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

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

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

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

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

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

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

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

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