Introduction: Ovarian cancer predominantly spreads within the peritoneal cavity causing peritoneal carcinomatosis, which is associated with poor prognosis. Rare distant metastases beyond the abdomen, including sites such as the liver parenchyma, lungs, brain, bone, and distant lymph nodes, represent a distinct and aggressive disease subset with limited clinical data. Aims: To evaluate clinical profiles and patterns of rare distant metastases in ovarian and peritoneal cancer. Materials and Methods: This retrospective, observational cohort study was conducted over a period of one year in the Department of Gynaecology & Obstetrics, Murshidabad Medical College and Hospital, West Bengal 742101. The study included a total of 400 patients with histologically confirmed primary ovarian or peritoneal carcinoma. Result: Out of 400 ovarian cancer patients, rare distant and intra-abdominal metastases showed varied frequency and prognosis. CNS (12%) and bone (8%) metastases had poor survival (10 and 7.5 months, respectively). Eye and skin metastases (4% each) had slightly better outcomes (14 and 12 months). No cases involved supraclavicular or inguinal nodes, while mediastinal–cardiophrenic (4%) and breast node (8%) metastases showed better survival (18 and 16 months). Among intra-abdominal sites, the spleen was most common (20%), followed by GI tract (12%), bronchus/trachea (8%), heart (4%) and placenta/fetus (4%) with survival ranging from 7 to 17 months. Prognosis varied significantly by site. Conclusion: Rare distant metastatic disease in ovarian cancer represents a biologically aggressive pattern with poorer prognosis than peritoneal carcinomatosis. Improved diagnostic vigilance and individualized treatment strategies are crucial. Future studies should focus on molecular profiling to better understand the metastatic behavior and identify therapeutic targets.

Introduction: Acute Coronary Syndrome (ACS) is a significant cause of morbidity and mortality globally with differing risk profiles and pathophysiological mechanisms across age groups. Objectives: To compare the angiographic characteristics of coronary artery involvement in patients diagnosed with ACS in two distinct age groups: those aged <40 years and those aged >60 years. Methods: This analytical cross-sectional study was conducted over 18 months, from March 1, 2023 to August 31, 2024at the Department of Cardiology, Nilratan Sircar Medical College and Hospital, Kolkata. The study population comprised adult patients below 40 years and above 60 years of age admitted with acute coronary syndrome. Results: In this study of 192 Acute Coronary Syndrome (ACS) patients, two age groups were compared: those below 40 years and those above 60 years. Younger patients showed a marked male predominance (84%), whereas the elderly group had a more balanced gender distribution. The mean TIMI score was significantly higher in older patients (3.56 ± 1.51) compared to the younger group (2.87 ± 1.69), indicating a greater risk profile in the elderly. Single-vessel disease was most common in the younger cohort (69%), while older patients had a higher prevalence of triple-vessel disease (29%). The left anterior descending artery (LAD) was the most frequently involved vessel across both groups, with higher involvement in the elderly. Additionally, left main coronary artery (LMCA) disease was significantly more common in older patients (29% vs. 11%). SYNTAX II scores further supported these findings, with younger patients more often falling into the low-risk category, whereas a significant portion of older patients had intermediate to high scores. Conclusion: Younger ACS patients tend to have less extensive but more thrombotic coronary involvement, often limited to a single vessel, with modifiable lifestyle-related risk factors predominating. Older patients, however, typically present with diffuse, multi-vessel atherosclerotic disease, correlating with higher rates of comorbidities. These findings underscore the need for age-specific preventive and interventional strategies in the management of ACS.

Introduction: Pre-eclampsia is a hypertensive disorder of pregnancy associated with maternal and fetal morbidity and mortality. Cancer antigen-125 (CA-125), a glycoprotein traditionally used as a tumor marker, has been reported to rise in pre-eclampsia and may correlate with disease severity. Aims and Objective: To evaluate the relationship between maternal serum CA-125 concentrations and the severity of pre-eclampsia. Methods: This observational analytical case-control study was conducted from May 2021 to April 2022 at the Department of Biochemistry in collaboration with the Department of Obstetrics and Gynaecology, Burdwan Medical College and Hospital. A total of 306 pregnant women were enrolled, comprising 153 pre-eclamptic cases and 153 normotensive controls. Maternal demographic and anthropometric data were recorded. Serum CA-125 levels were measured using chemiluminescent immunoassay. Pre-eclampsia cases were stratified into mild, moderate and severe categories. Statistical analysis included unpaired t-tests, ANOVA, and correlation analyses, with p < 0.05 considered significant. Results: Mean maternal age was comparable between case (27.88 ± 1.31 years) and control groups (28.12 ± 1.43 years, p = 0.115). Mean height was significantly higher in cases (159.56 ± 5.32 cm) compared to controls (153.87 ± 28.37 cm, p = 0.015), while weight differences were not significant. Serum CA-125 levels were significantly elevated in pre-eclamptic women (45.81 ± 11.05 IU/mL) versus controls (12.74 ± 2.13 IU/mL, p < 0.0001), with higher levels observed in severe cases. CA-125 positively correlated with blood pressure and proteinuria, indicating association with disease severity. Conclusion: Maternal serum CA-125 is significantly elevated in pre-eclampsia and correlates with disease severity. It may serve as a potential biomarker for risk stratification and monitoring in pre-eclamptic pregnancies.

Introduction: Gestational Diabetes Mellitus (GDM) is increasing globally, linked to obesity, age, and lifestyle changes. While insulin is the standard treatment, metformin is emerging as a safe, effective alternative. It improves insulin sensitivity and may reduce maternal and fetal complications. This study compares outcomes in GDM pregnancies treated with insulin versus metformin. Aims: To compare maternal and fetal outcomes in patients with gestational diabetes mellitus treated with Insulin or Metformin. Materials and Methods: This prospective observational comparative study was conducted from December 2022 to November 2023 at the OPD, antenatal, and postnatal wards of the Department of Obstetrics and Gynaecology, Chittaranjan Seva Sadan College of Obstetrics, Gynaecology and Child Health. A total of 106 pregnant women diagnosed with Gestational Diabetes Mellitus were included. The study aimed to compare maternal and fetal outcomes between insulin and metformin treatments. Results: In this study, insulin and metformin provided similar glycemic control in women with GDM. However, metformin was associated with significantly fewer neonatal complications such as hypoglycaemia (p=0.002), NICU admission (p=0.019), and respiratory distress (p=0.022). Neonatal birth weight was also lower in the metformin group (p=0.037), indicating a potentially safer neonatal profile. Conclusion: Untreated Gestational Diabetes Mellitus (GDM) can lead to serious maternal and neonatal complications. While insulin is the standard treatment, metformin has emerged as an effective and cost-efficient alternative. Widely accepted in the West and increasingly used in India, metformin effectively controls blood sugar levels in GDM. It is also linked to fewer pregnancy complications and better neonatal outcomes. These findings support metformin as a safe and effective option for GDM management.

Introduction: Intrauterine insemination (IUI) is a widely used first-line treatment for selected cases of subfertility due to its simplicity, cost-effectiveness, and minimal invasiveness. However, its success is influenced by multiple factors related to the couple, ovarian stimulation protocol, and semen parameters. Identifying predictive factors for pregnancy following IUI can help in optimizing patient selection and improving outcomes. Objectives: To evaluate the clinical, hormonal, and procedural factors associated with successful pregnancy following IUI and to identify significant predictors that influence the likelihood of conception. Materials and Methods: This prospective interventional open-label study was conducted in the Department of Obstetrics and Gynecology, Eden Hospital, Medical College and Hospital, Kolkata, over one year. Protocol development began in November 2016, and patient recruitment and data collection took place from January to July 2017 after ethics committee approval, followed by data analysis and thesis preparation. Women seeking infertility treatment in the OPD were counselled and enrolled after meeting the inclusion and exclusion criteria. Based on a previous study [xiv] and the formula n = 4pq/l², the calculated sample size was 257; however, due to time constraints and single-researcher limitations, 50% of this number (≈130 IUI cycle) were included. Results: In our study, female age, male age, BMI, and type of infertility were not significantly associated with pregnancy outcomes, although no women were older than 35 years and most pregnancies occurred in men over 35 years, contrasting with Mathieu et al., who reported poorer outcomes with increasing male age [93]. The majority of pregnancies (75%) occurred in women with infertility duration less than six years, with the highest conception rates seen in unexplained infertility (75%) followed by endometriosis (25%). Laparoscopic tubal patency assessment were more common in the conception group. Hormonal analysis showed that all who conceived had LH and FSH ≤10 mIU/mL, significantly lower prolactin (p = 0.0298), and no significant differences in TSH. Fasting and postprandial blood sugar levels were higher in the conception group but within normal limits. All pregnancies occurred when two preovulatory follicles were present, while endometrial thickness had no significant effect. Semen analysis revealed significantly higher semen volume, pre-wash sperm count, motility, and post-wash count among those who conceived. Conclusion: Several factors including cause of infertility, infertility duration, FSH, LH and PROLACTIN level, follicular response, semen volume, prewash sperm count, motility and post-wash sperm count are predictive of IUI success. Careful selection of patients and individualized stimulation protocols based on these predictors can enhance pregnancy outcomes in IUI cycles.

Introduction: Myofascial trigger points in the upper trapezius are a common cause of neck pain and functional limitation, contributing to increased neck disability in affected patients. Aims: This study aimed to compare the efficacy of dry needling, ultrasound therapy, and lignocaine injection in reducing neck disability in patients with upper trapezius myofascial trigger points. Data were collected through history, clinical examination, and recorded in a pre-designed proforma after obtaining informed consent. Materials and Methods: Comparative and randomized study conducted at the Department of Physical Medicine & Rehabilitation, Sambhu Nath Pandit Hospital, Kolkata, over 1 year, including 60 adults patients with myofascial trigger points of the upper trapezius muscle associated with myofascial pain syndrome. Result: All three interventions led to a progressive reduction in NDI scores over time. At the first and second visits, differences between groups were not statistically significant. By the third visit, Group B (ultrasound therapy) demonstrated a significantly greater improvement in NDI compared to Group C (lignocaine injection) (p = 0.009), while dry needling showed comparable but slightly lesser improvement. Demographic factors such as age, sex, occupation, handedness, and BMI did not significantly influence outcomes. Conclusion: Dry needling, ultrasound therapy, and lignocaine injection are all effective in reducing neck disability in patients with upper trapezius myofascial trigger points, with ultrasound therapy providing slightly superior functional improvement. These findings support the use of ultrasound-guided therapy as part of a multimodal approach to managing myofascial pain syndrome.

Introduction: Preeclampsia, a hypertensive disorder of pregnancy, is a leading cause of maternal and perinatal morbidity and mortality worldwide. Low-dose aspirin has been shown to reduce the risk of preeclampsia, preterm birth, and fetal complications, particularly when started before 16 weeks of gestation in high-risk women. Aims: To evaluate the efficacy of 75mg aspirin versus 150mgaspirin in prevention of pre eclampsia and its complications in high risk pregnant population. Materials and Methods: This observational study was conducted over 1.5 years at Nilratan Sircar Medical College, Kolkata, including 150 patients (75 in each group). Participants were followed at 24, 28, 32, 36 weeks, and weekly thereafter until delivery. The efficacy of two aspirin doses was evaluated in preventing preeclampsia and its complications. Result: In our study of 150 high-risk pregnant women, most were aged 21–25 years (39.3%) with primary education (42%). Baseline risk factors, including BMI ≤25, previous preeclampsia, and multifetal pregnancies, were similarly distributed between the two aspirin groups. Pregnancy complications occurred in 34% of participants, with gestational hypertension (21.3%) and preeclampsia (33–36%) being most common, while 68% showed a positive response to aspirin prophylaxis. Conclusion: We concluded that younger women with lower educational attainment made up a sizable share of the cohort in our study comparing 75 mg and 150 mg aspirin for the prevention of preeclampsia in high-risk pregnancies.

Introduction: Jejunoileal atresia (JIA) is a frequent cause of intestinal obstruction in the newborn and it occurs in 1-3 per 10,000 live births. The condition is caused by vascular accident in utero. The antenatal diagnosis is difficult even though prenatal imaging has improved. Neonates with JIA normally manifest within the first 24-48 hours of birth with biliary emesis and inability to empty meconium with or without abdominal distension. The gold standard is surgical resection of the atresia segment and end to end anastomosis. When neonates are in severe sepsis or in poor general state or in severe bowel distension, other surgical methods- stoma or a chimney procedure (e.g Santulli ) can be used. Survival rates in developed countries are more than 90% due to early diagnosis, neonatal intensive care advancements, pediatric anaesthesia expertise and access to total parenteral nutrition (TPN). Aims and Objectives: This paper seeks to carry out an institutional review based on cases of jejunoileal atresia that have been conducted over a period of 5 years basing on short term outcomes and survival influencing factors. Materials and Methods: A retrospective study was conducted on neonates admitted with jejunoileal atresia who were operated between January 2020 to December 2024. The data that was recorded include the demographics, clinical presentation, and preparation, surgical details and outcomes along with associated anomalies if any. To establish the significant predictors of survival, statistical analysis was done. Results: 33 neonates with jejunoileal atresia were operated with a male-female ratio of 1.36:1. 79% were low birth weight, and 64 % were very low birth weight. The average age of presentation was around 9.5 days. Our study indicated the timing of presentation and birth weight as significant factors of survival. Even though the overall survival which was 72% at the time of initial discharge had declined to 64% at least 6 months follow up, the switchover to Santulli ( chimney) procedure in the final 2 years yielded a survival of more than 90% Conclusions: Neonates with late presentation and low birth weight did poorly. High index of suspicion of intestinal obstruction in neonates who have biliary emesis is essential for early diagnosis. Survival might be enhanced by antenatal diagnosis by intervening in time. A chimney operation such as Santulli, which was found to have a higher survival rate than primary anastomosis in neonates of unfavorable general condition and massive luminal disparity, has turned out to be  saviour in resource-limited tertiary centres.

Introduction: Breast cancer is one of the leading causes of cancer-related morbidity and mortality in women worldwide. It is a heterogeneous disease, with genetic, hormonal, and environmental factors contributing to its development and progression. Among the most significant genetic factors influencing the risk and prognosis of breast cancer are mutations in the BRCA1 and BRCA2 genes, which are known to predispose individuals to hereditary forms of breast and ovarian cancers. Aims: This study aims to determine the incidence of BRCA1 gene mutations among breast carcinoma patients and analyze its impact on tumor characteristics, clinical outcomes, and prognosis. Additionally, the study will explore the potential for personalized treatment strategies based on BRCA1 mutation status. Materials & Methods: This is a prospective study conducted at the Institute of Postgraduate Medical Education and Research, SSKM Hospital, Kolkata, from January 2016 to August 2017, with a sample size of 50 breast carcinoma patients with BRCA1 gene mutations. Result: BRCA1 levels were highest in Grade I tumors (mean 102.73 ng/ml), followed by Grade II (mean 27.61 ng/ml) and Grade III tumors (mean 26.11 ng/ml). These findings suggest that BRCA1 expression decreases with increasing tumor grade, indicating its potential role in tumor aggressiveness. Conclusion: We concluded that according to our research, there were substantial differences in BRCA1 gene mutation levels among tumor stages, histological grades, and lymph node involvement groups. This suggests that BRCA1 expression may be correlated with the aggressiveness and progression of tumors.

Introduction: Trigger thumb is a flexion deformity of the interphalangeal joint caused by stenosing tenosynovitis of the flexor pollicis longus tendon. It is a common pediatric hand condition that can affect hand function and fine motor development. While some cases resolve spontaneously, persistent or severe deformities may require surgical intervention. There is ongoing debate regarding the optimal timing and choice between conservative and operative management in children. Methods: This prospective comparative study was conducted at B.C. Roy Children Hospital over 3 years on 50 pediatric trigger thumb patients (6 months–6 years). Demographic, clinical, and outcome variables were analyzed. Statistical tests included independent t-test and chi-square/Fisher’s exact test, with p < 0.05 considered significant. Results: A total of 50 children with trigger thumb were studied (25 surgical, 25 conservative). The mean ages were 4.8 ± 2.1 and 4.5 ± 2.3 years, respectively (p = 0.65), with no significant differences in gender distribution, laterality, or disease stage at presentation. Complete resolution occurred in 80% of surgical and 72% of conservative cases (p = 0.45). Complications were minimal; one infection occurred in the surgical group, while recurrence (8%) and residual flexion contracture (12%) were noted only in the conservative group. Parental satisfaction scores were comparable between groups and no significant differences (8.0 vs. 8.2, p = 0.18). Conclusion: In this study of 50 children with trigger thumb, surgical management showed superior outcomes compared to conservative treatment. Spontaneous resolution was rare, and delayed surgery often led to fixed flexion deformity with poor parental satisfaction. While children under 2 years may be managed conservatively, those over 2 years benefit from early surgical correction to achieve complete resolution and better functional outcomes.

Introduction: Recurrent patellar dislocation is a common cause of knee instability in the pediatric population, often resulting from injury or insufficiency of the medial patellofemoral ligament (MPFL). Surgical reconstruction of the MPFL has emerged as a reliable option to restore patellar stability, improve function, and prevent recurrence, especially in skeletally immature patients where traditional procedures may risk growth plate injury. Methods: The present study was a prospective comparative study conducted over 3 years at B.C. Roy Children Hospital. The study included 30 pediatric patients with recurrent patellar dislocation who underwent physis-sparing MPFL reconstruction and/or ACL reconstruction. Results: In this study of 30 pediatric patients undergoing medial patellofemoral ligament reconstruction, the mean age was 12.5 ± 2.1 years, with a slight male predominance (18 males, 12 females) and nearly equal distribution of affected knees (16 right, 14 left). The mean BMI was 19.8 ± 3.2 kg/m². Significant functional improvement was observed postoperatively, with the mean Kujala score increasing from 56.4 ± 8.7 to 89.3 ± 5.2 (p < 0.001) and the mean Lysholm score from 58.7 ± 7.9 to 91.1 ± 4.8 (p < 0.001). Recurrent patellar dislocation occurred in 2 patients (6.7%), and minor complications such as transient pain or swelling were noted in 4 patients (13.3%), with no major complications reported. Gender-wise comparison showed comparable functional outcomes between males and females, with no statistically significant differences in postoperative Kujala or Lysholm scores (p = 0.32 and 0.28, respectively). Conclusion: MPFL reconstruction in pediatric patients is safe and effective, improving knee stability and functional outcomes with low recurrence and minimal complications. Physeal-sparing ACL techniques, using the gracilis tendon and patellar suture anchor, preserve growth plates while providing stable fixation. Overall, these procedures reliably restore patellar and knee stability and improve quality of life in skeletally immature patients.

Introduction: The transmission mechanism of Mycobacterium leprae is not clearly known. There are evidences available showing healthy individuals living in close contact with active leprosy patients are at high risk. In studies from India itself, Mycobacterium leprae DNA, have been isolated from environmental samples such as soil and water which shows shedding of organism from active leprosy cases. The possibility of transmission of infection from environment being as a source of infection has yet to be proven. These findings challenged the long-held belief that M. leprae transmission occurred solely through human-to-human contact (respiratory route like in Tuberculosis). Aim/Objective: The central aim of this investigation was to detect Mycobacterium leprae DNA in environmental samples like fomite (pillow cover/ towel/ bedsheet etc.) by targeting the RLEP sequence using Polymerase Chain Reaction. Methods: This study is a prospective analytical study done for a study period of six months at an institute of national importance situated in Raipur, Chhattisgarh, India in which newly diagnosed patients of active leprosy disease attending the institute during study period were registered and samples from their household were collected. A total 147 sample were collected from 29 cases. DNA was extracted using salting out – proteinase K method. Detection of M. leprae was done using RLEP-PCR. Result: A total of 63 water samples and 84 fomite swab samples were collected from the houses of 29 patients and from various water bodies in and around their residence area. In this study, we analyzed 84 fomite samples, including swabs from beds, towels, and door handle, using LP-1 and LP-2 primers to amplify a 129 bp RLEP sequence. Among these, one door/floor sample and one towel sample from the household of a multibacillary (MB) case tested positive for RLEP-PCR. All remaining fomite samples, as well as all 63 water samples, were PCR negative. Conclusion: The detection of Mycobacterium leprae DNA in two fomite samples (door/floor and towel) from the household of a multibacillary case suggests the shedding of bacilli from the active case. However, M. leprae DNA were absent in all water samples and the majority of fomite samples.

Introduction: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are effective surgical interventions for end-stage osteoarthritis and other degenerative joint diseases. While pain relief is well established, assessment of functional outcomes and quality of life postoperatively remains critical for evaluating overall success. This study aimed to assess functional outcomes in patients undergoing primary or revision total knee or hip arthroplasty. Methods: This prospective observational study was conducted in the Department of Orthopaedics, Burdwan Medical College & Hospital, from June 2023 to June 2024, including 40 adult patients undergoing primary or revision total knee arthroplasty (TKA) or total hip arthroplasty (THA). Patients were evaluated for demographic variables such as age, gender, and BMI, along with comorbidities. Clinical outcomes were assessed using validated functional scores (WOMAC, KSS for TKA; HOOS for THA), pain scores (VAS), range of motion (ROM), and objective performance tests (6-minute walk test and Timed Up & Go test). Postoperative complications were recorded and analyzed. Data were collected systematically and subjected to appropriate statistical analysis to evaluate functional outcomes, pain relief, and complication rates following arthroplasty. Results: This study of 40 patients (20 TKA, 20 THA) demonstrated significant postoperative improvements in pain, function, and mobility with both procedures. TKA patients showed reductions in WOMAC (58.6 to 23.4) and gains in KSS (45.7 to 85.2), while THA patients improved in HOOS (55.3 to 20.7) (all p < 0.001). ROM, VAS, 6-minute walk distance, and TUG time improved significantly in both groups, with no significant difference in complication rates (3 cases each). Pearson’s correlation confirmed a strong negative association between pain reduction and functional improvement (TKA: r = –0.65, p = 0.002; THA: r = –0.58, p = 0.006). Conclusion: Total knee and hip arthroplasty provide significant improvement in pain relief and functional outcomes. Early postoperative rehabilitation and careful patient selection contribute to favorable results. These procedures demonstrate high efficacy and safety, significantly enhancing the quality of life in patients with degenerative joint disease.

Introduction: Long bone fractures are among the most common orthopedic injuries and require stable fixation for optimal functional recovery. Two widely practiced internal fixation methods are intramedullary (IM) nailing and plating. While IM nailing offers the advantages of load sharing, preservation of periosteal blood supply, and early mobilization, plating provides direct fracture visualization, anatomic reduction, and rigid fixation. The choice of method remains a matter of debate, particularly with regard to union rates, complications, and functional outcomes. Methods: This study was a prospective comparative observational study conducted in the Department of Orthopaedics at Burdwan Medical College & Hospital from July 2024 to July 2025. A total of 70 adult patients with diaphyseal fractures of the femur, tibia, humerus, or forearm were enrolled and divided equally into two groups: intramedullary nailing and plating. Data were collected on patient demographics (age and gender), fracture characteristics (site), intraoperative parameters (mean operative time, mean blood loss, and fluoroscopy time), postoperative outcomes including complications, and patient satisfaction. All patients were managed according to standard surgical protocols, and follow-up was conducted to assess fracture union, functional recovery, and overall satisfaction. Results: In this study of 70 patients with long bone fractures (35 IM nailing, 35 plating), baseline demographics and fracture characteristics were comparable. IM nailing showed shorter operative time (72.3 ± 15.6 vs. 98.7 ± 18.2 min, p <0.001), lower blood loss (120 ± 40 vs. 250 ± 60 ml, p <0.001), but higher fluoroscopy time (95 ± 25 vs. 60 ± 20 sec, p <0.001). Fracture union occurred earlier (16.5 ± 3.2 vs. 18.2 ± 3.5 weeks, p = 0.03), with similar rates of nonunion and malunion. Complications were low and comparable. Functional outcomes favored IM nailing, with lower DASH scores (12.5 ± 4.3 vs. 14.8 ± 5.1, p = 0.04) and earlier full weight bearing (14.1 ± 2.5 vs. 15.6 ± 3.0 weeks, p = 0.02). Patient satisfaction was high in both groups. Conclusion: Both intramedullary nailing and plating are effective methods of fixation for long bone fractures. Intramedullary nailing has advantages in terms of less operative morbidity, faster union, and earlier mobilization, making it more suitable for lower limb fractures. Plating remains valuable where precise anatomic reduction is required, especially in forearm fractures. An individualized approach considering fracture pattern, bone involved, and patient factors should guide the choice of fixation method.

Introduction: Fracture fixation implants play a critical role in achieving stable bone healing. With the development of novel implant designs, there is a need for rigorous biomechanical evaluation to assess their stability, load-bearing capacity, and resistance to failure under physiological conditions. Understanding these characteristics helps guide clinical decision-making and ensures patient safety. Methods: This study was a prospective experimental biomechanical investigation conducted at the Department of Orthopaedics, Burdwan Medical College & Hospital, from March 2019 to March 2020. A total of 100 adult synthetic bone models simulating human long bones were utilized to assess various parameters, including age, gender, fracture site, complications, patient satisfaction, mean operative time, mean blood loss, and fluoroscopy time. Standardized experimental protocols were applied to evaluate the biomechanical performance of the implants under controlled conditions, ensuring reproducibility and allowing comparative analysis of mechanical stability and failure modes. Results: The demographic and baseline characteristics of the bone models, including age, gender distribution, and bone density, were comparable between the Implant A and Implant B groups. Biomechanical testing demonstrated that Implant B outperformed Implant A, showing significantly higher load to failure (1380 ± 160 N vs. 1250 ± 150 N; p = 0.032), greater stiffness (245 ± 40 N/mm vs. 220 ± 35 N/mm; p = 0.014), superior cyclic loading resistance (53,000 ± 5,500 cycles vs. 48,000 ± 6,000 cycles; p = 0.008), and reduced deformation under load (3.9 ± 0.7 mm vs. 4.5 ± 0.8 mm; p = 0.045). Analysis of failure modes indicated that while screw pull-out and plate bending were more common in Implant A, these differences were not statistically significant, whereas bone fractures at the implant site were significantly higher in Implant B (60% vs. 30%; p = 0.009). Conclusion: The new fracture fixation implants exhibit superior biomechanical properties compared to conventional implants, including higher load tolerance, increased stiffness, and improved resistance to cyclic loading. These findings suggest potential clinical advantages in fracture stabilization, although in vivo studies are recommended to confirm efficacy and safety.

Introduction: Diaphyseal forearm fractures are among the most common fractures in the pediatric population. While conservative management with closed reduction and casting remains standard for most cases, unstable fractures, open fractures, or fractures failing conservative treatment often require surgical intervention. Titanium elastic nailing (ten) has emerged as a minimally invasive and effective method for internal fixation, offering advantages of early mobilization, excellent alignment, and rapid functional recovery. Methods: This institutional-based, prospective observational study was conducted at the department of orthopaedics, burdwan medical college & hospital, over a period of 18 months from may 2020 to october 2021. The study included 10 pediatric patients presenting to the outpatient department and emergency with diaphyseal forearm fractures, all of whom were treated with titanium elastic nailing. Written informed consent was obtained from all participants after explaining the study details. The study variables included age, sex, injury-to-surgery interval, postoperative complications, range of movement, and overall functional outcome. All patients were followed up to assess radiological union, range of motion, complications, and functional recovery. Results: In this study of 10 pediatric patients, the majority (80%) were aged 9–12 years, with a male predominance (80%). Surgery was performed within 14 days for most patients (90%), and radiological union was achieved within 10 weeks in 70% of cases. Postoperative complications were minimal, with only 3 patients experiencing issues such as granulation tissue, nail protrusion, or bending. Functional recovery was generally excellent, with 60% achieving full flexion and extension, and 70% attaining full supination and pronation, while minor restrictions were observed in a few patients. Overall, functional outcomes were excellent in 70% and good in 30% of patients, with no fair or poor results, indicating favorable recovery following surgical management. Conclusion: Titanium elastic nailing provides a safe and effective method for the surgical management of diaphyseal forearm fractures in children. It ensures stable fixation, allows early mobilization, and achieves excellent functional and radiological outcomes with minimal complications. Ten should be considered the preferred surgical option for pediatric forearm fractures unsuitable for conservative treatment.

Introduction: Post-arthroplasty joint infection (PJI) is a serious complication following joint replacement surgeries, associated with significant morbidity, prolonged hospitalization, and increased healthcare costs. Early diagnosis and appropriate management are crucial to optimize functional outcomes and reduce implant failure. Methods: This prospective observational study was conducted in the Department of Orthopaedics at Burdwan Medical College & Hospital over a period of one year, from May 2022 to May 2023. A total of 50 adult patients undergoing primary or revision total hip and knee arthroplasty were included. Data were collected on patient demographics (age and gender), type of arthroplasty performed, risk factors for post-arthroplasty joint infection, causative organisms, and management approaches. All patients were followed postoperatively to identify the occurrence of joint infections, and appropriate interventions were recorded. The study aimed to analyze the incidence, risk factors, microbial profile, and treatment outcomes of post-arthroplasty infections in this cohort. Results: In this study of 50 patients undergoing total hip or knee arthroplasty, the majority were aged 60 years or older (60%) and male (56%), with total knee replacement being the most common procedure (70%). Post-arthroplasty joint infections occurred in 8 patients (16%). Diabetes mellitus and prolonged surgery duration (>120 minutes) were significantly associated with infection, while obesity and revision surgery showed a non-significant trend. Staphylococcus aureus was the predominant pathogen (50%), followed by coagulase-negative staphylococci and Gram-negative organisms. Management outcomes demonstrated that two-stage revision arthroplasty achieved 100% infection control, whereas debridement with implant retention was successful in 66.7% of cases. Conclusion: Post-arthroplasty joint infections, though relatively uncommon, present significant challenges in orthopedic practice. Early recognition and timely intervention tailored to infection type and patient factors are critical to improving outcomes. Multi-disciplinary approaches combining targeted antibiotic therapy and appropriate surgical intervention remain the cornerstone of effective management.

Objective: To evaluate the patterns of utilization of emergency obstetric and gynecologic services by women presenting with ruptured ectopic pregnancy at a tertiary hospital. Methods: A retrospective cross-sectional study was conducted, analyzing records for demographics, risk factors, delays, interventions, and outcomes among women admitted with ruptured ectopic pregnancy over a five-year period. Results: The majority of patients presented with ruptured ectopic pregnancy (66–85%), with significant proportion requiring surgical intervention and blood transfusion. Delayed presentation, prior tubal pathology, and lower awareness contributed to adverse outcomes, including ICU admission and occasional mortality. Conclusion: Strengthening early detection and referral pathways, ensuring prompt access to emergency care, and optimizing peripheral provider training are critical to improving outcomes in ruptured ectopic pregnancy.

Background: Post-operative pain following laparoscopic cholecystectomy remains a common clinical concern, often necessitating opioid use that may result in undesirable side effects. Pre-emptive administration of non-steroidal anti-inflammatory drugs (NSAIDs) has been proposed as an effective opioid-sparing strategy. Aim and Objective: To evaluate the efficacy of intravenous (IV) ibuprofen compared with placebo when used as pre-emptive analgesia in patients undergoing elective laparoscopic cholecystectomy under general anaesthesia. Materials and Methods: This prospective, randomized, double-blinded, placebo-controlled study was conducted at SVBP Hospital, LLRM Medical College, Meerut, from May 2023 to April 2025. Sixty ASA I–II patients aged 20–60 years scheduled for elective laparoscopic cholecystectomy were enrolled and randomly allocated into two groups (n = 30 each). Group B received IV ibuprofen 400 mg in 100 ml saline, while Group C received 100 ml saline (placebo), both administered 30 minutes before induction. Standardized anaesthetic protocols were followed. Post-operative pain was assessed using the Visual Analogue Scale (VAS) at intervals up to 12 hours. Rescue analgesia with IV Tramadol (2 mg/kg) was administered if VAS >3, and total opioid consumption was recorded. Hemodynamic parameters and adverse events were also documented. Results: VAS scores were significantly lower in the ibuprofen group compared to placebo at 15 min, 30 min, 1 hr, 4 hr, 10 hr, and 12 hr postoperatively (p < 0.05). No significant differences were observed at 2 hr, 6 hr, and 8 hr. Mean Tramadol consumption was significantly reduced in the ibuprofen group (223 ± 43 mg) versus placebo (290 ± 30.5 mg; p = 0.0037). Hemodynamic parameters (pulse rate, SBP, DBP, MAP, SpO₂) remained stable in both groups, and adverse effects were minimal and comparable. Conclusion: Pre-emptive IV ibuprofen significantly reduces post-operative pain scores and opioid requirements compared to placebo, without compromising hemodynamic stability or safety. It represents a safe and effective component of multimodal analgesia for laparoscopic cholecystectomy.

Background: Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration, leading to increased fracture risk. The standard diagnostic tool, Dual-energy X-ray absorptiometry (DXA), measures bone mineral density (BMD) but does not capture the dynamic state of bone remodeling. Bone turnover markers (BTMs) reflect the rate of bone formation and resorption and may offer complementary diagnostic and prognostic information. Methods: A single-center, cross-sectional study was conducted on 150 postmenopausal women aged 50–75. Participants were categorized into three groups based on WHO T-score criteria: Healthy Controls (n=50, T-score > -1.0), Osteopenia (n=50, T-score between -1.0 and -2.5), and Osteoporosis (n=50, T-score ≤ -2.5). Fasting morning serum samples were collected and analyzed for P1NP and CTX-I levels using electrochemiluminescence immunoassays. BMD was measured at the lumbar spine and femoral neck by DXA. Data were analyzed using one-way ANOVA with Tukey’s post-hoc test. Results: The mean age of participants was significantly higher in the osteoporosis group (65.8 ± 6.1 years) compared to the osteopenia (61.2 ± 5.5 years) and control groups (58.4 ± 4.9 years) (p < 0.001). Serum P1NP levels were significantly elevated in the osteoporosis group (80.5 ± 21.2 ng/mL) compared to both the osteopenia group (55.3 ± 15.8 ng/mL) and the control group (35.1 ± 10.4 ng/mL) (p < 0.001). Similarly, serum CTX-I levels showed a stepwise increase, with the highest levels in the osteoporosis group (752.1 ± 148.3 ng/L), followed by the osteopenia group (501.7 ± 119.5 ng/L), and the lowest in controls (303.4 ± 82.6 ng/L) (p < 0.001). All pairwise comparisons between the groups for both markers were statistically significant (p < 0.01). Conclusion: Serum levels of P1NP and CTX-I are significantly and progressively elevated in postmenopausal women with osteopenia and osteoporosis compared to healthy controls. These findings support the potential role of BTMs as valuable adjuncts to BMD for identifying individuals with high bone turnover, assessing fracture risk, and potentially monitoring therapeutic response in osteoporosis management.

Antiphospholipid Syndrome (APS) is an autoimmune prothrombotic disorder characterized by recurrent arterial or venous thromboses and/or pregnancy-related complications in the presence of antiphospholipid antibodies. We report the case of a 21-year-old female presenting with left hemiparesis and imaging findings suggestive of chronic infarct with diffuse right internal carotid artery (ICA) narrowing. Laboratory workup confirmed elevated antiphospholipid antibodies consistent with APS. This case highlights the importance of early recognition and evaluation of autoimmune prothrombotic states in young stroke patients.

Background: Acute abdomen in children represents a frequent and diagnostically challenging clinical problem, marked by sudden severe abdominal pain requiring urgent evaluation. The causes in pediatric patients are highly variable and age-dependent, ranging from benign, self-limiting conditions to life-threatening surgical emergencies. Rapid identification and appropriate management are critical to minimize morbidity and mortality. Objectives: This study aimed to analyse the clinical presentation and age-wise distribution of causes of acute abdomen in children presenting to a tertiary care centre, emphasizing the patterns of pain localization and their correlation with underlying etiologies. Methods: A descriptive, observational study was conducted at a tertiary care centre involving 104 consecutive paediatric patients aged 1–14 years presenting with acute abdominal pain. Comprehensive demographic data, clinical symptoms, pain location, laboratory investigations, and imaging findings were recorded and analysed. Patients were divided into three age groups: 1–5 years, 6–10 years, and 11–14 years. Results: Of 104 children enrolled, 59% were males and 41% females, with a progressive increase in cases in older age groups. Periumbilical pain was most frequent in the youngest group (43.3%), while epigastric and right iliac fossa pain became more prominent in older children (27.9% and 25.6% respectively in 11–14 years). Generalized abdominal pain was least common in all groups. The trend in pain localization with increasing age correlated with a shift from nonspecific/infective etiologies (such as gastroenteritis and mesenteric lymphadenitis) in younger children to acid peptic disease and appendicitis in adolescents. Discussion: The findings highlight a clear age-dependent variation in the presentation of paediatric acute abdomen. Recognizing these clinical patterns enhances diagnostic precision, facilitates targeted investigations, and supports early intervention for surgical causes such as appendicitis, while reducing overtreatment of benign or functional conditions.

Background and Objectives: A common anesthetic method for lower limb procedures is spinal anesthesia. When haemodynamic changes do occur, they can be abrupt and harmful, especially in older people. Furthermore, spinal anesthesia has a finite duration. As a result, sequential combined spinal epidural (SCSE) anesthesia is becoming a safer method. The method combines the advantages of the two. To assess how the use of spinal anesthesia and SCSE block affects hemodynamic parameters during lower limb procedures. Methods: The study was conducted on 60 patients in the department of anesthesia from June 2022 to June 2023. A computer-generated number was used to randomly assign the patients to two groups of thirty each; the observations were made by an anesthetist who was not associated with the research. The study included ASA Grade I and II patients (male or female, 18–60 years old) who had posted for lower limb surgery with a maximum 2-hour surgical length. Results: 1 in group I, the number of patients who achieved T6 were 53% and in group II it was 20%, (p<0.05) was statistically significant. In group I the number of patients which achieved T8 were 27% and in group II it was 30%, (p>0.05). In group I, five patients had vomiting as against one patient in group II had vomiting p>0.05. The incidence of bradycardia and hypotension in either group was comparable. Conclusion: Sequential combined spinal epidural block maintains hemodynamic stability with minimal complications as compared to spinal anaesthesia.

Introduction: Occupational back injuries are a leading cause of disability and work absenteeism worldwide. Early identification of patients at high risk for requiring lumbar spine surgery can facilitate timely intervention and improve clinical outcomes. Objective: To identify early clinical and occupational indicators predictive of lumbar spine surgery within one year following an occupational back injury. Methods: This one-year prospective study at R. G. Kar Medical College & Hospital included 138 patients with occupational back injuries. Data collected covered demographics, job physical demand, delayed return to work, compensation status, and employer support. Clinical evaluations included pain (VAS), neurological deficits, and disability (ODI). MRI was used to identify disc herniation, nerve compression, and spondylolisthesis. Early healthcare use—timing of MRI, conservative treatment, and surgeon referral—was recorded. Psychosocial factors were assessed with FABQ, PHQ, and PCS questionnaires to identify predictors of lumbar spine surgery within 12 months. Results: Out of 138 patients, 42 (30.4%) had lumbar spine surgery. Surgery patients were older (48.6 vs. 44.3 years, p=0.018), had more heavy physical work (66.7% vs. 41.7%, p=0.008), higher pain scores (VAS 8.1 vs. 6.4, p<0.001), more neurological deficits (64.3% vs. 29.2%, p<0.001), and greater disability (ODI 58.5 vs. 42.3, p<0.001). They had more disc herniation on MRI (76.2% vs. 41.7%, p<0.001), higher psychosocial risk (FABQ 73.8% vs. 39.6%, p<0.001), and were less likely to receive early physiotherapy (28.6% vs. 60.4%, p=0.001). Despite 76.2% achieving ≥30% ODI improvement, fewer returned to full work (42.9% vs. 67.7%, p=0.007). Conclusion: Neurological deficits and MRI-confirmed disc herniation are strong early indicators for lumbar spine surgery in patients with occupational back injuries. Awareness of these predictors can guide clinicians and employers in optimizing management strategies, potentially reducing the need for surgery and improving return-to-work outcomes.

Background: Hysterectomy remains one of the most common gynecological surgeries performed worldwide, with varied indications depending on demographic and clinical factors. Analyzing elective procedures provides insights into patient profiles, surgical approaches, and outcomes, thereby guiding evidence-based clinical decisions. Aim & Objectives: The present study aimed to analyze elective hysterectomies performed at a tertiary care center with respect to indications, intraoperative findings, surgical approaches, and postoperative outcomes. Materials & Method: A retrospective observational study was conducted over a two-year period. Medical records of women undergoing elective hysterectomy for benign gynecological conditions were reviewed. Data regarding age, parity, indications, type of surgery, intraoperative complications, and hospital stay were collected and analyzed using descriptive statistics. Result: A total of 500 elective hysterectomies were reviewed. Most women (60%) were aged 40–50 years, and multiparity was observed in 80% of cases. Abnormal uterine bleeding and fibroid uterus were the most common indications. Abdominal hysterectomy was the predominant surgical approach, while minimal intraoperative complications and acceptable recovery outcomes were noted. Conclusion: Elective hysterectomy continues to be a frequently performed procedure, mostly for benign uterine pathology. Careful patient selection and standardized surgical techniques ensure favorable outcomes.

Background: Snakebite envenomation remains a significant but neglected tropical disease, disproportionately affecting rural and agrarian populations in low- and middle-income countries. Despite global reductions in mortality, India continues to contribute substantially to the worldwide burden. Objectives: To assess the occupational risk, temporal trends, clinical features, and outcomes of snakebite envenomation in a rural hospital setting. Methods: This hospital-based observational study was conducted over 12 months at a tertiary care centre serving predominantly agrarian communities. A total of 100 consecutive patients with confirmed or suspected snakebite presenting within 24 hours of the incident were included. Data were collected on demographic factors, bite characteristics, clinical features, management, and outcomes. Results: Farmers accounted for the majority of victims (81%), reflecting occupational vulnerability. Poisonous bites were more common among males (41 cases), while females more often sustained non-poisonous bites. Temporal analysis revealed peak incidence during evening hours (4–8 pm). The lower extremities were the most frequent bite sites (89% of cases). Vasculotoxic (28 cases) and neurotoxic (14 cases) envenomations were associated with systemic complications including bleeding, cellulitis, gangrene, and respiratory compromise. Anti-snake venom was administered in 28 cases, with supportive interventions such as diuretics, hemodialysis, and blood transfusion in selected patients. Mortality occurred in three vasculotoxic and two neurotoxic cases, whereas no deaths were observed in local toxicity cases. Conclusion: Snakebite envenomation in rural regions is primarily an occupational hazard for farmers, with evening outdoor activity posing the greatest risk. Lower limb involvement predominates, and systemic envenomation contributes significantly to morbidity and mortality. Timely administration of anti-snake venom and reducing preventable deaths and complications.

Introduction: Medial compartment osteoarthritis (OA) of the knee is a common degenerative joint disorder characterized by pain, reduced function, and progressive deformity. Traditional treatment options range from conservative management, including analgesics and physiotherapy, to high tibial osteotomy and total knee arthroplasty in advanced stages. Proximal fibular osteotomy (PFO) has recently emerged as a minimally invasive surgical option to relieve pain and improve function by redistributing the load from the medial to the lateral compartment of the knee. Methods: This prospective interventional study was conducted over one year, from November 2017 to October 2018, at the Orthopaedics OPD, male and female wards, and elective operation theatre. A total of 62 patients with medial compartment knee osteoarthritis were enrolled. Study variables included patient sex, age, preoperative pain score, femoro-tibial angle, American Knee Society Score (AKSS) range, and functional score, as well as postoperative outcomes and overall functional results. All patients underwent proximal fibular osteotomy, and their clinical, functional, and radiological parameters were systematically recorded and analyzed to evaluate the efficacy of the procedure. Results: In this study of 41 patients (62 knees) undergoing proximal fibular osteotomy, 29% were male and 71% female, aged 40–65 years, mostly 61–65 years (36.6%). Preoperatively, femoro-tibial angles were mainly 130–134° (33.87%) with severe pain (scores 6–9). Postoperatively, 51 knees corrected to 177–180°, pain scores improved to 1–4 in most knees, medial joint space increased from 2.33 ± 0.58 mm to 4.20 ± 0.30 mm, and lateral joint space decreased to 5.80 ± 0.30 mm. AKSS improved, with 11 patients ≥90 and 49 patients 70–89, while functional scores showed 45 patients ≥80. Overall, 77% had good and 19% excellent outcomes, with minimal complications, demonstrating significant pain relief, functional improvement, and joint correction. Conclusion: Proximal fibular osteotomy is a safe, cost-effective, and minimally invasive procedure that provides significant pain relief and functional improvement in patients with medial compartment osteoarthritis of the knee. It can serve as an alternative surgical option for patients who are not candidates for high tibial osteotomy or total knee arthroplasty, especially in early to moderate OA. Long-term studies are warranted to assess durability and delayed complications.

Introduction: Stent related symptoms (SRS) are common after placement of DJ stent. Various tudies have shown decreased SRS with changes in stent length, stent diameter and stent material. Here we present a prospective cohort study on the effects of SRS using a novel Triple J Dalela stent with assessment of SRS using the Ureteral Stent Symptom Questionnaire (USSQ). Methods: All first hundred consecutive patients being operated at our centre for renal/ ureteral stone disease from December 2024 to April 2025 were included in this study. Exclusion factors included bilateral stone disease deranged renal function, history of cancer urinary bladder, genitourinary tuberculosis, interstitial cystitis and patients with deranged coagulation parameters. Symptom assessment was done using USSQ questionnaire in the post-operative period at 1^st week, 4^th week and at the time of stent removal. Stent removal was done routinely at 6 weeks unless the patient complained of severe SRS. Results: All of the 100 patients were followed up till stent removal. The median indwelling stent duration was 47 days. SRS were recorded based on the USSQ aspects of urinary symptoms, pain symptoms, sexual dysfunction and work performance. SRS were recorded after 1 week, 4 week of stent insertion and lastly at the time of stent removal. Urinary symptoms and pain symptoms were the major cause affliction with occurrence of urgency and dysuria at week 1 (21% & 17%), week 4 (24% &20%) and at time of stent removal (25% & 22%). Pain symptoms were most common in the loin area occurring in almost 30% patient while pain in supra pubic area was reported by 25%. Sexual side effects were less common and probably psychogenic. A majority of patients reported some sort of limitation while performing work. Conclusion: SRS are a significant cause of morbidity for patients undergoing dj stenting following endourological procedures. New stent designs like this Triple J Dalela stent may help in alleviation of these symptoms.

Background: Fluid cytology plays a pivotal role in the evaluation of serous effusions and other body fluids. It offers a minimally invasive, cost-effective, and rapid diagnostic tool for identifying a wide spectrum of benign and malignant conditions. Despite being a vital part of diagnostic pathology, the utility and diagnostic spectrum of cytological examination in body fluids remain underexplored in certain regional healthcare settings, such as Bihar. Objective: To assess the diagnostic utility, spectrum of cytological findings, and the distribution of benign versus malignant cases in various body fluids (pleural, peritoneal, and cerebrospinal fluid) over a one-year period at a tertiary care hospital in Bihar. Materials and Methods: A retrospective study was conducted in the Department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, over a period of 12 months (August 2024 to July 2025). A total of 125 fluid samples were included, comprising pleural, peritoneal, and cerebrospinal fluids received in the cytology section. All samples were processed using standard centrifugation, smear preparation, and staining techniques (Papanicolaou, Giemsa, and H&E where needed). Cytological findings were categorized into benign, suspicious, and malignant categories. Results: Out of the 125 fluid samples analyzed, 102 (81.6%) were diagnosed as benign/reactive, 13 (10.4%) were malignant, and 10 (8%) were suspicious for malignancy. Among malignant cases, adenocarcinoma was the most frequently identified malignancy, predominantly involving pleural fluid. The diagnostic yield was highest for pleural effusions, followed by ascitic and cerebrospinal fluids. Cytological examination provided significant diagnostic clues in cases of suspected malignancy and infection, thus aiding in clinical decision-making. Conclusion: Fluid cytology is an indispensable diagnostic modality in the assessment of body fluids. Its non-invasive nature, combined with reasonable accuracy, makes it a valuable first-line investigation. In resource-constrained settings like Bihar, it proves to be both practical and cost-effective, especially in early detection of malignancies and infectious diseases.

Introduction: When severely ill patients are admitted to intensive care units (ICUs), thrombocytopenia—defined as a platelet count below 150,000/µL—occurs frequently.  Depending on underlying conditions, drugs, and treatments, its frequency among ICU patients varies greatly, ranging from 8.3% to 67.6%. Aims: To study prevalence, likely aetiologies, pattern among different categories of patients and impact of thrombocytopenia on the 7 days mortality among the critically ill patients in an intensive care unit of a tertiary care hospital in Eastern India. Materials & Methods: This study is a prospective observational study conducted in a single-center setup at Command Hospital (Eastern Command), Kolkata. The study period extends from 1st October 2022 to 31st March 2024, and a total of 150 consecutive patients admitted to the ICU will be included. Result: In our study, majority of the patients were male (64.7%) and most of the patients were from age group 61-80 years (46.7%). 79 patients (52.7%) were admitted with pre-existent thrombocytopenia and 43 patients (28.7%) had developed thrombocytopenia during their hospital stay. The platelet trajectory was found to be biphasic with initial thrombocytopenia having nadir at 4-5 days of admission. Thrombocytopenia was found to be associated with baseline liver and kidney dysfunction and along with development of sepsis and overt disseminated intravascular coagulation. Presence of thrombocytopenia was found to be significantly associated with mortality (33.6% vs 3.6%, among those with and without thrombocytopenia respectively). Thrombocytopenia was also found to be associated with requirement of vasopressors support, invasive ventilator support and requirement of dialysis (50.8%, 43.4% and 27.0% respectively in thrombocytopenia group versus 21.4%, 35.7% and 7.1% respectively in non-thrombocytopenia group). Conclusion: We concluded that thrombocytopenia is encountered frequently among critically ill patients of ICU. It is associated with sepsis and disseminated intravascular coagulation along with requirement of life-supports. It is also associated with higher 07-day mortality among critically ill patients.

Introduction: Emergency inguinal hernia repair is difficult because of complications such as irreducibility, obstruction, or strangulation. The most common are the Lichtenstein tension-free mesh repair and the modified Bassini repair, which is not well represented in any comparative data in emergency cases. This paper will draw a comparison between their effectiveness in a tertiary care setting. Methods and Materials: The study was a prospective randomized study and took place between May 2009 and April 2012 at a tertiary care centre and included 150 emergency inguinal hernia patients. The patients were divided at random into Lichtenstein (n=75) and modified Bassini (n=75) repair. Outcomes were operative time, hospital stay, wound complications (seroma, dehiscence, infection, mesh infection/rejection) and long term complications (neuralgia, recurrence). Analyses were conducted in SPSS version 20.0 (t-tests, chi-square tests, and logistic regression, p<0.05 to determine significance). Results: The mean age was 52.3/14.7 years (Lichtenstein) and 53.1/15.2 years (Bassini) (p=0.72). The Lichtenstein group had a lower mean operative time (54.2 ±11.3 vs. 60.1 ±13.7 minutes, p=0.01), and hospital stay (3.8 ±1.9 vs. 5.2 ±2.4 days, p<0.01). The Lichtenstein group had less wound complications (8% vs. 16%, p=0.04), and no mesh infections. The Lichtenstein group had significantly lower incidences of neuralgia (4% vs. 12% p=0.03) and recurrence (0% vs. 6.7% p=0.02). Conclusions: Lichtenstein method is better in repairing inguinal hernia in an emergency with less operative time, hospital stay, complications and recurrence rates. Using it should be a preferable option where possible in an emergency environment.

Introduction: Asthma is the most frequent chronic illness in childhood, and like many other chronic conditions, it is likely to have an influence on the social and emotional elements of children’s and families’ life. India is home to around 15 million of the world’s over 200 million asthmatics. Bronchial asthma affects more than 5% of youngsters in their nation, and the burden is steadily growing. Poorly managed asthma is linked to considerable morbidity and socioeconomic issues such as school absenteeism and a low quality of life. Bronchial asthma impacts not just respiratory function, but also the physical, social, and emotional aspects of life. Aims:  To assess serum Vitamin D levels in 150 Asthmatic children 1-12 years of age and to study the relation between Vitamin D levels. Materials and Method: This is an Observational Prospective Study was conducted in Pediatrics Department of Calcutta National Medical College, Kolkata. The study period was March, 2021- February, 2022. 150 patients were included in this study. Result: It was found that, lower number of patients had Severity of MV Needed (Mechanical Ventilation) [6 (4.0%)] it was statistically significant (p< 0.00001), (Z=15.9349) and we also found that lower number of patients had Severity of Family H/O Asthma [38 (25.3%)] it was statistically significant (p< 0.00001).(Z=8.5448). Conclusion: We concluded that the serum Vitamin D levels was associated with Asthmatic children 1-12 years of age.

Background: Pediatric shock is a common and life-threatening emergency in intensive care units, with sepsis being a leading cause. Early recognition, risk stratification, and prompt management are crucial to improving outcomes. This study aimed to evaluate the clinical profile, laboratory parameters, and outcomes of children presenting with shock in a tertiary care pediatric intensive care unit (PICU) in India, with particular focus on the predictive utility of the PRISM III score. Methods: A prospective observational study was conducted on 125 children admitted with shock. Demographic details, vital signs, laboratory parameters, etiology of shock, complications, need for inotropic support, and outcomes were recorded. PRISM III scores were calculated at admission to assess severity. Data were analyzed to identify factors associated with mortality. Results: The majority of children were aged 1–5 years (44%) and male (63.2%), with most residing in urban areas (62.4%). Clinically, increased temperature (73.6%), tachycardia (70.4%), and tachypnea (74.4%) were common, with 55.2% hypotensive and 37.6% exhibiting oliguria. Septic shock was the predominant etiology (60%), followed by hypovolemic (15%), cardiogenic (15%), vasoplegic (14%), and obstructive shock (2%). Laboratory abnormalities included hyponatremia (16.8%), elevated CRP (60.8%), ferritin (43.2%), and deranged renal function (14.4%). Overall survival was 68%, with a mortality rate of 32%, higher among children with septic shock (70%). The mean ± SD PRISM III score was significantly higher among non-survivors (28.15 ± 5.34) compared with survivors (11.48 ± 2.01), indicating its utility in severity assessment. Conclusion: Pediatric sepsis in India is associated with high mortality, particularly in patients with multiorgan dysfunction, deranged laboratory parameters, and higher PRISM III scores. The PRISM III score is a useful tool for risk stratification and predicting length of hospital stay among survivors. Larger multicenter studies using updated sepsis definitions are warranted to better understand the burden and outcomes of pediatric sepsis in developing countries.

Introduction: Dengue fever is a common mosquito-borne viral illness that may be complicated by neurological manifestations, especially in children. These complications, though less frequently reported, are associated with significant morbidity and mortality. Aims: To examine the distribution of patients’ ages and genders who exhibit Dengue’s neurological symptoms. To determine which neurological conditions—such as encephalitis, seizures, Guillain-Barré Syndrome, and others—are more prevalent. Materials & Methods: This observational and descriptive single-centre study was conducted at R. G. Kar Medical College and Hospital over a period of three years, from January 2022 to January 2025. The study included a total of 33 paediatric patients (up to 12 years of age) who had laboratory-confirmed dengue infection (by NS1 antigen, IgM/IgG ELISA, or PCR) and presented with neurological symptoms. Result: The mean age of patients was 8.7 ± 3.1 years, with a male-to-female ratio of 1.36:1. The most common neurological manifestations were seizures (42.4%) and encephalopathy (33.3%), both significantly associated with CNS involvement (p=0.001 and p=0.008 respectively). CSF pleocytosis was seen in 30.3% and abnormal MRI findings in 36.4% (p<0.05). Compared to children without neurological symptoms, those with neurological manifestations had significantly lower platelet counts and longer ICU stays. Full recovery was observed in 66.7%, while 18.2% had residual deficits and 15.1% succumbed to the illness. Conclusion: Neurological involvement in pediatric dengue fever is not uncommon and presents predominantly with seizures and encephalopathy. Early detection, neurodiagnostic evaluation, and intensive care support are crucial for improving outcomes and preventing long-term complications.

Introduction: Distal both bone leg fractures, involving the tibia and fibula, present a challenge in orthopedic management due to potential complications such as malunion, nonunion, delayed union, and infection. Optimal treatment strategies remain debated, particularly regarding tibial fixation combined with fibular fixation. Aims: To compare the incidence of complications in patients with distal both bone leg fractures treated with fibula fixation combined with conservative management for tibia and fibula fixation combined with operative fixation for tibia. Methods: This was a prospective study conducted at Calcutta National Medical College and Hospital from January 2021 to February 2022, including patients admitted with distal tibia and fibula fractures in the Department of Orthopaedics. A total of 60 patients were enrolled, divided equally into two groups of 30 each. Data were collected on demographic and clinical variables including age, sex, mode of injury, side involvement, comorbidities, AO fracture classification, wound complications, and fracture-related complications. These variables were analyzed to assess outcomes and compare the two groups in terms of operative parameters, postoperative recovery, and complication rates. Results: Among 60 patients, most were aged 21–30 years (35.0%) and male (58.3%), with road traffic accidents being the leading cause of injury (56.7%). AO A1 fractures were most common (50.0%), and side involvement and comorbidities were similar between groups. Most patients had no wound (83.3%) or fracture complications (71.7%), though Group B had slightly more anterior knee pain and wound dehiscence. Group A had shorter operative time (0.48 ± 0.19 vs. 1.50 ± 0.27 hours) but delayed full weight bearing (16.9 ± 1.9 vs. 14.7 ± 1.7 weeks) and fracture union (26.4 ± 2.0 vs. 22.6 ± 3.1 weeks) compared to Group B. Conclusion: Fibula fixation combined with operative management of the tibia offers better fracture alignment, earlier union, and superior functional outcomes compared to conservative tibial management, though at the expense of a higher risk of surgical site complications. Individual patient factors, fracture configuration, and soft tissue condition should guide the choice of treatment modality.

Introduction: Distal radius fractures are among the most common upper limb fractures in adults, particularly in the elderly and those involved in high-energy trauma. The choice between operative and non-operative management remains a subject of debate, with considerations including fracture pattern, patient age, bone quality, and functional demands. Aims: This study aimed to compare the functional and radiological outcomes of operative versus non-operative management in adult patients with distal radius fractures. Methods: This prospective observational comparative study was conducted over one year at Calcutta National Medical College and Hospital, including 78 adult patients (≥18 years) admitted with isolated distal radius fractures. Patients were evaluated for side of injury, mechanism of fracture, functional recovery at different time points, wrist motion (flexion, extension, supination, pronation), radiological parameters (radial height, radial inclination, volar tilt), and complications. Data were collected systematically to compare outcomes between operative and non-operative management, focusing on functional and radiological results as well as adverse events. Results: In 78 patients (operative: 39, non-operative: 39; mean age 43.3 ± 12.7 years), baseline characteristics were similar. Early DASH scores favored operative treatment at 6 weeks (38.2 vs 45.6, p = 0.001) and 3 months (22.5 vs 27.1, p = 0.003), but were comparable at 6 months (12.4 vs 13.8, p = 0.12). At 6 months, flexion (75.2° vs 70.5°, p = 0.002) and extension (72.4° vs 68.3°, p = 0.004) were better in the operative group. Radiological outcomes were superior with operative management: radial height (11.8 vs 10.2 mm), radial inclination (22.5° vs 19.8°), and volar tilt (8.6° vs 5.9°) (all p < 0.001). Complications were low and similar overall (operative: 20.5%, non-operative: 23.1%, p = 0.78). Conclusion: Operative management of distal radius fractures in adults provides superior early functional recovery and better anatomical restoration compared to non-operative treatment. However, long-term functional outcomes at 6 months are comparable. Treatment choice should be individualized based on fracture type, patient age, activity level, and comorbidities.

Introduction: Acute appendicitis is one of the most common surgical emergencies and appendectomy is one of the most common operations. The incidence of acute appendicitis ranges from 8.6 to 11 cases per 1000 persons/year. Lifetime risk of developing acute appendicitis is about 8.6% in males and 6.7% in females. There is no unifying hypothesis regarding aetiology of acute appendicitis. Aims: The study aimed to analyze the seasonal variations in the incidence of acute appendicitis. It also sought to identify patterns that could help in predicting peak periods and optimizing healthcare resource allocation. Materials & Methods: This was a retrospective study conducted at Midnapore Medical College and Hospital, Midnapore, from 1st September 2021 to 31st August 2022. The study included a total of 380 patients diagnosed with acute appendicitis. Result: Out of 380 patients who underwent appendectomy for acute appendicitis, the highest incidence was observed in the summer season (June–August) with 132 cases (34.74%), followed by spring (March–May) with 101 cases (26.58%), autumn (September–November) with 93 cases (24.47%), and the lowest in winter (December–February) with 54 cases (14.21%). The seasonal variation was statistically significant (p < 0.0001). The incidence in summer was 20.53% higher than winter, 10.27% higher than autumn, and 8.16% higher than spring. Conclusion: We concluded that acute appendicitis incidence is increased significantly in the summer season. This seasonal variation is associated with various causes like dehydration, dietary habits, environmental factors like temperature, rainfall, humidity, hours of sunshine, air pollution and increased incidence of GI infections.

Substance use disorder (SUD) is a recognized risk factor for deliberate self-harm (DSH), yet limited research has examined its clinical and demographic predictors in Indian male populations. This cross-sectional study aimed to assess the patterns and predictors of self-harm among men with SUD. Conducted at the Psychiatry Department of SMS Medical College, Jaipur, from October 2023 to September 2024, the study included 100 male outpatients aged 18–60 years, diagnosed with SUD as per DSM-5 criteria. Participants were evaluated using a semi-structured proforma, the Deliberate Self-Harm Inventory (DSHI). The mean age of participants was 35.4 years. Nicotine (80%), opioids (68%), and alcohol (66%) were the most commonly used substances, with cannabis use reported by 51%. Poly-substance use was prevalent, and the most frequent combination involved alcohol, nicotine, and cannabis. DSH was reported in 31% of the sample. A statistically significant association was found between cannabis use and DSH (p = 0.003), suggesting cannabis as an independent predictor of self-harming behavior. The majority of participants were married, urban residents, and lived in joint families. These findings highlight the urgent need for comprehensive psychiatric evaluation and integrated intervention strategies targeting high-risk individuals within addiction treatment services.

Objective: To observe the pattern of drug use in patients admitted with diagnosis of Respiratory problems in Pediatric department. Methods: An observational study was conducted on 100 patients admitted with respiratory problems in the pediatric department of a tertiary care teaching hospital. Data were collected using a standardized proforma and analyzed using appropriate statistical methods. Results: A total of 479 case-sheets were analyzed. Most of the pediatric patients belonged to 1-5 years age group, and 66% were males and 44% were females. A total of 2678 drugs were prescribed. Average number of drugs per patient was 3.3. Among the antibiotics (20.3%) prescribed, cephalosporin group were most commonly prescribed followed by aminoglycosides and penicillin. Nutritional supplements, bronchodilators and antipyretics were other commonly prescribed drugs. Conclusion: The study revealed that the majority of children were in 1-5 years age group. These patients were admitted mostly with a diagnosis of bronchiolitis, which was treated with cephalosporins. Supportive treatment was given with bronchodilators and antipyretics and nutritional supplements were used for symptomatic management.

Background: Merocel nasal packs are widely used in nasal surgeries and epistaxis management, but their role in otologic surgery remains unexplored. Objective: To assess the outcomes of postoperative Merocel application in the external auditory canal following conchomeatoplasty, meatal reconstruction, and in diffuse otitis externa. Methods: Prospective observational study of 50 patients, divided into Merocel and non-Merocel groups, followed postoperatively for epithelialization, healing, stoma maintenance, meatal aperture, and pain reduction. Results: The comparison between CWU and CWD groups showed no significant differences in baseline characteristics such as age, gender, or side distribution. Audiometric thresholds at 500, 1000, 2000, and 4000 Hz, as well as overall PTA, were comparable between the two groups both pre- and postoperatively. Audiometric gain across all tested frequencies was also similar, with no significant difference in mean PTA gain. Distribution of ABG closure (<10 dB, 11–20 dB, and >20 dB) did not differ significantly between groups. Complications such as infection, residual disease, dizziness, and granulation tissue formation were observed in both groups without significant variation. No meaningful correlation was found between studied parameters and outcomes in either group. Conclusion: Merocel serves as a simple, effective adjunct in ear surgeries and otitis externa management, with potential for broader application.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide, particularly in developing countries like India, where underdiagnosis and delayed treatment remain common. Understanding the epidemiological and clinical spectrum of COPD patients is essential for improving disease management. Methods: This cross-sectional, observational study included 110 spirometry-confirmed COPD patients attending a tertiary care hospital. Data on demographics, smoking history, comorbidities, nutritional status, pulmonary function, and radiological findings were collected using a structured proforma. Spirometric grading was performed according to GOLD criteria, and descriptive statistics were applied. Results: Most patients were older adults, with peak prevalence in the 61–65 years group (21.82%). A strong association with smoking was observed, with the largest subset having 56–60 pack-years (19.09%). Hypertension and diabetes were frequent comorbidities, with 40% of patients having both. Nearly one-fourth (25.45%) were underweighted, while 47.27% had normal BMI. Spirometry revealed predominantly moderate (40%) obstruction, followed by very severe (25.45%) and severe (20%) disease, indicating late presentation. Radiological findings were heterogeneous, with increased bronchovascular markings (26.36%) and emphysematous changes (22.73%) being common, though 26.36% had normal chest X-rays. Conclusion: COPD in this cohort was strongly linked to age and cumulative smoking exposure, frequently complicated by hypertension, diabetes, and undernutrition. Most patients presented in moderate to very severe stages, while radiological changes were variable and often non-specific. Early detection through routine spirometry, aggressive smoking cessation strategies, nutritional interventions, and integrated comorbidity management are essential to improve outcomes and reduce disease burden.

Background: Posterior pedicle screw instrumentation is the standard of care for unstable thoracolumbar spine injuries. While short-term efficacy is well-established, data on the long-term (>5 years) structural integrity of the instrumentation and its correlation with clinical outcomes remain limited. Methods: We conducted a retrospective cohort study at a single tertiary trauma center. A total of 121 patients with single-level thoracolumbar burst fractures (AO Spine Type A3/A4) treated with posterior-only pedicle screw fixation between January 2008 and December 2015 were included. The mean follow-up period was 8.2 ± 2.1 years (range, 5.5–12.0 years). Radiological evaluation included measurement of the local kyphotic Cobb angle and anterior vertebral body height (AVBH) percentage at pre-operative, immediate post-operative, and final follow-up time points. Instrumentation-related complications, including screw loosening, screw breakage, and rod fracture, were recorded. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for back pain and the Oswestry Disability Index (ODI). Results: The mean local kyphotic Cobb angle was significantly corrected from 21.5° ± 5.4° pre-operatively to 4.8° ± 2.1° post-operatively (p < 0.001). At the final follow-up, a minor but statistically significant loss of correction was observed, with a mean Cobb angle of 7.1° ± 2.8° (p < 0.001 compared to post-operative). Similarly, the AVBH percentage improved from 65.2% ± 10.1% to 92.4% ± 5.5% (p < 0.001) and slightly decreased to 88.9% ± 6.3% at final follow-up (p = 0.002). Instrumentation-related complications occurred in 11 patients (9.1%), including screw loosening (n=8, 6.6%) and rod fracture (n=3, 2.5%). Both VAS and ODI scores showed significant improvement from pre-operative to final follow-up (VAS: 8.1 ± 1.0 to 2.2 ± 1.3, p < 0.001; ODI: 75.4% ± 8.9% to 18.6% ± 10.2%, p < 0.001). Conclusion: Posterior pedicle screw instrumentation provides excellent and durable long-term stability for thoracolumbar burst fractures. Despite a minimal, statistically significant loss of sagittal correction over time, the fixation maintains overall spinal alignment and is associated with sustained, significant improvements in pain and function. The rate of long-term instrumentation failure is relatively low.

Background: The digital revolution has fundamentally transformed adolescent behavior patterns, with Internet addiction emerging as a significant concern. Despite extensive research, considerable debate exists regarding its conceptualization and measurement, particularly among adolescents in developing nations. This study aimed to estimate the prevalence of Internet addiction and associated comorbidities among school-going adolescents aged 10-18 years. Methodology: A cross-sectional study was conducted among 340 adolescents from rural and urban schools in Jaipur district using purposive sampling. Data collection employed validated instruments including the Chen Internet Addiction Scale (CIAS), Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HAM-A). Statistical analysis was performed using SPSS version 20, with chi-square tests and Pearson correlation analysis. Results: The study revealed significant Internet addiction patterns with 26.2% showing normal usage, 17.4% mild addiction, 36.5% moderate addiction and 20.0% severe addiction. Residential area (p=0.021) and school category (p=0.042) were significantly associated with Internet addiction levels. Depression was prevalent with 47.9% showing moderate and 32.1% severe depression. Anxiety affected 49.4% moderately and 20.6% severely. A significant positive correlation existed between Internet addiction and depression (r=0.233, p<0.01), while the correlation with anxiety was weaker (r=0.086, p=0.114). Conclusion: Internet addiction is highly prevalent among adolescents with significant associations with depression and anxiety. Urban residence, private schooling and increased screen time emerged as key risk factors. The findings emphasize the urgent need for comprehensive screening protocols and targeted interventions addressing both technological behavior and mental health outcomes.

Introduction: Cervical cancer remains a significant cause of morbidity and mortality among women globally, particularly in developing countries. Concurrent chemoradiotherapy (CCRT) followed by brachytherapy is the standard of care for locally advanced cervical cancer (FIGO stages IIB–IIIB). While this combined modality improves survival, it is associated with treatment-related toxicities, particularly involving the bladder and rectum, which can significantly affect patients’ quality of life (QoL). Assessment of both acute and late genitourinary (GU) and gastrointestinal (GI) toxicities is essential to optimize patient management and supportive care. Methods: The study was a prospective observational study conducted at the Department of Radiotherapy, Burdwan Medical College and Hospital, Burdwan, from 1st February 2021 to 31st January 2022. The study population included 60 patients attending the radiotherapy outpatient department with biopsy-proven squamous cell carcinoma of the cervix in locally advanced stages (FIGO Stage IB2–IVA) who received concurrent chemoradiotherapy followed by intracavitary brachytherapy. The study variables assessed were bowel toxicities, bladder toxicities, grading of bladder toxicity, functional scale, symptom scale, and global health scale to evaluate both treatment-related adverse effects and quality of life outcomes. Results: Before treatment, bowel and bladder toxicities were minimal. Following concurrent chemoradiotherapy and brachytherapy, mild bowel issues such as diarrhea (up to 14.5%), rectal discharge (15.8%), and intermittent bleeding (3.6%) peaked at 3 months but improved by 6 and 9 months, with severe complications like obstruction and fistula being rare (1.9%). Bladder toxicities, including mild cystitis, urinary frequency, urgency, and dysuria, followed a similar pattern, with most patients exhibiting grade 0 toxicity and severe events uncommon. Quality of life progressively improved over time, with functional scores increasing from 65.44 ± 12.98 to 81.09 ± 7.94, symptom scores decreasing from 35.05 ± 11.96 to 21.36 ± 8.77, and global health status rising from 48.35 ± 5.98 to 75.67 ± 12.79. Conclusions: Concurrent chemoradiotherapy followed by cobalt-based brachytherapy in locally advanced cervical cancer is effective but associated with measurable bladder and rectal toxicities, mostly mild to moderate in severity. While overall quality of life recovers post-treatment, persistent GU and GI symptoms can negatively impact patient well-being. Continuous monitoring, early management of toxicities, and supportive interventions are crucial to maintain QoL in survivors of cervical cancer.

Background: Hepatitis B virus (HBV) infection affects more than 296 million people worldwide and remains a leading cause of chronic liver disease and hepatocellular carcinoma. Many individuals remain asymptomatic, leading to incidental detection during routine evaluations. Screening individuals with abnormal liver function tests (LFTs) can provide an opportunity for early diagnosis and intervention. Methods: This descriptive study was conducted over one year (September 2023–September 2024) at a tertiary care center in Tamil Nadu. A total of 175 adult patients with abnormal LFTs detected during the routine master health checkups were screened for HBV surface antigen (HBsAg) using lateral flow immunochromatography (ICT) and chemiluminescent immunoassay (CLIA). Patients with known HBV infection, those under 18 years, and recently vaccinated individuals were excluded. Results: Of 175 samples, 11 (6.3%) tested positive by ICT, while 14 (8.0%) were positive by CLIA. All ICT-positive samples were confirmed by CLIA. The additional three cases detected only by CLIA highlight its superior sensitivity. Among positives, 9 were male and 5 were female. Age distribution showed most cases were in the 30–50 years group. Conclusion: Incidental detection of HBV in patients with abnormal LFTs during health checkups is valuable for identifying asymptomatic carriers. CLIA demonstrated better sensitivity compared to ICT, suggesting its preferred use in screening. Routine inclusion of HBsAg testing in health checkups can improve early diagnosis, reduce transmission, and guide appropriate follow-up and management.

Background: Diabetes mellitus (DM) is a major non-communicable disease characterized by chronic Hyperglycemia, with type 2 diabetes forming the majority of cases. Its burden is rising rapidly worldwide, particularly in India, due to demographic transition, sedentary lifestyle, obesity, and genetic predisposition. Identifying demographic and lifestyle factors associated with diabetes is critical for prevention and management. Methods: This cross-sectional observational study was conducted on 200 clinically and biochemically diagnosed diabetic patients. Data were collected on demographic characteristics, family history, body mass index (BMI), and lifestyle activity levels using a structured questionnaire. BMI was categorized according to WHO criteria, and lifestyle activity was classified as sedentary, mild, moderate, or vigorous. Descriptive statistics were applied to analyze the frequency distribution of risk factors. Results: The prevalence of diabetes increased progressively with age, with the majority of cases observed in patients above 60 years. Sedentary lifestyle was the most common activity level (33%), followed by moderate (26.5%), mild (21.5%), and vigorous (19%). Family history of diabetes was present in 76% of patients. Regarding BMI, 37% were obese, 29% overweight, 15.5% normal, and 18.5% underweight, with two-thirds of patients falling in the overweight/obese category. The findings demonstrate strong associations of diabetes with advancing age, sedentary lifestyle, positive family history, and higher BMI. Conclusion: Diabetes in this population was predominantly associated with modifiable factors such as sedentary lifestyle and obesity, along with non-modifiable determinants like age and family history. Preventive strategies focusing on lifestyle modification, weight management, and early screening of high-risk individuals are essential to reduce the growing diabetes burden in India.

Background: Motor neuron disease (MND) encompasses a group of progressive neurodegenerative disorders affecting motor neurons. Understanding the clinical and demographic patterns of MND in specific populations is crucial for improving diagnosis and management. This study aimed to analyze the clinical and demographic characteristics of MND patients presenting to a tertiary care center in Northeast India. Methods: This observational study analyzed 40 patients diagnosed with MND at the Department of Neurology, Gauhati Medical College, and Guwahati. Data collected included demographics, clinical presentation, El Escorial classification, and one-year survival outcomes. Statistical analysis was performed using appropriate tests with significance set at p<0.05. Results: The study cohort (n=40) showed male predominance (70%) with a mean age of 58.8 years. Spinal onset was most common (50%), followed by bulbar (30%), generalized (10%), and bibrachial (10%) onset. Bulbar involvement was present in 72.5% of patients. The majority were classified as probable ALS (62.5%) by El Escorial criteria. One-year survival was 82.5%. Numerical differences were observed in survival rates across onset types, with bibrachial onset showing 100% survival and generalized onset showing 50% survival, but these did not reach statistical significance (p=0.276). A trend toward lower survival in patients with definite ALS was noted, potentially reflecting more advanced disease at presentation. Conclusions: This study reveals distinct clinical patterns of MND in Northeast India, with high prevalence of bulbar involvement and relatively favorable one-year survival rates. The heterogeneity in presentation and outcomes based on onset type highlights the importance of individualized prognostic assessment and management strategies.

Introduction: Hypoglycemia is a common and potentially life-threatening condition encountered in medical wards. It presents with varied clinical symptoms and is influenced by multiple underlying illnesses and precipitating factors. Understanding the clinical spectrum, associated comorbidities, and precipitating causes is crucial for early diagnosis and management. Aims: Aims to document clinical presentations, identify background illnesses and precipitating factors, and follow the illness course during hospital stay in each hypoglycemia case. Materials and Methods: This hospital based single Centre study was conducted in the N.R.S. Medical College and Hospital Kolkata (Department of General Medicine Ward from March 2020 to August 2021.This study included 100 patients. Result: Among the 100 patients, the mean age was 48.22 ± 3.65 years, with a male predominance (64%). Common clinical features included cold clammy extremities (41%), convulsions (24%), and loss of consciousness (35%). Drug-induced hypoglycemia was the leading diagnosis (73%), followed by sepsis (19%) and alcohol-induced hypoglycemia (8%). Five patients (5%) died during hospitalization. Significant differences between death and survival groups included higher total leukocyte count, neutrophil percentage, CRP, urea, and urine albumin-creatinine ratio, and lower lymphocyte percentage and cortisol levels in those who died. Imaging showed cerebral edema was more common in deceased patients. No significant differences were found in age, sex, comorbidities, or drug history between groups. Conclusion: Hypoglycemia in hospitalized patients is associated with diverse clinical presentations and underlying conditions. Elevated inflammatory markers, renal dysfunction, low cortisol levels, and cerebral edema are linked to worse outcomes. Early identification of these factors may improve management and prognosis.

Pneumonia is the leading cause of mortality of under-five children in various developing countries, including India. This was a study of  community acquired pneumonia(CAP)conducted on 100 children in the age group of 1 month to 12 years, with clinical features of tachypnoea with fever and cough as per WHO criteria who got admitted under paediatrics department of Madha Medical College and Research Institute, Chennai during February 2023 to May 2024.Objectives of our study were to study the clinical and bacteriological profile of children admitted with CAP and to determine sensitivity and resistance patterns to various antibiotics to these organisms. Study showed that 71% of the children belonged to the age group of 1month-12months, male to female ratio was 1.22:1. Rapid breathing (100%), cough (100%) and fever (100%) were the most common symptoms. Refusal of feeds was present in 28% cases. Tachypnoea (100%), chest retractions (87%) and crepitations (82%) were the most common signs.65% were breast-fed and 35% were given bottle feeds. In our study, 68 % of patients were malnourished which includes severe acute malnutrition (33%) and moderate acute malnutrition (16%) in the age group of 6 months to 5 years of age and other 19 % undernourished children of more than 5 years of age and infant of 1 month to 6 months of age. Anemia was present in 55%. The conclusion from this study is that incidence of CAP is more common in the infant age group, children who are anaemic, malnourished and have inadequate vaccination coverage. The sensitivity and resistance pattern of antibiotics for isolated organism observed in this study can be used to formulate the antibiotic policy in children with community acquired pneumonia in the study hospital.

Background: Femoral fractures are highly painful and commonly require surgical fixation, typically performed under SAB (Subarachnoid Block). However, severe pain can hinder proper positioning for SAB. PNB (Peripheral Nerve Blocks), such as FNB (Femoral Nerve Block) and FICB (Fascia Iliaca Compartment Block) offer effective analgesia in these cases. Methods: This prospective observational study included 70 patients undergoing femur fracture surgery, divided into two groups: Group 1 (n=35) received ultrasound-guided FNB (15 ml of 0.25% bupivacaine), and Group 2 (n=35) received FICB before SAB. Parameters assessed included VAS during positioning, ease of interspinous space palpation, number of dural puncture attempts, patient satisfaction, and haemodynamic/respiratory changes. Results: Both blocks effectively reduced pain during positioning, but Group 2 (FICB) showed significantly lower VAS scores (p < 0.05), indicating superior analgesia. Both techniques had a similar onset of analgesia, achieving pain relief within 15 minutes (p < 0.05). Patient satisfaction was higher in the FICB group (p < 0.05). Quality of positioning, assessed by fewer spinal attempts, was also better in the FICB group (p < 0.05). No significant differences were observed between groups regarding interspinous palpation, haemodynamic, or respiratory changes. Conclusion: Preoperative FICB provides superior analgesia compared to FNB for SAB positioning in femur fracture surgeries, evidenced by lower VAS scores, better positioning, and higher patient satisfaction. Both techniques were safe with no significant impact on haemodynamics or respiration during positioning.

Background: Hypothyroidism is a common endocrine disorder characterized by decreased secretion of thyroid hormones, leading to a reduced metabolic rate. Emerging evidence suggests that thyroid dysfunction may be linked with oxidative stress due to impaired balance between reactive oxygen species (ROS) and antioxidant defense mechanisms. Objective: To evaluate the levels of oxidative stress markers and antioxidant status in patients with hypothyroidism, and to examine the association between these parameters and thyroid-stimulating hormone (TSH) levels in a Central Indian population. Methods: This case-control study was conducted at Index Medical College Hospital & Research Centre, Indore. A total of 135 hypothyroid patients and 204 age- and gender-matched healthy controls were included. Serum levels of malondialdehyde (MDA), superoxide dismutase (SOD), total antioxidant capacity (TAC), Vitamin C, Vitamin E, T3, T4, and TSH were measured using standardized spectrophotometric and immunoassay techniques. Statistical significance was assessed using t-tests and Pearson’s correlation analysis. Results: Hypothyroid patients showed significantly elevated MDA levels (3.1 ± 0.9 nmol/L vs. 1.07 ± 0.61 in controls, p< 0.0001), and reduced SOD (2.80 ± 0.11 U/mL), TAC (0.72 ± 0.31 mmol/L), Vitamin C (0.91 ± 0.12 mg/dL), and Vitamin E (0.66 ± 0.07 µg/dL) compared to controls (p< 0.0001 for all). TSH was significantly elevated. Pearson correlation showed MDA positively correlated with hypothyroidism (r = 0.45, p< 0.001), while SOD had a weak negative correlation (r = -0.31, p = 0.015) and TAC had a moderate positive correlation (r = 0.55, p< 0.001). Conclusion: Hypothyroidism is associated with increased oxidative stress and significantly impaired antioxidant defenses. These findings suggest a potential role for antioxidant monitoring and supplementation as adjunct therapy in the management of hypothyroid disorders.

Background: Assisted reproductive techniques (ART) have revolutionized infertility treatment, enabling many couples to achieve pregnancy. However, concerns persist regarding the safety of ART pregnancies, particularly in terms of maternal and fetal outcomes. This study evaluates maternal and fetal outcomes in ART-conceived pregnancies compared to spontaneously conceived pregnancies in a tertiary care center in Western Gujarat, India. Material and Methods: A retrospective cohort study was conducted at a tertiary care center in Western Gujarat for a period of 2 years, including 250 ART-conceived pregnancies and 500 age-matched spontaneously conceived pregnancies. Maternal outcomes assessed included gestational diabetes mellitus (GDM), hypertensive disorders, preterm birth, and cesarean section rates. Fetal outcomes included gestational age, birth weight, Apgar scores, and congenital anomalies. Logistic regression and t-tests were used to compare outcomes, adjusting for confounders like maternal age and parity. Results: ART pregnancies showed a higher incidence of GDM (OR 1.8, 95% CI 1.2–2.7), hypertensive disorders (OR 1.6, 95% CI 1.1–2.4), preterm birth (OR 1.5, 95% CI 1.0–2.2), and cesarean delivery (OR 2.0, 95% CI 1.4–2.9) compared to spontaneous pregnancies. Fetuses from ART pregnancies had lower mean gestational age (37.2 vs. 38.5 weeks, p=0.001) and birth weight (2.8 vs. 3.1 kg, p=0.002). Multiple pregnancies (25% in ART vs. 5% in controls) significantly mediated these outcomes. Congenital anomalies were slightly higher in ART (3.2% vs. 2.0%, p=0.08). Conclusion: The increased risks in ART pregnancies, particularly for GDM and preterm birth, align with global and Indian studies, likely due to multiple pregnancies and maternal factors. ART pregnancies in Western Gujarat exhibit higher maternal and fetal complications compared to spontaneous pregnancies, primarily driven by multiple gestations. Enhanced prenatal care is warranted to optimize outcomes.

Background: Hearing is essential for speech, language, and cognitive development. In India, 4–6 out of every 1000 children are born with significant hearing impairment. Early identification and intervention are critical, particularly in rural areas where prevalence is higher and access to care is limited. OAE (Otoacoustic Emission) testing, including TEOAE (Transient Evoked Otoacoustic Emission) and DPOAE (Distortion Product Otoa-coustic Emission) methods provide a simple, non-invasive tool for early hearing loss detection in neonates. Methods: This cross-sectional study was conducted from November 2016 to September 2018 in rural areas of Chikkaballapur district, Karnataka. A total of 953 neonates and infants attending primary health centers were screened using a three-stage protocol. The first and second stages involved TEOAE/DPOAE testing and those who failed were subjected to BERA (Brainstem Evoked Response Audiometry) as a confirmatory test. Results: Out of 953 screened neonates and infants, the prevalence of hearing loss was found to be 0.419%. The study demonstrated the effectiveness of the TEOAE/DPOAE screening protocol in early identification of con-genital hearing loss. Conclusion: OAE based screening is a reliable, feasible and efficient method for early detection of congenital hearing loss particularly in rural settings. Incorporating this method into UNHS (Universal Newborn Hearing Screening) programs can facilitate early diagnosis and timely intervention, promoting optimal speech and lan-guage development.

Background: Neonatal encephalopathy (NE) is the clinical syndrome of disordered neurological function, and hypoxic ischemic encephalopathy (HIE) is NE that follows a perinatal hypoxic ischemic event. Strict criteria for making this diagnosis are constantly being developed but the essential components are the development of encephalopathy in a term/near term neonate soon after birth following an intrapartum event likely to cause hypoxia-ischemia. Aim: To study the clinical profile and short-term outcomes of whole-body therapeutic hypothermia in patients of hypoxic ischemic encephalopathy. Method: It was a prospective observational study conducted in a level IIIA NICU in Shri Shishu Bhawan Hospital, Bilaspur which is a tertiary care hospital from April – 2022 to March – 2023. It included all the newborn patients admitted with birth asphyxia with convulsions. Epidemiological data was collected, and patients were monitored for other complications. APGAR scores were recorded and Modified Sarnat and Sarnat staging was used to categorize HIE. Data was analyzed through SPSSv30. Results: Out of 12 neonates with birth weight <2.5 kg, 10 (83.33%) neonates were discharged and 2 (16.67%) neonates died while out of 51 neonates with birth weight >2.5 kg, 34 (66.67%) neonates were discharged and 17 (33.33%) neonates died. Results also show mortality in low birth is less than birth weight >2.5 kg. Our study shows outcome is better and low death occur when therapeutic hypothermia starts before 6hrs as compared to initiated after 6hrs. This may be due to early start of therapy leads to early reversal of pathology, early resuscitations and supportive treatment. Conclusion: Therapeutic hypothermia initiated before 6hrs had lesser complication like seizures, persistent acidosis, cardiac arrhythmia, hypotension, hypoglycemia and oliguria compared to initiate after 6hrs this may be due to early reversal of pathology during the first stage which is primary neuronal death and taking benefits of the latent period between primary and delayed neuronal death which is approximately 6 hours.  Also, outcomes better if initiation of cooling is within 6hrs compared to after 6hrs mostly due to taking benefits of the latent period between primary and delayed neuronal death which is approximately 6 hours.

Background: Intraoperative squash smear cytology is an effective method for the prompt diagnosis of neurosurgical specimens. This method is easy, rapid, inexpensive and designed to evaluate the precision of intraoperative squash smear cytology in identifying space-occupying lesions within the Central Nervous System (CNS). Aims and Objectives: To evaluate the value of squash smear cytology for rapid intraoperative diagnosis of CNS tumors. To know the pattern of CNS tumors cytologically. To determine the limitations of squash smears. Methods: Intraoperatively, tumor tissues obtained from the neurosurgeon were subjected to a squash smear examination at the Department of Pathology, VIMSAR, Burla. The tissue samples were gently squashed between glass slides, stained with rapid Hematoxylin and Eosin (H & E) and Diff-Quik stain, and examined under a microscope. The cytological features were documented and correlated with subsequent histopathological diagnoses obtained from formalin-fixed, paraffin-embedded sections. Results: Eighty cases were received from the Department of Neurosurgery, of which 9 were non-neoplastic cases and 71 had neoplastic lesions. Meningioma accounted for the largest group of tumors among the neoplastic lesions, with 35 cases (49.29%). A total of 65 cases (91.54%) showed complete correlation with histopathology, one case (1.40%) showed partial correlation, and 5 (7.04 %) were discordant. Conclusion: Squash smear cytology is a reliable, rapid, and cost-effective method for intraoperative diagnosis of CNS tumors.

Background:  Despite the availability of various therapeutic options, achieving optimal glycemic control remains a major challenge in clinical practice. One of the primary barriers to effective diabetes management is poor medication adherence. Non-adherence is a common issue among patients with chronic illnesses and is particularly prevalent in diabetes due to the need for long-term therapy, polypharmacy, adverse effects of medications, lack of patient education, economic constraints, and complex dosing regimens. Methodology: A cross-sectional, observational study was conducted in which Structured Case Record Form (CRF) was Used to collect data on Demographics (age, gender, socioeconomic status), Clinical details (duration of diabetes, comorbidities, complications), Current medications (drug names, dose, frequency, combination), Investigations, if available (HbA1c, fasting and postprandial glucose, renal function).  The Morisky Medication Adherence Scale (MMAS-8) was used to assess adherence and Face-to-face interviews were conducted to assess factors influencing adherence such as, Awareness about diabetes, Side effects, Cost of therapy, Family and social support, Frequency of follow-up. Results: Metformin was the most prescribed drug (65%), followed by sulfonylureas (40%) and DPP-4 inhibitors (28%). Insulin was prescribed to 18% of patients, mostly in those with poor glycemic control or long-standing diabetes. Only 28.8% of patients demonstrated high adherence. A majority had moderate (39.2%) or low adherence (32.0%). Conclusion: Metformin was the most commonly prescribed drug, with a high prevalence of combination therapies. However, only 28.8% of patients demonstrated high adherence, while factors such as polypharmacy, low literacy, and high drug costs contributed to poor compliance.

Background: Female infertility is multifactorial, caused by ovarian, tubal, uterine, and peritoneal factors, as well as unexplained causes, affecting reproductive outcomes globally. Objective: To identify and determine the incidence of various causes of female infertility in patients presenting to a tertiary care center in India. Material and Methods: A prospective observational study was conducted among 80 women presenting with infertility. Clinical evaluation, hormonal profiling, imaging, and laparoscopic or hysteroscopic assessments were performed to determine etiological factors. Data were analyzed using descriptive and inferential statistics. Results: Ovarian and tubal factors were the most common causes of infertility. Uterine and peritoneal factors contributed significantly, while a substantial proportion remained unexplained. Hysterolaparoscopy provided comprehensive assessment, confirming multifactorial etiologies. Conclusion: Female infertility is predominantly multifactorial, with ovarian and tubal factors leading. A systematic, multidisciplinary diagnostic approach is essential to accurately identify causative factors and guide effective management.

Introduction: surgical site infections cause increased post-operative morbidity. In initial days antibiotics were used to be given post-operatively for longer durations which led to little reduction of surgical site infections. With advent of intravenous pre-operative antibiotic administration, the incidence of SSIs reduced significantly. The antibiotic concentration rises in blood and later reaches at the wound site the where the concentration of antibiotic is lower. With modern aseptic techniques and intravenous pre-operative antibiotic administration the incidence of SSI has reduced significantly but is almost constant for many years this has led to search for innovative efforts to reduce the SSI, in view of this pre-incisional infiltration of antibiotics seems to a good candidate. Various studies have shown the measured local antibiotic level to be considerably higher in the patients getting local infiltration of antibiotics than the patients getting intravenous antibiotics alone. Aim: To assess and compare reduction in incidence of surgical site infection between patients receiving parenteral antibiotics to patients receiving both parenteral and pre-incisional antibiotic infiltration of the wound site. Materials and Methods: 138 patients were enrolled in the assuming Alpha error (5%) power (80%) and confidence interval (95%), randomization was done by computer generated random tables for different sub groups. Patients were divided in two main groups. Group I received both pre-incisional local and parenteral antibiotics, Group II received only parenteral antibiotics, both the groups were further divided into 3 group each as clean, clean contaminated, contaminated and dirty groups. Inclusion criteria: Patients operated in both emergency and elective operation theatres, patients who underwent abdominal surgeries, procedure lasted less than 3 hours, patients who developed infection within 30 days of surgery. Exclusion criteria: patients with skin infections and infection at other site, patients with psoriasis and other exanthema disorders. Results: Incidence of SSI was significantly less in group receiving pre-operative intra-incisional antibiotics as compared to the group receiving only intravenous antibiotics. Conclusions: SSI occurred in 25 out of 92 males while 5 out of 46 females which is statistically significant. Poorly controlled diabetes, smoking and poor nutritional status were associated with higher rate of SSI. SSI was significantly more in emergency patients as compared to elective cases.

Background: Hemorrhoidal disease is a common anorectal condition causing significant morbidity and impaired quality of life. Sclerotherapy has been increasingly utilized as a minimally invasive and cost-effective therapeutic option, particularly in resource-limited settings. Objective: To evaluate the short-term and mid-term outcomes of sclerotherapy in patients presenting with bleeding hemorrhoids. Methods: A prospective observational study was conducted in the Department of General Surgery, Agartala Government Medical College & GBP Hospital, Tripura, over 18 months. A total of 270 patients with bleeding hemorrhoids were enrolled. Following proctoscopic diagnosis, patients received sclerotherapy using 5% phenol in almond oil, sodium tetradecyl sulphate, or polidocanol. Clinical outcomes were assessed at 1 week, 1 month, 3 months, and 6 months post-procedure. Results: The mean age of participants was 41.3 years, with a male predominance (64.1%). On proctoscopy, Grade II hemorrhoids were more common (61.1%) than Grade I (38.9%). Symptom resolution was achieved in 94.4% of patients after one week. The recurrence rate of bleeding within six months was 9.8%. Post-procedural complications occurred in 7.9% of cases, most being minor (tenesmus, dizziness, chest pain). Only 7.9% required additional sclerotherapy sessions. Conclusion: Sclerotherapy is a safe, effective, and minimally invasive outpatient procedure for the management of Grade I and II hemorrhoids. Its high symptom resolution and low recurrence rates support its continued use, particularly in regions with limited surgical resources.

Background: Pre-clinical subjects like biochemistry in medical education often present challenges due to their conceptual complexity and extensive information volume, leading to suboptimal student engagement with traditional teaching methods. The shift towards Competency Based Medical Education (CBME) necessitates innovative, active learning strategies. Game-Based Learning (GBL) platforms, such as Kahoot! offer interactive quiz-based formats designed to enhance participation and formative assessment. This study aimed to evaluate the effectiveness and feasibility of Kahoot! as a learning tool in Phase I MBBS biochemistry, and to analyse student and faculty perceptions regarding its utility and implementation. Methods: A 6-month descriptive, cross-sectional study was conducted at the Government Institute of Medical Sciences, Greater Noida, involving 99 Phase I MBBS students and 7 biochemistry faculty members. Kahoot! was integrated into standard biochemistry lectures for formative assessment, utilizing multiple-choice quizzes, competitive leaderboards, and audio-visual stimuli. Data on student and faculty perceptions were collected via a pre-validated Likert-scale questionnaire, and a Satisfaction Index (SI) was calculated for quantitative responses. Results: Student perceptions demonstrated high satisfaction, with 92.8% feeling inspired to learn more, 95.21% desiring more quiz game lectures, and 93.04% agreeing it improved conceptual understanding. A significant majority (90.75%) found classroom activity engaging, and 89.54% supported its use in assessment. Faculty responses also showed strong support, with 97.6% finding Kahoot! more interesting than traditional didactic lectures and supporting its future inclusion. Additionally, 95.2% of faculty observed increased student engagement and participation and agreed Kahoot! could be effectively used in assessment. Conclusion: The study concludes that Kahoot! is a feasible, effective, and well-received learning tool in Phase I MBBS biochemistry. Its successful integration significantly enhances student engagement, interaction, and conceptual understanding, while also providing valuable formative assessment opportunities. Both students and faculty expressed high satisfaction and strong support for its continued use, reinforcing its potential to enrich learning environments within a CBME framework.