Introduction: The Zuckerkandl tubercle (ZT) is an anatomic landmark that can be used for the identification of the RLN intra –operatively. The ZT is a lateral or posterior projection from the lateral thyroid lobe. Adequate recognition and dissection of the ZT is essential for successful thyroid surgery. Objectives: To estimate the proportion of Zuckerkandl tubercle in individuals. To determine the association between Identification of Zuckerkandl tubercle and tracing of recurrent laryngeal nerve in individuals who underwent thyroidectomy. Methods: Hospital based cross sectional study design. This study is conducted in the Department of General Surgery, Dr. SMCSI Medical College, and Karakonam. November2020–October2022 (2 years). A period of 18 months from the date of institutional ethical committee clearance. Result: In this study the mean age was 44.76 +/- 6.131 in the study population. The minimum was 32 maximum was 57 in the study population. Majority of the study population, 65.5 percent were females and 34.5 percent were males. RLN was found posterior to ZT in 56.4 percent of the individuals. RLN was found anterior to ZT in 9.1 percent of the individuals. After identifying ZT in 38 out of the 55 individuals RLN was identified in 35 out of 38 individuals and in the remaining 3, RLN was not identified with the help of ZT. Size of ZT was assessed and ZT less than 10mm was found in 37.5percent of the study population, ZT More than 10mm in 34.5 percent of the study population and ZT not visualized in 30.9 percent. Conclusion: In this study in 69% of individuals, ZT was visualized during thyroidectomy. Also ZT was visualized more on the right side (38.2%).Among 38 patients in whom ZT was visualized, in 35 patients it was helpful to identify RLN. Thus this study concludes that ZT is an important pointer which helps in identifying RLN during thyroidectomy.

Background/Introduction: The Zuckerkandl tubercle (ZT) is a posterior projection of the lateral thyroid lobe and serves as an important anatomical landmark for identifying the recurrent laryngeal nerve (RLN) during thyroid surgery. Recognition of ZT can reduce the risk of RLN injury, a common complication in thyroidectomies. Given its close anatomical relationship with the tracheoesophageal groove, the study aimed to assess the frequency and size distribution of ZT in individuals undergoing thyroidectomy and its role in aiding RLN identification. Objectives: To estimate the proportion of Zuckerkandl tubercle in patients undergoing thyroidectomy and evaluate its anatomical variations. Materials and Methods: A hospital-based cross-sectional study was conducted over 2 years (November 2020 – October 2022) at the Department of General Surgery, Dr. SMCSI Medical College, and Karakonam. Fifty-five patients undergoing thyroidectomy for benign thyroid conditions were included using non-probability sampling. Patients with malignancy, prior neck surgery or radiation, or unfit for surgery were excluded. ZT presence, laterality, size, and its utility in RLN identification were recorded intraoperatively. Data were analyzed using SPSS software with Chi-square test applied for association. A p-value <0.05 was considered statistically significant. Results: ZT was identified in 38 out of 55 patients (69.1%), while absent in 30.9%. ZT was found more frequently on the right side (38.2%) than the left (27.3%), and bilaterally in 3.6% cases. The size distribution among those with ZT showed equal proportions of ZT <10 mm and ZT >10 mm (both 50%). There was a highly significant association between ZT presence and its size (χ² = 55.000, df = 2, p < 0.001). No significant association was found between ZT presence and age (p = 0.219) or gender (p = 0.250). Mean age was 44.76 ± 6.13 years with a female predominance (65.5%). Conclusion: ZT was observed in nearly 70% of individuals undergoing thyroidectomy and served as a consistent and reliable anatomical marker for RLN identification. The tubercle was more frequently located on the right side and presented either as a small (<10 mm) or large (>10 mm) structure with equal prevalence. Recognizing and preserving this structure is essential to prevent RLN injury during thyroid surgeries.

Introduction: Abdominal tuberculosis poses a diagnostic challenge due to its nonspecific symptoms and varied imaging features. CT plays a key role in its evaluation, with oral contrast agents influencing image clarity. This study compares the diagnostic utility of neutral versus positive oral contrast in CT imaging of abdominal TB. Aims: The main purpose of our study is to evaluate intestinal and extra intestinal findings in patients with abdominal tuberculosis on CT using positive or neutral oral contrast. Materials and Methods: This cross-sectional analytic study was conducted in the Department of Radio-diagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, over a period of one year. A total of 40 patients diagnosed with abdominal tuberculosis were included in the study. Result: The neutral oral contrast group showed greater bowel distension across all segments (e.g., jejunum: 2.10 ± 0.52 cm vs. 1.70 ± 0.42 cm) and better fold visibility (Grade II in 65% vs. 45%). Appreciable mural enhancement was more frequent with neutral contrast (80% vs. 20%). Among 31 patients with lymphadenopathy, 54.83% had multi-compartment involvement, with mesenteric nodes most common (96.7%) and homogenous enhancement seen in 77.41% of cases. Conclusion: Neutral oral contrast agents showed better bowel distension, fold visibility, and mural enhancement than positive contrast on CT. These findings improve small bowel assessment and diagnostic accuracy. Mesenteric lymphadenopathy was the most common, often with multi-compartment involvement. Overall, neutral contrast enhances CT diagnostic yield in abdominal evaluations.

Background: Surgical Site Infections (SSIs) are a leading postoperative complication, particularly after cesarean sections (C-sections), impacting patient outcomes and healthcare resources. The risk of SSIs is significantly higher in emergency procedures compared to elective surgeries, due to multiple modifiable and non-modifiable factors. Aim of the study: To study and compare surgical site infections in emergency and elective Caesarean surgeries. Methodology: This prospective comparative study was conducted on 560 pregnant women undergoing either elective or emergency lower segment cesarean sections (LSCS) at the Government Maternity Hospital, Tirupati over a one-year period. Participants were assessed preoperatively, intraoperatively, and postoperatively for demographic characteristics, clinical risk factors, and signs of wound infection. Data were analyzed using SPSS v24, with chi-square and t-tests employed for statistical significance. Results: SSIs were observed in 8.2% (n=23) of emergency LSCS cases versus 1.07% (n=3) of elective LSCS cases. Emergency procedures showed higher association with risk factors like postoperative anemia (39.13%) and obesity (34.78%). Klebsiella spp. and Staphylococcus aureus were the predominant pathogens isolated in emergency and elective groups, respectively. Wound gaping and need for resuturing were significantly higher in the emergency group. Conclusion: Emergency LSCS is significantly associated with a higher incidence of SSIs compared to elective procedures. Identifying key risk factors like obesity, anemia, and hypothyroidism, along with targeted antibiotic therapy, can help reduce postoperative infections. Preoperative optimization and standardized infection control protocols are crucial to improving maternal outcomes.

Background: Medical education is increasingly adopting student-centered approaches, with Game-Based Learning (GBL) emerging as a cutting-edge method to boost engagement, motivation, and knowledge retention. In the past, teaching and learning methods predominantly emphasized knowledge acquisition over immersive educational experiences. Today, there is a growing embrace of playful approaches, with game-based learning (GBL) seamlessly integrating engagement and education. We implemented game-based applications and traditional learning methods using multiple-choice questions (MCQs) to evaluate their effectiveness in creating an engaging and productive learning experience for medical students. Methods: An interventional study was conducted among 60 Phase 3 Part 1 MBBS students at a Medical College and tertiary care Hospital in Eastern India. A crossover design was used, where two groups comprising 30 students in each group experienced both TL and GBL for different topics. Pre- and post-tests were conducted and student satisfaction was assessed using a Likert scale. Statistical analysis was done using paired, unpaired t-tests and the Wilcoxon Signed-Ranks Test, p value < 0.05 was considered significant. Results: In our study, post-test scores showed significant improvement within both groups (p < 0.05). The GBL group demonstrated a greater increase in scores compared to the TL group, with a statistically significant difference (p < 0.01). Student satisfaction ratings were notably higher for GBL, indicating a strong preference for this approach (p = 0.0001). Conclusion: GBL is an effective addition to traditional lectures, enhancing knowledge retention and learner satisfaction. While the study supports the use of GBL in medical education, larger studies are needed for broader validation.

Background: Numerous cross-sectional and retrospective case-control studies have linked elevated total homocysteine levels to peripheral, cerebral, and coronary vascular disease. . These investigations have also identified homocysteine as a unique risk factor that goes beyond the traditional risk factors. Because they might be influenced by a variety of factors, epidemiological findings suggesting a correlation between high HCY levels and cardiovascular risk do not establish a causative relationship. Moreover, other clinical studies revealed that vitamin supplementation had no discernible impact on cardiovascular risk, despite lowering HCY levels. Hence, our study aimed to evaluate the association between homocysteine and coronary and cerebral vascular disease without other risk factors like hyperlipidemia, diabetes mellitus, hypertension, smoking and old age. Methods: This was a case-control study involving 100 subjects of either sex of age group between 13 and 40 years, with 50 cases with myocardial and cerebral infarct and 50 controls. Plasma total homocysteine was determined by HPLC (High Performance Liquid-Chromatography). Results: The mean homocysteine level was 19.36±8.06090 among cases, while among controls it was 13.88±4.69. Hyperhomocystinemia was seen in a higher percentage of cases, 58%, compared to 38% among the control group. The cases had a 1.50-fold higher risk for MI or stroke than controls (the relative risk ratio), and the odds ratio is 2.25. The percentage of hyperhomocystinemia was 36% in the non-vegetarian group and 62% in the vegetarian group. The mean homocysteine was 18.92 µmol/L in stroke and 19.56 µmol/L in MI. Conclusion: Hyperhomocystinemia is an independent risk factor for coronary artery disease and cerebrovascular disease. In the present study, the cases had a 1.50-fold higher risk for MI or stroke than the controls. It is strongly recommended to screen for hyperhomocystinemia especially among young patients with arterial occlusive disease or venous thrombosis without other risk factors.

Background: Criminal behaviour often stems from poor social upbringing, disturbed family dynamics, substance dependence, and undiagnosed psychiatric conditions. The overlap between mental illness and substance abuse among offenders poses a major concern for both healthcare systems and the legal framework. Aim: To study the association between substance abuse and psychiatric disorders in relation to criminal behaviour among alleged offenders. Methods: This prospective, descriptive observational study was conducted in the Department of Forensic Medicine and Toxicology at SMS Medical College, Jaipur, from August 2019 to November 2020. A total of 250 alleged offenders were selected based on informed consent and eligibility for medico legal evaluation. Information was gathered on their demographic profile, criminal background, substance use habits, family circumstances, and mental health status. Results: Out of 980 individuals examined, 250 (25.5%) met the inclusion criteria. Most participants were male (98.4%) and within the 18–30 year age group (64.8%). Substance use was observed in 45.2% of cases, with alcohol (60.2%) and smack (31.9%) being the most used substances. Strong links were found between substance use and factors such as low educational attainment, exposure to family conflict or abuse, and involvement in property-related crimes. Although only 4% of offenders displayed identifiable mental disorders, those with psychiatric issues had a higher incidence of childhood trauma and substance dependence. A history of repeat offenses was strongly associated with long-term addiction (77.4%). Conclusion: This study reveals a clear connection between substance abuse and criminal behaviour, especially when combined with unstable family and social conditions. These findings highlight the urgent need for prison-based rehabilitation, mental health assessment, and early family-focused interventions to reduce repeat offending and support offender recovery.

Introduction: Cervical cancer is one of the leading causes of morbidity and mortality among women worldwide. Cervical cancer can be preventable by early detection and screening precursor lesions by Papanicolaou smear (PAP) smear. Aim: The aim of our study is to study spectrum of cervical cytology in conventional PAP smear by applying Bethesda system 2014 at tertiary care center Bastar C.G. Material and Method: This retrospective study is conducted by Department of Pathology at Lt. Baliram Kashyap Memorial Government Medical College, Jagdalpur for a period of 2 years. A total of 1046 cases included and slides were reported according to Bethesda system 2014. Result: Out of 1046 cases, maximum number of cases were in age group of 31 – 40 years comprise of 381(36.42%) followed by 32(30.87%) cases in 41-50 years. Highest number of cases 370(35.37%) belong to NILM, followed by ASC-US cases 92 (8.79%) followed by LSIL16 (1.52%) and HSIL, SCC and AGC (NOS) were found to be 08 (0.8%), 04(0.38%) and 04(0.38%) respectively. The remaining cases 16(1.52%) were Unsatisfactory. Conclusion: Cervical pap smear with Bethesda system 2014 help to categorise lesions as infective, inflammatory and neoplastic and for appropriate treatment by clinician especially in rural area.

Background & Objectives:  Detailed knowledge of the cervical transverse foramina (TF) morphology is crucial for surgical procedures and interventions involving the cervical spine. This review synthesizes computed tomography (CT)-based morphometric data on TFs in Indian adults, emphasizing anatomical variation and potential clinical implications. Methods: A narrative review was performed using data from peer-reviewed literature (published between 2020 and 2024) reporting CT-based morphometric analysis of TFs in Indian adults. Key morphometric parameters such as mean diameter, shape, symmetry, and presence of accessory foramina were extracted and analyzed descriptively. Results: Fifteen studies met the inclusion criteria. The mean TF diameter progressively decreased from C1 (6.3 mm) to C7 (4.1 mm). Oval-shaped foramina predominated in the upper cervical vertebrae, while irregular shapes and accessory foramina increased caudally. Asymmetry was reported in 18.3% of cases, with right-sided dominance. Interpretation & Conclusions: Cervical transverse foramina show considerable anatomical variation in the Indian population. Preoperative CT evaluation is recommended to minimize vertebral artery injury risk during cervical interventions. The study highlights the importance of population-specific anatomical databases.

Background: Undernutrition remains a major public health challenge, particularly among children under five years of age in low- and middle-income countries like India. Despite numerous government programs, a significant proportion of children continue to suffer from stunting, wasting, and underweight due to a complex interplay of dietary, social, and environmental risk factors. Understanding these determinants at the institutional level is crucial for designing targeted interventions to reduce childhood malnutrition. Material and Methods: A hospital-based cross-sectional observational study was conducted over a period of one year in the Pediatric Outpatient Department of a tertiary care teaching hospital. A total of 500 children aged 1 to 5 years were enrolled. Data regarding sociodemographic profile, parental education, socioeconomic status, feeding practices, and environmental conditions were collected through a semi-structured, pre-tested questionnaire. Anthropometric measurements were taken using standard protocols, and nutritional status was assessed using WHO Child Growth Standards (2006). Z-scores were calculated to classify children as underweight, stunted, or wasted. Statistical analysis was performed using Chi-square test, and a p-value < 0.05 was considered significant. Results: Out of the 500 children, 52% were males and 48% females. The majority (36%) belonged to the 1–2 year age group, and 62% were from low-income households. The prevalence of underweight, stunting, and wasting was 34.2%, 41.8%, and 17.6%, respectively. Significant associations were observed between undernutrition and factors such as low maternal and paternal education (p < 0.001), poor socioeconomic status (p < 0.001), and paternal alcohol use (p < 0.001). Exclusive breastfeeding showed a protective trend, though not statistically significant (p = 0.085). Overcrowding and poor environmental conditions were also linked to increased risk of undernutrition. Conclusion: The study highlights the multifactorial etiology of undernutrition among under-five children, emphasizing the critical role of parental education, household income, and behavioral factors. Addressing these determinants through community-based education, nutritional counseling, and socioeconomic development programs is essential for improving child health outcomes.

Introduction: Inferior wall myocardial infarction (IWMI) is frequently caused by right coronary artery occlusion and can often also involve the right ventricle. Right ventricular infarction (RVI) occurs in a significant proportion of these cases and is associated with worse clinical outcomes such as hemodynamic instability, arrhythmias, and increased risk of in-hospital complications such as cardiogenic shock and death. Despite its impact, RVI is often underdiagnosed in routine clinical practice. Early recognition is essential for timely intervention and improved outcomes. This observational study aims to assess the incidence of RVI in patients with IWMI and evaluate its association with in-hospital adverse events. Aims: Aim of the present study is to assess the RV infarction in Acute Inferior Wall Myocardial Infarction patients and it’s correlation on in hospital outcome. Materials & Methods: The study was Cross sectional Descriptive type of study. This study was completed within one and half year, One Year for data collection (2023-2024) and 6 months for data management. department of medicine, Agartala Government Medical College and GB Pant Hospital. And total sample size 110 acute inferior wall myocardial infarction patients. Result: We found that Out of the 110 patients with acute inferior wall myocardial infarction (IWMI), 53 (48.2%) had right ventricular myocardial infarction (RVMI). Arrhythmias were significantly more common in patients without RVMI (26.3%) compared to those with RVMI (3.8%). Mortality was higher in the RVMI group (11.3%) compared to the non-RVMI group (7.0%).Heart failure occurred more frequently in patients with RVMI (11.3%) than in those without RVMI (3.5%).Hypotension or cardiogenic shock was also more prevalent among patients with RVMI (30.2%) compared to non-RVMI patients (19.3%).Survival without complications was slightly lower in the RVMI group (43.4%) compared to the non-RVMI group (43.9%). Statistical analysis using the chi-square test showed a significant association between RVMI and in-hospital outcomes, with a chi-square value of 13.2225 and a p-value of 0.0102, indicating statistical significance (p < 0.05). Conclusion: We concluded that patients with inferior wall myocardial infarction (IWMI) with concomitant right ventricular (RV) infarction evaluated in this observational study.  53 patients out of 110 had RV involvement (RVMI) which begets adverse outcome.

Background: It is established that antipsychotic drug administration elevates prolactin secretion, which suppresses LH and testosterone in males. Hence, two novel drugs with different affinity profiles are administered to evaluate sexual dysfunction in males. Method: Out of 90, 45 patients were administered with risperidone, and the remaining 45 were administered with olanzapine. A simple rating scale that measures sex drive, arousal, penile erection, orgasm ability, and orgasm satisfaction. These scores range from 5 to 30. Sexual dysfunction is defined as a total score ≥ 19 or a score of > 5 on an item. Results: Comparison of sexual dysfunction, ASEX getting and keeping an erection, and ASEX satisfaction with orgasm had a significant p-value (p<0.001). Conclusion: The present comparative study pronounces that risperidone has higher sexual dysfunction than olanzapine in male schizophrenic patients.

Background: “Chronic obstructive pulmonary disease (COPD)” is a progressive respiratory disease that induces cardiac autonomic dysfunction and adversely impacts the autonomic nervous system. 50% of COPD mortality is associated with cardiovascular disease (CVD). COPD Severity could be examined by forced expiratory volume in 1s. “Heart rate variability (HRV)” is employed for evaluating cardiac autonomic function.   Aims and Objectives: To evaluate HRV parameters including mean HR, NN50, root mean square of successive differences (RMSSD) and pNN50 across various phases of COPD and observe whether these parameters had been associated with severity of disease. Materials and Methods: Cross-sectional research including 140 COPD patients was conducted. Pulmonary function test, HRV values, and anthropometric parameters were evaluated. Then divided into 4 categories as per “Global Initiative for Chronic Obstructive Lung Disease (GOLD)” stage criteria. Analysis of Variance (ANOVA) is employed for comparing mean ± standard deviation (SD) of continuous measurement results. When 4 groups’ p values have been considered to be significant (p < 0.05). Results: RMSSD levels reported lower in very severe, severe, and moderate COPD patients than in mild COPD patients. Patients with very severe, severe, and moderate COPD exhibited higher mean HR levels than those with mild COPD. Mean HR had a positive correlation with disease severity; however, RMSSD levels had a negative correlation. Conclusion: We have demonstrated that COPD patients experience cardiac autonomic dysfunction, indicated as elevated sympathetic and decreased parasympathetic activity. This correlation became more evident as severity of disease increased.

Introduction: Hypertension is one of the common medical complications of pregnancy that contributes significantly to maternal and perinatal morbidity and mortality. The neutrophil-to-lymphocyte ratio (NLR) is a marker of subclinical inflammation, used to predict hypertension incidence, especially preeclampsia. Objective: To compare neutrophil-lymphocyte ratio between subjects with pregnancy-induced hypertension and normotensive pregnant subjects. Materials & Methods: This cross-sectional comparative study was carried out over a period of one year after informed consent and ethical clearance. The study population included 260 antenatal patients of 29-40 weeks of gestation (130 pregnant women with pregnancy-induced hypertension (PIH) and 130 normotensive pregnant women) who were admitted in the department of Obstetrics & Gynaecology, Assam Medical College & Hospital, Dibrugarh, after fulfilment of inclusion and exclusion criteria. The primary outcome was neutrophil-lymphocyte ratio (NLR). Result: NLR was significantly higher in pregnant women with PIH (3.58±0.79) and normotensive pregnant women (2.38±0.58) (p <0.001). Conclusion: The study showed that the mean NLR value of pregnant subjects with PIH was noticeably higher than that of normotensive pregnant subjects, suggesting an increased inflammatory response in hypertensive disorder of pregnancy. Unlike many other inflammatory markers, NLR proves to be an inexpensive and readily available biomarkers, obtained from complete blood counts that may be useful for prediction and diagnosis of pre-eclampsia.

Background: Urinary tract infections are one of the commonest infections in India and worldwide leading to increased mortality and morbidity. Prevalence of bacterial agents causing UTI and it’s antibiogram varies in different geographical location. Culture and sensitivity testing remains gold-standard for diagnosis of UTI. It is essential to know the local prevalence rate and antibiogram of Uropathogens, before starting an empirical therapy, until arrival of reports. This study was undertaken to study the etiological factors and their antibiogram in a tertiary care hospital in Eastern India. Methods: In about 5512 admitted and out-patients of KPC Medical College and hospital, Kolkata, freshly passed mid-stream urine from non-catheterized  patients and from aseptic catheter port of catheterised patients was collected in a sterile container and was sent to Microbiology Department for a period of one year. The samples were plated in Mac Conkey and UTI agar and incubated at 37◦C overnight, following which next day it was processed in Vitek Automated machine for identification and Antibiotic susceptibility testing. Results were analysed using appropriate software. Results: Of the 5512 urine samples, prevalence of UTI was 8.85% (488). The females (60.86%) were more affected than the males(39.14%).Most susceptible age group susceptible to UTI was the elderly individuals above 60yrs (61.06%) followed by 46-60yr (13.93%).Out of the 488 positive urine growth samples, 447 (91.60%) samples had Gram Negative etiology, 20 (4.09%) samples yielded growth of Gram Positive cocci and 21 (4.31%) samples showed growth of Candida species. Most common pathogen isolated was Escherichia coli (45.90%) followed by Klebsiella sp (34.50%). They are sensitive to Fosfomycin (88.98%), Nitrofurantoin (79.86%), Tetracycline (77.85%), Cotrimoxazole (75.61%), Aminoglycosides (74.94%) and Carbapenems (70.25%). Conclusion: The study was helpful for giving an idea on Empirical therapy to be used when suspecting UTI. Fosfomycin, Nitrofurantoin, Cotrimoxazole, Aminoglycosides are better to treat UTI empirically. Hygiene, Health education and good Infection control practices can help in decreasing Urinary infection rates.

Introduction: The thyroid gland is the first endocrine gland to develop in the human embryo, beginning its formation by the third week of gestation as a thickening in the floor of the primitive pharynx between the first and second pharyngeal pouches. This thickening gives rise to a diverticulum that migrates caudally in front of the pharyngeal gut while remaining temporarily connected to the tongue by the thyroglossal duct. Aims: To compare the diagnostic accuracy of sonography, fine needle aspiration cytology (FNAC), and histopathological examination in evaluating thyroid disorders. To assess the correlation of clinical, radiological, and cytological findings with final histopathological outcomes in patients with thyroid swellings. Materials & Methods: The present study was a prospective observational study. This Study was conducted from 1 year at Department General Surgery, Al Azhar Medical College & Super Speciality Hospital,Total 107 patients were included in this study. Result: In our study of 107 patients, the majority (74 patients, 69.2%) had no comorbidities. Among those with comorbidities, diabetes mellitus (DM) was the most common, seen in 8 patients (7.5%), followed by hypertension (HTN) in 7 patients (6.5%). Some patients had combinations of conditions such as DM with HTN, COPD, or DLP. The statistical analysis showed a highly significant (P < 0.00001). In our study of 107 patients, the majority were euthyroid (74 patients, 69.2%), meaning they had normal thyroid function. Hyperthyroidism was found in 21 patients (19.6%), hypothyroidism in 12 patients (11.2%). The P value was < 0.00001, indicating a statistically significant. Conclusion: We concluded that the study carried out at a tertiary care facility in Idukki revealed a predominance of benign cytology (Bethesda II) and euthyroid status among patients. A considerable number were diagnosed with multinodular goitre, and some also had coexisting hypertension and diabetes mellitus.

Background: Acute Coronary Syndrome (ACS) is one of the most common causes of morbidity and death globally, and early diagnosis is critical to intervene in time and reduce outcomes. The measurement of cardiac troponin (cTn) is a gold standard biomarker for the diagnosis of myocardial damage. Traditional troponin assays (cTn) have been used for decades; however, their decreased sensitivity during the first few hours after the onset of symptoms can hamper diagnosis. High-sensitivity troponin assays (hs-cTn) were created to detect trace levels of circulating troponin, allowing for earlier diagnosis of myocardial necrosis. Objective: The objective of this study was to compare the diagnostic performance, time to diagnosis, and clinical utility of standard vs. high-sensitivity troponin assays in the early diagnosis of ACS in patients with chest pain. Methods: In this prospective comparative study conducted at a tertiary care cardiac center, adult patients presenting to the emergency department with suspected ACS were enrolled within 6 hours of symptom onset. Blood samples were obtained at baseline and at 1, 3, and 6 hours for both conventional cTnI assays and hs-cTnI assays. The primary outcomes were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC) for ACS diagnosis. Secondary outcomes included the proportion of patients diagnosed within 3 hours and the impact on subsequent clinical decision-making. Results: A total of 420 patients (mean age: 57.6 ± 11.2 years; 68% male) were included. At presentation, hs-cTn detected elevated troponin in 71.4% of confirmed ACS cases compared to 42.9% with conventional assays (p < 0.001). The sensitivity of hs-cTn at baseline was 92.8% versus 68.3% for conventional cTn, while specificity remained comparable (hs-cTn: 94.1%, conventional: 95.0%). AUC for hs-cTn was significantly higher (0.964) compared to conventional cTn (0.835). Early diagnosis within 3 hours was achieved in 88.6% of ACS patients using hs-cTn compared to 61.2% with conventional assays, reducing the median time to definitive diagnosis by 1.8 hours. Earlier diagnosis led to faster initiation of guideline-directed medical therapy and facilitated timely reperfusion interventions. Conclusion: High-sensitivity troponin assays demonstrate superior sensitivity and diagnostic accuracy for early detection of ACS compared to conventional assays, without compromising specificity. Their application significantly shortens time to diagnosis, allowing for earlier therapeutic intervention and possible enhancement of clinical outcomes. The use of hs-cTn testing in routine ACS evaluation protocols should be weighed in high-resource environments to maximize patient care.

Background: The choice of anesthetic technique for abdominal hysterectomy significantly influences postoperative recovery outcomes. This study aimed to evaluate the effect of combined spinal-epidural (CSE) anesthesia versus general anesthesia with epidural catheter (GE) on the quality of postoperative recovery in patients undergoing abdominal hysterectomy, assessed using the Quality of Recovery-15 (QoR-15) scale. Methods: This prospective, single-center observational study included 120 female patients aged 18-70 years with ASA physical status I-III undergoing elective abdominal hysterectomy. Patients were divided into two groups based on anesthetic technique: CSE group (n=60) and GE group (n=60). The primary outcome was the QoR-15 score at 24 hours postoperatively. Secondary outcomes included postoperative pain scores using the Numerical Rating Scale (NRS), analgesic consumption, incidence of postoperative nausea and vomiting (PONV), time to mobilization, hospital length of stay, and patient satisfaction scores. Results: At 24 hours post-surgery, the CSE group demonstrated significantly higher QoR-15 scores compared to the GE group (134.2 ± 9.1 vs 125.8 ± 12.6, p<0.001). The CSE group required significantly less postoperative analgesic consumption (98.4 ± 28.7 ml vs 132.6 ± 41.2 ml, p=0.001) and had lower incidence of rescue analgesia requirement (8.3% vs 25.0%, p=0.018). Pain scores were significantly lower in the CSE group during the first 6 hours postoperatively (p<0.001). PONV incidence was reduced in the CSE group (11.7% vs 28.3%, p=0.022). Time to mobilization and hospital length of stay showed no significant differences between groups. Conclusions: Combined spinal-epidural anesthesia provides superior postoperative recovery quality for patients undergoing abdominal hysterectomy compared to general anesthesia with epidural catheter. CSE technique offers enhanced pain control, reduced opioid requirements, and decreased incidence of postoperative complications, contributing to improved patient comfort and recovery experience.

Background: Quality control (QC) in clinical haematology laboratories is crucial for ensuring accurate and reliable test results, which directly impact patient care. Traditional QC programs, relying mainly on Westgard rules, often lead to unnecessary reruns and inefficiencies. Six Sigma metrics offer an advanced statistical approach to assess and enhance analytical performance by quantifying process variation and defects. Aim & Objective: This study was aimed to analyse haematology quality control using Six Sigma metrics, and determine appropriate frequencies of quality checks based on Sigma values. Methods: This was a cross-sectional observational study. Quality control (QC) samples were analysed twice daily at three levels for ten consecutive days, yielding 360 observations per control level. Sigma metrics were calculated for certain complete blood count (CBC) parameters like RBC, WBC, haemoglobin (Hb), Hematocrit (HCT), and platelet count in Sysmex XN 330 analyzer using standard formulas. Results: The Sigma metric analysis enabled categorization of analytes based on performance, supporting tailored QC strategies. Majority of the parameters like RBC, WBC, Hb, HCT and platelets had good to excellent performance (sigma >6) and hence one level QC can be run per day under the 1_3s rule. Platelet showed poor performance (sigma <3) in L1 (low QC) suggesting maximum quality control runs for that particular level. Conclusion: Six Sigma metrics provide an effective framework for optimizing haematology QC programs, minimizing unnecessary reruns, and improving laboratory efficiency. This method supports evidence-based QC planning and continuous quality improvement in resource-limited settings.

Background: Otitis media is a prevalent ENT infection in developing regions, increasingly complicated by antimicrobial resistance. Empirical treatment without microbiological guidance has led to selective pressure, promoting resistant strains. The need for local surveillance of pathogen profiles and resistance trends to guide successful therapy and stewardship activities is highlighted by rising failure rates and the prevalence of biofilm-forming organisms such as Pseudomonas aeruginosa and Staphylococcus aureus. Methods: For ten months, a prospective observational study was carried out at a tertiary care center, involving 390 patients with clinically diagnosed otitis media. All patients presented with profuse otorrhea unresponsive to empirical antibiotics. Aural swabs were collected under aseptic precautions, cultured on standard media, and put through the Kirby-Bauer disc diffusion method of antimicrobial susceptibility testing in compliance with CLSI recommendations. Results: Pseudomonas aeruginosa and Proteus mirabilis were the predominant Gram-negative isolates, while S. aureus was the most common Gram-positive organism. High resistance rates (>70%) were observed against ampicillin, amoxicillin-clavulanate, and cotrimoxazole. Sensitivity was better retained with ciprofloxacin, gentamicin, and amikacin, although early signs of resistance were noted. Multidrug-resistant (MDR) phenotypes were common, particularly among Pseudomonas isolates. Conclusion: The microbial landscape of ENT infections is shifting, with a growing prevalence of MDR pathogens and declining efficacy of conventional antibiotics. Empirical treatment protocols must be reevaluated in light of local resistance data. Routine culture and sensitivity testing should be integrated into clinical practice to support evidence-based antibiotic stewardship and improve patient outcomes.

Introduction: Skin is often considered a mirror of internal health, with various endocrinological disorders presenting with characteristic cutaneous manifestations. While diabetes mellitus is widely studied in this regard, numerous other endocrine conditions such as thyroid disorders, adrenal dysfunction, pituitary abnormalities, and gonadal hormone imbalances also lead to distinct skin changes. Recognition of these dermatological signs can aid in early diagnosis, guide management, and improve patient outcomes. Methods: This was a descriptive observational study conducted over a period of one year at the Calcutta School of Tropical Medicine. The study included a total of 50 patients with endocrinological disorders other than diabetes mellitus, attending both outpatient and inpatient departments. Data were collected on demographic variables such as age, gender, and body mass index (BMI), as well as clinical parameters including type of endocrine disorder—specifically thyroid, adrenal, pituitary disorders, and polycystic ovary syndrome (PCOS). Detailed dermatological evaluations were performed to document the presence and type of skin manifestations and specific skin features associated with each endocrine abnormality. All information was systematically recorded and analyzed to identify correlations between hormonal imbalances and cutaneous changes in this patient population. Results: In this study of 50 patients with endocrinological disorders other than diabetes mellitus, the mean age was 38.6 ± 12.4 years, with 56% males and 44% females, and a mean BMI of 25.3 ± 3.8 kg/m². Thyroid disorders were the most common (40%), followed by adrenal disorders (20%), pituitary disorders (16%), PCOS (14%), and other rare endocrine syndromes (10%). The most frequent skin manifestations were dry skin (36%), hyperpigmentation (24%), hirsutism (20%), acne (16%), and striae (12%). Among thyroid disorder patients, dry, rough skin (60%), hair thinning (40%), myxedema (25%), and palmar erythema (30%) were prominent. Laboratory analysis showed significant correlations between skin changes and elevated hormone levels, including TSH (8.2 ± 3.5 vs. 3.4 ± 1.2 µIU/mL, p = 0.001), cortisol (24.1 ± 6.3 vs. 15.8 ± 4.7 µg/dL, p = 0.002), testosterone (78 ± 25 vs. 42 ± 15 ng/dL, p = 0.005), and IGF-1 (320 ± 50 vs. 210 ± 45 ng/mL, p = 0.004). Conclusion: Cutaneous manifestations are common and often early indicators of endocrine dysfunction beyond diabetes mellitus. Awareness of these dermatological signs among clinicians can facilitate timely diagnosis and appropriate endocrine evaluation. Early recognition and intervention can prevent complications and improve patient quality of life.

We report the case of a 47-year-old male presenting with abdominal pain and systemic signs of inflammation. Laboratory tests revealed mild anemia, marked neutrophilic leukocytosis, and a critically elevated C-reactive protein (CRP). Pancreatic enzymes were significantly elevated. Contrast-enhanced CT of the abdomen demonstrated features consistent with mild acute pancreatitis. Concurrent urinary findings suggested cystitis, and anatomical anomalies of the renal-ureteric system were detected. Serological testing was positive for Scrub Typhus IgM, raising suspicion of a rickettsial etiology contributing to the systemic inflammatory response. The case highlights the importance of recognizing overlapping infectious and inflammatory etiologies and the value of integrated hematologic, biochemical, and radiological assessment in acute settings.

Introduction: Controlled ovarian stimulation (COS) with a GnRH antagonist protocol is commonly used in in-vitro fertilization (IVF) cycles. GnRH agonist (GnRHa) trigger is an established alternative to hCG in preventing ovarian hyperstimulation syndrome (OHSS), especially in high responders. However, concerns remain about the adequacy of oocyte maturation with a single GnRHa trigger dose. Recent studies suggest that a repeat or dual GnRHa trigger may improve outcomes, particularly in specific responder groups. Objective: To evaluate whether a repeat dose of GnRH agonist trigger, compared to a single dose, improves mature oocyte (MII) yield in normo-responders and hyper-responders undergoing IVF with an antagonist protocol. Methods: This prospective observational study was conducted at Craft Hospital and Research Centre, Kerala, from December 2017 to August 2018, involving women undergoing IVF cycles with a GnRH antagonist protocol. The study compared the outcomes of single versus repeat doses of GnRH agonist trigger in normo- and hyper-responders. Key variables assessed included age, type of infertility, AMH, AFC, pre-trigger LH, peak estradiol, post-trigger progesterone and LH levels, number of mature oocytes (MII), and maturity rate. The aim was to evaluate whether a repeat dose offered improved oocyte maturation compared to a single dose. Results: In this prospective observational study, baseline characteristics such as age, AMH, AFC, pre-trigger LH, peak estradiol, total gonadotropin dose, and stimulation duration were comparable between the single-dose (Group A) and repeat-dose (Group B) GnRH agonist trigger groups in antagonist IVF cycles. The majority had primary infertility in both groups. Although Group A showed slightly higher mean mature oocyte (MII) yield (15.69 vs. 14.73) and oocyte maturity rate (84% vs. 78%) than Group B, the differences were not statistically significant. Post-trigger LH and progesterone levels also did not differ significantly between groups. Thus, administering a repeat dose of GnRH agonist did not provide a significant advantage in mature oocyte yield compared to a single dose. Conclusion: Repeat-dose GnRH agonist trigger appears to be a safe and effective strategy to improve mature oocyte yield in both normo- and hyper-responders undergoing GnRH antagonist IVF cycles. This approach may be particularly beneficial in optimizing outcomes in patients with a higher follicular response, without increasing the risk of OHSS.

Introduction: Lower limb surgeries can be performed under local nerve block, regional anesthesia, or general anesthesia. Central neuraxial blockade is preferred due to its ease of administration, high success rates, and quick onset. Spinal anesthesia has a short duration, but adjuvants like fentanyl, morphine, and alpha2 agonists are used to prolong block duration and improve patient satisfaction. Aims and Objective: The study aimed to compare the effectiveness of subcutaneous dexmedetomidine and subcutaneous clonidine as adjuvants to intrathecal 0.5% hyperbaric bupivacaine in spinal anaesthesia for patients undergoing elective lower limb surgeries, including orthopaedic and plastic surgeries. Methods and Materials: November 2019 to October 2020. Total 92 Patients aged 20-60 years of age who were undergoing elective lower limb surgeries (orthopaedic and plastic surgeries) attending Medical College, Kolkata.] Result: In Group-C, the mean Time to first analgesic requirement (mean± s.d.) Of patients was 246.8261 ± 10.4271. In Group-D, the mean Time to first analgesic requirement (mean± s.d.) Of patients was 270.3478 ± 12.9430. Difference of mean Time to first analgesic requirement with both Group was statistically significant (p<0.0001). Conclusion: The study found that both clonidine and dexmedetomidine provide effective and safe anesthesia in elective lower limb orthopaedic and plastic surgery, with dexmedetomidine providing longer postoperative analgesia duration.

Introduction: Novel Corona virus infection (SARS-CoV-2), also known as COVID-19 in pregnancy is an important concern but currently limited data available to predict the risk of virus infection in pregnancy and its adverse outcome. Objective/Aim: Evaluate SARS-CoV-2 infection in pregnancy and its adverse outcome on mother as well on fetus. Materials and Methods: In this prospective observational study, total number of 1120 pregnant women admitted in the isolation ward of our institution were included. All women presented with common symptoms like fever, tiredness, headache, sore throat, and cough. Results: Sixty women were diagnosed SARS-CoV-2/COVID-19 positive by Reverse Transcriptase Polymerase Chain Reaction (RTPCR) examination of nasopharyngeal swab (NP), which was almost 5.3% of the isolated women. All neonates were tested negative for SARS-CoV- 2 infection. All the study subjects recovered with routine care and were sent home after 7 days with advice for “safe home” (nearby place where the COVID patients can safely stay isolated in a room with all oral medications and report immediately to the healthcare facility if any adverse condition) for further 7 days. Conclusions: SARS-CoV-2 infection in pregnancy most of the time presents in the latter half of pregnancy and management is similar to that in the general population. There is no increased risk of severe disease during pregnancy. Support of intimate partner, social support will promote mental health hygiene amongst the COVID positive mother. Due to immunological modulation in pregnancy, newborns are mostly protected from disease transmission.

Introduction: Anthracycline-based chemotherapy regimens are widely used as adjuvant treatment for operable breast cancer but are associated with significant cardiotoxicity and other adverse effects. Aims: This study aimed to evaluate whether anthracycline-free or short-term chemotherapy regimens are non-inferior to standard anthracycline-containing regimens in terms of disease-free survival (DFS) among patients with operable breast cancer. Materials and Methods: The present study was a prospective study conducted over a period of one year at R. G. Kar Medical College. A total of 100 patients with HER2-negative operable breast cancer were enrolled. The study variables included domain, toxicity, treatment group, median age, hormone receptor positivity, nodal status, tumor size, and grade III tumors. Detailed clinical and pathological data were collected for each patient, and relevant treatment-related toxicities were recorded. All patients were followed systematically to assess outcomes and adverse effects across the different study domains. Results: The study involved 100 patients equally divided into anthracycline-free, short-term anthracycline, and standard anthracycline groups, with comparable baseline characteristics across all groups. At 3 years, disease-free survival (DFS) rates were similar—87.9% for anthracycline-free and standard groups, and 91.2% for the short-term group—with both experimental regimens demonstrating non-inferiority to the standard. Overall survival (OS) rates also showed no significant differences among groups. The anthracycline-free regimen had significantly lower rates of grade 3–4 neutropenia and cardiotoxicity, while nausea and febrile neutropenia rates were comparable. Quality of life assessments favored the anthracycline-free group, showing significantly better physical and emotional well-being and reduced fatigue at 6 months post-treatment. Conclusions: Anthracycline-free and short-term anthracycline-containing adjuvant chemotherapy regimens provide non-inferior efficacy compared to standard anthracycline-based regimens in patients with operable breast cancer, with a more favorable safety profile. These findings support the consideration of anthracycline-sparing strategies in selected patients to reduce treatment-related toxicity without compromising clinical outcomes.

Background: Intertrochanteric femur fractures constitute a common orthopedic injury, especially in the elderly. Management strategies have evolved from classic techniques such as Dynamic Hip Screw (DHS) to newer modalities, including Proximal Femoral Nail Anti-rotation (PFNA), Gamma nails, minimally invasive plate osteosynthesis (MIPO), and hip arthroplasty. This paper reviews and compares classic and contemporary management techniques, highlighting their benefits and side effects. Methods: A review of randomized controlled trials, meta-analyses, cohort studies, and clinical reports (2008–2025) comparing traditional and new operative modalities for intertrochanteric femur fractures. Key outcome measures include functional recovery (Harris Hip Score), complications, operative metrics, and patient quality of life. Results: Classic DHS remains cost-effective and reliable for stable fractures but is associated with longer surgical time and delayed mobilization. Intramedullary nails and PFNA show reduced surgical time, earlier weight-bearing, and higher union rates, but with risks of implant-related complications. Hip arthroplasty—though traditionally reserved for fracture fixation failure—now sees expanded use in selected elderly populations, offering superior early mobilization and functional scores. MIPO and locking plates deliver high union rates for comminuted fractures and decrease infection and soft tissue complications. Conclusions: While classic methods like DHS are ideal for stable fractures, newer techniques (PFNA, Gamma nail, MIPO, and arthroplasty) provide improved outcomes in unstable or osteoporotic bones. Choice of therapy should be individualized, considering patient comorbidities, bone quality, fracture pattern, and expected rehabilitation.

Background: COVID-19 has been linked to a wide spectrum of cardiovascular complications, with myocarditis drawing particular attention. Although vaccination is known to lessen the severity of illness, uncertainty remains about the persistence of myocardial inflammation in individuals who contract the infection after immunization. Methods: A cross-sectional study was carried out over a one-year period in the Department of Medicine, Assam Medical College and Hospital, Dibrugarh. The study recruited 100 adults aged 18–59 years with a documented history of COVID-19 infection and complete vaccination. Participants with pre-existing cardiac, autoimmune, or chronic systemic diseases were excluded. Each subject underwent detailed clinical assessment, electrocardiography (ECG), and contrast-enhanced cardiac magnetic resonance imaging (MRI) to evaluate myocardial changes. Results: Abnormal ECG patterns were common, with sinus tachycardia detected in 48% and non-specific ST–T wave alterations in 38% of cases. Cardiac MRI demonstrated late gadolinium enhancement (LGE)-a characteristic marker of myocarditis—in 8% of participants. The relationship between previous COVID-19 infection and myocardial involvement was statistically significant (p = 0.01), with the majority of cases seen among men aged 30–39 years. Although no major structural heart disease was evident, subtle inflammatory changes were observed. Conclusion: This study suggests that even fully vaccinated individuals who recover from COVID-19 may experience silent myocardial injury. Incorporating ECG and cardiac MRI into follow-up protocols can aid in early detection. Younger male patients with lingering symptoms may benefit most from targeted cardiac surveillance.

This prospective observational study was conducted in Gauhati Medical College and Hospital, Guwahati for a period of one year from October 2022 to September 2023 in the Department of Obstetrics and Gynaecology. 350 patients undergoing laparotomy for benign gynaecological conditions, aged between 15-65 years of age were studied for post-operative complications for a period of 30 days after surgery and the associated risk factors were evaluated. The post-operative complications which were most frequently observed were paralytic ileus, surgical site infection, urinary tract infection and organ injury. Significant association was found between certain risk factors and the complications developed. Positive correlation was found between the development of surgical site infection with diabetes mellitus, obesity, and anaemia. Significant association was also seen between the occurrence of post-operative paralytic ileus with diabetes mellitus and prolonged duration of surgery. Urinary tract infection was seen to be associated with diabetes mellitus. Peri operative blood loss was also found to be associated with post-operative complications. No association was found between the age of the patients, raised blood pressure and hypoalbuminemia with the post-operative complications. It was concluded that the risk factors associated with post-operative complications were anaemia, obesity, diabetes mellitus, peri operative blood transfusion and prolonged duration of surgery. Hence, pre optimisation of the patient’s condition prior to surgery plays a vital role in prevention of these complications and will reduce the morbidity and health case expense associated with them.

Introduction: Vocal cord nodules are benign, bilateral, callous-like lesions on the vocal folds, commonly caused by chronic voice abuse or misuse. They are a frequent cause of hoarseness, particularly among professional voice users. Management options include conservative measures—such as voice therapy, vocal hygiene, and medical management—and surgical excision via microlaryngoscopy. While surgery offers rapid lesion removal, conservative treatment addresses the underlying phonotrauma, potentially reducing recurrence. The comparative effectiveness of these approaches remains a topic of clinical interest, particularly in resource-limited tertiary care settings. Objectives: To compare the outcomes of surgical treatment and conservative treatment in patients with vocal cord nodules, in terms of symptomatic improvement, objective voice quality measures, and recurrence rates. Methods: This prospective study was conducted in the Outpatient Department and indoor wards of the Department of ENT and Head Neck Surgery at R. G. Kar Medical College from December 2017 to December 2019. The study included 50 patients attending the ENT OPD during the study period who were diagnosed with benign bilateral vocal cord nodules. Data were collected on demographic variables (age, sex, occupation) and clinical parameters including pre-treatment GRBAS score, post-treatment GRBAS score, first change (Ch1) GRBAS score, second change (Ch2) GRBAS score, and post-follow-up GRBAS score. Patients were divided into two groups: Group A underwent surgical excision, while Group B received conservative management. All patients were evaluated using the GRBAS scale at baseline, post-treatment, and during follow-up to assess voice quality and treatment outcomes. Results: This study of 50 patients with vocal cord nodules found that most were aged 31–40 years (52%) and predominantly female (68%), especially in the surgical group (88.2%). Housewives were the most common occupation (36%), followed by singers (14%) and teachers (10%). The mean ages of the surgical (34.53 years) and conservative (34.85 years) groups were similar (p = 0.8586). Pre-treatment GRBAS scores were comparable, but post-treatment improvement was greater in the surgical group (p = 0.0409). While surgery showed faster early gains, follow-up scores revealed no significant long-term difference between the two groups. Conclusion: Both surgical and conservative treatments are effective in improving voice quality in patients with vocal cord nodules. Surgery offers faster symptomatic relief, but long-term outcomes are comparable when appropriate voice therapy is followed. Conservative treatment remains a valuable first-line approach, especially in motivated patients, while surgery is beneficial for refractory cases or professional voice users requiring rapid recovery.