Introduction: Laparoscopic cholecystectomy (LC) has become the gold standard for the management of symptomatic cholelithiasis due to its minimal invasiveness and faster recovery. However, it carries a risk of intraoperative and postoperative complications that can impact patient outcomes. Understanding these complications in a local institutional setting is essential for improving surgical safety and patient care. Objectives: To evaluate the incidence, nature, and outcomes of complications associated with laparoscopic cholecystectomy performed at our tertiary care center, and to identify factors associated with increased risk of complications. Methods: This retrospective observational study was conducted over a one-year period at Institute of Post-Graduate Medical Education and Research and Seth SukhlalKarnani Memorial Hospital, Kolkata and Nil Ratan Sircar Medical College and Hospital, Kolkata. and included 100 patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis. Data were collected from medical records and analyzed for intraoperative and postoperative complications, causes of conversion to open surgery, and bleeding events. Patient demographics and clinical variables, including age, gender, presence of acute cholecystitis, gallbladder wall thickness >4 mm, presence of adhesions, and operative time exceeding 90 minutes, were also recorded to assess their association with complications. Results: Among 100 patients undergoing laparoscopic cholecystectomy, 18% had complications. Intraoperative bile duct injury occurred in 1%, bleeding in 2%, gallbladder perforation in 4%, and bile leak in 6%. Conversion to open surgery was required in 5%. Postoperative complications included bile leak (6%), surgical site infection (3%), fever (5%), intra-abdominal collection (2%), pulmonary complications (1%), and reoperation (1%). No mortality was reported, and no patient or operative factor showed a significant association with complications. Conclusion: Laparoscopic cholecystectomy remains a safe and effective procedure for the management of gallstone disease. Most complications are minor and manageable; however, careful patient selection, meticulous surgical technique, and prompt recognition of complications are essential to minimize morbidity. Institutional audit of complications can help refine surgical protocols and enhance patient safety.

Introduction: Tympanoplasty is a surgical procedure aimed at repairing tympanic membrane perforations and restoring hearing. The underlay and overlay techniques are commonly employed, but there is ongoing debate regarding which approach yields better functional and anatomical outcomes. Aims: To compare the outcomes of underlay versus overlay tympanoplasty in patients with central and subtotal tympanic membrane perforations, in terms of graft success, postoperative hearing gain, and complications. Materials and Methods: The present study was a prospective comparative study. This study was conducted over a period of 16 months (February 2020 to May 2021) at the Department of Otorhinolaryngology, KPC Medical College & Hospital, Kolkata, West Bengal, India, and Pin-700032. The study population consisted of 50 patients with central tympanic membrane perforations who attended the outpatient department and fulfilled the inclusion criteria. Result: The underlay group demonstrated higher postoperative hearing gain, with 21 of 23 patients (91.3%) showing improvement, compared to 13 of 22 patients (59.1%) in the overlay group. Graft success was strongly correlated with Eustachian tube patency, achieving 95.6% in patent ET cases versus 25% in non-patent ET cases. Duration of preoperative dry ear also influenced graft uptake, with the highest success seen in patients with 1–6 months of dry ear (92.8%). Complications were fewer in the underlay group, with graft failure in 2 patients (8%) and pinhole perforation in 2 (8%), compared to 3 (12%) graft failures and higher rates of lateralization, healing problems, and myringitis in the overlay group. Conclusion: Underlay tympanoplasty demonstrated superior functional and anatomical outcomes compared to overlay tympanoplasty, with higher hearing improvement, greater graft success, and fewer complications. The study supports the preferential use of the underlay technique for central and subtotal tympanic membrane perforations, particularly in patients with patent Eustachian tubes and adequately dry middle ears.

Introduction: Anterior tympanic membrane perforations pose unique surgical challenges due to poor graft support and limited visualization. Various surgical techniques, including the anterior pull-through method and conventional flap method, have been proposed to improve graft uptake and functional hearing outcomes. Aims: The study aims to compare the anterior pull-through and conventional flap methods of tympanic membrane grafting with respect to complete graft uptake and postoperative hearing improvement. Specifically, it evaluates differences in graft success and hearing outcomes between the two techniques. Materials & Methods: This prospective, comparative hospital-based study was conducted in the Department of Otorhinolaryngology, KPC Medical College & Hospital, Jadavpur, Kolkata, over a period of 18 months (1st January 2023 to 30th June 2024). A minimum of 94 patients undergoing tympanoplasty for anterior tympanic membrane perforations were enrolled and allocated into two groups by simple random sampling after appropriate counseling and informed consent. Result: A total of 94 patients were equally divided into two groups: anterior pull-through (n=47) and conventional flap (n=47). The mean age was comparable between the groups (38.38 ± 7.25 vs. 36.00 ± 8.02 years; p=0.1341), with similar age distribution across 21–30, 31–40, and 41–50 years (p=0.5284). Both groups also had identical sex distribution with 14 females (29.8%) and 33 males (70.2%) each (p=1.000). Graft uptake at 2 weeks was 93.6% in the anterior pull-through group and 89.4% in the conventional group (p=0.4597), while at 1 and 3 months, uptake rates remained similar (93.6% vs. 91.5%, p=0.6944). Preoperative mean PTA was 26.83 ± 2.99 dB in the anterior pull-through group and 27.49 ± 3.12 dB in the conventional flap group (p=0.2977). At 1 month, PTA improved to 17.51 ± 3.69 dB vs. 18.28 ± 4.15 dB (p=0.3476), and at 3 months, further improved to 9.90 ± 3.93 dB vs. 10.73 ± 5.58 dB (p=0.4056). Overall, both techniques demonstrated high graft uptake rates and significant hearing improvement, with no statistically significant differences between them. Conclusion: The study indicate that both the anterior pull-through and conventional flap techniques of tympanoplasty are highly effective in managing anterior tympanic membrane perforations, achieving excellent graft uptake and significant hearing improvement. Graft success rates remained consistently above 89% in both groups at all follow-up intervals, while postoperative air-bone gap closure was substantial and comparable. No statistically significant differences were observed between the two methods in terms of graft uptake or hearing outcomes, suggesting that either technique can be reliably employed, with the choice depending on surgeon preference and intraoperative considerations.

Introduction: Patient satisfaction is a critical indicator of healthcare quality and is essential for the sustainability of public health institutions. In India, however, the systematic evaluation of patient perception remains an underutilized strategy for performance improvement. This study was conducted at GMERS Medical College & Hospital, Dharpur-Patan, 800-bedded tertiary care teaching hospital, to document and analyze patient satisfaction with its services. Methods: A descriptive cross-sectional study was conducted between April and June 2024. A total of 100 patients (50 OPD and 50 IPD) were selected using a stratified random sampling method. Data were collected via in-depth exit interviews using a pre-defined, semi-structured questionnaire covering domains such as registration/admission, clinical services, staff behavior, infrastructure, ancillary services, and the discharge process. Results: The study revealed a paradox in patient experience. While clinical services and the technical competence of doctors received high satisfaction ratings (88%), significant areas of dissatisfaction emerged in operational processes. Key issues for OPD patients included long waiting times and communication gaps. For IPD patients, major concerns were the poor quality of dietary services (76% dissatisfied) and a convoluted, lengthy discharge process (70% dissatisfied). Staff behavior was a critical determinant of the overall experience for both groups. Conclusion: Patient satisfaction at GMERS Hospital is a complex interplay of high trust in clinical competence and frustration with systemic inefficiencies. To enhance the overall quality of care, management must focus on improving patient flow, streamlining administrative processes like discharge, enhancing patient amenities, and fostering a uniformly patient-centric culture through staff training.

Background: Inadequate pain control in thyroid surgeries increases the level of stress hormones and rate of preoperative complications; hence, general anesthesia alone is often insufficient as postoperative analgesia; most patients require additional doses. Method: 72 (seventy-two) patients were selected for BSCPB with a saline group of 24 patients. Ropivacaine 0.487 = Group R24 patients; Ropivacaine 0.487 plus 10 µg/mL 5 µg/mL = Group RC 24 patients. Sufentanil was given during the intraoperative period for a 20% increase in arterial mean pressure or heart rate in patients with a bispectral index between 40 and 60. All patients received 4 gm of acetaminophen during the first 24 hours after surgery. The pain score was checked every 4 hours, and Nefopam was given to reduce pain scores >4 on a numeric pain scale. Results: The comparison of the mean values of demographic characteristics, age, height, and duration of surgery (minutes) remains insignificant (p>0.001). Indicates all groups have similar parameters. In the comparison of SBP at the end of resection, extubation had a significant p-value (p<0.001). In comparison and operative re-quirement, sufentanil (mg/kg) had a significant p-value (p<0.001) pain score in PACU; a pain score >6 was observed in group P. Conclusion: It is concluded that group RC (ropivacaine + clonidine) was significantly effective in the manage-ment of pain reduction and ideal anaesthetic agents to maintain hemodynamic status.

Background: Abdominal trauma significantly contributes to illness and death in emergency surgery, especially in areas with increasing road traffic accidents. Both blunt and penetrating injuries create challenges for diagnosis and treatment, often requiring quick action. Objectives: This study aimed to assess the clinical profile, presentation, diagnostic methods, management, and outcomes of patients with abdominal trauma at a tertiary care hospital. Methods: A prospective observational study was carried out at Al-falah medical college faridabad, haryana over two and half years (2023 to 2025). Seventy patients with abdominal trauma were enrolled after giving informed consent. We analyzed clinical data, injury type, imaging findings, organ involvement, management approaches, and outcomes using both descriptive and inferential statistics. Results: The average age of patients was 30.5 years, with a range from 14 to 65 years. Most patients were young adults between 21 and 30 years old (37.1%), and there was a male predominance (M:F = 4.8:1). Road traffic accidents (54.3%) and falls (37.1%) were the main causes of injury. Abdominal pain (91.4%) and tenderness (48.6%) were the most common symptoms. The FAST exam was positive in 81.5% of cases, showing splenic injuries (47.2%), liver injuries (39.6%), and renal injuries (9.4%). Conservative management was successful in 68.6% of patients, while 31.4% needed surgical procedures, including splenectomy, liver repair, nephrectomy, and bowel resection. Complications included wound infections, sepsis, and respiratory issues; mortality was linked to delayed care and severe bleeding. Conclusion: Abdominal trauma mainly impacts young males, with road traffic accidents as the leading cause. Non-operative management works well for most hemodynamically stable patients, while timely surgery is critical for those in unstable condition. Improving pre-hospital care, raising trauma awareness, and enhancing diagnostic facilities can help lower illness and death rates.

Background: The choice of anesthetic technique can significantly modulate the systemic stress and inflammatory response to surgery. Both general anesthesia (GA) and regional anesthesia (RA) are widely used, but their comparative impact on perioperative pathophysiology, as reflected by common blood markers, remains an area of active investigation. Methods: This prospective, comparative observational study included 120 patients (ASA physical status I-III) scheduled for primary unilateral TKA. Patients were allocated to receive either GA (n=60) or RA (n=60) based on patient and anesthesiologist preference. Venous blood samples were collected preoperatively (T0) and 24 hours postoperatively (T1). Markers analyzed included C-reactive protein (CRP), white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), serum cortisol, blood glucose, hemoglobin, and platelet count. Statistical analysis was performed using independent t-tests and Chi-square tests, with p<0.05 considered significant. Results: Baseline demographic and clinical characteristics were comparable between the two groups (p>0.05). At 24 hours postoperatively, the GA group exhibited significantly higher levels of key inflammatory markers compared to the RA group, including CRP (68.4 ± 9.2 mg/L vs. 47.1 ± 8.5 mg/L; p<0.001), WBC count (12.8 ± 1.9 x10⁹/L vs. 10.5 ± 1.7 x10⁹/L; p<0.001), and NLR (7.9 ± 1.5 vs. 5.6 ± 1.3; p<0.001). The GA group also showed a greater stress response, with significantly higher postoperative serum cortisol (24.8 ± 4.1 µg/dL vs. 18.2 ± 3.7 µg/dL; p<0.001) and blood glucose (135 ± 18 mg/dL vs. 119 ± 15 mg/dL; p<0.001). The postoperative decrease in hemoglobin and change in platelet count were not significantly different between groups (p=0.34 and p=0.18, respectively). Conclusion: In patients undergoing TKA, general anesthesia is associated with a significantly more pronounced systemic inflammatory and endocrine stress response at 24 hours post-surgery compared to regional anesthesia. These findings suggest that regional anesthesia may offer a protective advantage by attenuating the surgical stress response, which could have implications for patient recovery and postoperative outcomes.

Background: Pleomorphic adenoma is the most common benign salivary gland neoplasm, predominantly affecting the superficial lobe of the parotid gland. The standard treatment is superficial parotidectomy with preservation of the facial nerve. Two primary approaches for facial nerve dissection-antegrade (trunk-first) and retrograde (branch-first)-are practiced, yet their comparative outcomes remain debated. This study aims to evaluate surgical outcomes, complications, and recovery patterns between the two approaches. Methods: This prospective observational study was conducted in the Department of General Surgery, SCB Medical College, Cuttack, from May 2022 to September 2024, including 61 patients with primary pleomorphic adenoma of the superficial lobe of the parotid. Patients underwent superficial parotidectomy using either antegrade (n=30) or retrograde (n=31) facial nerve dissection. Operative time, duration of hospital stays, pain score, incidence of facial nerve paralysis, and other complications were recorded. Follow-up was done at 1, 3, and 6 months, with a maximum follow-up of 1.5 years. Statistical analysis was performed using SPSS v26.0. Results: Mean operative time was significantly shorter in the retrograde group (95.6 ± 7.4 min) compared to antegrade (116.2 ± 10.4 min; p<0.0001). Transient facial nerve paresis occurred more frequently with antegrade dissection (26.7%) versus retrograde (18.8%), with a significant difference (p=0.04). No cases of permanent paralysis, recurrence, or flap necrosis were reported. The incidence of parotid fistula and Frey’s syndrome was equal in both groups (3.6–4%). Mean hospital stays (≈9 days) and postoperative pain scores showed no significant difference. Conclusion: Retrograde facial nerve dissection in superficial parotidectomy is associated with reduced operative time and lower incidence of transient facial nerve paresis compared to the antegrade approach, with comparable complication rates and hospital stay. It is a safe and effective alternative for the management of pleomorphic adenoma.

Introduction: Warfarin therapy for venous thromboembolism (VTE) is complicated by wide inter-individual variability in dose requirements and response, largely influenced by genetic factors. Polymorphisms in CYP2C9 and VKORC1 genes modulate warfarin metabolism and sensitivity, with distinct prevalence and impact in different ethnic groups. Objective: To assess the distribution of CYP2C9 (*2 and *3) and VKORC1 (-1639G>A) polymorphisms in South Indian VTE patients and evaluate their influence on warfarin dosing and anticoagulation response. Methods: A cross-sectional study included 96 VTE patients on stable warfarin therapy and 96 healthy controls from Andhra Pradesh, India. Genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Associations between genotypes, maintenance dose, and INR were analyzed. Results: The VKORC1 genotype frequencies among patients were 64.6% GG, 22.9% GA, and 12.5% AA. CYP2C9 wild-type, heterozygous, and mutant allele frequencies were 29.2%, 6.3%, and 24%, respectively. Patients with VKORC1 AA genotype required significantly lower maintenance doses (mean 1.14 mg/day) compared to GG genotype (mean 3.59 mg/day), while maintaining higher INR (2.88 vs. 2.62). CYP2C9 variant carriers similarly showed reduced dose requirements. Conclusion: CYP2C9 and VKORC1 polymorphisms substantially modulate warfarin dose and response in South Indian VTE patients. Incorporation of pharmacogenetic testing into clinical practice may enhance personalized anticoagulation management and improve safety.

Background: Supracondylar fractures of the humerus are the most common elbow injuries in children, primarily affecting the 5–10-year age group. Proper stabilization is crucial to prevent complications like malunion, cubitus varus, and nerve injury. Two major pinning techniques cross pinning and lateral pinning are commonly used, but the optimal method remains debated due to concerns about mechanical stability and iatrogenic ulnar nerve injury. Aim: To compare the clinical and functional outcomes of cross pinning versus lateral pinning in the surgical management of displaced pediatric supracondylar humerus fractures using Flynn’s criteria. Materials and Methods: This longitudinal, hospital-based comparative study included 72 children (36 in each group) aged 2–12 years with Wilkins modified Gartland type IIB and III fractures. Patients underwent either cross pinning (medial and lateral entry) or lateral pinning (two or three lateral pins). Postoperative outcomes including loss of carrying angle, elbow range of motion, pin tract infection, and ulnar nerve injury were assessed. Data were analyzed using t-tests and chi-square tests. Results: Both groups had comparable demographics and fracture types. Loss of carrying angle (<5°) and elbow movement were similar between groups (p > 0.05). Pin tract infections were slightly higher in the cross-pinning group (11.11% vs 5.56%). Ulnar nerve neuropraxia occurred only in the cross-pinning group (5.56%), resolving after pin removal. Cross pinning showed slightly better mechanical stability, especially in Type III fractures, but lateral pinning demonstrated a superior safety profile with zero nerve injuries. Conclusion: Both techniques provide satisfactory functional and cosmetic outcomes. However, lateral pinning is safer, especially in swollen elbows or when nerve visualization is limited. The choice of pinning technique should be individualized based on fracture type, surgeon’s experience, and patient safety.

Background: Tennis elbow is a condition where the outer part of the elbow become sore and tender. It is a painful and debilitating condition, caused by angiofibroblastic hyperplasia of the tendinous origin of extensor carpi radialis brevis (ECRB) muscle. The disorder develops insidiously and is usually related to repetitive and strenuous physical activity and stress, mostly applied to the origin of the extensor carpi radialis brevis. Methods: This study was carried out prospectively on patients attending Out Patient Department of orthopedics, Sardar Patel Medical College, Bikaner with Chronic lateral epicondylitis between the age of 18-70 years of both male and female gender. Results: In male patients grip strength has been improved from 50% to 79.2% following injection at the end of 6th months. In female patients grip strength has been improved from 20% to 80% following injection at the end of 6th months. Conclusion:  We conclude that PRP injection significantly decrease pain and increased elbow performance at 6 months follow-up. It is an effective treatment modality for the management of Tennis elbow. 

Background: Glaucoma is a progressive optic neuropathy causing irreversible vision loss, often remaining asymptomatic until advanced stages. Awareness and knowledge of the disease are crucial for early detection and management. Aim: To evaluate glaucoma awareness and knowledge among glaucoma patients and a population-based sample of individuals without the condition, as well as to identify factors impacting awareness. Methodology: A cross-sectional study was conducted among 70 participants (35 with glaucoma, 35 without) at the Department of Ophthalmology, Patna Medical College and Hospital, Patna, Bihar, India. Data was collected via a structured questionnaire and Glaucoma Knowledge Level Questionnaire (GKLQ). Socio-demographic factors, awareness, and knowledge scores were analyzed using descriptive statistics, chi-square tests, and logistic regression. Results: Glaucoma presence was significantly associated with male gender, older age, and income status. Awareness was reported by 65% of males and 64.3% of females, with younger participants (40–64 years) and those with >8 years of education demonstrating higher knowledge (p<0.05). Age and education were significant determinants of awareness, whereas gender and income were not. Conclusion: Awareness of glaucoma is lower among older and less-educated individuals despite higher risk. Targeted educational interventions and community-based screening programs are essential for early detection and reducing glaucoma-related visual impairment.

Background: Hypertension is a prevalent systemic condition that adversely affects ^‘retinal microvasculature, leading to structural and functional changes detectable through advanced imaging. Retinal evaluation provides a non-invasive window into systemic vascular health. Aim: To assess the impact of chronic and relieved hypertension on retinal microvascular and structural parameters using Optical Coherence Tomography Angiography (OCTA) and standard ophthalmic examinations. Methodology: This cross-sectional study included 85 eyes from patients with chronic hypertension (n=45), relieved hypertensive retinopathy (n=40), and age-matched healthy controls (n=100). Participants underwent comprehensive ophthalmic evaluation, OCT, and OCTA imaging to measure vessel density (VD), perfusion density (PD), foveal avascular zone (FAZ), central foveal thickness (CFT), ganglion cell-inner plexiform layer (GC-IPL), and retinal nerve ^‘fiber layer (RNFL). Data were analyzed using SPSS, with p < 0.05 considered significant^’. Results: Chronic hypertensive participants exhibited significantly reduced VD and PD, enlarged FAZ, and thinner GC-IPL and RNFL compared to controls (p < 0.01). Relieved hypertensive participants showed partial improvement in these parameters. Strong correlations were observed between OCTA and structural OCT metrics, indicating a close link between vascular and neuronal retinal changes. Conclusion: Hypertension induces measurable retinal microvascular and structural alterations, which can be partially reversed with effective blood pressure management. Retinal imaging is a valuable non-invasive tool for early detection of hypertensive end-organ damage.

Background: Chronic pelvic pain (CPP) in women is a common yet often underdiagnosed condition with multifactorial etiologies, impacting quality of life, daily functioning, and reproductive health. This prospective observational study aims to evaluate the clinical presentation, associated factors, and diagnostic findings in females presenting with CPP at a tertiary care center in Patna. Objectives: To assess the clinical profile, possible etiologies, and diagnostic outcomes of chronic pelvic pain in women attending the gynecology outpatient department. Methods: A prospective observational study was conducted over a period of 12 months in the Department of Obstetrics and Gynaecology at Patna Medical College and Hospital. A total of 130 women aged between 18 and 45 years, presenting with pelvic pain persisting for more than six months, were enrolled after obtaining informed consent. Detailed clinical history, physical and pelvic examination, laboratory investigations, transvaginal sonography (TVS), and laparoscopy (when indicated) were performed to identify the underlying cause of pain. Results: Out of 130 participants, the most common complaints included dull aching lower abdominal pain (76.2%), dyspareunia (42.3%), and dysmenorrhea (39.2%). Gynecological causes were identified in 61.5% of cases, including pelvic inflammatory disease (28.5%), endometriosis (15.4%), and adnexal masses (10%). Non-gynecological causes such as urinary tract infection (13.1%) and irritable bowel syndrome (7.7%) were also noted. In 17.7% of patients, no definitive cause could be established despite thorough evaluation. Laparoscopy provided definitive diagnosis in 26.2% of cases, especially for conditions like endometriosis and pelvic adhesions not detected by routine imaging. Conclusion: Chronic pelvic pain in females is a complex clinical condition with diverse etiologies, predominantly of gynecological origin. A structured approach including detailed history, examination, imaging, and diagnostic laparoscopy can significantly aid in identifying the cause and guiding management. Increased awareness and timely intervention are essential to reduce the burden and improve quality of life in affected women.

Background: Abnormal uterine bleeding (AUB) is a very common gynecological complaint with a multifactor etiology that varies with age. Histopathological examination of endometrial lesions allows appropriate diagnosis as well as treatment. Objectives: To examine the histopathological diversity of endometrial disease in women with abnormal uterine bleeding (AUB) and to verify the diagnostic efficiency of dilation and curettage (D&C) across varying age categories and classes of parity. Methodology: A retrospective study of 322 women with AUB was conducted who underwent D&C/D&E. HPE of sample was done at Department of  Pathology, Darbhanga Medical College and Hospital Laheriasarai. Patients were also separated by age (18–39, 40–49, ≥50 years) and by parity. Histopathological findings were classified, and results of D&C were cross tabulated against follow-up hysterectomy specimens in 28 cases for validating diagnostic validity. Results: Functional endometrium and benign lesions were most common amongst premenopausal women and multiparous patients, whilst malignant (17.4%) and atrophic variants increased with age. Pregnancy-related diagnoses did not extend past patients aged < 50. D&C was extremely sensitive but not very specific (96.5%) for premalignant and malignant lesions and also not very accurate (75.6%) in distinguishing normal from pathologic endometrium. Hysterectomy grading of endometrioid adenocarcinoma was consistent with initial biopsy grading in majority of cases with minimal upgrading/downgrading (15.4%). Conclusion: Age- and parity-related patterns for endometrial lesions of AUB do exist. D&C is extremely effective for the detection of premalignant change as well as malignant change, justifying its use in age-related diagnostic strategies.

Background: Vitamin D deficiency is widespread across the world and could be involved in metabolic dysregulation. Non-alcoholic fatty liver disease (NAFLD), also called metabolic-associated fatty liver disease (MAFLD), is becoming increasingly seen in the presence of metabolic dysfunction. The relationship between vitamin D status and steatotic liver disease is under researched. Objective: To find out how vitamin D deficiency contributes to the development of steatotic liver disease in adults with metabolic impairment. Methodology: A cross-sectional study among 366 adults was carried out at the gastroenterology department of Big Apollo Spectra Hospital, Patna, India. Anthropometry, biochemical tests, and lifestyle information were collected. The serum 25(OH)D measured the vitamin D status and Fatty Liver Index (FLI) the presence of MAFLD. Study participants were divided into vitamin D sufficiency, insufficiency, or deficiency groups. The associations used logistic regression with confounder adjustment. Results: Prevalence of MAFLD was significantly higher in vitamin D–deficient participants (51.5%) and lowest in vitamin D–sufficients (23.1%, p < 0.001). The participants with deficiency had increased BMI, waist circumference, fasting glucose, HOMA-IR, and triglycerides and reduced HDL-cholesterol. Multivariate analysis showed increased vitamin D concentration to be independently protective against MAFLD (OR 0.93 per ng/mL, 95% CI 0.89–0.97. Conclusion: Vitamin D inadequacy significantly associates with the development of steatotic liver disease in adult cases with metabolic dysfunction, suggesting the potential beneficial effect of having adequate vitamin D levels.

Background: The Bodoland Territorial Region (BTR) in Indian state of Assam has historically lacked dedicated tertiary-level psychiatric care. With the establishment of Kokrajhar Medical College and Hospital (KMCH), a significant opportunity arose to understand the mental health needs of this previously underserved population. Aim: To study the socio-demographic and clinical profile of patients attending the Psychiatry OPD of KMCH, a newly established tertiary care centre in BTR, Assam, India. Objectives: (1) To assess the socio-demographic profile of patients attending the Psychiatry OPD. (2) To assess the clinical profile of these patients. Methods: A retrospective, cross-sectional study was conducted using data collected over 21 months from the KMCH Psychiatry OPD. A total of 1005 patients were included. Demographic details (age, gender, education, occupation, religion, and residence) and clinical diagnosis (based on ICD-10 criteria) were analysed using descriptive statistics. Results: The majority of patients were male (58.3%), with the most common age group being 21–30 years (28.7%). Most patients were Hindu (70%), followed by Muslim (26%) and Christian (4%). Mood disorders (F30–F39) were the most prevalent diagnostic group (24.4%), followed by neurotic, stress-related, and somatoform disorders (F40–F48, 22.8%), and schizophrenia, schizotypal, and delusional disorders (F20–F29, 17.3%). Conclusion: The findings reflect a high psychiatric morbidity burden in the region, particularly among young adults. The data highlights the urgent need for strengthening mental health services, awareness programs, and community outreach in BTR.

Introduction: Nurses are the backbone of a hospital supporting the patients, doctors and the administrator. The study of job satisfaction of nurses is of utmost importance as it is beneficial for the quality care of patients and management of a hospital. Aims: Aim of the study is to assess the level of job satisfaction and find out the factors contributing to the same. Materials & Methods: A mixed-method exploratory sequential study was conducted among nursing personnel at R.G. Kar Medical College and Hospital, Kolkata, over 8 months. The quantitative phase involved a cross-sectional survey of 113 nurses selected through proportionate random sampling, using a structured questionnaire on job satisfaction. The qualitative phase included focus group discussions and in-depth interviews with key nursing staff, analyzed thematically to explore factors influencing job satisfaction. Result: A study of 113 nursing personnel at R.G. Kar Medical College and Hospital, selected via proportionate random sampling, examined job satisfaction across intrinsic, extrinsic, and interpersonal domains. Most participants were aged 25–35, married, from nuclear families, and held BSc Nursing or GNM qualifications. Findings showed moderate satisfaction from intrinsic and extrinsic factors, with interpersonal relationships being the strongest contributor. Socio-demographic factors such as marital status, number of earning members, children, years of experience, residence, education, and place of posting significantly influenced satisfaction scores. Qualitative analysis highlighted fulfillment from patient care, stress from workload, nurse shortages, security issues, shift challenges, infection control concerns, inadequate recognition, pay dissatisfaction, and work-life balance issues. Participants suggested improving staffing, structured shifts, professional training, hospital security, and better support from colleagues and administrators to enhance job satisfaction and well-being. Conclusion: Job satisfaction among nursing personnel at R.G. Kar Medical College is shaped by intrinsic, extrinsic, and interpersonal factors, with interpersonal relationships playing a key role. Socio-demographic variables and work environment elements like workload and recognition significantly influence satisfaction levels. Enhancing staffing, professional growth, and organizational support is crucial for improving nurses’ job satisfaction and well-being.

Background: Spinal anaesthesia has been associated with intraoperative nausea and vomiting (IONV), especially during caesarean section, which is attributed to several mechanisms. Some recent studies showed that a few drugs used in anaesthesia practice like propofol, dexmedetomidine are effective in preventing intraoperative nausea and vomiting. Aims and Objective: To compare the efficacy of propofol and dexmedetomidine to decrease intraoperative nausea and vomiting during spinal anaesthesia for caesarean section under spinal anaesthesia. Methodology: An institution based prospective analytical study was conducted. 88 parturients, ASA class II, aged 20-30 years, who were going for spinal anesthesia for caesarean section were divided into two groups, group D (Dexmedetomidine group) and group P (Propofol group). Group D received 1μg/kg intravenous dexmedetomidine diluted to 20 mL with physiological saline, group P received 0.4 mg/kg intravenous propofol diluted to 20 mL with physiological saline, after umbilical cord clamping. Patients’ hemodynamics will be monitored at 3-minute intervals. Incidence of nausea and committing was evaluated according to Bellville scoring system during the intraoperative period. Results: Incidence of intraoperative nausea and vomiting was higher in Dexmedetomidine group than Propofol group, but it was not statisfically significant. Incidence of bradycardia was higher in Dexmedetomidine group (p < 0.05) but incidence of hypotension was significantly (p < 0.05) higher in Propofol group though neither of these required any drug intervention. Oxygen saturation level, sedation score and respiratory rates were similar between the two groups. Conclusion: Propofol and dexmedetomidine are equally effective to decrease intraoperative nausea and vomiting during spinal anaesthesia for caesarean section.

Introduction: The bacterial environment of the gastrointestinal tract has long been investigated for its role in health maintenance and relationship to various disease states. In healthy hosts, microorganisms are present throughout the gastrointestinal tract and are essential for gut barrier function, digestive support, and immune homeostasis. Small intestinal bacterial overgrowth (SIBO) is pathology of gut microbiota dysregulation. Aims: To determine the frequency of SIBO in cirrhotics and correlate with severity of cirrhosis. Materials & Methods: This is a prospective observational cohort study. This Study was conducted from January 2021 to October 2021 at Department of Gastroenterology, NH Rabindranath Tagore International Institute of Cardiac Sciences. Result: In our study, our patients with cirrhosis had mean age of 43.59 ± 5.04 years and frequency of SIBO in them was 46%. SIBO was more prevalent in patients with decompensated cirrhosis than in patients with compensated cirrhosis. Majority of our patients with cirrhosis belonged to CTP class B followed by class A and C. Frequency of SIBO increased progressively with increase in CTP class. The most common etiology of cirrhosis was alcohol followed by NAFLD, Hepatitis B and Hepatitis C. Conclusion: We found that, we found the frequency of SIBO was 46% in the patients with cirrhosis of liver. SIBO was statistically significantly associated with decompensated cirrhosis, high CTP score, ascites, low serum albumin and high serum total bilirubin.

Background: Pediatric femur fractures constitute about 1.6% of all pediatric fractures and pose significant treatment challenges. While Titanium Elastic Nail System (TENS) is commonly used due to its minimally invasive nature, it may be less effective in comminuted or segmental fractures and in heavier children. Submuscular bridge plating has emerged as an alternative, particularly for complex or metaphyseal fractures. Aims: This study aimed to compare the clinical and radiological outcomes of TENS and submuscular plating in children aged 6–14 years with shaft femur fractures. Methods: A prospective comparative study was conducted at Calcutta National Medical College and Hospital between October 2022 and April 2024, involving 40 patients. Twenty patients underwent submuscular plating (Group A) and 20 received TENS (Group B). Outcomes assessed included union time, functional results (FLYNN Score), and complications such as limb length discrepancy (LLD), angulation, infection, and implant-related issues. Results: No significant differences were observed in union time (10.1 weeks for plating vs. 9.6 weeks for TENS, p = 0.3806) or operative time, blood loss, or overall functional outcomes. Minor complications such as LLD and angulation were more frequent in the TENS group. All fractures united within three months, with no cases of nonunion or malrotation. Two superficial infections and implant prominence occurred in the TENS group only. Conclusion: Both TENS and submuscular plating offer comparable outcomes for pediatric femoral shaft fractures in stable patterns. Submuscular plating is a valid alternative, though further large-scale studies are needed to guide management of more complex cases.

Background: ARM is a prevalent congenital defect of the anorectum in female patients; in the majority of cases, it is vestibular fistula. Conventionally treated over several phases using colostomy, this method is associated with morbidity, expense and psychological pressure. Colostomy-free single-stage posterior sagittal anorectoplasty (PSARP) has the potential advantages of less invasive interventions and enhanced continence by early ano-cerebro-cortical reflex development. The paper evaluates its safety and effectiveness in a tertiary care environment. Materials & Methods: The case series was prospective and was held between September 2018 and August 2020 at Medical College Hospital Kolkata. Twenty female patients with vestibular fistula (15 anovestibular, 5 rectovestibular) aged 6 weeks to 3 years (median 6 months) were selected after ruling out pouch colon and life-incompatible anomalies using barium enema, echocardiography and ultrasonography. Preoperative preparation consisted of immunisation completion, bowel cleansing by use of polyethylene glycol and antibiotics. The PSARP was done under general anaesthesia in prone position with careful rectal-vaginal separation and anoplasty. Treatment in the postoperative period was nil oral for 5 days, IV nutrition, antibiotics, and frequent dressings. A 1-month follow-up every week, 3-month follow-up every month, and 3-monthly follow-up to 18 months were done to assess wound healing, continence, constipation, and complications. Results: Blood loss during the operation was 23.75 ml (10-75 ml) on average and 15% needed a transfusion. Operation time was between 75 and 120 minutes. Vaginal wall injury (per-operative) was found in 20% and was repaired at the time. The average stay in the hospital after the operation was 10-12 days. Mild perineal excoriations 15 percent at week 1 with a resolution rate of 15 percent at week 3. One (5%) was a partial wound dehiscence that was treated by colostomy and secondary suture. Constipation necessitating laxatives was present in 15 percent at a maximum of 3 months and stopped at 6 months except one (stopped at 9 months). There wasone case of anal dilation required 5 to 6 months. No anal stenosis, recurrence of fistula, prolapse and incontinence. Normal bowel habits (1-3 stools/day) were obtained in all 16 patients who had 9 months or more follow-up and were not using aids. Conclusions: Single-stage PSARP in the absence of colostomy is safe and effective in the treatment of the vestibular fistula in carefully selected females, with low complication rates, perfect continence, and no problems long-term, when pouch colon and major anomalies are excluded. It minimises morbidity and expenditure over and above compared to staged procedures.

Introduction: Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy, characterized by distinct cytological features. However, several histological and cytological variants of PTC exist, each with unique morphological features and clinical behavior. These variants often pose significant diagnostic challenges, especially in fine-needle aspiration cytology (FNAC), where subtle differences can be easily overlooked or misinterpreted. Aim: To evaluate the frequency and cytomorphological spectrum of different variants of papillary thyroid carcinoma and to assess the associated nuclear features that aid in accurate cytological diagnosis. Materials and Methods: This observational study was conducted on 60 cases diagnosed as PTC on FNAC. Smears were evaluated for architectural patterns, nuclear features such as grooves, intranuclear cytoplasmic inclusions (INCI), overlapping nuclei, powdery chromatin, optical clearing, and the presence of psammoma bodies. The cytological variants were categorized into classical PTC, follicular variant, tall cell, columnar cell, solid/trabecular, hobnail, and diffuse sclerosing type. Statistical analysis was performed to assess the correlation between variants and morphological features. Results: In this study of 60 cases of papillary thyroid carcinoma (PTC), the majority of patients were females and most were between 31–40 years of age. The classical variant was the most common, followed by follicular and tall cell variants. Statistically significant associations were found between age, gender, and PTC variants. Key nuclear features such as nuclear grooves and intranuclear cytoplasmic inclusions were prominent across variants and strongly associated with PTC diagnosis. Architectural patterns showed papillary structures as most frequent, while psammoma bodies were more common in classical and diffuse sclerosing types. A high cytological-histological concordance was observed, especially in classical and diffuse sclerosing variants. Although most cases fell under Bethesda Category V, the correlation with final histology was not statistically significant. BRAF mutation was most prevalent in tall cell (83.3%) and classical (71.4%) variants, with statistically significant variation across types. Recurrence occurred in 10 patients, most frequently in the tall cell and hobnail/columnar/solid variants, indicating a higher risk of recurrence in aggressive PTC subtypes. Conclusion: Cytological diagnosis of PTC variants requires meticulous evaluation of architectural and nuclear features. Recognition of less common variants is crucial due to their prognostic implications and therapeutic considerations. Awareness of these cytomorphological nuances can enhance diagnostic accuracy and guide appropriate clinical management.

Introduction: Breast carcinoma is the most frequently diagnosed cancer among women worldwide and a leading cause of cancer-related deaths. Prognosis and therapeutic planning depend significantly on multiple pathological parameters, among which histological grade and lymph node status are crucial. Histological grading based on tubule formation, nuclear pleomorphism, and mitotic count, reflects the tumor’s biological aggressiveness. Lymph node metastasis, on the other hand, is a reliable indicator of tumor dissemination. Establishing a correlation between histological grade and axillary lymph node involvement may enhance prognostication and assist in guiding surgical and adjuvant therapy decisions. Objectives: To evaluate the correlation between histological grade and axillary lymph node metastasis in patients diagnosed with invasive breast carcinoma and to assess whether tumor grade can serve as a predictive factor for nodal involvement. Materials and Methods: A Observational, cross-sectional study was conducted on 100 cases histopathological confirmed of invasive breast carcinoma diagnosed over a period from Jan 2024 to Jan 2025.at MGM Medical College. Histological grading was performed using the Nottingham modification of Scarff-Bloom-Richardson (SBR) grading system. Lymph node metastasis was assessed through routine pathological examination of axillary dissection specimens. The data were statistically analyzed using Spearman’s rank correlation and t-tests determine the significance of the correlation between tumor grade and lymph node status. Results: In our study of 100 patients, histological grade distribution was 30% Grade I, 45% Grade II, and 25% Grade III, with a significant difference (p = 0.001). Lymph node positivity increased with tumor grade: 20% in Grade I, 60% in Grade II, and 80% in Grade III (p = 0.001). Tumor size also correlated significantly with nodal involvement, with positivity rates of 25%, 65%, and 72% for tumors ≤2 cm, >2 to ≤5 cm, and >5 cm, respectively (p = 0.004). Lymphovascular invasion (LVI) was strongly associated with lymph node metastasis; 80% of patients with LVI had positive nodes compared to 26% without LVI (p < 0.001). Multivariate analysis showed Grade II and III tumors, tumor size >2 cm, and presence of LVI significantly increased the odds of lymph node positivity, with ORs of 3.5, 7.8, 4.2, and 6.9, respectively. Conclusion: Histological grade is significantly correlated with lymph node metastasis in invasive breast carcinoma, with higher grades showing increased nodal involvement. Tumor size and lymph vascular invasion also independently predict lymph node positivity. These factors are essential for accurate prognosis and guiding treatment decisions.

Background: Firearm injuries to the knee, particularly in police encounters, present unique medical, forensic, and legal challenges. While these injuries often spare neurovascular structures, they may result in complex musculoskeletal trauma. Understanding knee anatomy, especially neurovascular relationships with surrounding tissues, is crucial in assessing injury severity, management strategies, and forensic analysis. Case Presentation: This case series examines multiple patients with firearm-related knee injuries sustained during police operations, discussing their presentation, management, rehabilitation, forensic analysis, and legal implications. All three patients presented with firearm injury, soft tissue compromise, and without retained bullet fragments. Radiological investigations confirmed there were no retained firearm products. One had simple 2-part horizontal fracture of patella, second had a stellate fracture of patella, and the third had no bony injury. Patella fracture patients underwent emergency surgical interventions including debridement, open reduction, internal fixation. Post-operative rehabilitation was initiated, though constrained by the custodial setting. Functional outcomes were satisfactory in the short term, with no immediate signs of deep infection or neurovascular complications. Conclusion: A coordinated strategy involving orthopaedics, trauma care, law enforcement, and medico-legal services is necessary for inmate firearm injuries to the knee joint. Fracture stabilization, proper surgical decontamination, early diagnosis, and unambiguous medico-legal documentation are crucial. Within the limitations of custodial care, rehabilitation must be customized with a focus on joint mobility and infection control.

Background: Menopause is associated with hormonal decline, particularly estrogen deficiency, which predisposes women to cardiovascular disease, metabolic dysfunction, and oxidative stress. Visfatin, an adipocytokine implicated in endothelial dysfunction and inflammation, alongside markers of oxidative stress such as Thiobarbituric Acid Reactive Substances (TBARS), may provide insights into cardiovascular risk in postmenopausal women. Aim of this study is to evaluate serum visfatin levels and oxidative stress status in obese and non-obese postmenopausal women. Methods: This cross-sectional study was conducted in a tertiary care hospital with 55 postmenopausal women, stratified into obese (n=30) and non-obese (n=25) groups based on BMI. Serum visfatin was measured using ELISA, and oxidative stress was assessed by TBARS assay. Clinical, anthropometric, hematological, and biochemical parameters were recorded. Statistical analysis included Student’s t-test and Pearson’s correlation, with p<0.05 considered significant. Results: Obese postmenopausal women exhibited significantly elevated serum visfatin (19.58 ± 1.18 vs. 11.37 ± 5.12 nmol/mg, p<0.01) and TBARS levels (5.97 ± 1.00 vs. 4.48 ± 0.36 ng/L, p<0.05) compared to non-obese women. Positive correlations were observed between BMI and visfatin (r=0.951, p=0.001) and between BMI and TBARS (r=0.553, p=0.05). Additionally, obese women showed increased protein carbonyls and reduced antioxidant capacity. Conclusion: Obesity in postmenopausal women is associated with elevated visfatin and oxidative stress markers, indicating early endothelial dysfunction and increased cardiovascular risk. These findings highlight visfatin and TBARS as potential biomarkers for cardiovascular risk assessment in postmenopausal women. Lifestyle modification, weight reduction, and antioxidant supplementation may help mitigate these risks. Further longitudinal studies are needed to establish causality and therapeutic implications.

Background: Knee osteoarthritis (KOA) and type 2 diabetes mellitus (T2DM) are highly prevalent chronic diseases that often coexist, leading to worsened clinical outcomes. Both conditions share inflammatory pathways, yet the combined impact of glycemic control and systemic inflammation on functional disability has not been well studied. Aim: The present study aimed to evaluate the association between glycemic indices, inflammatory markers, and functional disability in patients with T2DM, KOA, and their coexistence. Methods: A total of 300 participants aged ≥60 years were enrolled and divided into three groups: Group 1 (T2DM + KOA, n = 100), Group 2 (T2DM only, n = 100), and Group 3 (KOA only, n = 100). Glycemic indices (HbA1c, FBS, PPBS), inflammatory markers (IL-6, hs-CRP), and functional disability (WOMAC index) were measured. Statistical analysis was performed using ANOVA and Pearson’s correlation, with p < 0.05 considered significant. Results: Group 1 exhibited significantly higher HbA1c (8.95 ± 0.45%), FBS (209.6 ± 15.8 mg/dL), and PPBS (270.5 ± 22.1 mg/dL) compared with Groups 2 and 3 (p < 0.001). Inflammatory markers were also highest in Group 1 (IL-6: 16.6 ± 3.6 pg/mL; hs-CRP: 6.63 ± 1.30 mg/L), followed by Group 3, and lowest in Group 2 (p < 0.001). Functional disability was most severe in Group 1 (WOMAC total 62.7 ± 5.3), moderate in Group 3 (45.9 ± 4.4), and minimal in Group 2 (12.2 ± 3.7, p < 0.001). Correlation analysis showed positive associations between HbA1c, inflammatory markers, and WOMAC scores. Conclusion: Patients with coexisting T2DM and KOA demonstrated significantly higher glycemic indices, elevated systemic inflammation, and greater functional disability compared with either condition alone. These findings highlight the synergistic impact of metabolic dysfunction and inflammation in exacerbating disability and underscore the importance of integrated management strategies targeting both metabolic and musculoskeletal health.

Background: Postoperative sepsis remains one of the most serious complications following emergency abdominal surgeries, contributing significantly to morbidity, mortality, and prolonged hospitalization. Despite advances in surgical and critical care management, postoperative intra-abdominal sepsis continues to challenge clinicians due to its multifactorial etiology and variable presentation. Aim: To determine the incidence, risk factors, and microbiological profile of postoperative sepsis among patients undergoing emergency abdominal surgeries, and to correlate clinical variables with patient outcomes. Methodology: A prospective hospital-based clinical study was conducted on 50 patients who underwent emergency abdominal surgeries at Narayana Medical College, Nellore, between January 2023 and June 2024. Data on demographics, surgical procedures, intra-operative findings, postoperative course, and culture results were analyzed. Sepsis was assessed using the qSOFA scoring system. Standard statistical methods were applied to evaluate associations between risk factors and postoperative sepsis. Results: Postoperative sepsis occurred in 42% of patients. The majority of cases were associated with contaminated (36%) and infected (30%) wounds. E. coli (12%), MRSA (6%), and polymicrobial infections (18%) were the most common isolates. Preoperative sepsis (54%) and prolonged surgical duration (mean 2.98 hrs) were significant predictors of postoperative sepsis. The mortality rate was 14%, and 42% required ICU care. Patients with sepsis had longer hospital stays (mean 12.6 days) and higher complication rates. Conclusion: Postoperative sepsis following emergency abdominal surgery remains a major preventable cause of morbidity and mortality. Early recognition, stringent aseptic techniques, appropriate antibiotic prophylaxis, and timely surgical intervention are essential to improve outcomes.

Background: Postoperative fasting has long been standard practice following major gastrointestinal surgeries to minimize nausea, vomiting, and anastomotic stress. However, prolonged fasting exacerbates malnutrition and delays recovery. Emerging evidence supports early enteral nutrition (EEN) in enhancing wound healing, immune response, and reducing postoperative morbidity. Aim: To compare the clinical outcomes of early versus late enteral feeding in patients undergoing major gastrointestinal surgeries. Methodology: This prospective observational study included 50 patients aged 18–60 years who underwent elective or emergency gastrointestinal surgeries at Narayana Medical College, Nellore, over 18 months. Patients were divided into two equal groups: Group A received early enteral feeding within 24–48 hours postoperatively, while Group B received delayed feeding after bowel function returned. Postoperative parameters—including paralytic ileus, wound infection, dehiscence, leak, intra-abdominal abscess, gastrointestinal complications, and hospital stay—were compared using chi-square and t-tests. Results: Early feeding significantly reduced postoperative complications. The incidence of paralytic ileus (16% vs 60%, p=0.001), wound infection (20% vs 48%, p=0.037), wound dehiscence (12% vs 40%, p=0.024), wound leak (4% vs 28%, p=0.021), intra-abdominal abscess (4% vs 32%, p=0.010), and gastrointestinal complications (28% vs 56%, p=0.045) was markedly lower in the early-fed group. Mean hospital stay was significantly shorter with early feeding (6.42 ± 1.9 days vs 10.9 ± 2.5 days, p=0.001). Conclusion: Early enteral feeding within 24–48 hours after major gastrointestinal surgeries is safe and beneficial. It enhances recovery, reduces postoperative morbidity, and shortens hospital stay, supporting its inclusion in enhanced recovery protocols.

Background: Perioperative hyperglycemia is a common and modifiable risk factor that increases the incidence of postoperative complications, particularly surgical site infections (SSIs). Diabetic patients are especially susceptible due to impaired immune responses and delayed wound healing. Although strict glycemic control can improve outcomes, the optimal target range for perioperative glucose remains uncertain. Aim: To study the association between perioperative glycemic levels and postoperative infections in diabetic patients undergoing general surgical procedures. Methodology: This hospital-based prospective study was conducted on 50 diabetic patients undergoing elective and emergency general surgery procedures in the Department of General Surgery, Narayana Medical College and Hospital, Nellore, from June 2023 to November 2024. Patients were categorized into four quartiles based on mean perioperative blood glucose levels (120–180 mg/dl, 181–220 mg/dl, 221–260 mg/dl, 261–350 mg/dl). Parameters such as fasting blood sugar, HbA1c, and postoperative glucose levels (days 1, 3, and 7) were correlated with postoperative complications including SSIs, urinary tract infections (UTIs), delayed wound healing, and reoperations. Results: Among 50 patients, 68% were female, and the most common age group was 51–60 years. Surgical site infection was the most frequent complication (64%), followed by delayed wound healing (28%) and UTI (20%). Patients with poor glycemic control exhibited higher rates of SSIs (78.9%) compared to those with good control (40%). Mean postoperative glucose levels were significantly higher in the SSI group on postoperative days 1, 3, and 7 (p < 0.05). However, HbA1c and fasting glucose did not show statistically significant associations with infection risk. Conclusion: The study emphasizes that perioperative hyperglycemia, particularly elevated postoperative glucose levels, strongly correlates with higher rates of SSIs and delayed recovery. Optimal perioperative glucose management significantly reduces infection risk and improves surgical outcomes.

Background: Liver abscesses, both amoebic and pyogenic, remain a major health problem in tropical regions, causing significant morbidity and mortality. Although medical therapy is the mainstay, a subset of patients require interventional drainage. With the advent of ultrasonography and CT-guided techniques, minimally invasive percutaneous drainage has replaced traditional surgical methods due to lower morbidity and higher success rates. Aim: To analyze the clinical presentation, risk factors, diagnostic methods, and evaluate the effectiveness of different modes of management of liver abscess in a tertiary care center. Methodology: A prospective observational study was conducted on 30 patients admitted with liver abscess to the Department of General Surgery, ACSR Medical College and Hospital, between July 2024 and August 2025. Detailed clinical assessment, laboratory investigations, and ultrasonography were performed. All patients received parenteral antibiotics, and those not responding within 48–72 hours underwent ultrasound-guided percutaneous catheter drainage (PCD). Patients were followed up for three months with serial ultrasonography. Results: The mean age of patients was 49.5 years, with a male predominance (96.7%) and a strong association with alcoholism (88%). The right lobe was involved in 73.3% of cases, and 73.3% had a single abscess. Twenty-eight patients (93.3%) were managed successfully with PCD, while two smaller abscesses (<3 cm) responded to medical therapy alone. The overall success rate was 100%, with no mortality. Pleural effusion was the most common complication (20%). Conclusion: Ultrasound-guided percutaneous catheter drainage combined with appropriate antibiotics is an effective, safe, and minimally invasive method for managing liver abscess, significantly reducing morbidity and hospitalization.

Background: Laparoscopic cholecystectomy (LC) has become the gold standard for managing symptomatic gallstone disease. Although minimally invasive and associated with faster recovery, LC carries a risk of biliary complications, particularly bile leakage, which may lead to significant morbidity if not promptly recognized and managed. Aim: To evaluate the incidence, causes, and management outcomes of biliary leakage following laparoscopic cholecystectomy. Methodology: A descriptive study was conducted on 200 patients undergoing elective LC at Narayana Medical College, Nellore, from June 2023 to June 2024. Patients aged above 12 years were included. Detailed clinical assessment, routine laboratory tests, and imaging (ultrasound or CECT) were performed preoperatively. Intraoperatively, abdominal drains were placed when bile duct injury or altered anatomy was suspected. Postoperative monitoring included drain output measurement, liver function tests, and imaging (ERCP or HIDA) for suspected leaks. Management strategies were planned according to the site and severity of bile leakage. Results: Among 200 patients (118 females, 82 males; mean age 41.2 years), gallstones were the most common indication (60%), followed by chronic cholecystitis (30%). The incidence of postoperative bile leakage was 2.5% (5 patients). Identified causes included cystic duct stump leak (2 cases), duct of Luschka leak (2 cases), and common bile duct leak (1 case). All patients were successfully managed conservatively—four with endoscopic retrograde cholangiopancreatography (ERCP) and stenting, and one requiring re-exploration for persistent leak. Mean hospital stay was 11.3 days, and there was no mortality. Conclusion: Biliary leakage remains an uncommon but important complication after laparoscopic cholecystectomy. Early detection, accurate localization using ERCP or HIDA, and minimally invasive management with ERCP and stenting result in excellent outcomes. Adherence to meticulous surgical technique and awareness of biliary anatomical variations are essential to minimize risk.

Background: Surgical site infections (SSIs) are among the most common hospital-acquired infections, significantly contributing to postoperative morbidity, mortality, and healthcare costs. Despite advances in aseptic techniques and perioperative care, SSIs remain a major challenge, especially in emergency surgeries where contamination risk and comorbidities are high. Aim: To identify the risk factors associated with surgical site infections in patients undergoing emergency laparotomy and laparoscopic procedures at Narayana Medical College and Hospital, Nellore. Methodology: A prospective clinical study was conducted on 50 patients aged 15–60 years who underwent emergency abdominal surgeries between June 2023 and June 2024. Patient demographics, comorbidities, BMI, surgical details (duration, wound class, blood loss, prophylaxis), and postoperative parameters were recorded. The incidence, type of SSI, and causative organisms were analyzed using appropriate statistical tests, with p < 0.05 considered significant. Results: Among 50 patients, 23 (46%) developed SSIs—56.5% superficial, 34.8% deep, and 8.7% organ-space infections. Higher BMI showed a significant correlation with infection (p = 0.05), with obesity (BMI >28.5) being the strongest predictor. Diabetes (30%) and smoking (44%) were common comorbidities but not statistically significant. Contaminated and dirty wounds had the highest infection rates, while preoperative antibiotic prophylaxis showed borderline significance (p = 0.052). Longer operative duration and higher intraoperative blood loss increased infection risk. Staphylococcus aureus (35%) and Escherichia coli (30%) were the predominant pathogens. Conclusion: The study identified obesity, wound contamination, and prolonged surgery as major risk factors for SSIs following emergency abdominal procedures. While comorbidities like diabetes and hypertension were frequent, their effect was not statistically significant. Strengthening infection control practices, optimizing antibiotic timing, and addressing obesity are key to reducing SSI incidence.

Background: Cataract is the most common ^‘reversible cause of blindness worldwide, with phacoemulsification and intraocular lens implantation being the gold standard treatment. Postoperative changes in the retina, especially those that are assessed in terms of changes in the macular thickness, may affect visual recovery, so it is important to assess these changes clinically. Aim: To assess the impact on macular thickness following uncomplicated cataract surgery using Optical Coherence Tomography (OCT). Methodology: This prospective as interventional study consists of 80 eyes of 80 patients who were undergoing routine phacoemulsification in the Regional Institute of Ophthalmology (RIO), IGIMS, Patna, India. Retinal and choroidal thickness was assessed by spectral-domain OCT before cataract surgery, then at 1 week postoperatively and at 1 month postoperatively. All patients received standard anti-inflammatory treatment in the postoperative period. Statistical analysis involved paired t-tests where p < 0.05 was considered significant. Results: Retinal thickness increased significantly from 305.12 ± 16.21 µm preoperatively to 308.89 ± 16.75 µm at week 1 (p = 0.012) and 313.79 ± 17.02 µm at 1 month (p < 0.001), indicating progressive postoperative thickening. Choroidal thickness remained largely unchanged (240.35 ± 80.42 µm preoperatively vs. 231.47 ± 81.12 µm at 1 month, p = 0.42). Vertical scan measurements also disclosed a similar pattern. These changes represent mild postoperative inflammation and transient disruption of^’ the blood-retinal barrier without progression to clinically significant macular edema. Conclusion: It can be concluded that uncomplicated phacoemulsification results in measurable retinal thickening within the first month with stability in choroidal thickness. Non-invasive OCT facilitates the detection of early postoperative changes in the retina and helps in the proper management of postoperative conditions.

Background: Dry eye disease (DED) is a multifactorial ocular surface disorder, often exacerbated by prolonged digital screen use. Medical students, due to extended computer exposure, are at increased ^‘risk of developing DED. Aim: To evaluate the prevalence and severity of DED in medical students using Ocular Surface Disease Index (OSDI) scores and Schirmer’s test, and to assess the relationship with daily computer usage. Methodology: A hospital-based, cross-sectional study was conducted on Department of RIO, IGIMS, Patna, Bihar, India for one year.  90 participants aged 20–40 years. Participants were grouped based on daily computer use: Group A (>2–4 hours), Group B (>4–6 hours), and Group C (>6–8 hours). DED was assessed subjectively via OSDI and objectively via Schirmer’s test, tear film break-up time (TBUT), and tear meniscus height (TMH). Data were analyzed using SPSS v27, with p<0.05 considered significant. Results: DED prevalence increased with computer use: Group A (9.3%), Group B (18.2%), Group C (45.7%). OSDI scores and ocular surface parameters worsened with higher screen time. Schirmer’s test, TBUT, and TMH showed progressive reduction across groups, indicating impaired tear production and stability. Conclusion: Prolonged computer use is strongly associated with DED in medical students. Combining subjective and objective assessments enables early detection and preventive interventions, including ergonomic adjustments, conscious blinking, and regular breaks.

Background: Anaemia is a major global health problem affecting over 1.62 billion individuals, with the highest burden among women of reproductive age. Accurate diagnosis and morphological typing are essential for effective management. Aim: The present study aimed to correlate morphological typing of anaemia using red blood cell (RBC) indices and red cell distribution width (RDW) from an automated haematology analyser with peripheral smear examination. Methodology: A prospective observational study was conducted in the Department of Pathology, Patna Medical College and Hospital, Bihar, from November 2019 to December 2021. Ninety anaemic patients were included. Blood samples were analysed using an automated haematology analyser to classify anaemia based on RBC indices and RDW, followed by independent peripheral smear examination. Concordance and discordance between the two methods were statistically evaluated. Results: Among the 90 cases, females predominated (58.9%). The most frequent type based on analyser indices was microcytic hypochromic anaemia with raised RDW (25.6%), followed by normocytic normochromic anaemia (41.1%). Peripheral smear findings also revealed microcytic hypochromic anaemia as the most common (45.6%). Overall, 80 cases (88.9%) showed concordance, while 10 (11.1%) were discordant, mainly within normocytic with raised RDW and macrocytic categories. Conclusion: Automated RBC indices with RDW demonstrated high agreement with peripheral smear findings, proving reliable for preliminary morphological typing. However, smear examination remains indispensable in atypical cases, especially macrocytic and dimorphic anaemias. An integrated approach ensures accurate and comprehensive diagnosis.

Background: Severe traumatic brain injury (TBI) frequently results in lingering cognitive impairment that has enormous clinical and socioeconomic consequences, especially in resource-poor areas such as Bihar, India. Some pharmacological agents, such as amantadine, may augment cognitive rehabilitation through modulation of dopaminergic and glutamatergic neurotransmission. Aim: The purpose of this study was to assess the efficacy and safety of amantadine for cognitive rehabilitation in patients with severe TBI in Bihar, India. Methodology: This was an observational, prospective study of 60 adult patients (age 18-65 years) who sustained a severe TBI and had plateaued or deterioration in cognitive function for at least 2 months post injury, who were enrolled at Darbhanga Medical College and Hospital. Patients were treated with amantadine 200mg/day for four weeks. Functional and cognitive outcomes were assessed at baseline, 1 week, 4 weeks, and 6 weeks using the Full Outline of Unresponsiveness (FOUR) score, the Disability Rating Scale (DRS), and Glasgow Outcome Scale (GOS). Adverse events were assessed throughout the study. Results: Statistically significant improvements were observed over the first 6 weeks in FOUR (median 10 → 14), DRS (median 20 → 6) and GOS (median 3 → 4) (p < 0.001). Most adverse events were mild-to-moderate, including spasticity (13.3%), vomiting (11.7%), and seizures (10%). Conclusion: Amantadine appears to be effective and well tolerated for cognitive and functional rehabilitation in patients with severe TBI, providing preliminary evidence for the potential for use as an adjunct treatment in cognitive rehabilitation programs in this clinical population.

Objective: The objective of present study was to evaluate the effectiveness of combination therapy with topical nifedipine (0.3%) plus lignocaine (1.5%), sitz bath and oral lactulose in the management of acute fissure-in-ano. Background: The combination therapy with topical nifedipine (0.3%) plus lignocaine (1.5%), sitz bath and oral lactulose in the management of acute fissure-in-ano were presented and it’s effectiveness evaluated. Material and Methods: This prospective observational study was conducted during the period of July 2023 to June 2025 on 75 patients who attended the OPD with the history of acute Fissure-in-Ano. All patients were evaluated clinically and prescribed the combination therapy consists of topical nifedipine(0.3%) plus lignocaine (1.5%), Sitz bath and oral lactulose solution. All patients were evaluated for relief from pain, bleeding per anus, fissure healing and patient’s satisfaction. Follow-up was done for the period of two weeks. Results: Acute fissure-in-ano is common in young age group patients (53.33%). It is more common in females (73.33%) than males (26.66%). Midline posterior is the commonest site in both males(90%) and females (81.81%). Patients taking mixed diet (low fibre diet) are commonly affected (80%). Sedentary life style accounts for 60% of cases. Some type of addiction (like alcohol, smoking, tobacco) associated with 66.66% and no addiction in 33.33% of cases. Combination therapy with topical Nifedepine (0.3%) plus Lignocaine (1.5%), Sitz bath and oral Lactulose accounts for pain relief in 80% cases in first week and 97.33% cases in second week, whereas cessation of bleeding per rectum in 91% cases in first week and 100% cases in second week. Increased anal tone is relieved in 93.33% cases in first week and 98.66% cases in second week of combination therapy. Complete healing of fissure is found in 53.33% cases in first week and 98.66% cases in second week of combination therapy. Conclusion: Among the different managements of acute fissure-in-ano, the present study found that the combination therapy with topical nifedipine (0.3%) plus lignocaine (1.5%), sitz bath and oral lactulose is the best option in the respect of duration to become symptoms free and fissure healing, non-invasive nature of treatment and excellent patient’s acceptance and satisfaction.

Background: Peptic ulcer disease (PUD) results from an imbalance between mucosal defense and aggressive factors such as acid and pepsin. Although most cases respond to medical management, complications like perforation remain life-threatening and require surgical intervention. Helicobacter pylori (H. pylori) has been established as a major etiological factor in PUD, but its role in perforated ulcers remains controversial, particularly in developing regions. Aim: To determine the prevalence of Helicobacter pylori infection in patients with peptic ulcer perforation and assess its association with demographic and lifestyle factors. Methodology: A prospective hospital-based study was conducted on 50 patients aged 15–60 years diagnosed intraoperatively with peptic ulcer perforation at Narayana Medical College, Nellore, between January 2023 and June 2024. Biopsies from the ulcer edge and surrounding mucosa were obtained and tested for H. pylori using Giemsa staining and Rapid Urease Test. Data on age, gender, risk factors, and clinical presentation were analyzed. Results: Of the 50 patients, 46 (92%) were male and 4 (8%) were female, with the highest incidence in the 24–42-year age group. Duodenal perforations (84%) predominated over gastric (16%). H. pylori was detected in 32 patients (64%), with 52% in duodenal and 12% in gastric perforations. Major risk factors included smoking (82%), alcohol use (82%), and NSAID intake (22%). Conclusion: H. pylori infection remains a significant etiological factor in peptic ulcer perforation, particularly in duodenal ulcers among middle-aged males with concurrent smoking and alcohol habits. Routine intraoperative biopsy and postoperative eradication therapy are recommended to reduce recurrence and complications.