Background: Open fractures are highly susceptible to contamination and subsequent surgical site infections (SSIs), posing significant challenges in orthopaedic management. Understanding the microbiological profile at different stages of wound management is crucial for effective infection control. Objective: To evaluate and compare the microbiological profile of open fracture wounds at pre-debridement, post-debridement, and during surgical site infection, and to assess factors influencing microbial growth. Methods: This observational study was conducted at the Department of Orthopaedics, SRM Medical College Hospital, from August 2023 to August 2024. A total of 50 patients with open fractures were included. Microbiological cultures were obtained at three stages: pre-debridement, post-debridement, and during SSI. Demographic data, injury characteristics, comorbidities, and clinical parameters were analyzed for association with microbial growth. Results: The majority of patients were males (56.7%) and belonged to the 40–50-year age group. Road traffic accidents were the most common cause of injury (40%). Pre-debridement cultures showed minimal microbial growth (3.3%), whereas post-debridement cultures demonstrated a significant increase in microbial positivity (76.7%). Gram-negative organisms, particularly Klebsiella species, were predominant. A subset of patients developed SSI, with Staphylococcus aureus being the most common isolate. Statistical analysis revealed no significant association between microbial growth and most demographic or clinical variables; however, gender showed a significant correlation. Conclusion: The microbiological profile of open fractures changes dynamically during treatment, with a notable increase in bacterial growth following debridement, suggesting possible nosocomial contamination. Early and targeted antimicrobial therapy, along with strict aseptic protocols, is essential to reduce infection rates and im-prove outcomes in open fracture management.

Background: Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine-metabolic disorder with variable reproductive and metabolic manifestations across different phenotypes. Aim: To evaluate the correlation of PCOS phenotypes with insulin resistance, obesity, and menstrual abnormalities among reproductive-age women. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology, KIMS, Narketpalli, from November 2025 to February 2026. Reproductive-age women diagnosed with PCOS according to the Rotterdam criteria were enrolled and classified into phenotypes A, B, C, and D. Clinical history, anthropometric parameters, menstrual profile, and ultrasound findings were recorded. Fasting blood glucose, fasting serum insulin, and HOMA-IR were assessed to evaluate insulin resistance. Statistical analysis was performed using chi-square test, t-test, and ANOVA as appropriate. Results: Classical phenotypes, particularly phenotype A, showed significantly higher body mass index, waist circumference, fasting insulin, and HOMA-IR values compared with non-classical phenotypes. Menstrual abnormalities were significantly more frequent in phenotypes A and B. Insulin resistance was significantly associated with obesity, menstrual disturbances, and hyperandrogenic phenotypes. Conclusion: PCOS phenotypes differ significantly in their metabolic and menstrual profile, and phenotype-based assessment may improve risk stratification and individualized management.

Background: Effective postoperative pain management is essential in lower limb surgeries to enhance recovery, reduce complications, and improve patient satisfaction. Epidural analgesia is widely regarded as a superior modality due to its ability to provide targeted and continuous analgesia. However, systemic analgesia remains commonly used because of its ease of administration and lower technical requirements. Comparative evaluation of these modalities remains clinically relevant. Aim: To compare the efficacy of epidural analgesia and systemic analgesia in patients undergoing lower limb surgeries. Methods: This prospective, randomized comparative study included 120 patients undergoing elective lower limb surgeries under regional or general anesthesia. Patients were divided into two groups: Group E (epidural analgesia, n=60) and Group S (systemic analgesia, n=60). Pain was assessed using the Visual Analog Scale (VAS) at predefined intervals postoperatively. Secondary outcomes included duration of analgesia, total analgesic consumption, hemodynamic parameters, and incidence of adverse effects. Results: Patients receiving epidural analgesia demonstrated significantly lower VAS scores at all postoperative intervals compared to the systemic analgesia group (p<0.05). The duration of analgesia was longer in Group E, with reduced requirement for rescue analgesics. Hemodynamic parameters remained more stable in the epidural group. The incidence of nausea and vomiting was higher in the systemic analgesia group, whereas mild hypotension was observed more frequently in the epidural group. Conclusion: Epidural analgesia provides superior postoperative pain relief, prolonged analgesic effect, and better hemodynamic stability compared to systemic analgesia in lower limb surgeries, making it a preferred modality in appropriate clinical settings.

Background: Perforation peritonitis remains a life-threatening abdominal surgical emergency with diverse aetiology and variable outcomes depending on regional, socioeconomic, and healthcare-related factors. Timely operative intervention is the cornerstone of management, and understanding institutional disease patterns is essential for optimising outcomes. Methods: A prospective observational study was conducted over 18 months in the Department of General Surgery at Oxford Medical College, Hospital and Research Centre, Bangalore. A total of 75 consecutive patients with clinical and radiological evidence of perforation peritonitis who underwent emergency laparotomy were enrolled. Demographic data, clinical presentation, comorbidities, site and cause of perforation, operative procedure, postoperative complications, length of hospital stay, and in-hospital mortality were systematically recorded and analysed. Results: The mean age of the study population was 43.2 ± 11.8 years with a male predominance (70.7%). Comorbidities were present in 62.7% of patients, most commonly diabetes mellitus (17.3%) and hypertension (14.7%). Universal presentation with acute abdominal pain was noted; 74.7% had abdominal distension or constipation, 44.0% vomited, and 34.7% were febrile. The appendix was the most frequent site of perforation (28.0%), followed by the duodenum (22.7%), ileum (20.0%), and stomach (16.0%). Modified Graham’s omentoplasty (34.7%) and primary closure (33.3%) were the most common operative procedures, followed by open appendectomy (28.0%). Postoperative ICU care was required by 46.7% of patients. Wound infection (20.0%) was the most common complication. In-hospital mortality was 5.3%, predominantly in patients with comorbidities, advanced age, and delayed presentation. Conclusions: Appendicular and peptic ulcer perforations are the predominant causes of perforation peritonitis in this tertiary care teaching hospital cohort. Prompt surgical intervention coupled with aggressive perioperative care results in acceptable morbidity and mortality. Advanced age, comorbidities, and delayed presentation are key determinants of adverse outcomes and warrant early recognition and referral.

Introduction: Ocular toxicity refers to adverse effects on the eye caused by drugs, chemicals, or environmental factors, potentially leading to visual impairment. Ethambutol, a first-line antitubercular drug, is known to cause optic neuropathy, affecting visual acuity and colour discrimination. Aim & Objectives: To report a case of Ethambutol-induced ocular toxicity in a tuberculosis patient and highlight the need for early detection and monitoring of adverse drug reactions (ADRs). Methods: A 59-year-old male with pulmonary tuberculosis presented with decreased vision after three months of Anti-Tubercular Therapy (ATT). Due to nausea and abdominal discomfort, he discontinued ATT, which was later reintroduced in a modified regimen. His medical history included chronic alcohol and masala consumption. Clinical evaluation and patient history suggested Ethambutol-induced optic neuropathy. Results: The patient exhibited symptoms of impaired visual acuity and night blindness, which are characteristic of Ethambutol-induced optic neuropathy. Upon discontinuation of Ethambutol and appropriate management, the patient showed gradual recovery. Summary & Conclusion: Ethambutol, though essential in tuberculosis treatment, can lead to serious ocular toxicity. Regular ophthalmic monitoring is crucial for early detection and prevention of irreversible vision loss. Caution is advised in high-risk patients, including those with pre-existing optic conditions.

Introduction: Hepatitis B virus (HBV) infection remains a major global public health problem and an important cause of chronic liver disease, cirrhosis, and hepatocellular carcinoma. Molecular testing has emerged as an essential tool for accurate diagnosis and monitoring of chronic HBV infection. Materials and Methods: This prospective observational study was conducted at the Department of Microbiology, GMERS Medical College and Hospital, Sola, Ahmedabad. A total of 300 HBsAg-positive blood samples were analyzed. Serological testing and HBV DNA quantification by real-time polymerase chain reaction (PCR) were performed to evaluate the role of molecular testing in chronic HBV infection. Results: Out of 300 HBsAg-positive samples, HBV DNA was detected in 226 cases (75.33%), while 73 cases (24.33%) were negative and 1 case (0.33%) was inconclusive. Male patients constituted 59.30% of positive cases, and the highest positivity was observed in the 21–40 years age group (46%). Viral load >20,000 IU/ml was observed in 38.05% of patients. Follow-up analysis demonstrated changes in viral load levels, highlighting the importance of serial molecular monitoring. Conclusion: Real-time PCR is a valuable tool for detection and monitoring of chronic HBV infection and provides accurate assessment of viral replication and disease activity.

Background and Objective: Tinea capitis is a prevalent infection, particularly in areas with few resources. The purpose of this study was to investigate the prevalence of tinea capitis in school-aged children and the impact of personal hygiene on prevalence. Materials and Methods: A cross-sectional study was carried out in 422 school going children. All the children belong to class first to class seven and the age group of 6 years to 14 years. A questionnaire was given out, and scalp cultures, skin scraping/hair stub samples were taken in order to identify and confirm the etiological agents. Results: Out of 422 children screened in the study, 42 were observed to have Tinea capitis by clinical examination, providing an overall prevalence rate of 10% among the school children. 252 males and 170 females aged between 6 and 14 years with mean age of 10.5 ± 2.16 years. Majority of children with Tinea capitis had black dot type of patches (57%) followed by those having grey patches (38.3%).  Majority of children had poor personal hygiene. Conclusion: Tinea capitis is common among school-aged children in Bangalore, Karnataka, and appropriate efforts must be made to reduce its prevalence.

Background: Airway management during laparoscopic cholecystectomy remains a critical component of anesthetic practice because pneumoperitoneum and patient positioning significantly influence respiratory mechanics and hemodynamic responses. Endotracheal tube (ETT) has traditionally been considered the gold standard airway device; however, second-generation supraglottic airway devices such as i-gel have emerged as effective alternatives with potential advantages including easier insertion, reduced sympathetic stimulation, and lower postoperative airway morbidity. Aim and Objectives: To compare i-gel and endotracheal tube regarding hemodynamic stability and ventilatory parameters in patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Material and Methods: This prospective randomized comparative study was conducted on 100 patients aged 18–60 years belonging to ASA physical status I and II scheduled for elective laparoscopic cholecystectomy. Patients were randomly allocated into two groups: Group I (i-gel, n=50) and Group E (ETT, n=50). Hemodynamic parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded at baseline, after insertion, after pneumoperitoneum, and after removal of airway device. Ventilatory parameters including oxygen saturation (SpO₂), end tidal carbon dioxide (EtCO₂), peak airway pressure (PAP), and airway leak pressure were assessed. Ease of insertion, insertion time, postoperative sore throat, cough, and other complications were also evaluated. Results: Insertion time was significantly shorter in the i-gel group compared to the ETT group (11.4 ± 2.3 sec vs 17.2 ± 2.9 sec, p<0.001). HR and MAP increased significantly after intubation in the ETT group compared to the i-gel group (p<0.001). Ventilatory parameters including SpO₂ and EtCO₂ were comparable between groups throughout surgery. Peak airway pressure was significantly lower in the i-gel group during pneumoperitoneum (p<0.05). Postoperative sore throat and coughing were significantly more common in the ETT group. Conclusion: The i-gel supraglottic airway device provides superior hemodynamic stability with comparable ventilatory efficacy and fewer postoperative airway complications compared to endotracheal tube during laparoscopic cholecystectomy. It may be considered a safe and effective alternative to endotracheal intubation in selected patients.

Background: Gestational diabetes mellitus (GDM)is a condition in which carbohydrate intolerance develops during pregnancy. A change in lipoprotein metabolism in the liver & adipose tissue during pregnancy along with insulin resistance leads to an alteration in serum concentration of fatty acids, triglycerides, cholesterol & phospholipids. Undiagnosed in time or inadequately treated, women with GDM are at increased risk for adverse obstetric and perinatal outcome. There are some current challenges and research gaps concerning GDM & its effect on maternal and foetal risk.  So, it is necessary to screen, diagnose and manage this disease early in pregnancy to ensure better feto-maternal outcome. Objectives: To estimate proportion of GDM among antenatal cases and to determine relationship between lipid profile, liver enzymes and GDM. Materials and Method: A hospital based cross-sectional observational study is conducted among 130 antenatal mothers after 12 weeks of gestation, considering inclusion and exclusion criteria. Estimation of blood glucose, lipid profile, ALT & GGT have been performed by XL- 640 fully automated autoanalyzer. Data analysis is performed using SPSS version 21.0 in windows PC with the help of Chi-square test& Student t-test. A p-value of 0.05 or less is considered statistically significant. Results: In this study, 12 out of 130 pregnant women are found to have GDM. The serum concentration of total cholesterol, triglyceride, LDL, VLDL, GGT are significantly higher in GDM pregnant women than non GDM pregnant women. The serum HDL is found to be lower in GDM pregnant women. There is no significant difference found in the analysis of serum ALT enzymes for GDM and non GDM pregnant women. Conclusion: This study highlights that the prevalence of GDM is 9.2%. Serum levels of Total Cholesterol, serum Triglyceride, serum VLDL, LDL & GGT are found higher in these pregnant women which leads to the conclusion that a higher value of serum total cholesterol, triglyceride and GGT can be considered as a predictor of gestational diabetes mellitus.

Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder requiring prolonged and effective drug therapy. The present study aimed to develop and evaluate a raft-forming drug delivery system of Famotidine and Domperidone to enhance gastric retention and improve therapeutic efficacy. The formulation was prepared using the wet granulation method with sodium alginate and pectin as raft-forming polymers, along with Carbopol 934 and HPMC K4M as release-retarding agents. Preformulation studies confirmed compatibility between drugs and excipients, along with acceptable flow properties. The prepared formulations were evaluated for floating behavior, raft strength, swelling index, drug content, and in-vitro drug release. All batches exhibited rapid floating with lag time between 7–15 seconds and prolonged buoyancy exceeding 8–12 hours. Among the formulations, batch F6 demonstrated optimal performance with maximum raft strength and drug content. In-vitro dissolution studies revealed sustained drug release over 12 hours, with cumulative release of 96.85% for Famotidine and 97.10% for Domperidone. In-vivo pharmacokinetic studies in rabbits showed significantly improved bioavailability of the test formulation, with higher Cmax, delayed Tmax, increased AUC, prolonged half-life, and enhanced mean residence time compared to control and reference formulations. The results confirm that the developed raft-forming system effectively enhances gastric retention, provides sustained drug release, and improves the bioavailability of both drugs. Thus, it represents a promising gastro-retentive drug delivery approach for the effective management of GERD.

Aim: Sentinel lymph node biopsy (SLNB) is the standard operative method for axillary staging in clinically node-negative early breast cancer, because it reduces morbidity compared with axillary lymph node dissection while preserving staging accuracy. Indocyanine green (ICG) fluorescence imaging has emerged as a near-infrared, real-time intraoperative mapping method that may simplify sentinel node localization while maintaining oncologic reliability. The aim of this paper is to assess the utility of ICG fluorescence in real-time intraoperative imaging for SLNB in breast cancer, with emphasis on feasibility, detection performance, safety, comparative effectiveness against conventional tracers, practical limitations, and its current role in evidence-based surgical practice. Materials and Methods: This paper is a narrative evidence synthesis based on peer-reviewed reviews, meta-analyses, prospective studies, and guideline-oriented literature addressing ICG-guided SLNB in breast cancer. Core evidence was drawn from an updated review published in 2023, a systematic review and meta-analysis published in 2020, an earlier diagnostic meta-analysis published in 2016, a prospective open-label clinical trial published in 2015, and a prospective observational noninferiority study published in 2022. Result: ICG fluorescence demonstrates consistently high sentinel node detection rates in breast cancer surgery and is repeatedly reported as superior to blue dye alone and broadly comparable to radioisotope-based mapping. In the 2016 meta-analysis of 19 studies and 2,594 patients, the pooled detection rate for ICG-guided SLNB was 0.98, with pooled sensitivity of 0.92, specificity of 1.00. Review-level evidence further suggests that ICG may increase intraoperative visualization, support real-time lymphatic mapping, and help identify a slightly greater number of sentinel nodes per patient than conventional techniques, although standardization of dose, concentration, injection site, timing, and imaging platform remains incomplete. Conclusion: Current evidence supports ICG fluorescence as a safe, feasible, and highly effective technique for real-time intraoperative sentinel lymph node mapping in breast cancer surgery. The most defensible present conclusion is that ICG is an important contemporary tracer for SLNB in breast cancer, either as an alternative to conventional agents in selected settings or as part of a combined strategy, pending further multicenter randomized evidence and broader guideline harmonization.

Background: Disaster victim identification (DVI) is a humanitarian, legal, and scientific process that seeks to restore identity to the deceased and provide families with timely, reliable answers after mass fatality incidents Rapid DNA testing has emerged as a promising operational advance because it can generate short tandem repeat (STR) profiles at or near the point of need in roughly 90 minutes. Aim: The present paper aims to examine how rapid DNA can be utilized in DVI, to analyze the scientific and practical role of forensic DNA phenotyping, and to discuss how both methods can be integrated within a structured forensic response to disasters. Materials and Methods: This paper is a narrative review and analytical synthesis based on published forensic literature, guidance-oriented sources, and peer-reviewed reports concerning rapid DNA deployment in mass fatality contexts and forensic DNA phenotyping in degraded human remains. Information was organized under major forensic workflow domains: scene recovery, postmortem sampling, antemortem reference collection, phenotypic inference, statistical interpretation, ethical considerations, and operational implementation. A descriptive statistical section was added using the published phenotyping accuracies and case counts reported in the reviewed study to illustrate how forensic data may be interpreted in an academic DVI context. Result: The reviewed evidence indicates that rapid DNA offers substantial operational value in DVI because it can produce actionable STR profiles in less than two hours and has already been used successfully in the field to aid disaster victim identification, including wildfire-related fatalities. Its main advantages are speed, reduced transport delays, simpler workflow, and the possibility of colocating DNA testing. The forensic DNA phenotyping literature reviewed here shows that HIrisPlex-S can provide useful probabilistic estimates of pigmentation traits from degraded bone-derived DNA, with reported overall prediction accuracies above 90% for iris, hair, and skin colour at a probability threshold of 0.7. Conclusion Rapid DNA testing is not a replacement for the entire DVI system, but it is a powerful operational enhancer when used within validated forensic protocols. Forensic DNA phenotyping adds another layer of value by helping infer likely physical appearance from degraded remains, particularly when comparison references are absent, delayed, or incomplete.

Introduction: Hemoglobin E (HbE) disorders and glucose-6-phosphate dehydrogenase (G6PD) deficiency are two important red cell genetic abnormalities highly prevalent in malaria-endemic regions of Southeast Asia. The Karbi tribe, one of the major ethnic groups of Northeast India, is considered to have a significant burden of these disorders; however, data on their prevalence remains limited. This study aimed to determine the prevalence of Hb E disease, HbE trait, and G6PD deficiency among Karbi tribal individuals attending a tertiary care centre in Northeast India. Methods: A total of 600 Karbi tribal patients were enrolled in this cross-sectional study facility based study. Demographic details including age, gender, and sub-clan distribution were recorded. High performance liquid chromatography was done for Hemoglobin variant and G6PD by a semi-automated analyzer. Data were analyzed for prevalence patterns across age groups, gender, and sub-clans. Results: Hemoglobin E trait was found in 84 subjects (14% ) and Hemoglobin E disease in 12 individuals (2%). G6PD deficiency was observed in 36 individuals (6.0%). Females showed a higher prevalence of HbE trait and disease, but the difference was statistically not significant. Males showed a statistically significant higher frequency of G6PD deficiency compared to females (4.33% vs 1.67%). Sub-clan analysis revealed Timung sub-clan had slightly higher distribution of HbE trait and G6PD deficiency. Coexistence of Hemoglobin E trait and G6PD deficiency was found in 6 individuals (1.0%). Conclusion: This study highlights a high prevalence of HbE trait and a considerable burden of G6PD deficiency in the Karbi population visiting the tertiary care center. The findings underline the importance of routine screening and genetic counseling in this community.

Introduction: Sedation during spinal anaesthesia improves patient comfort, reduces anxiety, and enhances surgical conditions. Among commonly used sedatives, dexmedetomidine and midazolam differ in their pharmacodynamic profiles, particularly in terms of sedation quality, hemodynamic stability, and respiratory effects. Aims: This study aimed to compare the efficacy and safety of dexmedetomidine versus midazolam for intraoperative sedation in patients undergoing procedures under spinal anaesthesia. Materials and Methods: Prospective, randomized, double-blind controlled study conducted in the department of anaesthesiology at ils dumdum, kolkata, over a period of 12 months. The study included 100 adult patients undergoing elective surgeries under spinal anaesthesia. Results: The sedation scores differed significantly between the dexmedetomidine and midazolam groups. In the dexmedetomidine group (n = 50), 5 patients (10.0%) had a sedation score of 2, 20 patients (40.0%) had a score of 3, 18 patients (36.0%) had a score of 4, and 7 patients (14.0%) had a score of 5. In the midazolam group (n = 50), 12 patients (24.0%) had a sedation score of 2, 25 patients (50.0%) had a score of 3, 10 patients (20.0%) had a score of 4, and 3 patients (6.0%) had a score of 5. The difference in sedation scores between the two groups was statistically significant (p = 0.042). Conclusion: Dexmedetomidine is a superior alternative to midazolam for sedation during spinal anaesthesia due to its better sedation quality, analgesic-sparing effect, and minimal respiratory depression, although careful monitoring for bradycardia is required.

Introduction: Preoperative anxiety is common in paediatric patients undergoing elective surgery and may adversely affect induction of anaesthesia, parental separation, and postoperative behaviour. Intranasal premedication is widely used due to its non-invasive and easy administration. Midazolam is traditionally used, but dexmedetomidine, an α2-adrenergic agonist, has emerged as an effective alternative with better sedation and anxiolysis and minimal respiratory depression. Aims and Objectives: To compare the efficacy and safety of intranasal dexmedetomidine versus intranasal midazolam as premedication in paediatric patients undergoing elective surgery. Materials and Methods: This prospective, randomized, comparative interventional study was conducted over 1 year at Dinhata Subdivisional Hospital, Coochbehar on 100 paediatric patients undergoing elective surgery under general anaesthesia. Patients were randomly assigned to receive either intranasal dexmedetomidine or midazolam, and outcomes including sedation, parental separation, mask acceptance, and adverse effects were compared. Results: Baseline characteristics were comparable (age p = 0.912, gender p = 0.841). Dexmedetomidine showed significantly higher sedation scores at 30 min (3.80 ± 0.72 vs 3.10 ± 0.69) and 45 min (4.20 ± 0.55 vs 3.60 ± 0.60; p < 0.001), better parental separation (76% vs 50%; p = 0.018), and improved mask acceptance (72% vs 44%; p = 0.021), with fewer adverse effects overall (p = 0.014). Conclusion: Intranasal dexmedetomidine is more effective than intranasal midazolam in providing sedation, anxiolysis, and smoother induction conditions in paediatric patients undergoing elective surgery, with a comparable safety profile. It can be considered a superior alternative for premedication in this population.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a significant pathogen in pediatric skin and soft tissue infections (SSTIs) worldwide, including India. In resource-limited settings like western Gujarat, limited local data on prevalence, clinical patterns, and resistance profiles hinder optimal management. This study aimed to determine the prevalence of MRSA in pediatric skin infections at a tertiary care center in western Gujarat over one year and to analyze associated demographic, clinical, and microbiological factors. Material and Methods: This prospective observational study was conducted over one year at a tertiary care hospital in western Gujarat. Children aged 1 month to 18 years presenting with skin and soft tissue infections were included after obtaining informed consent from parents/guardians. Swabs from lesions were processed using standard microbiological techniques, and antibiotic susceptibility was tested by Kirby-Bauer disc diffusion method following CLSI guidelines. MRSA was confirmed by cefoxitin disc diffusion. Data were analyzed using SPSS version 25 with appropriate statistical tests. Ethical approval was obtained from the institutional ethics committee. Results: Out of 285 children with SSTIs, S. aureus was isolated in 178 (62.5%) cases, of which 57 (32%) were MRSA. Boys were more commonly affected (64.8%). Impetigo and abscesses were the most frequent presentations. MRSA isolates showed high susceptibility to vancomycin (100%) and linezolid (96.5%), but resistance to clindamycin (38.6%) and erythromycin (52.6%). Hospital stay was significantly longer in MRSA cases (p<0.05). Conclusion: The study reveals a notable prevalence of MRSA (32%) in pediatric skin infections in western Gujarat, highlighting the need for region-specific empirical therapy and infection control measures. Continuous surveillance is essential to monitor resistance patterns.

Introduction: Neonatal sepsis is a clinical syndrome of a dysregulated host response to bloodstream infection in the first 28 days of life. It is categorized into early-onset sepsis (EOS) and late-onset sepsis (LOS) based on timing and mode of transmission. Neonatal sepsis contributes significantly to morbidity and mortality, particularly in low- and middle-income countries. Identification of risk factors, survival outcomes, and drug-related adverse events is crucial for improving management. Methods: This observational, prospective study was conducted in the Neonatal Intensive Care Unit of the pediatrics department of a tertiary care teaching hospital in Gujarat over 12 months. A total of 120 neonates diagnosed with neonatal sepsis were included. Data regarding clinical characteristics, maternal and neonatal factors, antimicrobial therapy, laboratory investigations, and outcomes were collected using case record forms. Statistical analysis was performed using Microsoft Excel and Jamovi software, with results expressed in percentages and hazard ratios. Results: Among 120 neonates, 69 (57.5%) were male and 51 (42.5%) were female. EOS was more frequent (76.6%) than LOS (23.3%). Majority of neonates were <7 days of age (83.3%), preterm (68.3%), and had low or very low birth weight (38.3% and 34.1%, respectively). Most neonates were delivered via normal vaginal delivery (65%) and were outborn (74.2%). Survival was 70% (84/120), while 30% (36/120) did not survive. Significant factors associated with mortality included preterm gestation [HR=2.32, P=0.014], outborn status [HR=3.66, P=0.017], delivery via LSCS [HR=2.21, P=0.018], resuscitation at birth [HR=0.48, P=0.028], maternal age >30 years [HR=2.13, P=0.044], and lack of ANC follow-up [HR=2.32, P=0.019]. Ampicillin + sulbactam (70.83%) was the most commonly prescribed antimicrobial, followed by Piperacillin + Tazobactam (55%) and Amikacin (53.33%). Three adverse drug reactions were reported, all minor and preventable. Conclusion: Neonatal sepsis in this tertiary care NICU had a survival rate of 70%. Preterm birth, outborn delivery, LSCS, resuscitation, maternal age >30 years, and lack of ANC follow-up were significant determinants of poor outcome. Timely diagnosis, appropriate antimicrobial therapy, and careful monitoring of risk factors are essential to reduce neonatal mortality and optimize management of neonatal sepsis.

Background: Adolescence is a critical period for growth, during which physical activity plays an important role in maintaining healthy nutritional status and preventing obesity. Objectives: To assess the nutritional status and prevalence of obesity among adolescents and to determine their relationship with physical activity levels. Methods: This prospective observational study was conducted in the Department of Pediatrics, Government Medical College, Wanaparthy, from October 2025 to March 2026. A total of 200 adolescents aged 10–19 years were included. Data on sociodemographic profile, anthropometry, and physical activity were collected using a structured proforma. Nutritional status was assessed using BMI-for-age criteria, and participants were categorized as undernourished, normal, overweight, or obese. Statistical analysis was performed using SPSS version 21.0. Results: Normal nutritional status was observed in 58.0% of participants, while 14.0% were undernourished, 18.0% overweight, and 10.0% obese. Low physical activity was seen in 31.0%, moderate in 44.0%, and high in 25.0%. A significant association was found between nutritional status and physical activity level (χ² = 29.84, p < 0.001). Mean BMI was highest among adolescents with low physical activity. Conclusion: Reduced physical activity was significantly associated with overweight and obesity among adoles-cents, highlighting the need for early lifestyle-based interventions.

Background: Pancytopenia is a common hematological condition characterized by reduction in all three blood cell lines and presents a diagnostic challenge due to its diverse etiologies. Bone marrow aspiration and biopsy are key diagnostic tools used to evaluate its underlying causes. Aim: To assess the diagnostic reliability and concordance of bone marrow aspiration and biopsy in determining the etiology of pancytopenia. Methodology: This retrospective observational study was conducted over one year at Department of Pathology, Phulo Jhano Medical College and Hospital, Dumka, Jharkhand, India, including 86 patients with pancytopenia. Clinical, hematological, and bone marrow findings were analyzed. Bone marrow aspiration and biopsy results were compared for diagnostic agreement, and statistical measures such as sensitivity, specificity, and accuracy were calculated. Results: The majority of patients were young adults (41.9%) with slight male predominance (55.8%). Pallor was the most common clinical feature (100%). Megaloblastic anemia (32.6%) and aplastic anemia (30.2%) were the leading causes. Diagnostic concordance between aspiration and biopsy was observed in 81.4% of cases, while 7% of cases required biopsy for definitive diagnosis. Bone marrow aspiration showed high sensitivity (89.5%), specificity (85%), and overall accuracy (87.2%). Conclusion: Bone marrow aspiration is a reliable initial diagnostic modality; however, biopsy plays a crucial complementary role, particularly in inconclusive cases, enhancing overall diagnostic accuracy in pancytopenia.

Background: Thyroid nodules are a common clinical entity, with a small but significant proportion of harboring malignancy. Fine needle aspiration cytology (FNAC) has become a key diagnostic tool for early evaluation and risk stratification, particularly in resource-limited settings. Aim: To assess the diagnostic accuracy and efficacy of FNAC in thyroid nodules by correlating cytological findings with histopathological outcomes. Methodology: This retrospective observational study was conducted on 97 patients with thyroid nodules at Department of Pathology, Phulo Jhano Medical College and Hospital, Dumka, Jharkhand, India. FNAC results were categorized using the Bethesda system and compared with histopathological findings. Diagnostic parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated. Results: The study showed a female predominance (78.4%) with a mean age of 41.8 ± 9.6 years. Most cases were benign (49.5%) on FNAC. Sensitivity, specificity, PPV, NPV, and overall diagnostic accuracy of FNAC were 82.5%, 84.2%, 80.5%, 85.9%, and 83.5%, respectively. A progressive increase in malignancy risk was observed with higher Bethesda categories. However, false positives (8 cases) and false negatives (7 cases) were noted. Conclusion: FNAC is a reliable, minimally invasive, and cost-effective diagnostic modality with good accuracy in evaluating thyroid nodules. However, limitations in indeterminate categories necessitate correlation with histopathology for definitive diagnosis.

Background: Acute gastroenteritis is one of the most common causes of fluid and electrolyte loss in India. If inadequately managed, it can lead to hypovolemia-induced acute kidney injury (AKI), which significantly increases morbidity and mortality, especially in the elderly and those with comorbidities. Early detection and prompt management of AKI in such patients is vital. Objective: To study the clinical profile, laboratory parameters, severity, and outcomes of patients who developed AKI following acute gastroenteritis. Methods: This prospective observational study was conducted at 12 months in the Department of Anesthesiology , Anugrah Narayan Magadh Medical College and Hospital, Gaya ji, Bihar, India. A total of 120 patients diagnosed with acute gastroenteritis and fulfilling KDIGO criteria for AKI were enrolled. Demographic data, clinical symptoms, laboratory results, and outcomes were recorded and analyzed. Results: Of 120 patients, 67 (55.8%) were male and 53 (44.2%) females. The mean age was 52.3 ± 17.6 years. Dehydration and hypotension were the most common findings on admission. Prerenal AKI was observed in 81 cases (67.5%), while 39 (32.5%) progressed to intrinsic AKI. Electrolyte abnormalities, especially hyponatremia and hyperkalemia, were noted in 47.5% and 28.3% of cases, respectively. 92 patients (76.6%) recovered with conservative management, while 16 required dialysis. Overall mortality was 5.8% (n = 7), mostly among those with comorbidities. Conclusion: AKI secondary to acute gastroenteritis remains a significant concern, particularly among elderly and volume-depleted patients. Early identification, aggressive fluid resuscitation, and close monitoring can substantially reduce the need for renal replacement therapy and improve outcomes.

Background: Post ^‘traumatic saddle nose deformity is a complex nasal condition causing both cosmetic disfigurement and functional airway impairment due to collapse of the nasal framework. Open rhinoplasty has emerged as an effective reconstructive approach for restoring nasal contour and support. Aim: To evaluate the tech0nical considerations, surgical outcomes, and postoperative complications of open rhinoplasty in patients with post traumatic saddle nose deformity. Methodology: A hospital-based prospective observational study was conducted in the Department of General Surgery (Plastic Surgery), Netaji Subhas Medical College and Hospital,Bihta, Patna, Bihar, India. among 80 patients with post traumatic saddle nose deformity. Patients underwent open rhinoplasty using various graft materials including septal, conchal, and costal cartilage. Postoperative cosmetic and functional outcomes and complications were assessed during follow-up. Results: The majority of patients were aged 26–35 years (36.3%), and road traffic accidents were the most common cause of trauma (47.5%). Moderate deformity was observed in 51.2% cases. Costal cartilage was the most frequently used graft material (35%). Satisfactory cosmetic outcome was achieved in 85% patients, while improved nasal airway function was observed in 78.8%. Complication rates were low and manageable. Conclusion: Open rhinoplasty provides effective structural reconstruction with favorable cosmetic and functional outcomes in post-traumatic saddle nose deformity.

Background: Drug use during pregnancy requires careful evaluation because physiological changes and placental drug transfer may affect both maternal and fetal health. Irrational prescribing and exposure to unsafe medications during pregnancy can lead to adverse maternal and fetal outcomes. Therefore, assessment of prescription patterns among pregnant women is essential to promote rational and safe drug use during antenatal care. Aim: To evaluate the drug prescription pattern and its associated factors among pregnant women attending the antenatal clinic in a tertiary care teaching hospital in Bihar, India. Methodology: A hospital-based retrospective cross-sectional study was conducted among 137 pregnant women attending the antenatal clinic. Data were collected from medical records and prescription charts using a structured proforma. Information regarding socio-demographic characteristics, obstetric profile, and prescribed medications was analyzed. Prescribed drugs were categorized according to therapeutic class and US-FDA pregnancy risk categories. Statistical analysis was performed using SPSS version 25, and associations were assessed using Chi-square test and adjusted odds ratio at 95% confidence interval. Results: A total of 283 drugs were prescribed, with an average of 2.06 drugs per prescription. Iron-folic acid, calcium, paracetamol, and antibiotics were the most commonly prescribed medications. Most prescribed drugs belonged to FDA Category B followed by Category A, while no Category X drugs were prescribed. Generic prescribing was achieved in all prescriptions. Maternal age, gravidity, ANC visits, timing of first ANC visit, and current maternal illness showed significant association with drug prescribing patterns. Conclusion: The study demonstrated relatively rational prescribing practices with predominant use of safer drugs during pregnancy. Continuous monitoring of prescription patterns and adherence to standard treatment guidelines are necessary to enhance maternal and fetal safety.

Introduction: Glaucoma is a chronic, progressive optic neuropathy characterized by degeneration of retinal ganglion cells and optic nerve head damage, leading to irreversible visual field loss. It is one of the leading causes of preventable blindness worldwide and is often asymptomatic in its early stages. Aims & objectives: The aim of this study was to screen patients aged above 40 years attending the OPD for early detection of glaucoma and to assess its association with various demographic factors and risk factors such as age, gender, systemic diseases, and ocular risk factors. Materials & Methods: A hospital-based observational cross-sectional study will be conducted in the Department of Ophthalmology, Kamineni Institute of Medical Sciences, Sreepuram, Narketpally, Nalgonda District, Telangana, India over a period of 1 year. The study will include a total sample size of 100 patients. Result: Symptom status showed a statistically significant association with glaucoma (p = 0.002). Glaucoma was detected in 12 patients (28.6%) among symptomatic individuals and in 3 patients (5.2%) among asymptomatic individuals. Conclusion: We concluded that hospital-based cross-sectional study comprising 100 patients aged above 40 years attending the ophthalmology OPD highlights the clinical and epidemiological profile of glaucoma and its associated risk factors. The findings demonstrate a statistically significant increase in glaucoma prevalence with advancing age, indicating age as a strong non-modifiable risk factor.

Introduction: Jaundice in pregnancy represents a significant clinical condition associated with considerable fetomaternal morbidity and mortality, particularly in developing countries. It is defined as yellow discoloration of the sclera and skin due to elevated serum bilirubin levels, often reflecting underlying hepatic or hematological dysfunction. Aims & Objectives: The aim of this study is to evaluate the clinical profile of pregnant women with jaundice and assess the fetomaternal outcomes, while the objective is to identify the underlying etiological factors and analyze associated maternal complications and fetal outcomes including morbidity and mortality. Materials & Methods: This was a prospective observational study conducted over a period of 1 year. The study included a total of 100 patients as the sample size. Result: In 100 patients, gestational age was significantly associated with clinical status (p = 0.001). Among <28 weeks (13 patients), 8 were present and 5 absent; in 28–36 weeks (47 patients), 17 were present and 30 absent; and in ≥37 weeks (40 patients), 6 were present and 34 absent. Overall, 31 were present and 69 absent, with risk decreasing as gestation advanced. Conclusion: We concluded that pregnancy complicated by jaundice is associated with significant fetomaternal morbidity and mortality, with a varied etiological spectrum in which hepatitis E is the most common cause followed by hepatitis B, intrahepatic cholestasis of pregnancy, HELLP syndrome, acute fatty liver of pregnancy, and other less frequent causes.

Introduction: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Visceral adiposity has emerged as an important predictor of cardiometabolic and cardiovascular risk. Computed tomography (CT)-based visceral fat assessment provides accurate evaluation of abdominal fat distribution and may help in early cardiovascular risk stratification. The present study was conducted to evaluate the association between CT-based visceral fat index and cardiovascular risk factors. Materials and Method: This hospital-based cross-sectional observational study included 85 participants undergoing CT evaluation. Demographic, clinical, anthropometric, and biochemical parameters were recorded. CT-based visceral fat area, subcutaneous fat area, and visceral fat index (VFI) were assessed using standard imaging protocols. Cardiovascular risk was evaluated using established cardiovascular risk parameters and scoring systems. Statistical analysis was performed using SPSS version 25.0, and p <0.05 was considered statistically significant. Result: The mean age of participants was 52.34 ± 11.28 years, with male predominance (61.2%). Hypertension was present in 54.1%, diabetes mellitus in 37.6%, and dyslipidemia in 45.9% of participants. Visceral fat area progressively increased from 112.46 ± 24.18 cm² in the low-risk group to 186.53 ± 34.92 cm² in the high-risk cardiovascular group. Similarly, visceral fat index increased significantly from 0.29 ± 0.07 to 0.54 ± 0.09 (p <0.001). Significant positive correlations were observed between VFI and cardiovascular risk score, systolic blood pressure, fasting blood glucose, triglycerides, LDL cholesterol, and BMI. Conclusion: CT-based visceral fat index showed significant association with cardiovascular risk factors and metabolic abnormalities. CT-derived visceral fat assessment may serve as a useful imaging biomarker for cardiovascular risk stratification and early preventive intervention.

Introduction: Atrial fibrillation (AF) is a common cardiac arrhythmia associated with increased risk of stroke and cardiovascular morbidity. Early detection of asymptomatic and paroxysmal AF remains challenging. Wearable devices offer continuous non-invasive rhythm monitoring and may improve AF detection. Materials and Method: This prospective observational study included 93 participants with symptoms suggestive of arrhythmia or cardiovascular risk factors. Participants underwent clinical evaluation, standard ECG, and wearable device monitoring. Wearable findings were correlated with ECG/Holter monitoring. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. Result: The mean age of participants was 58.42 ± 12.76 years, and 60.2% were males. Wearable devices detected irregular rhythm in 29 participants (31.2%), while AF was confirmed in 25 participants (26.9%). Asymptomatic AF was identified in 9 participants (9.7%). Wearable devices demonstrated sensitivity of 92.0%, specificity of 88.2%, PPV of 79.3%, NPV of 95.8%, and overall diagnostic accuracy of 89.2%. Conclusion: Wearable devices are reliable and effective tools for early detection of atrial fibrillation, particularly asymptomatic AF, and may aid in large-scale screening and prevention of AF-related complications.

Background: Estrogen deficiency and age-related bone loss make osteoporosis a serious health issue in postmenopausal women. Body Mass Index (BMI) is known to affect Bone Mineral Density (BMD) and there are very few data from eastern India available on this association. Objective: To determine the correlation between BMD and BMI among the post-menopausal women by using Dual Energy X-ray Absorptiometry (DEXA) scan. Method: It was an observational cross-sectional study done in the Department of Obstetrics and Gynaecology at Nalanda Medical College and Hospital, Patna, Bihar in the hospital setting among 105 post-menopausal women. The participants were divided into three groups based on WHO BMI classification: normal weight, overweight, and obese. Lumbar spine and femoral neck BMD was measured by DEXA scan. Data was analyzed by using ANOVA, Chi-square test, Pearson correlation and multivariate ordinal regression analysis. Conclusions: The prevalence of osteoporosis was higher among patients with normal BMI than in overweight and obese women. There were significant increases in mean BMD values for both the lumbar spine and femoral neck with BMI (p<0.001). BMI was significantly correlated with lumbar spine BMD (r=0.612) and femoral neck BMD (r=0.574). BMI and duration of menopause were correlated with a decreasing BMD. Conclusion: BMI was significantly correlated with BMD in postmenopausal women. Being underweight was found to be a risk factor for osteoporosis. Simple screening and preventive measures could help minimize osteoporosis complications.

Background: Endometriosis is a chronic estrogen-dependent gynecological disorder characterized by the presence of endometrial-like tissue outside the uterine cavity. It commonly affects women of reproductive age and is associated with pelvic pain, infertility, and reduced quality of life. Aim: To evaluate the clinical features, diagnostic modalities, anatomical distribution, and management outcomes of patients with endometriosis. Methodology: This retrospective observational study was conducted in the Department of Obstetrics and Gynaecology, Patna Medical College and Hospital. Medical records of 90 women diagnosed with endometriosis were reviewed. Data regarding demographic characteristics, clinical presentation, diagnostic investigations, disease sites, treatment modalities, and outcomes were analyzed using descriptive statistics. Results: Most patients were aged 26–35 years (40%). Dysmenorrhea (75.6%) and chronic pelvic pain (67.8%) were the most common symptoms, followed by infertility (42.2%). Ultrasonography was performed in all patients (100%), while diagnostic laparoscopy and histopathological confirmation were obtained in 64.4% and 57.8% of cases, respectively. Ovarian endometrioma was the most frequent site of involvement (53.3%). Medical management alone and combined medical-surgical treatment were each used in 42.2% of patients. Symptomatic improvement was observed in 82.2% of cases, while recurrence occurred in 17.8%. Conclusion: Endometriosis predominantly affects women of reproductive age and commonly presents with pain-related symptoms. Early diagnosis and individualized management contribute to favorable outcomes, although recurrence remains a significant challenge.

Background: Polycystic Ovarian Syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age and is characterized by ovulatory dysfunction, hyperandrogenism, and polycystic ovarian morphology. It is associated with menstrual irregularities, infertility, obesity, metabolic disturbances, and long-term reproductive and psychological complications. Understanding the clinical and reproductive profile of women with PCOS is essential for early diagnosis and appropriate management. Aim: To evaluate the clinical and reproductive profile of women diagnosed with polycystic ovarian syndrome attending the Department of Obstetrics and Gynecology at a tertiary care hospital. Methodology: This retrospective hospital-based study was conducted in the Department of Obstetrics and Gynecology, Patna Medical College and Hospital, Patna, Bihar, India, over a period of one year. A total of 95 women diagnosed with PCOS according to the Revised Rotterdam Criteria (2003) were included. Demographic, clinical, reproductive, anthropometric, and ultrasonographic data were collected from medical records and analyzed using SPSS version 25.0. Results: Many participants belonged to the 21–25 years age group (36.8%). Menstrual irregularities were the most common clinical presentation (86.3%), with oligomenorrhea accounting for 48.4% of cases. Hirsutism was observed in 57.9%, acne in 50.5%, obesity in 45.2%, and acanthosis nigricans in 30.5% of women. Infertility was present in 47.4% of participants. Bilateral polycystic ovarian morphology was identified in 71.6% of cases on ultrasonography. Conclusion: PCOS is a heterogeneous disorder with significant reproductive and metabolic implications. Menstrual disturbances, hyperandrogenic manifestations, obesity, and infertility were highly prevalent among affected women. Early identification and comprehensive management are essential to improve reproductive health outcomes and reduce long-term complications.

Background: Intestinal obstruction is a common surgical emergency associated with considerable morbidity and mortality worldwide. Delayed diagnosis and treatment may result in serious complications, including bowel ischemia, perforation, sepsis, and death. Understanding local etiological patterns, management approaches, and outcome determinants is essential for improving patient care and surgical outcomes. Aim: To assess the causes, management outcomes, and factors associated with treatment outcomes among patients diagnosed with intestinal obstruction in a tertiary care hospital in Gujarat, India. Methodology: A hospital-based retrospective observational study was conducted in the Department of General Surgery at Shri M.P. Shah Government Medical College, Jamnagar, Gujarat, India. Medical records of 76 patients diagnosed with intestinal obstruction were reviewed. Data regarding demographic characteristics, clinical presentation, etiology, treatment modality, postoperative complications, and outcomes were collected and analyzed using descriptive and inferential statistics. Results: Intestinal obstruction predominantly affected males and middle-aged adults. Most patients presented more than 24 hours after symptom onset. Adhesion/band obstruction was the most common etiology, followed by sigmoid volvulus and hernia. Operative management was required in the majority of patients, with resection and anastomosis being the most frequently performed procedure. Most surgically treated patients had an uncomplicated postoperative course, while surgical site infection was the commonest complication. Favorable outcomes were achieved in most patients, whereas morbidity and mortality occurred in a smaller proportion. Advanced age, delayed presentation, previous abdominal surgery, comorbidities, gangrenous bowel, and prolonged hospitalization were significantly associated with unfavorable outcomes. Conclusion: Intestinal obstruction remains a significant surgical emergency. Early diagnosis, timely intervention, and focused management of high-risk patients are crucial for improving outcomes and reducing complications and mortality.

Background: Spinal anesthesia is the most commonly used anesthetic technique for cesarean section, due to its effectiveness, quick onset and good maternal and neonatal results. While it has benefits, it also has drawbacks like hypotension, bradycardia, nausea, vomiting and shivering which can impact the safety of the mother. It is important to identify associated risk factors to enhance the perioperative management and outcome. Aim: To assess the occurrence of complications associated with spinal anesthesia and maternal outcomes among women who had cesarean section (CS) with spinal anesthesia. Method: The study was a retrospective observational study that was performed in the Department of Anaesthesiology at Shahid Nirmal Mahato Medical College and Hospital, Dhanbad, Jharkhand. One year of operations on 140 women who had elective or emergency cesarean section under spinal anesthesia were reviewed. Data were collected and analyzed with SPSS version 26.0, and demographic, obstetric, anesthetic, perioperative and outcome related data were collected. A multiple logistic regression analysis was conducted to determine independent predictors of complications. Result: The most common complication was hypotonia (50.7%), followed by shivering (30.7%), vomiting (25.7%), recovery time (22.1%) and bradycardia (17.1%). The important risk factors for hypotension were maternal age >35 years, obesity, anemia, emergency cesarean section and dose of bupivacaine >12.5 mg. The recovery process was uneventful in 73.6% of the patients and ICU admission (5.0%) and general anesthesia (3.6%) were uncommon. There was no maternal mortality. Conclusion: The bottom line: Spinal anesthesia is still a safe and effective method for cesarean section delivery. Timely recognition of patients with risk factors and careful monitoring during the operation can minimize complications and maternal outcomes.

Background: Arteriovenous malformations are part of the spectrum of vascular anomalies—a diverse group that includes both superficial vascular tumors and malformations. Over the past decade, various treatment modalities have been used, including endovascular embolization, surgical excision, laser therapy, or combined approaches. Among these, surgical excision remains the most important and definitive treatment for AVMs, especially when complete resection is achievable. Methodology: The present study was planned in the Department of Plastic Surgery, Shri Krishna Medical College and hospital, Muzaffarpur, Bihar.  Over the past decade, various treatment modalities have been used, including endovascular embolization, surgical excision, laser therapy, or combined approaches. Among these, surgical excision remains the most important and definitive treatment for AVMs, especially when complete resection is achievable. Patient and Method: Our study included a total of sixteen patients managed for arteriovenous malformations (AVMs). A male predominance was observed, with twelve male patients (75 %) and four female patients (25 %). The onset of the malformation occurred before the age of 25 in 75 % of cases. All patients were symptomatic at the time of diagnosis and presented with a swelling or mass, ranging in size from 4 cm to 18 cm. The localization of AVMs varied among patients. Two patients (11.1%) had frontal involvement, six patient (33.3%) had upper limb involvement, eight patient (44.4%) had lower limb involvement and two patient (11.1%) had abdominal involvement. Surgical Procedure: The aim of surgery is to remove the whole of the primarily pathologic tissue. At operation, and indeed on imaging, only the secondary pathology is visible, so the margins of the primary pathology, or nidus, must be inferred from the location of these visible secondary vessels. Surgical Planning It is critically important that all available imaging is reviewed in detail before surgery with the aim of localizing the nidus. Since the nidus is not generally visible, even on angiography, its boundaries must be inferred from the location of the visible secondarily involved vessels. Results and Discussion: A fundamental aspect of our surgical technique is the systematic dissection through healthy, anatomically unaffected tissue planes, away from the nidus. This approach not only improves the completeness of excision but also significantly reduces intraoperative bleeding and operative time. While embolization remains a valuable adjunct, it is the precision of the surgical act—respecting vascular planes and ensuring meticulous hemostasis—that ultimately determines functional and aesthetic outcomes. Outcomes were favorable in most cases, with good scar quality and preserved function. Conclusion: Treatment of vascular anomalies in appropriately selected patients in a single operative stage is safe with a low complication rate and can range from simple excision to use of microvascular free flap, providing pain relief, restoration of function, and repair of aesthetic deformities. Imaging-guided surgical excision, supported by selective embolization, is a safe and effective strategy for managing sAVMs, minimizing complications and recurrence.

Background: Incisional hernias occur in 10–15% of post-laparotomy patients and most commonly follow caesarean sections. While incarceration and strangulation are well recognized, appendicitis within an incisional hernia is exceptionally rare, with fewer than 20 cases reported world-wide and only a handful describing perforation. This rarity creates diagnostic challenges; displaced anatomy and surrounding edema can mask appendiceal inflammation on imaging, leading to misinterpretation and delayed diagnosis. Case Presentation: A 45-year-old female with prior classical caesarean section presented with a 2-day history of a painful, tender, irreducible midline scar swelling with local erythema and mild tachycardia with relatively soft rest of the abdomen. CT was reported as an incarcerated incisional hernia containing bowel and omentum; appendiceal inflammation was not identified. Open exploration revealed a perforated appendix within the hernia sac with purulent exudate and necrotic omentum. Appendectomy was performed and the fascial defect closed primarily using PDS sutures; no mesh was placed due to contamination. Postoperative treatment included Piperacillin–Tazobactam for 72 hours, early mobilization, and discharge on postoperative day 5. At three-month follow-up, the wound had healed and there was no recurrence. Conclusions: Appendicitis within an incisional hernia is a diagnostic trap that may evade detection on imaging because of altered anatomy. Clinicians should keep a high index of suspicion for appendiceal pathology in irreducible or inflamed hernias even when CT is non-diagnostic. Open exploration is both diagnostic and therapeutic in uncertain cases. In contaminated fields primary fascial repair is preferred, and mesh should be avoided or delayed. Early recognition and prompt surgical management result in favourable outcomes.