Background: Chronic kidney disease (CKD) is characterized by progressive loss of renal function and high cardiovascular risk. Microalbuminuria reflects glomerular and endothelial injury and is widely used for risk stratification. Oxidative stress has been implicated in CKD progression, yet the relationship between systemic antioxidant defenses and microalbuminuria across CKD stages requires clearer clinical characterization. Objective: To evaluate stage-wise changes in antioxidant biomarkers and to determine their association with microalbuminuria among CKD patients. Methods: This observational cross-sectional study included 60 CKD patients spanning stages 1–5. Participants were grouped as early CKD (stages 1–2), moderate CKD (stage 3), and advanced CKD (stages 4–5). Enzymatic antioxidants—superoxide dismutase (SOD), catalase, and glutathione peroxidase (GPx)—and total antioxidant capacity (TAC) were assessed. Microalbuminuria was measured using the urinary albumin–creatinine ratio (ACR). Stage-wise comparisons, correlation analysis, and multivariate linear regression were performed, adjusting for age, diabetes mellitus, and CKD stage. Results: Antioxidant biomarkers showed a significant progressive decline with advancing CKD stage (all p < 0.001), while ACR increased markedly across stages (p < 0.001). TAC demonstrated the strongest inverse correlation with ACR (r = −0.50, p < 0.001), followed by GPx (r = −0.48, p < 0.001). In multivariate regression analysis, TAC (β = −0.40, p < 0.001) and GPx (β = −0.35, p = 0.002) remained independent negative predictors of microalbuminuria, whereas CKD stage (β = +0.45, p < 0.001) and diabetes mellitus (β = +0.20, p = 0.01) were positive predictors. Conclusion: Declining antioxidant defense is independently associated with microalbuminuria in CKD, supporting oxidative imbalance as a mechanistic contributor to albuminuric renal injury.

Introduction: Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. Early identification of individuals at increased risk is essential for timely intervention. Carotid intima–media thickness (CIMT), measured by high-resolution B-mode ultrasonography, reflects early atherosclerotic changes and has emerged as a reliable, non-invasive marker of systemic atherosclerosis and cardiovascular risk. Aims: To evaluate carotid intima–media thickness as an independent predictor of coronary artery disease and to assess its association with cardiovascular risk factors. Materials and Methods: This hospital-based observational case–control study was conducted in the Department of Radiology, BKL Walawalkar rural medical college, Chiplun, Ratnagiri. The study included 52 angiographically confirmed CAD cases and 26 age- and gender-matched controls without CAD. All subjects underwent clinical evaluation, biochemical investigations, and carotid ultrasonography for measurement of CIMT, carotid plaque, and degree of carotid stenosis. Statistical analysis was performed to determine the association between CIMT and CAD. Results: Mean CIMT was significantly higher in CAD cases compared to controls. Carotid plaque was present in 65.38% of cases versus 23% of controls (p < 0.05). CAD cases showed significantly higher total cholesterol, LDL-C, triglycerides, post-prandial blood sugar, and body mass index, with lower HDL-C levels. Moderate to severe carotid artery stenosis was observed exclusively among cases, supporting the role of increased CIMT as an independent predictor of CAD.

Background: Oxidative stress is increasingly recognized as a central mechanism driving the progression of Chronic Kidney Disease (CKD) and glomerular injury. While the depletion of antioxidant defenses is well-documented in uremia, the specific relationship between Glutathione Peroxidase (GPx) activity—a critical enzyme in hydrogen peroxide scavenging—and the severity of albuminuria remains under-characterized in non-dialysis populations. This study aimed to evaluate the status of GPx activity across CKD stages and determine its correlation with urinary albumin excretion. Methods: We conducted an observational, cross-sectional study involving 60 patients with non-dialysis CKD (Stages 1–5) at a tertiary care center in Central India. Patients on antioxidant supplementation or renal replacement therapy were excluded. Serum GPx activity, Total Antioxidant Capacity (TAC), and Malondialdehyde (MDA) levels were quantified. Urinary albumin excretion was assessed using the Urinary Albumin-to-Creatinine Ratio (UACR). Statistical analysis included ANOVA for stage-wise comparisons and Pearson’s correlation coefficient to assess associations between oxidative markers and renal parameters. Results: The study cohort (mean age 56.4 ± 12.3 years) exhibited a systemic reduction in mean GPx activity (6.8 ± 2.1 U/mL) compared to reference standards. We observed a significant, stepwise decline in GPx activity advancing from CKD Stage 1 through Stage 5 ($p < 0.001$). Correlation analysis revealed a robust inverse relationship between serum GPx activity and microalbuminuria ($r = -0.48, p < 0.001$), as well as 24-hour urinary albumin excretion ($r = -0.52, p < 0.001$). Conversely, GPx activity was positively correlated with the estimated Glomerular Filtration Rate (eGFR). Conclusion: Our findings demonstrate that the depletion of Glutathione Peroxidase activity is strongly associated with the magnitude of albuminuria and the severity of renal impairment. This suggests that compromised enzymatic antioxidant defense is a pivotal factor in glomerular barrier dysfunction. Monitoring GPx activity may serve as a valuable biomarker for oxidative stress, highlighting a potential therapeutic target to retard CKD progression.

Background: Caesarean section remains a major operative procedure in obstetrics, accounting for approximately 20-30% of deliveries globally. The choice of skin closure technique influences postoperative wound complications and cosmetic outcome. Interrupted vertical mattress sutures provide rapid closure with wound eversion, while continuous subcuticular sutures offer superior cosmesis but require technical expertise. Objective: To compare interrupted vertical mattress sutures with continuous subcuticular sutures regarding wound infection, dehiscence, pain, operative time, and cosmetic outcome following caesarean section. Methods: A prospective comparative study was conducted at District Hospital Kishtwar, Department of Obstetrics and Gynaecology, Jammu & Kashmir, India from January 2025 to June 2025. A total of 100 women aged 18-40 years at gestation 37-41 weeks undergoing elective caesarean section via Pfannenstiel incision were allocated into two groups: Group A (continuous subcuticular polyglactin 2-0, n=50) and Group B (interrupted vertical mattress silk 2-0, n=50). All patients received single preoperative ceftriaxone 1gm IV, IV ceftriaxone BD ×3 days, then oral cefuroxime 500mg BD ×7 days. Primary outcomes were wound infection and dehiscence at 7-10 days postoperatively. Secondary outcomes included postoperative pain (visual analogue scale), operative time, and cosmetic appearance at 6 weeks. Statistical analysis used chi-square test for categorical variables and independent t-test for continuous variables; p<0.05 was considered statistically significant. Results: Baseline demographic characteristics were similar between groups (age Group A: 27.6±5.0 years vs Group B: 27.4±3.99 years, p=0.92). Wound infection occurred in 3.4% (n=2) of subcuticular group versus 24% (n=12) in mattress group (p=0.008). Dehiscence was observed in 2% (n=1) versus 10% (n=5) respectively (p=0.204). Mean operative time was 22±7.55 minutes for vertical mattress group. Subcuticular group demonstrated reduced pain, superior cosmesis and higher patient satisfaction compared to mattress group. Conclusion: Continuous subcuticular polyglactin sutures demonstrated significantly lower wound infection rates (3.4% vs 24%), reduced postoperative pain, and superior cosmetic outcome compared to interrupted vertical mattress silk sutures. Subcuticular closure is recommended as the preferred technique for routine elective caesarean sections.

Aim: To evaluate the efficacy of skin flap anchoring (quilting) technique combined with active seroma monitoring in reducing seroma formation, aspiration requirements, and improving postoperative outcomes in patients undergoing modified radical mastectomy for breast cancer. Materials and Methods: A prospective observational study was conducted over 24 months (January 2023 to December 2024) at Department of General Surgery RKDF Medical College Hospital & Research Center, Bhopal. A total of 156 consecutive female patients undergoing modified radical mastectomy for invasive breast carcinoma were enrolled. Patients were divided into two groups: Group A (n=78) underwent mastectomy with skin flap anchoring (quilting), and Group B (n=78) underwent conventional mastectomy without flap fixation. Active Seroma Monitoring Was Performed Using Ultrasonography On Postoperative Days 3, 7, 14, 30, And 60. Primary Endpoints Included Clinically Significant Seroma (CSS) Requiring Aspiration, Total Seroma Volume, And Drainage Duration. Secondary Endpoints Included Infection Rates, Skin Dimpling, Shoulder Mobility, And Patient Satisfaction Scores. Results: Clinically Significant Seroma (CSS) Requiring Aspiration Occurred In 12.8% (10/78) Of Patients In The Flap Anchoring Group Compared To 38.5% (30/78) In The Control Group (P=0.001). Mean Drainage Duration Was Significantly Reduced In The Flap Anchoring Group (4.2±1.8 Days Vs. 6.8±2.3 Days, P<0.001). Total Seroma Volume At 14 Days Was 45.3±28.6 Ml In The Flap Anchoring Group Versus 128.7±64.2 Ml In Controls (P<0.001). Infection Rates Were Comparable Between Groups (3.8% Vs. 5.1%, P=0.64). Shoulder Mobility Was Preserved In Both Groups Without Significant Limitation. Skin Dimpling Occurred In 7.7% Of The Flap Anchoring Group But Resolved Within 6 Months In All Cases. Conclusion: Skin Flap Anchoring Combined With Systematic Seroma Monitoring Effectively Reduces Clinically Significant Seroma Formation And Shortens Drainage Duration After Modified Radical Mastectomy Without Increasing Postoperative Complications. This Technique Should Be Adopted As Standard Practice In All Mastectomy Procedures For Improved Patient Outcomes And Reduced Morbidity.

Patau syndrome (Trisomy 13) is a rare chromosomal anomaly incidence being 1 in 12000-20,000 live births, caused by the presence of an extra copy of chromosome 13, with advanced maternal age being a common attributable risk factor. It is characterized by multiple congenital anomalies involving the central nervous system, cardiovascular, musculoskeletal, and genitourinary systems, and is associated with high neonatal morbidity and mortality. We report the case of a 1 month 15 days old female infant who presented with progressive respiratory distress, making weaning from oxygen support difficult. On physical examination, the infant exhibited multiple dysmorphic features, including microcephaly, microphthalmia, low-set ears, postaxial polydactyly, hypertonia, rocker-bottom foot, overlapping fingers, clenched hand and umbilical hernia.
Further evaluation revealed significant cardiac anomalies on two-dimensional echocardiography, including a 6mm atrial septal defect (ASD),8mm ventricular septal defect (VSD), and 4mm patent ductus arteriosus (PDA), complicated by severe pulmonary hypertension. Chest radiograph showed a normal cardiothoracic ratio, while ultrasonography of abdomen and pelvis revealed a left renal cortical cyst, indicating associated genitourinary involvement.
Owing to the presence of overlapping fingers and Rocker bottom foot, an initial clinical suspicion of Edwards’s syndrome was made. Karyotyping was subsequently performed. Cytogenetic analysis confirmed the diagnosis of Patau syndrome (Trisomy 13). The child then shifted to the intensive care unit, received ventilatory support, pulmonary vasodilators, and decongestive therapy (intravenous furosemide), along with comprehensive supportive care.  Despite intensive supportive care the infant’s condition deteriorated and she eventually succumbed.  This case highlights sometimes Patau Syndrome can mimic Edwards Syndrome. It also emphasizes the importance of early recognition of trisomy syndromes, the role of antenatal screening and diagnosis by chorionic villous sampling biopsy and amniocentesis by karyotyping, and the need for genetic counseling to guide management and parental decision-making.

Introduction: Major lumbar spine stabilization surgery causes significant postoperative pain. Analgesia enables early mobilization, recuperation, and hospital stay reduction. With few side effects, continuous spinal infusion of low-concentration local anesthetic relieves pain. Methods: Present Study included patients undergoing lumbar spine fixation under general anaesthesia induced with propofol, fentanyl, and vecuronium, maintained with isoflurane. Pain was assessed using the visual analogue scale (VAS) at multiple intervals up to 72 hours post-induction. Motor block was evaluated by the Bromage scale, and patient satisfaction was recorded on a verbal rating scale. Adverse events, including nausea, vomiting, pruritus, sensory deficits, and hypotension, were documented. Results: Most patients reported mild pain across all time points, with very few experiencing moderate or severe pain. The incidence of significant motor block and sensory deficits was low. Patient satisfaction scores were predominantly in the “satisfied” and “very satisfied” categories. Conclusion: Continuous epidural infusion of low-concentration bupivacaine provides effective postoperative analgesia after major lumbar spine fixation surgeries, facilitating early mobilisation and high patient satisfaction with a favourable safety profile.

Introduction: Head and neck squamous cell carcinoma (HNSCC) is a common malignancy with high rates of recurrence and poor survival in advanced stages. Immune checkpoint molecules, particularly programmed cell death protein-1 (PD-1) and its ligand PD-L1, have emerged as important therapeutic targets. Their expression in relation to human papillomavirus (HPV)–associated tumors, assessed by p16 immunohistochemistry, remains variable and incompletely understood. Materials and Methods: This observational, cross-sectional analytical study included 30 cases of primary HNSCC. Immunohistochemistry was performed on formalin-fixed paraffin-embedded tissues for PD-1, PD-L1, and p16. PD-L1 expression was assessed in tumor cells based on percentage, intensity, and H-score, while PD-1 expression was evaluated in intratumoral lymphocytes. p16 immunostaining was used as a surrogate marker for HPV infection. Statistical analysis was done to assess concordance between markers. Results: PD-L1 expression was observed in 66.6% of cases, while PD-1 expression in tumor-infiltrating lymphocytes was seen in 76.6% of cases. p16 positivity was noted in 20% of tumors. No statistically significant association was found between PD-L1 and p16 expression (p=0.33), or between PD-1 and p16 expression (p=0.66). Concordance between PD-1 and PD-L1 expression was approximately 70%, which was also not statistically significant (p=0.127). Conclusion: A substantial proportion of HNSCC cases express PD-1 and PD-L1 irrespective of p16 status. These findings suggest that immune checkpoint inhibitor–based immunotherapy may be beneficial in both p16-positive and p16-negative advanced or metastatic HNSCC. Larger studies are required to validate these observations and to refine biomarker-based patient selection for immunotherapy.

Objective: To study the effect of smoking on the cytology by analyzing the cytopathological changes and function by determining MCC time and pH of nasal mucosa of smokers. Methods: A tertiary care hospital based case control study done in 140 patients in the age group of 18-60 years with no symptoms pertaining primarily to nose over one year. 70 patients each were selected as smokers and non-smokers. pH of the nasal mucosa nasal mucosal clearance time were measured followed by procuring the nasal mucosa sample using a sterile small nylon brush for measurement of ciliated cells. All the tests were done in the same nasal cavity which was comparatively wider than the other. Results: The study observed a statistically significant prolongation in the mucociliary clearance time and reduction in the ciliated cell count in smokers. But no significant difference in pH of the nasal mucosa was observed between the two groups. A positive correlation was found between the pack years and the mucociliary clearance time. There was a significant difference in the mean MCC time among different types of smokers with persons smoking both beedi and hookah showing the maximum MCC time. Conclusion: Chronic exposure to tobacco smoke causes structural and functional changes in the nasal mucociliary system. These changes were found to be more in persons with high amount of exposure to smoke in terms of pack years. Bidi and hookah smokers are at much higher risk since they show maximum functional changes.

Background & Objectives: Obesity is a growing public health issues in India and Kerala. Kerala’s obesity rates surpass the national average. Though the NFHS-5 survey has highlighted the problem of obesity, more studies on the prevalence of obesity among professional college students are needed in our setting, with a focus on the risk factors. Considering the upward trajectory of obesity, our aim is to estimate the prevalence and identify the risk factors of obesity among professional college students in North Kerala. Methods: A Cross-sectional study was conducted among first-year professional college students in the Kozhikode district over a period of one year (June 2017 to June 2018). Data were collected using a pre–tested semi–structured questionnaire. The data were coded and entered into MS Excel, and statistical analysis was performed using SPSS Version 18 software. Results: The present study revealed a high prevalence of obesity (13.7%) among study subjects. Predominance of obesity was noted among males (21%) compared to females (10%). Male gender, upper socioeconomic status, family history of obesity, presences of co-morbidities, high consumption of sugar-sweetened beverages, dairy products and low physical activity were found to be significantly associated with obesity. Conclusion: The prevalence of obesity was high among professional college students in Kozhikode district (13.7%). Risk factors of obesity are lifestyle-related. Targeted public Health intervention is needed to address the obesity epidemic and advocate the prevention of future obesity.

Background: Hypertensive disorders of pregnancy (HDP) are critical medical complications affecting 6–10% of pregnancies globally. In developing nations like India, HDP remains a primary driver of maternal and perinatal mortality. Effective management requires balancing maternal blood pressure control without compromising uteroplacental perfusion. Drug utilization studies are essential to evaluate the safety, appropriateness, and adherence of prescribing practices to evidence-based guidelines. Objective: The study aimed to evaluate the prescription patterns of antihypertensive and supplementary medications among admitted pregnant women undergoing treatment for HDP at a tertiary care institute in Raipur, Chhattisgarh. Methods: A cross-sectional observational study was conducted from December 2019 to September 2021. Case records of 200 admitted patients (aged 18–45 years) with established diagnosis of HDP were analyzed. Data regarding Patient demographics, gestational age, diagnosis, and drug details (name, route, FDA pregnancy category) were collected using a pre-approved proforma and analyzed using Microsoft Excel. Results: The mean age of patients was 26.03 years with 69% patients having gestational age of 37–42 weeks. Gestational hypertension was the most common diagnosis (55%), followed by pre-eclampsia (36.5%). Labetalol was the most frequently prescribed antihypertensive (98%), followed by magnesium sulphate (34.5%). Monotherapy was sufficient for management in 60.5% of cases. Notably, 55.4% of drugs were administered parenterally, and 88% were prescribed by generic names. All drugs (100%) were selected from the Essential Drug List (EDL). Regarding safety, 76.2% of antihypertensives belonged to FDA Category C. Common non-antihypertensive supplements included Calcium (93%) and Vitamin C (89%). Conclusion: Prescribing practices at the institute showed high adherence to national guidelines and the Essential Drug List, emphasizing the use of Labetalol and generic prescribing. The high rate of parenteral administration and late-stage diagnoses suggests a lack of early antenatal care (ANC) utilization. Enhancing ANC services and maternal awareness is vital for early HDP detection and improved clinical outcomes.

Aim: To comprehensively review age-related macular degeneration (AMD) pathophysiology and elucidate the pharmacokinetic challenges in delivering therapeutic agents across ocular barriers to the posterior eye segment, with emphasis on current treatment strategies and future perspectives. Materials and Methods: A systematic literature review was conducted using PubMed, Google Scholar, and Scopus databases from 2015 to 2025. Search terms included “age-related macular degeneration,” “ocular drug delivery,” “blood-retinal barrier,” “intravitreal injection,” and “posterior segment drug delivery.” Studies were selected based on relevance to AMD pathophysiology and drug delivery mechanisms. Data extraction focused on epidemiological trends, barrier mechanisms, clinical outcomes of anti-VEGF therapy, and novel delivery approaches. Statistical analysis was performed using descriptive methods to synthesize findings from randomized controlled trials and observational studies. Results: Current literature demonstrates that AMD affects 8.69% of adults aged 45-85 years globally, with prevalence expected to increase to 15.3 million cases by 2034. Intravitreal anti-VEGF therapy remains the gold standard for neovascular AMD, with endophthalmitis rates of 0.16% per injection during year 1, decreasing to 0.06% by year 3. The blood-retinal barrier (BRB) and retinal pigment epithelium (RPE) present major impediments to systemic drug delivery, restricting molecules >2 nm. Novel delivery systems including sustained-release implants and nanoparticles demonstrate promising results in overcoming these barriers. Conclusion: Despite remarkable advances in intravitreal delivery systems, the inherent complexity of ocular anatomy and barrier physiology necessitates continued innovation in drug delivery technologies. Enhanced understanding of BRB dynamics and RPE function is crucial for developing next-generation therapeutics for AMD. The integration of nanotechnology and sustained-release formulations offers potential for improved therapeutic outcomes and reduced treatment burden.

Aim: This retrospective analysis aims to evaluate the clinicopathological profile and airway management strategies employed in patients with head and neck malignancies, and to assess outcomes associated with different airway management techniques. Materials and Methods: A retrospective review of 200 consecutive patients with histopathologically confirmed head and neck malignancies treated at a tertiary care center from January 2022 to December 2024 was conducted. Data regarding patient demographics, tumor characteristics, histopathological findings, TNM staging, and airway management strategies were collected and analyzed using SPSS version 25.0. Statistical analysis included descriptive statistics and chi-square test for categorical variables. Results: Of 200 patients (males 71.5%, females 28.5%), median age was 67 years (range 18-92 years). The most common sites were larynx (44.5%), oral cavity (30.5%), and oropharynx (20%). Squamous cell carcinoma was the predominant histological type (78%). Stage III and IV diseases represented 65% of cases. Airway management was achieved through orotracheal intubation (61%), nasotracheal intubation (15%), awake fibreoptic endoscopic intubation (15%), and tracheostomy under local anesthesia (9%). Complications were significantly lower with selective tracheostomy approach (p<0.05). Conclusion: Airway management in head and neck malignancies requires individualized risk stratification. The clinicopathological profile, tumor extent, and planned surgical approach should guide the selection of airway management strategy. Fibreoptic endoscopic techniques and selective tracheostomy based on risk assessment offer superior outcomes compared to routine prophylactic approaches.

Background: Low rectal cancer presents unique surgical challenges due to the confined pelvic anatomy and the need to balance oncologic clearance with sphincter and nerve preservation. Laparoscopic surgery has emerged as a minimally invasive alternative to open surgery, but concerns remain regarding oncological adequacy in low rectal tumors. Objective: To compare perioperative, oncological, and functional outcomes between laparoscopic and open surgery for low rectal cancer. Methods: This retrospective matched case–control study included 60 patients with histologically confirmed low rectal adenocarcinoma treated at Dr. Rajendra Gode Medical College. Thirty patients underwent laparoscopic low anterior resection (L-LAR) or laparoscopic abdominoperineal resection (L-APR), and 30 underwent open surgery (O-LAR or O-APR), matched for age, tumor stage, and comorbidities. Perioperative outcomes, oncological quality (R0 resection, circumferential resection margin [CRM], lymph node yield), and functional outcome using the Low Anterior Resection Syndrome (LARS) score at 6 months were compared. Results: Laparoscopic surgery had a longer operative time (198 ± 35 vs 164 ± 28 min; p<0.001) but significantly lower blood loss (180 ± 40 vs 320 ± 60 mL; p<0.01), faster bowel recovery (1.8 vs 3.4 days; p<0.001), and shorter hospital stay (5.3 vs 8.1 days; p<0.001). Complications were fewer in the laparoscopic group (16.7% vs 30%). R0 resection rates (93.3% vs 90%), CRM positivity, and lymph node yields were comparable. LARS scores were significantly better following laparoscopic low anterior resection (p<0.05). Conclusion: Laparoscopic surgery for low rectal cancer provides superior short-term recovery and functional outcomes while maintaining oncological safety compared with open surgery.

Background: The expansion of motorization and road networks in India has led to an increase in road traffic accidents (RTAs), causing substantial mortality and morbidity. This study aims to evaluate the pattern of limb injuries in fatal RTA cases in the north eastern state of Tripura. Methods: A hospital-based observational study was conducted at the Department of Forensic Medicine and Toxicology, Agartala Government Medical College (AGMC) and GBP Hospital from December 7, 2022, to May 6, 2024. All RTA fatalities undergoing medico-legal autopsy were included, except decomposed bodies. Data were collected from relatives of the deceased and analyzed using SPSS version 15.0. Results: Out of 1,361 autopsies conducted during the study period, 290 (21.3%) were RTA-related deaths. After applying exclusion criteria, 240 cases were included. Most victims were males (90.8%) and belonged to the 21–40 age group (43.8%). Two-wheeler accidents were predominant. Abrasions were the most common external limb injury, with lower limbs affected more frequently than upper limbs. External and internal injuries of head, neck, and face were prevalent, with head injury being the most common cause of death (63.3%). Conclusion: The study highlights the prevalence of limb and head injuries in fatal RTA cases, underscoring the importance of detailed forensic analysis for legal and public health measures.

Background: Bone tumors and tumor-like lesions present diagnostic challenges due to their rarity, heterogeneous presentation, and overlapping radiological features, necessitating integrated histopathological confirmation for accurate management. Discrepancies often arise in non-specialized centers from limited exposure, underscoring the need to quantify agreement between provisional radiological diagnoses and definitive histopathology using metrics like Cohen’s kappa. This study addresses these gaps in a tertiary care setting in Jodhpur, India. Methods: A prospective observational study analyzed 81 bone lesion specimens (biopsies, curettage, excisions) from Jan 2023 to April 2024 at Dr. SN Medical College Pathology Department, including all ages/sexes with complete radiological data but excluding hematological malignancies or inadequate samples. Tissues underwent formalin fixation, nitric acid decalcification, paraffin embedding, H&E staining, and selective IHC; lesions were classified per WHO criteria. Cohen’s kappa assessed diagnostic agreement, with p<0.05 significant via Excel-based statistics. Results: Patients peaked in 11-30 years (49%), males predominated (70.37%, M:F 2.21:1); pain/swelling affected 92.2%. Osteogenic tumors (25.93%), giant cell tumors (24.69%), and cartilage tumors (17.28%) prevailed; osteosarcoma led malignancies (61.29%), GCT benign (57.14%). Ill-defined lytic lesions were common radiologically (33.33%); Cohen’s kappa showed strong agreement (0.817, p=0.001), with 88.88% concordance and 11.12% discordance (e.g., osteosarcoma misdiagnosed as GCT). Conclusion: Multidisciplinary clinico-radiological-pathological correlation achieves excellent diagnostic concordance for bone tumors, affirming histopathology’s primacy with ancillary support. Representative sampling and clinical context minimize errors; this framework optimizes outcomes in resource-limited settings.

Background: Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit and is frequently followed by permanent scarring, particularly after inflammatory lesions. Post-acne atrophic scars pose a therapeutic challenge due to their variable morphology and depth. Fractional carbon dioxide (CO₂) laser resurfacing and microneedling using dermarollers are commonly employed modalities aimed at collagen remodelling and scar improvement. Aim: To compare the efficacy and safety of fractional CO₂ laser resurfacing and dermaroller therapy in the management of post-acne atrophic scars. Materials and Methods: This prospective, analytical, comparative study was conducted on 100 patients with moderate to severe post-acne atrophic scars. Patients were randomly divided into two groups of 50 each. Group A was treated with fractional CO₂ laser resurfacing, while Group B received dermaroller therapy. Six treatment sessions were performed at four-week intervals. Treatment response was evaluated using Goodman and Baron’s quantitative global acne scarring grading system and a 5-point visual analogue scale. Adverse effects were documented. Results: Both treatment modalities showed statistically significant improvement in acne scar scores from baseline. Dermaroller therapy demonstrated comparable efficacy with a slightly higher proportion of very good responses, whereas fractional CO₂ laser therapy showed a higher incidence of post-inflammatory hyperpigmentation. Pain was more frequently reported with dermaroller therapy, while erythema was universal but transient in both groups. Conclusion: Fractional CO₂ laser resurfacing and dermaroller therapy are both effective and safe for the treatment of post-acne atrophic scars. Dermaroller therapy offers comparable clinical improvement with fewer pigmentary adverse effects, making it a suitable alternative, especially in darker skin types.

Dengue, leptospirosis, and scrub typhus are among the most common febrile illnesses affecting developing nations. Their distinct seasonal and environmental patterns of occurrence predict co-circulation, especially in tropical regions. Recent peri-urban economic development and encroachment into dense and stifled forest ecosystems appear correlated with emerging infections in and around Tiruvannamalai, Tamil Nadu. Accurate incidence estimates are currently lacking for rural Tiruvannamalai, along with timely diagnostic considerations.
The present study is aimed at understanding the epidemiological characteristics of three major febrile illnesses—dengue, leptospirosis, and scrub typhus—in the rural regions of Tiruvannamalai district, Tamil Nadu. Our objectives aim to provide critical insights into disease trends, guide clinical suspicion during diagnosis, and inform localized disease control strategies in rural Tamil Nadu. The incidence and prevalence of dengue, leptospirosis, and scrub typhus in rural areas of Tiruvannamalai are significant public health challenges. By raising awareness, improving sanitation infrastructure, and implementing vector control measures, we can mitigate the impact of these diseases on the rural population.

Background: Railway track fatalities constitute a significant portion of accidental deaths in India due to the extensive railway network and high human–train interaction. These incidents often produce severe multisystem trauma, necessitating detailed medicolegal evaluation. This study analyzes the pattern and distribution of cranio-thoracoabdominal injuries in railway accident victims over four years. Material and Methods: A retrospective analysis of 78 fatal railway track cases autopsied at the Department of Forensic Medicine, PGIMS Rohtak, from January 2018 to December 2021 was conducted. Data regarding body condition, skull fractures, and intracranial hemorrhages, thoracic and abdominal injuries were obtained from autopsy records and police documents. Findings were compared with previously published studies. Results: Most victims (58.97%) were brought with the body intact while 41.03% showed varying degrees of dismemberment. Cranial vault fractures were present in 89.74% of cases with depressed fractures being the most common (37.17%). Intracranial hemorrhages were documented in 78.21% of victims, predominantly combined subdural and subarachnoid hemorrhage (48.71%). Thoracic injuries showed rib fractures alone in 43.5% and rib plus lung injuries in 21.79%. Abdominal injuries most frequently involved the liver, either alone (11.53%) or in combination with spleen and kidney (32.04%). Conclusion: Head injury is the principal fatal component in railway track deaths, accompanied by significant thoracic and abdominal trauma. The injury patterns reflect high-energy blunt impact typical of railway incidents. Detailed autopsy examination remains crucial for accurate medicolegal interpretation and differentiation of acci-dent, suicide or other manners of death.

Background: Febrile convulsions represent the most common seizure disorder in pediatric populations, affecting approximately 2-5% of children aged 6 months to 5 years. While the prognosis is generally favorable, recurrent episodes cause significant parental anxiety and may necessitate prophylactic intervention. Sodium valproate has demonstrated efficacy in seizure prevention; however, optimal dosing strategies that balance efficacy with minimal adverse effects remain under investigation. Methods: A prospective randomized controlled trial was conducted involving 156 children aged 6 months to 5 years with a history of at least two febrile convulsion episodes. Participants were randomly assigned to receive either low-dose (n=78) or standard-dose (n=78) sodium valproate for 12 months. Primary outcomes included recurrence rate and time to first recurrence. Secondary outcomes encompassed adverse effects, hepatic function parameters, and treatment adherence. Results: The recurrence rate was 14.1% in the low-dose group compared to 11.5% in the standard-dose group (p=0.624). Mean time to first recurrence was 7.8±2.3 months versus 8.2±2.1 months (p=0.412). Adverse effects were significantly lower in the low-dose group (17.9% vs. 34.6%, p=0.016). Treatment adherence was higher in the low-dose group (91.0% vs. 82.1%, p=0.048). Conclusion: Low-dose sodium valproate demonstrates comparable efficacy to standard-dose regimens in preventing recurrent febrile convulsions while exhibiting a superior safety profile and improved treatment adherence.

Background: Central obesity, reflected by increased waist–hip ratio (WHR), is an important anatomical marker of visceral adiposity and is closely linked with metabolic disturbances. Altered lipid metabolism associated with central fat distribution plays a key role in the development of cardiovascular disease. Simple anthropometric measurements combined with routine biochemical investigations may help in early identification of individuals at risk, especially in resource-limited settings. Objectives: (1) To assess waist circumference, hip circumference, and waist–hip ratio in adult subjects. (2) To evaluate serum lipid profile parameters including total cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol. (3) To determine the correlation between waist–hip ratio and serum lipid profile parameters. Materials and Methods: This hospital-based cross-sectional study was conducted at a tertiary care center over a period of one year. A total of 100 adult subjects were included. Anthropometric measurements were recorded using standard techniques, and fasting venous blood samples were analyzed for lipid profile. Statistical analysis was performed to assess correlations between waist–hip ratio and lipid parameters. Results: Waist–hip ratio showed a significant positive correlation with total cholesterol, triglycerides, and LDL cholesterol, and a significant negative correlation with HDL cholesterol. Subjects with higher WHR demonstrated a more adverse lipid profile, indicating increased cardiovascular risk. Conclusion: Waist–hip ratio correlates significantly with serum lipid abnormalities and serves as a simple, cost-effective anatomical marker for identifying individuals at risk of dyslipidemia. Its use alongside routine biochemical investigations can aid in early risk stratification in clinical practice.

Background: Intestinal obstruction is a common surgical emergency in adults with varied etiologies and outcomes. In India, causes such as adhesions, hernias, and tuberculosis are more prevalent than in North countries. This retrospective study evaluated the spectrum of adult intestinal obstruction at a tertiary care center in Gujarat over a year. Demographic patterns, causes, surgical management, and postoperative outcomes were analyzed. The aim was to identify trends that could improve clinical management and reduce morbidity and mortality. Material and Methods: This retrospective observational study was conducted at a tertiary care hospital in Gujarat, India. Ethical approval was obtained from the institutional review board. We reviewed medical records of adults aged 18 years and above admitted with intestinal obstruction over a year. Inclusion criteria encompassed confirmed cases via clinical examination, imaging (X-ray, CT scan), and surgical findings. Exclusion criteria included pediatric cases, chronic obstructions without acute symptoms, and non-surgical management. Data collected included demographics, symptoms, etiology, surgical procedures, complications, and outcomes. Statistical analysis was performed using SPSS software. Results: Of the 150 patients, 92 (61.3%) were male, with a mean age of 52.4 years. Small bowel obstruction predominated (68%), primarily due to adhesions (42%), followed by hernias (28%), malignancy (15%), and tuberculosis (10%). Large bowel cases were mainly neoplastic (5%). Surgical intervention was required in 128 (85.3%) patients, with adhesiolysis (45%), hernia repair (25%), and resection-anastomosis (20%) being common procedures. Postoperative complications occurred in 32 (21.3%) cases, including wound infections (12%) and anastomotic leaks (5%). Mortality was 8 (5.3%), linked to delayed presentation and comorbidities. Recovery was favorable in 118 (78.7%) patients, with a mean hospital stay of 7.2 days. Conclusion: This study underscores adhesions as the leading cause of intestinal obstruction in our setting, reflecting global trends but with a notable burden from hernias and tuberculosis. Timely surgical intervention improved outcomes, though complications remain a challenge. Enhanced preventive measures, such as early hernia repairs and adhesion barriers, could reduce incidence. Future multicenter studies are recommended to validate these findings and optimize protocols.

Background: Now a days, balanced solutions are commonly used in neurosurgery but among these balanced crystalloids, the crystalloid with most favourable metabolic effects in neurosurgical patients remains unclear.  The current study aimed to find a superior balanced solution among Sterofundin and Plasmalyte-A by comparing their metabolic effects and their impact on renal function in patients undergoing elective craniotomy for supratentorial brain tumor resection. Methods: 60 patients (n=30) aged 18- 60 years of either sex posted for elective craniotomies for supratentorial brain tumor resection were randomly divided into two groups: Patients of Group A were administered with Sterofundin and that of Group B with Plasmalyte-A. Arterial blood gas parameters and serum electrolytes as primary objectives, and serum creatinine and BUN as secondary objectives were compared between these two groups. Result: As compared to group B, group A showed statistically significant difference of pH, HCO3^–, base excess and lactate  at 3 h after induction of anesthesia and at 1, 6 and 24 h after extubation; significantly higher level of PaCO2 levels and anion gap at 6 and 24 h after extubation; significantly higher serum sodium, potassium and calcium levels. Difference of serum creatinine and BUN were statistically insignificant between these groups. Although the two groups showed significant difference in the ABG parameters and serum electrolytes, these parameters lie within the physiological range in both groups. Conclusion: Both Sterofundin and Plasmalyte-A  have comparable metabolic effects with no superiority of one over another and can be used safely with equally efficacy in adults undergoing elective craniotomies supratentorial brain tumor resection.

Background/Objective: The objective is to assess and compare the effectiveness of Ambu Aura Gain (AAG) and Laryngeal Mask Airway Supreme (LMAS) in adult patients undergoing surgery under general anesthesia. Methodology: A total of 100 patients between 18 to 80 years of age, of either gender, American Society of Anaesthesiologists [ASA] grade I or II and Mallampatti grade I or II were selected, categorized as Group A: Patients subjected to LMAS Group B: Patients subjected AAG. The study included patients scheduled for elective short duration surgical procedures (~2hrs), under general anesthesia. The ease of insertion, blood on the SGAD during removal, hemodynamic changes, oropharyngeal leak pressure and the functionality of gastric drain, sore throat were evaluated. Results: The hemodynamic parameters, device failure rate, and presence of blood following removal were similar between the two groups. LMAS, was significantly easier to insert (p = 0.031). Furthermore, compared to LMAS, AAG had a greater success rate for accurate insertion on the first try (92%Vs88%) and considerably superior functioning of gastric drain (p = 0.027), as well as a decreased incidence of sore throat (12% vs 28%; p = 0.046). Conclusion: AAG may be a more suitable compared to LMAS for surgery under general anesthesia the ease of insertion was significantly higher for LMAS. However, AAG had higher success rate for correct placement in first attempt, significantly better gastric drain functionality with lower sore throat complication and relatively better oropharyngeal leak pressure, thus providing a higher margin of safety against the risk of aspiration.

Background: Inflammatory breast diseases are a heterogeneous group of conditions that often clinically and radiologically mimic breast carcinoma. A comprehensive evaluation is required for accurate diagnosis and management. Methods: This prospective descriptive study included 60 female patients presenting with inflammatory breast conditions at a tertiary care center between April 2024 and September 2025. Clinical features, laboratory parameters, imaging findings, pathological diagnosis, and treatment outcomes were analyzed. Results: The mean age was 30.6 ± 6.0 years. Idiopathic granulomatous mastitis (26.7%) was the most common diagnosis, followed by non-lactational abscess (20%) and periductal mastitis/duct ectasia (18.3%). Ultrasound commonly revealed ill-defined hypoechoic masses, while histopathology confirmed granulomatous inflammation in most cases. Conclusion: Inflammatory breast conditions predominantly affect young women and frequently mimic malignancy. Integrated clinical, radiological, and pathological assessment is essential for accurate diagnosis and optimal management.

Aim: The study was carried out to evaluate the bacterial etiology in the course of disease and their drug sensitivity pattern in patients presenting with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: All hospitalized patients diagnosed with AECOPD, admitted in the Department of Medicine, Nalanda Medical College and Hospital, Patna, Bihar, India for the period of six months from March, 2025 to August, 2025 were evaluated. The individual bacterial isolates and their sensitive pattern to various antibiotics were also recorded in all one hundred 100 patients. COPD was diagnosed clinically and by using Spirometry according to the Global Initiative for Obstructive Lung Disease (GOLD) guidelines. Results: Out of 100 patients, diagnosed as AECOPD, 80% were males and 20% were females. 38% patients were in the age group 56-65 years followed by 66-75 (24%) age group. Out of a total 100 cases, forty-four (44%) were positive for pathogenic bacteria and fifty-six (56%) were non-pathogenic. Out of forty-six pathogenic bacteria, K. pneumoniae was the commonest (35.55%) followed by P. aeruginosa (22.22%), S. aureus (15.55%), S. pneumoniae (11.11%), S. pyogenes (6.66%). Among antibiotics, Amikacin was found highest sensitive followed by Azithromycin (68.68%), Amoxy Clavulanic acid (66.66%), Ciprofloxacin (62.22%) and Gentamycin (55.55%). However, Levofloxacin and Co-trimoxazole were found to be highly resistant 68.88% and 62.22% respectively among the drugs used in culture and sensitivity of 45 isolated pathogenic bacteria. Conclusion: Repeated exacerbation and hospital admission leads to a major impact on the quality of life of patients with COPD. Antibiogram helps in screening resistant pathogens and prescribing right treatment protocol.

Background: Acute respiratory infections and diarrheal diseases are major causes of morbidity and school absenteeism among children in low-resource settings. Hand hygiene is a simple, cost-effective strategy to interrupt transmission of these infections in schools. Aim: To assess the impact of an intensive hand hygiene campaign on illness-related absenteeism and laboratory-confirmed influenza among primary school children. Methodology: A cluster randomized controlled trial was conducted among 512 children (Grades I–III) in government elementary schools in Bihar, India. Schools were randomized to intervention or control groups. The intervention included supervised handwashing with soap, hygiene education, and behavioral reinforcement over 12 weeks. Illness-related absenteeism, in-class illness, and laboratory-confirmed influenza were compared between groups using school-level rates and relative risks. Results: Overall illness-related absenteeism was significantly lower in the intervention group compared to controls (RR 0.75; 95% CI: 0.64–0.88). Significant reductions were observed for influenza-like illness (RR 0.59), diarrhea (RR 0.64), and conjunctivitis (RR 0.36). Laboratory-confirmed influenza was also significantly reduced in the intervention group (30.0% vs. 48.5%; p = 0.01). Conclusion: Intensive hand hygiene promotion significantly reduced infectious illness and related absenteeism among schoolchildren, supporting its effectiveness as a scalable school-based public health intervention.

Background: Hyperandrogenism is the hallmark feature of polycystic ovarian syndrome; however, reliable and cost-effective biomarkers for diagnosis and clinical monitoring remain scarce. Prostate-specific antigen has been shown to be elevated in hyperandrogenic states and may therefore serve as a potential biomarker for the diagnosis of hyperandrogenism in women with PCOS. Objective: To compare serum PSA levels between women with PCOS and healthy controls, and to evaluate its correlation with testosterone and LH/FSH ratio. Methods: This observational comparative study included 40 women with PCOS (diagnosed by Rotterdam criteria) and 40 age-matched healthy controls at S.M.S. Medical College, Jaipur. Serum PSA, testosterone, LH, FSH, and metabolic parameters were measured. Data were analyzed using unpaired t-test, and Pearson correlation. Results: PCOS women showed significantly higher serum tPSA levels compared to controls (0.0372±0.0068 vs 0.0090±0.0002 ng/mL, p<0.001). Serum tPSA demonstrated strong positive correlation with testosterone (r=0.86, p<0.01) and LH/FSH ratio (r=0.73, p<0.01). ROC analysis revealed PSA cut-off of 0.0200 ng/mL with 100% sensitivity and 100% specificity (AUC=1.000) for detecting hyperandrogenism in PCOS. Conclusion: Serum PSA is significantly elevated in PCOS and strongly correlates with hyperandrogenism markers. It may serve as a cost-effective, minimally invasive biomarker for assessing androgen excess in women with PCOS, particularly in resource-limited settings.

Background: Ectopic pregnancy is a potentially life-threatening condition requiring early and accurate diagnosis. Color Doppler ultrasound (CDUS) enhances conventional ultrasound by evaluating vascular patterns, aiding in the identification of ectopic implantation. Aim: To assess the accuracy of color Doppler ultrasound in diagnosing ectopic pregnancy and its reliability in clinical evaluation. Methodology: A hospital-based observational study was conducted on 130 antenatal women. Standard ultrasound and color Doppler assessments were performed to identify gestational sacs and vascular patterns. Correlations between ultrasound findings, clinical presentation, and gestational age were analyzed. Statistical analysis utilized SPSS 25.0, with significance set at p < 0.05. Results: The study population primarily comprised women aged 21–30 years (73.8%), with a balanced parity distribution. Color Doppler identified characteristic “ring of fire” vascular patterns around ectopic sites, demonstrating high sensitivity and specificity. Strong correlations were observed between gestational age and fetal biometric parameters, with fetal kidney length showing the highest reliability (r = 0.958, p < 0.001). Progressive increases in fetal kidney length across gestational ages supported its use as a consistent marker in obstetric evaluation. Conclusion: Color Doppler ultrasound is a highly effective tool for the early diagnosis of ectopic pregnancy, providing precise visualization of vascular patterns and supporting timely clinical management.

Background: Birth asphyxia ^‘remains a major cause of neonatal morbidity and mortality, particularly in low- and middle-income countries, often resulting from maternal, intrapartum, and socio-demographic risk factors. Aim: To evaluate the prevalence of birth asphyxia and identify associated maternal risk factors among neonates delivered at a tertiary care hospital. Methodology: A retrospective observational study was conducted at the Department of Pediatrics, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India. Medical records of 80 neonates with birth asphyxia over a six-month period were reviewed. Maternal demographic, antenatal, and intrapartum factors were analyzed, and neonatal outcomes were recorded. Data were analyzed using SPSS; categorical variables were expressed as frequencies and percentages, and associations assessed using Chi-square or Fisher’s exact test. Results: Moderate birth asphyxia was most common (40%), followed by mild (35%) and severe (25%). Maternal anemia (50%), prolonged labor (27.5%), and meconium-stained amniotic fluid (22.5%) were predominant risk factors. Vaginal deliveries accounted for most cases (57.5%), while cesarean sections showed higher proportions of moderate and severe asphyxia. Over half of the neonates required basic resuscitation, and 67.5% had NICU stays ≥3 days. Early neonatal mortality was 7.5%. Conclusion: Birth asphyxia is multifactorial, with maternal anemia, labor complications, and delivery mode being major determinants. Vigilant antenatal care, skilled intrapartum management, and timely neonatal interventions are essential to improve outcomes.

Aim: This study aimed to evaluate the effects of semaglutide on weight loss, metabolic parameters, hormonal profiles, and menstrual regularity in obese female patients with polycystic ovarian syndrome (PCOS) through a retrospective observational analysis and systematic review of existing literature. The primary objective was to assess changes in body mass index (BMI) and secondary outcomes including insulin resistance (HOMA-IR), testosterone levels, and ovulation rates. We hypothesized that semaglutide would induce significant weight reduction and improve PCOS-related symptoms in this population. Materials and Methods: Medical records of 85 women (BMI >30 kg/m²) diagnosed with PCOS per Rotterdam criteria, treated with semaglutide (oral 7 and 14 mg) between June 2024 to January 2025 at a tertiary care center in Jabalpur, India, were reviewed retrospectively. Data extracted: baseline and post-treatment BMI, waist circumference, fasting glucose, insulin, HbA1c, total testosterone, and menstrual cycle regularity. For the systematic review, PubMed, Cochrane, and Scopus were searched (up to Oct 2025) for studies on semaglutide/GLP-1 agonists in obese PCOS women, following PRISMA guidelines. Randomized controlled trials (RCTs), observational studies, and meta-analyses were included; quality assessed via Newcastle-Ottawa Scale. Results: In our cohort (n=85, mean age 32.4±5.6 years, baseline BMI 36.2±4.1 kg/m²), semaglutide led to mean weight loss of 12.4 kg (95% CI: 10.8-14.0) at 6 months, BMI reduction to 30.1±3.8 kg/m² (p<0.001), HOMA-IR decrease from 4.8±1.9 to 2.9±1.2 (p<0.001), and testosterone drop from 1.2±0.4 to 0.7±0.3 nmol/L (p<0.001). Menstrual normalization occurred in 72% of patients. The systematic review (12 studies, n=1,256) confirmed pooled BMI reduction of 3.5 kg/m² (I²=45%), with low adverse events (nausea 15%). Conclusion: Semaglutide significantly improves weight, insulin sensitivity, hyperandrogenism, and menstrual cycles in obese PCOS women, outperforming lifestyle interventions alone. These findings support its role in PCOS management, warranting larger prospective trials.

Aim: This study aimed to assess the incidence, maternal-fetal effects, and treatment protocols for gestational diabetes mellitus (GDM) among pregnant women in Indore, Madhya Pradesh, India. We evaluated screening using the Diabetes in Pregnancy Study Group of India (DIPSI) criteria, risk factors, outcomes, and efficacy of lifestyle interventions combined with insulin or metformin where required. The primary objective was to determine local prevalence and compare outcomes with global and national benchmarks to inform region-specific protocols. Materials and Methods: A prospective cohort study was conducted from January 2024 to December 2025 at tertiary hospital in Bhopal, involving 1200 antenatal women between 24-32 weeks gestation. Inclusion criteria: singleton pregnancy, age 18-40 years. Exclusion: pre-existing diabetes, multiple gestation. Diagnosis used one-step 75g oral glucose tolerance test (OGTT) per DIPSI (2-hour plasma glucose ≥140 mg/dL). Participants were categorized into GDM (n=180, 15%) and non-GDM (n=1020) groups. Results: GDM incidence was 15%, higher in obese women (BMI>25 kg/m², OR=3.2, 95%CI 2.1-4.8). Maternal effects: preeclampsia 12% vs 4% (p<0.001), cesarean 65% vs 42% (p<0.001). Fetal effects: macrosomia (birthweight >4kg) 18% vs 6% (p<0.001), neonatal hypoglycemia 22% vs 5% (p<0.001). Treatment with MNT+insulin reduced macrosomia to 10% (RR=0.55), metformin to 12% (RR=0.67 vs routine care). Long-term follow-up (6 months postpartum) showed 8% progression to type 2 diabetes. Tables 1-4 detail observations. Conclusion: High GDM incidence in Indore underscores need for early universal screening. Lifestyle+pharmacotherapy mitigates effects, with metformin viable per recent WHO guidelines. Comparisons reveal higher rates than global (15.6%) but aligned with India (26.1%). Recommendations: integrate metformin first-line post-MNT, community education.

Background: Allergic rhinitis (AR) is a prevalent inflammatory disorder significantly impacting quality of life. While intranasal corticosteroid sprays remain the first-line treatment for moderate to severe AR, high-volume nasal irrigation with corticosteroids may offer enhanced mucosal drug delivery. This study aimed to evaluate the efficacy of budesonide nasal irrigation as adjunct therapy compared to standard oral medical treatment alone in patients with moderate to severe allergic rhinitis. Materials and Methods: This prospective randomized controlled study was conducted at Government Medical College, Dungarpur, Rajasthan from July 2023 to August 2024. Sixty patients with moderate to severe allergic rhinitis (ARIA classification) were randomized into two groups: Group A (n=30) received oral medical therapy plus budesonide nasal irrigation (1.5 mg budesonide in 250 mL saline, thrice daily), while Group B (n=30) received oral medical therapy alone. Outcomes were assessed using the Sino-Nasal Outcome Test-22 (SNOT-22) and Nocturnal Rhinoconjunctivitis Quality of Life Questionnaire (NRQLQ) at baseline, 1, 2, 3, and 6 months. Results: Both groups demonstrated significant improvement in SNOT-22 scores over time (p<0.001). However, the budesonide irrigation group showed significantly greater reduction in SNOT-22 scores (mean reduction: 37.96 ± 8.2 vs 27.03 ± 6.8; p=0.001) and NRQLQ scores (mean reduction: 34.08 ± 7.6 vs 25.64 ± 5.9; p=0.001) at 6 months follow-up. The success rate (defined as ≥50% improvement in SNOT-22) was significantly higher in Group A (83.3%) compared to Group B (60.0%; p=0.039). No significant adverse effects were observed in either group. Conclusion: Budesonide nasal irrigation as adjunct therapy provides significantly superior symptom relief and quality of life improvement compared to oral medical therapy alone in patients with moderate to severe allergic rhinitis. This cost-effective intervention should be considered as a valuable addition to the standard treatment protocol.

Background: Inferior wall myocardial infarction (IWMI) accounts for approximately 40–50% of all ST-elevation myocardial infarctions and carries significant morbidity and mortality, particularly when complicated by right ventricular infarction (RVMI) or conduction abnormalities. Objectives: To study the clinical profile, laboratory parameters, angiographic findings, and in-hospital outcomes of patients with IWMI at a tertiary care centre, with particular emphasis on differences according to MI location. Methods: A prospective observational study was conducted on 100 consecutive patients with acute IWMI diagnosed by standard ECG criteria and elevated cardiac biomarkers. Right-sided precordial leads were routinely obtained. Killip classification, echocardiography, and coronary angiography were performed in all patients. Results: Males constituted 86% of patients; 74% were above 50 years of age. Smoking (65%), diabetes (50%), and hypertension (40%) were predominant risk factors. RVMI was present in 34% (IWMI+RVMI: 24%; IWMI+PWMI+RVMI: 10%). Patients with RVMI showed markedly higher Killip Class IV rates (50–70%) and severe LV dysfunction compared to isolated IWMI (1.8% Class IV). Conduction abnormalities were significantly more prevalent in RVMI groups. The RCA was the culprit vessel in 65% of cases. Low HDL (<40 mg/dl) was identified in 55% of patients. Conclusion: IWMI in the Indian context predominantly affects middle-aged males with multiple risk factors. RVMI substantially worsens haemodynamic status, LV function, and conduction system involvement. Routine right-sided ECG leads and prompt identification of MI location are essential for risk stratification and optimal management.

Background: Bloodstream infections (BSIs) are medical emergencies associated with high morbidity and mor-tality, where delays in initiating appropriate antimicrobial therapy adversely affect outcomes. Although automat-ed blood culture systems reduce time to pathogen detection, conventional antimicrobial susceptibility testing (AST) requires additional incubation, leading to delayed targeted therapy. The EUCAST Rapid Antimicrobial Susceptibility Testing (RAST) method was developed to provide early phenotypic susceptibility results directly from positive blood culture bottles. Aim: To evaluate the diagnostic accuracy of the EUCAST RAST method, compare its performance with con-ventional disc diffusion AST using FDA Class II criteria, and determine the prevalent pathogens and resistance patterns in bloodstream infections. Methods: A prospective laboratory-based observational study was conducted over six months on monomicrobi-al positive blood cultures. RAST was performed directly from flagged blood culture bottles, with inhibition zones read at 8 hours and interpreted using EUCAST RAST breakpoints. Conventional Kirby–Bauer disc diffu-sion testing, interpreted as per CLSI guidelines, served as the reference standard. Categorical agreement and error rates were analyzed. Results: EUCAST RAST showed high categorical agreement (>90%) across all tested organisms. Perfect agreement was observed for Enterococcus faecium, Acinetobacter baumannii, and Salmonella enterica. Minor discrepancies were mainly associated with fluoroquinolones among Enterobacterales. Conclusion: EUCAST RAST is a rapid, reliable AST method that significantly reduces turnaround time and supports early targeted therapy and antimicrobial stewardship in BSIs.

Background: Despite minimal invasiveness, laparoscopic cholecystectomy causes significant postoperative pain. Opioid-based IV-PCA is effective but associated with adverse effects. Ultrasound-guided transversus abdominis plane (TAP) block offers an opioid-sparing alternative; however, the benefit of continuous infusion over single-shot block remains unclear. Aim: To compare analgesic efficacy of ultrasound-guided single-shot TAP block, continuous TAP block, and IV-PCA following laparoscopic cholecystectomy. Methodology: In this prospective randomized controlled study, 90 ASA I–II patients were allocated into three groups (n=30 each): Group A–IV-PCA, Group B–single-shot TAP + IV-PCA, and Group C–continuous TAP block. Pain scores (NRS) were assessed up to 48 hours. Opioid consumption, rescue analgesia, complications, and patient satisfaction were recorded. Result: Demographics were comparable. Pain scores at rest and movement were highest in Group A, intermediate in Group B, and lowest in Group C at all intervals (p<0.001). Mean oxycodone consumption decreased from 28.4±6.2 mg (A) to 18.7±5.1 mg (B) and 10.9±4.3 mg (C). Rescue analgesia requirement was 70%, 33.3%, and 13.3% respectively. Nausea and vomiting were significantly lower in Group C. Patient satisfaction was highest with continuous TAP block (excellent 66.7%). Conclusion: Continuous TAP block provides superior and prolonged analgesia with reduced opioid use and complications compared with single-shot TAP block and IV-PCA, making it the most effective modality after laparoscopic cholecystectomy.

Background: Ectopic pregnancy is a potentially life-threatening condition where the fertilized ovum implants outside the uterine cavity, leading to significant maternal morbidity and early pregnancy loss. Early diagnosis and appropriate management are crucial to prevent complications and preserve fertility. Aim: To evaluate the incidence, clinical presentation, risk factors, and management outcomes of ectopic pregnancy. Methodology: A hospital-based cross-sectional descriptive study was conducted for six months in Department of Obstetrics and Gynecology, Nalanda Medical College & Hospital, Patna, Bihar, India, including 80 reproductive-age women diagnosed with ectopic pregnancy. Data on demographics, symptoms, risk factors, site, treatment, and outcomes were collected through clinical examination, laboratory tests, and ultrasonography, and analyzed using SPSS. Results: Most patients were aged 25–30 years (37.5%), multiparous (52.5%), and from rural areas (57.5%). Common symptoms were abdominal pain (92.5%), amenorrhea (90%), and vaginal bleeding (75%). Pelvic inflammatory disease (32.5%) was the leading risk factor. The ampullary region was the commonest site (57.5%). Surgical management predominated (70%), followed by medical (22.5%) and expectant (7.5%) treatment. Recovery without complications occurred in 85% and no maternal mortality was observed. Conclusion: Ectopic pregnancy remains a major gynecological emergency; early diagnosis and timely individualized management significantly improve outcomes and reduce morbidity.

Background: Unplanned intensive care unit (ICU) admission after apparent recovery in the post-anesthesia care unit (PACU) is an important indicator of perioperative safety and may be associated with adverse outcomes. Aim: To evaluate the clinical characteristics and outcomes of patients requiring unplanned ICU admission either directly from the PACU or from the ward within seven days after PACU discharge. Methodology: This retrospective observational study included 88 adult patients who underwent surgery under general anesthesia and required unexpected ICU admission within seven days postoperatively. Patients were categorized into PACU group (n=52) and ward group (n=36). Demographics, comorbidities, surgical details, adverse events, ICU interventions, length of stay, and in-hospital mortality were analyzed. Results: Baseline characteristics were comparable between groups. Hypoxia and hypotension were predominant in the PACU group, whereas infectious and surgical complications were more frequent in the ward group. The ward group required more intensive interventions, had longer ICU stay (3.5 vs. 1.8 days), prolonged hospital stay (32 vs. 16 days), and higher in-hospital mortality (11.1% vs. 3.8%). Conclusion: Delayed ICU admission afterward transfer was associated with worse outcomes compared with direct admission from the PACU, emphasizing the importance of early recognition and timely intervention.

Background: Spinal anesthesia is widely used for lower limb surgeries due to ^‘rapid onset, effective analgesia, and reduced perioperative morbidity compared to general anesthesia. However, complications such as hypotension, post-dural puncture headache (PDPH), bradycardia, nausea, and urinary retention may occur. Aim: To retrospectively evaluate the incidence, nature, and predictors of complications associated with spinal anesthesia in patients undergoing elective lower limb surgeries. Methodology: A retrospective observational study was conducted at the Department of Anaesthesiology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India, over eight months. Medical records of 80 patients aged 18–70 years (ASA I–III) undergoing elective lower limb surgeries under spinal anesthesia were analyzed. Complications were recorded, and associations with patient demographics and ASA status were assessed. Results: Among 80 patients, 32 (40%) experienced complications. Hypotension was most frequent (22.5%), followed by PDPH (15%), nausea/vomiting (10%), bradycardia (8.7%), urinary retention (7.5%), and transient neurological symptoms (6.3%). Complication rates increased with higher ASA status, with ASA III patients showing the highest proportion. Conclusion: Spinal anesthesia is generally safe and well-tolerated in lower limb surgeries. Careful patient selection, vigilant monitoring, and adherence to protocols can minimize complications.

Background: ^“Vitamin D deficiency is common among critically ill patients and may influence immune function, inflammation, and clinical outcomes in the intensive care unit (ICU). Aim: To assess the prevalence of vitamin D deficiency and its association with disease severity and 28-day mortality in ICU patients. Methodology: This hospital-based cross-sectional observational study included 80 adult ICU patients over 12 months. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured within 24 hours of admission and classified as deficient (≤20 ng/ml), insufficient (21–29 ng/ml), or sufficient (≥30 ng/ml). Severity was assessed using APACHE II and SOFA scores. Associations with laboratory parameters and 28-day mortality were analyzed, and ROC curve analysis was performed to determine predictive value. Results: Vitamin D deficiency was observed in 60% of patients, with a mean level of 19.4 ± 8.7 ng/ml. Deficient patients had significantly higher APACHE II and SOFA scores, elevated CRP and lactate levels, and lower serum calcium (p < 0.05). Mortality was significantly higher in deficient patients (83.3% of^” non-survivors; p = 0.003). ROC analysis showed good predictive ability (AUC 0.79), with 83.3% sensitivity and 71.4% specificity at ≤18 ng/ml. Conclusion: Vitamin D deficiency is highly prevalent in ICU patients and is significantly associated with increased severity and 28-day mortality.

Background: Transfusion-dependent thalassemia is associated with iron overload–related endocrine complications, with thyroid dysfunction being a frequent concern in children. Early detection is essential to prevent adverse effects on growth and development. Aim: To assess thyroid function status and its association with iron overload and transfusion burden in transfusion-dependent thalassemic children. Methodology: This hospital-based cross-sectional study included 76 children aged 5–18 years with β-thalassemia major or HbE/β-thalassemia receiving regular transfusions. Serum FT4, TSH, and ferritin levels were measured using chemiluminescent immunoassay. Thyroid status was categorized as euthyroid, compensated (subclinical) hypothyroid, or uncompensated (overt) hypothyroid. Results: Most children were euthyroid (89.5%). Hypothyroidism was detected in 10.5%, predominantly compensated (9.2%), with overt hypothyroidism in 1.3%. All hypothyroid patients had serum ferritin ≥2000 ng/ml, showing a significant association with iron overload (p = 0.031). The hypothyroid group had a significantly higher mean number of transfusions (p < 0.0001). Conclusion: Thyroid dysfunction, mainly subclinical hypothyroidism, occurs in a notable proportion of transfusion-dependent thalassemic children and is associated with higher iron burden and transfusion exposure. Regular thyroid screening is recommended.

Aim: This case-control study aimed to investigate the prevalence of metabolic syndrome (MetS) in patients with moderate to severe psoriasis vulgaris (PASI score ≥6) compared to age- and sex-matched controls without psoriasis, using NCEP ATP III criteria. We hypothesized a higher prevalence of MetS in psoriasis patients due to shared inflammatory pathways. The study was conducted at a tertiary care center in Bhopal, India, to provide region-specific data for South Asian populations. Materials and Methods: We enrolled 150 cases (patients aged 18-65 years with moderate-severe psoriasis vulgaris, PASI ≥6) and 150 controls (healthy individuals without skin disease or family history of psoriasis). Diagnosis of psoriasis was clinical and biopsy-confirmed if needed; severity assessed via PASI score. MetS was defined per NCEP ATP III: ≥3 of waist circumference ≥102 cm (men)/≥88 cm (women), triglycerides ≥150 mg/dL, HDL <40 mg/dL (men)/<50 mg/dL (women), BP ≥130/85 mmHg, fasting glucose ≥100 mg/dL. Data collected via anthropometry, blood tests (fasting), and questionnaires. Statistical analysis used chi-square, t-tests, and logistic regression. Results: MetS prevalence was significantly higher in cases (42.0%) vs controls (18.7%; p<0.001, OR 3.24, 95% CI 2.01-5.23). Common MetS components in cases: abdominal obesity (58.7%), low HDL (52.0%), hypertriglyceridemia (48.0%). PASI scores correlated weakly with MetS (r=0.28, p=0.01). Males predominated (68%); mean age 45.2±12.3 years. Psoriasis duration >5 years associated with higher MetS (OR 2.15). No significant smoking/alcohol link. Conclusion: Moderate-severe psoriasis vulgaris is associated with 2.2-fold higher MetS prevalence, underscoring need for routine cardiovascular risk screening in dermatology practice. Early intervention on modifiable MetS components may mitigate comorbidity risks. Larger prospective studies recommended.

Background: Acute pancreatitis (AP) is an acute inflammatory condition of the pancreas with a wide spectrum of clinical severity, ranging from mild disease to severe forms associated with complications and mortality. Early assessment of disease severity is essential for effective management. Contrast-enhanced computed tomography and the CT Severity Index are widely used imaging tools for evaluating pancreatic inflammation, necrosis, and predicting clinical outcomes. Objective: To evaluate the role of CECT in patients with acute pancreatitis and determine its prognostic correlation with the CT Severity Index. Methods: This prospective observational study was conducted in the Department of Radiology, Sadar Hospital, Lakhisarai, Bihar, India and Sonoscan Pvt.Ltd, Malda, West Bengal, India. over a period of 8 months. A total of 80 patients diagnosed with acute pancreatitis based on clinical and laboratory findings were included. All patients underwent CECT abdomen within 72 hours of symptom onset. CT findings were assessed for pancreatic inflammation, necrosis, and peripancreatic complications, and CTSI scores were calculated. Clinical outcomes including hospital stay, organ failure, ICU admission, and mortality were recorded and correlated with CTSI. Results: Gallstones (45%) and alcohol (35%) were the most common etiological factors. Most patients had mild to moderate diseases based on CTSI. Higher CTSI scores were significantly associated with longer hospital stay, increased complications, ICU admission, and mortality. Conclusion: CECT with CTSI is a reliable imaging modality for early diagnosis, severity assessment, and prognostic evaluation in acute pancreatitis, aiding clinicians in risk stratification and appropriate management.

Background: Image-guided biopsy has become an essential diagnostic tool in modern medicine for obtaining tissue samples with high accuracy and minimal invasiveness. Percutaneous liver biopsy remains a key procedure for diagnosing various liver diseases, including fibrosis, cirrhosis, and malignancy. Despite its diagnostic importance, concerns regarding procedure-related complications continue to exist. Methods:  This retrospective observational study was conducted in the Department of Radiology of Sadar  Hospital,Lakhisarai, Bihar and Sonoscan Pvt.Ltd, Malda, West Bengal, India. over a period of 7 months. A total of 120 patients who underwent elective percutaneous liver biopsy were included in the study. Data were collected from hospital medical records and radiology databases. Patient demographics, hematological parameters (platelet count, INR, aPTT), imaging modality used, needle size, and number of biopsy passes were recorded. Procedure-related complications were documented and categorized as minor or major adverse events. Statistical analysis was performed using appropriate software, and associations between variables were assessed using relevant statistical tests with significance set at p < 0.05. Results: The mean age of patients was 46.2 ± 13.5 years, with a slight male predominance (56.7%). Ultrasound guidance was used in most procedures (73.3%). Most patients (93.3%) did not experience any complications. Minor complications occurred in 4.2% of cases, while major complications were observed in 2.5% of patients. Bleeding and pain were the most common complications reported. Conclusion: Percutaneous liver biopsy is a safe and effective diagnostic procedure with a low complication rate when performed with proper imaging guidance and careful patient evaluation.

Background: Spontaneous ^‘intracerebral haemorrhage (ICH) is associated with high mortality and disability, with early hematoma expansion being a key predictor of poor outcome. Tranexamic acid (TXA) may limit hematoma growth, but the impact of administration timing remains unclear. Aim: To evaluate the effect of early versus delayed tranexamic acid administration on hematoma expansion and early neurological outcomes in spontaneous ICH. Methodology: This prospective, randomized, double-blinded clinical trial included 100 patients with spontaneous ICH presenting within 8 hours of symptom onset. Patients were randomized to receive TXA within ≤4 hours (Group A) or between 4–8 hours (Group B). Hematoma volume was assessed on baseline and 24-hour CT scans. Clinical outcomes and adverse events were recorded. Results: Baseline characteristics were comparable between groups. Mean hematoma expansion was significantly lower in Group A compared to Group B (1.6 ± 2.4 mL vs. 5.6 ± 3.1 mL; p < 0.001). Hematoma expansion occurred in 18% of Group A versus 42% of Group B (p = 0.008). Group A demonstrated better 24-hour GCS scores and lower neurological deterioration, with no significant difference in adverse events. Conclusion: Early TXA administration within 4 hours significantly reduces hematoma expansion and improves early^’ neurological outcomes without increasing complications.

Background: Chronic liver disease (CLD) is a progressive condition characterized by persistent inflammation, fibrosis, and structural distortion of the liver, which may ultimately lead to cirrhosis and liver failure. Accurate assessment of disease severity is essential for prognosis and management. Imaging modalities such as ultrasound and computed tomography (CT) play an important role in evaluating morphological changes and complications associated with CLD and may correlate with clinical severity scores. Methods: This prospective observational study included 60 patients clinically suspected or diagnosed with chronic liver disease. All patients underwent detailed clinical assessment, including calculation of Child–Pugh and MELD scores. Imaging evaluation was performed using abdominal ultrasound with Doppler and contrast-enhanced CT scan. Imaging findings such as liver morphology, ascites, splenomegaly, portal vein diameter, and portosystemic collaterals were recorded. The correlation between imaging findings and clinical severity scores was analyzed using appropriate statistical methods. Results: Most patients were middle-aged males, and common clinical features included fatigue, jaundice, abdominal distension, and hepatomegaly. Ultrasound frequently demonstrated coarse liver echotexture, surface nodularity, ascites, and splenomegaly. CT findings showed irregular liver contour, caudate lobe hypertrophy, regenerative nodules, and evidence of portal hypertension. A significant correlation was observed between imaging findings and clinical severity scores (p < 0.05). Conclusion: Ultrasound and CT are valuable tools in the evaluation of chronic liver disease. Imaging findings show significant correlation with clinical severity scores and can aid in accurate assessment, staging, and management of patients with CLD.

Background: Body Mass Index (BMI) plays a crucial role in reproductive health and may influence age at menarche and menstrual characteristics. Extremes of BMI are associated with hormonal imbalance and menstrual irregularities. Aim: To assess the association of BMI with age at menarche and menstrual characteristics among young females. Methodology: A hospital-based cross-sectional analytical study was conducted among 140 unmarried females aged 17–25 years at Department of Obstetrics and Gynaecology, Nalanda Medical College and Hospital, Patna, Bihar, India. Data were collected using a structured questionnaire and anthropometric measurements. BMI was calculated and categorized. Statistical analysis included Chi-square test and independent sample t-test, with p < 0.05 considered significant. Results: The mean age at menarche was 13.21 ± 1.24 years and mean BMI was 22.18 ± 3.12 kg/m². Most participants (61.4%) had normal BMI. Menstrual irregularity was observed in 22.9% and was significantly higher among underweight (50%) and overweight (42.3%) participants compared to normal BMI (9.3%) (p < 0.001). Higher BMI was significantly associated with earlier menarche (p = 0.002). Conclusion: BMI is significantly associated with age at menarche and menstrual patterns. Maintaining normal BMI may promote optimal reproductive health.

Background: Maternal anemia is a prevalent public health concern, particularly in low-resource settings, and is associated with adverse neonatal outcomes such as low birth weight (LBW) and preterm birth. Aim: To assess the prevalence and severity of maternal anemia and examine its association with LBW and preterm birth among pregnant women. Methodology: A hospital-based cross-sectional study was conducted among 270 pregnant women in their second and third trimesters at Nalanda Medical College and Hospital, Patna, Bihar. Hemoglobin levels were measured, and anemia was classified per WHO criteria. Birth outcomes, including birth weight and gestational age, were recorded at delivery. Associations between maternal anemia and adverse outcomes were analyzed using Chi-square tests, with p<0.05 considered significant. Results: Among participants, 63% were anemic: mild (38.5%), moderate (22.2%), and severe (2.3%). LBW occurred in 26.7% and preterm births in 15.6% of deliveries. LBW was more frequent in anemic (35.3%) versus non-anemic mothers (12%), and preterm births were higher among anemic (18.8%) compared to non-anemic mothers (10%). Increasing anemia severity was associated with progressively worse birth outcomes. Conclusion: Maternal anemia is highly prevalent and significantly associated with LBW and preterm birth, with risks rising alongside severity. Targeted interventions to prevent and manage anemia during pregnancy are essential to improve neonatal outcomes.

Background: Surgical site infections (SSIs) are an important cause of morbidity and mortality for cancer patients undergoing major oncologic procedures, but we have limited data on incidence, risk factors, and outcomes in this patient population. Objectives: This study aimed to evaluate the medical and surgical characteristics, risk factors, microbiological milieu, antibiotic susceptibility, and postoperative outcomes of surgical site infections (SSIs) among a cohort of cancer patients undergoing major oncologic surgery. Materials and Methods: A prospective, observational study was carried out in 128 cancer patients undergoing major surgery at the Department of General Surgery, JIMSH, Kolkata, India. Data collection included patient demographics, comorbidities, previous treatment, type of surgery, invasive device usage, and administration of prophylactic antibiotics. Wound cultures were performed for identification of pathogens and testing of antibiotic susceptibility. Statistical analysis was completed to identify risk factors for SSIs and postoperative mortality. Results: A total of 128 post-operative surgical patients, 71 (55.5%) patients developed SSIs. The SSI patients tended to be older (mean age 49.6 years vs 43.2 years), more common in males, and they represented a significant risk with prolonged hospitalization, intra-operational blood loss, and invasive devices usage. Gram-negative bacteria were recovered from over 81.8% of the cultures, with Pseudomonas aeruginosa and Escherichia coli being the most common; 48% of the isolates were multidrug-resistant pathogens (resistant to antibiotics). Patients that developed SSIs had significantly increased mortality (43.7% vs 3.5%) and increased duration of stay. Additionally, the use of routine antibiotic prophylaxis differed between the two groups. Conclusion: SSIs continue to pose significant challenges in cancer surgical procedures, involving multidrug-resistant pathogens, increased length of stay, and increased mortality. Reducing the risk of SSIs is complex and requires individualized prophylaxis approaches, high-quality perioperative management, and improved infection prevention measures that will help to reduce overall SSIs in this patient population.

Background: Intertrochanteric femur fractures are common in the elderly and pose challenges due to osteoporotic bone and comorbidities. Stable fixation enabling early mobilization is crucial to prevent complications. Aim: To retrospectively evaluate the functional and radiological outcomes in patients surgically treated for intertrochanteric femur fractures, focusing on Tip–Apex Distance (TAD), fracture reduction quality, and post-operative function. Methodology: This hospital-based retrospective study included 80 patients with Boyd and Griffin type 1 and 2 intertrochanteric fractures treated with short proximal femoral nails at Nalanda Medical College and Hospital, Patna, between March 2025 and October 2025. Post-operative radiographs were analyzed for TAD, fracture reduction, and complications. Functional outcomes were assessed using the Harris Hip Score (HHS) at six months. Results: Most patients were males aged 60–69 years. Type 2 fractures were most prevalent (65%). Mean post-operative TAD was 22.8 ± 3.1 mm, with 81.3% achieving ≤25 mm. At six months, 77.5% achieved good to excellent HHS. Post-operative complications were low, with screw cut-out in 6.3% and delayed union in 7.5% of cases. Conclusion: Surgical fixation using PFN provides favorable functional and radiological outcomes when key principles, including optimal TAD and fracture reduction, are adhered to. Early mobilization and meticulous technique are critical for minimizing complications.

Background: Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance first recognized during pregnancy and is associated with significant maternal and neonatal morbidity. Aim: To assess risk factors associated with GDM and evaluate their impact on maternal and fetal outcomes. Methodology: A prospective observational study was conducted over 8 months in the Department of Obstetrics and Gynaecology at Nalanda Medical College and Hospital, Patna, Bihar, India. Sixty pregnant women diagnosed with GDM by 75 g OGTT (≥140 mg/dL) between 24–34 weeks were enrolled and followed until delivery. Women with overt diabetes were excluded. Data were analyzed using descriptive statistics and Chi-square test (p<0.05 significant). Results: Most women were aged 21–25 years (43.33%); 48.34% were overweight/obese and 33.33% had a family history of GDM. Maternal complications occurred in 38.33%, commonly polyhydramnios (13.33%) and pre-eclampsia (10%). Preterm delivery occurred in 25% and cesarean section in 40%. Neonatal complications included macrosomia (23.33%), NICU admission (15%), and hypoglycemia (10%). Significant correlations were observed between OGTT and gestational age (R=–0.432, p=0.001), and between APGAR score and gestational age (R=0.681, p<0.001). Conclusion: GDM significantly impacts maternal and fetal outcomes. Early detection, glycemic control, and timely intervention are crucial to improve perinatal outcomes.

Introduction: Sodium is the most prevalent cation of extracellular fluid. It is responsible for 90% of total serum osmolality. The body finely maintains serum sodium between 135 and 145 mmol/L in spite of variations in salt and water intake. This value reflects total sodium in the body compared to the total body water content. Dysnatremia is the most common electrolyte disorder in hospitalized patients. It encompasses hyponatremic and hypernatremic conditions.  It is a common finding at Intensive Care Unit (ICU) admission. Nearly one third of critically ill patients have dysnatremia at ICU admission. Objectives: Identification of prevalence of dysnatremia in critically ill patients and Identification of the etilogy of dysnatremia to find out the relation with treatment outcome. Materials & Methods: The present study was an institute based descriptive observational cross-sectional study conducted with 120 patients, for a duration of 12 months at Calcutta National Medical College and Hospital, Kolkata. Result: In our study, 15 (12.5%) patients had chronic kidney disease (CKD), 17 (14.2%) patients had Hyperosmolar Hyperglycaemic State (HHS), 14 (11.7%) patients had Ischemic dilated cardiomyopathy (DCM), 11 (9.2%) patients had multi-infarct state and 10 (8.3%) patients had urosepsis. Conclusion: We concluded that dysnatremia represents a significant clinical challenge in the management of critically ill patients in our setting, necessitating heightened awareness, proactive monitoring, and timely intervention strategies to mitigate its impact on patient outcomes. We observed that, association between admission and final serum sodium values of the patients with their outcome was statistically significant.

Background: Acetabular fractures are complex injuries that pose a significant challenge to orthopaedic surgeons. The incidence of these fractures continues to rise due to high-velocity road traffic accidents. Open reduction and internal fixation (ORIF) remain the standard of care for displaced acetabular fractures requiring surgical intervention. This study aimed to evaluate the functional and radiological outcomes of acetabular fractures treated by ORIF at a tertiary care centre. Materials and Methods: This descriptive observational study was conducted at the Department of Orthopaedics, SMS Medical College, Jaipur. Forty patients with displaced acetabular fractures who underwent ORIF were included and followed up for a minimum of 12 months. Fractures were classified using the Letournel and Judet classification. Functional outcomes were assessed using the Modified Merle D’Aubigne and Postel clinical grading system. Radiological outcomes were evaluated using Matta’s criteria for quality of reduction. Results: The mean age was 50.3 years with male predominance (75%). Road traffic accident was the mode of injury in 90% of cases. Anterior column (30%) and posterior wall (25%) fractures were the most common types. Kocher–Langenbeck approach was used in 45% of patients. Anatomical reduction was achieved in 45% patients, imperfect in 40%, and poor in 15%. According to Modified Merle D’Aubigne score, 25% had excellent, 15% very good, 30% good, 15% fair, and 15% poor outcomes. Patients operated within 1–2 weeks had significantly better outcomes. Complications included post-traumatic arthritis (10%), heterotopic ossification (20%), wound infection (7.5%), and sciatic nerve palsy (5%). Conclusion: ORIF of acetabular fractures yields satisfactory functional and radiological outcomes when performed with anatomical reduction, appropriate surgical approach, and timely intervention. Early surgery within 10–14 days, minimal initial displacement, and accurate reduction are the key determinants of favourable outcomes.

Background: Distal radius fractures are among the most frequently encountered injuries in trauma emergency departments, accounting for approximately 17% of all fractures. Intra-articular fractures of the distal radius pose a significant challenge due to the need for accurate reduction and stable fixation. The optimal surgical method for managing these fractures remains debatable. This study aimed to compare the functional and radiological outcomes of percutaneous Kirschner wire (K-wire) fixation versus volar locking plate (VLP) fixation in the management of intra-articular distal radius fractures. Materials and Methods: This prospective randomized interventional study was conducted at the Department of Orthopaedics, SMS Medical College, Jaipur, from December 2023 to October 2024. Seventy patients with intra-articular distal radius fractures (Frykman type III, IV, VII, and VIII) were randomly allocated into two groups: Group A (n=35) treated with percutaneous K-wire fixation and Group B (n=35) treated with volar locking plate fixation. Functional outcomes were assessed using the Quick DASH (QDASH) score and Modified Mayo Wrist Score (MMWS) at 6 months follow-up. Radiological parameters including radial height, radial inclination, and volar tilt were evaluated. Results: The mean age was 37.82±8.68 years (K-wire group) and 38.28±9.53 years (VLP group) with male predominance in both groups. Road traffic accidents were the commonest mode of injury. At final follow-up, the VLP group demonstrated significantly better radiological parameters: mean radial height (9.94±1.69 mm vs 8.48±1.40 mm, p<0.05) and radial inclination (19.48±1.61° vs 17.8±2.44°, p<0.05). The VLP group showed significantly better functional outcomes with lower QDASH scores (28.30±10.13 vs 35.38±9.45, p<0.05) and higher MMWS (81.85±8.14 vs 76.85±7.38, p<0.05). Grip strength was significantly higher in the VLP group (80.54±5.33% vs 76.2±4.15%, p<0.05). Complications were minimal in both groups. Conclusion: Volar locking plate fixation provides superior radiological and functional outcomes compared to percutaneous K-wire fixation in the management of intra-articular distal radius fractures. VLP fixation can be considered the preferred modality for treating these fractures with fewer complications and better long-term functional recovery.

Background: Bronchiolitis is a leading cause of lower respiratory tract infection and hospitalization in children under two years, especially in developing regions, with variable clinical presentation and outcomes. Aim: To evaluate the clinical presentation, hospital course, and prognosis of bronchiolitis in children below two years of age. Methodology: A retrospective observational study was conducted over eight months at Department of Pediatrics, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India. including 74 children aged 0–24 months. Data were collected from medical records and analyzed using standard statistical methods. Results: The mean age was 7.2 ± 4.8 months, with 51.4% ≤6 months and a male predominance (56.8%). Most cases occurred in winter (54.1%). Common symptoms were cough (81.1%) and breathlessness (78.4%). RSV positivity was 40.5%. ICU admission was required in 13.5%, and 12.2% needed ventilation. Oxygen therapy (64.9%) and bronchodilators (93.2%) were widely used. Complications were infrequent, with no mortality. No significant association was found between RSV status or age and ICU admission or hospital stay. Conclusion: Bronchiolitis predominantly affects younger infants with favorable outcomes under supportive care, and RSV status does not significantly influence severity or prognosis.

Background: Alopecia Areata (AA) is an autoimmune disorder causing patchy hair loss, with trace elements such as zinc (Zn) and copper (Cu) implicated in hair follicle function and immune regulation. Aim: To evaluate serum zinc and copper levels in AA patients and assess their correlation and potential role in disease pathogenesis. Methodology: A cross-sectional observational study was conducted on 60 AA patients and 30 healthy controls at the Department of Skin & VD and Biochemistry, Sri Krishna Medical College and Hospital, Muzaffarpur, India. Serum zinc and copper were measured using atomic absorption spectrophotometry. Data were analyzed with SPSS v27, using t-tests and correlation analysis; p<0.05 was considered significant. Results: AA patients exhibited significantly lower serum zinc (62.3 ± 10.5 µg/dL) and higher copper levels (115.4 ± 18.7 µg/dL) compared to controls (zinc 85.7 ± 12.2 µg/dL, copper 105.2 ± 14.3 µg/dL; p<0.001 and p=0.02, respectively). A significant inverse correlation was observed between zinc and copper (r = -0.38, p=0.004). No significant gender differences were noted. Conclusion: AA is associated with a disrupted zinc-copper balance, suggesting that trace element imbalance may contribute to disease mechanisms. Assessing serum zinc and copper may aid in understanding pathogenesis and guiding nutritional or therapeutic interventions.

Background: Premature ejaculation (PE) is a common male sexual dysfunction ^‘that adversely affects quality of life and is often underreported, particularly among patients with psychiatric disorders. Aim: To assess the prevalence of PE in patients diagnosed with psychiatric disorders and evaluate associated factors such as depression, anxiety, stress, and erectile dysfunction (ED). Methodology: A hospital-based cross-sectional study was conducted at the Department of Psychiatry, Netaji Subhas Medical College and Hospital, Patna, Bihar, India. Eighty male patients aged 18–60 years with diagnosed psychiatric disorders were enrolled. PE was assessed using the Premature Ejaculation Diagnostic Tool (PEDT), ED using the IIEF-5, and psychological status using DASS-21. Sociodemographic and clinical data were recorded, and associations were analyzed using chi-square and logistic regression (p < 0.05). Results: Among participants, 40% had confirmed PE, 22.5% probable PE, and 37.5% no PE. PE was significantly associated with younger age (≤40 years), depression or anxiety, and coexisting ED. Marital status, education, occupation, and duration of psychiatric illness showed no significant association. Conclusion: PE is highly prevalent among psychiatric patients, particularly younger individuals and those with depression, anxiety, or ED. Routine screening and integrated management strategies are essential to address sexual dysfunction and enhance overall mental health.

Background: Obsessive-Compulsive Disorder (OCD) is a chronic psychiatric condition characterized by ^‘recurrent obsessions and compulsions that cause significant distress and functional impairment. Understanding demographic characteristics and treatment outcomes is important for improving management strategies in clinical settings. Aim: To analyze the demographic profile, clinical characteristics, and treatment outcomes of patients with OCD in a tertiary care center. Methodology: This retrospective observational study was conducted in the Department of Psychiatry at Darbhanga Medical College and Hospital. Medical records of 90 patients diagnosed with OCD according to ICD-10 criteria were reviewed. Demographic details, clinical features, family history, treatment modalities, and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores were extracted. Data were analyzed using descriptive statistics and comparative tests to assess treatment response. Results: Most patients were aged 31–45 years (44.4%) and predominantly male (66.7%). The majority had symptom onset between 21–30 years (44.4%) and moderate baseline severity (55.6%), with mixed obsessions and compulsions (61.1%). Pharmacotherapy alone was the most common treatment (55.6%). Full response was observed in 33.3% of patients, while 44.4% showed partial improvement. Mean Y-BOCS scores reduced from 24.8±6.2 to 15.6±5.8. Conclusion: OCD predominantly affected middle-aged males and commonly presented with moderate mixed symptoms. Pharmacotherapy, alone or combined with CBT, significantly reduced symptom severity, though some patients showed partial or limited response.

Background: Depression is a common psychiatric disorder that affects multiple aspects of life, including sexual functioning. Sexual dysfunction is frequently ^‘reported among individuals with depressive symptoms and may significantly reduce quality of life and relationship satisfaction. Aim: To assess the correlation between depression and sexual dysfunction among adult males and females. Methodology: A hospital-based cross-sectional observational study was conducted among 90 adult patients attending the psychiatric outpatient department of Darbhanga Medical College and Hospital, Bihar, India. Participants aged 18–60 years were included after obtaining informed consent. Socio-demographic data were collected using a semi-structured proforma. Depression severity was assessed using Beck’s Depression Inventory (BDI), while sexual functioning was evaluated using the Arizona Sexual Experiences Scale (ASEX). Erectile function in males was further assessed using the International Index of Erectile Function (IIEF). Data were analyzed using descriptive statistics and Pearson’s correlation test. Results: Among the participants, 57.8% had sexual dysfunction. Moderate depression was the most common category (33.3%). Sexual dysfunction was slightly higher in males (62.5%) than females (52.4%). A statistically significant moderate positive correlation was observed between depression and sexual dysfunction scores (r = 0.46, p = 0.001). Conclusion: Depression is significantly associated with sexual dysfunction, indicating the importance of^’ assessing sexual health during psychiatric evaluation.

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder and a leading cause of anovulatory infertility, characterized by heterogeneous clinical, hormonal, and metabolic abnormalities. Aim: To evaluate the clinical and biochemical characteristics of women with PCOS and assess their correlation with infertility. Methodology: A hospital-based cross-sectional study was conducted on 80 infertile women aged 18–40 years diagnosed with PCOS using the Rotterdam criteria. Clinical features, anthropometric measurements, ultrasonographic findings, hormonal profiles, and metabolic parameters were assessed. Data were analyzed using SPSS version 27.0. Results: The mean age was 27.8 ± 4.9 years, with a high prevalence of overweight and obesity (70%). Oligomenorrhea was the most common menstrual abnormality (55%), and primary infertility was observed in 65% of cases. Polycystic ovarian morphology was present in 72.5%. Hormonal analysis showed elevated LH/FSH ratio and increased androgen levels. Insulin resistance and dyslipidemia were common metabolic findings. Conclusion: Infertility in PCOS results from complex interactions between ovulatory dysfunction, hyperandrogenism, and metabolic disturbances, emphasizing the need for comprehensive clinical and biochemical evaluation.

Background: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine condition that leads to infertility as a result of prolonged anovulation. Pharmacological ovulation induction (OI) using drugs like Letrozole and Clomiphene Citrate (CC) is a fundamental approach to reinstating fertility. Aim: To evaluate the effectiveness, endometrial response, ovulation, pregnancy outcomes, and tolerability of Letrozole compared to Clomiphene Citrate in women with PCOS. Methodology: This prospective, randomized, open-label comparative study was conducted at a tertiary care center in Patna from August 2024 to July 2025. Ninety women with PCOS were randomized into two groups: letrozole (5 mg) or CC (100 mg) from day 3–7 of the cycle. Follicular monitoring, endometrial thickness, ovulation, pregnancy outcomes, and adverse effects were assessed. Results: Ovulation rate was higher with letrozole (86.7%) than CC (75.6%), though not statistically significant. Endometrial thickness was significantly greater in the letrozole group (9.2 ± 1.1 mm vs 8.0 ± 1.3 mm; p<0.01). Clinical pregnancy rates were 33.3% with letrozole and 22.2% with CC. Adverse effects were slightly lower with letrozole. Conclusion: Letrozole demonstrated better endometrial response and a trend toward higher ovulation and pregnancy rates, with comparable safety, making it an effective alternative to clomiphene citrate in PCOS.

Background: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy caused by median nerve compression, leading to sensory and motor hand symptoms. Pregnancy predisposes women to CTS due to hormonal changes, fluid retention, and altered connective tissue compliance. Aim: To determine the prevalence and severity of CTS in pregnant women using electrodiagnostic evaluation and to compare clinical and electrodiagnostic findings. Methodology: A hospital-based cross-sectional study was conducted at Department of obstetrics and gynecology, Shaheed Nirmal Mahto Medical College and Hospital, India, including 80 pregnant women across all trimesters. Participants underwent clinical assessment (Phalen’s and Tinel’s tests) and nerve conduction studies to confirm CTS and grade severity as mild, moderate, or severe. Results: CTS was diagnosed electrodiagnostically in 16 women (20%), predominantly mild (56.2%). Symptomatic CTS (clinical and electrodiagnostic confirmation) occurred in 10 women (12.5%), mainly in the third trimester (80%), while subclinical CTS was present in 6 women (7.5%), mostly in earlier trimesters. Clinical tests alone were positive in 30 women (37.5%), highlighting moderate concordance with electrodiagnosis. CTS prevalence increased with gestational age, peaking in the third trimester. Conclusion: CTS is relatively common during pregnancy, especially in the third trimester, with most cases being mild. Electrodiagnostic testing detects subclinical cases missed by clinical examination, emphasizing its role in early diagnosis and management to prevent symptom progression.

Background: Chronic rhinosinusitis (CRS) is regarded as a multi factorial disease that causes different symptoms such as nasal obstruction, headache, nasal discharge and olfactory dysfunction due to inflammation of the nasal and sinonasal mucosa. It is a common health problem and has several effects on quality of life, along with high treatment costs. Nasal polyps are frequently associated with loss of smell which is a common symptom affecting 61-83% of patients of CRS with nasal polyps (CRSwNP). The ability to monitor our environment depends to a large degree on our sense of smell. The aim of the study was to evaluate olfaction in patients of CRSwNP and how functional endoscopic sinus surgery (FESS) modified olfaction in patients. Materials and Methods: In our study, in 40 patients of CRSwNP, olfactory dysfunction was assessed before and after FESS. Subjective assessment of disease was done using visual analog scale of SNOT-22 questionnaire. Olfaction was tested using odor identification test and threshold tests and objective assessment of disease was done using endoscopic grading according to Lund and Kennedy endoscopic scoring. NCCT scores were also obtained using Lund and Mackay staging system. All patients underwent FESS. Symptom scores, endoscopy scores and olfaction were compared in patients before and after surgery by statistical analysis. Results: Only 27 out of 40, i.e (67.5%) patients had complaints of olfactory dysfunction. 92.59% patients had improvement in olfaction post-surgery. There was a significant improvement in olfaction after surgery shown by olfactory scores assessment before and after surgery. Surgery had a positive outcome in improvement of the mental health of patients suffering from CRSwNP. 100% of the patients had improvement of SNOT-22 scores and hence a significant reduction of symptoms. Maxillary sinus was found to have the highest incidence of involvement (95%) as per CT assessment. Improvement in endoscopic scores was seen best at 1 month post op, and recurrence of polyps was seen in 8 patients at the end of 3 months. Conclusion: Our study was able to establish a significant correlation between olfaction and parameters of disease severity like SNOT-22, endoscopic score and CT scores. We concluded that FESS has a positive outcome in terms of improvement of olfactory dysfunction in patients of CRSwNP.

Background: Intestinal obstruction (IO) is a common surgical emergency associated with significant morbidity and mortality. Early identification of ^‘risk factors is essential to optimize postoperative outcomes. Aim: To evaluate the demographic, clinical, and intraoperative risk factors influencing postoperative outcomes in patients undergoing surgery for IO. Methodology: A prospective observational study was conducted over eight months at the Department of General Surgery, Patna Medical College and Hospital, Patna, Bihar, India. Eighty adult patients requiring surgical intervention for mechanical IO were enrolled. Data on demographics, comorbidities, symptom duration, etiology, intraoperative findings, and postoperative outcomes were systematically collected and analyzed. Results: The majority of patients were middle-aged (31–50 years, 52.5%) and male (62.5%). Adhesions (35%) and hernias (22.5%) were the most common causes, with small bowel obstruction predominating (56.2%). Gangrenous bowel was present in 12.5%, necessitating resection in 15%. Postoperative complications occurred in 31.2%, ICU admission was required in 15%, and 30-day mortality was 6.2%. Advanced age, comorbidities, prolonged symptom duration, malignant etiology, and bowel gangrene were significant predictors of adverse outcomes. Conclusion: Timely resuscitation, early surgery, and structured perioperative care are critical to improving recovery and minimizing complications in surgically managed IO, particularly in resource-limited settings.

Background: Pelvic Inflammatory Disease (PID) is a polymicrobial infection of the upper female genital tract, contributing to significant reproductive morbidity. Its prevalence, microbial etiology, and associated risk factors remain underreported in low-resource settings like Patna, Bihar, India. Aim: To assess PID prevalence, identify causative microorganisms, and evaluate demographic, behavioral, and reproductive risk factors. Methodology: A retrospective case–control study was conducted on 218 women (73 PID cases, 145 controls) attending Department of Obstetrics and Gynaecology, Nalanda Medical College and Hospital, Patna. Clinical records, laboratory reports, and microbiological findings were analyzed. Descriptive statistics and multivariate logistic regression were used to identify independent predictors of PID. Results: PID prevalence peaked in women aged 25–29 years. Single marital status (adjusted OR 2.41), secondary education (OR 1.78), history of STIs (OR 9.65), multiple sexual partners (OR 6.12), early sexual debut (OR 3.87), and use of IUDs (OR 4.42) or implants (OR 5.78) were significant predictors. Microbiologically, Chlamydia trachomatis (32.9%), Ureaplasma urealyticum (23.3%), and Mycoplasma hominis (20.6%) predominated, often in co-infections. Condom use was protective. Conclusion: PID in this cohort is multifactorial, driven by sexual behavior, reproductive history, and contraceptive practices, with polymicrobial infections predominating. Targeted sexual health education, STI prevention, and careful contraceptive counseling are essential to mitigate PID burden.

Background: Uterine fibroids are the most common benign tumors of the female reproductive system and can lead to significant reproductive and gynecological complications. Although several non-modifiable risk factors have been identified, the role of modifiable lifestyle factors remains less clearly understood. Aim: To identify modifiable factors associated with uterine fibroids among women of reproductive age. Methodology: A hospital-based cross-sectional study was conducted among 278 women aged 18–44 years attending the Department of Obstetrics and Gynecology at Nalanda Medical College and Hospital, Patna, India, over nine months. Data were collected through structured questionnaires, clinical examination, anthropometric measurements, and pelvic ultrasonography. Statistical analysis was performed using SPSS, and associations were assessed using Chi-square tests and logistic regression with odds ratios (OR) and 95% confidence intervals (CI). Results: The prevalence of uterine fibroids was 33.8%. Overweight (OR=1.89; 95% CI: 1.05–3.41) and obese women (OR=2.67; 95% CI: 1.45–4.92) had higher odds of fibroids compared with women with normal BMI. Irregular physical activity (OR=1.82; 95% CI: 1.06–3.11) and high-fat diet (OR=1.77; 95% CI: 1.04–3.01) were also significantly associated with fibroid occurrence. Family history showed a strong association (OR=3.12; 95% CI: 1.79–5.44). Conclusion: Modifiable lifestyle factors such as increased BMI, physical inactivity, and unhealthy dietary patterns are significantly associated with uterine fibroids. Lifestyle modifications may help reduce the risk and improve reproductive health outcomes.

Background: Effective postoperative pain control in lower abdominal surgeries ^‘remains a challenge. While intrathecal fentanyl enhances spinal anaesthesia, ultrasound-guided Transverse Abdominis Plane (TAP) block has emerged as an alternative opioid-sparing technique. Aim: To compare the efficacy and safety of ultrasound-guided TAP block with intrathecal fentanyl in patients undergoing spinal anaesthesia for lower abdominal surgeries. Methodology: This quasi-experimental study included 38 patients randomly divided into two groups: Group ST (spinal anaesthesia + TAP block) and Group SA (spinal anaesthesia + intrathecal fentanyl). Hemodynamic parameters, pain scores, rescue analgesia requirement, and side effects were assessed up to 36 hours postoperatively. Results: Hemodynamic parameters were comparable between groups (p>0.05). The ST group showed significantly lower pain scores from 4 to 36 hours (p<0.001) and reduced need for rescue analgesia (15.8% vs. 57.9%, p=0.007). Side effects were higher in the SA group, with pruritus significantly more frequent. Conclusion: Ultrasound-guided TAP block provides superior and prolonged postoperative analgesia with fewer side effects compared to intrathecal fentanyl, making it a safer and more effective option.

Background: Abnormal uterine bleeding (AUB) is a prevalent gynecological disorder characterized by deviations in menstrual cycle regularity, duration, frequency, and volume, with significant physical, psychological, and social impacts on reproductive-age women. Aim: To retrospectively analyze the clinical profile, etiological patterns, and management strategies of AUB in women of reproductive age. Methodology: A retrospective observational study was conducted at the Department of Obstetrics and Gynaecology, MGM Medical College and Hospital, reviewing 90 patient records from January 2023 to December 2023. Data on demographics, menstrual patterns, laboratory and imaging findings, etiological classification (PALM-COEIN), and treatment modalities were collected and analyzed using descriptive statistics and logistic regression. Results: The majority of participants were aged 25–34 years (38.9%) with normal BMI (55.6%) and parity of 1–2 children (44.4%). Heavy menstrual bleeding (42.2%) was the most common presentation. Structural causes (55.6%), particularly leiomyoma (20%) and adenomyosis (13.3%), slightly predominated over non-structural causes (44.4%). Anemia (33.3%), thyroid dysfunction (13.3%), and uterine abnormalities (50%) were frequently observed. Medical management, especially hormonal therapy (44.4%), was preferred, while surgical interventions were reserved for selected cases. Age, stress, hypertension, and smoking were significantly associated with AUB. Conclusion: AUB in reproductive-age women is multifactorial, with structural etiologies slightly more prevalent. Early recognition, individualized management, and addressing contributory factors are essential for improving outcomes and quality of^’ life.

Background: Neonatal jaundice is a common condition with potential for serious complications if untreated. Aim: To evaluate the clinical profile, treatment response, complications, and short-term outcomes of neonatal jaundice. Methodology: This prospective observational study included 93 neonates (0–28 days) admitted with jaundice at a Department of Pediatrics, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India.over six months. Clinical, laboratory, and treatment data were recorded and analyzed. Results: Most neonates were term (59.1%) with mean bilirubin 14.6 ± 5.0 mg/dL. Pathological jaundice predominated (61.3%), with ABO incompatibility (29%) as the leading cause. Phototherapy was the main treatment (80.6%) with good response in 86% cases; exchange transfusion was required in 5.4%. Mean hospital stay was 4.6 ± 2.4 days. Complications were infrequent; acute bilirubin encephalopathy occurred in 3.2%. Most neonates (92.5%) were discharged healthy. Preterm infants had significantly higher bilirubin levels, longer treatment, and more NICU admissions. Conclusion: Neonatal jaundice shows favorable short-term outcomes with timely management, though preterm neonates remain at higher risk and require closer monitoring.

Background: Acute diarrhea remains a leading cause of morbidity and mortality among under-five children, particularly in developing countries, with dehydration and malnutrition as major contributors to adverse outcomes. Aim: To assess the clinical profile and associated factors among under-five children admitted with acute diarrhea in a pediatric ward. Methodology: This descriptive hospital-based study was conducted over six months at Department of Pediatrics, Government Medical College and Hospital, Bettiah, Bihar, India, including 80 children aged 6 months to 5 years. Data on demographics, clinical features, dehydration status (WHO), nutritional status (IAP), and stool findings were collected and analyzed using descriptive statistics. Results: Most children were aged 1–3 years (40%) with male predominance (62.5%). Majority had no dehydration (75%), while 7.5% had severe dehydration. Vomiting was the most common symptom (45%). Nutritionally, 60% were normal, though 40% had varying grades of malnutrition. Stool findings were normal in 85% cases. Increased severity of dehydration was associated with higher grades of malnutrition. Conclusion: Acute diarrhea in under-five children is commonly mild, but malnutrition increases vulnerability to severe dehydration. Early assessment and nutritional support are essential for better outcomes.

Background: Cervical cancer remains a major public health concern, particularly in developing countries, were limited screening leads to late diagnosis and high mortality. Early detection of precancerous lesions through cytology is crucial for prevention. Aim: To assess the role of cervical cytology (Pap smear) in the early detection of precancerous lesions. Methodology: A hospital-based cross-sectional observational study was conducted on 80 sexually active women aged >21 years in the Department of Obstetrics and Gynecology, MGM Medical College, Jamshedpur. Pap smears were collected and reported using the Bethesda System. Abnormal cases were further evaluated by colposcopy and biopsy. Results: Most participants were aged 21–30 years. Vaginal discharge (37.5%) was the most common complaint. Pap smear findings showed 62.5% NILM, while 32.5% had epithelial abnormalities (ASC-US 12.5%, LSIL 10%, HSIL 7.5%). Abnormal findings increased with age, especially >40 years. Biopsy revealed CIN I (34.6%) as the most common lesion, with carcinoma cervix in 7.7% cases. Conclusion: Pap smear is an effective tool for early detection of precancerous lesions. Regular screening and timely intervention can significantly reduce cervical cancer burden.

Background: The spinal cord is a highly ^‘radiosensitive organ at risk in head and neck cancer radiotherapy. Excessive doses can cause irreversible complications, necessitating careful dose planning. Aim: To compare spinal cord doses in forward-planned intensity-modulated radiotherapy (FP-IMRT) and inverse-planned intensity-modulated radiotherapy (IP-IMRT) techniques and evaluate their dosimetric advantages. Methodology: A comparative observational study was conducted on 90 patients with stage III–IVA head and neck squamous cell carcinoma at the Department of Medical Physics, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Bihar, India. Patients underwent FP-IMRT and IP-IMRT planning on CT datasets, with dose-volume histogram (DVH) parameters recorded for 1 cm³, 2 cm³, and 5 cm³ (cc) volumes of the spinal cord. Plan quality and maximum dose (Dmax) were assessed, and statistical comparisons were performed using paired tests. Results: IP-IMRT consistently delivered lower spinal cord doses across all volumes (1 cm³: 37.0 Gy vs. 40.2 Gy; 2 cm³: 36.5 Gy vs. 39.5 Gy; 5 cm³: 35.2 Gy vs. 38.0 Gy) and reduced Dmax (38.2 Gy vs. 41.5 Gy) compared to FP-IMRT (p < 0.01). Volumes receiving 40 Gy and 45 Gy were significantly lower with IP-IMRT. Plan quality analysis favored IP-IMRT, with 53.3% rated excellent versus 24.4% for FP-IMRT. Conclusion: IP-IMRT provides superior spinal cord sparing and higher plan quality compared to FP-IMRT, supporting its use for safe and effective head and neck radiotherapy.

Background: Maternal anemia is a major public health concern in low-resource settings like India, contributing to adverse maternal and infant outcomes. Its multifactorial etiology includes micronutrient deficiencies and inflammation. Aim: To assess maternal anemia and related biomarkers during pregnancy and examine their association with infant outcomes in Bihar, India. Methodology: A hospital-based prospective observational study was conducted among 96 pregnant women at Department of Obstetrics and Gynecology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India. Hemoglobin and biomarkers (serum ferritin, vitamin B12, folate, CRP) were assessed during pregnancy. Infant outcomes, including birth weight, gestational age, and hemoglobin at 6 weeks, were recorded. Statistical analyses included regression and multivariable models. Results: Anemia prevalence was high (68.7%), with moderate anemia most common (33.3%). Iron deficiency (41.7%), vitamin B12 deficiency (37.5%), and elevated CRP (39.6%) were frequent. Mean birth weight was 2650 g, with 35.4% low birth weight and 27.1% preterm births. Increasing anemia severity was associated with lower birth weight, higher preterm rates, and reduced infant hemoglobin. Ferritin, vitamin B12, and folate positively influenced outcomes, while CRP showed negative associations. Conclusion: Maternal anemia and poor biomarker status significantly worsen infant outcomes, highlighting the need for early detection and nutritional interventions.

Background: Abnormal uterine bleeding (AUB) is a common gynecological problem among reproductive-age women, significantly affecting health and quality of life. It involves variations in menstrual frequency, duration, and volume, with multifactorial etiology. Aim: To study the pattern, clinical presentation, and underlying causes of AUB in reproductive-age women attending a tertiary care hospital in Bihar. Methodology: This prospective observational study included 100 women aged 15–49 years over eight months. Data were collected using a structured proforma, including clinical, laboratory, ultrasonographic, and histopathological findings. Cases were classified using the PALM-COEIN system and analyzed using SPSS. Results: AUB was most common in women aged 40–49 years (46%). Metrorrhagia (38%) was the predominant pattern. Leiomyoma (26%) was the most frequent ultrasound finding. According to PALM-COEIN classification, leiomyoma (26%) and ovulatory disorders (22%) were leading causes. Histopathology showed predominantly proliferative (34.3%) and secretory (25.7%) endometrium, with minimal malignancy (1.4%). Conclusion: AUB is more prevalent in perimenopausal women, with irregular bleeding patterns predominating. Structural causes, especially leiomyoma, are most common, though functional causes are also significant, highlighting the need for comprehensive evaluation.