Objective: To compare the effectiveness of extra amniotic saline infusion (EAS) by intracervical Foley catheter with prostaglandin E2 (PGE2) gel for cervical ripening and labor induction in women with unfavorable cervices. Methods: This prospective randomized trial included 100 women with unfavorable cervices. Women were randomly assigned to receive either EAS by intracervical Foley catheter or PGE2 gel for cervical ripening and labor induction. Results: Both EAS by intracervical Foley catheter and PGE2 gel were effective in achieving cervical ripening and labor induction. However, EAS had a shorter induction-to-active labor interval and higher post-induction Bishop’s score compared to PGE2 gel. Conclusion: EAS by intracervical Foley catheter is an effective method for cervical ripening and labor induction in women with unfavorable cervices, with some advantages over PGE2 gel.

Zandu Haldi Drops are a one-of-a-kind recipe intended to promote immunity and overall health. It possesses the goodness of saffron, cinnamon, cardamom, black pepper, and Haldi. The present work was designed to estimate Curcumin (Turmeric) by High-Performance Thin Layer Chromatography (HPTLC) as well as Piperine (Pepper) through UV Spectrophotometry, with reference to the marker compounds. A standard curve was prepared separately for Curcumin and Piperine using methanol as solvent. HPTLC plate was scanned in scanner at 421 nm. Sample peak area values were compared with that of standard’s area to determine the extent of drug present. The standard plot for Piperine was prepared by scanning the known concentrations at 342 nm and the unknown sample concentration was determined from this curve. The concentration of Curcumin was found to be 5.6 µg/ml and the Piperine concentration in the formulation was 2.5%. From the obtained results, it can be concluded that the formulation of Zandu haldi drops confirmed the presence of labelled ingredients viz, Turmeric and Pepper.

Background & Objectives: Inappropriate antimicrobial use leads to antimicrobial resistance (AMR) resulting in increased morbidity and mortality with a significant economic burden. Because of the increasing concern about AMR, World Health Organization (WHO) instituted Point Prevalence Survey (PPS) methodology to collect data to help formulate hospital interventions to optimise antimicrobial use. The objective was to analyse the prevalence of antimicrobial use among hospitalized patients at a point of time. Material & Methods: This cross-sectional point prevalence survey modified from the WHO PPS protocol was conducted among hospitalized patients who received antibiotics before 9AM on the survey date. Data were collected from case files using a pre-structured and validated google form based on the WHO Methodology under the guidance of the National Centre for Disease Control (NCDC). Results: The prevalence of antimicrobial use was 81.39% of which 98.9% were empirical. 40% of patients received one, 36% received two and 24% received more than two antimicrobials. 47% of all antimicrobials prescribed were from the “Access” group, 51.8% from the “Watch” group, and 1.2 % from the “Reserve” group. The most frequently prescribed antimicrobial was ceftriaxone (76%), followed by Metronidazole (41.7%) and amoxiclav (21%). Conclusion: Overall hospital antimicrobial use prevalence is high with preference for empirical prescription from the Watch group. The antimicrobial prescribing behaviour must adhere to the standard treatment guidelines, and prescribe preferably from the Access group of antibiotics so as to promote antimicrobial stewardship.

Introduction: Spinal anaesthesia is commonly used as a safe anaesthetic technique for both elective and emergency operations. Shivering is known to be a frequent complication in patients undergoing surgery under neuraxial anaesthesia with incidence of 40–70%. Shivering is described as an involuntary, spontaneous, and repetitive muscular movement, caused by vasoconstriction in upper limbs compensating the lower limb vasodilation. Hypothermia is one of the frequent causes that lower the shivering threshold. Shivering causes increase oxygen consumption, increase the risk of hypoxemia, induce lactic acidosis, and catecholamine release. We used different pharmacological drugs to control post spinal shivering. Methodology: In this prospective observational study, 90 patients who are candidates for subarachnoid block undergoing surgeries with American Society of Anesthesiologist (ASA) I or II, between 18 to 60 years, who are scheduled for abdominal and lower limb surgeries and who developed shivering following spinal anaesthesia we will divide them into 3 groups. Group A will get low dose iv ketamine(0.25mg/kg), Group B will get iv tramadol(0.5mg/kg), Group C will get iv dexmedetomidine(5mcg/kg). Result: Shivering was controlled in 24 (80%) patients in the ketamine group and 22 (74%) patients in the tramadol group, whereas it was controlled in 27 (90%) patients in the Dexmedetomidine group. Conclusion: Low-dose ketamine (0.25 mg/kg) ,tramadol (0.5 mg/kg) and dexmedetomidine (0.5mcg/kg) intravenously is efficient in lessening the shivering in patients having lower abdominal surgery under subarachnoid anaesthesia. However, Dexmedetomidine is associated with higher effective rate of shivering control.

Background: Gestation, or pregnancy, involves three trimesters where a fertilized egg develops into a fetus. Early pregnancy is marked by symptoms such as missed periods, nausea, vomiting, hunger and fatigue. Significant health concerns arise during this period, notably anemia, particularly iron deficiency anemia, which affects around 60% of pregnant women in regions like Madhya Pradesh, India. Hypothyroidism also poses risks, as maternal thyroid hormones are crucial for fetal development. Understanding these conditions underscores the necessity for targeted healthcare interventions to ensure maternal and fetal well-being throughout pregnancy. Aim & Objective: To study serum hepcidin and thyroid hormones in anemic pregnant women. Compare between Cases and Controls all these parameters & examine their correlation. Materials and Method: Total 300 subjects were studied which were divided into two groups of 150 of anemic pregnant women as cases and 150 non-anemic pregnant women as controls. Healthy controls after defining proper inclusion and exclusion criteria. Thyroids hormone was estimated on C.L.I.A. a while Hepcidin was estimated by ELISA. Results: Anemic pregnant women had significantly lower serum Hepcidin and thyroid hormone levels compared to non-anemic pregnant women as controls, (all P < 0.05). No significant correlations were found between serum Hepcidin and thyroid hormones in the anemic pregnant women. Conclusion: Our study highlights that anemia in pregnant women is linked to lower serum hepcidin and thyroid hormone levels, which may negatively impact maternal and fetal health. Routine screening and nutritional support are essential for optimizing outcomes in region.

Introduction:  Cerebrovascular stroke is a leading cause of morbidity and mortality worldwide. It is clinically defined as an abrupt onset of neurological deficit due to a focal vascular cause. Symptoms include loss of sensory and/or motor function, change of gait, change of vision or inability to speak or understand spoken words, headache, nausea, vomiting, giddiness, convulsions, loss of consciousness etc. There are few studies which have proven the association between elevated levels of NT Pro-BNP and cardioembolic cerebrovascular stroke as well as post-stroke outcomes. Some studies have shown a positive association between elevated plasma NT Pro-BNP levels in Acute Ischemic Stroke with atrial fibrillation. Hence this study aims to find the association of elevated levels of NT Pro-BNP in cardioembolic ischemic cerebrovascular stroke.  Materials and Methods:  This is a cross sectional type of study, conducted in the department of medicine at B.J Medical college Ahmedabad during the time period of October 2020 to December 2022. We included a total of 40 patients with ischemic cerebrovascular stroke for study. Patients with hemorrhagic stroke and those with stroke recurrence were excluded from the study. All the details were recorded in standard case record form and all these data were entered in Microsoft Excel sheet. Results were presented as mean + standard deviation (SD) or percentages. Continuous variables were analysed for normalization and compared using the student t test. Inter group comparisons were made using chi-square test. A cut-off value of p<0.05 was considered statistically significant. Results:  In this study we tested 40 patients with ischemic stroke of different etiologies for elevated NT Pro-BNP levels. Among these 40 patients, 55% stroke were of cardioembolic origin (n=22), 32% were having large artery thrombosis as a cause of cerebral ischemia (n-13), 5% with lacunar stroke (n=2) and 8% were of undetermined etiology (n=3). A cut-off value of 125pg/mL for age for NT Pro BNP levels was selected based on previous studies and the diagnostic kit used. We found that 53% (n=21) of patients with ischemic stroke were tested positive for elevated levels of NT Pro-BNP. Of those 21 patients who tested positive for elevated NT Pro BNP levels, 90% (n=19) were having cardio-embolic origin of stroke whereas only 10% (n=2) were having large artery thrombosis, a value that has a high statistical significance with a p value of 0.000034. Out of 22 patients with cardio-embolic origin of stroke 86% (n=19) patients had an elevated level of plasma NT Pro BNP, a value that is statistically significant with a p value of <0.05(p = 0.000034.). Conclusion:  It is important to diagnose and classify stroke in its acute phase as it is associated with majority of adverse outcomes. NT Pro-BNP can be used as a biomarker for identifying cardioembolic origin of stroke. Also, it is useful for ruling out thrombotic stroke. It can be useful for differentiation of cardioembolic from other stroke subtypes for initiating proper treatment.

Background: The purpose of the study was to compare the effects of nebulization with ropivacaine (0.75%) and nebulization with Dexmedetomidine on the hemodynamic response to intubation in patients undergoing surgery under general anaesthesia. Introduction: Laryngoscopy and tracheal intubation are known to cause significant sympathetic stimulation, leading to hemodynamic fluctuations such as increased heart rate and blood pressure. This study aims to compare the efficacy of nebulisation with ropivacaine, a local anaesthetic, with nebulization by dexmedetomidine, an alpha-2 adrenergic agonist, in mitigating these responses. Methods: A prospective observational study was conducted with 120 randomised patients scheduled for elective surgery under general anaesthesia. Patients were divided into three equal groups: Group R received nebulization with ropivacaine (0.75%), Group D received nebulization with dexmedetomidine (1 µg/kg), and Group P received a placebo. Hemodynamic parameters, including heart rate (HR) and mean arterial pressure (MAP), were recorded at baseline, during intubation, and at different interims post-intubation and during extubation. The primary aim was to compare the outcomes of the above 3 groups in reducing the stress response to laryngoscopy and intubation. The secondary objectives were to compare the hemodynamic parameters during extubation, postoperative sore throat & cough reflex to extubation. Results: Demographically all groups were similar. Group R and Group D significantly attenuated the hemodynamic response at intubation and extubation compared to the placebo group. Group D demonstrated a more pronounced reduction in HR and MAP during intubation and extubation. Specifically, Group D had a mean MAP of 90 ± 18.4 mmHg compared to 92.4 ± 16.1 mmHg in Group R and 99.5 ± 15.9 mmHg in Group C. Additionally, both groups exhibited a significant reduction in cough response and postoperative sore throat compared to the placebo group. Conclusion: Nebulized dexmedetomidine and ropivacaine both effectively reduced the hemodynamic response to intubation in patients undergoing surgery under general anesthesia. Dexmedetomidine may offer superior control of HR and MAP, making it a preferable choice in clinical settings where hemodynamic stability is crucial.

Background: The pandemic of COVID-19 has shaken the entire world, which resulted in many forms of health crisis in India, even after a virtual lockdown with social distancing and a complete ban on the sale of liquor. Evidence from earlier studies, as well as the recent news, confirm some parallel cases of gender violence across the globe, which have significant linkages with substance abuse. Objectives: The paper targets to map the relationship between substance use and gender violence in the Indian context. This also attempts to identify the significant socio-economic determinants of gender violence in India. Methods: The paper uses the latest National Family Health Survey-4 (2015-16) dataset by applying the two-way, three-ways cross-tabulation methods, Principal Component Analysis (PCA), Kernel density function, and three logistic regression models with the STATA-13 software. The dependent variables are the intensity of gender violence, and the control variables include socio-economic, demographic characteristics, substance use, empowerment dummy, wealth quintile and sources of entertainment, etc. Results: The results of the cross-tabulations and regression models explain the objectives of the study in concordance with the literature. The socio-economic and demographic characteristics, substance use, the role of education, health infrastructure, and the empowerment of women are significant factors. Conclusions: The paper goes with futuristic perspectives using the evidence from the past. Since the findings of the paper explain the role of several factors of gender violence and substance use, appropriate planning is essential in this direction to avoid further adverse impacts that emerged from the COVID19 pandemic.

Background: Antimicrobial resistance is a significant global issue causing millions of deaths, long-term impairments, and increased medical expenditures. The investigation reveals a direct relationship between the widespread use of antimicrobials in human and veterinary medicine and the proliferation of resistant bacteria strains. Aim & Objective: Antibiotic Resistance Profile and Molecular Confirmation of MRSA isolates by PCR from Clinical Samples at Tertiary Care Hospital in India. Material & Methods: In this study total 750 samples were included, out of which 358 samples were found positive for Staph aureus. Samples were cultured on Blood agar & MacConkey agar and bacterial identification along with antibiotic susceptibility testing. PCR also done for the confirmation of Positive MRSA. Result: In this study total 750 samples were included, out of which 358 samples were found positive for Staph aureus, after that antibiotic sensitivity testing was done for 358 Staph aureus isolates. Out of a total of 358 positive samples, 200 were identified as MRSA and confirmed by the detection of the MecA gene. Conclusion: Emergence of MRSA and VRSA infections is a growing problem in our hospital. Our study gives an outline of antibiotics susceptibility patterns of Staph aureus isolates which will help in formulating the local antibiotic policy for the hospital and to start the appropriate empirical antibiotic treatment before the culture and sensitivity are available.

Introduction: The infraorbital region of the face is used to block the infraorbital nerve for many procedures, such as wound closure, biopsy, scarification and other facial cosmetic procedures, so a thorough knowledge of this region is essential for doctors to anaesthetize infraorbital nerve effectively. The infraorbital nerve is the maxillary branch, another branch of the trigeminal nerve. The supraorbital foramen or notch and the infraorbital foramen are important anatomical landmarks where important nerves leave the skull. Aim: To assess normal and abnormal morphometry and morphology of the infraorbital foramen. Materials and Methods: A cross-sectional observational study was carried out from 1^st January 2024 to 31^st March 2024 in the Department of Anatomy of a leading Govt. Medical College of Jaipur, Rajasthan. A total of 50 adult dry skulls were evaluated for various osteological parameters. The metric range, mean and standard deviation of the parameters were calculated. Results: The mean of the greatest vertical diameter of infraorbital foramen was 4.49 mm on the right side and 4.54 mm on the left side. The average of the largest transverse diameter was 4.80 mm on the right side and 4.53 mm on the left side. The frequency of semilunar, oval and round shapes was 62%, 26% and 12%. Conclusion: The information presented in this study is useful in various fields of maxillofacial surgery and regional block anaesthesia medicine, dentistry and anthropometry.

The dengue virus (DENV), which is conveyed by Aedes mosquitoes, is the cause of dengue, an infectious disease that is carried by arthropods. This study aimed to understand the epidemiological pattern of dengue infection and investigate the clinical symptoms of different serotypes. A systematic study was conducted to gather information on the epidemiology, clinical characteristics, serotype distribution, and risk factors for dengue globally. This study set out to ascertain the prevalence of dengue virus infection in Ajmer. Dengue, which has spread throughout the urban and semi-urban areas of Ajmer, mainly affects men. Virus activity is highest during the monsoon and post-monsoon seasons, when vector breeding is most common. Thus, the importance of continuous seroepidemiological monitoring for the timely creation and implementation of a successful dengue control program is underscored by our work. In this paper, we will discuss it. Ajmer District dengue epidemiology: a thorough examination of serotype trends.

Background: Supraclavicular brachial plexus block provides safe, effective and low-cost anesthesia. There are always efforts to find better and safer local anesthesia along with adjuvant for supraclavicular brachial plexus block. Levobupivacaine has strongly emerged as a safer alternative for regional anesthesia than its racemic sibling bupivacaine. We conducted the study to compare levobupivacaine with clonidine or butorphanol for sensory block, motor block, duration of analgesia, sedation and adverse effects. Aims and Objectives: (1) To evaluate the analgesic efficacy of clonidine and butorphanol as an adjuvant to levobupivacaine. (2) To assess the onset and duration of sensory and motor block, duration of postoperative analgesia, visual analog score (VAS) scoring and the requirements of rescue analgesia. Methodology: A prospective randomized study was carried out which included 60 adult patients between the ages of 18-65 years of ASA 1 and 2 who underwent upper limb surgeries. Group A received 30 ml of 0.5% levobupivacaine with 40mcg clonidine and group B received 30 ml of levobupivacaine with 2 mg of butorphanol via supraclavicular approach. Onset, duration of sensory and motor block, duration of analgesia was observed. All patients were observed in post anesthesia care unit and received tramadol injection 100mg IV in 100ml normal saline as soon as they compared of pain as rescue analgesic. Duration of analgesia was taken as the time from placement of block till the injection of rescue analgesic. Result: Duration of block and analgesia was prolonged in group A compared to group B and it is statistically highly significant. Conclusion: Clonidine as an adjuvant with 0.5% levobupivacaine is more effective in prolonging the duration of sensory and motor block and the duration of analgesia when compared to butorphanol as an adjuvant to 0.5% levobupivacaine.

Background:  One of the most common operations in the general surgery department is inguinal hernia repair. The concept of hernia repair underwent evolution from Bassini’s repair to tension-free repair with the introduction of polypropylene mesh. This mesh can be implanted using either an open or laparoscopic technique. Laparoscopic repair is popular and this method is still being debated because it requires well equipped instruments and cost effective to the patient is more, long duration of surgery, general anesthesia requirement and associated complication. Open Pre peritoneal approach is theoretically and practically sound alternative approach established right before the laparoscopic era to treat challenging recurrent groin hernias with significant scarring and tissue loss. Aim of the study to compare the clinical outcome of open pre peritoneal approach versus Trans inguinal Lichtenstein approach in relation to post-operative pain, Seroma formation, Wound infection and Recurrence. Materials and Methods: This was a Prospective comparative study done in Department of general surgery, Narayana Medical College Hospital, Nellore from November 2019 to July 2021 in 30 cases, divided into two groups by random allocation technique. Groups A and B with 15 patients in each group. Results: In the open pre peritoneal repair group, the mean age was 52.46 ± 12.29, in the Trans-inguinal Lichtenstein repair group it was 51.60 ± 15.94. The incidence of chronic groin pain in Lichtenstein group was 20% at 3 months and 6.6% at 6 months. Incidence of seroma at end of post op 7^th day was higher in Trans inguinal Lichtenstein repair group (33.3%) compared to Open pre peritoneal repair group (6.7%). Incidence of wound infection was observed in Trans- inguinal Lichtenstein repair group to be 20% by the end of 1st month. There was only one case of recurrence in Transinguinal Lichtenstein group at 6 months. There were no recurrences in the open pre peritoneal repair group. Conclusion: From the study it can be concluded that inguinal hernia repair with open pre peritoneal approach (Trans rectus sheath pre peritoneal approach TREPP) has resulted in better patient comfort with low post-operative pain and also few complications. There was no recurrence observed in my study, the follow up period was only 6 months. TREPP seems to be an effective and safe technique which gives an approach to inguinal, femoral and obturator hernias and shares the same anatomical relationship

Introduction: Japanese Encephalitis (JE) is an endemic disease in Assam, India. It presents as Acute Encephalitis Syndrome (AES), usually characterized by sudden-onset fever, headache, and altered consciousness. Despite the introduction of JE vaccine in the National Immunization Schedule and adult immunization, JE virus infection continues. Gaps exist concerning its profile, presentation, and etiology in tertiary care centers in India. The profile of AES patients in tertiary centers is different, possibly due to delayed care-seeking, empirical therapy, and disease progression. Aim and Objective: To assess the profile of Japanese Encephalitis patients amongst Acute Encephalitis Syndrome cases attending a tertiary care Hospital in Assam. Materials and Methods: A record-based study was conducted in a tertiary care hospital in Assam from Jan 2023 to Aug 2024, where all AES cases admitted to the hospital during the study period were included. Along with socio-demographic variables, blood and CSF (cerebro-spinal fluid) reports were also collected and analyzed. Results: During the study period, 1177 AES cases were reported, of which 313 (26.59%) were positive for JEV. Both CSF and serum were positive for 196 (16.65%) samples; only CSF positive was 59 (5.01%), and only serum positive was for 58 (4.93%) samples. Males (57%) were affected more than females (43%). Majority of males belong to the age group of 10-19 years. Most AES cases reported were from the Dibrugarh district (34%), out of which JE cases were positive for 7%, followed by the Tinsukia district (AES – 18%, JE- 6%). An increasing trend was seen from June (15.33%), taking a peak during July (49.52%), followed by August (15.97%). Conclusion: Focusing on male teenagers may be decisive in JE transmission and vulnerability. A seasonal trend is also observed. Evidence-based interventions like immunization, personal protection against mosquito bites, integrated vector management, early diagnosis, and prompt treatment at peripheral hospitals must be promoted. Also, a complete investigation to exclude other causes of AES should be prioritized.

Background: Ectopic pregnancy remains a significant cause of maternal morbidity and mortality worldwide, particularly in developing regions where delayed diagnosis and intervention contribute to adverse outcomes. Aim and 0bjectives: To evaluate the clinical profile, risk factors, management, and outcomes of ectopic pregnancy cases managed at the Department of Obstetrics and Gynaecology, GMERS Medical College and General Hospital, Junagadh. Materials and Methods: A retrospective analysis of medical records of patients diagnosed with ectopic pregnancy from Jan 2022 to Feb 2024 was conducted. Demographic data, clinical presentation, diagnostic methods, treatment approaches, and outcomes were analyzed. Statistical comparisons were made to assess the effectiveness of surgical versus medical management. Results: A total of 100 cases of ectopic pregnancy were included in the analysis. The majority of patients (56%) were aged 26–35 years, with a mean age of 28.6 ± 5.4 years. The most common risk factors were pelvic inflammatory disease (32%), previous ectopic pregnancy (18%), and prior abortion (16%). Abdominal pain (80%) was the most frequent presenting symptom, followed by vaginal bleeding (64%) and amenorrhea (92%). Transvaginal ultrasound had a diagnostic accuracy of 94%, while serum β-hCG levels >1500 IU/L were observed in 78% of cases. Surgical management was required in 72% of cases, with laparotomy performed in 64% and laparoscopy in 8%. Medical management with methotrexate was successful in 26% of cases, while 15% required conversion to surgery. Ruptured ectopic pregnancies accounted for 58% of cases, with salpingectomy performed in 83%. The mean hospital stay was 4.2 ± 1.5 days for laparotomy and 2.8 ± 1.2 days for laparoscopy. No maternal deaths were recorded, and 92% of patients resumed normal menstrual cycles, with 40% achieving subsequent pregnancies. Conclusion: Ectopic pregnancy continues to pose a serious health risk, particularly in cases of delayed diagnosis. While surgical management remains the mainstay for ruptured ectopic pregnancies, methotrexate provides an effective alternative in selected cases. Early recognition, timely intervention, and improved access to ultrasound and β-hCG monitoring can help reduce morbidity and improve fertility outcomes.

The ketogenic diet (KD) is a high-fat, low-carbohydrate regimen that induces ketosis, shifting the body’s metabolism from glucose to ketone bodies. This systematic review consolidates evidence from 25 clinical and preclinical studies published between 2000 and 2023 to assess the role of KD as an adjunct therapy for Type 2 Diabetes Mellitus (T2DM). The findings show that KD significantly improves glycemic control, with a reduction in HbA1c by 0.9% (p < 0.001), enhances insulin sensitivity, indicated by a HOMA-IR reduction of 1.2 (p < 0.001), and leads to weight loss of approximately 5.4 kg (p < 0.001). Pharmacologically, the ketogenic diet lowers insulin requirements, but its interaction with sulfonylureas can increase the risk of hypoglycemia. Mechanistically, ketosis suppresses hepatic gluconeogenesis, boosts mitochondrial efficiency, and reduces oxidative stress. However, long-term safety data remain sparse, and maintaining adherence to the diet poses a challenge for many patients. Despite these limitations, KD demonstrates potential as an adjunct therapy, though personalized treatment strategies are required to mitigate potential risks.

Background: LOS (Late-Onset Seizures) in adults are a significant neurological concern, often indicating an underlying pathology rather than primary epilepsy. Unlike seizures in younger individuals, which are frequently idiopathic, seizures in adults and the elderly often result from cerebrovascular diseases, infections, metabolic disorders, or structural brain lesions. Understanding the etiology and clinical profile of these seizures is crucial for early diagnosis and appropriate management. Methods: This study was conducted on patients above the age of 20 years presenting with late-onset seizures at a medical college hospital. A detailed history, clinical examination, and relevant investigations, including EEG (Electroencephalography) and neuroimaging (CT/MRI), were performed. Etiological factors were categorized into cerebrovascular diseases, infections, metabolic disorders, and structural abnormalities. Results: The study included 100 patients, with a male predominance (84%). The most common age group af-fected was 41–50 years. Cerebrovascular disease was identified as the leading cause, followed by infections like neurocysticercosis and tuberculosis. Metabolic disorders, including hyponatremia and hypoglycemia, were also significant contributors. Partial seizures, particularly those evolving into generalized seizures, were the predomi-nant type. EEG abnormalities were observed in a majority of cases, with focal epileptiform discharges being the most common finding. Conclusion: Late-onset seizures have a diverse etiology with cerebrovascular events and infections being the most common causes. A systematic approach, including neuroimaging and biochemical evaluation, is essential for accurate diagnosis and management. Early identification of underlying causes can significantly improve patient outcomes.

Background: Distal end radius fractures are among the most frequently encountered skeletal injuries, particularly in elderly patients and young individuals sustaining high-energy trauma. Stable anatomical restoration is essential to maintain wrist function and prevent long-term disability. Volar locking compression plates (VLCPs) have emerged as the preferred modality for surgical fixation in unstable fractures. Objective: To evaluate the clinical and functional outcomes of open reduction and internal fixation using volar locking compression plates in patients with distal radius fractures. Methods: This prospective study was conducted at All India Institute of Medical Sciences (AIIMS), Patna, Bihar. Patients with unstable distal radius fractures treated with open reduction and volar plate fixation were included. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) score and Modified Mayo Wrist Score at follow-up intervals up to six months. Radiographic parameters and complication rates were also recorded. Results: A total of 30 patients were evaluated, with a mean age of 42.6 years. The majority sustained fractures due to road traffic accidents or falls. At six months, 80% of patients achieved excellent to good results on the Modified Mayo Wrist Score, and the mean DASH score showed significant improvement. Complication rates were low, with isolated cases of wound dehiscence and transient stiffness. Conclusion: Open reduction and internal fixation using volar locking compression plates provide reliable anatomical reduction, early mobilization, and favorable functional outcomes in unstable distal radius fractures. With proper technique and rehabilitation, VLCP is an effective and safe surgical option for managing these injuries.

Introduction: Low back pain (LBP) is a common musculoskeletal disorder that affects people across various age groups and professions. Medical students are especially susceptible to LBP due to the rigorous demands of their academic program. This study aims to assess the prevalence of LBP and identify its associated risk factors among medical students at a Tertiary Institute in Eastern India. Methodology: A cross-sectional study was conducted among MBBS students of a tertiary care Institute of Eastern India for one month period of November 2024. Sample was collected from 200 MBBS students by convenient sampling technique. Data was collected using an online questionnaire, collecting information regarding demographic profile, prevalence of back pain and its characteristics, potential risk factors. Data was analyzed using JAMOVI open statistical software. Result: Among the 200 study participants, 62% participants experienced back pain occasionally and 29 % experienced rarely. Regarding awareness of risk factor, 90%) were aware about the prolong sitting, (83%) for prolong standing posture and (83%) for obesity as a risk factors. Large no. of participants 45.5% don’t know the that lack of sleep and 31.54% don’t know that use of public transport are also the risk factors for back pain experiencing during the life. 13% were doing regular yoga, 30 % were doing regular exercise and 33% were performing outdoor games which are beneficial to prevent the back pain. Conclusion: Educational institutions should establish comprehensive wellness programs that emphasize physical activity and ergonomic practices. Promoting healthier lifestyle choices, such as regular exercise and yoga, can be instrumental in preventing low back pain and improving overall well-being among students.

Background: Surgical site infections (SSIs) are a common complication following surgery and pose a significant challenge to healthcare systems globally. These infections not only affect patient recovery but also contribute to increased healthcare costs and prolonged hospital stays. Identifying the incidence and associated comorbidities of SSIs can help in developing targeted strategies for prevention and management. Objective: The study aimed to assess the incidence of surgical site wound infections and determine the comorbidities that influence their occurrence in a tertiary care hospital in Bihar, India, over a period from sept 2022 to August 2023. Methods: This hospital-based observational study was conducted at the Department of Microbiology, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India. A total of 150 patients who underwent surgical procedures during the study period were included. Data regarding the incidence of SSIs, patient demographics, type of surgery, and comorbidities such as diabetes mellitus, hypertension, obesity, and smoking were collected. Postoperative wound surveillance was conducted, and SSIs were diagnosed according to standard clinical criteria. Microbial cultures were performed to identify the organisms responsible for the infections. Results: Out of 150 patients, 20% developed surgical site infections. The highest incidence was observed in patients who underwent abdominal surgeries (30%), followed by orthopedic and cardiovascular surgeries (20% each). The most common comorbidities associated with SSIs were diabetes mellitus (45%), hypertension (35%), and obesity (28%). The most frequently isolated organisms from infected wounds were Staphylococcus aureus (35%), Escherichia coli (22%), and Pseudomonas aeruginosa (18%). Patients with diabetes and obesity were found to have a significantly higher risk of developing SSIs (p < 0.05). Multivariate analysis showed that the presence of diabetes, obesity, and prolonged surgical duration were independent risk factors for SSIs. Conclusion: The incidence of surgical site infections in this study was 20%, with diabetes, obesity, and hypertension being significant risk factors. The findings underscore the need for comprehensive preoperative management, including optimizing blood sugar levels, controlling hypertension, and addressing obesity, to reduce the incidence of SSIs. Further studies with larger sample sizes and broader geographical coverage are recommended for validating these findings.

Background: Placenta previa is a critical obstetric condition associated with significant risks to both the mother and fetus. It is characterized by abnormal implantation of the placenta over or near the cervical os, leading to complications such as antepartum hemorrhage, preterm delivery, and maternal morbidity. Understanding the clinical outcomes of placenta previa is essential for improving maternal and neonatal health. Aim: This study aims to evaluate the feto-maternal outcomes in cases of placenta previa managed at the labor room of PMCH, Patna, focusing on maternal complications, neonatal outcomes, and associated risk factors. Methods: A prospective observational study was conducted over 12 months (Feb 2024 to Jan 2025) including 100 cases of placenta previa admitted to the labor room. Data on maternal demographic characteristics, clinical presentation, management strategies, and maternal and neonatal outcomes were collected. Statistical analysis was performed to identify significant correlations between risk factors and outcomes. Results: The study observed a high prevalence of antepartum hemorrhage (60%) and cesarean deliveries (96%) among placenta previa cases. Most common maternal complication was postpartum hemorrhage (33%). Neonatal outcomes showed a high rate of preterm deliveries (54%) and low birth weight (35%), with a perinatal mortality rate of 8%. Risk factors such as advanced maternal age, multiparity, and prior cesarean deliveries were significantly associated with adverse outcomes (p < 0.05). Conclusion: Placenta previa poses substantial risks to maternal and neonatal health. Early diagnosis, close monitoring, and timely intervention are critical for improving outcomes. This study emphasizes the need for comprehensive antenatal care and risk stratification to manage placenta previa effectively.

Background: Abnormal uterine bleeding (AUB) is a common gynecological complaint leading to significant morbidity and anemia in women of reproductive age. The Levonorgestrel Intrauterine System (LNG-IUS) has demonstrated promising therapeutic efficacy in reducing menstrual blood loss, improving hematologic parameters, and enhancing quality of life. This study evaluates the efficacy and acceptability of LNG-IUS in AUB treatment.nObjectives: To evaluate the clinical effectiveness of LNG-IUS in reducing menstrual blood loss, improving hemoglobin and ferritin levels, relieving dysmenorrhea, and enhancing patient satisfaction among women with AUB. Methods: A prospective interventional study was conducted  at the Department of Obstetrics and Gynecology, PMCH, Patna, Bihar, India from June 2023 to December 2024 . Fifty women aged 30–45 years with HMB (PBAC score >100) were enrolled. After thorough screening and exclusion of malignancies or structural distortions, LNG-IUS was inserted in the early post-menstrual phase. Patients were followed up at regular intervals (1, 3, 6, 12, 24, and 30 months). Menstrual blood loss was assessed via PBAC, and hemoglobin and serum ferritin levels were recorded. Patient satisfaction and adverse events were documented. Results: A significant decline in mean PBAC scores was observed from 401.8 ± 173 to 15.7 ± 6.5 at 30 months (p<0.001). Hemoglobin levels improved from 9.44 ± 0.66 to 12.13 ± 0.9 g/dL, and serum ferritin rose from 20.9 ± 1.1 to 42.5 ± 1.4 ng/mL (p<0.001). Amenorrhea was seen in 52% of women by 30 months. Dysmenorrhea resolved in all affected participants by 12 months. At 12 months, 88.6% of women scored ≥4 on the satisfaction scale, with 70% reporting being “very satisfied.” No major complications were reported. Conclusion: LNG-IUS is a highly effective, safe, and patient-acceptable therapy for AUB, offering substantial reductions in menstrual blood loss and improvement in hematologic parameters. Its non-invasive nature, sustained efficacy, and dual therapeutic benefits make it a valuable alternative to surgical interventions like hysterectomy, especially in resource-limited settings.

Background: Hypertension, once considered a condition of the elderly, is now increasingly being detected among younger adults, particularly in urban areas due to changing lifestyles, poor dietary habits, and physical inactivity. Early onset hypertension poses a long-term risk for cardiovascular morbidity if left undetected and unmanaged. Objective: To estimate the prevalence of hypertension and assess its associated risk factors among individuals aged 20 to 40 years residing in an urban locality of Durgapur, West Bengal. Methods: A community-based cross-sectional study was conducted over a period of 4 months in selected urban wards of Durgapur. A total of 300 adults aged 20–40 years were included using systematic random sampling. Data were collected using a pretested semi-structured questionnaire covering sociodemographic details, lifestyle habits, dietary pattern, body mass index, and family history. Blood pressure was measured following standard guidelines, and hypertension was classified as per JNC-8 criteria. Statistical analysis included descriptive and inferential methods to determine associations between variables. Results: The overall prevalence of hypertension among participants was 19.3%, with a higher rate in males (22.7%) compared to females (15.4%). Hypertension was significantly associated with body mass index ≥25 kg/m², sedentary lifestyle, tobacco consumption, high dietary salt intake, and family history of hypertension. Notably, 36% of hypertensive individuals were previously undiagnosed, underscoring the importance of early screening and awareness. Conclusion: The burden of hypertension among young urban adults is considerable and largely unrecognized. Community-based interventions focused on lifestyle modification, routine screening, and awareness generation are essential for early identification and prevention of long-term complications in this age group.

Background: Cervical cancer is still one of the most common causes of morbidity and mortality in women globally, especially in low- and middle-income countries. Early diagnosis of pre-invasive lesions greatly enhances prognosis and decreases the disease burden. Various screening techniques exist, but their efficacy differs. Aim: The objective of the present study was to assess and compare the accuracy of different screening modalities of cervical cancer-Pap smear, Visual Inspection with Acetic Acid (VIA), Liquid-Based Cytology (LBC), and testing for Human Papillomavirus (HPV) DNA-against pre-invasive lesions of cervix in detecting pre-invasive lesions using colposcopy-guided biopsy as a reference standard. Methods: A cross-sectional study was carried out among 300 women in the age group of 25–60 years visiting a Department of Obstetrics and Gynaecology, PMCH, Patna, Bihar, India, India. All four screening tests were done in each participant. Positive results were validated by colposcopic examination and biopsy. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of all the methods were estimated and compared. Results: Out of the 300 women screened, 64 (21.3%) were found to have pre-invasive lesions on confirmation. HPV DNA testing was most sensitive (93.8%) and NPV (97.7%), while Pap smear was most specific (93.3%). LBC was more accurate than standard Pap smear, and VIA was a moderately sensitive technique appropriate for low-resource settings. Conclusion: HPV DNA testing became the most sensitive screening method for the early detection of pre-invasive cervical lesions. VIA and LBC can be used as good alternatives in resource-constrained situations. Effective screening modalities must be integrated for the prevention and early detection of cervical cancer.

Background: Zinc plays a crucial role in immune function, cellular repair, and resistance to infections in children. Pneumonia remains a leading cause of morbidity and mortality in children under five years of age, particularly in low- and middle-income countries. Zinc deficiency may contribute to the incidence and severity of pneumonia in pediatric populations. This study aims to assess serum zinc levels in hospitalized children aged 2 months to 5 years diagnosed with pneumonia. Objectives: To evaluate serum zinc levels in children with pneumonia and compare them with clinical severity, age distribution, nutritional status, and outcomes. Methods: This hospital-based observational study was conducted over 12 months in the Department of Pediatrics, Government Medical College and Hospital, Bettiah, Bihar. Children aged 2 months to 5 years admitted with clinical and radiological diagnosis of pneumonia were enrolled after informed consent. Serum zinc levels were measured within 24 hours of admission. Clinical features, nutritional assessment, and pneumonia severity were documented. Data were analyzed using appropriate statistical tools. Results: A total of 150 children were included. The mean serum zinc level was significantly lower in children with severe pneumonia (49.2 ± 8.4 µg/dL) compared to those with mild to moderate pneumonia (62.1 ± 9.6 µg/dL). Zinc deficiency (<60 µg/dL) was observed in 68% of cases. Undernourished children exhibited a higher prevalence of zinc deficiency. A significant association was found between low serum zinc levels and increased duration of hospital stay and complications. Conclusion: Zinc deficiency is prevalent among children hospitalized with pneumonia, particularly those with severe illness and poor nutritional status. Early assessment and zinc supplementation may play a supportive role in reducing the severity and improving outcomes in pediatric pneumonia cases.

Background: Psoriasis vulgaris, a chronic inflammatory skin disorder, has increasingly been linked to systemic comorbidities, including components of metabolic syndrome. This association has important implications for early cardiovascular risk detection and holistic management of psoriatic patients. Objective: To evaluate the prevalence of metabolic syndrome among patients with psoriasis vulgaris and compare it with age- and sex-matched controls from the general population in a tertiary care setting in Madhubani, Bihar. Methods: A hospital-based case-control study was conducted in the Department of Dermatology, Madhubani Medical College & Hospital, from June 2023 to Dec 2024. A total of 130 participants were enrolled: 65 clinically diagnosed cases of psoriasis vulgaris and 65 matched controls without psoriasis. Metabolic syndrome was assessed using the modified NCEP ATP III criteria. Data on blood pressure, waist circumference, fasting blood glucose, triglycerides, and HDL cholesterol were collected and analyzed. Results: Metabolic syndrome was observed in 43.1% of psoriatic patients compared to 21.5% in controls (p < 0.01). Psoriatic patients had significantly higher mean waist circumference, triglyceride levels, and fasting glucose, along with lower HDL cholesterol levels. The prevalence of individual metabolic risk factors was also notably higher in the psoriasis group. Conclusion: There is a significant association between psoriasis vulgaris and metabolic syndrome, suggesting a need for routine metabolic screening in patients with psoriasis to mitigate long-term cardiovascular complications.

Background: Total laparoscopic hysterectomy (TLH) is a commonly performed gynecological procedure that is traditionally carried out under general anesthesia (GA). However, recent advancements in regional anesthesia techniques, particularly thoracic spinal anesthesia (TSA), have provided alternative approaches with potential advantages in terms of perioperative hemodynamics, pain control, and recovery profiles. This study compares the efficacy, safety, and outcomes of GA versus TSA in patients undergoing TLH. Methods: This prospective comparative study included 130 female patients scheduled for elective TLH, in the Department of Anesthesiology at Netaji Subhas Medical College and Hospital, Amhara, Bihta, Patna, Bihar, India. Patients were randomly allocated into two groups: Group GA (n=65) received general anesthesia, while Group TSA (n=65) underwent thoracic spinal anesthesia. Intraoperative hemodynamics, operative time, postoperative pain scores (VAS), analgesic requirements, complications, and patient satisfaction were assessed and compared. Results: The TSA group showed more stable intraoperative hemodynamic parameters, significantly lower postoperative VAS scores at 2, 4, and 6 hours, and reduced need for rescue analgesics. The incidence of postoperative nausea and vomiting (PONV) was markedly lower in the TSA group. Moreover, patient satisfaction scores were higher in the TSA group, with fewer reports of drowsiness and better early ambulation. Conclusion: Thoracic spinal anesthesia offers a safe and effective alternative to general anesthesia for total laparoscopic hysterectomy. It is associated with better postoperative pain control, lower incidence of PONV, early mobilization, and higher patient satisfaction, making it a viable option in selected patients.

Background: The coracoclavicular (CC) joint is an accessory articulation between the conoid tubercle of the clavicle and the coracoid process of the scapula. While typically absent in most individuals, the joint is of clinical interest due to its potential to mimic pathological conditions and complicate shoulder movement. The presence of a clavicular facet forming part of this joint can influence biomechanics, radiological interpretation, and surgical outcomes. Objective: To assess the presence, morphology, and morphometry of the clavicular facet associated with the coracoclavicular joint in adult dry human clavicles, and to highlight its anatomical and clinical significance. Materials and Methods: This osteological study was conducted on 130 adult dry human clavicles (both right and left) from the Department of Anatomy, Anugrah Narayan Magadh Medical College, Gaya, Bihar. Each bone was observed for the presence of a clavicular facet at the conoid tubercle region. When present, the facet was evaluated for shape, orientation, and size using a digital vernier caliper. The data were analyzed statistically to determine prevalence, laterality, and morphometric variations. Results: The clavicular facet was present in 14.6% of the specimens. It was more frequently observed on the left side (16.9%) compared to the right (12.3%). Oval-shaped facets were the most common, followed by circular and irregular forms. The mean length and breadth of the facet were 6.2 mm and 4.7 mm, respectively. No statistically significant difference was found in the dimensions between right and left sides. Conclusion: Although the clavicular facet of the CC joint is not universally present, its recognition is important due to its potential clinical implications. Knowledge of its morphological variations is valuable for anatomists, orthopedic surgeons, and radiologists in differentiating accessory joints from pathological lesions and in preventing iatrogenic injury during surgical interventions.

Background: Congenital uterine anomalies (CUAs) result from maldevelopment, incomplete fusion, or resorption failure of the Müllerian ducts during fetal life. These anomalies often go undiagnosed until pregnancy complications arise, including recurrent pregnancy loss, preterm labor, or abnormal presentations. Caesarean section provides an opportunity for incidental detection of uterine malformations. With rising caesarean rates, intraoperative identification of CUAs becomes increasingly feasible. This study aims to estimate the prevalence and classify the types of congenital uterine anomalies identified intraoperatively in women undergoing caesarean section. Methods: This hospital-based cross-sectional observational study was conducted at the Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Purnea, Bihar, over a 15-month period from October 2023 to December 2024. A total of 950 women who underwent lower segment caesarean section (LSCS) for various obstetric indications were enrolled. Intraoperative evaluation of the uterus was carried out immediately after fetal delivery and before uterine closure to identify any gross congenital uterine anomalies. Detected anomalies were classified according to the American Society for Reproductive Medicine (ASRM) classification system. Clinical characteristics, obstetric outcomes, and associations were analyzed. Results: Among the 950 caesarean deliveries evaluated, 33 cases (3.5%) were found to have congenital uterine anomalies. The most commonly detected anomaly was arcuate uterus (36.4%), followed by septate uterus (27.3%), bicornuate uterus (21.2%), and unicornuate uterus (9.1%). A single case of didelphys uterus (3.0%) was observed. The majority of these anomalies were undiagnosed prior to surgery and detected incidentally during intraoperative inspection. Anomalies were more common in primigravida women and in those with malpresentation, intrauterine growth restriction (IUGR), or previous first-trimester loss. Among the women with CUAs, 45.5% had abnormal fetal presentations and 27.3% had a history of early pregnancy loss. Conclusion: The prevalence of congenital uterine anomalies detected during caesarean section in this study was 3.5%, aligning with global estimates. Arcuate and septate uterus were the most frequently observed types. Routine intraoperative inspection during caesarean section offers a valuable opportunity to detect undiagnosed uterine anomalies, which may have reproductive implications. Early diagnosis can guide appropriate counseling and future fertility management strategies.

Background: Acute trauma is a leading cause of preventable mortality, with hemorrhage being a significant contributor to early deaths. Tranexamic acid (TXA), an antifibrinolytic agent, has shown promise in reducing bleeding and improving outcomes in trauma patients. This study aims to evaluate the efficacy of TXA in controlling bleeding compared to placebo in acute trauma cases. Methods: This prospective, randomized, double-blinded study was conducted in the Department of Anaesthesiology, Katihar Medical College, Al-Karim University, Katihar, Bihar, India. A total of 120 acute trauma patients presenting with signs of hemorrhage were enrolled and randomly assigned into two groups: Group A (n=60) received tranexamic acid, and Group B (n=60) received a placebo. Patients were assessed for total blood loss, requirement of blood transfusions, hemodynamic stability, and clinical outcomes over a 24-hour observation period and up to 7 days post-admission. Results: Patients in the TXA group showed a statistically significant reduction in total blood loss (p<0.05) and fewer blood transfusion requirements compared to the placebo group. Hemodynamic parameters remained more stable in the TXA group, and fewer complications were observed. There were no significant adverse events related to TXA use. Conclusion: Tranexamic acid is effective in reducing bleeding and the need for transfusion in acute trauma patients without increasing the risk of complications. Its early administration can be a valuable adjunct in trauma care in resource-limited settings.

Background: Acute trauma is a leading cause of preventable mortality, with hemorrhage being a significant contributor to early deaths. Tranexamic acid (TXA), an antifibrinolytic agent, has shown promise in reducing bleeding and improving outcomes in trauma patients. This study aims to evaluate the efficacy of TXA in controlling bleeding compared to placebo in acute trauma cases. Methods: This prospective, randomized, double-blinded study was conducted in the Department of Anaesthesiology, Katihar Medical College, Al-Karim University, Katihar, Bihar, India. A total of 120 acute trauma patients presenting with signs of hemorrhage were enrolled and randomly assigned into two groups: Group A (n=60) received tranexamic acid, and Group B (n=60) received a placebo. Patients were assessed for total blood loss, requirement of blood transfusions, hemodynamic stability, and clinical outcomes over a 24-hour observation period and up to 7 days post-admission. Results: Patients in the TXA group showed a statistically significant reduction in total blood loss (p<0.05) and fewer blood transfusion requirements compared to the placebo group. Hemodynamic parameters remained more stable in the TXA group, and fewer complications were observed. There were no significant adverse events related to TXA use. Conclusion: Tranexamic acid is effective in reducing bleeding and the need for transfusion in acute trauma patients without increasing the risk of complications. Its early administration can be a valuable adjunct in trauma care in resource-limited settings.

Background: Abnormal uterine bleeding (AUB) is a common gynecological complaint with varied etiologies across different age groups. Endometrial biopsy serves as a critical diagnostic tool to assess underlying endometrial pathology. This study aims to audit endometrial biopsies and establish clinico-pathological correlations in patients presenting with AUB. Methods: This retrospective observational study was conducted in the Department of Pathology, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, Uttar Pradesh, India from September 2021 to July 2022. A total of 125 endometrial biopsy samples from patients with AUB were analyzed. Relevant clinical data, including age, menstrual history, and presenting symptoms, were retrieved from hospital records. Histopathological examination of endometrial tissues was performed using standard hematoxylin and eosin staining techniques. Patterns of endometrial pathology were categorized and correlated with age groups and clinical findings. Results: The majority of patients (68%) were in the perimenopausal age group (40–50 years). The most common histopathological finding was proliferative endometrium (36%), followed by secretory endometrium (22%), endometrial hyperplasia (18%), and atrophic endometrium (10%). Atypical hyperplasia and endometrial carcinoma were identified in 4% and 2% of cases, respectively. There was a statistically significant correlation between patient age and the type of endometrial pathology identified. Endometrial hyperplasia and malignancy were more frequent in postmenopausal women. Conclusion: Endometrial biopsy remains an indispensable diagnostic modality in evaluating AUB, especially in perimenopausal and postmenopausal women. The study highlights the importance of histopathological assessment in guiding clinical management and detecting premalignant and malignant lesions at an early stage.

Background: Laparoscopic cholecystectomy, though minimally invasive, is often associated with considerable post-operative pain due to visceral irritation, pneumoperitoneum-induced stretch, and trocar site trauma. Effective perioperative analgesia is crucial to improve patient comfort, reduce opioid consumption, and facilitate early mobilization. Intravenous lidocaine and dexmedetomidine, both known for their analgesic and anti-inflammatory properties, have been investigated as adjuncts for perioperative pain control. This study aimed to compare the efficacy of perioperative infusion of lidocaine versus dexmedetomidine in attenuating post-operative pain in patients undergoing elective laparoscopic cholecystectomy. Methods: A prospective, randomized, controlled study was conducted in the Department of Anaesthesia at Government Medical College and Hospital, Bettiah, Bihar India from December 2023 to November 2024 . A total of 90 adult patients (ASA I and II) scheduled for elective laparoscopic cholecystectomy were randomly allocated into two groups: Group L received intravenous lidocaine infusion (1.5 mg/kg bolus followed by 2 mg/kg/hr infusion), and Group D received intravenous dexmedetomidine (1 µg/kg bolus followed by 0.5 µg/kg/hr infusion), both starting 10 minutes before induction and continued intraoperatively. Pain scores were assessed using the Visual Analog Scale (VAS) at 1, 2, 4, 8, 12, and 24 hours post-operatively. Total analgesic consumption, time to first rescue analgesia, and adverse effects were also recorded. Results: VAS scores were significantly lower in the dexmedetomidine group at 1 and 2 hours post-operatively (p < 0.05), while lidocaine showed better analgesic profile beyond 4 hours, especially at 8 and 12 hours (p < 0.05). Total tramadol consumption over 24 hours was lower in the lidocaine group (95.6 ± 18.4 mg) compared to dexmedetomidine group (112.7 ± 21.1 mg), with a statistically significant difference (p = 0.01). Time to first rescue analgesia was longer in the lidocaine group. Sedation scores were higher in the dexmedetomidine group in the early recovery period, while lidocaine was associated with faster post-operative awakening and minimal hemodynamic fluctuations. Conclusion: Both lidocaine and dexmedetomidine provide effective perioperative analgesia in laparoscopic cholecystectomy. However, intravenous lidocaine infusion offers superior late post-operative pain control, reduces opioid requirement, and facilitates quicker recovery, making it a preferable option in enhanced recovery protocols.

Background: Differentiating between benign thyroid nodules and papillary thyroid carcinoma (PTC) is a diagnostic challenge in routine histopathology. Immunohistochemical markers such as Claudin-1 and CD56 have shown promise in distinguishing these lesions more accurately. Objectives: This study aims to evaluate the expression patterns of Claudin-1 and CD56 in thyroid nodules to assess their utility in differentiating benign thyroid lesions from papillary thyroid carcinoma. Materials and Methods: A prospective observational study was conducted in the Department of Pathology, Darbhanga Medical College and Hospital, Bihar, India, over a period of 18 months. A total of 120 cases were included comprising 60 cases of histologically confirmed benign thyroid nodules (colloid goiter, follicular adenoma, and Hashimoto’s thyroiditis) and 60 cases of papillary thyroid carcinoma. Immunohistochemical staining for Claudin-1 and CD56 was performed and analyzed semi-quantitatively based on the intensity and extent of staining. Results: Claudin-1 was strongly expressed in 92% of PTC cases, while only 10% of benign nodules showed weak or focal Claudin-1 positivity. Conversely, CD56 expression was retained in 87% of benign nodules, whereas only 5% of PTC cases showed any positivity. A statistically significant inverse correlation between Claudin-1 and CD56 expression was observed in PTC cases (p < 0.001). Conclusion: Claudin-1 and CD56 serve as valuable complementary immunohistochemical markers in differentiating benign thyroid nodules from papillary thyroid carcinoma. The combined use of these markers enhances diagnostic accuracy, particularly in morphologically ambiguous cases.

Background: Fractures of both the radius and ulna (both bones forearm fractures) are common orthopedic injuries, particularly in young adults following trauma. Anatomical reduction and stable internal fixation are essential for restoring forearm rotation and upper limb function. Locking compression plates (LCPs) provide angular stability, especially in comminuted or osteoporotic bones, and allow for early mobilization. This study aimed to evaluate the functional outcome of surgically managed both bones forearm fractures using LCPs. Methods: A prospective interventional study was conducted at the Department of Orthopaedics, Government Medical College and Hospital, Bettiah, Bihar, India from feb 2023 to Jan 2024. A total of 40 patients with closed diaphyseal fractures of both radius and ulna were included. All patients underwent open reduction and internal fixation (ORIF) using locking compression plates under general or regional anesthesia. Postoperative assessment was done at regular intervals, and functional outcome was measured at 6 months using the Grace and Eversmann criteria, along with range of motion (ROM) evaluation for elbow, wrist, and forearm rotation. Results: Excellent to good functional outcomes were observed in 85% of the cases. The mean time to radiological union was 11.2 ± 2.1 weeks. Supination and pronation arcs improved progressively with physiotherapy. No major complications such as deep infection or implant failure were reported. Two patients developed mild restriction in supination, and one developed superficial infection that responded to antibiotics. Most patients regained near-normal hand function by the end of follow-up. Conclusion: Surgical management of both bones forearm fractures with locking compression plates offers excellent anatomical restoration, high union rates, and favorable functional outcomes with minimal complications. Early surgical intervention combined with proper physiotherapy significantly contributes to the restoration of limb function and rotational movements of the forearm.