Background: Acute on chronic liver failure (ACLF) is a multifactorial syndrome with intensive short-term mortality. It is defined by acute worsening of liver function in a patient with underlying liver disease. Objectives: To establish the clinical profile, precipitating causes, etiologies, and 30-day, 90-day, and 6-month outcomes of ACLF. Methods: A prospective observational study was carried out at Government Medical College, Srinagar between 2019 and 2021. Sixty patients fulfilling APASL and/or EASL-CLIF criteria were enrolled. Clinical, biochemical, etiological, and outcome information were assessed. Results: Mean age was 56.8 years; 81.7% of patients were male. Symptoms that were most common included jaundice (100%) and ascites (91.6%). NASH (38.3%) and hepatitis B (23.3%) were most common chronic etiologies. Sepsis (50%) and hepatitis B reactivation (21.7%) were most common acute insults. ACLF grade 3 was present in 53.3% of patients. 30-day, 90-day, and 6-month mortality were 53.3%, 65%, and 75%, respectively. Conclusion: ACLF has significant mortality, especially with grade 3 involvement. There should be early detection of precipitating events and aggressive management measures.

Background: Deep venous thrombosis (DVT) is a common complication in immobilized patients, particularly those with acute stroke. Despite improvements in prophylaxis, its occurrence remains a significant contributor to morbidity and mortality. Objectives: This study aimed to determine the prevalence of DVT among stroke patients admitted to a tertiary care center in North India. Methods: A hospital-based cross-sectional study was conducted on 120 stroke patients over two years. Patients were evaluated clinically and with duplex ultrasonography. Demographic data, comorbidities, stroke type, limb weakness, D-dimer levels, and prophylactic measures were assessed. Results: Of 120 patients, 6 (5%) developed DVT. All cases occurred in the paralysed limb and within 16 days post-stroke. Hemorrhagic stroke patients showed a significantly higher prevalence (7.5%) versus ischemic stroke (0%). DVT correlated with advanced age, lower limb power, and comorbidities like diabetes and hypertension. Conclusion: DVT is not uncommon in acute stroke patients, especially those with hemorrhagic stroke and significant immobility. Preventive strategies including mechanical and judicious chemoprophylaxis are critical.

Background: Vitamin D plays a crucial role in calcium homeostasis, bone metabolism, and immune function. Despite India’s abundant sunlight, several studies have highlighted a surprisingly high prevalence of vitamin D deficiency among different age groups and regions. Factors such as urbanization, increased indoor lifestyles, dietary habits, skin pigmentation, and cultural clothing practices contribute to this widespread deficiency. Aims: This study aimed to assess serum vitamin D levels in a representative sample of the Indian population and analyze their association with demographic and clinical variables. Methods: This cross-sectional clinical and epidemiological study was conducted over a period of six months in the Department of Biochemistry at BGS Medical College and Hospital, Bangalore. A total of 150 participants were enrolled to assess serum vitamin D levels across diverse demographic and lifestyle factors, providing a snapshot of vitamin D status within this population. Results: The study assessed serum vitamin D levels across various demographic and lifestyle factors. Mean vitamin D levels increased with age, while deficiency (<30 ng/mL) was highest among participants aged 18–30 years (80%) and lowest in those over 50 years (48%; p=0.001). Males showed higher mean vitamin D levels (28.9 ± 10.1 ng/mL) and lower deficiency rates (53.8%) compared to females (25.3 ± 9.2 ng/mL; 74.3% deficiency; p=0.038). Rural residents had significantly higher mean levels (30.9 ± 10.5 ng/mL) and lower deficiency prevalence (43.3%) than urban residents (24.8 ± 9.0 ng/mL; 76.7% deficiency; p=0.0002). Seasonal variation was marked, with the highest mean levels and lowest deficiency in summer (31.2 ± 9.7 ng/mL; 35% deficiency) and the lowest levels and highest deficiency in winter (24.5 ± 8.8 ng/mL; 78.2% deficiency; p < 0.0001). Conclusion: The study revealed a high prevalence of vitamin D deficiency in the Indian population, influenced by multiple demographic and lifestyle factors. Younger age, female gender, urban residence, winter season, and higher BMI were significantly associated with lower mean serum vitamin D levels and greater deficiency rates. These findings highlight the need for targeted public health interventions and awareness to improve vitamin D status, especially among vulnerable groups.

Background: Transfusion of blood and its components plays an important role in modern medicine and managing emergencies. So, blood is collected with utmost care, under strict aseptic precautions, components are prepared and subjected to rigorous testing, to make sure they are safe for transfusion. In the due process, few of the blood products get discarded due to various reasons, which, ideally should not happen. This study aims to evaluate the various reasons for the discard of blood products, so as to find ways to minimise the wastage of these blood and blood components. Methods: This is a retrospective, observational study conducted at the blood centre of a tertiary care hospital, ESIC MCH, Kalaburagi from 2019 to 2024. Results: Out of the 10811 total blood bags collected, 200 were whole blood, 5283 were packed red blood cells, 5283 were fresh frozen plasma and 45 were platelet concentrate. Among these, highest discard rate was observed with fresh frozen plasma and the most common reason was shelf-life expiry. Conclusion: As blood is a lifesaving resource, it should be judiciously utilised to minimise wastage. The most common reason for discard in this study and also few other studies, is shelf-life expiry. So, blood products transfer facility should be arranged for every blood centre.

Introduction: Locally advanced head and neck squamous cell carcinoma (LAHNSCC) requires optimal radiotherapy strategies to balance efficacy and toxicity. Simultaneous Modulated Accelerated Radiotherapy (SMART) and Simultaneous Integrated Boost Intensity-Modulated Radiotherapy (SIB-IMRT) are two advanced techniques with potential differences in clinical and dosimetric outcomes. Aims: To compare the dosimetric parameters, acute and late toxicities, and progression-free survival (PFS) between SMART and SIB-IMRT in the treatment of LAHNSCC. Materials and Methods: This single-institutional prospective observational study was conducted in the Department of Radiotherapy, Medical College and Hospital, Kolkata, from September 2022 to February 2024. A total of 89 biopsy-confirmed LAHNSCC patients were enrolled. Results: Both arms had comparable baseline characteristics. PTV-HR coverage was excellent in both arms (V95% >99%, p = 0.487). Most dosimetric parameters, including parotid, spinal cord, and brainstem doses, showed no significant differences. However, the mean laryngeal dose was significantly higher in the SMART arm (59.78 ± 7.69 Gy vs. 53.56 ± 9.23 Gy; p = 0.005). PFS at a median 14-month follow-up was 66.7% for SMART and 56.8% for SIB-IMRT. Acute toxicity was significantly higher in the SMART arm with respect to hoarseness of voice and xerostomia. No significant differences were observed in late toxicities or other outcomes. Conclusion: SMART is a feasible alternative to SIB-IMRT, offering reduced OTT with comparable efficacy. However, increased laryngeal dose and acute toxicities warrant cautious selection and further validation through randomized trials.

Introduction: One of the most popular surgical techniques utilized globally is inguinal hernioplasty, which is mainly used to treat inguinal hernias and relieve pain and discomfort brought on by hernia defects.  Post-operative pain is still a major worry, even though the operation is very simple. It frequently affects patient recovery, mobilization, and overall happiness. Aims: The aim of this study is to compare postoperative pain scores between patients who received a Transversus Abdominis Plane (TAP) block and those who did not, in order to evaluate the efficacy of the TAP block in postoperative analgesia. Additionally, the study seeks to assess the time to first analgesic requirement in both groups, thereby determining whether the TAP block provides prolonged pain relief and delays the need for supplemental analgesia following surgery. Materials & Methods: This prospective, randomized, controlled study. 1 year (from 1st January to 31st December2024). A total of 100 patients undergoing inguinal hernioplasty surgery under spinal anesthesia. Result: In our study, the total analgesic dose required in the first 24 hours postoperatively was significantly lower in the TAP Block Group compared to the Control Group (8.5 ± 3.2 mg vs. 18.3 ± 5.7 mg, p < 0.001). Conclusion: This study shows that postoperative analgesia is much enhanced when a Transverses Abdominals Plane (TAP) block is used in conjunction with spinal anaesthesia after inguinal hernioplasty. The TAP Block Group demonstrated considerably lower postoperative pain levels at all-time intervals, a longer time to first analgesic necessity, and a lower total analgesic consumption, despite the fact that baseline characteristics, surgery duration, and spinal aesthetic duration were similar between the groups.

Introduction: Radiotherapy plays a pivotal role in the treatment of carcinoma of the oral cavity. However, associated toxicities like xerostomia and dysphagia significantly affect patient quality of life. Advancements in radiotherapy techniques, including Intensity-Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT), have aimed to improve dosimetric outcomes and reduce toxicity to organs at risk (OARs). Aims: To compare acute and late toxicity in patients of well lateralized carcinoma of oral cavity treated with two different radiotherapy techniques: Intensity modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) with special interest in xerostomia and dysphagia. Materials and Methods: It was a Prospective Observational Study this study was conducted 2 years at the Department of Radiotherapy, Medical College Kolkata. 36 Patients were included in this study. Results: Target coverage was comparable in both groups with no significant differences in D95%, D50%, D2%, or D98%. VMAT demonstrated a significantly better conformity index (p < 0.002) and reduced doses to the parotid glands and pharyngeal constrictors (p < 0.001). Treatment time and MUs were significantly lower in the VMAT group (p < 0.0001). Although not statistically significant, VMAT showed a trend toward lower incidences of Grade 2 dysphagia and xerostomia at all-time points. No Grade 3 toxicities were reported in either group. Conclusion: VMAT provides superior conformity and reduced dose to critical OARs, along with shorter treatment times and fewer monitor units compared to IMRT. Clinically, VMAT is associated with a trend toward lower rates of xerostomia and dysphagia, supporting its potential as the preferred technique in well-lateralized oral cavity cancers.

Introduction: An infection is classified as a healthcare-associated infection (HAI) if it happens on or after the third calendar day of admission to an inpatient facility where the date of admission is a calendar day, according to the NHSN (National Healthcare Safety Network) site-specific infection criterion. Aims: To evaluate SSI caused by S. aureus including its drug-resistant isolates. To find relation if any between nasal carriage of S. aureus and occurrence of SSI caused by S. aureus. Materials & Methods: It was an institutional-based, descriptive study. The present study was conducted in the department of Microbiology and Department of Surgery, Bankura Sammilani Medical College and Hospital, Bankura, India. The duration of the study was for a period of twelve months from February 2015 to January 2016. Result: In our study, nasal carriage of methicillin-sensitive Staphylococcus aureus (MSSA) was present in 364 out of 591 patients (61.6%), with the association found to be statistically significant (p < 0.00001). In our study, surgical site infections (SSI) caused by Staphylococcus aureus were observed in 101 out of 336 patients (30%), with the association being statistically significant (p < 0.00001). Conclusion: We concluded that the incidence of surgical site infections (SSI) brought on by Staphylococcus aureus in a tertiary care hospital is significantly correlated with nasal carriage of this bacterium, according to this study. Of the 1600 postoperative patients, 336 had SSI, and 364 of the 591 patients were nasal carriers of MSSA.

Introduction: The Covid-19 pandemic affects worldwide health and causes economic disasters. Testing sample in pool is the best strategy for surveillance. Pooling of samples reduces cost and turn-around time of RT-PCR test if done in the setting of low prevalence. But at the same time, it may give false negative results due to dilution effect, especially in higher range of cycle threshold value (Ct value). So, it is recommended that every RT-PCR laboratory should optimize pool size for improving test output utilizing minimum resources and without compromising sensitivity of the test. Aim: Current study  was conducted to evaluate the dilution effect of pooling of samples on the sensitivity of RT-PCR Test and  compare Ct value of positive pool with that of individual positive sample. Materials and Methods: Wide range of positive samples starting from highest Cycle threshold value(Ct) 35 to lowest 15( i.e. 21 sets different Ct value positive specimen) were tested for 7  different sets of pool such as 3,5,10,15,20,25,30 specimen pool  for each gene(N and ORF1 ab) separately. After pool formation RNA extraction was done by both manual and automated extraction method followed by detection of COVID-19 target gene by RT-qPCR. Results: All pooled specimens of both genes were tested positive until and below Ct value 24 by both extraction methods. Dilution effect of pooling were noticed from Ct value 25 upwards. Sensitivity of pooled specimen decreases with increasing pool size. 100% sensitivity observed up to 10 pool and 15 pool sample in manual and automated extraction method respectively. Conclusion: Pool testing is the best strategy to carry out population-wide surveillance as new variant of COVID-19 is coming up frequently. Our study indicates we can increase pool size upto15 specimen pool with minimal loss of sensitivity. Current study also observed sensitivity of automated extractor outweighs manual extraction method. COVID-19 no longer constitutes a public health emergency of international concern but being a highly contagious disease, it has the potential to cause rapid outbreak especially in healthcare settings. So periodic surveillance of every ward and every new patient on admission should be incorporated in Hospital infection control programme of every Health care setting.

Von Recklinghausen or Neurofibromatosis1 is a neurocutaneous syndrome affecting both the integument and central nervous system (CNS) of varying severity. It occurs due to mutation of the NF1 gene. Here, we report a case of 13-year-old boy, second born of non-consanguineous marriage, who presented with complaints of tingling sensation of over the limbs for the past one-year, poor scholastic performance and behavioral problems. There was no significant family history neither any similar complaints in either of the parents or older sister. A delay in attaining developmental milestones were noted by mother at 3 years of age. Various examinations revealed multiple café au lait spots all over the body, shagreen patch over the neck. Lisch nodules in bilateral eyes with multiple neurofibromas over both arms. Neuroimaging of brain and spine showed characteristic findings specific for Neurofibromatosis 1. The child was treated with Gabapentin with regular multisystemic follow-up.

Introduction: AIDS,  the  acquired  immuno-deficiency  syndrome  is  a fatal  illness  caused  by  a  retrovirus  known  as  human immuno-deficiency   virus  (HIV). Transmission is ongoing in all countries globally. There were an estimated 39.9 million people living with HIV at the end of 2023. The disease process and clinical outcome can be influenced by a number of factors, including the patient’s social situation and current clinical condition. Objectives: To determine the socio demographic and clinical profile of HIV positive persons attending the ART Centre of Assam Medical College and Hospital. Materials and Methods: A Hospital based observational study was conducted at the Anti-Retroviral Therapy (ART) Centre of Assam Medical College on 150 PLHIV on ART. Results: Majority of the participants (64%) belonged to the age group of 30-49 years. Among the 57 female participants, 63.16% were in the age group of 30-49 years. Majority (92.67%) of the participants were literate while only 7.3 % of the participants were illiterate and 68% were employed. The most common route of transmission among the study participants was heterosexual route (82.7%). The mean CD4 count in the study participants was 385.18/mmᶾ with an SD of ±170.81/mmᶾ. 63.33% had opportunistic infection. The most common symptom that the participants complained of was fatigue (31.3%). Conclusion: Community intervention programmes may be implemented to the addresses the needs of high-risk and vulnerable populations, including female sex workers, men who have sex with men, and transgender individuals to reduce the incidence of new HIV infections.

Background: Developmental delays (DD) affect approximately 1–3 % of children worldwide and encompass impairments in motor, cognitive, language, social, and adaptive domains. Early identification of causative factors—genetic, environmental, perinatal, nutritional, and socioeconomic—is critical to optimize interventions and outcomes. Objective: To evaluate the prevalence and causes of developmental delays among children aged 6 months to 5 years at a tertiary paediatric centre, and to analyse associated risk factors. Methods: In this prospective observational study, 300 children presenting with suspected DD were enrolled over 18 months. Detailed histories, standardized developmental assessments (Bayley Scales of Infant Development III), laboratory investigations, neuroimaging, and genetic testing (where indicated) were performed. Data were analysed using SPSS 25.0: continuous variables as means ± SD (Student’s t-test), categorical as proportions (χ² test); multivariate logistic regression identified independent risk factors (p < 0.05 significant). Observation tables summarize demographic, clinical, and etiologic data. Results: Of 300 children (mean age 24.7 ± 13.2 months; 59% male), 42% had global DD, 34% language delay only, and 24% motor delay only. Aetiologies: 28% preterm/perinatal hypoxia, 22% genetic syndromes (e.g. Fragile X, Down), 18% environmental (lead exposure, low socioeconomic status), 14% metabolic/nutritional (iron-deficiency anaemia, hypothyroidism), and 18% idiopathic. Multivariate analysis identified low birth weight (OR 2.8; 95% CI 1.7–4.6), perinatal hypoxia (OR 3.4; 95% CI 2.0–5.8), and low maternal education (OR 1.9; 95% CI 1.1–3.3) as independent predictors of DD. Conclusions: Perinatal complications and socioeconomic factors are leading causes of DD in our cohort. Strengthening perinatal care, early developmental screening, genetic counselling, and addressing environmental/nutritional risks are essential to reduce the burden of DD.

Introduction: Breastfeeding remains a critical determinant of infant health, nutrition, and survival. Despite widespread institutional deliveries and healthcare outreach in Gujarat, gaps persist in optimal breastfeeding practices. This study was conducted to evaluate maternal breastfeeding behaviours and identify influencing socio-demographic factors in the field practice area of a tertiary care centre. Objective: To assess breastfeeding practices among mothers of children under two years of age and determine their association with key maternal and household characteristics. Methods: A cross-sectional study was carried out in 10 Anganwadi centres located in the Patan taluka of Gujarat, following a community-based approach. Mothers of children under two years were surveyed using a pre-tested structured questionnaire. Breastfeeding practices were scored and categorized as ‘good’ or ‘not so good’. Associations with socio-demographic variables were analysed using the Chi-square test. Data were entered in MS Excel. Prior to data collection, ethical approval and informed consent were secured. Results: Of 232 mothers, 65.5% initiated breastfeeding within one hour, and 69.4% practiced colostrum feeding. Exclusive breastfeeding with timely weaning was seen in 56.0%. Maternal education and socio-economic status showed significant associations with breastfeeding practices (p < 0.05), while age and occupation were not statistically significant. Conclusions: While the overall breastfeeding behaviour was encouraging, notable gaps in knowledge and consistency of practice were observed. Focused community-level health education, peer support, and enhanced antenatal counselling can bridge these gaps and improve maternal and child health outcomes in rural Gujarat.

Background: Hemoglobinopathies are among the most prevalent genetic disorders worldwide, with high phenotypic heterogeneity. The northeastern region of India shows a predominance of hemoglobin E and (HbE)-related variants. Methods: This prospective cross-sectional study was conducted at a tertiary care centre in N E India. Seventy patients aged over six months and diagnosed with hemoglobinopathy were included. Detailed demographic data, clinical features, hematological parameters, HPLC results, serum ferritin levels analysed. Genetic mutation profiles were analysed in twenty-five of these patients. Transfusion dependency and phenotypic outcomes were also studied. Results: HbE-related disorders were the most common, seen in 65.7% of cases. HbE/β-thalassemia accounted for 44.2%, followed by beta-thalassemia major (17.1%) and sickle cell disease (5.7%). Nearly 48.5% of the patients were transfusion-dependent. Poorly transfused individuals had significantly higher serum ferritin, hepatosplenomegaly, short stature, delayed puberty, and endocrinopathies. Among genetically analyzed cases, the most frequent mutations were c.79G>A (HbE variant) and IVS1-5(G>C) (β-thalassemia), with compound heterozygosity often predicting a severe phenotype. Conclusion: HbE/β-thalassemia is the predominant hemoglobinopathy in Assam with diverse clinical presentations. Transfusion status and chelation significantly influence growth and endocrine health. Mutation profiling enhances understanding of disease severity and can guide individualized care. Population-based studies are warranted to further characterize the regional mutation spectrum and phenotypic variability.

Introduction: Low back pain (LBP) is a prevalent musculoskeletal condition affecting a substantial portion of the global population. It is a leading cause of disability worldwide and poses a considerable burden on healthcare systems and individuals alike. Despite its widespread occurrence, the etiology of low back pain remains multifactorial and complex, often involving a combination of mechanical, psychological, and environmental factors. Aims: The aim of the study is to investigate the association between low back pain and Vitamin D deficiency and to determine if vitamin D levels correlate with pain intensity in indivisuals with low back pain. Materials and Methods: The present study was a institution based prospective observational study, conducted at the Orthopaedic Department of I.P.G.M.E.R. & S.S.K.M. Hospital, Kolkata, a tertiary care center catering to people of West Bengal. Result: The study found that 68 patients had low serum vitamin D levels (<20 ng/ml), with the majority (59%) falling into the mild deficiency category (10–19.9 ng/ml), 7% in the moderate deficiency category (5–9.9 ng/ml), and 2% in the severe deficiency category (<5 ng/ml). The mean duration of symptoms did not significantly differ between patients with normal vitamin D levels (21.13 ± 4.61 weeks) and those with vitamin D deficiency (20.69 ± 4.47 weeks, p = 0.655). Dietary preferences were comparable between vegetarians (57%) and non-vegetarians (43%, p = 0.742). However, the mean VAS score was significantly higher in the vitamin D deficiency group (5.60 ± 1.46) compared to the normal vitamin D group (4.88 ± 1.21, p = 0.016). Similarly, the mean ODI score was significantly higher in the deficient group (20.29 ± 13.12) than in the normal group (7.81 ± 5.62, p = 0.0002), indicating worse functional outcomes in vitamin D-deficient patients. Conclusion: We conclude that, the study highlights that low serum vitamin D levels are prevalent among patients, with the majority exhibiting mild deficiency. While the duration of symptoms and dietary preferences showed no significant association with vitamin D levels, patients with vitamin D deficiency demonstrated significantly worse pain (as indicated by higher VAS scores) and functional outcomes (reflected by higher ODI scores) compared to those with normal vitamin D levels. These findings underscore the potential impact of vitamin D deficiency on pain and functional health, emphasizing the need for further attention to vitamin D status in clinical practice.

Introduction: Autoimmune connective tissue disorders (ACTDs) such as systemic lupus erythematosus, rheumatoid arthritis, and scleroderma often coexist with other autoimmune conditions, including autoimmune thyroid disease. Thyroid dysfunction can significantly influence disease activity and patient outcomes in ACTDs. Early identification of thyroid abnormalities is crucial for comprehensive management. Aims: This study aims to evaluate the prevalence and pattern of thyroid function abnormalities in patients diagnosed with autoimmune connective tissue disorders and to analyze the correlation between thyroid dysfunction and clinical parameters of ACTDs. Methods: The present study was a cross-sectional observational study conducted in the Department of General Medicine, Endocrinology Clinic at Calcutta National Medical College and Hospital. The study population comprised patients attending the outpatient department as well as those admitted to the general medicine ward. The study was carried out over a period of one year, from 2015 to 2016. A total of 110 patients diagnosed with Autoimmune Connective Tissue Disorders (ACTDs) were included in the study to evaluate thyroid function in this specific population. Results: In this study of hypothyroid patients, a high prevalence of anemia was observed, with 84.04% having hemoglobin levels below 12 gm%. The most common anemia type was normocytic normochromic (61.05%), followed by microcytic hypochromic (35.78%) and macrocytic hyperchromic (3.15%). Hematological indices showed that 78.46% had low packed cell volume (<40), while most had normal mean corpuscular volume (75.38%) and normal mean corpuscular hemoglobin (63.84%). Elevated red cell distribution width was present in 67.69%, indicating anisocytosis. Total red blood cell counts mostly indicated mild to moderate reduction. Bleeding and clotting times were largely normal. Total leukocyte counts were normal in 88.46%, with some cases of leukopenia and leukocytosis. Platelet counts were generally normal, with mild thrombocytopenia in a small fraction and no severe thrombocytopenia detected, suggesting thrombocytopenia is uncommon in hypothyroidism. Conclusion: Thyroid dysfunction, particularly hypothyroidism, is common in patients with autoimmune connective tissue disorders. Routine screening for thyroid abnormalities should be incorporated into the clinical evaluation of ACTD patients to enable timely intervention and potentially improve disease prognosis.

Background: Knee joint injuries are prevalent among athletes and can significantly impair performance and quality of life. Magnetic Resonance Imaging (MRI) is widely used as a non-invasive modality for diagnosing internal derangements of the knee. Arthroscopy, while considered the gold standard, is invasive. Correlating MRI findings with arthroscopy helps validate its diagnostic accuracy in clinical practice. Aim and Objectives: To assess the diagnostic accuracy of MRI in detecting knee joint injuries in athletes and compare its findings with arthroscopic evaluation. Materials and Methods: This prospective observational study included 60 athletes with clinically suspected internal derangement of the knee who underwent both MRI and arthroscopy within a 3-week interval. MRI was performed using a 1.5 Tesla scanner with standard knee imaging protocols. Arthroscopic findings served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for MRI in detecting ACL tears, meniscal injuries, PCL tears, and cartilage lesions. Results: MRI showed high diagnostic performance for ACL tears (sensitivity 94.3%, specificity 91.7%, accuracy 93.3%), medial meniscus tears (sensitivity 89.3%, specificity 85.2%), and lateral meniscus tears (sensitivity 80.0%, specificity 94.1%). For PCL tears, MRI demonstrated sensitivity of 85.7% and specificity of 98.0%. Cartilage injuries were identified with lower sensitivity (66.7%) but high specificity (92.5%). ROC analysis for ACL detection yielded an AUC of 0.96. Conclusion: MRI is a reliable and accurate modality for diagnosing knee joint injuries in athletes, with strong correlation to arthroscopic findings. It serves as an effective non-invasive tool in preoperative evaluation and can reduce the need for diagnostic arthroscopies. However, attention should be given to its limitations in detecting cartilage lesions.

Aim: Diabetes mellitus patients have four visits to emergency department due to acute metabolic complications of the disease. These include Hypoglycaemia, DKA (Diabetic Ketoacidosis), HHS (Hyperglycaemic Hyperosmolar State) and recently focused EDKA (Euglycemic Diabetic Ketoacidosis). The objectives of the study are to determine the causes and precipitating factors of acute metabolic complications of diabetes mellitus and to determine their outcome. Material and Methods: We conducted a prospective observational study on 200 patients coming to the Trauma Centre of Civil Hospital, Ahmedabad, Gujarat. Patients with features and lab investigations suggestive of acute metabolic complications of Diabetes Mellitus were studied. Patients eligible for inclusion were aged > 12years, Known and Newly diagnosed patients of both type I and type II diabetes with documented blood reports of hypoglycemia or abnormal hyperglycemia with positive glycosuria and or ketonuria. Patients were divided into 4 groups DKA, HHS, Hypoglycemia and others. Patients with aged <12years or diagnosed with starvation and alcoholic ketoacidosis were excluded. Result: Most common complication of diabetes in the present study was found to be hypoglycaemia (66%), followed by Diabetic Ketoacidosis (32%) and HHS (2%). 81.5% number of patients had complaint of breathlessness and 74.5% had vomiting and most were on Oral Hypoglycaemic Agents (63%). Overall infection was the most common inciting factor followed by Non-compliance to treatment while in hypoglycaemia decreased dietary intake was most common. 58% of patients had comorbidities and maximum were known case of respiratory diseases. Hyponatremia was the most common electrolyte abnormality observed. About 86.5% were discharged from the hospital while 15% were shifted to ICU. Overall mortality rate of 7% was observed. Hypoglycaemia is associated with lowest mortality while HHS had the highest mortality. Conclusion: Metabolic Complications of diabetes mellitus contributes significantly to ED visits. Early diagnosis and management of Diabetes Mellitus helps in preventing these complications and subsequently reduce the morbidity and mortality.

Acetabular fractures represent complex intra-articular injuries of the hip joint that pose significant challenges in orthopedic trauma management. Historically, these injuries were associated with high morbidity due to difficulties in achieving anatomical reduction and stable fixation. Traditional treatment methods have primarily centered around open reduction and internal fixation (ORIF), with the Kocher-Langenbeck and ilioinguinal approaches being the mainstays. However, the last two decades have witnessed a paradigm shift in orthopedic surgical practices with the integration of advanced imaging, computer-assisted navigation, minimally invasive surgery, and patient-specific instrumentation. These innovations promise reduced operative morbidity, improved functional outcomes, and shorter rehabilitation timelines. This study explores and evaluates the efficacy, outcomes, and limitations of modern surgical methods—including percutaneous screw fixation, 3D-printed models for preoperative planning—in comparison to conventional open methods. Using clinical data and a thorough literature review, this paper aims to inform clinical decision-making and contribute to ongoing efforts in refining acetabular fracture treatment protocols.

Background: Optimal insertion conditions for laryngeal mask airway (LMA) devices during general anesthesia require smooth induction, minimal airway reflexes, and hemodynamic stability. Intravenous adjuvants such as dexmedetomidine and fentanyl are frequently used to enhance the insertion conditions of LMA with propofol. However, the comparative effectiveness and safety profile of these agents when used with LMA Supreme remains a subject of clinical interest. Aim: To compare the efficacy of dexmedetomidine and fentanyl as intravenous adjuvants to propofol for facilitating LMA Supreme insertion in adult patients undergoing elective surgeries. Materials and Methods: This prospective, randomized, double-blind comparative study was conducted on 100 adult patients (ASA I–II) scheduled for elective surgery under general anesthesia at a tertiary care centre in Jharkhand. Patients were randomly allocated into two groups: Group D received dexmedetomidine 1 µg/kg IV and Group F received fentanyl 2 µg/kg IV, both followed by propofol 2–2.5 mg/kg for induction. LMA Supreme was inserted 90 seconds after induction. Insertion conditions, number of attempts, hemodynamic changes, and perioperative complications were recorded and analyzed. Results: Both groups were comparable in demographic variables. Group D showed significantly better insertion conditions with fewer airway reflexes and higher first-attempt success rates compared to Group F. Hemodynamic stability was better maintained in Group D, while Group F had a higher incidence of hypotension and apnea. Adverse airway responses and postoperative sore throat were also lower in the dexmedetomidine group. Conclusion: Dexmedetomidine is a superior adjuvant to propofol for LMA Supreme insertion compared to fentanyl, providing smoother insertion conditions, greater hemodynamic stability, and fewer airway complications. Its incorporation into routine anesthesia induction protocols for LMA use may enhance procedural safety and patient outcomes.

Background: The extensor indicis proprius muscle contributes to independent extension of the index finger and exhibits anatomical variation across populations. Understanding its morphology and developmental origin provides insight into evolutionary adaptations and informs surgical approaches in the forearm and hand. Aim: To document the prevalence morphology and anatomical variations of the extensor indicis proprius muscle in adult cadavers from the North Indian region, and to discuss findings in light of ontogenic development and phylogenetic lineage. Methods: In this descriptive anatomic study twenty paired upper limbs were dissected from ten adult cadavers donated to the anatomy department. After careful exposure of the dorsal forearm, the extensor indicis proprius muscle was examined for origin insertion tendon number and course. Variations were recorded and photographed. Data were compared with embryologic development patterns and with reported morphologies in other species to infer ontogenic and phylogenetic implications. Results: The classic single-belly single-tendon morphology was observed in thirty-five of forty limbs (87 percent). Variant forms included a double tendon in four limbs (10 percent) and an accessory slip to the middle finger in one limb (3 percent). Origins ranged from the distal ulna to the interosseous membrane. No high origin variants were encountered. Ontogenic correlations suggest tendon splitting during muscle differentiation, while phylogenetic comparisons with non-human primates indicate conserved distal attachment reflecting functional demands. Conclusion: In the North Indian population the extensor indicis proprius muscle shows predominantly the standard morphology, with occasional tendon variations that reflect patterns of developmental splitting. Phylogenetic analysis supports its specialized role in independent digit extension. Surgeons should be aware of these variants during tendon grafting and decompression procedures to avoid inadvertent injury or misidentification.

Background: The nerve of Kuntz, an accessory neural connection between the thoracic sympathetic trunk and the brachial plexus, has been implicated in variable outcomes following sympathectomy and in unexplained autonomic phenomena in the upper limb. Understanding its prevalence anatomical pathways and variations is essential for improving surgical success rates and minimizing complications. Aim: To document the anatomical variants of the nerve of Kuntz in adult cadavers from the North Indian population and to discuss the clinical and surgical implications of these variants. Methods: In a descriptive anatomical study twenty paired thoracic sympathetic chains with adjacent brachial plexus structures were dissected in ten formalin fixed adult cadavers. Accessory nerve connections between the second thoracic ganglion and the brachial plexus were identified, traced and classified according to origin course and termination. Variants were photographed and measured then correlated with potential impacts on surgical procedures such as endoscopic thoracic sympathectomy and brachial plexus interventions. Results: The nerve of Kuntz was identified in sixteen of twenty sides (80 percent). Among these origins arose from the second thoracic ganglion in ten sides, from a common trunk in four sides and via dual connections in two sides. Terminations were into the brachial plexus sheath in twelve sides and directly into the stellate ganglion in four sides. The mean diameter of the nerve was 1.2 ± 0.3 millimetres and the mean length was 3.8 ± 0.7 centimetres. Recognition of these variants explained cases of incomplete sympathectomy and guided modification of surgical approaches. Conclusion: The nerve of Kuntz occurs in the majority of specimens and exhibits multiple anatomical patterns that can influence the outcomes of sympathetic and plexus surgeries. Preoperative awareness and intraoperative identification of these variants are critical to achieving complete sympathectomy and preventing inadvertent nerve injury.

Magnetic Resonance Imaging (MRI) plays a crucial role in the evaluation of soft tissue tumors of the hand and wrist. Given the intricate anatomy and a large variety of benign and malignant lesions that may arise in this region, accurate imaging is needed for diagnosis, surgical planning, and treatment guidance. MRI offers excellent soft tissue contrast and multiplanar capabilities, enabling detailed characterization of lesion size, location, tissue composition, and relationship to adjacent structures. Common benign tumors such as ganglion cysts, lipomas, and giant cell tumors of the tendon sheath, as well as less frequent malignant lesions, exhibit distinct MRI features that aid in differentiation. Advanced imaging techniques also assist in assessing vascularity, hemorrhagic components, and internal architecture. This abstract highlights the value of MRI in the comprehensive evaluation of soft tissue masses in the hand and wrist, emphasizing its utility in improving diagnostic confidence and optimizing clinical management.

Introduction: Sunshine Vitamin D, biologically active as 25(OH)₂D, is important for calcium absorption and maintains normal bone health. Other functions like cell growth, neuromuscular and immune function, and reduction of inflammation require the nutrient. Magnesium, the fourth most abundant mineral, activates hundreds of enzymes that are involved in important biological reactions. Without magnesium, vitamin D is not really useful. Recommended amount of magnesium is consumed to obtain the optimal benefits of vitamin D. Mg is required as cofactor for CYP2R1 and CYP24A1 enzymes important for vitamin D metabolism. Aim: To estimate serum magnesium and serum vitamin D levels. Materials and Methods: The study was conducted among 120 subjects of either sex and independent of age. Serum vitamin D [25(OH)D] and serum Magnesium were estimated using Fluorimetric Enzyme Immunoassay method and Xylidyl blue method respectively and the results obtained were statistically analyzed for drawing best possible outcome. Result: The mean age of the participants was 53.54±21.91 years. The participants had serum vitamin D level of 25.19±15.57 ng/ml and serum magnesium level of 2.07±1.13 mg/dl. Nearly 74% participants are hypovitaminosis D. About 53% male and 63% female are hypovitaminosis D. Subjects having low vitamin D also have lower serum magnesium. Conclusion: The data indicates only a little effect between vitamin D and serum Mg with high prevalence of vitamin D deficiency and insufficiency.

Introduction: When young people experience stress from their work, career tension, social life, and surroundings, one of the main issues they face is sympathetic over activity, also known as autonomic disturbance. Studies have shown that yoga practice enhances cardiac autonomic function and generates a number of alterations in normal physiology. So, this study was conducted to determine how yoga affected the cardiac autonomic functions in yoga practitioners. Objective: To assess the cardiac autonomic function in yoga practitioner and also compare the cardiac autonomic function among the yoga & non yoga practitioner. Methodology: This cross-sectional comparative study was started among 60 healthy volunteers in males, after recruiting them based on inclusion and exclusion criteria in the age group of 20–40 years. The autonomic reactivity tests like Resting Heart Rate, Heart Rate response to Valsalva maneuver, DBP rise to Sustained Hand-Grip test and DBP response to Cold Pressor Test were done. Results: Participants in the yoga group experienced a significant (P < 0.05) decrease in their resting heart rate (82.38 ±16.48 vs. 76.96 ± 6.39), as well as a sustained handgrip test (16.10 ± 3.04 vs. 13.93 ± 1.96) parameter. There was no significant difference between the groups in the DBP response to the Cold Pressor Test or the HR response to Valsalvamanoeuvre (P > 0.05). Conclusion: Among those who regularly practiced yoga, the current study found reduced sympathetic activity and increased parasympathetic activity. Thus, yoga can be used on a daily basis to lower stress and prevent lifestyle-related illnesses in the future.

Background: Preeclampsia is a significant complication of pregnancy characterized by hypertension and proteinuria, posing risks to both maternal and foetal health. Studies suggest that aspirin may play a preventive role in high-risk populations, particularly in women with a history of obstetric complications. Objective: This study aims to compare the efficacy of two different doses of aspirin (75 mg vs. 150 mg) in the prevention of preeclampsia among high-risk pregnant women attending the Antenatal Outpatient Department at Guwahati Medical College and Hospital. Methodology: A single-blind, two-armed, parallel randomized controlled trial was conducted over 18 months. The study enrolled 200 pregnant women, aged 18-43 years, in their 12 to 18 weeks of gestation, identified as high-risk through the Gestosis score, which evaluates 27 risk factors for hypertensive disorders. Participants were randomly assigned to receive either 75 mg or 150 mg of aspirin daily. Demographic data, obstetric history, and pre-pregnancy weight were collected, and mean arterial pressure was measured at baseline. Results: 74% of people taking 75 mg prevented preeclampsia from developing compared to 86% in the 150 mg group, according to the study, with a statistically significant p-value of 0.034. The maximum incidence of preeclampsia was observed among primigravidae, with age extremes contributing to higher risk. The findings corroborate previous research on the comparative efficacy of aspirin dosages. Conclusion: Both doses of aspirin demonstrated a preventive effect against preeclampsia, with the higher dosage exhibiting greater efficacy. These results support the use of aspirin as a preventative measure in high-risk pregnancies, emphasizing the importance of early intervention and tailored therapeutic approaches to improve maternal and fetal outcomes. Further studies are warranted to solidify these findings and refine dosage recommendations.

Background and Objective: To ensure better anaesthetic quality in peripheral nerve block, effective sedation has become an essential part of this regional anaesthetic technique. Thus, this study was conducted to compare the effects of intravenous dexmedetomidine and propofol for moderate intraoperative sedation during brachial plexus block in elective orthopaedic surgeries. Material and Methods: A prospective, randomized, double blinded study was carried out in 44 patients of either sex, 18-65 years, ASA grade I and II, posted for upper limb orthopaedic surgeries under brachial plexus block. Patients were randomized into 2 groups, group D and P of 22 each (n = 22). Group D received intravenous infusion of dexmedetomidine at an initial loading dose of 1 μg/kg over 10 minutes followed by maintenance infusion of 0.5-0.7 μg/kg/hr and group P received intravenous infusion of propofol at an initial loading dose of 75 μg/kg/min over 10 min followed by maintenance infusion of 30-60 μg /kg/min. Level of sedation using MOAA/S scoring system, hemodynamic changes, side effects, complications and overall patient satisfaction were assessed in both the groups. Results: Both groups were comparable with respect to demographic variables. Time to achieve adequate sedation (MOAA/S score of 3) was early in group P as compared to group D (13.91±1.41 min vs. 9. 20.91±2.11 min; p<0.001). Recovery from sedation was also early in group P as compared to group D (14.73±1.78 min vs 23.68±2.51 min; p<0.001). Intraoperatively HR decreased significantly from baseline in both the groups (p<0.01). Fall in MAP was more in group P than group D and significant decrease in RR was observed in group P as compared to group D. VAS score for pain 6 hours postoperatively remained lower in group D than group P and overall patient satisfaction score was better with group D. Conclusion: Dexmedetomidine and propofol both provided similar level of sedation but dexmedetomidine with its better hemodynamic profile, minimal respiratory depression, prolonged postoperative analgesic sparing property, less pain with injection and overall better patient satisfaction score could be used as a better alternative to propofol for intraoperative moderate sedation for surgeries under brachial plexus block.

Background: The peak expiratory flow rate (PEFR) is the maximal airflow during a forced expiratory vital capacity manoeuvre starting from a position of full inspiration. In healthy subjects this index reflects the calibre of the central airways and the force exerted by the expiratory muscles. Lungs are a potential target organ for diabetic microvascular complications. This is due to non-enzymatic glycosylation of proteins particularly collagen and elastin, as well as microangiopathy induced by chronic hyperglycemia. The thickening of the pulmonary capillary basal lamina and the alveolar epithelium and reduction in elastic recoil of the lung may result in decrease in the expiratory volume of air. Aims and Objectives: The study was undertaken to analyze the PEFR in type II diabetic patients and compare them with age and gender matched healthy control. Correlation between PEFR in diabetic patients with glycemic status and duration of the disease was also analyzed. Materials and Methods: A cross-sectional study was conducted among 100 type 2 diabetic patients and 100 normal healthy controls aged between 30 – 60 years to record PEFR by spirometer and to find the correlation between mean PEFR in diabetics and non – diabetics. Glycemic status – Fasting blood sugar (FBS) and Post-prandial blood sugar (PPBS) of subjects were determined by glucose oxidase and peroxidase methods. PEFR of diabetic patients and controls were compared by applying Student’s unpaired t test. Associations between PEFR and duration of illness in diabetic patients were analyzed by applying Pearson’s coefficient. Results: The mean PEFR in the total diabetic group is 265.35 ± 114.46 L/min which is lower than that of the total non-diabetic control group (359.71±123.68 L/min ) and the decreased value in the total diabetic control group is very highly significant (p<0.001). There is no significant correlation between PEFR with FBS among the total diabetic group (r = – 0.1, p > 0.05). There is no significant correlation of PEFR and PPBS among the diabetic cases (r = 0.04, p> 0.05) in this study. No significant correlation is observed between PEFR with the duration of disease among the total diabetic group (r = 0.00, p > 0.05). Conclusion: Our study concluded that impairment of pulmonary function (PEFR) is associated with diabetes mellitus.

Background: Acute pneumonia remains a leading cause of mortality and morbidity in children under five, particularly in developing nations. Zinc, a key micronutrient, plays a critical role in immune function, and its deficiency is associated with increased susceptibility to infections. Aim: To evaluate the effectiveness of zinc as an adjuvant therapy in improving clinical recovery outcomes in children aged 2 months to 5 years hospitalized with acute pneumonia. Methods: A prospective, randomized, controlled trial was conducted at the Department of Pediatrics, DMCH, and Laheriasarai. A total of 160 children diagnosed with acute pneumonia were randomly assigned to either a zinc-supplemented group (Group A, n=80) or a control group receiving standard care only (Group B, n=80). Outcomes including recovery time, duration of hospitalization, and need for oxygen support were compared. Zinc was administered as 10 mg/day for infants <12 months and 20 mg/day for those ≥12 months, for 7–14 days. Results: Patients in the zinc group showed a trend toward faster clinical recovery (mean 3.78 days vs. 4.22 days in control), though not statistically significant (p=0.22). Hospital stay was slightly shorter in the zinc group (mean 5.71 vs. 6.23 days; p=0.22). Adverse effects such as rash and diarrhea were significantly more frequent in the zinc group (p<0.001). No significant differences were found in baseline characteristics, antibiotic use, or final recovery rates (zinc: 95%; control: 97.5%). Conclusion: Zinc supplementation may offer a modest benefit in accelerating recovery in children with acute pneumonia, though it was not statistically significant in this study. Given its safety profile and immunological benefits, zinc could be considered a supportive adjunct therapy, especially in populations at risk for micronutrient deficiency.

Background: Bronchiolitis is a common cause of hospitalization in infants under two years, typically caused by RSV. Management is largely supportive. Recent attention has turned to 3% hypertonic saline nebulisation, which may enhance mucociliary clearance and reduce symptoms. Aim: To assess the clinical effectiveness of 3% hypertonic saline nebulisation versus standard care in hospitalized children aged 2–24 months with bronchiolitis, focusing on symptom resolution and hospital stay duration. Materials and Methods: A prospective, randomized controlled trial was conducted at DMCH, Laheriasarai, involving 200 children randomized into two groups: one receiving 3% hypertonic saline nebulisation and the other standard supportive care. Data on clinical parameters, symptom resolution, adverse events, and length of hospital stay were collected and analyzed. Observations: Children treated with hypertonic saline had significantly faster resolution of cough (59% in 4–5 days) and wheeze (92% in 1–2 days), and shorter hospital stays (88% discharged within 1–3 days), compared to controls. No adverse effects were reported. Conclusion: Nebulised 3% hypertonic saline appears to be a safe and effective adjunct therapy in managing bronchiolitis, resulting in faster symptom relief and reduced hospital stay. Further multicentric studies may help solidify its role in routine care.

Background: Transforaminal lumbar interbody fusion (TLIF) is a widely accepted surgical procedure for treating lumbar spinal instability and degenerative disorders. While interbody fusion can be achieved using autografts, the utilization of local corticocancellous bone grafts presents a promising alternative. However, the comparative effectiveness of single- versus multi-level TLIF using this graft type remains underexplored. Objective: To assess and compare the radiological and functional outcomes of single- and multi-level TLIF using local corticocancellous laminectomy bone grafts. Methods: A retro-prospective observational study was conducted on 100 patients who underwent TLIF over a 12-month period at a tertiary care center. Patients were categorized into single-level (n=60) and multiple-level (n=40) TLIF groups. Radiological outcomes were measured using anterior disc height (ADH), posterior disc height (PDH), segmental kyphosis (SK), and foraminal height (FH) at preoperative, immediate postoperative, 3-month, and 1-year intervals. Functional outcomes were assessed using Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Data were analyzed using descriptive statistics and inferential comparisons (p<0.05 considered significant). Results: At 1 year, both groups showed significant improvements in ODI (Single-level: 12.23 ± 2.01; Multi-level: 14.98 ± 2.34; p=0.018) and VAS (Single-level: 2.31 ± 0.94; Multi-level: 2.92 ± 0.98; p=0.041). Radiological improvements were greater in the single-level group with higher gains in ADH (3.72 ± 0.47 vs. 3.08 ± 0.52 mm; p=0.006) and PDH (3.26 ± 0.38 vs. 2.93 ± 0.46 mm; p=0.012). SK and FH improvements were observed in both groups without significant differences (p>0.05). Conclusion: Both single- and multiple-level TLIF using local corticocancellous grafts result in favorable clinical and radiological outcomes. However, single-level TLIF demonstrated superior improvements in disc height and disability scores, supporting its efficiency for isolated lumbar pathologies.

Background: Lumbar degenerative pathologies such as canal stenosis, segmental instability, and listhesis are common causes of chronic back pain and disability. Transforaminal Lumbar Interbody Fusion (TLIF) is a well-established surgical intervention for these conditions, offering decompression, stabilization, and alignment restoration. Functional assessment using the Oswestry Disability Index (ODI) is essential to gauge patient-reported outcomes. Objective: This study aimed to compare preoperative and postoperative ODI scores among patients with lumbar canal stenosis (LCS), LCS with instability, and listhesis undergoing TLIF using local corticocancellous bone grafts. Methods: A retro-prospective observational study was conducted on 100 patients undergoing TLIF at a tertiary center. Based on preoperative diagnosis, patients were categorized into three groups: LCS (n=44), LCS with instability (n=33), and listhesis (n=23). ODI scores were recorded preoperatively, on postoperative day 1, at 3 months, and at 1 year. Statistical analysis was performed using paired t-tests and ANOVA. A p-value < 0.05 was considered significant. Results: Baseline ODI was highest in the LCS group (61.13 ± 5.81), followed by LCS with instability (60.09 ± 4.66), and listhesis (58.17 ± 4.77), though the difference was not statistically significant (p=0.0921). Postoperative ODI scores showed marked improvement across all groups. Day 1 scores were similar among groups (p=0.9092), while significant differences emerged at 3 months (p<0.0001) and 1 year (p<0.0001). Intragroup analysis revealed substantial reduction in ODI from baseline to 1 year (LCS: ↓52.04, Instability: ↓51.88, Listhesis: ↓50.56; p<0.0001). Conclusion: TLIF using corticocancellous bone grafts leads to significant and sustained reduction in disability across lumbar degenerative pathologies. Despite variation in baseline disability, all diagnostic groups experienced comparable postoperative functional gains, reinforcing TLIF’s role as a versatile and effective surgical modality.

Background: Thyroid dysfunction is a common endocrine complication in children with transfusion-dependent beta-thalassemia major, primarily due to iron overload affecting the hypothalamic-pituitary-thyroid axis. Early detection is essential to prevent growth delays and other metabolic consequences. Aim: This study aims to assess the thyroid function status in transfusion-dependent thalassemic children and examine its association with serum ferritin levels. Methods: A cross-sectional observational study was conducted on 100 children (aged 6–18 years) diagnosed with beta-thalassemia major at the Department of Pediatrics, Daffodils by Artemis Hospitals, New Delhi,India. Data collected included transfusion history, chelation therapy, anthropometric measurements, and laboratory parameters. Serum levels of FT3, FT4, TSH, and ferritin were measured using ELFA and CLIA methods. Thyroid status was classified as euthyroid, subclinical, or overt hypothyroidism. Results: Thyroid dysfunction was observed in 26% of participants, with 18% having subclinical hypothyroidism and 8% overt hypothyroidism. Children with thyroid dysfunction had significantly higher serum ferritin levels (mean: 2835.4 ± 885.2 ng/mL) compared to euthyroid counterparts (mean: 1980.6 ± 620.3 ng/mL, p < 0.01). A significant proportion of affected children were also underweighted, indicating nutritional vulnerability. Conclusion: Thyroid dysfunction is prevalent in transfusion-dependent thalassemic children and is strongly associated with iron overload. Routine thyroid screening and aggressive iron chelation are essential to reduce endocrine morbidity and improve long-term outcomes.

Introduction: The invention of mobile phones is credited to Martin Cooper of Motorola, with continuous advancements leading to the development of smartphones, now integral to daily life across all age groups. Initially used for basic functions like calling, texting, and scheduling, smartphones have evolved into multifunctional devices. This study explores the patterns of smartphone usage among undergraduate medical students, focusing on their primary use, whether for educational activities or social networking and assesses its impact on their academic and personal lives. Material & Methods: A cross-sectional study was conducted at Government Medical College, Kota, using a structured and validated questionnaire distributed via Google Forms. Student responses were collected, tabulated, and analyzed to derive the results. Result: Most respondents were second-year MBBS students, with nearly equal gender distribution. Over half began using smartphones after age 17, and 40.1% reported daily usage of 4–6 hours, mostly during nighttime. Social networking was the most common use, with Instagram being the preferred app. A significant proportion reported using smartphones during daily routines like eating and before sleeping. Physical complaints included eye strain (77.7%) and headaches (61.5%), while mental effects included guilt (95.1%), sleep disturbances (74.1%), and reduced concentration (78.6%). Conclusion: The study highlights significant physical, mental, and social impacts of excessive smartphone usage among MBBS students, including reduced productivity, strained relationships, and preference for digital over real-life interactions. A majority expressed a desire to limit screen time and favored traditional learning methods. These findings emphasize the need for

Introduction: Distal femur fractures account for 6% of femoral fractures and present significant management challenges due to their complex nature, proximity to the knee joint. This study evaluates the functional outcomes of treating these fractures using distal femur locking compression plates (DF-LCPs). Materials & Methods: This prospective, quasi-experimental study evaluated 50 patients with distal femur fractures treated using locking compression plates at B.J. Medical College Hospital, Ahmedabad from December 2022 to March 2025. Patients above 18 years with type I, II, and IIIA open fractures were included. Functional outcomes were assessed using the NEER scoring system at 1, 3, and 6-month follow-ups. Results: The study population had male predominance (62.75%) with most patients aged 41-60 years (34%). Falls were the predominant injury mechanism (58%). Most surgeries were performed within 1-2 weeks post-injury. Mean radiological union time was 6.48±1.95 months. NEER scoring showed 32% excellent and 68% good outcomes with no fair/poor results. The mean total NEER score was 82.74±5.15. Conclusion: Distal femur locking compression plates provided excellent to good functional outcomes in all patients with consistent union and minimal complications. The technique offered stable fixation allowing early mobilization, particularly beneficial in comminuted and osteoporotic fractures, making it a reliable treatment option for distal femur fractures.

Background: A growing number of autoimmune and chronic conditions are associated with low vitamin D (Vit D) levels. This study aims to ascertain the incidence of vitamin D in patients with systemic lupus erythematosus (SLE) and its correlation with the SLEDAI score, a tool used to quantify disease activity. Methodology: A long-term study involving 50 confirmed SLE patient’s attended the departments of dermatology, and medicine at Silchar Medical College & Hospital was included. All of the samples underwent immunofluorescence testing for ANA, dsDNA, and ANCA, radioimmunoassay testing for vitamin. D levels, and SLEDAI scoring was used to gauge the severity of the illness. Results: The patients of SLE had mean Vitamin. D amounts of 18.07 with a standard deviation of 4.65. Following vitamin. D administration, the mean serum levels of the vitamin were 45.05, with a standard deviation of 14.05. A paired sample t test was run using the SLE patients’ pre- and post-vitamin. D data, and the p value was considered statistically significant at <0.001. Initial vitamin. D levels and the first SLEDAI (disease activity score) were found to be correlated; a very strong negative link was indicated by the Pearson link coefficient of -0.8755. p- Value for the same was found to be <0.001 which indicated that the finding is highly significant. Furthermore, a relationship between the improved disease activity score and the final levels of Vitamin. D after supplementation was examined. The Pearson correlation coefficient was -0.924 which suggested of a strong negative correlation. P value for the same was found to be <0.001 hence marking its significance. Conclusion: Patients with SLE had statistically reduced serum vitamin. D amounts. Additionally, a statistically significant rise was seen in vitamin. D amounts following the same. Furthermore, a substantial negative Pearson’s correlation coefficient was found between the disease activity score, or SLEDAI, & the vitamin. D amounts. Consequently, all the patients of SLE should have their vitamin. D levels checked, and supplements should be recommended as per need.

Background: Tympanic membrane perforation is seen as partial and/or total rupture of the ear membrane which can occur for many reasons such as trauma, infection, malignant tumors, or iatrogenic interventions. The aims of our study were to evaluate the outcome of office-based paper patch grafting in tympanic membrane (TM). Methodology: This is a retrospective study of 100 patients that underwent paper patch myringoplasty in Dept of ENT at ACPM Medical College, Dhule, Maharashtra. The clinical factors with potential impact on the healing status of the TM were investigated such as gender, age, laterality, etiology, duration of perforation, tinnitus, hearing loss, otorrhea, size and location of perforation, status of contralateral ear, ipsilateral findings of computed tomography, and duration of complete healing. Result: TM perforation completely healed in 75.00% cases, and the mean duration of complete healing was 15.11±16.2 weeks. Conclusion: Paper patch grafting can also be considered before formal surgical myringoplasty in the case of small, dry, chronic TM perforations.

Type 2 diabetes mellitus (T2DM) is a global health problem characterized by insulin resistance and metabolic dysfunction. Adiponectin and leptin, two key adipokines, play a crucial role in energy homeostasis, glucose metabolism, and insulin sensitivity. This study aimed to evaluate serum adiponectin and leptin levels in T2DM patients and compare them with healthy controls. A case-control study was conducted with 100 participants, including 50 T2DM patients and 50 healthy controls. Serum adiponectin and leptin levels were measured using ELISA kits, and their correlations with metabolic parameters such as fasting blood glucose (FBG), HbA1c, and body mass index (BMI) were analyzed. The results showed significantly lower adiponectin and higher leptin levels in T2DM patients compared to controls (p<0.05). Additionally, adiponectin showed a negative correlation with FBG and HbA1c, while leptin levels correlated positively with BMI and insulin resistance. The findings suggest that adiponectin deficiency and leptin excess contribute to insulin resistance and metabolic dysregulation in T2DM patients. These adipokines could serve as potential biomarkers for assessing diabetes risk and complications. Further research is required to explore therapeutic interventions targeting adipokine modulation for improved glycemic control.

Background: Thyroid nodules, affecting 5-10% globally, pose a diagnostic challenge in distinguishing between benign and malignant lesions. Fine-needle aspiration cytology [FNAC], a key diagnostic tool, is guided by the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Despite widespread adoption, challenges persist in accurately predicting thyroid lesions solely through cytology. Histopathologic examination remains the gold standard, and up to 20-30% of initially indeterminate nodules are later found to be malignant yet FNAC of the thyroid is the first line procedure that is widely used all over the world in the diagnosis of thyroid lesions. Aims: 1. To study the cytomorphology of various thyroid lesions utilising The Bethesda System of reporting thereby elucidating its utility. 2. Cytohistopathologic correlation; thereby analyzing the cause of diagnostic errors with an eventual aim to improve diagnostic accuracy. Methods: This retrospective study, conducted at Vikram Hospital, Mandya, spanned four years from August 2011 to May 2015. The study encompassed 205 patients who underwent fine-needle aspiration (FNA) of thyroid nodules, either sonographic guided or non-guided. Experienced cytopathologists, going through the clinical information, reviewed slides utilising the Bethesda System categories. Histopathologic slides were reviewed too and diagnoses were correlated with cytology. Descriptive statistics characterized Bethesda System categories and histopathologic outcomes. Concordance rates were calculated, and SPSS version 18.0 was used for statistical analyses (p < 0.001 considered significant). Results: In this study encompassing 205 patients, in the age group of 14-61 years, 12.6% were males and 87.3% were females, with the majority (72.7%) aged 20-40 years. Cytologic evaluation categorized 87.8% as benign, predominant lesions being nodular goitre (56.1%) and colloid goitre (38.8%). Follicular neoplasms [3.9%] and Papillary carcinoma [3.9%] showed equal prevalence Follow-up histopathology for 143 cases showed high concordance between cytologic and histopathologic diagnoses, with sensitivity (95.00%) and specificity (97.56%) indicating the reliability of cytology in identifying thyroid lesions. The overall accuracy of cytologic evaluation was commendable at 97.20%. Conclusion: In conclusion, our study contributes valuable insights into the diagnostic accuracy of thyroid cytology, emphasizing its role in stratifying thyroid lesions based on the Bethesda System; being a very useful, uniform and standardized system for reporting thyroid cytopathology. The high concordance rates, along with robust sensitivity and specificity values, highlight the reliability of cytologic assessments.

Background: Intraocular pressure is an important measurement that needs to be taken during ophthalmic exam-inations, especially in ocular hypertension and glaucoma patients. Numerous tonometers have been proposed but ideal, reliable, accurate technique is required for early diagnosis. Method: 90 patients with IOP were subjected to two methods of tonometry Goldmann applanation tonometry and Schiotz indentation tonometry (with 5.5 g, 7.5 g, and 10 g weights). Three recordings were obtained with each method, and significant results were noted. Results: The Goldmann applanation tonometer showed fair agreement with Schiotz tonometer and proved to be an effective screening tool. Conclusion: The Goldmann applanation tonometer was proved to be a better and safer tool for screening the IOP. It is much better than the Schiotz tonometer at predicting, measuring, and diagnosing intraocular pressure.

Aims and Objective: The objective of the study is to define the accuracy of CT urography over ultrasonography and its role in further patient management. Materials and Methods: A prospective study of 100 patients with urinary symptoms was conducted in a period of 2 years. Result: In a study of 100 patients, 64% of the patients presented with back pressure changes due to calculus in 42 cases (65.6%), PUJ obstruction in 6(9.3%), stricture in 5(7.8%) and malignant infiltration in 5(7.8%) were seen. There were 14 cases of neoplasms in our study, 7 cases of kidney & urinary bladder each and 9 cases of upper urinary tract infections which included 8 cases of pyelonephritis & 1 case of ureteritis. There were 6 cases of congenital anomalies: 2 cases had congenital pelvi-ureteric junction obstruction, one had medullary sponge kidney with Caroli’s disease, two had ectopic kidney, one had retrocaval ureter & one had pyelogenic cyst. A separate category consisting of 6 cases of non-neoplastic urinary bladder pathologies, which included 3 cases of blood clots in urinary bladder and 1 case each of vesical calculus, diverticulum and radiation cystitis. Conclusion: CT IVU proved to be more sensitive modality for diagnosis and follow-up of renal tract infection, screening for obstruction/ calculi, grading backpressure changes if any and to detect underlying anomalies. It defines the extent of disease and identifies significant complications and obstruction.

Background: Laparoscopic cholecystectomy (LC) is the gold standard treatment of symptomatic gallstone disease. LC is considered minimally invasive surgery and with some challenging cases, this may require conversion to open surgery. Correct surgical programming prior to surgery is key in ensuring complete patient care and preparedness for surgical intervention. Aim: To evaluate pre-operative risk factors that can predict difficult laparoscopic cholecystectomy in difficult cases focusing on the rate of conversion to open. Method: A retrospective observational study of patients who underwent elective LC was conducted at Department of General Surgery, AIIMS, Patna. 94 patients were identified in this study. Demographic, clinical, biochemical, and radiological variables were extracted from hospital records. Patients were divided into two groups: the group in which conversion to open cholecystectomy was required and the group which remained as LC. Statistical analysis of the data was conducted using SPSS (version 25) and a p-value of <0.05 was regarded as significant. Results: Of 94 patients, 7 (7.4%) required conversion to open surgery. Age greater than 50 (conversion rate: 18.75% p=0.015) and female gender (conversion rate: 9.6%, p=0.02) were both significantly predictive of difficult laparoscopic cholecystectomy. In terms of clinical symptoms, dyspepsia (p=0.04) was the only symptom that statistically correlated with the need for conversion in laparoscopic cholecystectomy. The remaining symptoms (i.e. pain, vomiting, jaundice, and fever) did not have a statistically significant p value. Conclusion: Older age, female gender, and the presence of dyspeptic symptoms all appear to be significantly predictive factors of difficult laparoscopic cholecystectomy. Including these factors in pre-operative assessments may provide a better framework for surgical planning, complications, and ultimately outcomes.

Background: Surgical site infections (SSIs) remain one of the most common postoperative complications in mesh hernioplasty, leading to increased morbidity, prolonged hospital stays, and elevated healthcare costs. The role of antibiotic prophylaxis in preventing SSIs is well-established, but the optimal regimen whether single or double antibiotic coverage is still debated. This study evaluates the comparative effectiveness of single versus double antibiotic prophylaxis in reducing SSIs in patients undergoing mesh hernioplasty. Aim and Objectives: To compare the incidence of surgical site infections in patients receiving single antibiotic prophylaxis versus those receiving double antibiotic prophylaxis prior to elective mesh hernioplasty. Materials and Methods: A prospective observational study was conducted in the Department of General Surgery at Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, involving 120 patients undergoing mesh hernioplasty. Patients were divided into two equal groups: Group A received a single antibiotic (ceftriaxone 1 g IV) 30 minutes prior to surgery, and Group B received a combination of two antibiotics (ceftriaxone 1 g IV + metronidazole 500 mg IV). All patients were monitored for development of SSIs over a 30-day postoperative period. Data were analyzed using appropriate statistical tests. Results: Of the 120 patients, SSIs were observed in 11.6% of the single antibiotic group and 3.3% of the double antibiotic group. The difference in infection rates was statistically significant (p < 0.05). The most common organisms isolated were Staphylococcus aureus and Escherichia coli. Patients with diabetes or longer operative durations had a higher risk of infection irrespective of the prophylactic regimen. Conclusion: Double antibiotic prophylaxis significantly reduces the incidence of surgical site infections in patients undergoing mesh hernioplasty compared to single antibiotic prophylaxis. The findings support the routine use of dual antibiotic coverage in high-risk surgical cases to minimize postoperative infectious complications.

Background: Head and neck cancers are a serious health issue in India and represent about 30–40% of all cancers. The cancers impair vital functions such as speech, swallowing, and appearance, leading to impaired quality of life (QoL). Objective: To assess the QoL of head and neck cancer patients presenting to the ENT outpatient department with the University of Washington Quality of Life (UW-QOL) questionnaire. Methodology: This Cross-sectional hospital-based analysis was carried out in the ENT department of Santosh Medical College, Ghaziabad, from January 2023 to December 2024. Sixty-four patients who were older than 18 years and had diagnosed head and neck cancers were included. The UW-QOL questionnaire was used to collect data and demographic and clinical data. Descriptive statistics were used to analyze the data. Results: 79.69% out of 64 were males, and the age group of 50–59 years was the highest (29.69%). The most common reported QoL complaints were pain (57.81%), difficulty in chewing (37.5%), and concern about appearance (37.5%). Swallowing difficulty was found in 31.25% of the patients, and 28.12% of the patients were found to have depression. The most frequent was moderate pain (39.06%). 50% of patients reported normal saliva and neutral sexual satisfaction, and 34.38% had shoulder problems. Conclusion: Physical and psychological challenges are prevalent in head and neck cancer patients with the most obvious QoL concerns being impairment and pain. Ongoing monitoring of QoL can guide holistic, patient-centered care.

Introduction: Stroke, a leading cause of morbidity and mortality worldwide, poses a significant threat to individuals with diabetes mellitus (DM). The bidirectional relationship between diabetes and stroke underscores the critical need for heightened awareness regarding stroke risk factors, warning signs, and preventive practices among diabetic patients. Materials & Methods: A cross-sectional study was conducted among 430 patients with diabetes attending a tertiary care center in Gujarat, India. Data on socio-demographic characteristics, clinical profiles, and knowledge, attitude, and practices (KAP) related to stroke were collected using a structured questionnaire. The study population included patients across various age groups and educational backgrounds. Statistical analysis was performed to determine the prevalence of awareness and preventive practices, and to identify associated factors. Results: Of the 430 diabetic patients, 47.9% demonstrated adequate overall knowledge of stroke, while 52.1% had insufficient knowledge. Specifically, knowledge regarding warning signs and risk factors was 43.7% and 47.4% sufficient, respectively. A positive attitude towards stroke prevention was observed in 67.9% of participants, with 75.3% recognizing the importance of blood pressure monitoring. However, only 40.5% reported good preventive practices, with routine physical exercise (30.7%) and weight loss efforts (34.4%) being particularly low. Hypertension (64.7%) and obesity (47.4%) were prevalent comorbidities. Conclusion: Despite a generally positive attitude towards stroke prevention, a significant gap exists in the knowledge and adoption of preventive practices among diabetic patients in this tertiary care center in Gujarat, India. These findings highlight the urgent need for targeted educational interventions to improve stroke risk awareness and promote effective preventive behaviors among this high-risk population.