Background: Effective analgesia during positioning and postoperative recovery is essential in femur fracture surgery. The Pericapsular Nerve Group (PENG) block has recently emerged as a targeted technique with potential advantages over the Fascia Iliaca Compartment Block (FICB). Material and Methods: This prospective comparative study included 30 patients undergoing femur fracture surgery, who received either a PENG block or an FICB. Pain during positioning for spinal anaesthesia, postoperative analgesia duration, and hemodynamic parameters were recorded. Results: The PENG block provided lower pain scores during positioning, prolonged postoperative analgesia, and greater hemodynamic stability compared with the FICB. Conclusion: The PENG block may be considered a more effective regional anaesthesia technique for femur fracture surgery due to its superior analgesic and physiological profile.

Background: Type 2 Diabetes Mellitus (T2DM) is a growing global health concern, with poor glycemic control leading to serious complications. Emerging evidence suggests a role of vitamin D in glucose metabolism. Aim: To evaluate the correlation between serum vitamin D levels and glycemic control (HbA1c) in T2DM patients. Methodology: A cross-sectional study was conducted on 50 T2DM patients aged 30–70 years. Serum 25(OH)D levels were measured using CLIA and HbA1c by HPLC. Vitamin D status was categorized as deficient, insufficient, or sufficient. Correlation was analyzed using Pearson’s coefficient. Results: Vitamin D deficiency was observed in 62% of patients, while 72% had poor glycemic control. Mean HbA1c was highest in deficient (8.4±1.1%) and lowest in sufficient groups (6.7±0.6%). Most deficient patients (26/31) had poor control, whereas better control was seen with sufficient vitamin D levels. Conclusion: An inverse relationship exists between vitamin D levels and HbA1c. Vitamin D deficiency is associated with poor glycemic control, suggesting its potential role in T2DM management.

Background: Recent demographic and epidemiological trends indicate that populations are living longer with an increasing burden of chronic diseases worldwide. Metabolic disorders such as fatty liver changes, hypercholesterolemia and impaired glycemic control are rising globally and may influence ocular refractive status through biochemical and osmotic mechanisms. However, the relationship between metabolic disorders and refractive errors has not been adequately explored. Objective: To evaluate the prevalence and age-wise concurrence of metabolic disorders (fatty liver changes, hypercholesterolemia, and elevated HbA1c levels) with refractive errors (normal vision, myopia, presbyopia and astigmatism). Methods: A cross-sectional observational study was conducted among adults aged 20–60 years. Participants were stratified into four age groups. Metabolic parameters were assessed using ultrasonography for fatty liver changes, serum cholesterol estimation for hypercholesterolemia and HbA1c levels for glycemic status. Other investigations such as blood pressure monitoring, electrocardiography (ECG) and treadmill test (TMT) were performed but excluded from the present analysis. Refractive status was determined using standard refractive examination techniques. The association between metabolic disorders and refractive errors was analyzed using the chi-square test. Results: Fatty liver changes and hypercholesterolemia peaked in the 30–50 years age group, while elevated HbA1c predominated in the 50–60 years group (88.9%). Refractive errors showed a transition from myopia in younger subjects to presbyopia in the older age group (81.5% in 50–60 years). Significant associations were observed between age group and metabolic disorders (p < 0.0001) and between age group and refractive errors (p < 0.0001). Conclusion: The present study highlights the association between metabolic disorders and refractive errors across different age groups, emphasizing the importance of metabolic evaluation in patients presenting with refractive abnormalities.

The medial collateral ligament (MCL) is commonly injured in the setting of anterior cruciate ligament (ACL) injuries. Because the MCL has better healing capacity than the ACL, the general perception is that MCL inju-ries can be treated conservatively. Treating these injuries conservatively, however, can lead to residual valgus laxity. Furthermore, it delays time to surgery, which prevents acute treatment of concomitant ACL injuries us-ing primary repair or acute reconstruction. Several treatment methods for MCL injuries have been proposed, including primary repair, augmented repair with autograft tissue, or primary reconstruction. In this surgical technique article, we present the technique of acute primary MCL repair with internal bracing with 2 lim-ited/mini-open incisions. With this technique, early surgical intervention is possible, and early rehabilitation is safe because of the internal bracing. Advantages include fast recovery, avoidance of muscle atrophy because of early mobilization, prevention of residual valgus instability, and maintenance of proprioception.

Purpose: To evaluate the efficacy of posterior subtenon interferon alpha-2b (IFN-α2b) combined with intravitreal bevacizumab (IVB) on central macular thickness (CMT) and best-corrected visual acuity (BCVA) in patients with macular edema. Methods: This observational analytical study included 40 eyes diagnosed with macular edema secondary to diabetic macular edema (DME), retinal vein occlusion (RVO), or age-related macular degeneration (ARMD). All patients received a single session of intravitreal bevacizumab (1.25mg/0.05ml) with posterior subtenon IFN-α2b (1mlU/ml). Outcomes were evaluated through CMT using spectral-domain optical coherence tomography (OCT) and BCVA on the LogMAR scale at baseline and post-injection follow-up. Results: Mean CMT decreased significantly from 507.9 ± 162.8 µm to 286.5 ± 78.6 µm (mean change −221.4 µm, p < 0.001) changes seen on October one month post injection. Mean BCVA improved from 1.13 ± 0.36 to 0.78 ± 0.25 LogMAR (mean gain −0.35 LogMAR, p < 0.001). All etiological groups (DME, RVO, and ARMD) showed significant anatomical and visual improvement. Severe macular edema (>500 µm) showed the largest CMT reduction (−354.4 µm) and BCVA improvement (−0.46 LogMAR). CMT reduction correlated strongly with visual improvement (ρ = 0.689, p < 0.001). Conclusion: Posterior subtenon IFN-α2b combined with intravitreal bevacizumab significantly reduces macular edema and improves visual outcomes. It is a promising steroid-sparing adjunct especially in severe or refractory cases.

Background: Benign prostatic hyperplasia (BPH) remains one of the most common causes of bladder outlet obstruction in ageing men. Among electrosurgical methods, transurethral bipolar enucleation of the prostate (B-TUEP/BipolEP/TUEB) and monopolar transurethral enucleation of the prostate (M-TUEP/mTUEP) use similar mechanical principles but differ in current delivery, irrigation environment, hemostatic profile, and electrolyte safety. Aim: The present paper aims to compare bipolar and monopolar prostate enucleation for BPH with respect to perioperative efficiency, safety, early and intermediate functional outcomes, and practical applicability in resource-variable settings. Materials and Methods: This paper is a structured comparative review based on guideline statements, technical descriptions, and comparative clinical literature addressing transurethral prostate enucleation with bipolar and monopolar energy for symptomatic BPH. Extracted outcome domains included operative time, resected tissue weight, symptom scores, peak urinary flow, catheterization duration, length of stay, bleeding, electrolyte changes, irrigation-related risk, and postoperative complications such as acute retention, urinary tract infection, and incontinence. Results: The most consistent finding across the comparative literature is that bipolar and monopolar transurethral enucleation provide broadly comparable efficacy in terms of adenoma clearance and postoperative symptom relief, but bipolar technology offers a more favorable intraoperative safety profile. The bipolar arm had significantly less intraoperative bleeding, shorter catheterization, shorter hospitalization, and higher intraoperative serum sodium stability, while the monopolar arm showed lower mean sodium and one case of transurethral resection syndrome. Conclusion: The available comparative evidence indicates that bipolar enucleation should be preferred because it reduces bleeding risk, shortens catheterization and admission time, and avoids the electrolyte vulnerability associated with non-saline monopolar systems. Monopolar enucleation nevertheless remains a clinically valid and pragmatic alternative in settings where bipolar technology is unavailable or unaffordable, provided that the surgeon is experienced and perioperative monitoring is meticulous. Future comparative work should strengthen the evidence base with multicenter randomized trials, standardized reporting of complications, and longer follow-up for durability, retreatment rates, and functional recovery.

Aim: This study evaluates serum levels of vascular endothelial growth factor-A (VEGF-A), endothelin-1 (ET-1), and magnesium in DR patients compared to controls and non-retinopathic diabetics to assess their diagnostic and prognostic utility. The primary aim was to determine if these biomarkers correlate with DR severity, particularly proliferative DR (PDR), and establish cut-off values for clinical use. Materials and Methods: A prospective case-control study was conducted at a Department of Biochemistry Chirayu Medical College and Hospital, Bhopal India, from January 2025 to December 2025, involving 120 participants: 40 healthy controls, 40 type 2 diabetics without retinopathy (NODR), 20 with non-proliferative DR (NPDR), and 20 with PDR. Inclusion criteria included age 40-70 years, confirmed type 2 diabetes >5 years, and fundoscopic grading per Early Treatment Diabetic Retinopathy Study (ETDRS) criteria. Exclusion criteria encompassed other ocular diseases, renal failure, or recent anti-VEGF therapy. Results: VEGF-A levels were significantly elevated in PDR (1521 ± 450 ng/mL) vs NPDR (850 ± 250 ng/mL), NODR (450 ± 150 ng/mL), and controls (250 ± 80 ng/mL; p<0.001). ET-1 was higher in DR groups (PDR: 16 ± 4 pg/mL; NPDR: 12 ± 3 pg/mL) vs NODR (8 ± 2 pg/mL) and controls (5 ± 1.5 pg/mL; p<0.001), with SMD 1.73 (95% CI 0.90-2.56). Magnesium was reduced in PDR (1.62 ± 0.13 mg/dL) vs NPDR (1.75 ± 0.14 mg/dL), NODR (1.92 ± 0.15 mg/dL), controls (2.25 ± 0.16 mg/dL; p<0.001). ROC analysis yielded AUC 0.975 for VEGF-A (cut-off 1521 ng/mL), 0.96 for ET-1 (16 pg/mL), and 0.837 for magnesium (1.7 mg/dL). Conclusion: Elevated VEGF-A and ET-1, alongside hypomagnesemia, are robust biomarkers distinguishing DR stages, with high predictive accuracy for PDR. These findings support their integration into screening protocols for high-risk diabetics, potentially enabling early intervention and reducing vision loss burden. Longitudinal studies are recommended to validate prognostic value.

Background: Prosthetic joint infection (PJI) is one of the most serious complications following total knee arthroplasty, leading to significant morbidity, prolonged hospitalization, and increased healthcare costs. Despite advances in surgical techniques and infection control measures, the burden of PJI remains substantial, particularly in patients with associated comorbidities. Objectives: To study the clinico-demographic profile, microbiological spectrum, management strategies, and outcomes of prosthetic joint infection in patients undergoing total knee arthroplasty. Methods: A hospital-based observational study was conducted over a period of two years at a tertiary care hospital in Western India. A total of 50 patients diagnosed with prosthetic joint infection following total knee arthroplasty were included. Data regarding demographic characteristics, comorbidities, clinical presentation, microbiological findings, treatment modalities, and outcomes were collected using a structured proforma. Statistical analysis was performed using appropriate tests, and p-value < 0.05 was considered significant. Results: The majority of patients belonged to the elderly age group with a female predominance. Osteoarthritis (80.0%) was the most common indication for surgery. Diabetes mellitus and obesity were the most frequent comorbidities and showed a significant association with poor outcomes. Pain (100%) was the most common presenting symptom. Staphylococcus aureus (40.0%) was the predominant organism isolated. Debridement, antibiotics, and implant retention (DAIR, 40%)) was the most commonly employed treatment modality, while two-stage revision (30.0%) was used in chronic cases. A favourable outcome was observed in the majority of patients; however, adverse outcomes were associated with delayed presentation, gram-negative infections, and presence of comorbidities. Conclusion: Prosthetic joint infection remains a challenging complication of total knee arthroplasty. Early diagnosis, appropriate surgical intervention, and optimization of risk factors are crucial for improving outcomes. Strengthening infection control practices and adopting standardized management protocols can further reduce the incidence and impact of PJI.

Background: Acne vulgaris is a common chronic inflammatory disorder of the pilosebaceous unit affecting adolescents and adults, often leading to significant clinical and psychosocial burden. Aim: To evaluate the clinical profile, severity patterns, and therapeutic outcomes of patients with acne vulgaris. Methodology: This hospital-based retrospective observational study included 80 patients aged ≥12 years attending the Department of Skin & VD, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar. Medical records were reviewed for demographic data, duration, family history, site of involvement, Investigator Global Assessment (IGA) severity grading, treatment modalities, and follow-up outcomes. Statistical analysis was performed using SPSS version 27. Results: The majority of patients were aged 17–25 years (60%) with female predominance (57.5%). Most had disease duration of 1–3 years (42.5%) and positive family history (65%). Moderate acne (IGA Grade 3) was most common (37.5%). Combination therapy (oral antibiotics with topical agents) was the preferred treatment (35%). At follow-up, 72.5% showed moderate to marked improvement. Conclusion: Acne vulgaris predominantly affects young adults with moderate severity and demonstrates favorable response to guideline-based combination therapy, though individualized management remains essential.

Background: Hyperpigmented skin disorders are common dermatological conditions, particularly in populations with darker skin types, and have significant cosmetic and psychosocial impact. Aim: To analyze the prevalence and patterns of hyperpigmented skin disorders in a dermatology OPD. Methodology: A retrospective, hospital-based descriptive study was conducted over 8 months in the Department of Skin & VD, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar. A total of 90 patients with clinically diagnosed hyperpigmented disorders were included. Data were analyzed using descriptive statistics. Results: The majority of patients belonged to the 21–30 years age group (24.44%), with female predominance (57.78%). Melasma (28.89%) was the most common disorder, followed by post-inflammatory hyperpigmentation (24.44%). The face was the most frequently affected site (44.44%). Most patients (31.11%) presented within 6 months of lesion onset. Conclusion: Hyperpigmented disorders are highly prevalent, especially among young females, with melasma and post-inflammatory hyperpigmentation being the most common. Early presentation and predominant facial involvement highlight the need for timely diagnosis and preventive strategies.

Background: Leprosy remains a public health concern in India, with a high proportion of multibacillary (MB) cases indicating ongoing transmission and delayed diagnosis. Aim: To evaluate the clinical and epidemiological profile of admitted leprosy patients and assess disease patterns over seven months. Methodology: This retrospective, descriptive study included 90 admitted leprosy patients at a Department of Skin & VD, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India from July 2025–January 2026. Data on demographics, clinical spectrum, smear status, disabilities, and treatment were collected from medical records and analyzed using descriptive statistics. Results: Most patients were males (62.2%) and belonged to 21–60 years (66.6%). MB forms predominated, with borderline lepromatous (33.3%) being most common. Smear positivity was high (64.4%). Type I reaction (31.1%) and disabilities (27.8%) were frequent. Although 68.9% had no disability, claw hand was the most common deformity. Over half (53.3%) were newly diagnosed. Most patients presented within 6–12 months (31.1%), but 18.9% had delays >2 years. Conclusion: The predominance of MB cases, reactions, and delayed presentation highlights the need for early diagnosis, improved surveillance, and timely treatment to reduce transmission and disability.

Background: Autoimmune bullous disorders (ABDs) are rare, chronic mucocutaneous diseases characterized by autoantibody-mediated blister formation and significant morbidity. Aim: To analyze the epidemiological, clinical, laboratory profile, and treatment patterns of ABDs in a tertiary dermatology department. Methodology: This retrospective observational study at Department of Skin & VD, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India.  included 67 patients with histopathology- and direct immunofluorescence-confirmed ABDs. Demographic, clinical, laboratory, comorbidity, therapeutic, and relapse data were extracted from medical records and analyzed using descriptive statistics. Results: Intraepidermal (n=34) and subepidermal (n=33) diseases were nearly equally distributed. Pemphigus vulgaris (82.4%) predominated among intraepidermal disorders (mean age 48.9 years; M:F 1.25:1), while bullous pemphigoid (72.7%) was most common among subepidermal disorders (mean age 62.8 years; slight female predominance). Hypertension and diabetes were frequent, particularly in subepidermal cases. Azathioprine was the most commonly used adjuvant in both groups. Relapses were more frequent in intraepidermal disorders (35.3% single relapse). Conclusion: ABDs showed distinct age and comorbidity patterns. Intraepidermal diseases had higher relapse rates, highlighting the need for individualized long-term management.

Aim: This study aims to compare the progression of post-COVID interstitial lung disease (ILD) with idiopathic ILD, primarily idiopathic pulmonary fibrosis (IPF), in terms of pulmonary function decline, radiological changes, and survival outcomes. Post-COVID ILD emerges as a sequela in severe SARS-CoV-2 cases, while idiopathic ILD follows a relentlessly progressive course. By analyzing longitudinal data, we seek to identify differences in forced vital capacity (FVC) decline, diffusing capacity for carbon monoxide (DLCO), and mortality, informing targeted therapies like antifibrotics. Materials and Methods: A retrospective cohort study included 100 patients: 50 with post-COVID ILD (diagnosed 3-6 months post-discharge, severe COVID history) and 50 with idiopathic ILD (IPF confirmed by HRCT/MDCT and biopsy where needed). Inclusion: age 40-75, FVC >40% predicted at baseline. Exclusion criteria included significant comorbidities such as heart failure and active smoking. Assessments at baseline, 6, 12, 24 months: PFTs (FVC, DLCO), 6MWT, HRCT (fibrosis score 0-5). Progression defined as ≥10% FVC decline or ≥15% DLCO decline. Stats: t-tests, ANOVA, Kaplan-Meier survival analysis. Results: Post-COVID ILD showed initial FVC 82.4% vs 71.2% in idiopathic ILD (p<0.01). Annual FVC decline: 4.2% post-COVID vs 9.8% idiopathic (p<0.001). DLCO decline: 12% vs 18% (p=0.02). Radiological fibrosis score increased 1.2 points post-COVID vs 2.1 idiopathic at 24 months (p<0.05). Mortality at 24 months was 12% in post-COVID ILD compared with 32% in idiopathic ILD (hazard ratio 2.8, p = 0.003). Improvement in 28% post-COVID cases vs 4% idiopathic. Conclusion: Post-COVID ILD progresses more slowly than idiopathic ILD and demonstrates potential for regression, in contrast to the inexorable decline observed in IPF. Early intervention may help halt disease progression in post-COVID cases. These findings support close monitoring and further evaluation of antifibrotic therapies in post-COVID ILD.

Background: Chronic kidney disease is emerging as a major health concern globally. CKD patients on hemodialysis are at a higher risk for developing bacteremia. This study aimed at finding out the bacteriological profile with its antibiotic susceptibility pattern in patients undergoing hemodialysis in nephrology department, Government medical college Kottayam. Methods: This was a Descriptive study conducted over a period of one year (April 2024-March 2025) at Department of Microbiology Kottayam. Paired Blood samples collected in conventional & automated blood culture received from 235 chronic kidney disease patients on hemodialysis were processed, isolates identified & appropriate antimicrobial susceptibility testing was done. Results: Out of 235 patients,53 patients had a positive blood culture showing the prevalence of bacteremia as 22.56%. 66% of patients were males whereas females were 33.96%. Higher incidence of bacteremia was found in patients above 50 yrs. Among the isolates 50.94% were Gram negative bacteria as compared to 49.05% Gram positive bacteria. As per our study among the gram-negative bacteria causing bacteremia, Pseudomonas aeruginosa 10 (35.71%) was the predominant organism followed by Klebsiella species 7 (25%), Acinetobacter species 4(14.29%), Elizabethkingae meningoseptica 3(10.71%), Burkholderia cepacia 2(7.14%), Stenotrophomonas maltophilia 1(3.57%), Pantoea species 1(3.57%). Out of 26 isolates of Gram-positive organisms, 7(26.92%) were Methicillin Sensitive Staphylococcus aureus, 9 (34.61%) were Methicillin Resistant Staphylococcus aureus, 6(23.07%) were Methicillin resistant Coagulase negative Staphylococci and 4(15.38%) were Enterococcus spp. Among Pseudomonas aeruginosa 60% isolates were sensitive to Ceftazidime,40% isolates were sensitive to Ciprofloxacin, Gentamicin, Amikacin, 20% isolates were sensitive to cotrimoxazole,100 % isolates are susceptible to Piperacillin Tazobactum, Imipenam & Meropenam. MRSA strains were 100% Resistant to Penicillin and Cefoxitin, 66.66% were susceptible to cotrimoxazole, 20% were susceptible to Gentamicin, 33.33% were susceptible to Erythromycin, 66.66% susceptible to Clindamycin, 88.88% were susceptible to Doxycycline, 100 % were susceptible to Vancomycin and Linezolid. Conclusion: The increased use of antibiotics in this particular subset of patients and their recurrent exposure to the healthcare system, there has been a rise in the incidence of infections with multidrug resistant (MDR) organisms. Thus, identification of locally prevalent pathogens is important for optimal care in patients since the choice of empiric treatment or prophylactic antibiotics depends on the prevalent pathogens in a local community.

Background: Refractive error is the most common and avoidable cause of visual impairment among school children. Early detection and correction are essential to prevent long-term visual disability. Objective: To determine the prevalence and pattern of refractive error among government school children in Angul district, Odisha. Methods: A retrospective study was conducted among 1,006 schoolchildren. Data were collected from the school-based vision screening program conducted from December 2025 to February 2026 in 44 schools in the rural and urban regions of Angul district of Odisha under the National Program for Control of blindness and Visual Impairment (NPCBVI). Results: A total of 10,935 schoolchildren from 44 schools in the age group 6 -17 years were examined. Of these children, 1006 had refractive error. Average age was 12.7 +- 2.0 years (range 6-17 years). There were boys (36%) and girls (64%). The prevalence of refractive error was 9.2%. Myopia (6.6%) and astigmatism (2.5%) were more common than hypermetropia (0.07%). The prevalence of refractive error among boys was 9.2%, and among girls was 9.1%. 77 % children were from the general category, 13% from the scheduled caste, and 10% from the scheduled tribe. Conclusion: A notable proportion of children with refractive error were either undiagnosed or not using corrective measures. Therefore, coordinated effort involving schools, parents and health care providers is essential to implement effective screening and awareness initiatives.

Background: Hypertension produces progressive vascular changes that may lead to subclinical involvement of the central nervous system. The brainstem auditory pathway is particularly vulnerable due to its high metabolic demand. Brainstem Auditory Evoked Potentials (BAEPs) provide an objective and sensitive method for detecting early auditory brainstem dysfunction. Objective: To evaluate and compare BAEP parameters in hypertensive patients and age- and sex-matched normotensive controls. Materials and Methods: This cross-sectional comparative study included 70 participants aged 40–60 years, comprising 35 essential hypertensive patients and 35 normotensive controls. BAEP recordings were obtained using monaural click stimuli at 40, 50, and 60 dB sensation levels. Absolute latencies of waves I, III, and V, interpeak latencies (I–III, III–V, I–V), and wave amplitudes were analyzed. Statistical comparison was performed using Student’s unpaired t-test, with p < 0.05 considered significant. Results: Hypertensive patients showed significant prolongation of wave III and V latencies and increased interpeak latencies III–V and I–V at all stimulus intensities (p < 0.05), while wave I latency remained unaffected. Wave III and V amplitudes were significantly altered at higher intensities, indicating impaired central auditory conduction with preserved peripheral auditory nerve function. Conclusion: Essential hypertension is associated with early subclinical dysfunction of central auditory brainstem pathways. BAEP is a useful, non-invasive tool for early detection and monitoring of central nervous system involvement in hypertensive patients.

Background: Pediatric trauma is a major cause of morbidity and mortality worldwide. Children differ anatomically and physiologically from adults, requiring specialized trauma assessment and surgical management. Understanding injury trends and outcomes is essential for improving trauma care. Objective: To evaluate trends, management patterns, and outcomes of pediatric trauma surgery cases admitted over a two-year period. Methods: From January 2021 to December 2022, 100 pediatric trauma patients who needed surgical intervention participated in a retrospective observational study. Analysis was done on demographic information, injury type, mechanism of injury, surgical techniques, complications, hospital stay, and results. SPSS version 24 was used for statistical analysis. A p-value of less than 0.05 was deemed significant. Results: Road traffic accidents were the commonest cause of trauma (38%), followed by falls (32%) and blunt abdominal trauma (15%). Orthopedic injuries were most frequent (40%), followed by abdominal injuries (28%) and head injuries requiring surgery (18%). Emergency surgery was required in 72% cases. Postoperative complications occurred in 16% patients. Favorable recovery was seen in 90%, while mortality was 4%. Delayed presentation was significantly associated with complications (p=0.01). Conclusion: Traffic accidents and falls are the main causes of pediatric trauma, which continues to be a major surgical burden. Results can be enhanced by interdisciplinary pediatric trauma care, early intervention, and trauma prevention techniques.

Introduction: Neuromuscular blocking agents are commonly used during general anesthesia to facilitate endotracheal intubation and optimize surgical operations. Timely and effective reversal is crucial to prevent residual paralysis and postoperative complications. Aims: To evaluate and compare the efficacy and safety of sugammadex and neostigmine in reversing neuromuscular blockade in patients undergoing surgery. Settings and Design: A prospective parallel arm quasi-experimental study conducted at a tertiary care hospital, involving 40 adult patients undergoing elective surgery under general anaesthesia. Methods and Material: Patients were alternatively allocated into group S (n=20), received Sugammadex 2mg/kg and group N (n=20) received Neostigmine 0.05mg/kg with Glycopyrrolate 0.01mg/kg at the return of the second twitch on Train of Four (TOF) monitoring. Results: Baseline characteristics were comparable between groups. Sugammadex significantly reduced recovery time to TOF ≥0.9 (4.12±1.91 min) compared to neostigmine (12.25 ± 2.94 min; p<0.001). The time M1 and M2 was also shorter in the sugammadex group (p < 0.01). Postoperative heart rate and blood pressure were significantly lower in the sugammadex group (p<0.05). Conclusions: Sugammadex provides a faster, safer, and more hemodynamically stable reversal of neuromuscular blockade than neostigmine in adult surgical patients.

Introduction: Artificial Intelligence and Machine Learning have been the significant advancements of Science and Technology. Artificial intelligence (AI) a broad term that describes the use of machine-based learning algorithms and software, in healthcare settings. In diagnosing, treating and preventing diseases in paediatric population, AI could play a pivotal role. Paediatrics, a field that could have many practical challenges such as comorbidities, emergency admissions, and a lack of access to paediatric care providers, that could hinder quality and care provided to the patients. AI if implemented in paediatrics can streamline the work-force and help in clinical decision-making by making better use of clinician’s knowledge and time. However various ethical concerns exist, regarding data privacy and safety. Instead of complete automation, it would be better to focus on collective human-support AI systems. Moreover, it is crucial that the explainability of AI models, potential opportunities, and challenges when integrating ML in healthcare, especially for the pediatric population, need to be evaluated. The present study is done with the aim of identifying role of AI in various domains in paediatrics. To analyse the ethical concerns in AI use in Paediatrics. Objective: The study is planned to analyse the role of AI in various Paeidatric domains, to explore the potential benefits and limitations of AI integration into Paediatric healthcare systems. Methods: A systematic analysis was carried out by analysing articles indexed in PubMed Central, Embase, SCOPUS journals in the English language. This methodical approach involved a comprehensive search, selection, and synthesis of relevant studies to address. The ethical concerns with its use, that are associated with AI use in paediatric population have been analysed. Results: There is emerging literature on uses of Artificial intelligence in paediatrics. AI promises to improve accuracy, early diagnosis and treatment. The role of AI in paediatrics, the importance of various algorithms in diagnosing diseases such as neonatal jaundice, neonatal sepsis, traumatic brain injury, in various endocrine diseases and in malignancies have been analysed. The role of AI has shown promising results in early and non-invasive diagnosis in neonatal jaundice and neonatal sepsis, in classification of paediatric malignancies. However legal and ethical issues need to be addressed in more detail.

Background: Deep neck space infections (DNIs) are potentially fatal disorders that affect the neck’s deep cervical spaces and fascial planes. Due to their fast growth, complicated architecture, and closeness to critical structures including the airway, major arteries, and mediastinum, DNIs continue to provide important therapeutic issues even though their prevalence has decreased in the antibiotic era. The most frequent etiological causes are still tonsillopharyngeal and odontogenic infections, which are frequently impacted by concomitant diseases, delayed presentation, and poor dental hygiene. Aim: To compare conservative and surgical treatment for patients with deep neck space infections in order to assess the clinical profile, etiological variables, management approaches, and results. Methodology: At a Patna Medical College and Hospital, Patna. 75 people who had been identified with deep neck space infections were looked at in a historical observational study. Analysis was done on demographic information, etiology, affected neck spaces, treatment technique, complications, and results. Result: The majority of patients were between the ages of 21 and 60, and male preponderance was seen. The submandibular space was most commonly affected, and odontogenic infection was the most prevalent cause. In most cases, surgery was necessary. For several patients, conservative treatment worked. With minimal rates of complications and death, the majority of patients fully recovered. Conclusion: For deep neck space infections to have the best possible results, early diagnosis, suitable imaging, and prompt action are essential.

Background: Urinary ^‘tract infections (UTIs) are among the most common bacterial infections in clinical practice, with rising antimicrobial resistance complicating their management, particularly in urology settings. Aim: To retrospectively assess the demographic profile, clinical presentation, microbiological spectrum, and risk factors associated with UTIs in patients attending the urology department. Methodology: This retrospective observational study was conducted in the Department of Urology at Netaji Subhas Medical College and Hospital, Bihta, Patna over 12 months. A total of 80 adult patients with confirmed UTIs were included. Data were collected from medical records, and urine samples were analyzed using standard microbiological methods. Statistical analysis was performed using descriptive and inferential tools. Results: The majority of patients were aged ≥60 years (27.50%) with male predominance (57.50%). Dysuria (72.50%) and urinary frequency (65.00%) were the most common symptoms. Escherichia coli (47.50%) was the predominant pathogen, followed by Klebsiella spp. (20.00%). Major risk factors included previous UTI (40.00%), recent antibiotic use (37.50%), and catheterization (35.00%). Conclusion: UTIs are more prevalent among elderly patients with identifiable risk factors. Early diagnosis, targeted therapy, and antimicrobial stewardship are essential to improve outcomes and limit resistance.

Purpose: The aim of the study was to assess the impact of myopia on vision related quality of life by evaluating their stereopsis and contrast sensitivity. Methods: This is a hospital-based, cross sectional analytical study conducted on 150 young patients with myopia. After a detailed evaluation of anterior and posterior segment using slit lamp bio microscopy to rule out any other concurrent ocular comorbidity, UCVA, BCVA was assessed using Snellen’s chart. Stereopsis and contrast sensitivity were assessed using Titmus Dots and Circles chart and Pelli Robson chart respectively. Posterior segment was evaluated using indirect ophthalmoscopy with 20D to rule out any other pathology. Descriptive statistics, namely, mean, standard deviation to express quantitative variables wherever applicable. Correlation between myopia and stereopsis and correlation between myopia and contrast sensitivity was analyzed by using Chi-square test and Pearson’s correlation coefficient. P value <0.05 was considered as statistically significant. Results: Among total 150, 64 (42.7 %) were myopes, 61 (40.7 %) had simple myopic astigmatism, 25 (16.7 %) had compound myopic astigmatism. Contrast sensitivity was found decreased in 78.1% myopes, 65.6% simple myopic astigmatism, 48% compound myopic astigmatism. Further, contrast sensitivity was abnormal in 67.3% with mild myopia (<3D); in 72.7% with moderate myopia (3-6D) and 100% with high myopi (>6D) respectively. There was a strong negative correlation showing that, as the severity of myopia increased, the contrast sensitivity loss increased too. A statistically significant reduction in stereopsis was also noted with increase in degree of refractive error. Conclusion: Myopic refractive error is associated with reduced stereopsis and contrast sensitivity, causing a negative impact on vision related quality of life. Early detection and correction of same needs added emphasis particularly in the growing years to ensure both good quality of vision and visual acuity.

Introduction: Acute cholecystitis following endoscopic common bile duct (CBD) stone removal is a recognized but underreported complication. Identifying the risk factors associated with post-procedural cholecystitis is important for early diagnosis, prevention, and appropriate management. Aim: To evaluate the risk factors of acute cholecystitis after endoscopic common bile duct (CBD) stone removal. Materials and Methods: This study included patients who underwent endoscopic removal of CBD stones. Demographic data, clinical history, gallbladder status, stone characteristics, procedural details, and post-procedural outcomes were analyzed. Patients were followed for the development of acute cholecystitis. Risk factors such as gallbladder stones, cystic duct obstruction, multiple or large stones, gallbladder wall thickening, and history of biliary symptoms were assessed. Statistical analysis was performed to identify significant predictors. Results: Acute cholecystitis developed in a subset of patients following CBD stone removal. The presence of gallbladder stones, especially multiple or large stones, was a significant risk factor. Patients with cystic duct obstruction or impaired gallbladder emptying showed a higher incidence of cholecystitis. A prior history of biliary colic or cholangitis was also associated with increased risk. Procedural factors such as incomplete clearance of biliary sludge and post-endoscopic papillary edema may have contributed to gallbladder stasis and subsequent inflammation. Post-ERCP complications show variable timing, with pancreatitis occurring early (2.5 ± 1.2 days) and cholangitis (8.0 ± 3.9 days) and acute cholecystitis (12.0 ± 5.8 days) presenting later, underscoring the need for both immediate and delayed surveillance. Conclusion: Acute cholecystitis after endoscopic CBD stone removal is associated with identifiable risk factors, including gallbladder stones, impaired cystic duct patency, and pre-existing biliary disease. Careful patient selection, close post-procedural monitoring, and consideration of prophylactic cholecystectomy in high-risk patients may help reduce the incidence of this complication.

Introduction: Patients with chronic kidney disease (CKD) undergoing haemodialysis are at increased risk of acquiring and transmitting blood-borne infections, particularly Hepatitis B virus (HBV). Monitoring of Hepatitis B DNA viral load is essential for early detection, disease monitoring, and infection control in dialysis units. Aim: To quantify Hepatitis B virus (HBV) DNA viral load in patients undergoing haemodialysis for chronic kidney disease and to assess the burden of viral replication in this high-risk population. Materials and Methods: This study is designed as a hospital-based cross-sectional observational study conducted in the Department of Nephrology and Dialysis Unit of a tertiary care teaching hospital over a period of one year. The study population includes patients diagnosed with chronic kidney disease who are receiving regular maintenance haemodialysis during the study period. A total of 122 patients undergoing haemodialysis were included as the sample size for analysis. Results: Among the total 122 patients, vaccination status showed a significant association with HBV DNA positivity. Out of 46 fully vaccinated patients, 3patients (6.5%) were HBV DNA positive. Among 38 partially vaccinated patients, 8 patients (21.1%) were HBV DNA positive. In contrast, among 38 non-vaccinated patients, 16 patients (42.1%) were HBV DNA positive. Overall, 27 patients (22.1%) patients were HBV DNA positive in the study population. The association between vaccination status and HBV DNA positivity was statistically highly significant (p = 0.004). Conclusion: HBV DNA viral load monitoring is crucial in haemodialysis patients for early identification of active and occult infections. Routine molecular screening, along with strict infection control measures and vaccination programs, is essential to reduce HBV transmission in dialysis units.

Background: Accurate prediction of labour progress during ^‘the first stage remains challenging with conventional clinical assessments, which are often subjective. Intrapartum ultrasonography offers objective parameters, including the fetal occiput–spine angle (OSA), reflecting fetal head flexion and alignment. Aim: To evaluate the role of fetal occiput–spine angle during the first stage of labour as a predictor of labour progress and outcome. Methodology: This prospective observational study included 90 term women in active labour with singleton, cephalic pregnancies. Transabdominal ultrasound was used to measure OSA on admission. Labour progress, duration of labour stages, need for oxytocin augmentation, mode of delivery, and maternal and fetal outcomes were recorded. Statistical analysis was performed using SPSS version 27.0, including ROC curve analysis. Results: Women with OSA <126° had significantly prolonged first and second stages of labour, higher oxytocin requirements, increased abnormal labour progress, higher caesarean section rates, and more maternal and fetal complications compared to those with OSA ≥126°. An OSA cut-off of 126° showed good sensitivity and specificity in predicting adverse outcomes. Conclusion: Fetal occiput–spine angle is a simple, reliable ultrasound marker for predicting labour progress and outcome, with potential value in intrapartum risk stratification.

Background: Accurate detection of occult cervical lymph node metastasis in clinically N0 neck remains a major challenge in upper aerodigestive tract squamous cell carcinoma (UADT SCC), significantly influencing prognosis and treatment decisions. Aim: To compare the diagnostic performance of PET/CT with conventional imaging modalities (USG and CECT) in detecting occult nodal metastasis. Methodology: This prospective observational study included 80 patients with histopathologically confirmed UADT SCC and clinically N0 neck. All patients underwent preoperative USG, CECT, and 18F-FDG PET/CT, followed by neck dissection. Histopathology served as the gold standard. Diagnostic parameters were calculated and compared. Results: Occult metastasis was detected in 35% of patients. PET/CT demonstrated superior performance with sensitivity (89.3%), specificity (92.3%), and accuracy (91.3%), compared to CECT (75%, 84.6%, 81.3%) and USG (64.3%, 76.9%, 72.5%). PET/CT also showed the highest PPV (86.2%) and NPV (94.1%). Conclusion: PET/CT is more accurate than USG and CECT in evaluating clinically N0 neck and may help reduce unnecessary interventions. However, it should be used as an adjunct within a multimodal diagnostic approach.

Background: Early and accurate detection of recurrent colorectal carcinoma (CRC) is crucial for timely treatment planning and improving patient outcomes. Aim: To evaluate the role of ¹⁸F‑FDG PET/CT in detecting recurrent CRC and its impact on patient management. Methodology: This retrospective observational study included 65 previously treated CRC patients who underwent ¹⁸F‑FDG PET/CT for suspected recurrence, rising CEA levels, or equivocal conventional imaging. PET/CT findings were analyzed and correlated with clinical data and subsequent changes in management. Result: PET/CT detected local recurrence in 21.5%, distant metastases in 40%, and both in 18.5% of patients, while 20% showed no evidence of disease. The most common metastatic sites were liver and lymph nodes. PET/CT findings led to a change in treatment strategy in 29.2% of cases. Conclusion: ¹⁸F‑FDG PET/CT is a valuable imaging modality for detecting recurrent CRC and significantly influences patient management.

Introduction: PCOS is a common endocrine disorder in reproductive-age women diagnosed mainly by Rotterdam criteria, which include hyperandrogenism, oligo/anovulation, and polycystic ovarian morphology. However, AMH is emerging as a potential biomarker reflecting ovarian dysfunction. This study compares the diagnostic accuracy of Rotterdam criteria with AMH levels and ultrasound features in PCOS diagnosis. Aims and Objectives: The aim of this study was to compare the diagnostic accuracy of the Rotterdam criteria with serum Anti-Müllerian Hormone (AMH) and ultrasound features in diagnosing Polycystic Ovary Syndrome (PCOS). The objective was to determine the most sensitive and specific diagnostic method among them. Materials and Methods: This was a hospital-based comparative study conducted in the Department of Obstetrics and Gynaecology at Deben Mahato Govt Medical College over a period of 12 months. The study included women of reproductive age (18–40 years) with suspected Polycystic Ovary Syndrome (PCOS), with a total sample size of 80 Patients. Results: In this study of 80 women, most were aged 18–25 years (35%) with no significant age variation (p = 0.092). Menstrual irregularity was most common (85%) (p = 0.012). PCOS was detected in 70% by Rotterdam criteria (p < 0.001), elevated AMH in 67.5% (p = 0.0012), and polycystic ovaries in 62.5% (p = 0.003). Rotterdam criteria showed highest accuracy (90%) compared to AMH (87.5%) and ultrasound (83%) (p = 0.001). Conclusion: The study concludes that Rotterdam criteria remain the most accurate method for diagnosing PCOS, while AMH is a strong supportive biomarker and ultrasound is useful but less sensitive. A combined approach improves overall diagnostic accuracy.

Gastroesophageal reflux disease (GERD) is a chronic gastrointestinal disorder requiring effective and prolonged therapeutic management. The present study aimed to develop and evaluate a raft-forming drug delivery system containing Famotidine and Domperidone to enhance gastric retention, sustain drug release, and improve bioavailability. The formulations were prepared using the wet granulation method employing sodium alginate and pectin as primary raft-forming polymers along with Carbopol 934 and HPMC K4M. Preformulation studies confirmed good compatibility and flow properties of the powder blends. The prepared tablets were evaluated for physicochemical parameters, buoyancy, raft strength, swelling behavior, drug content, and in-vitro drug release. All batches exhibited acceptable hardness, friability, and weight variation within pharmacopoeial limits. The floating lag time was found to be minimal (7–15 seconds), with total floating duration exceeding 8 hours, confirming excellent buoyancy. Among all formulations, batch F6 demonstrated superior performance with optimal raft strength, highest drug content, and sustained drug release (Famotidine: 96.85%, Domperidone: 97.10% over 12 hours). The study concludes that the developed raft-forming system is a promising approach for effective GERD management by improving therapeutic efficacy and patient compliance.

Background: Extubation can provoke significant hemodynamic and airway responses, particularly in abdominal surgeries like open cholecystectomy. Dexmedetomidine, an α2-adrenergic agonist, has been shown to attenuate these responses, but the optimal dose remains uncertain. Aim: To compare the efficacy and safety of three different doses of dexmedetomidine (0.5 µg/kg, 0.75 µg/kg, and 1.0 µg/kg) in attenuating the extubation response in patients undergoing open cholecystectomy. Methods: A prospective, randomized, double-blind study was conducted at the Department of Anaesthesiology, Phulo Jhano Medical College, Dumka, Jharkhand, India. A total of 84 ASA I/II patients undergoing open cholecystectomy were divided into three groups of 28. Dexmedetomidine was administered intravenously 15 minutes before extubation. Extubation quality, hemodynamic parameters, time to first rescue analgesia, and adverse events were recorded and reviewed. Results: The doses of 0.75 µg/kg and 1.0 µg/kg improved extubation quality and hemodynamic instability compared to the dose of 0.5 µg/kg, although the highest dose of dexmedetomidine (1.0 µg/kg) was associated with greater bradycardia and hypotension. The dose of 0.75 µg/kg provides the best efficacy-safety profile. Conclusion: Dexmedetomidine, at a dose of 0.75 µg/kg, provides the best combination of efficacy and safety in blunting extubation responses in patients having an open cholecystectomy.

Background: Liver cirrhosis is a chronic condition associated with multiple complications, the most significant being portal hypertension and gastrointestinal bleeding. Upper gastrointestinal endoscopy (UGIE) plays a critical role in detecting mucosal lesions such as esophageal varices, gastric varices, portal hypertensive gastropathy, and peptic ulcers in cirrhotic patients. Understanding the prevalence and spectrum of these lesions is essential for risk stratification and timely intervention. Objective: To evaluate the endoscopic spectrum and prevalence of upper gastrointestinal lesions in patients diagnosed with liver cirrhosis. Methods: This prospective observational study was conducted on 125 patients with clinically or radiologically confirmed cirrhosis of liver who underwent UGIE at Anugrah Narayan Magadh Medical College and Hospital, Gaya ji, Bihar, India, Endoscopic findings were recorded and analyzed for prevalence, type of lesion, and association with clinical parameters including Child-Pugh classification and history of gastrointestinal bleeding. Results: Out of 125 patients, 78 (62.4%) were male and 47 (37.6%) females. The most common lesion observed was esophageal varices (78.4%), followed by portal hypertensive gastropathy (56.8%) and gastric varices (22.4%). Peptic ulcers were seen in 9.6% of cases. Large varices were more common in patients with higher Child-Pugh grades and prior history of hematemesis. Multiple lesions coexisted in over 60% of cases. Conclusion: Upper gastrointestinal lesions are highly prevalent in cirrhotic patients, with esophageal varices and portal hypertensive gastropathy being the most frequent findings. Early UGIE screening is crucial for timely detection, classification, and management to prevent life-threatening bleeding episodes.

Background: Newborn jaundice is a common clinical condition and a leading cause of newborn morbidity and hospitalizations. Physiological jaundice is typically benign, but severe hyperbilirubinemia can lead to significant neurological consequences if not detected and treated early. Aim: To study the etiological causes, preventative strategies and early consequences of newborn jaundice in a hospital-based environment. Methods: This was prospective observational research undertaken at the Department of Paediatrics, Sheikh Bhikhari Medical College Hospital, Hazaribagh, Jharkhand for one year. A total of 90 newborns diagnosed with Jaundice were studied. Information about demographics, clinical characteristics, gestational age, birth weight, onset and severity of jaundice, etiological causes, preventative behaviors, therapy and complications was gathered on a standardized proforma. Data was analyzed using SPSS version 27.0 where p < 0.05 was considered statistically significant. Results: Most newborns (53.3%) were male and presented within 4–7 days of life. 66.7% were term newborns, and 26.7% were low-birth-weight infants. Moderate jaundice was observed in 37.8% of cases, whereas 44.5% had severe to very severe jaundice. Septicemia was the most common cause (24.4%), followed by physiological jaundice (20%) and birth asphyxia (15.6%). Adequate preventive behaviors were observed in 57.8% of cases. Phototherapy was the first-line treatment for 64.4% of newborns. Complications were observed in 66.7%, and severe jaundice was significantly associated with low birth weight (p<0.05). Conclusion: Neonatal jaundice is a serious health problem. Early diagnosis of risk factors, effective preventative measures and prompt therapy are crucial to decrease complications and enhance infant outcome.

Background: Pneumonia remains a leading cause of morbidity and mortality among children under five years of age, particularly in low- and middle-income countries. Identification of modifiable risk factors is essential to reduce disease severity and improve outcomes. Aim: To identify socio-demographic, environmental, nutritional, and clinical factors associated with severe pneumonia among children under five. Methodology: A hospital-based analytical cross-sectional study was conducted over one year in the Department of Pediatrics, Sheikh Bhikhari Medical College Hospital, Hazaribagh, Jharkhand, India. A total of 110 children aged 2–59 months diagnosed with pneumonia as per WHO IMNCI guidelines were enrolled using consecutive sampling. Data were collected through caregiver interviews and medical records and analyzed using SPSS version 25. Result: Pneumonia was more common among males and children from rural areas. Severe pneumonia was significantly associated with incomplete immunization, undernutrition, exposure to biomass fuel, overcrowding, parental smoking, low maternal education, and recent diarrhea or upper respiratory tract infection. Antibiotic use prior to hospitalization was associated with a reduced risk of severe pneumonia. Conclusion: Severe pneumonia in children under five is strongly linked to preventable and modifiable risk factors. Strengthening immunization coverage, nutritional interventions, environmental improvements and early community-based management may reduce pneumonia severity and related morbidity.

Background: Post-traumatic saddle nose deformity is a challenging condition causing collapse of ^‘the nasal dorsum, leading to significant functional and aesthetic impairment requiring complex reconstruction. Aim: To assess technical modifications in open rhinoplasty for correction of post-traumatic saddle nose deformity and evaluate functional and cosmetic outcomes. Methodology: Prospective observational study of 90 patients with post-traumatic saddle nose deformity conducted over one year at Netaji Subhas Medical College and Hospital,Bihta, Patna, Bihar, India. Patients underwent open rhinoplasty using tailored grafts including septal, conchal, costal cartilage with technical modifications such as spreader grafts and columellar struts. Outcomes were assessed for aesthetic, functional improvement, and complications. Results: Most patients were aged 26–35 years (37.8%) with male predominance (71.1%). Road traffic accidents (45.6%). Septal cartilage graft was most used (31.1%) followed by costal cartilage (23.3%). Postoperative outcomes showed 86.7% cosmetic improvement, 80% airway improvement, and 92.2% graft stability with minimal complications; 67.8% had no major complications. Conclusion: Open rhinoplasty with individualized graft selection and technical modifications is an effective and safe method for correction of post-traumatic saddle nose deformity, providing reliable structural, functional, and aesthetic outcomes with low complication and revision rates.

Background: Obesity among adolescents is an emerging public health concern in developing countries due ^‘to changing lifestyle, dietary habits, and reduced physical activity. Aim: To assess obesity patterns and associated determinants among school-going adolescents. Methodology: A cross-sectional observational study was conducted among 90 adolescents aged 13–18 years in selected schools of Madhubani, Bihar. Data on sociodemographic factors, dietary habits, physical activity, and family history were collected using a semi-structured questionnaire. Anthropometric measurements were taken, and BMI was calculated. Statistical analysis was performed using SPSS, with p<0.05 considered significant. Results: Among participants, 50% had normal BMI, while 22.2% were overweight and 16.7% obese. Regular junk food consumption (44.4%), inadequate physical activity (61.1%), and higher screen time were common. Significant associations were observed between obesity and junk food intake (p=0.01), physical inactivity (p=0.02), screen time (p=0.03), and family history (p=0.001). Conclusion: Adolescent obesity is influenced by unhealthy lifestyle behaviors and genetic factors, highlighting the need for targeted preventive strategies.

Background: Excessive screen time has become increasingly common among young adults and may adversely affect psychological well-being and physiological health through stress-related inflammatory responses. Aim: To evaluate the impact of screen time on hematological inflammatory markers and perceived stress levels among healthy young adults. Methods: This cross-sectional study included 100 undergraduate students aged 18–25 years. Participants were categorized into low (<4 hours/day) and high (≥4 hours/day) screen time groups. Perceived stress was assessed using the Perceived Stress Scale (PSS-10). Hematological inflammatory markers including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) were calculated from complete blood count parameters. Results: Participants with high screen time demonstrated significantly higher PSS scores, NLR, PLR, and SII values, along with lower LMR compared to the low screen time group (p<0.05). Screen time showed a positive correlation with perceived stress and inflammatory markers. Conclusion: Prolonged screen exposure is associated with increased stress levels and low-grade systemic inflammation among young adults, highlighting the importance of healthy digital habits.

Background: Surgical site infection (SSI) is a major complication following open fracture fixation, particularly in resource-limited settings where trauma burden and infection risk are high. Open tibia and femur fractures are especially vulnerable because of extensive soft tissue injury and contamination. Aim: To evaluate the incidence of SSI, associated bacterial profile, and antibiotic sensitivity pattern following fixation of open tibia and femur fractures. Methodology: This prospective observational study was conducted in the Department of Orthopaedics at Government Medical College & Hospital, Bettiah, Bihar, over a period of 6 months. A total of 80 adult patients with open tibia and femur fractures undergoing surgical fixation were included. Patients were followed postoperatively for development of SSI based on CDC criteria. Culture and antibiotic sensitivity testing were performed in suspected cases. Results: The majority of patients were aged 18–40 years. Open tibia fractures accounted for 65% cases. SSI developed in 14 patients (17.5%). Staphylococcus aureus was the most common organism isolated, followed by Escherichia coli and Pseudomonas aeruginosa. Conclusion: SSI remains a significant complication after open fracture fixation. Early debridement, strict aseptic measures, and culture-guided antibiotic therapy are essential to reduce postoperative infections.

Background: Diaphyseal fractures of long bones, particularly the tibia and femur, are common injuries often resulting from high-energy trauma. Closed intramedullary interlocking nailing is widely used due to its minimally invasive nature and favorable outcomes. Aim: To evaluate the clinical and functional outcomes of closed intramedullary nailing in patients with long bone diaphyseal fractures. Methodology: This prospective case series included 40 patients aged 18–60 years with tibial or femoral diaphyseal fractures treated with closed intramedullary nailing. Patients were followed up with clinical, radiological, and functional assessments using standardized scoring systems over a period of one year. Result: The majority of patients were males (70%) with road traffic accidents being the most common cause (75%). Radiological union was achieved in 95% of cases, with mean union time of 20.5 weeks for tibia and 18.2 weeks for femur. Most patients showed good to excellent functional outcomes (over 80% in tibia and 87% in femur). Conclusion: Closed intramedullary interlocking nailing is a highly effective treatment modality for diaphyseal fractures, demonstrating high union rates, early mobilization, and satisfactory functional recovery.

Background: Conversion from laparoscopic to open surgery is still a major intra-operative event that might raise postoperative morbidity and impact surgical outcomes. Identification of characteristics linked with conversion can enhance surgical planning and patient management. Objective: To analyse the risk variables for conversion to open surgery and to assess the surgical outcomes linked. Method: This retrospective observational study was conducted in the Department of General Surgery, Shri M.P. Shah Government Medical College, Jamnagar, Gujarat for the period of 10 months. One hundred and twenty patients receiving laparoscopic surgeries were enrolled. Hospital records were reviewed for demographic, clinical, surgical, and post-operative data and analysed to discover characteristics related with conversion. Results: Conversion rate was poor. The variables related with conversion identified were advanced age, male gender, morbid obesity, higher ASA grade and preoperative inflammatory condition. Cholecystectomy was the most common for conversion. The converted cases were related to longer operating duration and increased post-operative morbidity as compared to successfully completed laparoscopic procedures. Conclusions: Conversion from laparoscopic to open surgery is associated with adverse postoperative outcomes and is influenced by a variety of patient- and procedure-related variables. Early identification of high-risk patients may enhance surgical planning and patient safety.

Background: Postoperative nausea and vomiting (PONV) remain among the most common complications following general anesthesia, with significant impact on patient satisfaction and recovery. Risk stratification using the Apfel score and multimodal prophylaxis has been recommended for effective prevention. Aim: To evaluate risk stratification and the effectiveness of multimodal prevention strategies for PONV in patients undergoing general anesthesia. Methodology: This prospective observational study was conducted in the Department of Anesthesiology, Shahid Nirmal Mahato Medical College and Hospital, Dhanbad, Jharkhand, over one year. A total of 88 adult patients undergoing elective surgeries under general anesthesia were included. Patients were assessed preoperatively using the Apfel risk score and received prophylaxis based on risk category. Postoperative monitoring for nausea, vomiting, and rescue antiemetics was done for 24 hours. Results: The overall incidence of PONV was 34.1%. A higher incidence was observed in high‑risk patients (50%) compared to low‑risk patients (10%). Early PONV (0–6 hours) was more common. Patients receiving no or single prophylaxis had higher PONV rates, while multimodal prophylaxis significantly reduced incidence (18.7%). Rescue antiemetics were required in 29.5% of patients. Conclusion: Risk stratification using the Apfel score effectively predicts PONV, and multimodal prophylaxis significantly reduces its incidence. A tailored, risk‑based approach is essential for improving postoperative outcomes.

Background: The management of small renal masses (SRMs) via active surveillance (AS) is increasingly adopted, particularly in elderly patients with comorbidities such as diabetes mellitus (DM) and chronic kidney disease (CKD). However, the impact of these conditions on AS trajectories and outcomes remains unclear. Aim: To evaluate the effect of DM and CKD on progression to delayed intervention (DI) and overall survival (OS) in patients undergoing AS for SRMs. Methodology: This retrospective cohort study included 58 patients with clinically localized SRMs (≤4 cm) managed under AS at Department of General Surgery, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India. Patients were stratified by DM and CKD status. Tumor growth rate, crossover to intervention, and survival outcomes were analyzed using multivariable logistic regression. Results: Mean age was 72.4 ± 10.8 years, with 34.5% diabetics and 41.4% CKD patients. Overall, 24.1% required DI, while 75.9% remained on AS. Faster tumor growth predicted DI (adjusted OR 4.88, p=0.04), whereas DM and CKD were not independent predictors. DM significantly increased mortality risk (adjusted OR 6.12, p=0.02); CKD showed a nonsignificant trend. Higher tumor growth rate also independently predicted poorer OS. Conclusion: In SRM patients under AS, diabetes adversely affects survival, while tumor kinetics guide intervention decisions. CKD influences outcomes but is less definitive. Comorbidities and tumor growth should inform personalized AS management.

Background/Aim: To study the incidence and risk factors of cystobiliary communication (CBC) in patients undergoing surgery for hepatic hydatid disease (HD). Methods: All patients undergoing surgery for hepatic HD between March 2021 and December 2025 were included in the study. All patients were evaluated by history, clinical examination, routine blood investigations, and ultrasound (US) abdomen/CECT/MRCP. All patients were checked for CBC intraoperatively by the presence of bile in the cyst, presence of daughter cysts in the common bile duct, direct or indirect cholangiogram via the cystic duct, and postoperatively by the presence of bile in the drain. Result: Between March 2021 and November 2025, 67 patients with hepatic hydatid cysts were included in the study, with a female predominance (68.7%) and a mean age of 41.2 years. Cystobiliary communication (CBC) was identified in 31 patients, giving an incidence of 46.3% (95% CI: 34.3%–58.2%). There was no significant difference between CBC and non-CBC groups with respect to age or gender distribution. Most patients were symptomatic, with abdominal pain being the most common presenting complaint. Jaundice and clinical icterus were more frequently observed in the CBC group, and all patients with icterus had underlying CBC. Hepatomegaly was also more common among patients with CBC, although this difference was not statistically significant. Median liver enzyme levels (SGOT, SGPT, and ALP) were comparable between the two groups. On ultrasonography, cysts larger than 10 cm were significantly more common in the CBC group compared to the non-CBC group (p = 0.012). Notably, two-thirds of patients with cysts exceeding 10 cm had CBC. Contrast-enhanced CT demonstrated a trend toward larger cyst size in patients with CBC, though the difference did not reach statistical significance (p = 0.072). Centrally located cysts were more frequently associated with CBC, but without statistical significance. Conclusion: Cystobiliary communication was observed in nearly half of patients with hepatic hydatid disease and was more frequently associated with larger cysts and central cyst location. Clinical features such as jaundice and icterus were strongly suggestive of underlying CBC, although statistical significance could not be consistently demonstrated. Ultrasonography showed a significant association between cyst size greater than 10 cm and the presence of CBC, while CECT demonstrated a similar trend without statistical significance. These findings suggest that cyst size and selected clinical features may help predict CBC and guide preoperative evaluation and management.

Background: Cardiovascular disease is the most common cause of morbidity and mortality in end stage renal disease (ESRD) patients on maintenance hemodialysis (MHD). The accumulation of calcium in the cardiac valves (CVC) is a growing trend to acknowledge this population as a marker of systemic cardiovascular risk, especially for the aortic and mitral valves. Objectives: This study sought to assess the relationship between cardiac valve calcification and cardiovascular complications and mortality in maintenance hemodialysis (MHD) patients. The methodology used: A retrospective study of the Department of General Medicine, Netaji Subhas Medical College & Hospital, Patna, Bihar, was carried out. A total of 130 adult patients with ESRD who were on maintenance hemodialysis were enrolled and divided into two groups: CVC patients, those with a positive CVC; and CVC negative, those with a negative CVC. Data on demographics, clinical, laboratory, echocardiographic, cardiovascular outcome and mortality data were analysed. Results: Fifty-eight patients (44.6%) had cardiac valve calcification. Significant differences were observed between patients with CVC and those with non-CVC in age, diabetes mellitus, previous history of cardiovascular disease, left atrial enlargement, interventricular septal thickness, left ventricular mass index, serum albumin, and β2-microglobulin. The CVC group had significantly higher all-cause mortality (41.4% vs 19.4%), cardiovascular mortality (31.0% vs 11.1%), major cardiovascular events, hospitalization for heart failure, acute coronary syndrome and stroke. CVC was an independent predictor of all-cause and cardiovascular mortality, as was revealed by multivariate Cox regression analysis. Conclusion: There is strong association of cardiac valve calcification with poor cardiovascular outcomes and death in maintenance hemodialysis patients. Echocardiographic screening can be useful in identifying high-risk individuals and in providing the opportunity for early preventive measures.

Background: Chronic kidney disease (CKD) is associated with a significantly increased risk of cardiovascular disease and acute coronary syndrome (ACS). Interpretation of high-sensitivity cardiac troponin (hs-cTn) levels in CKD patients is often challenging because baseline troponin concentrations may remain elevated even in the absence of acute myocardial injury. Despite this limitation, hs-cTn remains an important biomarker for cardiovascular risk assessment. Aim: To evaluate the diagnostic and prognostic significance of high-sensitivity cardiac troponin in CKD patients presenting with chest pain. Methodology: A prospective observational study was conducted over one year in the Department of General Medicine, Netaji Subhas Medical College and Hospital, Amhara, Bihta, Patna, Bihar, India. A total of 95 adult CKD patients who were present with chest pain were enrolled. Clinical evaluation, electrocardiography, echocardiography, renal function assessment, and serial hs-cTn measurements were performed. Results: Among the 95 patients, 62.1% were males and 46.3% were aged above 60 years. ACS was diagnosed with 43.2% of patients. Elevated hs-cTn levels were significantly associated with advanced CKD stages and ACS diagnosis (p<0.001). Patients with higher troponin levels demonstrated increased rates of reduced left ventricular ejection fraction, heart failure (34.3%), arrhythmia (22.9%), ICU admission (42.9%), revascularization (37.1%), mortality (20.0%), and major adverse cardiac events (60.0%). Conclusion: Elevated hs-cTn is a significant diagnostic and prognostic marker in CKD patients presenting with chest pain and is strongly associated with ACS and adverse cardiovascular outcomes.

Background: Type 2 Diabetes Mellitus (T2DM) is a ^‘rapidly growing global health concern, with India contributing a significant burden. Poor glycemic control increases the risk of long-term complications, making regular assessment essential. Aim: To evaluate glycemic control outcomes and associated clinical patterns in patients with T2DM using a retrospective approach. Methodology: A hospital-based retrospective observational study was conducted in the Department of Medicine, Nalanda Medical College and Hospital, Patna. Medical records of 90 T2DM patients were analyzed. Data on age, gender, duration of diabetes, HbA1c levels, treatment patterns, and microvascular complications were collected and assessed using descriptive statistics. Results: The majority of patients were aged 51–60 years (31.1%), with a male predominance (57.8%). Poor glycemic control (HbA1c ≥7%) was observed in 60% of patients. Most patients had diabetes for more than 5 years (37.8%). Neuropathy was the most common microvascular complication (22.2%), followed by nephropathy (15.6%) and retinopathy (11.1%). Conclusion: The study demonstrates suboptimal glycemic control in a majority of T2DM patients, with increasing disease duration and complications. Early intervention, strict monitoring, and treatment intensification are essential for improving outcomes.

Background: Dengue fever is a quickly spreading viral illness transmitted by mosquitos that poses a substantial public health risk in India. It causes a wide range of clinical symptoms, from mild febrile sickness to severe sequelae including dengue hemorrhagic fever and dengue shock syndrome. Early diagnosis and management are difficult since there is no particular antiviral medication, and the clinical presentation is varied. Aim: To assess the clinical and laboratory characteristics of dengue fever in adult patients admitted to a tertiary care hospital. Method: This six-month prospective observational research was undertaken at the Department of Medicine at Nalanda Medical College and Hospital in Patna, Bihar. We enrolled 105 adult patients (≥12 years) with serologically confirmed dengue illness. Detailed demographic information, clinical symptoms, and laboratory data were collected and analyzed using descriptive statistical techniques. Result: The majority of patients (62.9%) were between the ages of 21 and 40, with 73.3% being men. Fever was present in 100% of the patients, followed by headache (94.8%) and myalgia (90.7%). Other common clinical findings were conjunctival suffusion (39.4%), skin rash (37.9%), stomach discomfort (24.5%), pleural effusion (20%), and ascites (16.3%). Thrombocytopenia was the most prevalent hematological disorder, occurring in 69.5% of patients. Elevated liver transaminases were detected in 88.5% of patients, whereas leucopenia and increased hematocrit were detected in 20.2% and 20.8%, respectively. Conclusion: Dengue fever primarily affects young adult males and is distinguished by fever, headache, myalgia, thrombocytopenia, and hepatic involvement. Early detection and frequent monitoring of clinical and laboratory indicators are critical to avoiding complications and lowering morbidity and mortality.

Background: Incidental gallbladder carcinoma (IGBC) is defined as a cancer that is found in the gallbladder during or soon after a cholecystectomy for a presumed non-cancerous condition. It is often missed in the pre-operative diagnosis as the symptoms resemble those of chronic cholecystitis or cholelithiasis. Objective: To study incidence and clinicopathological profile of incidental gallbladder carcinoma in routine cholecystectomy specimen at Nalanda Medical College and Hospital, Patna, Bihar. Methods: The study was a retrospective observational study that involved 190 patients who had cholecystectomy, either elective or emergency, performed within a 1-year period for what was supposed to be a benign gallbladder condition. Operative findings, patient records and histopathological reports were reviewed. Demographic, clinical, pathological, staging and outcome parameters were analyzed in the carcinoma diagnoses made after the postoperative pathological examination. Results: Gallbladder carcinoma was found incidentally in 3 of 190 patients (1.58%). The clinical symptoms were not specific, most cases being presented with epigastric pain, dyspepsia and nausea/vomiting. Female predominance and age 52-68 years was observed in IGBC cases. Two cases had gallstones. Histological diagnosis revealed adenocarcinoma in most cases, with one case presenting Aden squamous carcinoma. Two cases were detected at an early stage and survived, while one case in T2 stage died due to disease progression. Summary: Incidental gallbladder carcinoma is rare and yet clinical in nature. All cholecystectomy specimens should be routinely histopathologically examined, which is particularly important in high-risk areas to detect early and enhance the patient’s management.

Background: Glycemic variability has emerged as an important factor influencing the development of complications in type 2 diabetes mellitus, beyond the traditional measure of glycemic control assessed by HbA1c. Aim: To assess the association between glycemic variability and diabetic complications in patients with type 2 diabetes mellitus. Methodology: This hospital-based cross-sectional study was conducted over one year at Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar. A total of 80 patients with type 2 diabetes mellitus were enrolled using a consecutive sampling technique. Glycemic parameters, including fasting blood glucose, postprandial blood glucose, HbA1c, and indicators of glycemic variability, were analyzed. Diabetic complications were assessed clinically and through relevant investigations. Result: The study showed poor glycemic control among participants, with a mean HbA1c of 8.9%. Neuropathy (42.5%) was the most common complication. A significant association was observed between higher glycemic variability and the presence of diabetic complications (p < 0.05). Conclusion: Glycemic variability is significantly associated with diabetic complications and should be considered alongside HbA1c in diabetes management to improve clinical outcomes.

Background: Internet use has become an integral part of students’ lives, but its excessive use can lead to behavioral addiction affecting mental health and daily functioning. Aim: To determine the prevalence of internet addiction among college students and identify associated factors. Methodology: A cross-sectional study was conducted among 500 undergraduate students at a Lokmanya Tilak Municipal Medical College and Hospital (LTMMC), Mumbai, Maharashtra (2019–2022). Data were collected using a structured questionnaire, Young’s Internet Addiction Test (YIAT-20), and Kessler Psychological Distress Scale (K10). Statistical analysis included descriptive measures and logistic regression. Results: Out of 500 participants, 52% were normal users, while 32% had mild, 13.4% moderate, and 2.6% severe addiction. Males showed slightly higher addiction levels than females. Higher prevalence was observed among older students (24–26 years) and final-year students. Rural participants exhibited a relatively greater proportion of severe addiction. Social networking and entertainment use were significantly associated with higher addiction levels, whereas academic use showed lower risk. Conclusion: Internet addiction is moderately prevalent among college students, influenced by demographic and behavioral factors. Early interventions, awareness programs, and promotion of balanced internet use are essential.

Background: Acne vulgaris is a common chronic inflammatory disorder of the pilosebaceous unit that frequently affects adolescents and can significantly impact physical appearance and quality of life. Various genetic, dietary, and lifestyle factors contribute to its development and severity. Aim: To assess the clinical profile of acne vulgaris and identify associated risk factors among adolescents. Methodology: A hospital-based cross-sectional observational study was conducted among 80 adolescents aged 10–19 years attending the Department of Skin & VD, Anugrah Narayan Magadh Medical College and Hospital, Gaya ji, Bihar. Data were collected using a structured questionnaire and clinical examination. Associations between risk factors and acne severity were analyzed using appropriate statistical tests, with p<0.05 considered significant. Results: The majority of participants were aged 14–16 years (42.5%), females (55.0%), and urban residents (57.5%). Mild acne was the most common presentation (45.0%), and facial involvement was observed in 60.0% of cases. Frequent fast-food consumption (65.0%), high screen time (62.5%), inadequate sleep (57.5%), and high stress levels (52.5%) were common. Positive family history was present in 42.5% of participants. Significant associations were found between moderate-to-severe acne and fast-food consumption (p=0.021), high screen time (p=0.032), inadequate sleep (p=0.027), high stress (p=0.015), and positive family history (p=0.018). Conclusion: Acne vulgaris among adolescents is significantly associated with unhealthy lifestyle habits and genetic predisposition. Early identification of risk factors and lifestyle modification may help reduce disease severity and prevent complications.

Background: Sports-related musculoskeletal injuries are a major public health concern among adolescents and young adults due to increased participation in physical activities and growth-related vulnerabilities. Aim: To assess the prevalence, types, and anatomical distribution of sports-related musculoskeletal injuries among adolescents and young adults. Methodology: A hospital-based cross-sectional study was conducted among 80 participants aged 10–25 years at Netaji Subhas Medical College and Hospital, Bihta, Patna in Bihar over six months. Data were collected using a structured questionnaire covering demographics, sports participation, and injury history. Statistical analysis was performed using SPSS version 27.0. Results: The overall prevalence of musculoskeletal injuries was 62.50%. The majority of participants were aged 16–20 years (37.50%) and male (60.00%). Recreational sports participation was most common (35.00%). Strains (25.00%) and sprains (22.50%) were the most frequent injuries, while fractures accounted for 15.00%. The lower limb was the most affected site (48.00%). Conclusion: A high prevalence of sports-related injuries was observed, particularly among late adolescents and young adults, highlighting the need for preventive strategies and awareness programs.

Background: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by persistent hyperglycemia and associated microvascular complications. Microalbuminuria is an early marker of diabetic nephropathy and endothelial dysfunction. Aim: To evaluate T2DM as a threat indicator for microalbuminuria and to assess its association with glycemic control (HbA1c) and duration of diabetes. Methodology: A hospital-based cross-sectional observational study was conducted on 50 T2DM patients aged ≥30 years. HbA1c was estimated using the Latex Agglutination Inhibition Method, and urinary microalbumin was measured by the immunoturbidimetric method. Statistical analysis was performed using SPSS version 19. Student’s t-test and Pearson’s correlation were applied, with p < 0.05 considered significant. Results: Microalbuminuria was present in 40% of patients. Its prevalence increased with rising HbA1c levels, particularly >7.5%. A significant positive correlation was observed between microalbuminuria and HbA1c (r = 0.61, p = 0.002), and a strong correlation with duration of diabetes (r = 0.78, p < 0.001). Mean HbA1c was significantly higher in patients with microalbuminuria (8.52 ± 1.18%) than those without (7.46 ± 1.02%) (p = 0.001). Conclusion: Poor glycemic control and longer duration of T2DM significantly predict microalbuminuria, highlighting the importance of early screening and strict metabolic control.

Background: Diabetes mellitus causes chronic hyperglycemia leading to microvascular complications, particularly diabetic nephropathy. Blood urea and serum creatinine are important biochemical markers for early detection of renal impairment. Aim: To compare blood urea and serum creatinine levels in diabetic patients and non-diabetic individuals and evaluate their clinical relevance in assessing renal function. Methodology: A comparative cross-sectional study was conducted on 40 subjects (20 Type-2 diabetics and 20 age-matched controls) aged 35–65 years at a tertiary care hospital. Fasting and post-prandial glucose, HbA1c, blood urea (urease method), and serum creatinine (Jaffe’s method) were measured. Data were analyzed using Student’s t-test and correlation analysis (p<0.05 significant). Result: Diabetics showed significantly higher blood urea (58.92±11.34 vs 26.80±4.90 mg/dl) and serum creatinine (1.62±0.38 vs 0.86±0.14 mg/dl) (p<0.001). Renal abnormalities were present only in diabetics. HbA1c positively correlated with blood urea (r=0.61) and creatinine (r=0.68). Creatinine was significantly higher in male diabetics. Conclusion: Diabetes is strongly associated with impaired renal function. Elevated urea and creatinine, particularly with poor glycemic control, indicate early nephropathy; routine monitoring is essential for prevention.

Background: Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. Percutaneous coronary intervention (PCI) with stent implantation is a widely used treatment modality. Drug-eluting stents (DES) were developed to reduce restenosis associated with bare-metal stents (BMS), but comparative outcome data remain clinically important. Aim: To compare the clinical and angiographic outcomes of drug-eluting stents and bare-metal stents in patients undergoing PCI for coronary artery disease. Methodology: This prospective comparative study included 90 patients who underwent PCI, comprising 45 patients treated with DES and 45 treated with BMS. Demographic characteristics, cardiovascular risk factors, angiographic findings, and clinical outcomes were analysed. Outcomes assessed included in-stent restenosis, target lesion revascularization, recurrent myocardial infarction, major adverse cardiac events (MACE), and all-cause mortality. Statistical analysis was performed using appropriate comparative tests, with p<0.05 considered statistically significant. Results: Baseline demographic and clinical characteristics were comparable between the two groups. In-stent restenosis occurred in 8.9% of DES patients compared with 24.4% of BMS patients (p=0.047). MACE was observed in 11.1% of DES recipients and 26.7% of BMS recipients (p=0.049). Follow-up stenosis was significantly lower in the DES group (14.2 ± 6.8%) than in the BMS group (26.5 ± 10.4%; p<0.001). Mortality and recurrent myocardial infarction were lower in the DES group, although the differences were not statistically significant. Conclusion: Drug-eluting stents demonstrated superior clinical and angiographic outcomes compared with bare-metal stents, with significantly lower rates of restenosis, follow-up stenosis, and major adverse cardiac events. DES may therefore be considered the preferred stent option for patients undergoing PCI.

Abstract: Women’s pain satisfaction post‑cesarean section remains a challenge. Accurate assessment of pain severity of post‑cesarean section helps to choose the most appropriate anesthetic approach, drug, and dose, as well as improvement of treatment of postoperative pain. Our objective was to compare the efficacy of ultrasound‑assisted transversus abdominis plane (TAP) block in the first 24 h postoperative in women who underwent cesarean section. The primary outcome was postoperative pain at 2, 4, 6, 12, and 24 h. The secondary outcomes were intestinal mobility, early mobilization, nausea, vomiting, heart rate, and respiratory rate. Materials and Methods: The study population consisted of 60 patients posted for elective and emergency caesarean section. They were blindly divided into two groups of 30 patients each. Group T received 40ml 0.25% Ropivacaine in Transverses abdominis plane (TAP) block for postoperative analgesia and group I received 40ml 0.25% ropivacaine as infiltration at incision site for postoperative analgesia. Patients were observed for numeric pain score NPS, analgesic requirements, total analgesic consumption and adverse effects if any. Results: There was highly significant difference in numeric pain scores at 2^nd, 6^th, 12^th and 24^th hours (p<0.0001). Both the time for first rescue analgesic and total amount of analgesic consumed are statistically significant (p<0.0001). Conclusions: TAP block is an effective postoperative analgesic procedure for post caesarean section patients.

Fever is identified as a mani-festation of diseases since old time, as written by former scholars like Hippocrates. Which was found as a disease but later as a accompaniment to varied diseases, fever is a easily noted and a reliable marker of diseases. Normal body temperature is 37.0 °C or 98.6°F. The exact range is sort of wide, being littered with site of measurement, di urnal changes, vigorous exercise, hormonal and menstrual status, variation of individual, and surrounding factors. A patient’s vital sign is usually estimated by measurements taken within the mouth. For reasons of convenience, but oral temperatures will be littered with mouth-breathing, by the rate of respiration, and by recent drinking of hot or cold liquids.

Background: The concept of a psychiatric emergency refers to any condition that causes sudden changes in one’s mental status, behaviors, mood, or perceptions. An appreciation of the trend of the psychiatric emergency cases is crucial for developing better services of emergency psychiatry, ensuring proper use of resources, and formulating adequate mental health policies in the tertiary level hospital environment. Aim: To evaluate the sociodemographic profile, clinical presentation, diagnosis, emergency management, and patient outcomes of psychiatric emergencies at a tertiary care hospital. Methodology: An observation study based on retrospective medical record analysis was carried out at the Department of Psychiatry, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India. The data from the medical records of 130 patients who presented with psychiatric emergencies within a year were collected. The demographic profile, emergency presentation, diagnosis, intervention, and outcome of the patients were noted using a proforma. Results: Most of the patients belonged to the age group of 21-40 years (47.7%) and more male patients (56.9%) and those hailing from rural background (60%). The most common type of psychiatric emergency included acute psychosis (26.2%), suicidal attempts or self-harm (21.5%) and substance induced psychiatric emergency (16.9%). Schizophrenia (27.7%) was found to be the most frequent diagnosis, followed by substance misuse disorders (18.5%) and bipolar affective disorder (16.9%). Injectables for psychotic disorder (46.2%) and emergency psychological counseling (43.1%) were the most commonly prescribed interventions. Almost half of the patients (44.6%) needed admission in the in-patient department for mental illness whereas 32.3% were discharged following stabilization. Conclusion: Emergency cases that occurred in psychiatry primarily involved young people and were related to psychosis, suicide, and drug use. Timely diagnosis, early treatment, an interdisciplinary approach, and improved psychiatric emergency service are important for the improvement of patients’ results and betterment of the quality of emergency psychiatric care.

Background: Airway control is an essential part of safe anesthetic practice for patients receiving general anesthesia. Despite advances in airway devices and monitoring, unanticipated airway issues can arise during elective surgical procedures and may lead to perioperative morbidity. Aim: The objective of this study was to retrospectively determine the occurrence of airway management problems during general anesthesia in patients having elective surgical procedures and to identify associated preoperative predictors and peri-intubation complications. Methodology: We conducted a retrospective observational study in 180 individuals undergoing elective surgery under general anesthesia. Demographic characteristics, preoperative airway evaluation measures such Modified Mallampati grade, thyromental distance, inter-incisor gap and neck mobility were reviewed. Intraoperative parameters evaluated included Cormack–Lehane grading, number of intubation attempts, use of airway adjuncts, incidence of difficult airway, and peri-intubation problems. Results: Most of the patients had good preoperative airway features and straightforward care of the airway. However difficult airway was noted in 40 patients (22.2%). The incidence of difficult airways increased with the Modified Mallampati grade and restriction of neck movement. Most patients had effective first-attempt intubation; some patients required several tries or adjuncts for airway management. Peri-intubation problems were few and the most prevalent was oxygen desaturation. Conclusion: Difficult airways continue to pose a serious problem for elective general anesthesia. A thorough preoperative airway examination, early awareness of risk factors, and adequate preparedness with advanced airway devices can improve patient safety.

Background: Birth asphyxia remains a leading cause of neonatal morbidity and mortality globally, especially in low- and middle-income countries. It is characterized by failure to initiate or sustain breathing at birth, resulting in hypoxia, multi-organ dysfunction, and potential long-term neurological deficits. Aim: To evaluate the incidence, clinical profile, and short-term outcomes of neonates with birth asphyxia. Methodology: A hospital-based retrospective observational study was conducted over six months at the Department of Pediatrics, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India. Eighty neonates diagnosed with birth asphyxia and admitted within 24 hours of birth were included. Data on demographics, perinatal risk factors, APGAR scores, resuscitation measures, interventions, and short-term outcomes were collected and analyzed using SPSS 27. Results: Among 80 neonates, 56% were male, 69% term, and 56% had birth weight 2.5–3.5 kg. Low APGAR scores (<7 at 5 min) were observed in 50%, and 63% required resuscitation. Supportive NICU care included oxygen supplementation (75%) and intravenous fluids (88%), while 31% required mechanical ventilation. Favorable recovery occurred in 69%, while 31% developed complications, including seizures (19%) and hypoxic-ischemic encephalopathy (13%). Conclusion: Early recognition, prompt resuscitation, and timely^’ interventions, including therapeutic hypothermia, are critical ^‘to improving short-term outcomes in neonates with birth asphyxia.

Background: Pediatric meningitis is a life-threatening condition with significant morbidity and mortality, particularly in children under two years of age. Early recognition and treatment are critical for improving outcomes. Aim: To retrospectively analyze the clinical profile, laboratory findings, and treatment outcomes of pediatric meningitis cases at a tertiary care center. Methodology: This retrospective observational study reviewed medical records of 80 children aged 1 month to 12 years admitted with bacterial meningitis at the Department of Pediatrics, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, over seven months. Demographic data, clinical features, cerebrospinal fluid (CSF) analysis, treatment, and outcomes were documented and analyzed using descriptive and inferential statistics. Results: The majority of cases were in children aged 13–24 months (31.3%) with male predominance (62.5%). Fever was present in all patients; seizures (43.8%), vomiting (52.5%), neck stiffness (35%), and bulging fontanelle in infants (18.8%) were observed. CSF findings confirmed bacterial etiology in 71.3% of cases, predominantly Streptococcus pneumoniae. Complete recovery was achieved in 75% of patients, while 18.8% had neurological sequelae and mortality was 6.3%. Conclusion: Pediatric meningitis predominantly affects younger males, with fever as a universal symptom. Early diagnosis, prompt antimicrobial therapy, and vigilant follow-up are essential to reduce morbidity, mortality, and long-term neurological complications.

Background: Diabetes mellitus is a major metabolic disorder characterized by chronic hyperglycemia that may lead to long-term complications affecting various organs, particularly the kidneys. Renal impairment in diabetic patients is commonly assessed using biochemical markers such as blood urea and serum creatinine. Aim: To compare blood urea and serum creatinine levels between diabetic and non-diabetic individuals and evaluate their association with renal dysfunction. Methodology: This comparative cross-sectional study included 48 subjects (24 diabetic patients and 24 non-diabetic controls) aged 35–65 years. Blood samples were collected and analyzed for fasting blood sugar, post-prandial blood sugar, HbA1c, blood urea, and serum creatinine using standard biochemical methods. Data were expressed as mean ± SD and analyzed using Student’s t-test. Results: Diabetic subjects showed significantly higher mean values of blood urea (61.25 ± 10.64 mg/dl) and serum creatinine (1.72 ± 0.58 mg/dl) compared to non-diabetics (26.48 ± 4.97 mg/dl and 0.86 ± 0.15 mg/dl, respectively; p < 0.05). Elevated urea and creatinine levels were observed only in diabetic patients. Conclusion: The study demonstrates that diabetic patients have significantly elevated renal function markers, indicating a higher risk of renal impairment. Regular monitoring of blood urea and serum creatinine may help in the early detection of diabetic nephropathy.

Background: Periprosthetic joint infection (PJI) is one of the most severe complications after total joint arthroplasty (TJA), leading to increased morbidity, longer hospital stays, multiple procedures and higher healthcare costs. The identification of risk factors associated with the patient should be useful for improving both the patient’s outcome and postoperative complications. Aim: To estimate the prevalence of PJI after primary TJA and to identify the demographic, clinical, and perioperative risk factors for the development of PJI. Methodology: A retrospective observational study done in the Department of Orthopedics at Darbhanga Medical College and Hospital, Laheriasarai, Bihar. The records of 120 patients who had undergone total hip arthroplasty or total knee arthroplasty as their first operation during a 12-month period were reviewed. Demographic data, comorbidities, operative factors, laboratory data and postoperative outcomes were evaluated. Univariate comparison and multivariate logistic regression model analysis were used for statistical analysis to determine independent predictors of PJI. Results: The PJI rate was 8.3%. Univariate analysis revealed diabetes mellitus, obesity, anemia, hypoalbuminemia, smoking history, rheumatoid arthritis, prolonged operative duration, corticosteroid use and elevated inflammatory markers as significant risk factors for PJI. Multivariate logistic regression analysis revealed diabetes mellitus, obesity, hypoalbuminemia, operative duration > 120 minutes and preoperative corticosteroid use as independent risk factors for PJI. Conclusion: PJI continues to be a major complication after TJA. Modifiable risk factors, careful patient selection, better nutritional and metabolic status, reducing surgical time and closely following infection prevention and control protocols can significantly lower the risk of PJI and enhance surgical outcomes.

Background: Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease in the world. Hepatic steatosis assessment is crucial for early diagnosis, grading of the disease and monitoring. MRI-PDFF is currently recognized as a reference method for liver fat quantitation but is not widely available and is expensive. A promising alternative is quantitative ultrasound (QUS), which is a cost-effective option. Aim: To compare quantitative ultrasound parameters with MRI parameters to assess the correlation between these two techniques in the evaluation of hepatic steatosis in patients with NALFD. Methodology: Prospective, Cross sectional, Observational study was carried out in Department of Radiodiagnosis, Indira Gandhi Institute of Medical Sciences Patna, Bihar, India for one year. A total of 102 patients (adults) with suspected or diagnosed with NAFLD were examined by quantitative ultrasound and MRI-PDFF. Correlations between quantitative ultrasound parameters (attenuation coefficient and backscatter coefficient) and MRI-PDFF were performed. The statistical methods used were Pearson’s correlation, ROC curve analysis and diagnostic accuracy measures. Results: Attenuation coefficient had a strong positive correlation with MRI-PDFF (r = 0.854, p < 0.001) and the backscatter coefficient had significant correlation (r = 0.768, p < 0.001). The results showed that quantitative ultrasound was very sensitive (92.9%), very specific (88.9%), very accurate (92.2%) and had an area under the ROC curve of 0.935, which are excellent diagnostic performance. Conclusion: Quantitative ultrasound was highly correlated with MRI-PDFF and was able to determine the severity of hepatic steatosis. Due to its diagnostic accuracy, non-invasive nature, affordability and availability, QUS is a suitable alternative to MRI for routine evaluation and follow-up of patients with NAFLD, especially in resource-limited healthcare environments.

Background: Difficult airway and failed endotracheal intubation remain major causes of perioperative morbidity and mortality, particularly in emergency general surgery where rapid airway control is often required. Aim: To determine the incidence of difficult airway and failed endotracheal intubation and evaluate the airway management strategies and related complications in emergency general surgery. Methodology: This prospective observational study was conducted over one year in the Department of Anesthesiology at Katihar Medical College and Hospital, Bihar. Eighty adult patients undergoing emergency general surgery under general anesthesia were enrolled. Preoperative airway assessment, intubation characteristics, airway management techniques, and airway-related complications were prospectively recorded and analyzed using SPSS version 27.0. Results: Most patients had Modified Mallampati Grade I–II (72.5%), and 75% were successfully intubated on the first attempt. Difficult airway occurred in 15% of patients, while failed endotracheal intubation was observed in 2.5%. Bougie-assisted intubation (35.7%) and videolaryngoscopy (28.6%) were the most frequently used rescue techniques. Airway-related complications were absent in 81.3% of patients, with oxygen desaturation (7.5%) being the most common adverse event. Conclusion: Difficult airway remains a significant challenge in emergency general surgery. Comprehensive preoperative airway assessment, availability of advanced airway devices, and timely use of rescue techniques improve intubation success and reduce airway-related complications.

Background: Allergic rhinoconjunctivitis (ARC) is a common IgE-mediated inflammatory disorder that adversely affects patients’ quality of life (QoL). Evidence from the Indian population remains limited. Objective: To evaluate the impact of allergic rhinoconjunctivitis on quality of life and its association with disease severity among patients attending a private ENT clinic in Bangalore. Methods: A prospective observational study was conducted among 115 adults with clinically diagnosed ARC. Disease severity was assessed using the Allergic Rhinitis and its Impact on Asthma (ARIA) classification and Visual Analogue Scale (VAS), while quality of life was evaluated using the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Associations between disease severity and QoL were analysed using correlation, ANOVA, and multiple linear regression. Results: The mean age was 31.8 ± 11.2 years, and 58.3% were male. Moderate-to-severe persistent disease was the most common ARIA category (40.0%). The mean VAS and RQLQ scores were 6.9 ± 1.8 and 3.18 ± 1.05, respectively. Nasal symptoms and sleep were the most affected QoL domains. VAS scores showed a strong positive correlation with RQLQ scores (r = 0.76, p < 0.001). Higher VAS scores, persistent disease, and coexisting bronchial asthma independently predicted poorer QoL. Conclusion: Allergic rhinoconjunctivitis significantly impairs quality of life, particularly in patients with persistent and severe disease. Routine assessment using ARIA classification, VAS, and RQLQ may facilitate comprehensive evaluation and individualized management.