study was done including 48 neonatal sepsis cases in study group and 42 cases in control group. For all cases Plasma fibrinogen, prothrombin time (PT), activated plasma thrombin time (APTT), C-reactive protein (CRP) and blood culture were performed. Mean Plasma fibrinogen levels for both groups and cut off value of plasma fibrinogen for diagnosis was calculated using receiver operating characteristic curve. Results: Plasma fibrinogen levels were found to be higher in study group with than in control group (p< 0.050). Cutoff value of plasma fibrinogen for diagnosing neonatal sepsis was found to be 305.5mg/dl with a sensitivity and specificity of 80% and 72.8% respectively. Conclusion: In our study, we found that plasma fibrinogen act as an acute phase reactant and can be used as an immediate marker for detection of early onset neonatal sepsis.

Background: Soft tissue mass lesions with morphologic heterogeneity occur in the non-epithelial extra skeletal tissue. Soft tissue tumours and tumour like lesions posed diagnostic difficulties as they exhibit similar clinical and radiological features. The clinical presentation is myriad with benign lesions masquerading as malignant tumours such as sarcomas, lymphomas and metastatic carcinoma. This study was undertaken to evaluate soft tissue tumours and tumour like lesions and characterise their distribution in a tertiary care centre of South India. Methods: Data was obtained from clinical records of patients diagnosed as soft tissue mass lesions. Corresponding surgical specimens were processed to paraffin block and sectioned. The slides were stained with routine Haematoxylin and eosin stain. Appropriate special and immune- histochemical stains were performed to confirm histopathological diagnosis. The soft tissue tumours were categorized according to the WHO 2020 classification and graded by FNLCC grading system. The proportion of subjects was distributed according to epidemiological and histopathological features and statistically evaluated. The data was represented in terms of frequency distribution tables. The categorical and counting variables were presented by frequencies and percentages. Results: Among 284 soft tissue lesions,241 (15.43%) were soft tissue tumours and 43 (2.75%) were tumour like lesions. Benign soft tissue tumours 220(91.29%) were more common than malignant 19 (7.88%) and intermediate soft tissue tumours 2(0.82%). The most common benign soft tissue tumours were from adipocytic group and the mean age was 40.27 years with a male to female ratio of 132:88(1.50). The common site was upper limb. The most common malignant tumour was Liposarcoma. Among the tumour like lesion ganglion cyst was more common followed by synovial cyst. Conclusions: Adipocytic tumours were the most common soft tissue tumours both benign and malignant. Histopathological examination is necessary for unmasking the true biological nature of tumours as they masquerade clinically as benign or malignant entities.

Coronavirus disease 2019 (COVID-19) is an infectious respiratory disease caused by novel coronavirus SARS-CoV-2 predominately involving the respiratory system. Bronchoalveolar lavage (BAL) is a safe, easily performed, minimally invasive and well tolerated procedure which explores large areas of the alveolar compartment providing cells as well as non-cellular constituents from the lower respiratory tract. It opens a window to the lung. Alterations in BAL fluid cellular and non-cellular components reflect pathological changes in the lung parenchyma. The information obtained from BAL fluid analysis, if considered carefully can have a reliable diagnostic criterion.

Background: Thyroid nodules are a common endocrine disorder with a broad spectrum of benign and malignant lesions. Accurate preoperative differentiation is essential to avoid unnecessary surgery while ensuring timely treatment of malignancy. Fine-Needle Aspiration Cytology (FNAC), interpreted using the Bethesda System for Reporting Thyroid Cytopathology, is widely employed as the primary diagnostic modality, with histopathology serving as the gold standard for confirmation. Aim: To evaluate the diagnostic performance of Fine-Needle Aspiration Cytology in thyroid nodules through correlation with histopathological findings in a tertiary care hospital in Bihar, India. Methodology: This retrospective observational study included 117 patients with thyroid nodules who underwent FNAC followed by surgical excision and histopathological examination over a one-year period at the Department of Pathology, Nalanda Medical College and Hospital, Patna,Bihar, India. Cytological findings were classified according to the Bethesda System and compared with histopathological diagnoses. Diagnostic indices, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy, were calculated. Results: Thyroid nodules were most frequently observed among patients aged 31–50 years, with a marked female predominance. Bethesda II (benign) was the most common cytological category, while histopathology confirmed benign lesions in 57.3% and malignant lesions in 42.7% of cases. A highly significant association was observed between Bethesda categories and histopathological diagnosis (p<0.001). Papillary thyroid carcinoma was the predominant malignant lesion. FNAC demonstrated a sensitivity of 86%, specificity of 91%, PPV of 87.8%, NPV of 89.7%, and an overall diagnostic accuracy of 88.9%, with strong cytohistopathological concordance. Conclusion: FNAC, when interpreted using the Bethesda System, is a reliable, minimally invasive, and cost-effective diagnostic tool for the preoperative evaluation of thyroid nodules. Its high diagnostic accuracy and strong correlation with histopathological findings support its continued use as the first-line investigation for differentiating benign from malignant thyroid lesions and guiding appropriate clinical management.

Background: Placement of C1 pedicle screws is an effective method for atlantoaxial stabilization but remains technically challenging because of the complex anatomy and proximity to critical neurovascular structures. The Pedicle Stump Technique has been proposed as a simple and safe freehand method for accurate screw placement. Aim: To evaluate the safety, accuracy, and clinical outcomes of the Pedicle Stump Technique for C1 pedicle screw placement in patients with atlantoaxial instability. Methodology: This prospective observational study included four patients with atlantoaxial instability who underwent posterior C1–C2 fixation using the Pedicle Stump Technique. Demographic, operative, radiological, and clinical outcome data were analyzed using descriptive statistics. Results: The mean patient age was 49 years, and 75% were male. Mean operative time was 143.75 minutes, and mean blood loss was 180 mL. Grade A screw placement accuracy was achieved in 75% of cases and Grade A in 25%. All patients demonstrated neurological improvement with reduced postoperative Nurick grades. No vertebral artery injury, occipital neuralgia, neurological deterioration, or implant-related complications occurred. Successful fusion was achieved in all patients. Conclusion: The Pedicle Stump Technique is a simple, safe, and effective method for C1 pedicle screw placement, providing accurate fixation, favorable neurological outcomes, and excellent fusion rates with minimal complications.

Background: Type 2 diabetes mellitus (T2DM) is strongly associated with non-alcoholic fatty liver disease (NAFLD), increasing the risk of progressive liver fibrosis, cirrhosis, and hepatocellular carcinoma. Liver biopsy remains the gold standard for fibrosis assessment but is invasive and unsuitable for routine clinical practice. Several serum-based fibrosis scores have been developed as non-invasive alternatives; however, their diagnostic performance varies across different populations. This study compared the diagnostic accuracy of APRI, FIB-4, BARD, and NAFLD Fibrosis Score (NFS) using FibroScan as the reference standard in diabetic patients with NAFLD. Methods: A prospective cross-sectional study was conducted among 378 adult patients with T2DM and ultrasonographically diagnosed NAFLD attending a tertiary care centre. Clinical characteristics, anthropometric measurements, biochemical parameters, and FibroScan findings were recorded. APRI, FIB-4, BARD, and NFS were calculated using standard formulae. Diagnostic performance was assessed by sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, and receiver operating characteristic (ROC) analysis. Results: Among the 378 patients, 272 (71.96%) were male and 106 (28.04%) were female. The mean HbA1c was 7.72 ± 1.06%, and most patients had diabetes for 2–5 years. FibroScan demonstrated no fibrosis in 29.36%, significant fibrosis in 56.35%, and advanced fibrosis in 14.29% of patients. FIB-4 showed the highest diagnostic performance with an AUC of 0.627, followed by APRI (0.606), NFS (0.572), and BARD (0.468). BARD demonstrated the highest sensitivity (92.88%) but the lowest specificity (5.45%), whereas FIB-4 showed the highest specificity (60.00%) and PPV (78.11%). Conclusion: FIB-4 demonstrated the best overall diagnostic performance among the evaluated non-invasive fibrosis scores and appears to be the preferred first-line screening tool for diabetic NAFLD patients. APRI may serve as an acceptable alternative where FibroScan is unavailable. BARD and NFS should not be used as standalone diagnostic tests because of their limited specificity.

Background: Tibial shaft fractures are common long bone injuries, frequently affecting young and middle-aged individuals, and are often associated with high-energy trauma. Intramedullary nailing (IMN) is widely accepted as the standard surgical treatment. Aim: To evaluate the clinical outcomes and complication profile of intramedullary nailing in the management of tibial shaft fractures. Methodology: A hospital-based prospective observational study was conducted in the Department of Orthopedics, Darbhanga Medical College and Hospital,Laheriasarai, Darbhanga, Bihar, over one year. Ninety adult patients with closed or Gustilo-Anderson type I and II open tibial shaft fractures treated with IMN were included. Patients were followed for clinical and radiological assessment, and data were analyzed using SPSS version 27. Results: Most patients were males (71.1%) aged 31–60 years. Closed fractures (75.6%) and road traffic accidents (57.8%) predominated. Radiological union occurred within 20 weeks in 80% of cases. Excellent to good functional outcomes were observed in 77.7% of patients. Anterior knee pain (17.8%) was the most common complication, while deep infection (3.3%) and implant failure (2.2%) were infrequent. Conclusion: Intramedullary nailing provides favorable union rates and functional recovery with an acceptable complication profile in tibial shaft fractures.

Background: Distal radius fractures are common upper limb injuries with significant functional implications. Management strategies include conservative fixation with K-wires and operative fixation with volar locking plates, yet consensus on optimal treatment remains debated. Aim: To compare the clinical and radiological outcomes of K-wire fixation versus volar plating in patients with distal radius fractures. Methodology: This retrospective observational study analyzed 80 patients treated at the Department of Orthopedics, Darbhanga Medical College and Hospital, Laheriasarai, Bihar. Patients aged ≥18 years with extra-articular distal radius fractures were included. They were managed either with closed reduction and K-wire fixation or open reduction with volar plating. Radiological parameters (radial height, inclination, volar tilt) and functional outcomes (wrist range of motion, pain) were assessed at three months post-treatment. Results: Volar plating achieved superior radiological alignment, with 92.9% of cases showing acceptable alignment versus 73.7% in the K-wire group. Wrist flexion (68.2° vs. 58.6°) and extension (65.4° vs. 54.3°) were significantly higher, and pain scores lower (VAS 2.1 vs. 3.8) in the plating group (p < 0.01). Conclusion: Volar plating provides better anatomical restoration, improved functional recovery, and reduced pain compared to K-wire fixation, particularly in unstable or osteoporotic distal radius fractures. K-wire fixation remains suitable for minimally displaced fractures.

Background: Laryngopharyngeal reflux (LPR) has emerged as a potential risk for otitis media with effusion (OME) through reflux-induced inflammation of the Eustachian tube and middle ear. However, evidence regarding this association in adults remains limited, particularly in the Indian population. Objective: To evaluate the association between laryngopharyngeal reflux and otitis media with effusion in adults presenting with chronic throat complaints. Materials and Methods: This hospital-based analytical cross-sectional study was conducted over a period of 12 months in the Department of Otorhinolaryngology at a tertiary care teaching hospital. A total of 120 adults with chronic throat complaints were enrolled and classified into LPR-positive (n=60) and LPR-negative (n=60) groups using the Reflux Symptom Index (RSI) and Reflux Finding Score (RFS). All participants underwent detailed otorhinolaryngological examination, pneumatic otoscopy, and tympanometry. OME was diagnosed based on a Type B tympanogram with compatible otoscopic findings in the absence of acute infection. Results: The mean RSI (18.6±4.8 vs. 7.4±3.1; p<0.001) and RFS (10.3±2.5 vs. 4.5±1.8; p<0.001) were significantly higher in the LPR-positive group. Globus sensation, throat clearing, hoarseness, ear fullness, and subjective hearing impairment were significantly more frequent among participants with LPR. Type B tympanograms were observed in 28.3% of participants with LPR compared with 6.7% of those without LPR (p=0.002). OME was diagnosed in 17 (28.3%) participants with LPR and 4 (6.7%) participants without LPR, corresponding to a prevalence ratio of 4.25 (p=0.004). Allergic rhinitis was also significantly associated with OME (39.3% vs. 10.9%; p<0.001), whereas age, sex, and smoking status showed no significant association. Conclusion: Laryngopharyngeal reflux is significantly associated with otitis media with effusion in adults presenting with chronic throat complaints. Patients with LPR are more likely to have middle-ear effusion, Type B tympanograms, and ear-related symptoms. Assessment for LPR should be considered in adults with unexplained OME, and further prospective studies are required to clarify the causal relationship and therapeutic implications.

Background: Community-acquired pneumonia (CAP) remains a major cause of hospitalization and mortality worldwide. Early identification of patients at high risk of in-hospital mortality is crucial for timely intervention and optimal resource utilization. Artificial intelligence (AI)-based predictive models have the potential to improve prognostic accuracy by integrating multiple clinical variables. Objectives: To develop and evaluate an AI-based model for predicting in-hospital mortality among patients with community-acquired pneumonia and compare its performance with conventional severity scoring systems. Materials and Methods: A prospective observational study was conducted among 500 adults admitted with CAP to a tertiary care teaching hospital over 18 months. Demographic, clinical, laboratory, radiological, and comorbidity data were collected at admission. The primary outcome was in-hospital mortality. The dataset was divided into training (80%) and testing (20%) cohorts. Machine learning algorithms were developed using five-fold cross-validation, and model performance was assessed using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy. Results: Of the 500 patients, 60 (12.0%) died during hospitalization and 440 (88.0%) survived. Non-survivors were significantly older and had higher rates of diabetes mellitus, chronic obstructive pulmonary disease, ICU admission, and mechanical ventilation (p<0.001). The strongest predictors of mortality were advanced age, low oxygen saturation, elevated blood urea nitrogen, respiratory rate, serum creatinine, and C-reactive protein. The AI model demonstrated superior performance (AUC 0.94, sensitivity 91.7%, specificity 89.8%, and accuracy 90.4%) compared with the Pneumonia Severity Index (AUC 0.86) and CURB-65 (AUC 0.82). Conclusion: The AI-based model accurately predicted in-hospital mortality and outperformed conventional severity scores. AI-assisted risk stratification may improve early clinical decision-making and optimize management of patients with CAP. Further multicenter validation is required before routine clinical implementation.

Background: Ovarian masses range from benign cysts to malignant neoplasms, making accurate preoperative diagnosis essential for appropriate management. Conventional ultrasonography is the primary imaging modality, while Color Doppler improves lesion characterization by assessing tumor vascularity. Histopathological examination remains the gold standard for definitive diagnosis. Aim: To evaluate the imaging features of ovarian masses using conventional ultrasonography and Color Doppler and correlate these findings with histopathological diagnosis. Methodology: A retrospective hospital-based observational study was conducted at a Netaji Subhas Medical College and Hospital in Adityapur, Jharkhand, India. A total of 135 patients with ovarian masses who underwent preoperative ultrasonography with or without Color Doppler followed by histopathological examination were included. Imaging findings were compared with histopathological diagnosis, and diagnostic performance was assessed. Results: Most patients were aged 21–40 years (49.6%) and 71.1% were premenopausal. Abdominal or pelvic pain (43.0%) was the most common symptom. Malignant masses showed significantly higher frequencies of large size, thick walls, multiloculated septations, papillary projections, solid components, ascites, central vascularity, low RI, low PI, and high PSV (p < 0.001). The addition of Color Doppler improved sensitivity from 82.1% to 94.9%, specifically from 88.5% to 95.8%, and overall diagnostic accuracy from 86.7% to 95.6%. Conclusion: Combined ultrasonography and Color Doppler provide a reliable, non-invasive, and highly accurate approach for differentiating benign and malignant ovarian masses, with excellent correlation to histopathological findings.

Background: New-onset seizures are a common neurological presentation requiring prompt evaluation to identify underlying structural brain abnormalities. Magnetic resonance imaging (MRI) plays a crucial role in detecting epileptogenic lesions, facilitating accurate diagnosis, guiding treatment, and improving patient outcomes. However, the diagnostic yield and spectrum of MRI-detected epileptogenic lesions vary across different populations. Aim: To determine the diagnostic yield of MRI and evaluate the spectrum of epileptogenic lesions in patients presenting with new-onset seizures. Methodology: A hospital-based prospective observational study was conducted in the Department of Radiodiagnosis, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, over a period of one year. A total of 145 consecutive patients with new-onset seizures were enrolled. All patients underwent detailed clinical evaluation, routine electroencephalography (EEG), and MRI brain using a dedicated epilepsy imaging protocol. MRI findings were categorized as epileptogenic lesions, non-epileptogenic lesions, or normal, and correlated with seizure type and EEG findings. Statistical analysis was performed using SPSS version 26.0, with p < 0.05 considered statistically significant. Results: The mean age of the participants was 39.8 ± 17.2 years, with a male predominance (59.3%). MRI identified epileptogenic lesions in 54 (37.2%) patients, non-epileptogenic lesions in 24 (16.6%), while 67 (46.2%) had normal MRI findings. Mesial temporal sclerosis (22.2%) was the most common epileptogenic lesion, followed by gliosis/encephalomalacia (20.4%), developmental cortical malformations (14.8%), and neuroinfective lesions (14.8%). Epileptogenic lesions were significantly associated with epileptiform EEG abnormalities (p = 0.001) and focal seizures (p = 0.002). Conclusion: MRI demonstrated a diagnostic yield of 37.2% in detecting epileptogenic lesions among patients with new-onset seizures and showed significant correlation with EEG abnormalities and focal seizure type. Routine epilepsy-protocol MRI should be incorporated into the diagnostic evaluation of patients presenting with first-time seizures to facilitate early etiological diagnosis and appropriate clinical management.

Background: Pelvic Inflammatory Disease (PID) is a major reproductive health problem among women of reproductive age and is associated with significant short- and long-term complications, including chronic pelvic pain, infertility, ectopic pregnancy, and tubal damage. Early detection, appropriate management, and identification of risk factors are essential for reducing disease burden and preventing adverse reproductive outcomes. Aim: To study the prediction, early detection, prevention, and management of Pelvic Inflammatory Disease (PID) and its associated sequelae among women attending the Gynecology Outpatient Department. Methodology: This hospital-based observational study included 323 women diagnosed with PID attending the Gynecology OPD. Detailed demographic, clinical, obstetric, microbiological, laboratory, and imaging data were collected. Disease severity, treatment modalities, treatment response, and long-term sequelae were assessed. Logistic regression analysis was performed to identify independent predictors of sequelae. Results: Vaginal discharge (81.7%), abdominal pain (mean VAS score 6.22 ± 1.76), and abnormal uterine bleeding (57.9%) were the most common presenting symptoms. Adnexal tenderness (83.3%), cervical motion tenderness (77.1%), and uterine tenderness (72.8%) were the predominant examination findings. Chlamydia trachomatis (25.1%) was the most common pathogen, followed by Mycobacterium tuberculosis (17.0%). Moderate and severe PID accounted for 46.8% and 39.6% of cases, respectively. More than half of the women (51.1%) developed sequelae, with chronic pelvic pain (10.8%), tubal blockage (10.5%), and infertility (9.3%) being the most frequent complications. Previous STI/PID history (OR=6.508), uterine fixity (OR=4.523), and poor treatment response (OR=2.123) were significant independent predictors of sequelae. Conclusion: PID continues to impose a substantial reproductive health burden, with a high prevalence of moderate-to-severe disease and long-term complications. Early diagnosis, prompt and appropriate treatment, prevention of recurrent infections, and identification of high-risk women are crucial to reducing sequelae and improving reproductive outcomes.

Background: Glaucoma is a chronic optic neuropathy that involves progressive changes to the retinal nerve fiber layer (RNFL) and resulting changes to the function of the visual field. Assessment of structural and functional changes is required for early diagnosis and monitoring of glaucoma. Optical Coherence Tomography (OCT) is an objective measure of RNFL thickness and Standard Automated Perimetry (SAP) is the gold standard measure of visual field defects. Knowing how these parameters are related is critical for glaucoma management. Objectives: To assess the correlation between visual field parameters and retinal nerve fibre layer thickness in patients with primary glaucoma. Methodology: This is an observational cross-sectional study which was carried out in the Department of Ophthalmology, Narayan Medical College and Hospital,Sasaram, Bihar in 24 months. 78 patients (156 eyes) with primary glaucoma were enrolled. All participants received complete ophthalmic examination, Standard Automated Perimetry with Humphrey Field Analyzer (HFA) and retinal nerve fiber layer (RNFL) assessment with Spectral-Domain Optical Coherence Tomography (SD-OCT). Visual field indices: Mean Deviation (MD), Pattern Standard Deviation (PSD), and Visual Field Index (VFI) were correlated with RNFL thickness measurements. Results: The mean RNFL thickness was 76.39 ± 21.78 µm. A significant positive correlation was seen between the RNFL thickness and Mean Deviation (ρ = 0.682, p < 0.001) and Visual Field Index (ρ = 0.658, p < 0.001). Moderate negative correlation was observed between the thickness of RNFL and Pattern Standard Deviation (ρ = −0.486, p < 0.001). A progressive thinning of the RNFL was correlated with increasing severity of glaucoma, which suggests deteriorating structure and function. Conclusion: The findings obtained from the study of thickness of the RNFL by SD-OCT demonstrated a good correlation with the results of visual field in primary glaucoma. Structural and functional assessment is an integrated approach that enhances the diagnosis, staging and monitoring of glaucoma, allowing for earlier identification of glaucoma progression and improved preservation of visual function.

Background: Cataract continues to be the major cause of reversible blindness globally and is common in the elderly population. In addition to visual impairment, age-related lens enlargement is a cause of anterior chamber angle narrowing which may lead to angle closure glaucoma. Not only does Small Incision Cataract Surgery (SICS restore vision but can also create favorable anatomical changes in the anterior chamber. An Anterior Segment Optical Coherence Tomography (AS-OCT) can be used to measure these changes in an objective and non-invasive way. Aim: To assess the anterior chamber angles changes after Small Incision Cataract Surgery with Anterior Segment Optical Coherence Tomography. Design: A prospective observational study in Department of Ophthalmology-Narayan Medical College & Hospital for a period of 24 months. Material and Methods: The study was a prospective observational study carried out in 24 months in Department of Ophthalmology, Narayan Medical College & Hospital. Overall, 110 patients aged 50 years and older with age-related cataract (ARC) were enrolled in uncomplicated SICS. Preoperatively and after surgery (on day 7 and day 30), anterior chamber angle (ACA), angle opening distance at 500 μm (AOD500), and trabecular iris space area at 500 μm (TISA500) were measured in the nasal and temporal quadrants. Intraocular pressure (IOP) was also taken. Results: There was significant postoperative improvement in ACA, AOD500 and TISA500 in both the nasal and temporal quadrants (p<0.001). The mean IOP was significantly reduced at one month postoperatively from 15.78 ± 2.39 mmHg preoperatively to 11.91 ± 1.70 mmHg at one month postoperatively (p<0.001). A significant positive correlation was seen between greater angle widening and reduction in IOP. Conclusions: SICS is associated with important anterior chamber angle widening and intraocular pressure decrease. AS-OCT is a useful and non-invasive technique to assess changes in the anterior segment after surgery and could help with the risk assessment and management of glaucoma.

Background: Fine-needle aspiration cytology (FNAC) is a rapid, minimally invasive, and cost-effective technique widely used for the preoperative evaluation of palpable breast lesions. Although FNAC demonstrates high diagnostic performance, histopathological examination remains the gold standard for definitive diagnosis. This study evaluated the diagnostic accuracy of FNAC by correlating cytological findings with subsequent histopathological diagnoses in patients with detectable breast lesions. Aim: To assess the diagnostic accuracy of FNAC in palpable breast lesions through retrospective cyto-histopathological correlation. Methodology: A retrospective observational study was conducted in the Department of Pathology, Madhubani Medical College & Hospital, Bihar, from January 2025 to December 2025. Ninety-three patients underwent FNAC for clinically detectable breast lumps, of whom 47 with corresponding histopathological reports were included for analysis. Histopathology served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy of FNAC were calculated. Results: Most patients belonged to the 21–30 years age group. Fibroadenoma was the most common benign lesion, while invasive ductal carcinoma was the predominant malignant lesion. Cyto-histopathological correlation showed 9 true-positive, 36 true-negative, 1 false-positive, and 1 false-negative case. FNAC demonstrated a sensitivity of 90.0%, specificity of 97.3%, PPV of 90.0%, NPV of 97.3%, and an overall diagnostic accuracy of 95.7%, indicating excellent agreement with histopathological findings. Conclusion: FNAC is a highly reliable, accurate, and minimally invasive first-line diagnostic modality for the evaluation of palpable breast lesions. Its excellent diagnostic performance supports its routine use in clinical practice, while histopathological confirmation remains essential for suspicious or discordant cases to ensure accurate diagnosis and appropriate patient management.

Introduction: The spectrum of skin changes in neonates ranges from completely physiological to grossly pathological entities. Prevalence of physiological skin changes in neonates was reported to be 41% to 72%. Present study was undertaken to analyze the pattern of physiological skin conditions in neonates of eastern part of the country. Aims and Objectives: (1) To determine the proportion of physiological skin conditions and their clinical pattern among neonates of a tertiary care hospital in eastern India. (2) To establish the relationship between various maternal factors, neonatal factors and the physiological dermatoses. Materials and Methods: A hospital based, cross sectional study conducted on 500 neonates delivered in the department of obstetrics and gynaecology for a period of 1 year. Maternal history and demographic details were taken from the informant. Sex, age, birth weight of the neonate were recorded. Statistical analysis: Collected data was analysed using Chi-Square test and Fisher’s exact test. The analysis was carried out using SPSS software. Results: Among the 500 neonates examined, 325 (65%) were males and 175 (35%) were females. Physiological changes were most commonly encountered in 340 babies (68%). Among the physiological conditions, physiological desquamation was frequently encountered in 108 (21.6%) babies followed by lanugo hairs in 105 (21%), sebaceous gland hyperplasia in 35 (7%) and cutis marmorata in 30 (6%) neonates. Lanugo hairs and cutis marmorata were significantly high among preterm babies. Conditions like physiological desquamation and lanugo hairs were frequent between 3-5 days of age. Conclusion: Newborn babies may have skin changes which usually causes apprehension in the parents hence they need to be thoroughly examined and treated appropriately to avoid unnecessary expenditure on investigations and treatment.

Background: Unilateral nasal masses have a broad spectrum of aetiologies. Clinically, they are often presumed to be either an antrochoanal polyp or a malignancy based on the patient’s age. However, such assumptions may be misleading and can result in missed or unexpected pathological diagnoses. Histopathological examination plays a pivotal role in establishing the definitive diagnosis and identifying occult pathologies. This case series highlights the importance of routine histopathological evaluation in all cases of unilateral nasal masses. Methodology: A retrospective review was conducted of patients who underwent surgical excision of unilateral nasal masses at our institution between January 2026 and June 2026. All excised specimens were subjected to histopathological examination, and the reports were analysed. Patients were followed up for a period of six months postoperatively. Results: A total of 14 patients were included, with a mean age of 37.64 years; the majority were male. Eight patients presented with right-sided nasal masses, while six had left-sided lesions. Histopathological examination revealed inflammatory polyps in eight cases, inverted papilloma, angiofibroma, rhinoscleroma, granuloma, carcinoma in one case each, and a dual pathology of antrochoanal polyp with inverted papilloma in one case. Conclusion: The identification of uncommon and coexisting pathologies in this series underscores the indispensable role of routine histopathological examination in all unilateral nasal masses. Reliance on clinical diagnosis alone may overlook significant underlying pathology, potentially affecting patient management and prognosis.

Background: Chronic otitis media (COM) is a significant health concern worldwide. It is associated with perforation of the tympanic membrane and ear discharge.COM can lead to life-threatening complications if not managed properly. To solve this problem we need to do culture and sensitivity of the ear discharge and start on antibiotics looking into the sensitivity patterns. Objective: The aim of this study isto determine common Bacteriological agents in COM and antimicrobial sensitivity in the ear discharge of patients with chronic otitis media at a tertiary health institution in southern India. Methods: A prospective cross-sectional study was conducted with 60 patients, who had clinical features of chronic otitis media with ear discharge. Ear discharge was collected using sterile swabs. This was taken for culture and sensitivity studies and bacteriological study. Results: The study population was predominantly male (63.3%), with 77.3% of patients aged 30 years or younger. Positive aerobic cultures were obtained in 33 cases (53%). Gram-negative aerobic bacteria were the most prevalent pathogens, with Pseudomonas aeruginosa as the commonest (37.73%), followed by Staphylococcus aureus (20.75%), Escherichia coli (20.75%), and Proteus (16.98%). Isolates showed high resistance (over 70%) to traditionally used first-line antibiotics such as Penicillin, Ampicillin, and Tetracycline. However, Ciprofloxacin demonstrated high efficacy and remains a preferred first-line treatment in the region. Conclusion: The most common organism associated with chronic otitis media in our study was Pseudomonas aeruginosa. There have been high resistance to several antibiotics in case of COM. Ciprofloxacin is a highly effective, low-cost, and preferred first-line therapy to combat this problem. Continuous surveillance of antimicrobial resistance patterns is required for effective clinical management. This also helps in preventing of irreversible complications.

Background: Antimicrobials are widely prescribed for the treatment of infectious disease in pediatric populations. This study was aimed to evaluate prescribing pattern of antimicrobial agents in hospitalized pediatric patients. Material and Methods: The observational, prospective study was conducted at hospitalized pediatric patients, who were prescribed antimicrobials. Data were recorded at baseline and patients were followed up till discharge. Prescriptions were analyzed by using WHO (World Health Organization) core indicators, Phadke’s criteria and Modified Kunin’s criteria respectively. Data was analyzed by using Microsoft Excel version 2007. Results: Total 600 patients were studied. Common infection observed was respiratory tract infection (40.66%). Most common prescribed antimicrobials were Beta-lactam antimicrobials. Rational, semi rational and irrational prescriptions were 69.66%, 27.34% and 3% respectively according to Phadke’s criteria. According to Modified Kunin’s criteria prescriptions were appropriate (69%) and inappropriate (31%). Majority (99.40%) of the Adverse drug reactions (ADRs) were non-serious, possible causal association with suspect drug and non-preventable in nature. Conclusion: Majority antimicrobials prescribed were appropriate and rational.