Hemoglobinopathies are inherited blood disorders that affect the hemoglobin molecule, the protein in red blood cells that carries oxygen. These disorders can be caused by mutations in the genes that code for the globin chains that make up hemoglobin. They can result in abnormal hemoglobin structure, reduced hemoglobin production, or both. The purpose of the present study was to evaluate the prevalence of hemoglobninopathies detected by capillary electrophoresis method in individuals by capillary electrophoresis method. Methods: This study was carried out on 395 individuals referred medical college. Blood samples were collected in EDTA vacutainer tubes, then CBC including blood indexes (MCV, MCH), level of Hemoglobin A, Hb F, Hb A2 and other hemoglobin’s were evaluated and also genetic tests applied for them to confirm results that were acquired by capillary electrophoresis method. Results: 77 (19.7%) subjects had HbA2 ≥3.5%, thus were classified as beta thalassemia carrier and 3.3%, 2.5%, 1.5% and 0.5% of the individuals were heterozygote for Hb S, Hb D, Hb C and Hb Bart, respectively. Results of the genetic analysis showed the mutations in these subjects; cd36-37(-T) was the most frequent mutation in beta thalassemia carriers in this geographic region. Conclusion: This study showed high frequency of beta thalassemia mutations in the (19.7), and 7.85% of the individuals had hemoglobin variants including Hb S, Hb D and Hb C detected by capillary electrophoresis. Capillary electrophoresis could be used for detection of hemoglobinopathies.

Introduction: Diabetes mellitus is a chronic metabolic disorder causing elevated blood glucose levels. It leads to complications like retinopathy, nephropathy, and neuropathy, affecting organ systems. Understanding these complications is crucial for healthcare providers to provide comprehensive care and prevent long-term adverse outcomes. Peripheral neuropathy and diabetic retinopathy are common microvascular complications, highlighting the need for a holistic approach to diabetes management. Aims: The aim of the study is to assess the incidence of peripheral neuropathy and its effect on the severity of retinopathy in Type 2 diabetes patients attending a tertiary care hospital. Materials and Methods: The present study was a Observational and cross-sectional study. This Study was conducted from 1 Year at Department of Ophthalmology. Study population 150. Result: A significant association was found between diabetic retinopathy (DR) and diabetes mellitus (DM) groups (χ² = 150.0000, p < 0.0001), with varying eye involvement across DM subgroups (χ² = 84.6154, p < 0.0001). Motor and sensory nerve latency and amplitude changes were strongly associated with DM status (χ² = 38.2353, p < 0.0001). Additionally, RNFL thickness decreased with increasing DR severity (χ² = 58.0364, p < 0.0001). Conclusion: Peripheral neuropathy in type 2 diabetes patients is linked to advanced stages of diabetic retinopathy, necessitating early screening and comprehensive diabetes care to manage complications.

Objective: To analyze the frequency of complications during laparoscopic surgery and identify associated risk factors. Methods: A descriptive observational study was performed between January 2024 and December 2024 and included all laparoscopies performed at our center. Variables were recorded for patient characteristics, indication for surgery, length of hospital stay (in days), major and minor complications, and conversions to laparotomy. Results: Of all 188 laparoscopies included, most were procedures of moderate difficulty (adnexal surgery) (54.2%). The overall frequency of major complications was 1.93%, and that of minor complications was 4.29%. The level of technical difficulty and existence of prior abdominal surgery were associated with a higher risk of major complications and conversions to laparotomy. Conclusion: Laparoscopic surgery is associated with a low frequency of complications but is a procedure that is not without risk. Greater technical difficulty, inexperienced surgeon and prior surgery were factors associated with a higher frequency of complications.

Background and Objectives: To find minimal and effective dose of tramadol as an adjuvant for brachial plexus block for faster onset of motor, sensory block, and duration of analgesia. Material and Methods: This prospective, randomized, comparative, double blind study was conducted on 75 patients undergoing upper limb surgeries under supraclavicular brachial plexus block among three groups of 25 each (Group R, Group RT 1 and Group RT 2). Block was given with 20 mL of 0.5% Ropivacaine + 10 ml NS in Group B, 20 mL of 0.5% Bupivacaine with Tramadol 1 mg/kg and 1.5 mg/kg in 10ml NS in Group BT1 and Group BT2 respectively. Onset of sensory and motor block, duration of analgesia and motor block, side effects associated with tramadol were observed and compared among groups. Observations and Results: Onset of sensory and motor blockade was significantly faster statistically (p < 0.05) in Group RT2 (11.2 minutes and 6.00 minutes respectively) compared to Group RT1 (13.6 minutes and 9.00 minutes respectively) and Group R (18.8 minutes and 10.5 minutes respectively). Duration of analgesia among groups was significantly longer statistically in Group RT2 (326.20 minutes) compared to other groups. Duration of motor blockade among groups significantly longer in the RT2 (270.8 minutes) compared to Group RT1 and Group R. There were statistically insignificant side effects among groups. Conclusion: Tramadol in various doses, as an adjuvant to local anesthetics can be used safely and effectively with insignificant side effects.

Background: Dry Eye Disease (DED) is a common ocular condition characterized by tear film instability and ocular surface damage. Recent studies indicate a strong association between DED and depressive disorders, particularly in newly diagnosed cases. Both conditions share inflammatory and neurophysiological mechanisms that may exacerbate visual symptoms and reduce quality of life. Objective: To determine the prevalence of dry eye disease among newly diagnosed depressive disorder patients prior to any pharmacological intervention and to analyze clinical parameters associated with DED in this group. Methods: A cross-sectional observational study was conducted at the Departments of Psychiatry and Ophthalmology, Government Rajaji Hospital, Madurai, involving 100 patients diagnosed with depressive disorder. Patients were classified based on ICD-10 criteria and underwent a comprehensive ophthalmic evaluation including visual acuity testing, slit-lamp examination, Schirmer’s test, Tear Film Break-Up Time (TBUT), Tear Film Meniscus Height (TFMH), and Oxford grading. Dry eye was diagnosed if two or more tests were abnormal. Statistical analysis was performed using SPSS v16.0. Chi-square test was used to assess significance, with p<0.05 considered statistically significant. Results: Among 100 patients, 42% were diagnosed with DED. A significant association was found between age >50 years and dry eye (63.6%). Female patients (58.2%) were more affected than males (22.2%) (p=0.029). Abnormal blink rate and increased severity of depression correlated with higher incidence of DED. TBUT was abnormal in 40%, Schirmer’s score in 38%, TFMH in 37%, and Oxford score in 38% of dry eye cases. Conclusion: Dry eye disease was prevalent in 42% of newly diagnosed depressive disorder patients, independent of antidepressant use. Early screening for DED in psychiatric settings may prevent complications and improve patient outcomes through timely ophthalmologic intervention.

Introduction: Asphyxial deaths from strangling or hanging are most commonly caused by neck lesions associated with laryngohyoid fractures.  Therefore, it is unclear if these clinical characteristics are important for diagnosing the asphyxia mode. Aims: This study aims to compare macroscopic neck findings in asphyxial deaths due to hanging and strangulation, focusing on hyoid bone fractures. It evaluates their frequency and patterns to aid in determining the manner of death, supporting accurate differentiation between suicidal, homicidal, and accidental asphyxia in forensic investigations. Materials and Methods: For this observational cross-sectional investigation, asphyxial death cases from hanging or strangling were collected between July 2022 and December 2023.  While autopsy records were used to include cases, decomposed or mangled remains and other types of asphyxia were excluded.  The sample size was calculated using Solvin’s technique, and statistical analysis was performed using GraphPad Prism software version 8. Results: The most common method among the 100 instances was hanging (n=83), which was followed by throttling (n=3), partial hanging (n=5), and strangulation (n=9).  26% of instances had abrasions, whereas 69% showed none at all.  Most of the knots were placed over the left mastoid (56%), followed by the right mastoid (17%) and the occipital bone 7%.  Seventy-seven percent of the deceased in the hanging cases had a high level of ligature material.  Grooved ligature marks were significantly more common in hanging victims than in strangulated victims (56% vs. 1%, p<0.0001), and they were most common in victims aged 41–50 years (p=0.91).  19% of hanging and strangulation instances had abrasions, compared to 77% (p<0.0001), 37.5% of strangling victims had damaged skin, but 59% of hanging victims had dry skin beneath the ligature (p < 0.0001). Conclusion: By pointing up significant variations in outcomes between hanging and strangling fatalities, this study enhances forensic assessments and highlights the importance of thorough autopsy.

Objectives:  To study outcomes of mothers with GDM attending a tertiary care hospital in Kolkata. Methods: This prospective observational study was done in a tertiary care hospital, Kolkata for one year. Single-step testing using 75 gm oral glucose and measuring blood sugar 2 hours after ingestion was done on the first visit irrespective of associated risk factors and gestational period. Mothers diagnosed with GDM were managed by Medical Nutrition Therapy with or without pharmacotherapy as required for glycemic control. Maternal and neonatal outcomes were documented and analyzed. Results: Out of 981 screened with OGTT, 102(10.39%) mothers were diagnosed to have GDM. Ninety-two mothers were followed up till delivery. Most of the GDM mothers are between 25-30yrs. PPH and Hypertensive disorders of pregnancy were common antenatal complications. No maternal death or congenital anomalies occurred among mothers with GDM. Conclusion: Detecting GDM at the earliest and proper management reduces maternal as well as neonatal adverse outcomes.

Introduction: This study investigates the frequency of liver involvement in dengue patients and the potential of abnormal liver function tests as early indicators of illness severity. Results show a clear correlation between severe dengue outcomes and hepatic impairment, highlighting the importance of early detection and treatment for this public health concern. Aims: To assess the prevalence of liver dysfunction in Dengue patients and its association with Dengue-related complications. Materials and Methods: The present study was a Hospital based Observational Cross sectional study. This Study was conducted from February 2022 to June 2022 at Department of Biochemistry and Microbiology, Central Laboratory, OPD Biochemistry and Microbiology Laboratory, Medical College & Hospital, Kolkata. 121 dengue infected patients were included in our study. Result: The results indicate that the majority of participants were young to middle-aged, predominantly male, and mostly from urban areas. Fever was a universal symptom, with vomiting and abdominal pain also common. Liver enzyme levels were elevated in many patients, indicating varying degrees of hepatic dysfunction—most commonly mild to moderate. A significant association was found between the severity of dengue and liver dysfunction, with abnormal liver function more prevalent in severe cases. Moreover, patients with hepatic dysfunction had a higher incidence of ICU admission and mortality, highlighting liver involvement as a marker of worse clinical outcomes in dengue infection. Conclusion: In summary, the study findings highlight that hepatic dysfunction is prevalent among dengue patients, particularly in more severe forms of the disease. While most liver involvement is mild to moderate, its presence correlates with a higher likelihood of adverse outcomes. These results underscore the importance of early identification and monitoring of liver function in dengue patients, especially those presenting with warning signs or severe symptoms.

Introduction: The Opioids are frequently used as adjuncts to local anesthetics in epidural anesthesia. Although the systemic use of narcotic analgesics does provide acceptable analgesia, but when these drugs are used through epidural route, they provide superior quality of analgesia without systemic side effects. Nalbuphine  is one such opioid which has been used extensively via systematic route but not through epidural pathway. Aims: We aim to study the efficacy and duration of postoperative analgesia and safety of Bupivacaine with nalbuphine via epidural route for lower limb surgeries. Settings and Design: A prospective, randomized and double-blind study was conducted involving 80 patients for elective lower limb surgeries carried under epidural anesthesia. Methods and Material: Epidural anesthesia at L1-2 space was given with 15 ml bupivacaine(0.5%) in control group and 15ml of  bupivacaine(0.5%) with nalbuphine (10mg in 1ml) in the test group. The time to reach the sensory and motor blockade as well as duration of same along with quality and duration of analgesia was assessed along with any side effects such as respiratory depression, sedation or vomiting etc. Results: The Mean time of onset of sensory blockade with Nalbuphine as adjuvant observed in present study is found to be 5.4 ±1.12 minutes while that without adjuvant was 15.95± 2.64 minutes(p<0.005). The mean duration of analgesia in group receiving nalbuphine was 287.37± 23.72 minutes which was significantly longer (P value = 0.001) when compared to control group which had mean duration of sensory blockade of 162.95 ± 37.89 minutes. Similarly, the mean time to achieve complete motor blockade was significantly (p value<0.0001) earlier (12.35 ± 1.24 minutes) in Nalbuphine group compared to control group (23.04 ±2.80 minutes) and the duration of motor block was significantly longer as well in the group receiving epidural nalbuphine (168.85 ± 16.76 in nalbuphine group vs 120.25 ± 20.51minutes in control group with p value <0.0001). The hemodynamic parameters were comparable in both the groups and no significant respiratory depression or any other side effect was noted. Conclusions: The addition of nalbuphine with bupivacaine epidurally was effective for postoperative analgesia in terms of quality  and duration of analgesia without any systemic side effects or hemodynamic instability.

Background: Post-operative sore throat (POST) is a common complication following laryngeal mask airway (LMA) insertion, often leading to patient discomfort and dissatisfaction. Various interventions have been proposed to mitigate this issue, including gargling with substances such as magnesium sulphate and ketamine. In this prospective, randomized study, we aimed to compare the efficacy of magnesium sulphate and ketamine gargles in preventing POST following ProSeal Laryngeal Mask Airway (PLMA) insertion. This comparative evaluation provided valuable insights into optimizing patient comfort and satisfaction in the perioperative period. Methods: We included seventy-five patients, aged 18-60, of any gender, with ASA I and II, scheduled for surgeries requiring general anesthesia with ProSeal laryngeal mask airway. Patients were randomly assigned to three groups: group-M (n=25) received magnesium sulphate gargle (1.2 g), group-K (n=25) received ketamine gargle (30 mg), and group-D (n=25) received dextrose gargle (20%).   We recorded the number of attempts required for ProSeal insertion, nasogastric tube insertions, any blood staining of the ProSeal, post-operative sore throat incidence and severity at 0, 2, 4, and 24 hours, and any drug-related side effects. Results: The overall incidence of sore throat at 0, 2, 4, and 24 hours post-operatively was 12%, 16%, 20%, and 8%, respectively, in group-M, 20%, 28%, 28%, and 12%, respectively, in group-K, and 24%, 36%, 32%, and 12%, respectively, in group-D. Compared to group-D, sore throat incidence was significantly lower in group-M at 2 hours (p=0.023) and 4 hours (p=0.031), but no significant difference was observed between group-D and group-K. The severity of sore throat was significantly reduced in group-M at 0 hours (p=0.004), 2 hours (p=0.001), and 4 hours (p=0.001) compared to group-D, and in group-K at 2 hours (p=0.002) and 4 hours (p=0.001). However, compared to group-K, the severity of sore throat in group-M was significantly lower at 0 hours (p=0.049) and 2 hours (p=0.018). No significant side effects were observed. Conclusion: Magnesium sulphate gargling was more effective than ketamine gargling in reducing the incidence and severity of post-operative sore throat in patients undergoing general anesthesia with ProSeal laryngeal mask airway, without any observed side effects.

Introduction: Prescription audits in healthcare settings play a crucial role in evaluating and enhancing the quality of patient care. We have assessed the prescription patterns and practices of physicians at a sub-district hospital, Gondal-36011, Gujarat, India. A study focusing on compliance with WHO-recommended core prescribing indicators. Additionally, we had examined the completeness of prescriptions concerning essential components such as patient details, drug details, and instructions to patients. Methodology: A prospective, descriptive cross-sectional study was conducted in May 2024 at the pediatric outpatient department (OPD) of a sub-district hospital. We had analyzed 150 prescriptions. Data collection included demographic details, prescription completeness assessment, and adherence to prescribing standards. We conducted descriptive statistical analyses for detailed evaluation. Results: Out of 150 prescriptions audited, notable findings included an average of 2.44 drugs per prescription. Prescription errors were prevalent, with missing patient information (age, weight, gender) in varying percentages, absence of prescriber identification in all cases, and not written in capital letters. Generic name usage was at 78.41%, and prescriptions adhering to NLEM comprised 75.68%. Antibiotics were prescribed in 23.33% of cases and injections in 3.33%. Essential prescription components such as dosage (39.33%), frequency (12%), duration (56%), and instructions to patients (84%) were frequently omitted. Conclusion: The study highlights a critical need to improve prescription writing. It has identified common mistakes such as failing to provide instructions to patients, absent diagnosis, dose or treatment duration details, not using generic names, and illegible handwriting of prescribers. Educated and qualified medical professionals should follow the guidelines to write clear and efficient prescriptions. Effective strategies to improve prescription quality involve adopting electronic prescribing systems along with participating in continuous professional education programs. Regular prescription audits and sensitizing medical professionals are crucial for enhancing healthcare systems.

Background: Type 2 diabetes is recognized as a major public health concern with a considerable impact on human life and health expenditures. Rapid economic development and urbanization have led to a rising burden of diabetes. Chronic hyperglycemia with metabolic derangements in patients with diabetes mellitus can cause complications of which are microvascular and macrovascular complications. Dyslipidemia is one of the risk factors for ASCVD (Atherosclerotic cardiovascular disease) major cause of death worldwide. Early detection of dyslipidemia is necessary to prevent the mishap. Methods: Type 2 diabetes mellitus patients who came to OPD or got admitted in KR Hospital, Mysore Medical College and Research Institute, Mysore. All patients fulfilling the inclusion criteria was interviewed as per proforma and a detailed clinical examination was done. The wanted blood tests, urine examination and imaging were done. The values are correlated with duration of type 2 diabetes mellitus. Results: In our study of 100 patients, the minimum age taken was 26 years and the maximum age taken was 85 years with a mean value of 57. Majority of patients were above 60 years of age. Our study had female predominance with 52% and male: female ratio of 12:13,74% patients have HbA1c level >7, Hypertriglyceridemia is more as duration of diabetes increases levels are higher in patients with higher duration of diabetes which is statistically significant (p<0.05). HDL levels are lower in patients with higher duration of diabetes which is statistically significant (p<0.05). Conclusion: Results suggest high prevalence of dyslipidemia among type 2 diabetes mellitus study subjects, Most common pattern observed was single parameter dyslipidemia. Dyslipidemia is more as duration of diabetes mellitus. These lipid abnormalities might be the important in view of development of cardiovascular or cerebrovascular diseases. Hence type 2 diabetic patient should undergo the routine monitoring of blood sugar and lipid profile.

Background: Type 2 diabetes mellitus (T₂DM) is associated with hemostatic abnormalities that may contribute to microvascular and macrovascular complications. This study evaluated coagulation parameters in T₂DM patients and investigated their association with diabetic complications. Methods: This prospective, cross-sectional study included 130 adult T₂DM patients attending a tertiary hospital. Patients were divided into those with complications (n=69) and without complications (n=61). Prothrombin time (PT) activated partial thromboplastin time (aPTT), international normalized ratio (INR), bleeding time (BT), and clotting time (CT) were measured. Statistical analysis included Student’s t-test and Pearson correlation. Results: A significant majority of T₂DM patients exhibited low PT and INR values. All patients with diabetic complications had low PT and INR compared to only a portion of those without complications (p<0.001). Mean PT and INR were significantly lower in patients with complications versus those without (p<0.001). For aPTT, a substantial proportion of patients with complications had low values compared to none without complications (p<0.001), with lower mean aPTT in the complications group (p<0.001). All patients had normal BT and CT, but mean BT was significantly shorter in patients with complications (p<0.001). Conclusions: T₂DM patients, especially those with complications, demonstrate a hypercoagulable state characterized by shortened PT, aPTT, and BT. The strong correlation between HbA1c and coagulation parameters suggests that poor glycemic control contributes to coagulation abnormalities. These findings highlight the importance of monitoring coagulation parameters in T₂DM patients for early identification of thrombotic risk.

Background: Severe anemia in pregnancy remains a major public health concern in India, contributing significantly to maternal and fetal morbidity and mortality. Early detection and appropriate management are crucial to improving outcomes. Aim: To study the cases of severe anemia during pregnancy and evaluate their effects on maternal and fetal outcomes at Gujarat Adani Institute of Medical Sciences, Bhuj, and Kachchh. Material and Methods: A prospective observational study was conducted at G.K. General Hospital, Bhuj, from November 2019 to October 2021. A total of 150 antenatal and/or intranatal patients with severe anemia (Hb <7.0 gm %) and ≥28 weeks gestation was included. Detailed clinical history, obstetric examination, and relevant investigations were performed. Patients were managed with oral iron, parenteral iron, or blood transfusions as appropriate and followed for maternal and fetal outcomes. Results: The majority of patients (42%) were aged 25–29 years, with 55.33% booked and 44.67% unbooked. Severe anemia (Hb 4–6.9 gm %) was seen in 93.33% and very severe anemia (<4 gm %) in 6.66%. Vaginal delivery was the predominant mode (86.66%), with LSCS in 13.33%. Fetal outcomes included 91.33% live births, 8.66% stillbirths/IUD, 47% preterm births, and 41% NICU admissions. Maternal complications included infections, preterm labor, and cardiac strain. Conclusion: Severe anemia significantly impacts both maternal and fetal health, increasing the risk of preterm birth, NICU admission, and stillbirth. Strengthening antenatal care, early screening, and appropriate anemia management are essential to improve maternal and fetal outcomes.

Background: The selection of an ideal induction agent for general anaesthesia is pivotal in ensuring intraoperative hemodynamic stability. While propofol is widely preferred for its rapid onset and smooth recovery, it is often associated with hypotension. Etofol, a novel combination of etomidate and propofol, is being explored for its ability to preserve cardiovascular function during induction. Aim: To evaluate and compare the hemodynamic effects of propofol and etofol as induction agents in elective surgeries under general anaesthesia. Materials and Methods: A prospective, randomized, double-blinded study was conducted on 80 adult patients undergoing elective surgeries. Patients were divided into two groups: Group I (n=40) received propofol 2 mg/kg and Group II (n=40) received etofol (etomidate 0.15 mg/kg + propofol 1 mg/kg) Hemodynamic parameters—heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP)—were recorded at baseline, during induction, and at intervals up to 60 minutes post-induction. Results: Baseline parameters were comparable between the two groups. Group II (etofol) exhibited significantly higher SBP, DBP, and MAP at all post-induction time points (p < 0.001), indicating better cardiovascular stability. Group I (propofol) showed marked hypotension following induction. HR was mostly comparable, though a significant difference was noted at 1 minute post-induction (p = 0.041). Conclusion: Etofol demonstrates superior hemodynamic stability compared to propofol during induction of general anaesthesia. It may serve as a safer and more effective alternative in patients where maintaining blood pressure is critical.

Background: Traumatic brain injury remains a major cause of morbidity and mortality globally, with road traffic accidents being the most common cause. Prompt and accurate neurological assessment is crucial for prognosis. Although widely used, the Glasgow Coma Scale (GCS) has limitations, particularly when dealing with intubated patients. The FOUR (Full Outline of UnResponsiveness) score was developed to address these limitations by including brainstem reflexes and respiratory patterns. This study compares the effectiveness of GCS and FOUR scores in predicting mortality and morbidity among TBI (Traumatic Brain Injury) patients. Methods: A hospital-based prospective observational study was conducted in the emergency and neurosurgery departments of Valluvanad Hospital Complex, Ottapalam, from August 2022 to December 2023. Seventy-three patients with TBI, aged above 12 years, were enrolled. GCS and FOUR scores were recorded at presentation. Mortality and morbidity were assessed using the mRS (modified Rankin Scale) at discharge and at 30-day follow-up. Statistical analyses included ROC curve analysis, Pearson correlation, and comparison of sensitivity, specificity, and predictive values. Results: Among 73 patients, 80.8% were male and 82.2% sustained TBI due to road traffic accidents. The overall mortality rate was 21.9%. Mean GCS and FOUR scores were significantly higher in survivors (GCS: 9.6 ± 2.6, FOUR: 12.1 ± 2.5) compared to non-survivors (GCS: 6.4 ± 2.8, FOUR: 6.8 ± 2.7). ROC analysis revealed an AUC of 0.7840 for GCS and 0.9139 for FOUR in predicting mortality. FOUR score had higher sensitivity (87.5%) and specificity (80.7%) compared to GCS (sensitivity: 68.75%, specificity: 73.68%). There was a statistically significant negative correlation between both scores and mortality, as well as poor functional outcome at 30 days. Conclusion: Both GCS and FOUR scores are effective in predicting mortality and morbidity in TBI patients, but the FOUR score demonstrates superior predictive accuracy, especially in intubated patients or those with impaired verbal communication. It provides a more comprehensive assessment by including brainstem and respiratory functions, making it a more reliable tool in emergency settings.

Background: Right-ventricular after-load, reflected by pulmonary-artery systolic pressure (PASP), is a key determinant of prognosis in chronic obstructive pulmonary disease (COPD). Whether routine spirometry reliably signals haemodynamic stress remains debated. Objective: To quantify concordance between spirometric severity (GOLD grades) and echo-derived PASP categories; to derive cut-points of FEV₁ %-predicted for identifying clinically relevant PH; and to propose a combined lung–heart grid for integrated staging. Methods: In 126 clinically stable COPD out-patients (June 2016–May 2019) we compared GOLD 2024 grades (1–4) with PASP strata (normal < 30 mmHg, mild 30–40, moderate 40–55, severe > 55). PASP was obtained from the tricuspid-regurgitant jet; mean PAP estimated with Chemla’s regression. Concordance was assessed by weighted Cohen’s κ. Receiver-operating-characteristic (ROC) analysis evaluated FEV₁ %- predicted for detecting PASP > 40 mmHg (moderate-severe PH). Results: Median FEV₁ was 51 %-predicted; median PASP 34 mmHg. Grade-to-stratum agreement was substantial (κ = 0.72, 95 % CI 0.61–0.82). Misclassification occurred in 14 %: 9 “lung-mild/heart-severe” and 9 “lung-severe/heart-mild”. ROC analysis yielded area-under-curve 0.81 (95 % CI 0.73–0.88). An FEV₁ threshold < 48 % achieved 78 % sensitivity and 74 % specificity for PASP > 40 mmHg. Incorporating PaO₂ < 65 mmHg improved AUC to 0.85 (p = 0.04). We propose a four-quadrant Lung–Heart Severity Grid that identifies discordant phenotypes warranting targeted imaging or cardiopulmonary exercise testing. Conclusions: Spirometric severity and PASP demonstrate good—but not perfect—concordance. FEV₁ %- predicted < 48 % flags patients likely to harbour moderate-to-severe pulmonary hypertension, however, in this study 1 in 7 remain misclassified. A simple Lung–Heart grid may aid comprehensive staging and timely referral for right-heart evaluation in COPD clinics.

Osteoarthritis (OA) is defined by the progressive and irreversible deterioration of articular cartilage accompanied by a subsequent inflammatory response. Nonetheless, most medicinal medications for osteoarthritis only mitigate symptoms without targeting the underlying disease. We engineered an inflammation-responsive carrier and encapsulated bioactive substances to address this issue. Oxaprozin is a non-steroidal anti-inflammatory agent characterised by insufficient oral bioavailability and gastrointestinal adverse effects. This project aims to develop a unique topical Oxaprozin nanogel. Arthritis was produced in Wistar rats utilising Freund’s complete adjuvant (FCA), and the formulation’s antiarthritic efficacy was examined. The effects were juxtaposed with those of Diclofenac. Upon the study’s conclusion, blood samples were collected for biochemical as well as haematological analysis. The Oxaprozin Nanogel formulation demonstrated considerable antiarthritic efficacy, comparable to that of Diclofenac. The formulation’s antiarthritic efficacy is corroborated by biochemical and haematological analyses. The oxaprozin nanogel formulation demonstrated considerable antiarthritic efficacy against FCA-induced arthritis in Wistar rats.

Background and Aim: Dexmedetomidine, an α2-adrenergic agonist, is increasingly used as an adjuvant in regional anaesthesia to improve block quality and prolong postoperative analgesia. However, the optimal route of administration—intravenous versus perineural—remains under debate. This study aimed to compare the efficacy of intravenous versus perineural dexmedetomidine when used as an adjunct to levobupivacaine in ultrasound-guided supraclavicular brachial plexus blocks. Material and Methods:  A prospective randomized study was conducted on 100 adult patients undergoing elective upper limb surgeries. Patients were divided into two groups (n=50 each). Group DP received perineural dexmedetomidine (1 µg/kg) with levobupivacaine, and Group DIV received intravenous dexmedetomidine (1 µg/kg) with levobupivacaine alone perineurally. Primary outcomes included onset time and duration of sensory and motor block. Secondary outcomes were sedation, hemodynamic stability, and duration of analgesia. Results: Onset of both sensory and motor block was significantly faster in Group DIV compared to Group DP (p < 0.001). However, the duration of sensory and motor block, as well as postoperative analgesia, was significantly longer in the DP group (p < 0.001). No significant adverse effects were observed in either group. Conclusion: Intravenous dexmedetomidine leads to a quicker onset of block, while perineural administration offers prolonged analgesia and block duration. Both routes are safe and effective, and the choice may be tailored based on surgical requirements and desired clinical outcomes.

Introduction: Acne vulgaris is an exceedingly common chronic disease of the pilosebaceous unit, affecting approximately 40 million adolescents and 25 million adults. Additionally to the potential for long-term scarring and disfigurement, acne vulgaris carries a significant psychosocial morbidity including social withdrawal, clinical depressive disorder, and suicide. Aims: To determine the role of Intense Pulsed Light in the treatment of all grades of acne. Materials & Methods: The present study was an Interventional study. This Study was conducted from One year at Department of Dermatology in a tertiary care hospital. Total 81 patients were included in this study. Result: In this study, the most commonly reported side effect was erythema, observed in 13 patients (16.05%), and followed by itching in 5 patients (6.17%) and burning sensation in 3 patients (3.70%). The side effects were generally mild and manageable, indicating a favourable safety profile for the treatment used. Conclusion: We concluded that, intense Pulsed Light (IPL) therapy, used as monotherapy in this study, proved to be an effective and well-tolerated treatment modality for acne. A significant reduction in lesion count was observed over successive sessions, with the majority of patients showing good to excellent clinical improvement.

Purpose: To evaluate the optic nerve head (ONH) parameters and retinal nerve fibre layer (RNFL) thickness in patients suffering from migraine, and to assess whether migraine chronicity correlates with changes in ocular structures. Methods: A cross-sectional observational study was conducted on 160 migraine patients (320 eyes) aged 20–60 years. Participants were categorized based on migraine chronicity (chronic vs. episodic) using ICHD-3 guidelines. Comprehensive ophthalmologic evaluation including optical coherence tomography (OCT) was performed to assess RNFL, central macular thickness (CMT), intraocular pressure (IOP), and ONH parameters. Results: The mean RNFL thickness was significantly lower in patients with chronic migraine (Right Eye: 90.84 µm; Left Eye: 92.97 µm) compared to episodic migraine (Right Eye: 100.39 µm; Left Eye: 98.84 µm, p<0.05). Older age and longer migraine duration were significantly associated with RNFL thinning. Visual acuity was also reduced in patients with RNFL thinning. There was no significant difference in intraocular pressure between groups. Conclusion: Migraine, especially in its chronic form, is associated with thinning of RNFL, suggesting potential subclinical optic nerve involvement. OCT serves as a valuable tool for early detection of such changes, aiding in preventive ophthalmic care in migraine patients.

Background: Bloodstream infections (BSIs) are a major cause of morbidity and mortality in hospitalized patients. Timely identification of causative organisms and their antimicrobial susceptibility are essential for effective management and infection control. This study aimed to evaluate the prevalence of bacterial pathogens that cause BSIs and their resistance patterns in a tertiary care hospital. Methods: This prospective observational study was conducted from October 2023 to October 2024 at the NAMO Medical Education and Research Institute, Silvassa. A total of 2,290 blood culture samples from patients with suspected BSIs were processed using both manual and automated methods. Bacterial isolates were identified using conventional biochemical tests and the VITEK-2 compact system. Antimicrobial susceptibility testing was performed using disk diffusion and automated methods in accordance with the CLSI 2023 guidelines. Results: Of the 2,290 samples, 199 (8.7%) were culture-positive and 116 isolates were confirmed to be pathogenic. Escherichia coli (27.6%) and Klebsiella pneumoniae (26.7%) were the most common Gram-negative isolates, while Staphylococcus aureus and Enterococcus faecalis predominated among Gram-positive organisms. High levels of resistance were observed against third-generation cephalosporins and fluoroquinolones, especially against Klebsiella and Acinetobacter. Colistin and linezolid retained 100% efficacy against all the isolates.
This study highlights the growing challenge of multidrug-resistant pathogens in BSIs, underscoring the need for routine susceptibility testing, local antibiogram-guided therapy, and robust antimicrobial stewardship. Empirical treatments should be regularly updated based on regional resistance trends to improve patient outcomes and curb the spread of resistant organisms.

Introduction: Sleep deprivation is known to adversely affect cognitive and motor performance, yet its specific impact on male college students remains underexplored, particularly in an Indian context. Aims: This study aims to assess the acute effects of 24-hour sleep deprivation on the cognitive and motor skills of male college students in India. Materials and Methods: This observational study was conducted in the East West Institute Of Medical Sciences And Research, Burdwan – Suri Road, Talit, Purba Barddhaman – 713141, over a period of one year from February 2024 to January 2025. The study involved a sample of 100 male college students, selected to evaluate relevant clinical or behavioural parameters within this demographic. Result: After 24-hour sleep deprivation, the experimental group showed significantly slower choice reaction time (435.7 ± 80.4 ms vs. 373.9 ± 63.5 ms, p = 0.01) and lower working memory performance at N=1 (98.6 ± 17.9 vs. 105.4 ± 8.3, p = 0.03). Selective attention improved significantly post-test (p < 0.001). Significant differences were observed in retention phases for observational and mental tasks (p = 0.001 – 0.002). Conclusion: This study found that 24-hour sleep deprivation impaired cognitive functions in male college students, especially in choice reaction time, working memory, and divided attention. The experimental group performed slower in these areas, though selective attention improved post-test. Physical and combined control tasks were not significantly affected. Overall, sleep deprivation primarily impacted cognitive skills with minimal effects on physical performance.
This study highlights the growing challenge of multidrug-resistant pathogens in BSIs, underscoring the need for routine susceptibility testing, local antibiogram-guided therapy, and robust antimicrobial stewardship. Empirical treatments should be regularly updated based on regional resistance trends to improve patient outcomes and curb the spread of resistant organisms.

Background: Patients in tertiary care hospitals are often affected by significant ADRs that increase illness and the duration of their hospital stays. Often such systems neglect to detect many ADRs for two reasons: people do not report them and their observers have biases. By using Trigger Tool, designed by the IHI, clinicians can proactively recognize ADRs with the help of several clinical, laboratory and prescription-based indicators. Aim: To evaluate how well the Trigger Tool works in finding adverse drug reactions, relative to the way adverse events are reported by health personnel. Methods: The study was designed as prospective, cross-sectional research at Department of Pharmacology, ESIC Medical College and Hospital, Bihta, Patna, Bihar, India for one year. Using a modified Trigger Tool checklist, we screened 200 inpatients who had been admitted to the hospital to find incidents to review. Causality of the identified triggers was assessed using the WHO-UMC causality scale, the Naranjo algorithm, Hartwig and Siegel’s severity scale and Scheumock and Thornton’s preventability assessment. ADRs reported spontaneously by people using the drug were also recorded to check for similar results. Results: 200 patients examined, 67 had signs that suggested an ADR and a detailed review confirmed 51 ADRs. Among all ADRs confirmed, more than half were considered possible (54.9%) and the severity was mostly listed as moderate (64.7%). 43.1% of the ADRs in the study were tagged as preventable. Meanwhile, the spontaneous reporting system captured 21 reports of ADRs during those six months and had both fewer moderate-to-severe cases and lower preventability rates (19.0%). Conclusion: The Trigger Tool method was far better than spontaneous reporting at finding both the number and clinical importance of ADRs. It is a useful tool for improving patient safety and improving pharmacovigilance practices in healthcare settings with limited resources since it can find preventable and moderate-to-severe ADRs.This study highlights the growing challenge of multidrug-resistant pathogens in BSIs, underscoring the need for routine susceptibility testing, local antibiogram-guided therapy, and robust antimicrobial stewardship. Empirical treatments should be regularly updated based on regional resistance trends to improve patient outcomes and curb the spread of resistant organisms.

Background: Spinal anaesthesia is the preferred technique for caesarean section due to its rapid onset and reliable block. However, plain hyperbaric bupivacaine may have limited postoperative analgesic duration. The addition of intrathecal fentanyl, a lipophilic opioid, is known to enhance the quality of anaesthesia and postoperative pain control. Aim: To compare the effects of hyperbaric bupivacaine alone versus bupivacaine with fentanyl citrate for spinal anaesthesia in caesarean sections, focusing on sensory and motor block characteristics, hemodynamic stability, and neonatal outcomes. Materials and Methods: A prospective randomized study was conducted on 40 pregnant women aged 18–35 years undergoing elective caesarean section. Patients were randomly divided into two groups: Group A received 2 ml of 0.5% hyperbaric bupivacaine with 0.25 ml normal saline, and Group B received 2 ml of 0.5% hyperbaric bupivacaine with 0.25 ml fentanyl (12.5 μg) intrathecally. Both groups were evaluated for onset and duration of sensory and motor block, intraoperative vitals, APGAR scores, and postoperative analgesia. Results: The addition of fentanyl significantly prolonged the duration of sensory block (p < 0.001) without affecting the onset time or motor block characteristics. Hemodynamic parameters (heart rate and blood pressure) remained stable and comparable in both groups. Neonatal APGAR scores at 1 and 5 minutes were ≥7 and ≥9 respectively in all cases, indicating no adverse effects. Postoperative analgesia was enhanced in the fentanyl group. Conclusion: Intrathecal fentanyl as an adjuvant to hyperbaric bupivacaine in spinal anaesthesia for caesarean sections provides prolonged sensory blockade, better postoperative analgesia, and stable maternal and neonatal outcomes, without increasing complications.

Background: Road traffic accidents (RTAs) are a significant public health challenge globally, contributing to substantial morbidity and mortality. In India, RTAs are responsible for a high proportion of fatalities, underscoring the need to understand the injury patterns that lead to death. This study aims to investigate the patterns of fatal injuries in road traffic accidents in southern Bengal based on autopsy findings. Methods: This retrospective study reviewed the autopsy records of individuals who died in RTAs over a three-year period (January 2023–December 2024) at mortuary of College of Medicine and Sagore Dutta Hospital, Kolkata which is a tertiary forensic center in southern Bengal. Data on the demographics of the victims, injury patterns, causes of death, and the type of road user involved were collected and analyzed. Results: The study examined 426 cases. Males constituted 81.2% of the victims, with the highest number of fatalities occurring in the 21–40 age group (46.7%). Abrasions were commonest type of eternal injury (86.9%). Traumatic brain injuries were the leading cause of death (44.3%), followed by hemorrhagic shock due to polytrauma (40.8%). Pedestrians represented the most affected group (39.9%). Head injuries (48.4%) were the most frequently affected regional injury to the body. Conclusion: This study highlights the predominance of head injuries and multiple trauma in fatal RTA cases. It emphasizes the need for stricter enforcement of road safety laws, especially regarding the use of helmets and seatbelts, and the provision of better trauma care facilities in southern Bengal.

Aim: To evaluate the level of medication adherence among Type 2 Diabetes Mellitus (T2DM) patients and to examine its correlation with glycemic control (HbA1c levels) and influencing socio-demographic and treatment-related factors. Objective: To assess the degree of adherence to oral anti-diabetic medications using the Morisky Medication Adherence Scale (MMAS-8), determine factors contributing to non-adherence, and analyze the association between adherence and HbA1c levels. Methodology: This hospital-based cross-sectional study included 200 T2DM patients aged 30 years and above at Department of General Medicine at Kannur Medical College, Anjarakkandy. Adherence was assessed using MMAS-8, and recent HbA1c values were recorded. Data were statistically analyzed using Pearson’s Chi-square test, Mann-Whitney U test, and Spearman’s rank correlation coefficient. Result: Only 27.5% of patients were adherent to their anti-diabetic medications. A significant association was found between poor adherence and increased age, longer duration of diabetes (p=0.007), and higher cost of medication (p<0.001). No statistically significant gender-based difference in adherence was noted. Medication adherence showed a significant inverse correlation with HbA1c levels (p<0.001), indicating poorer glycemic control among non-adherent patients. Conclusion: The study highlights a low rate of adherence to oral anti-diabetic medications among T2DM patients, particularly in the elderly and those with longer disease duration. Financial burden, forgetfulness, and lack of awareness were major barriers to adherence. Improved patient^’ education, free or subsidized medication, and routine follow-up could enhance adherence and thus glycemic control.

Introduction: Non-communicable chronic diseases (NCDs) such as diabetes, cardiovascular diseases, chronic kidney disease, and liver disorders alter drug pharmacokinetics, impacting absorption, distribution, metabolism, and excretion. These changes can lead to therapeutic failure or adverse drug reactions, necessitating individualized drug therapy. Objectives: This study systematically reviews and comparsses pharmacokinetic alterations of commonly used drugs in NCD patients, evaluating their impact on drug efficacy and safety, dose adjustments, and treatment optimization. Methods: A systematic review was conducted following PRISMA guidelines. Data from PubMed, Scopus, Embase, and Cochrane Library were analyzed. Studies reporting pharmacokinetic parameters in NCD patients were included. Risk of bias was assessed using the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale. Results: Out of 4,000 studies screened, 120 met inclusion criteria. Key findings include delayed absorption (e.g., metformin in CKD), altered distribution (e.g., beta-blockers in hypertension), reduced metabolism (e.g., statins in liver disease), and impaired excretion (e.g., aminoglycosides in CKD). These variations necessitate dose adjustments to optimize therapy and prevent toxicity. Conclusion: Significant pharmacokinetic alterations in NCD patients necessitate individualized dosing strategies. Understanding these changes is crucial for improving drug efficacy, minimizing adverse effects, and optimizing pharmacotherapy. Further research on novel drugs is recommended.