Introduction: Diabetic foot is a common and serious complication of diabetes mellitus, often leading to infection, ulceration, and even amputation. Early diagnosis and appropriate management are crucial to prevent morbidity and improve patient outcomes. Aims and Objectives: To evaluate the clinical presentation, diagnostic patterns, and management strategies of diabetic foot in patients attending a tertiary care center in Kolkata. To assess the outcomes of various medical and surgical interventions, including wound healing and amputation rates. Methods: This was a one-year, institution-based observational and prospective study conducted at the Department of General Surgery, KPC Medical College and Hospital (June 2023–May 2024). The study included 60 diabetic patients with foot ulcers, infections, or other diabetic foot complications, selected according to WHO criteria. Results: Among 60 participants, most were male, with a mean age of 56.5 years and high prevalence of hypertension, smoking, and below-average economic status. Clinically, sensory abnormalities and absent peripheral pulses were common, and 86.7% had infections, predominantly polymicrobial. Ulcers were mostly unilateral, affecting the dorsum, forefoot, and great toe. Escherichia coli and Staphylococcus aureus were the most frequent isolates. Surgical interventions, particularly skin grafting and debridement with flap, were associated with significant improvement or healing, while infection, absent pulses, and sensory deficits negatively impacted outcomes. Conclusion: Most participants showed improvement in ulcer status, though complete healing was less common. Surgical interventions, especially skin grafting and debridement with flap, were linked to better outcomes. Infection, absent peripheral pulses, and sensory abnormalities were key factors associated with poorer healing, highlighting the importance of managing these conditions to enhance recovery and reduce recurrence.

Background: The celiac artery, also known as the celiac axis or celiac trunk, represents the initial major abdominal branch of the aorta. Various anatomical variations and accessory vessels have been documented with differing frequencies. This study aimed to investigate the pattern of the celiac trunk and its anatomical variations within a sample of the South Indian population. Methodology: The celiac trunk was dissected in 30 fresh South Indian cadavers aged ≥18 years. Specimens with prior abdominal surgery, trauma, pathology, or decomposition were excluded. Variations in trunk diameter, accessory branches, and vertebral origin were recorded. The study was approved by the institutional ethics committee. Results: In most dissections (83.3%), the celiac trunk trifurcated into the common hepatic, left gastric, and splenic arteries. Variant trifurcation occurred in one specimen, and bifurcation was absent. Additional branches were seen in 13.2% of cases, with the trunk giving rise to one or both phrenic arteries in 6.6%. Tetrafurcation and pentafurcation were each observed in 6.6%, while higher-order divisions were absent. The mean trunk diameter was 0.85 cm (range: 0.3–1.3 cm), with no significant variation across types. In 92% of cases, the celiac trunk originated between the lower border of T12 and the upper border of L1. Conclusions: The observed frequency of celiac trunk trifurcation was lower than previously reported. A substantial proportion of cases exhibited additional vessels.

Background: Intra-operative problems encountered by surgeons include pedicle fracture, neurovascular injury, and screw cut-out. To avoid these difficulties, it is essential to compare the pedicle length and axis length with those of commercially available pedicle screws. Main objective of the study: The main objective of the study is to determine the optimum length of pedicle screw by finding the pedicle length and pedicle axis length with axial view of thoracolumbar CT using Radiant Dicom viewer technology, and quantifying the average pedicle length among the normal population and comparing it with commercially available screws. Methodology: The study is a retrospective and analytical investigation conducted among 150 participants aged 12-80 years, comprising both genders. Radiant Dicom viewer shows axial CT of the thoracolumbar spine area. Subjects with spinal deformity, spine malignancy, spine fracture, spine infection, congenital abnormalities, and thoracolumbar surgical history were excluded from the study. The study protocol was presented to the institutional ethics committee for approval and was approved.  Informed consent was obtained from all participants. The confidentiality of the data collected was strictly ensured by electronic storage. Results: The study found gender-specific differences in pedicle length. Males’ minimum particle length is 12.05 mm, and maximum length is 23.90 mm. Females’ particle length ranges from 11.95 to 20.25 mm. Males had a pedicle axis length of 31.85mm to 49.65mm, while females had a length between 27.50mm and 44.60mm. Conclusions: The pedicle axis length in the L1 vertebra showed significant differences between males and females. As a result, we may conclude that pre-operative computed tomography examination of patients is necessary, along with the selection of the proper screw length, to prevent post-operative complications in the spine in the future.

The present systematic review integrates perspectives from oral pathology, microbiology, and pharmacotherapeutics to elucidate how antihypertensive agents reshape the biological landscape of the oral cavity. By analyzing high-quality open-access studies published between 2000 and 2025, this work establishes that cardiovascular pharmacotherapy exerts measurable effects on gingival architecture, microbial ecology, and host immune response. Calcium channel blockers emerge as the most consistent inducers of fibroblast hyperactivity and extracellular matrix accumulation. This transformation leads to gingival enlargement, pseudo-pocket formation, and an environment conducive to anaerobic bacterial proliferation. The mechanistic substrate involves elevated interleukin-6 and transforming growth factor beta, alongside suppressed matrix metalloproteinase activity, which together produce a fibrotic and infection-prone phenotype. In contrast, angiotensin converting enzyme inhibitors and angiotensin receptor blockers display a tissue protective profile characterized by decreased oxidative stress, reduced osteoclastic resorption, and preservation of periodontal architecture. Beta adrenergic blockers exert milder influences, primarily affecting vascular tone and wound healing kinetics rather than inducing direct infection. Evidence from molecular and microbial studies demonstrates that antihypertensive drug class determines oral microbiome composition more strongly than systemic hypertension itself. Drugs that impair perfusion or collagen turnover promote colonization by Prevotella intermedia and Fusobacterium nucleatum, while those that normalize endothelial function encourage the restoration of commensal microbial balance. These findings position pharmacotherapy as a central ecological determinant of oral homeostasis. The pharmacogenomic dimension introduces further complexity, as polymorphisms such as CYP3A4*22 and TGF beta1 modify susceptibility to drug induced gingival alterations, explaining patient specific variability. Integrating biochemical, cellular, and microbial evidence, the review reveals that oral pathology under antihypertensive influence is not a secondary phenomenon but an adaptive tissue response to chronic pharmacologic modulation. From a clinical standpoint, these insights mandate coordinated management between medical and dental disciplines. Patients on calcium channel blockers require preventive periodontal strategies emphasizing early plaque control and monitoring for fibrotic transformation. Conversely, angiotensin pathway inhibitors may serve as adjunctive modulators of inflammation and bone metabolism. The synthesis underscores that the mouth mirrors systemic pharmacologic balance and that dental outcomes must be interpreted through the lens of vascular and immunologic modulation. Future research should prioritize longitudinal designs incorporating salivary biomarkers, genetic profiling, and microbial sequencing to establish predictive models for oral drug response. Precision pharmacology integrating cardiovascular and dental perspectives offers the possibility of individualized therapy that maintains systemic control without compromising oral tissue integrity

Background: Subacromial impingement syndrome (SIS) remains a common cause of chronic shoulder pain. Platelet-rich plasma (PRP) is increasingly utilized, but high-quality long-term studies, particularly in large cohorts, are lacking. This prospective study evaluates clinical, pain, and functional outcomes after subacromial PRP injections in 40 patients with SIS, followed for two years at PGIMS Rohtak. Methods: Forty adults (mean age 41.2 ± 8.1 years) with clinical and MRI-confirmed SIS, unresponsive to at least three months of conservative therapy, received two subacromial PRP injections four weeks apart. Structured home-based physiotherapy followed. Outcomes were measured using the Visual Analog Scale (VAS) for pain, Constant-Murley Score (CMS), and the University of California Los Angeles (UCLA) score at baseline, 6 weeks, 3 months, 6 months, 1 year, and 2 years. Results: Significant improvements were noted across all outcomes. Mean VAS scores reduced from 7.4 at baseline to 1.5 at two years. CMS improved from 42.6 ± 7.3 to 84.1 ± 6.9, while UCLA scores increased from 15.3 ± 2.8 to 31.2 ± 3.7. Over 85% of patients reported excellent or good outcomes by UCLA criteria at two years. No major complications occurred. Conclusions: Subacromial PRP with rehabilitation confers substantial and durable pain relief and functional improvement in SIS over two years in a real-world clinical population. These findings support the integration of PRP for patients unresponsive to initial conservative management.

Background: Chronic pain, particularly nociceptive and nociplastic types, imposes a significant burden on patients and healthcare systems. While nociceptive pain arises from tissue damage, nociplastic pain stems from central sensitization without clear injury. Appropriate pharmacological strategies are essential but often vary in real-world settings. Objectives: The present study aimed to evaluate the prescribing patterns of analgesic and adjunctive medications for chronic nociceptive and nociplastic pain in an outpatient setting and to assess treatment adherence, effectiveness, and adverse drug reactions (ADRs). Materials and Methods: A cross-sectional observational study was conducted at the Department of Physical Medicine and Rehabilitation of a tertiary care teaching hospital in eastern India over a period of one year. A total of 97 patients aged 18 years and above with nociceptive or nociplastic chronic pain were enrolled. Drug utilization patterns were analyzed based on prescriptions from the first and last visits. Pain intensity was assessed using the Visual Analogue Scale (VAS), adherence using the MMAS-8 scale, and ADRs using WHO-UMC, Naranjo, and Hartwig-Seigel assessment tools. Results: Multidrug therapy involving gabapentinoids, NSAIDs, and paracetamol was common at the initial visit, while later prescriptions showed a shift toward gabapentinoid monotherapy. The mean VAS score declined from 4.13 to 2.99, and 75.26% of patients reported improvement in quality of life. High adherence (MMAS-8 score = 8) was noted in 72.18% of patients. ADRs were mostly mild, with only one patient requiring hospitalization. Conclusion: The study highlights a rational trend in pharmacological management of chronic pain, favouring simplified, mechanism-based therapy with good adherence and safety outcomes. Regular monitoring and individualized therapy may further optimize pain management strategies in similar outpatient settings.

Background: Regional anaesthesia has changed anaesthetic practice. Spinal and epidural anaesthesia are the two most commonly used neuraxial techniques. Each has its own benefits and drawbacks. Combined spinal-epidural anaesthesia (CSEA) was created to combine the fast onset and dense block of spinal anaesthesia with the flexibility of epidural anaesthesia. However, there is limited comparative evidence between CSEA and epidural anaesthesia (EA) in gynaecological surgery. Aim: The goal of this study is to evaluate and compare the effectiveness and safety of CSEA and EA in lower abdominal gynaecological surgeries. We will look at drug requirements, onset and duration of pain relief, blood pressure stability, muscle relaxation, and complications. Methods: This prospective, randomised study included 100 patients undergoing elective gynaecological surgeries. Patients were randomly divided into two groups of 50: Group CSEA (combined spinal-epidural) and Group EA (epidural). Both groups received standard premedication, monitoring during surgery, and oxygen. We assessed onset and duration of sensory and motor blocks, changes in blood pressure, quality of muscle relaxation, pain relief, total drug use, and complications. Data were analysed with statistical tests, considering p < 0.05 significant. Results: Demographic and baseline characteristics were similar across groups. Group CSEA had a significantly faster onset of sensory and motor block, better muscle relaxation, and lower total drug use compared to Group EA. The duration of effective pain relief was longer in Group CSEA, requiring fewer extras. Blood pressure remained stable in both groups, although transient low blood pressure was more frequent in CSEA. Adverse events like nausea, shivering, and post-dural puncture headache were minimal and similar in both groups. Conclusion: CSEA offers better conditions during surgery with faster onset, longer pain relief, and lower anaesthetic needs compared to EA, without compromising blood pressure safety. It may be a more effective neuraxial technique for lower abdominal gynaecological surgeries.

Background: Laparoscopic appendectomy is the preferred approach for treating acute appendicitis. Specimen retrieval techniques may influence operative times and postoperative outcomes. Objective: To compare the operative outcomes between Plastic Endo-Bag retrieval and Direct 10mm Umbilical Port retrieval during laparoscopic appendectomy. Materials and Methods: In this prospective observational study conducted over 18 months, 50 patients diagnosed with acute appendicitis were alternatively allocated into two groups: Group A (Endo-Bag retrieval) and Group B (Direct retrieval). Mean operative time, specimen retrieval time, first passage of flatus, length of hospital stay, and port-site infections were evaluated. Results: Mean operation and specimen retrieval times were significantly longer in Group A compared to Group B (p<0.05). Port-site infections were slightly more common in Group B but without statistical significance. No differences were observed regarding the first passage of flatus and hospital stay. Conclusion: Direct retrieval through a 10mm umbilical port reduces operative time and specimen retrieval time without significantly affecting infection rates. Larger studies are recommended to confirm these findings.

Introduction: Postoperative pain management plays a pivotal role in the outcome of knee arthroplasty and is a major challenge affecting recovery and patient satisfaction. While opioids and NSAIDs remain standard, their side effects limit long-term use. Transdermal buprenorphine patches and intraoperative multimodal cocktail injections are emerging alternatives, each with unique pharmacologic benefits. However, no study to date has directly compared these two modalities. This study aims to compare their efficacy in managing postoperative pain following total knee arthroplasty. Materials and Methods: This observational analytical study was conducted at Gandhi Medical College and Hamidia Hospital, Bhopal, from May 2023 to October 2024. Fifty adult patients undergoing total knee arthroplasty were randomized into two groups (n=25 each). Group 1 received a 10 mg transdermal buprenorphine patch applied 12 hours preoperatively. Group 2 received a 45 mL intraoperative cocktail injection consisting of ropivacaine, cefuroxime, triamcinolone, ketorolac, adrenaline, and normal saline. Pain was assessed using the Visual Analog Scale (VAS) pre operatively and at 4, 8, 12, 24, 48, 72, and 120 hours post operatively. The requirement and timing of rescue analgesia were recorded for comparing the two modalities. Results: Demographic and surgical parameters were comparable between groups. VAS scores were not significantly different preoperatively or at 4 hours postoperatively (p = 0.81 and p = 0.33). However, the intraoperative cocktail group had significantly lower VAS scores at 8, 12, 24 and 48hours (p < 0.05). At 72 and 120 hours, buprenorphine patch group showed slightly better pain control, though not statistically significant (p = 0.48 and p= 0.06). Rescue analgesia was required in 88% of patients in the buprenorphine group versus 64% in the cocktail group. The mean number of rescue doses was higher in the patch group (3.56 vs. 1.84). The time to first rescue dose was significantly delayed in the cocktail group (p = 0.04). No major complications were noted in either group. Conclusion: Intraoperative cocktail injections offer superior early postoperative pain control and reduce the need for rescue analgesia. Buprenorphine patches provide sustained analgesia beyond 72 hours. Both are safe and effective; their selection should be individualized based on clinical context and patient needs. This is the first study to directly compare these two modalities, addressing a significant gap in postoperative analgesia in total knee arthroplasty.

This study entitled as “Relation between Red cell distribution width and HbA1c levels in patients with Type 2 diabetes mellitus” was conducted among patients with Type 2 DM for more than one year duration in the age group of 20-50 years coming to Diabetology department in SGMC &RF. It was done to find out the relation between RDW & HbA1C levels in patients with type 2 Diabetes Mellitus. The total sample size was 148. Details were collected using questionnaire and Biochemical Analysis. For Biochemical Analysis, 2ml of blood was collected from patients attending the OPD after getting the informed consent and was given to pathology lab for estimating RDW. Blood level of RDW was done by Flow cytometry method and HbA1c by HPLC method was done in the laboratory. As against various literatures available, this study failed to prove any significant association between RDW and HbA1c. Here the p value is 0.234 and the r value is -0.098 which says that there is no relation between RDW and HbA1c. This study seems quite inadequate enough to draw any correlation between RDW and HbA1c and demands further changes in the pattern of approach.

Background: Cephalometric analysis is fundamental to orthodontic diagnosis and treatment planning. McNamara’s analysis, although widely adopted, is primarily based on Caucasian reference data. This study aims to establish cephalometric norms for young adults from Tamil Nadu and compare these with McNamara’s established standards. Methods: One hundred standardized lateral cephalograms (50 males and 50 females), aged 19–26 years, were selected from the archives of the Department of Orthodontics, Tamil Nadu Government Dental College and Hospital. All participants exhibited clinically acceptable Class I occlusion and no history of orthodontic treatment. The radiographs were digitized and analyzed using VistaDent OC software following McNamara’s protocol. Descriptive and inferential statistics were employed to evaluate gender-based differences and deviations from McNamara’s norms. Results: Tamil Nadu males exhibited significantly greater midfacial and mandibular lengths than females (P < 0.001). Compared with McNamara’s norms, the midfacial length in Tamil Nadu males was reduced, indicative of a retrusive maxilla. Females showed more upright maxillary and mandibular incisors and a more prominent chin. Intra-examiner reliability was established with a Cronbach’s alpha > 0.6. Conclusion: Distinct cephalometric patterns were observed among Tamil Nadu young adults, emphasizing the importance of population-specific reference values in orthodontic diagnosis and treatment planning.

Atopic Dermatitis (AD) is a chronic inflammatory skin condition that affects both children and adults globally, significantly impacting quality of life. This review explores the efficacy of Virechan (therapeutic purgation) in managing Atopic Dermatitis (AD), known as Vicharchika in Ayurveda, by integrating classical Ayurvedic principles with modern clinical insights. Research data were gathered from published clinical trials, foundational Ayurvedic literature (e.g., Charaka Saṃhitā, Sūṣruta Saṃhitā, Aṣṭāṅga Hṛdaya), and pertinent biomedical studies found in databases such as PubMed and the AYUSH Research Portal. Studies published between 2000 and 2024 were included, incorporating keywords such as “Virechan”, “purgation therapy”, “atopic dermatitis”, “eczema”, “Vicharchika”, “gut-skin axis”, and “Pitta”. The inclusion criteria focused on clinical studies and classical references related to the condition’s pathogenesis and treatment. Data were synthesized to identify mechanistic underpinnings and clinical outcomes. Virechan, as described in Ayurvedic texts, demonstrates significant potential in alleviating symptoms and improving skin conditions in AD/Vicharchika, supported by various studies that highlight its role in balancing Pitta and Kapha doshas. Integrating Virechan therapy with both traditional Ayurvedic and modern medical approaches offers a holistic strategy for managing atopic dermatitis, presenting promising avenues for future research and clinical application.

Introduction: Subclinical hypothyroidism (SCH) is characterized by elevated serum thyroid-stimulating hormone (TSH) levels with normal free thyroxine (FT₄) concentrations. Although often asymptomatic, SCH has been associated with alterations in lipid metabolism, potentially increasing cardiovascular risk. Understanding lipid profile changes in SCH is crucial for early intervention. Aims: To assess and compare the lipid profile parameters in patients with subclinical hypothyroidism and euthyroid controls, and to evaluate the relationship between serum TSH levels and lipid abnormalities. Materials and Methods: This was a cross-sectional comparative study conducted at the Physiology, Government Medical College, Kozhikode, Kerala 673008. The study was carried out over a period of one year from June 2018 to June 2019. The study population included 90 patients aged 25–60 years with subclinical hypothyroidism, who were enrolled as cases, and 90 age- and sex-matched euthyroid individuals as controls. Both cases and controls were recruited from the hospital’s outpatient department, including staff and patient bystanders. The study specifically evaluated the lipid profile in patients with subclinical hypothyroidism, with a total sample size of 90 patients. Results: In this study, patients with subclinical hypothyroidism showed significant metabolic alterations compared to euthyroid controls. They had lower HDL-C levels and higher triglyceride levels, along with elevated fasting plasma glucose and increased waist circumference. All differences between the two groups were statistically significant, indicating that subclinical hypothyroidism is associated with an atherogenic and metabolically adverse profile, which may predispose these individuals to cardiovascular disease and metabolic syndrome. Conclusion: Subclinical hypothyroidism is associated with atherogenic lipid abnormalities, particularly elevated total cholesterol and LDL-C. Early screening and monitoring of lipid profiles in SCH patients may help in reducing long-term cardiovascular risk through timely management.

Introduction: Periprosthetic joint infection (PJI) is a rare but serious complication following total knee replacement (TKR), leading to significant morbidity, functional impairment, and increased healthcare costs. Two-stage revision arthroplasty is widely regarded as the gold standard for managing chronic or recurrent PJI, offering high rates of infection eradication. However, long-term outcomes in terms of functional recovery, implant survivorship, complications, and patient satisfaction remain incompletely understood. Objective: This study aimed to evaluate the long-term clinical and functional outcomes of patients undergoing two-stage revision for infected TKR. Methods: A prospective observational study was conducted at the Department of Orthopaedics, MGM Medical College and Hospital, Jamshedpur, Jharkhand, India, over 2 years. Thirty patients with infected TKR who underwent two-stage revision surgery were included. Stage 1 involved prosthesis removal and placement of an antibiotic-loaded cement spacer, followed by systemic antibiotic therapy. Stage 2 consisted of reimplantation once infection was controlled. Demographic data, comorbidities, microbiological profile, interval between stages, functional outcomes measured by Knee Society Score (KSS) and function score, range of motion (ROM), complications, and patient-reported satisfaction were analyzed. Results: The mean age of patients was 65.3 ± 8.4 years, with 18 males and 12 females. The most common pathogens were Staphylococcus aureus (40%) and MRSA (20%), with 10% culture-negative cases. The mean interval between stages was 10.2 ± 2.8 weeks. Postoperative functional outcomes improved significantly, with mean KSS increasing from 42.3 ± 10.5 to 82.1 ± 7.6 and function score from 45.7 ± 9.2 to 79.4 ± 8.3 (p < 0.001). Knee flexion improved from 85.3° ± 15.2 to 110.5° ± 12.3, and extension deficit decreased from 15.0° ± 5.2 to 5.0° ± 3.0. Complications occurred in 23.3% of patients, most commonly persistent pain (10%) and re-infection (6.7%). Patient satisfaction was high, with 60% very satisfied and 26.7% satisfied. Conclusion: Two-stage revision surgery for infected TKR provides durable infection control, significant functional improvement, and high patient satisfaction, with an acceptable complication rate. These findings support the effectiveness and generalizability of two-stage revision as the standard treatment for chronic or recurrent PJI following TKR.

Introduction: Subclinical hypothyroidism (SCH) is a prevalent endocrine condition defined by elevated thyroid-stimulating hormone (TSH) levels with normal free thyroxine (FT4). SCH has been linked to lipid metabolism abnormalities, contributing to an increased risk of cardiovascular disease. Early identification and management of dyslipidemia in SCH patients are vital for cardiovascular risk reduction. Aims: To evaluate and compare the lipid profile of patients with subclinical hypothyroidism and euthyroid individuals. Materials and Methods: This cross-sectional observational study was carried out in the Department of Physiology, Government Medical College, Kozhikode, Kerala 673008, from June 2018 to June 2019. It included 80 subjects aged 18–60 years: 40 patients diagnosed with SCH (elevated TSH with normal FT4) and 40 age- and sex-matched euthyroid controls. Results: The mean age of SCH patients (46.2 ± 7.8 years) and controls (45.5 ± 8.1 years) was comparable (p = 0.58). Serum FT4 levels were similar between groups (1.11 ± 0.14 ng/dL vs. 1.13 ± 0.13 ng/dL, p = 0.49), but SCH patients had significantly higher TSH levels (8.52 ± 2.0 µIU/mL vs. 2.15 ± 0.75 µIU/mL, p < 0.001). SCH patients showed significantly elevated total cholesterol (p = 0.02), triglycerides (p = 0.03), and LDL-C (p = 0.01), along with lower HDL-C (p = 0.009). Atherogenic indices like the total cholesterol/HDL ratio (p = 0.02) and LDL/HDL ratio (p = 0.008) were also higher in SCH patients. Conclusion: Patients with subclinical hypothyroidism showed significantly higher TSH levels and adverse lipid profile changes, including increased total cholesterol, triglycerides, LDL-C, and reduced HDL-C. Atherogenic ratios were also elevated, indicating higher cardiovascular risk. Routine lipid monitoring in SCH patients is recommended to enable early intervention and reduce long-term complications.

Background: Soft tissue tumors (STTs) and tumor-like lesions present a wide range of diagnostic challenges due to their clinical and morphological diversity. Fine Needle Aspiration Cytology (FNAC) has emerged as a reliable, minimally invasive, and cost-effective diagnostic technique for the preliminary evaluation of such lesions. It helps differentiate benign from malignant conditions and guides further management. Aim: To evaluate the diagnostic utility of FNAC in the diagnosis of soft tissue tumors and tumor-like lesions and to correlate cytological findings with histopathological results. Methods: A prospective observational study was conducted over 12 months from July 2024 to June 2025 at Patna Medical College and Hospital, including 100 patients presenting with palpable soft tissue swellings. FNAC was performed using standard technique, and cytological diagnoses were categorized. Surgical excision and histopathological correlation were performed in 60 cases. Data were analyzed using SPSS version 23.0 to calculate diagnostic accuracy, sensitivity, specificity, (PPV), and (NPV). Results: Out of 100 cases, 60% were benign, 30% malignant, and 10% tumor-like/inflammatory lesions. Lipoma (40%) was the most common benign tumor, while sarcoma (15%) was the most frequent malignant tumor. FNAC findings correlated with histopathology in 54 of 60 cases (90%). The sensitivity and specificity of FNAC in detecting malignancy were 88.8% and 92.1%, respectively. The overall diagnostic accuracy was 90%, with PPV of 94.1% and NPV of 85.7%. Conclusion: For soft tissue cancers and tumor-like lesions, FNAC is a useful initial diagnostic technique because of its ease of use, speed, and high diagnostic accuracy. It is very useful for differentiating between benign and malignant lesions, and in many situations, it can greatly minimize the need for an open biopsy. Recommendations: FNAC should be incorporated as a routine first-line investigation for soft tissue lesions. Whenever possible, cytological diagnosis should be supported by ancillary techniques such as immunocytochemistry and correlated with histopathological findings for precise subtyping. Further studies with larger sample sizes and image-guided FNAC are recommended for deep-seated lesions.

Background: Asprosin is an adipokine that is produced during fasting and is implicated in insulin resistance and hepatic glucose release. Interest has grown in its potential to detect gestational diabetes mellitus (GDM) early. Objective: To evaluate whether serum asprosin levels measured during early pregnancy can foretell the onset of GDM later on. Methods: This prospective multicentre cohort study included 600 pregnant women (11–14 weeks gestation) recruited from three tertiary care hospitals in India between January 2023 and June 2024. Fasting serum asprosin was estimated using a standardized ELISA protocol. After a 75-g OGTT conducted between weeks 24 and 28, the IADPSG criteria were used to diagnose GDM. Logistic regression, ROC analysis, and model improvement metrics were applied. Results: A total of 92 women (15.3%) got GDM. Women who eventually developed GDM had significantly higher median blood asprosin levels at 11–14 weeks than normoglycemic controls (20.2 vs. 14.1 ng/mL). Good predictive performance was demonstrated by asprosin (AUC 0.76; 95% CI 0.71–0.81). Discrimination increased from AUC 0.74 to 0.81 (p=0.002) when asprosin was included to a clinical model that included maternal age, BMI, obstetric history, and family history of diabetes. The best cut-off was 17.5 ng/mL, which produced 70% specificity and 73% sensitivity. Conclusion: Elevated first-trimester serum asprosin levels are associated with increased risk of GDM and significantly enhance early predictive accuracy when added to routine clinical factors. Asprosin may serve as a practical early biomarker for GDM risk stratification.

Background: The injuries at volar aspect of wrist are a common but difficult problem for the patient, surgeon and hand therapist. They require a great deal of rehabilitation and subsequent procedures thereby causing a significant cost to patients and health care system. Objectives: This study was undertaken to determine various modes of wrist injury, nature of structures involved, frequency of injury to various structures at wrist, functional outcomes of various structures repaired at wrist. Methods: Fifty patients of volar wrist injuries were prospectively studied. After identification the involved structures were taken up for repair. The tendon repair was done by modified Kessler technique (core suture) with 4-0 proline reinforced by epitenon sutures (6-0 proline). After wound closure light dressings were applied and dorsal splint was applied keeping the wrist in 20-45degrees of flexion and metacarpophalangeal joints in 40-60degree of flexion. Post operatively the patients were followed up to six months for assessment of tendon function, deformity, opposition, intrinsics and sensations. All the patients were followed with strict standard post-op rehabilitation protocol. Results and Conclusion: In this study male patients accounted for majority of cases (86%) while females comprised 14% of cases with mean age of male patients 28.7years and mean age of female patients was 30.7years. Glass cut was the main mode of injury in the studied patients accounting for 64%. Tin injury, bandsaw injury, knife and axe injuries were the next in frequency. Most of the patients had right sided involvement (74%), whereas left sided injuries were noticed in 26% of patients. Most of the patients had a wound size between 5-7cm. Wound sizes ranging from 2cm to 10cms. The mean wound size was 6.2cm. FDS was the most common tendon involved in 66% of the patients. FCU and FDP were the next in frequency accounting for 48% and 42% respectively. 16% of the patients had no tendon involvement whereas 18% had all tendons affected. Most (60%) of the patients had 1-3 tendons cut. Ulnar nerve was the most frequently injured nerve in 54% of cases whereas median nerve was involved in 42% of cases. Simultaneous injury of both nerves was observed in 16% of patients. 20% of the patients had no nerve injury. Ulnar artery was most commonly involved vessel accounting for 48% of cases. Radial artery was affected in 24%of patients. Combined injury of both vessels was observed in 10% of cases. 38%of patients had no vascular injury. Tendon function was found to be excellent in 92% of cases. 4% patients had well and another 4% had poor function. Opposition was excellent in 86% of the patients and poor in 4% of patients. Intrinsic function yielded similar results with majority of patients (78%) exhibiting excellent function. Sensory recovery was reported excellent in 74% of patients. 12% had well, 10% had fair and another 4% had poor sensory recovery. Deformity was classified as minor if there was either claw hand or ape thumb. Major deformity was defined as presence of both claw hand and ape thumb. Only 4% of patients developed minor deformities. This study emphasized early mobilization and use of microsurgical repair of structures involved. From the study we concluded that overall good functional outcomes of wrist injuries can be obtained in majority of patients and early post-operative mobilisation can have a very beneficial effect in determining such results. Furthermore, any small looking incised wound need not to be overlooked and its timely exploration and repair of injured structures coupled with use of microsurgical techniques, magnification, use of finer sutures and early post-operative mobilisation form the cornerstone for a successful outcome.

Background: Bear maul injuries form a significant portion of wildlife-related injuries in forest-adjacent regions of Jammu and Kashmir, often resulting in soft tissue damage, facial disfigurement, and long-term disability and psychosocial damage. Objective: To analyze the demographic profile, injury patterns, radiological findings, and management of bear maul victims presenting at aperipheral hospital in Chenab valley of Jammu and Kashmir. Methods: A combined retrospective and prospective study was conducted on 57 patients admitted at Government District Hospital, Kishtwar, between January 2019 and October 2025. Data were collected on patient demographics, injury site, circumstances of attack, FAST findings, and treatment approaches. Statistical analysis was performed to determine distribution and outcomes. Results: Among 57 evaluated cases, 68.43% were male and 31.57% female; adults constituted 75.43% of victims. USG FAST was positive in 15.78% of cases, indicating intra-abdominal involvement. The face and scalp were the most commonly affected areas (45.61%), followed by upper limbs (28.07%) and lower limbs (15.78%). Most attacks were sudden (63.15%), while provocative and predatory encounters accounted for 24.56% and 12.28%, respectively. Surgical intervention was required in 57.89% of patients, primarily for wound wash, debridement, and fracture fixation, while 42.11% were managed conservatively with dressings and prophylaxis. Conclusion: Bear maul injuries represent a major surgical challenge in hilly regions. Early wound management, infection prevention, ARV administration and coordinated trauma care, coupled with community awareness and wildlife safety measures, are essential to minimize morbidity and improve outcomes.

Background: Vitamin D is essential for the health of both mother and fetus and plays important roles in placental ability, fetal growth, and immunity. Maternal vitamin D deficiency during pregnancy has been linked to negative obstetrical and neonatal outcomes. Objective: To investigate the relationship between maternal vitamin D deficiency and pregnancy complications and neonatal outcomes. Methods: A retrospective cohort study was performed among 450 singleton pregnancies at Nalanda Medical College & Hospital, Patna, Bihar, India. Participants were classified based on serum 25(OH)D levels as deficient (DD, <20 ng/mL), insufficient (DS, 20–30 ng/mL), or sufficient (SS, ≥30 ng/mL). Obstetric and neonatal outcomes were examined using ANOVA, Chi-square, and multivariable logistic regression. Results: Vitamin D deficiency was associated with an increased rate of preterm births (<34 weeks; DD 6.7%, DS 2.3%; adjusted OR = 2.56, 95% CI 1.02–6.42) and lower mean birth weight (2850 ± 590 g vs. 2975 ± 520 g; p = 0.041). Mothers who were vitamin D deficient had higher rates of necrotizing enterocolitis (DD 3.3% vs. SS 0.3%; OR = 12.5) and developmental delay at one year (DD 8.9% vs. SS 2.0%; OR = 3.94). Conclusion: Maternal vitamin D deficiency is linked to preterm birth, low birth weight, and higher rates of neonatal morbidity and developmental delay. Adequate vitamin D status during pregnancy is important for optimal maternal and neonatal health outcomes.

Background: It is important in its relationships to maternal and neonatal outcomes to examine Maternal Body Mass Index (BMI) in early pregnancy. The extremes of BMI whether underweight or overweight are found to be associated with adverse events in pregnancy. Aim: To evaluate the association between first trimester maternal BMI and pregnancy outcomes in women with singleton pregnancies. Method: A prospective observational study recruited 180 women who were attending at Nalanda Medical College & Hospital, Patna, Bihar, India. Participants were grouped into four BMI categories (underweight, normal, overweight, and obese). Maternal complications, mode of delivery, and neonatal outcomes were analyzed utilizing ANOVA and Chi-squared tests (p<0.05 significant). Results: Normal BMI women accounted for 48.9% of the cohort. Higher BMI increased the incidence of pregnancy related hypertension (16.7%) and gestational diabetes (33.3%). Severe anemia (21.4%) and intra-uterine growth restriction (35.7%) was more prevalent in underweight women. Rates of Cesarean delivery increased with BMI and postpartum complications (PPH, wound sepsis) were common in obese women. Neonates of underweight mothers tended to be SGA (35.7%) and neonates of obese mothers had an increased incidence of macrosomia (12.5%). Conclusion: Low and high maternal BMI both have a negative impact on pregnancy outcomes and need assessment along with clinical interventions initiated in early pregnancy based on their BMI.

Background: Lesions of the nasal cavity and paranasal sinuses encompass a wide histopathological spectrum ranging from simple inflammatory polyps to malignant neoplasms. Their overlapping clinical presentations often make histopathological evaluation indispensable for accurate diagnosis and management. Aim: To evaluate and classify the histopathological spectrum of nasal and paranasal sinus lesions, and to study their distribution with respect to age, sex, and site. Materials and Methods: A prospective observational study was conducted on 50 cases of nasal and paranasal sinus lesions. Routine haematoxylin–eosin-stained sections were studied, and lesions were categorized into non-neoplastic and neoplastic (benign and malignant) types. Results: Out of 50 cases, 32 (64 %) were non-neoplastic, 11 (22%) benign neoplastic, and 7 (14%) malignant neoplastic. Inflammatory nasal polyp was the most common lesion (46%), followed by chronic sinusitis (12%). Among benign tumors, nasopharyngeal angiofibroma was most frequent (8%), and squamous cell carcinoma was the predominant malignant tumour (10%). The majority of patients were in the fourth to fifth decade with a male-to-female ratio of 1.6:1. The nasal cavity was the most common site involved (70%). Conclusion: Inflammatory lesions constitute the bulk of nasal and paranasal sinus pathologies. Histopathological examination remains the gold standard for distinguishing between benign and malignant conditions, enabling appropriate therapeutic planning and prognostic assessment.

Background: Laparoscopic surgeries are widely performed under general anaesthesia, where haemodynamic stability is often challenged by stress responses to laryngoscopy, intubation, and pneumoperitoneum. Traditionally, opioids such as fentanyl are used to attenuate these responses; however, opioid-related side effects like respiratory depression, nausea, and delayed recovery have driven exploration of opioid-free anaesthesia (OFA) protocols using agents such as dexmedetomidine, lignocaine, and bupivacaine. Aim: To compare the haemodynamic stability and postoperative analgesia between opioid-based anaesthesia (fentanyl) and opioid-free anaesthesia (dexmedetomidine + lignocaine + bupivacaine) in patients undergoing laparoscopic surgeries. Methods: This randomized, prospective study was conducted 80 ASA I–II adult patients aged 18–60 years were enrolled and divided into two groups (n=40 each). (1) Group A (OGA): Fentanyl 2 µg/kg IV + maintenance boluses. (2) Group B (OFA): Dexmedetomidine 0.7 µg/kg IV + lignocaine 1 mg/kg IV, followed by continuous dexmedetomidine (0.3 µg/kg/hr) and lignocaine (1.5 mg/kg/hr) infusions; local bupivacaine infiltration at closure. Haemodynamic parameters (HR, SBP, DBP, MAP, SpO₂, EtCO₂) were recorded at baseline, induction, post-intubation, and throughout surgery. Postoperative pain was assessed using the Visual Analogue Scale (VAS). Data were analysed using Student’s t-test; p<0.05 was considered significant. Results: Both groups were demographically comparable. The OFA group exhibited significantly attenuated rises in HR and MAP post-intubation (p<0.001). Postoperative pain scores were lower in OFA at 2, 4, and 6 hours (VAS <3), with reduced need for rescue analgesia. Incidence of nausea and vomiting was lower in OFA (5%) than OGA (22%). No severe bradycardia or hypotension was observed. Conclusion: Opioid-free anaesthesia using dexmedetomidine and lignocaine with local bupivacaine provides superior haemodynamic stability and prolonged postoperative analgesia compared to fentanyl-based anaesthesia, with fewer opioid-related adverse effects. OFA is a safe and effective alternative for laparoscopic procedures.

Introduction: Third trimester vaginal bleeding is a major cause of maternal and perinatal morbidity and mortality even in modern day obstetrics and is one of the most frequent emergencies in obstetrics. Bleeding from the genital tract from 27th weeks of pregnancy to the delivery of the baby. Aims: To study the prevalence of vaginal bleeding in third trimester at tertiary care hospital, the importance of early diagnosis and prompt treatment in the improvement of maternal and perinatal outcome, the value of current obstetric practice in managing bleeding in third trimester. Materials and Method: The present study was a Prospective, Observational Study. This study was conducted over 18 months after getting approval from institutional ethics committee at Obstetrics and Gynaecology Department and Paediatric Medicine Department of Burdwan Medical College & Hospital. 162 patients were included in this study. Result: From our study we could discover statistically significant association with various demographic factors like age of patient, literacy, socio economic status etc. Majority patients were Multi Gravida, mostly delivering preterm. Almost half (49.3 %) had placenta previa, followed by abruptio placentae in 48.1 % of cases. Most common presentation was cephalic (70 %).62 % patients delivered by emergency caesarean sections, around 5 % underwent CS with B/L uterine artery ligation, and 1 % of patients required obstetric hysterectomy. 72 (44.4%) patients underwent 1-unit   PRBC transfusion. A significant association between APH and other risk factors like GDM and PIH was found. In our study, 2.46% patients developed DIC, 3.70% patients developed ARF, 3.08% patients developed sepsis, and 12.34% patients developed PPH as complications. 9.87% of patients needed CCU management and recovered. Only 3 patients died even after extensive CCU support. We found alive birth rate of 87.1% and a preterm birth rate of 54.9%.54.93% babies had a birth weight <2500 gm. Maximum babies APGAR at 1 min ranged between 4-6. Of the total neonatal deaths, 10.5% baby died due To HIE, 14.8 % died due to respiratory Distress. Conclusion: We observed that third trimester vaginal bleeding even in a tertiary care hospital is associated with adverse and fatal maternal as well as fetal outcomes.

Background: Shoulder pain is one of the common ailments of older people in India. Measuring ACEA and assessing the incidence of the sourcil sign on plain shoulder X-rays can be very useful, time-saving, and cost-effective in patients with shoulder pain. Aim: The main objective of the study is to determine the incidence of sourcil sign in shoulder pain patients and to measure the ACEA angle in plain X-rays and compare its association with sourcil sign and increased ACEA angle. Methodology: The study is an analytical investigation conducted among patients with shoulder pain attending SRM Medical College Hospital and Research centre, Irungalur, Trichy. A total of 77 subjects were included in the study. We collected X-rays of the shoulder joint for 6 months, from June to November 2018. Following this, the X-rays were converted to the RADIANT DICOM viewer, and the ACEA angle was measured.  The incidence of the sourcil sign was determined, and the correlation with the ACEA angle was statistically analyzed. Results: The ACEA values ranged from 15.4 to 40.0 degrees, indicating moderate variation in the study population, and 16 participants (20.8%) showed a positive sourcil sign, while 61 participants (79.2%) were negative for the sign. Participants with a positive sourcil sign had a lower mean ACEA (25.57 ± 7.49°) compared to those with a negative sourcil sign (28.73 ± 5.48°). However, this difference was not statistically significant (p = 0.097). Conclusions: In our study, there is an increased prevalence of higher ACEA angle in the general population with shoulder pain. However, ACEA showed only limited predictive performance in detecting the sourcil sign. Diagnosing with this simple radiological tool (plain X-rays) and early treatment have a positive impact on quality of life.

Tracheoesophageal fistula in adults is a rare condition that may be congenital or acquired. Congenital TEF, often an H-type, can present late with recurrent respiratory infections and aspiration due to chronic microaspiration. Understanding the distinctions between congenital and acquired TEF, along with prompt diagnosis and tailored treatment-including ATT in tubercular cases-is essential to improve outcomes and reduce morbidity in affected adults. We present a rare case of tubercular tracheoesophageal fistula in a 32-year-old female.

Background: The sniffing position is commonly used for optimal intubation during endotracheal procedures, but the precise alignment required can vary. This study aims to assess whether using a customized pillow to align the external auditory meatus (EAM) with the sternal notch improves glottic visualization and eases the intubation process, compared to a fixed-height pillow. Methods: This comparative, prospective study was approved by the institutional ethics committee and conduct-ed with 450 adult patients (ASA PS I-IV) undergoing elective surgeries. Patients were randomized into two groups: the Fixed Pillow (FP) group, where a standard 4 cm height pillow was used, and the Custom Pillow (CP) group, where additional sheets were placed to align the EAM with the sternal notch. Primary outcomes included Cormack-Lehane (CL) grading of glottic visualization, intubation time, number of attempts, and the need for assistance (e.g., bougie, stylet, external laryngeal manipulation). Data were analyzed using unpaired t-tests and odds ratios, with a significance level of P < 0.05. Results: A total of 450 patients completed the study. The mean pillow height in the CP group was 6.22 ± 0.83 cm. While the difference in CL grading between the groups was not statistically significant, the CP group showed a significantly shorter intubation time (13.52 ± 3.01 seconds) compared to the FP group (15.85 ± 3.14 seconds, P = 0.01). Additionally, the CP group had fewer intubation attempts (P = 0.04). Conclusion: Customizing pillow height to achieve horizontal alignment of the EAM with the sternal notch improves intubation efficiency by reducing both time and attempts. This approach may be particularly beneficial for patients with difficult airways.

Background: Unanticipated difficult laryngoscopic tracheal intubation remains a major cause of anaesthesia-related morbidity and mortality. Preoperative airway assessment tools, such as the Modified Mallampati Test (MMT) and the Upper Lip Bite Test (ULBT), are used to predict difficult laryngoscopy, but their diagnostic accuracy varies. Methods: This prospective, single-blinded observational study included 300 adult patients (ASA I–II) undergoing elective surgery under general anaesthesia with endotracheal intubation at Burdwan Medical College and Hospital. Preoperative airway assessment was performed using MMT and ULBT. Direct laryngoscopy was conducted under standard anaesthetic conditions and graded according to the Cormack-Lehane classification. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for both tests. Results: Of the 300 patients, 52 (17.3%) exhibited difficult laryngoscopic views (grades III–IV). ULBT demonstrated superior diagnostic performance, with sensitivity of 88.46%, specificity of 92.74%, PPV of 71.87%, NPV of 97.45%, and accuracy of 92.00%. In contrast, MMT showed a sensitivity of 19.23%, specificity of 91.93%, PPV of 33.33%, NPV of 84.44%, and accuracy of 79.33%. Conclusion: The Upper Lip Bite Test showed significantly higher sensitivity and overall diagnostic accuracy than the Modified Mallampati Test for predicting difficult laryngoscopy. ULBT is a more reliable and practical bedside tool for preoperative airway assessment and may enhance patient safety when integrated into routine anaesthetic evaluation.

Background: Prehypertension is an early indicator of future hypertension and cardiovascular morbidity. Young women, despite being considered a low-risk group, are increasingly exposed to lifestyle factors that predispose them to elevated blood pressure. Early identification of prehypertension and its correlates is crucial for initiating preventive strategies in this population. Methods: A cross-sectional study was conducted among 334 college-going women aged 18–22 years in Pathanamthitta district, Kerala, from December 2017 to May 2019. Participants were selected through multistage cluster sampling. Data on sociodemographic factors, dietary habits, physical activity, and family history were collected using a semi-structured questionnaire. Anthropometric measurements and blood pressure were recorded using standard procedures. Prehypertension was defined as systolic BP 120–139 mmHg and/or diastolic BP 80–89 mmHg (JNC-8). Data were analyzed using chi-square and t-tests, with p < 0.05 considered statistically significant. Results: The prevalence of prehypertension was 40.7% among the study participants. A total of 56% reported a family history of hypertension. Prehypertension showed a significant association with certain dietary factors, including frequent consumption of fish, eggs, and vegetables, while no significant associations were observed with socioeconomic status, family type, or marital status. Although 33.2% of participants had a moderate risk of future type 2 diabetes mellitus (based on IDRS), no significant association was found between prehypertension and diabetes risk. Conclusion: The high prevalence of prehypertension among young college women in South Kerala highlights the urgent need for targeted lifestyle interventions, regular screening, and awareness programs. Early risk modification may help prevent the progression of hypertension and reduce long-term cardiovascular burden.

Introduction: Thyroid disorders, particularly multinodular goitre and thyroid malignancies, are common indications for surgical intervention. Thyroidectomy, while generally safe, is associated with a range of postoperative complications, including hypothyroidism, hypocalcemia, and voice changes. Understanding the incidence and spectrum of these complications is essential for optimizing patient care and surgical outcomes. Aims: To evaluate the demographic profile, clinical characteristics, surgical procedures, histopathological patterns, and postoperative complications in patients undergoing thyroidectomy at a tertiary care centre. Materials and Methods: The present study was a retrospective observational (cohort) study conducted over a period of 12 months (January 2023 to December 2023) at the Department of General Surgery, Al-azhar Medical College and Super Speciality Hospital, Ezhalloor, Thodupuzha, Idukki District, Kerala, India. The study population comprised 150 patients who underwent thyroidectomy during the study period. Result: The mean age was 51.05 ± 9.36 years, with most patients (61.3%) aged 41–60 years. The cohort was predominantly female (93.3%). Multinodular goitre (65.3%) was the most common diagnosis, followed by papillary carcinoma (5.3%). Total thyroidectomy was the most frequent procedure (72%). Histopathology showed benign nodular goitre in 83.3% and malignancies in 13.3%, mostly papillary carcinoma. Postoperative complications included hypothyroidism (39.3%), hypocalcemia (17.3%), hyperthyroidism (9.3%), vocal cord palsy (2.0%), and minor surgical site issues (≤3.3%), while 7.3% had no complications. Conclusion: Thyroidectomy is a safe and effective surgical intervention for thyroid disorders. Hypothyroidism and hypocalcemia were the most common postoperative complications, whereas serious events such as hematoma, infection, and nerve injury were rare. Careful surgical technique and perioperative management remain crucial to minimizing complications.