Introduction: Asymptomatic bacteriuria (ASB) in pregnancy is associated with adverse maternal and fetal outcomes, including pyelonephritis, preterm labor, and low birth weight. Physiological changes during pregnancy, such as ureteral dilation, urinary stasis, and hormonal alterations, increase the risk of ASB. Escherichia coli is the predominant uropathogen, followed by Klebsiella pneumoniae and Staphylococcus aureus. This study aimed to determine the prevalence of ASB among pregnant women in a tertiary care hospital in Gujarat, India. Materials and Methods: A cross-sectional study was conducted over six months, enrolling 220 asymptomatic antenatal women. Midstream urine samples were collected, cultured, and analyzed for bacterial growth. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method per CLSI guidelines. Data were analyzed using SPSS version 21, with categorical variables compared using chi-square or Fisher’s exact test. A p-value <0.05 was considered statistically significant. Results: Among 220 antenatal women, 17.3% had ASB. ASB prevalence was significantly higher in antenatal women with lower socioeconomic status, prior UTI, diabetes, and hypertension. Escherichia coli was the most common isolate (57.9%), followed by Staphylococcus aureus and Enterococcus faecalis (10.5% each). E. coli showed high sensitivity to amikacin (90%), gentamicin (100%), and piperacillin-tazobactam (90%) but moderate resistance to ampicillin (40%). Conclusion: ASB prevalence in antenatal women was 17.3%, underscoring the need for routine screening, especially in high-risk women with a history of UTIs, diabetes, or hypertension. Empirical treatment should follow local antimicrobial susceptibility patterns to prevent resistance. Targeted health education and counselling for women from lower socioeconomic backgrounds should emphasize ASB risks, personal hygiene, and the benefits of early screening.

Introduction: The aim is to introduce flipped classroom as teaching learning method and to assess its effectiveness for students in anaesthesia postings. Methods: The present study was conducted after taking institutional ethical clearance and informed consent of the participants. One hundred fifty students participated and were divided into two Groups A and B. Two topics of anaesthesiology were taught to both groups using either FC-assisted self-directed learning (SDL) sessions or online lecture classes. A cross-over of groups was done to prevent any bias. Pretest and posttest scores of all topics were assessed using multiple-choice questions (MCQs) and feedback was taken. Program evaluation was done. Results: There was no significant difference in performance in pretest MCQ examinations between the two groups. Students of both Groups A and B performed significantly better in posttest MCQ examinations as compared to pretest MCQ examinations. However, the posttest results of the FC group were better. 46.40% strongly agree that there will be increased interest in subject by FC method.47.40% agree that enhancement in learning by FC method .43.30% agree that FC should be preferred teaching learning method .40.20% feel there is improved understanding and course satisfaction.42.30% agree that exam performance will improve by FC method. Conclusion: Faculty and students provided positive views in support of the sessions. Students were highly satisfied with the program. The flipped classroom approach proves to be a superior teaching method, promoting better academic outcomes and greater student engagement and satisfaction More than 40% students believe that it is a better teaching tool and will improve their performance. Teacher’s feedback is the same but they fear that too much effort and resources are required in this FC method.

Background: Ultrasound guidance (USG) for brachial plexus blocks has been described for the supraclavicular, infraclavicular  and axillary approaches. These reports have shown that USG guided brachial plexus blocks have high success rates and few complications. Compared with the axillary approach, the brachial plexus block at the level of the clavicle can anaesthetize all four distal upper extremity nerve territories without the requirement for a separate block of the musculocutaneous nerve. Aim and Objective: The aim of the study was to compare the effect of both supraclavicular and infraclavicular brachial plexus blocks in terms of time taken for onset, duration, block performance, and block success and incidence of adverse events. Materials and Methods: This study conducted on patients of age group between 18 – 60 years of either sex belonging to ASA Grade 1-3 with BMI<35 in patients undergoing elective upper limb surgery. 60 patients were randomised into two groups. Supra clavicular (group S) and infra clavicular (group I). All the patients were given 25 ml of 0.5% ropivacaine (p) as local anesthetics. The block performance time, time taken for onset of sensory and motor blockade, total duration of block, and hemodynamic parameters were observed. The block performance times and the onset of the sensory blockade were the primary outcomes while the duration of the block, success of block, patient satisfaction and hemodynamic parameters were secondary outcomes. Results: The block performance time for the infraclavicular group was 16.1 ± 3.17 min, whereas for supraclavicular group, it was 10.53 ± 2.80 min with similar success rates . Onset of sensory blockade was achieved earlier (8.31 ± 1.23 min) in Group I than Group S (14.20 ± 1.50 min, P = 0.041). The onset of motor blockade was similar in Group I (11.22 ± 1.20 min) and Group S (16.52 ± 28.42 min, P = 0.462). The duration of action, block success and patient satisfaction were similar in both the groups. Adverse events are more in Group S. Conclusion: Ultrasound-guided infraclavicular block is a relatively safer technique when compared to the supraclavicular technique with faster onset, better patient satisfaction and fewer complications.

Aims and Objectives: The primary objective is to study the incidence of POUR after Spinal Anaesthesia using Levobupivacaine and Ropivacaine. The secondary objectives includes correlation between POUR and modified bromage score and to correlate  time to ambulation. Background: Postoperative urinary retention (POUR), a frequent complication after surgery in which patients cannot urinate despite having a full bladder. POUR is common, with occurrence rates varying from 5% to 70%, depending on the type of surgery. The condition arises from disturbances in the nervous system pathways that regulate bladder function, often due to anesthesia, medications, pain, or the physiological effects of surgery. Bladder overstretching from urine retention can lead to long-term complications like detrusor muscle damage. Although catheterization is a common solution, it carries risks such as infection or trauma. Effective management of POUR involves identifying at-risk patients before surgery, using preventive strategies, and ensuring postoperative care to avoid bladder overdistension. Materials and Methods: An observational hospital based study was conducted at the Department of anaesthesiology in Gandhi Medical College Bhopal spanning from August 2022 to December 2023. 60 patients were divided into 2 groups. GROUP L-30 patients received 15 mg (3ml) of Hyperbaric Levobupivacaine 0.5% (Total volume-3ml) and GROUP R -30 patients received 22.5 mg (3ml) of Hyperbaric Ropivacaine 0.75% (Total volume-3ml). Incidences of POUR, Bromage scale and time of ambulation was noted postoperatively. Results: There was no statistically significant difference in demographic data, mean pulse rate, mean diastolic BP between the two groups in this study while sensory regression and motor regression showed variations. The trend showed faster regression of sensory block and motor block in Group R compared to Group L at 5 hours marking and 6 hours marking respectively. the observed differences in POUR incidence between Group L and Group R were not significant. no significant association between intrathecal levobupivacaine and ropivacaine and the severity of POUR. Conclusion: Comparison between intrathecal Levobupivacaine and intrathecal ropivacaine concluded that Intrathecal Levobupivacaine provides long duration of sensory and motor blockade in lower limb surgeries as compared to intrathecal ropivacaine. Therefore, can be used for anticipated long lower limb orthopaedic surgeries. There was no significant difference in the incidence of POUR between the two groups. Although POUR can depend on various other risk factors like gender, age or presence of BPH.

Background: Carcinoma breast, accounts for about 23% of all cancers in women worldwide. Correlation of various prognostic variables of breast carcinoma helps us in assessment of prognosis and to assess the response to treatment. This study aimed to correlate the histological grade of the tumour with hormone receptor expression. Materials and Methods: This was a prospective study, conducted by the Department of Pathology, in a government medical college for a period of 6 months. Histopathological examination and ER, PR, Her-2- neu status was assessed for 50 patients who had underwent mastectomy. Hormone receptor status was then correlated with histological grade of the tumour. Results: Majority of the samples were found to be diagnosed as Infiltrating Ductal Carcinoma No Special Type with Ductal Carcinoma In Situ (IDC-NOS-DCIS) (50%). Most of the cases belonged to grade II carcinoma. Correlation of histological grading with the hormone status indicates that the hormone receptor expression decreases with increasing grade of the tumour and was found to be statistically significant. Conclusion: Hormone receptor expression carries an inverse relationship with the histological grade of the tumor. Evaluating the prognostic factors helps us to provide better treatment and to understand the prognosis of the patient.

Background: Acute biliary pancreatitis is a severe gastrointestinal condition often triggered by gallstones. The timing of laparoscopic cholecystectomy in these patients is crucial for optimizing outcomes and reducing complications. This study aims to compare the effectiveness of early versus late laparoscopic cholecystectomy in managing acute biliary pancreatitis. Objective: To determine whether early laparoscopic cholecystectomy (performed within 72 hours of symptom onset) results in better clinical outcomes compared to late laparoscopic cholecystectomy (performed after initial conservative management of inflammation). Methods: This prospective randomized study enrolled 120 patients diagnosed with acute biliary pancreatitis at JIET Medical College and Hospital, Jodhpur, Rajasthan. Patients were randomly assigned to either early or late cholecystectomy groups. Primary outcomes measured included length of hospital stay, complication rates, and recurrence of pancreatitis. Secondary outcomes focused on overall patient recovery and cost-effectiveness of treatment approaches. Results: The study anticipates that early laparoscopic cholecystectomy will reduce the length of hospital stay, decrease complication rates, and prevent the recurrence of pancreatitis compared to the late intervention group. Statistical analysis will be employed to evaluate the data collected, providing a robust comparison between the two approaches. Conclusion: The findings are expected to clarify the optimal timing for laparoscopic cholecystectomy in patients with acute biliary pancreatitis, potentially influencing clinical guidelines and improving patient management. Demonstrating the benefits of early intervention could lead to a shift in surgical practices and enhanced recovery rates for patients suffering from this condition.

Background: Cystic swellings of the scrotum, including spermatoceles and epididymal cysts, are common benign conditions that can cause discomfort and warrant clinical intervention. The choice between conservative management, sclerotherapy, and surgical excision remains subject to debate due to varying efficacy and patient outcome profiles. Objective: This study aims to evaluate and compare the effectiveness of conservative management, sclerotherapy, and surgical excision for treating cystic swellings of the scrotum, focusing on symptom resolution, recurrence rates, and patient satisfaction. Methods: The study was conducted at the Department of General Surgery, JIET Medical College and Hospital, Jodhpur, Rajasthan, India from feb 2024 to December 2024 . 100 male patients diagnosed with cystic scrotal swellings. Participants were randomly assigned to receive conservative management, sclerotherapy, or surgical excision. Outcomes measured included symptom resolution, complication rates, recurrence within a year, and patient satisfaction assessed through standardized questionnaires. Results: The study is expected to demonstrate varying effectiveness of the treatment modalities, with surgical excision likely showing the highest efficacy in symptom resolution and lowest recurrence rates. However, less invasive treatments such as sclerotherapy might offer a favorable balance of outcome and lower risk of complications. Conclusion: The findings will provide valuable insights into the optimal treatment strategies for cystic swellings of the scrotum, aiding in the refinement of clinical guidelines and improving patient management. This study will help establish evidence-based practices that can enhance patient outcomes and satisfaction.

Background: Iron deficiency anemia (IDA) is a critical health concern worldwide, particularly in developing countries where it affects a significant portion of the pediatric population. Known primarily for its role in impairing cognitive development and physical growth, IDA has also been suspected to influence neurological functions. Given the high prevalence of febrile seizures in young children, which represent a major pediatric emergency, understanding the potential link between IDA and these seizures is essential for developing preventive strategies. Objectives: This study aims to quantitatively determine the prevalence of IDA in children who experience febrile seizures and to investigate the potential association between iron deficiency and the frequency, severity, and clinical outcomes of these seizures. Methods: A comprehensive prospective observational study was conducted involving a cohort of 120 children under the age of five, presenting with febrile seizures at Department of Pediatrics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India. Iron status was assessed using standardized hemoglobin and serum ferritin measurements upon hospital admission. Detailed patient histories, including dietary iron intake and previous medical history of febrile episodes, were also collected to adequately adjust for confounding variables in the analysis. Results: Preliminary findings suggest a significantly higher rate of IDA in children with febrile seizures compared to the national average for pediatric IDA. Initial statistical analyses indicate a robust correlation between reduced iron levels and increased risk of recurrent and severe febrile seizures. Conclusion: The study underscores a potential modifiable risk factor for febrile seizures in the form of iron deficiency. The data advocate for routine screening for IDA in children and suggest that correcting iron deficiency could diminish the incidence or severity of febrile seizures, thereby improving pediatric health outcomes.

Background: Drug response variability is influenced by multiple biological and computational factors, including pharmacogenomics, epigenetics, gut microbiota, and artificial intelligence (AI). Understanding these factors is crucial for optimizing personalized medicine approaches. While pharmacogenomics and epigenetics provide insights into genetic and environmental influences on drug metabolism, gut microbiota plays a pivotal role in modulating drug efficacy and toxicity. AI-driven models are revolutionizing drug response prediction by integrating these multifaceted variables into precision medicine frameworks. Objective: This systematic review synthesizes current evidence on how pharmacogenomics, epigenetics, gut microbiota, and AI collectively shape drug action, aiming to provide a comprehensive understanding of their roles in advancing personalized medicine. Methods: A systematic literature search was conducted across PubMed, Scopus, Web of Science, and Google Scholar, following PRISMA guidelines. Studies published between 2015 and 2023 focusing on the impact of pharmacogenomics, epigenetics, microbiota, and AI on drug response were included. Data extraction covered study characteristics, methodologies, and key findings, with meta-analysis performed where applicable. Bias risk was assessed using established quality evaluation tools. Results: From an initial pool of 1,279 studies, 40 met the inclusion criteria, with five eligible for meta-analysis. Pharmacogenomic variations were strongly linked to differential drug metabolism and adverse drug reactions, while epigenetic modifications influenced gene expression and drug response plasticity. Gut microbiota emerged as a key player in drug bioavailability, metabolism, and toxicity modulation. AI-driven algorithms, particularly machine learning models, demonstrated superior predictive accuracy in identifying drug response patterns and personalizing treatment regimens. Meta-analysis revealed a moderate overall effect size (SMD = 0.56, 95% CI: 0.29–0.83), with AI-driven models showing the highest impact on drug response predictions (SMD = 0.87, SE = 0.05). Conclusion: Pharmacogenomics, epigenetics, and gut microbiota significantly influence drug action, and AI offers a transformative tool to integrate these factors for precision medicine. The findings underscore the need for further research to validate AI-driven predictive models and to standardize methodologies for assessing drug response variability. Future studies should emphasize large-scale clinical trials, improved biomarker identification, and AI-powered decision-support systems to enhance therapeutic precision and patient outcomes.

Objective: Resistant hypertension (RH) is defined as uncontrolled blood pressure (BP) despite adherence to at least three optimally dosed antihypertensive medications, including a diuretic. Spironolactone is a recommended add-on therapy for RH. This study aims to evaluate the efficacy of spironolactone in BP control and its impact on cardiac mass index, assessed by left ventricular mass index (LVMI), in a South Indian population. Materials and Methods: Sixty patients diagnosed with RH were enrolled after ethical committee approval. Spironolactone (25 mg daily) was added to their existing regimen. BP and LVMI were measured at baseline, third, sixth, and ninth months. Tolerability was assessed through biochemical investigations and clinical evaluation. Results: Fifty-six patients completed the study (55% males, 45% females; median age: 45 years). Spironolactone significantly reduced both systolic and diastolic BP at all follow-up intervals (p < 0.001). LVMI regression was also significant (p < 0.001). Serum sodium levels decreased (p < 0.05), while serum potassium increased (p < 0.001) but remained within normal limits. Hyperkalemia occurred in 3.5% (n=2), requiring study withdrawal. Minor adverse effects included vomiting (1.7%, n=1), gastric ulcers (7%, n=4), and breast discomfort (1.7%, n=1), resolving with temporary drug discontinuation. Conclusion: Spironolactone is an effective add-on therapy for RH, significantly improving BP control and reducing LVMI, with manageable side effects. These findings support its use in managing difficult-to-treat hypertension.

Objective: This study aims to evaluate the efficacy of α-tocopherol (Vitamin E) and ascorbic acid (Vitamin C) in reducing insulin resistance in newly diagnosed Type 2 Diabetes Mellitus (T2DM) patients. Materials and Methods: This open-label, randomized controlled study was conducted in adult patients with Type 2 Diabetes attending the outpatient department of a tertiary care hospital in Chennai. The study included a 4-week treatment period followed by a 4-week follow-up per patient. A total of 60 patients were enrolled and randomized into two groups:
Control Group: Metformin 500 mg once daily (OD).
Study Group: Vitamin C 500 mg OD + Vitamin E 400 mg OD + Metformin 500 mg OD.
Participants were randomly assigned using simple randomization. Insulin resistance was assessed using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Results: Out of 124 patients screened, 60 patients were included in the study, all of whom completed the trial. The study group demonstrated significant reductions compared to the control group:
Insulin resistance (HOMA-IR): Study group: -4.95, Control group: -2.54 (p = 0.030).
Fasting plasma glucose (mg/dl): Study group: -38, Control group: -34 (p = 0.020).
Postprandial glucose (mg/dl): Study group: -75, Control group: -55 (p = 0.038).
The most commonly observed adverse effect was gastrointestinal disturbances, occurring in 33.3% of the study group and 36.6% of the control group. Conclusion: The addition of Vitamin C and Vitamin E to standard Metformin therapy significantly reduces insulin resistance in newly diagnosed Type 2 Diabetes Mellitus patients compared to Metformin alone.

Peripheral nerve blocks have certain advantages over central neuraxial anaesthesia and general anaesthesia, hence they have become increasingly popular for the  management of pain during surgery. The development of ultrasonography in regional anaesthesia made it possible to confirm precise needle placement and appropriate local anaesthetic administration. Furthermore, it is possible to prevent     problems such as intravascular and intraneuronal injections. Real-time ultrasound  not only lowers the amount of local anaesthetic needed for a successful nerve block  but also enhances the quality of the block. Ultrasonographic guidance is beneficial in reducing intra neural injection and targets the neural sheath where drug can be deposited and block can be achieved with minimum possible volume. This study attempts to determine minimum possible volume of bupivacaine 0.5% to achieve adequate motor and sensory blockade by using ultrasound guided brachial plexus block. Methodology: The study was conducted in Department of Anaesthesiology, Gandhi Medical College and associated Hamidia Hospital, Bhopal during August 2022 to December 2023 after approval from institutional ethics committee. It was an Observational hospital-based study. The study was an observational study comprising of 75 patients between age group 18-60 years of either sex belonging to ASA grade I or II, scheduled for elective upper limb surgery. Patients with neurologic deficit in upper limb, Diaphragm palsy, Respiratory distress and Allergy to the local anaesthetics were excluded. Under all aseptic precautions ultrasonography was done at the level of supraclavicular region and structures traced from cephalic to caudal direction. the probe was placed in the coronal plane to visualize the subclavian artery and the brachial plexus in a transverse sectional view. Once the needle penetrated the brachial plexus, the bupivacaine 0.5% was injected after negative aspiration for blood or air just next to the artery, then the needle was repositioned to inject on the upper pole of the artery. Twenty five patients received 10 ml Drug (group A), next 25 patients received 15 ml Drug (group B) and next 25 patients received 20 ml Drug (group C) each. Result: Based on our findings, we determined that a volume of 15 ml of bupivacaine 0.5% reliably achieves effective sensory and motor blockade in the patients undergoing upper limb surgeries. This volume provides adequate anaesthesia while potentially reducing the risk of systemic toxicity associated with higher volume.

Background: Multiple modalities are existing for chronic knee pain management. Genicular nerve neurolysis/Rhyzotomy and intra-articular steroid injection (IASI) are available treatment options for patients with knee osteoarthritis. There is increasing evidence supporting the effectiveness of cooled radiofrequency ablation (RFA) in treating genicular nerves for patients with chronic knee osteoarthritis (OA). This study aims to compare the efficacy of cooled RFA with that of intra-articular steroid injection (IASI) in patients with knee pain caused by OA. Aims and Objectives: The primary objective of this observational, prospective study was to evaluate the long‐term outcomes, including pain, function, and perceived effect of treatment, in subjects undergoing cooled radiofrequency ablation (CRFA) who have pain due to osteoarthritis (OA) of the knee. Methods: The prospective observational type of study was carried out on thirty patients with Kellgren–Lawrence grade 2–4 knee OA in the department of Anaesthesiology at Gandhi Medical College Bhopal after the approval of Institutional Ethics Committee of our hospital. The patients were assigned into 2 groups randomly as IASI (N=15) and CRFA (N=15) group. All the patients were evaluated with Visual analogue score (VAS) for pain intensity and Western Ontario and Mc Master Universities Osteoarthritis Index (WOMAC) for functional status of the patients. All assessments were measured and compared at baseline, 1 month, 3 month and 6th month after treatment. Furthermore, patient satisfaction was also recorded. Results: All evaluation parameters were significantly improved in IASI and CRFA groups. Both VAS and WOMAC score of CRFA group were significantly lower than VAS and WOMAC score of IASI group during all the intervals of time (p<0.001). Satisfaction grades did not differ between the two groups. Conclusions: Cooled radiofrequency ablation (CRFA) of the genicular nerve and intra-articular steroid injection (IASI) are potential treatments for knee joint pain in osteoarthritis. However, CRFA provides better pain relief and enhances functional capacity in patients with knee joint pain from osteoarthritis compared to IASI.

Immunotherapy may greatly enhance rheumatoid arthritis treatment. Tumor necrosis factor alpha antagonists, such as infliximab, etanercept, and adalimumab, are used to treat rheumatoid arthritis. These drugs lower inflammation and improve symptoms by targeting and inhibiting tumor necrosis factor alpha, a significant inflammatory cytokine implicated in the development of rheumatoid arthritis. Infliximab not only improves physical performance and quality of life, but it also slows the progression of joint deterioration and keeps the signs and symptoms of rheumatoid arthritis at bay. Etanercept is both safe and effective in the treatment of rheumatoid arthritis. Combination treatment with etanercept and methotrexate is more successful than monotherapies in reducing disease activity, slowing joint deterioration, and improving function. Adalimumab, alone or in conjunction with methotrexate, alleviates rheumatoid arthritis symptoms. Because of the introduction of biosimilars that are less expensive than the original drugs, treatment may now be made available to a larger number of patients. The review includes a thorough examination of the most recent evidence-based data on tumor necrosis factor alpha inhibiting biosimilars with respect to their safety and efficacy.

Background: The majority of thyroid nodules that are inadvertently found are benign and asymptomatic. Though the malignant nodules make up 5% of thyroid nodules, they must be diagnosed accurately for clinical reasons. While conventional ultrasonography is a reliable method for identifying thyroid nodules, it is not possible to distinguish between benign and malignant nodules. The primary drawback of FNA cytology is that 10–15% of specimens are indeterminate and 10–15% are nondiagnostic. FNA cytology is invasive and vulnerable to errors in sampling and analysis. Thus, there is a need to enhance and perfect non-invasive techniques to diagnose malignant lesions. Palpable thyroid nodule stiffness is a subjective measure that cannot reliably predict cancer. It has been demonstrated that sonoelastography is helpful in differentiating between benign and malignant tumours. In contrast to the surrounding normal tissues, the majority of benign tumours are softer, whereas the majority of malignant tumours are stiff and hard. Thus, the purpose of this study was to illustrate the diagnostic precision and usefulness of sonoelastography in identifying thyroid nodules that are benign or malignant. Methods: This cross-sectional study, which involved 41 patients with thyroid nodules was carried out in the radiology department of a tertiary care hospital between September 2017 and October 2018. Strain sonoelastography was carried out during the conventional ultrasound examination of the thyroid gland. The ‘Rago’ criteria-based sonoelastography colour scoring system was applied. The trial participants subsequently had a ultrasound-guided FNA cytology of the lesions. SPSS 22 version software was used for data analysis after the data was entered into a Microsoft Excel data sheet. Frequencies and proportions were used to depict categorical data. For qualitative data, the chi-square test or Fischer’s exact test was employed as the significance test. The mean and standard deviation were used to depict continuous data. Data visualisation was done using Microsoft Word and Excel to create a variety of graphs, including pie charts and bar charts. Results: The majority of these individuals (41.5%) were in the age range of 31 to 40. 90.2% of the patients were female. In the B-mode, there were 5.1% malignant lesions, 23.7% indeterminate lesions, and 71.2% benign lesions. 13.6% of elastography scores were 1, 66.1% were 2, 10.2% were 3, 8.5% were 4, and 1.7% were 5. 10.2% of the lesions were determined to be malignant and 89.8% to be benign based on the elastography scores. In reference to sonoelastography, only 66.7% of the malignant lesions and 33.3% benign lesions were found to be picked up in B-mode sonography; similarly, among those indeterminate lesions of B-mode sonography, 14.3% were found to be malignant and 85.7% to be benign on sonoelastography; and among those benign lesions of B-mode sonography, 4.8% were found to be malignant and 95.2% were benign by sonoelastography. Among the thyroid nodules, 88.1% of lesions were found to be benign based on FNAC/HPE, whereas 11.9% were found to be malignant. Colloid goitre (22%), papillary carcinoma (10.2%), and follicular carcinoma (1.7%) made up the majority of the study findings, with hyperplastic nodules accounting for 66.1%. All the malignant lesions identified by B-mode sonography were found to be concordant in HPE (100%); 14.3% of those with B-mode indeterminate lesions were found to be malignant by FNA cytology/ HPE and 85.7% to be benign; 2 benign lesions of B-mode (4.88%) were found to be malignant. Thus, the B – mode sonography had a sensitivity of 42.86%, specificity of 100%, PPV of 100%, NPV of 95.24% with diagnostic accuracy of 95.56% in diagnosis of malignant lesions in comparison with HPE. Sonoelastography showed a sensitivity of 85.71%, specificity of 100%, PPV of 100%, NPV of 98.1% with diagnostic accuracy of 98.3% in the diagnosis of malignant lesions in comparison with HPE. Combined sonoelastography and B Mode sonography showed a 100% sensitivity, specificity and NPV of 100% with diagnostic accuracy of 100% in diagnosis of malignant lesions in comparison with HPE. Conclusion: An imaging method that shows promise for characterising thyroid nodules is sonoelastography. When B-mode and sonoelastography are used together, the outcomes are superior to when they are used separately.

Introduction: Subarachnoid block (SAB) is commonly used for lower limb and abdominal surgeries due to its benefits like reduced bleeding and good operative conditions. However, it can cause side effects like hypotension and bradycardia due to sympathetic blockade, reduced cardiac output, and peripheral blood pooling. Non-invasive blood pressure (NIBP) monitoring has limitations in detecting beat-to-beat perfusion variations. Perfusion index (PI), measured via pulse oximetry, assesses perfusion dynamics and may predict hypotension after subarachnoid block (SAB). This study aimed to determine if a baseline PI >3.5 predicts hypotension following spinal anesthesia. Perfusion index (PI), measured by pulse oximetry, reflects peripheral blood flow and vasomotor tone, influenced by factors like sympathetic tone, pain, and temperature. It indicates variations in blood volume and sympathetic vascular tone. PI changes with vasodilation and regional blocks, serving as a non-invasive marker of perfusion and sympathetic activity. Aims and Objectives: To evaluate the correlation between baseline perfusion index and incidence of hypotension following subarachnoid block in Lower limb orthopedic surgeries. Methodology: The study was conducted in Department of Anesthesiology, Gandhi Medical College Bhopal for a period of 1.5 years. This observational prospective cohort study involved 60 patients (aged 15-60, ASA grade I/II) undergoing lower limb orthopedic surgeries. Preoperative perfusion index (PI) was recorded, and various vital parameters were monitored during surgery. Subarachnoid block with 0.5% bupivacaine was administered, and blood pressure changes were compared to preoperative PI. Hypotension episodes were analyzed to assess PI’s predictive value for intraoperative hypotension. Result: Demographic variables like age, weight, and surgery indication were similar across both groups and did not affect results. A significant difference in intraoperative blood pressure (SBP, DBP, MAP) was observed, with the PI >3.5 group showing a greater drop. Hypotension occurred in 73.3% of PI >3.5 patients versus 16.7% in PI <3.5 patients. Surgery duration and nausea/vomiting incidence were similar in both groups, with no respiratory distress or pruritus reported. Conclusion: The study found that a preoperative perfusion index (PI) >3.5 correlates with a higher incidence of intraoperative hypotension in lower limb orthopedic surgeries under spinal anesthesia compared to PI <3.5.

Background: Tuberculosis (TB) and diabetes mellitus (DM) are two major global health challenges, with their coexistence increasingly recognized as a serious public health concern, particularly in low- and middle-income countries like India. The dual burden of TB and DM complicates disease management and adversely affects treatment outcomes. This study aimed to assess the socio-demographic profile, glycemic control, and treatment outcomes in newly diagnosed pulmonary TB patients with coexisting diabetes in Gujarat, India. Methods: A longitudinal observational study was conducted for six months across five Tuberculosis Units (TUs) in Gujarat. Eighty newly diagnosed pulmonary TB patients with diabetes were enrolled and followed through three stages: at diagnosis, after the intensive phase of TB treatment, and at the end of therapy. Socio-demographic data, glycemic parameters (FBG, PPBG, HbA1c), and treatment outcomes were assessed using pre-tested questionnaires and laboratory investigations. Data were analyzed using SPSS version 25.0. Results: The majority of participants were middle-aged males (61.25%), with laborers constituting the largest occupational group (42.5%). Significant improvement in glycemic control was observed during treatment: mean FBG reduced from 162.8 mg/dL to 139.5 mg/dL (p<0.001) and PPBG declined from 247.3 mg/dL to 210.9 mg/dL (p<0.001). Treatment success was achieved in 90.2% of patients, while 6.9% were lost to follow-up and 2.8% died. Conclusion: Integrated management of TB and diabetes significantly improved glycemic control and resulted in favorable treatment outcomes. Comprehensive bidirectional screening and collaborative management are essential for improving the prognosis of TB-DM comorbid patients.

Background: Distal radius fractures are common orthopedic injuries, particularly affecting young males and older women. In elderly patients, conservative management with closed reduction and casting is often preferred due to surgical contraindications. The cast index, a ratio of sagittal-to-coronal width at the fracture site, has been suggested as a predictor of treatment success, though its role in elderly patients remains underexplored. Aim: This study evaluates the predictive value of the cast index in determining clinical and radiographic outcomes in elderly patients with distal radius fractures managed conservatively. Methodology: A prospective observational study was conducted at K.S. Hegde Medical Academy, Mangalore, from September 2022 to April 2024. Sixty patients with dorsally displaced, metaphyseal, extra-articular distal radius fractures undergoing closed reduction were included. The cast index was assessed using X-rays on Days 1, 8, and 42. Statistical analysis was performed using SPSS 24.0, with significance set at p < 0.05. Results: Radial height increased significantly from 7.88 ± 2.75 mm (Day 1) to 8.90 ± 3.06 mm (Day 42) (p=0.001). Post-hoc analysis confirmed significant changes between Days 1 and 8 (p=0.008) and Days 1 and 42 (p=0.001). Ulnar variance also showed a significant increase from Day 8 to Day 42 (p=0.001). Volar tilt exhibited a minor but significant increase (p=0.031). Conclusion: These findings emphasize the importance of radiographic monitoring in elderly distal radius fractures. Age and sex influence fracture displacement, with older patients at higher risk. Further research is needed to refine predictive models for optimizing conservative treatment.

Background & Methods: Caudal anaesthesia is a very reliable technique used in pediatric age group for infraumblical interventions. The aim of the study is to observe the trend of perfusion index which is the ratio of the pulsatile blood flow to non-pulsatile static blood flow in a patients’ peripheral tissue such as fingertip, toe, ear lobe in pediatric population after administration of general anaesthesia followed by caudal block. This study involved 130 children between age group 2-7 years of either sex belonging to ASA grade I to II. Perfusion index was noted at 0,1,5,10, and then every 10 minutes interval upto 30 minutes following caudal block. Results: Perfusion index was noted at 0,1,5,10, and then every 10 minutes interval upto 30 minutes following caudal block. In our study, the baseline PI measurement was 1.87 ± 0.77, which increased to 4.91 ± 1.63 at 5 minutes post-block, indicating a substantial 162.6% increase. The paired t-test results indicated statistical significance (p < 0.05) for all time points compared to baseline, highlighting the rise in PI after a successful caudal block. Conclusion: There was a significant rise in the perfusion index following caudal block at all time intervals reflecting the block’s ability to achieve the desired anaesthetic and perfusion outcomes, ensuring adequate regional anaesthesia and improved surgical conditions. A progressive improvement in perfusion indices following the administration of anaesthesia reflects its reliability as a promising non-invasive indicator of successful caudal block.

Effective postoperative pain management is crucial for enhancing patient recovery and improving quality of life following surgery. Ultrasound-guided thoracic interfascial plane blocks, specifically the Pectoral Nerve Block II (PEC II) and the Serratus Anterior Plane Block (SAPB), are relatively simple and easy-to-learn techniques. These blocks have been developed as alternatives to thoracic epidural anaesthesia and paravertebral blocks for regional analgesia in breast surgeries. Our study aimed to evaluate the effectiveness of these two blocks in managing postoperative pain for 24 hours following breast surgeries, such as modified radical mastectomy (MRM) or simple mastectomy. Pain was assessed using the Visual Analog Scale (VAS), along with the timing of the first analgesic requirement and the total tramadol consumption within 24 hours. This observational study was conducted to determine the impact of these blocks on acute post-surgical pain. Methodology:  This interventional study was conducted on 30 patients undergoing breast surgeries under general anaesthesia, with 15 patients receiving either a PECS-II blocks or a Serratus Anterior Plane Block (SAPB). A total of 30 ml of anaesthetic solution was prepared using 25 ml of 0.25% levobupivacaine combined with dexmedetomidine (1 mcg/kg), diluted to 30 ml with normal saline. Tramadol (1-2 mg/kg) was provided as rescue analgesia. Postoperative pain was assessed using the Visual Analog Scale (VAS) at multiple time points (0, 1, 2, 4, 8, 16, and 24 hours after surgery). Additionally, the time to first analgesia (TFA) and any complications were recorded. Result:  In this study, we observed that first rescue analgesia or duration of analgesia was more in patients who received SAP (511.0 ± 40) than patients who received PEC block (378.4 ± 60) which was statistically highly significant (p< 0.001). Conclusion: This study has clarified that employing an ultrasound-guided SAP block, combined with dexmedetomidine as an adjuvant alongside 0.25% levobupivacaine, results in superior postoperative analgesia compared to PEC block.

Background: Hypertension is a leading global health concern with multifactorial etiology, including genetic and environmental influences. ABO “blood groups have been implicated in disease susceptibility, including hypertension. This study investigates the correlation between ABO blood groups and hypertension across different age groups. Methods: A retrospective study was conducted in the Department of Physiology, Anugrah Narayan Magadh Medical College, Gaya, Bihar. Data from 98 participants (51 males, 47 females) were collected over nine months. Blood pressure was measured using a mercury sphygmomanometer, and ABO and Rh blood groups were determined using the slide agglutination method. Body mass index (BMI) was calculated using standard WHO classifications. Statistical analysis was performed using SPSS version 27, with a significance threshold of p < 0.05. Results: Blood group B was the most prevalent (34.69%), followed by O (28.57%), A (27.55%), and AB (9.18%). Rh-positive individuals constituted 92.86% of the sample. Blood group B exhibited the highest prevalence of pre-hypertension and Stage I hypertension. Additionally, obesity (BMI ≥30) was most common in blood group B, while blood group AB had no obese individuals. Pre-hypertension was more frequent across all blood groups than Stage I hypertension. Conclusion: This study suggests a potential association between blood group B and increased susceptibility to hypertension and obesity. The findings highlight the need for further” large-scale studies to validate these associations and explore underlying genetic and physiological mechanisms.

Background: One of the main causes of cancer-related deaths worldwide, colorectal cancer (CRC) is the third most frequent type of cancer.  Despite treatment advancements, the prognosis for advanced-stage colorectal cancer remains unfavourable.  The tumor-node-metastasis (TNM) staging system is commonly utilized for prognostic assessment; however, it fails to incorporate systemic inflammation, a significant factor in cancer progression.  The Glasgow Prognostic Score (GPS), which utilizes serum C-reactive protein (CRP) and albumin levels, serves as an inflammation-based prognostic instrument that could improve risk assessment in CRC. Aim: The purpose of this study is to determine the predictive importance of systemic inflammation in disease development in CRC patients by examining the association between GPS and TNM staging. Methodology: The study employed a cross-sectional design involving 88 patients with colorectal cancer at Department of General Surgery,  AIIMS, Patna, Bihar, India.  GPS was assessed through CRP and albumin levels, and TNM staging was categorized according to the American Joint Committee on Cancer (AJCC) 8th edition guidelines.  Statistical analysis, utilizing chi-square tests, was conducted to assess the relationship between GPS and TNM staging, with significance established at p < 0.05. Results: GPS and TNM stage were shown to be significantly correlated (p = 0.0123).  Increased GPS scores were observed in Stage III patients, suggesting an association between systemic inflammation and disease advancement.  Stage IV patients exhibited a greater proportion of GPS 0, indicating a complex interplay between inflammation and tumor burden. Conclusion: The findings indicate that GPS is substantially linked with TNM staging in patients with CRC.  Integrating GPS with TNM staging could enhance prognostic accuracy and facilitate personalized treatment planning. Additional research is required to investigate the biological mechanisms that underlie this association.

Background: Postoperative nausea and vomiting (PONV) are prevalent complications associated with general anesthesia, impacting as many as 80% of patients identified as high-risk. PONV can prolong recovery time, extend hospital stays, and result in serious complications. 5-HT3 receptor antagonists, including Ondansetron, have traditionally been considered the gold standard; however, Palonosetron, a newer agent with an extended half-life and increased receptor affinity, has been proposed as a viable alternative. This research evaluates the effectiveness of Palonosetron versus Ondansetron in preventing postoperative nausea and vomiting (PONV) in patients undergoing abdominal surgery. Aim: To assess the effectiveness of intravenous (IV) Palonosetron (0.075 mg) and IV Ondansetron (4 mg) in preventing postoperative nausea and vomiting (PONV) in patients undergoing general anesthesia for abdominal surgery. Methodology: A comparative study was undertaken at Department of Anesthesia, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India on 70 patients receiving major abdominal surgery.  Patients were randomly assigned to two groups: Group P (Palonosetron, n=35) and Group O (Ondansetron, n=35). The incidence of postoperative nausea and vomiting (PONV), its severity, the requirement for rescue antiemetics, and visual analog scale (VAS) scores were evaluated over a 48-hour period.  Data analysis utilized SPSS v25.0, with a significance threshold set at a p-value of less than 0.05. Results: PONV was well-controlled in both groups. Vomiting remained minimal throughout.  Nausea scores were significantly higher in Group P, with p=0.001 at the 24–48 hour mark.  Group O exhibited reduced PONV scores and VAS scores at the 24–48 hour interval (p=0.002).  Both groups exhibited minimal consumption of rescue antiemetics. Conclusion: Ondansetron showed a slight but noteworthy benefit in reducing the intensity of nausea and the requirement for rescue medication, while Ondansetron and Palonosetron prevented PONV equally well. The long-term benefits of Palonosetron’s extended half-life require further investigation in future studies.

Background: Abnormal uterine bleeding (AUB) is a prevalent yet complex gynaecological condition with many aetiologies, necessitating precise evaluation for suitable therapy. While clinical diagnosis provides a first assessment, histological examination remains the definitive standard for confirming underlying aetiologies and guiding appropriate therapeutic choices. Objective: The objective is to correlate histological findings with clinical manifestations in patients undergoing hysterectomy for abnormal uterine bleeding, therefore enhancing diagnostic precision and therapeutic approaches. Methods: This prospective observational study involved 74 patients Undergoing hysterectomy for abnormal uterine bleeding at the Department of Obstetrics and Gynaecology, Jagannath Gupta Institute of Medical Sciences and Hospital, Budge budge, Kolkata, India. Hysterectomy specimens underwent histological examination, ultrasonic evaluation, and clinical assessment. The statistical correlation between clinical and histological diagnoses was included in the data analysis. Results: The perimenopausal age group of 41 to 45 years, including 29.7%, exhibited the highest prevalence of abnormal uterine bleeding (AUB). The most prevalent presentation was menorrhagia (40.5%). Histopathological findings revealed proliferative endometrium (27.0%) and secretory endometrium (24.3%), following endometrial hyperplasia (18.9%), fibroids (16.2%), and adenomyosis (8.1%). 5.4% of patients exhibited malignancy. Histological analysis confirmed many illnesses, with dysfunctional uterine bleeding (DUB) being the predominant clinical diagnosis at 33.8%. This underscores its critical role in diagnosis and therapy. Conclusion: Histological research is essential for establishing a clinical diagnosis of AUB and preventing misinterpretation.  Patient outcomes can be improved by carefully choosing a hysterectomy and, where possible, reviewing conservative therapy options.

Background: Even though MRI is an expensive technique, not every lesion or mass of the uterus can be visualized on ultrasound due to obscuration of the pelvis by bowel gas; hence, both studies are mandatory to conclude the uterine mass in addition to the histopathology of the uterine mass.  Method: In 90 adult women with uterine masses, transabdominal ultrasound, transvaginal ultrasound, and MRI were performed in all patients. The observations were compared. Results: The clinical manifestations were 63 (70%) had pain, 33 (36.6%) had bleeding PV, 27 (30%) had discharged PV, 6 (6.6%) had a mass abdomen, 6 (6.6%) had loss of weight and appetite pre-menopausal, and 30 (33.3%) were post-menopausal. According to their histopathological report, they were classified into five groups: adenomyosis was affected in 21 patients, fibroids were observed in 42 individuals, endometrial cancer was in 6 patients, and cervical cancer was polyp. Out of ten women, two had adnexal pathology. Conclusion: To localize, characterize, and evaluate the number of uterine lesions, both benign and malignant, along with their staging in pelvic pathologies, MRI was found to be more precise and the gold standard in comparison to USG. Most times, MRI had an edge over USG in detecting endometrial invasion in the case of endometrial carcinoma and staging in the case of cervical carcinoma.

Background: Dyspepsia is a clinical problem with many manifestations, such as belching, heartburn, anorexia, nausea, and vomiting. Proper medication is necessary; hence, an ideal prokinetic drug has to be studied with a comparison of the efficacy of both drugs. Method: Out of 90 patients with dyspepsia, 45 patients were treated with Itopride and 45 with Levosulpiride, and their efficacy was compared. Results: More relief was observed in the Itopride group 28 (62%) compared to the 22 (48.8%) group of Levosulpiride. Moderate relief was highest in Itopride 15 (33.3%) and 14 (31%); in Levosulpiride, worsening of the symptoms was observed only in Levosulpiride 1 (2.22%). The comparison of serum biochemistry and Q.T interval of both drugs has a significant p-value (p < 0.001). The side effect of diarrhea was 2 (4.4%) in levosulpiride, while headache was 3 (6.6%) in Itopride. Conclusion: Both levosulpiride and Itopride were equally effective and well-tolerated in treating the symptoms of non-ulcer dyspepsia.

Background: Tibial spine avulsion fractures, though uncommon, are functionally significant injuries that disrupt anterior cruciate ligament (ACL) continuity and knee joint stability. These fractures occur more frequently in adolescents and young adults and are often the result of high-energy trauma or sports-related injuries. Arthroscopic fixation techniques have emerged as the preferred modality due to their minimally invasive nature and ability to achieve stable reduction. Objective: To evaluate the functional outcome of patients undergoing arthroscopic suture pull-out fixation for displaced tibial spine avulsion fractures at a tertiary care center using standardized clinical scoring systems. Methods: This prospective study was conducted at All India Institute of Medical Sciences (AIIMS), Patna, Bihar. Patients with displaced tibial spine avulsion fractures (Meyers and McKeever type II–IV) treated with arthroscopic suture pull-out fixation using non-absorbable sutures were included. Clinical and functional outcomes were assessed using the Lysholm Knee Score and IKDC (International Knee Documentation Committee) Score at regular follow-up intervals over a period of six months. Results: A total of 25 patients were enrolled. The majority were adolescents with a mean age of 16.4 years. All patients achieved satisfactory fracture union with restoration of knee stability. At the final follow-up, the mean Lysholm Score was 91.6, and the mean IKDC Score was 87.8. No case of fixation failure, infection, or arthrofibrosis was reported. Most patients resumed pre-injury activity levels within 3 to 4 months. Conclusion: Arthroscopic suture pull-out fixation is a safe, effective, and functionally rewarding technique for displaced tibial spine avulsion fractures. It facilitates early rehabilitation, excellent joint stability, and high patient satisfaction with minimal complications.

Background: Postdated pregnancies are characterized by beyond the anticipated delivery date, which is associated with a heightened risk of morbidity for both the mother and the neonate. Complications have consistently been linked to oligohydramnios, meconium-stained amniotic fluid, and lower segment cesarean section during emergency birth. At the neonatal stage, these pregnancies have a considerable incidence of low birth weight, NICU admissions, and perinatal death. Labor induction in postdated pregnancies is a frequently executed procedure that entails inherent risks and problems. Aim: This study aim to evaluate maternal and newborn outcomes in postdated pregnancies, focusing on the implications of labor induction, complication rates, and associated risks. Methods:  This retrospective study was conducted in the Department of Obstetrics and Gynecology at Government Medical College and Hospital, Purnea, Bihar, India for one year . 94 women with postdated pregnancies, comparing outcomes between those who underwent induced labor and those who experienced spontaneous labor. The collected data encompassed rates of oligohydramnios, meconium-stained amniotic fluid, delivery methods, newborn outcomes, and maternal problems. Results: Induced labor correlated with increased incidences of oligohydramnios (52% compared to 35%), meconium-stained amniotic fluid (25% against 12%), and emergency lower segment cesarean section (60%). Neonatal outcomes were worse in the induced labor cohort, exhibiting elevated NICU hospitalizations (16%) and heightened incidences of low birth weight (13%). Maternal problems, such as postpartum hemorrhage and infection, were more prevalent in induced labor. Conclusion: Postdated pregnancies have considerable risks, particularly with labor induction. Attentive surveillance, prompt intervention, and pregnancy-specific treatment techniques can enhance both maternal and newborn outcomes.

Background: Diabetes mellitus (DM) is a chronic metabolic disorder with an increasing global prevalence, particularly in India. Iron metabolism has been “implicated in the pathogenesis of type 2 diabetes mellitus (T2DM), with evidence suggesting a correlation between elevated serum ferritin levels and impaired glycemic control. Understanding this association could provide novel insights into the metabolic disturbances underlying T2DM. Objectives: This study aims to evaluate the relationship between serum ferritin levels and glycemic control in T2DM patients, with a specific focus on its correlation with glycated hemoglobin (HbA1c) levels and disease duration. Methods: A case-control study was conducted at Department of Biochemistry, Patna Medical College, India, including 76 participants (38 T2DM cases and 38 age-matched healthy controls). Serum ferritin and HbA1c levels were measured using Electrochemiluminescence Immunoassay (ECLIA) and Turbidimetric Inhibition Immunoassay, respectively. Data were analyzed using SPSS 27.0, employing Student’s t-test and Pearson’s correlation. Results: T2DM patients exhibited significantly higher serum ferritin levels (528.46 ± 142.30 µg/L) compared to controls (178.62 ± 94.75 µg/L) (p < 0.0001). A positive correlation was observed between serum ferritin and HbA1c levels (r = 0.621, p < 0.0001), suggesting that higher ferritin levels are associated with poorer glycemic control. Additionally, a weak but significant correlation was found between serum ferritin and diabetes duration (r = 0.278, p = 0.047). Conclusion: Elevated serum ferritin levels are significantly associated with impaired glycemic control and disease progression in T2DM. These findings underscore the role of ferritin as a biomarker for metabolic dysregulation in diabetes management.

Background: Type 2 Diabetes Mellitus (T2DM) is a progressive metabolic disorder characterized by insulin resistance and β-cell dysfunction. C-peptide, a marker of endogenous insulin secretion, plays a crucial role in assessing β-cell function. This study evaluates the correlation between fasting and postprandial C-peptide levels with glycemic markers in T2DM patients to better understand β-cell function and its relationship with glycemic control. Methods: A cross-sectional study was conducted in the Department of Biochemistry, Patna Medical College, Bihar, India, with 86 T2DM patients. Fasting and postprandial plasma glucose, C-peptide levels, and HbA1c were measured. Correlation analysis was performed between C-peptide levels and glycemic parameters using Pearson’s correlation coefficient. Results: The mean age of participants was 52.3 ± 10.4 years, with a male-to-female ratio of 1.2:1. The mean fasting and postprandial plasma glucose levels were 152.6 ± 28.4 mg/dL and 225.7 ± 35.2 mg/dL, respectively, while the mean HbA1c was 8.3 ± 1.5%. A significant negative correlation was observed between fasting C-peptide and HbA1c (r = -0.42, p < 0.001) and postprandial C-peptide and HbA1c (r = -0.48, p < 0.001), indicating declining β-cell function with worsening glycemia. Conclusion: C-peptide levels negatively correlate with HbA1c and plasma glucose levels, highlighting the progressive decline in β-cell function in T2DM. These findings suggest that C-peptide assessment can serve as a valuable tool in evaluating β-cell reserve and optimizing treatment strategies. Further, longitudinal studies are warranted to explore its prognostic significance.

Objective: To evaluate maternal complications and fetal outcome in eclampsia and to formulate strategies to improve the maternal and perinatal outcome. Methods and Material: It is a prospective study in which 100 patients with eclampsia antenatal or within 10 days after delivery were included, Patients with seizures due to epilepsy or other cerebral conditions were excluded. A thorough general physical examination, systemic and obstetric examinations were done.  Immediate decision regarding mode of delivery was taken. Maternal complications and foetal outcome were noted. Patient followed through from admission till discharge. Results: Out of 100 patients of eclampsia, 77 cases were antepartum, most of patients were nulliparous, with age between 20-30 years, unbooked, belonging to rural population. maternal complications were cerebral oedema 6%, CVT 3%, pulmonary oedema 2%, deranged LFT 3%, grade 1 nephropathy 3%, grade 1 hypertensive retinopathy 12%, massive ascites 3%, abruptio placentae 1%, PPH 3% and PRES 4%.maternal mortality is 2% and perinatal mortality is 22.22%. Conclusion: This study is done in an area which is considered underdeveloped & backward in the state, therefore early diagnosis of hypertension and its prompt management will prevent eclampsia and thereby preventing complications of eclampsia, hence by increasing awareness, regular antenatal check-ups, improving medical and transport facilities, the incidence and associated morbidity & mortality can be further reduced.

Background: The aim of this study is to assess and compare between ultrasound guided, peripheral nerve stimulator and combined technique for supraclavicular brachial plexus block in patients undergoing elbow and below elbow surgeries with respect to ease of administration, success rate and quality of block. Materials and Methods: 75patientsbelongingtoASA I and II grades and presenting for elective upper limb surgeries in the age group of 20-60 years were included in the study. They were randomly divided into one of the following three groups. Patients who received supraclavicular block through PNS technique were labeled asGroup A. Patients who received supraclavicular block through USG technique were labelled as Group B. Patients received supraclavicular block through combined method were labelled as Group: We used 20-35 ml of local anesthetics for all 3 groups which was a mixture of Lignocaine, Bupivacaine, Hyalase, Dexa with distilled water. In all 3 groups we noted block execution time, time taken for achieving complete nerve block, onset of sensory block, onset of motor block, duration of sensory block , duration of motor block, need for supplementation, safety profile, success and failure. Observation and Results: There were no significant changes noted in all 3 groups with respect to demographic parameters. Mean time required for performing block was significantly lesser in combined group (6.32 +/- 1.60 min). Similarly, onset of sensory block was minimum in combined technique (5.56+/-2.56 min) Mean duration of sensory block was observed to be more in combined technique (8.54 +/- 2.79 hours). Conclusion: We observed shorter procedure time, faster onset time of sensory and motor block with combined USG and PNS guided supraclavicular block. There was no incidence of complications such as arterial puncture, nerve injury and pneumothorax with any of the techniques.

Cancer is an important major health problem with high mortality rate around the world. By 2040, the number of new cancer cases per year is expected to rise to 29.9 million and the number of cancer-related deaths to 15.3 million, Therefore is an urgent need to develop new strategy of anticancer treatments to reduce mortality of patients and increase their life quality during treatment journey. Drug repurposing is a faster way to find new treatments for serious diseases like cancer. Through reusing drugs that have been already approved for other conditions and  tested in clinical trials and data related to their pharmacokinetics is already described. Research suggests that antipsychotic drugs might be effective in treating cancer. This review examines studies on how different antipsychotics affect different types of cancer, including lung, breast, colon, liver, brain, leukemia, oral, ovarian and skin cancer. Results indicated that perphenazine and prochlorperazine have impact on cell viability, motility, and protein content (MITF and tyrosinase) in melanotic (COLO829) and amelanotic (C32) melanoma cells. In addition to chlorpromazine (CPZ) which has demonstrated significant anti-endometrial cancer activity with derivatives JX57 and JX66 showing even stronger effects with minimal side effects. CPZ is also being explored for glioblastoma (GBM) due to its inhibitory effects on cancer cell growth via dopamine receptor modulation. Epidemiological data support a reduced cancer risk in patients treated with CPZ. Furthermore, flupentixol has emerged as a potential anticancer agent for lung cancer by acting as a PI3K inhibitor, regulating the cell cycle, reducing cell proliferation and causing apoptosis in several types of cancer cells. It was also found that this drug is able to target cancer-related proteins, such as ABCB1 and P-glycoprotein as well as to regulate the Akt and Wnt signaling pathways. In conclusion, this summary imply that antipsychotics repurposing may be one of the best strategy to develop oncology therapy.

Background: Hip fractures in the elderly represent a major public health challenge, often leading to significant loss of independence and functional decline. Regaining pre-fracture mobility is crucial for maintaining quality of life, yet a considerable proportion of elderly patients fail to recover their baseline ambulatory status following surgery. Identifying the risk factors responsible for poor functional recovery can help guide postoperative care and rehabilitation strategies. Objective: To evaluate clinical, nutritional, and rehabilitation-related factors influencing the inability to regain pre-fracture mobility in elderly patients after hip fracture surgery. Methods: This prospective observational study was conducted over 10 months at the Department of Orthopaedics, Sri Krishna Medical College, Muzaffarpur, Bihar, India. A total of 120 patients aged ≥65 years who underwent surgery for hip fractures were enrolled. Pre-fracture ambulatory status was assessed at admission using the Modified Functional Ambulation Classification (MFAC), and patients were followed for 3 months postoperatively to evaluate recovery. Data regarding demographic characteristics, comorbidities, cognitive status, nutritional indicators (serum albumin), time to surgery, and access to physiotherapy were collected and analyzed. Results: Out of 120 patients, 51 (42.5%) failed to regain their pre-fracture level of mobility at 3-month follow-up. On multivariate analysis, the strongest independent predictors of poor functional recovery included age >80 years, cognitive impairment, serum albumin <3.5 g/dL, surgical delay >72 hours, and lack of postoperative physiotherapy (p < 0.05). Female sex and higher comorbidity index were also associated with worse outcomes but did not reach statistical significance. Conclusion: Recovery of ambulatory function after hip fracture surgery in the elderly is influenced by both modifiable and non-modifiable factors. Early surgical intervention, nutritional support, cognitive evaluation, and structured rehabilitation play critical roles in optimizing mobility outcomes. Incorporating these factors into postoperative planning may help improve independence and quality of life in this vulnerable population.

Background: Hypertensive disorders are among ^‘the most common medical complications during pregnancy, affecting 6–8% of pregnancies. The systemic inflammatory response plays a crucial role in the pathophysiology of these disorders. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have emerged as potential markers for evaluating the severity of hypertensive disorders of pregnancy. Aim: This study aimed to retrospectively evaluate leukocyte and platelet counts in hypertensive disorders of pregnancy and their association with disease severity. Methodology: A prospective, comparative study was conducted at  Department of Obstetrics and Gynaecology, Katihar Medical College and Hospital, Katihar, Bihar, India including 80 pregnant women diagnosed with hypertensive disorders (chronic hypertension, gestational hypertension, mild preeclampsia, and severe preeclampsia). Leukocyte and platelet count, as well as NLR and PLR, were analyzed using SPSS 27.0, with statistical significance set at p < 0.05. Results: The study found a progressive increase in total leukocyte and neutrophil counts from gestational hypertension to severe preeclampsia, indicating an intensified inflammatory response. The NLR and PLR were significantly higher in severe preeclampsia compared to other groups, showing strong positive correlations with disease severity (NLR: r = 0.65; PLR: r = 0.58; p < 0.05). Conclusion: Elevated NLR and PLR are indicative of increased systemic inflammation and correlate with the severity of hypertensive disorders in pregnancy. These hematological markers may serve as valuable tools for assessing disease progression.

Background: Cerebral palsy encompasses a range of movement and posture disorders caused by brain injury occurring before or during early development. Epilepsy occurs in 35-41% of children with cerebral palsy, significantly complicating their management, particularly in cases of intractable epilepsy. The prior identification of predictive risk factors for drug-resistant epilepsy can facilitate the development of targeted interventions. Aim: This study recognises risk aspects for persistent epilepsy in children with cerebral palsy, thereby improving clinical decision-making and patient outcome. Methodology: 96 children with epilepsy and cerebral palsy participated in a retrospective observational study in a tertiary care facility in India. Demographic, perinatal, seizure, and neurological characteristics were analysed retrospectively. Multivariate analysis revealed significant predictors of intractable epilepsy. Results: Among the 96 participants (53 males, 43 females), 36 individuals (37.5%) were diagnosed with intractable epilepsy. Key risk factors identified were low Apgar scores at 5 minutes (OR 3.12; p=0.04), a history of neonatal seizures (OR 3.28; p=0.03), and focal epilepsy (OR 3.27; p=0.005). The combination of these factors resulted in an AUC of 0.825, signifying high predictive accuracy. Children exhibiting all four primary risk factors demonstrated a 92% likelihood of developing intractable epilepsy. Conclusion: Intractable epilepsy in CP is predicted by poor neonatal outcomes, early seizure onset, and specific seizure patterns. The findings highlight the necessity for early, intensive, multidisciplinary intervention to enhance management strategies and improve long-term outcomes.

Background: Phototherapy is the standard treatment for neonatal hyperbilirubinemia; however, it is associated with certain adverse effects, one of which is hypocalcemia. This study aimed to evaluate the incidence of phototherapy-induced hypocalcemia and its correlation with the duration of phototherapy in neonates. Objectives: To assess the frequency of hypocalcemia in neonates undergoing phototherapy for hyperbilirubinemia and to determine the relationship between the duration of phototherapy and the development of hypocalcemia. Methods: This prospective observational study was conducted at the Department of Paediatrics, Nalanda Medical College and Hospital, Patna, Bihar, from June 2018 to may 2019. A total of 100 term neonates with uncomplicated neonatal hyperbilirubinemia requiring phototherapy were enrolled. Serum calcium levels were measured before initiation and after completion of phototherapy. The data were analyzed to find the incidence of hypocalcemia and its correlation with the duration of phototherapy. Results: Out of 100 neonates, 32% developed hypocalcemia after phototherapy. The incidence was significantly higher in neonates who received phototherapy for more than 24 hours. A statistically significant inverse correlation was observed between serum calcium levels and the duration of phototherapy (p < 0.05). Clinical symptoms of hypocalcemia, such as jitteriness and irritability, were observed in a few cases but were mostly subclinical. Conclusion: Phototherapy is associated with a considerable risk of hypocalcemia in neonates, especially with prolonged exposure. Routine monitoring of serum calcium levels during phototherapy is recommended to prevent potential complications.

Background: Stroke in young adults, although less common than in the elderly, has emerged as a significant health concern due to its socio-economic impact and increasing incidence. Understanding the clinical presentations and angiographic findings in younger patients is crucial for early diagnosis, appropriate treatment, and secondary prevention. Objectives: To evaluate the clinical features, risk factors, and angiographic patterns of stroke among patients aged 15–45 years presenting to a tertiary care hospital. Methods: A prospective observational study was conducted over a period of 12 months at the Department of Neurology, Paras HMRI Hospital, Patna, Bihar, India. A total of 100 patients aged between 15 to 45 years diagnosed with ischemic or hemorrhagic stroke were enrolled. Detailed clinical histories, neurological examinations, and relevant laboratory investigations were recorded. All patients underwent brain imaging and cerebral angiography (CTA/MRA/DSA) to assess vascular pathology. Results: The majority of patients were male (62%), with a mean age of 38.5 years. The most common clinical presentation was hemiparesis (74%), followed by speech disturbances (45%) and visual symptoms (18%). Hypertension (42%), smoking (35%), and dyslipidemia (31%) were the predominant risk factors. Angiographic evaluation revealed large vessel occlusion in 41% of cases, small vessel disease in 27%, arterial dissection in 11%, and cardioembolic sources in 9%. A subset of patients (12%) had no identifiable cause (cryptogenic stroke). Conclusion: This study highlights the diverse clinical and angiographic profile of young stroke patients in Bihar. Traditional vascular risk factors are still significant contributors, but non-atherosclerotic mechanisms like arterial dissection and cardio embolism also play a critical role. Early identification and targeted management strategies are essential to improve outcomes and reduce long-term disability in this age group.

Background: Non-fermenting Gram-negative bacilli (NFGNB) are increasingly recognized as significant opportunistic pathogens, particularly in hospital settings. These organisms are notorious for their intrinsic and acquired resistance to multiple antibiotics, posing serious challenges in clinical management. This study was conducted to determine the prevalence and antibiotic resistance profiles of NFGNB isolated from clinical specimens at Netaji Subhas Medical College and Hospital, Bihar, India. Objectives: (1) To determine the prevalence of NFGNB in various clinical samples from hospitalized patients. (2) To evaluate the antibiotic resistance patterns of NFGNB isolates. (3) To assess the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains. Methods: A retrospective observational study was conducted at in the Department of Microbiology at Netaji Subhas Medical College and Hospital, Bihar, India from March 2022 to Feb 2023. A total of 130 clinical samples, including sputum, pus, blood, urine, and body fluids, were processed. NFGNB were identified using conventional biochemical methods and the VITEK-2 automated system. Antibiotic susceptibility testing was performed using the Kirby-Bauer disk diffusion method and VITEK-2, interpreted as per CLSI guidelines. Results: Of the 130 samples, 45 (34.6%) were confirmed as NFGNB. Pseudomonas aeruginosa (53.3%) was the predominant isolate, followed by Acinetobacter baumannii (33.3%) and Stenotrophomonas maltophilia (8.9%). High resistance was observed against cephalosporins, fluoroquinolones, and carbapenems. Multidrug resistance was identified in 51.1% of isolates, particularly among ICU-derived strains. Colistin remained the most effective agent, showing 100% susceptibility. Conclusion: The study underscores a high prevalence of multidrug-resistant NFGNB in clinical settings, especially in critical care units. These findings emphasize the urgent need for robust antimicrobial stewardship, regular resistance surveillance, and strict infection control practices to mitigate the rising threat of antimicrobial resistance in tertiary care hospitals.

Background: Post-operative astigmatism remains a key determinant of visual rehabilitation following cataract surgery. The location of the scleral incision in manual small incision cataract surgery (MSICS) significantly influences the magnitude and axis of surgically induced astigmatism (SIA). This study compares the effects of superior versus superotemporal scleral incisions on post-operative astigmatism in MSICS. Methods: A prospective, comparative study was conducted at the Department of Ophthalmology, Sri Krishna Medical College Hospital, Muzaffarpur, Bihar, India from September 2024 to December 2024. A total of  100 patients undergoing MSICS were enrolled and randomly assigned into two groups: Group A (superior scleral incision) and Group B (superotemporal scleral incision). Post-operative astigmatism was assessed using manual keratometry and corneal topography at 1 week, 1 month, and 3 months post-surgery. Results: The mean post-operative astigmatism was significantly higher in Group A (superior incision) compared to Group B (superotemporal incision) at all follow-up points. The superotemporal incision demonstrated better stability and reduced surgically induced astigmatism, especially in with-the-rule astigmatic cases. Statistical analysis confirmed a significant difference (p < 0.05) between the two groups in terms of mean SIA. Conclusion: Superotemporal scleral incisions in MSICS are associated with lower post-operative astigmatism compared to superior incisions, leading to improved visual outcomes. This technique may be preferred, particularly in patients with pre-existing with-the-rule astigmatism or in cases requiring rapid visual rehabilitation.

Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that often requires long-term systemic corticosteroids and immunosuppressive agents for disease control. These treatments, while effective, may have ocular side effects including the development or exacerbation of glaucomatous features. This study aimed to assess the impact of systemic steroids combined with immunosuppressive therapy on intraocular pressure (IOP) and other glaucomatous changes in SLE patients. Methods: A prospective observational study was conducted over at the Department of Ophthalmology, Sri Krishna Medical College Hospital, Muzaffarpur, Bihar, India from October 2024 to January 2025. A total of 80 patients diagnosed with SLE and undergoing systemic steroid and immunosuppressive treatment were enrolled. Comprehensive ophthalmic evaluations including intraocular pressure measurement, optic disc assessment, gonioscopy, and visual field analysis were performed at baseline and at 3-month intervals. Patients with pre-existing glaucoma or ocular hypertension were excluded. Results: Among the 80 patients, 32.5% developed elevated IOP during the follow-up period, with 18.75% exhibiting early glaucomatous changes on optic disc examination. Visual field defects consistent with glaucoma were detected in 12.5% of cases by the end of the study. The risk of developing ocular hypertension was significantly higher in patients receiving systemic steroids for more than 6 months. A positive correlation was observed between cumulative steroid dose and IOP elevation (p<0.01). No significant differences were observed between various types of immunosuppressive agents used. Conclusion: Systemic corticosteroid therapy, especially when prolonged, significantly increases the risk of developing ocular hypertension and glaucomatous changes in SLE patients. Regular ophthalmologic screening and timely intervention are crucial for the early detection and management of steroid-induced glaucoma in this high-risk population.

Background: Mid-trimester pregnancy termination, especially in women with previous cesarean sections, presents unique challenges and risks. Mechanical and pharmacological methods, such as Foley catheter and mifepristone with misoprostol, are widely used for induction. Aim: To compare the efficacy and safety of Foley catheter plus misoprostol versus mifepristone plus misoprostol for mid-trimester abortion in women with prior cesarean sections. Methodology: This prospective, comparative study was conducted at Government Medical College and Hospital, Bettiah, Bihar, with 80 women aged 18–35 years, between 13–26 weeks of gestation. Group A (n=48) received Foley catheter with misoprostol, while Group B (n=32) received mifepristone followed by misoprostol. Outcomes measured included induction-to-abortion interval (IAI), cervical dilatation, abortion completeness, and safety. Results: Group A had a significantly shorter mean IAI (6.5 ± 1.0 hours) than Group B (9.2 ± 2.5 hours). Complete abortion occurred in 100% of cases in both groups. Group A demonstrated faster cervical dilatation and shorter IAIs across all gestational age categories. No major complications were reported. Conclusion: Foley catheter combined with misoprostol proved more efficient than mifepristone with misoprostol in inducing mid-trimester abortion, especially in women with a previous cesarean section. This method is safe, effective, and cost-efficient, supporting its use in low-resource settings.

Background: Infertility is a growing concern worldwide, affecting 8–12% of reproductive-age couples. Metabolic disorders such as insulin resistance, hyperprolactinemia, and thyroid dysfunction play a crucial role in subfertility. Addressing ^‘these metabolic factors may improve reproductive outcomes in affected women. Aim: This study evaluates the impact of correcting metabolic factors on enhancing pregnancy outcomes in sub-fertile women. Methodology: A prospective observational study was conducted at the Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Bettiah, Bihar, India. The study included 90 sub-fertile women aged 18–45 years. Participants were screened for metabolic abnormalities, including thyroid dysfunction, hyperprolactinemia, and insulin resistance. Corrective interventions included levothyroxine for thyroid dysfunction, metformin for insulin resistance, and dopamine agonists for hyperprolactinemia. Ovulation was monitored over three menstrual cycles post-intervention, and hormonal levels were reassessed. Results: A significant reduction in thyroid-stimulating hormone (TSH) (p < 0.001), serum prolactin (p < 0.001), and luteinizing hormone (LH) (p < 0.05) was observed after three months of treatment. Estradiol and progesterone levels increased significantly (p < 0.05, p < 0.001, respectively). Ovulation occurred in 66.67% of participants within three cycles, while 8.33% ovulated within six cycles. However, 25% required extended treatment. Conclusion: Correcting metabolic abnormalities significantly enhances ovulation and improves fertility outcomes in sub-fertile women. Addressing these factors should be a key component of infertility management.