Introduction: CAUTIs are common ICU infections caused by bacterial colonization and biofilm formation on catheters, leading to increased morbidity and antimicrobial resistance. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa are predominant pathogens. Prolonged catheterization and poor aseptic practices heighten infection risks. Early catheter removal and strict infection control are key to reducing CAUTI rates in ICU patients. Materials and Methods: This hospital-based prospective observational study was conducted in a 15-bedded Medical ICU over one year, enrolling 100 patients requiring Foley’s catheterization. Patients were followed from catheter insertion to discharge or death. Inclusion criteria included >48 hours of catheterization and clinical signs of infection, while those with pre-existing UTIs or fungal infections were excluded. Urine samples were collected aseptically and processed using standard microbiological techniques, with antibiotic susceptibility testing (AST) conducted per CLSI guidelines. Data analysis was performed using SPSS version 21.1, with statistical significance set at p<0.05. Results: In our study, 12% of catheterized patients developed CAUTI, with a rate of 8.4 per 1000 urinary catheter days. The majority of patients were 51–70 years old (36%), with a male predominance (55%). Escherichia coli was the most common pathogen (6%), followed by Enterococcus (4%) and Pseudomonas (3%). CAUTI incidence increased with catheter duration, rising from 2.86% in 1–5 days to 50% beyond 11 days. Antibiotic susceptibility testing showed high efficacy of Nitrofurantoin (100%), Imipenem (91.67%), and Colistin (91.67%) against Gram-negative bacteria, while Enterococcus exhibited 100% susceptibility to High Gentamycin and Linezolid. Conclusion: CAUTI remains a significant concern in ICU patients, with prolonged catheterization increasing infection risk. Strict infection control measures, timely catheter removal, and targeted antibiotic therapy are essential to reducing CAUTI rates and improving patient outcomes.

Fowl adenovirus (FAdV) infects chickens and leads to hepatitis, in a condition called inclusion body hepatitis (IBH), and hepatitis with accumulation of fluids in the pericardial sac of the heart in a condition known as hepatitis hydropericardium syndrome (HHS). Both conditions are associated with other pathologies in several organs in addition to these stated features. However, the fluid in pericardial sac distinguishes HHS from IBH. IBH is caused by Fowl adenoviruses group D, serotype 2-11, and group E, serotypes 8a, 8b and 11. The adenoviruses that cause HHS is of group C, serotype 4. In this study, the postmortem and pathologic findings found characteristic hepatitis and hydro pericardium of HHS. Hepatitis and hydropericardium were confirmed grossly, histologically and biochemically by testing ALT and AST in infected chickens. Deformity In the heart, renal and hepatic hemorrhages, necrosis in liver, kidney and heart muscle, and expansion of the pericardial sac, inclusion body in hepatocytes are reported in this study. The PCR, Hexone gene sequence and phylogenic tree confirmed the involvement of adenovirus group E in HHS. This finding was reported for the first time. The discovery that HHS is caused by group E will have implications for vaccine usage in the field.

Introduction: Stroke is a leading cause of disability and mortality worldwide, with a rising incidence in young adults. Stroke in young adults has significant socio-economic and health impacts. Modifiable risk factors such as hypertension, diabetes, obesity, smoking, and alcohol consumption contribute to this rise. This study aims to analyze the risk factors, clinical features, and outcomes of stroke in young adults. Materials and Methods: This cross-sectional study was conducted at a tertiary care hospital over six months, including young adults aged 18-45 years diagnosed with acute stroke. Data were collected from medical records and clinical evaluations using a semi-structured questionnaire, covering demographic details, risk factors, and clinical features. Stroke severity was assessed with the NIHSS (National Institutes of Health Stroke Scale) and functional outcomes with the MRS (Modified Rankin Scale). Results: Mean age of the patients was 37.2 ± 8.23 years with male predominance (66.3%). Modifiable risk factors such as overweight and obesity (55.0%), hypertension (38.8%), smoking (27.5%), and diabetes mellitus (26.3%) were commonly observed. The anterior circulation was the most commonly affected (70.0%). At the time of admission, 32 patients (40.0%) presented with moderate stroke (NIHSS score: 5 to 15), and 35 patients (43.8%) had moderate disability (MRS score: 3 to 4). The majority of patients survived (95.0%), with significant improvement in their NIHSS and MRS scores at discharge. Conclusion: Early intervention and lifestyle changes, including weight management, smoking cessation, and blood pressure control, are vital in preventing stroke recurrence. Regular screening for risk factors in high-risk populations and prompt, aggressive treatment can improve outcomes and reduce disability in young stroke patients.

Introduction and Background: Chronic kidney Disease (CKD) is defined as the presence of Kidney damage or a decreased level of kidney function for a period of 3 months or more. Auditory system abnormalities commonly occur in patients with Chronic Kidney Disease and End Stage Renal Disease patients undergoing hemodialysis. This Study was done to evaluate Brainstem Auditory Evoked Potentials in CKD patients, and patients undergoing hemodialysis and to document the reversibility of the BAEP changes after successful Renal Transplantation. Aims: The aim of our study was to evaluate Brainstem Auditory Evoked potentials in chronic kidney disease patients and patients on hemodialysis and in those who have undergone Renal transplantation. Methodology: The Experimental Group included 20 patients with CKD, 20 patients with CKD stage 5 undergoing hemodialysis and 20 Pateints who have undergone Renal Transplantation within one year of Diagnosis of CKD. Control Group Had 20 Healthy volunteers. Measurements included Absolute Peak Latencies I, II, III, IV & V and Inter peak Latencies I-III, III-V & I-V of the Auditory Brainstem Responses. Results: Abnormal BAEP Recordings were seen in CKD patients and hemodialysis patients in the form of Prolonged Absolute Peak Latencies and Interpeak Latencies. There was a significant improvement in the BAEP Waveforms after Renal Transplantation. Hence this study showed that neural conduction along the Auditory Pathway is delayed in patients with CKD and CKD patients who were on hemodialysis. Renal transplantation significantly improves the auditory function.

Background: Chronic Rhinosinusitis (CRS) is a common illness that reduces a patient’s quality of life. When medication is inadequate, Functional Endoscopic Sinus Surgery (FESS) can improve quality of life and symptoms of sickness both temporarily and permanently. However, 65% of patients with FESS experienced mild to severe pain on postoperative Day 1 (POD1). Although Remimazolam is a new ultrashort-acting benzodiazepine with minimal side effects and hemodynamic stability, it is rapidly becoming a sedative-anesthetic in clinical practice. Remimazolam have anti-inflammatory, immunomodulatory and analgesic properties. Aim: The current study aims to compare the effects of remimazolam and dexmedetomidine with respect to the QoR-40 score of patients who have undergone FESS. Method: GMERS Medical College in Junagadh, Gujarat, was the place to conduct a single-blind, randomized controlled clinical trial for this investigation. The university’s ethical committee accepted the study, and regular procedures were followed to ensure the research’s validity. A 1:1:1 random assignment was used to place the 120 eligible patients in Group R, Group D, or Group C.  Age between 18 and 65 years, synchronous sinonasal symptoms that have persisted for more than 12 weeks, sinusitis as shown by a sinus computerized tomography (CT) scan, physical status I or II as defined by the American Society of Anesthesiologists (ASA), and a scheduled elective FESS were the criteria used to prospectively enroll CRS subjects. Results: QoR-40 scores of Groups R (154.5, 152.0–159.0) and D (155.0, 154.8–159.3) had lower QoR-40 (median, IQR) scores overall at POD1 than Group C (139.0, 136.8–142.0) (P < 0.001). The overall QoR-40 score did not differ significantly between Groups R and D. Moreover, the emotional intelligence scores on POD1, Groups R and D had lower state, physical comfort, and pain dimensions than Group C (P < 0.005). Moreover, the maximal VAS pain score was lower in the PACU and ward in Groups R and D than in Group C (P < 0.001). The RASS score was lower upon PACU arrival in Groups R and D than in Group C (P < 0.001). Conclusion: From the analysis of study, it has been concluded that after FESS, remimazolam and dexmedetomi-dine may lower the intensity of pain and enhance the quality of recovery. Remimazolam’s efficacy and safety are on par with dexmedetomidine.

Introduction and background: The percentage of senior citizens in India has been growing at an increasing rate in recent years and the trend is likely to continue. Traumatic Brain Injury (TBI) still remains a major cause of morbidity and mortality. In developing countries like India where motorized travel is quickly growing without accompanying safety precautions and adherence to traffic rules and regulations, road traffic accidents are more frequent leading to increase in traumatic brain injuries. Elderly patients sustaining TBI have higher morbidity and mortality and prolonged recovery trajectories than younger patients. The current “One size fits all” approach to traumatic brain injury management of adult patients neglects special issues of elderly population. Aims: Aim of the study is to analyze demographic data, clinico-radiological features, co-morbid illness of elderly patients with traumatic brain injuries treated either with surgical or conservative management, to evaluate the risk factors predicting poor prognosis among elderly TBI patients, to study the outcome and mortality among elderly (65-75) and very elderly ( >75 years) age groups and to study the validation of eTBI (Elderly Traumatic Brain Injury) score in predicting mortality. Methodology: This is a prospective single center study conducted at the Institute of Neurosurgery, Madras Medical College, Chennai, Tamilnadu, India. We enrolled 200 patients of ≥ 65 years of age with Traumatic brain Injury between May 2021 and October 2021. Information about patients, demographic data, clinical and radiological features, co-morbid conditions, in-hospital course of treatment and associated complications as well as outcome was recorded. The collected data were analyzed with IBM-SPSS statistics software 23.0 Version. To find the significance in categorical data Chi-Square test was used. The probability value .05 is considered as significant level. Results: Mean age among the patients is 70.16 and maximum age enrolled in this study is 88. 144 were males and 38 were females. There were 91 patients with mild injury (50%), 68 patients with moderate injury (37.4%) and 23 patients with severe injury (12.6%). About 127 (69.8%) patients had favorable outcome and 55 (30.2%) patients had unfavorable outcome. Road traffic accidents accounted for most injuries (n=100) followed by ground level falls (n = 74) with other causes accounting for very few numbers. Most common associated comorbidity found was systemic hypertension which was seen in 34.1% followed by diabetes in 25.3%. Statistical analysis showed poor GCS score at admission, absent/effaced basal cisterns and/or presence of midline shift in CT, presence of co-morbidities like diabetes, hypertension and CAD, preinjury intake of antiplatelets or anticoagulants or beta blockers were all associated with unfavorable outcome. Lower eTBI scores were associated with unfavorable outcome. Prolonged ICU stay and prolonged mechanical ventilation both of which was found to adversely affect the clinical outcome in our study.

Introduction and Background: Sural nerve can be used for diagnostic purposes like nerve conduction velocity study and for nerve biopsy for various neuromuscular disorders. It is also widely used for electrophysiological studies. Knowledge about the course of the sural nerve and variations in its course would be hugely helpful in carrying out the aforementioned studies. This knowledge will also be helpful while performing procedures like autologous peripheral nerve grafting and nerve biopsy. Aims and Objectives: The aim of this study is to study the variations of sural nerve formation, its course in the leg and its relations with Tendo-Calcaneus, short saphenous vein and lateral malleolus for its clinical application. Methodology: This was a descriptive study done in the Institute of Anatomy, Madras Medical College, Chennai, Tamilnadu, India. The study was conducted by following the guidelines of Cunningham’s manual. This study included 50 lower limb specimens from 25 cadavers fixed in 10% formalin. Both male and female cadavers were included in the study. The data was collected by dissection method by using dissection instruments and parameters (measurements) were obtained by using measuring tape and Vernier’s calliper. Results: The mean length of leg measured from flexor crease to heel in our study was 43.96 cm. The most common type of sural nerve formation is Type-A. In males, Type-A sural nerve formation was most commonly located at lower 1/3rd of leg with 63.7% specimens (n=7) on right side. In females, Type-A sural nerve formation was most commonly located at lower 1/3rd of leg with 71.4% specimens (n=5) on right side and 75% specimens (n=6) on left side. The symmetricity of sural nerve formation between right and left lower limbs was noted in 11 male cadavers (78.6%) and 6 female cadavers (n=54.5%). Sural nerve formation was asymmetric in 3 male (21.4%) and 5 female (45.5%) cadavers. Sural nerve pierced deep fascia most commonly at lower 1/3rd of leg as noted in 50% of specimens. The mean distance between the site of sural nerve piercing deep fascia and lower border of lateral malleolus was 18.07 cm. The mean length of sural nerve measured from its formation to lateral malleolus was 31.54 cm. the mean distance between sural nerve and posterior border of lateral malleolus at its midpoint was 0.95 cm. The mean distance between the site of sural nerve crossing lateral border of Tendo-calcaneus and lower border of lateral malleolus was 4.82 cm. The mean distances noted at 5cm reference point was 0.17 cm lateral to Tendo-calcaneus. At 7cm and 10cm reference points, sural nerve was medial to lateral border of Tendo-calcaneus with mean distances -1.5cm and -3.92 cm respectively.

Background: Medication adherence and compliance are crucial for effective chronic disease management. Poor adherence can lead to disease progression, increased hospitalizations, and higher healthcare costs. This study examines the patterns and factors influencing medication adherence among chronic disease patients. Objectives: To assess medication adherence levels, identify barriers to compliance, and explore strategies to improve adherence in chronic disease patients. Methods: A cross-sectional survey was conducted with 150 chronic disease patients. Medication adherence was evaluated using a standardized questionnaire. Statistical analyses, including Chi-square tests and logistic regression, were performed to identify factors influencing adherence. Results: The study found that 62% of patients were non-adherent to their prescribed medication regimen. Key barriers included forgetfulness (32%), medication cost (27%), and side effects (21%). Patients with higher health literacy showed better adherence rates (p < 0.05). Conclusion: Medication non-adherence is prevalent among chronic disease patients, primarily due to forgetfulness, cost, and side effects. Interventions focused on patient education and cost reduction could improve adherence.

Introduction: Surgical site infections (SSIs) pose a major challenge in orthopedic surgeries in India, with infection rates varying across hospitals. High infection rates in certain settings emphasize the need for effective surveillance and infection control measures. The presence of multidrug-resistant strains further complicates treatment, making continuous monitoring and antibiotic stewardship essential. This study aimed to determine the bacteriological profile, SSI rates, antibiotic susceptibility, and associated risk factors to improve infection prevention and management strategies in orthopedic surgeries. Material and Methods: This study was conducted as an active surveillance program in a tertiary care hospital to monitor surgical site infections (SSI) in orthopedic patients. Patients were systematically assessed post-operatively, and suspected SSIs were identified based on clinical symptoms. Data collection included demographic details, surgical and anesthesia type, risk factors, and wound classification. Standard preoperative protocols, antibiotic prophylaxis, and microbiological analysis were followed for infection detection. Statistical analysis using SPSS software assessed SSI incidence and associated risk factors, with p < 0.05 considered significant. Results: Our study found an SSI incidence of 5.5% among 180 orthopedic patients, with the highest infection rate observed in patients aged 0-25 (8.82%). Staphylococcus aureus (60%), was the most frequently isolated pathogen, followed by Pseudomonas aeruginoa (30%) and Acinetobactor spp. (10%), indicating the need for targeted infection control strategies. Among surgical procedures, Plate/K-wire fixation had the highest SSI rate (9.45%), followed by implant removal (5.26%). The SSI rate was significantly associated with prolonged hospital stay (>6 days: 13.8%), emergency surgeries (66.6%), general anesthesia (25%), dirty wounds (75%), and prolonged surgical duration (>2 hours: 50%) (p < 0.0001). While diabetes (50%) showed an increased risk, their association was not statistically significant (p = 0.4003). Conclusion: Effective infection control strategies, risk assessment, and optimized surgical protocols are essential to reduce SSIs in orthopedic patients, particularly in high-risk cases such as emergency surgeries, prolonged hospital stays, and contaminated wounds.

Background: Male infertility is noted Up to 50% vitro studies revealed that, bacteria can negatively impact on sperm function. Hence the human microbe and dysbiosis have to be ruled out. Method: 65 (sixty-five) infertile adults aged between 25 to 40 years were studied. Semen samples were collected in a sterile container by masturbation after the minimum obstinate of 3 days. Semen parameters included appearance, volume, pH, viscosity, liquefaction, motility, and morphology, which were analyzed microscopically. Results: Out of 65, 55 (84.6%) were primary infertility, and 10 (15.3%) were secondary infertility. In a comparative study of semen parameters of bacteriological culture of positive and negative studies, mean volume, pH, sperm concentration, progressive motility, normal formation of sperm, had significant p-value (p<0.001). In comparison of PCR semen concentration, progressive motility morphology had a significant p-value (p<0.01). Conclusion: Present bacteriological and PCR studies will help the clinician to rule out the etiology of abnormal semen parameters and to treat efficiently such infertile male cases.

Background: Cord clamping is a crucial step in the third stage of labor, influencing both neonatal and maternal outcomes. While early cord clamping (ECC) has been the standard practice, delayed cord clamping (DCC) is gaining recognition for its potential benefits. Aim This study compares the effects of DCC and ECC on neonatal hemoglobin levels, incidence of neonatal jaundice, and maternal postpartum blood loss. Material and Methods: A prospective comparative study was conducted on 200 term deliveries, with participants randomly assigned to ECC (clamping within 30 seconds) or DCC (clamping after 2–3 minutes). Neonatal hemoglobin and bilirubin levels were measured at 24 and 48 hours post-delivery, while maternal blood loss was assessed through postpartum hemoglobin changes. Results: DCC significantly increased neonatal hemoglobin levels, reducing neonatal anemia incidence. However, neonatal bilirubin levels were slightly higher in the DCC group, leading to a moderate increase in jaundice cases requiring phototherapy. Maternal blood loss and postpartum hemorrhage rates were not significantly different between the two groups. Conclusion: DCC provides substantial benefits in neonatal iron status while posing a manageable risk of jaundice. Given its advantages, DCC should be considered a routine practice with adequate neonatal jaundice monitoring.

Introduction: Catheter-associated urinary tract infection (CAUTI) is a major healthcare-associated infection (HAI), significantly contributing to prolonged hospital stays, increased morbidity, and antimicrobial resistance. The widespread use of indwelling urinary catheters in intensive care units (ICUs) makes CAUTI a critical concern, particularly in critically ill patients. As the risk of bacteriuria increases with each day of catheter use, early removal and adherence to infection control measures are crucial in preventing CAUTI-related complications. Aim and objectives: To evaluate the incidence, risk factors, microbial profile, and antibiotic resistance patterns of catheter-associated urinary tract infections (CAUTI) in ICU patients to enhance infection control strategies and antimicrobial stewardship. Materials and Methods: This hospital-based prospective observational study was conducted in the Medical Intensive Care Unit (MICU) of a tertiary care center in Western Gujarat, enrolling 100 catheterized patients. Urine samples were collected and processed for microbial identification and antibiotic susceptibility testing. Patients were monitored for clinical symptoms of CAUTI, and relevant demographic and clinical data were recorded. Bacterial isolates were identified using standard microbiological techniques, and antibiotic susceptibility was assessed following CLSI guidelines. Statistical analysis was performed using descriptive methods and chi-square tests, with a p-value <0.05 considered statistically significant. Results: A total of 100 catheterized MICU patients were monitored for CAUTI incidence, microbial profile, and antibiotic susceptibility patterns. The majority of patients were in the 51–70 years age group (34%), followed by 11–30 years (26%), with the lowest representation in those above 70 years (18%). CAUTI cases were most frequently observed in the third week of catheterization (55%), followed by the second week (35%), with the lowest occurrence in the first week (10%). Microbial analysis identified Escherichia coli (6%) as the most common pathogen, followed by Enterococcus species (4%) and Pseudomonas species (3%), while 83% of urine cultures were sterile. Antibiotic susceptibility testing revealed high sensitivity of Imipenem (90%) and Colistin (95%) against Gram-negative bacilli, while Nitrofurantoin showed 100% efficacy. Resistance was noted with Ceftazidime (55%) and Piperacillin/Tazobactam (60%), highlighting the need for judicious antibiotic use and infection control measures. Conclusion: Our study emphasizes the significant role of prolonged catheterization in CAUTI development and highlights the importance of early catheter removal, infection control measures, and antimicrobial stewardship to reduce incidence and combat antibiotic resistance in ICU settings.

Wives of alcoholics’ coping mechanisms are an important part of negotiating the difficulties in homes where alcoholism is prevalent. These women adopt a variety of techniques to deal with the practical, psychological, emotional, and other stresses brought on by their spouse’s addiction. These people use a variety of intricate coping strategies, ranging from self-care activities and social support seeking to denial and enabling. In order to meet the needs of alcoholic spouses and provide focused interventions that aim to build resilience, encourage healthy coping mechanisms, and improve family well-being overall, it is essential to comprehend these coping habits. Researchers examined the coping mechanisms used by alcoholics’ spouses in this publication.

Background: After total hip replacement, analgesic demand is very significant due to its link to severe early postoperative pain. Enhancing rehabilitation protocols and pain management strategies has a major influence on the results of the surgery. Aims and Objectives: This study compares the duration of motor block, the time it takes for sensory block to start, the duration of sensory block to start, the adverse effects of drugs in two groups, post-operative analgesia and the amount of time it takes to take the first dose of analgesic needed during the recovery period. Methods: This is a double-blinded randomized and comparative study for which 60 patients were selected out of which 30 patients had in group BD and 30 patients had in group BF. Patients were allocated into 2 groups: group-BD (0.25% bupivacaine 15 ml and dexmedetomidine-1 ml, i.e., 50 micrograms)- 30 patients and group-BF (0.25% bupivacaine 15 ml and fentanyl-1 ml, i.e., 50 micrograms)-30 patients and compared. Results: There was a statistically significant difference (p<0.0001) in the mean length of sensory block, motor block, and mean time commencement of sensory block between the two groups. Conclusion: The study concludes that dexmedetomidine, when used as an adjuvant to epidural bupivacaine, exhibits a quick start of sensory block, a shorter time to reach maximal sensory level, a longer duration of analgesia, and a longer duration of motor blockade than fentanyl.

Background: Vitamin B12 deficiency is increasingly being recognized as a common concern in patients with type 2 diabetes mellitus (T2DM). Vitamin B12 plays a critical role in red blood cell formation, neurological function, and DNA synthesis. Aim: This review focuses on the prevalence of vitamin B12 deficiency in newly diagnosed T2DM patients, exploring potential mechanisms, clinical implications, and recommendations for screening and treatment. Method: Patients in OPD with new onset diabetes mellitus type 2 who were between age group of 18-50 years with no history of any OHA uptake or any other risk factor to cause vit B 12 deficiency were taken into study Result: 64(32%) patients of newly diagnosed type 2 diabetes were found to be vit B12 deficient, 87(43.5%) patients range in border line category and in 49(24.5) patients vit b12 levels are in normal limit. Conclusion: Vitamin B12 deficiency is prevalent among newly diagnosed T2DM patients. Due to the overlap of clinical symptoms between B12 deficiency and diabetic complications such as neuropathy, it is crucial for healthcare providers to consider B12 deficiency in their diagnostic workup.

In the Asia-Pacific region, scrub typhus is a major public health concern. It makes one million people sick every year and poses a hazard to one billion people worldwide. Scrub typhus is caused by Orientia tsutsugamushi and, if left untreated, can cause severe multiorgan failure with a 75-80% case fatality rate. O. tsutsugamushi’s antigenic heterogeneity permits reinfection and prevents generic immunity. Scrub typhus is a neglected disease, and the little epidemiologic data and other relevant public health information on the disease in its endemic areas show that we still don’t fully understand it. We studied the infection’s clinical characteristics in 90 individuals who visited this tertiary care facility over a 16-month period. The ELISA’s seropositivity rate was 11.11%, whereas the rapid test analysis revealed a rate of 22.22%. Scrub typhus was found to be substantially correlated with both eschar and animal exposure in this study. The PROGEN OXK antigen suspension (Weil-Felix) and the InBios scrub typhus IgM ELISA kit showed a significant difference in scrub typhus diagnosis (p<0.05). The results of the quick agglutination test showed that the sensitivity, specificity, positive predictive value, and negative predictive value were 60.0%, 82.5%, 30.0%, and 94.28%, respectively. Reducing morbidity and death from this condition will be greatly aided by raising awareness of it and managing it promptly.

Lower urinary tract symptoms (LUTS) are a common complaint among women, and their prevalence increases with age. This study aimed to evaluate the urodynamic parameters of 150 female patients presenting with LUTS, considering age-related bladder dynamic changes. Our results show that the urodynamic parameters varied significantly across different age groups, with older women exhibiting decreased bladder capacity, increased detrusor pressure, and reduced flow rates. These findings highlight the importance of considering age-related bladder dynamic changes in the diagnosis and management of LUTS in women.

Background: The common cold is one of the most frequent illnesses affecting school-aged children, leading to significant school absenteeism and healthcare burden. While symptomatic treatments are commonly used, there has been growing interest in the potential role of zinc supplementation in reducing the severity and duration of the common cold. Zinc plays a crucial role in immune function, modulating inflammatory responses, and inhibiting viral replication. However, existing literature on its efficacy in pediatric populations remains inconclusive. Objectives: This study aims to evaluate the role of zinc supplementation in reducing the severity, duration, and recurrence of the common cold in school-aged children. The study also seeks to determine whether zinc administration at the onset of symptoms provides measurable benefits in mitigating cold-related morbidity. Methods: A prospective study was conducted at Department of Pediatrics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India, involving 120 school-aged children (6–12 years) presenting with symptoms of the common cold. Participants were randomly assigned to two groups: the zinc supplementation group, which received 15 mg of zinc sulfate daily for seven days, and the control group, which received a placebo. The primary outcomes measured included the duration of cold symptoms (cough, nasal congestion, and fever), the severity of symptoms using a standardized symptom severity score, and the recurrence rate within the subsequent three months. Statistical analyses were conducted to assess the differences between groups. Results: Children receiving zinc supplementation showed a statistically significant reduction in the duration of symptoms compared to the control group. The mean duration of symptoms was 4.2 days in the zinc group compared to 6.1 days in the control group (p < 0.001). The severity scores were also significantly lower in the zinc group after three days of treatment (p = 0.02). Additionally, the recurrence of cold episodes within three months was lower in the zinc group (15% vs. 30%, p = 0.04), suggesting a possible protective effect of zinc supplementation against future infections. Conclusion: Zinc supplementation significantly reduces the duration and severity of the common cold in school-aged children and may contribute to reducing recurrence rates. These findings support the potential inclusion of zinc in therapeutic and preventive strategies for managing common cold symptoms in pediatric populations. However, further large-scale studies are recommended to validate these findings and determine optimal dosing strategies.

Background: Low birth weight (LBW), defined as a weight of less than 2500 grams at birth, poses a substantial risk for infant mortality and morbidity, as well as long-term adverse health outcomes. Early identification and subsequent management of LBW are critical, especially in developing countries where resources are limited and healthcare challenges are significant. Traditional methods for identifying LBW babies can be impractical in scenarios lacking immediate and precise weighing mechanisms. This study proposes the use of mid-arm circumference (MAC) and chest circumference (CC) as potentially reliable indicators for early detection of LBW infants, which could be particularly useful in resource-constrained environments. Objectives: The primary aim of this research is to explore the efficacy of MAC and CC measurements taken within the first 24 hours of life as predictive tools for determining LBW in neonates. This study seeks to establish statistically significant correlations between these anthropometric measurements and actual birth weights, thereby providing a basis for developing a simple, rapid, and cost-effective screening tool to identify LBW babies soon after birth. Methods: This prospective cohort study was conducted at Department of Darbhanga Medical College and Hospital for six months  involved a sample of 120 neonates born , MAC and CC were measured for each newborn within 24 hours of delivery using standardized anthropometric techniques and equipment. Birth weight was recorded using a calibrated neonatal weighing scale. The study utilized multiple linear regression models to analyze the relationship between the circumferences and birth weight, adjusting for confounders such as gestational age, sex of the newborn, and maternal health factors. Results: It is anticipated that the study will demonstrate a strong positive correlation between the measurements of MAC and CC and the neonatal weight, with higher circumferences being indicative of higher birth weights. The regression analysis will help refine the predictive model by quantifying the strength of the association and adjusting for possible confounders. This will include calculating sensitivity, specificity, positive predictive value, and negative predictive value of MAC and CC measurements in predicting LBW. Conclusion: Should the correlations be statistically significant and strong, MAC and CC could be validated as practical, non-invasive screening tools for early detection of LBW in neonates. This would be especially beneficial in settings where traditional weighing scales are unavailable or impractical to use immediately after birth. Implementing such a screening tool could lead to quicker and more efficient neonatal care interventions, ultimately improving survival rates and health outcomes for LBW infants.

Background: Neonatal sepsis is a major cause of morbidity and mortality, particularly among preterm and low birth weight infants in developing countries like India. The condition is difficult to diagnose early due to nonspecific clinical manifestations, leading to delayed treatment and poor outcomes. Early and reliable laboratory markers are critical for timely diagnosis and intervention. Aim: This study aims to evaluate the diagnostic utility of various hematological parameters in neonatal sepsis and assess their correlation with blood culture positivity. Methodology: A prospective study was conducted in the Department of Pathology and Pediatrics, GMCH, Purnia, Bihar, India for one year. A total of 90 neonates aged 0–28 days with suspected sepsis were included. Blood samples were collected and analyzed for complete blood count (CBC), differential count, C-reactive protein (CRP), micro erythrocyte sedimentation rate (ESR), and morphological changes in neutrophils. Blood culture was performed to confirm^’ bacterial sepsis. Sensitivity and specificity of individual and combined hematological parameters were statistically analyzed using SPSS version 27. Results: Among 18 culture-positive cases, significant markers included an elevated immature-to-mature neutrophil ratio (94.44%), increased CRP levels (94.44%), and thrombocytopenia (88.89%). Elevated CRP exhibited the highest sensitivity (95.2%) but low specificity (14.3%), while combining multiple positive markers yielded the best diagnostic performance (sensitivity: 96.1%, specificity: 84.2%). Conclusion: Hematological parameters, particularly the combination of multiple markers, can serve as reliable screening tools for early neonatal sepsis diagnosis. Their prompt use can improve neonatal outcomes by facilitating early intervention.

Background: Lymphadenopathy, which is defined as the swelling of lymph nodes, is a frequent clinical presentation with a wide differential diagnosis that includes both cancers and benign reactive processes. Fine needle aspiration cytology (FNAC) is a less invasive, economical diagnostic method for assessing lymphadenopathy, facilitating the identification of various causes. Objective: The objective of this study was to evaluate the cytomorphological spectrum of enlarged lymph nodes in patients at a tertiary healthcare facility, emphasizing the incidence of neoplastic and non-neoplastic lesions and their distribution across various age groups and genders. Methodology: A cross-sectional research was performed in the Department of Pathology at Darbhanga Medical College and Hospital, Bihar, India. Seventy-four individuals exhibiting lymphadenopathy received fine needle aspiration cytology (FNAC). Aspirates were processed and stained with conventional cytological methodologies, including Hematoxylin & Eosin, Papanicolaou, Giemsa, and Ziehl-Neelsen stains. Cytological diagnosis were classified into non-neoplastic and neoplastic lesions, with additional sub classification as warranted. Results: The largest prevalence of lymphadenopathy occurred in the 21–30 years age range (20.3%), with a male preponderance (56.8%). The cervical region was the most often impacted area (54.1%). Non-neoplastic lesions comprised 70.2% of cases, with reactive lymphoid hyperplasia (32.4%) and tuberculous lymphadenitis (27.0%) as the most prevalent. Neoplastic lesions constituted 29.8% of patients, with metastatic carcinoma (13.5%) being the most prevalent, followed by Non-Hodgkin’s lymphoma (6.7%) and Hodgkin’s lymphoma (5.4%). Conclusion: FNAC serves as an efficient preliminary diagnostic tool for assessing lymphadenopathy, offering significant insights into the underlying disease. The research indicates an increased occurrence of non-neoplastic diseases, including reactive hyperplasia and TB, among the examined group. The prevalence of metastatic carcinoma highlights the necessity of evaluating secondary malignancies in differential diagnosis, particularly in elderly individuals.

Introduction: Diabetes has emerged as one of the fastest growing global health emergencies of the 21st century. The real burden of diabetes is due to its micro and macrovascular complication which lead to increased morbidity and mortality. Judicious use of antidiabetic drugs by adhering to guidelines will decrease the complication and cost of drug therapy. Aims and Objectives: The objective of this study was to evaluate drug utilization pattern of antihyperglycemic agents in Type 2 diabetes mellitus (T2DM). Materials and Method: A single centric cross sectional prospective observational study was conducted over a period of 6 months (May 2017 to October 2017) in the diabetic clinic of Assam Medical College and Hospital (AMCH), Dibrugarh, Assam. The data were analyzed using descriptive statistics. Continuous data were expressed as mean percentage and nominal data were expressed as frequency and percentages. Results: In this study a total of 207 prescriptions were analyzed and was observed that Metformin was the most common drug prescribed both as monotherapy (53.7%) and in combination with Gliclazide (50%). Amlodipine (16.9%) was the most common non-diabetic drug prescribed in our patients. Average number of drugs per prescription was 4.06, while average number of antihyperglycemic agents per prescription was 1.92. Average cost of antihyperglycemic agents per prescription was under Rs 100/month (55.5 %) with 42.45 % of drugs prescribed as generic drugs. Conclusion: Metformin being the most commonly prescribed antihyperglycemic drug in T2DM should be available in sufficient quantities in health care system. Polytherapy is given adequately for the various macro and microvascular complications due to long standing diabetes mellitus. Generic drugs should be used to reduce the cost of treatment.

Background: Hemiarthroplasty is a widely performed surgical intervention for displaced femoral neck fractures, particularly in elderly patients with osteoporosis and functional limitations. The choice between cemented and uncemented prostheses remains a subject of debate, as both approaches have unique advantages and risks. Cemented hemiarthroplasty provides superior initial fixation, better pain relief, and lower implant subsidence, while uncemented implants reduce operative time and avoid cement-related complications such as bone cement implantation syndrome (BCIS). This study compares the clinical, functional, and radiological outcomes of cemented versus uncemented hemiarthroplasty in elderly patients with displaced femoral neck fractures. Objectives: To compare functional outcomes, intraoperative and postoperative complications, and implant stability between cemented and uncemented hemiarthroplasty in elderly patients with displaced femoral neck fractures. Secondary objectives include evaluating surgical time, intraoperative blood loss, early postoperative mobility, and long-term prosthesis survivorship. Methods: This prospective comparative study was conducted at the Department of Orthopaedics, K S Hegde Medical Academy, Nitte University, Mangalore, India. A total of 120 patients (≥60 years) with displaced femoral neck fractures were enrolled, with 60 patients undergoing cemented hemiarthroplasty and 60 receiving uncemented hemiarthroplasty. Clinical outcomes were assessed over a 12-month follow-up period using the Harris Hip Score (HHS) and Visual Analog Scale (VAS) for pain at 6 weeks, 3 months, 6 months, and 12 months. Radiological evaluations assessed implant positioning, periprosthetic fractures, and aseptic loosening. Surgical parameters, including operative time, intraoperative blood loss, hospital stay duration, and postoperative complications, were documented. Results: The cemented hemiarthroplasty group exhibited better early functional recovery, with higher HHS scores at 6 weeks (82.5 ± 4.3 vs. 75.8 ± 5.1, p = 0.002) and 3 months (85.7 ± 3.8 vs. 79.1 ± 4.5, p = 0.001). The VAS pain scores were also lower in the cemented group at 6 weeks (3.2 ± 1.1 vs. 4.7 ± 1.3, p = 0.004). However, the cemented group had a longer operative time (74.6 ± 10.3 min vs. 62.1 ± 9.8 min, p = 0.001) and higher intraoperative blood loss (325.4 ± 58.2 mL vs. 210.3 ± 49.5 mL, p = 0.002) compared to the uncemented group. The uncemented hemiarthroplasty group showed higher rates of early periprosthetic fractures (10% vs. 3.3%, p = 0.03) and initial postoperative instability (15% vs. 6.7%, p = 0.04). In contrast, the cemented group had a slightly increased incidence of thromboembolic events (8.3% vs. 3.3%, p = 0.08, not statistically significant). Long-term implant survival and complication rates at 12 months were comparable, with no significant difference in aseptic loosening (cemented: 3.3% vs. uncemented: 5%, p = 0.62). Conclusion: Cemented hemiarthroplasty provides better early functional outcomes, superior pain relief, and enhanced implant stability, making it the preferred option in elderly patients with osteoporotic bone. However, it is associated with longer operative time and increased intraoperative blood loss. Uncemented hemiarthroplasty, while reducing cement-related complications and operative time, carries a higher risk of periprosthetic fractures and early postoperative instability, especially in patients with poor bone quality. The decision between cemented and uncemented prostheses should be individualized, considering bone quality, patient comorbidities, rehabilitation potential, and surgeon expertise, to optimize functional outcomes and minimize complications.

Background: Urbanization, lifestyle, and stress have led to an increase in hypertension, a risk factor for cardiovascular disease, among young adults. The determinants analysis and prevalence of hypertension among adults aged 20–40 years in urban Gujarat is as follows. Objective: To assess the prevalence and risk factors of hypertension among adults aged 20–40 years in urban Gujarat to enable early intervention and prevention. Methods: Cross-sectional study was conducted among 440 participants of urban field practice area. Information was collected by semi-structured questionnaire, anthropometric parameters, and blood pressure. JNC 8 guidelines were applied for categorization of the hypertension status, and statistical analysis was employed to determine the relationship between sociodemographic parameters and hypertension. Results: Prevalence of Stage 1 and Stage 2 hypertension was 17.9%, and another 51.6% was pre-hypertensive. The significant risk factors were advancing age (30–40 years: OR = 2.5, 95% CI: 1.66 – 4.25), chewing of tobacco (OR = 4.7, 95% CI: 2.62 – 7.59), stress (OR = 3.1, 95% CI: 1.77 – 4.91), and obesity (OR = 3.5, 95% CI: 1.49 – 7.11). The family history of hypertension was highly significant (P < 0.001). Conclusion: Pre-hypertension and hypertension are common in young urban adults, and this calls for early intervention and screening. Lifestyle modification, stress reduction, and public health education programs are required to avert the rising burden of hypertension and minimize long-term cardiovascular risk.

Background: The increasing prevalence of type 2 diabetes mellitus (T2DM) poses a significant public health challenge worldwide, with India being recognized as the diabetes capital of the world. Hyperuricemia, a condition characterized by elevated serum uric acid (SUA) levels, has been implicated as a potential risk factor for T2DM. However, conflicting evidence exists regarding the association between SUA levels and diabetes. This study aims to evaluate the relationship between SUA levels and the duration of T2DM.  Aim: To assess the association between serum uric acid levels and the risk of developing type 2 diabetes mellitus, while considering the duration of the disease. Methodology: A prospective study was conducted over six months at Anugrah Narayan Magadh Medical College, Gaya, Bihar, India. A total of 80 patients with T2DM were randomly selected from the medicine outpatient department. Inclusion criteria included patients above 40 years of age with T2DM, while individuals with cardiovascular, metabolic, or endocrine disorders were excluded. Blood samples were collected after an 8-hour fasting period, and SUA levels were estimated using the Uricase-peroxidase method. Statistical analysis was performed using SPSS version 27, with a p-value of <0.05^’ considered significant. Results: The study revealed a significant association between SUA levels also diabetes duration (<5 years: p=0.02; >10 years: p=0.01). Gender differences in SUA levels were also noted, with males having higher SUA levels than females (p=0.03). Patients with normal BMI exhibited significant variations in SUA levels (p=0.04), while hypertensive individuals were excluded from analysis. Conclusion: The study findings suggest a potential role of hyperuricemia in the pathophysiology of T2DM. Elevated SUA levels may serve as an independent biochemical marker for diabetes risk. Further large-scale studies are necessary to establish a definitive causal relationship.

Background: Laryngoscopy and tracheal intubation induce significant hemodynamic changes, which can be detrimental in patients with cardiovascular or neurological conditions. Various pharmacological agents, includ-ing fentanyl and dexmedetomidine, have been used to mitigate this response. However, limited studies have compared their efficacy when administered via nebulization. Aim: This study aims to evaluate and compare the effectiveness of fentanyl and dexmedetomidine nebulization in attenuating the hemodynamic stress response to laryngoscopy and intubation. Methodology: A prospective study was conducted at the Department of Anesthesia, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Bihar, India, from October 2023 to October 2024. A total of 85 patients, aged 18–60 years, classified as ASA I and II, were randomized into two groups. Group A received fentanyl nebuliza-tion (2 µg/kg), while Group B received dexmedetomidine nebulization (1 µg/kg) before induction. Hemody-namic parameters, including heart rate (HR) and mean arterial pressure (MAP), were recorded at various time points. Statistical analysis was performed using SPSS version 27. Results: Group B exhibited a significantly lower HR at 1, 5, and 10 minutes post-intubation (p < 0.0001). MAP reduction was more pronounced in Group B at 10 minutes (p < 0.0001). Propofol consumption was sig-nificantly lower in Group B (p < 0.0001). Conclusion: Dexmedetomidine nebulization demonstrated superior efficacy in blunting hemodynamic responses to laryngoscopy’ and intubation while reducing anesthetic requirements, suggesting a potential advantage over fentanyl nebulization.

Background: Acute pancreatitis (AP) is a common gastrointestinal emergency with significant morbidity and mortality. Local complications, including pancreatic “fluid collections (PFC), necrosis, and vascular issues, often require surgical intervention. This study evaluates the surgical management of local complications of AP and associated outcomes. Methods: A retrospective study was conducted at  Department of General Surgery, AIIMS, Patna, India, involving 80 patients who underwent surgical procedures for local complications of AP between 2021 and 2024. Patients were selected using purposive sampling. Clinical, laboratory, and imaging data were collected, and surgical outcomes were assessed using the Clavien-Dindo classification. Data were analyzed using SPSS version 27. Results: Of the 80 patients, 52.5% were male and 47.5% were female. The leading cause of AP was ethanol consumption (52.5%), followed by biliary causes (42.5%). Pseudocyst (40%) and acute necrotic collection (33.75%) were the most common complications. The body and tail of the pancreas were more frequently involved (67.5%) than the head (32.5%). Video-assisted retroperitoneal drainage (VARD) and open cysto-enterostomy were the most common procedures (17.5% each). Postoperative complications included surgical site infection (10%), hospital-acquired pneumonia (7.5%), and re-exploration (3.75%). Conclusion: Ethanol and biliary causes were the primary etiologies of AP. Minimally invasive procedures, including VARD, were associated with favorable outcomes and low complication rates. Early diagnosis and a multidisciplinary approach are essential for optimizing clinical outcomes.

Background: Chronic pelvic pain (CPP) is a prevalent and multifactorial condition affecting women of all ages, significantly impairing quality of life and placing a substantial burden on healthcare systems. The diagnostic complexity of CPP arises from its diverse etiologies spanning gynecological, urological, gastrointestinal, musculoskeletal, and psychosocial domains. This prospective observational study aimed to comprehensively assess CPP in both reproductive-aged and postmenopausal women, emphasizing clinical characteristics, diagnostic pathways, and associated factors. Methods: The study was conducted at the Department of Obstetrics and Gynaecology, Netaji Subhas Medical College and Hospital, Bihar. Ninety women aged 18 to 70 years presenting with CPP were enrolled after informed consent. Data collection included detailed history, physical examination, imaging studies, and laboratory investigations. The causes of CPP were classified into gynecological, gastrointestinal, musculoskeletal, and psychosocial categories. Statistical analysis was performed using SPSS version 20. Results: The majority (36.7%) of participants were aged 31-40 years, and 53.3% belonged to lower socioeconomic status. Gynecological causes predominated (62.3%), with chronic pelvic inflammatory disease (25.6%), endometriosis (21.1%), and adenomyosis (15.6%) being common. Associated symptoms such as dysmenorrhea (63.3%) and abnormal vaginal discharge (40%) were frequent. In postmenopausal women, urogenital atrophy and pelvic organ prolapse emerged as prominent contributors. Conclusion: CPP in women requires a holistic diagnostic approach integrating physical, psychological, and social factors. Differences in underlying causes between reproductive-aged and postmenopausal women highlight the need for age-specific diagnostic and therapeutic strategies to improve patient outcomes.

Background: Ovarian lesions encompass a wide spectrum of non-neoplastic and neoplastic conditions. As ova-ries are a common site for both benign and malignant tumors, histopathological evaluation plays a vital role in diagnosis, management, and prognosis. Aim: This study aims to analyze the histopathological spectrum of ovarian lesions in a tertiary care center, fo-cusing on their distribution and frequency across age groups. Methods: A retrospective study was conducted in the Department of Pathology, Netaji Subhas medical College and Hospital, Amhara, Bihta, Patna, Bihar. A total of 94 ovarian specimens with Histo-pathologically proven lesions were included. Data were collected, reviewed, and analyzed for clinical and histopathological correlation using SPSS version 27.0. Results: Non-neoplastic lesions were the most common (68.1%), particularly in younger women. Benign tu-mors (13.8%) peaked in the 41-50 years age group, while malignant tumors (7.4%) were most frequent in wom-en aged 61-70 years. Surface epithelial tumors dominated the neoplastic lesions, with serous tumors being the most common (59.2%). Among germ cell tumors, mature teratomas accounted for 80%, whereas immature tera-tomas contributed 20%. Conclusion: The study highlights the predominance of non-neoplastic ovarian lesions in reproductive-age women and the increasing incidence of malignancy in older women. Surface epithelial tumors, especially serous tumors, are the most frequent neoplastic lesions. Histopathological examination remains the cornerstone for accurate diagnosis and management. The findings emphasize the importance of early detection and screening programs, particularly for postmenopausal women, to improve patient outcomes.

Introduction & Objectives: India has experienced a notable rise in its elderly population since 1991. With advancing age, individuals face heightened risks of developing various skin disorders, including cancers. Despite global focus on geriatric healthcare, there remains a lack of comprehensive statistical studies on skin diseases in India. Methods: We conducted a study involving 181 consecutive patients, aged 60 years and above who visited the Dermatology outpatient Department. Each patient provided informed written consent before data collection. A detailed medical history was obtained, followed by thorough cutaneous and systemic examinations. Investigations were carried out wherever necessary, and statistical analysis was performed using the Chi-square test. Result: Out of the 181 patients, 119 (65.7%) were male and 62 (34.3%) were female, resulting in a male-to-female ratio of 2:1. The most frequently reported complaint among the patients was pruritus, which affected 68.5% of them. Fungal infections were noted in 60 patients (33.1%), followed by eczematous disorders in 35 patients (19.3%). Diabetes mellitus was diagnosed in 105 patients (58%). The most common age-related changes observed were wrinkling (100%) and graying of hair (100%). The prevalence of malignancy was 1%. Alopecia affected 76.2% of the patients. About 20.99% of patients had nail involvement. Conclusion: The majority of elderly individuals seeking dermatological advice are males in the 60-69 year age group. Dermatoses in this demographic can be either age-related changes or pathological conditions. Given the unique needs of this population, a comprehensive examination is crucial to identify potential indicators of skin or systemic diseases. Prompt recognition and management of senile dermatoses play a pivotal role in enhancing the longevity and quality of life among the geriatric population.

Introduction: Because to advancements in therapy and early identification, the number of cancer survivors has climbed in tandem with the rise in the disease’s prevalence over the past ten years. Despite these developments, one of the most dreaded and unwanted side effects of chemotherapy are cancer therapy-related heart dysfunction (CTRCD), which affects about 10% of patients. Aims: To compare between Two Dimensional Transthoracic Echocardiography and Two Dimensional Speckle Tracking Echocardiography in early detection of cardiotoxicity in patients receiving cardiotoxic chemotherapy for breast cancer. Materials & Methods: This study is a prospective, observational study for a period of 18 months (1st November 2022 to 31st April 2024) from Department of Cardiology (OPD, IPD, Echocardiography room) and Department of Radiotherapy (OPD and IPD) in NRS Medical College, Kolkata. Result: In our study, 8 (14.3%) patients had hypertension. The value of z is 7.5593. The value of p is < 0.00001. The result is significant at p < 0.05. In our study, 4 (7.1%) patients had Diabetes mellitus. The value of z is 9.0711. The value of p is < 0.00001. The result is significant at p < 0.05. In our study, 4 (7.1%) patients had dyslipidemia. The value of z is 9.0711. The value of p is < 0.00001. Conclusion: We concluded that evaluating patients receiving chemotherapy for cancer, 2D speckle tracking echocardiography can evaluate the global longitudinal strain in the left ventricle. When it comes to detecting patients with CTRCD, LVGLS is more sensitive and effective than 2D-LVEF.

Aim: This study aims to estimate the prevalence of anaemia among pregnant women in Purnea, Bihar, and to identify the demographic and clinical variables affecting this condition. Methodology: This observational study was carried out at the Department of Obstetrics and Gynaecology at Government Medical College and Hospital, Purnea, Bihar, India  from October 2023 to September 2024 including 74 pregnant women aged 18 to 35 years. Employing a convenience sampling approach, haemoglobin levels among the chosen samples were classified to determine the degree of anaemia. The chi-square test for statistical significance was conducted using SPSS version 27 software. Results: Upon evaluation, 74.3% of patients were identified as anaemic, with 33.8% classed as mild, 27% as moderate, and 13.5% as severe. The prevalence rates among the 18-25 age range have risen. In comparison to primigravida, multigravida saw a greater impact, indicating that this group need highly targeted medications. Conclusion: This study highlights the high prevalence of anemia in pregnant women, particularly first-time mothers, emphasizing the need for targeted nutritional support, regular screening, and improved prenatal care. Addressing dietary deficiencies and enhancing healthcare access are crucial to improving maternal and fetal outcomes while mitigating anemia-related risks.

Background: Vitamin D insufficiency is a widespread global nutritional problem, particularly prevalent among youngsters.  In addition to its established function in preserving bone health, vitamin D plays a vital role in regulating the immune system.  Vitamin D deficiency has been associated with heightened vulnerability to recurrent respiratory tract infections during childhood.  Suboptimal nutritional status, encompassing shortages in critical nutrients like zinc, iron, and vitamin A, may contribute to increased vulnerability to infections. Objective: The purpose of this study is to assess the correlation between the prevalence of RRTI among children aged 1–5 years, the status of vitamin D, and the overall nutritional status. Methodology: A non-randomized, prospective, two-group design study was conducted in the Department of Pediatrics at Kurji Holy Family Hospital in Patna, India.  A total of 64 youngsters were examined, comprising 32 cases and 32 controls.  Serum 25-hydroxyvitamin D was evaluated using the Radioimmunoassay (RIA) technique.  Statistical techniques were employed for the comparison between cases and controls. Results: 84.4% of the children with vitamin D deficiency (<20 ng/mL) were categorized in the RRTI group, while 34.4% were in the non-RRTI group (p < 0.001).  The vitamin D concentration in the RRTI group was markedly reduced (40.5 nmol/L) compared to the non-RRTI group (66.8 nmol/L).  Exposure to sunlight and exclusive breastfeeding correlated with improved vitamin D levels and a reduced incidence of recurrent respiratory tract infections (RRTI). Conclusion: Early in childhood, vitamin D deficiency is closely linked to an increased risk of RRTI.  Optimal vitamin D levels through a balanced diet, supplementation, or solar exposure will reduce the incidence of infections.

Background: The performance of second-trimester abortion presents significant clinical challenges in patients with a prior history of caesarean sections.  The combination of Foley catheter and mifepristone demonstrates synergistic effects in facilitating cervical ripening.  Data regarding the effectiveness of their combination may be crucial for optimizing termination practices. Objective: The purpose of this study was to evaluate the efficacy of Mifepristone in conjunction with Foley’s catheter and Foley’s catheter alone for second-trimester abortion in women who have undergone previous caesarean sections. Methodology: A randomised controlled trial (RCT) was conducted at the Department of Obstetrics and Gynaecology, Patna Medical College and Hospital, India.  In this study, 84 singleton pregnant women requiring termination of pregnancy between 14 and 28 weeks, with a history of one or two prior caesarean operations, were randomised into two groups: the experimental group receiving Mifepristone in conjunction with a Foley’s catheter, and the control group receiving a Foley’s catheter alone.  Data analysis utilized SPSS version 26.0, with statistical significance defined as p < 0.05. Result: The experimental group had a higher successful abortion rate (83.3% vs. 61.9%, p=0.031) and a lower induction failure rate (7.1% vs. 19.0%, p=0.031) than the control group.  The experimental group exhibited a significantly shorter mean induction-to-abortion interval (53.2 ± 15.1 hours) in comparison to the control group (63.5 ± 16.8 hours, p=0.027).  The complication rates of retained placenta and excessive haemorrhage were similar in both groups. Conclusion: The combination of Mifepristone and Foley’s catheter markedly enhances success rates and decreases the induction-abortion interval compared to the use of Foley’s catheter alone.  This method is a safe and effective approach for second-trimester abortion in women with a history of caesarean sections.

Background: Glycometabolic alterations in coronary artery disease (CAD) patients have been linked to increased mortality and complications in acute coronary syndrome (ACS). Glycosylated hemoglobin (HbA1c) is recognized as a marker of long-term glucose regulation and a potential predictor of cardiovascular outcomes. However, its prognostic significance in CAD remains unclear. Aim: This study aims to assess the relationship between HbA1c levels and clinical outcomes in ACS patients. Methodology: A hospital-based observational study was conducted in the Department of General Medicine, ESICMCH, Bihta, Patna, Bihar, India, involving 80 ACS patients admitted to the Coronary Care Unit (CCU). Patients were categorized into two groups based on HbA1c levels: normal (<5.6%) and high-normal (5.7%-6.4%). Clinical parameters, including BMI, lipid profile, left ventricular ejection fraction (LVEF), and troponin T levels, were recorded. Statistical analysis was performed using SPSS version 27. Results: Among the 80 patients, 65% had high-normal HbA1c levels. A higher prevalence of STEMI (76.92%) was observed in this group compared to NSTEMI (23.08%). Elevated HbA1c levels correlated with increased troponin T levels and a higher incidence of heart failure (68.75%). The findings suggest a strong association between HbA1c and adverse cardiovascular outcomes in ACS patients. Conclusion: Elevated HbA1c levels in ACS patients are associated with more severe cardiovascular manifestations, including STEMI and heart failure. HbA1c may serve as an independent prognostic marker for ACS outcomes.

Background: Displaced fractures of the femoral neck in elderly patients are associated with high morbidity and mortality. Hemiarthroplasty remains the preferred surgical option in this population, but the choice between cemented and uncemented implants continues to be debated, particularly in terms of postoperative function, pain, and complication rates. Objective: To compare the clinical and functional outcomes of cemented versus uncemented hemiarthroplasty in elderly patients with displaced neck of femur fractures treated at a tertiary care institution in Eastern India. Methods: This prospective comparative study was conducted at All India Institute of Medical Sciences (AIIMS), Patna, Bihar. A total of 60 patients aged 60 years and above with displaced femoral neck fractures were enrolled and randomly allocated to undergo either cemented or uncemented hemiarthroplasty. Patients were followed for a period of one year. Functional outcomes were assessed using the Harris Hip Score (HHS) and Visual Analog Scale (VAS) for pain. Operative time, intraoperative blood loss, early mobilization, and complication rates were also recorded and analyzed. Results: Patients in the cemented group demonstrated significantly better functional outcomes at 6 and 12 months as per Harris Hip Scores. They also reported lower VAS pain scores during early postoperative follow-up. However, the uncemented group had shorter operative time and less intraoperative blood loss. Complication rates were comparable in both groups, though early postoperative thigh pain was more frequent in uncemented cases. Conclusion: Cemented hemiarthroplasty offers superior mid-term functional outcomes and pain relief in elderly patients with displaced femoral neck fractures, albeit with a longer operative time. Uncemented implants may be preferable in patients with higher intraoperative risk or compromised cardiorespiratory reserve. Careful patient selection remains essential to optimize surgical outcomes.

Background: The aim of this studyis 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: 75patients belonging to ASA 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 labeled as Group C. 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+/-2.56min). 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.

Background and Objectives: Neuraxial techniques are the gold standard for intra partum labour analgesia. Epidural route is probably the most commonly used method for achieving labour analgesia. The present study was designed to find out which one out of Fentanyl and Clonidine is better as an adjuvant to Levobupivacaine for epidural labour analgesia in respect of quality of analgesia, duration of analgesia, maternal satisfaction, total dose required, maternal & fetal safety. Methodology: Total 80 pregnant women of age group between the range of 18 to 35 years, without any comorbidities willing for labour analgesia were included in the study. Patients who received bolus epidural Inj. Levobupivaciane (0.125%) plus Inj Fentanyl (25microgram), total volume of 10cc were included in Group A. Patients who received bolus epidural Inj Levobupivacaine (0.125%) plus Inj Clonidine (50 microgram), total volume of 10cc were included in Group B. Maternal blood pressure, maternal heart rate, FHR, cervical dilatation, Visual Analog Score (VAS) score and Numerical Rating Scale (NRS)score was measured every5 mins till the onset of analgesia after the administration of bolus dose. Study subjects were given top up dose of 3ml containing same combination of drugs when NRS>4 and then maternal blood pressure, maternal heart rate, FHR, cervical dilatation, VAS score and NRS score was measured every 15 minutes till the delivery of fetus.
Observations and Result: The following observations were noted:

1. There was no significant difference found in demographic characteristics and parity wise distribution between the two groups.
2. P value was not significant in either groups with respect to average maternal heart rate & average systolic blood pressure and average diastolic blood pressure.
3. There was a significant difference between mean values of duration of onset of analgesia, duration of action of bolus dose and duration of active labor when Group A compared with Group B (p=0.0001). There was early onset of analgesia and significantly longer duration of action in group B as compared to group A. The duration of labor was significantly shorter in group B as compared to group
4. There was no significant difference found in modes of delivery among the two
5. There was no significant difference found in FHS and APGAR scores among the two groups.
6. There was a significant difference between mean values of Total dose of Inj.Levobupivacaine, and the total number of top ups given when Group A compared with Group B (p=0.001) The total dose of local anesthetics required, and total number of top ups given was less in group B as compared to group A.
7. There was a significant difference between mean values of VAS and NRS score at 30 mins as compared to the baseline values in the individual groups. But no significant difference was noted in the VAS and NRS scores between the two
8. When compared the complications and side effects among the two groups, overall safety of the patients was observed in both the groups.

Conclusion: In conclusion, Levobupivacaine is an S (-) enantiomer to bupivacaine with a less cardiotoxicity and neurotoxicity and has a promising safety profile for the patients. Clonidine can be considered as a useful adjunct in labour analgesia with Levobupivacaine as it provides early and longer analgesia than Levobupivacaine with fentanyl combination. It also has local anaesthetic sparing effect without any significant side effects.

Background: Lateral epicondylitis, commonly referred to as tennis elbow, is a degenerative condition affecting the extensor tendons of the forearm. Non-surgical interventions such as corticosteroid injections have long been used for symptom relief; however, recent advances suggest that platelet-rich plasma (PRP) may offer longer-term benefits due to its regenerative potential. Objectives: To compare the clinical efficacy of platelet-rich plasma (PRP) injections versus corticosteroid injections in terms of pain reduction, functional improvement, and recurrence rates in patients with lateral epicondylitis. Methods: This prospective comparative study was conducted over a period of 12 months in the Department of Orthopaedics at Sri Krishna Medical College, Muzaffarpur, Bihar, India. A total of 120 patients clinically diagnosed with lateral epicondylitis were randomly assigned into two equal groups: Group A received PRP injections, while Group B received corticosteroid injections. Patients were evaluated using the Visual Analogue Scale (VAS) and the Disabilities of the Arm, Shoulder and Hand (DASH) score at baseline, 2 weeks, 6 weeks, and 12 weeks. The results were statistically analyzed using paired and unpaired t-tests. Results: Both groups demonstrated significant improvement in VAS and DASH scores post-injection. However, the PRP group showed sustained improvements through 12 weeks, whereas the corticosteroid group exhibited early relief that plateaued or regressed slightly after 6 weeks. Recurrence was higher in the corticosteroid group (18%) compared to the PRP group (5%). Conclusion: PRP injections are a more effective and sustainable treatment option than corticosteroid injections in the management of lateral epicondylitis. Their regenerative properties contribute to prolonged symptom relief and lower recurrence.

Aims: This research aims to investigate the impact of hemoglobin A1c levels in iron deficient anemia using a cross-sectional study. Methods: A cross-sectional research was conducted with 100 patients, including 50 with Iron Deficiency Ane-mia and 50 in the control group. They had an investigation for serum ferritin, iron levels, blood samples, HbA1c, and total iron-binding capacity. Results: The mean HbA1c values in the IDA group are marginally elevated at 6.1 ± 0.4% in contrast to the controls at 5.7 ± 0.3%, with this disparity being statistically significant. Total iron binding capacity was ele-vated in the iron deficiency anemia group (460 ± 25 μg/dL) compared to controls (310 ± 20 μg/dL), which is characteristic of iron deficiency conditions. The Pearson correlation value between HbA1c and serum ferritin was -0.25, and between HbA1c and hemoglobin was -0.35. Conclusion: Increased HbA1c levels as compared to controls suggest that iron deficiency may influence the HbA1c WAs viewed as a measure of glycemic management. Clinicians must consider their iron levels when analyzing HbA1c values in non-diabetic individuals with iron deficiency anemia.

Background: Inguinal hernia repair is one of the most commonly performed general surgical procedures. Laparoscopic Inguinal Hernia Repair (LIHR) has been associated with reduced postoperative complications and faster recovery compared to Open Inguinal Hernia Repair (OIHR). However, the impact of anesthesia type on postoperative outcomes remains unclear. This study aims to compare the short-term postoperative outcomes between LIHR and OIHR, considering anesthesia modality. Methods: This prospective, comparative study was conducted at Department of General Surgery,  Rajendra Institute of Medical Sciences (RIMS), Ranchi, involving 84 patients with unilateral, reducible inguinal hernias. Patients were randomly assigned to either LIHR (n=42) or OIHR (n=42). Postoperative outcomes, including pain scores, hospital stay, wound complications, and return to activities, were analyzed. Statistical analysis was performed using SPSS version 27.0, with a significance threshold of p<0.05. Results: LIHR was associated with a significantly lower postoperative pain score (3.2 ± 1.1 vs. 5.6 ± 1.4, p<0.001), shorter hospital stay (1.5 ± 0.7 vs. 3.4 ± 1.2 days, p<0.001), and faster return to normal activities (7.8 ± 2.3 vs. 14.5 ± 3.6 days, p<0.001). Although wound infection and recurrence rates were slightly higher in OIHR, the differences were not statistically significant. Conclusion: LIHR offers significant advantages over OIHR in terms of reduced postoperative pain, shorter hospital stays, and faster recovery. These findings support the preference for LIHR in eligible patients, though cost considerations and anesthesia risks should be evaluated.

Background: The non-progressive motor impairment condition known as cerebral palsy (CP) is brought on by brain lesions during early development, making it a major cause of childhood disability. CP is commonly asso-ciated with comorbidities like epilepsy, learning disabilities, and behavioral disorders. The incidence of epilepsy in CP kids ranges from 20-45%, with an increased incidence in those with spastic quadriplegia. Epilepsy in CP is often drug-resistant and can significantly affect the quality of life, requiring polytherapy for control. Aim: This study aimed to determine the prevalence of epilepsy in children with CP and to identify the correlat-ed risk aspects, including demographic, clinical, and aetiological factors. Methodology: A cross-sectional study was conducted at the Christian Medical College, India, with a sample size of 100 kids diagnosed with CP. The children were categorized based on the category of CP, severity of movement disorders, and brain imaging results. Psychological assessments were used to evaluate intellectual development. Epilepsy was diagnosed following the International League Against Epilepsy (ILAE) criteria. The study utilized statistical analyses to determine significant associations between selected parameters and epilepsy. Results: Children with epilepsy showed a higher prevalence of microcephaly, lower social quotient, neonatal seizures, and a family history of seizures. Perinatal and neonatal disorders were the most common aetiologies, with perinatal asphyxia and intrauterine growth restriction being prevalent. The majority of CP children with epilepsy had generalized seizures, and a significant portion exhibited drug-resistant epilepsy. Conclusion: Epilepsy is highly frequent in kids with CP, particularly those with microcephaly, developmental delays, and perinatal risk factors. The study highlights the need for early diagnosis and intervention to manage epilepsy and improve outcomes in this vulnerable population.

Background: Wound dehiscence is a significant postoperative complication following caesarean sections, leading to increased morbidity, prolonged hospital stays, and higher healthcare costs. Various maternal, surgical, and postnatal factors contribute to wound dehiscence, making early identification of high-risk cases crucial for improving surgical outcomes. Factors such as obesity, diabetes, hypertension, anemia, prolonged labor, chorioamnionitis, surgical technique, and improper postoperative wound care have been implicated in wound healing complications. This study aims to evaluate the risk factors associated with wound dehiscence following caesarean sections at a tertiary care hospital in Bihar. Objectives: This study aims to assess the prevalence and risk factors of wound dehiscence in post-caesarean patients, evaluate the impact of maternal comorbidities and surgical factors, and analyze the relationship between intraoperative and postoperative complications and wound healing. Methods: A prospective observational study was conducted at the Department of Obstetrics and Gynaecology, Patna Medical College and Hospital, Patna, Bihar, India, over twelve months. A total of 120 post-caesarean patients who developed wound dehiscence were included in the study and compared with 120 matched controls who had uneventful wound healing. Data on patient demographics, maternal comorbidities (diabetes, hypertension, anemia), BMI, nutritional status, duration of labor, presence of chorioamnionitis, intraoperative factors (type of incision, duration of surgery, blood loss), and postoperative care were collected and analyzed. The wound was assessed using standard criteria, including signs of infection, gaping, and serous or purulent discharge. Statistical analysis was performed to determine significant risk factors. Results: The incidence of wound dehiscence was 8.5% among post-caesarean patients. Obesity (BMI > 30 kg/m²) was observed in 32% of cases, while diabetes mellitus (24%) and anemia (36%) were also significantly associated with wound dehiscence. Prolonged labor (>12 hours) and emergency caesarean sections (60%) were identified as independent risk factors (p < 0.01). Chorioamnionitis was present in 18% of cases, contributing to infection-related wound breakdown. The use of vertical midline incisions (22%) and increased intraoperative blood loss were significantly associated with dehiscence. Patients with inadequate postoperative wound care and early mobilization had a higher risk of wound complications. Conclusion: Wound dehiscence following caesarean section is influenced by multiple risk factors, including obesity, diabetes, anemia, prolonged labor, emergency surgeries, and surgical technique. Optimizing maternal health, improving intraoperative hemostasis, and ensuring adequate postoperative wound care can significantly reduce the incidence of wound complications. Preventive strategies, including better glycemic control, nutritional support, and the use of standardized surgical techniques, are essential in improving maternal surgical outcomes in caesarean deliveries.

Background: Cervix cancer is one of the most preventable yet prevalent cancers affecting women in India. Despite the availability of effective screening methods like the Pap smear and preventive vaccines against human papillomavirus (HPV), the burden of cervix cancer remains high due to poor awareness and underutilization of screening services, especially in low-resource settings. Urban women, though with relatively better access to healthcare, may still lack adequate knowledge regarding cervix cancer prevention. Objectives: To assess the level of knowledge and awareness among urban women regarding Pap smear screening, cervix cancer, and HPV infection and to identify factors associated with awareness levels. Methods: A cross-sectional, questionnaire-based study was conducted at the Department of Obstetrics & Gynaecology, Jawaharlal Nehru Medical College & Hospital, Bhagalpur, Bihar, India, over a period of 12 months. A total of 480 urban women aged 21–60 years were selected using stratified random sampling. Data were collected through a pre-validated structured questionnaire and analyzed using SPSS v25. Descriptive statistics, chi-square tests, and logistic regression analysis were used to evaluate associations between sociodemographic factors and awareness levels. Results: Overall, only 41.7% of women had heard of Pap smear screening, while 27.3% were aware of HPV as a causative agent of cervix cancer. Educational level, occupation, and monthly income were significantly associated with awareness (p < 0.001). Despite being from urban settings, misconceptions were common regarding the symptoms, risk factors, and prevention methods for cervix cancer. Conclusion: The study highlights a critical gap in knowledge regarding cervix cancer screening and HPV among urban Indian women. Health education campaigns targeting urban populations are essential to improve awareness and promote early detection through screening practices.

Aim: The present study is to assess the effectiveness of urine luteinizing hormone (LH) surge kits in comparison to transvaginal ultrasonography (TVS) for the detection of ovulation in ovulatory infertile women. Methods: This observational research, conducted at Department of Obstetrics and Gynaecology,  Patna Medical College and Hospital, Patna ,Bihar, India involved 84 ovulatory infertile women aged 18 to 35 with normal semen analysis. Patent tube Participants were randomized into two groups: Group 1 utilized urine LH surge kits, whereas Group 2 received transvaginal sonography monitoring. All participants were administered letrozole for the purpose of ovulation induction. The primary objectives were the rates of ovulation confirmation; the secondary outcomes encompassed letrozole dose, conception rates, and follicular size at the time of ovulation. Statistical analyses were conducted with SPSS. Results: Ovulation was verified in 83.3% (35/42) of Group 1 and 90.5% (38/42) of Group 2 (p=0.35). The mean time to ovulation detection was consistent at 20 hours (p=0.92). Conception rates were comparable: 51.4 percent in Group 1 and 52.6 percent in Group 2 (p=0.92). The mean follicular diameters at ovulation were 20.5 mm for Group 1 and 20.3 mm for Group 2, demonstrating no significant differences. Conclusions: Urinary LH surge kits are equivalent to transvaginal ultrasound for identifying ovulation in ovulatory infertile women, offering a less intrusive and more economical option without jeopardizing fertility results. These findings endorse the use of LH surge kits into fertility treatment strategies.

Background: Neonatal intestinal obstruction is a significant surgical emergency requiring prompt diagnosis and intervention to prevent life-threatening complications. Various congenital anomalies, including anorectal malformation (ARM), Hirschsprung’s disease (HD), intestinal atresia, meconium ileus, and gut malrotation, contribute to this condition. Aim: This study aimed to analyze the etiological patterns, gender distribution, and postoperative complications of neonatal intestinal obstruction in the Jharkhand region. Methodology: A prospective comparative study was conducted at the Department of General Surgery, Rajendra Institute of Medical Sciences, Ranchi, India, from Feb 2022 to Jan 2023. Eighty neonates who underwent sur-gery for congenital intestinal obstruction were included. Data were collected retrospectively from hospital rec-ords and analyzed using SPSS version 27.0. Statistical tests such as Student’s t-test, Mann-Whitney U test, Chi-square, and Fisher’s exact test were applied, with significance set at p < 0.05. Results: The most common cause of neonatal intestinal obstruction was ARM (28.8%), followed by HD (21.3%), intestinal atresia (17.5%), and meconium ileus (15.0%). Male predominance (55%) was observed. Short-segment HD (53.8%) was the most frequent subtype. Ileal atresia (38.8%) was the most common type of atresia. Postoperative complications were primarily sepsis (58.8%), wound infection (17.5%), and aspiration pneumonia (11.3%). Conclusion: ARM and HD were the leading causes of neonatal intestinal obstruction in this study. Early diag-nosis, timely surgical intervention, and effective postoperative care are essential in improving survival rates and outcomes in affected neonates.

Background: Feeding preterm neonates poses unique challenges due to their immature physiological systems. Various feeding methods such as gavage, spoon, and paladai feeding are commonly employed in neonatal intensive care units (NICUs). These methods can have varying impacts on vital parameters like pulse rate, oxygen saturation (SpO₂), and respiratory effort. This study aims to evaluate and compare these physiological responses in preterm neonates based on different feeding techniques. Objectives: To assess and compare the changes in pulse rate, oxygen saturation, and respiratory effort in preterm newborns after feeding via gavage, spoon, and paladai methods. Methods: A prospective observational study was conducted  at Neonatal Intensive Care Unit (NICU) of the Department of Paediatrics, Nalanda Medical College and Hospital, Patna, Bihar, over a period of 12 months from July 2018 to June 2019. involving 90 preterm neonates admitted to the NICU. The newborns were divided into three groups based on the feeding method used: gavage (n=30), spoon (n=30), and paladai (n=30). Pulse rate, SpO₂, and respiratory effort were recorded pre-feeding, during feeding, and post-feeding at defined intervals. Statistical analysis was performed using ANOVA and paired t-tests to assess intra-group and inter-group differences. Results: All three feeding methods were associated with transient variations in vital parameters. Gavage feeding resulted in minimal changes, while spoon and paladai feeding showed statistically significant increases in pulse rate and respiratory effort, along with mild decreases in SpO₂ during feeding. Post-feeding, most parameters returned to baseline within 15 minutes. Gavage feeding was better tolerated in terms of physiological stability. Conclusion: Among the feeding methods studied, gavage feeding caused the least physiological stress in preterm neonates. Spoon and paladai feeding, while more interactive, may transiently affect oxygen saturation and increase respiratory effort. Monitoring of vital signs during and after feeding is essential to ensure safety in preterm infants, and the choice of feeding method should be individualized based on the neonate’s maturity and clinical condition.

Background: Anemia is one of the most common medical complications during pregnancy and is a significant contributor to maternal and perinatal morbidity and mortality, especially in developing countries like India. The severity of anemia plays a crucial role in determining obstetric and neonatal outcomes. Objectives: To evaluate the impact of varying degrees of anemia in pregnancy on maternal health and perinatal outcomes in a tertiary care setting. Methods: This prospective observational study was conducted at the Department of Obstetrics and Gynecology, PMCH, Patna, Bihar, India, from August 2022 to July 2023. A total of 130 pregnant women beyond 28 weeks of gestation were enrolled. Hemoglobin levels were measured at admission and categorized as per WHO criteria into mild (10–10.9 g/dL), moderate (7–9.9 g/dL), and severe (<7 g/dL) anemia. Maternal outcomes such as mode of delivery, postpartum hemorrhage, sepsis, and ICU admissions were documented. Neonatal outcomes included birth weight, APGAR score, NICU admission, and neonatal mortality. Statistical analysis was conducted using SPSS version 25. Results: Among the participants, 38% had mild anemia, 45% had moderate anemia, and 17% had severe anemia. Severe anemia was significantly associated with higher rates of preterm labor, postpartum hemorrhage, maternal ICU admission, low birth weight, NICU admission, and neonatal mortality. Blood transfusion was required in 79% of women with severe anemia, while the remaining patients either declined transfusion or were managed conservatively. The correlation between anemia severity and adverse maternal and perinatal outcomes was statistically significant (p < 0.01). Conclusion: The severity of anemia in pregnancy is a strong predictor of adverse maternal and perinatal outcomes. Strengthening antenatal screening, nutritional interventions, and timely management is essential to reduce the burden of anemia-related complications in pregnancy.

Background: Metabolic syndrome (MetS), a cluster of cardiovascular risk factors including obesity, hypertension, dyslipidemia, and insulin resistance, has emerged as a significant concern in patients with epilepsy, particularly those on long-term antiepileptic drugs (AEDs). Certain AEDs are known to alter metabolic profiles, potentially increasing the risk for cardiovascular disease and diabetes in this population. Objective: To assess the prevalence of metabolic syndrome among epilepsy patients on antiepileptic medications and to analyze the association between AED type and metabolic abnormalities. Methods: A cross-sectional descriptive study was conducted over a one year  period at the Department of Neurology, Paras HMRI Hospital, Patna, Bihar, India. A total of 120 adult patients with epilepsy on AEDs for more than 6 months were evaluated. Clinical assessments, anthropometric measurements, and laboratory investigations were carried out. Metabolic syndrome was diagnosed based on the NCEP ATP III criteria. Results: The prevalence of metabolic syndrome was found to be 38.3% among the study participants. The most common components were abdominal obesity (64%) and hypertriglyceridemia (56%). Patients receiving valproate (52%) and carbamazepine (44%) had a higher prevalence of MetS compared to those on newer AEDs like levetiracetam (18%). The duration of AED use >2 years was significantly associated with increased MetS risk (p < 0.05). Conclusion: A substantial proportion of epilepsy patients on antiepileptic therapy exhibit metabolic syndrome, particularly those on older-generation AEDs. Regular metabolic screening and individualized AED selection are recommended to mitigate long-term cardiovascular risks in this vulnerable group.

Background: Pneumonia remains one of the leading causes of morbidity and mortality in children under five years of age, especially in developing countries. Zinc, an essential micronutrient, plays a crucial role in maintaining immune function. Deficiency of zinc has been associated with increased susceptibility to respiratory tract infections, including pneumonia. This study was conducted to assess serum zinc levels in children aged 2 months to 5 years hospitalized with pneumonia. Methods: This prospective observational study was carried out in the Department of Paediatrics, Nalanda Medical College and Hospital, Patna, Bihar, over a period of 12 months from July 2018 to June 2019. A total of 100 children aged between 2 months and 5 years, admitted with clinically and radiologically confirmed pneumonia, were enrolled. Serum zinc levels were estimated within 24 hours of admission using atomic absorption spectrophotometry. Children were categorized based on their zinc levels into normal and deficient groups, and correlations were made with the severity of pneumonia and clinical outcomes. Results: Out of the 100 children included, 64% were found to have low serum zinc levels (<70 µg/dL). A significant association was found between low zinc levels and increased severity of pneumonia. Children with zinc deficiency had a higher incidence of complications, longer hospital stays, and delayed recovery. The majority of zinc-deficient children were below the age of two and belonged to lower socioeconomic groups. Conclusion: Serum zinc deficiency is highly prevalent among children with pneumonia and is associated with increased disease severity and prolonged recovery. Routine screening for zinc levels and consideration of zinc supplementation may be beneficial in the management and prevention of pneumonia in young children.

Background: Thalassemia trait screening often relies on the quantification of Hemoglobin A2 (HbA2) levels, which are typically elevated in beta-thalassemia carriers. However, iron deficiency, a highly prevalent condition in India, especially among females, has been postulated to reduce HbA2 levels, potentially leading to false-negative screening results. Understanding the impact of iron deficiency on HbA2 values is critical to ensuring accurate detection of thalassemia carriers, especially in population-level screening programs. Objectives: To evaluate the effect of iron deficiency on HbA2 levels and determine whether iron deficiency can mask the diagnosis of beta-thalassemia trait in individuals undergoing screening. Methods: This observational cross-sectional study was conducted in the Department of Pathology, Darbhanga Medical College and Hospital, Bihar, from August 2022 to July 2023. A total of 130 individuals aged 18–40 years undergoing anemia evaluation or thalassemia screening were included. Participants were grouped into iron-deficient and non-iron-deficient groups based on serum ferritin, transferrin saturation, and complete blood count findings. HbA2 quantification was done using high-performance liquid chromatography (HPLC). Statistical analysis was performed to assess the correlation between iron status and HbA2 levels. Results: Out of 130 participants, 72 were iron-deficient while 58 had normal iron stores. The mean HbA2 level in the iron-deficient group was 2.3 ± 0.4%, significantly lower than the non-iron-deficient group which had a mean HbA2 level of 3.1 ± 0.5% (p < 0.001). Among iron-deficient individuals with suspected thalassemia trait, HbA2 levels were found to be within normal or borderline ranges, indicating the possibility of masked diagnosis. Upon iron repletion and re-evaluation in a subset, HbA2 levels rose significantly, unmasking latent beta-thalassemia trait in some cases. Conclusion: Iron deficiency significantly lowers HbA2 levels and may obscure the diagnosis of beta-thalassemia trait in screening programs. Screening for thalassemia should either follow correction of iron deficiency or incorporate parallel iron status assessment to avoid misclassification. This is particularly relevant in high-prevalence regions like Bihar where iron deficiency anemia is common.

Background: Fine Needle Aspiration Cytology (FNAC) is a well-established, minimally invasive, rapid, and cost-effective diagnostic tool used in the initial evaluation of palpable breast lumps. It plays a pivotal role in the preoperative diagnosis of both benign and malignant breast lesions. However, its diagnostic accuracy is best evaluated when correlated with histopathological findings, which remain the gold standard. Objectives: The aim of this study was to analyze the morphological spectrum of various breast lesions diagnosed on FNAC and to evaluate the diagnostic accuracy by correlating the cytological findings with subsequent histopathological outcomes. Methods: This prospective study was conducted in the Department of Pathology, Darbhanga Medical College and Hospital, Bihar, over a period of one year. A total of 120 patients with palpable breast lumps underwent FNAC followed by excisional biopsy or lumpectomy. The cytological findings were categorized according to standard reporting systems, and histopathological correlation was performed wherever tissue diagnosis was available. Results: Among the 120 cases evaluated, 68 (56.7%) were benign, 42 (35%) were malignant, and 10 (8.3%) were suspicious or indeterminate on cytology. The most common benign lesion was fibroadenoma, while invasive ductal carcinoma was the predominant malignant entity. The overall concordance rate between FNAC and histopathology was 91.7%. The sensitivity, specificity, positive predictive value, and negative predictive value of FNAC in diagnosing malignant lesions were 94.6%, 97.1%, 95.2%, and 96.7% respectively. Conclusion: FNAC is a reliable, rapid, and highly accurate diagnostic modality for the initial evaluation of breast lesions. When interpreted by experienced cytopathologists and correlated with clinical and radiological findings, it offers excellent concordance with histopathological diagnosis and can significantly aid in planning appropriate patient management.

Background: Eyes trauma represents a significant source of visual disability and blindness, offering a formidable public health challenge, mainly in developing areas with poor ophthalmic facilities. In spite of its socio-economic importance, it is lacking in well-structured epidemiological information on the prevalence, risk factors, and clinical outcomes of eye injuries. Knowledge of the distribution, causes, and consequences of ocular injuries will be highly important in developing preventive measures and enhancing early intervention practices. Aim: To evaluate the epidemiological profile, risk factors and clinical outcomes of ocular trauma in patients reported at a tertiary care center in Patna, Bihar, India. Methods: A tertiary care hospital in Patna, Bihar, hosted this hospital-based observational study from November 2019 to April 2021. Patients with mechanical and non-mechanical ocular trauma (150) were included. All patients underwent anterior and posterior segment exams and in-depth ocular evaluation. Ultrasound B-scan, CT scan, and X-ray were done as needed. Compare data to determine demographics, injury kinds, causes, and clinical outcomes. Results: Trauma to the eyes was more prevalent among males (83%), particularly between the age group 20-30 (38%).  Rural communities recorded 80% of the cases, illustrating more susceptibility within limiting environments.  Closed globe injury resulted in 18% contusions and 20% lamellar lacerations, and open globe injury resulted in 16% penetrating trauma, 6% rupture, and 34% adnexal injuries.  The most frequent eye trauma came from road traffic crashes (42%), followed by injuries sustained in occupations (28%). The majority of patients (75%) presented within 6 hours, and prompt therapy enhanced visual outcomes.  Analysis (χ² = 8.21, p = 0.016) reaffirmed a close association between early presentation and good prognosis. Conclusion: Ocular trauma is most common in young men and caused by car accidents. Its significant prevalence in rural areas highlights the need for increased awareness, early treatment, and traffic safety policies. Delaying medical care increases the chance of severe visual loss and permanent blindness, according to the study. Reduce the ocular trauma load by improving preventive measures, traffic safety, job safety, and ophthalmic care, especially in rural regions.

Background: Post-operative astigmatism significantly impacts visual outcomes and patient satisfaction in manual small incision cataract surgery (MSICS). The location of the scleral incision plays a crucial role in determining the magnitude of surgically induced astigmatism (SIA). Comparative analysis between superior and superotemporal incisions can guide surgeons in optimizing refractive stability and visual recovery. Aim: The aim of this study is to compare post-operative astigmatism and visual recovery in patients undergoing MSICS with superior versus superotemporal scleral incisions and to evaluate which incision site yields better refractive outcomes and patient satisfaction. Methods: A prospective comparative observational study was conducted over 12 months in the Department of Ophthalmology, Esic Model Hospital, bapunagar, Ahmedabad, Gujarat, India. One hundred patients aged 40–80 years undergoing MSICS were randomly allocated into two groups: 50 patients with superior scleral incisions and 50 with superotemporal scleral incisions. Preoperative keratometry, standardized surgical techniques, and post-operative evaluations at 1 week, 1 month, and 3 months were performed. Uncorrected and best-corrected visual acuity along with post-operative keratometry readings were recorded. Statistical analysis included independent t-tests and repeated measures ANOVA to assess differences and trends over time. Results: Patients in the superotemporal incision group demonstrated significantly lower post-operative astigmatism values at all follow-up intervals (1.12 D at 1 week, 0.98 D at 1 month, and 0.85 D at 3 months) compared to the superior incision group (1.45 D, 1.30 D, and 1.20 D, respectively). Additionally, a higher number of patients in the superotemporal group achieved uncorrected visual acuity of 6/12 or better (90% at 3 months) compared to the superior group (76%). Conclusion: Superotemporal scleral incisions in MSICS result in significantly lower surgically induced astigmatism and faster visual recovery compared to superior incisions. These findings suggest that superotemporal incisions offer greater refractive stability, reduced spectacle dependence, and improved patient satisfaction, supporting their wider adoption in clinical practice for cataract surgery.

Background: Acute pancreatitis is a sudden inflammatory condition of the pancreas, often caused by gallstones or excessive alcohol intake. It presents with abdominal pain and can range from mild to severe, potentially leading to multi-organ dysfunction. Aim: To analyze the clinical features, etiological factors, complications, and outcomes of acute pancreatitis. Methodology: A retrospective comparative study was conducted in the Department of General Surgery, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India. A total of 60 patients diagnosed with acute pancreatitis based on clinical, laboratory, and radiological assessments were included. Statistical analysis was performed using SPSS software version 27, with significance determined at P < 0.05. Results: Acute fluid collection was the most frequent local complication (26.7%), while pancreatic necrosis (6.7%) and pseudocyst formation (5.0%) were less common. Hypocalcemia (20%) was the most prevalent metabolic complication. Respiratory involvement (41.7%) was the most frequent organ complication, followed by multiple organ dysfunction syndrome (20%). The majority (56.7%) of patients had a hospital stay of fewer than seven days. Based on the CT Severity Index, 70% of patients had mild disease, while 13.3% had severe cases. Conclusion: Acute pancreatitis exhibits diverse clinical presentations and severity. Most cases were effectively managed with supportive care, emphasizing the importance of early diagnosis and targeted interventions to improve patient outcomes.

Background: Periodontal disease and diabetes mellitus share a bidirectional relationship, where chronic hyperglycemia exacerbates periodontal inflammation, and severe periodontitis may contribute to poor glycemic control. Periodontal infection induces systemic inflammation and oxidative stress, which can impact insulin resistance and glycemic status. Understanding this interrelationship is essential for developing integrated management strategies. This study was conducted to evaluate the clinical correlation between glycemic control and periodontal health status among patients with type 2 diabetes mellitus. Methods: This cross-sectional clinical study was carried out at the Department of Dentistry, ESIC Medical College & Hospital, Bihta, Patna, Bihar, India from feb 2024 to Sept 2024 . A total of 120 subjects aged 30–65 years were included and divided into two groups: Group I (n = 60) included patients with type 2 diabetes mellitus (T2DM), and Group II (n = 60) included age- and sex-matched non-diabetic individuals. Comprehensive periodontal evaluation was performed, including probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), and plaque index (PI). Glycemic control was assessed by fasting blood glucose (FBG) and glycated hemoglobin (HbA1c). Correlations between periodontal parameters and glycemic markers were analyzed statistically. Results: The mean probing pocket depth and clinical attachment loss were significantly higher in diabetic patients compared to non-diabetics (p < 0.001). A positive correlation was observed between HbA1c levels and both PPD (r = 0.61) and CAL (r = 0.58), indicating worsening periodontal status with poor glycemic control. The prevalence of moderate to severe periodontitis was 73.3% in diabetics versus 36.7% in non-diabetics. Bleeding on probing and plaque index scores were also significantly elevated in the diabetic group (p < 0.05). Duration of diabetes and poor glycemic control were identified as significant risk factors for advanced periodontal destruction. Conclusion: This study reinforces the strong association between diabetes mellitus and periodontal disease. Poor glycemic control in diabetic patients is correlated with increased periodontal inflammation and tissue destruction. Routine periodontal screening and integrated management strategies should be a part of diabetic care to reduce the burden of oral-systemic complications.

Background: Hypertension in pregnancy is a leading cause of maternal and fetal morbidity and mortality. Prediction early in pregnancy, followed by prompt intervention, is pivotal to preventing adverse outcomes. Doppler ultrasound, a non-invasive method, has potential as a means of identifying the abnormal patterns of blood flow that precede clinical presentation of these disorders. Aim: The objective of this research was to examine the use of spiral and uterine artery Doppler ultrasound in the early second trimester as a predictor of hypertensive disorders in pregnancy, such as gestational hypertension and preeclampsia. Methods: A prospective cohort study was undertaken on Department of Obstetrics and Gynecology, PMCH, Patna, Bihar, India for Jan 2022 to December 2022.  220 pregnant women with gestational ages between 18 and 22 weeks. Doppler assessment was done using spiral and uterine artery for measuring Resistance Index (RI), Pulsatility Index (PI), and also to identify diastolic notching. All the participants were followed up until delivery to see if there were any developments in hypertensive disorders. Statistical comparison was done for determining the predictive ability of Doppler parameters. Results: Hypertensive complications arose in 13.6% of the subjects, consisting of 9.1% gestational hypertension and 4.5% preeclampsia. Uterine artery PI and diastolic notching were the strongest predictors. Uterine artery PI had sensitivity of 75% and specificity of 80.5%, and diastolic notching had high sensitivity of 90%. Spiral artery Doppler values also had moderate predictive ability. Conclusion: Spiral and uterine artery Doppler ultrasound at the early second trimester was found to be useful in forecasting hypertensive disorder of pregnancy. The integration of Doppler screening into standard antenatal management may facilitate the early detection of high-risk pregnancy, with initiation of timely intervention. Large trials are, however, suggested for confirmation of findings and improving clinical utility.

Background: Phototherapy is a standard and effective treatment for neonatal hyperbilirubinemia. However, it is associated with certain metabolic side effects, including hypocalcemia. This study aimed to evaluate the incidence of phototherapy-induced hypocalcemia and its correlation with the duration of phototherapy in neonates diagnosed with indirect hyperbilirubinemia. Objectives: To assess the prevalence of hypocalcemia following phototherapy and to determine whether the duration of phototherapy significantly correlates with the development and severity of hypocalcemia in neonates. Methods: This prospective observational study was conducted over 10 months at the Department of Pediatrics, Government Medical College and Hospital, Bettiah, Bihar. A total of 100 neonates with indirect hyperbilirubinemia requiring phototherapy were enrolled. Serum calcium levels were measured before the initiation and 48 hours after the completion of phototherapy. Data were analyzed to observe changes in calcium levels and their association with phototherapy duration. Results: The study observed that 38% of neonates developed hypocalcemia after 48 hours of phototherapy. The mean pre-phototherapy calcium level was 9.1 ± 0.5 mg/dL, which dropped to 8.2 ± 0.6 mg/dL post-phototherapy (p < 0.001). A significant correlation was found between longer phototherapy duration and a greater decline in calcium levels (r = -0.45, p = 0.002). No significant gender-based differences were noted. Conclusion: Phototherapy is associated with a significant risk of hypocalcemia in neonates with hyperbilirubinemia, particularly with extended treatment durations. Monitoring of serum calcium levels is recommended during phototherapy to prevent potential complications.

Background: With rising life expectancy and improving healthcare access, the proportion of elderly women is steadily increasing in India. Geriatric women often face a unique set of gynecological challenges that are frequently underreported and inadequately addressed. Despite a considerable disease burden, routine gynecological care in this age group remains neglected. This study aims to assess the prevalence and pattern of gynecological disorders among geriatric women and evaluate their healthcare-seeking behavior. Methods: This hospital-based cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College & Hospital, Bhagalpur, Bihar, over a period of 12 months. A total of 140 women aged 60 years and above attending the gynecology outpatient department were enrolled. Detailed history, clinical examination, and relevant investigations such as Pap smear, pelvic ultrasonography, and endometrial sampling were performed. Diagnosed gynecological conditions were categorized into benign, infectious, prolapse-related, and malignant disorders. Data were analyzed using descriptive and inferential statistics; p-values <0.05 were considered statistically significant. Results: The most common gynecological disorder observed was pelvic organ prolapse (34.3%), followed by genitourinary infections (25.7%), postmenopausal bleeding (15.0%), and benign ovarian or uterine pathologies (12.1%). Malignancies were identified in 7.9% of women, primarily involving the cervix and endometrium. A significant proportion (42.9%) delayed seeking care due to social stigma, lack of awareness, or financial constraints. Uterovaginal prolapse was more prevalent among multiparous and rural women, while genitourinary infections showed association with poor hygiene and diabetes (p < 0.01). Conclusion: Geriatric women are vulnerable to a spectrum of gynecological conditions, with prolapse and infections being the most common. Targeted screening, awareness programs, and geriatric-friendly gynecological services are essential to address this overlooked healthcare need and improve quality of life among aging women.

Background: Herpes Zoster (HZ) is a painful, localized rash caused by the reactivation of the varicella-zoster virus. Early antiviral treatment can help reduce the severity and duration of the disease. This study aims to compare the efficacy, safety, and patient outcomes of oral Acyclovir versus oral Famciclovir in the treatment of Herpes Zoster. Methods: A prospective, randomized, comparative study was conducted between June 2023 and August 2024  at Department of Dermatology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India . A total of 120 adult patients diagnosed with Herpes Zoster were randomly assigned to receive either oral Acyclovir (800 mg, five times daily for 7 days) or oral Famciclovir (500 mg, three times daily for 7 days). Primary outcomes included the time to resolution of symptoms, the duration of pain, and the incidence of complications such as post-herpetic neuralgia (PHN). Secondary outcomes involved assessing the safety and tolerability of both drugs. Results: The study included 120 participants with an equal distribution between the two groups. The mean time to resolution of the rash was significantly shorter in the Famciclovir group compared to the Acyclovir group (7.5 days vs. 9.3 days, p<0.05). The duration of pain also significantly decreased in the Famciclovir group (6.2 days vs. 8.5 days, p<0.05). There were fewer cases of PHN in the Famciclovir group compared to the Acyclovir group (6.7% vs. 12.5%). Both drugs were well-tolerated with no significant adverse events reported. Conclusion: Oral Famciclovir was found to be more effective than oral Acyclovir in reducing the time to resolution of Herpes Zoster symptoms, shortening the duration of pain, and decreasing the incidence of post-herpetic neuralgia. Famciclovir also demonstrated a better safety profile. Based on these findings, Famciclovir may be considered a more favorable treatment option for Herpes Zoster, particularly in terms of patient comfort and reduced risk of complications.

Background:  Road traffic accidents (RTAs) are a leading cause of mortality and morbidity worldwide, particularly in developing countries like India. Understanding the epidemiological characteristics of RTA victims is crucial for planning preventive and control measures. This study aims to analyze the epidemiological profile of RTA victims admitted to the emergency department of Darbhanga Medical College and Hospital (DMCH), Bihar. Objectives: To assess the demographic distribution, injury patterns, contributing risk factors, and outcomes among road traffic accident victims admitted in the emergency department of DMCH. Materials and Methods: This hospital-based cross-sectional study was conducted in the Emergency Department of DMCH, Darbhanga, over a period of 6 months. A total of 130 RTA victims admitted during this period were included using a purposive sampling method. Data were collected using a pre-designed, semi-structured questionnaire focusing on socio-demographic details, time and place of accident, type of road user, vehicle involved, safety measures, injury type, and treatment outcome. Data were analyzed using descriptive statistics. Results:  Out of 130 RTA victims, 72.3% were males and 27.7% were females, with the majority (61.5%) aged between 21–40 years. Two-wheeler riders and pillion passengers constituted the highest proportion of victims (54.6%), followed by pedestrians (20%). Most accidents occurred during evening hours (42.3%) and on urban roads (57.7%). Non-use of safety measures like helmets and seatbelts was observed in 68.5% of applicable cases. Head injuries (38.5%) and lower limb fractures (26.2%) were the most common types of injuries. Among the victims, 86.2% recovered with treatment, while 5.4% succumbed to their injuries. Conclusion: The study highlights that young adult males, especially two-wheeler users, are at higher risk of RTAs. Lack of protective measures and poor road safety awareness contribute significantly. Strengthening traffic law enforcement, public education on road safety, and infrastructural improvements are urgently needed to reduce RTA-related morbidity and mortality.

Background: Propofol is widely used as an intravenous induction agent due to its rapid onset and short duration of action. However, pain on injection is a common and distressing adverse effect associated with its use. Various strategies have been tried to reduce this pain, including pretreatment with lidocaine, use of larger veins, and cooling the drug or the carrier fluid. This study aimed to evaluate the efficacy of cold normal saline as a carrier fluid in reducing propofol-induced pain. Methods: This prospective observational study was conducted in the Department of Anesthesiology, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, from November 2022 to October 2023. A total of 120 patients, aged 18–60 years, scheduled for elective surgeries under general anesthesia, were enrolled and randomly divided into two groups. Group A received room temperature normal saline (25°C) followed by propofol injection, while Group B received cold normal saline (4°C) before the propofol injection. Pain on injection was assessed using a verbal rating scale (VRS) immediately after the administration. Results: Patients in Group B who received cold normal saline reported significantly less pain during propofol injection compared to those in Group A. The incidence of moderate to severe pain was markedly lower in Group B. No adverse effects were noted with the use of cold saline. Conclusion: The use of cold normal saline as a carrier fluid significantly reduces the pain associated with propofol injection. This simple, cost-effective, and easily implementable method can be routinely employed to enhance patient comfort during induction of anesthesia.

Background: Diabetes is a leading cause of mortality and disability globally, with increasing prevalence and associated disabilities over the past decade, diabetes affects 13.7% of the population, with a significant number at risk due to prediabetic conditions. Family history is a recognized risk factor influencing diabetes susceptibility and perceived risk, prompting the need for preventative measures. Aim: The purpose of this study was to evaluate the association between the risk of prediabetes and diabetes in urban populations in Bihar, India, and family history of the disease. Methodology: This retrospective study was conducted at the Department of Community Medicine, Netaji Subhas Medical College and Hospital, Bihta ,Bihar India  for six months. 80 participants were surveyed, excluding pregnant women and known diabetes cases, to examine the impact of family history on fasting blood glucose levels also body mass index. Participants provided informed consent, underwent fasting blood glucose tests, and completed questionnaires regarding their family medical history. Results: Analysis revealed that individuals with a family history of diabetes exhibited significantly lower percentages of normal blood glucose levels (71.4% in diabetics) compared to those without such a history (85%). Additionally, people with a positive family history of diabetes had a greater frequency of obesity (51.6%) compared to people without such a history (27.8%). Conclusion: The findings underscore the critical role of family history in influencing diabetes risk and related health behaviors. With a notable association between familial risk and both glucose metabolism and BMI, targeted lifestyle interventions are necessary for individuals with a family history of diabetes to mitigate their risk.

Background: With advancements in antiretroviral therapy (ART), HIV infection has transformed into a manageable chronic illness. However, beyond clinical outcomes, assessing the quality of life (QoL) of people living with HIV/AIDS (PLHIV) has gained paramount importance in comprehensive patient care. Objectives: To assess the quality of life of HIV-positive patients attending the ART Centre at Darbhanga Medical College and to identify factors influencing QoL in this population. Methods: This cross-sectional study was conducted among 130 HIV-positive patients attending the ART Centre of Darbhanga Medical College over a period of Nine  months. A pre-designed, pre-tested questionnaire incorporating the WHOQOL-HIV BREF instrument was used to evaluate the physical, psychological, social, environmental, level of independence, and spiritual domains of QoL. Socio-demographic and clinical data were also collected and analyzed. Results: The study revealed that the psychological and environmental domains were the most adversely affected aspects of QoL among the participants. Factors such as lower educational level, unemployment, advanced WHO clinical stage, and presence of opportunistic infections were significantly associated with poorer QoL scores. Patients on ART for more than 1 year demonstrated relatively better QoL across most domains. Conclusion: The study emphasizes the need for holistic and individualized patient care, addressing not only the medical but also the psychological and social well-being of HIV-positive individuals. Interventions should be tailored to improve life quality, particularly among socioeconomically disadvantaged and clinically vulnerable patients.

Background: The styloid process, a slender bony projection from the temporal bone, plays a vital role in various physiological and pathological conditions. Variations in its length and morphology have been associated with clinical symptoms such as Eagle’s syndrome and cervicofacial pain. Objective: This study aims to analyze the morphometric characteristics of the styloid process in human cadavers and assess their potential clinical implications. Methods: A descriptive, cross-sectional cadaveric study was conducted in the Department of Anatomy, Anugrah Narayan Magadh Medical College, Gaya, Bihar. A total of 120 adult human cadavers (240 styloid processes) were examined over a period of January 2024 to December 2024. The length, thickness, and angulation of each styloid process were measured using digital vernier calipers and goniometric tools. Data were analyzed for side-wise differences, sexual dimorphism, and correlations with potential clinical symptoms based on known thresholds. Results: The mean length of the styloid process was found to be 27.6 ± 4.2 mm on the right side and 28.1 ± 3.9 mm on the left side. Elongation (>30 mm) was observed in 18.3% of the cadavers. Statistically significant differences were noted in length between male and female cadavers (p < 0.05). No bilateral symmetry was observed in 65% of cases. Conclusion: The study highlights the anatomical variability of the styloid process, emphasizing the importance of morphometric assessment in clinical diagnosis and surgical planning, especially in patients presenting with unexplained cervicofacial symptoms.

Background: Mucinous carcinoma of the breast is a rare subtype of invasive breast carcinoma characterized by extracellular mucin production. Although fine-needle aspiration cytology (FNAC) is a useful tool for preoperative diagnosis of breast lesions, the cytological diagnosis of mucinous carcinoma poses significant challenges due to overlapping features with benign lesions and other mucin-producing tumors. Aim: To analyze the cytological features of mucinous breast carcinoma and identify common diagnostic pitfalls encountered in FNAC interpretations. Methods: This prospective observational study was conducted in the Department of Pathology, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India from June 2022 to may 2023. A total of 120 patients with clinically suspicious breast lumps underwent FNAC. Among them, 30 cases were histopathologically confirmed as mucinous carcinoma and were included for detailed cytological correlation. FNAC features such as cellularity, mucinous background, nuclear atypia, and architectural patterns were evaluated and compared with histopathological findings. Results: Out of the 30 confirmed mucinous carcinoma cases, FNAC correctly diagnosed 22 cases (73.3%), while 8 cases (26.7%) were misclassified as benign or suspicious lesions. Diagnostic challenges were primarily related to low cellularity, mild nuclear atypia, and the misinterpretation of mucin pools. Although abundant extracellular mucin and mild atypia were frequently observed, these features were often under-recognized. Conclusion: FNAC remains a valuable preoperative diagnostic tool, but mucinous carcinoma presents significant diagnostic challenges due to its deceptively bland cytological appearance. A high index of suspicion, awareness of its subtle cytomorphological features, and mandatory histological correlation are essential for accurate diagnosis.

Background: Head and neck lesions encompass a wide array of pathological conditions, including inflammatory, benign, and malignant entities, affecting vital structures like the oral cavity, thyroid, salivary glands, lymph nodes, and upper respiratory tract. Histopathological examination remains the gold standard for definitive diagnosis, helping to distinguish between these varied presentations and guiding appropriate treatment. Objectives: To study the histopathological spectrum of head and neck lesions, analyze their distribution by site, age, and gender, and correlate them with clinical presentations. Materials and Methods: This prospective study was conducted at the Department of Pathology, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, Uttar Pradesh, India from January 2022 to December 2022. A total of 120 head and neck lesion specimens were received and processed. Standard histopathological procedures were followed, and cases were classified as non-neoplastic, benign neoplastic, or malignant neoplastic. Clinical correlation and statistical analysis were performed using descriptive methods. Results: Among 120 cases, benign neoplasms were most common (55%), followed by malignant tumors (35%) and non-neoplastic/reactive lesions (10%). The oral cavity was the most frequently involved site (30%), followed by lymph nodes (25%) and thyroid gland (20%). Squamous cell carcinoma was the most prevalent malignancy. A male predominance (M:F = 2.2:1) was noted, with the peak incidence in the 41–60 years age group. Conclusion: Histopathological evaluation remains indispensable for the accurate diagnosis of head and neck lesions. The findings underscore the predominance of neoplastic lesions, especially squamous cell carcinoma among malignancies. Early biopsy and tissue diagnosis are crucial for effective clinical management, particularly in high-risk groups.

Background: Inguinal hernia repair is a commonly executed surgical intervention, with mesh repair recognized as the gold standard. The discourse around laparoscopic and open repair methodologies, namely the “Transabdominal Preperitoneal (TAPP) and Totally Extraperitoneal (TEP) techniques” in contrast to the open Lichtenstein procedure, has been extensively investigated. These techniques differ in recovery time, pain levels, complications, and recurrence rates. Aim: This study compares postoperative outcomes, including pain, recovery time, complications, and recurrence rates, between laparoscopic and open mesh hernia repair techniques. Methods: A randomized, prospective study was conducted with 70 patients diagnosed with inguinal hernia, divided into two groups: laparoscopic hernioplasty (35 patients) and open hernioplasty (35 patients). The Visual Analogue Scale (VAS) was used to measure postoperative pain at various intervals, and chronic pain, hematomas, and infection were tracked. Additionally documented were the length of hospitalization and recuperation. Results: The laparoscopic group’s hospital stay was shorter (2.75 ± 1.13 days vs. 3.12 ± 1.45 days, p = 0.08), their operating duration was greater (135.42 ± 22.18 min vs. 82.56 ± 24.61 min, p < 0.001). Within the first 72 hours following surgery, the laparoscopic group experienced much less pain (p < 0.001). The open group experienced two incidences of seroma, but the laparoscopic group experienced neither recurrence nor seroma. Chronic pain persisted in 2 patients in the open group at 6 months, compared to 0 in the laparoscopic group. Conclusion: Laparoscopic hernia repair offers better postoperative pain control and fewer complications, particularly in terms of seroma and chronic pain, making it a favorable option, although it requires a longer operative time.

Background: Scaphoid fractures are among the most common carpal bone injuries, particularly in young, active individuals. Given the scaphoid’s tenuous blood supply and high risk of non-union, optimal management remains a subject of ongoing debate. While conservative treatment with cast immobilization is effective in many undisplaced cases, operative fixation offers early mobilization and potentially faster return to function. This study aims to compare clinical and radiological outcomes of conservative versus operative treatment in patients with acute scaphoid fractures. Methods: A prospective, comparative study was conducted at the Department of Orthopaedics, Government Medical College and Hospital, Bettiah, West Champaran, Bihar, India from January 2023 to December 2023. A total of 60 patients with acute scaphoid fractures confirmed radiographically were enrolled and randomly divided into two equal groups. Group A (n=30) received conservative management using a below-elbow thumb spica cast, while Group B (n=30) underwent percutaneous or open reduction and internal fixation using a headless compression screw. Patients were followed at regular intervals for a minimum of 6 months and evaluated clinically (pain, wrist range of motion, grip strength, Mayo wrist score) and radiologically (union time, nonunion incidence). Results: Radiological union was achieved in 26 (86.7%) patients in the conservative group and 29 (96.7%) in the operative group. The mean time to union was significantly shorter in the operative group (9.4 ± 1.7 weeks) compared to the conservative group (13.6 ± 2.3 weeks; p < 0.01). Patients in the operative group also showed significantly better functional scores at 6 months (mean Mayo wrist score 88.6 vs. 78.4; p < 0.05) and faster return to normal activity. Complications included delayed union in 3 cases and nonunion in 1 case in the conservative group. No major complications were noted in the operative group. Conclusion: Both conservative and operative treatments are effective for acute scaphoid fractures; however, surgical fixation is associated with faster union, improved early function, and earlier return to daily activities. Operative treatment may be preferable in patients with high functional demands or when early mobilization is desired. Clinical judgment should guide treatment decisions, considering fracture pattern, patient activity level, and risk of complications.

Background: Open tibia fractures are among the most common long bone injuries associated with high-energy trauma and a significant risk of infection due to compromised soft tissue and periosteal vascularity. Intramedullary nailing remains the preferred method of stabilization for diaphyseal tibial fractures. However, postoperative infection remains a major challenge, especially in open wounds. The use of antibiotic-coated intramedullary nails provides local antibiotic delivery with high concentrations at the fracture site, reducing systemic toxicity and infection rates. This study evaluates the prophylactic role of antibiotic-coated intramedullary nails in preventing infection and promoting healing in open tibial shaft fractures. Methods: This prospective interventional study was conducted at the Department of Orthopaedics, Government Medical College and Hospital, Bettiah, Bihar, India from December 2021 to November 2022 . A total of 60 patients with Gustilo-Anderson Type I, II, or IIIA open tibia shaft fractures were enrolled. Thirty patients received standard uncoated intramedullary nails (Group A), while thirty patients received nails coated with a custom-made layer of gentamicin-impregnated bone cement (Group B). All patients underwent initial debridement and were followed up for a minimum of 6 months. Outcomes were assessed based on infection rate, radiological union time, need for secondary procedures, and functional recovery using the Johner-Wruhs criteria. Results: Infection occurred in 6 patients (20%) in the uncoated group compared to only 1 patient (3.3%) in the antibiotic-coated nail group (p = 0.04). Mean time to union was 22.3 ± 3.4 weeks in Group A versus 19.2 ± 2.7 weeks in Group B (p < 0.01). Functional outcome was rated as excellent or good in 83.3% of Group B patients, significantly higher than 63.3% in Group A. No systemic adverse effects related to local antibiotic delivery were observed in either group. Conclusion: The use of antibiotic-coated intramedullary nails in open tibia fractures significantly reduces infection rates and promotes earlier union without increasing systemic side effects. It is a promising technique, particularly valuable in high-risk open injuries where infection prevention is paramount. Prophylactic local antibiotic delivery should be considered an adjunct in the standard care protocol for open tibial shaft fractures.

Background: Acute pancreatitis (AP) is a common and potentially life-threatening inflammatory condition of the pancreas, characterized by a wide spectrum of clinical presentations, from mild self-limiting episodes to severe necrotizing disease with systemic complications. Early identification of clinical and laboratory predictors of severity is essential for effective triage, appropriate supportive care, and improved patient outcomes. This study was conducted to evaluate the clinico-pathological profile and immediate in-hospital outcomes of patients admitted with acute pancreatitis in a tertiary care setting in Bihar. Methods: A prospective observational study was carried out over a period of 12 months at the Department of Medicine, AIIMS, Patna, Bihar, India. A total of 120 patients aged 18 years and above diagnosed with acute pancreatitis based on clinical symptoms, elevated serum amylase/lipase levels, and imaging findings were included. Detailed history, examination, laboratory investigations, and imaging were documented. Patients were assessed for etiology, clinical severity, laboratory abnormalities, complications, and outcome measures including length of hospital stay, need for ICU admission, and in-hospital mortality. Severity classification was based on the Revised Atlanta Classification. Results: Among the 120 patients studied, the most common presenting symptoms were abdominal pain (100%) and vomiting (85%). Alcohol (43%) and gallstones (39%) were the leading etiological factors. Elevated serum amylase and lipase were observed in all cases, with hyperglycemia, leukocytosis, and elevated CRP significantly associated with moderate to severe pancreatitis (p < 0.01). Radiologically, 22% had evidence of pancreatic necrosis, while 15% had peripancreatic fluid collections. ICU care was required in 28% of patients, and the overall in-hospital mortality rate was 6.7%. Patients with higher BISAP scores and organ dysfunction at admission had significantly poorer outcomes and longer hospital stays. Conclusion: This study highlights the clinical heterogeneity and multifactorial etiology of acute pancreatitis in this region, with alcohol and gallstones as leading contributors. Certain laboratory and imaging markers such as leukocytosis, CRP, and pancreatic necrosis serve as important indicators of disease severity and can predict the need for intensive care. Early identification and risk stratification using clinical and pathological markers are vital in improving prognosis and reducing hospital morbidity and mortality in acute pancreatitis.

Background: Dermatophytosis, particularly tinea corporis and tinea cruris, has emerged as a common superficial fungal infection in tropical regions, with rising incidence and therapeutic challenges due to antifungal resistance and recurrent cases. Multiple topical antifungal agents are available, yet head-to-head comparative data on their clinical efficacy remains limited. This study aimed to evaluate and compare the clinical efficacy of four commonly used topical antifungal agents—amorolfine, luliconazole, sertaconazole, and terbinafine in the treatment of tinea corporis and tinea cruris. Methods: This prospective, randomized, comparative study was conducted over 10 months in Department of SKIN and VD, SKMCH, Muzaffarpur, Bihar, India. A total of 160 patients clinically and mycologically diagnosed with tinea corporis and/or tinea cruris were randomly divided into four treatment groups (n=40 each), receiving topical amorolfine 0.25%, luliconazole 1%, sertaconazole 2%, or terbinafine 1% cream, respectively. Patients were advised to apply the assigned medication twice daily for 4 weeks. Efficacy was assessed clinically using a composite symptom score (itching, erythema, scaling) and mycological cure (KOH negativity) at baseline, 2 weeks, and 4 weeks. Statistical analyses were performed to compare improvement across treatment groups. Results: At the end of 4 weeks, the highest clinical and mycological cure rates were observed in the luliconazole group (92.5%), followed by sertaconazole (87.5%), amorolfine (80.0%), and terbinafine (75.0%). Mean symptom scores showed significant reduction in all groups, with luliconazole demonstrating the most rapid clinical improvement by week 2 (p < 0.01). Adverse effects were minimal and comparable across groups. The difference in cure rates between luliconazole and terbinafine was statistically significant (p = 0.03). Conclusion: Among the four topical antifungal agents studied, luliconazole emerged as the most effective in terms of clinical response and mycological clearance, followed by sertaconazole, amorolfine, and terbinafine. Considering its rapid onset, high cure rate, and safety profile, luliconazole may be considered the preferred topical agent in the treatment of dermatophytosis, particularly in cases of tinea corporis and tinea cruris.

Background: Abnormal uterine bleeding (AUB) is among the most common gynecological problems affecting women, particularly in the reproductive and perimenopausal age groups. Various etiological factors contribute to AUB, and recent attention has been given to the role of body mass index (BMI) as a significant, modifiable risk factor. Higher BMI has been linked to hormonal disturbances, anovulation, and endometrial abnormalities, which may predispose women to abnormal bleeding patterns. This study was undertaken to evaluate the association between BMI and abnormal uterine bleeding patterns. Methods: This prospective observational study was conducted at the Department of Obstetrics and Gynaecology, Netaji Subhas Medical College and Hospital, Amhara, Bihta, Patna, Bihar, India, over a period of  march 2024 to July 2024. A total of 150 women aged 18–50 years presenting with AUB were included. BMI was calculated using standard anthropometric methods and classified according to WHO guidelines. Detailed history, clinical examination, pelvic ultrasonography, and endometrial assessment were performed. The association between BMI categories and bleeding patterns, as well as endometrial pathology, was statistically analyzed. Results: Out of 150 women enrolled, 45 (30.0%) had normal BMI, 56 (37.3%) were overweight, and 49 (32.7%) were obese. Anovulatory bleeding patterns were significantly higher in overweight and obese women (p < 0.001). Heavy menstrual bleeding and irregular cycles were also more frequent in women with elevated BMI. Histopathological examination revealed a higher incidence of endometrial hyperplasia among obese women compared to women with normal BMI (p = 0.002). Conclusion: A positive correlation was observed between higher BMI and abnormal uterine bleeding, particularly anovulatory patterns and endometrial hyperplasia. Addressing obesity and overweight status among women may play a critical role in the early prevention and management of AUB and its associated complications.

Background: Fine Needle Aspiration Cytology (FNAC) has emerged as a reliable, minimally invasive diagnostic tool for evaluating intra-abdominal and pelvic masses. The integration of radiological guidance, including ultrasound and computed tomography (CT), significantly enhances the precision and safety of FNAC, especially for deeply located or non-palpable lesions. Radiologically assisted FNAC offers rapid diagnosis, facilitates early management decisions, and reduces the need for more invasive surgical biopsies. Objectives: (1) To assess the diagnostic efficacy of radiologically guided FNAC in abdomino-pelvic lesions. (2) To correlate cytological findings with radiological impressions and histopathological outcomes wherever available. Methods: A prospective cross-sectional study was conducted at the Department of Pathology, Government Medical College and Hospital, Bettiah, West Champaran, Bihar, India, from January 2021 to December 2021. A total of 120 patients presenting with abdomino-pelvic masses underwent FNAC under radiological guidance. Samples were evaluated for cellular adequacy, diagnostic yield, and cytomorphological patterns. Final diagnoses were correlated with radiological findings and histopathological examination wherever feasible. Statistical analysis was performed to assess sensitivity, specificity, and diagnostic accuracy. Results: Radiologically guided FNAC achieved a high sample adequacy rate of 95%. Malignant lesions constituted the majority of the cases, predominantly originating from gastrointestinal tract, ovary, and lymph nodes. Sensitivity, specificity, and overall diagnostic accuracy were found to be 92.8%, 96.2%, and 94.1%, respectively. Radiological correlation improved the localization and targeting of lesions, minimizing complications and inadequate sampling. Conclusion: Radiologically assisted FNAC is a safe, highly effective diagnostic technique for abdomino-pelvic lesions. It offers high diagnostic accuracy, excellent sample adequacy, and minimal complication rates, making it a preferred initial investigative modality for intra-abdominal and pelvic masses.

Background: Fluid cytology serves as a crucial, minimally invasive diagnostic tool for evaluating effusions in various body cavities. Examination of serous fluids can offer valuable insights into infectious, inflammatory, and malignant conditions, often guiding therapeutic decisions without the need for more invasive procedures. In tertiary care settings, fluid cytology plays an integral role in the diagnostic approach to pleural, peritoneal, and pericardial effusions, especially in patients with suspected malignancies or chronic infections. Objectives: (1) To evaluate the diagnostic efficacy of fluid cytology in pleural, peritoneal, and pericardial effusions. (2) To categorize the cytomorphological spectrum of diseases diagnosed through fluid cytology. Methods: A prospective cross-sectional study was conducted at the Department of Pathology, Government Medical College and Hospital, Bettiah, West Champaran, Bihar, India, from March 2021 to January 2022. A total of 180 fluid samples including pleural, peritoneal, and pericardial fluids were collected and analyzed. Cytological evaluation was performed using standard staining techniques. Findings were classified into benign, inflammatory, suspicious, and malignant categories. Whenever available, cytology results were correlated with clinical, radiological, and histopathological findings. Results: Among the 180 fluid samples analyzed, the majority were pleural effusions followed by peritoneal and pericardial effusions. Malignant effusions accounted for 35.6% of cases, predominantly involving adenocarcinomas. Benign and inflammatory conditions comprised the majority of non-malignant diagnoses. Cytological examination demonstrated high sensitivity and specificity for the detection of malignancy, with a diagnostic accuracy of 92.3%. Conclusion: Fluid cytology remains an effective, minimally invasive diagnostic tool with high diagnostic yield and accuracy, particularly for identifying malignant effusions. Its integration with clinical and radiological assessment enhances early diagnosis and aids in timely clinical management.

Background: Carcinoma of the cervix remains one of the leading causes of cancer-related morbidity and mortality among women, particularly in low- and middle-income countries like India. The disease has a well-established pre-invasive stage, commonly referred to as cervical intraepithelial neoplasia (CIN), which makes it largely preventable through timely detection and appropriate management. Several screening modalities are currently available, including the conventional Papanicolaou (Pap) smear, visual inspection with acetic acid (VIA), and human papillomavirus (HPV) DNA testing. Each method varies in sensitivity, specificity, cost, and feasibility, especially in resource-limited settings. This study was undertaken to compare the diagnostic efficacy of Pap smear, VIA, and HPV DNA testing in detecting pre-invasive cervical lesions. Methods: This prospective comparative study was conducted at the Department of Obstetrics and Gynaecology, Netaji Subhas Medical College and Hospital, Amhara, Bihta, Patna, Bihar, India, from April 2024 to August 2024. A total of 180 sexually active women aged 25–65 years attending the gynecology outpatient department for routine screening or with suspicious symptoms were enrolled. All participants underwent Pap smear, VIA, and HPV DNA testing. Colposcopy-guided biopsy was performed for all screen-positive cases and served as the gold standard for confirmation. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each screening method were calculated and compared. Results: Of the 180 women screened, 42 (23.3%) had biopsy-confirmed pre-invasive lesions (CIN I, II, or III). HPV DNA testing showed the highest sensitivity (90.5%) followed by VIA (78.6%) and Pap smear (64.3%). However, Pap smear demonstrated the highest specificity (92.0%) compared to VIA (86.7%) and HPV DNA testing (80.7%). When evaluating overall diagnostic accuracy, HPV DNA testing emerged as the most reliable method for early detection, whereas VIA was found to be a practical and cost-effective tool in settings with limited resources. The combination of Pap smear with HPV DNA testing further improved the detection rates. Conclusion: Among the screening methods evaluated, HPV DNA testing was the most sensitive for detecting pre-invasive cervical lesions, while Pap smear offered superior specificity. VIA proved to be a viable alternative in low-resource settings with reasonable sensitivity and ease of application. A combined or sequential screening strategy utilizing multiple methods may offer optimal detection while balancing cost and resource constraints, particularly in underserved populations.

Background: Surgical stress and anesthesia are known to cause significant alterations in blood glucose levels, particularly in diabetic patients. Perioperative hyperglycemia is associated with increased risk of infections, delayed wound healing, and adverse outcomes. Spinal anesthesia, by attenuating the neuroendocrine stress response, may influence perioperative glycemic control favorably. Objectives: (1) To assess the effect of spinal anesthesia on perioperative blood glucose levels in diabetic patients undergoing lower limb orthopedic surgeries. (2) To evaluate the incidence of perioperative hyperglycemia and associated risk factors. Methods: A prospective observational study was conducted at the Department of Anesthesiology, NMCH, Patna, Bihar, India, from September 2021 to August 2022. Seventy diabetic patients scheduled for elective lower limb orthopedic procedures under spinal anesthesia were enrolled. Blood glucose levels were recorded preoperatively, intraoperatively at 1-hour intervals, and postoperatively up to 6 hours. Glycemic variations were analyzed, and associations with patient demographics, duration of surgery, and baseline glycemic control were evaluated. Results: Spinal anesthesia was associated with relative stability of intraoperative and immediate postoperative blood glucose levels. Significant perioperative hyperglycemia (blood glucose >180 mg/dL) was observed in 24% of patients, mainly in those with poor preoperative glycemic control (HbA1c >8%). No major intraoperative hemodynamic instability or adverse outcomes were recorded. Conclusion: Spinal anesthesia helps in maintaining better perioperative glycemic stability in diabetic patients undergoing lower limb orthopedic surgeries. Preoperative glycemic optimization remains crucial in minimizing perioperative hyperglycemia and associated complications.

Background: Neonatal hyperbilirubinemia is a common condition managed frequently with phototherapy. However, phototherapy can lead to potential side effects, including hypocalcemia, which may remain unnoticed if not monitored properly. Early identification of phototherapy-induced hypocalcemia and understanding its correlation with the duration of phototherapy is crucial for timely intervention and prevention of complications. Objectives: (1) To assess the incidence of hypocalcemia in neonates receiving phototherapy for hyperbilirubinemia. (2) To evaluate the correlation between the duration of phototherapy and the development of hypocalcemia. Methods: This prospective observational study was conducted at the Department of Pediatrics, Darbhanga Medical College and Hospital,  Darbhanga, Bihar, India for one year. A total of 100 neonates diagnosed with hyperbilirubinemia and initiated on phototherapy were enrolled. Baseline serum calcium levels were measured prior to phototherapy initiation and re-evaluated at 24, 48, and 72 hours. Detailed demographic, clinical, and treatment data were recorded. The relationship between the duration of phototherapy and incidence of hypocalcemia was statistically analyzed using appropriate tests. A p-value of <0.05 was considered statistically significant. Results: A significant proportion of neonates undergoing phototherapy developed hypocalcemia, with incidence increasing proportionally with the duration of exposure. Hypocalcemia was observed more prominently after 48 hours of continuous phototherapy. Statistical analysis revealed a significant correlation between longer duration of phototherapy and decreased serum calcium levels (p<0.05). Conclusion: Phototherapy-induced hypocalcemia is a notable concern among neonates treated for hyperbilirubinemia, with longer durations posing higher risks. Regular monitoring of serum calcium levels, especially beyond 24 hours of phototherapy, is recommended to prevent complications and ensure safer management.

Background: Head injury constitutes a major cause of morbidity and mortality worldwide, particularly in low- and middle-income countries. Timely evaluation and management are crucial to improving outcomes. Understanding the patterns, severity, and predictors of outcomes among head injury patients provides essential insights for optimizing clinical care and resource allocation. Objectives: (1) To assess the patterns and severity of head injuries among patients presenting at Darbhanga Medical College and Hospital. (2) To evaluate the clinical outcomes associated with different types and severities of head injury. Methods: A prospective observational study was conducted in the Upgraded Department of General Surgery, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India, over a period from January 2021 to December 2021. A total of 120 patients with head injuries were enrolled after informed consent. Detailed clinical assessments, Glasgow Coma Scale (GCS) scoring, imaging findings, and outcomes at discharge were recorded. Data were analyzed statistically to evaluate associations between injury patterns and outcomes. Results: Road traffic accidents were the leading cause of head injuries, followed by falls. The majority of patients sustained mild to moderate injuries as per GCS classification. Mortality was highest among patients with severe head injuries. Early surgical intervention and intensive care support significantly improved survival rates among moderate-to-severe head injury patients. Conclusion: Early identification of head injury severity and timely intervention are crucial determinants of patient outcomes. Road traffic accidents remain the predominant cause of head injuries, highlighting the urgent need for preventive strategies. Institutional strengthening for critical care facilities can further reduce mortality associated with severe head injuries.

Background: Menstruation is a natural physiological process that signifies the onset of reproductive maturity in adolescent girls. Despite being a normal phenomenon, menstrual irregularities and associated problems are common during adolescence, often affecting physical health, psychological well-being, and academic performance. Understanding menstrual patterns and problems during this crucial developmental period is essential to promote reproductive health and timely interventions. Objectives: (1) To evaluate the pattern of menstruation among adolescent school girls. (2) To assess the prevalence and types of menstrual problems experienced by them. Methods: This school-based cross-sectional study was conducted from December 2019 to November 2020 among adolescent girls aged 10–19 years studying in selected schools of Darbhanga district, Bihar. A total of 200 girls who had attained menarche were included using a stratified random sampling technique. Data regarding menstrual characteristics, regularity, duration, and associated problems were collected using a pre-tested, semi-structured questionnaire administered through face-to-face interviews. Data were analyzed using SPSS version 22. Descriptive statistics and chi-square tests were applied to assess associations between variables. Results: The majority of girls experienced regular menstrual cycles with an average cycle length of 28–30 days. Dysmenorrhea was the most common menstrual problem reported, followed by irregular cycles and menorrhagia. A significant association was observed between the age at menarche and the prevalence of menstrual irregularities. Many girls reported absenteeism from school during menstruation due to discomfort and embarrassment. Conclusion: Menstrual problems are common among adolescent girls and can adversely impact their quality of life and education. Early identification, counseling, and health education programs in schools are crucial to address these issues effectively and to promote positive menstrual health practices.

Background: Thalassemia major is a hereditary blood disorder requiring lifelong blood transfusions, leading to iron overload and multiple endocrine complications. Among these, thyroid dysfunction is increasingly recognized as a common and significant complication, often underdiagnosed until late stages. Early identification of thyroid dysfunction in transfusion-dependent children is crucial to prevent growth retardation, delayed puberty, and metabolic complications. Objectives: (1) To assess thyroid function status in children with transfusion-dependent thalassemia major. (2) To evaluate the prevalence of thyroid dysfunction and its association with transfusion history and serum ferritin levels. Methods: A cross-sectional observational study was conducted in the Department of Pediatrics, Darbhanga Medical College and Hospital, Bihar, from January 2020 to November 2020. A total of 80 transfusion-dependent thalassemic children aged 2–18 years were enrolled. Clinical examination and detailed transfusion history were recorded. Thyroid function tests (TSH, Free T4) and serum ferritin levels were measured. Data were analyzed using SPSS version 22, and associations between thyroid status and iron overload were assessed statistically. Results: Subclinical hypothyroidism was the most common thyroid dysfunction observed, followed by overt hypothyroidism. Higher serum ferritin levels correlated significantly with thyroid dysfunction. Duration of transfusion dependency and poor chelation therapy compliance were important risk factors. Early thyroid screening was found to be crucial to initiate timely intervention. Conclusion: Thyroid dysfunction is a frequent complication in transfusion-dependent thalassemia major patients. Regular monitoring of thyroid function and effective iron chelation therapy are imperative to improve long-term outcomes and quality of life in these children.

Background: Uncontrolled bleeding remains a major cause of early mortality in trauma patients. Tranexamic acid, an antifibrinolytic agent, has shown promising results in reducing blood loss and improving survival in trauma settings by stabilizing clot formation and preventing fibrinolysis. Objectives: (1) To compare the effectiveness of tranexamic acid versus placebo in controlling blood loss among acute trauma patients. (2) To evaluate secondary outcomes including transfusion requirements and early mortality. Methods: A prospective randomized controlled study was conducted in the Department of Anesthesiology, NMCH, Patna, Bihar, India from September 2021 to July 2023. A total of 100 acute trauma patients meeting inclusion criteria were randomized into two groups: Group A (Tranexamic acid) and Group B (Placebo). Blood loss, transfusion needs, hemodynamic stability, and 24-hour mortality rates were recorded and compared. Results: Patients receiving tranexamic acid demonstrated significantly reduced blood loss compared to the placebo group. The requirement for blood transfusions was also lower in Group A. No significant adverse effects attributable to tranexamic acid were observed. Early mortality was slightly lower in the tranexamic acid group, though not statistically significant. Conclusion: Tranexamic acid is effective in reducing blood loss and transfusion requirements in acute trauma patients without increasing adverse events. Its early administration may be beneficial in improving trauma outcomes.

Background: Anaemia ranks as a common global health condition that impacts developing countries especially, with huge implications on individual health and socio-economic development. Early classification and diagnosis of anaemia, according to morphology and red blood cell (RBC) as well as platelet indices, are fundamental to proper management. Aim: To examine the spectrum of RBC and platelet indices among the various types of anaemia and determine their diagnostic value. Methodology: Descriptive cross-sectional study was done over a period of Jan 2023 to December 2023 within the haematology wing of the Department of Pathology. 80 anaemic cases were considered on the basis of RBC and platelet indices, on the basis of peripheral smear examination as well as automated blood cell analyzer results. Results: The analysis revealed the RBC and platelet index distributions unique to Microcytic Hypochromic Anaemia (MHA), Normocytic Normochromic Anaemia (NNA), Macrocytic Anaemia, and Dimorphic Anaemia. The maximum platelet counts and varying RBC indices were recorded for MHA, and the minimum platelet count and stable RBC indices were reported for NNA. Macrocytic and Dimorphic Anaemias presented similar traits as they both had increased MCV and RBC indices. Conclusion:  RBC and platelet indices are of key importance for the diagnostics and classification of anaemia types and yield useful information for clinical management. The results endorse the application of automated hematology instruments for rapid and accurate anaemia detection.

Background: Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder in children, characterized by symptoms of inattention, hyperactivity, and impulsivity. Growing evidence suggests that nutritional and biochemical factors, particularly deficiencies in micronutrients such as Vitamin D and ferritin, may contribute to the pathophysiology of ADHD by influencing neurotransmitter synthesis, neuroinflammation, and brain development. This study was undertaken to assess the serum levels of Vitamin D and ferritin in children diagnosed with ADHD and explore their association with ADHD severity. Methods: This cross-sectional, case-control study was conducted at the Department of Pediatrics, Nalanda Medical College and Hospital, Patna, Bihar, India from January  2024 to October 2024. A total of 100 children aged 5–12 years were included, comprising 50 newly diagnosed cases of ADHD based on DSM-5 criteria and 50 age- and sex-matched healthy controls. Serum 25(OH) Vitamin D and ferritin levels were estimated using chemiluminescent immunoassay. ADHD severity was assessed using the Conners’ Parent Rating Scale–Revised (CPRS-R). Statistical analyses were conducted to compare serum levels between groups and to determine correlations with ADHD symptom scores. Results: Children with ADHD had significantly lower mean serum Vitamin D levels (18.9 ± 5.7 ng/mL) compared to controls (27.2 ± 6.1 ng/mL, p < 0.001). Similarly, serum ferritin levels were also lower in the ADHD group (23.4 ± 7.6 ng/mL) compared to controls (32.1 ± 8.5 ng/mL, p = 0.002). A significant inverse correlation was observed between ADHD severity scores and serum Vitamin D (r = -0.52, p < 0.01) as well as ferritin levels (r = -0.41, p = 0.01). Children with combined-type ADHD showed the lowest micronutrient levels among subtypes. Conclusion: The study indicates a significant association between low serum Vitamin D and ferritin levels and the presence and severity of ADHD in children. These findings suggest that screening for and correcting micronutrient deficiencies may represent a supportive strategy in the comprehensive management of ADHD. Further longitudinal studies are warranted to establish causal relationships and evaluate the therapeutic role of supplementation.

Background: Umbilical cord blood gas analysis provides crucial insights into the fetal acid-base status at birth and is a valuable tool for predicting immediate neonatal outcomes, particularly in high-risk deliveries. Early identification of newborns at risk of adverse outcomes based on cord blood pH, pCO₂, pO₂, and base excess levels enables timely intervention and can significantly improve neonatal prognosis. Objectives: (1) To evaluate the correlation between cord blood gas parameters and short-term neonatal outcomes in high-risk deliveries. (2) To determine the predictive value of abnormal cord blood gas values for immediate neonatal morbidity. Methods: A prospective observational study was conducted at the Department of Pediatrics, IGIMS, Patna, Bihar, India, over 12 months. A total of 120 high-risk deliveries were included. Umbilical arterial blood samples were collected immediately after birth and analyzed for pH, pCO₂, pO₂, bicarbonate, and base excess. Neonatal outcomes including Apgar scores, need for resuscitation, NICU admission, and early neonatal mortality were recorded. Statistical analysis was done to assess correlations and predictive values. Results: A significant association was observed between low cord pH and poor short-term neonatal outcomes. Newborns with metabolic acidosis (pH <7.20) demonstrated a higher incidence of low Apgar scores, need for resuscitation, NICU admission, and early complications. Base deficit values also correlated strongly with adverse outcomes. Cord blood gas analysis showed high sensitivity and specificity in predicting neonatal morbidity immediately after birth. Conclusion: Cord blood gas analysis is a reliable and effective tool for predicting short-term outcomes in neonates born from high-risk deliveries. Routine use of cord blood gas evaluation in such settings can help in early identification of at-risk newborns, allowing prompt and appropriate management to reduce morbidity and mortality.

Background: Intrauterine foetal demise (IUFD) remains a tragic obstetric complication with significant emotional and psychological impacts on affected families. Understanding the clinical and demographic factors associated with IUFD is essential to design effective preventive strategies and improve obstetric outcomes. Despite advances in prenatal care, the incidence of IUFD remains a concern in both developing and developed countries. Objectives: (1) To analyze the clinical and demographic characteristics associated with intrauterine foetal demise. (2) To identify the probable etiological factors contributing to IUFD in a tertiary care setting. Methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology, VMMC and SJH new Delhi, India . A total of 150 cases of intrauterine fetal demise beyond 20 weeks of gestation were included. Maternal demographics, antenatal history, gestational age at demise, fetal weight, mode of delivery, and probable causes were recorded and analyzed statistically. Results: The majority of IUFD cases occurred in primigravida women and in the third trimester. Hypertensive disorders of pregnancy, placental abruption, and maternal infections were the most commonly identified etiological factors. A significant proportion of cases presented with absent fetal movements as the initial complaint. Timely antenatal surveillance and management of high-risk pregnancies emerged as critical areas for intervention. Conclusion: Intrauterine fetal demise continues to pose a significant challenge in obstetric practice. Early identification of high-risk pregnancies, strict antenatal monitoring, and prompt management of maternal conditions can substantially reduce the incidence of IUFD. Focused efforts are required to strengthen antenatal care services, especially in high-risk populations.

Background: Vitamin D deficiency has been increasingly recognized as a global health issue, with emerging evidence suggesting its association with the development and progression of type 2 diabetes mellitus (T2DM). Hypovitaminosis D may influence glucose metabolism, insulin resistance, and β-cell function, highlighting the need to assess vitamin D status in newly diagnosed diabetic patients. Objectives: (1) To determine the prevalence of vitamin D deficiency among newly diagnosed type II diabetes mellitus patients. (2) To evaluate the correlation between serum vitamin D levels and glycemic control parameters. Methods: A retrospective study was conducted at the Department of General Medicine, AIIMS, Patna, Bihar, India from November 2019 to October 2020. A total of 120 newly diagnosed T2DM patients were enrolled. Serum 25-hydroxyvitamin D levels were measured and categorized as deficient, insufficient, or sufficient. Fasting blood glucose, HbA1c, and other relevant clinical parameters were recorded. Statistical analysis was performed to evaluate associations between vitamin D status and glycemic markers. Results: Vitamin D deficiency was found in a significant proportion of newly diagnosed T2DM patients. Lower vitamin D levels were associated with higher fasting blood glucose and HbA1c values. Patients with vitamin D sufficiency exhibited better glycemic control compared to those with deficiency or insufficiency. A significant negative correlation was observed between serum 25(OH)D levels and HbA1c values. Conclusion: Vitamin D deficiency is highly prevalent among newly diagnosed type II diabetes mellitus patients and is inversely correlated with glycemic control. Early assessment and correction of vitamin D deficiency may represent a potential strategy for better glycemic management in T2DM.

Background: Neonatal jaundice is one of the most common conditions requiring medical evaluation and intervention in the early neonatal period. Accurate measurement of bilirubin levels is critical for timely diagnosis and management. While conventional serum bilirubin estimation remains the gold standard, transcutaneous bilirubinometry offers a non-invasive, rapid alternative that reduces discomfort and potential complications associated with blood sampling. Objectives: (1) To assess the correlation between serum bilirubin levels measured by transcutaneous method and conventional blood sampling in neonates. (2) To evaluate the reliability of transcutaneous bilirubinometry as a screening tool in clinical practice. Methods: This cross-sectional observational study was conducted among neonates presenting with clinical jaundice at Department of Pediatrics in collaboration with the Department of Pathology at GMCH, Purnia, Bihar, over a period of ten months. Paired transcutaneous bilirubin readings and venous serum bilirubin samples were obtained and analyzed. Statistical analysis included Pearson correlation and Bland-Altman plots to assess agreement between the two methods. Results: A strong positive correlation was found between transcutaneous and serum bilirubin measurements. Although transcutaneous values tended to slightly underestimate serum bilirubin at higher levels, the method demonstrated acceptable agreement and could reliably predict clinically significant hyperbilirubinemia. Conclusion: Transcutaneous bilirubinometry is a reliable, non-invasive screening tool for estimating bilirubin levels in neonates. It can substantially reduce the need for invasive blood sampling, thereby enhancing patient comfort without compromising diagnostic accuracy.

Background: Epithelial ovarian cancer remains one of the leading causes of gynecological malignancy-related mortality worldwide, often diagnosed at an advanced stage due to nonspecific symptoms. Biomarkers such as Cancer Antigen-125 (CA-125) and hematological parameters like platelet count have been studied individually as prognostic factors. The possible correlation between elevated platelet counts and serum CA-125 levels offers potential insight into tumor biology and patient stratification. Objectives: (1) To evaluate the pre-operative platelet counts in patients diagnosed with epithelial ovarian carcinoma. (2) To analyze the correlation between platelet counts and serum CA-125 levels. Methods: This cross-sectional observational study was conducted jointly by the Department of Obstetrics and Gynaecology, Katihar Medical College and Hospital, Katihar, Bihar, and the Department of Pathology, GMCH, Purnia, Bihar, India for 12 months included patients with histopathologically confirmed epithelial ovarian cancer who underwent surgical intervention. Pre-operative platelet counts and serum CA-125 levels were recorded. Statistical analysis was performed using SPSS version 22. Pearson’s correlation coefficient was calculated to determine the relationship between platelet counts and CA-125 levels. Results: The study observed that a significant proportion of patients exhibited thrombocytosis pre-operatively. A positive correlation was found between elevated platelet counts and higher serum CA-125 levels, suggesting that thrombocytosis may reflect increased tumor burden and aggressive disease biology. Conclusion: Pre-operative thrombocytosis correlates positively with elevated CA-125 levels in epithelial ovarian cancer patients. Combined evaluation of hematological and tumor markers may enhance risk stratification, prognostic evaluation, and personalized treatment planning.

Background: Acute pancreatitis is a potentially life-threatening inflammatory disorder characterized by a wide clinical spectrum, ranging from mild, self-limiting disease to severe forms associated with multi-organ failure. Early identification of severity predictors is critical for appropriate management and improving hospital outcomes. Objectives: (1) To evaluate the clinical and pathological profile of patients admitted with acute pancreatitis. (2) To assess the immediate hospital outcomes and identify factors associated with severe disease and mortality. Methods: A prospective observational study was conducted at the Department of General Medicine, AIIMS, Patna, Bihar, India from July 2020 to June 2021. A total of 80 patients diagnosed with acute pancreatitis based on clinical features, elevated pancreatic enzymes, and imaging studies were included. Clinical presentation, laboratory parameters, etiological factors, severity scores (Modified Glasgow score, BISAP score), and hospital outcomes were recorded and analyzed. Results: Alcohol consumption and gallstone disease were the most common etiologies identified. Abdominal pain and vomiting were the predominant presenting symptoms. A higher Modified Glasgow score and elevated BISAP score were significantly associated with severe disease, longer hospital stays, and increased in-hospital mortality. Overall, early aggressive fluid resuscitation and supportive care contributed to favorable outcomes in most cases. Conclusion: Early clinical assessment, evaluation of severity scores, and timely supportive management are vital in improving immediate hospital outcomes in acute pancreatitis. Recognizing high-risk patients at admission allows for better resource allocation and monitoring, ultimately reducing mortality.

Background: Hypertension is a major global contributor to cardiovascular morbidity and mortality. Despite widespread availability of antihypertensive drugs, significant variability in individual drug responsiveness and the long-term cost burden remains key challenges in ensuring sustained blood pressure control. A strategic approach that personalizes therapy based on early pharmacodynamic response, while integrating cost-tiering, may help optimize outcomes, particularly in resource-constrained settings. Aim: To develop and evaluate a Pharmaco-Responsiveness-Based Tiered Pricing Model (PRTPM) that integrates early pharmacological response into a structured pricing mechanism, to enable cost-effective and personalized antihypertensive therapy in patients with Stage 1 and 2 hypertension. Methods: This prospective interventional study was conducted, Department of Pharmacology, University college of medical science & GTB Hospital, India from April 2021 to Jan 2022. A total of 240 patients aged 30–65 years, diagnosed with Stage 1 or 2 essential hypertension, were enrolled and randomized to receive monotherapy with one of four first-line antihypertensive classes—ACE inhibitors, ARBs, calcium channel blockers, or thiazide diuretics. Blood pressure was monitored at 2 and 4 weeks to determine early pharmacodynamic responsiveness. Based on predefined criteria, patients were classified into high, intermediate, or low responsiveness tiers. A retrospective cost simulation was then performed by applying the PRTPM framework to evaluate monthly drug cost variation across tiers. Primary outcomes included BP control rates at 4 and 12 weeks, drug switch rates, and estimated cost savings under the proposed pricing model. Results: Out of 240 patients enrolled during the study period, 61.7% demonstrated high responsiveness to their initial therapy, 28.3% intermediate, and 10% low. Blood pressure control at 4 weeks was significantly higher in the high-responsiveness group (88.6%) compared to the low-responsiveness group (42.1%, p<0.001). Application of the PRTPM retrospectively showed a potential mean monthly cost reduction of 23.5% per patient, with higher subsidies applied to lower-response categories, thereby supporting timely drug optimization. Patients in the high-responsiveness tier also had lower drug switch rates and improved adherence at 12 weeks. Conclusion: The PRTPM model, developed and evaluated over a one-year period, offers a novel and pragmatic approach to personalize and rationalize antihypertensive therapy. By linking early response patterns to a tiered pricing strategy, it enables both clinical efficiency and economic sustainability in hypertension management.

Background: Adverse drug reactions (ADRs) are unintended, harmful responses to medications ^‘that contribute significantly to patient morbidity, prolonged hospital stays, and increased healthcare costs. Traditional voluntary reporting systems suffer from under-reporting and bias, underscoring the need for more systematic pharmacovigilance methods. Aim: To clinically evaluate the effectiveness of trigger tools in identifying ADRs, including hypertension-related events, in a tertiary-care teaching hospital. Methodology: This prospective study was carried out in the Department of Pharmacology, M.P Shah Government Medical College and GGS Hospital, India from march 2021 to December 2021. 80 consenting nurses participated. After completing a pretested KAP questionnaire on pharmacovigilance and trigger tools, participants received training and a list of triggers adapted from the IHI Global Trigger Tool. Over subsequent weeks, nurses reported ADRs using the trigger-tool method, first under supervision and then independently, with weekly SMS reminders. Post-intervention, the KAP questionnaire was re-administered. Data were analyzed in SPSS v27; continuous variables used t-tests or Mann–Whitney U tests, categorical variables used Chi-square or Fisher’s exact tests, with p < 0.05 considered significant. Results: Participants were predominantly male (70%), mean age 43.1 ± 16.4 years, mean hospital stay 5.8 ± 3.1 days. Among 80 triggers, IV fluid, pruritus, and weight gain had 100% positive predictive values (PPV); thrombophob gel and rash yielded PPVs of 66.7% and 50%, respectively. Overall sensitivity and specificity of the trigger-tool method were 100% and 21.7%. The most frequent ADRs detected were gastritis (n = 20), thrombophlebitis (n = 12), and headache (n = 9). Conclusion: Trigger tools, particularly high-PPV indicators, provide a sensitive, time-efficient supplement to voluntary reporting for early ADR detection in acute care. Selective application of validated triggers can enhance pharmacovigilance and patient safety in resource-limited settings.

Background: Accurate diagnosis of skin diseases often requires a combination of clinical evaluation and histopathological confirmation. While clinical diagnosis remains the first line of assessment, histopathology plays a crucial role in confirming or ruling out differentials, particularly in cases with atypical presentations. Objective: To evaluate the correlation between clinical and histopathological diagnoses of various dermatological conditions and to assess the reliability of clinical judgment in skin disease diagnosis. Methods: This observational, cross-sectional study was conducted over a period of 12 months at Advanced Skin, Hair & Laser Clinic, Patna, Bihar, India. A total of 120 patients with clinically diagnosed dermatological conditions underwent skin biopsies. Clinical findings were documented prior to histopathological examination, and results were analyzed to determine the degree of correlation. Results: Out of 120 cases, 92 (76.7%) showed strong clinicopathological correlation. The highest concordance was observed in papulosquamous disorders (89.4%) and infectious dermatoses (85.2%). In contrast, lower correlation was noted in pigmentary disorders and vesiculobullous diseases. In 28 cases (23.3%), the histopathological findings either modified or completely changed the initial clinical diagnosis. Conclusion: Histopathological evaluation significantly enhances diagnostic accuracy, particularly in clinically ambiguous skin conditions. A high clinicopathological concordance in several common dermatoses supports the reliability of clinical acumen but also underscores the importance of biopsy in unclear or complex cases. Integration of clinical expertise with pathological assessment remains essential for optimal dermatological care.

Background: With aging, the skin undergoes physiological changes, becoming thinner, drier, and more sensitive. The use of soaps and creams, while essential for hygiene and skin care, may contribute to or exacerbate dermatological issues in elderly individuals due to altered skin barrier function and product sensitivity. Objective: To assess the prevalence, types, and contributing factors of skin complications associated with the use of soaps and creams among elderly individuals. Methods: A cross-sectional observational study was conducted at Advance Skin, Hair & Laser Clinic, Patna, Bihar, in India among 120 elderly participants aged 60 years and above, residing in urban and semi-urban areas over a period of 6 months. Data were collected using a structured questionnaire covering demographic details, skin care practices, types of soaps and creams used, frequency of use, and any skin complications experienced. Clinical examination was also conducted to identify dermatological conditions. Results: Out of 120 participants, 42 (35%) reported skin complications linked to the use of soaps and/or creams. The most common issues included dryness (25%), itching (18%), erythema (11%), and allergic dermatitis (7%). Harsh soaps with strong fragrances and alcohol-based creams were more frequently associated with adverse reactions. Women reported a higher incidence of complications compared to men. Infrequent use of moisturizers and frequent washing with alkaline soaps were identified as significant contributing factors (p<0.05). Conclusion: A substantial proportion of elderly individuals experience skin complications related to the use of common soaps and creams. There is a need for increased awareness about age-appropriate skin care products and practices to prevent dermatological issues in this vulnerable population. Clinicians should provide guidance on gentle, non-irritating skin care regimens tailored to geriatric needs.

Background: Hypertension is a common cardiovascular disease globally and the major cause of cardiovascular mortality. Hypertension prevalence in India is on the rise, particularly in India’s urban population, but there is little evidence on its prevalence and determinants in young adults between the ages of 20 and 40 years. Objective: The study assesses the burden and determinants of hypertension risk between adults aged 20–40 years in urban Bihar, India, to inform public health action. Methodology: This Cross-sectional study was conducted between January  2018 and December 2018 on 98 urban adults of Sri Krishna Medical College and Hospital’s field practice area, Muzaffarpur, Bihar. Data were collected with the help of a semi-structured questionnaire for the estimation of blood pressure, stress, BMI, and lifestyle. Independent risk factors were identified using logistic regression. Results: Out of the participants, 2% were Stage 2 hypertensive, 15.3% Stage 1 hypertensive, 52% pre-hypertensive, and 30.4% normotensive. The major risk factors for hypertension were age (30–40 years), family history, chewing tobacco, stress, and obesity. Age (OR = 2.1), family history (OR = 3.05), smoking (OR = 3.95), and stress (OR = 2.45) were independent predictors of hypertension in logistic regression analysis. Conclusion: Hypertension is common among urban Bihar’s young adults between the ages of 20–40 years, and modifiable risk factors such as tobacco consumption, stress, and obesity are the major factors implicated in its etiology. Screening and lifestyle modification at an early age are required to reduce the long-term health consequences.

Background: Tuberculosis (TB) remains a significant global health issue, with India bearing a substantial disease burden. The co-existence of Diabetes Mellitus (DM) further complicates TB outcomes due to compromised immunity. Aim: To evaluate the clinical outcomes and demographic profiles of patients with TB-DM comorbidity in a regional setting in Bihar, India. Methodology: This hospital-based cross-sectional observational study was conducted at Sri Krishna Medical College and Hospital (SKMCH), Muzaffarpur, Bihar, from November 2017 to October 2018. A total of 90 newly diagnosed TB patients aged over 18 years, including 50 with diabetes and 40 without, were enrolled. Baseline data were collected, and patients were followed through the intensive and continuation phases of anti-TB treatment under ^‘the Revised National Tuberculosis Control Programme (RNTCP). Statistical analysis was performed using SPSS v27.0. Results: Diabetic TB patients were predominantly male and over 50 years of age. They also exhibited higher fasting, postprandial, and random blood sugar levels, and longer smoking duration (p<0.05). Pulmonary TB was more common among diabetics (98% vs. 67.5%). Common symptoms included cough (78.7%) and fever (56%). TB-DM patients had higher cure rates (63.63%) but also higher mortality (66.6%) compared to non-diabetics. Conclusion: TB-DM comorbidity presents unique clinical challenges with older age, higher risk behaviors, and elevated mortality. Integration of diabetes screening and management into TB care, especially in high-burden regions like Bihar, is crucial for improving outcomes.

Background: Social anxiety disorder (SAD), also referred to as social phobia, demonstrates a high prevalence among student populations, with particularly elevated rates observed in individuals enrolled in academically rigorous programs such as medical colleges. It involves a persistent and excessive fear of social performance and social interactions, which can hinder academic, clinical, and interpersonal functioning. Despite its clinical significance, social phobia tends to go unnoticed and untreated among students. Aim: The purpose of this study is to investigate the frequency of social phobia among undergraduate medical students and the factors that may contribute to its development. Methods: This cross-sectional study was conducted on 250 undergraduate medical students. A semi-administered structured questionnaire was used for data collection. socio-demographic and Social Phobia Inventory data was completed by all participants. Data was analyzed with SPSS 26.0.  Binary logistic regression was used to uncover social phobia predictors and report adjusted odds ratios (AORs) with 95% CIs. Results: Prevalence of social phobia was 43.6%, and 24.4% had mild, 12.0% had moderate, and 7.2% had severe symptoms. The average SPIN score was 20.12 ± 12.88. Female gender (AOR: 1.98, p = 0.004), rural background (AOR: 1.67, p = 0.038), low maternal education (AOR: 3.25, p = 0.013), humiliation in the past (AOR: 2.40, p = 0.001), conflict at home (AOR: 2.60, p = 0.004), and poor parent-adolescent relationships (AOR: 2.10, p = 0.021) had significant associations with increased odds for social phobia. Conclusion: Social phobia is a serious issue among medical undergraduates, with almost half of the students having varying degrees of social anxiety. The results highlight the need for early detection and focused mental health intervention.

Background: Vitamin D has attracted growing attention in recent years for its possible role in glucose metabolism, insulin resistance, and chronic inflammatory processes. Hypovitaminosis D is suspected to be a contributing factor in the development and progression of type 2 diabetes mellitus (T2DM), particularly in populations with high cardiometabolic risk. Objective: To evaluate the correlation between serum vitamin D levels and a spectrum of clinical and lifestyle-related risk factors among adult patients with T2DM. Methods: A retrospective study was conducted at Department of Respiratory medicine, Sardar Patel Medical College, Bikaner, Rajasthan, India for one year  . A total of 240 adult T2DM patients were enrolled. Data were collected on age, gender, BMI, physical activity, diet, sun exposure, duration of diabetes, and glycemic control. Serum 25-hydroxyvitamin D [25(OH)D] was assessed using chemiluminescent immunoassay. Statistical analysis included Pearson’s correlation and multivariate regression models to identify independent predictors of low vitamin D. Results: Among the 240 participants, 63.3% were vitamin D deficient (<20 ng/mL), and only 13.8% had sufficient levels (>30 ng/mL). There was a significant inverse correlation between vitamin D and HbA1c (r = –0.31, p < 0.001), BMI (r = –0.27, p = 0.003), and sedentary lifestyle (p = 0.01). Poor glycemic control and obesity remained independent predictors in multivariate analysis. Conclusion: Vitamin D deficiency is widespread among diabetic patients and is significantly associated with obesity, physical inactivity, and poor glycemic control. Timely screening and correction of vitamin D status may support better metabolic management in T2DM.

Background: Colorectal cancer (CRC) is a growing concern, with early-onset cases (<40 years) being more aggressive and often diagnosed late. While India’s CRC incidence is “lower than in the West, EOCRC cases are rising due to genetic, environmental, and lifestyle factors. This study aims to analyze the clinico-demographic profile and epidemiological trends of CRC in patients younger than 40 years in a tertiary care hospital in eastern India from 2012 to 2015. Methods: A retrospective observational study was conducted at the Department of Gastroenterology, S.M.S. Medical College, Jaipur, Rajasthan, India. Data from 98 histopathologically confirmed CRC patients were analyzed. Patients were categorized into two groups: those younger than 40 years (n=32) and those aged 40 years and above (n=66). Demographic, clinical, histopathological, and treatment variables were compared. Statistical analyses included chi-square tests and independent t-tests, with a significance threshold of p<0.05. Results: Among the total CRC cases, 32.7% were EOCRC. Younger patients were more likely to present with rectal bleeding (62.5% vs. 43.9%, p=0.048), mucinous/signet ring histology (18.8% vs. 4.5%, p=0.031), and poorly differentiated tumors (28.1% vs. 12.1%, p=0.041). A significantly higher proportion were diagnosed at advanced stages (78.1% vs. 54.5%, p=0.023). Surgical resection rates were similar (87.5% vs. 92.4%, p=0.457), but younger patients required more adjuvant chemotherapy (75% vs. 56.1%, p=0.066). Conclusion: EOCRC exhibits distinct clinico-pathological features, with an aggressive disease course and higher rates of late-stage diagnosis. Increased awareness, early screening strategies, and tailored treatment approaches are crucial to improving outcomes” for younger patients.

Background: Hepatic encephalopathy (HE) is a neuropsychiatric disorder associated with liver failure, while minimal hepatic encephalopathy (MHE) represents its initial and mild stage.  MHE results from cognitive and psychomotor disorders primarily induced by hyperammonemia.  The gastrointestinal bacterium Helicobacter pylori (H. pylori), which secretes urease and contributes to ammonia generation, may exacerbate MHE. Aim: This research examines the effects of H. pylori infection on MHE and the effects of its eradication on metabolic parameters and cognitive function. Methodology: A prospective observational study involving 75 patients diagnosed with cirrhosis, of which 40 presented with minimal hepatic encephalopathy (MHE).  Patients were subjected to psychometric assessments, fasting blood ammonia measurements, and H. pylori identification through rapid urease tests.  MHE patients underwent two weeks of triple therapy for H. pylori eradication and were subsequently re-evaluated after four weeks. Results: Pre-treatment levels of ammonia were significantly higher in H. pylori-positive patients (1.82 ± 0.30 μg/mL) compared to H. pylori-negative patients (1.38 ± 0.15 μg/mL).  Following eradication, ammonia levels decreased significantly (1.20 ± 0.25 μg/mL), which was associated with improved psychometric functioning (p < 0.001).  The results indicate that H. pylori are involved in the pathogenesis of MHE via systemic ammonia elevation and neurocognitive impairment. Conclusion: H.pylori eradication considerably improves biochemical and neuropsychometric indicators, suggesting that it could be a treatment target for MHE.  Confirmation of the results is necessary, and the long-term effects require further investigation.  The eradication of H. pylori may serve as an innovative approach to prevent the progression of minimal hepatic encephalopathy (MHE) and enhance patient outcomes.

Background: A major public health issue, poisoning especially affects underdeveloped countries like India where high death rates follow from toxin exposure.  Deaths from poisoning follow from soci-demographic differences, poison access, and health inequalities. Aim: To investigate from medicolegal autopsy records the demographic and toxicological aspects of confirmed poisoning deaths. Methodology: Based on medicolegal autopsy records, retroactive observational study was conducted in the Department of Forensic Medicine and Toxicology, NMCH, Patna, Bihar, India. Studied were 98 verified poison deaths determined by autopsy, clinical history, chemical analysis, and other means.  Data on trends for age, gender, duration to death, manner of poisoning, and used poisonous chemicals was computed using SPSS. Results: The majority of the victims (59.18%) died within two hours of exposure.  Suicidal poisoning (71.43%), followed by accidental (15.31%) and homicidal (8.16%), was the most often occurring type.  Most affected was the 15–29 year age group.  The most often used poisonous agents were organophosphorus compounds (45.92%), followed by alcohol (10.20%) and aluminium phosphide (20.41%).  Among the remainder were carbamates, pyrethroids, acids, benzodiazepines, and propane derivatives. Conclusion: The study emphasised the need of poisoning prevention and early intervention, particularly among vulnerable young people.  Pesticides are used extensively and call both public education and control.  Medicolegal autopsy clarifies poisoning trends and guides public health policies.

Background: Age estimation is essential in forensic medicine, legal investigations, and therapeutic assessments. Although a variety of methods are employed, such as biochemical indicators and dental examination, radiographic evaluation is still a dependable and non-invasive approach. The shoulder joint, which includes the humerus, clavicle, and scapula, has distinctive epiphyseal alterations that make it useful for estimating skeletal age. Data on region-specific populations, such those in Bihar, India, where socioeconomic and environmental variables might affect bone formation and maturation, are few. Aim: To evaluate the accuracy of shoulder joint digital radiography imaging in determining the chronological age of Bihar’s youth and young adults. Methodology: The present study was conducted in the Department of Forensic Medicine and Toxicology NMCH, Patna, Bihar, India. 92 people between the ages of 14 and 20 participated in a cross-sectional research. Using Jit and Kulkarni’s four-stage categorization, digital X-rays of the shoulder joint were examined for epiphyseal fusion of the acromion process, coracoid process, and humeral head. Simple random selection was used to choose participants who satisfied certain inclusion requirements. Results: As age increased, the research showed a gradual pattern of ossification and fusion. By the time they were 18 to 20 years old, stage 3 (full fusion) was the most common. In accordance with known developmental tendencies, females had somewhat earlier epiphyseal fusion than males. Conclusion: A valid and useful method for estimating age in the Bihar population is the radiographic evaluation of shoulder ossification. Skeletal maturity data particular to a region improves the precision of forensic and medico-legal investigations.

Background: Road traffic crashes (RTCs) constitute a worldwide public health concern, with pedestrian fatalities accounting for a substantial proportion of total deaths.  Pedestrians constitute one of the most susceptible categories of road users, frequently incurring significant injuries from direct car collisions.  Recognizing the patterns of injuries and the severity of pedestrian fatalities is essential for devising effective road safety measures. Objective: The study assesses pedestrian injury patterns in road traffic mortality by analyzing the severity, character, and distribution of injuries sustained in RTAs. Methodology: A cross-sectional study of 96 pedestrian fatalities in RTAs was carried out in Patna, Bihar, India.  Data was obtained from medical records, inquest reports, and police documentation.  Injuries were categorized based on anatomical locations, severity, and injury type.  Statistical analysis, including frequency distributions and chi-square tests, was performed with SPSS software. Results: The largest age group of victims was 25-35 years, comprising 41.4%, while the majority of victims were male, accounting for 83.59%.  Head injuries constituted 28.13% of cases, making them the most prevalent type of injury, followed by lower limb injuries at 17.97%.  The majority of severe injuries constituted 51.56%, with fatal injuries primarily including head traumas at 15.63% and head-chest trauma at 14.58%.  Pedestrian fatalities resulted from high-impact crashes, primarily involving four-wheelers and big automobiles on national highways. Conclusion: The study highlights the significance of vehicle type, road condition, and collision severity in pedestrian RTAs.  Pedestrian safety apparatus, improved roadway infrastructure, and rigorous traffic laws are vital to reduce pedestrian injuries and fatalities.

Background: Postoperative pain is a common clinical problem, which may compromise recovery and hospital stay. Proper pain management, preferably in infra-umbilical procedures, is very important to optimize patient’s outcomes. Although opioids such as tramadol are popular, their adverse effects – nausea, vomiting, sedation, and respiratory depression – do not make them desirable. Intravenous (IV) paracetamol: a non-opioid analgesic, which is gaining popularity as the potential alternative with favourable safety profile. Aim: To compare intravenous paracetamol and tramadol for efficacy and safety for use in the postoperative period in patients undergoing infra-umbilical general surgeries. Methods: It was an observational study that took place in Sheikh Bhikari Medical College, Hazaribagh, Jharkhand, India for one year. 52 patients undergoing elective infra-umbilical surgeries were randomly selected in to the two groups. Group A (IV paracetamol 15mg/kg) and group B (IV tramadol 2mg/kg). The intensity of pain was measured by the Visual Analogue Scale at 0, 1, 2, 4, 6 hours post operatively. Undesirable effects and need for rescue analgesia were also noted. Results: The two groups exhibited similar outcomes in the early hours of having their blood. However, Group A (paracetamol) had statistically lower VAS scores reported at 2, 4, and 6 hours. More adverse effects such as nausea and sedation occurred in Group B (tramadol), which would suggest for better tolerability with paracetamol. Conclusion: IV paracetamol has better analgesic efficacy in the later postoperative period and has fewer side effects than tramadol and is thus, a safe drug for the postoperative pain management system on infra-umbilical operation.

Background: Hollow viscus perforation (HVP) represents a common surgical emergency associated with high morbidity and mortality. The Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM) scoring system is widely used to predict postoperative outcomes. This study aimed to assess the validity of POSSUM scoring in predicting morbidity and mortality among patients undergoing emergency surgery for hollow viscus perforation at a tertiary care hospital in Bihar. Methods: This prospective observational study was conducted in the Department of General Surgery, Himalaya Medical College, and Hospital, Chiksi, Paliganj, Patna, Bihar, from June 2024 to November 2024. A total of 130 patients diagnosed with hollow viscus perforation and managed surgically were included. Preoperative physiological parameters and intraoperative operative severity scores were recorded as per the POSSUM protocol. Predicted morbidity and mortality were compared with observed outcomes, and the predictive accuracy was analyzed using the O:E ratio and Chi-square test. Results: Among 130 patients, the most common cause of HVP was duodenal ulcer (38.5%), followed by typhoid ileal perforation (25.4%). The observed mortality was 11.5% compared to a predicted mortality of 13.1%. The observed morbidity was 27.7%, while the predicted morbidity was 30.8%. The O:E ratio for mortality and morbidity was 0.88 and 0.90, respectively, suggesting POSSUM slightly overpredicts adverse outcomes but remains a reliable risk stratification tool. Conclusion: POSSUM scoring is a useful predictor of postoperative morbidity and mortality in patients with hollow viscus perforation. Although it tends to slightly overestimate risk, it serves as an effective tool for surgical audit and clinical decision-making in resource-limited settings.

Background: Chronic venous insufficiency (CVI) is a common vascular disorder characterized by compromised venous return from the lower limbs, frequently presenting with symptoms like leg pain, edema, and varicosities. Non-invasive diagnostic tools, particularly color duplex ultrasonography, have become the cornerstone in the evaluation of CVI due to their reliability and accessibility. Objectives: To assess the pattern, distribution, and severity of lower limb venous insufficiency using color duplex ultrasonography in a defined population through a retrospective analysis. Methods: A retrospective observational study was conducted in the Department of Radiology, Sri Krishna Medical College, and Hospital, Muzaffarpur, Bihar, India. A total of 120 patients who underwent color duplex ultrasonography for clinically suspected lower limb venous insufficiency between April 2020 and March 2021 were included. Patient demographics, clinical presentation, and ultrasonographic findings were reviewed. Reflux was analyzed in the superficial, perforator, and deep venous systems. Results: Among the 120 patients, 72 (60%) were male and 48 (40%) were female, with a mean age of 47.3 ± 12.1 years. The predominant symptom was lower limb swelling (68%), followed by pain (55%) and visible varicose veins (42%). Color duplex evaluation revealed venous reflux in the great saphenous vein (GSV) in 78 patients (65%), small saphenous vein (SSV) in 34 patients (28%), and perforator veins in 46 patients (38%). Deep venous reflux was identified in 26 patients (22%). Bilateral venous insufficiency was seen in 52 patients (43%). Reflux severity was categorized as mild (28%), moderate (46%), and severe (26%). Conclusion: Color duplex ultrasonography proves to be an effective, non-invasive modality for diagnosing and classifying lower limb venous insufficiency. The findings underscore the predominance of superficial venous reflux, particularly involving the GSV, and reinforce the importance of early imaging for timely intervention.

Background: Appendicoliths are calcified deposits within the appendix and are considered important diagnostic indicators in acute appendicitis. Contrast-enhanced computed tomography (CT) is a key imaging modality for appendicitis diagnosis, but the optimal amount of contrast material needed for clear visualization of appendicoliths remains unclear. Balancing diagnostic clarity with contrast dose minimization is critical to reduce potential adverse reactions and cost. Objective: To evaluate the correlation between the amount of intravenous contrast material administered during abdominal CT and the detection rates of appendicoliths in patients with suspected appendicitis. Materials and Methods: This retrospective study analyzed abdominal CT scans performed between May 2020 to April 2021 in patients presenting with right lower quadrant abdominal pain. A total of 135 patients were included (sample size: 100–150), divided into three groups based on contrast volume used: low-dose (≤80 mL), standard-dose (81–100 mL), and high-dose (>100 mL). Radiological detection of appendicoliths was assessed by two experienced radiologists blinded to the contrast volume. Data on patient demographics, imaging parameters, and appendicolith visibility were recorded and analyzed statistically. Results: Among the 135 patients, appendicoliths were detected in 42 cases (31.1%). Detection rates were 22.5%, 35.5%, and 37.8% in the low-, standard-, and high-dose groups, respectively. A statistically significant improvement in appendicolith detection was observed in the standard and high-dose groups compared to the low-dose group (p < 0.05). However, the difference between standard and high doses was not statistically significant (p > 0.05). Conclusion: While higher volumes of contrast improve appendicolith detection on abdominal CT, standard doses (81–100 mL) may offer an optimal balance between diagnostic accuracy and contrast load. These findings suggest a need for protocol refinement to minimize contrast-related risks without compromising diagnostic efficacy.

Background: Total knee arthroplasty (TKA) is one of the best surgical treatments for people with end-stage knee osteoarthritis (OA) because it relieves discomfort and helps them move around again. The range of motion (ROM) of the knee after surgery is a very important feature that affects how happy patients are. There has been a lot of research on preoperative factors such body mass index (BMI), tibiofemoral angle, and preoperative knee ROM. However, it is still not obvious how beforehand ROM affects postoperative knee flexion hip. Aim: To find out how preoperative hip ROM affects knee flexion three months after surgery in people who have main TKA. Methodology: This study was done at the Department of Orthopaedics at Justice K.S. Hegde Charitable Hospital in Mangalore from September 2022 to April 2024. We looked at 23 patients with primary knee OA who were having TKA. Before the surgery, they measured the hip and knee ROM, BMI, serum albumin, HbA1c, and tibiofemoral angle. Three months after the operation, the knee flexion was assessed. We used SPSS software to do statistical analysis and Spearman’s correlation to find connections. Results: The average knee flexion three months after surgery was 94.78° ± 8.46°. There were strong negative relationships between BMI (r = -0.475, p = 0.022) and tibiofemoral angle (r = -0.421, p = 0.046) and knee flexion after surgery. Preoperative hip flexion and postoperative knee flexion had a moderate positive connection (r = 0.406, p = 0.054), which was close to being statistically significant. There was no significant link between other hip motions, age, serum albumin, or HbA1c and surgical outcomes. Conclusion: Hip flexion before surgery may affect knee flexion after TKA, which means that hip mobility should be taken into account during the preoperative evaluation. BMI and the tibiofemoral angle are still crucial factors that can help predict how much range of motion the knee will have after surgery. More research with bigger groups is needed to confirm these results.

Background: Chronic low back pain (CLBP) is a prevalent clinical condition with multifactorial etiology, often involving both radiculopathy and myofascial trigger points. While Transforaminal Epidural Steroid Injection (TFESI) is an established intervention for radicular pain, it may be insufficient when myofascial components are concurrently present. This study evaluates whether combining TFESI with Trigger Point Injection (TPI) offers superior pain relief and functional outcomes compared to TFESI alone. Objectives: To assess and compare the effectiveness of TFESI alone versus TFESI combined with TPI in reducing pain intensity, improving functional status, prolonging analgesic duration, and reducing analgesic requirement in patients with chronic low back pain. Methods: This was a prospective, comparative study conducted from January 2018 to December 2018 at Department of Anesthesia, Government Medical College, Bettiah, Bihar, India. A total of 120 patients with chronic low back pain were randomly divided into two groups: Group A received TFESI alone, while Group B received TFESI combined with TPI. Pain severity was measured using the Visual Analogue Scale (VAS), and functional impairment was assessed using the Oswestry Disability Index (ODI). Assessments were done at baseline, 1 week, 1 month, and 3 months post-procedure. Duration of analgesia, rescue analgesic requirement, adverse effects, and patient satisfaction were also recorded. Results: Both groups showed significant improvement in VAS and ODI scores post-intervention. However, Group B (TFESI + TPI) demonstrated significantly better pain relief and functional outcomes at all follow-up intervals (p < 0.001). The duration of analgesia was significantly longer in Group B (8.7 ± 2.2 weeks) than in Group A (4.1 ± 1.4 weeks), and fewer patients in Group B required rescue analgesics. Patient satisfaction was higher in the combination group, and no major complications were reported. Conclusion: The combination of TFESI with TPI provides enhanced and prolonged analgesia, superior functional improvement, and greater patient satisfaction compared to TFESI alone in managing chronic low back pain. This combined approach is safe, effective, and should be considered in routine clinical practice for patients with both radicular and myofascial components of pain.

Background: The supraclavicular brachial plexus block is a commonly employed regional anesthetic technique for upper limb surgeries. Ropivacaine, a long-acting local anesthetic, is frequently used in this block. To enhance its efficacy and duration, various adjuvants such as opioids and α2-adrenergic agonists are used. This study compares the efficacy of dexmedetomidine versus fentanyl as adjuvants to ropivacaine (0.75%) in supraclavicular brachial plexus block. Objectives: To evaluate and compare the onset, duration, and quality of sensory and motor block, as well as postoperative analgesia and side-effect profile of dexmedetomidine and fentanyl when used with ropivacaine (0.75%). Methods: A randomized, double-blind comparative study was conducted on 120 patients scheduled for upper limb surgeries under supraclavicular brachial plexus block. Patients were randomly divided into two groups: Group RD (n=60) received 30 mL of 0.75% ropivacaine with 1 μg/kg dexmedetomidine, and Group RF (n=60) received 30 mL of 0.75% ropivacaine with 1 μg/kg fentanyl. Onset and duration of sensory and motor block, duration of analgesia, hemodynamic changes, and adverse effects were recorded. Results: Group RD showed significantly faster onset and longer duration of both sensory and motor block compared to Group RF. Duration of postoperative analgesia was significantly prolonged in the dexmedetomidine group. Hemodynamic stability was better maintained in Group RD, with fewer incidences of nausea and vomiting compared to Group RF. Conclusion: Dexmedetomidine as an adjuvant to 0.75% ropivacaine in supraclavicular brachial plexus block provides superior block characteristics and longer postoperative analgesia than fentanyl, with a better safety profile.

Background: Everyone agrees that breastfeeding is the best way to keep babies healthy and alive. Even with global and national programs like the WHO’s Baby-Friendly Hospital Initiative (BFHI) and India’s MAA program, the rates of exclusive breastfeeding are still not good enough, especially among first-time moms in developing areas. Aim: The goal of this study was to look at the problems that healthy first-time moms of full-term babies confront when they leave the hospital and to find out what factors affect breastfeeding success in mothers, babies, and society. Methods: Between February 2023 and October 2023, a cross-sectional observational study was done in the postnatal ward of Kurji Holy Family Hospital in Patna. A standardised questionnaire was sent to 280 healthy first-time mothers with full-term newborns. We gathered information on the mother’s age, mode of birth, nursing methods, and problems that came up and used SPSS v25 to analyse the data. Results: 79.6% of moms exclusively breastfed their babies, 17.5% partially breastfed, and 2.9% did not breastfeed at all. Some common problems were pain when feeding (28.2%), breast engorgement (17.9%), not enough milk (15.4%), and not having enough privacy (16.1%). Psychological and social problems, such as maternal worry and the state of the ward, made breastfeeding even harder. Conclusion: The study shows that most first-time mothers start breastfeeding, but there are several reasons why they can’t keep doing it exclusively. To increase breastfeeding results and make sure the health of both the mother and the baby, structured lactation assistance, antenatal counselling, and adjustments to the baby’s surroundings after birth are all necessary.

Background: Chronic anal fissures are a common proctologic condition causing severe pain and distress. Two prominent modalities for treatment include chemical sphincterotomy using topical agents and surgical lateral internal sphincterotomy (LIS). This study aims to compare the efficacy, safety, and recurrence rates of both techniques. Methods: A prospective randomized comparative study was conducted at Department of General Surgery in Patna Medical College and Hospital, Patna, Bihar, India from February 2020 to January 2021. A total of 120 patients diagnosed with chronic anal fissures were randomly assigned to either chemical sphincterotomy (0.2% glyceryl trinitrate) or lateral internal sphincterotomy. Outcomes measured included pain relief, healing time, complications, and recurrence. Results: LIS demonstrated a significantly faster healing rate and better long-term fissure resolution. However, minor complications such as transient incontinence were slightly more common in the surgical group. Chemical sphincterotomy was associated with fewer immediate complications but had a higher recurrence rate. Conclusion: While both methods are effective, LIS provides superior long-term outcomes despite a slightly higher risk of transient complications. Patient selection and individual risk assessment are crucial for determin-ing the ideal therapeutic approach.

Background: Post-dural puncture headache (PDPH) is a common complication following spinal anesthesia during caesarean section. This study aims to evaluate the effect of intrathecal fentanyl in preventing PDPH in women undergoing caesarean section under spinal anesthesia. Objectives: (1) To evaluate the efficacy of intrathecal fentanyl in preventing the occurrence of post-dural puncture headache (PDPH) following caesarean section under spinal anesthesia. (2) To compare the incidence, severity, and duration of PDPH between women who received intrathecal fentanyl and those who received local anesthetic alone. (3) To assess the requirement for additional postoperative analgesia in both groups and determine the effectiveness of intrathecal fentanyl in enhancing post-operative pain control. (3) To monitor and document any potential side effects or complications associated with the use of intrathecal fentanyl during spinal anesthesia for caesarean section. Methods: This prospective randomized controlled trial was conducted at Department of Anesthesiology, Netaji Subhas Medical College, and Hospital, Bihta, Patna, Bihar, India for one year.  A total of 150 pregnant women undergoing elective caesarean section under spinal anesthesia were randomly divided into two groups: one group received 25 µg of intrathecal fentanyl along with the local anesthetic, while the other group received local anesthetic alone. Postoperative assessments were made for the incidence, severity, and duration of PDPH, additional analgesic requirements, and any side effects of the intervention. Results: The incidence of PDPH was significantly lower in the fentanyl group compared to the control group. Additionally, the severity and duration of PDPH were reduced in the fentanyl group. Patients in the fentanyl group also required less supplementary analgesia postoperatively, demonstrating better pain control. No significant adverse effects were observed in the fentanyl group. Conclusion: Intrathecal fentanyl is an effective adjunct to spinal anesthesia for preventing PDPH in women undergoing caesarean section. It significantly reduces the incidence, severity, and duration of PDPH and improves post-operative pain control, making it a valuable option in this patient population.

Background: Vitamin D is a critical nutrient involved in various biological processes, including calcium regulation, immune function, and vascular health. During pregnancy, particularly in the third trimester, vitamin D deficiency is associated with an increased risk of complications such as preeclampsia, a condition characterized by hypertension and proteinuria. Preeclampsia remains a leading cause of maternal and fetal morbidity worldwide, and its pathophysiology is believed to involve immune system dysfunction, endothelial injury, and disturbed vascular remodeling. This review explores the potential connection between vitamin D deficiency in the third trimester of pregnancy and the development of preeclampsia, focusing on whether pharmacological intervention through vitamin D supplementation may help mitigate this risk. Objective: The objective of this comprehensive review  is to assess the role of vitamin D in preventing or reducing the incidence of preeclampsia, particularly in women who experience vitamin D deficiency during the third trimester. By reviewing current literature, this study aims to establish whether pharmacological intervention with vitamin D supplementation is an effective strategy to override the risk of preeclampsia. Methods: This study is a retrospective analysis conducted at Department of Obstetrics and Gynaecology, Katihar Medical College, and Hospital, Katihar, Bihar, India for one year. A thorough literature search was conducted using databases. to identify relevant studies on the role of vitamin D in pregnancy and its impact on preeclampsia. The review includes randomized controlled trials, cohort studies, and systematic reviews that examine the relationship between vitamin D levels and the onset of preeclampsia, as well as studies assessing the efficacy of vitamin D supplementation in pregnant women. Results: Studies consistently show a strong association between low vitamin D levels and the increased risk of developing preeclampsia. Women with deficient or insufficient vitamin D levels in the third trimester are more likely to develop hypertensive disorders compared to those with adequate vitamin D levels. Moreover, clinical trials suggest that vitamin D supplementation during pregnancy, especially in the third trimester, may reduce the incidence of preeclampsia, though the optimal dosage and timing remain areas of active research. Conclusion: This review underscores the importance of maintaining adequate vitamin D levels during pregnancy to reduce the risk of preeclampsia. Pharmacological intervention through vitamin D supplementation appears to be a promising preventive measure, but further research is needed to confirm the optimal dose and timing of supplementation. The findings suggest that vitamin D supplementation may be a key strategy in managing pregnancy-related hypertensive disorders, particularly in populations with high rates of vitamin D deficiency.

Background: Acute pancreatitis (AP) can lead to several local complications, including pancreatic necrosis, pseudocysts, and walled-off necrosis, which occasionally necessitate surgical intervention. Early identification of surgical indications and understanding postoperative outcomes are essential for optimal patient management. Objectives: To analyze the indications for surgery in local complications of acute pancreatitis and to evaluate the clinical outcomes following operative management. Methods: This prospective observational study included 132 patients with acute pancreatitis who developed local complications and underwent surgical intervention at Department of General Surgery, Patna Medical College and Hospital, Patna, Bihar, India between Oct 2019 and September 2020. Data were collected on demographic profile, type of local complication, indication for surgery, procedure performed, and postoperative outcomes. Results: The most common indication for surgery was infected pancreatic necrosis (45.4%), followed by symptomatic pseudocysts (27.3%) and persistent abdominal sepsis due to walled-off necrosis (18.2%). Open necrosectomy was the most frequently performed procedure. Postoperative morbidity occurred in 34.8% of patients, and mortality was recorded in 9.8%. Factors associated with poor outcomes included delayed presentation, organ failure, and extensive necrosis. Conclusion: Surgical management of local complications of acute pancreatitis is often life-saving when performed based on strict indications. Early recognition and timely intervention significantly reduce morbidity and mortality, especially in patients with infected necrosis and systemic complications.

Background: Displaced ^‘femoral neck fractures are a serious condition among elderly adults, in which surgery is normally necessary to regain function and reduce mortality. Two procedures, Total Hip Arthroplasty (THA) and Hemiarthroplasty (HA), are most frequently used but best selection is debatable. Aim: To compare the clinical results of HA and THA in elderly patients with displaced femoral neck fractures treated at a tertiary care Centre in Bihar, India. Methodology: Retrospective observational study included 80 patients aged ≥60 years who were operated with either THA (n=40) or HA (n=40) for one year. Hospital records provided data, which included demographic data, hospital stay, postoperative complications, revision surgery, and functional outcome by the Harris Hip Score (HHS). Statistical analysis was performed using SPSS v27. Results: Demographically equivalent groups were the groups. Patients undergoing THA had a greater mean HHS at six months (85.1 ± 6.2) than HA patients (76.3 ± 7.5) (p < 0.001). Hospital stay was longer in the THA group (6.7 vs. 5.4 days; p < 0.05). No statistically significant differences were observed between groups in rates of complication or revision surgery. Conclusion: THA offers superior functional outcomes compared to HA in elderly patients, despite longer hospital stays. HA remains a viable option for frail patients. This study supports individualized surgical decision-making and provides local data to inform clinical practice in resource-constrained settings.

Background: Ankle osteoarthritis (OA) with a coronal plane deformity makes surgery very difficult. In the past, total ankle replacement (TAR) was not done in these circumstances because people were worried about fixing the alignment and the implant’s long-term success. However, improvements in surgical methods and implant design, especially with the STAR prosthesis, have made TAR possible for more people, even those with moderate to severe deformity. Aim and Objective: The goal of this study was to look at the long-term functional and radiological results of STAR complete ankle replacement in people with moderate to severe coronal plane abnormalities, as well as the rates of implant survival and complications. Materials and Methods: The research took the form of an observational study that monitored patients at the Department of Orthopaedics in Government Medical College and Hospital, Purnea, Bihar,India for 12 months, 72 patients with end-stage ankle OA and varus or valgus deformities of 10° or more had STAR complete ankle replacement surgery. We used AOFAS Ankle-Hindfoot scores, FAAM scores, and VAS pain levels to measure how well things worked. At least five years of follow-up were used to look at how well the radiographic alignment was maintained and how long the implant lasted. Results: The average AOFAS score increased from 43.7 ± 9.4 before surgery to 84.9 ± 8.1 at the last follow-up. All the scores went up: FAAM scores went from 45.6 ± 11.2 to 82.7 ± 9.6, and VAS pain levels went down from 7.6 ± 1.3 to 2.1 ± 1.2 (p < 0.001 for all). 91.7% of patients kept their coronal alignment. The Kaplan-Meier survival analysis showed that 97.2% of implants survived after five years and 91.5% after eight years. There were not many complications or revisions overall. Conclusion: When done with careful surgical planning and the right correction of deformity, STAR total ankle replacement gives patients with moderate to severe coronal plane deformities excellent long-term functional outcomes, long-lasting alignment correction, and a high rate of implant survival. It is a reliable way to preserve motion instead of ankle arthrodesis for these difficult patients.

Background: Laryngoscopy and tracheal intubation provoke significant sympathetic stimulation, leading to transient but marked increases in heart rate and blood pressure. Fentanyl, a synthetic opioid, is widely used to blunt this response. This study evaluates the comparative efficacy of two different intravenous fentanyl doses in attenuating these hemodynamic changes. Objectives: To compare the hemodynamic responses—specifically systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR)—to laryngoscopy and tracheal intubation following administration of 2 µg/kg and 4 µg/kg fentanyl. Methods: This prospective study was conducted on 120 adult patients aged 18–60 years undergoing elective surgery under general anesthesia. Patients were randomly allocated into two groups: Group F2 received 2 µg/kg fentanyl, and Group F4 received 4 µg/kg fentanyl 5 minutes before induction. Hemodynamic parameters were recorded at baseline, after fentanyl, post-induction, and at 1, 3, and 5 minutes post-intubation. Results: Both groups experienced an increase in HR and BP after intubation; however, Group F4 showed significantly blunted responses across all parameters. The rise in SBP, DBP, MAP, and HR was significantly lower in Group F4 at all measured time points post-intubation (p < 0.05). Conclusion: Higher dose fentanyl (4 µg/kg) more effectively attenuates the pressor and tachycardic responses to laryngoscopy and tracheal intubation compared to the standard 2 µg/kg dose, without any notable adverse effects.

Background: Spinal anesthesia is the preferred anesthetic technique for elective cesarean sections due to its simplicity, rapid onset, and reliability. Bupivacaine is commonly used for spinal anesthesia; however, the addition of intrathecal opioids like fentanyl can improve the quality of anesthesia and analgesia. This study evaluates the effects of varying doses of fentanyl in combination with bupivacaine on intraoperative anesthesia quality, duration of analgesia, and maternal and neonatal outcomes. Objectives: To compare the efficacy and side effect profile of three different doses of fentanyl (10 µg, 20 µg, and 25 µg) when combined with 0.5% hyperbaric bupivacaine in spinal anesthesia for elective cesarean section. Methods: A retrospective observational study was conducted at Patna Medical College and Hospital. Medical records of 135 parturients who underwent elective cesarean section under spinal anesthesia for one year . Patients were categorized into three groups based on the dose of intrathecal fentanyl used: Group A (10 µg), Group B (20 µg), and Group C (25 µg), each with 45 patients. Data regarding sensory and motor block characteristics, intraoperative analgesia, hemodynamic changes, side effects, and neonatal APGAR scores were collected and analyzed. Results: All three groups achieved adequate surgical anesthesia. Group C had the longest duration of postoperative analgesia (mean 245 ± 30 min) compared to Group A (180 ± 25 min) and Group B (215 ± 28 min). Incidence of pruritus and nausea was higher in Group C. Hemodynamic stability and neonatal outcomes were comparable among all groups. Conclusion: The addition of fentanyl to intrathecal bupivacaine enhances postoperative analgesia in a dose-dependent manner. A dose of 20 µg offers a favorable balance between efficacy and side effects, making it a suitable choice for elective cesarean sections.

Background: Nutrient foramina are essential anatomical landmarks through which the principal nutrient artery enters the bone, playing a vital role in the nourishment and growth of long bones. In surgical procedures such as orthopedic fixation, joint replacement, and fracture management, detailed anatomical knowledge of the location, number, and direction of nutrient foramina is critical to prevent vascular compromise. Despite their importance, variations exist in their number and position across populations and individual bones. This study was undertaken to analyze the number, location, and direction of nutrient foramina in the long bones of the lower limb among individuals in the Bihar population. Objectives: (1) To identify and record the number of nutrient foramina in the femur, tibia, and fibula. (2) To determine the typical and atypical location of nutrient foramina on these bones. (3) To assess the direction and distance of the foramina from bone landmarks and correlate with existing anatomical norms. Materials and Methods: This cross-sectional observational study was conducted in the Department of Anatomy, Anugrah Narayan Magadh Medical College, Gaya, Bihar. A total of 180 dry adult human long bones of the lower limb (60 each of femur, tibia, and fibula) were studied. Bones with deformities or pathological alterations were excluded. The number and location of nutrient foramina were recorded using magnifying lenses and measuring tapes. Distance from proximal and distal ends, direction of canal, and position on specific bone surfaces were documented. Data were statistically analyzed to determine frequency distributions and morphometric ranges. Results: Out of 180 bones, 92% had at least one nutrient foramen, with the femur most frequently showing a single foramen (76.7%). The tibia showed two foramina in 30% of cases, while the fibula had a single foramen in 83.3% of specimens. The nutrient foramen was most commonly found on the posterior surface in the femur and tibia, and on the medial surface of the fibula. The direction of all foramina followed the general rule of “towards the elbow and away from the knee.” Mean distance from the upper end varied from 12 to 15 cm across bones. Conclusion: This anatomical study reinforces that the number, location, and direction of nutrient foramina follow a consistent population-based pattern, with some variations observed. Awareness of these parameters is crucial for surgeons during intramedullary nailing, bone grafting, and reconstructive procedures to minimize vascular injury. The findings provide region-specific anatomical data that can aid in better surgical planning and academic reference for the Bihar population.

Background: Orthodontic tooth movement (OTM) involves the application of mechanical forces that induce changes in the periodontal tissues. Cathepsin K, a protease enzyme, plays a significant role in bone remodeling during OTM. This study aimed to assess the presence and levels of Cathepsin K in the gingival crevicular fluid (GCF) of individuals undergoing orthodontic treatment. Methods: This prospective study was conducted in the Department of Dentistry, Narayan Medical College, and Hospital, Sasaram, Bihar, India from Jan 2018 to December 2018. A total of 120 patients (60 males and 60 females, aged 18–35 years) undergoing orthodontic treatment were selected for the study. Gingival crevicular fluid samples were collected at baseline, and at 1, 2, and 4 weeks following the application of orthodontic forces. The levels of Cathepsin K in the GCF were quantified using enzyme-linked immunosorbent assay (ELISA). Results: The levels of Cathepsin K in the GCF increased significantly within the first two weeks after the initiation of orthodontic treatment, with the highest levels observed at the second week. The data showed a marked variation in enzyme levels between different regions of the dental arch, with the highest levels seen in areas where maximum force was applied. Conclusion: Cathepsin K is a key biomarker in the monitoring of bone remodeling during orthodontic treatment. The increased concentration of Cathepsin K in gingival crevicular fluid during the early phase of orthodontic tooth movement suggests its potential as a diagnostic tool for evaluating bone remodeling processes in orthodontics.

Background: Achieving adequate interproximal space between teeth is a fundamental prerequisite for band placement during fixed orthodontic therapy. Dental separators serve this purpose by temporarily displacing adjacent teeth without causing irreversible damage or significant patient discomfort. With advancements in material science, various radiologically visible separators have been developed to improve placement accuracy and clinical monitoring. However, a comparative evaluation of their separation efficacy remains underexplored, particularly within the Indian dental population. Aim: To evaluate and compare the separation efficacy of four different radiologically detectable dental separator types using standardized interproximal space measurement techniques. Materials and Methods: This randomized controlled clinical trial was conducted in the Department of Dentistry, Narayan Medical College, and Hospital, Sasaram, Bihar, India from May 2018 to April 2019. A total of 80 patients requiring orthodontic band placement were divided into four equal groups (n=20) based on the type of separator used: Elastomeric separators, Dumbbell separators, Radiopaque coil spring separators, and Radiopaque separating modules. The separators were placed interdentally between the maxillary first molar and second premolar. Standardized bitewing radiographs were taken pre-placement and at 24, 48, and 72 hours to evaluate the separation achieved. Measurements were recorded in millimeters using digital calipers on radiographic images. Results: At 72 hours, all four separator types achieved clinically acceptable separation; however, the Dumbbell separator group showed the highest mean separation (0.42 mm ± 0.05), followed by Radiopaque coil spring (0.39 mm ± 0.06), Radiopaque separating module (0.36 mm ± 0.04), and Elastomeric separator (0.33 mm ± 0.03). Statistically significant differences were observed between groups at each time point (p<0.05). Conclusion: Dumbbell separators demonstrated superior separation efficacy among the four evaluated types, followed closely by radiopaque coil springs. The findings suggest that material design and radiopacity significantly influence clinical performance. Careful selection of separator type can improve treatment efficiency and patient outcomes in orthodontic practice.

Background: Nasotracheal intubation is frequently employed in maxillofacial, dental, and certain head‐and‐neck procedures to optimize surgical access. Unlike orotracheal techniques, the nasal route may evoke differing sympathetic and nociceptive stimuli, potentially leading to distinct haemodynamic perturbations. Acute elevations in heart rate and blood pressure during intubation can increase myocardial oxygen demand and precipitate complications in vulnerable patients. Despite its common use, detailed characterization of the timing, magnitude, and duration of cardiovascular responses to nasotracheal intubation remains limited. This study aimed to quantify the haemodynamic changes occurring immediately before, during, and after nasotracheal intubation under standardized general anaesthesia. Methods: In this prospective observational study, 60 adult patients (ASA I–II), aged 18–65 years, scheduled for elective maxillofacial or dental surgery requiring nasotracheal intubation were enrolled. All received a uniform anaesthetic regimen: premedication with midazolam 0.05 mg/kg and fentanyl 2 µg/kg, induction with propofol 2 mg/kg and vecuronium 0.1 mg/kg, and maintenance with isoflurane in oxygen/air. A well‐lubricated, appropriately sized nasotracheal tube was passed under direct laryngoscopy. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded at baseline (pre‐induction), pre‐intubation (post‐muscle relaxation), immediately after tube placement (T0), and at 1 (T1), 3 (T3), and 5 minutes (T5) following intubation. Data were analysed using repeated‐measures ANOVA with Bonferroni correction; p < 0.05 was deemed significant. Results: All 60 patients completed the protocol. Compared with baseline, HR increased by 18 ± 6 bpm at T0 (p < 0.001), peaked at T1 with a rise of 22 ± 7 bpm (p < 0.001), and gradually returned toward baseline by T5 (increase 6 ± 4 bpm; p = 0.04). SBP rose from 122 ± 10 mm Hg at baseline to 150 ± 12 mm Hg at T0 (p < 0.001), peaked at 155 ± 14 mm Hg at T1 (p < 0.001), then declined to 130 ± 11 mm Hg by T5 (p = 0.02). DBP and MAP exhibited similar patterns, with maximal increases of 20 ± 5 mm Hg and 25 ± 6 mm Hg at T1, respectively (both p < 0.001). No patient experienced arrhythmias or required pharmacologic intervention beyond the planned protocol. Conclusions: Nasotracheal intubation under general anaesthesia elicits pronounced sympathetic responses, with heart rate and blood pressure peaking at approximately one minute post-intubation and returning toward baseline by five minutes. These transient haemodynamic surges should be anticipated and, when necessary, attenuated with tailored anaesthetic depth or short-acting vasoactive agents, especially in patients with cardiovascular comorbidities.

Background: Spinal anaesthesia with ropivacaine is widely used for lower abdominal and lower limb surgeries due to its favorable sensory-motor separation and safety profile. The baricity of the local anaesthetic solution influences onset time, density of block, and hemodynamic effects. Plain (isobaric) solutions tend to spread unpredictably, whereas hyperbaric formulations—made denser by addition of dextrose—may offer more reliable block characteristics. This study compares onset, level, duration of sensory and motor blockade, haemodynamic changes, and adverse effects between plain and hyperbaric 0.75% ropivacaine in elective lower abdominal and lower limb procedures. Methods: In this prospective, randomized, double-blinded trial, 100 ASA I–II adult patients (age 18–65 years) scheduled for elective lower abdominal or lower limb surgery under spinal anaesthesia were enrolled. Patients were randomized to receive 3 mL of 0.75% isobaric ropivacaine (Group P, n=50) or 3 mL of 0.75% hyperbaric ropivacaine (Group H, n=50). Spinal puncture was performed at L3–L4 with a 25G Whitacre needle in the sitting position. Sensory block onset (time to T10 dermatome), maximum level achieved, and two-segment regression time were recorded. Motor block was assessed by Modified Bromage Scale every minute until full block. Hemodynamic parameters (heart rate, blood pressure) were monitored every 2 minutes for 20 minutes, then every 15 minutes until end of surgery. Adverse events (hypotension, bradycardia, nausea, headache) were documented. Results: Group H exhibited a faster sensory onset (mean ± SD: 3.2 ± 0.8 min vs. 4.5 ± 1.1 min; p < 0.001) and higher maximum block level (T4 vs. T6; p = 0.002). Two-segment regression was prolonged in Group H (180 ± 22 min vs. 150 ± 18 min; p < 0.001). Motor block onset and duration were also significantly faster and longer respectively in Group H (onset 4.0 ± 0.9 min vs. 5.3 ± 1.2 min, p < 0.001; duration 160 ± 20 min vs. 135 ± 15 min, p < 0.001). Incidence of hypotension was higher in Group H (30% vs. 16%; p = 0.04), though easily managed with fluid bolus and vasopressors. No significant differences in bradycardia or other side effects were noted. Conclusions: Hyperbaric 0.75% ropivacaine provides faster onset, higher block level, and longer duration of sensory and motor blockade compared with plain solution but is associated with a greater incidence of hypotension. Selection of hyperbaric formulation may be advantageous when rapid, dense block is desired, with preparedness to manage hemodynamic changes.

Background: Effective postoperative pain management is crucial to enhance recovery and reduce morbidity following major abdominal surgeries. Epidural administration of local anesthetics such as ropivacaine provides segmental analgesia, but may be insufficient for optimal pain control in some patients. Tramadol, a weak μ-opioid receptor agonist with monoaminergic properties, has been shown to augment analgesia when delivered epidurally. This study aims to compare the analgesic efficacy and safety profile of epidural ropivacaine alone versus ropivacaine combined with tramadol in adult patients undergoing elective abdominal surgeries under general anaesthesia. Methods: In this prospective, randomized, double-blind trial, 80 adult patients (ASA I–II), aged 18–65 years, scheduled for elective lower abdominal surgery under general anaesthesia with epidural analgesia, were enrolled. Patients were randomly assigned to one of two groups (n=40 each):

• Group R received epidural ropivacaine 0.2% at 6 mL/hour.
• Group RT received ropivacaine 0.2% with tramadol 1 mg/mL at the same infusion rate.

General anaesthesia protocols were standardized across both groups. Postoperative pain intensity was assessed using a 10-point visual analogue scale (VAS) at 2, 4, 8, 12, 24, and 48 hours. Rescue analgesia (intravenous morphine 2 mg) was administered for VAS > 4, and cumulative morphine consumption was recorded. Hemodynamic parameters, sedation scores, and adverse events (nausea, vomiting, pruritus, respiratory depression) were monitored throughout the 48-hour postoperative period. Results: Both groups were comparable in demographic and intraoperative variables. Group RT demonstrated significantly lower mean VAS scores at all time points beyond 4 hours postoperatively (p < 0.05). The total morphine requirement in the first 48 hours was reduced by 35% in Group RT compared to Group R (mean ± SD: 8.2 ± 2.4 mg vs. 12.6 ± 3.1 mg; p < 0.001). Hemodynamic stability was maintained in both groups, with no clinically significant differences. Incidence of nausea and vomiting was slightly higher in Group RT (15% vs. 8%), though not statistically significant. No cases of respiratory depression or pruritus were observed. Conclusions: Adding tramadol to epidural ropivacaine significantly enhances postoperative analgesia and reduces opioid requirements in adult patients following abdominal surgery, without compromising hemodynamic stability. This combination may be considered an effective and safe option for postoperative pain management in this population.