Background: Laparoscopic surgeries performed in steep Trendelenburg position with pneumoperitoneum cause significant intraocular pressure (IOP) elevation, posing a potential risk for perioperative ocular complications. Anaesthetic technique plays a crucial role in modulating these changes. This study compares the effects of Total Intravenous Anaesthesia (TIVA) using propofol versus desflurane-based inhalational anaesthesia on IOP and haemodynamic stability. Methodology: A prospective, randomized comparative study was conducted on 60 patients (ASA I–II) undergoing elective laparoscopic surgery. Patients were assigned to either the Propofol TIVA group (Group P, n=30) or the Desflurane group (Group D, n=30). Intraocular pressure was recorded at baseline, post-induction, after pneumoperitoneum, and at 10, 30, and 60 minutes of Trendelenburg, followed by the return to supine position. Haemodynamic parameters were also assessed. Statistical analysis was performed using t-tests and chi-square tests, with p<0.05 considered significant. Results: Baseline demographics were comparable across groups. Group D showed significantly higher IOP at all surgical stress points—after induction (p=0.01), after pneumoperitoneum (p<0.001), and during Trendelenburg at 10, 30, and 60 minutes (all p<0.001). IOP returned toward baseline after resuming supine position but remained significantly higher in Group D (p<0.001). Haemodynamic variables including mean arterial pressure showed no significant intergroup differences at any time point. Conclusion: Propofol-based TIVA is more effective in attenuating intraoperative IOP rise than desflurane anaesthesia during laparoscopic surgeries requiring pneumoperitoneum and Trendelenburg position. Both techniques provide stable haemodynamics; however, TIVA may be preferable in patients at risk for ocular hypertension or glaucoma.

Introduction: The optimal operative strategy for managing inguinal hernia (IH) in the adolescent population remains undetermined. This investigation sought to analyse and contrast the short-term perioperative results and the durable long-term prognosis among young patients suffering from IH who were treated either with minimally invasive laparoscopic hernia repair (LHR) or conventional open hernia repair (OHR). Methodology: This was a retrospective cohort study examining historical clinical and pathological characteristics of adolescent IH patients who initially received either LHR or OHR at VIMSAR, Burla between March 2018 and February 2024. Prognostic indicators associated with patient survival and outcome were isolated using univariate and subsequently multivariate Cox regression modelling. To mitigate potential selection bias, Propensity Score Matching (PSM) analysis was implemented to establish equivalent cohorts of patients from the LHR and OHR groups, matching them in a 1:1 ratio. Results: The initial cohort of adolescent IH patients comprised 122 individuals in the LHR group and 126 individuals in the OHR group. Following the execution of PSM, 94 patients were successfully matched in each study arm. Relative to the OHR cohort, the LHR group exhibited numerous advantages, including a shorter duration of hospital stay, reduced intraoperative haemorrhage, a lower incidence of total postoperative morbidities, and decreased rates of both recurrence and persistent postsurgical pain. Furthermore, the LHR cohort demonstrated markedly improved recurrence-free survival compared to the OHR group, a finding confirmed both prior to and following the PSM procedure. Conclusion: Laparoscopic management of inguinal hernia in adolescent patients represents a viable and safe therapeutic option, consistently yielding superior perioperative measures and favourable long-term outcomes.

Background: Laparoscopic surgeries performed in steep Trendelenburg position with pneumoperitoneum cause significant intraocular pressure (IOP) elevation, posing a potential risk for perioperative ocular complications. Anaesthetic technique plays a crucial role in modulating these changes. This study compares the effects of Total Intravenous Anaesthesia (TIVA) using propofol versus desflurane-based inhalational anaesthesia on IOP and haemodynamic stability. Methodology: A prospective, randomized comparative study was conducted on 60 patients (ASA I–II) undergoing elective laparoscopic surgery. Patients were assigned to either the Propofol TIVA group (Group P, n=30) or the Desflurane group (Group D, n=30). Intraocular pressure was recorded at baseline, post-induction, after pneumoperitoneum, and at 10, 30, and 60 minutes of Trendelenburg, followed by the return to supine position. Haemodynamic parameters were also assessed. Statistical analysis was performed using t-tests and chi-square tests, with p<0.05 considered significant. Results: Baseline demographics were comparable across groups. Group D showed significantly higher IOP at all surgical stress points—after induction (p=0.01), after pneumoperitoneum (p<0.001), and during Trendelenburg at 10, 30, and 60 minutes (all p<0.001). IOP returned toward baseline after resuming supine position but remained significantly higher in Group D (p<0.001). Haemodynamic variables including mean arterial pressure showed no significant intergroup differences at any time point. Conclusion: Propofol-based TIVA is more effective in attenuating intraoperative IOP rise than desflurane anaesthesia during laparoscopic surgeries requiring pneumoperitoneum and Trendelenburg position. Both techniques provide stable haemodynamics; however, TIVA may be preferable in patients at risk for ocular hypertension or glaucoma.

Introduction: Up to 80% of people will experience chronic low back pain (CLBP) at some point in their lives, making it one of the most common musculoskeletal conditions in the world.  CLBP has a complex aetiology that frequently includes ligamentous instability, facet joint arthropathy, intervertebral disc degeneration, and sympathetic nervous system involvement. Aims: The study aimed to evaluate the efficacy of Gray Rami Communicantes Block (GRCB) in alleviating pain and improving functional outcomes in patients with chronic low back pain, while also comparing changes in pain scores, disability indices, serum biomarkers, and adverse events between the GRCB group and those receiving standard therapy. Materials & Methods: This prospective, randomized, controlled clinical study was conducted over one year (from 1st August 2023 to 31st July 2024) and included 32 patients with chronic low back pain.16 in Gray Rami Communicantes Block (GRCB)and 16 in control group (received conventional management only). Result: In our study of 32 patients, the GRCB group (n = 16) showed significantly better clinical outcomes than controls (n = 16), with 10 patients (62.5%) markedly improved, 4 (25%) moderately improved, and 2 (12.5%) slightly improved, while none worsened. In the control group, only 2 (12.5%) were markedly improved, and 3 (18.8%) showed no change or worsening (p < 0.001). Conclusion: We came to the conclusion that Gray Rami Communicantes Block (GRCB) was quite effective at treating persistent low back pain.  Because both groups were similar at baseline, the evaluation was objective.

Background: Endotracheal intubation using the Macintosh laryngoscope is the standard technique for securing the airway but is associated with significant haemodynamic stress due to direct laryngoscopy. The Intubating Laryngeal Mask Airway (ILMA) provides an alternative method that may attenuate this response by avoiding direct stimulation of upper airway structures. This study compares the haemodynamic changes, intubation characteristics, ventilation parameters, and complications between ILMA and Macintosh laryngoscope (ML) in adult elective surgical patients. Methods: A randomized prospective study was conducted on 60 ASA I–II patients aged 18–60 years undergoing elective surgery under general anaesthesia. Participants were allocated into two groups of 30 each: ILMA-guided intubation and ML-guided intubation. Standardized anaesthetic induction was followed by intubation using the assigned device. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and EtCO₂ were recorded at baseline, pre-induction, at intubation, and at 3-, 5-, 10-, and 15-minutes post-intubation. Intubation time and complications were also assessed. Statistical analysis was performed using Student’s t-test, with p < 0.05 considered significant. Results: Baseline demographic variables were comparable between groups (p > 0.05). The ML group exhibited significantly higher HR, SBP, and DBP from intubation through 15 minutes post-intubation (p < 0.05), indicating a stronger haemodynamic response. In contrast, ILMA maintained more stable cardiovascular parameters across all time points. EtCO₂ values showed no significant difference between groups at any interval (p > 0.05), indicating similar ventilation efficacy. Intubation time was significantly longer with ILMA (64.36 ± 6.58 sec) compared to ML (21.33 ± 4.16 sec; p < 0.0001). Complication rates were low in both groups; however, dental injury occurred only in ML, while a single case of laryngospasm occurred with ILMA. Conclusion: Both ILMA and Macintosh laryngoscope are effective for airway management, but ILMA offers superior haemodynamic stability during and after intubation, with fewer trauma-related complications. The Macintosh laryngoscope allows faster intubation but is associated with a more pronounced pressor response. ILMA may be preferred in patients where minimising cardiovascular stress is essential, whereas ML remains advantageous in situations requiring rapid airway access.

Background: Protein Energy Malnutrition (PEM) remains a major pediatric health burden in developing countries, frequently accompanied by anemia that worsens morbidity, impairs immunity, and negatively affects growth and neurodevelopment. Understanding hematological alterations in PEM is essential for timely diagnosis and effective intervention. Objectives: To evaluate the clinical profile and hematological patterns of anemia among children with PEM attending a tertiary care hospital. Methods: A cross-sectional study was conducted over 12 months in the Department of Pediatrics, including 120 children aged 6 months to 5 years with PEM, classified using WHO criteria. Detailed clinical assessment, anthropometric measurements, complete blood count, peripheral smear, and serum ferritin analysis were performed. Anemia was categorized by WHO hemoglobin cut-offs and morphologic patterns. Results: Of the 100 children, 58.3% were males, with a mean age of 27.4 ± 10.6 months. Pallor (82%), lethargy (65%), and recurrent infections (48%) were common presenting features. Anemia was observed in 88.3% of children, predominantly microcytic hypochromic (56.6%), followed by normocytic normochromic (28.3%) and macrocytic (15%). Severe anemia was significantly more prevalent in Grade III and IV PEM (p < 0.05). Mean hemoglobin and red cell indices showed a significant decline with increasing severity of PEM. Conclusion: Anemia is highly prevalent in children with PEM, with microcytic hypochromic anemia being the most common pattern. The severity of anemia correlates strongly with the degree of malnutrition. Routine hematological evaluation and early correction of nutritional deficiencies should be integrated into PEM management to reduce morbidity and improve long-term outcomes.

Background: Obesity is strongly associated with insulin resistance which contributes to the development of diabetes and other metabolic disorders. Conventional lifestyle and pharmacologic therapies often fail to sustain long-term metabolic improvement. Yoga a holistic mind–body intervention may enhance insulin sensitivity via stress reduction, autonomic balance and increased physical activity. Objectives: This interventional study aims to assess whether a structured yoga program can improve insulin sensitivity and metabolic function in obese individuals. Materials and Method: An interventional study was carried out in 200 Obese individuals in which 100 are cases and 100 controls in Physiology YOG OPD. A 3-month of yoga session minimum 5 days in week was given to the subjects in the morning hours for 40 minutes completing a set of select yogic exercises for 3 month by a trainer. Insulin resistance (IR) was determined using the homeostasis model assessment of IR (HOMA-IR) formula at baseline, 1 month and after 3 month. Results: The study found a significant improvement in insulin resistance among obese individuals who practiced yoga for three months. Participants demonstrated a notable reduction in fasting insulin levels from 15.55 µIU/mL to 12.49 µIU/mL, HOMA-IR: 4.05 → 2.87 compared to baseline measurements. Conclusion: These results suggest that yoga may be an effective non-pharmacological approach to managing insulin resistance in obese patients.

Background: Inguinal hernia repair remains a cornerstone procedure in general surgery. While mesh use, exemplified by Lichtenstein’s technique, is prevalent, its suitability is compromised in complex hernias and resource-constrained settings. The Desarda no-mesh repair offers a promising tissue-based solution. Objective: This study sought to evaluate the outcomes of Desarda’s repair in a cohort of patients with complicated inguinal hernias where mesh repair was contraindicated. Methods: A prospective observational study was conducted on 30 patients undergoing Desarda’s repair at a tertiary care centre between March 2024 and June 2025. Data captured included patient demographics, operative variables, pain assessments, complication rates, and time to activity resumption. Results: Mean patient age was 55.2 ± 16.2 years, exclusively male. The right side was predominant (66.6%). Mean operative time was 96 minutes, and average hospitalization was 4.5 days. Postoperative pain showed a significant decrease from day 1 (VAS 4.8) to day 7 (VAS 0.3), with no chronic pain at 30 or 90 days. Complications were observed in 23.3% (seroma, wound infection, hematoma), all minor and manageable. No recurrences were documented. A remarkable 93% of patients returned to normal activities within 15 days. Conclusion: Desarda’s repair is a safe, effective, and cost-beneficial alternative to mesh hernioplasty, particularly advantageous for complicated inguinal hernias.

Introduction: The shift from traditional open techniques to minimally invasive approaches in hernia surgery has been widely embraced, with laparoscopic methods demonstrating advantages such as reduced long-term post-operative discomfort, lower risk of wound-related complications like infections and hematomas, and faster recovery. This analysis focuses on evaluating two laparoscopic inguinal hernia repair modalities: transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) techniques. Methodology: The Purpose of the study is to assess the clinical outcomes and procedural efficiency of TAPP and TEP in the treatment of inguinal hernias, emphasizing their comparative strengths and limitations. A systematic review was conducted, incorporating peer-reviewed randomized controlled trials (RCTs) comparing TAPP and TEP procedures, sourced from PubMed, Embase, and the Cochrane Library up to December 2024. Key metrics evaluated included operative duration, postoperative pain intensity, and length of inpatient stay, stratified by hernia type. Results: The analysis included 12 RCTs involving 905 participants randomized into TAPP or TEP groups. TEP was associated with prolonged operative times, abbreviated hospitalization, and diminished postoperative pain levels. However, a notable subset required conversion to open surgery in TEP cases. Conversely, TAPP demonstrated shorter procedural times but did not consistently reduce inpatient duration. Conclusion: Both TAPP and TEP offer distinct clinical benefits. TEP proves advantageous in minimizing postoperative pain and reducing hospitalization for primary hernia cases, albeit with potential trade-offs in procedural duration and conversion rates. TAPP, while expedient in terms of operation time, may not consistently yield superior outcomes in recovery metrics. These findings underscore the importance of patient-specific factors and collaborative decision-making when selecting between these two laparoscopic techniques for inguinal hernia repair.

Introduction: Cardiovascular disease is one of the major causes of mortality in the world. India has also shown an increase in the incidence of mortality related to cardiovascular disease. The establishment of Von Willebrand factor (vWF) as a new risk factor for cardiovascular disease is one of the initiatives towards its prevention and moreover, it has been widely studied in the western countries. Aims and Objectives: Distribution of Von Willebrand factor and platelet count and its correlation among different age groups in Guwahati city. Materials and Methods: This cross sectional study was carried out on 200 Healthy adult individuals over 1 year duration. The estimation of vWF concentration was done in MINIVIDAS machine and Platelet count was enumerated by direct method of platelet estimation. The study protocol was presented to the institutional ethics committee for approval and was approved.  Informed consent was obtained from all participants. Results: the mean vWF levels with standard deviation increased with the increasing age with subjects for the age group of >50 years measured the highest (86.38±17.64IU/dl) as compared to age group 41-50 years (77.57±15.98 IU/dl); age group 31-40 years (77.63±17.38 IU/dl) and age group 21-30 years (70.10±9.75IU/dl). The Platelet count for age group 21-30 years was the highest (1.88±0.25lacs/cu.mm) as compared to the age group of 31-40 years (1.83±0.21 lacs/cu.mm); age group 41-50 years (1.80±0.21 lacs/cu.mm) and the age group of subjects >50 years (1.75±0.27 lacs/cu.mm). Conclusion: Our study showed a significant statistical difference between vWF and Platelet count among different age groups. As it is an established fact that increased vWF levels are associated with incidence of arterial and venous thromboembolism vWF levels may become an important parameter to be recognized as a new risk factor in the development of the cardiovascular disease.

Aim: To compare the diagnostic accuracy and clinical efficacy of color Doppler ultrasound (CDU) and digital subtraction angiography (DSA) in patients with lower limb ischemia due to occlusive arterial disease, with assessment of sensitivity, specificity, and cost-effectiveness. Materials and Methods: A prospective comparative study was conducted on 85 consecutive patients presenting with symptoms of lower limb ischemia (claudication or rest pain) due to suspected arterial occlusive disease. Both color Doppler ultrasound and digital subtraction angiography were performed sequentially within 7 days. Arteries were graded on a 5-point scale (0=normal to 4=complete occlusion). Demographic data, clinical presentation, imaging findings, and procedural complications were recorded and analyzed using chi-square test and Cohen’s kappa for agreement. Results: Of 85 patients (mean age 62.3 ± 8.9 years, 71% male), color Doppler demonstrated 89.4% sensitivity and 86.7% specificity compared to DSA as the gold standard. Color Doppler showed superior performance in hemodynamically significant stenoses (≥70%) and was superior in detecting soft plaques and recanalization. DSA was superior in detecting calcification and complex lesions. Doppler-related complications were absent, while DSA showed 7.1% minor complications. Conclusion: Color Doppler ultrasound is a reliable, non-invasive alternative to digital subtraction angiography for initial assessment of lower limb occlusive arterial disease with excellent agreement and diagnostic accuracy. It should be the first-line imaging modality for hemodynamically significant lesions, with DSA reserved for therapeutic interventions or cases requiring precise anatomical detail.

Skin disinfection before any central neuraxial block is of immense importance as it can prevent undue dreaded systemic infections. Though Povidone-iodine has been traditionally used for the disinfection process, Chlorhexidine gluconate has demonstrated equally satisfactory or even superior results in recent studies. This study was thus undertaken to investigate and compare the overall efficacy of Chlorhexidine and Povidone-iodine for skin disinfection before subarachnoid block. Materials and Methods: 130 patients, aged between 18 to 65 years of either sex, American Society of Anesthesiologists physical status I and II, undergoing elective surgery requiring subarachnoid block were allocated into two groups. Group-P received skin preparation with aqueous solution of 10% Povidone iodine and Group-C received that with alcoholic solution of 0.5% Chlorhexidine at intended sites. Two quantitative skin swab samples, each before and after skin disinfection with either solution were obtained, in a 4-cm diameter soya agar contact plate. The results were recorded as number of Colony Forming Unit in pre and post sample plates. Results: The mean reduction of colony count was significantly higher in Group C than in Group P. Conclusion: 0.5% Chlorhexidine is more effective than 10% Povidone-iodine for skin disinfection prior to Central Neuraxial Block.

Background: Transfusion-transmissible infections (TTIs) like HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis and malaria can pose a significant threat to blood safety despite the obligatory screening. TTIs in blood donors vary considerably geographically in India and voluntary non-remunerated blood donors are usually thought safer, than replacement donors. This paper has compared TTIs seroprevalence rates between voluntary and replacement donors in the Silchar Medical College and Hospital (SMCH) Blood Centre, Assam, and explained demographic predictors of TTI positivity. Methods: The study under question was a prospective cross-sectional study carried out between 1 February 2023 and 31 January 2024 at the SMCH Blood Centre, which is a tertiary care hospital in North-East India. All the potential donors between the ages 1865 years were enrolled through written informed consent. The demographic data and type of donor (voluntary or replacement) was used. HBsAg, anti-HCV and HIV-1/2 antibody and p24 antigen screening of sera were performed in third and fourth-generation ELISAs; syphilis and malaria were detected in rapid immunochromatographic assays; in line with the national regulations. Seroprevalence was calculated and the proportions analyzed by Pearson chi-square test (p<0.05). Results: Out of 7, 536 donors, 5,394 (71.6) were replacement and 2,142 (28.4) were voluntary donors; 93.1% of them were men. In general, the TTI prevalence was 2.96 percent with 223 donors being seroreactive to at least one of the TTI. The most common diseases were HBV (0.97) and syphilis (1.02) and then there was HIV (0.50), HCV (0.40) and multiple infections (0.07); not a single donor was positive to malaria. Most infections were due to replacement donors (e.g. 92.2% of syphilis and 87.7% of HBV cases), however, the mixing of specific TTIs by type of donor was also statistically non-significant (2.931, p=0.569). Conversely, TTI positivity was highly age-dependent (2=31.266, p=0.002), with the highest percentage of seropositive donors being 2435 years old, and sex-dependent ( 2=13.909, p=0.008), where 96.4% of the seropositive donors were male. Conclusion: TTIs still continue to be a significant issue among blood donors in this tertiary care centre and close to 3 percent of seemingly healthy blood donors have demonstrated some form of infection. TTI positivity was significantly dependent on age and male sex but not the donor type. It is necessary to improve the recruitment of voluntary non-remunerated donors, improving pre-donation counselling, and ensuring a high level of screening to increase the level of blood safety even further.

Background: Errors in the total testing process are being increasingly recognized as an important cause of preventable patient harm, and pre-analytical phase has the highest percentage of these events. Contemporary data on the prevalence and spectrum of pre-analytical error in routine biochemistry laboratories, especially in low- and middle-income settings, are still sparse. Methods: This observational single centre cross-sectional study was conducted in the laboratory of clinical biochemistry at Department of Biochemistry, Government P.D.U. Medical College, Churu, Rajasthan, India, from May 2024 to December 2024. Every serum and plasma sample admitted to routine and urgent chemistry analyses was screened on arrival in line with International Federation of Clinical Chemistry (IFCC) quality indicators as sample identification, request form, collection, transporting, or specimen quality-related errors. The frequencies of pre-analytical errors were computed as the percentage of samples with 1 or more error. Chi-square test and multivariate logistic regression were used to compare patient location (outpatient, inpatient, and intensive care) and request priority (routine vs emergency). Results: Out of 45,126 samples, 810 contained at least one error of pre-analysis meaning a total prevalence of error of 1.8. The most commonly occurring problems were quality problems of the specimen (52.1%), hemolysis (28.5%), lack of volume in the sample (21.0%), and anticoagulation clotting of the sample (18.6%). The deficiencies of request forms shared 26.5 percent consisting of mostly non-completely clinical detail as well as physician signature and patient / sample identification errors constituted 8.3 percent. Error rates on pre-analytical were considerably much greater among inpatient and outpatient samples (2.2% vs 1.3% p<0.001) and between emergency and routine requests (2.5% vs 1.6% p<0.001). Inpatient origin and emergency status realized their status as independent predictors of error, after adjustment. Conclusion: This medium level biochemistry laboratory had close to 1 out of 55 samples with at least one pre-analytical error, with hemolysis and inadequate volume being the most common. Centralization of errors in emergency and inpatient samples indicates that a specific intervention, such as standardized training on phlebotomy, improved communication with clinical areas, and ongoing monitoring with harmonized quality indicators will be necessary.

Background: Chronic lymphocytic leukemia (CLL), the most prevalent adult leukemia in Western countries, is relatively uncommon in India, where it accounts for <5% of all leukemias. Studies from India suggest that patients often present at a younger age, with distinct clinical and molecular characteristics compared to Western cohorts [6–12]. Limited data exist from northern India, particularly the Kashmir region. Objective: To evaluate the clinico-pathological characteristics, molecular profile, treatment indications, therapeutic approaches, and short-term outcomes of CLL patients at a tertiary care center in Kashmir. Methods: This retro-prospective observational study included 100 consecutive CLL patients diagnosed between January 2023 and June 2025 at Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar. Clinical, hematological, immunophenotypic, cytogenetic, and molecular parameters were analyzed. Staging was performed using Modified Rai and Binet systems. Treatment decisions followed iwCLL criteria. Outcomes assessed included overall survival (OS), progression-free survival (PFS), response rates, and complications. Results: The mean age at diagnosis was 63.3 years (range: 40–83), with 60% aged >60 years. A male predominance was noted (M:F = 1.43:1). Forty-one percent were asymptomatic; lymphadenopathy (26%), splenomegaly (28%), and fatigue (20%) were common findings. Anemia (30%) and thrombocytopenia (22%) were frequent laboratory abnormalities. Flow cytometry confirmed classic CLL phenotype (CD5/CD19/CD23 positivity in 95%). The most common cytogenetic lesion was del(13q) (49.4%). IGHV was unmutated in 80% and TP53 mutations were rare (3%). Modified Rai stages 0–II constituted 62% of cases; Binet Stage A comprised 52%. Fifty-two percent had no treatment indication; BR chemotherapy was the most common regimen (23%). Novel agents were used in 8% of cases. At a median follow-up of 23 months, OS was 92% and PFS was 85%. Advanced stage and cytopenias correlated with worse outcomes. Conclusion: CLL patients in Kashmir present at a younger age and predominantly in early stages. Favorable cytogenetics (del13q) and low TP53/del17p burden contribute to excellent short-term outcomes. BR remains the main therapy due to economic constraints, though limited use of targeted agents is increasing. Larger multicenter studies with longer follow-up are required to assess long-term outcomes and optimize treatment strategies.

Introduction: Colour vision serves as a critical indicator of cone photoreceptor function and offers valuable complementary information to assessments of spatial visual performance, such as best-corrected visual acuity (BCVA), contrast sensitivity and inherited and acquired retinal disorders. Aim & Objectives: 1. To investigate the relationship between cone photoreceptor function and hue discrimination ability using the Farnsworth-Munsell 100 Hue Test (FM100). 2. To explore the potential of the FM100 Hue Test as a clinical tool for detecting and monitoring cone-related retinal dysfunction. Material & Methods: An Observational, Cross-sectional research study was systematically conducted in the Physiology department in association with the Ophthalmology department in SMS Medical College, Jaipur, to assess the prevalence and characteristics of colour vision deficiency (CVD) among 170 medical students. Participants were screened for CVD using the Ishihara pseudoisochromatic plates and further evaluated using the Farnsworth-Munsell 100 Hue (FM100) Test to assess hue discrimination ability. All collected data were systematically entered and organized in tabular form. A p-value of <0.05 was considered statistically significant. Result: A total of 170 medical students (age range: 18- 25 years; mean age: 21.5± 2.45 years) were included in the final analysis. Revealed significant variation in Hue discrimination ability in Medical students. The result exhibits Mean Box specific Error Score (ES) and Mean Total Error Score (TES) were significantly elevated. Conclusion: This study’s findings support the application of the FM100 Hue Test as a sensitive tool for evaluating functional aspects of cone-mediated vision, particularly in clinical and occupational screening settings.

Background: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) classifies thyroid fine-needle aspiration cytology (FNAC) results into six diagnostic categories, offering a standardized and evidence-based method for interpretation and management of thyroid nodules. Aim of our study is to establish the correlation between cytological findings categorized by TBSRTC and histopathological outcomes, and to assess the spectrum and prevalence of thyroid lesions in patients attending a tertiary care hospital in the Nilgiris district. Materials and Methods: A retro-prospective analytical study was conducted on 235 patients with thyroid swellings between July 2018 and August 2020. FNAC was performed using a non-aspiration technique, and smears were stained with Hematoxylin and Eosin. Results were categorized as per TBSRTC. Histopathological correlation was available for 68 patients who underwent surgery. Data were statistically analyzed to determine concordance rates. Results: Out of 235 cases, 210 (89.3%) were benign (Bethesda II), 9 (3.8%) nondiagnostic, 5 (2.1%) atypia/FLUS, 6 (2.5%) follicular neoplasms, 4 (1.7%) suspicious for malignancy, and 2 (0.8%) malignant. Histopathological correlation showed 92.6% overall concordance. The most common benign lesion was nodular colloid goitre (72.6%), while papillary carcinoma was the predominant malignancy. Conclusion: FNAC, interpreted under the Bethesda framework, is a highly reliable, cost-effective diagnostic tool for evaluating thyroid nodules. Despite occasional diagnostic challenges in follicular-patterned and cystic lesions, FNAC substantially reduces unnecessary surgeries and remains essential in clinical decision-making.

Background: Psychosis during adolescence represents one of the most challenging areas in psychiatry, both diagnostically and therapeutically. Adolescence is marked by neurobiological vulnerability and psychosocial transitions, and the emergence of psychotic symptoms during this critical period can result in lasting social and cognitive impairments. Despite the increasing recognition of adolescent psychosis, data from developing countries remain limited. Aim of this study is to analyze the sociodemographic characteristics and clinical presentation of adolescents with psychosis attending psychiatric consultation at a tertiary care hospital. Methods: A hospital-based cross-sectional study was conducted at the Institute of Mental Health over 12 months (November 2021–November 2022). One hundred adolescents aged 10–19 years, diagnosed with psychotic disorders as per ICD-10 criteria (F10–F39), were included. Individuals with intellectual disability, neurological disorders, or childhood-onset conditions were excluded. Each participant underwent detailed sociodemographic and clinical assessment using standardized tools including the Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), and CRAFFT questionnaire, Leeds Dependence Questionnaire (LDQ), Adolescent Stress Questionnaire (ASQ), and the Kuppuswamy Socioeconomic Scale (2022). Statistical analysis was performed using SPSS v26 with descriptive statistics and chi-square tests. Results: Among 100 adolescents, 55% were male and 45% female, with a mean age of 14.49 ± 2.89 years. Urban participants accounted for 53%, while 53% belonged to lower socioeconomic strata. Family history of psychosis was present in 22%. The mean BPRS score was 42.53 ± 10.44, indicating moderate severity. YMRS scores revealed that 64% had mild mania, 14% moderate, and 12% severe. CRAFFT scores ≥2 were noted in 64%, indicating risky substance use. LDQ revealed medium dependence in 50% and high dependence in 35%. The majority (75%) had moderate stress and 20% had severe stress on ASQ. Conclusion: Adolescent psychosis is closely associated with socioeconomic deprivation, high psychosocial stress, and comorbid substance use. Early identification and multi-pronged psychosocial interventions are essential to reduce chronicity and improve long-term functional outcomes.

Introduction:  Paraquat is a widely used herbicide associated with high morbidity and mortality following ingestion. Early recognition and prompt management are critical, yet clinical presentations can be variable. Understanding the presenting features and outcomes of paraquat poisoning is essential for improving patient care. Aims: This study aims to conduct a comprehensive analysis of patients admitted with alleged paraquat poisoning to a tertiary care hospital, focusing on their presenting features, clinical course, and outcomes. By identifying key determinants of mortality and morbidity, the study seeks to inform clinical practices and public health strategies to mitigate the impact of paraquat poisoning. Methods: This was a hospital-based cross-sectional observational study conducted over a period of one year at Jalpaiguri Medical College and Hospital. A total of 46 patients admitted with alleged paraquat poisoning were included in the study. Data were collected on demographic variables such as age and gender, as well as clinical features including oral ulcers, acute kidney injury, abdominal pain, and respiratory symptoms such as hemoptysis and shortness of breath. Laboratory parameters and clinical severity scores were also recorded to assess the extent of organ involvement and predict outcomes. The study aimed to evaluate the relationship between these variables and patient outcomes, including discharge or mortality, to identify key clinical and laboratory predictors of prognosis in paraquat poisoning. Results: In this study of 46 patients with alleged paraquat poisoning, 40 (87%) were discharged and 6 (13%) expired. Most patients were aged 21–30 years (30.4%), followed by 11–20 years (26.1%) and 31–40 years (23.9%), with no significant association between age or gender and outcome. Clinically, oral ulcers were common (93.5%) but not linked to mortality. In contrast, acute kidney injury (63%) and respiratory symptoms such as hemoptysis and shortness of breath (15.2%) were significantly associated with death. Abdominal pain was reported in 47.8% of patients but showed no significant correlation with outcomes. Patients who expired had higher mean [parameter] values (16.0 ± 5.66) compared to those discharged (10.88 ± 6.52). Conclusion: Paraquat poisoning continues to be associated with significant morbidity and mortality. Early identification of high-risk patients based on presenting features and laboratory parameters may improve outcomes. Public health measures to prevent accidental and intentional exposure, coupled with standardized management protocols, are essential.

Background: Proximal humerus fractures constitute approximately 5% of appendicular skeletal injuries, predominantly affecting elderly patients with osteoporotic bone. Surgical intervention is frequently required for displaced fractures, yet the optimal fixation method remains debatable. Materials and Methods: This retrospective observational study analyzed hospital records from January 2020 to December 2024, identifying 100 patients with isolated proximal humerus fractures treated surgically. Patients were stratified into PHILOS plating (n=50) and K-wire fixation (n=50) groups. Demographic characteristics, operative parameters, duration of hospitalization, complication rates, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores at 1, 3, and 6 months postoperatively were systematically evaluated. Results: Both groups demonstrated comparable demographic profiles. K-wire fixation exhibited significantly reduced mean operative time (32.4±7.9 minutes versus 85.6±12.1 minutes, p<0.0001), diminished blood loss (21.2±6.8 ml versus 91.5±15.7 ml, p<0.0001), and abbreviated hospital stay (3.6±0.7 versus 11.3±1.4 days, p<0.0001). DASH scores revealed no statistically significant difference at 6-month follow-up (K-wire 13.8±4.5 versus PHILOS 12.9±4.2, p=0.38). Complication rates were minimal and comparable between groups. Conclusion: Both PHILOS plating and K-wire fixation achieve equivalent functional outcomes. K-wire fixation demonstrates substantial advantages in operative efficiency, minimal surgical trauma, and reduced healthcare resource utilization, establishing it as a viable minimally invasive alternative for proximal humerus fracture management.

Introduction: TORCH infections are major causes of congenital anomalies. Among them, cytomegalovirus (CMV) is the most frequent perinatal viral infection and the leading cause of congenital CMV disease, with seroprevalence ranging widely from 30.4% in Ireland to 98.9% in Turkey. Herpes simplex virus type-2 (HSV-2), a common sexually transmitted infection, can be transmitted in utero, during delivery, or postnatally, resulting in congenital or neonatal disease. These infections are often asymptomatic, making clinical diagnosis difficult. Serological testing, particularly ELISA, offers a sensitive and specific method for detection. This study aimed to determine the seroprevalence of CMV and HSV-2 among pregnant women. Methods: A cross-sectional study was conducted on 100 pregnant women attending the antenatal clinic of a tertiary care hospital. Five milliliters of venous blood were collected, and sera were analyzed for anti-CMV and anti-HSV-2 IgM and IgG antibodies using ELISA. Results: Most participants were between 21 and 25 years of age, from rural areas (76%), in the third trimester (84%), nulliparous (69%), and from lower socioeconomic status (59%). None of the women tested positive for anti-CMV or anti-HSV-2 IgM antibodies. The seroprevalence of anti-CMV IgG was 67%, while anti-HSV-2 IgG was 47%. Conclusion: A substantial proportion of pregnant women showed prior exposure to CMV and HSV-2, although no active infections were detected. Greater awareness of these infections and their adverse outcomes is needed. Routine antenatal screening and preventive education should be emphasized to reduce maternal and neonatal morbidity and mortality.

Background: Environmental pollution has emerged as a major public health concern worldwide. Chronic exposure to air, noise, and industrial pollutants has been linked not only to cardiopulmonary morbidity but also to dysregulation of the autonomic nervous system and cognitive disturbances mediated through stress pathways. Objective: To determine the prevalence of stress-related autonomic symptoms and cognitive complaints among individuals chronically exposed to environmental pollution. Methods: A cross-sectional questionnaire-based study was conducted among 360 adults residing in high-pollution zones. Stress-related autonomic symptoms were assessed using a standardized autonomic symptom checklist, while cognitive complaints were evaluated using a validated subjective cognitive assessment questionnaire. Data were analyzed using descriptive statistics, independent t-tests, and correlation analysis. Results: Autonomic symptoms were reported by 61.4% of participants, while cognitive complaints were present in 54.2%. Individuals with higher pollution exposure duration demonstrated significantly greater autonomic symptom scores and cognitive complaints (p < 0.001). A moderate positive correlation was observed between autonomic symptom burden and cognitive complaints (r = 0.49). Conclusion: Chronic exposure to environmental pollution is associated with a high prevalence of stress-related autonomic symptoms and cognitive complaints. Early identification and stress-mitigation strategies may reduce the neurophysiological impact of environmental pollution.

Background: Ocular trauma remains a significant global contributor to visual impairment, often leading to complex structural damage within the eye. Specifically, blunt trauma can trigger a cascade of pathological events, particularly affecting the delicate architecture of the macula, the area responsible for central, high-resolution vision. Understanding the precise macular changes early on is vital for accurate prognostication and timely intervention. The primary aim of this observational study was to assess the spectrum and prevalence of macular involvement in patients who presented with blunt ocular trauma at a tertiary eye care hospital. Material and Method: A prospective, hospital-based study was conducted from September 2018 to October 2019, enrolling 51 patients who had sustained blunt ocular injuries. Following a comprehensive history and routine clinical examination, all participants underwent detailed slit-lamp examination, fundus examination, and crucially, Optical Coherence Tomography (OCT). OCT provided non-invasive, high-resolution cross-sectional imaging, allowing for microstructural analysis of the macula. Data, including demographic details, mechanism of injury, and clinical findings, were analyzed to draw statistical conclusions. Result: The results indicated a pronounced male predominance (75%), with the highest incidence occurring in the young population aged 11–20 years, often students (41.18%). The most common cause of injury was sports-related, specifically trauma by a ball (23.53%). Anteriorly, the pupil was the most frequently affected structure (41.17%), typically presenting with traumatic mydriasis. Posteriorly, Retinal Detachment (11.76%) was the most common gross pathology. Utilizing OCT, subtle macular involvement was widely detected, with the most frequent findings being Berlin’s Oedema, Lamellar Macular Hole, Macular Oedema, and Macular Scarring (all at 3.92%). Conclusion: Blunt ocular trauma severely impacts young males and can result in significant visual impairment due to a range of anterior and posterior segment injuries. The study confirms that OCT is an indispensable tool, revealing fine microstructural macular changes that might be missed by conventional clinical examination. Early OCT evaluation is therefore recommended for all blunt trauma cases to guide subsequent management and improve visual outcomes.

Background: Knee osteoarthritis is a leading cause of chronic pain and functional limitation. In patients who are unsuitable for or unwilling to undergo surgical intervention, minimally invasive interventional pain management techniques are increasingly utilized. Intra-articular corticosteroid injections provide short-term pain relief, whereas cooled radiofrequency ablation (CRFA) of genicular nerves has emerged as a promising modality for longer-lasting analgesia. Objectives: To compare the safety and effectiveness of cooled radiofrequency ablation with intra-articular corticosteroid injection in the management of chronic knee pain due to osteoarthritis. Materials and Methods: This prospective, randomized clinical trial was conducted at a tertiary care center after obtaining institutional ethics committee approval. Eighty patients aged 40–70 years with radiographically confirmed knee osteoarthritis (Kellgren–Lawrence grade III or IV) and baseline Numeric Rating Scale (NRS) pain score >6 were enrolled. Patients were randomly allocated into two groups: the CRFA group (n = 40) and the intra-articular steroid (IAS) group (n = 40). Outcomes were assessed at baseline and at 1-, 3-, and 6-months following intervention. The primary outcome was the proportion of patients achieving a ≥50% reduction in NRS pain score at 6 months. Secondary outcomes included changes in pain scores at follow-up, analgesic consumption, and adverse events. Results: Both treatment modalities resulted in significant pain reduction during the early follow-up period. However, patients in the CRFA group demonstrated significantly greater and sustained reduction in NRS pain scores at all follow-up intervals compared to the IAS group. At 6 months, a higher proportion of patients in the CRFA group achieved clinically meaningful pain relief and required fewer rescue analgesics. No serious adverse events were observed in either group. Conclusion: Cooled radiofrequency ablation provides superior and longer-lasting pain relief compared to intra-articular corticosteroid injection in patients with knee osteoarthritis, with a comparable safety profile. CRFA represents an effective minimally invasive treatment option for long-term management of chronic knee pain in patients unsuitable for surgical intervention.

Background: Hydrocelectomy is the definitive treatment for symptomatic adult hydrocele, a common scrotal condition amenable to day-care surgery. Local anaesthesia (LA) offers potential advantages over spinal anaesthesia (SA) including reduced complications and faster recovery, though direct comparative data remains limited. Objective: To compare postoperative pain, hospital stay, and need for extra analgesia between LA and SA in 144 adults undergoing unilateral hydrocelectomy. Methods: Prospective and retrospective randomized study of 144 patients (72 LA, 72 SA) undergoing hydrocelectomy. Spermatic cord block with lignocaine used for LA whereas low-dose bupivacaine – fentanyl was used for SA. Outcomes measured included VAS pain scores (2-24h), hospital stay, rescue analgesia (diclofenac/tramadol if VAS≥4) and complications. Results: LA showed lower VAS scores (2h: 2.4±1.1 vs 3.6±1.4; 6h: 2.8±1.2 vs 4.3±1.5. Hospital stay shorter (20.8±6.4 vs 26.1±7.9h. Rescue analgesia needed by 30.6% LA vs 59.7% SA. SA had more urinary retention (12.5% vs 1.4%) and headache (8.3% vs 0). Conclusion: LA provides superior pain control, shorter stay, and fewer complications than SA for adult hydrocelectomy, supporting its use as preferred technique in day-care settings.

Background: The care of critically ill children in paediatric intensive care units (PICUs) is essential for improving outcomes in resource-limited settings. This study aimed to analyse the clinical profile and causes of admissions (morbidity patterns) in children admitted to a PICU in a tertiary care hospital in Northeast India, focusing on demographic factors, system involvement, and morbidity distribution. Methods: This prospective observational study was conducted from July 2019 to June 2020 in the PICU of Silchar Medical College and Hospital, Assam. Children aged 1 month to 12 years admitted to the PICU were included, excluding those who died within 2 hours of admission, stayed beyond the study period, or left against medical advice. Data on demographics, source of admission, socioeconomic status (modified Kuppuswamy scale), and system involved, specific diagnoses, length of stay, and outcomes were collected using a predesigned proforma. Statistical analysis was performed using SPSS version 25, with chi-square tests for categorical variables (p < 0.05 considered significant). Results: Of 747 children (58% male, Male:female ratio 1.38:1), 54.5% were under 1 year, 25.7% aged 1-5 years, and 19.8% aged 5-12 years. Mean length of stay was 7.99 ± 2.66 days (range 3-24 days). Admissions were primarily from emergency (42.6%), outpatient department (23.4%), and wards (22%). Most families were upper lower socioeconomic class (modified Kuppuswamy scale). Respiratory system disorders accounted for 24.9% of admissions (pneumonia 47.8%, bronchiolitis 22%), followed by infections/sepsis (19.7%), central nervous system (CNS) disorders (12.2%; meningitis 29.4%, febrile convulsions 25.3%), and renal disorders (12%; urinary tract infection 45.6%). Other systems included gastrointestinal (11%), cardiovascular (8.7%), haematological (3.1%), surgical (3.9%), poisoning (2.4%), and miscellaneous (2.1%). Differences in system involvement were not statistically significant (p = 1.693). Conclusion: Respiratory and infectious diseases dominate PICU admissions in this setting, with infants most affected. Targeted interventions for preventable causes like infections and improved community education could reduce morbidity.

Objective: To evaluate the effect of intraturbinal Triamcenolone acetonide in AR. Patients: Eighty patients were included and followed for one year. All of them received three consecutive doses of intraturbinal TAA at 7 days interval. Main Outcome Measure: Reduction of rTNSS was the main outcome measure. Results: all the categories of AR have significant reduction of rTNSS. In mild and moderate form, we observed near complete resolution of symptoms. In severe and very severe case 50% to 75% reduction in rTNSS was found. Conclusion: Intraturbinal TAA have long term results in AR. When used with correct injection techniques it has least serious complications.

Background: The perineal body (PB) is a key anatomical structure of the pelvic floor that plays a vital role during vaginal childbirth. Perineal body length (PBL), measured from the posterior vaginal fourchette to the center of the anal orifice, varies among women and may influence the duration of labor, mode of delivery, risk of perineal trauma, and neonatal outcomes. Identifying women at risk of adverse obstetric outcomes using a simple, non-invasive parameter such as PBL may help optimize intrapartum management and improve maternal and neonatal outcomes. Aim: To evaluate the relationship between perineal body length and the duration of the second stage of labor and mode of delivery in low-risk primigravida women. Methodology: This prospective observational study was conducted at the Department of Obstetrics and Gynaecology, GMC & Government General Hospital, Guntur, from July 2023 to December 2024. A total of 100 low-risk primigravida women with term singleton pregnancies (37–40 weeks) planned for vaginal delivery were included. Perineal body length was measured antenatally and categorized as <3 cm or ≥3 cm. Maternal outcomes assessed included duration of the second stage of labor, mode of delivery, episiotomy, and degree of perineal tears. Neonatal outcomes included birth weight, head circumference, APGAR scores, birth asphyxia, and NICU admission. Statistical analysis was performed using EPI INFO version 7.2.5.0, with p<0.05 considered significant. Results: Women with PBL <3 cm had a significantly higher incidence of severe perineal tears (third- and fourth-degree), instrumental vaginal deliveries, and neonatal birth asphyxia compared to those with PBL ≥3 cm (p<0.05). Shorter PBL was also associated with lower APGAR scores. The duration of the second stage of labor was shorter in women with PBL <3 cm, while those with PBL ≥3 cm had longer second-stage duration. Higher birth weight was significantly associated with increased perineal trauma. Conclusion: Perineal body length is a significant predictor of maternal and neonatal outcomes during vaginal delivery. A PBL <3 cm is associated with higher rates of operative delivery, severe perineal trauma, and adverse neonatal outcomes. Routine antenatal assessment of PBL may aid in individualized labor management and prevention of perineal morbidity.

Introduction: In modern obstetrics, lowering the prevalence of primary cesarean deliveries is a top priority for maternal safety. In certain circumstances during the second stage of labor, operational vaginal delivery (OVD) is a desirable alternative to cesarean delivery. Objective: This prospective observational longitudinal study aims to provide the outcomes of operative vaginal delivery in a tertiary care center. Method: This study comprised 150 pregnant women with gestational ages ranging from 37 to 42 weeks. The study recorded maternal outcomes: third degree perineal tears or cervical tear or vaginal lacerations, injury to bladder, bowel, uterus; post-partum hemorrhage and need for blood transfusion and fetal outcome: admission to Neonatal intensive care unit (NICU) / Special Newborn Care Unit (SNCU), any birth trauma to the new-born and APGAR scores at first and fifth minutes of birth. Results: In women who delivered via surgical vaginal delivery, there were no perineal tears, postpartum hemorrhage, blood transfusion requirements, or problems in 71.33%, 86.66%, 94.66%, and 86% of cases, respectively. About 94.66% of babies had normal birth weight (2500-3999) and 3.33% had more than 4 kg of birth weight who were born with the aid of operative vaginal delivery. Absence of need for hospitalization, complications and successful discharge were recorded in 90%, 90% and 97.33% of babies who were delivered via operative vaginal delivery. Conclusion: When difficulties emerge during the second stage of labor, OVD remains a safe and viable option.

Introduction: Pre-eclampsia remains a leading cause of maternal and perinatal morbidity and mortality globally, with hyperuricemia frequently observed as a biochemical marker of disease severity. This study aimed to evaluate the association between maternal serum uric acid levels and perinatal outcomes in preeclamptic pregnancies. Materials and Methods: A retrospective observational analytical study was conducted at Smt. N.H.L. Municipal Medical College, Ahmedabad, analyzing medical records of 100 pregnant women with pre-eclampsia admitted between January 2019 and December 2019. Serum uric acid levels were measured at admission, with patients categorized into two groups using 6.0 mg/dL as the cut-off value. Perinatal outcomes were compared using Chi-square test. Results: Hyperuricemia (≥6.0 mg/dL) was present in 65% of preeclamptic women. Elevated uric acid levels showed significant associations with preterm delivery (61.6% vs 11.4%, p less than 0.0001), cesarean section (61.5% vs 28.6%, p=0.002), induction of labour (96% vs 16%, p less than 0.00001), low birth weight (51.5% vs 26.3%, p=0.01), fetal growth restriction (38.5% vs 2.9%, p less than 0.0001), and NICU admission (44.1% vs 13.2%, p=0.0007). Conclusion: Elevated maternal serum uric acid levels in preeclamptic pregnancies are significantly associated with adverse perinatal outcomes, serving as a valuable prognostic marker for high-risk pregnancy identification.

Background: The mode of delivery significantly influences maternal postpartum recovery. Vaginal delivery is a physiological process, whereas cesarean section is a major surgical intervention associated with delayed recovery and higher complications. With increasing cesarean rates, evaluating their impact on postpartum outcomes is essential. Objectives: To compare postpartum recovery outcomes between vaginal delivery and cesarean section in terms of pain, mobility, hospital stay, complications, breastfeeding, and return to routine activities. Methods: A prospective comparative study was conducted on 120 postnatal women admitted to the Department of Obstetrics & Gynecology, Government Medical College, Churu, from July 2022 to July 2023. Participants were divided into vaginal delivery (n=60) and cesarean section (n=60) groups. Data on demographics, obstetric history, postpartum pain (VAS), and time to ambulation, hospital stay, complications, breastfeeding difficulties, and return to routine activities were collected and analyzed using SPSS. A p-value <0.05 was considered statistically significant. Results: Women in the vaginal delivery group had significantly lower pain (VAS >4: 23.3% vs. 63.3%, p=0.0001), earlier ambulation (<24h: 80% vs. 36.7%, p=0.0001), shorter hospital stay (2.1 ± 0.5 vs. 4.6 ± 0.8 days, p=0.0001), and earlier return to routine activities (<7 days: 70% vs. 30%, p=0.0001) compared to the cesarean group. Difficulty in breastfeeding and postpartum complications were also higher in cesarean deliveries (33.3% vs. 13.3% and 46.7% vs. 15%, respectively, p<0.05). Demographic and obstetric characteristics were comparable between groups. Conclusion: Vaginal delivery is associated with faster postpartum recovery and fewer complications. Cesarean sections should be performed based on medical indications to ensure optimal maternal health and recovery.

Effective postoperative pain control is essential in pediatric cardiac surgery to prevent physiological and psychological complications. This prospective comparative study evaluated whether adding dexmedetomidine to fentanyl improves postoperative analgesia in children undergoing corrective congenital heart surgery. Fifty patients aged 3–12 years were randomized into two groups: Group A received fentanyl infusion (0.5 µg/kg/hr), while Group B received fentanyl (0.5 µg/kg/hr) plus dexmedetomidine (0.5 µg/kg/hr). Pain scores using the Wong–Baker Faces Scale, sedation scores, and rescue analgesic requirements were recorded at extubation and up to 24 hours post-extubation.
Group B demonstrated significantly lower pain scores at extubation and at 3, 6, and 12 hours, improved sedation quality, and reduced rescue analgesic use without hemodynamic instability. The findings support dexmedetomidine as an effective adjuvant to fentanyl, enhancing analgesia and sedation while reducing opioid requirements in pediatric cardiac surgery.

Introduction: Posterior urethral valve (PUV) is the most common cause of lower urinary tract obstruction in male infants and young children. If not diagnosed and managed timely, it can lead to significant morbidity including urinary tract infections, renal insufficiency, and long-term chronic kidney disease. Early detection, stabilization, and surgical intervention are critical for optimal outcomes. Aims: This study aimed to evaluate the presentation of posterior urethral valve among under five baby boys and outcome after complete valve ablation. Methods: The present study was a Prospective Interventional study. This Study was conducted from September’ 2021- July’ 2022. Department of Paediatric Surgery, IPGME&R/SSSKM Hospital-the Centre of excellence. Study population 52. Results: In 52 male infants with PUV, complete valve fulguration significantly improved outcomes. Mean BMI increased from 15.53 to 16.87 (p < 0.001). Right kidney APD decreased from 23.24 mm to 15.71 mm (p < 0.001), bladder wall thickness from 5.24 to 3.7 mm (p < 0.001), PVRU from 34.06% to 13.02% (p < 0.001), right DRF from 30.12% to 37.47% (p < 0.001), and VUR decreased from 32.69% to 11.54% (p = 0.002), demonstrating improved growth, bladder function, and renal outcomes. Conclusion: In 52 male infants with PUV, complete valve fulguration significantly improved growth, bladder function, renal drainage, and renal function. Early and complete intervention effectively alleviates obstruction and preserves renal function, underscoring the importance of timely diagnosis and close follow-up.

Introduction: Hyperbilirubinemia is a common neonatal condition, affecting a significant proportion of term and preterm infants during the first week of life. Elevated unconjugated bilirubin can lead to neurological impairment, even in full-term neonates. Early identification and assessment are crucial to prevent long-term developmental complications. Aims: To compare the motor and mental development of full-term neonates with severe versus moderate hyperbilirubinemia at six months of age. Materials and Methods: This is a tertiary hospital based Prospective observational study. 363 full term neonates in each group with severe and moderate hyperbilirubinemia were selected by convenience sampling to compare the Mental development of neonates with severe and moderate hyperbilirubinemia. Study was conducted in the Sick Neonatal Care Unit of Dr. B.C. Roy P.G.I.P.S at Kolkata in Eastern India between December 2000- March 2022 after approval from institutional ethics committee in a pretested Proforma. Result: The three groups were comparable with respect to age distribution, sex, birth weight, and gestational age (p > 0.05). Motor development scores (MO DASII) at six months were significantly lower in neonates with severe hyperbilirubinemia compared to those with moderate and no hyperbilirubinemia (p = 0.009). Similarly, mental development scores (ME DASII) were significantly reduced in the severe hyperbilirubinemia group (p = 0.001). A strong positive correlation was observed between motor and mental development scores at six months (r = 0.824, p < 0.001). Conclusion: Severe neonatal hyperbilirubinemia is associated with significant impairment in both motor and mental development at six months of age in full-term neonates. These findings emphasize the need for early identification, timely intervention, and structured neurodevelopmental follow-up in neonates with moderate to severe hyperbilirubinemia, particularly in resource-limited settings.

Background/Introduction: Cervical cancer remains one of the leading causes of cancer-related deaths among women in developing nations, particularly in India. While developed countries have reduced incidence through widespread screening programs, awareness and uptake remain critically low in many regions. Objective: To assess the level of knowledge, awareness, and attitudes toward cervical cancer and Pap smear screening among women working in a tertiary healthcare institution. Methods: This cross-sectional study was conducted among 300 women aged 21–65 years working at Government General Hospital, Kakinada, Andhra Pradesh, between August 2024 and January 2025. Data were collected via a structured, pre-validated questionnaire and analyzed using IBM SPSS v20.0. Results: Of the 300 participants, 59.8% had never heard of cervical cancer screening, and 68.6% were unaware of the significance of Pap smear testing. Only 4.9% had ever undergone the test. However, 94.2% expressed interest in learning more about cervical cancer screening. Limited recommendations from physicians and poor dissemination of information were noted as major barriers. Conclusion: The study highlights a considerable gap in awareness regarding cervical cancer screening. Promoting education and encouraging active participation in screening programs is essential for early detection and prevention.

Background: Small bowel obstruction (SBO) is a common surgical emergency, with adhesions causing up to 70% of cases. While laparoscopy offers faster recovery and lower morbidity than open surgery, its emergency use in India remains limited due to feasibility and cost concerns. This study from a tertiary center in Gujarat compares perioperative outcomes and cost-effectiveness of laparoscopic vs. open adhesiolysis to guide local surgical practice. Material and Methods: A retrospective cohort study was conducted on 120 adults (>18 years) with adhesive SBO at a tertiary care hospital over a period of 18 months. Patients were grouped into laparoscopic (n=60) and open (n=60) surgery based on surgeon discretion and intraoperative findings. Inclusion criteria were imaging-confirmed adhesive SBO with failed conservative management, while exclusions included strangulated bowel, malignancy, or prior extensive surgery. Data collected included demographics, operative details, recovery, complications (Clavien-Dindo), length of stay, and direct costs (INR). Statistical tests used were Student’s t-test for continuous variables, chi-square for categorical, and ICER for cost-effectiveness. A p-value <0.05 was considered significant. Ethical approval was obtained. Results: Demographics were comparable (mean age 48±12 years; 55% female). Laparoscopic group showed longer operative time (92±18 min vs. 68±15 min, p<0.001) but reduced blood loss (45±20 ml vs. 120±35 ml, p<0.001), shorter LOS (4.8±1.2 days vs. 7.5±2.1 days, p<0.001), and lower complication rates (12% vs. 28%, p=0.01). Mortality was similar (3.3% vs. 5%, p=0.68). Total mean cost per case was INR 1,45,000±22,000 for laparoscopic vs. INR 2,10,000±35,000 for open (p<0.001), yielding an ICER of INR 12,500 per complication avoided. Conclusion: Laparoscopic adhesiolysis for emergency small bowel obstruction offers superior outcomes with reduced morbidity and cost savings, supporting its preferential use in suitable candidates at resource-limited centers. Future prospective trials should validate these findings in diverse Indian populations.

Introduction: Endometriosis is an estrogen-based disorder, resulting in severe pelvic pain, dysmenorrhea, dyspareunia, along with infertility. The level of CA-125 in serum has been cited as a biomarker for the evaluation of the severity of disease and different clinico-pathological relationships among women suffering from endometriosis. Method: This cross-sectional observational study was conducted in the Department of Obstetrics and Gynaecology at GCS Medical College over 1 year, from June 2024 to August 2025, involving 50 clinically diagnosed endometriosis patients undergoing laparoscopy or laparotomy. Preoperative serum CA-125 levels were measured, with 35 U/mL as the upper limit. Clinical, radiological, and intraoperative findings, disease stage, adhesion severity, and pain scores were correlated with CA-125 levels using appropriate statistical tests, with p < 0.05 considered significant. Result: Serum CA-125 levels did not differ significantly by age (≤40 years: 57.10 ± 14.05 vs >40 years: 53.84 ± 11.98; p = 0.72) or marital status (single: 36.92 ± 11.88 vs married: 42.15 ± 5.12; p = 0.81). In contrast, CA-125 increased significantly with advancing endometriosis stage (p < 0.001) and higher adhesion scores (p = 0.03). Lesion size was significantly associated with CA-125 levels (p = 0.03), whereas clinical complaints (p = 0.23) and VAS pain scores (p = 0.68) were not. Conclusion: The study has concluded that the CA-125 level in serum is a significant marker for the severity of disease and the pathological challenge for endometriosis. This does not correlate with different demographic parameters or the intensity of pain.

Background: Macrosomia, typically characterized by a neonatal birth weight exceeding 4000 grams, constitutes a significant obstetric challenge due to its association with heightened perinatal morbidity and delivery-related complications. Although gestational diabetes mellitus (GDM) is a well-established etiological factor, the pathophysiological contributors to macrosomia in euglycemic pregnancies remain inadequately elucidated. Objective: To investigate the potential correlation between maternal serum triglyceride concentrations in the third trimester with macrosomia among normoglycemic, non-obese metabolically healthy pregnant women. Methods: A prospective observational study was undertaken at the Department of Obstetrics and Gynaecology, Gauhati Medical College, encompassing a cohort of non-diabetic, non-obese, normotensive gravid women devoid of pre-existing metabolic comorbidities. Maternal serum triglyceride levels were quantified during the third trimester, and participants were longitudinally followed until parturition. Neonatal birth weights were meticulously recorded, and instances of macrosomia were identified. Results: Analysis revealed a statistically significant and positive association between elevated maternal triglyceride levels in late gestation and the occurrence of macrosomia. Subjects exhibiting hypertriglyceridemia were demonstrably more predisposed to delivering macrosomic neonates relative to counterparts with normative lipid profiles. Conclusion: Third-trimester maternal hypertriglyceridemia may function as an autonomous risk factor for macrosomia in the absence of gestational diabetes. The incorporation of routine lipid profiling into antenatal care protocols may facilitate the early stratification of risk and inform evidence-based dietary and lifestyle modifications aimed at mitigating the incidence of excessive fetal growth.

Background: Decreased fetal movements (DFM) are a frequent concern during pregnancy and are linked to unfavourable perinatal outcomes such as stillbirth, intrauterine growth restriction (IUGR), and neonatal complications. Prompt and accurate assessment of fetal well-being is crucial. The vibroacoustic stimulation test (VAST) is a non-invasive, quick, and easy method that evaluates fetal well-being by provoking fetal heart rate accelerations and movements in response to accoustic stimulus. Aim: This study aims to assess the usefulness of VAST as a predictive tool for fetal well-being in pregnancies complicated by decreased fetal movements. Objectives: (1) To investigate the various underlying causes of decreased fetal movements. (2) To evaluate the role of VAST in antenatal assessment of fetal health in women reporting reduced fetal activity. (3) To correlate VAST findings with perinatal outcomes. Materials and Methods: A prospective observational study was carried out involving 196 pregnant women beyond 32 weeks of gestation who reported decreased fetal movements. VAST was administered following a standardized procedure and categorized as reactive or non-reactive based on fetal heart rate response. Outcomes such as mode of delivery, amniotic fluid characteristics, APGAR scores, NICU admissions, and birth weights were recorded. Results: Among the 196 participants, 80.6% exhibited a reactive vast response, while 19.4% had a non-reactive result. A non-reactive vast was significantly associated with increased rates of emergency cesarean deliveries 81.6%, meconium-stained amniotic fluid, 39.5% lower APGAR scores, NICU admissions 52.6%, and low birth weights 55.3%. VAST demonstrated a sensitivity of 66.7% and a high specificity of 98.6% in identifying adverse perinatal outcomes. Conclusion: VAST serves as an effective supplementary tool in the evaluation of pregnancies with decreased fetal movements. It provides prompt reassurance of fetal health in most cases and helps identify those at risk who may benefit from closer monitoring or intervention. Due to its simplicity, cost-effectiveness, and non-invasive nature, VAST can be efficiently incorporated into both primary and tertiary healthcare settings for routine fetal surveillance.

Background: Junctura tendinae are fibrous intertendinous connections between the extensor tendons on the dorsum of the hand. They play a crucial role in coordinated finger extension, force transmission, and stabilization of the metacarpophalangeal joints. Anatomical variations and morphometric differences in these structures can influence hand biomechanics and surgical outcomes. However, detailed data regarding juncturae tendinae in the South Indian population are limited. Aim: To analyse the morphometry and morphological variations of junctura tendinae in cadaveric hands of a South Indian population. Materials and Methods: A descriptive cadaveric study was conducted on 30 adult embalmed human hands (18 right and 12 left) in the Department of Anatomy at a tertiary care hospital in South India. The dorsal extensor compartments were dissected to expose junctura tendinae. Measurements of length, breadth, thickness, and distance from the metacarpophalangeal joint were obtained using digital callipers. Junctura tendinae were classified into Type 1 (filamentous), Type 2 (fibrous band), and Type 3 (tendon-like) based on von Schroeder’s classification. Data were analysed using descriptive statistics and Student’s t-test. Results: Junctura tendinae were present in all specimens, predominantly in the second and third intermetacarpal spaces (100%), with slightly reduced frequency in the fourth space (93.3%). Morphometric analysis revealed a mean length of 8.5 ± 1.4 mm, breadth of 3.1 ± 0.7 mm, thickness of 1.2 ± 0.4 mm, and an average distance of 12.7 ± 2.1 mm from the metacarpophalangeal joint. Type 3 junctura were most common (42%), followed by Type 2 (35%) and Type 1 (23%). No statistically significant difference was observed between right and left hands (p > 0.05). Accessory and hypertrophied slips were identified in a few specimens. Conclusion: The present study demonstrates considerable morphological variation in junctura tendinae among the South Indian population, with predominance of tendon-like (Type 3) connections. The morphometric values obtained provide useful baseline data that can assist clinicians and surgeons in planning and executing extensor tendon procedures, thereby improving diagnostic accuracy and surgical outcomes.

Introduction: Spinal anesthesia is widely used for lower limb orthopedic surgeries due to its rapid onset, reliable sensory and motor blockade, and minimal systemic effects. Hyperbaric bupivacaine is the conventional choice; however, ropivacaine, a newer long-acting amide local anesthetic, is associated with reduced motor blockade and cardiotoxicity. The addition of intrathecal fentanyl can enhance analgesia and improve block characteristics. Aims: This study aimed to compare the efficacy and safety of intrathecal hyperbaric ropivacaine with fentanyl versus hyperbaric bupivacaine with fentanyl in patients undergoing orthopedic surgeries. Materials and Methods: This was a comparative interventional analytical study conducted over 1 year in the operation theatres of College of Medicine and JNM Hospital, Kalyani, and Ramkrishna Mission Seva Pratisthan& Vivekananda Institute of Medical Sciences, Kolkata. The study population comprised patients undergoing elective lower extremity orthopedic surgeries under spinal anesthesia, with a total sample size of 202 patients. Group A patient had received intrathecal 0.75% Hyperbaric Ropivacaine 2.5ml along with 25 mcg Fentanyl. Group B patients had received intrathecal 0.5% hyperbaric bupivacaine 2.5ml along with 25 mcg Fentanyl. Results: In this study, baseline characteristics including age, weight, height, ASA physical status, and duration of surgery were comparable between Group A (Ropivacaine with Fentanyl) and Group B (Bupivacaine with Fentanyl), showing no significant differences. Mean time of Onset of sensory and motor block as well as time to reach peak sensory level were similar. Whereas recovery time from sensory block [9.27 ± 1.48 minutes in Group A compared to 9.29 ± 0.69 minutes in Group B (p = 0.903] and motor block [ 158.77 ± 18.94 minutes in Group A versus 211.21 ± 11.78 minutes in Group B (p < 0.0001)] were significantly longer in Group B (p < 0.0001). Sedation scores were comparable, but micturition occurred earlier in Group A (220.10 ± 30.12 min vs. 289.60 ± 39.09 min; p < 0.0001). Complications were minimal, with hypotension observed only in 6.93% of Group B patients, indicating that both regimens were safe and well tolerated, with faster recovery in the Ropivacaine group. Conclusion: Intrathecal hyperbaric ropivacaine with fentanyl provides effective sensory block comparable to hyperbaric bupivacaine with fentanyl but with reduced motor blockade, allowing earlier postoperative mobilization. Both agents are safe and provide satisfactory anesthesia and analgesia for orthopedic procedures. Ropivacaine may be preferred when early motor recovery is desirable.

Introduction: Perioperative myocardial injury and cardiac arrhythmias remain common complications in patients undergoing off-pump coronary artery bypass (OPCAB) surgery despite avoidance of cardiopulmonary bypass. Magnesium sulphate has known anti-arrhythmic and cardioprotective properties, but its role in preventing myocardial injury and arrhythmias in OPCAB surgery remains inadequately defined. Aim: To evaluate the effect of perioperative intravenous magnesium sulphate infusion on the prevention of myocardial injury and cardiac arrhythmias in patients undergoing off-pump coronary artery bypass surgery. Materials and Methods: This prospective, randomized, placebo-controlled, double-blind clinical trial was conducted over a period of one year in the Department of Cardiac Anesthesia at NH- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata. Ethical permission was issued from RN Tagore. The study included 100 adult patients aged 18–75 years of either gender who were scheduled to undergo elective off-pump coronary artery bypass surgery. Patients were divided to two groups to receive either intravenous magnesium sulphate infusion 2gm intraoperative and 1gm each twice post-operatively at 6hours and 12hours post cabg. Placebo group received Normal saline at same time interval. Results: In our study, baseline demographics and cardiac characteristics were comparable between groups. Mean age was 62.4 ± 8.1 vs 61.7 ± 7.9 years (p = 0.650), BMI 26.8 ± 3.2 vs 27.1 ± 3.5 kg/m² (p = 0.720), and LVEF 55 ± 6% vs 54 ± 7% (p = 0.450). Male patients were 72% vs 68% (p = 0.680), hypertension 56% vs 60% (p = 0.680), diabetes 44% vs 48% (p = 0.690), and smokers 40% vs 36% (p = 0.670). Heart rates (Baseline, Post-protamine, Post-operative at 24 hours) were 73 ± 10, 78 ± 8, 85 ± 7 vs 76 ± 10, 80 ± 9, 90 ± 8 bpm Differences at baseline and post-protamine were not significant (p = 0.24, 0.45), but at 24 hours the Magnesium group had a significantly lower heart rate (p = 0.02); MAP differences were non-significant (p = 0.41, 0.97, 0.97). Postoperative myocardial injury was significantly less in Magnesium treated group over control as judged by TropI (1.2 ± 0.5 vs 2.1±0.8 ng/ml, p=0.001), CKMB (18±6 vs. 28±10 U/L, p=0.002 and BNP (120±40 vs 160±50, p=0.005).Postoperative cardiac arrhythmia was also significantly less in magnesium treated patients over control group like atrial fibrillation (8% vs 24%, p 0.03 and ventricular tachycardia (2% vs 10 %, p=0.09), need for antiarrhythmic drugs (12% vs 30%, p=0.03). Conclusion: Perioperative intravenous magnesium sulphate infusion appears to be an effective and safe strategy for reducing myocardial injury and preventing cardiac arrhythmias in patients undergoing off-pump coronary artery bypass surgery. Its routine use may contribute to improved perioperative cardiac outcomes in this patient population. Magnesium modestly reduced postoperative heart rate at 24 hours without affecting blood pressure, indicating a mild cardioprotective effect.

Aim: The aim of the present study was to evaluate and compare the efficacy, hemodynamic stability, assess recovery profile, post-operative analgesia and complications using ketamine or fentanyl along with propofol in patients undergoing Dilatation and Curettage. Methods: The study was carried out in the Department of Anaesthesiology, Jagannath Gupta Institute of Medical Sciences, Kolkata, West Bengal, India. The study was conducted in 100 patients, aged 18-35 years of ASA Grade I and II scheduled for Dilatation and Curettage procedures lasting upto 30 minutes. Results: Pre-induction heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, spO₂ were comparable in both the groups with a statistically no significant difference between them (p < 0.05). Conclusion: It may be concluded from our present study that propofol with ketamine as an adjuvant in the dose of 0.75 mg/kg compared to propofol with fentanyl as adjuvant in the dose of 2 mcg/kg provides deep sedation. Propofol-ketamine group is more efficacious and provides better peri-operative hemodynamic stability during anaesthesia as compared to propofol-fentanyl group. Propofol-ketamine combination produces good analgesia with less requirement of rescue drug in post-operative period with fewer peri-operative complications than propofol-fentanyl combination. No psychotomimetic effects were encountered with ketamine in the dose of 0.75mg/kg. Hence, propofol-ketamine combination is a better choice especially when hemodynamic stability is of great importance in patients undergoing Dilatation and Curettage.

Background: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in reproductive-aged women, associated with menstrual, hormonal, and metabolic abnormalities. Objective: To estimate the prevalence of polycystic ovary syndrome (PCOS) among reproductive-aged women in educational institutions across Bihar, India, and to examine its associated anthropometric, metabolic, and hormonal risk factors. Methods: A cross-sectional study was conducted from nine months among 1500 women aged 15–40 years in educational institutions of Bihar using multistage random sampling. Initial screening assessed menstrual irregularities and hyperandrogenic symptoms. Probable PCOS cases underwent clinical, biochemical, hormonal, and ultrasonographic evaluation. Diagnosis was based on Rotterdam 2003 criteria, with NIH and AE-PCOS criteria applied for comparison. Anthropometric, metabolic, and hormonal parameters were recorded. Results: Of 1500 women screened, 696 (46.4%) were probable PCOS, and 266 completed full evaluation. PCOS prevalence was 36.0% by Rotterdam, 29.5% by NIH, and 33.7% by AE-PCOS criteria, highest in the 20–24 years age group. The classic phenotype (oligomenorrhea + hyperandrogenism + polycystic ovarian morphology) was most common (52.6%). Women with PCOS had higher Ferriman–Gallwey scores, elevated LDL, reduced HDL, and impaired glucose tolerance compared to controls. Conclusion: PCOS is highly prevalent among young women in Bihar, especially in early reproductive years. Early screening, awareness programs, and lifestyle interventions are crucial to prevent long-term reproductive and metabolic complications. Multicentric studies are needed to establish population-specific diagnostic and preventive strategies.

Background: Cervical cancer is largely preventable, and early detection of precancerous lesions through screening can significantly reduce morbidity and mortality. Objective: This study aimed to evaluate the utility of the Pap smear for detecting precancerous cervical lesions in women attending a gynecology outpatient clinic. Methods: A total of 780 sexually active women over 21 years of age attending the Department of Obstetrics & Gynecology at Nalanda Medical College and Hospital, Patna, Bihar, were enrolled. Women with visible malignant cervical lesions, previously treated cervical cancer, or pregnancy were excluded. All participants underwent detailed history taking, clinical, per speculum, and vaginal examinations. Cervical smears were collected using an Ayre spatula, fixed in 95% ethyl alcohol, and sent for cytopathological evaluation according to the 2014 Bethesda System. Women with abnormal cytology results were referred for colposcopy and biopsy as indicated. Results: Most participants were aged 41–50 years and multiparous. Vaginal discharge (36.66%) was the most common complaint, followed by abdominal pain (25.38%) and irregular menstrual cycles (12.82%), while 15.12% were asymptomatic. Adequate smears were obtained in 93.72% of cases. Cytology was negative for malignancy in 49.35%, with 42.94% showing inflammation. ASCUS, LSIL, and HSIL were detected in 2.3%, 4.35%, and 1.02% of women, respectively. Abnormal findings were further evaluated with colposcopy and biopsy as indicated. Conclusions: The Pap smear is a simple, safe, cost-effective, and reliable screening tool for early detection of precancerous cervical lesions. Abnormal results warrant colposcopy and biopsy to guide timely management and reduce cervical cancer morbidity and mortality.

Background: Spinal and epidural anesthesia are commonly employed for lower abdominal surgeries; however, both techniques may cause sympathetic blockade–related hemodynamic changes, influencing perioperative safety. Aim: To compare the hemodynamic responses and anesthesia-related complications of spinal versus epidural anesthesia in patients undergoing lower abdominal surgeries. Methodology: This double-blind randomized clinical trial included 97 ASA I–II adult patients scheduled for elective lower abdominal surgery. Participants were allocated to spinal anesthesia (Group S, n=49) or epidural anesthesia (Group E, n=48). Systolic, diastolic, and mean arterial pressures, along with heart rate, were recorded at baseline and at regular intervals for 30 minutes after block administration. Intraoperative hypotension, vasopressor requirement, and postoperative complications were analyzed using SPSS. Results: Baseline demographics were comparable. Epidural anesthesia produced significantly greater and sustained reductions in systolic, diastolic, and mean arterial pressures compared with spinal anesthesia (p<0.05), while heart rate remained similar between groups. Hypotension requiring ephedrine was significantly higher in the epidural group (60.4% vs. 8.2%, p<0.001). Post-dural puncture headaches were more frequent with spinal anesthesia. Conclusion: Spinal anesthesia provided better hemodynamic stability with fewer hypotensive episodes, whereas epidural anesthesia was associated with greater blood pressure reductions and higher vasopressor use in lower abdominal surgeries.

Background: Brachial plexus block is widely used for forearm surgeries. Bupivacaine is effective but associated with potential toxicity, while ropivacaine is considered a safer alternative with favorable sensory–motor characteristics. Aim: To compare the efficacy, onset, duration, and safety of 0.5% bupivacaine versus 0.5% ropivacaine in brachial plexus block for forearm procedures. Methodology: This prospective randomized study included 40 ASA I–II patients undergoing elective forearm surgeries, divided into two groups: Group I received 30 ml of 0.5% bupivacaine and Group II received 30 ml of 0.5% ropivacaine. Sensory and motor block characteristics, duration of analgesia, hemodynamic parameters, and adverse effects were assessed and statistically analyzed. Results: Demographic variables and hemodynamic parameters were comparable between groups. Ropivacaine showed a significantly faster onset of sensory and motor block, whereas bupivacaine provided a significantly longer duration of sensory and motor blockade. Duration of postoperative analgesia was similar in both groups. Conclusion: Both drugs are safe and effective for brachial plexus block. Ropivacaine offers faster onset, while bupivacaine provides prolonged blockade, allowing choice based on clinical requirements.

Background: Urinary tract infections (UTIs) are among the most common bacterial infections in hospitalized patients, with Escherichia coli being the predominant causative agent. Rising antimicrobial resistance has complicated effective empirical treatment. Aim: This study aimed to determine the antibiotic sensitivity and resistance patterns of E. coli isolated from UTIs in hospitalized patients. Methodology: A descriptive cross-sectional study was conducted on 115 urine samples positive for E. coli. Isolates were identified using standard microbiological and biochemical methods. Antibiotic susceptibility testing was performed by the Kirby–Bauer disc diffusion method, and results were interpreted according to CLSI guidelines. Results: UTIs due to E. coli were more common in females (72.2%) than males (27.8%). High resistance was observed to ampicillin (97.4%), amoxicillin (93.0%), cephalosporins (>82%), ciprofloxacin (84.3%), and co-trimoxazole (80.9%). High sensitivity was noted to colistin (99.1%), fosfomycin (93.9%), imipenem (92.2%), meropenem (90.4%), and nitrofurantoin (85.2%). Multidrug resistance was detected in 14.8% of isolates. Conclusion: The study reveals a high burden of antimicrobial resistance among uropathogenic E. coli, highlighting the need for routine susceptibility testing and rational antibiotic use to guide effective therapy.

Background: Ocular ^‘trauma is a major cause of preventable visual impairment, particularly among young, active individuals. Understanding its epidemiology and outcomes is essential for improving emergency eye care and prevention strategies. Aim: To assess the demographic profile, patterns, risk determinants, clinical presentation, and visual outcomes of ocular trauma patients. Methodology: This prospective observational study included 80 patients aged 1–80 years presenting with ocular trauma at the Regional Institute of Ophthalmology, IGIMS, Patna. Detailed history, ocular examination, imaging when required, and follow-up at 1, 3, and 6 weeks were performed. Data were analyzed using SPSS v27 with significance at p < 0.05. Results: Most patients were males (72.5%) and aged 21–40 years (40%). Closed globe injuries were most common (65%), followed by open globe injuries (22.5%). Occupational incidents (25%) and road traffic accidents (22.5%) were major causes. Initial visual acuity was poor in most cases, but significant improvement was noted at follow-up, with ≥6/18 vision increasing from 27.5% to 47.5% (p < 0.001). Severe impairment and no-light-perception cases showed limited recovery. Conclusion: Ocular trauma predominantly affects young males and is largely preventable. Timely management significantly improves outcomes, emphasizing the need for safety awareness and early intervention.

Background: Microbial keratitis is a sight-threatening corneal infection with diverse etiologies, rapid progression, and potential for permanent visual impairment. Tertiary care hospitals frequently encounter severe cases, highlighting the need for detailed clinical and microbiological profiling. Aim: To evaluate the clinical profile, predisposing factors, microbial spectrum, and outcomes of microbial keratitis in patients presenting to a tertiary care hospital. Methodology: A prospective observational study was conducted on 110 patients with suspected microbial keratitis at the Ophthalmology Department of Indira Gandhi Institute of Medical Science, Patna. Demographic, clinical, and predisposing factor data were collected, and slit-lamp examinations were performed. Corneal samples were cultured to identify bacterial and fungal pathogens. Statistical analysis was performed using SPSS. Results: Contact lens use (27.27%) and ocular trauma (16.36%) were the leading predisposing factors. Culture positivity was 54.55%, with bacterial infections predominating (86.67%), particularly Gram-positive Staphylococcus aureus and Streptococcus pneumoniae, and Gram-negative Pseudomonas aeruginosa. Fungal infections were less common (13.33%), mainly associated with trauma. Predisposing factors correlated significantly with microbial patterns (p < 0.001). Conclusion: Microbial keratitis in tertiary care settings shows multifactorial etiology, predominantly bacterial, with contact lens use and trauma as major risk factors. Understanding these associations aids early diagnosis and targeted management to prevent vision loss.

Background: Laparoscopic surgery alters ^‘respiratory mechanics due to pneumoperitoneum and patient positioning, making the choice of ventilation strategy crucial for optimal perioperative respiratory management. Aim: To compare volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) with respect to respiratory mechanics, oxygenation, and hemodynamic parameters during laparoscopic surgery. Methodology: This prospective randomized comparative study included 60 ASA I–II patients undergoing elective laparoscopic surgery, divided equally into VCV and PCV groups. Standardized anesthesia and monitoring were employed. Airway pressures, respiratory mechanics, oxygenation, ventilation, and hemodynamic parameters were recorded at predefined intraoperative intervals and analyzed statistically. Results: Demographic and baseline characteristics were comparable between groups. PCV significantly reduced peak and plateau airway pressures and improved dynamic lung compliance compared to VCV. Mean airway pressure and arterial oxygen tension (PaO₂) were significantly higher in the PCV group. Tidal volume, minute ventilation, SpO₂, EtCO₂, and hemodynamic parameters remained comparable between groups. Conclusion: Both ventilation modes were safe and effective; however, PCV offered superior airway pressure profiles, better lung compliance, and improved arterial oxygenation without hemodynamic compromise, suggesting it as a more lung-protective strategy during laparoscopic surgery.

Background: Airway management is fundamental to anesthetic practice, with laryngoscopy being central to successful tracheal intubation. Video laryngoscopy has emerged as an alternative to conventional direct laryngoscopy, potentially improving visualization and patient safety. Aim: To compare video laryngoscopy and direct laryngoscopy with respect to glottic visualization and hemodynamic response during endotracheal intubation. Methodology: This progressive, randomized comparative study enrolled 80 adult patients (ASA I–II) scheduled for elective surgery with general anesthesia. The patients were divided into two groups: video laryngoscopy (Group V, n=40) and direct laryngoscopy (Group D, n=40). Demographic data, airway parameters, Cormack–Lehane grades, and hemodynamic responses were recorded and analyzed. Results: Both groups were comparable in demographic and baseline airway characteristics. Video laryngoscopy suggested enhanced glottic visualisation, resulting in a greater incidence of Cormack–Lehane Grade I views and a reduction in challenging views. It was additionally correlated with markedly reduced elevations in heart rate and meant arterial pressure relative to direct laryngoscopy (p<0.05). Conclusion: Video laryngoscopy offers improved glottic visualization and better hemodynamic stability compared to direct laryngoscopy, supporting its role as an effective and safer airway management technique.

Background: Epidermal inclusion cysts (EIC) are the most common cutaneous cysts and can occur anywhere on the body. These cysts can occur anywhere on the body, typically present as nodules directly underneath the patient’s skin, and often have a visible central punctum. It commonly results from the trauma to the pilosebaceous unit in the hair bearing area. In areas without hair, these cysts are considered implantation and proliferation of squamous epithelium into the dermis due to injury. Objective: It is to evaluate the clinicopathologic details of the usual and unusual sites of the Epidermoid cyst. Material & Method: Patients of epidermal inclusion cyst encountered over a period of 1 year from January 2023 to December 2023 were evaluated. A total of 70 cases were studied retrospectively. The clinical details including age, gender, sites and dimensions were noted. The histopathological findings were evaluated and correlated with the clinical findings. Result: The highest incidence was observed in the age group of 21–30 years (21.4%, 15/70) and the most common affected region was the head and neck region (60%, 42/70). The size of cysts ranged from 0.3 to 9 cm in diameter with a mean of 2.1 cm. The unusual sites observed in this study were one at the plantar aspect of foot and one at dorsal aspect of foot. Three cases were reported from the upper eyelid, one from the breast, one from the chest, two from the gluteal region, and one from the finger. Histopathological findings included rupture of epidermoid cysts with giant cell reaction. Conclusion: Epidermoid cysts are common benign intradermal or subcutaneous tumors, but they can have unusual presentations and histopathological findings. Epidermoid cysts need early diagnosis and treatment as they can cause cosmetic and functional impairment.

Background: Renal cell carcinoma (RCC) is a common kidney malignancy, and nephrectomy remains the standard ^‘treatment for large tumors (>10 cm). Open radical nephrectomy (ORN) is traditionally preferred, but laparoscopic radical nephrectomy (LRN) offers potential minimally invasive benefits. Aim: To evaluate perioperative outcomes, tumor characteristics, and the feasibility of LRN versus ORN in managing large renal tumors. Methodology: A retrospective observational study of 51 patients with RCC >10 cm at a high-volume tertiary center (2009–2024) was conducted. Thirty patients underwent LRN and 23 underwent ORN. Demographics, tumor characteristics, surgical variables, and postoperative outcomes were analyzed. Results: Tumors in the LRN group were smaller (11.32 ± 1.69 cm vs. 13.5 ± 2.34 cm, p=0.001). LRN had shorter operative times (167 ± 44 min vs. 235 ± 57 min, p<0.001), lower blood loss (202 ± 186 ml vs. 605 ± 336 ml, p<0.001), and reduced hospital stay (5.1 ± 2.2 days vs. 7.2 ± 1.7 days, p=0.001). Histopathology was comparable, predominantly clear cell carcinoma, with low metastatic burden. ORN was used more for larger, complex tumors requiring additional procedures. Conclusion: LRN is a safe and effective minimally invasive alternative to ORN for selected patients with large renal tumors, providing superior perioperative outcomes without compromising oncological efficacy.

Background: Dermatophytosis is a common superficial fungal infection affecting keratinized tissues and poses a significant public health problem in tropical countries like India. Accurate laboratory diagnosis is essential due to varied clinical presentations and overlapping features with other dermatoses. Aim: To isolate and identify dermatophytes among clinically suspected cases of dermatophytosis in a tertiary care teaching hospital. Methodology: A descriptive cross-sectional study was conducted over 7 months involving 96 clinically suspected cases. Skin, nail, and hair samples were subjected to direct microscopic examination using KOH mount and fungal culture. Isolates were identified based on standard macroscopic and microscopic characteristics. Results: Tinea corporis (50%) was the most common clinical presentation, followed by tinea cruris (22.9%). Overall culture positivity was 68.8%, while KOH positivity was 64.6%. Hair samples showed 100% culture positivity. Trichophyton rubrum (56.1%) was the predominant species, followed by T. mentagrophytes (40.9%). Conclusion: Dermatophytosis was predominantly caused by Trichophyton species, with glabrous skin involvement being most common. Combined use of KOH mount and culture is essential for accurate diagnosis and effective management.

Background: Dengue, a viral disease that is transmitted by mosquitoes, is caused by the dengue virus (DENV) and is considered a major public health problem in the tropical and subtropical areas. Its spread has been accelerated by rapid urbanization, growing populations, global warming, and, in addition, inadequate vector control; hence, the need for early detection and sero epidemiological surveillance as a part of the management process has become vital. Objective: The objective of the research was to ascertain the seroprevalence of dengue infections in febrile patients visiting a higher-level medical facility in Patna, Bihar, and to elaborate on the related clinical and epidemiological traits. Methods: A prospective observational study has been performed on 320 patients who were suspected of having dengue clinically. Blood samples were drawn from veins and tested for Dengue NS1 antigen, IgM, and IgG antibodies through ELISA method. Demographic, clinical, and laboratory data were collected using a previously designed proforma. Results: Most patients belonged to the young adult group of 21–30 years (28.1%) with a mild male predominance (56.3%). People living in the cities made up 65.6% of the total cases. The symptoms that occurred most often were fever (100%), headache (78.1%), and muscle pain (68.8%). The results of serological testing showed that out of the total samples, 37.5% showed NS1 antigen, 34.4% showed IgM antibodies, and 25% showed IgG antibodies, suggesting mainly acute primary dengue infection. Conclusion: Infection with dengue mainly concerns young adults living in the city, and the typical symptoms of fever are observed in them. Early diagnosis by means of NS1 and IgM ELISA assures prompt management. Continuous monitoring, controlling the vectors, and health interventions are major factors in cutting down the number of cases and deaths due to dengue in regions where it is commonly found.

Background: Interpregnancy interval (IPI), defined as the time between a previous childbirth and conception of a subsequent pregnancy, plays a crucial role in determining maternal and fetal outcomes. Short interpregnancy interval (SIPI), commonly defined as less than 18 months, has been associated with adverse outcomes due to inadequate maternal physiological recovery, nutritional depletion, and unresolved pregnancy-related morbidities. Despite extensive international evidence, prospective Indian data examining the impact of SIPI on both maternal and fetal outcomes remain limited, particularly in resource-constrained settings. Aim: To determine the impact of short interpregnancy interval on maternal and fetal outcomes. Methodology: This prospective observational study was conducted over a period of two years at Government Maternity Hospital, SVMC, and Tirupati. A total of 160 antenatal women were enrolled and categorized into Group S (short interpregnancy interval <18 months) and Group C (optimal interpregnancy interval). Women with multiple gestation, primigravida, prior preterm birth, early pregnancy complications, and chronic medical disorders were excluded. Detailed demographic data, obstetric history, clinical examination findings, and laboratory parameters were recorded. Participants were followed until delivery to assess maternal outcomes including gestational hypertension, preeclampsia, gestational diabetes mellitus, anemia, hypothyroidism, and mode of delivery. Fetal outcomes assessed included APGAR scores, NICU admission, and stillbirth. Statistical analysis was performed using appropriate comparative tests, with significance set at p < 0.05. Results: Women with short interpregnancy intervals demonstrated significantly higher rates of gestational hypertension (21.25% vs 8.75%; p = 0.0273), preeclampsia (30% vs 13.75%; p = 0.0132), gestational diabetes mellitus (22.5% vs 7.5%; p = 0.0081), and twin pregnancies (31.25% vs 2.5%; p < 0.0001) compared to controls. Caesarean section rates were significantly higher in the SIPI group (83.75% vs 48.75%; p < 0.0001). Although NICU admissions were more frequent among neonates born to SIPI mothers (28.75% vs 20%), the difference was not statistically significant. APGAR scores and stillbirth rates were comparable between groups. Conclusion: Short interpregnancy intervals are significantly associated with adverse maternal outcomes, including hypertensive disorders, gestational diabetes, increased operative deliveries, and higher twin pregnancy rates. While fetal outcomes showed modest differences, the overall findings emphasize the importance of optimal birth spacing. Strengthening postpartum counseling, improving contraceptive access, and enhancing awareness regarding pregnancy spacing are essential to reduce maternal and perinatal morbidity in the Indian context.

Background: Calcium channel blockers (CCBs) are recommended as first-line agents for hypertension management. Amlodipine is widely used; however, newer CCBs such as cilnidipine and benidipine possess additional pharmacological properties that may improve tolerability and end-organ protection. Methods: A comparative observational study was conducted in patients with essential hypertension receiving amlodipine, cilnidipine, or benidipine. Changes in systolic and diastolic blood pressure were evaluated along with biochemical parameters, including lipid profile and renal markers. Adverse drug reactions were recorded during follow-up. Results: All three drugs produced significant reductions in systolic and diastolic blood pressure. Cilnidipine and benidipine demonstrated antihypertensive efficacy comparable to amlodipine, with a lower incidence of pedal edema and more favorable biochemical stability. Conclusions: Cilnidipine and benidipine offer effective blood pressure control with better tolerability than amlodipine and may be preferred for long-term management of hypertension.

Objective: Lateral epicondylitis (tennis elbow) is a common degenerative condition of the elbow causing lateral-sided pain and functional impairment. Corticosteroid injections are frequently used for symptomatic relief; however, their benefits are often short-term with high recurrence rates. Platelet-rich plasma (PRP) has emerged as a biological treatment that promotes tendon healing and may provide sustained clinical improvement. This study aimed to compare the clinical outcomes of autologous PRP injection and corticosteroid injection in the management of chronic tennis elbow. Methods: This prospective double-blind study included sixty patients diagnosed with chronic lateral epicondylitis who met the inclusion criteria. Patients were randomly allocated into two groups. Group I received a local corticosteroid injection, while Group II received an autologous PRP injection. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Numerical Pain Score (NPS). Evaluations were performed prior to injection and at 6 weeks, 3 months, and 6 months post-injection. Results: Both groups showed significant improvement in pain scores following treatment. The corticosteroid group demonstrated greater pain relief at early follow-up; however, pain scores increased over time. In contrast, the PRP group showed gradual and sustained improvement. At the 6-month follow-up, the PRP group demonstrated significantly lower VAS and NPS scores compared to the corticosteroid group, and the difference was statistically significant. Conclusion: Autologous PRP injection provides superior and longer-lasting pain relief compared to corticosteroid injection in patients with chronic lateral epicondylitis. PRP appears to be an effective and promising treatment modality for tennis elbow, particularly in cases unresponsive to conservative management.

Introduction: Acute coronary syndrome (ACS) is an umbrella term for situations where the blood supplied to the heart muscle is blocked. The FFAs is a major fuel in mammals besides glucose. Aims: To find out whether any significant change of   FFA (Free Fatty Acid) and H₂S (Hydrogen Sulphide) level occur in patients suffering from ACS. (Acute Coronary Syndrome).To finds out any difference in of FFA & H₂S level in Diabetic ACS in comparison to non-Diabetic ACS. To compare these two parameters with conventional biochemical parameters done in ACS, like Lipid Profile, and Lp(a). Materials & Methods: The study was an observational, cross-sectional study conducted in the Department of Biochemistry in collaboration with the Department of Cardiology, NRS Medical College and Hospital, Kolkata. A total of 88 patients with Acute Coronary Syndrome were recruited during the study period from August 2017 to September 2018. Result: One way ANOVA showed that there was significant difference in mean level of high density cholesterol of the patients of the three groups (p<0.0001). Tukey’s test showed that the mean level of high density cholesterol of the controls was significantly higher than that of the other two groups (p<0.01). Conclusion: We concluded that this study was under taken with the objective to find out whether any significant changes of level of FFA and H₂S in patients suffering from ACS with or without DM along with conventional biochemical parameters.

Introduction: Metabolic syndrome (MetS) is a cluster of cardiometabolic abnormalities—central obesity, dyslipidemia, hypertension, and insulin resistance—that significantly increases the risk of atherosclerosis. Oxidative stress plays a pivotal role in the pathogenesis of atherosclerotic vascular disease. Aims: Evaluate serum MPO and PON1 levels in individuals with metabolic syndrome and compare them with healthy controls, and to assess the correlation between these biomarkers and atherosclerotic risk indicators, including lipid profile parameters and carotid intima–media thickness (CIMT). Materials and Methods: This cross-sectional, case–control study was conducted over a period of one year in the Department of Biochemistry, College of Medicine & Sagore Dutta Hospital. The study included 50 adult participants aged 18–60 years, comprising patients clinically diagnosed with metabolic syndrome according to IDF/NCEP-ATP III criteria as cases, and age- and sex-matched healthy individuals without metabolic syndrome or known cardiovascular, renal, or hepatic disorders as controls. Results: In our study, cases had significantly higher MPO levels (208.5 ± 44.2 ng/mL) and MPO/PON1 ratio (2.91 ± 0.95) and lower PON1 activity (71.8 ± 14.9 U/L) compared to controls (p < 0.001). Elevated MPO and MPO/PON1 ratio were associated with higher CIMT, while lower PON1 activity correlated with higher triglyceride levels. These findings indicate a significant association of increased oxidative stress and reduced antioxidant activity with atherosclerotic risk. Conclusion: Serum MPO and PON1 levels show significant, opposite correlations with cardiometabolic risk markers and subclinical atherosclerosis in metabolic syndrome. Elevated MPO and reduced PON1 may serve as useful biomarkers for early assessment of oxidative stress and vascular risk in MetS. Monitoring these biomarkers could aid in risk stratification and preventive cardiovascular interventions.

Introduction: Ventral hernias are common clinical conditions often arising after abdominal surgeries and associated with significant morbidity. Surgical repair aims to prevent complications like incarceration or strangulation, but postoperative outcomes vary due to patient comorbidities and surgical factors. Aims and Objectives: This study aimed to evaluate the demographic profile, comorbidities, surgical approaches, and postoperative complications including seroma, surgical site infections (SSI), and sinus/fistula tract development, mesh infection, recurrence based on modified Ventral hernia working group classification system(VHWG) in patients undergoing ventral hernia repair. Materials and Methods: A prospective observational study was conducted on 122 patients undergoing ventral hernia repair. Demographic data, comorbidities, and surgical details were recorded and patients were classified into 3 grades according to modified VHWG classification system. Postoperative complications were assessed at 1 month, 6 months, and 1 year, with seroma, SSI, and sinus/fistula graded for severity. Results: The study included 122 patients, predominantly female (76.2%), with a mean age of 55.55 ± 9.87 years and most patients belonging to the 51–60 year age group (42.6%). Obesity was the most common comorbidity (51.8%), and surgical approaches were equally distributed between laparoscopic and open methods (50% each). Seroma formation and surgical site infection, mesh infection were significantly associated with higher grades, with Grade 3 showing higher incidence at 1 month (seroma 27.6%, SSI 27.6%,mesh infection 10.3%) and delayed resolution at 1 year (seroma resolution 58.6%, SSI persistence 27.6%; p < 0.05). Sinus/fistula tract formation, Wound dehiscence, Recurrence were rare (0.8%) and did not show a statistically significant association with grade (p >0.05). Conclusion: Development of post-operative complications like Seroma, Surgical site infection, infected mesh increases with rising grade according to modified Ventral Hernia Working Group classification system. This study demonstrates the validity of Modified ventral hernia working group classification system in predicting the post operative outcomes based on previous risk factors with obesity found to be commonest risk factor.

Background: Granulomatous inflammation is a distinct chronic inflammatory response characterized by organized collections of epithelioid macrophages, often triggered by infectious or non-infectious agents. Accurate histopathological identification, supported by special stains, is essential for determining etiology and guiding management. Aim: To assess the frequency, anatomical distribution, morphological patterns, and etiological spectrum of granulomatous lesions, with reference to special staining techniques. Methodology: A descriptive cross-sectional study was conducted on 135 histopathologically confirmed granulomatous lesions at the Department of Pathology, Government Medical College, Bettiah. Specimens were processed using routine H&E staining, with Ziehl–Neelsen, PAS, and GMS stains applied as needed. Clinical and demographic data were recorded, and lesions were classified based on morphology and etiology. Results: Patients ranged from 1–80 years, with a slight male predominance (53.3%). The most common sites were skin/subcutaneous tissue (25.2%), lymph nodes (22.2%), and bones/joints (15.6%). Tuberculosis was the leading cause (45.9%), followed by leprosy (13.3%) and fungal infections (10.4%). Epithelioid granulomas predominated (57.8%). Ziehl–Neelsen staining detected acid-fast bacilli in only 22.6% of tuberculous cases, highlighting limitations of conventional staining. Conclusion: Granulomatous lesions exhibit diverse etiologies and morphological patterns, with infectious causes, particularly tuberculosis, being predominant. Histopathology supplemented with special stains is vital for accurate diagnosis and effective patient management.

Background: Human papillomavirus (HPV) is a prevalent sexually transmitted infection, with high-risk types contributing to cervical cancer. Despite its public health significance, awareness of HPV, cervical cancer, and preventive measures like Pap smear screening remains low among urban women. Aim: To evaluate urban women’s knowledge, awareness, and attitudes regarding Pap smear screening, HPV infection, and cervical cancer. Methodology: A cross-sectional descriptive study was conducted at Department of Obstetrics and Gynaecology, Radha Devi Jageshwari Memorial Medical College and Hospital, Muzaffarpur, Bihar, India, involving 60 urban women aged ≥18 years. Participants completed a structured questionnaire assessing sociodemographics, awareness of HPV, cervical cancer symptoms and risk factors, and Pap smear knowledge. Data was analyzed using SPSS 27, with chi-square tests evaluating associations between awareness and education level. Results: Most participants were young to middle-aged (73.3% aged 18–35), married (80%), and moderately educated (66.7% secondary or graduate level). Awareness of HPV was low (30%), with only 16.7% recognizing its link to cervical cancer. Pap smear awareness (41.7%) and uptake (16.7%) were limited. Higher education was significantly associated with greater Pap smear awareness (χ² = 7.84, p = 0.049). Conclusion: Urban women exhibited significant deficiencies in their understanding of HPV, cervical cancer, and Pap smear screening, underscoring the necessity for focused health education and accessible preventative interventions.

Background: Tibial shaft fractures are common long-bone injuries with a high ^‘risk of delayed union and complications due to subcutaneous anatomy, limited soft-tissue coverage, and frequent high-energy trauma. Understanding factors influencing healing is essential for optimizing outcomes. Aim: To evaluate patient-, injury-, and treatment-related factors affecting fracture healing and functional outcomes in tibial shaft fractures managed with circular external fixation. Methodology: A prospective observational study with retrospective analysis was conducted on 50 adult patients with tibial shaft fractures treated using circular external fixators. Demographic data, fracture characteristics, reduction quality, fixation parameters, time to union, complications, and functional outcomes were analyzed over a six-month period. Results: The majority were young to middle-aged males injured by high-energy trauma. Most fractures united within 17–26 weeks, with a mean consolidation time of 21.3 ± 5.8 weeks. Delayed union occurred in 16%. Pin-track infection was the most common complication, predominantly low-grade. Functional outcomes were excellent or good in 76% of patients. Better reduction quality and supplementary fixation were associated with faster union. Conclusion: Circular external fixation provides reliable union and favorable functional outcomes in tibial shaft fractures when optimal reduction, stability, and pin-site care are ensured.

Background: Distal radius fractures are common upper-limb injuries, and the optimal management of intra-articular fractures remains debated. Frykman type III fractures pose particular challenges due to articular involvement and risk of functional impairment. Aim: To compare functional and radiological outcomes of Frykman type III distal radius fractures managed by conservative and surgical techniques. Methodology: This prospective observational comparative study included 70 patients with closed Frykman type III distal radius fractures treated either conservatively (n=47) or surgically (n=23). Patients were followed for six months. Outcomes were assessed using time to union, Visual Analogue Scale (VAS) for pain, Saito demerit point system, grip strength, and radiological parameters. Statistical analysis was performed using SPSS, with p<0.05 considered significant. Results: Surgical management resulted in significantly earlier fracture union (12.8 vs 19.5 weeks, p<0.001), better volar tilt and ulnar variance, improved grip strength, and a higher proportion of excellent functional outcomes (47.8% vs 29.8%, p=0.018). Pain scores and Saito functional scores were comparable between groups. Conclusion: Both treatment modalities provide satisfactory outcomes; however, surgical management offers faster union, superior anatomical restoration, and better overall functional results in Frykman type III distal radius fractures.

Background: Maternal mortality is a key indicator of women’s health and healthcare system performance. Despite advances, preventable maternal deaths remain high in developing countries, including India. Aim: To analyze the maternal mortality rate (MMR), epidemiological patterns, and causes of maternal deaths in a tertiary care hospital. Methodology: A retrospective record-based observational study was conducted at Nalanda Medical College, Patna. Data on 80 maternal deaths recorded during the study period were extracted from hospital registers and case records. Epidemiological characteristics, causes of death, and MMR were analyzed using descriptive statistics. Results: The MMR was 320 per 100,000 live births (80 deaths among 25,000 live births). Most deaths occurred in women aged 20–24 years (42.5%), multiparous women (56.2%), rural residents (67.5%), unbooked cases (82.5%), illiterate women (62.5%), and those from low socioeconomic status (80%). Direct obstetric causes accounted for 72.5% of deaths, mainly hemorrhage (27.6%), eclampsia (25.9%), and sepsis (19%). Indirect causes constituted 27.5%, with anemia (36.4%) being the leading factor. Conclusion: Maternal mortality was predominantly due to preventable causes associated with poor antenatal care, socioeconomic disadvantage, and delayed referral. Strengthening antenatal services, early risk identification, and timely emergency obstetric care is essential to reduce maternal deaths.

Background: Immunization is a key public health intervention for ^‘reducing childhood morbidity and mortality. Despite good initial vaccine uptake under India’s Universal Immunization Programme (UIP), completion of the full immunization schedule remains a challenge in many settings. Aim: To assess immunization coverage and dropout rates among children aged 12–23 months using UIP records and to identify factors associated with immunization dropout. Methodology: A community-based cross-sectional study was conducted among 90 children aged 12–23 months in the field practice area of the Department of Community Medicine, Nalanda Medical College, Patna. Immunization status was verified using MCP cards and caregiver recall. Dropout rates were calculated using WHO formulas. Data were analyzed using SPSS version 26.0. Results: BCG coverage was highest (95.6%), while measles/MR coverage was 71.1%. Overall, 67.8% of children were fully immunized and 32.2% were partially immunized. The highest dropout rate was observed between BCG and measles vaccination (25.6%). Low maternal education, distance to health facility, non-institutional delivery, and late ANC registration were significantly associated with dropout. Conclusion: Although initial immunization coverage was high, dropout rates remained substantial. Strengthening caregiver awareness, follow-up mechanisms, and service accessibility is essential to improve full immunization coverage.

Background: The dimensions of coronary arteries differ in different populations and determine the accuracy of diagnosis and outcome after interventional procedures. There is limited data on the coronary measurements of the Intravascular Ultrasound (IVUS) in Indians in spite of the high incidence of coronary artery diseases. Objective: To assess IVUS-measured dimensions and plaque burden of Left Main (LM), proximal Left Anterior Descending (LAD), and proximal Left Circumflex (LCX) arteries in an Indian population and determine clinical determinants. Methodology: The study was a prospective observational study involving 150 adults who underwent IVUS-guided coronary angiography between 2022-2023. ANOVA was used to compare the vessel diameters with the plaque burden and the clinical variables to identify the predictors of the arterial dimensions and the effect of coronary dominance. Result: LM demonstrated the greatest diameter (4.77 +- 0.63 mm) and the greatest plaque burden (49%). The LAD was 3.58 +- 1.41 mm and the LCX was the smallest (0.83 +- 1.63 mm). Women Hypertension and body surface area were significant predictors of LM size; age and BSA were significant predictors of LCX size; no factors had an effect on LAD dimensions. There was also an influence of coronary dominance on the distribution of plaque, with right circulation being related to a higher LAD plaque burden and left/co-dominance correlating with greater LCX involvement. Conclusion: IVUS displays different patterns of coronary dimensions and preponderation based on plaque in Indian patients. These results can be used to offer the population-specific reference values and offer the strategies of coronary intervention to the individual.

Background: Bacterial skin and soft tissue infections are common clinical conditions associated with significant morbidity and increasing antimicrobial resistance, particularly in developing countries. Continuous surveillance of causative organisms and their resistance patterns is essential for effective management. Aim: To determine the prevalence of bacterial pathogens causing skin infections and to assess their antibiotic sensitivity patterns. Methodology: This single-centre cross-sectional study included 130 clinically diagnosed cases of bacterial skin infections. Samples were subjected to Gram staining, culture, and identification, followed by antibiotic susceptibility testing using the Kirby–Bauer disc diffusion method as per CLSI guidelines. Results: Males (64.6%) and adults aged 21–50 years were predominantly affected. Staphylococcus aureus was the most common isolate (32.3%), with a high proportion of MRSA (40.5%). All S. aureus isolates were 100% sensitive to vancomycin and linezolid. Among Gram-negative isolates, Escherichia coli was most frequent, and carbapenems showed the highest sensitivity. ESBL production was detected in 37.1% of Gram-negative isolates. Conclusion: The study highlights a high burden of antimicrobial resistance, including MRSA and ESBL-producing organisms, emphasizing the need for routine culture-based therapy and strengthened antimicrobial stewardship.

Background: Cutaneous tuberculosis, a rare extrapulmonary manifestation of Mycobacterium tuberculosis infection, poses diagnostic challenges due to its varied clinical presentations and resemblance to other dermatological conditions. Aim: To evaluate the clinical spectrum, demographic profile, and diagnostic modalities of cutaneous tuberculosis in patients attending a tertiary care centre. Methodology: A hospital-based descriptive observational study was conducted on 60 patients aged ≥10 years with clinically suspected and confirmed cutaneous tuberculosis. Demographic data, lesion morphology, anatomical distribution, and systemic involvement were documented. Diagnostic investigations included histopathology, Mantoux test, Ziehl–Neelsen staining, chest X-ray, and CBNAAT/PCR. Data were analyzed using SPSS 27. Results: Most patients were aged 21–40 years (43.3%) and male (56.7%), with a predominance of rural residents (63.3%). Lupus vulgaris (36.7%) and scrofuloderma (26.7%) were the most common types. Lesions primarily affected the face, neck, and limbs. Histopathology (86.7%) and Mantoux test (80%) were the most sensitive diagnostic modalities, whereas Ziehl–Neelsen staining (30%) and CBNAAT/PCR (20%) had limited yield. Conclusion: Cutaneous tuberculosis predominantly affects young adults and rural populations, with lupus vulgaris and scrofuloderma as common presentations. Early recognition using clinical suspicion supported by histopathology and Mantoux testing is crucial for timely management and reducing morbidity.

Background: Deep vein thrombosis (DVT) is a major cause of preventable morbidity and mortality after major abdominal surgery. Although pharmacological thromboprophylaxis is recommended internationally, mechanical methods alone are still commonly used in many low- and middle-income healthcare settings. The true burden of postoperative DVT under this strategy remains under-reported. This study aimed to determine the in-hospital prevalence of DVT and identify associated risk factors among patients undergoing elective major abdominal surgery. Methods: This prospective observational cohort study included 200 consecutive adult patients undergoing elective major abdominal surgery at Dr. Rajendra Gode Medical College, Amravati, India, following Institutional Ethics Committee approval (2023). All patients received mechanical thromboprophylaxis using graduated compression stockings and intermittent pneumatic compression devices. Bilateral lower-limb Doppler ultrasonography was performed in all patients before hospital discharge. Demographic, clinical, and intraoperative variables were recorded. The primary outcome was the prevalence of objectively confirmed postoperative DVT. Results: The overall in-hospital prevalence of DVT was 15% (29/200). Colectomy had the highest DVT prevalence (25.7%), followed by gastrectomy (14.0%) and liver resection (13.3%). Age >65 years, body mass index (BMI) >30 kg/m², prolonged operative duration (>180 minutes), and prior venous thromboembolism were significantly associated with DVT (p < 0.05). Conclusion: A substantial burden of postoperative DVT was observed in patients receiving mechanical thromboprophylaxis alone after major abdominal surgery. Risk-stratified incorporation of pharmacological prophylaxis may significantly reduce thromboembolic complications in high-risk patients.

Background: Granulomatous inflammation is a distinctive chronic inflammatory response encountered frequently in histopathological practice, with diverse infectious and non-infectious etiologies and varied morphological patterns, often posing diagnostic challenges. Aim: To evaluate the histopathological spectrum of granulomatous lesions in biopsy samples with respect to their prevalence, morphology, and anatomical distribution. Methodology: This hospital-based descriptive observational study included 80 biopsy specimens showing granulomatous inflammation. Routine hematoxylin and eosin staining was performed, supplemented with special stains such as Ziehl–Neelsen and PAS where indicated. Data were analyzed using descriptive statistics and expressed as frequencies and percentages. Results: Granulomatous lesions were more common in adults, with a female predominance (60%). Lymph nodes (32.5%) and skin (22.5%) were the most frequently involved sites. Caseating granulomas were the predominant morphological pattern (52.5%). Tuberculosis was the most common etiology (35%), followed by sarcoidosis and granulomatous lesions not otherwise specified (17.5% each). Ziehl–Neelsen stain was positive in 30% of cases. Conclusion: Granulomatous lesions show wide morphological and etiological diversity. Histopathological examination, supported by special stains and clinicopathological correlation, remains crucial for accurate diagnosis and effective patient management.

Background: First trimester bleeding is a common obstetric problem with diverse etiologies ranging from benign to life-threatening conditions. Clinical assessment alone often lacks accuracy due to overlapping presentations. Aim: To evaluate the role of ultrasonography in improving diagnostic accuracy and guiding management in women presenting with first trimester bleeding. Methodology: A prospective observational study was conducted over six months on 82 pregnant women with first trimester bleeding at RDJM Medical College and Hospital,Turki, Muzaffarpur, Bihar, India. All participants underwent detailed clinical evaluation followed by transabdominal and/or transvaginal ultrasonography. Clinical diagnoses were compared with ultrasonographic findings, and their impact on management decisions was analyzed. Results: Ultrasonography identified threatened abortion as the most common diagnosis (43.9%). Concordance between clinical and USG diagnosis varied across conditions, with significant misclassification noted clinically, especially in complete abortion, missed abortion, and ectopic pregnancy. Clinical diagnosis showed high accuracy for viable intrauterine pregnancy (83%) and ectopic pregnancy (98%) but lower accuracy for non-viable intrauterine pregnancy (63%). Ultrasonography significantly improved diagnostic precision and influenced appropriate management. Conclusion: Ultrasonography is an indispensable tool in the evaluation of first trimester bleeding, significantly enhancing diagnostic accuracy and guiding timely, appropriate management while reducing unnecessary interventions and complications.

Background: Cervical cancer ^‘remains a major public health problem, particularly in low- and middle-income countries. Premalignant cervical lesions represent a critical stage where early detection can effectively prevent progression to invasive cancer. Aim: To determine the frequency and histopathological distribution of premalignant cervical lesions in cervical biopsy specimens. Methodology: This hospital-based descriptive observational study was conducted in the Department of Pathology, Darbhanga Medical College and Hospital, Bihar. A total of 600 cervical biopsy specimens from women aged ≥21 years were evaluated over nine months. Specimens were processed using standard histopathological techniques and classified as cervical intraepithelial neoplasia (CIN I, II, and III) according to WHO criteria. Data were analyzed using SPSS version 27.0. Results: Premalignant lesions were identified in 240 cases (40%), while 360 cases (60%) were negative. Among premalignant lesions, CIN I was most common (50%), followed by CIN II (29.2%) and CIN III (20.8%). Conclusion: A substantial burden of premalignant cervical lesions was observed, with predominance of low-grade lesions. Histopathological evaluation of cervical biopsies remains essential for early diagnosis and prevention of cervical cancer.

Background: Cervical cancer remains a major public health concern worldwide, with high incidence and mortality in low- and middle-income countries. Early detection through Pap smear screening is crucial for identifying premalignant and malignant cervical lesions. Aim: To evaluate the prevalence of cervical cytological abnormalities among women of reproductive age and correlate findings with demographic and clinical variables. Methodology: A prospective, hospital-based study was conducted over 7 months at Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, including 500 women aged ≥21 years presenting to the Gynecology OPD. Cervical samples were collected using Ayre’s spatula and examined after staining with stain Papanicolaou. Data was analyzed using SPSS version 27. Results: Most participants were married (84%), multiparous (80%), and aged 26–45 years (76%), with 56% from low socioeconomic backgrounds. Vaginal discharge was the most common presenting symptom (44%), while 24% were asymptomatic. Cytological evaluation revealed 60% normal smears, 20% inflammatory changes, and 18% epithelial cell abnormalities; 2% were unsatisfactory. Conclusion: Pap smear screening effectively identifies premalignant and inflammatory cervical conditions, especially in high-risk, socioeconomically deprived populations. Routine cytology, including opportunistic screening, is essential for early detection and prevention of invasive cervical cancer.

Background: Colorectal carcinoma is one of the most important public health problems causing significant morbidity and mortality globally and here the main cause of mortality is tumor invasion and metastasis. Pathogenesis of colorectal is a multistep process during which different molecular pathways come into play. Beta-catenin, a central molecule of Wnt signaling system, expresses in epithelial cells as two main forms; membrane localization and nuclear accumulation. This beta catenin is responsible for cell proliferation, differentiation and enhanced survival of colorectal epithelial cells. Membrane localization can be detected in normal cells and tumor lineage whereas nuclear accumulation is exclusively detected in immature and tumor cells. Methods: All radical excised specimens and colonoscopy biopsies were collected from histopathology section and immunohistochemistry was done in the Department of Pathology, VIMSAR, Burla from August 2022 to July 2024. Results: 60 cases of colonic carcinoma were received from Department of General Surgery of which 29 were colectomy and 31 were endoscopic biopsy specimens. All were of adenocarcinoma with M:F ratio 1.26:1 and most common site being rectum. High membranous expression was seen in 67% cases whereas 60% cases showed nuclear positivity. Conclusion: Expression of beta catenin shows gradual transition from predominant membranous expression to subsequent positivity in cytoplasmic and nuclear location as we progress from low histological grade to high grade of colorectal carcinoma. This property of beta catenin helps to detect the cases earlier and initiate early treatment.

Background: Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY) is India’s flagship health program designed to provide universal health coverage and reduce catastrophic out-of-pocket expenditure (OOPE) for low-income families. While Bihar is one of the states most in need of such financial protection, its implementation and awareness rates have historically lagged behind national averages. Objectives: This study aimed to investigate the level of awareness, enrolment, and utilization of the AB-PMJAY scheme among eligible families residing in the urban and rural field practice areas of Madhubani Medical College, Bihar. Material and Methods: A community-based descriptive cross-sectional study was conducted over two months among 100 eligible families. Participants were selected via purposive sampling and interviewed using a pre-designed, pre-tested questionnaire. Data analysis included descriptive statistics and independent sample T-tests to determine statistical significance. Results: The study found a high level of engagement with the program, with 74% of households being both aware of and enrolled in PM-JAY. The primary source of information was the public relations (PR) outreach campaigns conducted by the hospital (55%), followed by mass media (35%). Service utilization was robust; the most frequent uses were for surgical procedures (n=26), medical procedures (n=21), and invasive medical services like dialysis (n=12). Significantly, 100% of enrolled households reported that the scheme successfully decreased their out-of-pocket expenses. Conclusion: Awareness and utilization in the study area were considerably higher than the state average. This success is attributed to intensive hospital-led PR campaigns and the accessibility of a tertiary care facility empanelled with the scheme. The findings underscore the importance of localized outreach in achieving the goals of universal health coverage.

Background: Obesity is a growing global public health concern and has been increasingly linked to adverse reproductive outcomes, including menstrual disorders and infertility, among women of reproductive age. Aim: To assess the association between obesity, menstrual irregularities, and infertility in women aged 18–40 years. Methodology: A hospital-based descriptive cross-sectional study was conducted among 80 overweight and obese women attending the outpatient department of General Medicine at Nalanda Medical College and Hospital in Bihar, India. Data on sociodemographic characteristics, menstrual patterns, infertility status, and anthropometric measurements were collected using a structured questionnaire. BMI was classified according to WHO criteria. Statistical analysis was performed using SPSS version 27.0. Results: The majority of participants were aged 18–35 years. Menstrual irregularities were observed in 62.5% of women, with oligomenorrhea being the most common. The prevalence of irregular menstrual cycles increased progressively with higher BMI categories. Infertility was reported in 45% of participants, with primary infertility being more common than secondary infertility. Conclusion: Obesity is significantly associated with menstrual disorders and infertility, with increasing BMI linked to worsening reproductive outcomes. Early identification and weight management may improve menstrual regularity and fertility potential.

Background: Chronic kidney disease-mineral and bone disorder (CKD -MBD) is a frequent and clinically significant complication of chronic kidney disease, which develops in response to abnormalities in the metabolism of calcium, phosphate, parathyroid hormone (PTH) and vitamin D. These deformities cause skeletal morbidity and cardiovascular problems, hence high mortality is seen in patients with CKD. There is limited information on CKD-MBD prevalence and biochemical profile in eastern India. Objectives: The present study aimed to determine the prevalence of mineral and bone disorder among patients with chronic kidney disease and to evaluate its biochemical correlates, including serum calcium, phosphate, intact parathyroid hormone (iPTH), vitamin D, and alkaline phosphatase levels. Methods: This hospital-based cross-sectional study was conducted in the Department of General Medicine, Nalanda Medical College and Hospital, Patna. A total of 88 adult CKD patients were enrolled using simple random sampling. Biochemical parameters assessed included serum calcium, phosphate, iPTH, 25-hydroxy vitamin D, total alkaline phosphatase, and bone-specific alkaline phosphatase. Data were analyzed using SPSS version 20, and associations were evaluated using chi-square test and ANOVA. Results: CKDMBD was very common in the research population. Hypocalcemia was found in 54.5 percent of the patients, hyperphosphatemia in 65.9 percent, high levels of IPTH in 81.8 percent and vitamin D deficiency/insufficiency in 81.8 percent. The majority of patients had moderate to the very high bone turnover. There was a significant rise in the levels of serum phosphate, alkaline phosphatase, and bone-specific alkaline phosphatase with an increase in the levels of iPTH (p < 0.05). Conclusion: Mineral and bone disorder occurs so high in CKD patients, and the biochemical derangements are greatly correlated with bone turnover conditions. Biochemical surveillance should be done in routine to detect and manage CKD–MBD early so that there are fewer skeletal and cardiovascular complications.

Background:  Altered mental status (AMS) is a critical presentation in emergency medical settings, reflecting diverse neurological, metabolic, infectious, and toxic etiologies. Early recognition and intervention are essential to reduce morbidity and mortality. Aim: To evaluate the clinical profile, etiological spectrum, laboratory findings, and outcomes of patients presenting with AMS in the emergency department. Methodology: A prospective observational study was conducted at Nalanda Medical College and Hospital, Patna, including 115 adult patients with acute onset AMS (GCS <15). Clinical assessment, laboratory investigations, neuroimaging, and EEG were performed as indicated. Patients were managed according to standard protocols, and outcomes were recorded. Results: The majority of patients were males (61.7%) aged 41–60 years (41.7%). Moderate consciousness impairment (GCS 9–12) was most common. Stroke (33%) and infections (26.1%) were leading causes, followed by metabolic disturbances (25.2%). Laboratory abnormalities included elevated infection markers (36.5%) and blood glucose disturbances (30.4%). Most patients recovered and were discharged (71.3%), 30.4% required ICU care, and mortality was 20%. Mean hospital stay was 7.8 ± 3.5 days. Conclusion: AMS predominantly affected middle-aged and elderly males, with neurological, infectious, and metabolic etiologies. Early assessment, targeted investigations, and timely management are critical for improving patient outcomes.

Background: Müllerian duct anomalies (MDAs) are congenital uterine malformations associated with variable reproductive outcomes, including miscarriage, preterm birth, and altered delivery modes. Aim: To evaluate and compare pregnancy outcomes among women with different types of Müllerian anomalies. Methodology: This retrospective comparative study included 80 pregnant women with confirmed MDAs who received care at Department of Obstetrics and Gynaecology, Jannayak Karpoori Thakur Medical College and Hospital, Bihar, India. Anomalies were classified using standard criteria, and pregnancy outcomes—including miscarriage, preterm and term live births, intrauterine fetal death (IUFD), ongoing pregnancies, and mode of delivery—were analyzed. Results: Septate (35%) and bicornuate uteri (25%) were most common. Miscarriage occurred in 27.5% of cases, preterm live births in 20%, term live births in 25%, IUFD in 5%, and 22.5% had ongoing pregnancies. Septate and bicornuate uteri showed the highest miscarriage rates, whereas didelphys and arcuate uteri had higher term live birth rates. Among 36 deliveries, caesarean section was slightly more common (55.6%) than vaginal delivery (38.9%). Conclusion: Pregnancy outcomes vary by anomaly type, with septate and bicornuate uteri carrying higher miscarriage risk and didelphys and arcuate uteri showing favorable outcomes. Individualized counseling, careful antenatal monitoring, and tailored obstetric management are crucial.

Background: Hysterectomy is a definitive treatment for fibroid uterus, and minimally invasive approaches such as nondescent vaginal hysterectomy (NDVH), laparoscopically assisted vaginal hysterectomy (LAVH), and total laparoscopic hysterectomy (TLH) are increasingly utilized, each with distinct operative profiles. Aim: To compare operative outcomes and postoperative complications among NDVH, LAVH, and TLH in women with fibroid uterus. Methodology: This prospective analytical study included 80 women with fibroid uterus undergoing hysterectomy at Department of Obstetrics and Gynaecology, Jannayak Karpoori Thakur Medical College and Hospital (JNKTMCH) Madhepura, Bihar, India. Patients were allocated to NDVH (n=30), LAVH (n=25), or TLH (n=25). Operative time, blood loss, uterine weight, complications, analgesic requirement, and hospital stay were compared using ANOVA. Results: NDVH had the shortest mean operative time (56.1 ± 14.8 min) and least blood loss (58.4 ± 15.9 mL), while TLH had the longest operative time (124.3 ± 9.1 min) and highest blood loss (112.6 ± 18.7 mL) (P < 0.0001). Intra-operative complications were minimal across groups. Postoperative complications were mild and comparable, and hospital stay did not differ significantly. Conclusion: NDVH is the most efficient approach in appropriately selected patients, while LAVH and TLH provide safe alternatives when vaginal hysterectomy is not feasible.

Background: Hepatitis E virus (HEV) is an emerging cause of acute viral hepatitis (AVH), particularly in regions with limited sanitation. Clinical differentiation from other hepatotropic viruses is challenging without laboratory confirmation. Aim: To assess the seroprevalence of HEV among patients presenting with suspected AVH and analyze associated demographic, clinical, and biochemical features. Methodology: A hospital-based, cross-sectional study was conducted at Patna Medical College and Hospital over six months. Ninety patients with suspected AVH were enrolled. Serum samples were tested for anti-HEV IgM by ELISA. Demographic, clinical, and biochemical data were collected and analyzed using SPSS 26.0. Results: HEV seropositivity was 20% (18/90). No significant associations were observed between HEV infection and age, gender, or residence. Clinically, jaundice (88.9%) and fatigue (77.8%) were most common in HEV-positive patients, similar to HEV-negative cases. Biochemically, HEV-positive patients had significantly higher ALT (610.4 ± 198.6 U/L) and AST (575.2 ± 187.3 U/L) compared to HEV-negative individuals (p < 0.01), indicating greater hepatocellular injury. Conclusion: HEV infection affects all adult age groups irrespective of gender or residence and presents with clinical features indistinguishable from other AVH causes. Significantly elevated transaminases may suggest HEV infection, emphasizing the need for routine laboratory testing for timely diagnosis and public health management.

Background: Colorectal carcinoma is one of the most important public health problems causing significant morbidity and mortality globally and here the main cause of mortality is tumor invasion and metastasis. Pathogenesis of colorectal is a multistep process during which different molecular pathways come into play. Beta-catenin, a central molecule of Wnt signaling system, expresses in epithelial cells as two main forms; membrane localization and nuclear accumulation. This beta catenin is responsible for cell proliferation, differentiation and enhanced survival of colorectal epithelial cells. Membrane localization can be detected in normal cells and tumor lineage whereas nuclear accumulation is exclusively detected in immature and tumor cells. Methods: All radical excised specimens and colonoscopy biopsies were collected from histopathology section and immunohistochemistry was done in the Department of Pathology, VIMSAR, Burla from August 2022 to July 2024. Results: 60 cases of colonic carcinoma were received from Department of General Surgery of which 29 were colectomy and 31 were endoscopic biopsy specimens. All were of adenocarcinoma with M:F ratio 1.26:1 and most common site being rectum. High membranous expression was seen in 67% cases whereas 60% cases showed nuclear positivity. Conclusion: Expression of beta catenin shows gradual transition from predominant membranous expression to subsequent positivity in cytoplasmic and nuclear location as we progress from low histological grade to high grade of colorectal carcinoma. This property of beta catenin helps to detect the cases earlier and initiate early treatment.

Background: Malaria ‘remains a major public health concern in endemic regions, necessitating rapid and accu-rate diagnosis to guide timely treatment and control transmission. Aim: To evaluate the diagnostic performance of commercially available rapid diagnostic tests (RDTs) compared with conventional peripheral smear microscopy. Methodology: A comparative, laboratory-based study was conducted at Nalanda Medical College and Hospital, Patna, India, including 90 clinically suspected malaria cases. Blood samples were tested using peripheral smear examination and RDTs targeting Plasmodium falciparum (Pf-HRP II) and Plasmodium vivax (PV-pLDH). Sen-sitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated. Results: Among 90 participants, peripheral smear detected 45 positive cases, while RDTs detected 48. Species-specific detection showed RDTs slightly outperformed microscopy for P. falciparum and P. vivax, with full concordance for mixed infections. RDTs demonstrated 95% sensitivity, 93% specificity, 89% PPV, 97% NPV, and 94% overall accuracy. Conclusion: RDTs offer a rapid, reliable, and practical diagnostic tool for malaria, particularly in resource-limited settings. Integrating RDTs with microscopy can enhance diagnostic accuracy, improve patient manage-ment, and support malaria control programs.

Background: Laparoscopic cholecystectomy (LC) is the treatment of first choice in the case of gallstone disease, whereas bile duct injury (BDI) remains the severe adverse event that has a high morbidity. Knowledge of modern incidences, risk factors and outcomes is crucial in enhancing patient management. Hypothesis: To retrospectively determine the incidence, nature and treatment of bile duct trauma in patients who undergo LC in a tertiary care hospital. Methodology: It is a retrospective observational study that analyzed 576 records of patients in ANMMCH, Gaya ji,Bihar. The data analyzed were demographic, clinical, and operative data. Strasberg-Bismuth and McMahon systems were used to classify BDIs. The relationship between risk factors and BDI was tested using Chi-square or Fisher exact tests (p≤0.05). Result: CBD damage was observed in 5 (0.9) patients. BDI was not significantly related to age, gender and most comorbidities except renal disease (p=0.024). After Strasberg-Bismah type A (60 percent), type D (20 percent), and type E1 (20 percent) ranked as the most frequent injuries, 60 percent were minor injuries, and 40 percent were major injuries per McMahon. ERCP and stenting were administered to control four patients, and one patient underwent surgical repair. A majority of the injuries were postoperative. Conclusion: BDI in LC is uncommon, yet of clinical significance. Kidney disease can be a risk factor, and injuries can be minor or severe. Timely identification, proper categorization, and specific management are essential to achieve the best results.

Background: Acute cholecystitis is a frequent cause of emergency abdominal admissions, with the standard treatment being LC. The best timing of the surgery, early versus delay remains open to question. Aim: To compare the clinical outcomes between early laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy in patients diagnosed with acute cholecystitis. Materials and Methods: A total of 160 patients aged between 18 and 70 years suffering from acute calculous cholecystitis presenting to ANMMCH, India, were prospectively subjected to ELC within 72 hours (n = 80) or DLC ≥6 weeks after initial conservative management (n = 80). Intraoperative and postoperative outcomes such as operative time, conversion to open surgery, complications, and hospital stay were recorded prospectively and analyzed using SPSS. Results: The mean operative time was significantly shorter in the ELC group: 58.6 ± 11.8 min versus DLC, 72.3 ± 14.1 min, p<0.001. Conversion rates, intraoperative bleeding, and bile duct injuries were comparable. Postoperatively, ELC was associated with significantly shorter hospital stay (3.0 ± 1.0 versus 5.4 ± 1.3 days, p<0.001) and a trend toward fewer complications. The readmission rates and specific postoperative complications were lower for ELC but did not reach statistical significance. Conclusion: Early laparoscopic cholecystectomy is safe, decreases operative time and hospital stay, has comparable complication rates to delayed surgery, and thus will remain the preferred approach in acute cholecystitis.

Background: Ovarian tumors are a diverse group of neoplasms that include benign, borderline, and malignant types, each with unique clinical presentations and prognoses. Despite advancements in oncology, ovarian tumors remain difficult to detect early, contributing to high morbidity and mortality rates. This study aims to analyze the clinical presentation and histopathological spectrum of ovarian tumors in a tertiary care setting. Aim: To investigate the distribution, histopathological characteristics, and clinical features of ovarian tumors in patients at a tertiary hospital. Methodology: A retrospective analysis of 120 patients diagnosed with ovarian tumors at Department of Obstetrics and Gynaecology, Nalanda Medical College and Hospital, Patna, India, was conducted. Data from clinical records, radiological findings, and histopathological reports were reviewed. Statistical analysis was performed using SPSS version 25. Results: Surface epithelial tumors (68.3%) were the most common, followed by germ cell tumors (28.3%) and sex-cord stromal tumors (3.3%). Among benign tumors, serous (37.5%) and mucinous (25%) were the most frequent. Borderline tumors made up 7.5%, with mucinous variants predominating. Malignant tumors were rare, with mucinous carcinoma being the most common. Conclusion: Surface epithelial tumors were the most prevalent, and benign tumors predominated in this cohort. Malignant cases, although less common, were diverse, emphasizing the need for early detection and appropriate management in ovarian tumor care.

Background: Abnormal uterine bleeding (AUB) in perimenopausal women may indicate underlying benign, premalignant, or malignant endometrial pathology. Transvaginal ultrasonography (TVS) provides a non-invasive method to assess endometrial thickness (ET) and predict histopathological abnormalities. Aim: To evaluate optimal endometrial thickness cut-offs using TVS for predicting abnormal endometrial histology in perimenopausal women with AUB. Methodology: In this cross-sectional study, 60 perimenopausal women with AUB underwent TVS and Doppler assessment of endometrial thickness and vascularity, followed by histopathological examination. ROC curve analysis determined the optimal ET cut-off for predicting abnormal endometrium, and logistic regression identified associated risk factors. Results: Abnormal endometrium was observed in 18/60 (30%) cases. Mean ET was significantly higher in abnormal (14.2 ± 3.9 mm) versus normal endometrium (7.85 ± 2.6 mm, p < 0.001). An ET cut-off >10.5 mm showed 77.8% sensitivity, 85.7% specificity, 70% positive predictive value, and 90% negative predictive value (AUC = 0.88). Age >45 years (OR = 3.9), obesity (BMI ≥30 kg/m², OR = 3.5), and ET >10.5 mm (OR = 18.7) were significant predictors of abnormal histology. Conclusion: TVS-measured endometrial thickness >10.5 mm is a reliable non-invasive predictor of histopathological abnormalities in perimenopausal women with AUB. Advanced age and obesity further increase risk, supporting targeted endometrial sampling in high-risk patients.

Aim: The aim of this study was to estimate and compare the effects of different dietary habits and habits related to physical activity in the development of overweight and obesity among rural school going adolescents. Methods: The prospective cross-sectional study which was carried in Department of Community Medicine, Bhagwan Mahavir Institute of Medical Sciences, (BMIMS), Pawapuri, Nalanda, Bihar, India. A prospective follow-up study was conducted among adolescents (14–18 years) studying at secondary and higher-secondary level (Classes IX to XII) in four selected school. The participants, who were permanent residents of the rural areas, were surveyed at the beginning, and a follow-up assessment was done after 6 months. Thus, two repeated measures were taken on each individual participant. A total of 100 participants (38 male and 62 female    respondents) were ultimately included in this study. Results: In the cumulative (overall)  model, intake of fast showed highest risk (3.15, 95% CI: 1.97–4.86) in favor of development of overweight. The risk estimate for fast food intake causing overweight was also the highest among the girls (4.60, 95% CI: 1.81–10.75). Those who had a regular intake of soft drinks were at 2.42 (95% CI: 1.52–3.88) times risk of getting overweight. In the GEE model for boys, older age did not have any statistically significant effect. However, similar to the cumulative model fruit and vegetables ingestion, soft drinks, and fast food, intake did have a statistically significant relationship. Among the boys, the maximum risk was observed with eating less vegetable (4.75, 95% CI: 1.95–11.80). In case of the girls, risk of older girls becoming overweight was 5.12 (95% CI: 1.82–14.69). While none of the variables related to physical activity were significant statistically in any of the models, inadequate daily work was observed to have statistically significant risk of 2.59 (95% CI: 1.22–5.67). Eating less vegetable was not statistically significant among girls. However, intake of soft drinks had a risk (4.50, 95% CI: 1.94–10.60) comparable to that of fast-food intake. Overall unhealthy dietary habit was found to contribute a risk of 8.73 (95% CI: 5.49–13.91), which was higher compared to risk contributed by inadequate physical activity (6.69, 95% CI: 3.83–10.94). Both these risks increase in boys and girls separately. Conclusions: Strong evidence was generated of dietary practices being more rigidly related to overweight among the adolescents. Healthy dietary practices coupled with physical activity should be promoted to mitigate the risk of obesity.

Aim: Nutritional factors affecting the prevalence of anemia among pregnant women in bihar region. Methods: A cross-sectional study was conducted at Department of Community Medicine, Bhagwan Mahavir Institute of Medical Sciences, (BMIMS), Pawapuri, Nalanda, Bihar, India. All pregnant women registered at UHTC and RHTC were assessment of micronutrient intake on the prevalence of anemia amongst pregnant women. Sahli’s method was used to estimate the concentration of hemoglobin in capillary blood. Results: Majority (86.5%) of the women get married between ages 20-30 years. Overall, more than half (64%) of the respondents belonged to Hindu and 36% were Muslims. The overall prevalence of anemia was 70% among the pregnant women. The moderate anemia was found in 43.57% women; mild anemia was 47.14% and severe anemia was 9.29% (table 2). The calorie intake was significantly (p<0.0001) lower in anemic women (1841.59 ± 259.8) as compared to non-anemic women (2322.17 ± 309.07). The protein intake was significantly (p<0.0001) lower in anemic women (35.78 ± 10.03) as compared to non- anemic women (43.21 ± 10.74). The fat intake was significantly (p<0.0001) lower in anemic women (35.24 ± 10.26) as compared to non-anemic women (41.12 ± 12.12). The iron intake was significantly (p<0.0001) lower in anemic women (25.12 ± 5.08) as compared to non-anemic women (26.84 ± 6.73). The folic acid intake was significantly (p<0.0001) lower in anemic women (132.54 ± 32.74) as compared to non-anemic women (145.42 ± 40.15). Conclusion: The micronutrient intake was lower in the studied population and it was found to be significantly associated with problem of anemia amongst pregnant women.

Background: The place of delivery is a critical determinant of maternal and neonatal health outcomes. Despite efforts ^‘to promote institutional deliveries, a significant proportion of women in developing regions continue to deliver at home due to multiple interrelated factors. Aim: To assess the factors associated with home versus institutional deliveries among recently delivered women. Methodology: A community-based cross-sectional study was conducted among 90 women who had delivered within the past one year in the field practice area of the Department of Community Medicine, BMIMS, Pawapuri, Bihar. Data were collected using a structured questionnaire covering socio-demographic variables, antenatal care (ANC) utilization, education, accessibility, and awareness-related factors. Data were analyzed using SPSS version 27, and associations were tested using the Chi-square test. Results: Institutional delivery was reported by 62.2% of participants, while 37.8% had home deliveries. Maternal education and adequate ANC visits (≥4) showed a statistically significant association with institutional delivery (p < 0.05). Awareness of government maternity schemes, availability of transportation, proximity to health facilities, and family decision-making also influenced the place of delivery. Conclusion: Institutional delivery was more common, but home deliveries remain substantial. Strengthening ANC coverage, female education, awareness, and access to services is essential to improve institutional delivery rates.

Background: post-operative pain remains inadequately managed in many patients despite advances in anesthesia and analgesic techniques. Poor pain control adversely affects patient comfort, sleep quality, early mobilization, recovery, and satisfaction, highlighting the need to evaluate existing pain management practices. Objectives: To assess post-operative pain intensity, analgesic requirements, patient satisfaction, and analgesic-related complications in patients undergoing major surgical procedures. Methods: A prospective observational study was conducted over four months in the Department of Anesthesiology at various tertiary centre in Ranchi, Jharkhand India. One hundred adult patients undergoing major surgeries across various specialties were included. Data were collected from case records and bedside assessments in the post-operative ward. Variables recorded included demographic details, surgical and anesthetic characteristics, analgesic modalities used, pain intensity, sleep quality, patient satisfaction, delays in analgesic administration, and adverse effects. Data were analyzed using descriptive statistics. Results: A significant proportion of patients experienced moderate to severe post-operative pain at rest and during movement. Poor sleep quality due to pain was reported by more than half of the patients. Transdermal fentanyl patches were the most used adjunctive analgesic modality, while epidural analgesia, regional nerve blocks, and patient-controlled analgesia were underutilized. Only one-third of patients were fully satisfied with pain management, and 16% reported delays in receiving analgesics. Analgesic-related adverse effects, particularly drowsiness and postoperative nausea and vomiting, were frequently observed. Conclusion: Post-operative pain management was suboptimal. A structured, protocol-based acute pain service emphasizing standardized pain assessment, multimodal analgesia, and timely intervention is required to improve patient outcomes.

Background: Placenta previa is a major cause of antepartum hemorrhage and remains an important contributor to maternal and perinatal morbidity and mortality, especially in low-resource settings. Aim: To evaluate feto-maternal outcomes in cases of placenta previa admitted to the labour room of a tertiary care hospital. Methodology: A prospective observational study was conducted over one year in the Department of Obstetrics and Gynaecology, PMCH, Patna. Eighty pregnant women with ultrasonographically confirmed placenta previa (≥28 weeks gestation) were included. Maternal demographics, risk factors, obstetric complications, mode of delivery, and neonatal outcomes were recorded and analyzed using descriptive statistics. Results: Most women were aged 25–30 years (40%) and multigravida (67.5%). Previous cesarean section was noted in 47.5%. Antepartum hemorrhage occurred in 57.5% and postpartum hemorrhage in 35% of cases. Blood transfusion was required in 42.5%, and 65% underwent emergency cesarean section. Preterm delivery occurred in 45% of cases, low birth weight in 42.5%, and NICU admission in 37.5%. The perinatal mortality rate was 7.5%. Conclusion: Placenta previa is associated with significant maternal hemorrhagic morbidity and adverse neonatal outcomes. Early diagnosis, adequate antenatal care, and planned delivery in tertiary centers are essential to improve feto-maternal outcomes.

Background: Polypharmacy is increasingly prevalent among older adults due to rising multimorbidity and is associated with adverse drug events and increased healthcare utilization. Evidence from low- and middle-income settings remains limited. Aim: To evaluate the association between polypharmacy and healthcare utilization outcomes, including emergency department (ED) visits, hospitalizations, pneumonia-related care, and mortality among older adults. Methodology: A retrospective observational cohort study was conducted using medical records of 192 patients aged ≥65 years at Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India. Polypharmacy was defined as the use of five or more medications. Healthcare utilization outcomes were assessed over a three-year follow-up. Multivariable logistic regression adjusted for age, gender, smoking, depression, and comorbidity burden was performed. Results: Polypharmacy was present in 59.4% of participants and was associated with older age, higher comorbidity burden, smoking, and depression. After adjustment, polypharmacy was independently associated with higher odds of recurrent all-cause ED visits (aOR 2.41), hospitalizations (aOR 2.18), pneumonia-related ED visits (aOR 1.97), pneumonia hospitalizations (aOR 2.63), and mortality (aOR 2.12). Conclusion: Polypharmacy is an independent predictor of increased healthcare utilization and mortality in older adults, highlighting the need for regular medication review and optimization.

Background: Drug-induced liver injury (DILI) is an important cause of liver disease with variable clinical presentations, ranging from mild enzyme elevation to acute liver failure. Limited region-specific data exist on the spectrum of DILI in tertiary care settings. Aim: To evaluate the demographic profile, clinical features, implicated drugs, histopathology, management, and outcomes of DILI in patients admitted to a tertiary care hospital. Methodology: A retrospective observational study was conducted at Darbhanga Medical College and Hospital, India, including 150 patients diagnosed with DILI. Data on demographics, clinical presentation, laboratory tests, drug history, histopathology, and outcomes were extracted from hospital records. Causality was assessed using the RUCAM scale. Descriptive statistics summarized findings. Results: The mean age was 51 ± 11 years, with 56% males. Jaundice (65.3%), fatigue (50.7%), and abdominal pain (45.3%) were common. Hypertension (24%) and diabetes (18%) were frequent comorbidities. Antibiotics (32%), NSAIDs (24.7%), and herbal supplements (17.3%) were the most implicated drugs. Mean ALT and AST were markedly elevated (820 ± 390 U/L and 700 ± 340 U/L, respectively). Liver biopsy showed hepatocellular injury (45%), cholestatic (35%), and mixed patterns (20%). Management involved discontinuation of offending drugs (100%) and supportive care; 8 patients underwent liver transplantation, and 12 (8%) died. Conclusion: DILI exhibits diverse clinical and histopathological patterns. Prompt drug withdrawal and supportive care are essential, though severe outcomes, including transplantation and mortality, may occur.

Background: Anaemia emanates as a common hematological disease of varied aetiologies. The peripheral smear morphological classification and ^‘those of the red cell and platelet indices have been used as a quick and economical method of diagnosis particularly in areas with limited resources. The combination of the two modalities can complement the diagnostic sensitivity and knowledge on the type of anaemia. Aim: To find out the frequency of morphological types of anaemia and correlate it with red blood cell indices (MCV, MCH, MCHC, RDW) and platelet indices (PLT, MPV PDW) of adult patients with anaemia. Methodology: The study is a cross-sectional observational study and involved 350 anaemic patients aged between 18and 65 years and carried out in the Department of Pathology, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India between 6 months. A 5-part automated haematology analyser is utilized to study blood samples, and the morphology of anaemia is studied through microscopically examining peripheral blood smears. ANOVA and chi-square test are used to compare the red cell and platelet indices of groups of microcytic hypochromic, normocytic, normochromic, and macrocytic anaemia. Results:  Study stated that 60.6 percent of 350 patients were women and 39.4 percent males, and with a mean age of 34.8 years. Most common (48.6 per cent) was microcytic hypochromic anaemia with normocytic coming second (34.3 per cent) and macrocytic anaemia third (17.1 per cent). There was a significant difference in red cell indices of differently typed anaemia (p < 0.001) with RDW being significantly higher in both microcytic and macrocytic types of anaemia. Difference between groups was also found in platelet indices (MPV, PDW), the highest PDW was observed in macrocytic anaemia (p < 0.01). Conclusion: It can be proposed that the combination of morphological classification and indices of red cells and platelets would provide a more strong and cost-efficient means of providing an evaluation of the state of anaemia. Such combined philosophy enhances a more accurate diagnosis and may direct early and selective treatment, especially in a situation of^’ scarce diagnostic facilities.

Background: Vesiculobullous disorders are a heterogeneous group of blistering diseases with overlapping clinical features, often requiring histopathology and direct immunofluorescence (DIF) for accurate diagnosis. Aim: To study the clinicopathological spectrum of vesiculobullous disorders and evaluate the diagnostic utility of histopathology and DIF. Methodology: A prospective observational study was conducted on 90 newly diagnosed patients with vesiculobullous lesions at Narayan Medical College and Hospital, Jamuhar, Rohtas, Bihar, India. Detailed clinical evaluation was followed by histopathological examination using H&E staining and DIF analysis. Clinicopathological and immunofluorescence correlation was performed, and data were analyzed using descriptive statistics. Results: Most patients were middle-aged adults (41–60 years), with male predominance and rural representation. Pemphigus vulgaris (37.8%) was the most common disorder, followed by bullous pemphigoid (28.9%). Intraepidermal and subepidermal blisters were almost equally distributed. DIF showed higher diagnostic concordance (83 cases) compared to histopathology alone (76 cases), with IgG and C3 being the most frequent immunoreactants. Conclusion: An integrated clinicopathological approach with DIF significantly improves diagnostic accuracy in vesiculobullous disorders and is essential for optimal patient management.

Background: Chronic low back pain (CLBP) is a major global health problem strongly associated with core muscle weakness, impaired postural control, and altered neuromuscular coordination. Conventional core exercises improve symptoms but often neglect respiratory–postural integration. Aim: To compare the effects of Dynamic Neuromuscular Stabilization (DNS) and conventional core exercises on core muscle weakness, postural control, pain intensity, and disability in individuals with CLBP. Methodology: A single-blinded randomized controlled trial was conducted among 90 individuals with non-specific CLBP. Participants were randomly allocated to either the DNS group or the conventional core exercise group (n = 45 each). Both groups underwent 12 supervised exercise sessions over a four-week period. Outcome measures included ultrasound-based percent change in transversus abdominis, lumbar multifidus, and diaphragm muscle thickness; postural control parameters assessed using a computerized balance system; pain intensity measured using the Visual Analog Scale; and functional disability assessed using the Oswestry Disability Index and Roland–Morris Disability Questionnaire. Results: Both groups demonstrated significant post-intervention improvements across all outcomes. However, the DNS group showed significantly greater increases in deep core muscle thickness, superior improvements in postural control, and larger reductions in pain and disability scores compared to the control group (p < 0.001). Conclusion: Dynamic Neuromuscular Stabilization is more effective than conventional core exercises in improving deep core muscle function, postural stability, and clinical outcomes in individuals with chronic low back pain.

Background: Bronchial asthma is a common chronic respiratory disorder in children, influenced by genetic predisposition and environmental exposures. Identification of risk and triggering factors is essential for effective prevention and management. Aim: To evaluate the risk and triggering factors associated with bronchial asthma in children attending a tertiary care hospital in Bihar, India. Methodology: A hospital-based descriptive observational study was conducted over one year at Patna Medical College and Hospital. Eighty-two children aged 1–16 years with clinically diagnosed bronchial asthma were enrolled. Data on demographics, family history, environmental exposures, dietary habits, physical factors, and triggers were collected using structured proforma. Clinical examination, peak expiratory flow measurement, bronchodilator reversibility testing, and supportive laboratory investigations were performed. Results: Environmental factors were the most prevalent risk contributors (45.1%), including exposure to allergens, pollution, seasonal changes, and passive smoking. Dietary factors accounted for 23.2% of cases, physical factors 18.3%, family history 7.3%, and miscellaneous/emotional triggers 6.1%. Common triggers included respiratory infections, cold air, allergens, and physical exertion. Conclusion: Childhood bronchial asthma results from a multifactorial interplay of environmental, dietary, physical, genetic, and emotional factors. Targeted interventions addressing these determinants are essential for effective prevention and management.

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance and hyperglycemia, with increasing prevalence worldwide. Effective management often requires pharmacotherapy tailored to patient-specific factors. Aim: To evaluate the prescribing patterns of antidiabetic drugs in patients with T2DM and assess associated comorbidities. Methodology: A prospective observational study was conducted over 7 months at Darbhanga Medical College and Hospital, Bihar, India. Ninety patients with T2DM receiving antidiabetic therapy for at least one month were enrolled. Data on demographics, prescribed medications, combination therapies, and comorbid conditions were collected using a structured proforma and analyzed with SPSS v22. Results: Among 90 patients, 57.78% were male, and 43.33% were aged 41–60 years. Oral monotherapy was prescribed to 31.11%, injectable monotherapy to 52.22%, while multi-drug combinations (five or six drugs) were used in over 60% of patients, indicating a high reliance on polypharmacy. Hypertension (40%) and dyslipidemia (33.33%) were the most common comorbidities, with dyslipidemia showing a significant association (p < 0.05). Conclusion: The study highlights prevalent polypharmacy and the need for individualized treatment strategies in T2DM patients. Comprehensive management addressing both glycemic control and comorbidities is essential for optimizing clinical outcomes.

Background: Traumatic ^“spinal injuries are a major cause of morbidity and long-term disability. Surgical spinal instrumentation has become a key modality for managing unstable spinal fractures, aiming to improve neurological, radiological, and functional outcomes. Aim: To evaluate the neurological, radiological, and functional outcomes of posterior spinal instrumentation in patients with traumatic spinal injuries. Methodology: This hospital-based prospective observational study included 90 adult patients with radiologically confirmed unstable traumatic spinal injuries treated with posterior pedicle screw instrumentation. Neurological status was assessed using the ASIA impairment scale, while radiological parameters and functional outcomes were evaluated pre-operatively and during follow-up. Results: The majority of patients were males (80%) aged 31–45 years, with falls being the most common mode of injury. Thoracolumbar injuries and burst fractures predominated. Significant neurological improvement was observed, with increased ASIA Grade D and E patients at follow-up. Radiological outcomes showed marked improvement in vertebral body height loss, kyphotic angle, and spinal canal compromise (p < 0.001). Functional improvement was seen in 71.1% of patients, with a low complication rate. Conclusion: Posterior spinal instrumentation provides effective stabilization, significant radiological correction, favorable neurological recovery in incomplete injuries, and improved functional outcomes in traumatic spinal injuries.

Background: Cutaneous leishmaniasis (CL) is a neglected vector-borne disease with diverse clinical manifestations and diagnostic challenges. Integrated clinical, parasitological, and molecular characterization is essential for accurate diagnosis and control. Aim: To assess the clinical, parasitological, and molecular profiles of CL and identify associated risk factors among suspected patients. Methodology: A hospital-based cross-sectional study was conducted on 165 clinically suspected patients at Department of Microbiology, Darbhanga Medical College and Hospital, Bihar,India.  Clinical examination, Giemsa smear microscopy, culture on NNN medium, and ITS-1 PCR were performed. Socio-demographic and environmental factors were analyzed using logistic regression. Results: Most patients were male (63%), aged 15–29 years (35.2%), and rural residents (72.1%). Ulcerative lesions (52.7%) and facial involvement (43%) predominated. Overall parasitological confirmation was 73.3%. PCR detected infection in 64.2%, identifying L. tropica (35.8%), L. major (23%), and L. donovani complex (5.5%). PCR showed highest sensitivity (95%) and specificity (88.6%). Rural residence (AOR 3.28), sleeping outdoors (AOR 3.96), nearby animal shelters (AOR 2.63), and vegetation (AOR 2.41) increased risk, while regular bed-net use was protective (AOR 0.36). Conclusion: CL predominantly affects rural young adults and is strongly influenced by environmental exposure. Molecular diagnosis improves detection and species identification, supporting targeted prevention and control strategies.

Background: Candidemia ^‘is a serious healthcare-associated bloodstream infection with high morbidity and mortality, particularly among critically ill and immunocompromised patients. Changing species epidemiology and rising antifungal resistance necessitate continuous local surveillance. Aim: To analyze the epidemiology, risk factors, species distribution, antifungal susceptibility patterns, and clinical outcomes of candidemia cases in a tertiary care hospital. Methodology: A retrospective observational study was conducted on 90 laboratory-confirmed candidemia cases at Department of Microbiology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India. Demographic details, risk factors, Candida species identification, antifungal susceptibility profiles, and clinical outcomes were analyzed using descriptive statistics. Results: Most patients were aged 41–60 years (34.4%) and admitted to the ICU (57.8%). Candida albicans was the most common isolate (37.8%), while non-albicans Candida species collectively predominated. Prolonged antibiotic use (67.8%) and central venous catheterization (53.3%) were major risk factors. Echinocandins and amphotericin B showed high susceptibility (>90%), whereas azole resistance was notable. Recovery occurred in 63.3% of patients, while mortality was 21.1%. Conclusion: Candidemia remains a life-threatening infection with shifting species patterns and significant azole resistance, underscoring the need for early^’ diagnosis, species identification, and antifungal stewardship.

Background: Breast cancer is a biologically heterogeneous malignancy, requiring precise diagnostic and prognostic tools. Immunohistochemistry (IHC) facilitates tumor characterization by evaluating hormone receptor and HER2/neu status, guiding therapy and prognosis. Aim: To assess the clinical and prognostic significance of IHC markers in invasive breast carcinoma and their correlation with tumor grade, molecular subtype, and lymph node involvement. Methodology: A retrospective observational study was conducted on 40 female patients with histologically confirmed breast carcinoma at Bhagwan Mahavir Institute of Medical Sciences, Bihar, India. Formalin-fixed, paraffin-embedded tissue samples were analyzed for ER, PR, and HER2/neu expression using standardized IHC protocols. Data on tumor characteristics, grade, lymph node status, and molecular subtype were collected and statistically analyzed. Results: ER and PR positivity were observed in 65% and 55% of cases, respectively, while HER2/neu overexpression occurred in 25%. Luminal A (35%) and Luminal B (30%) were the predominant molecular subtypes. Hormone receptor expression declined with increasing tumor grade, whereas HER2 positivity increased. Lymph node involvement was higher in HER2-enriched and Luminal B tumors. Conclusion: IHC is a valuable diagnostic and prognostic tool in breast cancer, enabling accurate tumor subtyping, risk stratification, and personalized therapy, especially in resource-limited settings.

Background: Postdated pregnancy, defined as gestation extending beyond 40 completed weeks, is a common clinical scenario associated with increased risks of maternal morbidity, obstetric interventions, and adverse perinatal outcomes. Careful monitoring and timely obstetric decision-making are crucial in reducing complications. Clinicopathological assessment of maternal and fetal outcomes in postdated pregnancies helps in understanding local trends and guides evidence-based management strategies. Aim and Objectives: The present study aimed to evaluate the maternal and fetal clinicopathological profile of postdated pregnancies, to assess the mode of delivery, intrapartum and postpartum complications, and perinatal outcomes. Materials and Methods: This prospective observational study was conducted in the Department of Obstetrics & Gynecology, Anugrah Narayan Magadh Medical College & Hospital, Gaya, Bihar,India, from July 2024 to October 2025. A total of 126 women with postdated pregnancy (sample size within 100–150) admitted during the study period were included. Detailed clinical histories, maternal demographic data, parity, and gestational age at delivery were recorded. All patients underwent routine antenatal investigations, ultrasonographic evaluation, and fetal monitoring. Mode of delivery, intrapartum events, placental and cord examination, neonatal outcomes, and need for NICU admission were analyzed. Data were expressed as frequencies, percentages, means, and standard deviations. Results: The mean maternal age was 26.8 ± 4.1 years, with most women in the 21–30 years age group. Multiparas formed the majority. The mean gestational age at delivery was 41.6 weeks, with the largest proportion delivering between 41–41+6 weeks. Common maternal complications included oligohydramnios, meconium-stained liquor, and prolonged labor. Induction of labor was required in 62.7% of cases, while 34.1% underwent cesarean delivery, most often for fetal distress. Placental examination revealed features of infarction and meconium staining in a subset. Neonatal outcomes showed that 18.3% had low birth weight (<2.5 kg), and 21.4% required NICU admission, mainly due to birth asphyxia and meconium aspiration. Perinatal morbidity was observed in 23.8%, while perinatal mortality was 3.9%. Conclusion: Postdated pregnancy is associated with increased maternal interventions and perinatal risks, predominantly due to placental insufficiency and meconium-related complications. Careful antenatal surveillance, timely induction, and judicious obstetric decision-making are vital to optimize outcomes. Histopathological examination of placenta and membranes provides valuable insight into the underlying pathophysiological changes.

Background: Hysterectomy is one of the most frequently performed gynaecological surgical procedures worldwide, indicated for a wide range of benign and malignant conditions. Histopathological examination of hysterectomy specimens provides a definitive diagnosis, helps confirm the preoperative clinical impression, and reveals incidental pathologies that may have prognostic implications. A retrospective evaluation of hysterectomy specimens offers insights into the disease spectrum prevalent in a particular population, aiding clinicians in tailoring preventive and therapeutic strategies. Aim and Objectives: The present study aimed to analyze the histopathological spectrum of gynaecological hysterectomy specimens over a one-year period in a tertiary care hospital and to correlate findings with clinical indications. Materials and Methods: This retrospective observational study was conducted in the Department of Obstetrics & Gynecology, Anugrah Narayan Magadh Medical College & Hospital, Gaya, Bihar, India from November 2024 to October 2025. A total of 120 hysterectomy specimens (sample size chosen between 100–150) received during the study duration were included. Relevant demographic and clinical details were retrieved from hospital records. All specimens were fixed, processed, and examined histopathologically. The lesions were categorized based on uterine, cervical, ovarian, and adnexal pathologies, and findings were correlated with clinical indications. Results: Out of 120 hysterectomy specimens, the majority were performed for benign indications. The most common histopathological finding was leiomyoma (uterine fibroid), followed by adenomyosis and endometrial hyperplasia. Among cervical pathologies, chronic cervicitis was predominant, while incidental cases of cervical intraepithelial neoplasia (CIN) were also detected. Ovarian lesions included benign cysts such as serous and mucinous cystadenomas. Malignant conditions constituted a minority, comprising endometrial carcinoma and ovarian malignancies. A few specimens showed more than one coexisting pathology. Conclusion: Histopathological evaluation of hysterectomy specimens remains indispensable in confirming the preoperative clinical diagnosis, detecting unexpected lesions, and ensuring appropriate follow-up, especially in cases with premalignant or malignant potential. The findings of this study underscore the predominance of benign uterine conditions as indications for hysterectomy in our setup, while also highlighting the importance of careful pathological examination to identify incidental significant lesions.

Background: Breast cancer is the most common malignancy among women in India, with rural populations often presenting at advanced stages due to limited healthcare access. Tumor grade, clinical stage, and hormone receptor status (ER, PR, HER2) are critical prognostic and therapeutic indicators. Aim: To evaluate the correlation between histopathological grade, clinical stage, and hormone receptor status in breast carcinoma patients from a rural Indian population. Methodology: A retrospective observational study was conducted on 70 female breast cancer patients at Department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar. Tumor grading was performed using the Nottingham system, clinical staging by AJCC criteria, and hormone receptor status determined by immunohistochemistry. Associations were analyzed using Chi-square tests. Results: Most tumors were Grade II (54.3%) and Stage II (50%). ER and PR positivity declined with increasing grade and stage: Grade I tumors were ER/PR-positive in 86%/79%, decreasing to 33%/39% in Grade III; Stage I tumors were ER/PR-positive in 80%/70%, dropping to 25% in Stage IV. HER2 positivity increased with grade and stage, highest in Grade III (39%) and Stage III (35%). Conclusion: Higher tumor grade and advanced stage are associated with hormone receptor negativity and increased HER2 expression. These findings underscore the importance of integrating receptor profiling with clinicopathological evaluation to guide prognosis and personalized therapy in rural populations.

Background: Anemia is a common comorbidity among hospitalized patients and is associated with adverse clinical outcomes. Iron deficiency anemia (IDA) and anemia of chronic disease (ACD) are the most prevalent subtypes, yet their comparative prevalence and outcomes in general inpatients are not well defined. Aim: To compare the prevalence and clinical outcomes of IDA and ACD using basic laboratory markers in hospitalized adults. Methodology: This retrospective observational study included 288 anemic adults admitted in Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India. Patients were classified as IDA (n=124) or ACD (n=164) based on hemoglobin, ferritin, iron indices, and C-reactive protein. Clinical outcomes assessed were length of hospital stay, 30-day readmission, and in-hospital mortality. Results: ACD was more prevalent than IDA (56.9% vs. 43.1%) and affected older patients with higher comorbidity burden. ACD patients had significantly longer hospital stays (8.0 vs. 6.0 days), higher 30-day readmission rates (25.0% vs. 14.5%), and greater in-hospital mortality (8.5% vs. 3.2%). Laboratory markers clearly differentiated IDA (microcytosis, low ferritin) from ACD (elevated ferritin, high CRP). Conclusion: ACD is more common than IDA in hospitalized adults and is associated with poorer short-term clinical outcomes. Basic laboratory markers are effective for anemia subtype differentiation and risk stratification.

Background: Surgical Site Infections (SSIs) remain a major postoperative complication contributing to morbidity, prolonged hospitalization, and increased healthcare costs. Despite advancements in surgical practices, SSIs continue to challenge infection control globally, especially in resource-limited settings. Aim: To classify SSIs, identify associated risk factors, and evaluate clinical management and microbial patterns among postoperative patients. Methodology: A hospital-based observational study was conducted in the Department of General Surgery, Netaji Subhas Medical College and Hospital, Jamshedpur, Jharkhand, including 80 postoperative patients with SSIs. Cases were classified using CDC criteria, and data on risk factors, microbial isolates, and antibiotic sensitivity were analyzed using SPSS v27. Results: Middle-aged males (41–60 years) were most affected. Gastrointestinal and general surgeries showed the highest SSI incidence. Superficial incisional infections (52.5%) predominated, followed by deep (28.8%) and organ-space (18.7%) infections. Major risk factors included prolonged surgery (32.5%), diabetes (27.5%), and emergency procedures (25%). Staphylococcus aureus (37.5%) was the most common isolate, highly sensitive to Vancomycin and Linezolid. Conclusion: SSIs are multifactorial, with patient comorbidities and procedural variables playing crucial roles. Continuous surveillance, aseptic techniques, and culture-guided antibiotic therapy are essential to minimize infection rates and improve surgical outcomes.

Background: The above ^‘factors of surgical procedures are a significant burden to a patient, and the final outcomes will also depend not only on the extent of the skills of a surgeon but also on the quality of perioperative nursing services. The use of comprehensive nursing care (CNC) encompassing physical, psychological and educational support has resulted in becoming a way of enhancing patient recovery as opposed to the traditional nursing care (CoNC). Aim: The purpose of the study is to compare the efficacy of preoperative and postoperative comprehensive nursing care with that of the conventional nursing care to determine the enhancement of surgical recovery, psychological well-being, and patient satisfaction. Methodology: A comparative observational study has been done on 90 surgical patients, the Department of General Surgery, Netaji Subhas Medical College and Hospital, Jamshedpur, Jharkhand, India. The groups of patients were equally split into CoNC and CNC. The SPSS v27.0 was used to analyze the data of recovery rate, anxiety, depression, complications, and satisfaction. Results: CNC patients had significantly reduced hospital stay (7.6 vs. 10.2 days), less anxiety and depression, less postoperative pain and complications, quicker ambulation and greater patient satisfaction (p < 0.05). Conclusion: Comprehensive nursing care substantially improves surgical recovery, psychological stability, and overall satisfaction. Its integration into perioperative practice enhances holistic healing and should be prioritized in modern surgical care.

Background: Labor monitoring is critical to prevent maternal and fetal complications arising from abnormal labor patterns. The Partograph is a graphical tool designed to track labor progress, enabling early identification of deviations and timely interventions. Aim: To evaluate the effectiveness of the Partograph in monitoring labor patterns and improving maternal outcomes. Methodology: A prospective observational study was conducted at Nalanda Medical College & Hospital, Patna, India, over 7 months, including 80 term primigravida and multigravida women with singleton pregnancies and spontaneous labor. Labor was monitored using the WHO Modified Partograph, documenting cervical dilatation, fetal descent, uterine contractions, fetal heart rate, and maternal parameters. Maternal outcomes and mode of delivery were recorded. Statistical analyses included ANOVA, unpaired t-tests, and chi-square tests. Results: Normal labor predominated in Zone A (96.8%), with higher abnormal labor incidence in Zones B and C. Abnormal labor had significantly longer durations (16.8 ± 2.41 hours vs. 9.48 ± 2.35 hours; p < 0.001) and higher maternal morbidity, including fever (33.3% vs. 2.9%), wound sepsis (16.7% vs. 0%), and blood transfusion (8.3% vs. 1.5%). Effective Partograph use correlated with higher vaginal delivery rates, while inadequate monitoring was associated with increased cesarean and instrumental interventions. Conclusion: The Partograph is an effective tool for early detection of abnormal labor patterns, guiding timely interventions, improving maternal outcomes, and promoting safe childbirth.

Background: Cervical cancer remains a major public health problem in India, largely caused by persistent Human Papillomavirus (HPV) infection. Despite availability of effective vaccines, uptake remains low, largely influenced by guardians’ awareness and perceptions. Aim: To assess awareness and acceptance of HPV vaccination among guardians of adolescent girls and identify factors influencing acceptance. Methodology: A hospital-based cross-sectional study was conducted among 1,240 guardians of girls aged 9–17 years attending the Obstetrics and Gynecology outpatient department of Nalanda Medical College & Hospital, Patna. Data were collected using a structured questionnaire. Descriptive statistics, Chi-square test, Wilcoxon rank-sum test, and multivariable logistic regression were applied. Results: Overall vaccine acceptance was 70.8%. Awareness was moderate: 71.3% had heard of HPV and 82.6% knew vaccination prevents cervical cancer, but only 41.8% knew the recommended vaccination age. Acceptance was significantly associated with higher education (OR 1.86), urban residence (OR 1.34), high knowledge (OR 2.74), perceived infection risk (OR 3.21), and doctor recommendation (OR 4.08), while safety concerns reduced acceptance (OR 0.58). Conclusion: Although acceptance was favorable, knowledge gaps and safety concerns persist. Physician counseling and targeted awareness programs can significantly improve HPV vaccine uptake.

Background: Axillary brachial plexus block is widely used for upper-limb surgeries. Selection of local anaesthetic influences onset, duration of block and safety. Bupivacaine provides prolonged blockade but has toxicity concerns, whereas ropivacaine offers improved safety and differential block. Aim: To compare clinical efficacy and safety of 0.5% bupivacaine and 0.5% ropivacaine in axillary brachial plexus block. Methodology: A prospective randomized study was conducted on 60 ASA I–II patients undergoing elective upper-limb surgery. Patients received either 30 ml 0.5% bupivacaine (Group B, n=30) or 30 ml 0.5% ropivacaine (Group R, n=30). Onset and duration of sensory and motor block, duration of analgesia, hemodynamics and adverse effects were assessed and statistically analyzed. Results: Groups were demographically comparable. Sensory onset (7.9±1.9 vs 11.9±2.4 min) and motor onset (15.0±3.3 vs 23.8±4.1 min) were faster with ropivacaine (p<0.001). Bupivacaine produced longer sensory (452.2±48.3 vs 419.6±36.8 min) and motor block (410.6±52.1 vs 368.4±39.6 min) (p<0.01). Duration of analgesia was similar (~8.5 h). Hemodynamics and complications were comparable. Conclusion: Both drugs are safe and effective. Ropivacaine provides faster onset and earlier motor recovery, while bupivacaine offers prolonged blockade.

Background: Lymphomas represent a heterogeneous group of lymphoid malignancies with diverse histological and immunophenotypic profiles. Accurate classification is essential for diagnosis, prognostication, and therapy. Aim: To perform a comparative analysis of lymphoma variants based on histological features and immunohistochemical (IHC) profiling. Methodology: This hospital-based cross-sectional study included 80 lymph node biopsy cases diagnosed as lymphoma at the Department of Pathology, Phulo Jhano Medical College, Dumka, Jharkhand, over 8 months. Specimens were processed for histology using Hematoxylin and Eosin staining and further analyzed with an IHC panel including CD3, CD15, CD20, CD30, LCA, Bcl-2, and Pancytokeratin. Lymphomas were classified according to the 2017 WHO criteria, and data were analyzed descriptively using SPSS v27. Results: Non-Hodgkin lymphomas (NHL) comprised 71.3% of cases, with Diffuse Large B-Cell Lymphoma (DLBCL) being predominant (35%). Hodgkin lymphomas (HL) represented 28.7%, mainly classical HL. IHC profiling showed CD20 and LCA positivity in NHL, while CD15 and CD30 were characteristic of HL. A male predominance (62.5%) and peak incidence in the 41–60 years age group were observed. Conclusion: Histological assessment combined with IHC profiling is critical for accurate subclassification of lymphoma variants, guiding targeted therapy and prognostication.

Background: The phenomenon of anaemia in pregnancy is among the primary issues of the population health that requires monitoring in low-resource environments because of the high susceptibility of mothers and fetuses to the disease and the high nutritional requirements. Aim: To estimate the prevalence rates of anemia among pregnant women and assess the relationship between anemia and maternal and infant outcomes. Methodology: A prospective observational research design was used on 100 expectant women who visited the Department of Obstetrics and Gynaecology at Nalanda Medical College and Hospital, Patna. Participants who had valid CBC reports were classified according to the WHO hemoglobin criteria. A structured questionnaire was used in obtaining sociodemographic, obstetric, dietary, and clinical data. The Chi-square test was used to make associations between anemia and other factors, such as unfavorable perinatal outcomes. Findings: Younger maternal age, rural life, low level of education, low income, vegetarian diet, low frequency of consuming fruit and vegetables, and consumption of tea/coffee after meals were strongly related to anemia. Deficiency in iron supplements, past anemia and low birth intervals were also contributing factors. There were increased rates of pre-term labor, postpartum bleeding, ICU stay, low birth weight, pre-term birth and fetal distress (p < 0.05) among women who were anemic. Conclusion: Anemia in pregnancy is multi-factorial and has a significant impact on adverse perinatal outcomes. It is crucial to reinforce nutritional education, iron supplementation and specific antenatal care.

Background: Fungal keratitis is a major cause of corneal blindness in tropical regions, often resulting from trauma and delayed diagnosis. Sri Krishna Medical College & Hospital (SKMCH), Muzaffarpur, serves a largely rural population at risk due to agricultural exposure. Aim: To evaluate the clinical features, microbiological profile, and risk factors of fungal keratitis in patients presenting with corneal ulcers at SKMCH. Methodology: A prospective cross-sectional study was conducted over seven months, including 60 patients with suspected fungal keratitis. Detailed clinical evaluation and corneal scrapings were performed. Samples were analyzed via KOH and Gram stains and cultured on blood agar, chocolate agar, and Sabouraud’s Dextrose Agar. Fungal isolates were identified based on colony morphology and microscopic characteristics. Results: Among 60 cases, 36 (60%) had pure fungal infections, and 4 (6.7%) had mixed fungal-bacterial infections. Fungal keratitis predominantly affected males (66.7%) and rural residents (61.1%), mainly following corneal trauma (77.8%), especially from vegetative matter (57.1%). Fusarium spp. (38.9%) and Aspergillus spp. (22.2%) were the most frequently isolated fungi. Clinical suspicion correlated with microbiological findings in most cases, though KOH and Gram staining provided additional confirmation. Conclusion: Fungal keratitis in north Bihar is primarily trauma-related, with hyaline fungi—particularly Fusarium and Aspergillus—being the leading pathogens. Accurate diagnosis requires combined clinical and microbiological evaluation for effective management.

Background: Fixed-dose combinations (FDCs) are widely used to improve adherence and therapeutic efficacy, but irrational combinations may increase adverse effects and compromise outcomes. Aim: To evaluate the prescribing pattern and rationality of FDCs through an indication-based assessment in a tertiary-care hospital. Methodology: A hospital-based cross-sectional observational study was conducted in Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India, over six months. A total of 1,750 prescriptions were screened; 525 containing FDCs were analyzed. Data regarding demographics, department, therapeutic category, and indication were collected. Rationality was assessed using WHO criteria and standard treatment guidelines. Result: FDCs constituted 30% of prescriptions, predominantly prescribed by brand name (81.7%). Most were from Medicine (32%). Antimicrobials accounted for 56.2% of FDCs. Overall, 79% were rational while 21% were irrational. Inappropriate use was prominent in respiratory, gastrointestinal, and antidiabetic combinations, whereas infectious diseases and pain management showed largely appropriate use. Conclusion: Although most FDC prescribing was rational, significant irrational use persists, highlighting the need for prescriber education, adherence to guidelines, and promotion of generic prescribing.

Background: Serious adverse drug ^‘reactions (ADRs) are a significant cause of morbidity, mortality, and hospital admissions worldwide, imposing substantial clinical and economic burden on healthcare systems. Aim: To evaluate the pattern of serious ADRs requiring hospitalization, identify commonly implicated drugs, assess causality, and determine clinical outcomes. Methodology: A hospital-based retrospective observational study was conducted at the Department of Pharmacology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India, over six months. A total of 80 serious ADR cases reported to the Adverse Drug Reaction Monitoring Centre were analyzed. Causality was assessed using the WHO-UMC scale, and severity and outcomes were evaluated using standard criteria. Data were analyzed using descriptive statistics. Results: The majority of patients were aged 41–60 years (35%) and male (57.5%). Cutaneous reactions (27.5%) were the most common, followed by gastrointestinal (20%) and hematological (15%) manifestations. Antibiotics (32.5%) were the leading causative drug class. Most ADRs were categorized as probable (47.5%). Recovery was observed in 77.5% of patients, while mortality occurred in 5%. Conclusion: Serious ADRs predominantly affected middle-aged adults, with antibiotics being the principal contributors. Strengthened pharmacovigilance and rational prescribing are essential to reduce hospitalization and adverse outcomes.

Background: Spinal anaesthesia is widely used for lower limb orthopedic surgeries but its limited duration often leads to significant postoperative pain. Preemptive analgesia using pregabalin may reduce central sensitization and postoperative analgesic requirement. Aim: To evaluate the efficacy of oral pregabalin 150 mg as a preemptive analgesic in lower limb orthopedic surgeries under spinal anaesthesia. Methodology: A prospective, randomized, double-blind, placebo-controlled study was conducted on 70 ASA I–II patients (18–60 years). Patients received either pregabalin (Group P) or placebo (Group C) one hour before spinal anaesthesia. Postoperative outcomes assessed over 24 hours included time to two-segment regression, time to first rescue analgesic (VAS > 3), total diclofenac consumption, pain episodes, sedation, patient satisfaction, and adverse effects. Results: Group P showed prolonged sensory regression (118.64 vs 101.27 min), delayed rescue analgesia (246.82 vs 168.36 min), and reduced diclofenac consumption (108.57 vs 182.14 mg) (p < 0.001). Fewer pain episodes and higher satisfaction were observed. Sedation was greater in Group P. Dizziness and hypotension were more frequent but manageable. Conclusion: Preoperative oral pregabalin significantly improves postoperative analgesia and reduces analgesic requirement, making it a useful component of multimodal analgesia in lower limb orthopedic surgeries under spinal anaesthesia.

Background: Effective postoperative analgesia improves recovery and patient satisfaction after gynecological surgery. Opioids are effective but cause significant adverse effects. Multimodal analgesia combines drugs and techniques acting at different pain pathways to reduce opioid exposure. Aim: To compare efficacy, opioid consumption, adverse effects, and patient satisfaction between multimodal and opioid-based analgesia in elective gynecological surgeries. Methodology: A prospective randomized comparative study was conducted on 120 ASA I–II women undergoing elective gynecological procedures at Sheikh Bhikari Medical College and Hospital. Patients were allocated to multimodal (paracetamol, NSAID, TAP block, local infiltration) or opioid group (intravenous morphine). Pain scores (VAS), rescue analgesia, opioid consumption, adverse effects, and satisfaction were assessed over 24 hours. Results: Multimodal analgesia showed significantly lower VAS scores at 1, 6, 12, and 24 hours (p<0.001). Mean opioid consumption was reduced (6.8±2.1 mg vs 14.2±2.8 mg), and time to rescue analgesia was prolonged (152±34 vs 68±18 min). Adverse effects were lower: nausea 10% vs 30%, vomiting 8.3% vs 25%, sedation 6.7% vs 23.3%, pruritus 5% vs 16.7%, respiratory depression 0% vs 6.7%. Patient satisfaction was significantly higher (p<0.001). Conclusion: Multimodal analgesia provides superior pain control, fewer complications, reduced opioid requirement, and greater satisfaction compared with opioid-based analgesia.

Background: In females who had a previous lower segment caesarean section (LSCS), management of labour is not an easy task and must be done with great care because there are risks regarding both uterine scar and fetus distress. The WHO modified partograph is an especially useful implement for keeping an eye on the progress of labour and making quick interventions if necessary. Objectives: To assess the influence of the WHO modified partograph in the labor management of patients with previous LSCS undergoing trial of labor after cesarean, who are receiving intervention. Materials and Methods: The study was an observational one of a retrospective nature, and it was conducted for six months at Jannayak Karpoori Thakur Medical College and Hospital, Madhepura, Bihar, India. A total of thirty patients who had previous LSCS for non-recurrent indications, with adequate pelvis and fetuses in cephalic presentation, were included in the study. Results: Most patients were within the age range of 18 to 24 years, with 56.7% in this category, while 83.3% delivered at term. A repeat lower segment caesarean section (LSCS) was the mode of delivery in 60% of total births while in the remaining 40% vaginal delivery including 6.7% instrumental deliveries was practiced. The most frequent reason for repeat LSCS was fetal distress (66.7%). Conclusion: The modified partograph of WHO is a straightforward, trustworthy, and efficient instrument for labor management in the cases of previous LSCS, thereby allowing the abnormal labor to be detected early, and consequently, safe VBAC to take place in selected cases with the support of the modified partograph.

Background: Epidural anesthesia is a versatile regional technique that provides segmental neural blockades with favorable hemodynamic stability and effective postoperative analgesia. Its role as a sole anesthetic modality in abdominal surgeries warrants evaluation in routine clinical practice. Aim: To retrospectively assess the efficacy, outcomes, and complications of segmental epidural anesthesia in patients undergoing abdominal surgeries. Methodology: This retrospective observational study was conducted in the Department of Anaesthesiology at Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India over eight months. Twenty-four adult patients (ASA I–III) who underwent elective abdominal surgeries under epidural anesthesia were included. Data regarding demographics, type and duration of surgery, epidural top-ups, intraoperative hemodynamics, sedation, vasopressor use, and postoperative analgesia were analyzed using descriptive statistics. Results: Most patients were aged 41–60 years (41.67%) and female (66.67%). Open cholecystectomy (25%) was the most common procedure. Surgeries lasting 1–2 hours (41.67%) required 2–3 top-ups. Sedation was required in 70.83% cases, while hypotension and vasopressor use occurred in 25% each. Postoperative epidural analgesia was required in 58.33%. Conclusion: Segmental epidural anesthesia is a feasible and safe sole anesthetic technique for abdominal surgeries, with acceptable complication rates and effective perioperative analgesia.

Background: Postoperative pain is a common surgical complication ^‘that can delay recovery, increase morbidity, and reduce patient satisfaction. Effective pain management is crucial to optimize clinical outcomes. Aim: To evaluate postoperative pain management practices and their clinical outcomes in surgical patients. Methodology: A prospective observational study was conducted over 8 months in the Department of Anaesthesiology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India. Eighty patients aged ≥18 years undergoing elective or emergency surgery were included. Postoperative pain was assessed using the Numeric Rating Scale (NRS) within the first 24 hours. Data on demographics, type of surgery, anesthesia, analgesic use, complications, and patient satisfaction were collected and analyzed using descriptive and inferential statistics. Results: Among 80 patients, 50% experienced moderate pain (NRS 4–6) and 18.7% severe pain (NRS 7–10) on Day 1. Non-opioid analgesics were used in 68.8% of cases, opioids in 37.5%, and regional blocks in 15%. Rescue analgesia was required in 35% of patients, and non-pharmacological interventions were employed in 25%. Mobility (40%) and sleep disturbances (35%) were the most common postoperative complications. Overall, 75% of patients reported satisfaction with pain management. Conclusion: Moderate-to-severe postoperative pain remains prevalent despite standard protocols. Multimodal and individualized analgesic strategies are essential to improve recovery^’, reduce complications, and enhance patient satisfaction.

Background: Airway management is a critical component of anesthetic practice, with difficulties potentially leading to perioperative complications even in elective surgeries. Preoperative prediction of difficult airway ^‘remains challenging despite standardized assessment tools. Aim: To evaluate the incidence, predictors, and intraoperative characteristics of airway management difficulties in elective surgical patients under general anesthesia. Methodology: A retrospective observational study was conducted on 90 adult patients undergoing elective surgeries under general anesthesia at Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India. Preoperative airway assessments, intraoperative laryngoscopic findings, intubation attempts, use of adjuncts, and complications were recorded and analyzed. Difficult airway was defined as difficulty in mask ventilation, >2 intubation attempts, Cormack–Lehane grade III–IV view, or need for alternative airway devices. Data were analyzed using descriptive statistics and chi-square tests. Results: The incidence of difficult airway was 22.2%. Most patients had favorable airway predictors (Mallampati I–II: 68.9%, thyromental distance ≥6.5 cm: 77.8%, adequate inter-incisor gap: 75.6%). Higher Mallampati grades (III–IV) and restricted neck mobility were significantly associated with difficult airway (p < 0.05). Eighty percent of patients were intubated on the first attempt; 20% required airway adjuncts. Conclusion: Despite preoperative optimization, a notable proportion of elective surgical patients experienced difficult airway. Multimodal assessment and preparedness with adjunct devices are essential to enhance perioperative safety.

Background: Pediatric tuberculous meningitis (TBM) is a severe form of tuberculosis with high morbidity and mortality, particularly in young children. Factors such as BCG vaccination and nutritional status may influence disease severity and outcomes. Aim: To prospectively evaluate the clinical manifestations and outcomes of pediatric TBM in relation to BCG vaccination status and nutritional status. Methodology: A prospective study was conducted on 42 children aged 6 months to 12 years diagnosed with definite or probable TBM at Patna Medical College and Hospital. Clinical evaluation, cerebrospinal fluid analysis, and neuroimaging were performed. BCG vaccination was confirmed by scar presence, and nutritional status was assessed using the IAP classification. Patients were managed with standard anti-tubercular therapy and corticosteroids, and outcomes were assessed at three months. Results: TBM predominantly affected children aged 1–5 years (42.9%) with male predominance (61.9%). Most patients presented in advanced stages (Stage II: 50%; Stage III: 31%). BCG-vaccinated children had higher complete recovery rates (16/28) and lower mortality (3/28) compared to unvaccinated children (4/14 recovery; 5/14 deaths). Nutritional status strongly influenced outcomes; children with normal nutrition had the best recovery, whereas severe malnutrition was associated with higher mortality and residual deficits. Conclusion: Early diagnosis, BCG vaccination, and adequate nutrition significantly improve outcomes in pediatric TBM. Malnutrition and lack of vaccination are associated with severe disease and higher mortality.

Background: Angle closure glaucoma (ACG) is a significant cause of irreversible blindness, particularly in Asian populations, due to delayed diagnosis and rapid progression in advanced stages. Aim: To evaluate the demographic profile, clinical presentation, and functional outcomes of patients with primary angle-closure disorders at a tertiary care center. Methodology: This hospital-based retrospective observational study was conducted in the Department of Ophthalmology at Patna Medical College and Hospital, Bihar, India, over eight months. Ninety patients aged ≥18 years diagnosed with PACS, PAC, or PACG as per ISGEO criteria were included. Data on visual acuity, intraocular pressure (IOP), gonioscopy, optic nerve status, and visual fields were analyzed using SPSS version 27. Results: The mean age was 54.9 ± 10.5 years with female predominance (54.4%). PACG constituted 38.9% of cases. Mean IOP increased progressively from PACS (17.8 ± 2.5 mmHg) to PACG (32.4 ± 5.2 mmHg). Severe visual impairment (<6/60) was observed in 20% of patients, predominantly in PACG. Visual field defects were mainly confined to PACG cases. Conclusion: Advancing age, female gender, elevated IOP, and progressive visual field loss were strongly associated with PACG, highlighting the need for early screening and timely intervention.

Background: Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness worldwide, characterized by progressive optic nerve damage and visual field defects. Age and sex may influence disease severity and visual outcomes. Aim: To evaluate the clinical profile of POAG patients and compare visual field defects according to age and sex. Methodology: A hospital-based cross-sectional study was conducted on 40 POAG patients (80 eyes) aged 28–78 years at Patna Medical College and Hospital, Patna, Bihar, India. Comprehensive ocular examinations, including visual acuity, intraocular pressure (IOP), cup-to-disc ratio (CDR), visual field testing, and retinal nerve fiber layer (RNFL) thickness measurement, were performed. Data were analyzed using t-tests and ANOVA. Results: Mean age was 56.4 ± 12.85 years, with males comprising 55%. Poorer visual acuity correlated significantly with higher CDR (p=0.012), higher IOP (p=0.0001), and thinner RNFL (p=0.0001). RNFL thickness declined significantly with age (p=0.018), whereas CDR and IOP were not significantly age-dependent. No significant gender differences were observed for RNFL thickness, CDR, or IOP. Conclusion: POAG predominantly affects middle-aged and older adults, with structural optic nerve changes closely associated with visual acuity decline. Age influences RNFL thinning, but sex does not significantly affect key clinical parameters. Early detection and monitoring are essential to preserve vision.

Background: Glaucoma is a progressive optic neuropathy and a leading cause of irreversible blindness worldwide. Early structural changes often precede functional visual field loss, making Optical Coherence Tomography (OCT) a valuable tool for early detection. Aim: To evaluate the role of spectral-domain OCT in detecting early glaucomatous progression and to correlate structural parameters with visual field changes. Methodology: This hospital-based prospective observational study was conducted over 7 months in the Department of Ophthalmology, Anugrah Narayan Magadh Medical College, Gaya, Bihar. Ninety patients with primary open-angle glaucoma or suspected glaucoma were enrolled. Comprehensive ophthalmic examination, standard automated perimetry, and OCT assessment of RNFL, GCC, and optic nerve head parameters were performed. Statistical analysis was done using SPSS version 27.0. Results: The majority of participants were aged 51–60 years (31.1%) with male predominance (57.8%). Mean RNFL thickness (82.6 ± 9.8 µm) and GCC thickness (76.3 ± 8.9 µm) were reduced. RNFL (r = 0.62, p < 0.001) and GCC (r = 0.58, p < 0.001) showed significant positive correlation with visual field mean deviation, while C:D ratio showed negative correlation (r = –0.49, p = 0.002). Conclusion: OCT demonstrates strong structural–functional correlation and serves as a reliable modality for early detection and monitoring of glaucoma progression.

Background: Bacterial conjunctivitis is a common ocular infection with rising concerns regarding antibiotic resistance among causative pathogens. Aim: To determine the bacterial profile and antibiotic resistance patterns in patients with bacterial conjunctivitis. Methodology: A hospital-based cross-sectional study was conducted in the Department of Ophthalmology, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India, over seven months. Ninety adult patients with clinically suspected bacterial conjunctivitis were enrolled. Conjunctival swabs were cultured, organisms identified, and antibiotic susceptibility testing performed using disc diffusion according to BSAC guidelines. Results: Females (57.8%) and elderly patients (>70 years, 17.8%) were more commonly affected. Purulent discharge (91.1%) and conjunctival hyperemia (84.4%) were predominant symptoms. Gram-positive bacteria predominated, with Staphylococcus aureus (33.3%) and Streptococcus pneumoniae (22.2%) most frequent. Among Gram-negative isolates, Pseudomonas aeruginosa (13.3%) was common. Ciprofloxacin and gentamicin showed low resistance rates, whereas chloramphenicol exhibited comparatively higher resistance across isolates. Conclusion: Gram-positive organisms were predominant, and fluoroquinolones remain effective empirical therapy. Continuous surveillance and rational antibiotic use are essential to limit emerging resistance.

Background: Hypertensive emergencies are acute, severe elevations in blood pressure accompanied by target organ damage, often leading to significant morbidity and mortality. High-sensitivity cardiac troponin (hs-cTn) has emerged as a biomarker for detecting myocardial injury and assessing prognosis in these patients. Aim: To evaluate the prognostic significance of hs-cTn levels in patients presenting with hypertensive emergencies. Methodology: This hospital-based observational study included 80 adult patients with hypertensive emergencies admitted to the Department of General Medicine, Patna Medical College and Hospital, India. Patients were stratified into normal and elevated hs-cTn groups. Clinical parameters, target organ damage, and in-hospital outcomes were recorded. ROC curve analysis assessed hs-cTn’s predictive value for mortality. Results: Patients with elevated hs-cTn were older, had higher prevalence of diabetes, longer hypertension duration, and more severe hemodynamic and renal impairment. They exhibited significantly greater target organ damage, including acute heart failure (45% vs. 15%), acute kidney injury (50% vs. 20%), hypertensive encephalopathy (35% vs. 12.5%), and advanced retinopathy (40% vs. 17.5%). Elevated hs-cTn was associated with longer hospital stay, increased ICU admission, mechanical ventilation, and higher in-hospital mortality (25% vs. 5%). ROC analysis showed AUC of 0.82, with 83.3% sensitivity and 75% specificity for predicting mortality. Conclusion: Elevated hs-cTn is a strong prognostic marker in hypertensive emergencies, enabling early risk stratification and guiding intensive management.

Background: Knee injuries are common musculoskeletal problems affecting stability, weight-bearing, and movement. Trauma, sports activities, overuse, and degenerative changes contribute to internal derangements, and accurate diagnosis is essential to prevent chronic pain, joint instability, and osteoarthritis. MRI is the preferred imaging modality due to its ability to visualize both soft tissue and bony structures in multiple planes. Objective: To retrospectively analyze MRI findings in patients with knee injuries and determine the frequency, pattern, and associated abnormalities. Methods: A ^‘retrospective observational study was conducted on 120 patients who underwent MRI for knee injuries at Sonoscan Pvt.Ltd, Malda, West Bengal, India. Data on age, gender, clinical history, side of injury, and MRI findings were collected using a structured data sheet. Standard MRI protocols including T1, T2, Proton Density, and fat-suppressed sequences in sagittal, coronal, and axial planes were used. Descriptive statistics were applied to assess the frequency and distribution of injuries. Results: Most patients were males (65%), and the 21–30 years age group was most affected (30%). Right knee injuries were slightly more frequent (56.7%). ACL tears (38.3%) and medial meniscus tears (33.3%) were the most common injuries. Joint effusion (43.3%) and bone marrow edema (28.3%) were frequently associated findings, while cartilage injuries were observed in 16.7% of cases. Conclusion: MRI provides a detailed evaluation of knee injuries, aiding diagnosis and management. ACL and medial meniscus injuries are predominant in young adults, and MRI detection of associated abnormalities helps guide treatment and improve patient outcomes.

Background: Retained superficial foreign bodies (FBs) are a common clinical problem and may lead to infection, granuloma, and delayed healing if undetected. Imaging plays a crucial role in their detection and depth assessment. Aim: To compare the utility of digital radiographs and high-resolution ultrasonography (HRUSG) in detecting superficial foreign bodies and determining their depth. Methodology: This prospective comparative study was conducted in the Department of Radio-diagnosis, IPGMER and SSKM Hospital, from January 2019 to August 2020. Fifty patients with suspected retained superficial foreign bodies were evaluated using digital radiography followed by HRUSG. Surgical findings served as the reference standard where available. Detection rates and depth assessment accuracy were compared using appropriate statistical tests. Results: Organic materials predominated, with thorn (50%) and wood (34%) being most common. Most foreign bodies were radiolucent (92%), superficial (0–10 mm depth, 84%), and subcutaneous (78%). Digital radiography detected 8% of cases, whereas HRUSG identified 98% as hyperechoic lesions, demonstrating superior sensitivity and accurate depth localization. Conclusion: HRUSG showed significantly higher diagnostic utility than digital radiography, particularly for radiolucent superficial foreign bodies, and is the preferred modality for detection and depth assessment.

Background: Surgical site infections (SSIs) are among the most common healthcare-associated infections and represent a major cause of postoperative morbidity, prolonged hospitalization, and increased healthcare expenditure. In developing countries such as India, the burden of SSIs is compounded by limited infection control resources and increasing antimicrobial resistance. Understanding the local microbiological profile and antibiotic sensitivity patterns is essential for effective empirical therapy and infection prevention strategies. Objectives: This study aimed to determine the microbiological spectrum of SSIs, evaluate antibiotic susceptibility patterns of isolated pathogens, and assess resistance trends among postoperative patients in a tertiary care hospital setting. Methods: A hospital-based observational study was conducted on 135 clinically diagnosed SSI patients. Wound swab samples were collected aseptically and processed using standard microbiological techniques. Bacterial isolates were identified by conventional biochemical tests. Antibiotic susceptibility testing was performed using the Kirby–Bauer disc diffusion method following Clinical and Laboratory Standards Institute (CLSI) guidelines. Data were analyzed using descriptive and inferential statistical methods. Results: Out of 135 samples, 120 (88.9%) were culture positive, yielding 130 bacterial isolates. Gram-negative organisms constituted 63%, while Gram-positive organisms accounted for 37% of isolates. Staphylococcus aureus (29.2%) was the most common pathogen, followed by Escherichia coli (23.1%), Klebsiella pneumoniae (18.5%), and Pseudomonas aeruginosa (13.8%). High resistance was observed to penicillin, cephalosporins, and fluoroquinolones. Vancomycin and linezolid showed high efficacy against Gram-positive isolates, while carbapenems and aminoglycosides demonstrated superior activity against Gram-negative organisms. Conclusion: The study highlights a rising prevalence of multidrug-resistant organisms in SSIs. Routine microbiological surveillance and antibiotic sensitivity testing are crucial to guide rational antibiotic use. Implementation of antimicrobial stewardship programs and strengthened infection control practices are essential to reduce SSI burden and resistance development.

Background: Antibiotics are essential in hospital care but their irrational use contributes to antimicrobial resistance, especially in tertiary care settings. Monitoring prescribing patterns against WHO indicators helps identify areas of inappropriate use. Aim: To assess antibiotic prescribing patterns in a tertiary care hospital and compare them with WHO core prescribing indicators. Methodology: A retrospective, cross-sectional study was conducted at Anugrah Narayan Magadh Medical College & Hospital, Bihar. A total of 560 inpatient prescriptions containing at least one antibiotic were analyzed over six months. Data on patient demographics, diagnosis, and drug-related variables were collected and WHO prescribing indicators calculated. Results: Patient and drug documentation was largely complete (≥97.8%). The average number of drugs per encounter was 3.8, antibiotics were prescribed in 72.5% of encounters, and injections in 64.2%, all exceeding WHO standards. Generic prescribing (82.6%) and use of essential medicines (91.4%) were below optimal. Cephalosporins and quinolones were the most prescribed antibiotics (injectable: 41.6% & 21.7%; oral: 26.2% & 29.5%). Antibiotics were frequently prescribed for viral fever (34%) and gastroenteritis (22%), suggesting potential irrational use. Conclusion: While documentation was adequate, over-prescription of antibiotics and injections indicates irrational use. Strengthened antibiotic stewardship, guideline adherence, and regular prescription audits are essential to promote rational use and curb antimicrobial resistance.

Background: Proton pump inhibitors (PPIs) are widely prescribed for acid-related disorders, but inappropriate use in hospitalized patients can increase risks such as Clostridium difficile infection and pneumonia. Aim: To assess the rate and reasons for inappropriate PPI prescribing among hospitalized patients. Methodology: A retrospective observational study was conducted at Anugrah Narayan Magadh Medical College and Hospital, India, over six months, including 1,780 adult patients admitted to medicine and allied departments. Data on demographics, PPI prescriptions, indications, and complications were collected from medical records. Appropriateness of PPI use was evaluated based on established clinical guidelines. Statistical analysis was performed using SPSS. Results: PPIs were prescribed to 820 patients (46.1%), of whom only 280 (34.1%) had a valid indication, most commonly GERD (8.8%) and peptic ulcer disease (6.6%). Inappropriate use was higher in general wards (69.0%) than in ICUs (58.5%). PPI users had higher rates of Clostridium difficile infection (2.9% vs. 0.9%, p<0.001) and pneumonia (12.0% vs. 7.5%, p=0.003). Chart review revealed 80% of prescriptions without valid indication were for prophylaxis, undocumented reasons, or continuation of home medications. Conclusion: Inappropriate PPI prescribing is common among hospitalized patients, particularly in general wards, and is associated with increased infectious complications. Enhanced guideline-based prescribing and documentation are essential to improve patient safety.

Background: Ovarian tumors exhibit diverse histopathological patterns and clinical presentations, with age influencing their occurrence and malignancy risk. Understanding these variations aids in diagnosis and management. Aim: To analyze the clinicopathological spectrum of ovarian tumors across different age groups, correlating clinical features with histopathological patterns. Methodology: A retrospective observational study was conducted at the Department of Obstetrics and Gynaecology, Netaji Subhas Medical College and Hospital, Bihta, Patna, India, over one year. Seventy-six surgically treated and histopathologically confirmed ovarian tumor cases were reviewed. Clinical data were collected from hospital records, and excised specimens underwent microscopic examination and classification according to WHO (2010). Results: Benign tumors predominated (58 cases, 76.3%), followed by malignant (13 cases, 17.1%) and borderline tumors (5 cases, 6.6%). Surface epithelial tumors were most common (44 cases, 57.9%), primarily serous and mucinous types. Germ cell tumors (25 cases, 32.9%) were mainly mature cystic teratomas. Sex cord stromal tumors were rare (7 cases, 9.2%), mostly malignant granulosa cell tumors. Benign tumors were frequent in 21–30 years age group, whereas malignancies were more common in 51–60 years. Conclusion: Ovarian tumors demonstrate wide histopathological diversity with age-related patterns. Benign tumors are prevalent in younger women, while malignancies increase with age, highlighting the importance of age-specific clinicopathological evaluation for accurate diagnosis and management.

Background: Advanced ovarian cancer carries poor prognosis, with most patients presenting at FIGO stage III–IV. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as a potential strategy ^‘to improve survival. Aim: To evaluate the clinical outcomes, perioperative morbidity, and survival benefits of CRS with HIPEC in patients with advanced epithelial ovarian cancer. Methodology: A retrospective observational study was performed with 80 patients aged 18-70 years who underwent, With or without HIPEC, interval, secondary, or upfront CRS at Jagannath Gupta Institute of Medical Sciences, India. Patients underwent assessment of optimal cytoreduction (CC0+CC1) and postoperative complications. DFS and OS were evaluated using Kaplan–Meier methods. Results: The median age was 52 years and the majority, 81.3%, were diagnosed at stage III. In a very high percentage, at 90%, high-grade serous carcinoma was diagnosed. Optimal cytoreduction was achieved in 93.8% of^’ patients. Major postoperative complications were low and equivalent between the two groups (95%40). CRS + HIPEC showed significantly improved DFS and OS in both the upfront setting (DFS: 35.2 months vs. 23.0 months; OS: 73.0 months, 44.0 months, p<0.001) and interval setting (DFS: 19.5 vs. 13.8 months; OS 55.0 months vs. 45.2 months, p<0.05). A secondary CRS is associated with an OS benefit (37.0 months vs. 28.5 months; p=0.048). Conclusion: HIPEC and CRS work well together as an adjuvant to surgical treatment for advanced ovarian cancer because they are safe and improve survival, especially when used early.

Background: Maternal vitamin D deficiency is a prevalent public health concern associated with adverse obstetric outcomes. Despite adequate sunlight in many regions, deficiency remains common among pregnant women. Aim: To evaluate the association between maternal vitamin D deficiency and subsequent pregnancy outcomes in a retrospective study. Methodology: A six-month retrospective study was conducted among 112 pregnant women attending Department of Obstetrics and Gynaecology, Patna Medical College and Hospital, Patna, India. Serum 25(OH)D₃ levels were measured using ECLIA and classified as normal (≥50 nmol/L), insufficient (30–50 nmol/L), or deficient (<30 nmol/L). Participants were followed until delivery to assess gestational hypertensive disorders (GHD), gestational diabetes mellitus (GDM), preterm birth, anemia, and mode of delivery. Data were analyzed using chi-square and logistic regression tests. Results: Vitamin D deficiency was observed in 39.3% of participants. Deficiency was significantly associated with GHD (AOR 3.12; p=0.021), GDM (AOR 2.46; p=0.047), preterm birth (AOR 2.89; p=0.044), and anemia (AOR 2.67; p=0.022). The association with cesarean section was not statistically significant. Conclusion: Maternal vitamin D deficiency is an independent risk factor for adverse pregnancy outcomes. Early screening and supplementation may improve maternal and neonatal health.

Background: Direct laryngoscopy and endotracheal intubation are associated with significant sympathetic stimulation resulting in tachycardia, hypertension, and increased myocardial oxygen demand. Attenuation of this cardiovascular response is an important anesthetic consideration, especially in patients with limited cardiovascular reserve. Aim: To study and compare the effects of intravenous esmolol hydrochloride (0.5 mg/kg), labetalol hydrochloride (0.25 mg/kg), and lignocaine hydrochloride (1 mg/kg) in attenuation of the cardiovascular response to direct laryngoscopy and endotracheal intubation. Materials and Methods: This prospective, randomized, comparative clinical study was conducted on 90 adult patients belonging to ASA physical status I and II, scheduled for elective surgical procedures under general anaesthesia. Patients were randomly allocated into three groups of 30 each. Group L received intravenous lignocaine (1 mg/kg), Group E received intravenous esmolol (0.5 mg/kg), and Group B received intravenous labetalol (0.25 mg/kg), administered two minutes prior to laryngoscopy. Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and rate pressure product were recorded at baseline, immediately before laryngoscopy, and at 1, 3, 5, 7, and 10 minutes following endotracheal intubation. Data were statistically analyzed using appropriate tests. Results: Demographic parameters and baseline hemodynamic variables were comparable among the three groups. Following laryngoscopy and intubation, all groups showed an increase in heart rate and blood pressure. The lignocaine group demonstrated the maximum increase in hemodynamic parameters. Esmolol effectively attenuated the heart rate response but provided partial control of blood pressure. Labetalol demonstrated the most effective attenuation of both heart rate and blood pressure, with better control of rate pressure product. All drugs were well tolerated with no serious adverse effects. Conclusion: Intravenous labetalol hydrochloride at a dose of 0.25 mg/kg is more effective than esmolol and lignocaine in attenuating the cardiovascular response to laryngoscopy and endotracheal intubation. Labetalol provides superior hemodynamic stability with minimal adverse effects and can be safely recommended for routine clinical use in ASA I and II patients.

Background: Severe acute malnutrition (SAM) remains a critical public health issue in India, contributing to high morbidity and mortality among children under five. Multiple socio-demographic, nutritional, and health-related factors influence its occurrence and outcomes. Aim: To assess etiological factors, clinical presentation, and treatment outcomes among children with SAM admitted to a pediatric ward in Muzaffarpur, Bihar. Methodology: A retrospective observational study was conducted over eight months, reviewing hospital records of 70 children aged 6–60 months meeting WHO criteria for SAM. Data on demographics, feeding practices, birth weight, comorbidities, hospital stay, and outcomes were analyzed using descriptive statistics. Results: Most children were aged 1–2 years (45.7%) with female predominance (60%) and lower socio-economic background (42.9%). Exclusive breastfeeding for ≥6 months was observed in 57.1%, while early complementary feeding (<6 months) occurred in 54.3%. Low birth weight was noted in 40% of cases. Common comorbidities included acute respiratory infections (57.1%) and anemia (42.9%). Recovery rate was 71.4%, with 21.4% leaving against medical advice and 7.1% mortality. Hospital stay was predominantly 7–15 days (54.3%). Conclusion: SAM in children is closely linked to socio-economic disadvantages, suboptimal feeding practices, and comorbidities. Hospital-based management yields favorable recovery, but early intervention, nutritional support, and monitoring are essential to reduce mortality and improve outcomes.

Background: Urinary tract infections (UTIs) are a common pediatric problem associated with significant morbidity and potential long-term renal complications. Aim: To determine the prevalence and clinical–demographic profile of UTIs among children in a tertiary care setting. Methodology: A retrospective observational study was conducted over six months including 70 children (1 month–17 years) with clinically and laboratory-confirmed UTIs. Data on demographics, clinical features, laboratory findings, urine culture, treatment, and outcomes were analyzed using descriptive statistics. Results: Females predominated (65.7%), with the highest cases in 1–5 years (28.6%). Fever (82.9%) was the most common symptom. Positive urine cultures were found in 57.1%, with Escherichia coli (55%) as the leading pathogen. Mean hospital stay was 5.9±2.1 days. Cefotaxime (54.3%) was the most commonly used empirical antibiotic. Most patients (85.7%) recovered completely. Conclusion: Pediatric UTIs are more frequent in females and young children, commonly presenting with fever. E. coli remains the predominant pathogen. Early diagnosis and appropriate antibiotic therapy result in favorable outcomes.

Background: Cardiac disease in pregnancy poses significant risks due to physiological cardiovascular adaptations that may exacerbate underlying heart conditions. In low-resource settings, rheumatic heart disease (RHD) remains a major contributor to maternal and fetal morbidity. Aim: To retrospectively analyze the spectrum of cardiac disorders complicating pregnancy and evaluate their fetomaternal outcomes at a tertiary care center in Bihar, India. Methodology: This retrospective observational study included 40 pregnant women with diagnosed cardiac disease who delivered at NMCH, Patna, Bihar, India over 8 months. Data were collected from medical records and analyzed using descriptive statistics. Maternal cardiac complications, obstetric complications, mode of delivery, and perinatal outcomes were assessed. Results: RHD was the most common cardiac disorder (75%), predominantly involving the mitral valve (40%). Cardiac complications occurred in 20% of cases, mainly congestive cardiac failure. Anemia (45%) and preterm labour (20%) were frequent obstetric complications. Vaginal delivery was achieved in 55% of cases. Live births occurred in 90%, with 25% low birth weight and 20% prematurity. Maternal mortality was 2.5%, with no neonatal deaths. Conclusion: Rheumatic valvular heart disease predominates in pregnancy-related cardiac disorders. With multidisciplinary management at tertiary centers, favorable maternal and perinatal outcomes can be achieved despite significant morbidity.

Background: Vitiligo is a chronic autoimmune depigmenting disorder characterized by melanocyte destruction, with increasing evidence supporting the role of inflammatory cytokines in its pathogenesis. Aim: To compare serum levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in patients with vitiligo and healthy controls, and to assess their correlation with disease activity. Methodology: This hospital-based comparative cross-sectional study included 80 participants (40 vitiligo patients and 40 age- and sex-matched controls). Serum IL-6 and TNF-α levels were measured using ELISA. Disease activity was evaluated using the Vitiligo Disease Activity (VIDA) score. Statistical analysis was performed using SPSS version 27.0. Results: Mean serum IL-6 (18.62 ± 6.84 pg/mL) and TNF-α (32.15 ± 9.72 pg/mL) levels were significantly higher in vitiligo patients compared to controls (9.47 ± 3.95 pg/mL and 17.36 ± 5.88 pg/mL, respectively; p < 0.001). Both cytokines showed significant positive correlation with VIDA score (IL-6: r = 0.58; TNF-α: r = 0.49). Conclusion: Elevated IL-6 and TNF-α levels and their association with disease activity support the role of systemic inflammation in vitiligo and highlight their potential as biomarkers.

Background: Heart failure (HF) is a leading cause of hospitalization with high morbidity and in-hospital mortality. Identifying clinical predictors of mortality can guide early interventions and improve outcomes. Aim: To evaluate clinical, laboratory, and echocardiographic factors associated with in-hospital mortality among HF patients in a tertiary care setting. Methodology: This retrospective observational study analyzed records of 80 adult patients admitted with HF at the Department of General Medicine, Government Medical College Hospital, Bettiah, India, over 8 months. Demographics, comorbidities, laboratory parameters including NT-proBNP and renal function, echocardiographic findings, pharmacological treatments, and outcomes were reviewed. Cox regression and Kaplan-Meier analyses were used to identify independent predictors of in-hospital mortality. Results: The mean age was 62 ± 14 years; 62.5% were male. Comorbidities included hypertension (50%) and diabetes (35%). HFrEF and HFpEF were equally prevalent (31.3% each). In-hospital mortality was 22.5%. Advanced age (61–80 years), renal impairment, elevated NT-proBNP, reduced ejection fraction, and cardiometabolic comorbidities were significantly associated with mortality. Conclusion: In-hospital mortality in HF remains substantial. Early recognition of high-risk patients using clinical and laboratory predictors is essential for targeted management, optimizing therapy, and improving outcomes.

Background: Chronic Kidney Disease (CKD) is associated with progressive impairment of renal function, leading to disturbances in electrolyte and acid–base balance. Serum electrolyte abnormalities may reflect disease severity and influence clinical outcomes. Aim: To evaluate the pattern of serum sodium, potassium, and chloride abnormalities in patients with chronic kidney disease (CKD) and to explore their relevance in clinical severity assessment. Methodology: A hospital-based observational record review was conducted in the Department of General Medicine, Government Medical College Hospital, Bettiah, over 8 months (March 2025–October 2025). Ninety CKD patients aged >20 years with complete records were included. Serum sodium, potassium, and chloride were measured using an ELYTE 5i semi-auto analyzer. Data were analyzed using IBM SPSS version 20; p < 0.05 was considered statistically significant. Results: Among 90 patients, 55.6% were males and 44.4% females; most were aged 41–80 years (72.2%). Sodium abnormality was present in 57.8% (hyponatremia 41.1%, hypernatremia 16.7%), potassium abnormality in 57.8% (hypokalemia 30.0%, hyperkalemia 27.8%), and chloride abnormality in 52.2% (hypochloremia 40.0%, hyperchloremia 12.2%). No statistically significant association was found between gender and sodium (p=0.42), potassium (p=0.53), or chloride status (p=0.216). Conclusion: Serum electrolyte derangements are frequent in CKD, affecting more than half of patients, with hyponatremia and dyskalemia being the most common. Although gender did not influence electrolyte status, routine monitoring and early correction are essential. Electrolyte profiling, interpreted alongside eGFR-based staging and clinical status, can support severity assessment and reduce preventable complications.

Background: Bipolar disorder (BD) is a chronic mood disorder characterized by recurrent episodes ^‘that significantly impair psychosocial and occupational functioning. Hospitalization is often required for acute manic or depressive episodes and high suicide risk. Understanding risk factors and symptom patterns is essential to optimize patient outcomes. Aim: To assess the demographic, clinical, psychosocial, and comorbid factors influencing hospitalization and symptomatology in patients with BD. Methodology: A hospital-based retrospective study was conducted at Department of Psychiatry, Darbhanga Medical College and Hospital Laheriasarai, Darbhanga, Bihar, India. Medical records of 90 patients aged ≥18 years, admitted with BD over six months, were analyzed. Data on demographics, episode type, symptomatology, comorbidities, risk factors, and hospitalization metrics were extracted. Statistical analyses included descriptive statistics and multivariate analysis to identify associations. Results: The majority of patients were 26–35 years old (33.3%) with a slight male predominance (55.6%). Manic episodes were most common (42.2%), with psychotic features in 26.7% and functional impairment in 77.8%. Key risk factors included previous hospitalization (44.4%), psychosocial stressors (33.3%), family history (31.1%), and substance use (24.4%). Comorbidities included anxiety (22.2%) and hypertension (13.3%). Mean age at onset was 28.4 ± 8.2 years, illness duration 5.6 ± 4.1 years, and average hospital stay 12.5 ± 4.8 days. Conclusion: BD predominantly affects young adults, with mania, functional impairment, and psychosocial stressors contributing to hospitalization. Early identification and comprehensive management are crucial to reduce hospital stay and improve outcomes.

Background: Erectile dysfunction (ED) is a common sexual health problem that significantly affects ^‘the quality of life of men. Psychiatric disorders and the medications used in their treatment are known to increase the risk of sexual dysfunction, yet ED often remains underreported and inadequately addressed in psychiatric settings. Aim: To assess the prevalence and severity of erectile dysfunction among patients visiting psychiatric outpatient departments. Methodology: A hospital-based cross-sectional observational study was conducted among 80 male patients attending the psychiatric outpatient department of Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar. Eligible participants aged 18 years and above who had been on psychiatric treatment for at least three months were included. Sociodemographic and clinical data were collected using a structured questionnaire. Erectile dysfunction was assessed using the International Index of Erectile Function (IIEF). Data were analyzed using SPSS version 27.0 with descriptive statistics and Chi-square test. Results: Erectile dysfunction was present in 55% of participants. Mild ED was most common (25%), followed by mild-to-moderate (15%), moderate (10%), and severe ED (5%). The prevalence of ED increased with advancing age and was frequently observed among patients with depressive and anxiety disorders. Conclusion: Erectile dysfunction is highly prevalent among psychiatric patients, highlighting the need for routine screening and management of^’ sexual health issues in psychiatric practice.

Background: Age-related macular degeneration (ARMD) is a progressive degenerative disorder of ^‘the macula and a major cause of visual impairment among the elderly population worldwide. The increasing life expectancy and ageing population have contributed to a rising burden of ARMD, making early detection and identification of risk factors essential for preventing vision loss. Aim: To determine the prevalence and determinants of age-related macular degeneration among patients aged ≥50 years attending SKMCH. Methodology: A hospital-based cross-sectional observational study was conducted in the Department of Ophthalmology at Sri Krishna Medical College and Hospital (SKMCH), Muzaffarpur, Bihar, over a period of 7 months. A total of 90 patients aged ≥50 years were included. Detailed demographic data, clinical history, and risk factors were recorded. All participants underwent comprehensive ophthalmic examination including visual acuity assessment and fundus examination. Data were analyzed using SPSS version 27.0. Results: Among 90 participants, 28 patients (31.1%) were diagnosed with ARMD. Early ARMD was the most common type (42.9%), followed by dry ARMD (35.7%) and wet ARMD (21.4%). Major associated risk factors included hypertension (50%), high sun exposure (46.4%), smoking (39.3%), and diabetes mellitus (32.1%). Conclusion: ARMD was found to be a significant ocular health concern among individuals aged ≥50 years. Early detection and management of modifiable risk factors are essential to reduce disease burden and prevent visual impairment.

Background: Hypertension is a common chronic non-communicable disease and a major public health problem associated with multiple systemic complications. The eye provides a unique opportunity ^‘to directly observe vascular changes caused by hypertension, particularly in the retina. Early detection of these ocular manifestations is important for preventing vision-threatening complications and assessing systemic vascular damage. Aim: To determine the prevalence and pattern of ocular manifestations among hypertensive patients attending the ophthalmology OPD at SKMCH, Muzaffarpur. Methodology: A hospital-based cross-sectional observational study was conducted in the Department of Ophthalmology at SKMCH, Muzaffarpur, over a period of 8 months. A total of 90 hypertensive patients aged ≥30 years were included based on inclusion and exclusion criteria. Detailed history, blood pressure measurement, and comprehensive ophthalmic examination including fundus evaluation were performed. Data were analyzed using SPSS version 27.0. Results: Ocular manifestations were observed in 48 patients (53.3%). The most common finding was arteriolar narrowing (20%), followed by arteriovenous crossing changes (13.3%), retinal hemorrhages (7.8%), cotton wool spots (5.6%), hard exudates (4.4%), and hypertensive retinopathy with disc changes (2.2%). Conclusion: More than half of hypertensive patients showed ocular manifestations, highlighting the importance of regular ophthalmic screening for early detection and prevention of hypertensive ocular complications.

Background: Preeclampsia is a major hypertensive disorder of pregnancy associated with significant maternal and perinatal morbidity and mortality. Early identification of high-risk women during the first trimester may allow timely preventive interventions and improved outcomes. Aim: To evaluate the predictive performance of first-trimester maternal characteristics, serum placental growth factor (PlGF), and estimated placental volume for the development of preeclampsia. Methodology: This prospective observational study included 80 singleton pregnancies between 11 and 13+6 weeks of gestation. Maternal clinical data were recorded, serum PlGF levels were measured using ELISA, and placental volume was assessed by three-dimensional ultrasonography. Participants were followed until delivery for the development of preeclampsia. Diagnostic performance was evaluated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Preeclampsia developed in 17.5% of participants. Women who developed preeclampsia had significantly lower first-trimester PlGF levels and placental volumes, and higher body mass index (p < 0.05). PlGF alone showed a sensitivity of 71.4% and specificity of 81.8%, while reduced placental volume demonstrated moderate predictive accuracy. The combined model incorporating maternal characteristics, PlGF, and placental volume achieved the highest sensitivity (85.7%) and specificity (89.4%), with a negative predictive value of 96.7%. Conclusion: Integration of maternal characteristics with first-trimester PlGF and placental volume significantly improves early prediction of preeclampsia. An integrated screening approach may facilitate early risk stratification and targeted preventive care.

Background: Acute cholecystitis is a common surgical emergency, often associated with gallstones. Optimal timing of laparoscopic cholecystectomy (early versus delayed) ^‘remains debated due to concerns over operative difficulty, complications, and hospital stay. Aim: To compare early and delayed laparoscopic cholecystectomy in terms of operative outcomes, postoperative complications, and hospital stay in patients with acute cholecystitis. Methodology: A prospective comparative study was conducted at the Department of General Surgery, Patna Medical College and Hospital, India, including 90 patients aged ≥18 years diagnosed with acute cholecystitis. Patients were allocated to early (n=45; surgery within 72–96 hours of symptom onset) or delayed (n=45; surgery 6–8 weeks after initial conservative management) laparoscopic cholecystectomy. Operative time, complications, conversion rates, and hospital stay were recorded and analyzed. Results: Early cholecystectomy showed shorter mean operative time (68.4 vs. 74.9 minutes), lower complication rates (wound infection, bile leak, conversion to open surgery), and significantly reduced hospital stay (3.8 vs. 6.2 days) compared to delayed surgery. Conversion rates were slightly higher in the early group but remained within acceptable limits. Conclusion: Early laparoscopic cholecystectomy is a safe and effective approach, reducing postoperative morbidity, hospital stay, and recurrence risk, and should be preferred when patient condition and surgical expertise permit.

Background: The prevalence of overweight and obesity among women of reproductive age has increased globally, contributing to adverse maternal and fetal outcomes. Elevated maternal body mass index (BMI) has been associated with several pregnancy and delivery complications. Aim: To assess the association between high maternal weight status and complications during pregnancy and delivery. Methodology: A retrospective observational cohort study was conducted at Department of Obstetrics and Gynaecology, Nalanda Medical College and Hospital, Patna,Bihar, India including 3,312 pregnant women. Maternal BMI was calculated from antenatal records and categorized as normal (<25 kg/m²), overweight (25–29.9 kg/m²), and obese (≥30 kg/m²). Data on pregnancy and delivery complications were extracted from hospital records. Statistical analysis was performed using SPSS, and associations were evaluated using chi-square tests and logistic regression with odds ratios (OR) and 95% confidence intervals. Results: Among participants, 33.2% were overweight and 18.5% were obese. Higher BMI was significantly associated with increased risks of gestational diabetes (OR 2.05 for overweight; OR 3.92 for obese), gestational hypertension (OR 2.18; OR 3.41), pre-eclampsia (OR 2.25; OR 3.88), and caesarean delivery (OR 1.54; OR 2.43) (p < 0.001). Delivery complications such as placenta previa, placental abruption, and postpartum hemorrhage also increased with BMI. Conclusion: High maternal BMI is significantly associated with increased pregnancy and delivery complications, highlighting the need for early screening, weight management, and enhanced antenatal care.

Background: Ovarian cysts are common gynecological conditions with often nonspecific clinical presentations, complicating early diagnosis and management. Transvaginal ultrasonography (TV-US) has emerged as a key diagnostic tool for preoperative evaluation. Aim: To assess the correlation between clinical presentation and ultrasonographic features in patients with ovarian cysts and evaluate surgical outcomes. Methodology: A retrospective observational study was conducted at Department of obstetrics and gynecology, Nalanda Medical College and Hospital, Patna, Bihar, India. on 90 patients presenting with ovarian cysts. Clinical data, ultrasonographic patterns, and surgical outcomes were reviewed. TV-US features were analyzed to differentiate between benign and borderline lesions. Surgical interventions, predominantly laparoscopic cystectomy, were assessed for efficacy and preservation of ovarian function. Results: Most patients were premenopausal, with endometriotic and dermoid cysts predominating. TV-US accurately identified cyst type, with 52.6% showing hypoechoic “ground glass” patterns and 66.6% demonstrating thick-walled heterogeneous contents. Minimally invasive laparoscopic management was successful in the majority, with low complication rates and preservation of ovarian function. Conclusion: Integration of clinical assessment with pattern-based TV-US allows reliable preoperative differentiation of ovarian cysts. Individualized surgical planning, particularly laparoscopic approaches, optimizes outcomes while preserving fertility. This structured diagnostic and therapeutic approach enhances decision-making and patient care.

Background: Ectopic pregnancy is a serious obstetric condition in which implantation occurs outside ^‘the uterine cavity and is a major cause of maternal morbidity and mortality during early pregnancy. Early diagnosis and appropriate treatment are essential to prevent life-threatening complications. Aim: To compare the outcomes of medical and surgical management in patients diagnosed with ectopic pregnancy. Methodology: A retrospective comparative observational study was conducted in the Department of Obstetrics and Gynecology at Nalanda Medical College and Hospital, Patna, Bihar, India for a period of 6 months. A total of 80 hemodynamically stable women with confirmed ectopic pregnancy were included and divided into two groups: medical management with methotrexate (n=40) and surgical management (n=40). Data regarding clinical presentation, treatment success rate, duration of hospital stay, and complications were analyzed using SPSS version 27.0. Results: The majority of patients were aged 26–30 years (37.5%). Abdominal pain (87.5%) was the most common presenting symptom. Surgical management showed a higher success rate (95%) compared with medical management (80%) (p=0.04). However, the mean hospital stay was shorter in the medical group (2.8±1.2 days) than in the surgical group (5.4±1.8 days). Most patients (76.3%) experienced no complications. Conclusion: Surgical management demonstrated a higher treatment success rate, while medical management offered shorter hospitalization and fewer procedure-related complications. Appropriate patient selection remains crucial for optimal outcomes.

Background: Abnormal uterine bleeding (AUB) is a common gynecological condition affecting women of reproductive age and significantly impacts physical, psychological, and reproductive health. Understanding its clinical characteristics and management patterns is essential for improving patient outcomes. Aim: To evaluate the clinical characteristics, underlying causes, and management of abnormal uterine bleeding among reproductive-age women using the FIGO PALM–COEIN classification. Methodology: A hospital-based cross-sectional study was conducted among 300 women aged 20–50 years presenting with AUB at the Department of Obstetrics and Gynecology, Nalanda Medical College and Hospital, Patna,Bihar, India. Data on sociodemographic profile, clinical characteristics, causes of AUB, and treatment modalities were collected through interviews, clinical examination, and medical records. Causes were classified according to the FIGO PALM–COEIN system, and data were analyzed using SPSS version 25. Results: Most participants had irregular menstrual cycles (67.3%), and heavy menstrual bleeding was reported in 39.3% of cases. Polycystic ovarian syndrome (32.7%) was the most common comorbidity, and anemia was the major complication (34.7%). Non-structural causes were predominant, particularly ovulatory dysfunction (32%) and unclassified cases (38.4%), while leiomyoma (17.3%) was the most frequent structural cause. Medical management, especially combined oral contraceptive pills (26%) and NSAIDs (24%), was the most commonly used treatment. Conclusion: AUB in reproductive-age women is mainly associated with non-structural causes and is largely managed medically. Early diagnosis and appropriate classification can help improve management and reduce complications.

Background: Pediatric epilepsy is a common neurological disorder with diverse clinical presentations and significant impact on quality of life. Aim: To evaluate the clinical characteristics, etiology, and treatment outcomes of epilepsy in children. Methodology: A retrospective observational study was conducted in the Department of Pediatrics, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar. A total of 90 children (<18 years) diagnosed with epilepsy were included. Data were collected from medical records and analyzed using descriptive statistics. Results: The majority of patients were aged 1–5 years (37.8%) with male predominance (57.8%). Generalized seizures were most common (62.2%), and onset was highest in early childhood (42.2%). Most patients experienced 2–4 seizures/month (40%), with duration <5 minutes (55.6%). Idiopathic etiology predominated (46.7%), followed by structural (24.4%) and infectious causes (17.8%). Monotherapy was used in 64.4% cases. However, only 44.4% achieved well-controlled seizures, while 55.6% had partial or poor control. Conclusion: Pediatric epilepsy commonly presents in early childhood with generalized seizures and idiopathic etiology. Despite treatment, a significant proportion shows suboptimal control, highlighting the need for improved management strategies.

Background: Pediatric meningitis ^‘remains a major cause of morbidity and mortality, particularly in children under five, with outcomes influenced by age, causative pathogen, and timeliness of treatment. Aim: To evaluate treatment outcomes and prognostic factors in pediatric meningitis cases. Methodology: A hospital-based cross-sectional analytic study was conducted at the Department of Pediatrics, Sri Krishna Medical College and Hospital, Muzaffarpur, India, over eight months. Eighty children aged 1 month to 18 years with clinically and/or laboratory-confirmed meningitis were enrolled. Clinical features, laboratory findings, and treatment responses were recorded. Outcomes were categorized as complete recovery, recovery with complications, or death. Statistical associations between clinical factors and outcomes were analyzed using chi-square tests (p < 0.05). Results: The majority of cases were males (57.5%) and aged 1–5 years (37.5%). Fever (95%), vomiting (62.5%), and neck stiffness (60%) were common presentations. Streptococcus pneumoniae (32.5%) was the predominant pathogen. Complete recovery occurred in 47.5%, recovery with complications in 30%, and mortality was 22.5%. Poor outcomes were significantly associated with age ≤5 years (p=0.041), seizures (p=0.003), altered sensorium (p=0.001), and delayed presentation >3 days (p=0.028). Conclusion: Early recognition, prompt antibiotic therapy, and close monitoring are essential for improving prognosis in pediatric meningitis, particularly in younger children and those presenting with neurological complications.

Background: Neonatal sepsis is a major cause of morbidity and mortality, particularly in developing countries, due ^‘to immature immunity and delayed diagnosis. Aim: To evaluate the clinical profile, risk factors, and outcomes of neonatal sepsis in a tertiary care center. Methodology: This hospital-based retrospective observational study was conducted in the Department of Paediatrics, Sri Krishna Medical College and Hospital, Bihar, over one year. A total of 80 neonates (0–28 days) diagnosed with sepsis were included. Data were collected from medical records and analyzed using SPSS version 27.0. Results: Most neonates were admitted within the first week (57.5%), with male predominance (60%) and a high proportion of low birth weight (55%). Common maternal risk factors included preterm birth (37.5%) and maternal fever (27.5%). Clinical features were predominantly nonspecific, with poor feeding (62.5%) and lethargy (52.5%) being most frequent. CRP positivity (70%) and leukocyte abnormalities (56.3%) were more common than culture positivity (40%). Overall mortality was 22.5%, significantly higher in low-birth-weight neonates (31.8%). Conclusion: Neonatal sepsis remains a critical health issue with high mortality, especially among low-birth-weight infants, highlighting the need for early^’ diagnosis and effective management.

Background: Pneumonia remains a leading cause of morbidity and mortality among children under five years, with those under two years being particularly vulnerable due to immature immunity. Aim: To evaluate the clinical profile and outcomes of pneumonia in children under two years of age. Methodology: This hospital-based retrospective observational study was conducted in the Department of Paediatrics at Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India. A total of 90 children under two years diagnosed with pneumonia were included. Data were collected from medical records and analyzed using SPSS version 27.0. Results: The highest proportion of cases was seen in infants aged 0–6 months (35.6%), with a male predominance (57.8%). Common clinical features included cough (90%), fever (82.2%), tachypnea (77.8%), and difficulty in breathing (75.6%). Severe pneumonia was observed in 46.7% of cases. Most patients recovered (80%), while 11.1% developed complications and 8.9% expired. Conclusion: Pneumonia poses a significant health burden in children under two years, with a considerable proportion presenting as severe disease. Early diagnosis and prompt management are crucial to improve outcomes and reduce mortality.

Background: Recurrent respiratory tract infections (RRTIs) are a leading cause of morbidity in children aged 1–5 years. Vitamin D, crucial for immune modulation, may influence susceptibility to these infections. Aim: To assess the prevalence of RRTIs and examine their association with vitamin D deficiency in children aged 1–5 years in Bettiah, Bihar. Methodology: A prospective, hospital-based observational study included 68 children, divided into cases (RRTI, n=34) and controls (no RRTI, n=34). Serum 25-hydroxy Vitamin D levels were measured, and demographic, nutritional, breastfeeding, and sunlight exposure data were collected. Statistical analysis evaluated associations between vitamin D status and RRTIs. Results: Vitamin D deficiency (<20 ng/mL) was significantly higher in children with RRTI (82.4%) compared to controls (35.3%; OR = 8.6, p < 0.001). Mean vitamin D levels were lower in the RRTI group (42.3 ± 15.2 nmol/L) versus controls (68.5 ± 30.6 nmol/L, p = 0.0002). Exclusive breastfeeding and adequate sunlight exposure were protective against deficiency only in children without RRTI. Bronchopneumonia, HRAD, and WALRI were predominantly observed in vitamin D deficient children. Conclusion: Vitamin D deficiency is strongly associated with increased susceptibility to RRTIs in young children. Maintaining adequate vitamin D levels through diet, supplementation, and sunlight exposure may reduce the burden of recurrent respiratory infections.

Background: Dengue is a rapidly increasing mosquito-borne viral disease with significant pediatric morbidity in endemic regions like India. Children often present with varied and severe manifestations, necessitating early recognition. Aim: To evaluate the clinical and laboratory profile of dengue infection in hospitalized children. Methodology: This retrospective observational study was conducted over 6 months in Department of Pediatrics, Government Medical College and Hospital, Bettiah, Bihar, India, including 80 children (0–15 years) with serologically confirmed dengue (NS1/IgM ELISA). Clinical features and laboratory parameters were recorded and analyzed using descriptive statistics. Results: Most patients were aged 10–15 years (47.5%) with male predominance (62.5%). Dengue hemorrhagic fever was most common (62.5%). Fever (100%), hemorrhagic manifestations (56.25%), vomiting (52.5%), and rash (50%) were frequent. NS1 positivity (70%), leukopenia (67.5%), and hemoconcentration (65%) were common. Thrombocytopenia was observed in 88.75%, strongly associated with severe dengue (DHF/DSS). Conclusion: Dengue in children commonly presents with severe forms and significant hematological abnormalities. Early diagnosis using combined clinical and laboratory indicators, especially thrombocytopenia, is essential for effective management.

Background: Preterm delivery (PTD) is a major cause of neonatal morbidity and mortality. Early predictions remain challenging, particularly in low-resource settings, making reliable screening tools like mid-trimester cervical assessment essential. Aim: To evaluate the predictive value of mid-trimester transvaginal ultrasound cervical assessment in identifying women at risk of preterm delivery. Methodology: This prospective cohort study included 187 singleton pregnancies (18–20 weeks) at Department of obstetrics and gynecology, MGM Medical College and Multicentric Hospital, Jamshedpur, Jharkhand, India. Cervical length (CL), funneling, and internal os morphology were assessed via transvaginal ultrasound. Participants were categorized into high- and low-risk groups and followed until delivery. Statistical analysis included logistic regression and ROC curve analysis. Results: High-risk women had significantly shorter CL (3.0 vs 4.5 cm, p<0.001), higher funneling (45% vs 0%), and increased PTD (75% vs 4.8%). Cervical length was the only significant predictor (OR=0.52, p<0.05). ROC analysis showed good predictive accuracy (AUC=0.84), with a cut-off <3.5 cm (sensitivity 92%, specificity 66%). Conclusion: Mid-trimester cervical length is a strong independent predictor of PTD and a useful screening tool for early risk identification and intervention.

Background: Breast cancer radiotherapy requires precise dose delivery to maximize tumor control while minimizing exposure to surrounding organs at risk (OARs). Forward-planned IMRT (FP-IMRT) and inverse-planned IMRT (IP-IMRT) are commonly used techniques with distinct planning approaches. Aim: To compare FP-IMRT and IP-IMRT in terms of target coverage, dose homogeneity, conformity, hotspot distribution, organ sparing, and overall plan quality in early-stage breast cancer patients. Methodology: A prospective observational study was conducted on 80 female patients (≤70 years) post-breast-conserving surgery at the Department of Medical Physics, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Bihar, India, from January 2022 to December 2024. Both FP-IMRT and IP-IMRT plans were generated for each patient using CT-based simulation. Dosimetry parameters, including planning target volume (PTV) coverage, homogeneity index (HI), conformity index (CI), and doses to the heart, ipsilateral lung, and contralateral breast, were analyzed. Statistical comparison was performed using Student’s t-test. Results: IP-IMRT achieved superior PTV coverage (97.2% vs. 94.8%), better homogeneity (HI 0.12 vs. 0.18), higher conformity (CI 0.96 vs. 0.89), fewer hotspots (15% vs. 37.5%), and improved OAR sparing compared to FP-IMRT. Overall plan quality favored IP-IMRT (50% excellent plans vs. 22.5%). Conclusion: IP-IMRT provides superior dosimetric outcomes in target coverage, homogeneity, conformity, and OAR sparing, while FP-IMRT remains simpler and resource-efficient with reduced low-dose bath; technique selection should be individualized based on patient and institutional factors.

Background: Uterine fibroids are the most common benign tumors in women, often presenting with menstrual disturbances and requiring hysterectomy for definitive management. Aim: To evaluate the clinicopathological correlation of fibroid uterus in patients undergoing hysterectomy. Methodology: This prospective observational study was conducted over 7 months at Department of Obstetrics and Gynecology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India, including 66 symptomatic women. Clinical, surgical, and histopathological data were collected and analyzed using SPSS. Results: The mean age was 42.10±7.05 years, with most patients being multiparous. Menstrual disturbances (77.3%), especially menorrhagia (54.9%), were the most common symptoms, with many patients exhibiting moderate to severe anemia. Total abdominal hysterectomy was the predominant procedure. Intramural fibroids (60.6%) were most frequent. Histopathology revealed proliferative endometrium (66.7%) and high prevalence of chronic cervicitis (86.4%), with adenomyosis in 15.2%. Conclusion: Fibroid uterus commonly affects perimenopausal, multiparous women and presents with abnormal uterine bleeding. A strong clinicopathological correlation exists, emphasizing the role of histopathology in confirming diagnosis and identifying associated conditions.

Background: Eclampsia is a severe hypertensive disorder of pregnancy contributing significantly to maternal and perinatal morbidity and mortality, especially in low-resource settings like India. Aim: To determine the incidence and evaluate the clinical profile, maternal complications, and perinatal outcomes of eclampsia. Methodology: This prospective observational study was conducted in Department of Obstetrics and Gynecology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India, including 74 eclampsia patients. Data on demographics, clinical features, management, and outcomes were collected and analyzed using descriptive statistics. Results: Most patients were aged 20–30 years (64.8%), primigravida (70.3%), and unbooked (81.1%). Antepartum eclampsia was most common (64.9%). Severe hypertension was observed in 56.8%. Caesarean section was performed in 59.5% cases. Maternal complications included ICU admission (16.2%) and pulmonary oedema (13.5%), with 4.1% mortality. Perinatal outcomes showed 62.2% live births, while 37.8% had adverse outcomes. Conclusion: Eclampsia remains a major obstetric challenge, particularly among unbooked primigravidas, with significant maternal and perinatal risks. Strengthening antenatal care and early intervention are essential.

Background: Caesarean section (CS) is a vital obstetric intervention for preventing maternal and perinatal morbidity and mortality. However, rising CS rates and associated complications necessitate evaluation of its indications and outcomes, particularly in resource-limited settings. Aim: To analyze the indications of caesarean delivery and assess associated maternal and fetal outcomes in a tertiary care hospital. Methodology: A retrospective observational study was conducted at Department of Obstetrics and Gynaecology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, over 8 months. A total of 82 CS cases were analyzed using hospital records. Data on demographics, indications, maternal complications, and neonatal outcomes were statistically evaluated. Results: Emergency CS (61%) outnumbered elective procedures. The most common indication was previous LSCS (36.6%), followed by cephalopelvic disproportion (14.6%) and failed induction (9.8%). Maternal complications occurred in 34 cases, with wound infection (29.4%) being most frequent. Perinatal morbidity was 20.7%, mainly due to meconium aspiration and respiratory distress. Neonatal mortality was 4.9%, predominantly in emergency cases. Conclusion: Emergency caesarean sections are associated with higher maternal and neonatal complications. Rational use of CS, improved antenatal care, and timely intervention are essential to improve outcomes.