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.