Introduction: Asymptomatic bacteriuria (ASB) in pregnancy is associated with adverse maternal and fetal outcomes, including pyelonephritis, preterm labor, and low birth weight. Physiological changes during pregnancy, such as ureteral dilation, urinary stasis, and hormonal alterations, increase the risk of ASB. Escherichia coli is the predominant uropathogen, followed by Klebsiella pneumoniae and Staphylococcus aureus. This study aimed to determine the prevalence of ASB among pregnant women in a tertiary care hospital in Gujarat, India. Materials and Methods: A cross-sectional study was conducted over six months, enrolling 220 asymptomatic antenatal women. Midstream urine samples were collected, cultured, and analyzed for bacterial growth. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method per CLSI guidelines. Data were analyzed using SPSS version 21, with categorical variables compared using chi-square or Fisher’s exact test. A p-value <0.05 was considered statistically significant. Results: Among 220 antenatal women, 17.3% had ASB. ASB prevalence was significantly higher in antenatal women with lower socioeconomic status, prior UTI, diabetes, and hypertension. Escherichia coli was the most common isolate (57.9%), followed by Staphylococcus aureus and Enterococcus faecalis (10.5% each). E. coli showed high sensitivity to amikacin (90%), gentamicin (100%), and piperacillin-tazobactam (90%) but moderate resistance to ampicillin (40%). Conclusion: ASB prevalence in antenatal women was 17.3%, underscoring the need for routine screening, especially in high-risk women with a history of UTIs, diabetes, or hypertension. Empirical treatment should follow local antimicrobial susceptibility patterns to prevent resistance. Targeted health education and counselling for women from lower socioeconomic backgrounds should emphasize ASB risks, personal hygiene, and the benefits of early screening.

Introduction: The aim is to introduce flipped classroom as teaching learning method and to assess its effectiveness for students in anaesthesia postings. Methods: The present study was conducted after taking institutional ethical clearance and informed consent of the participants. One hundred fifty students participated and were divided into two Groups A and B. Two topics of anaesthesiology were taught to both groups using either FC-assisted self-directed learning (SDL) sessions or online lecture classes. A cross-over of groups was done to prevent any bias. Pretest and posttest scores of all topics were assessed using multiple-choice questions (MCQs) and feedback was taken. Program evaluation was done. Results: There was no significant difference in performance in pretest MCQ examinations between the two groups. Students of both Groups A and B performed significantly better in posttest MCQ examinations as compared to pretest MCQ examinations. However, the posttest results of the FC group were better. 46.40% strongly agree that there will be increased interest in subject by FC method.47.40% agree that enhancement in learning by FC method .43.30% agree that FC should be preferred teaching learning method .40.20% feel there is improved understanding and course satisfaction.42.30% agree that exam performance will improve by FC method. Conclusion: Faculty and students provided positive views in support of the sessions. Students were highly satisfied with the program. The flipped classroom approach proves to be a superior teaching method, promoting better academic outcomes and greater student engagement and satisfaction More than 40% students believe that it is a better teaching tool and will improve their performance. Teacher’s feedback is the same but they fear that too much effort and resources are required in this FC method.

Background: Ultrasound guidance (USG) for brachial plexus blocks has been described for the supraclavicular, infraclavicular  and axillary approaches. These reports have shown that USG guided brachial plexus blocks have high success rates and few complications. Compared with the axillary approach, the brachial plexus block at the level of the clavicle can anaesthetize all four distal upper extremity nerve territories without the requirement for a separate block of the musculocutaneous nerve. Aim and Objective: The aim of the study was to compare the effect of both supraclavicular and infraclavicular brachial plexus blocks in terms of time taken for onset, duration, block performance, and block success and incidence of adverse events. Materials and Methods: This study conducted on patients of age group between 18 – 60 years of either sex belonging to ASA Grade 1-3 with BMI<35 in patients undergoing elective upper limb surgery. 60 patients were randomised into two groups. Supra clavicular (group S) and infra clavicular (group I). All the patients were given 25 ml of 0.5% ropivacaine (p) as local anesthetics. The block performance time, time taken for onset of sensory and motor blockade, total duration of block, and hemodynamic parameters were observed. The block performance times and the onset of the sensory blockade were the primary outcomes while the duration of the block, success of block, patient satisfaction and hemodynamic parameters were secondary outcomes. Results: The block performance time for the infraclavicular group was 16.1 ± 3.17 min, whereas for supraclavicular group, it was 10.53 ± 2.80 min with similar success rates . Onset of sensory blockade was achieved earlier (8.31 ± 1.23 min) in Group I than Group S (14.20 ± 1.50 min, P = 0.041). The onset of motor blockade was similar in Group I (11.22 ± 1.20 min) and Group S (16.52 ± 28.42 min, P = 0.462). The duration of action, block success and patient satisfaction were similar in both the groups. Adverse events are more in Group S. Conclusion: Ultrasound-guided infraclavicular block is a relatively safer technique when compared to the supraclavicular technique with faster onset, better patient satisfaction and fewer complications.

Aims and Objectives: The primary objective is to study the incidence of POUR after Spinal Anaesthesia using Levobupivacaine and Ropivacaine. The secondary objectives includes correlation between POUR and modified bromage score and to correlate  time to ambulation. Background: Postoperative urinary retention (POUR), a frequent complication after surgery in which patients cannot urinate despite having a full bladder. POUR is common, with occurrence rates varying from 5% to 70%, depending on the type of surgery. The condition arises from disturbances in the nervous system pathways that regulate bladder function, often due to anesthesia, medications, pain, or the physiological effects of surgery. Bladder overstretching from urine retention can lead to long-term complications like detrusor muscle damage. Although catheterization is a common solution, it carries risks such as infection or trauma. Effective management of POUR involves identifying at-risk patients before surgery, using preventive strategies, and ensuring postoperative care to avoid bladder overdistension. Materials and Methods: An observational hospital based study was conducted at the Department of anaesthesiology in Gandhi Medical College Bhopal spanning from August 2022 to December 2023. 60 patients were divided into 2 groups. GROUP L-30 patients received 15 mg (3ml) of Hyperbaric Levobupivacaine 0.5% (Total volume-3ml) and GROUP R -30 patients received 22.5 mg (3ml) of Hyperbaric Ropivacaine 0.75% (Total volume-3ml). Incidences of POUR, Bromage scale and time of ambulation was noted postoperatively. Results: There was no statistically significant difference in demographic data, mean pulse rate, mean diastolic BP between the two groups in this study while sensory regression and motor regression showed variations. The trend showed faster regression of sensory block and motor block in Group R compared to Group L at 5 hours marking and 6 hours marking respectively. the observed differences in POUR incidence between Group L and Group R were not significant. no significant association between intrathecal levobupivacaine and ropivacaine and the severity of POUR. Conclusion: Comparison between intrathecal Levobupivacaine and intrathecal ropivacaine concluded that Intrathecal Levobupivacaine provides long duration of sensory and motor blockade in lower limb surgeries as compared to intrathecal ropivacaine. Therefore, can be used for anticipated long lower limb orthopaedic surgeries. There was no significant difference in the incidence of POUR between the two groups. Although POUR can depend on various other risk factors like gender, age or presence of BPH.

Background: Carcinoma breast, accounts for about 23% of all cancers in women worldwide. Correlation of various prognostic variables of breast carcinoma helps us in assessment of prognosis and to assess the response to treatment. This study aimed to correlate the histological grade of the tumour with hormone receptor expression. Materials and Methods: This was a prospective study, conducted by the Department of Pathology, in a government medical college for a period of 6 months. Histopathological examination and ER, PR, Her-2- neu status was assessed for 50 patients who had underwent mastectomy. Hormone receptor status was then correlated with histological grade of the tumour. Results: Majority of the samples were found to be diagnosed as Infiltrating Ductal Carcinoma No Special Type with Ductal Carcinoma In Situ (IDC-NOS-DCIS) (50%). Most of the cases belonged to grade II carcinoma. Correlation of histological grading with the hormone status indicates that the hormone receptor expression decreases with increasing grade of the tumour and was found to be statistically significant. Conclusion: Hormone receptor expression carries an inverse relationship with the histological grade of the tumor. Evaluating the prognostic factors helps us to provide better treatment and to understand the prognosis of the patient.

Background: Acute biliary pancreatitis is a severe gastrointestinal condition often triggered by gallstones. The timing of laparoscopic cholecystectomy in these patients is crucial for optimizing outcomes and reducing complications. This study aims to compare the effectiveness of early versus late laparoscopic cholecystectomy in managing acute biliary pancreatitis. Objective: To determine whether early laparoscopic cholecystectomy (performed within 72 hours of symptom onset) results in better clinical outcomes compared to late laparoscopic cholecystectomy (performed after initial conservative management of inflammation). Methods: This prospective randomized study enrolled 120 patients diagnosed with acute biliary pancreatitis at JIET Medical College and Hospital, Jodhpur, Rajasthan. Patients were randomly assigned to either early or late cholecystectomy groups. Primary outcomes measured included length of hospital stay, complication rates, and recurrence of pancreatitis. Secondary outcomes focused on overall patient recovery and cost-effectiveness of treatment approaches. Results: The study anticipates that early laparoscopic cholecystectomy will reduce the length of hospital stay, decrease complication rates, and prevent the recurrence of pancreatitis compared to the late intervention group. Statistical analysis will be employed to evaluate the data collected, providing a robust comparison between the two approaches. Conclusion: The findings are expected to clarify the optimal timing for laparoscopic cholecystectomy in patients with acute biliary pancreatitis, potentially influencing clinical guidelines and improving patient management. Demonstrating the benefits of early intervention could lead to a shift in surgical practices and enhanced recovery rates for patients suffering from this condition.

Background: Cystic swellings of the scrotum, including spermatoceles and epididymal cysts, are common benign conditions that can cause discomfort and warrant clinical intervention. The choice between conservative management, sclerotherapy, and surgical excision remains subject to debate due to varying efficacy and patient outcome profiles. Objective: This study aims to evaluate and compare the effectiveness of conservative management, sclerotherapy, and surgical excision for treating cystic swellings of the scrotum, focusing on symptom resolution, recurrence rates, and patient satisfaction. Methods: The study was conducted at the Department of General Surgery, JIET Medical College and Hospital, Jodhpur, Rajasthan, India from feb 2024 to December 2024 . 100 male patients diagnosed with cystic scrotal swellings. Participants were randomly assigned to receive conservative management, sclerotherapy, or surgical excision. Outcomes measured included symptom resolution, complication rates, recurrence within a year, and patient satisfaction assessed through standardized questionnaires. Results: The study is expected to demonstrate varying effectiveness of the treatment modalities, with surgical excision likely showing the highest efficacy in symptom resolution and lowest recurrence rates. However, less invasive treatments such as sclerotherapy might offer a favorable balance of outcome and lower risk of complications. Conclusion: The findings will provide valuable insights into the optimal treatment strategies for cystic swellings of the scrotum, aiding in the refinement of clinical guidelines and improving patient management. This study will help establish evidence-based practices that can enhance patient outcomes and satisfaction.

Background: Iron deficiency anemia (IDA) is a critical health concern worldwide, particularly in developing countries where it affects a significant portion of the pediatric population. Known primarily for its role in impairing cognitive development and physical growth, IDA has also been suspected to influence neurological functions. Given the high prevalence of febrile seizures in young children, which represent a major pediatric emergency, understanding the potential link between IDA and these seizures is essential for developing preventive strategies. Objectives: This study aims to quantitatively determine the prevalence of IDA in children who experience febrile seizures and to investigate the potential association between iron deficiency and the frequency, severity, and clinical outcomes of these seizures. Methods: A comprehensive prospective observational study was conducted involving a cohort of 120 children under the age of five, presenting with febrile seizures at Department of Pediatrics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India. Iron status was assessed using standardized hemoglobin and serum ferritin measurements upon hospital admission. Detailed patient histories, including dietary iron intake and previous medical history of febrile episodes, were also collected to adequately adjust for confounding variables in the analysis. Results: Preliminary findings suggest a significantly higher rate of IDA in children with febrile seizures compared to the national average for pediatric IDA. Initial statistical analyses indicate a robust correlation between reduced iron levels and increased risk of recurrent and severe febrile seizures. Conclusion: The study underscores a potential modifiable risk factor for febrile seizures in the form of iron deficiency. The data advocate for routine screening for IDA in children and suggest that correcting iron deficiency could diminish the incidence or severity of febrile seizures, thereby improving pediatric health outcomes.

Background: Drug response variability is influenced by multiple biological and computational factors, including pharmacogenomics, epigenetics, gut microbiota, and artificial intelligence (AI). Understanding these factors is crucial for optimizing personalized medicine approaches. While pharmacogenomics and epigenetics provide insights into genetic and environmental influences on drug metabolism, gut microbiota plays a pivotal role in modulating drug efficacy and toxicity. AI-driven models are revolutionizing drug response prediction by integrating these multifaceted variables into precision medicine frameworks. Objective: This systematic review synthesizes current evidence on how pharmacogenomics, epigenetics, gut microbiota, and AI collectively shape drug action, aiming to provide a comprehensive understanding of their roles in advancing personalized medicine. Methods: A systematic literature search was conducted across PubMed, Scopus, Web of Science, and Google Scholar, following PRISMA guidelines. Studies published between 2015 and 2023 focusing on the impact of pharmacogenomics, epigenetics, microbiota, and AI on drug response were included. Data extraction covered study characteristics, methodologies, and key findings, with meta-analysis performed where applicable. Bias risk was assessed using established quality evaluation tools. Results: From an initial pool of 1,279 studies, 40 met the inclusion criteria, with five eligible for meta-analysis. Pharmacogenomic variations were strongly linked to differential drug metabolism and adverse drug reactions, while epigenetic modifications influenced gene expression and drug response plasticity. Gut microbiota emerged as a key player in drug bioavailability, metabolism, and toxicity modulation. AI-driven algorithms, particularly machine learning models, demonstrated superior predictive accuracy in identifying drug response patterns and personalizing treatment regimens. Meta-analysis revealed a moderate overall effect size (SMD = 0.56, 95% CI: 0.29–0.83), with AI-driven models showing the highest impact on drug response predictions (SMD = 0.87, SE = 0.05). Conclusion: Pharmacogenomics, epigenetics, and gut microbiota significantly influence drug action, and AI offers a transformative tool to integrate these factors for precision medicine. The findings underscore the need for further research to validate AI-driven predictive models and to standardize methodologies for assessing drug response variability. Future studies should emphasize large-scale clinical trials, improved biomarker identification, and AI-powered decision-support systems to enhance therapeutic precision and patient outcomes.

Objective: Resistant hypertension (RH) is defined as uncontrolled blood pressure (BP) despite adherence to at least three optimally dosed antihypertensive medications, including a diuretic. Spironolactone is a recommended add-on therapy for RH. This study aims to evaluate the efficacy of spironolactone in BP control and its impact on cardiac mass index, assessed by left ventricular mass index (LVMI), in a South Indian population. Materials and Methods: Sixty patients diagnosed with RH were enrolled after ethical committee approval. Spironolactone (25 mg daily) was added to their existing regimen. BP and LVMI were measured at baseline, third, sixth, and ninth months. Tolerability was assessed through biochemical investigations and clinical evaluation. Results: Fifty-six patients completed the study (55% males, 45% females; median age: 45 years). Spironolactone significantly reduced both systolic and diastolic BP at all follow-up intervals (p < 0.001). LVMI regression was also significant (p < 0.001). Serum sodium levels decreased (p < 0.05), while serum potassium increased (p < 0.001) but remained within normal limits. Hyperkalemia occurred in 3.5% (n=2), requiring study withdrawal. Minor adverse effects included vomiting (1.7%, n=1), gastric ulcers (7%, n=4), and breast discomfort (1.7%, n=1), resolving with temporary drug discontinuation. Conclusion: Spironolactone is an effective add-on therapy for RH, significantly improving BP control and reducing LVMI, with manageable side effects. These findings support its use in managing difficult-to-treat hypertension.

Objective: This study aims to evaluate the efficacy of α-tocopherol (Vitamin E) and ascorbic acid (Vitamin C) in reducing insulin resistance in newly diagnosed Type 2 Diabetes Mellitus (T2DM) patients. Materials and Methods: This open-label, randomized controlled study was conducted in adult patients with Type 2 Diabetes attending the outpatient department of a tertiary care hospital in Chennai. The study included a 4-week treatment period followed by a 4-week follow-up per patient. A total of 60 patients were enrolled and randomized into two groups:
Control Group: Metformin 500 mg once daily (OD).
Study Group: Vitamin C 500 mg OD + Vitamin E 400 mg OD + Metformin 500 mg OD.
Participants were randomly assigned using simple randomization. Insulin resistance was assessed using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Results: Out of 124 patients screened, 60 patients were included in the study, all of whom completed the trial. The study group demonstrated significant reductions compared to the control group:
Insulin resistance (HOMA-IR): Study group: -4.95, Control group: -2.54 (p = 0.030).
Fasting plasma glucose (mg/dl): Study group: -38, Control group: -34 (p = 0.020).
Postprandial glucose (mg/dl): Study group: -75, Control group: -55 (p = 0.038).
The most commonly observed adverse effect was gastrointestinal disturbances, occurring in 33.3% of the study group and 36.6% of the control group. Conclusion: The addition of Vitamin C and Vitamin E to standard Metformin therapy significantly reduces insulin resistance in newly diagnosed Type 2 Diabetes Mellitus patients compared to Metformin alone.

Peripheral nerve blocks have certain advantages over central neuraxial anaesthesia and general anaesthesia, hence they have become increasingly popular for the  management of pain during surgery. The development of ultrasonography in regional anaesthesia made it possible to confirm precise needle placement and appropriate local anaesthetic administration. Furthermore, it is possible to prevent     problems such as intravascular and intraneuronal injections. Real-time ultrasound  not only lowers the amount of local anaesthetic needed for a successful nerve block  but also enhances the quality of the block. Ultrasonographic guidance is beneficial in reducing intra neural injection and targets the neural sheath where drug can be deposited and block can be achieved with minimum possible volume. This study attempts to determine minimum possible volume of bupivacaine 0.5% to achieve adequate motor and sensory blockade by using ultrasound guided brachial plexus block. Methodology: The study was conducted in Department of Anaesthesiology, Gandhi Medical College and associated Hamidia Hospital, Bhopal during August 2022 to December 2023 after approval from institutional ethics committee. It was an Observational hospital-based study. The study was an observational study comprising of 75 patients between age group 18-60 years of either sex belonging to ASA grade I or II, scheduled for elective upper limb surgery. Patients with neurologic deficit in upper limb, Diaphragm palsy, Respiratory distress and Allergy to the local anaesthetics were excluded. Under all aseptic precautions ultrasonography was done at the level of supraclavicular region and structures traced from cephalic to caudal direction. the probe was placed in the coronal plane to visualize the subclavian artery and the brachial plexus in a transverse sectional view. Once the needle penetrated the brachial plexus, the bupivacaine 0.5% was injected after negative aspiration for blood or air just next to the artery, then the needle was repositioned to inject on the upper pole of the artery. Twenty five patients received 10 ml Drug (group A), next 25 patients received 15 ml Drug (group B) and next 25 patients received 20 ml Drug (group C) each. Result: Based on our findings, we determined that a volume of 15 ml of bupivacaine 0.5% reliably achieves effective sensory and motor blockade in the patients undergoing upper limb surgeries. This volume provides adequate anaesthesia while potentially reducing the risk of systemic toxicity associated with higher volume.

Background: Multiple modalities are existing for chronic knee pain management. Genicular nerve neurolysis/Rhyzotomy and intra-articular steroid injection (IASI) are available treatment options for patients with knee osteoarthritis. There is increasing evidence supporting the effectiveness of cooled radiofrequency ablation (RFA) in treating genicular nerves for patients with chronic knee osteoarthritis (OA). This study aims to compare the efficacy of cooled RFA with that of intra-articular steroid injection (IASI) in patients with knee pain caused by OA. Aims and Objectives: The primary objective of this observational, prospective study was to evaluate the long‐term outcomes, including pain, function, and perceived effect of treatment, in subjects undergoing cooled radiofrequency ablation (CRFA) who have pain due to osteoarthritis (OA) of the knee. Methods: The prospective observational type of study was carried out on thirty patients with Kellgren–Lawrence grade 2–4 knee OA in the department of Anaesthesiology at Gandhi Medical College Bhopal after the approval of Institutional Ethics Committee of our hospital. The patients were assigned into 2 groups randomly as IASI (N=15) and CRFA (N=15) group. All the patients were evaluated with Visual analogue score (VAS) for pain intensity and Western Ontario and Mc Master Universities Osteoarthritis Index (WOMAC) for functional status of the patients. All assessments were measured and compared at baseline, 1 month, 3 month and 6th month after treatment. Furthermore, patient satisfaction was also recorded. Results: All evaluation parameters were significantly improved in IASI and CRFA groups. Both VAS and WOMAC score of CRFA group were significantly lower than VAS and WOMAC score of IASI group during all the intervals of time (p<0.001). Satisfaction grades did not differ between the two groups. Conclusions: Cooled radiofrequency ablation (CRFA) of the genicular nerve and intra-articular steroid injection (IASI) are potential treatments for knee joint pain in osteoarthritis. However, CRFA provides better pain relief and enhances functional capacity in patients with knee joint pain from osteoarthritis compared to IASI.

Immunotherapy may greatly enhance rheumatoid arthritis treatment. Tumor necrosis factor alpha antagonists, such as infliximab, etanercept, and adalimumab, are used to treat rheumatoid arthritis. These drugs lower inflammation and improve symptoms by targeting and inhibiting tumor necrosis factor alpha, a significant inflammatory cytokine implicated in the development of rheumatoid arthritis. Infliximab not only improves physical performance and quality of life, but it also slows the progression of joint deterioration and keeps the signs and symptoms of rheumatoid arthritis at bay. Etanercept is both safe and effective in the treatment of rheumatoid arthritis. Combination treatment with etanercept and methotrexate is more successful than monotherapies in reducing disease activity, slowing joint deterioration, and improving function. Adalimumab, alone or in conjunction with methotrexate, alleviates rheumatoid arthritis symptoms. Because of the introduction of biosimilars that are less expensive than the original drugs, treatment may now be made available to a larger number of patients. The review includes a thorough examination of the most recent evidence-based data on tumor necrosis factor alpha inhibiting biosimilars with respect to their safety and efficacy.

Background: The majority of thyroid nodules that are inadvertently found are benign and asymptomatic. Though the malignant nodules make up 5% of thyroid nodules, they must be diagnosed accurately for clinical reasons. While conventional ultrasonography is a reliable method for identifying thyroid nodules, it is not possible to distinguish between benign and malignant nodules. The primary drawback of FNA cytology is that 10–15% of specimens are indeterminate and 10–15% are nondiagnostic. FNA cytology is invasive and vulnerable to errors in sampling and analysis. Thus, there is a need to enhance and perfect non-invasive techniques to diagnose malignant lesions. Palpable thyroid nodule stiffness is a subjective measure that cannot reliably predict cancer. It has been demonstrated that sonoelastography is helpful in differentiating between benign and malignant tumours. In contrast to the surrounding normal tissues, the majority of benign tumours are softer, whereas the majority of malignant tumours are stiff and hard. Thus, the purpose of this study was to illustrate the diagnostic precision and usefulness of sonoelastography in identifying thyroid nodules that are benign or malignant. Methods: This cross-sectional study, which involved 41 patients with thyroid nodules was carried out in the radiology department of a tertiary care hospital between September 2017 and October 2018. Strain sonoelastography was carried out during the conventional ultrasound examination of the thyroid gland. The ‘Rago’ criteria-based sonoelastography colour scoring system was applied. The trial participants subsequently had a ultrasound-guided FNA cytology of the lesions. SPSS 22 version software was used for data analysis after the data was entered into a Microsoft Excel data sheet. Frequencies and proportions were used to depict categorical data. For qualitative data, the chi-square test or Fischer’s exact test was employed as the significance test. The mean and standard deviation were used to depict continuous data. Data visualisation was done using Microsoft Word and Excel to create a variety of graphs, including pie charts and bar charts. Results: The majority of these individuals (41.5%) were in the age range of 31 to 40. 90.2% of the patients were female. In the B-mode, there were 5.1% malignant lesions, 23.7% indeterminate lesions, and 71.2% benign lesions. 13.6% of elastography scores were 1, 66.1% were 2, 10.2% were 3, 8.5% were 4, and 1.7% were 5. 10.2% of the lesions were determined to be malignant and 89.8% to be benign based on the elastography scores. In reference to sonoelastography, only 66.7% of the malignant lesions and 33.3% benign lesions were found to be picked up in B-mode sonography; similarly, among those indeterminate lesions of B-mode sonography, 14.3% were found to be malignant and 85.7% to be benign on sonoelastography; and among those benign lesions of B-mode sonography, 4.8% were found to be malignant and 95.2% were benign by sonoelastography. Among the thyroid nodules, 88.1% of lesions were found to be benign based on FNAC/HPE, whereas 11.9% were found to be malignant. Colloid goitre (22%), papillary carcinoma (10.2%), and follicular carcinoma (1.7%) made up the majority of the study findings, with hyperplastic nodules accounting for 66.1%. All the malignant lesions identified by B-mode sonography were found to be concordant in HPE (100%); 14.3% of those with B-mode indeterminate lesions were found to be malignant by FNA cytology/ HPE and 85.7% to be benign; 2 benign lesions of B-mode (4.88%) were found to be malignant. Thus, the B – mode sonography had a sensitivity of 42.86%, specificity of 100%, PPV of 100%, NPV of 95.24% with diagnostic accuracy of 95.56% in diagnosis of malignant lesions in comparison with HPE. Sonoelastography showed a sensitivity of 85.71%, specificity of 100%, PPV of 100%, NPV of 98.1% with diagnostic accuracy of 98.3% in the diagnosis of malignant lesions in comparison with HPE. Combined sonoelastography and B Mode sonography showed a 100% sensitivity, specificity and NPV of 100% with diagnostic accuracy of 100% in diagnosis of malignant lesions in comparison with HPE. Conclusion: An imaging method that shows promise for characterising thyroid nodules is sonoelastography. When B-mode and sonoelastography are used together, the outcomes are superior to when they are used separately.

Introduction: Subarachnoid block (SAB) is commonly used for lower limb and abdominal surgeries due to its benefits like reduced bleeding and good operative conditions. However, it can cause side effects like hypotension and bradycardia due to sympathetic blockade, reduced cardiac output, and peripheral blood pooling. Non-invasive blood pressure (NIBP) monitoring has limitations in detecting beat-to-beat perfusion variations. Perfusion index (PI), measured via pulse oximetry, assesses perfusion dynamics and may predict hypotension after subarachnoid block (SAB). This study aimed to determine if a baseline PI >3.5 predicts hypotension following spinal anesthesia. Perfusion index (PI), measured by pulse oximetry, reflects peripheral blood flow and vasomotor tone, influenced by factors like sympathetic tone, pain, and temperature. It indicates variations in blood volume and sympathetic vascular tone. PI changes with vasodilation and regional blocks, serving as a non-invasive marker of perfusion and sympathetic activity. Aims and Objectives: To evaluate the correlation between baseline perfusion index and incidence of hypotension following subarachnoid block in Lower limb orthopedic surgeries. Methodology: The study was conducted in Department of Anesthesiology, Gandhi Medical College Bhopal for a period of 1.5 years. This observational prospective cohort study involved 60 patients (aged 15-60, ASA grade I/II) undergoing lower limb orthopedic surgeries. Preoperative perfusion index (PI) was recorded, and various vital parameters were monitored during surgery. Subarachnoid block with 0.5% bupivacaine was administered, and blood pressure changes were compared to preoperative PI. Hypotension episodes were analyzed to assess PI’s predictive value for intraoperative hypotension. Result: Demographic variables like age, weight, and surgery indication were similar across both groups and did not affect results. A significant difference in intraoperative blood pressure (SBP, DBP, MAP) was observed, with the PI >3.5 group showing a greater drop. Hypotension occurred in 73.3% of PI >3.5 patients versus 16.7% in PI <3.5 patients. Surgery duration and nausea/vomiting incidence were similar in both groups, with no respiratory distress or pruritus reported. Conclusion: The study found that a preoperative perfusion index (PI) >3.5 correlates with a higher incidence of intraoperative hypotension in lower limb orthopedic surgeries under spinal anesthesia compared to PI <3.5.

Background: Tuberculosis (TB) and diabetes mellitus (DM) are two major global health challenges, with their coexistence increasingly recognized as a serious public health concern, particularly in low- and middle-income countries like India. The dual burden of TB and DM complicates disease management and adversely affects treatment outcomes. This study aimed to assess the socio-demographic profile, glycemic control, and treatment outcomes in newly diagnosed pulmonary TB patients with coexisting diabetes in Gujarat, India. Methods: A longitudinal observational study was conducted for six months across five Tuberculosis Units (TUs) in Gujarat. Eighty newly diagnosed pulmonary TB patients with diabetes were enrolled and followed through three stages: at diagnosis, after the intensive phase of TB treatment, and at the end of therapy. Socio-demographic data, glycemic parameters (FBG, PPBG, HbA1c), and treatment outcomes were assessed using pre-tested questionnaires and laboratory investigations. Data were analyzed using SPSS version 25.0. Results: The majority of participants were middle-aged males (61.25%), with laborers constituting the largest occupational group (42.5%). Significant improvement in glycemic control was observed during treatment: mean FBG reduced from 162.8 mg/dL to 139.5 mg/dL (p<0.001) and PPBG declined from 247.3 mg/dL to 210.9 mg/dL (p<0.001). Treatment success was achieved in 90.2% of patients, while 6.9% were lost to follow-up and 2.8% died. Conclusion: Integrated management of TB and diabetes significantly improved glycemic control and resulted in favorable treatment outcomes. Comprehensive bidirectional screening and collaborative management are essential for improving the prognosis of TB-DM comorbid patients.

Background: Distal radius fractures are common orthopedic injuries, particularly affecting young males and older women. In elderly patients, conservative management with closed reduction and casting is often preferred due to surgical contraindications. The cast index, a ratio of sagittal-to-coronal width at the fracture site, has been suggested as a predictor of treatment success, though its role in elderly patients remains underexplored. Aim: This study evaluates the predictive value of the cast index in determining clinical and radiographic outcomes in elderly patients with distal radius fractures managed conservatively. Methodology: A prospective observational study was conducted at K.S. Hegde Medical Academy, Mangalore, from September 2022 to April 2024. Sixty patients with dorsally displaced, metaphyseal, extra-articular distal radius fractures undergoing closed reduction were included. The cast index was assessed using X-rays on Days 1, 8, and 42. Statistical analysis was performed using SPSS 24.0, with significance set at p < 0.05. Results: Radial height increased significantly from 7.88 ± 2.75 mm (Day 1) to 8.90 ± 3.06 mm (Day 42) (p=0.001). Post-hoc analysis confirmed significant changes between Days 1 and 8 (p=0.008) and Days 1 and 42 (p=0.001). Ulnar variance also showed a significant increase from Day 8 to Day 42 (p=0.001). Volar tilt exhibited a minor but significant increase (p=0.031). Conclusion: These findings emphasize the importance of radiographic monitoring in elderly distal radius fractures. Age and sex influence fracture displacement, with older patients at higher risk. Further research is needed to refine predictive models for optimizing conservative treatment.

Background & Methods: Caudal anaesthesia is a very reliable technique used in pediatric age group for infraumblical interventions. The aim of the study is to observe the trend of perfusion index which is the ratio of the pulsatile blood flow to non-pulsatile static blood flow in a patients’ peripheral tissue such as fingertip, toe, ear lobe in pediatric population after administration of general anaesthesia followed by caudal block. This study involved 130 children between age group 2-7 years of either sex belonging to ASA grade I to II. Perfusion index was noted at 0,1,5,10, and then every 10 minutes interval upto 30 minutes following caudal block. Results: Perfusion index was noted at 0,1,5,10, and then every 10 minutes interval upto 30 minutes following caudal block. In our study, the baseline PI measurement was 1.87 ± 0.77, which increased to 4.91 ± 1.63 at 5 minutes post-block, indicating a substantial 162.6% increase. The paired t-test results indicated statistical significance (p < 0.05) for all time points compared to baseline, highlighting the rise in PI after a successful caudal block. Conclusion: There was a significant rise in the perfusion index following caudal block at all time intervals reflecting the block’s ability to achieve the desired anaesthetic and perfusion outcomes, ensuring adequate regional anaesthesia and improved surgical conditions. A progressive improvement in perfusion indices following the administration of anaesthesia reflects its reliability as a promising non-invasive indicator of successful caudal block.

Effective postoperative pain management is crucial for enhancing patient recovery and improving quality of life following surgery. Ultrasound-guided thoracic interfascial plane blocks, specifically the Pectoral Nerve Block II (PEC II) and the Serratus Anterior Plane Block (SAPB), are relatively simple and easy-to-learn techniques. These blocks have been developed as alternatives to thoracic epidural anaesthesia and paravertebral blocks for regional analgesia in breast surgeries. Our study aimed to evaluate the effectiveness of these two blocks in managing postoperative pain for 24 hours following breast surgeries, such as modified radical mastectomy (MRM) or simple mastectomy. Pain was assessed using the Visual Analog Scale (VAS), along with the timing of the first analgesic requirement and the total tramadol consumption within 24 hours. This observational study was conducted to determine the impact of these blocks on acute post-surgical pain. Methodology:  This interventional study was conducted on 30 patients undergoing breast surgeries under general anaesthesia, with 15 patients receiving either a PECS-II blocks or a Serratus Anterior Plane Block (SAPB). A total of 30 ml of anaesthetic solution was prepared using 25 ml of 0.25% levobupivacaine combined with dexmedetomidine (1 mcg/kg), diluted to 30 ml with normal saline. Tramadol (1-2 mg/kg) was provided as rescue analgesia. Postoperative pain was assessed using the Visual Analog Scale (VAS) at multiple time points (0, 1, 2, 4, 8, 16, and 24 hours after surgery). Additionally, the time to first analgesia (TFA) and any complications were recorded. Result:  In this study, we observed that first rescue analgesia or duration of analgesia was more in patients who received SAP (511.0 ± 40) than patients who received PEC block (378.4 ± 60) which was statistically highly significant (p< 0.001). Conclusion: This study has clarified that employing an ultrasound-guided SAP block, combined with dexmedetomidine as an adjuvant alongside 0.25% levobupivacaine, results in superior postoperative analgesia compared to PEC block.

Background: Hypertension is a leading global health concern with multifactorial etiology, including genetic and environmental influences. ABO “blood groups have been implicated in disease susceptibility, including hypertension. This study investigates the correlation between ABO blood groups and hypertension across different age groups. Methods: A retrospective study was conducted in the Department of Physiology, Anugrah Narayan Magadh Medical College, Gaya, Bihar. Data from 98 participants (51 males, 47 females) were collected over nine months. Blood pressure was measured using a mercury sphygmomanometer, and ABO and Rh blood groups were determined using the slide agglutination method. Body mass index (BMI) was calculated using standard WHO classifications. Statistical analysis was performed using SPSS version 27, with a significance threshold of p < 0.05. Results: Blood group B was the most prevalent (34.69%), followed by O (28.57%), A (27.55%), and AB (9.18%). Rh-positive individuals constituted 92.86% of the sample. Blood group B exhibited the highest prevalence of pre-hypertension and Stage I hypertension. Additionally, obesity (BMI ≥30) was most common in blood group B, while blood group AB had no obese individuals. Pre-hypertension was more frequent across all blood groups than Stage I hypertension. Conclusion: This study suggests a potential association between blood group B and increased susceptibility to hypertension and obesity. The findings highlight the need for further” large-scale studies to validate these associations and explore underlying genetic and physiological mechanisms.

Background: One of the main causes of cancer-related deaths worldwide, colorectal cancer (CRC) is the third most frequent type of cancer.  Despite treatment advancements, the prognosis for advanced-stage colorectal cancer remains unfavourable.  The tumor-node-metastasis (TNM) staging system is commonly utilized for prognostic assessment; however, it fails to incorporate systemic inflammation, a significant factor in cancer progression.  The Glasgow Prognostic Score (GPS), which utilizes serum C-reactive protein (CRP) and albumin levels, serves as an inflammation-based prognostic instrument that could improve risk assessment in CRC. Aim: The purpose of this study is to determine the predictive importance of systemic inflammation in disease development in CRC patients by examining the association between GPS and TNM staging. Methodology: The study employed a cross-sectional design involving 88 patients with colorectal cancer at Department of General Surgery,  AIIMS, Patna, Bihar, India.  GPS was assessed through CRP and albumin levels, and TNM staging was categorized according to the American Joint Committee on Cancer (AJCC) 8th edition guidelines.  Statistical analysis, utilizing chi-square tests, was conducted to assess the relationship between GPS and TNM staging, with significance established at p < 0.05. Results: GPS and TNM stage were shown to be significantly correlated (p = 0.0123).  Increased GPS scores were observed in Stage III patients, suggesting an association between systemic inflammation and disease advancement.  Stage IV patients exhibited a greater proportion of GPS 0, indicating a complex interplay between inflammation and tumor burden. Conclusion: The findings indicate that GPS is substantially linked with TNM staging in patients with CRC.  Integrating GPS with TNM staging could enhance prognostic accuracy and facilitate personalized treatment planning. Additional research is required to investigate the biological mechanisms that underlie this association.

Background: Postoperative nausea and vomiting (PONV) are prevalent complications associated with general anesthesia, impacting as many as 80% of patients identified as high-risk. PONV can prolong recovery time, extend hospital stays, and result in serious complications. 5-HT3 receptor antagonists, including Ondansetron, have traditionally been considered the gold standard; however, Palonosetron, a newer agent with an extended half-life and increased receptor affinity, has been proposed as a viable alternative. This research evaluates the effectiveness of Palonosetron versus Ondansetron in preventing postoperative nausea and vomiting (PONV) in patients undergoing abdominal surgery. Aim: To assess the effectiveness of intravenous (IV) Palonosetron (0.075 mg) and IV Ondansetron (4 mg) in preventing postoperative nausea and vomiting (PONV) in patients undergoing general anesthesia for abdominal surgery. Methodology: A comparative study was undertaken at Department of Anesthesia, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India on 70 patients receiving major abdominal surgery.  Patients were randomly assigned to two groups: Group P (Palonosetron, n=35) and Group O (Ondansetron, n=35). The incidence of postoperative nausea and vomiting (PONV), its severity, the requirement for rescue antiemetics, and visual analog scale (VAS) scores were evaluated over a 48-hour period.  Data analysis utilized SPSS v25.0, with a significance threshold set at a p-value of less than 0.05. Results: PONV was well-controlled in both groups. Vomiting remained minimal throughout.  Nausea scores were significantly higher in Group P, with p=0.001 at the 24–48 hour mark.  Group O exhibited reduced PONV scores and VAS scores at the 24–48 hour interval (p=0.002).  Both groups exhibited minimal consumption of rescue antiemetics. Conclusion: Ondansetron showed a slight but noteworthy benefit in reducing the intensity of nausea and the requirement for rescue medication, while Ondansetron and Palonosetron prevented PONV equally well. The long-term benefits of Palonosetron’s extended half-life require further investigation in future studies.

Background: Abnormal uterine bleeding (AUB) is a prevalent yet complex gynaecological condition with many aetiologies, necessitating precise evaluation for suitable therapy. While clinical diagnosis provides a first assessment, histological examination remains the definitive standard for confirming underlying aetiologies and guiding appropriate therapeutic choices. Objective: The objective is to correlate histological findings with clinical manifestations in patients undergoing hysterectomy for abnormal uterine bleeding, therefore enhancing diagnostic precision and therapeutic approaches. Methods: This prospective observational study involved 74 patients Undergoing hysterectomy for abnormal uterine bleeding at the Department of Obstetrics and Gynaecology, Jagannath Gupta Institute of Medical Sciences and Hospital, Budge budge, Kolkata, India. Hysterectomy specimens underwent histological examination, ultrasonic evaluation, and clinical assessment. The statistical correlation between clinical and histological diagnoses was included in the data analysis. Results: The perimenopausal age group of 41 to 45 years, including 29.7%, exhibited the highest prevalence of abnormal uterine bleeding (AUB). The most prevalent presentation was menorrhagia (40.5%). Histopathological findings revealed proliferative endometrium (27.0%) and secretory endometrium (24.3%), following endometrial hyperplasia (18.9%), fibroids (16.2%), and adenomyosis (8.1%). 5.4% of patients exhibited malignancy. Histological analysis confirmed many illnesses, with dysfunctional uterine bleeding (DUB) being the predominant clinical diagnosis at 33.8%. This underscores its critical role in diagnosis and therapy. Conclusion: Histological research is essential for establishing a clinical diagnosis of AUB and preventing misinterpretation.  Patient outcomes can be improved by carefully choosing a hysterectomy and, where possible, reviewing conservative therapy options.

Background: Even though MRI is an expensive technique, not every lesion or mass of the uterus can be visualized on ultrasound due to obscuration of the pelvis by bowel gas; hence, both studies are mandatory to conclude the uterine mass in addition to the histopathology of the uterine mass.  Method: In 90 adult women with uterine masses, transabdominal ultrasound, transvaginal ultrasound, and MRI were performed in all patients. The observations were compared. Results: The clinical manifestations were 63 (70%) had pain, 33 (36.6%) had bleeding PV, 27 (30%) had discharged PV, 6 (6.6%) had a mass abdomen, 6 (6.6%) had loss of weight and appetite pre-menopausal, and 30 (33.3%) were post-menopausal. According to their histopathological report, they were classified into five groups: adenomyosis was affected in 21 patients, fibroids were observed in 42 individuals, endometrial cancer was in 6 patients, and cervical cancer was polyp. Out of ten women, two had adnexal pathology. Conclusion: To localize, characterize, and evaluate the number of uterine lesions, both benign and malignant, along with their staging in pelvic pathologies, MRI was found to be more precise and the gold standard in comparison to USG. Most times, MRI had an edge over USG in detecting endometrial invasion in the case of endometrial carcinoma and staging in the case of cervical carcinoma.

Background: Dyspepsia is a clinical problem with many manifestations, such as belching, heartburn, anorexia, nausea, and vomiting. Proper medication is necessary; hence, an ideal prokinetic drug has to be studied with a comparison of the efficacy of both drugs. Method: Out of 90 patients with dyspepsia, 45 patients were treated with Itopride and 45 with Levosulpiride, and their efficacy was compared. Results: More relief was observed in the Itopride group 28 (62%) compared to the 22 (48.8%) group of Levosulpiride. Moderate relief was highest in Itopride 15 (33.3%) and 14 (31%); in Levosulpiride, worsening of the symptoms was observed only in Levosulpiride 1 (2.22%). The comparison of serum biochemistry and Q.T interval of both drugs has a significant p-value (p < 0.001). The side effect of diarrhea was 2 (4.4%) in levosulpiride, while headache was 3 (6.6%) in Itopride. Conclusion: Both levosulpiride and Itopride were equally effective and well-tolerated in treating the symptoms of non-ulcer dyspepsia.

Background: Tibial spine avulsion fractures, though uncommon, are functionally significant injuries that disrupt anterior cruciate ligament (ACL) continuity and knee joint stability. These fractures occur more frequently in adolescents and young adults and are often the result of high-energy trauma or sports-related injuries. Arthroscopic fixation techniques have emerged as the preferred modality due to their minimally invasive nature and ability to achieve stable reduction. Objective: To evaluate the functional outcome of patients undergoing arthroscopic suture pull-out fixation for displaced tibial spine avulsion fractures at a tertiary care center using standardized clinical scoring systems. Methods: This prospective study was conducted at All India Institute of Medical Sciences (AIIMS), Patna, Bihar. Patients with displaced tibial spine avulsion fractures (Meyers and McKeever type II–IV) treated with arthroscopic suture pull-out fixation using non-absorbable sutures were included. Clinical and functional outcomes were assessed using the Lysholm Knee Score and IKDC (International Knee Documentation Committee) Score at regular follow-up intervals over a period of six months. Results: A total of 25 patients were enrolled. The majority were adolescents with a mean age of 16.4 years. All patients achieved satisfactory fracture union with restoration of knee stability. At the final follow-up, the mean Lysholm Score was 91.6, and the mean IKDC Score was 87.8. No case of fixation failure, infection, or arthrofibrosis was reported. Most patients resumed pre-injury activity levels within 3 to 4 months. Conclusion: Arthroscopic suture pull-out fixation is a safe, effective, and functionally rewarding technique for displaced tibial spine avulsion fractures. It facilitates early rehabilitation, excellent joint stability, and high patient satisfaction with minimal complications.

Background: Postdated pregnancies are characterized by beyond the anticipated delivery date, which is associated with a heightened risk of morbidity for both the mother and the neonate. Complications have consistently been linked to oligohydramnios, meconium-stained amniotic fluid, and lower segment cesarean section during emergency birth. At the neonatal stage, these pregnancies have a considerable incidence of low birth weight, NICU admissions, and perinatal death. Labor induction in postdated pregnancies is a frequently executed procedure that entails inherent risks and problems. Aim: This study aim to evaluate maternal and newborn outcomes in postdated pregnancies, focusing on the implications of labor induction, complication rates, and associated risks. Methods:  This retrospective study was conducted in the Department of Obstetrics and Gynecology at Government Medical College and Hospital, Purnea, Bihar, India for one year . 94 women with postdated pregnancies, comparing outcomes between those who underwent induced labor and those who experienced spontaneous labor. The collected data encompassed rates of oligohydramnios, meconium-stained amniotic fluid, delivery methods, newborn outcomes, and maternal problems. Results: Induced labor correlated with increased incidences of oligohydramnios (52% compared to 35%), meconium-stained amniotic fluid (25% against 12%), and emergency lower segment cesarean section (60%). Neonatal outcomes were worse in the induced labor cohort, exhibiting elevated NICU hospitalizations (16%) and heightened incidences of low birth weight (13%). Maternal problems, such as postpartum hemorrhage and infection, were more prevalent in induced labor. Conclusion: Postdated pregnancies have considerable risks, particularly with labor induction. Attentive surveillance, prompt intervention, and pregnancy-specific treatment techniques can enhance both maternal and newborn outcomes.

Background: Diabetes mellitus (DM) is a chronic metabolic disorder with an increasing global prevalence, particularly in India. Iron metabolism has been “implicated in the pathogenesis of type 2 diabetes mellitus (T2DM), with evidence suggesting a correlation between elevated serum ferritin levels and impaired glycemic control. Understanding this association could provide novel insights into the metabolic disturbances underlying T2DM. Objectives: This study aims to evaluate the relationship between serum ferritin levels and glycemic control in T2DM patients, with a specific focus on its correlation with glycated hemoglobin (HbA1c) levels and disease duration. Methods: A case-control study was conducted at Department of Biochemistry, Patna Medical College, India, including 76 participants (38 T2DM cases and 38 age-matched healthy controls). Serum ferritin and HbA1c levels were measured using Electrochemiluminescence Immunoassay (ECLIA) and Turbidimetric Inhibition Immunoassay, respectively. Data were analyzed using SPSS 27.0, employing Student’s t-test and Pearson’s correlation. Results: T2DM patients exhibited significantly higher serum ferritin levels (528.46 ± 142.30 µg/L) compared to controls (178.62 ± 94.75 µg/L) (p < 0.0001). A positive correlation was observed between serum ferritin and HbA1c levels (r = 0.621, p < 0.0001), suggesting that higher ferritin levels are associated with poorer glycemic control. Additionally, a weak but significant correlation was found between serum ferritin and diabetes duration (r = 0.278, p = 0.047). Conclusion: Elevated serum ferritin levels are significantly associated with impaired glycemic control and disease progression in T2DM. These findings underscore the role of ferritin as a biomarker for metabolic dysregulation in diabetes management.

Background: Type 2 Diabetes Mellitus (T2DM) is a progressive metabolic disorder characterized by insulin resistance and β-cell dysfunction. C-peptide, a marker of endogenous insulin secretion, plays a crucial role in assessing β-cell function. This study evaluates the correlation between fasting and postprandial C-peptide levels with glycemic markers in T2DM patients to better understand β-cell function and its relationship with glycemic control. Methods: A cross-sectional study was conducted in the Department of Biochemistry, Patna Medical College, Bihar, India, with 86 T2DM patients. Fasting and postprandial plasma glucose, C-peptide levels, and HbA1c were measured. Correlation analysis was performed between C-peptide levels and glycemic parameters using Pearson’s correlation coefficient. Results: The mean age of participants was 52.3 ± 10.4 years, with a male-to-female ratio of 1.2:1. The mean fasting and postprandial plasma glucose levels were 152.6 ± 28.4 mg/dL and 225.7 ± 35.2 mg/dL, respectively, while the mean HbA1c was 8.3 ± 1.5%. A significant negative correlation was observed between fasting C-peptide and HbA1c (r = -0.42, p < 0.001) and postprandial C-peptide and HbA1c (r = -0.48, p < 0.001), indicating declining β-cell function with worsening glycemia. Conclusion: C-peptide levels negatively correlate with HbA1c and plasma glucose levels, highlighting the progressive decline in β-cell function in T2DM. These findings suggest that C-peptide assessment can serve as a valuable tool in evaluating β-cell reserve and optimizing treatment strategies. Further, longitudinal studies are warranted to explore its prognostic significance.

Objective: To evaluate maternal complications and fetal outcome in eclampsia and to formulate strategies to improve the maternal and perinatal outcome. Methods and Material: It is a prospective study in which 100 patients with eclampsia antenatal or within 10 days after delivery were included, Patients with seizures due to epilepsy or other cerebral conditions were excluded. A thorough general physical examination, systemic and obstetric examinations were done.  Immediate decision regarding mode of delivery was taken. Maternal complications and foetal outcome were noted. Patient followed through from admission till discharge. Results: Out of 100 patients of eclampsia, 77 cases were antepartum, most of patients were nulliparous, with age between 20-30 years, unbooked, belonging to rural population. maternal complications were cerebral oedema 6%, CVT 3%, pulmonary oedema 2%, deranged LFT 3%, grade 1 nephropathy 3%, grade 1 hypertensive retinopathy 12%, massive ascites 3%, abruptio placentae 1%, PPH 3% and PRES 4%.maternal mortality is 2% and perinatal mortality is 22.22%. Conclusion: This study is done in an area which is considered underdeveloped & backward in the state, therefore early diagnosis of hypertension and its prompt management will prevent eclampsia and thereby preventing complications of eclampsia, hence by increasing awareness, regular antenatal check-ups, improving medical and transport facilities, the incidence and associated morbidity & mortality can be further reduced.

Background: The aim of this study is to assess and compare between ultrasound guided, peripheral nerve stimulator and combined technique for supraclavicular brachial plexus block in patients undergoing elbow and below elbow surgeries with respect to ease of administration, success rate and quality of block. Materials and Methods: 75patientsbelongingtoASA I and II grades and presenting for elective upper limb surgeries in the age group of 20-60 years were included in the study. They were randomly divided into one of the following three groups. Patients who received supraclavicular block through PNS technique were labeled asGroup A. Patients who received supraclavicular block through USG technique were labelled as Group B. Patients received supraclavicular block through combined method were labelled as Group: We used 20-35 ml of local anesthetics for all 3 groups which was a mixture of Lignocaine, Bupivacaine, Hyalase, Dexa with distilled water. In all 3 groups we noted block execution time, time taken for achieving complete nerve block, onset of sensory block, onset of motor block, duration of sensory block , duration of motor block, need for supplementation, safety profile, success and failure. Observation and Results: There were no significant changes noted in all 3 groups with respect to demographic parameters. Mean time required for performing block was significantly lesser in combined group (6.32 +/- 1.60 min). Similarly, onset of sensory block was minimum in combined technique (5.56+/-2.56 min) Mean duration of sensory block was observed to be more in combined technique (8.54 +/- 2.79 hours). Conclusion: We observed shorter procedure time, faster onset time of sensory and motor block with combined USG and PNS guided supraclavicular block. There was no incidence of complications such as arterial puncture, nerve injury and pneumothorax with any of the techniques.

Cancer is an important major health problem with high mortality rate around the world. By 2040, the number of new cancer cases per year is expected to rise to 29.9 million and the number of cancer-related deaths to 15.3 million, Therefore is an urgent need to develop new strategy of anticancer treatments to reduce mortality of patients and increase their life quality during treatment journey. Drug repurposing is a faster way to find new treatments for serious diseases like cancer. Through reusing drugs that have been already approved for other conditions and  tested in clinical trials and data related to their pharmacokinetics is already described. Research suggests that antipsychotic drugs might be effective in treating cancer. This review examines studies on how different antipsychotics affect different types of cancer, including lung, breast, colon, liver, brain, leukemia, oral, ovarian and skin cancer. Results indicated that perphenazine and prochlorperazine have impact on cell viability, motility, and protein content (MITF and tyrosinase) in melanotic (COLO829) and amelanotic (C32) melanoma cells. In addition to chlorpromazine (CPZ) which has demonstrated significant anti-endometrial cancer activity with derivatives JX57 and JX66 showing even stronger effects with minimal side effects. CPZ is also being explored for glioblastoma (GBM) due to its inhibitory effects on cancer cell growth via dopamine receptor modulation. Epidemiological data support a reduced cancer risk in patients treated with CPZ. Furthermore, flupentixol has emerged as a potential anticancer agent for lung cancer by acting as a PI3K inhibitor, regulating the cell cycle, reducing cell proliferation and causing apoptosis in several types of cancer cells. It was also found that this drug is able to target cancer-related proteins, such as ABCB1 and P-glycoprotein as well as to regulate the Akt and Wnt signaling pathways. In conclusion, this summary imply that antipsychotics repurposing may be one of the best strategy to develop oncology therapy.

Background: Hip fractures in the elderly represent a major public health challenge, often leading to significant loss of independence and functional decline. Regaining pre-fracture mobility is crucial for maintaining quality of life, yet a considerable proportion of elderly patients fail to recover their baseline ambulatory status following surgery. Identifying the risk factors responsible for poor functional recovery can help guide postoperative care and rehabilitation strategies. Objective: To evaluate clinical, nutritional, and rehabilitation-related factors influencing the inability to regain pre-fracture mobility in elderly patients after hip fracture surgery. Methods: This prospective observational study was conducted over 10 months at the Department of Orthopaedics, Sri Krishna Medical College, Muzaffarpur, Bihar, India. A total of 120 patients aged ≥65 years who underwent surgery for hip fractures were enrolled. Pre-fracture ambulatory status was assessed at admission using the Modified Functional Ambulation Classification (MFAC), and patients were followed for 3 months postoperatively to evaluate recovery. Data regarding demographic characteristics, comorbidities, cognitive status, nutritional indicators (serum albumin), time to surgery, and access to physiotherapy were collected and analyzed. Results: Out of 120 patients, 51 (42.5%) failed to regain their pre-fracture level of mobility at 3-month follow-up. On multivariate analysis, the strongest independent predictors of poor functional recovery included age >80 years, cognitive impairment, serum albumin <3.5 g/dL, surgical delay >72 hours, and lack of postoperative physiotherapy (p < 0.05). Female sex and higher comorbidity index were also associated with worse outcomes but did not reach statistical significance. Conclusion: Recovery of ambulatory function after hip fracture surgery in the elderly is influenced by both modifiable and non-modifiable factors. Early surgical intervention, nutritional support, cognitive evaluation, and structured rehabilitation play critical roles in optimizing mobility outcomes. Incorporating these factors into postoperative planning may help improve independence and quality of life in this vulnerable population.

Background: Hypertensive disorders are among ^‘the most common medical complications during pregnancy, affecting 6–8% of pregnancies. The systemic inflammatory response plays a crucial role in the pathophysiology of these disorders. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have emerged as potential markers for evaluating the severity of hypertensive disorders of pregnancy. Aim: This study aimed to retrospectively evaluate leukocyte and platelet counts in hypertensive disorders of pregnancy and their association with disease severity. Methodology: A prospective, comparative study was conducted at  Department of Obstetrics and Gynaecology, Katihar Medical College and Hospital, Katihar, Bihar, India including 80 pregnant women diagnosed with hypertensive disorders (chronic hypertension, gestational hypertension, mild preeclampsia, and severe preeclampsia). Leukocyte and platelet count, as well as NLR and PLR, were analyzed using SPSS 27.0, with statistical significance set at p < 0.05. Results: The study found a progressive increase in total leukocyte and neutrophil counts from gestational hypertension to severe preeclampsia, indicating an intensified inflammatory response. The NLR and PLR were significantly higher in severe preeclampsia compared to other groups, showing strong positive correlations with disease severity (NLR: r = 0.65; PLR: r = 0.58; p < 0.05). Conclusion: Elevated NLR and PLR are indicative of increased systemic inflammation and correlate with the severity of hypertensive disorders in pregnancy. These hematological markers may serve as valuable tools for assessing disease progression.

Background: Cerebral palsy encompasses a range of movement and posture disorders caused by brain injury occurring before or during early development. Epilepsy occurs in 35-41% of children with cerebral palsy, significantly complicating their management, particularly in cases of intractable epilepsy. The prior identification of predictive risk factors for drug-resistant epilepsy can facilitate the development of targeted interventions. Aim: This study recognises risk aspects for persistent epilepsy in children with cerebral palsy, thereby improving clinical decision-making and patient outcome. Methodology: 96 children with epilepsy and cerebral palsy participated in a retrospective observational study in a tertiary care facility in India. Demographic, perinatal, seizure, and neurological characteristics were analysed retrospectively. Multivariate analysis revealed significant predictors of intractable epilepsy. Results: Among the 96 participants (53 males, 43 females), 36 individuals (37.5%) were diagnosed with intractable epilepsy. Key risk factors identified were low Apgar scores at 5 minutes (OR 3.12; p=0.04), a history of neonatal seizures (OR 3.28; p=0.03), and focal epilepsy (OR 3.27; p=0.005). The combination of these factors resulted in an AUC of 0.825, signifying high predictive accuracy. Children exhibiting all four primary risk factors demonstrated a 92% likelihood of developing intractable epilepsy. Conclusion: Intractable epilepsy in CP is predicted by poor neonatal outcomes, early seizure onset, and specific seizure patterns. The findings highlight the necessity for early, intensive, multidisciplinary intervention to enhance management strategies and improve long-term outcomes.

Background: Phototherapy is the standard treatment for neonatal hyperbilirubinemia; however, it is associated with certain adverse effects, one of which is hypocalcemia. This study aimed to evaluate the incidence of phototherapy-induced hypocalcemia and its correlation with the duration of phototherapy in neonates. Objectives: To assess the frequency of hypocalcemia in neonates undergoing phototherapy for hyperbilirubinemia and to determine the relationship between the duration of phototherapy and the development of hypocalcemia. Methods: This prospective observational study was conducted at the Department of Paediatrics, Nalanda Medical College and Hospital, Patna, Bihar, from June 2018 to may 2019. A total of 100 term neonates with uncomplicated neonatal hyperbilirubinemia requiring phototherapy were enrolled. Serum calcium levels were measured before initiation and after completion of phototherapy. The data were analyzed to find the incidence of hypocalcemia and its correlation with the duration of phototherapy. Results: Out of 100 neonates, 32% developed hypocalcemia after phototherapy. The incidence was significantly higher in neonates who received phototherapy for more than 24 hours. A statistically significant inverse correlation was observed between serum calcium levels and the duration of phototherapy (p < 0.05). Clinical symptoms of hypocalcemia, such as jitteriness and irritability, were observed in a few cases but were mostly subclinical. Conclusion: Phototherapy is associated with a considerable risk of hypocalcemia in neonates, especially with prolonged exposure. Routine monitoring of serum calcium levels during phototherapy is recommended to prevent potential complications.

Background: Stroke in young adults, although less common than in the elderly, has emerged as a significant health concern due to its socio-economic impact and increasing incidence. Understanding the clinical presentations and angiographic findings in younger patients is crucial for early diagnosis, appropriate treatment, and secondary prevention. Objectives: To evaluate the clinical features, risk factors, and angiographic patterns of stroke among patients aged 15–45 years presenting to a tertiary care hospital. Methods: A prospective observational study was conducted over a period of 12 months at the Department of Neurology, Paras HMRI Hospital, Patna, Bihar, India. A total of 100 patients aged between 15 to 45 years diagnosed with ischemic or hemorrhagic stroke were enrolled. Detailed clinical histories, neurological examinations, and relevant laboratory investigations were recorded. All patients underwent brain imaging and cerebral angiography (CTA/MRA/DSA) to assess vascular pathology. Results: The majority of patients were male (62%), with a mean age of 38.5 years. The most common clinical presentation was hemiparesis (74%), followed by speech disturbances (45%) and visual symptoms (18%). Hypertension (42%), smoking (35%), and dyslipidemia (31%) were the predominant risk factors. Angiographic evaluation revealed large vessel occlusion in 41% of cases, small vessel disease in 27%, arterial dissection in 11%, and cardioembolic sources in 9%. A subset of patients (12%) had no identifiable cause (cryptogenic stroke). Conclusion: This study highlights the diverse clinical and angiographic profile of young stroke patients in Bihar. Traditional vascular risk factors are still significant contributors, but non-atherosclerotic mechanisms like arterial dissection and cardio embolism also play a critical role. Early identification and targeted management strategies are essential to improve outcomes and reduce long-term disability in this age group.

Background: Non-fermenting Gram-negative bacilli (NFGNB) are increasingly recognized as significant opportunistic pathogens, particularly in hospital settings. These organisms are notorious for their intrinsic and acquired resistance to multiple antibiotics, posing serious challenges in clinical management. This study was conducted to determine the prevalence and antibiotic resistance profiles of NFGNB isolated from clinical specimens at Netaji Subhas Medical College and Hospital, Bihar, India. Objectives: (1) To determine the prevalence of NFGNB in various clinical samples from hospitalized patients. (2) To evaluate the antibiotic resistance patterns of NFGNB isolates. (3) To assess the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains. Methods: A retrospective observational study was conducted at in the Department of Microbiology at Netaji Subhas Medical College and Hospital, Bihar, India from March 2022 to Feb 2023. A total of 130 clinical samples, including sputum, pus, blood, urine, and body fluids, were processed. NFGNB were identified using conventional biochemical methods and the VITEK-2 automated system. Antibiotic susceptibility testing was performed using the Kirby-Bauer disk diffusion method and VITEK-2, interpreted as per CLSI guidelines. Results: Of the 130 samples, 45 (34.6%) were confirmed as NFGNB. Pseudomonas aeruginosa (53.3%) was the predominant isolate, followed by Acinetobacter baumannii (33.3%) and Stenotrophomonas maltophilia (8.9%). High resistance was observed against cephalosporins, fluoroquinolones, and carbapenems. Multidrug resistance was identified in 51.1% of isolates, particularly among ICU-derived strains. Colistin remained the most effective agent, showing 100% susceptibility. Conclusion: The study underscores a high prevalence of multidrug-resistant NFGNB in clinical settings, especially in critical care units. These findings emphasize the urgent need for robust antimicrobial stewardship, regular resistance surveillance, and strict infection control practices to mitigate the rising threat of antimicrobial resistance in tertiary care hospitals.

Background: Post-operative astigmatism remains a key determinant of visual rehabilitation following cataract surgery. The location of the scleral incision in manual small incision cataract surgery (MSICS) significantly influences the magnitude and axis of surgically induced astigmatism (SIA). This study compares the effects of superior versus superotemporal scleral incisions on post-operative astigmatism in MSICS. Methods: A prospective, comparative study was conducted at the Department of Ophthalmology, Sri Krishna Medical College Hospital, Muzaffarpur, Bihar, India from September 2024 to December 2024. A total of  100 patients undergoing MSICS were enrolled and randomly assigned into two groups: Group A (superior scleral incision) and Group B (superotemporal scleral incision). Post-operative astigmatism was assessed using manual keratometry and corneal topography at 1 week, 1 month, and 3 months post-surgery. Results: The mean post-operative astigmatism was significantly higher in Group A (superior incision) compared to Group B (superotemporal incision) at all follow-up points. The superotemporal incision demonstrated better stability and reduced surgically induced astigmatism, especially in with-the-rule astigmatic cases. Statistical analysis confirmed a significant difference (p < 0.05) between the two groups in terms of mean SIA. Conclusion: Superotemporal scleral incisions in MSICS are associated with lower post-operative astigmatism compared to superior incisions, leading to improved visual outcomes. This technique may be preferred, particularly in patients with pre-existing with-the-rule astigmatism or in cases requiring rapid visual rehabilitation.

Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that often requires long-term systemic corticosteroids and immunosuppressive agents for disease control. These treatments, while effective, may have ocular side effects including the development or exacerbation of glaucomatous features. This study aimed to assess the impact of systemic steroids combined with immunosuppressive therapy on intraocular pressure (IOP) and other glaucomatous changes in SLE patients. Methods: A prospective observational study was conducted over at the Department of Ophthalmology, Sri Krishna Medical College Hospital, Muzaffarpur, Bihar, India from October 2024 to January 2025. A total of 80 patients diagnosed with SLE and undergoing systemic steroid and immunosuppressive treatment were enrolled. Comprehensive ophthalmic evaluations including intraocular pressure measurement, optic disc assessment, gonioscopy, and visual field analysis were performed at baseline and at 3-month intervals. Patients with pre-existing glaucoma or ocular hypertension were excluded. Results: Among the 80 patients, 32.5% developed elevated IOP during the follow-up period, with 18.75% exhibiting early glaucomatous changes on optic disc examination. Visual field defects consistent with glaucoma were detected in 12.5% of cases by the end of the study. The risk of developing ocular hypertension was significantly higher in patients receiving systemic steroids for more than 6 months. A positive correlation was observed between cumulative steroid dose and IOP elevation (p<0.01). No significant differences were observed between various types of immunosuppressive agents used. Conclusion: Systemic corticosteroid therapy, especially when prolonged, significantly increases the risk of developing ocular hypertension and glaucomatous changes in SLE patients. Regular ophthalmologic screening and timely intervention are crucial for the early detection and management of steroid-induced glaucoma in this high-risk population.

Background: Mid-trimester pregnancy termination, especially in women with previous cesarean sections, presents unique challenges and risks. Mechanical and pharmacological methods, such as Foley catheter and mifepristone with misoprostol, are widely used for induction. Aim: To compare the efficacy and safety of Foley catheter plus misoprostol versus mifepristone plus misoprostol for mid-trimester abortion in women with prior cesarean sections. Methodology: This prospective, comparative study was conducted at Government Medical College and Hospital, Bettiah, Bihar, with 80 women aged 18–35 years, between 13–26 weeks of gestation. Group A (n=48) received Foley catheter with misoprostol, while Group B (n=32) received mifepristone followed by misoprostol. Outcomes measured included induction-to-abortion interval (IAI), cervical dilatation, abortion completeness, and safety. Results: Group A had a significantly shorter mean IAI (6.5 ± 1.0 hours) than Group B (9.2 ± 2.5 hours). Complete abortion occurred in 100% of cases in both groups. Group A demonstrated faster cervical dilatation and shorter IAIs across all gestational age categories. No major complications were reported. Conclusion: Foley catheter combined with misoprostol proved more efficient than mifepristone with misoprostol in inducing mid-trimester abortion, especially in women with a previous cesarean section. This method is safe, effective, and cost-efficient, supporting its use in low-resource settings.

Background: Infertility is a growing concern worldwide, affecting 8–12% of reproductive-age couples. Metabolic disorders such as insulin resistance, hyperprolactinemia, and thyroid dysfunction play a crucial role in subfertility. Addressing ^‘these metabolic factors may improve reproductive outcomes in affected women. Aim: This study evaluates the impact of correcting metabolic factors on enhancing pregnancy outcomes in sub-fertile women. Methodology: A prospective observational study was conducted at the Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Bettiah, Bihar, India. The study included 90 sub-fertile women aged 18–45 years. Participants were screened for metabolic abnormalities, including thyroid dysfunction, hyperprolactinemia, and insulin resistance. Corrective interventions included levothyroxine for thyroid dysfunction, metformin for insulin resistance, and dopamine agonists for hyperprolactinemia. Ovulation was monitored over three menstrual cycles post-intervention, and hormonal levels were reassessed. Results: A significant reduction in thyroid-stimulating hormone (TSH) (p < 0.001), serum prolactin (p < 0.001), and luteinizing hormone (LH) (p < 0.05) was observed after three months of treatment. Estradiol and progesterone levels increased significantly (p < 0.05, p < 0.001, respectively). Ovulation occurred in 66.67% of participants within three cycles, while 8.33% ovulated within six cycles. However, 25% required extended treatment. Conclusion: Correcting metabolic abnormalities significantly enhances ovulation and improves fertility outcomes in sub-fertile women. Addressing these factors should be a key component of infertility management.

Aim: To determine the prevalence of systemic diseases in individuals with chronic generalized periodontitis in the population of Bihar. Materials and Methods: This epidemiological study was carried out in Department of Dentistry, ESIC Medical College & Hospital, Bihta, Patna, Bihar, India from march 2024 to Oct 2024. Among these patients, 400 patients with periodontal disease (cases) and 200 patients without periodontal disease (controls) were included in the study. A detailed case history of each patient was recorded on a pro forma. The medical history like Diabetes, Respiratory diseases, Epilepsy, Hypertension, Cardiovascular disorders, Liver Diseases, Blood disorders, Kidney disorders, Cancer and Radiotherapy, Psychiatric problems, AIDS/HIV, Bone disorders, Gastro- intestinal problems and allergies was enquired through a health questionnaire and recorded. The patients were divided into five groups according to age groups: 18-29, 30-39, 40-49, 50-59 and above 60 years. Patient who had history of systemic disease and diagnosed by the physician with relevant investigation reports. Those who present suggestive signs or symptoms of systemic disorder were referred to appropriate medical clinics for evaluation. Minimum of 20 teeth present. Results: Age group 30-39 had highest percentage of carious teeth (67.70%). Smokers are most commonly found in CVS disorders  (61.90%), respiratory diseases   (57.14%)   and Cancer (57.14%), GIT disorders (47.05%), hypertension (39.70%), allergies (35.13%) and diabetes (29.41%). Habits are found to be more common in cases when compared to controls. Patients with periodontal diseases (cases) had higher prevalence of hypertension (17%), diabetes (12.75%) CVS disorders (5.25%) (Among 21 patients, 15-angina and 6-Myocardial Infarction) than patients without periodontal diseases (Controls) 2%, 2.5% and 0% respectively. Yates corrected Chi-square test, showed a significant difference between cases and controls. Cases had a higher prevalence of 4.25% GIT disorders(among 17 patients; 6-Gastro-esophageal reflux, 8-gastritis, 3-peptic ulcer), 4% of bone disorders (among 16 patients; 15-arthritis and 1-osteomalacia), 3.5% of respiratory diseases (among 14 patients; 8- asthmatic 4- tuberculosis, 2- COPD), 2% of epilepsy than Controls, 2%, 1.5%, 1% and 0.5% respectively. Yates corrected Chi- square test assessed showed no significant difference between cases and controls. Prevalence of psychiatric disorders in both cases and controls are same (0.5%). Conclusion: The future of dental practice will be dramatically altered if subsequent research confirms that periodontal disease is a true risk factor for systemic disease and that the initiation or progression of these medical conditions can be reduced by periodontal treatment. Most obviously, there will be further integration of dental and general medicine that will bring new opportunities for diagnosis and collaboration across specialities. Dental practitioners may also contribute their expertise in assessing risk for several systemic conditions.

Background: Effective postoperative analgesia is a cornerstone of enhanced recovery following surgery. Infraumbilical procedures are associated with significant postoperative discomfort, necessitating the use of safe and effective analgesics. Intravenous (IV) paracetamol and IV tramadol are commonly employed analgesics with distinct mechanisms of action and side effect profiles. This study aimed to compare the efficacy and safety of IV paracetamol and IV tramadol in providing postoperative pain relief in patients undergoing infraumbilical surgeries. Methods: This prospective, randomized, comparative study was conducted on 120 adult patients undergoing elective infraumbilical surgeries under spinal anesthesia at Katihar Medical College, Al-Karim University, Bihar. Patients were randomly allocated into two groups: Group P received IV paracetamol 1 g every 6 hours, and Group T received IV tramadol 100 mg every 6 hours. Pain scores were assessed using the Visual Analogue Scale (VAS) at 1, 2, 4, 6, and 8 hours postoperatively. Additional analgesic requirements, vital parameters, and adverse effects such as nausea, vomiting, and sedation were also recorded. Results: Both groups achieved adequate pain control; however, Group P exhibited significantly lower VAS scores at 4 and 6 hours postoperatively. Group T had a higher incidence of nausea and vomiting (28.3%) compared to Group P (8.3%). Sedation scores were also higher in the tramadol group. The requirement for rescue analgesia was comparable in both groups, though slightly lower in Group P. Conclusion: IV paracetamol was found to be as effective as IV tramadol in managing postoperative pain following infraumbilical surgery, with the added advantages of fewer side effects and better patient tolerance. It may be considered a preferable alternative for postoperative analgesia in similar clinical settings.

Background: Uterine fibroids are a prevalent gynecologic disorder that can influence pregnancy outcomes. The objective of this study was to examine the effects of uterine fibroids on fetal and maternal outcomes during pregnancy. Aim: The objective of this research was to compare and assess maternal and fetal complications in uterine fibroids-affected pregnancies and non-fibroids pregnancies. Methods: The present retrospective cohort study of 200 pregnant women, 100 with fibroids (Cohort A) and 100 without fibroids (Cohort B), who gave birth at Department of Obstetrics and Gynecology, PMCH, Patna, Bihar, India from January 2023 to December 2024. Medical record data regarding maternal characteristics, obstetric complications, and neonatal outcomes were gathered. Descriptive statistics and hypothesis testing (Chi-square and t-tests). Results: Pregnant women with fibroids had significantly higher preterm labor, cesarean section, postpartum hemorrhage, and placental abruption rates. Fetal outcomes were increased low birth weight, NICU stays, and lower birth weight in the cases compared to the control group. The maternal and fetal outcome difference between the groups was statistically significant. Conclusion: Pregnancy-related uterine fibroids had more maternal and fetal complications. Early diagnosis, vigilant follow-up, and multi-disciplinary management are needed to enhance the outcomes in such pregnancies. Additional prospective studies are advisable to further clarify the management approach.

Background: Asthma and allergic disorders such as allergic rhinitis and atopic dermatitis are increasingly prevalent in children worldwide. In India, especially in rural and semi-urban settings like Bihar, there is limited region-specific data documenting the burden of these conditions among school-going children. Understanding their prevalence is vital for developing school-based screening and preventive health interventions. Objectives: To estimate the prevalence of asthma and allergic disorders among school children aged 6–16 years in selected schools across the Bihar region and to identify associated demographic and environmental factors. Methods: A community-based cross-sectional descriptive study was conducted over 12 months at the Department of Pediatrics, Government Medical College and Hospital, Bettiah, Bihar, India. A total of 200 school children were selected using stratified random sampling from both urban and rural schools. Data were collected using a standardized, pretested questionnaire adapted from the ISAAC protocol. Clinical confirmation was conducted for cases with suggestive symptoms. Relevant sociodemographic data, family history, and environmental exposures were also recorded. Results: The study observed a prevalence of asthma in approximately 13% of the children, allergic rhinitis in 18%, and atopic dermatitis in 7%. Male children and those with a positive family history of allergic disorders showed a significantly higher prevalence. Urban school children demonstrated a marginally higher burden of asthma and allergic conditions compared to rural students. Environmental exposures, such as indoor smoke and pet ownership, were significantly associated with increased symptomatology. Conclusion: The findings highlight a considerable burden of asthma and allergic disorders among school children in the Bihar region. There is a pressing need for early detection strategies, health education, and region-specific policy formulation to address pediatric allergic diseases at the community level.

Background: The Pericapsular Nerve Group (PENG) block is a novel regional anesthesia technique gaining popularity for providing effective postoperative analgesia in patients undergoing hip surgeries. This study compares the efficacy of 0.2% ropivacaine combined with dexamethasone versus fentanyl when used in PENG blocks. Objective: To evaluate and compare the analgesic duration, pain scores, and rescue analgesia requirements between two groups: 0.2% ropivacaine with dexamethasone and 0.2% ropivacaine with fentanyl in patients receiving PENG block for hip surgery. Methods: A prospective, randomized, double-blinded comparative study was conducted at the Department of Anesthesiology, Netaji Subhas Medical College and Hospital, Bihta, Patna, from Dec 2022 to Jan 2023. A total of 120 patients undergoing elective hip surgeries were included and randomly assigned into two equal groups. Group D received 0.2% ropivacaine (20 ml) with 8 mg dexamethasone, while Group F received 0.2% ropivacaine (20 ml) with 50 µg fentanyl. The primary outcome measured was duration of analgesia; secondary outcomes included pain scores (VAS), rescue analgesia requirement, and any adverse effects. Results: Group D showed significantly prolonged duration of analgesia compared to Group F. Mean VAS scores were lower in Group D at 6, 12, and 24 hours postoperatively. Rescue analgesia requirement was less frequent in Group D, and no major complications were observed in either group. Conclusion: The addition of dexamethasone to 0.2% ropivacaine in PENG block offers superior and longer-lasting analgesia compared to fentanyl, with reduced need for postoperative analgesics and comparable safety profile.

Background: Dengue fever epidemics have been reported in tropical, subtropical, and temperate regions across the globe during the previous three centuries. There are 50 million cases of Dengue fever and 100 million cases of Dengue fever reported annually globally; the case fatality rate in Asia varies from 0.5% to 3.5%. Aim: The study was to investigate the factors that influence the duration of hospitalization in pediatric and adolescent patients with dengue. Methodology: A retrospective research was undertaken in the ‘Department of Community Medicine, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India’. The research involved 60 patients. In children with a strong clinical suspicion of Dengue infection, NS1 antigen and/or Dengue antibodies IgM and IgG were assessed. Individuals with confirmed Dengue cases provided written informed permission and were questioned about the risk factors associated with Dengue infection. Results: The predominant demographic of hospitalized patients included adolescents, older children, and men. The majority had a hospitalization period of 4 to 6 days. No statistically significant correlation was seen between the relevant parameters and the length of hospitalization. Conclusion: The dengue mostly affects adolescents and older children, with a higher incidence in men, suggesting more external contact to the vector. The correlation between socio-demographic and clinical parameters such as platelet count and hemoglobin level.

Background: Multiple pregnancies are associated with increased maternal and fetal risks compared to singleton pregnancies. Understanding the maternal and neonatal outcomes of these pregnancies is essential for guiding clinical practice and improving antenatal care, especially in resource-limited regions like Bihar. Objective: To compare maternal and fetal outcomes in multiple versus singleton pregnancies delivered at a tertiary care center in Purnea, Bihar. Methods: A hospital-based comparative observational study was conducted at the Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Purnea, Bihar. A total of 120 pregnant women were included in the study over a September 2023 to December 2024. 60 women with multiple pregnancies and 60 with singleton pregnancies. Data were collected on maternal complications, delivery mode, neonatal outcomes, and perinatal morbidity and mortality. Statistical analysis was performed to identify significant differences between the two groups. Results: The incidence of preterm delivery, anemia, hypertensive disorders, and cesarean section was significantly higher in the multiple pregnancy group. Neonatal outcomes such as low birth weight, NICU admission, and neonatal mortality were also notably more frequent in twins than in singletons. Conclusion: Multiple pregnancies are associated with a higher incidence of maternal and neonatal complications compared to singleton pregnancies. Strengthening antenatal surveillance and improving delivery preparedness can significantly enhance outcomes, particularly in under-resourced settings like Bihar.

Background: Gastrointestinal (GI) disorders encompass a wide spectrum of pathological lesions, ranging from benign inflammatory conditions to malignant neoplasms. Endoscopic biopsy is a crucial diagnostic tool that allows direct visualization and sampling of suspicious mucosal lesions for histopathological examination. This study was undertaken to evaluate the histopathological spectrum of lesions in gastrointestinal endoscopic biopsies and to establish a correlation with clinical and endoscopic findings. Methods: This prospective study was conducted in the Department of Pathology, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, Uttar Pradesh, India from September 2022 to may 2023. A total of 138 gastrointestinal endoscopic biopsies were included. The specimens were obtained from patients presenting with various upper and lower gastrointestinal symptoms and were processed using standard histopathological techniques. Clinical and endoscopic data were retrieved and correlated with microscopic findings. Results: Out of 138 cases, the majority of biopsies were obtained from the stomach (41.3%), followed by the colon (30.4%), esophagus (18.8%), and small intestine (9.5%). Inflammatory lesions were the most commonly observed category (53.6%), with chronic gastritis being the predominant diagnosis in gastric biopsies. Among neoplastic lesions, adenocarcinoma was the most frequent malignancy, seen predominantly in gastric and colonic biopsies. Pre-malignant conditions such as intestinal metaplasia and dysplasia were also observed in a subset of patients. A strong clinico-pathological correlation was established, particularly in cases with neoplastic and dysplastic changes. Conclusion: Gastrointestinal endoscopic biopsy is an invaluable diagnostic modality that provides essential insights into the nature and severity of mucosal lesions. Histopathological evaluation not only aids in the accurate diagnosis of gastrointestinal diseases but also plays a pivotal role in early detection of malignancies and monitoring of pre-malignant conditions. Routine biopsy of endoscopically abnormal mucosa should be emphasized for timely diagnosis and appropriate management.

Background: Urinary bladder neoplasms encompass a wide range of benign and malignant tumors, with urothelial carcinoma being the most prevalent histological subtype. These tumors pose significant diagnostic and therapeutic challenges due to their high recurrence rate and potential for progression. Histopathological evaluation remains the cornerstone for accurate diagnosis, grading, and staging, all of which are essential for optimal management. Objectives: This study aimed to evaluate the histopathological spectrum of urinary bladder neoplasms, classify them according to WHO criteria, and correlate histological findings with relevant clinical parameters. Materials and Methods: A prospective study was conducted in the Department of Pathology, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, from September 2022 to July 2023. A total of 132 bladder biopsy and resection specimens were included. Detailed clinical information, including age, gender, symptoms, and radiological findings, was recorded. All specimens were formalin-fixed, paraffin-embedded, and stained with hematoxylin and eosin. Tumors were classified and graded based on the 2016 WHO/ISUP classification. Invasion status and variant histologies. were also assessed. Results: The majority of cases were urothelial carcinomas, accounting for 88.6% of all tumors. Among these, high-grade urothelial carcinoma constituted 54.3% and low-grade 34.3%. A small proportion of cases were squamous cell carcinoma (4.5%), adenocarcinoma (3.0%), and papillary urothelial neoplasm of low malignant potential (PUNLMP) (3.8%). The most commonly affected age group was 51–70 years, with a male-to-female ratio of 3.2:1. Painless hematuria was the most frequent presenting symptom. Muscle invasion was noted in 42.4% of urothelial carcinoma cases. Conclusion: Urothelial carcinoma remains the predominant histological subtype in urinary bladder neoplasms. High-grade lesions with muscle invasion are common in the older population and indicate poor prognosis. Routine histopathological analysis of all bladder lesions is crucial for diagnosis, risk stratification, and planning of further management. The study highlights the importance of early detection and pathological classification in improving clinical outcomes.

Background: Spinal anesthesia-induced hypotension is a common and clinically significant complication during cesarean delivery, posing risks to both maternal hemodynamic stability and fetal oxygenation. Phenylephrine, a selective alpha-1 adrenergic agonist, has traditionally been the vasopressor of choice. However, its association with reflex bradycardia and reduced cardiac output has led to the exploration of alternatives such as noradrenaline, a mixed alpha-1 and weak beta-1 agonist, which may offer better hemodynamic balance. This randomized trial aimed to compare the efficacy and safety of intermittent intravenous boluses of phenylephrine and noradrenaline in managing spinal anesthesia-induced hypotension during elective cesarean sections. Methods: This randomized controlled study was conducted in the Department of Anaesthesia, Government Medical College and Hospital, Bettiah, Bihar, India from feb 2024 to December 2024. A total of 100 participants aged 20–35 years with ASA physical status I or II undergoing elective lower segment cesarean section under spinal anesthesia were randomly allocated into two groups: Group P received intravenous bolus doses of phenylephrine 100 μg, and Group N received intravenous bolus doses of noradrenaline 8 μg, whenever hypotension (defined as systolic blood pressure < 100 mmHg or fall > 20% from baseline) occurred. Hemodynamic parameters, total number of boluses, heart rate, incidence of bradycardia, nausea, vomiting, and neonatal outcomes (Apgar scores) were recorded and analyzed. Results: Both vasopressors were effective in managing spinal-induced hypotension. However, the noradrenaline group maintained higher heart rate values with significantly lower incidence of bradycardia (10% vs 32%; p = 0.01). Total number of vasopressor boluses required was comparable between groups. The mean systolic blood pressure restoration time was similar in both groups (p > 0.05). Maternal side effects such as nausea and vomiting were lower in the noradrenaline group. Neonatal outcomes, assessed by 1-minute and 5-minute Apgar scores, were comparable and within normal limits in both groups. Conclusion: Both phenylephrine and noradrenaline are effective in treating spinal anesthesia-induced hypotension during cesarean section. However, noradrenaline offers a better hemodynamic profile by maintaining heart rate and reducing maternal side effects, making it a promising alternative to phenylephrine in obstetric anesthesia.

Background: Hysterectomy is one of the most commonly performed gynecological surgeries worldwide for both benign and malignant conditions. Histopathological examination of hysterectomy specimens plays a vital role in confirming clinical diagnoses and detecting incidental findings that may impact patient management. Objectives: To evaluate the histopathological spectrum of lesions observed in hysterectomy specimens received at the Department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar. Methods: This descriptive study included 130 hysterectomy specimens received over a 2-years period. Each specimen was thoroughly examined grossly and microscopically. Findings were categorized based on organ involvement and pathological diagnosis. Results: The most common indication for hysterectomy was abnormal uterine bleeding. The predominant lesions observed were leiomyoma (43.8%), adenomyosis (29.2%), and endometrial hyperplasia (10.8%). Malignant lesions were observed in 6.2% of cases, with endometrial and cervical carcinomas being the most frequent. Conclusion: Histopathological evaluation of hysterectomy specimens is essential for accurate diagnosis, therapeutic planning, and detection of unsuspected malignancies.

Background: Bile duct injury is a serious complication of laparoscopic cholecystectomy. There is considerable consensus that this consequence increases following LC versus open cholecystectomy (OC), although comparison data are sparse. Aim: The purpose of this research was to determine the risks associated with open vs laparoscopic cholecystectomy for common bile duct injury. Methods: All patients who had BDI in OC or LC at  Department  of  General  Surgery, Jawaharlal Nehru Medical College and Hospital in Bhagalpur, Bihar, India’, were included in this research. The following factors were examined: underlying biliary disease, type of BDI, age, sex, intraoperative cholangiography performance, mortality, morbidity, and late morbidity. Results: The occurrence of bile duct damage was higher in group II of laparoscopic cholecystectomies (N: 16, 0.95%) compared to group I of open cholecystectomy (N: 26, 0.6%). Furthermore, when an open procedure conversion was necessary, the patient group had a higher frequency of BDI (3/109, 2.7%, p < 0.05). In comparison with group II (LC, 12/16), intraoperative diagnoses of BDIs were made more often in group I (OC, 18/19). When it came to patients managed by staff doctor’s vs residents, BDI was more prevalent in both groups, primarily with complex gallbladder patients whose bile ducts were less than 7 mm in diameter. Conclusions: Postoperative morbidity and mortality after BDI following LC are comparable to those following OC. Converted patients had a much higher incidence of BDI, making them a high-risk category.

Background: Type IIIB tibial fractures, as classified under the Gustilo-Anderson open fracture system, are complex injuries involving extensive soft tissue damage and periosteal stripping. These fractures present a significant challenge in orthopedic trauma due to their high risk of infection, delayed union, and functional impairment. External fixation remains a cornerstone of management, with the AO tubular external fixator and Ilizarov ring fixator being the most commonly utilized methods. This study was conducted to compare the functional and radiological outcomes of these two fixation systems in patients with Type IIIB open tibial fractures. Methods: A prospective comparative study was conducted at the Department of Orthopaedics, Government Medical College and Hospital, Bettiah, Bihar, India from May 2022 to April 2023. A total of 50 patients with Gustilo-Anderson Type IIIB tibial fractures were enrolled and allocated into two groups: 25 managed with AO external fixator (Group A) and 25 with Ilizarov ring fixator (Group B). All patients underwent thorough debridement and definitive fixation, followed by appropriate soft tissue coverage. Outcomes were assessed at regular intervals over 6 months using radiographic union, complication rates, and functional recovery based on the Johner-Wruhs criteria. Results: Radiological union was achieved in 84% of patients in the Ilizarov group compared to 68% in the AO group within the 6-month follow-up period. Mean time to union was shorter in the Ilizarov group (21.6 ± 3.5 weeks) compared to the AO group (25.4 ± 4.1 weeks; p < 0.01). Pin tract infections were more frequent in the AO group (36%) versus the Ilizarov group (20%). Functional outcome rated as excellent or good was observed in 76% of patients in the Ilizarov group, whereas it was only 52% in the AO group. Limb alignment and range of motion were also better preserved in the Ilizarov cohort. Conclusion: Both AO and Ilizarov external fixation methods are effective in the management of Type IIIB tibial fractures. However, the Ilizarov fixator demonstrated superior outcomes in terms of union rate, functional recovery, and complication profile. The circular fixator’s stability, modularity, and ability to simultaneously address bone loss, deformity, and soft tissue healing make it a preferred option in complex open tibial injuries. Clinical selection should be tailored based on the surgeon’s expertise, fracture complexity, and available resources.

Background: Osteoarthritis (OA) is the most prevalent degenerative joint disorder, particularly affecting the elderly and leading to chronic pain, stiffness, and functional impairment. Conventional pharmacologic management primarily targets symptom relief but is often associated with gastrointestinal, renal, and cardiovascular side effects. Nutraceuticals, comprising dietary supplements like glucosamine, chondroitin sulfate, MSM, and omega-3 fatty acids, have gained popularity for their potential chondroprotective and anti-inflammatory effects. This study evaluates the clinical efficacy of nutraceuticals in improving pain, stiffness, and joint function in patients with knee osteoarthritis. Methods: A prospective interventional study was conducted at the Department of Orthopaedics, Government Medical College and Hospital, Bettiah, Bihar India from August 2022 to July 2023. A total of 80 patients with radiologically confirmed primary knee osteoarthritis (Kellgren-Lawrence grade II or III) were enrolled. All participants received a standard combination of nutraceuticals containing glucosamine sulfate, chondroitin sulfate, methyl sulfonyl methane (MSM), and omega-3 fatty acids daily for a period of 12 weeks. Patients were assessed at baseline, 6 weeks, and 12 weeks using the Visual Analog Scale (VAS) for pain, WOMAC score for function, and Lequesne Index for stiffness and disability. Results: Significant improvements were observed in all clinical outcome scores. The mean VAS score decreased from 7.2 ± 1.1 at baseline to 4.1 ± 1.0 at 6 weeks and 2.8 ± 0.9 at 12 weeks (p < 0.001). Similarly, the WOMAC total score improved from 56.3 ± 8.5 to 33.7 ± 6.4 over 12 weeks. The Lequesne Index also showed a marked reduction from 11.4 ± 2.3 to 6.5 ± 1.9 at the end of the study. No serious adverse effects were reported, and compliance was high. Patients reported better mobility, reduced stiffness, and enhanced quality of life. Conclusion: Nutraceutical supplementation demonstrated clinically significant benefits in reducing pain, stiffness, and improving functional mobility in patients with knee osteoarthritis. These agents provide a safer alternative or adjunct to NSAIDs, especially in long-term management. Their incorporation into standard osteoarthritis protocols can offer a holistic and tolerable approach for chronic joint care.

Background: Psoriasis is a chronic, immune-mediated inflammatory skin disorder with established systemic implications, particularly an increased risk of cardiovascular disease. Dyslipidemia and atherogenic lipid ratios have been frequently reported in psoriatic patients, potentially contributing to enhanced atherosclerotic burden. While conventional lipid parameters are routinely assessed, internal ratios such as TC/HDL, LDL/HDL, and TG/HDL may serve as more sensitive markers of cardiovascular risk. This study aimed to evaluate plasma lipid profile parameters and their internal ratios in clinically sub-grouped psoriasis patients. Methods: This cross-sectional analytical study was conducted at the Department of  General Medicine, AIIMS, PATNA, Bihar, India.  for 18 months. A total of 120 patients diagnosed with psoriasis were enrolled and stratified into three clinical subgroups: mild, moderate, and severe, based on the Psoriasis Area and Severity Index (PASI). Fasting blood samples were collected for lipid profile estimation including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Atherogenic indices such as TC/HDL, LDL/HDL, and TG/HDL were calculated. Statistical analyses were performed to assess variations in lipid levels and ratios across clinical subgroups and to examine correlations with PASI scores. Results: Patients with severe psoriasis had significantly elevated levels of TC (216.7 ± 32.4 mg/dL), TG (187.9 ± 26.1 mg/dL), and LDL-C (141.3 ± 25.6 mg/dL) compared to those with mild and moderate disease (p < 0.001). HDL-C levels were significantly lower in severe cases (36.4 ± 5.7 mg/dL). Atherogenic ratios such as TC/HDL, LDL/HDL, and TG/HDL were markedly higher in the severe group, and strong positive correlations were observed between these ratios and PASI scores (r > 0.6, p < 0.01). These findings indicate an increased cardiometabolic risk among patients with more extensive disease. Conclusion: The study highlights a significant association between psoriasis severity and lipid abnormalities, including elevated atherogenic lipid ratios. Clinically severe psoriasis patients exhibit a more atherogenic lipid profile, underscoring the need for early cardiovascular risk screening and management in this population. Routine assessment of lipid ratios may provide a more nuanced cardiovascular risk evaluation than individual lipid parameters alone.

Background: Simple febrile seizures (SFS) are the most common type of seizure disorder in children aged six months to five years, typically triggered by fever in the absence of intracranial infection or metabolic disturbance. Emerging evidence suggests that iron deficiency may play a contributory role in the pathogenesis of febrile seizures by altering neuronal excitability and neurotransmitter metabolism. This study aims to assess the association between iron deficiency and simple febrile seizures in children below five years of age in a tertiary care setting in Bihar. Methods: This hospital-based case-control study was conducted over a period of 12 months at the Department of Pediatrics, Patna Medical College and Hospital, Patna, Bihar. A total of 200 children aged 6 months to 5 years were enrolled, including 100 cases with simple febrile seizures and 100 age- and sex-matched febrile controls without seizures. Detailed clinical history, nutritional assessment, and laboratory parameters were evaluated. Iron status was assessed using hemoglobin levels, serum ferritin, mean corpuscular volume (MCV), and red cell distribution width (RDW). Standard WHO criteria were used to define iron deficiency. Statistical analysis was performed to compare iron parameters between the two groups and assess their association with febrile seizures. Results: Iron deficiency was significantly more prevalent among children with febrile seizures (58%) compared to controls (32%), with a statistically significant difference (p < 0.001). The mean hemoglobin level in the seizure group was 9.6 ± 1.2 g/dL, which was significantly lower than in the control group (10.7 ± 1.4 g/dL, p = 0.003). Serum ferritin levels were also lower in the case group (22.5 ± 7.1 ng/mL) versus controls (31.4 ± 8.6 ng/mL, p < 0.001). A higher frequency of microcytic and hypochromic anemia was observed in children with seizures. The odds ratio for developing simple febrile seizures in the presence of iron deficiency was calculated at 2.9 (95% CI: 1.7–5.0). Conclusion: This study demonstrates a significant association between iron deficiency and simple febrile seizures in children under five years of age. Routine screening for iron deficiency in febrile children may help in early identification and prevention of seizure episodes. Addressing nutritional anemia in this vulnerable age group could serve as a low-cost intervention in reducing the incidence of febrile seizures, especially in regions with high anemia prevalence such as Bihar.

Background: Accurate estimation of haemoglobin levels is critical for the diagnosis and management of anemia, a widespread public health issue affecting diverse populations globally. Multiple methods are available for haemoglobin estimation, ranging from simple colorimetric techniques to advanced automated analyzers. Each method has distinct advantages and limitations concerning accuracy, feasibility, cost, and ease of use. Comparative evaluation of these methods is essential to select the most appropriate approach in different clinical and resource settings. Objectives: (1) To compare the accuracy and reliability of different haemoglobin estimation methods. (2) To assess the agreement between manual and automated techniques for haemoglobin estimation. Methods: A cross-sectional comparative study was conducted at the Department of Pathology, Government Medical College and Hospital, Bettiah, West Champaran, Bihar, India, from March 2020 to January 2023. A total of 150 blood samples were analyzed using different haemoglobin estimation methods including Sahli’s method, Cyanmethemoglobin method, and Automated Hematology Analyzer method. Each sample was subjected to all three methods, and the results were compared. Statistical analysis was performed using correlation coefficients, Bland-Altman plots, and paired t-tests to determine the agreement and differences among the methods. Results: Among the methods compared, the Automated Hematology Analyzer provided the most accurate and consistent haemoglobin values, followed closely by the Cyanmethemoglobin method. Sahli’s method, although easy to use and inexpensive, showed considerable variability and lower accuracy. Strong positive correlation was observed between the Automated Analyzer and the Cyanmethemoglobin method (r=0.95, p<0.001), while Sahli’s method demonstrated moderate correlation (r=0.78, p<0.05). Conclusion: While automated analyzers remain the gold standard for haemoglobin estimation in terms of accuracy and reliability, the Cyanmethemoglobin method serves as a feasible and reliable alternative in resource-limited settings. Sahli’s method, although widely used in peripheral centers, needs cautious interpretation due to its relatively lower accuracy.

Background: Anemia in pregnancy remains a major public health concern globally, with a disproportionately high burden in developing countries like India. It is associated with increased risks of maternal complications, adverse perinatal outcomes, and long-term effects on neonatal development. The World Health Organization defines anemia in pregnancy as hemoglobin levels below 11 g/dL and classifies it based on severity as mild, moderate, or severe. Despite national initiatives aimed at improving antenatal care and iron supplementation, the prevalence of anemia remains unacceptably high in rural and semi-urban populations. This study was conducted to assess the severity of anemia among pregnant women and to analyze its impact on maternal and perinatal outcomes. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Netaji Subhas Medical College and Hospital, Amhara, Bihta, Patna, Bihar, India, from March 2024 to October 2024.A total of 200 pregnant women beyond 28 weeks of gestation were enrolled and categorized into four groups based on WHO hemoglobin criteria: non-anemic (≥11 g/dL), mildly anemic (10–10.9 g/dL), moderately anemic (7–9.9 g/dL), and severely anemic (<7 g/dL). Detailed obstetric history, clinical examination, and relevant investigations were recorded. The maternal outcomes assessed included mode of delivery, incidence of pre-eclampsia, antepartum hemorrhage, postpartum hemorrhage, and need for blood transfusion. Perinatal outcomes such as birth weight, Apgar score, NICU admission, and perinatal mortality were also evaluated. Results: Among the 200 pregnant women studied, 22.5% were mildly anemic, 44.5% moderately anemic, and 18.0% severely anemic, while only 15.0% were non-anemic. Increasing severity of anemia was significantly associated with higher rates of maternal complications including preterm labor, postpartum hemorrhage, and blood transfusion. Cesarean section rates were higher among severely anemic women. In terms of perinatal outcomes, low birth weight, NICU admissions, and perinatal deaths were significantly more common in moderate and severe anemia groups (p < 0.01). Severe anemia was found to be an independent predictor of poor neonatal outcomes. Conclusion: The study confirms that the severity of maternal anemia in pregnancy is directly associated with adverse maternal and perinatal outcomes. Moderate to severe anemia significantly increases the risk of obstetric complications and poor neonatal health indicators. Early screening, effective antenatal care, nutritional counseling, and timely correction of anemia are essential strategies to reduce the burden of anemia-related complications in pregnancy.

Background: Postpartum hemorrhage (PPH) remains one of the leading causes of maternal mortality and morbidity globally, accounting for nearly one-quarter of maternal deaths, especially in low-resource settings. Defined as blood loss of more than 500 mL following vaginal delivery or more than 1000 mL after cesarean section, PPH can rapidly become life-threatening if not promptly identified and managed. Despite advancements in obstetric care, inconsistent adherence to standardized guidelines and lack of preparedness continue to contribute to preventable maternal deaths. This review aims to synthesize the most current evidence-based guidelines for the prevention and management of PPH and assess their applicability in a tertiary care center. Materials and Methods: A Observational Study conducted with the aim of synthesizing the latest evidence-based guidelines and literature on the prevention and management of postpartum hemorrhage (PPH). The review was carried out in the Department of Obstetrics and Gynaecology, Netaji Subhas Medical College and Hospital, Amhara, Bihta, Patna, Bihar, India, from April 2024 to December 2024 . The focus was to analyze existing recommendations, compare international protocols, and assess their relevance and application in the context of clinical practice within a tertiary care center. Results: Current evidence supports the routine use of AMTSL as a key strategy to prevent primary PPH, with oxytocin (10 IU IM/IV) identified as the first-line uterotonic agent. Alternatives such as misoprostol, ergometrine, and carbetocin have specific indications based on availability and patient profile. Tranexamic acid is now recommended as an early adjunct in cases of established PPH. Non-surgical methods such as uterine massage, bimanual compression, and intrauterine balloon tamponade play crucial roles in the early management of atonic PPH. In refractory cases, uterine artery ligation, compression sutures, or hysterectomy may be required. Protocol-based care and rapid response teams significantly reduce maternal complications. Simulation-based training and availability of PPH kits are increasingly recognized as best practices. Conclusion: Evidence-based prevention and management of PPH require timely intervention, judicious use of uterotonics, and structured institutional protocols. Adopting global guidelines within the framework of local resources and infrastructure can improve maternal outcomes. Regular training of healthcare workers, early identification of risk factors, and adherence to AMTSL and response algorithms are crucial to reducing the burden of PPH-related maternal morbidity and mortality.

Background: Supraclavicular brachial plexus block is an effective regional anesthesia technique for upper limb surgeries. The addition of adjuvants to local anesthetics like ropivacaine aims to enhance the quality and duration of analgesia. Dexmedetomidine and fentanyl are widely studied adjuvants with distinct pharmacological profiles. Objectives: (1) To compare the onset and duration of sensory and motor blockade achieved with ropivacaine (0.75%) combined with dexmedetomidine versus fentanyl. (3) To assess postoperative analgesia quality, duration, and side effect profiles in both groups. Methods: A prospective randomized comparative study was conducted in the Department of Anesthesiology, NMCH, Patna, Bihar, India from September 2020 to July 2023. A total of 90 adult patients scheduled for upper limb surgeries under supraclavicular brachial plexus block were randomized into two groups: Group D (ropivacaine + dexmedetomidine) and Group F (ropivacaine + fentanyl). Parameters assessed included onset and duration of sensory and motor blocks, duration of analgesia, hemodynamic variables, and incidence of complications. Results: Group D exhibited a significantly faster onset of sensory and motor blocks, prolonged duration of both blocks, and extended postoperative analgesia compared to Group F. Hemodynamic stability was maintained in both groups, with mild sedation more commonly observed in Group D. No major complications were recorded. Conclusion: Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block provides superior block characteristics and prolonged postoperative analgesia compared to fentanyl, with a favorable safety profile.

Background: Hypertensive disorders of pregnancy (HDP), including preeclampsia and gestational hypertension, remain a major cause of maternal and perinatal morbidity and mortality. Early identification of women at risk is critical for timely intervention. Doppler ultrasound assessment of uterine and spiral arteries during the early second trimester has emerged as a promising non-invasive tool to detect impaired placentation, which is strongly associated with subsequent development of hypertensive disorders. This study was undertaken to evaluate the predictive value of uterine and spiral artery Doppler parameters in the early second trimester for hypertensive complications in pregnancy. Methods: A prospective observational study was conducted at the Department of Obstetrics and Gynecology, PMCH, Patna, Bihar, India from September 2022 to August 2023.A total of 120 singleton pregnant women between 18–22 weeks of gestation underwent uterine and spiral artery Doppler sonography. Parameters including pulsatility index (PI), resistive index (RI), and the presence or absence of diastolic notching were recorded bilaterally. The participants were followed throughout pregnancy to monitor the development of hypertensive disorders. Sensitivity, specificity, and predictive values of Doppler findings were calculated. Results: Out of 120 participants, 24 (20.0%) developed hypertensive disorders later in pregnancy. Abnormal uterine artery Doppler findings (elevated PI >1.45 and/or persistent notching) were present in 18 of these 24 cases (75.0%). The presence of bilateral notching and high PI showed strong association with the development of preeclampsia. The sensitivity and specificity of abnormal uterine artery Doppler for predicting HDP were 75.0% and 88.5%, respectively. Spiral artery Doppler abnormalities, particularly elevated RI and absent end-diastolic flow were also significantly associated with HDP (p < 0.01). Conclusion: Early second trimester Doppler assessment of the uterine and spiral arteries provides a valuable, non-invasive screening modality to identify pregnancies at high risk for hypertensive disorders. Incorporating Doppler screening between 18–22 weeks in routine antenatal care could enable closer surveillance and timely prophylactic strategies to reduce maternal and fetal complications associated with HDP.

Background: Papillary thyroid carcinoma (PTC) is the most common histological type of thyroid cancer, accounting for the majority of endocrine malignancies. Surgical resection remains the cornerstone of management, with different operative strategies tailored based on tumor size, location, lymph node involvement, and risk stratification models. Objectives: (1) To evaluate the surgical approaches employed in the management of papillary thyroid carcinoma. (3) To assess post-operative outcomes, complications, and recurrence rates. Methods: This observational study was conducted at Department of General Surgery, GMERS Medical College, Junagadh, Gujarat, from February 2024 to December 2024. Patients diagnosed with papillary thyroid carcinoma and undergoing surgical treatment were included. Surgical modalities included hemithyroidectomy, total thyroidectomy, and total thyroidectomy with neck dissection based on preoperative and intraoperative findings. Post-operative complications, hospital stay, histopathological findings, and recurrence rates were analyzed. Results: Total thyroidectomy was the most frequently performed procedure, followed by hemithyroidectomy in selected low-risk cases. Central compartment neck dissection was performed in patients with clinically evident lymphadenopathy. The overall post-operative complication rate was low, with transient hypocalcemia being the most common complication. Recurrence was rare during the short-term follow-up period. Conclusion: Surgical management of papillary thyroid carcinoma yields excellent outcomes with low morbidity when appropriately tailored to individual patient risk factors. Total thyroidectomy remains the standard of care for most cases, while selective use of hemithyroidectomy is justified in low-risk patients.

Background: Abnormal uterine bleeding (AUB) is a frequent gynecological complaint across all age groups and encompasses a wide spectrum of underlying etiologies, including benign and malignant endometrial pathologies. Early detection of endometrial malignancy is crucial for prompt treatment. Colour Doppler ultrasonography offers a non-invasive tool to assess uterine and endometrial blood flow patterns, which can aid in differentiating benign from malignant conditions. Objectives: (1) To evaluate the role of uterine blood flow assessment by colour Doppler in predicting malignant endometrial pathologies in women with AUB. (2) To correlate Doppler findings with histopathological examination outcomes. Methods: A prospective diagnostic study was conducted at the Department of Obstetrics and Gynaecology VMMC and SJH hospital new Delhi, India from July 2022 to March  2023. A total of 100 women presenting with AUB were subjected to transvaginal colour Doppler ultrasonography. Uterine artery pulsatility index (PI), resistive index (RI), and endometrial vascular patterns were recorded. Histopathological examination of endometrial samples obtained via biopsy or curettage was considered the gold standard for diagnosis. Results: Malignant endometrial lesions exhibited significantly lower uterine artery PI and RI values compared to benign lesions. Abnormal vascular patterns such as multiple vessels with low resistance flow were more frequently observed in malignant cases. Colour Doppler parameters showed high sensitivity and specificity in predicting endometrial malignancy when compared with histopathological findings. Conclusion: Colour Doppler assessment of uterine blood flow provides valuable non-invasive information for the prediction of malignant endometrial pathologies in women with abnormal uterine bleeding. Integration of Doppler findings with clinical evaluation and histopathological confirmation can improve early diagnosis and management of endometrial malignancies.

Background: Chronic lymphocytic thyroiditis, an autoimmune condition affecting thyroid function, is one of the most common benign thyroid lesions diagnosed by fine-needle aspiration cytology (FNAC). It often presents with variable cytological and hormonal profiles that help assess the disease severity and guide clinical management. Aim: To evaluate the cytomorphological features and correlate cytological grading with thyroid hormone status in cases of chronic lymphocytic thyroiditis. Methodology: This descriptive, cross-sectional study was conducted in the Department of Pathology Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India. A total of 90 clinically suspected cases underwent FNAC, cytological evaluation, and thyroid function tests (T3, T4, TSH). Cytological features were assessed qualitatively and quantitatively, and graded into three categories. Statistical analysis was done using SPSS v27. Results: All cases (100%) showed thyroid epithelial cells, lymphocytic infiltration, and background lymphocytes. Anisokaryosis (78.88%) and Hurthle cells (77.77%) were common, while granulomas (6.66%) and germinal centers (11.11%) were infrequent. Grade II thyroiditis was most prevalent (70%), followed by Grade I (17.78%) and Grade III (12.22%). Hypothyroidism was observed in 64.44% of patients, with a strong association with Grade II and III thyroiditis. Euthyroid and hyperthyroid profiles were noted in 20% and 15.56% respectively. Conclusion: FNAC remains a vital tool in diagnosing and grading chronic lymphocytic thyroiditis. Grade II thyroiditis with hypothyroidism was the most frequent pattern, reinforcing the role of cytological grading in clinical correlation and disease management.

Background: Diabetes mellitus is a well-established risk factor for the development and progression of coronary artery disease. Acute myocardial infarction (AMI) in diabetic patients is often associated with atypical presentation, delayed diagnosis, increased complications, and higher mortality rates compared to non-diabetic patients. Objectives: (1) To compare the complications and in-hospital mortality following acute myocardial infarction between diabetic and non-diabetic patients. (2) To analyze the clinical profile, risk factors, and outcomes associated with AMI in the two groups. Methods: A prospective observational study was conducted at the Department of General Medicine, AIIMS, Patna, Bihar, India from January 2020 to December 2020. A total of 200 consecutive AMI patients were enrolled, comprising 100 diabetic and 100 non-diabetic individuals. Clinical presentation, risk factors, in-hospital complications, and mortality were recorded and compared between the groups. Statistical analysis was performed to assess differences and predictors of adverse outcomes. Results: Diabetic patients with AMI had a higher incidence of heart failure, arrhythmias, cardiogenic shock, and multi-organ dysfunction compared to non-diabetics. In-hospital mortality was significantly higher among diabetic patients. Diabetics also exhibited a greater prevalence of multi-vessel coronary artery disease. Poor glycemic control and the presence of associated comorbidities were significant predictors of adverse outcomes in the diabetic cohort. Conclusion: Diabetes mellitus adversely influences the clinical course and short-term outcomes following acute myocardial infarction. Diabetic patients experience higher complication rates and mortality compared to non-diabetics. Aggressive risk factor control, early diagnosis, and tailored management strategies are essential to improve survival in diabetic individuals presenting with AMI.

Background: Anaemia remains one of the most common global public health challenges, particularly in developing countries like India. It affects individuals across all age groups and genders, leading to significant morbidity, impaired quality of life, and increased risk of mortality, especially in vulnerable populations. Objectives: (1) To determine the clinical and hematological profile of patients presenting with anaemia at a tertiary care hospital. (2) To categorize anaemia based on morphological classification and etiological factors. Methods: A cross-sectional study was conducted at the Department of General Medicine, AIIMS, Patna, Bihar, India from November 2020 to October 2022. A total of 150 patients diagnosed with anaemia (hemoglobin <12 g/dL in females, <13 g/dL in males) were enrolled. Detailed clinical evaluation, complete blood counts, peripheral smear examination, reticulocyte count, serum ferritin, vitamin B12, and folate assays were performed. Anaemia was classified morphologically and etiologically. Results: Microcytic hypochromic anaemia was the most common morphological pattern observed, predominantly associated with iron deficiency. Nutritional deficiency remained the leading cause across all age groups, followed by anaemia of chronic disease. Female preponderance was noted. A substantial proportion of patients presented with moderate to severe anaemia requiring specific therapeutic interventions. Conclusion: Anaemia continues to impose a substantial health burden, predominantly due to preventable and treatable causes like nutritional deficiencies. Early diagnosis through detailed clinical and hematological evaluation can facilitate timely management and reduce the morbidity associated with anaemia. Targeted public health measures focusing on nutrition, infection control, and chronic disease management are necessary.

Background: Postoperative nausea and vomiting (PONV) is a frequent and distressing complication following abdominal surgeries, affecting patient comfort and recovery. Ondansetron and palonosetron, both serotonin 5-HT3 receptor antagonists, are widely used to prevent PONV. However, the comparative efficacy of these medications in abdominal procedures remains an area of ongoing research. Aim: The purpose of this research is to evaluate palonosetron and ondansetron, two drugs used to avoid PONV, side by side in patients having elective abdominal operations. Methodology: A retrospective study was conducted in the Department of Anaesthesiology at IMS BHU in Varanasi, Uttar Pradesh , India, 90 patients who were having elective abdominal surgery were part of a probable, randomized, double-blind study. Before anesthesia, patients were given either 8 mg of ondansetron or 0.075 mg of palonosetron intravenously pursuant to a random allocation. Occurrence of postoperative nausea and vomiting (PONV) within the first day after surgery was the main target. The necessity of rescue antiemetics and negative side effects were deemed secondary outcomes. Results: Compared to 66.67% in the 24-48-hour post-operative period, 96.67% showed a considerably greater complete response rate with palonosetron (p = 0.008). The palonosetron group had a much-reduced occurrence of vomiting, especially inside the first 24 hours (3.33% vs. 33.33%, p = 0.008). Adverse impact profiles were equivalent across the two sets. Conclusion: While both palonosetron and ondansetron have similar safety profiles, palonosetron is superior at preventing delayed PONV, especially in the first 48 hours after surgery. Based on these results, palonosetron seems to be a superior choice for individuals undergoing abdominal surgery to avoid PONV in the long run.

Background: The COVID-19 pandemic prompted rapid vaccine development ^‘to curb disease transmission and reduce mortality. India initiated its vaccination drive in January 2021 using Covishield, Covaxin, and later, Sputnik V. Monitoring post-vaccination antibody responses is essential to understand vaccine-induced immunity. Aim: To evaluate the SARS-CoV-2 antibody response in healthcare workers following COVID-19 vaccination and analyze the temporal dynamics of humoral immunity. Methodology: This longitudinal cross-sectional study was conducted at Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar,  from April  2020 to march 2021. Ninety-two healthcare workers who received at least one dose of COVID-19 vaccine were enrolled. Participants were grouped based on their vaccination status: Group 1 (single dose) and Group 2 (both doses). Serum samples were collected at baseline and three months later. Antibody titres were measured using the Elecsys Anti-SARS-CoV-2S electrochemiluminescence immunoassay. Non-parametric tests were used for statistical analysis. Results: In Group 1, the median antibody titre significantly decreased from 9,500 U/ml at 4 weeks post-first dose to 2,150 U/ml at 18 weeks (p < 0.001), indicating waning immunity. The overall seropositivity rate was 96.5% after the first dose and 100% after the second. Breakthrough infections were mild. Adverse events following immunization (AEFI) were more frequent after the first dose but were generally mild. No correlation was found between antibody levels and AEFI. Conclusion: COVID-19 vaccines elicit a strong initial antibody response that diminishes over time, emphasizing the need for booster doses and ongoing surveillance to sustain immunity.

Background: Mental illnesses have emerged as a significant public health issue in India, especially in low-resource states where psychiatric care is either lacking or centralized in tertiary care facilities. Outpatient departments (OPDs) are key points of access for diagnosis, follow-up, and long-term treatment of mental illnesses. Aim: The main objective of this research was to monitor and examine the patterns of psychiatric OPD visits, such as demographic data, types of psychiatric diagnosis, and seasonal patterns, in a tertiary medical center for one year. Methods: Retrospective observational research was carried out by utilizing OPD registers of 4,832 patients who visited the psychiatric department of a tertiary care hospital between January 2018 to December 2018. Information gathered consisted of age, sex, place of residence (urban/rural), type of visit (new/follow-up), and clinical diagnosis. Statistical analysis was done by utilizing SPSS v25.0, and descriptive and inferential statistics were utilized. Results: Out of 4,832 patients, most of them were males, i.e, 56.7%, and females were i.e. 43.3%. The maximum affected age range was 21–40 years (46.5%). The majority (67.3%) of patients were from rural areas. Most frequent diagnoses included depressive disorder (32.1%), anxiety disorder (21.7%), and schizophrenia (18.4%). OPD had the highest visitation in October and December, and the lowest was in May. Conclusion: The results indicated an excessive psychiatric burden among young adults and the rural population, with depression and anxiety disorders being the most common. There were seasonal variations in attendance and gender differences. The findings highlight the importance of decentralized mental health care, community intervention, and stigma reduction measures to optimize access and outcomes in low-resource settings.

Background: Migraine is a common neurological condition that severely disables quality of life and is often related to psychiatric comorbidities, especially depression and anxiety. In spite of increasing evidence of such association, the nature and degree of their clinical correlation were yet to be determined. Aim: The goal of this study was to assess the clinical concordance between mood disorders and migraine, and the severity and frequency of the depressive and the anxiety symptoms among those diagnosed with migraine. Methods: A cross-sectional observational study with 300 adult patients with migraine attending psychiatry outpatient clinics was undertaken. Information was gathered on a standardized format by using MIDAS, HAM-D, and HAM-A. Pearson correlation and multiple linear regression analysis were used for the statistical analyses to determine association and predictors of severity of migraine. Results: The results showed that 54% of the subjects were moderately to severely depressed and 58% were moderately to severely anxious. MIDAS scores were strongly positively correlated with HAM-D (r = 0.61, p < 0.001) and HAM-A (r = 0.58, p < 0.001) scores. Depression and anxiety were found to be significant predictors of migraine disability using regression analysis, controlling for demographic variables. Conclusion: The study reaffirmed the significant clinical association between migraine and mood disorders. These findings underscore the importance of incorporating mental health assessment and management into routine migraine care to enhance treatment outcomes and support overall patient well-being.

Background: Despite significant national progress in childhood immunization coverage, socioeconomic disparities persist in rural India. Children from lower-income households often remain under-vaccinated, contributing to preventable morbidity and mortality. Decomposition analysis is a robust method to quantify the magnitude and drivers of wealth-based inequality in health service utilization. Aim: To assess the extent of wealth-based inequality in child vaccination coverage in rural Bihar and to identify the key contributors to this disparity using decomposition analysis. Methods: A cross-sectional analytical study was conducted from January 2020 to December 2020 among 920 children aged 12–23 months in rural blocks of Muzaffarpur district, Bihar. Data on full immunization coverage and relevant socioeconomic indicators were collected using a structured questionnaire administered to caregivers. Concentration indices were computed to measure wealth-related inequality, and Wagstaff-type decomposition analysis was applied to determine the contribution of factors such as maternal education, institutional delivery, antenatal care, birth order, and health service access to observed disparities. Results: The overall full immunization coverage was 68.3%, with a clear pro-rich distribution (concentration index = 0.241). Maternal education (27.8%), antenatal care utilization (21.6%), and institutional delivery (16.3%) were the largest contributors to the inequality. Birth order and geographical access to immunization services contributed to a lesser extent. Even after adjusting for these factors, residual inequality persisted, indicating potential influence of unmeasured structural and behavioral determinants. Conclusion: Significant wealth-based disparities exist in child vaccination coverage in rural Bihar. Educational and service utilization factors explain the majority of this inequality. Targeted interventions to improve maternal awareness, access to antenatal services, and institutional deliveries may help bridge the immunization gap among socioeconomically disadvantaged groups.

Background: Asthma is a chronic inflammatory airway disease with variable clinical expression and severity. Identifying modifiable and non-modifiable risk factors for disease progression and evaluating treatment patterns is essential for effective asthma control in adult populations. Objective: To assess the association between clinical and environmental risk factors and asthma severity, and to analyze treatment modalities used among adult asthma patients. Methods: A retrospective study was conducted at Department of Respiratory medicine, Sardar Patel Medical College, Bikaner, Rajasthan, India from 12 months. A total of 210 adult asthma patients were included. Severity classification was done based on GINA 2021 guidelines. Demographic variables, family history, occupational exposure, smoking status, comorbidities, and treatment regimens (including ICS, LABA, LAMA, oral corticosteroids) were recorded. Statistical analysis included Chi-square tests and logistic regression to identify significant predictors of moderate-to-severe asthma. Results: Of the 210 patients, 43.8% had mild asthma, 39.5% had moderate asthma, and 16.7% had severe asthma. Significant risk factors associated with higher severity included smoking (p < 0.001), biomass fuel exposure (p = 0.004), obesity (p = 0.01), allergic rhinitis (p = 0.03), and family history (p = 0.04). Combination therapy with ICS+LABA was the most common regimen in moderate cases, while oral corticosteroids were frequently prescribed in severe cases. Logistic regression identified smoking, obesity, and poor treatment adherence as independent predictors of severe asthma. Conclusion: Asthma severity in adults is influenced by both modifiable (smoking, obesity, biomass exposure) and intrinsic (genetic, allergic) risk factors. Optimization of treatment adherence and early identification of high-risk individuals can significantly improve control and reduce disease burden.

Background: Acute upper gastrointestinal bleeding (AUGIB) is a serious medical emergency that has to be treated right away. The Bleeding Care Pathway (BCP) is a structured procedure designed to maximize patient outcomes by prompt endoscopic care, resuscitation, and risk assessment. Aim: The purpose of this study is to assess how the BCP’s implementation affects clinical outcomes, such as death, rebleeding rates, hospital stay duration, and transfusion needs. Methods: This study was conducted in the Department of Gastroenterology, S.M.S. Medical College, Jaipur, Rajasthan, India, from December 2012 to November 2013. A cohort of patients presenting with AUGIH was analyzed retrospectively before and after BCP implementation. Patient demographics, Rockall and Glasgow-Blatchford scores, time to endoscopy, transfusion requirements, hospital stay duration, rebleeding rates, and mortality were recorded and compared between the two groups. Results: BCP implementation significantly improved adherence to evidence-based practices. The post-BCP cohort demonstrated a reduction in time to endoscopy (mean 6.2 vs. 12.5 hours, p < 0.01), lower transfusion rates (32% vs. 47%, p = 0.03), and a decrease in hospital stay (5.1 vs. 7.8 days, p < 0.05). Mortality (5.8% vs. 7.3%) and rebleeding rates (10.2% vs. 12.6%) showed a declining trend but were not statistically significant. Conclusion: The BCP enhances clinical outcomes by streamlining AUGIB management. Further multi-center studies are required to validate its long-term benefits and optimize protocol adherence.