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.

Objectives:  Hypertension is an important public health hazard in India as well as globally. If not properly treated, it can lead to stroke, heart failure and renal failure. So, hypertension is known as silent killer. The goal of this study was to determine the alteration of the haematological parameters in primary hypertensive subjects in comparison to normal subjects. Methods: A comparative cross-sectional study was conducted from September 2022 to August 2023 on 120 (60 primary hypertensive and 60 healthy) subjects at a tertiary care centre in Western Odisha. Blood pressure was measured by using mercury sphygmomanometer. Haemoglobin, RBC count, Haematocrit, WBC count, Platelet count, Mean Corpuscular Volume, Mean Corpuscular Haemoglobin and Mean Corpuscular Haemoglobin Concentration were determined using automated haematology analyzer after taking informed consent. P value less than 0.05 was considered as significant. Results: In this study, it was found that patients with primary hypertension have increased haemoglobin, RBC count, haematocrit and total platelet count, but decreased WBC count in comparison to healthy controls. Conclusion: Haematological parameters may be used to detect individuals who are prone to develop hypertension in future. It can also help to prevent the cardiovascular complications in hypertension.

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.

Aim: To assess the prevalence and severity of psychiatric problems including anxiety, depression, and reduced self-esteem in young acne vulgaris patients, and to establish the correlation between acne severity and psychological morbidity in an adolescent and young adult population. Materials and Methods: A cross-sectional observational study was conducted on 180 patients aged 15-25 years presenting with acne vulgaris to the Dermatology Out-Patient Department. Participants were evaluated using Global Acne Grading System (GAGS), Hospital Anxiety and Depression Scale (HADS), and Rosenberg Self-Esteem Scale (RSES). Data including demographics, acne severity, and psychological parameters were systematically recorded and analyzed. Results: Out of 180 participants (55% female, 45% male), moderate acne was most prevalent (51.9%). Anxiety was observed in 47.5% (moderate-to-severe), depression in 28.75%, and low self-esteem in 51.25% of patients. Female patients exhibited significantly higher anxiety and depression scores compared to males (p < 0.05). Quality of life was considerably impacted, with 62.8% of patients experiencing moderate to very large impact on daily functioning. Conclusion: There is necessity for integrated dermatological and psychiatric management approaches. Early identification and intervention for mental health comorbidities, combined with effective acne treatment, are essential for optimal patient outcomes and improved quality of life.

Aim: To investigate the association between meibomian gland dysfunction (MGD) and digital screen time exposure in young adults aged 18-35 years, and to establish the prevalence and severity of MGD relative to daily device usage patterns. Materials and Methods: A cross-sectional observational study was conducted on 462 participants (mean age: 22.4±4.2 years) recruited from educational institutions and office settings. Meibomian gland morphology was assessed using non-contact meibography, and tear film parameters were evaluated using Schirmer’s test and tear breakup time (TBUT). Digital screen exposure was quantified using a structured questionnaire documenting daily screen time across computers, laptops, tablets, and smartphones. Result: Participants were stratified into three groups based on daily screen exposure: <2 hours (n=45, 9.7%), 2-6 hours (n=187, 40.5%), and >6 hours (n=230, 49.8%). MGD was identified in 68.2% (n=315) of participants overall. Severity of MGD showed significant dose-dependent association with screen time (p<0.001). In the <2-hour group, 20% demonstrated MGD; in the 2-6-hour group, 52% showed MGD; and in the >6-hour group, 89% exhibited MGD with gland atrophy. Meibomian gland loss was identified in 34.8% of the >6-hour group. Tear parameters were significantly compromised with increased screen exposure: mean Schirmer’s test values declined from 16.2±2.1 mm (<2 hrs) to 8.4±1.8 mm (>6 hrs), and TBUT decreased from 12.1±1.9 seconds to 4.3±1.2 seconds respectively. Conclusion: This study demonstrates a significant positive association between prolonged digital screen time and meibomian gland dysfunction in young adults. The dose-dependent relationship between screen exposure and MGD severity suggests that interventions targeting reduced screen time and regular blinking exercises may be critical in preventing permanent meibomian gland loss in this population. Clinical awareness and preventive strategies are essential for ophthalmologists managing young adults with increasing digital device usage.

Aim: To comprehensively review the clinical significance, and management strategies of exercise-induced desaturation (EID) in patients with chronic obstructive pulmonary disease (COPD), and to identify the relationship between EID and disease progression, quality of life, and mortality outcomes. Materials and Methods: A systematic review of peer-reviewed literature published between 2001 and 2025 was conducted using PubMed, Scopus, and ScienceDirect databases. Search terms included “exercise-induced desaturation COPD,” “exertional hypoxemia,” “six-minute walk test desaturation,” and related terminology. A total of 47 studies met inclusion criteria and were analyzed for quality, methodology, and relevance. Results: Exercise-induced desaturation occurs in approximately 20-55% of stable COPD patients, with prevalence increasing with disease severity. Risk factors include older age, female sex, lower forced expiratory volume in 1 second (FEV₁), low baseline resting SpO₂, reduced diffusing capacity of the lungs for carbon monoxide (DLCO), and comorbid atrial fibrillation. EID is associated with reduced exercise tolerance, impaired health-related quality of life, accelerated decline in lung function, increased frequency of acute exacerbations, and higher mortality rates. Conclusion: Exercise-induced desaturation represents a significant clinical finding in COPD patients, serving as an independent prognostic marker for adverse outcomes including disease progression and mortality. Early detection through standardized exercise testing facilitates timely therapeutic intervention, including oxygen supplementation during exertion and pulmonary rehabilitation.

Introduction: Juvenile nasopharyngeal angiofibroma are rare benign but locally invasive vascular lesion that have traditionally be resected using open surgical approach. However, with availability of super selective Intra-arterial embolization, the advent of improved endoscopic transnasal technique and advances in instrumentation, recent year with end a shift towards the use of less invasive strictly endoscopic method for management of such lesion. Aims: The purpose of this article is to compare the endoscopic and open approach surgery and to evaluate the advantage disadvantage and complication of both the approach and also assess favourable approach. Material and Method: This prospective observational study was conducted in the department of ENT and head neck surgery, IPGMER and SSKM hospital Kolkata. confirmed case of JNA undergoing surgical intervention either endoscpic or open approach were studied   prospectively for a period of six month after the operation to note any recurrence of disease. Result: In this study endoscopic approach had minimum blood loss shorter operation time and less postoperative complication. Conclusion: We concluded that the intraoperative complications like blood loss, postoperative pain, epiphora, loss of tactile sensation of face, need for postoperative blood transfusion or duration of operation were less in Endoscopic approach than open approach surgery in JNA, though number of residual disease or recurrence of disease had been found to be more in endoscopic approach compared to the open one.

Introduction: Uterine fibroids are the most common benign tumors of the female reproductive system, often causing abnormal uterine bleeding, pelvic pain, pressure symptoms, and reduced quality of life. Medical management with agents such as Mifepristone and Ulipristal acetate provides a non-surgical option for symptom relief and fibroid size reduction. Aims: To compare the efficacy, acceptability, compliance, and adverse effects of ulipristal acetate versus mifepristone in managing fibroids in symptomatic reproductive-age women. Materials and Methods: The present study was an institution-based comparative descriptive study with a prospective design conducted in the Department of Obstetrics and Gynaecology at K.P.C. Medical College & Hospital. A total of 112 study subjects were enrolled using systematic random sampling, and data were collected over a 12-month period from 1st November 2023 to 30th October 2024. Result: Both Mifepristone and Ulipristal significantly improved hemoglobin at six months (Mifepristone: 10.9 ± 0.2 g/dL; Ulipristal: 11.1 ± 0.4 g/dL; p = 0.001) and reduced PBAC scores (Mifepristone: 41.4 ± 4.5; Ulipristal: 74.2 ± 6.0; p = 0.001). Dysmenorrhea, polymenorrhea, pelvic pain, pelvic pressure, and bladder frequency improved in both groups (p < 0.05), with Mifepristone more effective for dysmenorrhea, metrorrhagia, polymenorrhea, and bladder frequency, and Ulipristal better for menorrhagia and pelvic pressure. Uterine and myoma volumes decreased significantly in both groups (p = 0.001). Conclusion: Both Mifepristone and Ulipristal acetate are effective in managing symptomatic uterine fibroids. Treatment should be individualized based on patient symptom profiles, with Mifepristone offering better relief for bleeding and pain-related symptoms.

Introduction:  Obesity is a major public health issue, but its concurrent effects on respiratory and cardiovascular systems warrant further investigation. This study examined the relationship between Body Mass Index (BMI) and pulmonary/cardiovascular function. Aims and Objectives: This study examined the relationship between Body Mass Index (BMI) and pulmonary/cardiovascular function. Materials and Methods:  In this cross-sectional analysis, 200 participants (mean age 36±10 years; 50% female) with mean BMI 27.5±4.5 kg/m² underwent spirometry and cardiovascular assessment. Statistical analyses included ANOVA and correlation coefficients. Results: Increasing BMI categories showed progressive lung function decline. FEV1 decreased from 3.5±0.5L (normal weight) to 2.8±0.5L (obese), while FVC declined from 4.5±0.6L to 3.7±0.6L (p<0.001). The FEV1/FVC ratio showed slight but significant reduction (p=0.02). Conversely, blood pressure increased substantially with BMI elevation (p<0.001). Correlation analysis revealed moderate inverse relationships between BMI and FEV1 (r=-0.42) and FVC (r=-0.45), and strong positive correlations with systolic (r=0.50) and diastolic blood pressure (r=0.48) (all p<0.001). Conclusion: Elevated BMI demonstrates significant associations with impaired lung function, suggesting restrictive pathology, and increased blood pressure. These findings emphasize the multisystemic impact of excess weight and highlight weight management’s crucial role in maintaining cardiopulmonary health.

Background: Thyroid diseases are considered ^‘to be some of the most prevalent endocrine diseases in the world second only to diabetes mellitus. They have a large impact on metabolism, growth, and health of the body in general especially in those areas where there is variation on the intake of the iodine. Aim: The aim of the study was to clinically assess range, frequency and biochemical characteristics of thyroid disorders among patients admitted in a tertiary care hospital. Methodology: A cross-sectional research was undertaken at a hospital called the Department of General Medicine, Nalanda Medical College and Hospital, Patna, Bihar and involved 80 patients aged more than 18 years. Clinical assessment, thyroid analysis (T3, T4, TSH), ultrasound and lipid profile were done. Analysis of data was done in SPSS version 27.0. Results: Thyroid disorders were most prevalent among middle-aged females, particularly from rural areas. Hypothyroidism (42.5%) was the most common disorder, followed by hyperthyroidism (25%) and subclinical hypothyroidism (22.5%). Fatigue, weight changes, and cold intolerance were the predominant symptoms. Biochemically, hypothyroid patients showed elevated TSH and dyslipidemia, whereas hyperthyroid patients exhibited suppressed TSH with lower lipid levels. Conclusion: The study emphasizes the high prevalence of hypothyroidism, particularly in women, and its strong association with lipid abnormalities. Routine thyroid screening and early management are crucial to prevent long-term metabolic and cardiovascular complications.

Background: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities (including central obesity, dyslipidemia, hypertension, and impaired glucose metabolism) ^‘that increases the risk of cardiovascular disease and type 2 diabetes. Middle-aged adults (40–60 years) are particularly vulnerable due to lifestyle and hormonal factors. Aim: To assess the prevalence, risk factors, and clinical profile of MetS among middle-aged adults attending a tertiary care hospital in Bihar, India. Methodology: A cross-sectional observational study was conducted among 90 adults (48 males, 42 females) in the Department of General Medicine, Nalanda Medical College and Hospital. Anthropometric, clinical, and biochemical parameters were recorded. MetS was diagnosed using NCEP-ATP III criteria. Statistical analysis was performed using SPSS v27, with significance set at p < 0.05. Results: MetS prevalence was 51.1%, higher in females (57.1%) than males (45.8%). Age ≥50 years, sedentary lifestyle, and positive family history of diabetes were significantly associated with MetS (p < 0.05). Abdominal obesity (60%) and elevated blood pressure (61.1%) were the most common components. Gender-specific differences were noted, with males showing higher waist circumference and blood pressure, while females had greater abdominal obesity and lower HDL cholesterol. Conclusion: MetS is highly prevalent among middle-aged adults, particularly in females. Early screening, lifestyle interventions, and risk factor management are essential to reduce cardiometabolic complications.

Background: Regional anaesthesia, particularly the supraclavicular brachial plexus block, provides excellent surgical anaesthesia and postoperative analgesia for upper limb procedures. Ropivacaine is widely preferred due to its favourable sensory–motor differentiation and reduced cardiotoxicity. However, its duration of action may be insufficient for prolonged analgesia. Clonidine, an α₂-adrenergic agonist, has been shown to enhance block characteristics and prolong analgesia when used as an adjuvant. This study evaluates the efficacy of adding clonidine to 0.75% ropivacaine in supraclavicular brachial plexus blocks. Materials And Methods: This prospective, randomized, interventional study was conducted over 18 months at a tertiary care centre. A total of 108 ASA I–II patients undergoing elective upper limb surgeries were randomly allocated into two groups: Group A (n = 54): 30 ml of 0.75% ropivacaine Group B (n = 54): 30 ml of 0.75% ropivacaine + 75 µg clonidine Sensory and motor block onset and duration, postoperative analgesia duration, hemodynamic parameters, and adverse effects were assessed. Pain was evaluated using the VAS (Visual Analogue Scale), and rescue analgesia was administered when VAS > 5. Results: Both groups had comparable demographic and clinical profiles. The addition of clonidine significantly hastened sensory onset (8.5 ± 1.3 min vs. 11.8 ± 1.6 min, p < 0.001) and motor onset (10.4 ± 1.5 min vs. 14.6 ± 1.8 min, p < 0.001). Group B showed prolonged sensory block (515.6 ± 22.5 min vs. 480.3 ± 24.7 min, p < 0.001) and motor block (468.8 ± 28.7 min vs. 430.5 ± 30.2 min, p < 0.001). Postoperative analgesia was significantly longer in Group B (725.2 ± 48.6 min vs. 590.4 ± 40.5 min, p < 0.001). Hemodynamic variables remained stable in both groups, with only mild sedation noted in Group B (7.4%), and no serious adverse effects. Conclusion: The addition of 75 µg clonidine to 0.75% ropivacaine in supraclavicular brachial plexus block significantly improves block onset, prolongs sensory and motor blockade, and extends postoperative analgesia without compromising safety. This combination is effective, safe, and clinically advantageous for upper limb surgeries.

Background: Chronic dacryocystitis is the infection of lacrimal apparatus characterised by watering eye (epiphora). Which has a social impact. Method: This is prospective study involving patients with chronic dacryocystitis. Ten patients were included, all of them were subjected to end-DCR. Group-A (5 patients) were treated with mitomycin-c at osteotomy site. The rest (Group-B) were treated without it. Main Outcome Measures: Post-operative relief of epiphora and endoscopic documentation of the patency of rhinostome were the main outcome measure.  Results: Patients treated with mitomycin-c (Group-A) do not have synechiae and granulation formation and the osteotome size was well maintained. Conclusion: Use of mitomycin-c prevents the post-operative complication like granulation and synechiae formation. The result is not statistically significant. A properly and adequately performed surgery is more vital for successful result.

Since 1900, the pharmaceutical industry has profited from natural resource extraction. Accessibility, cost, and absorption into broader belief systems are the main reasons herbal medicine is widely used in economically challenged cultures. Lack of quality control for natural goods and production methods is a major issue for the herbal industry. Herbal medicine standards and active substances are commonly linked. Many researchers are having trouble administering or targeting drugs to induce systemic effects. This work was built on prior research in analytical chemistry, pharmacology, phytochemistry, applied medicinal chemistry, formulation science, and quality assurance. This thesis investigates three medicinal plants: the Indian Nyctanthus arbortristis Linn, also known as Night-flowering Jasmine or Coral Jasmine; the Canadian Solanum xanthocarpum, also known as yellow-berried nightshade; and the Indian Clerodendrum serratum, also known as Brahmannayastika. Modern analytical methods were used to verify these drugs’ validity, purity, safety, and efficacy, standardizing them. These drugs were also tested for standardization, biological screening, and conversion into classic and innovative topical dose forms with specific effects. This study employed molecular docking to assess the extract’s anti-inflammatory potential. The extract was used to find and extract analytical and chemical markers with similar features, and chromatographic procedures were employed to establish the indicators. In addition to biological screening, spectroscopic and chromatographic procedures standardized the components and extracts that served as chemical and analytical markers in the original and new formulations. The standardized formulations used in this study were analytically stable. This study investigates historically significant plants from three civilizations to educate people about inflammatory treatment options.

Introduction: Dengue is the most prevalent and rapidly spreading arbovirus causing risk for 4 billion people in the world. The number of cases reported worldwide increased from 2.4 million in 2010 to 5.2 million in 2019. Objective Utilizing APRI score or Aspartate Aminotransferase to Platelet Ratio Index, a non-invasive tool used to assess the likelihood of liver fibrosis or cirrhosis. Methods: A hospital based cross sectional study was conducted in a tertiary care hospital at western part of India during September 29, 2023 and December 29, 2023. Classification of patients into dengue fever, dengue fever with warning signs and severe dengue was done as per latest WHO recommendation. APRI score was calculated and statistical analysis correlating APRI score with dengue severity was done using AI. Results: A total of 334 participants were included; out of (62.5%) males and (37.5%) females. The peak admission rate was seen in October 2023 (59%), followed by November 2023 (33%). When stratified by severity, mean APRI rises from 7.93 in DF to 9.29 in DWS and peaks at 13.67 in SDC, with corresponding medians of 6.13, 6.91, and 9.39, respectively. This graded increase suggests that higher APRI values—which reflect both hepatocellular injury (elevated AST) and thrombocytopenia—are associated with more severe clinical phenotypes. Conclusion: APRI should be integrated with other warning signs, laboratory markers, and patient factors to improve prognostic accuracy. In practice, APRI could serve as one component of a multiparametric risk score, rather than a sole predictor, to guide triage and monitoring intensity.

Background: Regional anaesthesia, particularly the supraclavicular brachial plexus block, provides excellent surgical anaesthesia and postoperative analgesia for upper limb procedures. Ropivacaine is widely preferred due to its favourable sensory–motor differentiation and reduced cardiotoxicity. However, its duration of action may be insufficient for prolonged analgesia. Clonidine, an α₂-adrenergic agonist, has been shown to enhance block characteristics and prolong analgesia when used as an adjuvant. This study evaluates the efficacy of adding clonidine to 0.75% ropivacaine in supraclavicular brachial plexus blocks. Materials And Methods: This prospective, randomized, interventional study was conducted over 18 months at a tertiary care centre. A total of 108 ASA I–II patients undergoing elective upper limb surgeries were randomly allocated into two groups: Group A (n = 54): 30 ml of 0.75% ropivacaine Group B (n = 54): 30 ml of 0.75% ropivacaine + 75 µg clonidine Sensory and motor block onset and duration, postoperative analgesia duration, hemodynamic parameters, and adverse effects were assessed. Pain was evaluated using the VAS (Visual Analogue Scale), and rescue analgesia was administered when VAS > 5. Results: Both groups had comparable demographic and clinical profiles. The addition of clonidine significantly hastened sensory onset (8.5 ± 1.3 min vs. 11.8 ± 1.6 min, p < 0.001) and motor onset (10.4 ± 1.5 min vs. 14.6 ± 1.8 min, p < 0.001). Group B showed prolonged sensory block (515.6 ± 22.5 min vs. 480.3 ± 24.7 min, p < 0.001) and motor block (468.8 ± 28.7 min vs. 430.5 ± 30.2 min, p < 0.001). Postoperative analgesia was significantly longer in Group B (725.2 ± 48.6 min vs. 590.4 ± 40.5 min, p < 0.001). Hemodynamic variables remained stable in both groups, with only mild sedation noted in Group B (7.4%), and no serious adverse effects. Conclusion: The addition of 75 µg clonidine to 0.75% ropivacaine in supraclavicular brachial plexus block significantly improves block onset, prolongs sensory and motor blockade, and extends postoperative analgesia without compromising safety. This combination is effective, safe, and clinically advantageous for upper limb surgeries.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a major health burden particularly in India with treatment guided by GOLD classifications. Management aims to improve lung function, reduce symptoms and prevent exacerbations primarily through bronchodilators and anti-inflammatory agents. Tiotropium, a LAMA, is effective for maintenance therapy, while ICS–LABA combinations like fluticasone–salmeterol enhance symptom control and reduce exacerbations. Triple therapy (LAMA, LABA, ICS) provides broader benefits by offering superior lung function improvement and exacerbation reduction compared to monotherapy, though ICS-related pneumonia risk requires consideration. This study evaluates the efficacy and safety of triple therapy versus tiotropium alone in stable COPD. Materials and Methods: A prospective observational study conducted in the Department of Pharmacology at a tertiary care teaching hospital over a period of 18 months, covering patient recruitment, treatment administration, follow-up and data analysis. Total 100 participants were enrolled. 2 groups enrolled, group A with triple therapy and group B with monotherapy. Results: Group A showed slightly better baseline lung function. Group B had more emphysema and air trapping initially and demonstrated greater radiological worsening over time. At follow-up, Group B exhibited significantly more symptoms, including cough, sputum, dyspnea, wheeze and chest tightness. Physiological measures favored Group A with lower heart and respiratory rates, lower PaCO₂, higher SpO₂ and superior FEV₁/FVC. GOLD scoring showed all Group A patients remained mild whereas Group B had a higher proportion of moderate disease indicating worse progression. Conclusion: Triple therapy provides superior symptom relief, lung function improvement and slower COPD progression compared to tiotropium alone, offering markedly better overall outcomes.

Background: Worsening heart failure (WHF) ‘represents a high-risk phase of heart failure characterized by clini-cal deterioration despite standard therapy, with frequent hospitalization and elevated mortality. Vericiguat, a soluble guanylate cyclase stimulator, offers a novel mechanism to improve cardiac function and outcomes. Aim: To evaluate the efficacy, tolerability, and treatment adherence of vericiguat in patients with WHF. Methodology: This prospective observational study enrolled 90 adults with left ventricular ejection fraction <45% and recent HF decompensation at the Department of Cardiology, Nalanda Medical College and Hospital, Patna, Bihar, India. Participants received vericiguat alongside guideline-directed therapy, with follow-up at 2 weeks, 1 month, and every 3 months up to 12 weeks. Outcomes included NYHA functional class, LVEF, bi-omarkers (BNP, NT-proBNP), adverse events, and adherence. Results: Vericiguat improved functional status, increasing NYHA Class II patients from 24.4% to 47.8% and LVEF from 32.6% to 37.4%. BNP and NT-proBNP levels decreased significantly, and HF hospitalizations dropped from 38.9% to 18.9%. Adverse events were mostly mild, with 4.4% discontinuation. Adherence was high, with 87.8% taking >90% of prescribed doses. Conclusion: Vericiguat is effective, well-tolerated, and associated with high adherence in WHF, improving cardiac function and reducing clinical deterioration, supporting its integration into real-world HF management.

Background: Medial compartment osteoarthrosis (OA) of the knee is a significant contributor to disability in the aging population. Although traditional surgical options, including high tibial osteotomy and arthroplasty, are effective, they are typically more invasive and costly. Proximal fibular osteotomy (PFO) has recently been sought as a simpler and minimally invasive treatment for pain relief and functional improvement. Aim: The aim of the study was to examine the clinical and radiological outcomes of PFO in patients with medial compartment osteoarthrosis of the knee at one-year post-operation. Methodology: In this prospective cohort study, the outcomes of 18 patients (18 knees) with medial compartment knee OA were studied. All patients underwent PFO using a consistent approach. Pain was assessed using the Visual Analogue Scale (VAS), function was examined using the American Knee Society Score (AKSS), and alignment was assessed radiologically through the medial -to- lateral (ML) joint space ratio at baseline, three months, and one year. Results: Statistically significant improvements were noted for all variables (p < 0.001). The mean VAS decreased from 7.72 ± 0.71 to 3.81 ± 1.24, clinical AKSS improved from 57.18 ± 7.14 to 72.38 ± 9.41, and functional AKSS improved from 47.92 ± 13.78 to 70.92 ± 14.87. The ML ratio also improved from 0.32 ± 0.18 to 0.50 ± 0.21. Conclusion: PFO provides substantial pain relief, improvement of function, and biomechanical realignment making it a safe, cost effective, and minimally invasive option to treat medial compartment knee OA.

Background: Surgical resection of intracranial lesions demands precise localization and real-time assessment of residual pathology. Brain shift limits the reliability of preoperative MRI/CT-based neuronavigation. Intraoperative ultrasound (IOUS) offers real-time imaging, portability, and affordability, making it particularly valuable in resource-limited settings. Objective: To evaluate the effectiveness of IOUS in localization, characterization, and extent-of-resection assessment during brain lesion surgery. Methods: A prospective observational study of 35 consecutive patients undergoing planned brain lesion surgery at IGIMS, Patna. IOUS using the SonoSite M-Turbo (5–12 MHz linear probe) was employed for lesion localization, margin delineation, resection guidance, and final cavity evaluation. IOUS findings were compared with postoperative contrast-enhanced CT/MRI for concordance. Results: IOUS successfully localized lesions in all patients (100%). Lesion echogenicity showed strong correlation with preoperative imaging. Complete concordance (100%) was observed between IOUS assessment of residual tumor and postoperative imaging. Deep-seated lesions were adequately visualized, and IOUS modified the surgical trajectory in 14.3% of cases. No complications were attributable to IOUS use. Conclusion: IOUS is a reliable, accurate, and cost-effective intraoperative navigation tool. It enhances surgical precision, reduces residual tumor burden, and provides real-time feedback, making it a valuable adjunct in neurosurgery, especially where intraoperative MRI/CT is unavailable.

Background: Type 2 Diabetes Mellitus imposes a considerable strain on the Indian healthcare system, with rising prevalence, early age of onset, and complex pharmacological needs. Evaluating drug utilization patterns is critical to ensuring rational prescribing, improving glycemic control, and aligning with evidence-based treatment guidelines. Objective: To analyze the prescribing patterns of antidiabetic medications in patients with T2DM at a tertiary care facility in Central India, with emphasis on drug used, combination therapy, and demographic data. Material and Methods: A prospective exploratory study was performed from January 2022 to December 2024 at Index Medical College, Indore. A total of 408 T2DM patients (aged ≥20 years) attending the OPD were enrolled. Demographic data, comorbidities, and medication prescriptions were gathered via a structured case report form. Descriptive and inferential statistical analyses were performed using SPSS v30. A p-value < 0.05 was regarded as statistically significant. Results: The mean chronological age of the study population was 45.74 ± 10.61years, with a significant male predominance (56.61%). The predominant age group was 41-50 years, comprising 39.95%. Metformin was the most commonly prescribed medication (40.75%), succeeded by glimepiride (21.66%), sitagliptin (10.47%), and dapagliflozin (7.17%). Combination therapy was more prevalent (60.54%) compared to monotherapy (39.46%), with dual therapy (48.04%) being significantly more common than triple therapy (12.5%). The most prescribed fixed-dose combination was metformin with glimepiride (19.12%). The Body Mass Index (BMI) and Glycated hemoglobin (HbA1c) values exhibited a positive connection (r = 0.997). indicating a relationship between obesity and poor glycemic control. Conclusion: This study highlights a strong preference for metformin-based combination regimens, reflecting adherence to standard treatment protocols. The high prevalence of polypharmacy and significant associations with comorbidities underscore the need for periodic prescription audits and individualized therapy to ensure rational drug use and optimize patient outcomes.

Background: In normal population, each kidney is drained by a single renal vein. The renal veins show a wide range of anatomical variations in the general population which is influenced by race and ethnicity. These variations play an important role in selection of the donor kidney for renal transplantation and also influence the renal vasculature surgeries. Majority of the CT based studies on variations of renal veins are from western countries. These studies have evaluated the number, confluence pattern and other variations of renal veins. There are few studies from Asian countries and India and hence we do not have adequate data on the prevalence of anatomical variations of renal veins for our population. Objectives: The aim of the present study was to observe the length and diameter of renal veins and estimate the prevalence of the anatomical variations in healthy North Indian population. Material & Methods: In this observational study eighty-seven prospective healthy voluntary kidney donors (males and females; mean age of years), were evaluated for the renal vein anatomy by MDCT and CT angiography as part of preoperative assessment prior to donor nephrectomy. The number, length, diameter of the renal vein and presence of anatomical variations on either side was recorded. Results: The right and left Kidney was drained by single renal vein in 70.1% and 98.6% cases respectively. The mean length of the right renal vein was 15.28 ±7.02 mm and the left renal vein measured 24.04 ±11.51 mm in length. The mean diameter of right renal vein was 10.39±2.63 mm and the left renal vein measured 10.9±3.99 mm in diameter. Twenty-six of 87 (29.9%) of right kidney had an extra or supernumerary renal vein. On the left side only one kidney (1.1%) had a single supernumerary renal vein. Late confluence of the renal veins was observed in 28.7% cases on the right side and in 12.6% cases on the left side. Circumaortic left renal vein was seen in 5.7% cases. No retroaortic left renal vein was observed in our study. Discussion: The anatomical variations of renal veins are quite frequent in our population. The right renal vein shows a higher percentage of supernumerary renal veins and late confluence of the veins compared to the left renal vein. This information is of great importance to transplant surgeons as it facilitates the decision to harvest the donor left kidney for renal transplantation.

Aim: To compare the clinical efficacy and functional outcomes of non-operative versus surgical treatment in patients with acute Grade 3 (Rockwood Type 3) acromioclavicular dislocation through a prospective randomized controlled trial study. Materials and Methods: A prospective randomized controlled study was conducted over 24 months involving 120 patients with acute Grade 3 acromioclavicular dislocation. Patients were randomly assigned to two groups: Group A (n=60) underwent non-operative treatment with sling immobilization for 4 weeks followed by structured physiotherapy, while Group B (n=60) received surgical reconstruction using the double-endobutton technique. Primary outcome measures included Constant Score, American Shoulder and Elbow Surgeons (ASES) score, and pain visual analog scale (VAS) at 6, 12, and 24 weeks. Results: Both treatment groups demonstrated significant clinical improvement by the 24-week follow-up. The non-operative group achieved mean Constant Score of 88.3 ± 6.2 compared to 89.7 ± 5.8 in the surgical group (p = 0.312, not significant). ASES scores were comparable: non-operative 87.5 ± 7.1 versus surgical 89.2 ± 6.4 (p = 0.198, not significant). Pain relief measured by VAS showed similar trajectories, with non-operative group scoring 2.1 ± 1.3 and surgical group 1.8 ± 1.1 at final follow-up (p = 0.217, not significant). However, residual radiological displacement persisted in 78% of non-operative patients compared to 12% in surgical group (p < 0.001). Complications were significantly higher in surgical group (16.7%) including hardware prominence, residual pain, and need for revision surgery, compared to non-operative group (3.3%) (p = 0.008). Conclusion: This randomized controlled trial demonstrates that both non-operative and surgical treatment approaches yield comparable functional and clinical outcomes in acute Grade 3 acromioclavicular dislocations at 2-year follow-up. While surgical treatment achieved superior radiological reduction, the clinical benefit did not translate to significantly better functional scores. Non-operative treatment with structured physiotherapy represents a viable first-line approach, reserving surgery for select cases with persistent symptoms, functional deficits, or high-demand athletes.

Background: Pseudomonas aeruginosa is a major opportunistic pathogen associated with severe healthcare-associated infections. Its ability to form biofilms is a key virulence factor that contributes to persistence of infection and increased antibiotic resistance. Aim: To determine the prevalence of biofilm formation among clinical isolates of P. aeruginosa and to evaluate its correlation with antibiotic resistance. Methodology: A cross-sectional study was conducted on 94 non-repetitive clinical isolates of P. aeruginosa obtained from various specimens in a tertiary care hospital. Isolates were identified by standard microbiological methods. Antibiotic susceptibility testing was performed using the Kirby–Bauer disk diffusion method as per CLSI guidelines. Biofilm production was assessed by the Congo Red Agar method, and its association with antibiotic resistance was statistically analyzed. Results: Biofilm formation was observed in 32 (34.0%) isolates, with 14 (14.9%) strong and 18 (19.1%) moderate producers. Biofilm producers were more frequent in ICU settings and in tracheal aspirate and urine samples. High resistance was noted against cefepime (80.9%) and ceftazidime (63.8%), while all isolates were sensitive to colistin. A strong association was observed between biofilm production and resistance to multiple antibiotics, including carbapenems, aminoglycosides, and fluoroquinolones. Conclusion: Biofilm formation in P. aeruginosa is significantly associated with multidrug resistance, posing a serious therapeutic challenge. Routine detection of biofilms and rational antibiotic use are essential for effective infection management.

Background: Awareness under general anesthesia (AAGA) is a ^‘rare but distressing complication with significant psychological and medico-legal implications, particularly in high-risk surgical patients. Aim: To determine the incidence of awareness under general anesthesia and identify associated perioperative risk factors. Methodology: This prospective observational study included 80 adult high-risk patients undergoing surgery under general anesthesia at a Bhagwan Mahavir institute of medical sciences (BMIMS), Pawapuri, Nalanda, Bihar,India. Standard anesthetic practices were followed. Patients were interviewed using a structured questionnaire immediately postoperatively, at 24 hours, and on day 7 or at discharge. Data were analyzed using descriptive statistics and appropriate tests of association. Results: Awareness was absent in 92.5% of patients. Possible awareness occurred in 5% and definite awareness in 2.5%, giving an overall incidence of 7.5%. Most cases were detected at 24 hours or later. Emergency surgery, one-lung ventilation, difficult airway, and intra-operative hypotension showed significant associations with awareness. Conclusion: Although uncommon, awareness under general anesthesia persists in high-risk patients. Vigilant anesthetic management, stable hemodynamic control, and repeated postoperative interviews are essential to reduce its incidence and ensure timely detection.

Background: Regional anaesthesia provides effective analgesia with ^‘reduced systemic complications but may be associated with patient anxiety and discomfort. Clonidine and dexmedetomidine are examples of α-2 adrenergic agonists that are used as adjuncts to enhance analgesia, sedation, and anxiolysis. Aim: To compare the efficacy of epidural clonidine and dexmedetomidine as adjuvants to ropivacaine in patients undergoing vaginal hysterectomy. Methodology: In this prospective, randomized, double-blind trial, 60 female patients (ASA I–II) were allocated to receive epidural ropivacaine with either clonidine (Group C, 2 µg/kg) or dexmedetomidine (Group D, 1.5 µg/kg Sedation, haemodynamics, postoperative analgesia, sensory and motor block, and other characteristics were noted and assessed. Results: Demographic parameters were comparable. Dexmedetomidine significantly accelerated sensory (2.8 ± 0.6 vs. 3.9 ± 0.8 min) and motor block onset (4.1 ± 0.7 vs. 5.2 ± 0.9 min), reduced time to maximum sensory level, and prolonged sensory (260 ± 35 vs. 215 ± 30 min), motor block (230 ± 30 vs. 190 ± 25 min), and postoperative analgesia (340 ± 45 vs. 280 ± 40 min) compared to clonidine (p < 0.05). Sedation was higher with dexmedetomidine. Conclusion: Dexmedetomidine is a superior epidural adjuvant to clonidine, offering faster onset, prolonged anesthesia and analgesia, and enhanced sedation, improving perioperative comfort and patient satisfaction.

Background: Renal cell carcinoma (RCC) is a heterogeneous malignancy with diverse genetic alterations, variable ^‘tumor biology, and differences in clinical presentation across age groups. Although age-related clinical patterns are recognized, the clinical utility of genetic testing across different tumor characteristics remains incompletely defined. Aim: To evaluate the association between genetic patterns, tumor biology, and clinical outcomes in RCC, and to assess the role of selective genetic testing based on tumor laterality and focality. Methodology: This study included RCC patients treated between 2013 and 2024 in the retrospective cohort and newly diagnosed cases enrolled prospectively. Comprehensive clinical, demographic, radiological, surgical, pathological, and genetic data were collected. Whole-exome sequencing was performed in patients aged ≤46 years and those with familial, bilateral, or multifocal renal tumors. Statistical analysis was conducted using SPSS version 22, with a significance threshold of p < 0.05. Results: A total of 167 patients were analyzed. Older patients demonstrated a higher burden of comorbidities, whereas younger patients more frequently presented with early-stage disease. Clinical presentation, tumor laterality, and surgical approaches were comparable between age groups. Pathogenic genetic mutations were predominantly identified in patients with bilateral multifocal tumors and in rare aggressive histological subtypes such as primitive neuroectodermal tumor and SDH-deficient RCC. No pathogenic genetic alterations were detected in bilateral unifocal tumors. Conclusion: The diagnostic yield of genetic testing appears higher in selected high-risk RCC subgroups, particularly bilateral multifocal tumors and rare aggressive variants. A selective, risk-based approach to genetic evaluation may aid in risk stratification and individualized patient management.

Background: Ventilator-associated pneumonia (VAP) is a common ICU-acquired infection, frequently caused by multidrug-resistant (MDR) Gram-negative bacteria, particularly Acinetobacter baumannii, leading to high morbidity and mortality. Aim: To determine the prevalence of MDR A. baumannii and related species in VAP and evaluate their antimicrobial susceptibility patterns. Methodology: A retrospective observational study was conducted on 415 endotracheal aspirate samples from mechanically ventilated ICU patients at Department of Microbiology, Patna Medical College and Hospital, Patna, Bihar, India. Samples were cultured, and isolates were identified using standard biochemical methods. Antimicrobial susceptibility was assessed using the disc diffusion method following CLSI guidelines. MDR was defined as resistance to ≥3 antibiotic classes. Data were analyzed using SPSS v25. Results: Out of 415 samples, 278 (67%) were culture-positive, and 62 patients (14.9%) were diagnosed with VAP. A. baumannii was the most prevalent pathogen (45.2%), with 67.9% of isolates being MDR. MDR strains exhibited high resistance to ceftazidime (89.5%), ciprofloxacin (84.2%), and carbapenems (imipenem 84.2%, meropenem 78.9%), while minocycline (68.4%) and amikacin (42.1%) retained relative efficacy. Clinical outcomes were poor, with 57.9% mortality among MDR A. baumannii VAP cases. Conclusion: MDR A. baumannii is a major VAP pathogen with limited treatment options and high mortality, highlighting the need for strict infection control, antimicrobial stewardship, and continuous surveillance.

Background: The clinical and epidemiological peculiarities of Acute Coronary Syndrome (ACS) among young adults (under 45 years) are unique and are associated with increasing prevalence under the impact of changeable lifestyle factors. Aim: To assess the risk factors, clinical presentation, angiographic pattern, and in-hospital outcomes of the young patients in ACS presentations. Methodology: An observational study (prospective) was carried out in Fortis Escorts, Heart Institute, New Delhi, India. by registering 80 consecutive ACS patients under 45 years of age, who received coronary angiography. Elaborate demographic, clinical, laboratory, echocardiographic and angiographic data were gathered and the results noted up to time of discharge. Findings: The median age was 38.1 +- 5.4 years, and male (82.5). The smoking (67.5%), dyslipidemia (41.25%), hypertension (37.5%), diabetes (35%), and family history of CAD (22.5) were major risk factors. The most frequent presentation was STEMI (66.25). Eighty percent had had obstructed CAD which was mostly a single-vessel disease (47.5%). Seventy-five percent of patients had LV dysfunction. The main treatment was PCI and the TIMI 3 flow was realized in 93.4. Mortality in the hospital was minimal (3.75%), which was accompanied by the occurrence of complications like heart failure (22.5%). Conclusion: ACS patients of young age have a high prevalence of modifiable risk factors, and obstructive CAD is predominant, which points to the necessity of early control of risk factors and specific preventive measures.

Background: Superficial fungal infections are highly prevalent worldwide and increasingly complicated by antifungal resistance, leading to chronicity, recurrence, and treatment failure. Aim: To evaluate changing clinical patterns, antifungal resistance profiles, and treatment outcomes of superficial fungal infections in a tertiary care setting. Methodology: This retrospective observational study analyzed 114 patients with superficial fungal infections attending a dermatology outpatient department over one year. Clinical features, infection sites, prior treatment history, mycological findings, antifungal susceptibility (broth microdilution), and treatment outcomes were assessed using descriptive statistics. Results: Infections predominantly affected males (63.2%) and young adults aged 21–40 years (63.1%). Trunk (36.0%) and groin (32.5%) were the most common sites, with pruritus as the leading symptom (88.6%). High resistance was observed to terbinafine (51.8%) and fluconazole (43.0%), while itraconazole showed the highest sensitivity (78.1%). Oral itraconazole achieved superior clinical (82.6%) and mycological cure (76.1%) with the lowest relapse rate (15.2%). Conclusion: The study demonstrates a shift toward increased antifungal resistance, particularly to commonly used agents, underscoring the importance of susceptibility-guided therapy and rational antifungal use.

Background: Increasing obesity in women of reproductive age presents considerable maternal and neonatal health hazards.  The pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) are critical factors influencing pregnancy outcomes. Aim: To evaluate the relationship between pre-pregnancy BMI and gestational weight gain (GWG) with gestational diabetes mellitus (GDM), hypertension, and fetal growth outcomes. Methodology: An observational study was conducted in a hospital setting with 80 pregnant women at Department of Obstetrics and Gynaecology, Radha Devi Jageshwari Memorial Medical College and Hospital, Bihar, India. Pre-pregnancy BMI was calculated using documented or first-trimester weight, and GWG was determined by weight difference in the third trimester. GDM screening and hypertension assessment were performed according to standard protocols. Data was analyzed using SPSS 27, with chi-square and logistic regression applied to determine associations. Results: Half of the participants had normal BMI, while 25% were overweight and 12.5% obese. Excessive GWG was more common in overweight and obese women. The incidence of gestational diabetes mellitus (GDM) increases with body mass index (BMI): 0% in underweight individuals, 5% in normal-weight adults, 20% in overweight individuals, and 30% in obese women.  Hypertension had a comparable pattern: 0% in underweight individuals, 2.5% in those of normal weight, 15% in overweight participants, and 30% in obese subjects. Conclusion: Elevated pre-pregnancy BMI is associated with excessive GWG, GDM, and hypertension. Preconception counseling and individualized weight management are crucial to optimizing maternal and neonatal outcomes.

Background: Displaced midshaft clavicle fractures are common orthopedic injuries, and ^‘the optimal management (conservative versus surgical) remains debated, particularly regarding functional outcomes. Aim: To compare radiological union and functional outcomes between conservative and surgical management of displaced midshaft clavicle fractures. Methodology: This prospective comparative observational study included 60 patients (18–60 years) with displaced midshaft clavicle fractures (Robinson type 2B1), divided equally into conservative (n=30) and surgical (n=30) groups. Patients were followed for six months. Radiological union and functional outcomes were assessed using the Constant–Murley Shoulder Score, along with documentation of complications. Results: Demographic and injury characteristics were comparable between groups. The surgical group achieved significantly earlier radiological union (mean 11.2 ± 2.4 weeks) compared to the conservative group (14.8 ± 3.2 weeks). Excellent functional outcomes were more frequent in the surgical group (60%) than in the conservative group (26.7%), with a higher mean Constant–Murley score (89.2 ± 7.8 vs. 78.4 ± 10.6). Conclusion: Surgical management of displaced midshaft clavicle fractures results in faster union and superior functional outcomes compared to conservative treatment.

Background: Open fractures of the tibia pose significant challenges due to high ^‘risks of infection, delayed union, and functional impairment. Timely and appropriate management is crucial for optimal recovery. Aim: To evaluate the management strategies and functional outcomes of Gustilo-Anderson Grade I open tibial fractures. Methodology: A prospective observational study was conducted on 70 adult patients at a tertiary care center in Bihar, India. Patients underwent surgical stabilization via intramedullary nailing or external fixation, early debridement, and a structured antibiotic regimen, followed by physiotherapy and follow-up at 3 weeks, 3 months, and 6 months. Functional outcomes were assessed using Johner & Wruhs criteria. Results: The majority of patients were males (71.4%) aged 31–45 years (42.9%), with road traffic accidents being the predominant cause (64.3%). Intramedullary nailing was performed in 78.6% of cases. Complications were low, with superficial infections in 8.6% and delayed union in 7.1%. Functional outcomes were excellent in 42.9% and good in 35.7% of patients, indicating 78.6% achieved favorable recovery. Conclusion: Gustilo-Anderson Grade I open tibial fractures can be effectively managed with timely surgical intervention, intramedullary nailing, early mobilization, and structured postoperative care, resulting in low complication rates and satisfactory functional outcomes.

Background: Intertrochanteric fractures of the femur are common in the elderly and are associated with significant morbidity and mortality. Optimal surgical fixation is crucial for early mobilization and functional recovery. Aim: To compare clinical, functional, and radiological outcomes of intertrochanteric fractures managed with Dynamic Hip Screw (DHS) versus Proximal Femoral Nail (PFN) fixation. Methodology: A prospective study was conducted on 50 patients with AO 31-A1 and 31-A2 intertrochanteric fractures, randomly allocated into DHS (n=25) and PFN (n=25) groups. Intraoperative parameters, postoperative mobilization, radiological union, functional recovery (Harris Hip Score), and complications were assessed over months. Results: PFN fixation had longer operative time (68.2 ± 11.6 min vs. 55.6 ± 9.4 min; p<0.001) but significantly lower blood loss (94.7 ± 15.8 ml vs. 158.3 ± 22.1 ml; p<0.001). PFN patients achieved earlier partial (3.8 ± 1.2 vs. 6.2 ± 1.4 days; p<0.001) and full weight bearing (6.3 ± 1.4 vs. 8.1 ± 1.6 weeks; p<0.001), faster radiological union (2.4 ± 0.7 vs. 4.3 ± 0.6 months; p<0.001), and superior Harris Hip Scores at 12 months (88.1 ± 4.0 vs. 84.3 ± 4.6; p<0.001). Mechanical complications occurred only in the DHS group, while infection rates were comparable. Conclusion: PFN fixation provides superior functional outcomes, earlier mobilization, faster fracture union, and fewer mechanical complications compared to DHS, despite a slightly longer operative time, making it the preferred option for intertrochanteric fractures.

Background: Low birth weight (LBW) is a major contributor to perinatal morbidity and mortality, particularly in low- and middle-income settings. Identifying its determinants and outcomes is essential for targeted interventions. Aim: To determine the prevalence, predictors, and perinatal outcomes of low-birth-weight newborns over a five-year period. Methodology: A descriptive retrospective study was conducted among 4,820 deliveries (≥28 weeks gestation) at a Nalanda Medical College, Patna, Bihar, India. Data were extracted from delivery registers and electronic records. Bivariate and multivariate logistic regression analyses were performed to identify predictors of LBW and its association with perinatal outcomes. Results: LBW was more common among preterm births (43.6%) than term births (17.9%). Independent predictors of LBW included maternal age <20 years (AOR 1.34), >35 years (AOR 1.29), <4 antenatal care visits (AOR 1.86), primigravida status (AOR 1.28), grand multiparity (AOR 1.41), and preterm delivery (AOR 3.62). LBW was strongly associated with stillbirth (AOR 6.84), low Apgar scores, and death within 24 hours (AOR 1.91). Conclusion: Low birth weight remains prevalent and is driven by modifiable maternal and obstetric factors, with serious adverse perinatal outcomes. Strengthening antenatal care and preventing preterm birth are crucial to reducing LBW and improving neonatal survival.

Background: Exclusive breastfeeding (EBF) for ^‘the first six months is vital for optimal infant growth and survival, yet its practice remains suboptimal in many low- and middle-income settings, including India. Aim: To assess breastfeeding practices and identify factors influencing exclusive breastfeeding among mothers of infants. Methodology: A hospital-based cross-sectional observational study was conducted among 80 mothers of infants aged 0–6 months attending the preventive clinic of a Nalanda Medical College, Patna, Bihar, India . Data were collected using a pre-tested semi-structured questionnaire. Statistical analysis was performed using SPSS version 27.0, applying descriptive statistics, bivariate analysis, and multivariable logistic regression. Results: Exclusive breastfeeding was practiced by 57.5% of mothers. Higher maternal education, health facility delivery, early initiation of breastfeeding within one hour, four or more antenatal care visits, and receipt of breastfeeding counseling were significantly associated with EBF. Early initiation of breastfeeding and counseling showed the strongest independent associations. Conclusion: The prevalence of exclusive breastfeeding was moderate. Strengthening maternal education, promoting institutional delivery, ensuring early initiation, and enhancing antenatal and postnatal counseling are essential to improve exclusive breastfeeding practices.

Background: Birth asphyxia remains a major cause of neonatal morbidity and mortality, particularly in low- and middle-income countries, despite advances in perinatal care. Aim: To evaluate maternal characteristics and intrapartum and neonatal risk factors associated with birth asphyxia and related neonatal outcomes. Methodology: A retrospective cohort study was conducted at Department of Pediatrics, Maheshwara Medical College and Hospital, Hyderabad, Telangana, India.  including 43,773 live-born neonates (≥34 weeks gestation). Maternal, intrapartum, and neonatal variables were extracted from hospital records. Associations were assessed using univariate analysis and multivariate logistic regression. Results: Birth asphyxia occurred in 576 neonates. Independent risk factors included primiparity (adjusted OR 1.15), maternal hypertensive disorders (adjusted OR 2.45), prolonged rupture of membranes (adjusted OR 1.36), meconium-stained amniotic fluid (adjusted OR 2.01), fetal distress (adjusted OR 3.72), and low birth weight (adjusted OR 3.22). Maternal age ≥35 years was not significantly associated. Neonates with asphyxia had significantly higher rates of NICU admission, resuscitation, intubation, and early neonatal mortality. Conclusion: Birth asphyxia is strongly associated with specific maternal, intrapartum, and neonatal risk factors. Early identification and optimal management of high-risk pregnancies and labor complications are essential to improve neonatal outcomes.

Background: Ventilator-associated pneumonia (VAP) is a serious nosocomial infection occurring in patients mechanically ventilated for more than 48 hours, contributing to increased morbidity, prolonged ICU stay, and mortality. Gram-negative bacteria, particularly multidrug-resistant strains, are the predominant pathogens. Understanding the clinic-microbiological profile, risk factors, and outcomes is essential to improve patient management and implement preventive strategies. Methods: A retrospective observational study was conducted on 150 ICU patients ventilated for more than 48 hours between May 2025 and September 2025 at Himalaya Medical College and Hospital, Patna, India. Data on demographics, comorbidities, duration of mechanical ventilation, microbiological culture results, ICU stay, and clinical outcomes were collected. Patients meeting CDC-NHSN criteria for VAP were included. Data were analyzed using SPSS v21, with descriptive statistics, Chi-square tests, and t-tests applied. Results: Among 150 patients, most were male (65%) and aged 31–50 years (40%). Comorbidities were present in 70% of patients, with hypertension (25%) and diabetes mellitus (20%) being common. Prolonged mechanical ventilation, especially beyond 10 days, increased VAP risk. Gram-negative bacteria predominated: Pseudomonas aeruginosa (34.4%), Klebsiella pneumoniae (28.1%), and Acinetobacter baumannii (21.9%), with notable multidrug resistance. Clinical outcomes showed 70% recovery, 15% complications, and 15% mortality. Conclusion: VAP remains a major ICU complication with high morbidity and mortality. Early diagnosis, culture-guided antimicrobial therapy, strict ventilator care bundles, and timely weaning are key strategies. Continuous microbiological surveillance and antimicrobial stewardship are essential to limit multidrug resistance and optimize patient outcomes in critical care settings.

Background: Acute abdomen is a surgical emergency ^‘requiring prompt and accurate diagnosis to reduce morbidity and mortality. Plain abdominal radiography (X-ray) and computed tomography (CT) are commonly used imaging modalities, with CT offering superior resolution but higher cost and radiation exposure. Aim: To compare the diagnostic accuracy of X-ray versus CT in patients presenting with acute abdomen. Methodology: A prospective, randomized, comparative study was conducted on 80 patients at Department of Radio-Diagnosis, RDJM Medical College, Turki, Muzaffarpur, India. Participants were randomized into X-ray (n = 40) and CT (n = 40) groups. Imaging findings were correlated with final clinical diagnoses. Diagnostic performance, need for additional imaging, and hospital stay were analyzed using SPSS 27.0. Results: CT demonstrated higher sensitivity (100% vs. 94.7%), specificity (77.8% vs. 71.4%), positive predictive value (93.9% vs. 75%), negative predictive value (100% vs. 93.7%), and overall accuracy (96.2% vs. 82.5%) compared to X-ray. Fewer patients in the CT group required additional imaging (7.5% vs. 30%, p = 0.01), and hospital stay was shorter (3.2 ± 1.5 vs. 4.8 ± 2.1 days, p = 0.02). Conclusion: CT is significantly superior to X-ray in diagnosing acute abdomen, reducing the need for further imaging and hospital stay. Low-dose CT protocols offer a safe, efficient, and accurate imaging strategy, while X-ray remains valuable for rapid initial assessment or in resource-limited settings.

Background: Radiological imaging, particularly high-^‘resolution computed tomography (HRCT), plays a pivotal role in diagnosing and managing chest diseases by visualizing structural and pathological changes in the lungs, pleura, and mediastinum. Aim: To evaluate the spectrum of radiological findings in common chest diseases among adults and correlate patterns with age and gender. Methodology: This prospective, observational study included 90 patients aged 20–60 years undergoing HRCT at RDJM Medical College and Hospital, Bihar, India. Clinical evaluation was followed by HRCT imaging to identify parenchymal, airway, and pleural abnormalities. Data were analyzed using SPSS 27.0, with categorical variables expressed as frequencies and percentages. Results: Consolidation was the most common finding (33.3%), followed by ground-glass opacities (27.8%), fibrosis/reticulations (22.2%), nodules/masses (11.1%), and pleural effusions (5.6%). Infectious diseases (38.9%) predominated, followed by interstitial lung disease (22.2%) and COPD (16.7%). Older adults (51–60 years) showed higher rates of fibrosis, while nodules/masses were distributed in middle and older age groups. Females exhibited slightly higher frequencies of parenchymal abnormalities. Conclusion: HRCT effectively identifies both acute and chronic chest pathologies, highlighting consolidation and ground-glass opacities as predominant patterns, with age and gender influencing disease expression.

Background: Bowel injury is a serious but infrequent complication of pelvic surgery, associated with significant morbidity and mortality. Awareness of risk factors, mechanisms, and management strategies is essential for optimizing outcomes. Aim: To assess the prevalence, risk factors, treatment, and results of intestinal damage sustained following pelvic operations. Methodology: A prospective observational study was conducted on 60 patients undergoing gynecological, colorectal, urological, and general pelvic surgeries at Netaji Subhas Medical College and Hospital and ESIC Medical College and Hospital, Bihta, Patna, Bihar, India. Data on demographic profile, type of surgery, mechanism of bowel injury, management modality, and postoperative outcomes were collected and analyzed using descriptive statistics and Chi-square/Fisher’s tests. Results: Most patients were females (63.3%) aged 31–40 years (30%). Most had no comorbidities (53.3%). Primary repair was the most common management (48.3%), followed by resection with anastomosis (30%) and stoma formation (21.7%). Postoperative complications included surgical site infection (23.3%), sepsis (13.3%), anastomotic leaks (10%), and fistula formation (8.3%). Mean hospital stay was 13.4 ± 4.2 days; reoperation was required in 15%, with 5% mortality. Conclusion: Bowel injury during pelvic surgery can be effectively managed with timely recognition and intervention. Early detection, appropriate surgical management, and careful postoperative monitoring are critical to minimizing morbidity and improving patient outcomes.

Background: AKI is a ^‘frequent and serious complication in critically ill septic patients in an ICU setting. Progress in the field of critical care has been unable to diminish the association noted between sepsis-associated AKI and prolonged length of stay, morbidity, and mortality. Aim: Assess the incidence, risk factors, and clinical implications of AKI in septic critically ill patients in the ICU, using the KDIGO classification. Methods: This retrospective observational study was conducted at the Department of Internal Medicine at Gouri Devi Institute of Medical Sciences and Hospital, Durgapur, West Bengal. The study population included 70 adults who were admitted to the ICU with sepsis, based on the Sepsis-3 definitions, and were reviewed for clinical features, comorbidities, laboratory parameters, and outcomes. Acute kidney injury (AKI) was diagnosed and staged according to KDIGO guidelines. Disease severity was determined using the APACHE II score. Results: Of the 70 septic patients, 62.9% were male, and most patients were aged between 41 and 60 years old (42.9%). The most prevalent comorbidities included hypertension (42.9%) and diabetes (40%). The most common source of sepsis was respiratory infections (40%). AKI occurred in 60% of patients Stage 1 (25.7%), Stage 2 (20%), and Stage 3 (14.3%). Of the AKI cases, 23.8% required renal replacement therapy. Complete renal recovery was achieved in 47.6%, partial in 19%, and 9.5% had no recovery or died. The mean APACHE II score was 21.6 ± 6.4, and the mean ICU stay was 8.5 ± 3.2 days. Conclusion: Sepsis-related acute kidney injury (AKI) is common and has significant consequences on outcomes for patients in the intensive care unit (ICU). Early identification, hemodynamic optimization, and timely initiation of renal support are essential for improving prognosis.

Background: Inguinal hernia is a common surgical condition, predominantly affecting males, with recurrence remaining a major postoperative concern. Surgical technique is considered an important factor influencing recurrence rates. Aim: To retrospectively evaluate the impact of conventional open versus laparoscopic surgical techniques on inguinal hernia recurrence rates. Methodology: A retrospective analysis was conducted on 25 patients who underwent inguinal hernia repair at a NMCH, Sasaram, Bihar, India. Data on demographics, type of surgery (conventional or laparoscopic), and postoperative recurrence were collected from medical records. Statistical analysis was performed using descriptive statistics and the Chi-square test. Results: Of the 25 patients, 13 (52%) underwent conventional repair and 12 (48%) laparoscopic repair. Overall recurrence was observed in 32% of cases. Recurrence occurred in 38.5% of the conventional group and 25.0% of the laparoscopic group. Although laparoscopic repair showed a lower recurrence proportion, the difference was not statistically significant (p = 0.446). Conclusion: Both conventional and laparoscopic techniques demonstrated comparable outcomes regarding inguinal hernia recurrence. While laparoscopic repair showed a lower trend toward recurrence, surgical technique alone did not significantly influence outcomes, highlighting the role of multiple contributing factors.

Background: Diabetes mellitus is a common medical disorder complicating pregnancy and is associated with increased maternal and neonatal morbidity. Aim: To evaluate ^‘the impact of different types of diabetes mellitus on maternal and neonatal outcomes from a combined medicine–gynecology perspective. Methodology: This hospital-based observational study included 70 pregnant women with pre-existing type 1 diabetes, type 2 diabetes, or gestational diabetes mellitus managed at Department of General Medicine, Nalanda Medical College and Hospital, Patna, Bihar, India. Participants were followed from antenatal period until delivery, and maternal complications, obstetric outcomes, and early neonatal outcomes were recorded and analyzed. Results: Gestational diabetes mellitus was the most prevalent type (57.2%), with diet-controlled GDM being the most common. Hypertensive disorders (28.6%), preterm labor (22.9%), and a high Caesarean section rate (57.1%) were notable maternal outcomes. Neonatal complications included low birth weight (25.7%), macrosomia (14.3%), hypoglycemia (22.9%), respiratory distress (20%), and increased NICU admissions (28.6%). Conclusion: Diabetes mellitus in pregnancy significantly influences maternal and neonatal outcomes. Early screening, optimal glycemic control, and multidisciplinary care are essential to improve perinatal outcomes.

Background: Chronic Kidney Disease (CKD) is a significant societal health issue that is linked to a high morbidity rate, mortality, and healthcare burden especially in developing nations such as India. Most of the time the disease is asymptomatic during the initial stages of the disease, which leads to late diagnosis and late presentation in the tertiary care facilities. The clinical and demographic profile of CKD patients are necessary to provide early intervention and better outcomes. The objective of the present study was to assess demographic, clinical profile, lab results, and staging of the patients with chronic kidney diseases in a tertiary care hospital. Methods: This cross-sectional analytical study was a hospital-based study and was carried out over a period of 7 months at the Department of General Medicine, Nalanda Medical College and Hospital, Patna, Bihar. The enrollment of 84 patients diagnosis with CKD was done through predetermined inclusion and exclusion criteria. The specific demographic information, the clinical description, the comorbidities, and the laboratory parameters were documented. The stage of CKD was done according to the estimated glomerular filtration rate (eGFR) as calculated by Cockcroft Gault formula. The analysis involved the use of descriptive statistics and chi-square tests. Results: The average age of the patients was 52.6 / 13.4 years, and the majority were males (61.9). Majority of the patients were rural and underprivileged. The most common comorbidities were hypertension (64.3) and diabetes mellitus (47.6). The common clinical findings were anemia (69.0%) and pedal edema (58.3%). The proportion of patients that showed up in late stages (Stage 4 and 5) of CKD (more than 60 percent) showed that diagnosis and referral was delayed. Conclusion: CKD patients presenting to tertiary care centers are predominantly middle-aged males with significant comorbidities and advanced disease. Early screening, improved control of diabetes and hypertension, and timely referral are essential to reduce disease progression and associated complications.

Background: Diabetic foot ulcers (DFUs) are a major complication of diabetes, often leading ^‘to infection, delayed healing, and limb amputation. Identifying effective and affordable dressing is essential to improve clinical outcomes, particularly in resource-limited settings. Aim: To compare the effectiveness of topical Phenytoin Sodium dressing with 5% Povidone Iodine dressing in the management of diabetic ulcers. Methodology: A randomized comparative clinical study was conducted on 100 patients with Wagner Grade I–II diabetic ulcers at IGIMS, Patna, between April 2023 and March 2025. Participants were randomly allocated into two groups: Phenytoin Sodium (n = 50) and Povidone Iodine (n = 50). Dressings were applied on alternate days, with an 8-week follow-up period. Healing progression, infection status, and time to 50% and complete wound healing were recorded. Statistical analysis was performed using SPSS version 25.0. Results: Patients treated with Phenytoin Sodium dressing demonstrated significantly faster healing, with a shorter mean time to 50% wound reduction (11.3 vs. 14.9 days) and complete healing (25.1 vs. 31.6 days) compared to the Povidone Iodine group. A lower proportion of infections was observed in the Phenytoin group (20%) compared to the Povidone Iodine group (34%), although this difference did not reach statistical significance. Baseline demographic and clinical characteristics were comparable between the groups. Conclusion: Topical Phenytoin Sodium dressing is more effective than Povidone Iodine in accelerating wound healing in diabetic ulcers and demonstrates a clinically favorable trend toward reduced infection, making it a useful and cost-effective option in routine clinical practice.

Background: Carbapenem-resistant Enterobacterales (CRE) pose a serious threat to patient safety in tertiary care hospitals, limiting treatment options and increasing morbidity and mortality. Aim: To evaluate the prevalence, species distribution, and carbapenem resistance patterns among Enterobacterales isolated from clinical specimens in a tertiary care hospital. Methodology: An observational laboratory-based study was conducted over a period of seven months at Patna Medical College and Hospital, Patna, Bihar, India. A total of eighty non-duplicate carbapenem-resistant Enterobacterales isolates obtained from hospitalized patients were included. Identification and antimicrobial susceptibility testing were performed using standard microbiological methods in accordance with Clinical and Laboratory Standards Institute (CLSI) 2025 guidelines. Data were analyzed using SPSS version 27.0. Results: CRE infections were most commonly observed among patients aged 41–60 years (40%) and in males (60%). Blood (27.5%) and respiratory samples (22.5%) were the predominant sources of isolates. Klebsiella pneumoniae (42.5%) was the most frequently isolated organism, followed by Escherichia coli (32.5%). High resistance rates were observed against ertapenem (82.5%), imipenem (77.5%), meropenem (72.5%), and doripenem (67.5%). The highest proportion of isolates was reported from the intensive care unit (37.5%). Conclusion: The high burden of carbapenem-resistant Enterobacterales, particularly in critical care settings, highlights the need for continuous surveillance, strict infection control practices, and effective antimicrobial stewardship programs.

Background: Sepsis is a leading cause of morbidity and mortality among patients presenting to emergency departments, particularly in low- and middle-income countries. Early identification of high-^‘risk patients is crucial for improving outcomes. Aim: To identify clinical, laboratory, and management-related predictors of in-hospital mortality among sepsis patients admitted through emergency medicine. Methodology: A hospital-based retrospective observational cohort study was conducted at Department of Medicine NMCH, Patna, Bihar, India. Medical records of 110 adult sepsis patients admitted through the emergency department were analyzed. Demographic details, clinical parameters, laboratory findings, treatment variables, and outcomes were recorded. Multivariable logistic regression was used to identify independent predictors of mortality. Results: The in-hospital mortality rate was 21.8%. Mortality was significantly higher among patients aged >60 years, those with qSOFA ≥2, serum lactate >2 mmol/L, vasopressor requirement, ICU admission, and delayed antibiotic administration. Multivariable analysis identified age >60 years, qSOFA ≥2, elevated lactate levels, vasopressor use, and delayed antibiotics as independent predictors of mortality. Conclusion: Mortality in sepsis patients admitted through emergency medicine is strongly associated with advanced age, disease severity at presentation, hemodynamic instability, and delayed treatment. Early risk stratification and timely intervention are essential to improve survival.

Background: Genitourinary Syndrome of Menopause (GSM) is a common but underdiagnosed condition resulting from estrogen deficiency in postmenopausal women, significantly affecting quality of life. Aim: To assess the prevalence, clinical features, and severity of GSM among postmenopausal women attending a tertiary care hospital. Methodology: A descriptive cross-sectional study was conducted among 90 postmenopausal women attending the gynecology outpatient department of JNKTMCH, Madhepura, Bihar, from March 2025 to October 2025. GSM was diagnosed based on ISSWSH and NAMS criteria using symptom assessment and clinical examination. Severity and quality-of-life impact were evaluated using the Day-to-Day Impact of Vaginal Ageing (DIVA) questionnaire. Data were analyzed using SPSS version 27.0. Results: The majority of participants were aged 50–59 years. Vaginal dryness was the most common symptom (77.8%), followed by vaginal itching (50%) and urinary discomfort (33.3%). Clinical signs included vaginal dryness (72.2%) and pale, thin epithelium (66.7%). Moderate GSM was observed in 44.4% of women, while 22.2% had severe GSM. Conclusion: GSM is highly prevalent among postmenopausal women, with moderate severity being most common and significant impact on quality of life. Early recognition and appropriate management are essential.

Background: Hysterectomy is a common gynecological procedure for benign uterine conditions. While Total Abdominal Hysterectomy (TAH) is widely practiced, Non-Descent Vaginal Hysterectomy (NDVH) offers a minimally invasive alternative with potential benefits in blood loss, complications, and recovery. Aim: To retrospectively compare intraoperative blood loss, complications, and hospital stay between NDVH and open TAH. Methodology: A retrospective observational study was conducted at Department of Obstetrics and Gynaecology, JNKTMCH, Bihar, including 70 women undergoing hysterectomy for benign uterine conditions (TAH: 35, NDVH: 35). Data on demographics, uterine size, surgical indications, intra- and postoperative complications, blood transfusion, and hospital stay were collected from medical records and analyzed statistically. Results: Both groups were comparable in age and parity. NDVH was associated with fewer intraoperative complications (22.9% vs. 54.3%), lower postoperative blood transfusion requirement (8.6% vs. 31.4%), reduced postoperative morbidity, particularly wound infection (0% vs. 14.3%), and shorter hospital stay ≤7 days (68.6% vs. 40.0%) compared to TAH. Conclusion: NDVH demonstrates superior perioperative and postoperative outcomes, with reduced complications, lower blood loss, and faster recovery compared to open TAH, supporting its use as a safe and efficient approach for selected benign uterine conditions.

Background: Dengue fever, a mosquito-borne viral disease, poses significant public health concern in tropical regions. Identifying past dengue exposure is crucial for risk stratification, outbreak prevention, and guiding vaccination strategies. Aim: To evaluate the utility of Dengue IgG ELISA in detecting previous dengue virus exposure among a high-risk population. Methodology: A cross-sectional study was conducted at Department of Microbiology, Nalanda Medical College and Hospital, Patna, India, including 60 adults from dengue-endemic areas. Serum samples were analyzed using a commercial indirect Dengue IgG ELISA. Demographic data were collected, and test performance metrics were calculated. Results: Among participants, 60% were seropositive, 6.7% equivocal, and 33.3% seronegative. The essay demonstrated high diagnostic accuracy with 88.2% sensitivity, 91.7% specificity, and substantial agreement with the reference standard (Cohen’s kappa = 0.79). Seropositivity was higher among younger, urban, and male participants, reflecting potential exposure risk factors. Conclusion: Dengue IgG ELISA reliably identifies past dengue exposure and reveals substantial seroprevalence in the studied population. The findings support its use for epidemiological surveillance, targeted prevention, and vaccination planning in endemic regions.

Background: Dengue is a mosquito-borne viral infection causing significant illness in tropical regions. Early and accurate diagnosis during the febrile phase is essential to guide treatment, prevent complications, and support outbreak control. Rapid Diagnostic Tests (RDTs) and ELISA are widely used, but their comparative accuracy in the early phase needs evaluation. Objective: To compare the diagnostic accuracy of Rapid ICT assays with ELISA for detecting dengue NS1 antigen, IgM, and IgG in patients presenting within five days of fever. Methodology: A cross-sectional study was conducted in the Department of Microbiology, Nalanda Medical College and Hospital, Patna, India. A total of 120 clinically suspected dengue cases were enrolled. Blood samples were collected, serum separated and tested using commercial Rapid ICT kits and ELISA for NS1, IgM, and IgG. Diagnostic performance was assessed using sensitivity, specificity, PPV, NPV, and Kappa agreement. Results: Rapid ICT showed high sensitivity (83.3%) and specificity (86.7%) for NS1 detection. IgM demonstrated moderate sensitivity (70%) and specificity (76.7%), while IgG showed good accuracy (78.6% sensitivity, 80% specificity). Substantial agreement with ELISA was recorded for all markers (Kappa 0.68–0.72). Rapid ICT provided fast and cost-effective results suitable for field and resource-limited settings. Conclusion: Rapid ICT assays offer reliable and timely detection of dengue during the early febrile phase. While NS1 results are highly accurate, IgM and IgG may require ELISA confirmation. Combining both methods strengthens diagnostic accuracy and supports effective clinical and public health decisions.

Background: Anastomotic leak ^‘remains a serious complication of bowel surgery, contributing to significant morbidity and mortality despite advances in surgical techniques. Tissue adhesives such as cyanoacrylate have been proposed as adjuncts to improve anastomotic integrity. Aim: To compare outcomes of bowel anastomosis performed with and without cyanoacrylate glue reinforcement. Methodology: This prospective randomized controlled study was conducted at Department of General Surgery, DMCH, Laheriasarai, Darbhanga, Bihar, India for 15 months. Eighty adult patients undergoing intestinal resection with primary anastomosis were randomized into two groups: control (no glue, n=40) and intervention (cyanoacrylate reinforcement, n=40). The primary outcome was anastomotic leak, while secondary outcomes included postoperative complications and drain characteristics. Results: Anastomotic leaks occurred in 15% of patients in the no-glue group compared to 5% in the glue group. Postoperative fever, tachycardia, and abnormal drain outputs were less frequent in the cyanoacrylate group. Although the reduction in leak rate was not statistically significant, a clear clinical trend favoring glue use was observed. Conclusion: Cyanoacrylate glue reinforcement appears to reduce anastomotic leaks and postoperative complications and may be a useful adjunct in bowel surgery, particularly in high-risk settings.

Background: Cataract remains a leading cause of visual impairment worldwide, with surgical intervention being the definitive treatment. Phacoemulsification and small incision cataract surgery (SICS) are commonly performed techniques, yet comparative postoperative outcomes require further evaluation. Aim: To compare postoperative visual outcomes and complication rates following phacoemulsification and SICS in patients with senile cataract. Methodology: A hospital-based, observational study was conducted on 200 patients (100 per group) at Department of Ophthalmology, Bhagwan Mahaveer Institute of Medical Sciences,Pawapuri, Bihar, India. Patients underwent either phacoemulsification or SICS and were followed for 28 days. Postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and intraoperative and postoperative complications were recorded. Statistical analysis was performed using independent t-tests and chi-square tests. Results: Mean UCVA at 28 days was 0.52 ± 0.48 logMAR (~6/18) in the phaco group and 0.61 ± 0.55 logMAR (~6/24) in the SICS group (p = 0.184). Normal vision (≥6/18) was achieved in 58% of phaco patients and 50% of SICS patients (p = 0.256). Intraoperative and postoperative complication rates were comparable between groups, with no statistically significant differences. Conclusion: Both phacoemulsification and SICS provide favorable postoperative visual outcomes with similar safety profiles. Phacoemulsification shows a modest, non-significant advantage in early visual recovery, but both techniques remain effective and safe.

Background: Electrolytes are vital for physiological homeostasis, and the kidneys play a central role in regulating their balance. Chronic Kidney Disease (CKD) impairs renal function, often leading to disturbances in sodium, potassium, and chloride levels, which can exacerbate morbidity and complications. Aim: To clinically evaluate electrolyte alterations in CKD patients and assess their distribution with respect to gender and age. Methodology: A hospital-based cross-sectional study was conducted at Himalaya Medical College and Hospital, Patna, including 80 participants (40 CKD patients and 40 healthy controls). Serum sodium, potassium, and chloride levels were measured using a semi-automatic analyzer. Data were analyzed with IBM SPSS Version 20, and independent t-tests assessed differences between groups. Results: Electrolyte imbalances were observed among CKD patients, with decreased sodium, potassium, and chloride levels being common. No statistically significant differences were found between genders for sodium (p=0.421), potassium (p=0.53), or chloride (p=0.216). Most participants were middle-aged or older, reflecting a higher vulnerability to electrolyte disturbances in this population. Conclusion: CKD is associated with notable electrolyte derangements irrespective of gender. Routine monitoring of serum electrolytes is essential for early detection, timely correction, and improved clinical management of CKD patients.

Background: Female sterilization is a widely adopted permanent contraceptive method, especially in developing countries, but it is not entirely free from complications. Systematic evaluation of these complications is essential to ensure safety and quality of family planning services. Aim: To assess the pattern, management, and outcomes of complications following female sterilization procedures. Methodology: A retrospective observational study was conducted at Department of Community Medicine, Bhagwan Mahavir Institute of Medical Sciences, (BMIMS), Pawapuri, Nalanda, Bihar, India, involving 80 women who developed perioperative or immediate postoperative complications after puerperal or interval sterilization. Data were collected from hospital records and analyzed using descriptive statistics. Results: Most affected women were aged 25–34 years, multiparous, from rural areas, and had low educational status. Puerperal sterilization accounted for 65% of cases. The commonest complications were hemorrhage (30%) and surgical site infection (25%). Nearly half of the cases were managed conservatively, while 35% required surgical intervention. Overall recovery was noted in 95% of participants. Conclusion: Female sterilization is generally safe, but preventable complications persist. Strengthening preoperative assessment, surgical skills, aseptic practices, and postoperative monitoring can further improve outcomes.

Background: Antibiotic utilization is markedly high in Intensive Care Units (ICUs) due to severe infections, empirical therapy, and critical patient conditions, contributing to rising costs and antimicrobial resistance. Drug utilization studies using standardized methods are essential to promote rational antibiotic use. Aim: To assess the pattern and extent of antibiotic utilization in the ICU using the WHO-recommended ATC/DDD methodology. Methodology: A retrospective observational study was conducted in a 7-bedded general ICU of Darbhanga medical college and Hospital, Laheriasarai, Darbhanga, Bihar, India. Medical records of 540 ICU patients were reviewed. Antibiotics were classified using the ATC system, and utilization was expressed as DDD per 100 bed-days. Descriptive statistics were applied. Results: The mean number of drugs per prescription was 3.65, with an average of 2.9 antimicrobials. Broad-spectrum antibiotics were predominantly used, with meropenem (16.72 DDD/100 bed-days) being the most consumed, followed by piperacillin–tazobactam and ceftriaxone. Parenteral antibiotics accounted for 75.6% of prescriptions. PDD/DDD ratios were close to unity for most agents, indicating generally appropriate dosing. Conclusion: The study reveals high and intensive use of broad-spectrum antibiotics in the ICU. Regular monitoring and strengthening antimicrobial stewardship programs are essential to ensure rational antibiotic use and curb resistance.

Background: Cutaneous adverse drug reactions (CADRs) are common manifestations of adverse drug reactions (ADRs), posing significant clinical challenges due to their variable severity and potential for serious outcomes. Monitoring CADRs is essential for patient safety. Aim: To analyze the characteristics, drug associations, severity, and outcomes of CADRs reported to the Adverse Drug Reaction Monitoring Center (AMC) at a tertiary care hospital. Methodology: A retrospective descriptive study was conducted over 8 months, including 322 CADR cases reported to the AMC. Data on demographics, clinical patterns, suspected drugs, severity, causality (WHO–UMC scale), and outcomes were extracted and analyzed using descriptive statistics. Results: Females (54%) and middle-aged adults (41–50 years, 22.4%) were most affected. Pruritus (38.5%), maculopapular rash (26.7%), and erythema (19.3%) were the most common manifestations. Antibacterial drugs (57.1%) were the leading cause, followed by NSAIDs (11.8%) and antiepileptics (9%). Most reactions were mild (66.5%) or moderate (26.7%), with 6.8% severe. Causality was predominantly probable (92.5%), and 85.1% of patients fully recovered. Conclusion: CADRs are generally mild, commonly associated with antibiotics, and show favorable outcomes. Continuous pharmacovigilance, early detection, and careful drug use are essential to prevent serious reactions and improve patient safety.

Background: Skin, the largest organ, is prone to diverse pathological conditions, ranging from benign to malignant, impacting health and quality of life. Histopathological examination of skin biopsies remains essential for accurate diagnosis. Aim: To retrospectively analyze the age, sex distribution, anatomical sites, and histopathological patterns of skin biopsies over one year. Methodology: This descriptive study included 153 skin biopsy specimens from patients of all ages and sexes at Narayan Medical College and Hospital, Sasaram, Bihar, India. Demographic data and biopsy findings were retrieved from departmental archives. Specimens underwent routine Hematoxylin and Eosin staining, with special stains and immunohistochemistry when required. Lesions were classified as non-malignant, granulomatous, or malignant. Results: The majority of patients were aged 21–40 years (male 37.8%, female 40.5%), with a slight female predominance (51.6%). The leg was the most common biopsy site (9.8%). Non-malignant lesions predominated (62.7%), with psoriasis (14.6%) most frequent. Granulomatous lesions (22.2%) were largely leprosy-related, while malignant lesions (15.1%) included basal cell carcinoma (30.4%) and squamous cell carcinoma (26.1%). Conclusion: Skin biopsies reveal a wide spectrum of dermatological conditions, predominantly non-malignant and granulomatous, with malignant lesions less frequently. Histopathology remains indispensable for accurate diagnosis, classification, and management of skin diseases.

Background: Upper limb impairment is a common and disabling consequence of stroke, limiting independence and quality of life. Virtual reality (VR) has emerged as a novel rehabilitation approach that may enhance motor recovery through task-oriented, repetitive, and engaging practice. Aim: To evaluate the effectiveness of VR-integrated physiotherapy on upper limb performance in individuals with chronic stroke compared with conventional physiotherapy. Methodology: A two-armed controlled trial was conducted on 30 individuals with chronic stroke (≥6 months), randomly allocated to an experimental group (VR-integrated physiotherapy) or a control group (conventional physiotherapy). Both groups received supervised therapy three times per week for 12 weeks. Upper limb performance was assessed pre- and post-intervention using the Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), WMFT-Time, and Hand Grip Strength (HGS). Results: Both groups showed significant improvements in all outcome measures (p < 0.05). However, the experimental group demonstrated significantly greater gains in ARAT and WMFT scores, faster WMFT-Time, and higher hand grip strength compared with the control group (p ≤ 0.002). Conclusion: VR-integrated physiotherapy is more effective than conventional physiotherapy alone in improving upper limb function, motor performance, and strength in individuals with chronic stroke.

Background: Hypertension is a prevalent chronic disease contributing significantly to cardiovascular morbidity and mortality. Drug utilization studies in tertiary care settings provide insight into prescribing patterns and adherence to treatment guidelines. Aim: To evaluate the utilization pattern of antihypertensive drugs and associated adverse drug reactions among patients attending a tertiary care teaching hospital. Methodology: A prospective, cross-sectional study was conducted over six months at Darbhanga Medical College and Hospital, India. A total of 150 hypertensive patients aged ≥18 years were enrolled. Data on demographics, clinical profile, antihypertensive prescriptions, therapy type, and adverse drug reactions were collected and analyzed using descriptive statistics. Results: The majority of patients were aged 41–60 years (52%) with a slight male predominance (54.7%). Stage 2 hypertension was observed in 45.3% of patients. Monotherapy was used in 48%, dual therapy in 30.7%, and triple/polytherapy in 21.3%. Calcium channel blockers were the most commonly prescribed agents, followed by ARBs, beta blockers, and ACE inhibitors. Adverse drug reactions occurred in 32 patients, predominantly mild to moderate, with ACE inhibitors and calcium channel blockers being the most frequent causative agents. Conclusion: Antihypertensive prescribing patterns largely adhered to standard guidelines, with calcium channel blockers forming the cornerstone of therapy. Continuous monitoring of drug utilization and adverse effects is recommended to optimize patient outcomes.

Background: Severe traumatic brain injury (TBI) is a major cause of mortality and disability, with raised intracranial pressure (ICP) being a critical determinant of outcome. Decompressive craniectomy (DC) is a surgical option for controlling refractory ICP. Aim: To evaluate the role, outcomes, and complications of decompressive craniectomy in patients with severe head injury. Methodology: A prospective observational study was conducted at Silchar Medical College and Hospital, Assam, including 80 patients aged ≥18 years with severe TBI (GCS ≤8) and refractory ICP. Clinical, radiological, and outcome parameters were recorded. DC (unilateral or bifrontal) was performed following failure of maximal medical therapy. Postoperative outcomes were assessed using the Glasgow Outcome Scale (GOS) at discharge. Results: The cohort was predominantly male (77.5%), aged 31–45 years (35%), with road traffic accidents as the leading cause (65%). Cerebral edema (80%) and midline shift >5 mm (57.5%) were common radiological findings. Unilateral DC was performed in 70% of cases. At discharge, 30% achieved good recovery, 47.5% had moderate to severe disability, and mortality was 12.5%. Postoperative complications included seizures (17.5%), CSF leaks (15%), infections (12.5%), and hydrocephalus (10%). Conclusion: DC effectively reduces ICP and improves survival in severe TBI, though functional recovery varies. Careful patient selection, timely surgery, and vigilant postoperative care are essential to optimize outcomes.

Background: Urinary tract infections (UTIs) are among the most common bacterial infections, predominantly caused by Escherichia coli. Rising antimicrobial resistance has reduced the effectiveness of empirical therapy and necessitates local surveillance. Aim: To determine the prevalence and antimicrobial resistance pattern of Escherichia coli isolated from urine samples of UTI patients over six months. Methodology: A retrospective cross-sectional study was conducted in the Department of Microbiology, Darbhanga Medical College and Hospital, Bihar, India. A total of 490 urine samples from clinically suspected UTI patients were processed by standard culture methods. Significant isolates were identified using biochemical tests and antibiotic susceptibility testing was performed by Kirby–Bauer disc diffusion as per CLSI guidelines. Results: Females constituted 68.16% cases, with maximum incidence in 41–60 years (35.92%). E. coli was the predominant pathogen (63.67%). High sensitivity was observed to meropenem (86.54%), nitrofurantoin (78.85%), imipenem (75.64%), and amikacin (75%). Marked resistance occurred against ampicillin (96.15%), cephalosporins (57–73%), and fluoroquinolones (~59%). Multidrug resistance was seen in 53.85% isolates and 11.54% were extensively drug-resistant. Conclusion: E. coli remains the leading uropathogen with high multidrug resistance, limiting empirical therapy; culture-guided treatment and antimicrobial stewardship are essential.

Background: Intestinal parasitic infections (IPI) remain a major public health problem in developing countries due to poor sanitation, unsafe water, and inadequate hygiene. These infections cause significant morbidity, particularly among children and immuno-compromised individuals. Aim: To determine the prevalence and distribution of intestinal parasitic infections detected in stool samples at a tertiary care hospital in Bihar. Methodology: A hospital-based retrospective descriptive study was conducted in the Department of Microbiology, Darbhanga Medical College and Hospital,Laheriasarai, Darbhanga, Bihar, India over 6 months. A total of 144 stool samples were examined using macroscopic and microscopic methods including saline, iodine wet mounts, and modified Ziehl–Neelsen staining. Data were analyzed using descriptive statistics. Results: Overall prevalence was 28.5% (41/144). Infection was slightly higher in males (30.5%) than females (25.8%). Highest positivity occurred in 51–60 years (33.3%) and 0–10 years (30.7%). Protozoa predominated (65.9%), mainly Entamoeba histolytica (12.5%) and Giardia lamblia (6.3%). Helminths accounted for 31.7%, chiefly Ascaris lumbricoides (3.5%) and hookworm (2.8%). Detection was highest in loose stools (38.5%). Conclusion: Intestinal parasitic infections remain common, with protozoa predominating. Improved sanitation, hygiene awareness, and routine stool examination are essential for control.

Background: Leukemias are heterogeneous malignant disorders of the hematopoietic system, characterized by clonal proliferation/ maturation arrest of hematopoietic cells. Accurate classification using bone marrow aspiration (BMA) is essential for diagnosis, prognosis, and management. Aim: To evaluate the morphological spectrum and frequency of leukemias on bone marrow aspiration, with age-wise distribution and clinical presentation. Methodology: A prospective descriptive study was conducted on 142 patients with suspected leukemia at Department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India. Clinical features, hematological parameters, and bone marrow morphology were recorded. Cytochemistry and immunophenotyping were performed in selected cases. Data were analyzed using descriptive statistics. Results: Males constituted 54.9% of patients; the most affected age group was 10–20 years (22.5%). Common symptoms included fatigue (73.2%), fever (69%), loss of appetite (62%), and weight loss (53.5%). Hematological findings showed anemia (64.8%), leukocytosis (60.6%), and thrombocytopenia (54.9%). Acute leukemias were most frequent: ALL (26.8%) and AML (23.9%), while CML (19.7%), CLL (7%), and other marrow disorders were less common. ALL predominated in younger patients, whereas chronic leukemias appeared mainly in adults. Conclusion: Bone marrow aspiration remains a vital diagnostic tool for leukemia. Acute leukemias were common in younger populations, while chronic forms prevail in older adults & elderly. Combining clinical evaluation, hematology, and morphological assessment ensures accurate diagnosis and guides management.

Background: The process of surgical wound healing is one of the critical factors affecting the outcome of postoperative recovery due to patient and procedure-specific factors. Although surgical care has improved, delayed healing and associated complications are still prevalent clinical problems. Purpose: To determine the role of patients and operational factors in the healing of surgical wounds in patients who have had different surgical procedures. Methodology: A prospective observational study was carried out on 120 patients in the department of general surgery, Netaji Subhas medical college and hospital, Jamshedpur, Jharkhand, India, The SPSS v26 was used to analyze and collect data on demographic, clinical, and intraoperative factors. Statistical analysis such as Chi-square and logistic regression was used to determine the independent predictors of delay healing and complications. Result: Diabetes mellitus (23.3%), smoking (30%), obesity (25%), and nutritional deficiency (15%) were found to be significantly correlated with wound healing delay (p < 0.05). Poor outcomes were also caused by prolonged surgery (>2 hours) and poor aseptic practices. The highest mean time of healing (24 +- 5 days) and the highest rate of complication (32%) was recorded in diabetic patients. On the contrary, the compliance with aseptic methods led to the healing improvement greatly (17 +- 3 days; p < 0.01). Conclusion: There are systemic as well as procedural factors that have a critical influence on the healing of surgical wounds. A thorough preoperative optimization process and strict compliance with the aseptic requirements are obligatory in order to improve the results and reduce the number of complications.

Background: Salivary gland neoplasms are uncommon tumors with diverse histopathological patterns and variable biological behavior. Objectives: To study the histopathological spectrum of salivary gland neoplasms in patients presenting to a tertiary care center. Methods: A descriptive observational study was conducted on 70 histopathologically confirmed cases of salivary gland neoplasms, which were classified according to established diagnostic criteria and analyzed for demographic and anatomical distribution. Results: Benign tumors constituted 57.14% of cases, with pleomorphic adenoma being the most common lesion, while mucoepidermoid carcinoma was the most frequent malignant tumor. The parotid gland was the most commonly involved site. Conclusion: Salivary gland neoplasms exhibit wide histopathological diversity, and detailed histopathological evaluation remains essential for accurate diagnosis and effective clinical management.

Background: Effective analgesia after total knee arthroplasty (TKA) must balance pain relief with preservation of quadriceps strength to enable early mobilization. Femoral nerve block (FNB) provides good analgesia but causes motor weakness. Adductor canal block (ACB) may preserve motor function while maintaining analgesia. Aim: To compare ACB and FNB regarding quadriceps strength, postoperative pain, opioid consumption, and mobilization after TKA. Methodology: In this prospective randomized single-blind trial, 60 patients undergoing unilateral TKA were allocated to ACB (n=30) or FNB (n=30). Quadriceps strength (percentage of baseline), VAS pain scores, morphine consumption, mobilization tests, and adverse effects were assessed up to 24 hours postoperatively. Results: Quadriceps strength was significantly higher with ACB at all time points (e.g., 24 h: 74.3±11.2% vs 46.8±13.6%; p<0.001). Pain scores and morphine consumption were comparable between groups (21.4±6.2 vs 22.1±6.5 mg; p=0.65). Mobilization improved with ACB: faster Timed Up-and-Go (38.6±7.9 vs 55.4±10.3 sec), higher mobility score (7.6±1.2 vs 5.2±1.4), more ambulation within 24 h (83.3% vs 46.7%). Falls occurred only with FNB (10%). Conclusion: ACB preserves quadriceps strength and enhances early mobilization without compromising analgesia, making it preferable to FNB after TKA.

Background: Surgical site infections (SSIs) are common healthcare-associated complications that increase morbidity, hospital stay, and cost. Surgical antimicrobial prophylaxis (SAP) reduces infection risk, but inappropriate selection, timing, duration, and re-dosing promote antimicrobial resistance. Aim: To evaluate antibiotic selection, timing of administration, duration, and intra-operative re-dosing practices of SAP and their association with SSIs. Methodology: A six-month retrospective observational study reviewed 136 elective clean and clean-contaminated surgeries. Data from medical and operative records were assessed against standard guidelines using descriptive and comparative statistical analysis. Results: Cephalosporins predominated (ceftriaxone 42.6%). Appropriate timing within 60 minutes occurred in 63.2% of cases, appropriate duration (≤24 h) in 45.6%, and correct re-dosing in 33.3% of eligible cases. Overall guideline compliance was 42.6%. SSI incidence was 10.3%. Infection occurred in 5.17% of compliant and 14.1% of non-compliant cases (RR=0.37, p>0.05). Conclusion: SAP practices showed partial adherence, with prolonged duration and inadequate re-dosing as major deviations. Although compliance reduced SSI risk, the association was not statistically significant. Strengthened antimicrobial stewardship and standardized protocols are needed to improve rational prophylaxis.

Background: Rapid integration of digital display devices into medical education has increased visual strain and may contribute to Dry Eye Syndrome (DES), a condition affecting comfort, vision, and productivity among students. Aim: To assess digital display device usage patterns and determine their relationship with the prevalence and severity of DES among medical students. Methodology: A descriptive cross-sectional study was conducted among 300 MBBS students (18–25 years) Participants completed a structured questionnaire and Ocular Surface Disease Index (OSDI). Those with abnormal scores underwent Tear Break-Up Time, Schirmer I test, and fluorescein staining. Data were analyzed using SPSS with significance at p<0.05. Results: About 75.3% of students had dry eye symptoms (mild 27.3%, moderate 25.3%, severe 22.7%). Females and students with refractive errors showed significantly higher OSDI scores (p<0.05). OSDI scores increased with smartphone (>5 h: 31.8±20.4) and computer (>5 h: 30.4±20.3) usage. Closer viewing distance, higher brightness, and absence of protective filters significantly worsened symptoms, while protective filters and longer viewing distance reduced severity. Conclusion: DES is highly prevalent among medical students and strongly associated with prolonged screen time and poor ergonomic practices. Preventive education and behavioral modification are recommended.

Background: Enteric fever remains a major public health problem in developing countries, particularly affecting children due to poor sanitation, unsafe drinking water, and immature immunity. Pediatric patients often present with atypical and non-specific symptoms; in many cases, abdominal pain is the predominant presenting complaint, which may delay diagnosis and increase the risk of complications. Objectives: To evaluate the clinical spectrum, laboratory abnormalities, and complications of enteric fever among pediatric patients. Methods: This hospital-based observational cross-sectional study included 240 children aged 6 months to 16 years with enteric fever admitted to a tertiary care hospital. The majority of cases belonged to the 5–15-year age group. Diagnosis was based on clinical features and laboratory confirmation using complete blood count, Typhi-dot test, and blood or stool culture. Clinical, demographic, laboratory, and outcome data were analyzed using SPSS version 20, and statistical significance was assessed using the chi-square test. Results: Fever was present in all patients (100%). Abdominal pain was the predominant presenting symptom, followed by malaise (62.5%). The most affected age group was 5–15 years (37.5%), with a slight male predominance (56.3%). Laboratory abnormalities included anemia (37.5%), leukopenia (33.3%), thrombocytopenia (25%), and elevated liver enzymes (41.6%). Most patients presented between 7 and 14 days of illness. Complications were observed in 37.5% of cases, with hepatitis being the most frequent. Hematological abnormalities showed a significant association with the occurrence of complications. Conclusion: Enteric fever in children presents with a wide clinical spectrum and significant laboratory abnormalities. Early diagnosis, prompt treatment, and careful monitoring of hematological parameters are essential to reduce complications and improve outcomes.

Background: Peri-operative complications under general anesthesia remain an important concern despite advances in anesthetic techniques, monitoring, and patient safety protocols. Continuous evaluation of adverse events is essential to improve peri-operative outcomes. Aim: To retrospectively analyze the pattern and frequency of peri-operative complications occurring under general anesthesia in a tertiary care hospital. Methodology: A hospital-based retrospective observational study was conducted in the Department of Anaesthesiology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India, over 7 months. Medical records of 80 patients who underwent elective and emergency surgeries under general anesthesia were reviewed. Demographic details, surgical characteristics, co-morbidities, intraoperative and postoperative complications were analyzed using SPSS version 27.0. Results: The majority of patients were aged 21–40 years (37.5%), with male predominance (57.5%). Most surgeries were elective (72.5%) and lasted 1–2 hours (52.5%). Sixty percent had at least one co-morbidity, hypertension being the most common (22.5%). Intraoperatively, hypotension (15.0%) and tachycardia (12.5%) were the most frequent complications, while 36.25% had no intraoperative events. Postoperatively, 52.5% had no complications; postoperative nausea and vomiting (20.0%) was most common. Conclusion: General anesthesia was largely safe, with predominantly minor and manageable peri-operative complications.

Background: Microbial keratitis is a vision-threatening ocular emergency, particularly prevalent in tropical regions, where fungal infections are common. Early differentiation between fungal and bacterial keratitis is essential for appropriate management and improved outcomes. Aim: To evaluate and compare the clinical profile, microbiological spectrum, and outcomes of fungal and bacterial keratitis. Methodology: This hospital-based retrospective comparative study was conducted in the Department of Ophthalmology, Patna Medical College and Hospital, including 90 patients with microbiologically confirmed infectious keratitis. Clinical details, risk factors, microbiological findings, treatment, and outcomes were analyzed using descriptive and inferential statistics. Results: Fungal keratitis (55.6%) was more prevalent than bacterial keratitis (44.4%). The most affected age group was 41–60 years (38.9%). Vegetative trauma (42.2%) was the leading risk factor, predominantly in fungal cases, while contact lens use was more common in bacterial infections. Aspergillus spp. (44%) and Staphylococcus aureus (35%) were the most common fungal and bacterial isolates, respectively. Healing with corneal scarring occurred in 66.7% of cases; however, complications such as perforation and therapeutic keratoplasty were more frequent in fungal keratitis. Conclusion: Fungal keratitis predominates in this region and is associated with more severe complications, underscoring the need for early microbiological diagnosis and targeted therapy.

Background: Diabetes mellitus (DM) is a major risk factor for cataract, with patients often presenting late with advanced lens opacities. Cataract surgery in diabetics is crucial for visual rehabilitation and assessment of diabetic retinopathy, but outcomes may be compromised by systemic and ocular comorbidities. Aim: To evaluate and compare the visual outcomes of cataract surgery in diabetic patients with advanced cataracts versus age- and sex-matched non-diabetic controls. Methodology: A hospital-based case–control study was conducted at Patna Medical College and Hospital, India, over seven months. Forty patients were enrolled: 20 diabetics (cases) and 20 non-diabetics (controls), all undergoing extracapsular cataract extraction with posterior chamber intraocular lens implantation. Pre- and postoperative visual acuity (VA) was recorded at 1 week, 4 weeks, 2 months, and 6 months. Surgical complications and comorbidities were documented. Results: Postoperative VA improved in both groups, with diabetics achieving a mean VA of 0.42 ± 0.44 and non-diabetics 0.55 ± 0.29 at six months (p>0.05). Diabetics had more systemic/ocular comorbidities (18 vs 7) and higher intra- and postoperative complications (25 vs 8). Poor visual outcomes in diabetics were mainly due to diabetic retinopathy/maculopathy and other retinal pathologies. Conclusion: Cataract surgery improves vision in diabetics with advanced cataracts, though visual gains are slightly less than in non-diabetics due to comorbidities and higher complication rates. Careful pre- and postoperative management is recommended.

Background: Distal tibial fractures are challenging injuries due to limited soft tissue coverage and proximity to the ankle joint. Locking compression plate (LCP) and intramedullary nailing (IMN) are commonly used fixation methods, each with distinct advantages and limitations. Aim: To compare the clinical, radiological, and functional outcomes of LCP and IMN in the management of extra-articular distal tibial fractures. Methodology: This prospective comparative study was conducted in the Department of Orthopedics, Nalanda Medical College and Hospital, Patna, over six months. Eighty skeletally mature patients with extra-articular distal tibial fractures were divided into IMN (n=40) and LCP (n=40) groups. Operative parameters, time to union, RUST score, Olerud-Molander Ankle Score (OMAS), and complications were assessed over six months. Results: IMN showed significantly shorter operative time, less blood loss, and earlier union compared to LCP (p<0.05). RUST and OMAS scores at 3 and 6 months were significantly higher in the IMN group. Overall complication rates were comparable, though anterior knee pain was more frequent with IMN. Conclusion: IMN demonstrated superior operative efficiency, faster union, and better early functional outcomes than LCP, making it a favorable option for extra-articular distal tibial fractures.

Background: Hypokalemia and Hypomagnesemia are common electrolyte disturbances in intensive care units (ICUs) and frequently coexist due to shared pathophysiological mechanisms. Their combined presence increases the risk of arrhythmias, neuromuscular dysfunction, and refractory potassium depletion. Aim: To evaluate the prevalence of hypomagnesemia among hypokalemic ICU patients and determine the correlation between serum potassium and magnesium levels. Methodology: This hospital-based cross-sectional study was conducted over one year in the ICU of Adesh Medical College & Hospital, Haryana, India. Ninety adult ICU patients (≥18 years) with documented hypokalemia (≤3.5 mEq/L) were included. Serum potassium and magnesium levels were measured using standardized laboratory methods. Data were analyzed using SPSS v27. Pearson’s correlation, chi-square test, and ROC curve analysis were applied. Results: Hypomagnesemia (<1.7 mg/dL) was present in 62.2% of patients. A moderate positive correlation was observed between serum potassium and magnesium levels (r = 0.46, p = 0.001). The severity of hypokalemia was significantly associated with hypomagnesemia (p = 0.012). A potassium cut-off^” ≤3.1 mEq/L showed fair specificity (75%) but limited sensitivity (52.5%) for predicting hypomagnesemia. Conclusion: Hypomagnesemia is highly prevalent among hypokalemic ICU patients and correlates significantly with potassium levels, supporting ^‘routine magnesium assessment and combined electrolyte correction.

Background: Lumbar canal stenosis (LCS) is a common degenerative spinal condition causing back pain, neurogenic claudication, and functional impairment, traditionally managed by open decompressive surgery. Minimally invasive spine surgery (MIS) has emerged as an alternative aiming to reduce surgical morbidity while providing comparable clinical outcomes. Aim: To compare the clinical efficacy, perioperative parameters, functional outcomes, and complication rates of MIS versus conventional open surgery in patients with LCS. Methodology: A prospective, comparative observational study was conducted at Nalanda Medical College and Hospital,Patna, Bihar, India involving 90 patients (MIS: n=45; OPEN: n=45) aged 30–75 years with radiologically confirmed LCS. Patients were evaluated pre- and postoperatively using Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI), and perioperative parameters. Statistical analysis was performed using SPSS v27, with significance set at p<0.05. Results: MIS significantly reduced operative time (95.6 ± 15.4 vs. 110.3 ± 18.7 min, p<0.001), intraoperative blood loss (120.5 ± 40.3 vs. 280.7 ± 75.6 ml, p<0.001), hospital stay (3.2 ± 1.1 vs. 6.5 ± 1.8 days, p<0.001), and early postoperative pain (VAS day 3: 3.8 ± 1.0 vs. 5.6 ± 1.3, p<0.001). Six-month functional outcomes favored MIS (ODI: 18.6 ± 6.2 vs. 25.4 ± 7.8; VAS: 2.1 ± 0.9 vs. 3.4 ± 1.1; p<0.001). Overall complication rate was lower in MIS (13.3% vs. 33.3%, p=0.02). Conclusion: MIS provides effective decompression with superior perioperative recovery, improved functional outcomes, and reduced complications compared to open surgery, making it a preferred approach for appropriately selected patients.

Background: Cataract is the leading cause of reversible blindness worldwide, with surgery being the only definitive treatment. Despite advances, variations in surgical patterns and postoperative complications remain clinically significant. Aim: To evaluate the patterns of cataract surgery and associated postoperative complications over six months. Methodology: A prospective observational study was conducted at the Department of Ophthalmology, Anugrah Narayan Magadh Medical College, Gaya ji, Bihar, India, including 80 patients aged ≥40 years undergoing cataract surgery. Data on demographics, surgical techniques, intraoperative and postoperative complications, and visual outcomes were recorded. Surgeries included phacoemulsification, ECCE, and MSICS. Postoperative follow-up extended to six months, and statistical analysis was performed using SPSS v27. Results: Patients were predominantly elderly, with a slight female predominance (52.5%). Phacoemulsification was the most common procedure (52.5%), with posterior chamber foldable IOLs implanted in 66.3% of cases. Intraoperative complications occurred in 13.7%, with posterior capsule rupture being most frequent. Postoperative complications were infrequent, with corneal edema (10%) and posterior capsule opacification (7.5%) being the most common. Conclusion: Phacoemulsification with posterior chamber foldable IOLs provides excellent visual outcomes with low complication rates. Patient selection, surgical expertise, and structured postoperative follow-up are critical for^” optimal outcomes.

Background: Heart failure (HF) is a major global health problem classified into heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF), each with distinct clinical profiles and outcomes. Aim: To compare the clinical characteristics and short-term outcomes of patients with HFpEF and HFrEF. Methodology: This hospital-based prospective observational comparative study was conducted in the Department of General Medicine, Patna Medical College and Hospital, Bihar, over 6 months. A total of 90 patients were enrolled and divided equally into HFpEF (LVEF ≥50%) and HFrEF (LVEF <40%) groups. Demographic data, comorbidities, echocardiographic findings, and in-hospital outcomes were analyzed using appropriate statistical tests. Results: HFpEF patients were older (64.2 ± 9.8 vs 58.6 ± 10.4 years; p=0.012) and had higher prevalence of hypertension (75.6%; p=0.038), whereas coronary artery disease was more common in HFrEF (64.4%; p=0.006). HFrEF patients had significantly higher need for mechanical ventilation (24.4% vs 8.9%; p=0.041), longer hospital stay (8.4 ± 3.5 vs 6.2 ± 2.1 days; p=0.003), more complications (35.6%; p=0.028), higher in-hospital mortality (20.0%; p=0.048), and greater six-month readmissions (40.0%; p=0.048). Conclusion: HFrEF is associated with poorer short-term outcomes compared to HFpEF, highlighting the need for intensive management and close follow-up.

Background: Malnutrition remains a major public health problem among under-five children in rural India and is closely linked with increased morbidity and mortality. Aim: To assess the nutritional status and morbidity pattern among children aged 6–60 months in the rural field practice area of Upgraded Department of Pediatrics, PMCH, Patna, Bihar, India. Methodology: A community-based cross-sectional study was conducted among 300 children aged 6–60 months selected by systematic random sampling from rural field practice areas of our tertiary care hospital. Socio-demographic details and morbidity history were collected using a structured questionnaire. Anthropometric measurements were taken as per WHO guidelines, and nutritional status was assessed using WHO Child Growth Standards (2009). Data were analyzed using appropriate statistical tests. Results: Underweight, stunting, and wasting were observed in 43.3%, 63.3%, and 25% of children, respectively. Stunting showed a significant increase with age (p < 0.05), while gender had no significant association with nutritional status. Anemia was the most common morbidity (35%), followed by acute respiratory infections (20%), fever (18.3%), and diarrhea (8.3%). Multiple overlapping morbidities were present in 21.7% of children. Conclusion: The study reveals a high burden of chronic undernutrition and morbidity among rural under-five children, highlighting the need for sustainable & effective nutritional interventions, anemia control, and strengthened child health services.