Introduction: Both thyroid and prolactin hormones play key role in fertility among women. Disturbances in these hormones leads to infertility by causing menstrual irregularities and anovlatory cycles. Early detectation of these hormonal imbalances can help in better outcome in patients of infertility. This study showed correlations of Prolactin level and Hypothyroidism in female infertility patients. Materials and Methods: In this study, we studied the thyroid profile and prolactin levels in 60 infertile women who visited the obstetrics and gynecology department or in vitro fertilization center of a tertiary care hospital. The frequency of hypo and hyperthyroidism along with hyperprolactinemia was studied, and the association between thyroid dysfunction and levels of serum prolactin was analyzed. Results: The majority of the infertile women were having normal thyroid function tests and normal serum prolactin level. Thyroid dysfunction was noted in 41.66% of infertile women, with 8.33% showing hyperthyroidism and 33.33% showing hypothyroidism. Hyperprolactinemia was observed in 31.66% of infertile females. Hypothyroidism was found to be positively associated with hyperprolactinemia. Conclusion: Thyroid function test and prolactin level is important routine workup in female infertility patients so that appropriate measures can be taken to improve results.

Background: Regional anaesthesia technique is mostly preferred for upper limb surgeries due to superior analgesia and reduced systemic complications. The addition of adjuvants to local anaesthetics influences both block characteristics and cardiovascular stability. Dexmedetomidine and fentanyl are commonly used adjuvants; however, comparative evidence remains limited. Objective: To compare the onset & duration of sensory and motor block, hemodynamic effects and analgesic efficacy of dexmedetomidine versus fentanyl when used as adjuvants to a bupivacaine–lignocaine combination in ultrasound-guided supraclavicular brachial plexus block. Materials and Methods: A Prospective randomized comparative study including 105 patients (ASA I–II) undergoing unilateral upper limb surgeries below the shoulder were randomly allocated into three groups (n=35 each): Inj. Bupivacaine–lignocaine (Group A), Inj. Bupivacaine–lignocaine with dexmedetomidine 1 µg/kg (Group B), and Inj. Bupivacaine–lignocaine with fentanyl 1 µg/kg (Group C) ; Onset and duration of sensory and motor block, duration of postoperative analgesia and adverse effects were recorded. Results: Dexmedetomidine significantly reduced onset time and prolonged duration of sensory and motor blockade compared to Group A and Group C. Similarly, it demonstrated significantly lower heart rate and blood pressure compared to Groups A and C (p<0.05), without clinically significant hypotension. Duration of analgesia was significantly prolonged in Group B compared to Group C and Group A (p<0.001). Mild bradycardia was observed in the dexmedetomidine group but required no intervention. Conclusion: Dexmedetomidine provides superior hemodynamic stability and prolonged postoperative analgesia compared to fentanyl when used as an adjuvant in supraclavicular brachial plexus block.

Background: Gastrointestinal adenocarcinomas (GIAs) constitute a major proportion of global cancer incidence and mortality. Among their diverse biological behaviours, molecular heterogeneity significantly influences prognosis and therapy. HER2/neu (human epidermal growth factor receptor-2) is a proto-oncogene encoding a tyrosine kinase receptor involved in cell growth and differentiation. Its overexpression has diagnostic and therapeutic relevance in several malignancies, notably breast and gastric cancers. This study aimed to do comparative analysis of HER2/neu overexpression in gastrointestinal adenocarcinomas across different sites. Materials and Methods: A total of 50 cases of histopathologically proven gastric and colorectal adenocarcinomas were evaluated retrospectively and prospectively at a tertiary care teaching hospital for a extended period of two years. Immunohistochemistry (IHC) for HER2/neu was performed on formalin-fixed, paraffin-embedded sections using the Hoffmann et al. scoring system. Expression patterns were correlated with histological subtype, grade, and demographic parameters. Statistical analysis was carried out using SPSS v26 with p < 0.05 considered significant. Results: HER2/neu positivity (3+) was detected in 12 (24%) of 50 cases—7 (25%) gastric and 5 (22.7%) colorectal carcinomas. Overexpression was most frequent in well-differentiated intestinal-type adenocarcinomas, while poorly differentiated tumors were uniformly negative (p = 0.003). No significant correlation was observed with patient age or sex. Conclusion: HER2/neu expression correlates strongly with histological differentiation in gastrointestinal adenocarcinomas. Its assessment provides valuable adjunctive information to routine histopathology, assisting in prognostication and therapeutic stratification, especially for anti-HER2 targeted treatment.

Background: Type 2 diabetes mellitus (T2DM) and obesity represent major public health challenges in India, with a large proportion of individuals remaining undiagnosed. Central obesity has been shown to be more strongly associated with dysglycemia than generalized obesity. Emerging evidence suggests that early peripheral neuropathy may occur even in prediabetes. However, limited data from South India simultaneously examine obesity markers, glycemic status, and early peripheral neuropathy in screening populations. Our objective is to estimate the prevalence of obesity, dysglycemia, and early peripheral neuropathy among adults undergoing screening for T2DM, and to assess the association of obesity markers with glycemic status and early peripheral neuropathy. Materials and Methods: This hospital-based cross-sectional study was conducted among 360 adults attending a tertiary care non-communicable disease clinic in South India. Anthropometric measurements (BMI, waist circumference, waist–hip ratio), glycemic status (OGTT and HbA1c), and early peripheral neuropathy (Diabetic Neuropathy Symptom score and 128-Hz tuning fork test) were assessed. Associations were analyzed using chi-square tests and multivariable logistic regression. Results: Overweight/obesity was prevalent in a majority of participants, with central obesity being more common than generalized obesity. Dysglycemia was detected in a substantial proportion of the screened population. Early peripheral neuropathy was present not only in newly diagnosed diabetes but also in individuals with prediabetes. Waist circumference and waist–hip ratio showed stronger associations with dysglycemia and early neuropathy than BMI. Conclusion: Simple anthropometric markers, particularly measures of central obesity, are strongly associated with dysglycemia and early peripheral neuropathy. Incorporating these low-cost measures into routine diabetes screening may enhance early risk stratification and prevention strategies.

Background: The rapid expansion of digital technology has led to increased exposure of young children to smartphones, tablets, and television. Early childhood is a critical period for speech and language development, and excessive screen exposure may interfere with parent–child interaction and verbal stimulation. Objective: To assess the association between digital device use and speech delay among preschool children aged 2–5 years. Methods: A cross-sectional study was conducted among 200 preschool children aged 2–5 years attending the pediatric OPD. Data regarding digital device exposure, duration of screen time, age of first exposure, and parental interaction were collected using a structured questionnaire. Speech development was assessed using age-appropriate developmental milestone checklists based on standard pediatric developmental guidelines. Children who failed to achieve expected speech milestones for their age were categorised as having speech delay. Statistical analysis was performed using chi-square tests and logistic regression. Results: Among the 200 children studied, 62% used digital devices daily. Speech delay was observed in 28% of participants. Children exposed to screens for more than two hours per day had significantly higher rates of speech delay compared with those exposed for less than one hour per day (p < 0.001). Early exposure before the age of two years was also associated with increased risk of speech delay. Conclusion: Excessive digital device use is significantly associated with speech delay among preschool children. Limiting screen exposure and promoting interactive communication between parents and children may help support optimal language development.

Background: It is still difficult for clinicians to diagnose gestational diabetes mellitus (GDM) early. Pregnancy-related metabolic regulation and insulin resistance are profoundly affected by adipokines, especially leptin and adiponectin. Objective: To analyze pregnant women’s first-trimester serum leptin, adiponectin, and leptin–adiponectin ratio (LAR) profiles and determine their potential as early GDM biomarkers. Methods: 180 pregnant women between weeks 11 and 13 were included in a prospective cohort study. ELISA was used to measure serum levels of adiponectin and leptin. The IADPSG criteria were used to diagnose GDM at 24–28 weeks. Analysis was done using receiver operating characteristic (ROC), correlation, and comparison. Results: In the first trimester, women with GDM (n=42) had significantly higher levels of leptin and significantly lower levels of adiponectin and LAR than normoglycemic controls (p<0.001). LAR had the best predictive value, with an AUC of 0.86.  Conclusion: These findings suggest that gestational diabetes mellitus (GDM) is associated with altered adipokine profiles during early pregnancy. The leptin–adiponectin ratio (LAR) shows promising potential as a screening biomarker for early risk stratification.

Background: Obstructive sleep apnea (OSA) is associated with systemic inflammation and increased cardiopulmonary morbidity. Although continuous positive airway pressure (CPAP) is the standard therapy, its impact on inflammatory biomarkers and their relationship with clinical outcomes such as hospitalization remains incompletely understood. Aim and Objectives: This study evaluated changes in C-reactive protein (CRP) and body mass index (BMI) over 12 months of CPAP therapy and examined whether baseline or persistent inflammation predicts dyspnea-related hospitalization. Materials and Methods: In this prospective cohort study, 166 adults with polysomnography-confirmed OSA initiating CPAP were enrolled. After exclusion of deaths and 76 participants lost to follow-up or non-adherent to CPAP, 90 patients completed 12-month evaluation. Baseline demographics, comorbidities, CRP, and BMI were recorded and reassessed at 12 months. The primary outcome was change in CRP; secondary outcomes included BMI change and time to first hospitalization for dyspnea. Analyses included paired tests, Chi-square tests, Cox proportional hazards models, Kaplan–Meier curves, and Fine-Gray competing-risk regression. Results: CRP decreased significantly after 12 months of CPAP (median 4.1 to 2.6 mg/L, p < 0.001), whereas BMI showed no significant change (31.6 to 31.5 kg/m², p = 0.12). Forty-one patients (45.6%) required dyspnea-related hospitalization, with 78% of events occurring after 8 months. Hospitalized patients had higher baseline CRP, higher 12-month CRP, and worsening CRP over time. In univariate Cox analysis, age, smoking, drinking, hypertension, baseline CRP, post-therapy CRP, and persistently high CRP were associated with increased hospitalization risk. In multivariate analysis, baseline CRP (HR 1.18), post-therapy CRP (HR 1.23), and persistently elevated CRP (HR 1.92) remained independent predictors, along with age, drinking history, and hypertension. Fine-Gray competing-risk models confirmed that CRP—but not BMI—was consistently associated with higher subdistribution hazard for dyspnea-related hospitalization. Conclusions: Twelve months of CPAP therapy significantly reduced systemic inflammation but did not alter BMI. Persistently elevated or rising CRP was strongly associated with increased risk of dyspnea-related hospitalization, while BMI showed limited prognostic value. These findings support CRP as a clinically relevant biomarker for risk stratification in CPAP-treated OSA and highlight the need for continued monitoring of inflammatory status and comorbid conditions to identify patients at elevated risk of clinical deterioration.

Background: Small bowel obstruction (SBO) is a common surgical emergency associated with significant morbidity and mortality if not managed appropriately. Management strategies include conservative ^‘treatment and surgical intervention depending on the severity and underlying cause. Aim: To evaluate and compare the outcomes of surgical and conservative management in patients with small bowel obstruction. Methodology: A hospital-based observational retrospective study was conducted in the Department of General Surgery, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India, for six months. A total of 80 patients aged ≥18 years with clinically and radiologically confirmed SBO were included. Patients were managed either conservatively or surgically based on clinical condition. Data were analyzed using SPSS version 27.0. Results: The majority of patients were aged 51–60 years (25%), with a male predominance (57.5%). Postoperative adhesions (35%) were the most common cause of SBO, followed by hernia (22.5%). Conservative management was adopted in 60% of patients, while 40% underwent surgery. Complete recovery was observed in 65% of cases, partial recovery in 20%, postoperative complications in 10%, and mortality in 5%. Conclusion: Conservative management was effective in most cases of SBO; however, timely surgical intervention remains essential in patients with complications or failure of conservative treatment.

Background: Hernia is one of ^‘the most common surgical conditions worldwide and constitutes a significant portion of the general surgical workload. Understanding the pattern of hernia presentation and surgical outcomes is important for improving patient management and treatment strategies. Aim: To evaluate the pattern of hernia presentation and assess the surgical outcomes of hernia repair among patients treated at a tertiary care hospital. Methodology: A retrospective observational study was conducted in the Department of General Surgery at Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Bihar, for 7 months. A total of 90 patients aged 18 years and above who underwent hernia repair were included. Data regarding demographic characteristics, type of hernia, surgical procedures, and postoperative outcomes were collected from hospital records and analyzed using descriptive statistics. Results: The majority of patients were aged 51–60 years and above 60 years (24.4% each), with a clear male predominance (75.6%). Inguinal hernia was the most common type (60%), followed by umbilical (15.6%) and incisional hernia (13.3%). Open hernioplasty with mesh repair was the most frequently performed procedure (68.9%). Most patients (71.1%) had complete recovery without complications, while minor complications occurred in 17.8% of cases. Conclusion: Hernia was more prevalent among older males, with inguinal hernia being the most common type. Open mesh repair remained the preferred surgical technique and demonstrated favorable postoperative outcomes with low complication and recurrence rates.

Background: Open fractures of the lower limb are severe injuries often resulting from high-energy trauma such as road traffic accidents and falls from height. These injuries are associated with significant soft tissue damage, contamination, and increased risk of infection and delayed fracture healing. Early stabilization of fractures using primary internal fixation has gained increasing acceptance with advances in surgical techniques and antibiotic therapy. Aim: To evaluate the clinical, radiological, and functional outcomes of open fractures of the lower limb treated with primary internal fixation. Methodology: A prospective observational study was conducted on 40 adult patients with open fractures of the lower limb treated with primary internal fixation. Patients were followed for 12 months. Outcome measures included fracture union time, functional outcome, and complication rates. Results: The mean age of patients was 34.6 ± 11.8 years, with 75% males. The most common mechanism of injury was road traffic accidents (65%). The average time to fracture union was 20.4 weeks. Excellent or good functional outcomes were observed in 78% of patients. Complications included superficial infection (10%), deep infection (5%), delayed union (7.5%), and non-union (2.5%). Conclusion: Primary internal fixation provides stable fracture fixation and satisfactory functional outcomes in open fractures of the lower limb when combined with proper wound debridement and antibiotic therapy.

Background: The bicipital groove (intertubercular sulcus) of the humerus lodges the tendon of the long head of the biceps brachii and plays a crucial role in maintaining shoulder stability and biomechanics. Variations in its morphology have been associated with biceps tendon instability, tendinitis, and surgical complications. Objective: To systematically review published literature on the morphometric variations of the bicipital groove of the humerus in adult human populations. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases including PubMed, Google Scholar, and Scopus were searched for relevant studies published between 1999 and 2025. Original anatomical studies reporting quantitative morphometric parameters of the bicipital groove were included. Data were extracted and synthesized narratively. Results: Fourteen studies met the inclusion criteria. Considerable variations were observed in the length, width, depth, and wall angles of the bicipital groove across different populations. Several studies reported shallow grooves and altered wall angulations, which may predispose to instability of the long head of the biceps tendon. Conclusion: Significant morphometric variations of the bicipital groove of the humerus exist across populations. Awareness of these variations is essential for anatomists, orthopedic surgeons, and radiologists to improve diagnostic accuracy, surgical planning, and implant design.

Background: Accessory renal arteries are the most common variation in renal vascular anatomy. Their branching pattern further adds complexity and has significant clinical implications. Objective: To determine the prevalence, number, and branching patterns of accessory renal arteries in adult cadavers. Methods: A multicentric cadaveric study was conducted on 60 adult cadavers. Renal arteries were dissected and analyzed for the presence of accessory renal arteries and their branching patterns. Results: Accessory renal arteries were present in 21.7% of cadavers. Most were unilateral with right-side predominance. Double arteries were most common. Pre-hilar branching was the most frequent pattern, followed by pre-segmental branching. Conclusion: Accessory renal arteries with variable branching patterns are common. Knowledge of these variations is crucial for safe surgical and radiological interventions.

Background: Neonatal sepsis remains a major cause of morbidity and mortality in developing countries and requires timely diagnosis and appropriate antimicrobial therapy. Objectives: To determine the bacteriological spectrum and antimicrobial-resistance pattern of neonatal sepsis and to assess the diagnostic utility of C-reactive protein (CRP) and Procalcitonin (PCT). Methods: A hospital-based cross-sectional observational study was conducted among 110 neonates with suspected sepsis admitted to the NICU and SNCU of Bankura Sammilani Medical College & Hospital (March 2024–August 2025). Blood cultures were processed using the BACT/ALERT 3D system, isolates were identified by the Vitek 2 Compact System, and antimicrobial susceptibility testing was performed as per CLSI 2023 guidelines. Serum C-reactive protein (CRP) and procalcitonin (PCT) levels were measured by immunoturbidimetric and ELFA methods, respectively. Diagnostic performance was assessed using ROC curve analysis. Results: Of 110 neonates evaluated, 33 (30.0%) were culture‑positive. Late‑onset sepsis accounted for the majority of cases (69.7%). Gram‑positive bacteria constituted 51.5% of isolates, predominantly Staphylococcus aureus and coagulase‑negative staphylococci, while Gram‑negative bacilli accounted for 21.2%. Fungal isolates (Candida species) represented 27.3% of cases. Gram‑positive isolates showed complete sensitivity to vancomycin and linezolid, whereas Gram‑negative organisms demonstrated multidrug resistance. ROC analysis showed good diagnostic accuracy for CRP (AUC = 0.87) and excellent accuracy for PCT (AUC = 0.98). At optimal cut‑offs (CRP ≥14.27 mg/L; PCT ≥1.77 ng/mL), PCT demonstrated higher sensitivity and specificity than CRP. Conclusion: Gram‑positive cocci were the predominant bacterial pathogens, with a notable proportion of fungal sepsis among neonates. Procalcitonin proved to be a more reliable biomarker than CRP for early diagnosis of neonatal septicaemia. Integration of biomarker assessment with microbiological surveillance may facilitate early detection, guide rational antimicrobial therapy, and improve management of neonatal sepsis.

Background: Nevi are frequently encountered cutaneous lesions that may be either congenital or acquired, originating from different tissues. Their clinical manifestations vary depending on factors such as age, gender, and histological subtype. Recognizing demographic distribution and clinical characteristics is important for accurate diagnosis and appropriate management. Methods: A cross-sectional observational study was carried out among 100 patients presenting with different types of nevi. Demographic variables including age, gender, residence, and socioeconomic status were documented. Clinical parameters such as the type of nevus, tissue of origin, side of body involvement, and age at onset were evaluated. Statistical analysis was performed using suitable tests, and a p-value < 0.05 was considered statistically significant. Results: Of the 100 patients included in the study, 52% were females and 48% were males, showing no statistically significant overall gender difference (p = 0.68). The largest proportion of patients (40%) belonged to the 1–10 years age group. In 56% of cases, nevi were present since birth, indicating a predominance of congenital lesions (p < 0.001). Epidermal nevi were the most common subtype (48%), followed by melanocytic nevi (31%). Becker’s nevus demonstrated a significant male predominance (p = 0.04), whereas Nevus of Ota showed a higher occurrence among females (p = 0.03). No significant difference was noted with respect to the side of body involvement. A greater proportion of patients belonged to the Above Poverty Line category (66%), which was statistically significant (p = 0.003). Conclusion: Nevi are more commonly observed in the pediatric age group and are frequently congenital in origin, with epidermal nevi representing the most prevalent subtype. Certain individual types of nevi exhibit gender predilection; however, the overall distribution between males and females remains relatively comparable.

Background/Introduction: Nutritional deficiencies, bone marrow failure, and malignancies are just a few of the many causes of pancytopenia, a common hematological condition marked by a decrease in all three blood cell lineages. Appropriate management requires an accurate diagnosis. Trephine biopsy (BMB) and bone marrow aspiration (BMA) are essential tools for assessing these patients. The purpose of this study is to evaluate the results of bone marrow aspiration and biopsy in patients who present with pancytopenia and to determine the diagnostic utility of both procedures. Methods: This prospective observational study was carried out at the Department of Pathology, Government Medical College, Bettiah, Bihar, over the course of a year (25 January 2025– 25 January 2026). There were 200 patients in all who met the requirements for pancytopenia. Comprehensive laboratory, hematological, and clinical data were documented. In every case, a trephine biopsy and bone marrow aspiration were carried out, followed by morphological evaluation and any necessary ancillary tests. Descriptive statistics were used to analyze the data. Results: Of the patients, 40% were between the ages of 21 and 40, and 59% were male. Fever (55%), pallor (81%), and generalized weakness (85%) were common clinical features. In 52% of cases, a bone marrow examination showed hypercellular marrow. Megaloblastic anemia accounted for 40% of the cases, with aplastic anemia coming in second at 18%, acute leukemias at 15%, and myelodysplastic syndrome at 7%. In 77% of cases, bone marrow aspiration alone was diagnostic; in 23% of cases, biopsy yielded additional or confirmatory information, especially in cases involving hypocellular marrow, fibrosis, focal infiltration, and dry tap. In 82% of cases, aspiration and biopsy results were in agreement. Conclusion: The most common cause of pancytopenia in this group is still megaloblastic anemia. Although bone marrow aspiration is a useful first diagnostic method, trephine biopsy greatly improves diagnostic precision, particularly in certain situations. For the best assessment of pancytopenia, both methods must be used in conjunction with clinical correlation.

Background: Adhesive capsulitis, commonly known as frozen shoulder, is a disabling condition characterized by progressive pain and restriction of shoulder joint movements. Intra-articular corticosteroid injections are widely used for symptomatic relief due to their anti-inflammatory effects. Aim: To evaluate the efficacy of intra-articular corticosteroid injections in improving pain, range of motion (ROM), and functional outcomes in patients with adhesive capsulitis over a 6-month follow-up period. Materials and Methods: This prospective study included 100 patients diagnosed with adhesive capsulitis attending the Physical Medicine & Rehabilitation department of a tertiary care hospital. Patients received a single intra-articular corticosteroid injection under aseptic precautions. Outcome measures included Visual Analog Scale (VAS) for pain, Shoulder Pain and Disability Index (SPADI), and ROM (abduction, flexion, external rotation). Assessments were performed at baseline 6 weeks, 3 months, and 6 months. Statistical analysis was conducted using paired t-test. Results: Significant improvement in pain scores was observed as early as 6 weeks post-injection (p < 0.001), with sustained reduction up to 6 months. ROM showed marked improvement, particularly in abduction and external rotation (p < 0.001). SPADI scores demonstrated significant functional improvement over time. Maximum benefit was observed within the first 6–12 weeks. Conclusion: Intra-articular corticosteroid injection is an effective, safe, and minimally invasive modality for short- to mid-term management of adhesive capsulitis, providing rapid pain relief and improved shoulder function.

Introduction: The new coronavirus that triggered the COVID-19 pandemic began to spread quickly over the world in December of 2019. When the epidemic first started, clinical attention was focused on the symptoms and epidemiology in addition to the patients’ computed tomography images. A positive nucleotide amplification result would then be used to make the diagnosis. Aims: The aims to determine the correlation of COVID-19 patients by systematically analyzing the baseline haematological characteristics and laboratory indices. Materials and Method: This is a hospital based; observational cross-sectional study was conducted in the department of pathology Medical College Kolkata in collaboration with the department of chest medicine. The study period was one year. 382 patients were included in this study. Result: Lymphocyte counts significantly decrease as disease severe (p<0.0001), while NLR shows a dramatic rise in severe cases [8.8328mean±7.1585] (p<0.0001) .In Moderate, the mean ESR [70.2299± 30.6405] and In Severe, the mean ESR [70.8662± 30.7169], Distribution of mean ESR with Severity was statistically significant (p=0.0001). Mean CRP was significantly higher in severe severity [108.0000± 68.9692] than mild severity [28.1538± 25.1832] and moderate severity [77.5709± 51.0397] (p<0.0001). Mean Platelet shows significantly higher trends in severe cases [277459.7701± 103473.3765] than mild [232060.5634 ± 84759.5239] (p=0.0004). Conclusion: In conclusion, the association shown in COVID-19 patients between hematological traits and disease severity highlight the significance of blood profile monitoring as a critical instrument for determining the prognosis of a patient. The severity of COVID-19 has been observed to substantially correlate with hematological indicators, including lymphopenia, high neutrophil-to-lymphocyte ratio (NLR), elevated ESR, CRP, increased platelets with elevated INR and D dimer levels. According to these results dynamic alterations in blood components may function as prognostic markers of the course of a disease, allowing prompt intervention and treatment techniques that enhance patient outcomes.

Background: Upper gastrointestinal bleeding (UGIB) remains a common medical emergency with significant morbidity. Early identification of patients requiring blood transfusion is critical for appropriate triage and resource utilisation. The Glasgow–Blatchford Score (GBS) is a validated pre-endoscopic risk stratification tool used to predict clinical intervention in UGIB. Objectives: To evaluate the association between Glasgow–Blatchford Score and blood transfusion requirement in patients presenting with UGIB. Methods: This hospital-based cross-sectional study included adult patients presenting with UGIB. Glasgow–Blatchford Score was calculated at admission using standard criteria. Blood transfusion requirement during hospitalisation was the primary outcome. Statistical analysis included categorical association testing, receiver operating characteristic (ROC) curve analysis, and logistic regression. Results: Higher Glasgow–Blatchford Scores were significantly associated with increased blood transfusion requirement. Mean GBS was significantly higher in transfused patients. ROC analysis demonstrated good discriminative ability of GBS for predicting transfusion. Conclusion: Glasgow–Blatchford Score is a robust predictor of blood transfusion requirement in upper gastrointestinal bleeding and remains a useful bedside tool for early risk stratification and triage.

Introduction: Choledochal cysts, rare congenital anomalies of the biliary tract, typically present in childhood, yet in 20% of patients the diagnosis is delayed until adulthood. Presentation in adult-life is often associated with other hepatobiliary pathologies, complicating surgical management. These may remain asymptomatic. Symptomatic patients mostly present with symptoms mimicking calculous biliary tract disease. Diagnosis is made by imaging of the biliary tree, can also be incidental. Surgical management is the definitive treatment, dictated by the cyst type along with the presence of associated hepatobiliary pathology. Aims: To highlight the clinical features, diagnostic approach, and management of an extremely rare case of a giant choledochal cyst. Materials and Methods :An observational, prospective study was conducted on 36 patients, meeting the study criteria, attending General Surgery OPD at Medical College and Hospital, Kolkata (June, 2022 – June, 2024) treated with cyst excision with Roux-en-Y Hepaticojejunostomy. Patients were followed up for six months postoperatively. Results: Majority were female (63.6%), median age 38.5 years. Most presented with right upper quadrant pain and jaundice (54.5%). Commonest was Type IVa (68.8%), abnormal pancreatico-biliary junction:13.8%. Commonest associated pathology was cholelithiasis (54.5%). Post-operatively, median hospital stay was 8 days. Most common complication: Surgical site infection (22.2%). Outcomes: Uneventful post-operative course- 56.%, Clavien-Dindo Grade I-25%, Grade II-13%, Grade IVa- 5.6%. The median day of abdominal drain removal-Day 6.5, initiation of enteral nutrition-Day 3, bile leak in 8.3%. Bile: Culture-no growth (58.6%), Amylase-raised (22.7%). HPE: non-malignant in 100%. Follow up: Deranged LFT- 2.8%, incisional hernia: 5.6%. Conclusion: Choledochal cysts are rare congenital biliary anomalies that require timely diagnosis and appropriate surgical management to prevent complications such as cholangitis, pancreatitis, and malignancy. Early recognition using appropriate imaging modalities allows for definitive surgical planning. Complete excision of the cyst with biliary reconstruction remains the treatment of choice and is associated with good postoperative outcomes. The management of a giant choledochal cyst poses additional surgical challenges due to its size, anatomical distortion, and risk of complications; however, successful surgical excision can be achieved with careful planning and expertise. Overall, surgical management provides favorable outcomes with low morbidity when performed appropriately, emphasizing the importance of early intervention and standardized surgical techniques.

Background: Endometriosis is a chronic estrogen-dependent disorder commonly affecting women of reproductive age and is strongly associated with infertility. Management remains challenging due to its multifactorial pathophysiology and variable response to treatment. Aim: To evaluate clinical characteristics, treatment modalities, and reproductive outcomes in women with endometriosis-associated infertility. Methodology: This hospital-based prospective observational study included 90 infertile women aged 20–40 years with confirmed endometriosis. Patients received individualized management in the form of surgical, medical, combined therapy, or assisted reproductive techniques (ART). Clinical and reproductive outcomes were assessed during follow-up. Results: Most participants were aged 26–35 years and had primary infertility. Moderate to severe disease (rASRM Stages III–IV) predominated. Combined surgery and medical therapy were the most common treatment approach (42.2%). Overall, 48.9% of women achieved pregnancy, with 28.9% conceiving spontaneously and 20% through ART, while 51.1% did not conceive. Conclusion: Nearly half of women with endometriosis-associated infertility achieved pregnancy following treatment. Multimodal, individualized management strategies, including surgery and ART, play a crucial role in optimizing reproductive outcomes.

Background: Cesarean section (CS) is a common obstetric procedure globally, offering vital benefits in high-risk pregnancies. Rising CS rates, particularly in tertiary care hospitals, necessitate evaluation to ensure appropriate clinical use. Aim: To retrospectively analyze cesarean section rates and their indications among women delivering at a tertiary care hospital. Methodology: This descriptive cross-sectional study included 90 women delivering at the Department of Obstetrics and Gynaecology, SNMMCH, Dhanbad, Jharkhand, over one year. Data on maternal age, parity, mode and type of delivery, and CS indications were collected from medical records. Descriptive statistics summarized findings, and CS rates were calculated as proportions. Results: Of 90 deliveries, 44.4% were cesarean, with emergency CS comprising 70% of cases. The predominant indications were previous cesarean (25%), fetal distress (17.5%), and non-progress of labor (15%). Most mothers were aged 20–30 years (67.8%) and multigravida (55.6%). Vaginal delivery remained slightly higher (55.6%) than CS. Conclusion: CS rates in this tertiary hospital were higher than WHO recommendations, driven mainly by maternal and fetal risk factors. Evidence-based evaluation, judicious surgical decision-making, and wider implementation of VBAC could optimize maternal and neonatal outcomes.

Background: Early detection of oral malignant and potentially malignant lesions is essential to reduce morbidity and mortality associated with oral squamous cell carcinoma. Although histopathology remains the gold standard for diagnosis, it is invasive and may not always be feasible. Oral brush cytology has emerged as a non-invasive adjunctive diagnostic tool for early detection and screening. Objectives: To evaluate the utility of brush cytology in the screening and early diagnosis of oral malignant and premalignant lesions and to correlate cytological findings with histopathological diagnosis. Materials and Methods: A total of 76 patients with clinically suspected oral malignant and premalignant lesions were included. Buccal mucosal scrapings were obtained using the brush technique, followed by punch biopsy from the same lesion. Cytological findings were correlated with histopathological diagnosis, which was considered the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. Results: Out of 76 cases, 43 were confirmed malignant on histopathology. Brush cytology correctly identified 37 true positive and 33 true negative cases, with 6 false negative and no false positive cases. The sensitivity and specificity were 86% and 100%, respectively. The positive predictive value was 100%, negative predictive value was 84.6%, and overall diagnostic accuracy was 92.1%. Conclusion: Oral brush cytology is a simple, cost-effective, and non-invasive adjunctive diagnostic tool with high specificity and good sensitivity. It is particularly useful for screening and early detection of oral malignant and premalignant lesions, especially in resource-limited settings.

Background: Controlled hypotensive anesthesia is essential in middle ear surgery to reduce bleeding and improve surgical visibility. Isoflurane and sevoflurane are commonly used volatile anesthetics with distinct pharmacological profiles. This study aimed to compare their efficacy in producing controlled hypotension. Methods: In this prospective randomized study, 120 ASA I–II patients aged 20–30 years undergoing elective middle ear surgery were equally divided into two groups: Group I received isoflurane, and Group S received sevoflurane for maintenance of anesthesia. Hemodynamic parameters, oxygen saturation, urine output, and perioperative complications were recorded and analyzed. Results: Both agents effectively achieved the target mean arterial pressure (55–65 mmHg) with comparable hemodynamic stability. Pulse rate, systolic and diastolic blood pressures, and SpO₂ remained similar between groups. No significant complications were observed. Sevoflurane demonstrated smoother and faster recovery, whereas isoflurane was more cost-effective. Conclusion: Isoflurane and sevoflurane are equally effective and safe for controlled hypotension in middle ear surgery, with sevoflurane offering the advantage of improved recovery characteristics.

Background: Effective postoperative analgesia is essential for optimal recovery and patient satisfaction. Dexmedetomidine and nalbuphine are commonly used adjuvants, but their comparative efficacy remains under evaluation. Aim: To compare the duration of postoperative analgesia and associated clinical parameters between dexmedetomidine and nalbuphine. Methods: A randomized, prospective, single-blinded controlled study was conducted on 110 patients undergoing elective surgery. Patients were divided into two groups: Group A (dexmedetomidine) and Group B (nalbuphine). Parameters assessed included onset and duration of sensory and motor block, duration of analgesia, hemodynamic changes, and adverse effects. Results: Dexmedetomidine demonstrated significantly faster onset of sensory and motor block (p < 0.001) and prolonged duration of analgesia (13.83 ± 0.78 hours vs 12.07 ± 0.99 hours, p < 0.001). Hemodynamic parameters showed significant reductions in pulse rate and mean arterial pressure in Group A at specific intervals, while oxygen saturation remained stable in both groups. Conclusion: Dexmedetomidine is superior to nalbuphine in providing prolonged and effective postoperative analgesia with stable respiratory parameters and acceptable hemodynamic effects.

Background: Papulosquamous skin disorders are a diverse group of dermatological conditions with overlapping clinical features, making accurate diagnosis challenging and often necessitating histopathological confirmation. Aim: To evaluate the clinicopathological correlation in papulosquamous skin disorders at a tertiary care centre in Muzaffarpur. Methodology: This retrospective observational study was conducted in the Department of Skin & VD, Sri Krishna Medical College and Hospital, Muzaffarpur, over 6 months. A total of 60 patients with clinically diagnosed papulosquamous disorders who underwent skin biopsy were included. Clinical findings were compared with histopathological diagnoses, and data were analyzed using descriptive statistics and appropriate tests. Results: The majority of patients were aged 31–40 years (26.67%) with a slight male predominance (56.67%). Psoriasis was the most common disorder (36.67%), followed by lichen planus (23.33%). Lower limbs were the most frequently involved site (30%). Clinicopathological correlation was observed in 76.67% of cases, while 23.33% showed discordance. Conclusion: A high level of clinicopathological correlation was observed; however, discrepancies highlight the importance of histopathological examination in confirming diagnosis and improving management of papulosquamous disorders.

Background: Government health schemes are essential for improving access to healthcare and achieving universal health coverage in India. Major initiatives such as Ayushman Bharat and National Health Mission aim to provide affordable and accessible healthcare services. However, awareness and utilization of these schemes among young adults remain suboptimal, leading to underutilization of available services. Objective: This narrative review aims to assess the level of awareness and utilization of government health schemes among young adults in India, and to identify key determinants, barriers, and strategies for improving access and uptake. Methodology: A narrative review was conducted using literature from PubMed, Google Scholar, Scopus, and Web of Science, along with reports from national and international organizations. Studies published between 2010 and 2025 were included based on predefined inclusion and exclusion criteria. Data were extracted and synthesized into thematic domains including awareness levels, utilization patterns, socio-demographic determinants, and barriers to access. Results: The review found that overall awareness of government health schemes ranges from 40%–60%, with awareness of Ayushman Bharat between 30%–50% and services under National Health Mission between 50%–70%. Utilization remains low, with Ayushman Bharat usage ranging from 10%–30% and NHM service utilization between 30%–60%. Key barriers include lack of awareness (40%–50%), administrative challenges (20%–30%), accessibility issues (20%–25%), and preference for private healthcare (25%–35%). Targeted IEC/BCC interventions have been shown to improve awareness by 20%–30% and utilization by 15%–25%. Conclusion: Awareness and utilization of government health schemes among young adults in India are influenced by multiple behavioural, social, and systemic factors. Strengthening communication strategies, improving accessibility, and addressing administrative barriers are essential to enhance utilization and achieve equitable healthcare access.

Background: Drug utilization studies are essential to evaluate prescribing practices and ensure rational, safe, and cost-effective medication use, particularly in pediatric populations where pharmacotherapy differs significantly from adults. Aim: To assess the drug utilization pattern and prescribing practices in pediatric patients using WHO prescribing indicators. Methodology: A retrospective, observational study was conducted over six months in a teaching hospital, analyzing 97 pediatric patient records (0–18 years). Data on demographics, prescribed drugs, dosage, route, and adherence to the National List of Essential Medicines (NLEM) were collected and evaluated using descriptive statistics and WHO indicators. Results: A total of 118 drugs were prescribed, with an average of 1.22 drugs per encounter, indicating low polypharmacy. Branded drugs predominated (72.88%), while only 27.12% were prescribed generically. Essential medicines constituted 30.51% of prescriptions. Antibiotics were used in 24.74% of encounters, and injections in 35.05%. Pantoprazole was the most commonly prescribed drug. Oral (40.67%) and intravenous (28.81%) routes were most frequent. Conclusion: Prescribing practices showed low polypharmacy but suboptimal adherence to generic prescribing and essential medicine use. Improvement in rational prescribing, particularly increasing generic use and optimizing antibiotic and injection practices, is recommended.

Background: Adverse drug reactions (ADRs) are a major cause of morbidity and underreported in India despite expanding pharmacovigilance systems. Aim: To evaluate the incidence and pattern of ADRs in a tertiary care hospital. Methodology: A retrospective observational study was conducted over six months using 147 ADR reports from an ADR Monitoring Centre. Data were analyzed for demographics, drug classes, causality (Naranjo scale), and severity (Hartwig scale) using descriptive statistics. Results: ADRs were more common in males (55.78%) and predominantly affected the 16–30 years age group (31.29%). Dermatology (30.61%) and General Medicine (20.41%) reported the highest cases. Antibiotics were the leading cause (40.82%), followed by anticancer drugs (13.61%) and NSAIDs (12.24%). Most ADRs were classified as possible (50.34%) or probable (44.22%). Severity assessment showed that 48.98% were mild, 40.82% moderate, and 10.2% severe. Conclusion: ADRs were mainly mild to moderate, with antibiotics being the most implicated drugs. Strengthening pharmacovigilance and rational prescribing is essential to enhance drug safety.

Background: Urinary tract infections are among the most common bacterial infections encountered in clinical practice. The increasing prevalence of carbapenem‑resistant gram‑negative bacilli has emerged as a major therapeutic challenge, especially in tertiary care hospitals. Aim: To study the microbiological profile, antimicrobial susceptibility pattern, and prevalence of carbapenemase‑producing gram‑negative bacteria isolated from urinary samples. Methodology: This hospital‑based cross‑sectional study included 80 culture‑positive urinary isolates of gram‑negative bacilli. Identification was done using standard microbiological methods. Antimicrobial susceptibility testing was performed by the Kirby–Bauer disc diffusion method as per CLSI guidelines. Carbapenem resistance was detected phenotypically, and resistant isolates were further tested for carbapenemase and metallo‑β‑lactamase production. Result: Escherichia coli was the most common isolate, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa. Carbapenem resistance was observed in a significant proportion of isolates, predominantly among Klebsiella and non‑fermenters. Carbapenemase production was the most common resistance mechanism. High resistance was noted to fluoroquinolones and aminoglycosides, while colistin showed 100% susceptibility. Conclusion: The study highlights the alarming presence of carbapenem‑resistant and carbapenemase‑producing uropathogens. Routine surveillance, early detection of resistance, and rational antibiotic use are essential to curb the spread of multidrug‑resistant organisms.

Background: The rising incidence of thyroid disorders has led to increased surgical interventions, with post-operative complications such as hypocalcemia and voice change significantly affecting patient outcomes. Aim: To retrospectively assess the incidence, pattern, and risk factors of hypocalcemia and voice change following thyroid surgery. Methodology: A retrospective observational study was conducted on 78 patients undergoing thyroid surgery at PMCH, Patna in Bihar, India. Data were collected from medical records and analyzed using descriptive statistics and Fisher’s exact test. Results: Overall, 30.77% of patients developed complications. Hypocalcemia (20.51%) was the most common, followed by voice change (17.95%). Most cases were temporary (75% and 64.29%, respectively). Total thyroidectomy showed significantly higher complication rates than hemithyroidectomy (p<0.05). Complications decreased over time, with marked reduction at 6 months. Gender showed no significant association. Conclusion: Post-operative complications are relatively common but largely transient. Total thyroidectomy is associated with higher risk, emphasizing the need for careful surgical planning and follow-up.

Background: Benign prostatic hyperplasia (BPH) is a prevalent age-related urological condition characterized by non-malignant enlargement of the prostate, leading to lower urinary tract symptoms (LUTS) and impaired quality of life. Aim: To evaluate the clinicopathological profile of patients with BPH in a tertiary care Centre. Methodology: A prospective observational study was conducted on 90 patients presenting with LUTS and undergoing transurethral resection of the prostate (TURP). Clinical features, prostate size, surgical modality (monopolar/bipolar TURP), and histopathological findings were analyzed using standard statistical methods. Results: The majority of patients were aged 60–69 years (37.8%). Common symptoms included weak urinary stream (82.2%), frequency (80%), and nocturia (75.6%). Most patients (42.2%) had prostate size 30–50 g. Bipolar TURP (51.1%) and monopolar TURP (48.9%) were almost equally performed. Histopathology showed BPH in 86.7% and BPH with chronic prostatitis in 13.3% of cases. Conclusion: BPH predominantly affects elderly males and commonly presents with mixed LUTS. Moderate prostate enlargement is frequent, and both TURP techniques are widely utilized. Histopathology confirms BPH as the predominant pathology. Early diagnosis and appropriate management are essential for improved outcomes.

Background: Statins, particularly atorvastatin, are among the most prescribed lipid-lowering agents worldwide. While their cardiovascular benefits are well-established, growing evidence suggests that long-term atorvastatin use may adversely alter glycemic homeostasis, potentially accelerating the onset of new-onset diabetes mellitus (NODM) or worsening pre-existing glucose intolerance. Despite this pharmacological concern, data from tertiary care settings in India remain limited. Objectives: This study aimed to evaluate glycemic status, including fasting blood glucose (FBG), postprandial blood glucose (PPBG), glycated haemoglobin (HbA1c), and insulin resistance indices, among hypercholesterolemic patients receiving atorvastatin therapy in a tertiary care hospital. Materials and Methods: A retrospective record-based study was conducted over 12 months at a tertiary care hospital. Medical records of 182 adult hypercholesterolemic patients on atorvastatin (10 mg to 40 mg daily) without baseline diabetes were analysed. Glycemic parameters were recorded at baseline, 6 months, and 12 months. Data were analysed using SPSS version 22.0 and statistical significance was set at p < 0.05. Results: The mean age of patients was 51.4 ± 10.7 years with a male predominance (53.8%). Statistically significant increases in FBG (96.4 to 107.3 mg/dL), PPBG (128.7 to 143.5 mg/dL), HbA1c (5.3% to 5.9%), and HOMA-IR (1.94 to 2.73) were observed over 12 months (p < 0.05). New-onset diabetes was detected in 14 patients (7.7%) at 12 months, with higher incidence in those receiving 40 mg atorvastatin (10.9%) compared to 10–20 mg (4.4%). Impaired fasting glucose increased from 20.9% at baseline to 39.6% at 12 months. Conclusion: Atorvastatin therapy is associated with progressive and dose-dependent worsening of glycemic parameters in hypercholesterolemic patients. Routine glycemic surveillance should be mandated in all patients receiving atorvastatin therapy, particularly those on higher doses or with pre-existing metabolic risk factors.

Background: Chronic non-healing ulcers are a major clinical challenge, and split-thickness skin grafting (STSG) is widely used for definitive wound coverage. Aim: To evaluate outcomes of STSG in non-healing ulcers and assess the influence of patient- and ulcer-related factors on graft success. Methodology: This retrospective study included 80 patients with non-healing ulcers (>3 weeks) treated with STSG at Department of General Surgery, Jagannath Gupta Institute of medical Sciences, Budge Budge, Kolkata, West Bengal, India. Data regarding demographics, ulcer etiology, comorbidities, and graft outcomes were analysed using descriptive and inferential statistics. Results: Most patients were aged 41–50 years (27.5%) and males (65%). Diabetic ulcers were the most common etiology (37.5%). Excellent graft uptake (>90%) was seen in 50% of cases, while 27.5% had good outcomes. Overall, 77.5% achieved satisfactory graft uptake. Patients without comorbidities showed significantly better outcomes (95.5% excellent/good) compared to those with comorbidities (55.6%). Comorbid conditions were associated with higher rates of fair/poor graft results. Conclusion: STSG is an effective and reliable method for managing non-healing ulcers. However, outcomes are strongly influenced by comorbidities and systemic health status. Proper patient selection and optimization of underlying conditions are essential for improved graft success.

Background: Gastrointestinal tract (GIT) diseases range from inflammatory conditions to malignant neoplasms and represent a major health burden worldwide. Endoscopy with biopsy plays a crucial role in the diagnosis of GIT lesions, while histopathological examination provides definitive confirmation and characterization of these lesions. Aim: To study the histopathological spectrum of gastrointestinal tract lesions and evaluate their correlation with endoscopic findings. Methodology: A retrospective observational study was conducted over six months in the Department of Pathology, Government Medical College Bettiah, Bihar. A total of 64 gastrointestinal biopsy specimens obtained during endoscopy were analyzed. Clinical data, endoscopic findings, and histopathological diagnoses were reviewed and correlated. Tissue samples were processed using routine histopathological techniques and analyzed using descriptive statistics and Chi-square test. Results: The majority of patients were aged 40–59 years (40.63%) with male predominance (65.63%). The stomach was the most commonly involved site (53.13%), followed by the duodenum (31.25%) and esophagus (15.63%). Chronic gastritis (31.25%) was the most frequent lesion, followed by duodenitis (18.75%) and chronic active gastritis with H. pylori (12.5%). Adenocarcinoma accounted for 10.94% of cases. Overall concordance between endoscopic and histopathological findings was 76.56% with moderate agreement (κ = 0.46). Conclusion: Endoscopy shows good correlation with histopathology; however, histopathological examination remains essential for definitive diagnosis and accurate characterization of gastrointestinal lesions.